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Foundations of EMS
Midterm #1
183
Medical
Undergraduate 3
10/17/2010

Additional Medical Flashcards

 


 

Cards

Term
Scene Size Up
Definition

Scene safe

BSI

# of patients

MOI/NOI

Do I need help

Term
Patient Assessment consists of...(4)
Definition

Initial Assessment

Physical Exam

Patient History

Ongoing Assessment

Term
Profession
Definition
existence of a specialized body of knowledge or expertise
Term
Primary Responsibilities
Definition

Preparation for action

Response

Scene assesment & care

patient assessment

treatment and management

disposition and transport

patient transfer

documentation

returning to service/patient advocacy

Term
Three pillars of airway management
Definition

1) Integrity of the airflow

 

2) Protection from pulmonary aspiration

 

3) Assurance of adequante ventilation/oxygenation

Term
Pulmonary Ventilation
Definition
movement of air in and out of the lungs so that gases may be exchanged
Term
Internal Respiration
Definition

Exchangement of gases in the capillaries of the lungs made between blood and tissue cells

 

"inside the body"

Term
External Respiration
Definition

Gas exchange between the between the blood and the air of the alveoli

 

respiratory system exposed to outside air

 

"bad gases out, good gases in"

Term
Cellular Respiration/metabolism use _____ for fuel
Definition
cells use O2 for fuel
Term
3% of oxygen inhaled
Definition
stays in the plasma
Term
Respiratory tract stems from the ______ to the ______
Definition
nose
alveoli
Term
Conducting portion of the respiratory tract stems from the _______ to the ________
Definition

Nose

larger bronchioles

"where air moves"
Term
Upper airway consists of...
Definition
nose
mouth
pharynx (nasopharynx, oropharynx, laryngopharynx)
Larynx
Term
Respiratory portion of the respiratory system stems from the ______ to the _______
Definition

Larger bronchioles

alveoli

"where gases are exchanged"
Term
Lower airway consists of...
Definition
Larynx
Mainstem bronchi
Bronchioles
alveolar ducts
alveoli
Term
what is the glottic opening?
Definition
space at the vocal chords (vocal chords sit on top of trachea)
Term
Nose consists of...
Definition
Nares
Septum
Palate
Turbinate
Ethmoid bone
Sphenoid bone
Term
Sinuses consist of...
Definition
Frontal sinus
Ethmoid sinus
Sphenoid sinus
Maxillary sinus
Term
Mouth & Pharynx consist of...
Definition
Cheeks
Hard palate
Soft palate
Uvula
Tongue
Teeth
Term
What are the 3 functions of the larynx?
Definition
Air passage
protective sphincter
speech production
Term
________ surround the glottic opening
Definition
vocal chords
Term
the three cartilages surrounding the glottic opening are...
Definition
top: cuneiform cartilage
bottom: corniculate cartilage
inner: arytenoid cartilage
Term
the ______ is at the bifurcation of the trachea
Definition
carina
Term
The right lung is ________ in comparison the the left lung because it has _______ lobes
Definition
slightly larger
3
Term
The first and only complete ring in the trachea is the _______ and is the __________ below the larynx
Definition
cricoid ring
first prominence
Term
The gap between the larynx and the cricoid ring is the ___________
Definition
cricothyroid membrane
Term
The outside of the larynx is known as the ________
Definition
thryroid cartilage
Term
The left lung is _______ than the right lung and has _______ lobes because it shares the ________ space with the _______
Definition
smaller
2
thoracic
heart
Term
Visceral pleura
Definition
membrane ON the lung

think visceral = "organ"
Term
Parietal pleura
Definition
membrane on the inside of the thoracic cavity
Term
Pneumothorax
Definition
air in the pleural space of the lung
Term
The functional unit of the lung...
Definition
alveoli
Term
Deoxygenated blood is supplied to the lungs by the _______________
Definition
pulmonary arteries
Term
Freshly oxygenated blood is delivered to the heart by the ______________
Definition
pulmonary veins
Term
____________ and ______ supply blood to the lung tissue
Definition
Bronchial arteries and veins
Term
Pleural cavity is the ______________ between the visceral and parietal pleura
Definition
potential space
Term
Boyle's law is important because...
Definition
intrapulmonary pressure = atmospheric pressure

thus to get air into the lungs we have to create negative pressure in the intrapleural space
Term
Inspiration is an increase in ________ and a _________ in pressure
Definition
increase in volume
decrease in pressure
Term
Expiration is a __________ in volume and a increase in __________
Definition
decrease in volume increase in pressure
Term
Atelectasis

what are the two types?
Definition
collapse of lung tissue

Compression & Absorption
Term
Compression Atelectasis
Definition
outside pressure/forces cause alveolar collapse
Term
Absorption Atelectasis
Definition
hypoventilation causes decrease of volume in the lungs -> pressure changes, alveoli become obstructed, and the lungs collapse
Term
Dalton's law of partial pressures is important because...

p1 + p2 + p3 = ptotal
Definition
changing pressures causes different effects from different gasses.
Term
Henry's law is important because...
Definition
changing pressures causes differences in absorption of gases
Term
Oxygen is transported by _______ & _______
Definition
plasma & hemoglobin
Term
Carbon dioxide is transported by...(3)
Definition
plasma
hemoglobin
bicarbonate ions
Term
Stretch receptors and chemoreceptors help to ______________

2 other ways?
Definition
regulate respiration

Hypoxic drive (CO2 content)
Temperature changes
Term
COPD patients use __________ to regulate oxygen levels instead of carbon dioxide levels because...
Definition
hypoxic drive
the system that measures CO2 saturation is not working properly
Term
Tidal Volume How much air?
Definition
amount of air inhaled and exhaled in one breath 500ml
Term
Inspiratory reserve

how much?
Definition
air inspired forcibly beyond the tidal volume

2100-3200mL
Term
Residual Volume

important because?
Definition
air left after the most forceful expiration

helps maintain alveolar patency and prevents lung collapse
Term
Expiratory Reserve

how much?
Definition
air forced out after exhalation

1000-1200mL
Term
Sums of lung volumes are called...
Definition
capacities
Term
Functional Reserve Capacity
Definition
residual and expiratory reserve volumes

"amount of air left after tidal expiration"
Term
Vital Capacity
Definition
total amount of exchangeable air

tidal volume + inspiratory reserve volume + expiratory reserve volume
Term
Total lung capacity
Definition
maximum lung capacity

amount of air in the lungs after maximal inhalation

vital capacity + reserve volume

aprx. 6000mL
Term
Minute Ventilation
Definition
tidal volume x Respiratory rate

shows the amount of air inhaled and exhaled in one minute
Term
Dead Space
Definition
air that is not exchanging gases
Term
Essential airway parameters
Definition
Rate, Regularity, Effort
Term
Orthopnea
Definition
tripoding
Term
PEEP
Definition
Positive End Expiratory Pressure

pressure left in the airway after expiration

keeps the alveoli open for gas exchange
Term
Retractions indicate that ___________ are being used
Definition
accessory muscles
Term
paradoxical motion should make you suspicious of a ________
Definition
pneumothorax
Term
False readings from Pulse Oximetry can happen from...
Definition
CO poisoning
Temperature extremes
medications causing vasoconstriction
Term
All forms of artificial ventilation use __________ ventilation
Definition
positive pressure
Term
artificial ventilations should increase tidal volume by _______ cc/kg
Definition
10-15
Term
Barrel trauma comes from _________
Definition
over trapping of air
Term
4 types of artificial ventilation
Definition
Mouth to mouth

2 person BVM

Flow restricted oxygen powered ventilation device

1 person BVM
Term
Sellick Maneuver prevents...

do not use when patient is...

be cautious when...
Definition
passive regurgitation

actively vomiting

there is cervical damage
Term
Fluid in the smaller airways produces moist, fine bubbling or crackling sounds called...
Definition
rales
Term
Vocal chords clamping together is a condition known as a...
Definition
laryngospasm
Term
Endotracheal intubation
Definition
Insertion of a tube into the trachea in order to maintain a patent airway
Term
Why/when do we intubate?
Definition
intubate when BLS skills are not working
Term
Hypoxia
Definition
inadequate oxygenation of the blood
Term
Hypercarbia
Definition
greater than normal levels of CO2 in the blood
Term
Indications of Intubation
Definition
hypoxia
altered respiratory effort (not compatible with life)
Altered LOC
Hypercarbia
Inability to protect airway
Possibility of cardiac arrest, respiratory collapse
possibility of respiratory obstruction (swelling)
Term
Most common type/method of intubation used by paramedics & hospitals
Definition
orotracheal intubation by direct visualization
Term
Conscious patients requiring intubation receive ________ intubation
Definition
nasal
Term
Digital intubation is used when...
Definition
you cannot identify structures

(uses fingers to identify structures)
Term
Apneic patients have...
Definition
suspension of external breathing
Term
Uncuffed endotracheal tubes have a diameter from ____ to ____ mm and are usually reserved for _____________ patients
Definition
2.5 to 4.5

pediatric
Term
Average adult male uses what size ED tube?
Definition
7.5 to 8.5mm
Term
Average adult female uses what size ED tube?
Definition
7.0 - 8.0mm
Term
What size ED tube is generally accepted for both males and females?
Definition
7.5mm
Term
Intubation Procedure
Definition
BLS management
Pre-oxygenate and evaluate patient for intubation difficulties
place patient in sniffing position
right, midline, lift
visualize cords
pass tube so cuff passes just beyond chords
inflate cuff & ventilate
confirm tube placement with 2 methods
secure tube
reassess
Term
(Mallampati Classification) Class I
Definition
everything visible
Term
(Mallampati Classification) Class II
Definition
soft palate, fauces, and uvula are visible
Term
(Mallampati Classification) Class III
Definition
Soft palate and base of the uvula are visible
Term
(Mallampati Classification) Class IV
Definition
soft palate is not visible at all
Term
(Cormack and Lehane) Grade I
Definition
complete glottis visible
Term
(Cormack and Lehane) Grade II
Definition
anterior glottis not visible
Term
(Cormack and Lehane) Grade III
Definition
epiglottis seen, glottis not visible
Term
(Cormack and Lehane) Grade IV
Definition
epiglottis not visible (nothing visible)
Term
sniffing position cannot be used when...
Definition
c-spine injury exists
Term
How to use the Macintosh blade
Definition
place tip in volecula, lift up putting pressure on the hyoid bone which indirectly manipulates the epiglottis and moves it out of the line of sight
Term
what does the miller blade do?
Definition
directly manipulates the epiglottis by sitting on top of it, and directly moves it out of the line of sight
Term
You must auscultate in ___ places when confirming a ET tube

what are they?
Definition
6

Epigastric area, bilateral bases, bilateral apices, and sternal notch
Term
Unequal/absent breath sounds when auscultating for tube confirmation may suggest...(4)
Definition
Esophogeal placement
Right mainstem placement
Pneumothorax
Bronchial obstruction
Term
Average tube depth in males is ____
Definition
22cm
Term
Average tube depth in females is _____
Definition
21cm
Term
Ways to confirm ET tube placement (3)
Definition
Auscultation
Direct re-visualization
Tube depth
EDD
End tidal CO2
Condensation in tube
BVM compliance
Pulse Oximetry
Term
Check tube placement after...
Definition
major moves
moves in patient's head position
changes in patient condition
10 minutes
Term
Secure the tube with either ______ or _____
Definition
tape
ET Tube holder (commercial device)
Term
Viewmax
Definition
fiberoptic blade for laryngoscope
Term
BURP is? and is used to manipulate the _______
Definition
Backwards Upwards Rightwards Pressure

larynx
Term
Progressive visualization
Definition
start shallow and move deeper
Term
ELM
Definition
external laryngeal manipulation

(maneuvering the larynx into the visual field)
Term
When you can't see the vocal chords, elevate the ear canal to the level of the _________
Definition
xyphoid process
Term
When suctioning measure from ________ around the ______ to the corner of the ________

or?
Definition
sternum
ear
mouth

2 x tube catheter
Term
Advantages of nasal intubation
Definition
head in neutral position
helpful for: clenched teeth, oral/facial trauma, intact gag reflex, difficult visualization/positioning
Term
Disadvantages of nasal intubation
Definition
Difficult/time consuming
causes trauma to nasal passages
blind procedure
patient must be breathing
Term
Contraindications of nasal intubation
Definition
cannot be used for:
cardiac/respiratory arrest
nasal/skull fractures
Term
Complications of Nasal tracheal intubation
Definition
epistaxis (nosebleed)
infections
low success rates
Term
Nasal intubation device

What sound does it make on exhalation
Definition
BAAM - Beck Airway Air Flow Monitor

Makes a whistling sound on exhalation
Term
Patient must be _____________ in order to digitally intubate
Definition
unresponsive
Term
Combitube
Definition
dual lumen device requiring blind insertion that ventilates endotracheally or esophageally
Term
People 5ft and taller use a ________ size combitube
Definition
regular
Term
People 4-5 ft in height use a ________ combitube
Definition
SA
Term
Advantages of combitube
Definition
Rapid/easy insertion
diminishes gastric distention
can suction stomach
don't need mask seal
Term
Contraindications of combitube
Definition
Gag reflex
known esophageal disorder (esophageal varices)
height/age restrictions
Term
How much do you inflate combitube cuffs to?
Definition
100ml

15ml
Term
Combitube placement can be confirmed with...
Definition
chest rise and fall
Term
Lighted stylet intubation uses a ___________ technique and requires ___________
Definition
blind

low light levels
Term
LMA stands for? and is used for? doesn't protect from?
Definition
laryngeal mask airway

used for short airway management

doesn't protect from pulmonary aspiration
Term
LMA doesnt require the use of a _______, doesn't pass through the _____________, doesn't require a _____________, and can't be used with a _____________
Definition
blade
vocal chords
mask seal
full stomach
Term
King airway differs from combitube by...(2)
Definition
not dual lumen
cannot ventilate if distal end ends up in trachea
Term
Contraindications of King Airway
Definition
responsive patients w/ gag reflex
known esophageal disease
known ingested caustic substances
Term
the king airway ________ protect the airway from ___________
Definition
does not
the effects of regurgitation/aspiration
Term
The _____________ is recommended for Grade II & III cormic and lehane airway
Definition
Gum Elastic Bougie
Term
Gum Elastic Bougie cannot be used on ________ patients
Definition
pediatric
Term
Cricothyrotomy is used when __________ is not feasible or does not relieve the obstruction

examples?
Definition
intubation

Examples
facial/laryngeal trauma
burns
head injury
extended transport
Term
The ___________ must stay in place during use of a Gum Elastic Bougie
Definition
laryngoscope
Term
Needle Cricothyrotomy
Definition
Percutaneous puncture of the Cricothyroid membrane using IV catheter and ventilating through a needle with a high pressure/high flow source
Term
Needle Cricothyrotomy MUST have a _____________
Definition
jet ventilator
Term
Needle Cricothyrotomy contraindications (2)
Definition
total airway obstruction
equipment not available
Term
Surgical Cricothyrotomy contraindications
Definition
patients less than 8 years old
inability to identify anatomical landmarks
tracheal transection
underlying anatomical abnormality
Term
Cricothyrotomy common complications
Definition
hemmhorage
infection
accidental removal
laryngeal nerve damage
Term
Surgical tracheotomy
Definition
Access to the airway through the anterior portion of a tracheal ring
Term
We place the patient in the sniffing position during intubation because...
Definition
The sniffing position allows for a better alighnment of the three axis of the airway, the
Oral Axis, the Pharyngeal Axis, and the Laryngeal Axis, to aide in visualization of the glottis for intubation.
Term
When exposed to low levels of oxygen cardiac levels __________ and then __________
Definition
increase and then decrease. Become tachycardic and then bradycardic.
Term
What is the quickest/easiest mucosa to examine in patients?
Definition
Ocular mucosa
Term
RSI stands for?

What is it?
Definition
Rapid Sequence Intubation

combined administration of a sedative and a neuromuscular blocker to facilitate intubation
Term
RSI _______ make it easier to intubate the patient
Definition
does not
Term
Cricoid pressure/Sellick's maneuver cannot be used when...because it....
Definition
there is suspected c-spine injury because it puts pressure on the cricoid ring (traps the ring between fingers and C6)
Term
RSI indications?
Definition
combative patient
not able to secure their own airway but have intact gag reflex
Term
King airway may be used in patients over _____ ft in height
Definition
4
Term
LMA does not ___________
Definition
protect the airway
Term
Does the combitube help protect against aspiration?
Definition
yes
Term
Surgical Cricothyrotomy Contraindications
Definition
pediatric patients
crush injury to larynx
inability to identify structures
Term
Surgical cricothyrotomy differs from needle cricothyrotomy by
Definition
regular ventilation (don't need jet ventilator)
ETT tube inserted into airway
Term
3 reasons to use RSI
Definition
prevent aspiration
facilitate intubation
prevent psychological trauma
Term
RSI ___________ the patient in order to facilitate endotracheal intubation
Definition
sedates and paralyzes
Term
When attempting RSI what 3 things must you assume?
Definition
the patient has a full stomach
You CAN intubate the patient
You CAN resuscitate the patient
Term
RSI contraindications
Definition
Any condition preventing mask ventilation/intubation

allergies to meds

airway swelling with adequate respiration

anatomical abnormalities
Term
Paralytics do nothing for __________
Definition
mentation
Term
Poor technique
Anatomical variations
Coincident diseases
Trauma
are all indications of a...
Definition
difficult airway
Term
Lidocaine is used in RSI premedication to...
Definition
reduce cardiac response to intubation
slow/blunt the rise in intercranial pressure (ICP)
Term
Atropine is used in RSI premedication to...
Definition
Decrease bradycardia
(vagally mediated and succhinylcholine mediated)
Term
2 topical anesthetics used in RSI
Definition
Cocaine (applied for nasotrachial intubation) & Lidocaine
Term
Pain reducing medications used in RSI
Definition
Fentanyl
Morphine
Term
Medications used as sedatives in RSI
Definition
etomidate (amidate)
propofol (diprivan)
Term
Etomidate
Definition
short acting sedative
Term
Propofol
Definition
sedative that looks like a milky substance

acts as a "on-off switch"
Term
Depolarizing paralytic used in RSI
Definition
Succinylcholine - rapid onset, not long term -> short acting
Term
3 Non-depolarizing paralytics used in RSI

most common?
Definition
Vecuronium - lasts 30mins
Curare
Rocuronium
Term
Non-depolarizing agents are also known as...
Definition
Neuromuscular blockade agents
Term
Biphasic effect
Definition
the paralyzing agent acts like Ach and stimulates the muscle -> causes fasciculation (in depolarizing agents)
Term
Order of paralysis
Definition
eyes, face, neck
extremities
abdomen
intercostals, glottis
diaphragm
Term
common Succinylcholine dosage is ____ via ____
Definition
1-1.5 mg/kg via IV
Term
Non-depolarizing agents compete with ____ for receptors but _______ them
Definition
ACh
don't activate
Term
__________ is the second leading cause of death due to unintentional injuries among children and young adults (1-24)
Definition
drowning
Term
The 3 phases of trauma care are...
Definition
Pre-incident
Incident
Post-incident
Term
what are the 3 categories of trauma deaths?
Definition
Immediate (within seconds of injury)
Early (within first 2-3 hours of injury)
Late (days/weeks after injury)
Term
What are level 1 trauma centers?
Definition
Centers with EDs and on call physicians that are available 24/7 and never turn away patients
Term
What are level 2 trauma centers?
Definition
Centers that provide emergency medicine to patients who do not require level 1 centers
Term
What are level 3 trauma centers?
Definition
Centers that provide emergency medicine to patients who do not require level 1 or 2 centers
Term
Patients who have ____(5 items)____ should go to trauma centers
Definition
alteration in LOC
Systolic pressure below 90
Injury
MOI - fall greater than 10ft, MVA with death, something not right
Respiratory distress
Special concerns
Term
Abbreviated Injury Scale (AIS) divides the body into _____ regions and gives a score to each injury from ___ to ___

AIS is a form of _______ injury score
Definition
6 regions

from 1-6

Anatomical
Term
Physiologic Injury Score consists of what 3 parts?
Definition
Glasgow coma score
trauma score
revised trauma score
Term
Parameters of revised trauma score include...
Definition
respiratory rate
systolic BP
glasgow coma score
Term
What are 6 things that indicate air transport?
Definition
fall greater than 20ft
amputation
scalping/degloving injury
severe hemorrhage/shock
burns
spinal cord/column injury
Term
______ is the leading cause of death with known risk factors
Definition
trauma
Term
_____ are the leading cause of injury death among those 65 and older
Definition
Falls
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