PAAM Final Flashcards
(159 cards)
1
Q
What is always your number one priority on any call:
When is scene safety assessed:
When would you use NOI versus MOI?
Do you have a legal obligation to enter a unsafe scene:
A
= yourself
= when you first get the call
= After you make your GI of the PT
= NO
2
Q
What is known as “action circle” at the scene of an accident?
What is the safe (minimum) radius of the action circle?
What is the purpose of the “Circle Survey”?
A
= circular area extends out from accident vehicles & 50ft (min) radius
= 50ft
= Survey all 360 degrees of accident
3
Q
Dangers of performing rescue in confined space?
Dangers of performing a rescue in a farm silo?
Order which you should conduct a water rescue?
A
= Gases & Collapsing
= Sinking, only up & down
= Reach (with long pole), Throw (flotation device), Row (boat), Go (water entry)
4
Q
Distance to park w/ 1 of cars on fire at road incident?
Position of vehicle approaching potential hazard?
Book most used to identify hazard materials:
Must be worn working scene of vehicle accident:
A
= 100ft or>
= Uphill & Upwind
= Emergency Response Guidebook
= Reflective vest
5
Q
What info do you obtain w/ general impression?
What is the purpose of the primary assessment?
A
= Immediate life/death signs/hemorrhaging, PT info
= Fix any life threatening problems
6
Q
Assessed during PT assessment?
Something wrong in primary assessment, what are you to do?
Type of hemorrhage cause interruption of ABCs:
A
= 1. SS/sizeing, M/NOI, 2. PT assess, 3. LOC, 4A, 5B, 6C
= Stay & Play
= squirting/arterial
7
Q
Assessed during “A” phase of primary assessment?
Assessed during “B” phase of primary assessment?
Assessed during “C” phase of primary assessment?
A
= Airways all possible & best airways
= Breathing; quality, rate, rhythm, symmetry,
= Circulation; CTC, quality, rate, rhythm, regularity, strength
8
Q
How do you use the AVPU scale?
GCS- E points:
M points:
S Points:
A
= Alert, Verbal, Pain, Unresponsive
= 4 Alert, 3 Verbal, 2 Pain, 1 Unresponsive
= 5 Oriented, 4 Confused, 3 inappropriate words, 2 sounds, 1 no audiation
= 6 Obeys comands, 5 localizes to pain, 4 withdraws w/ pain, 3 flextion, 2 extension, 1 no response
9
Q
Systolic BP estimates for following pulse sites- Radial
Femoral:
Carotid:
A
= 80
= 70
= 60
10
Q
How long to conduct a primary assessment?
A
= 60secs
11
Q
Goal of therapeutic communication?
What is therapeutic communication?
A
= PTs feel heard & understood; can help reduce anxiety, build trust, & improve quality of care provided.
= Specific techniques & strategies to establish a positive rapport, convey empathy, & effectively gather info from PTs.
12
Q
Active communication consists of what 4 things?
What actions can you take for a good 1st impression?
A
= sender, a message, a receiver, and feedback
= Introduction, Open stance, eye contact, ect
13
Q
PT distance in intimate zone?
You assess for what in what zone?
PT distance in person space?
where most our PT assessment occurs
Distance for social space?
Distance for public space?
A
= 0-1.5 feet
= Internal signs in intimate zone
= 1.5-4ft
= Personal zone
= 4-12ft
= 12ft or more
14
Q
3 different relative Lvls mean to a PT:
1. Remaining at eye level:
2. Standing above/over PT:
3. Dropping below eye level indicates:
A
= eye contact Lvl
= equality
= authority & can be intimidating
= Willing for PT have some control (w/ elderly&PEDI)
15
Q
Eye contact 50/70 rule- 50%:
70%:
helps interaction by making it by creating a :
A
= maintain eye contact 50% of the time= speaking
= Maintain eye contact 70% of the time= listening.
= comfortable & engaging w/o making other uneasy
16
Q
Be familiar with the parts of active listening:
A
Silence, Reflection, Facilitation, Empathy, Clarification, Confrontation, Interpretation, Asking about feelings, Explanation, Summarization,
17
Q
SAMPLE history:
OPQRST-ASPN:
AEIOU-TIPS:
DCAP-BLS-TIC:
A
= Sign/Symptoms, Allergies, Meds, Past med/ Hx, Last oral intake, Events leading up
= Onset, Provocation/Palliation, Quality, Radiating, Severity, Timing - Associated Sign/Symptoms & Pertinent Negatives
= Alcohol, Epilepsy, Insulin (hypo/hyperglycemia), Overdose, Uremia (kidney failure), Trauma, Infection, Psychosis, Stroke
= Deformities, Contusions, Abrasions, Punctures/Penetrations, Burns, Lacerations, Swelling, Tenderness, Instability, Crepitus
18
Q
Goal of the secondary assessment?
4 techniques when assessing PT in 2nd assessment?
A
=more through exam objective & measurable (quantifiable) info is taken from PT’s health condition: vitals, SAMPLE, ect
= 1st. Visual, 2nd. Palpation, 3rd. Percussion, 4th. Auscultation
19
Q
2nd. Palpation inspection:
A
= Fingers for sensations EX pulse, Ball of hand(calluses) for vibrations (tactile fremitus- vibration in back when talking)
20
Q
3rd. Percussioning:
A
= striking surface of body; Direct EX sinus taping listening for hypo-rresonant dull sound means filled sinuses, Indirect= tap on top of own fingers (percussing for pneumo) Blunt percussion= hitting hard EX kidneys hitting & listening for pain response
21
Q
Erb’s point @:
&means:
A
= 3rd ICS L-sternal border.
= heart murmurs can be heard more distinctly.
22
Q
4th. Auscultation:
A
= Diaphragm hyper-sounds lungs bell= (held at stem), BP & heart sound
23
Q
Percussion sounds:
Tympany sound:
Hyperresonance sound:
Resonance sound:
Dull sound:
Flat sound:
A
= tone’s resonance/lack of indicates if region is filled w/ air, air under pressure, fluid, or normal tissue
= “drumlike” , loud intensity, High pitched, Medium duration, located in stomach “teeter-totter”
= “Booming” ,loud intensity, Low pitched, long duration, located in Hyperinflated-Lung “Hums of mongolian”
= “Hallow” , loud intensity, low pitched, long duration, located in a normal lung “Ringing tornado”
= “thud” , Medium intensity, medium pitched, medium duration, in solid organs “Dumb down-syndrome”
= “Extremely dull” , Soft intensity, High pitched, short duration, in muscle & atelectasis “fly flying by”
24
Q
dysarthria:
dysphonia:
aphasia:
expressive aphasia:
Receptive aphasia:
PT w/ aphasia be mistaken for:
A
= defective speech caused by motor deficits
= voice changes caused by vocal cord prob/s
= defective language from brain damage
= words will be garbled
= words will be clear but unrelated to your questions.
= a psych disorder b/c such difficulty speaking
25
(ODERS) Fruity breath:
Urine or ammonia:
Bitter almonds:
General bad breath:
Fishy vaginal/penis odor:
Fecal breath:
= DKA
= UTI
= cyanide poisoning
= hygiene and/or infection
= infection and/or Ghonearrhea
= GI obstruction
26
Pulse Deficit:
Pulse Deficit indicates:
Pulsus Alternans:
Pulsus Alternans indicates:
= difference in HR w/ auscultation & PR w/ palpation.
= not all heartbeats make palpable pulse, often A-Fib
= Alternation of strong & weak pulses, typically
=L-ventricle dysfunc/or H-failure & often chronic condition of the heart.
27
Cardiac Output formula:
HR:
SV:
Formula for BP:
Calculate a PT’s MAP:
= CO=HR×SV
= Heart Rate (beats per minute)
= Stroke Volume (amount of blood pumped per beat)
= BP= SVR x (SV x HR)
= DBP+ ⅓(SBP-DBP)
28
(Korotkoff sounds & in order) 1st sound:
2nd sound:
3rd sound:
4th sound:
5th sound:
Mnemonic:
= snapping
= swooshing
= tapping
= thumping (muffling)
= silence
= “Sounds Silly That They Sing”
29
(skin signs) 1. Pallor:
2.Cyanosis:
3. Jaundice:
4. Erythema:
5. Petechiae:
6. Purpura:
7. Mottling:
8. Ecchymosis:
9. Vesicle:
10. Cyst:
11. Bulla:
12. Telangiectasia:
13. Excoriation:
14. Scale:
15. Lichenification:
16. Atropy:
1. =Abnorm/ pale; hypoxia by shock or hypothermia.
2. = Blue: hypoxia
3. = yellow: liver failure
4. = Red: carbon monoxide
5. = small flat purple spots by cap/blood/;many etiologies
6. = purple spots by minor cap/ bleeding
7. = purplish patches; poor circu/oxygen/seen near-death
8. = Bruising
9. = elevated area <1cm w/ serous fluid
10. = elevated palpable area w/ liquid or viscous matter
11. = “bulb” Vesicle diameter >1cm
12. = Red/blue threads "spider"
13. = linear epidermis loss leaving dermis exposed
14. = excessive exfoliation white-silver-tan
15. = thickening/hardening epidermis w/ emphasize lines
16. = thin “clear” epidermis
30
Skin turgor test:
Norm/ skin tugor:
Decreased skin mobility suggests:
“Tenting” Poor turgor:
= pulling skin fold over bony area then releasing it
= immediately returns to its original state.
= edema or scleroderma, a progressive skin disease.
= results from dehydration
31
(Abnormal Nails) Clubbing:
Paronychia:
Onycholysis:
Terry’s nails:
Transverse/Beau's lines:
Psoriasis:
= “finger clubs” distal phalanx of fingers rounded/ bulbous & Proximal nail feels spongy; from chronic hypoxia in COPD & lung cancer.
= inflamed nail; can be acute trauma or chronic & Cuticle isn't visible
= Separation of nail from nail bed; can be from fungal infections, psoriasis, or trauma.
= white w/ narrow pink band @ tip; can indicate liver disease, diabetes, or heart failure
= horizontal grooves; nail growth disruption from illness, trauma, or nutritional deficiencies
= small pits; can be an early sign of psoriasis
32
Medical word for unequal pupils >1mm:
Unequal pupils alert you to:
Medical word used for pinpoint pupils:
Medical word used for dilated pupils:
Name of eye chart used to test visual acuity:
Bitemporal hemianopsia:
Left/Right Homonymous Hemianopsia:
Homonymous Quadrantic Defect:
Medical word for ecchymosis around eyes& sign of:
= anisocoria
= Brain trauma!!!
= Miosis
= Mydriasis
= Snell chart
= loss of vision in the outside half of each eye
= loss of vision in right or left half of both eyes
= loss of vision in the same quadrant of both eyes
= Periorbital ecchymosis & basilar skull fracture
33
3 parts of the ear:
What part contains the three ossicles:
= Outer, middle, Inner
= Middle ear
34
Outer Ear consists:
= Auricle, External Acoustic Meatus “Ear canal”, & Tympanic membrane “eardrum”
35
Inner ear contains:
Names of 3 ossicles:
= Vestibule, Semicircular canals, Cochlea, Labyrinth
= “Hammer” malleus, “Stirup” incus, “Anvil” stapes
36
"Hammer" of ear:
= Malleus “both have M”
37
"Stirup" of ear:
= Incus
38
"Anvil" of ear:
= Stapes
39
Medical word for ecchymosis behind ears & a sign of: What can be assessed using an otoscope:
= Retroauricular- ecchymosis
= Typmanic membrane for Otitis media
40
Name/meaning for increased JVD during inhalation:
Kussmaul’s sign & Hemothorax
41
Pressure in the jugular veins approximate:
Elevated jugular venous pressure can indicate:
= central venous pressure (CVP)indicator of body's overall blood volume & venous return
= L-side ventricle failure or fluid overload.
42
PT w/ subcutaneous emphysema:
= Air leaking from respiratory into tissues of neck ;indicating a serious neck/chest injury.
43
Presence of Carotid bruit:
What is a carotid bruit:
= usually means= atherosclerosis
= sound of turbulent blood flow around partial vessel obstruction
44
3 phases when assessing PT's chest- Phase 1:
Phase 2:
Phase 3:
= Inspection: shape, symmetry, & abnormal m-nts or signs.
Palpation: Feel for tenderness, vibrations, & abnormalities.
Percussion: Tap to assess the underlying lung tissue & identify areas of abnormal density
45
adventitious lung sounds:
= crackles/rales, wheezes, rhonchi, stridor, & pleural rubs
46
What is considered normal heart sounds?
= S1/S2 “lub dub”
47
S1 Sounds auscultate @:
S2 Sounds (aortic) auscultate @:
S2 Sounds (Pulmonic) auscultate @:
= 5th ICS at Left Sternal border “TRI BI”
= 2nd ICS at Right Sternal border “aoRtic Right”
= 2nd ICS at Left Sternal “puLmonic L”
48
Aortic Valve auscultate @:
Pulmonic Valve auscultate @:
Erb’s Point auscultate @:
Tricuspid Valve auscultate @:
Mitral Valve (Apex) auscultate @:
= 2nd ICS, Right Sternal border.
= 2nd ICS, Left Sternal border
= 3rd ICS Left sternal border.
= 4th ICS Left Sternal border
= 5th ICS, Left Midclavicular line
49
What makes the heart sounds?
What heart valves are open during diastole?
What heart valves are open during systole?
= Bi/Tricuspid valves closing S1 & pulmonic/aortic valves closing S2
= Bi&Tricuspid
= Pulmonic & Auratic
50
What is a scaphoid abdomen & its significance?
Obvious pulsating mass indicates what in abdomen?
Accumulation of fluid across PT’s abdomen is?
= Abdomen appears sunken; can indicate malnutrition or diaphragmatic hernia.
= Indicates an abdominal aortic aneurysm. AAA
= Ascites
51
Cullen’s Sign:
Grey Turner’s sign:
= Bruising @ umbilicus; intra-abdominal bleeding
= Shoulder referred pain from abdomen
52
PT vomiting up bright red blood is called?
PT coughing up blood from respiratory system is?
PT passing bright red blood in stool is? Hematochezia
PT passing very dark, sticky, foul Smelling stool is?
= Hematemesis: upper GI bleed “em flem”
= Hypotyposis "hy-pot cough":resp/ bleed
= Hematochezia; Lower GI bleed “crap w/ blood”
= Melena; Upper GI bleed
53
What is Kehr’s sign/meaning:
PT w/ Murphy’s sign means?
Where/what is McBurney’s Point?
= Referred shoulder pain from spleen or liver
= Suspected gall bladder infection→ cupping under rib w/ breath causes pain
= LRQ pain w/ rebound tenderness ⅔ of way from umbilicus to illicac; pos/ appendicitis
54
(Pitting edema)- +1 grade:
+2 grade:
+3 grade:
+4grade:
= 1-2 mm (0.04-0.08 inches)
= 3-4 mm (0.12-0.16 inches)
= 5-6 mm (0.20-0.24 inches)
= 7-8 mm (0.28-0.31 inches)
55
(0, +1, +2, or +3 pulses)- 0 pulse grade:
+1 pulse grade:
+2 pulse grade:
+3 pulse grade:
= Absent, no detectable pulse
= Weak; thready, barely detectable,
= Normal; easily felt but not bounding.,
= Strong; full & easily palpable.
56
What is Lordosis?
What is Scoliosis?
What is Kyphosis?
= Swayback "Lord the way swayback"
= Lateral curve "S curve"
= Humpback
57
CN 1:
= Olfactory → smell "1 nose"
58
CN 2:
= Optic → vision (sensing light) "2 eyes"
59
CN 3:
= Oculomotor: pupil m-vt (controls pupils sizes) "3 words cocaine constricts pupils"
60
CN 4:
= Trochlear: eye motor function (look up & down) "it go up, down, up, down"
61
CN 5:
= trigeminal “suicide “= chewing muscles (chewing mastication), Sensory→Ophthalmic (forehead), maxillary (cheek)& mandibular (chin) "5 fingers to the face/chew"
62
CN 6:
= abducens= Lateral Eye m-vt "6 letters (TO SIDE)"
63
CN 7:
= facial: controls facial expressions, taste @ front 2/3s of tongue, & some F.s of salivary & lacrimal glands “L I C K M A D”
64
CN 8:
= vestibulocochlear= sense hearing, balance, equilibrium
65
CN 9:
= glossopharyngeal= controls taste @ back of tongue, helps w/ swallowing by saliva production. "9 lime"
66
CN 10:
= vagus “wondering” parasympathetic F.s: HR, digestion, & RR & also provides sensory info from throat & voice box.
67
CN 11:
= Accessory = traps Muscles motor
68
CN 12:
= Hypoglossal = motor tongue control out "12 & 21 baskin robin flavors"
69
Cranial nerves carrying parasympathetic nerve fibers?
CN: 3,7,9,10
70
Ocular Muscles do what & Innervated by 3CNs:
Remember by:
= control eye m-nt by Oculomotor (CN-III), trochlear (CN-IV),& abducens (CN-VI)
= OCULAR MUSCLES is 13 letters = CN 3+4+6
71
Contractile cell RP:
Contractile cell AP:
Autorhythmic cell RP:
Autorhythmic cell AP:
Neuron cell RP:
Neuron cell AP:
= -90mV
= -85mV
= -60mV
= -40mV
= -70mV
= -55mV
72
Ion that depolarizes Contractile cell :
Ion that repolarizes Contractile cell :
Ion that depolarizes Autorhythmic cell :
Ion that repolarizes Autorhythmic cell :
Ion that depolarizes Neuron cell :
Ion that repolarizes Neuron cell :
= Sodium
= Potassium
= Calcium
= Potassium
= Sodium
= Potassium
73
(Pacemaker spots in heart w/ firing rates) SA
AV rate:
Purjunkie rate:
= 60-100
= 40-60
= 15-40
74
Electrical stimulus travel from SA node to L-atrium via:
= Backman’s Bundle
75
(Einthoven’s Triangle) Negative Lead 1@:
Positive Lead 1 @
Negative Lead 2 @
Positive Lead 2 @
Negative Lead 3 @
Positive Lead 3@
Remember by:
= RA
= LA
= RA
= LL
= LA
= LL
= neg-pos RA to arm to LL
76
(Einthoven’s Triangle 12/15lead) V1=
V2 lead @=
V4 lead @=
V3 lead @=
V5 lead @=
V6 lead @=
V4R lead @=
V5/8 lead @=
V6/9 lead @=
Numbers:
= (anterior)4th ICS(between 4&5th~1inch R sternum)
= (anterior) 4th ICS ~1inch L of the Sternum
= (anterior) 5th ICS Midclavicular (left breast)
= (anterior) ½ way in between V2&4
= (anterior) 5th ICS Anterior Axillary
= (anterior) 5th ICS Mid Axillary
= (anterior) 5th ICS Midclavicular
= (posterior) 5th ICS Mid-Scapular
= (posterior) ½ way in-between Scapula & Spine
= 4 & 5 ICS and 1/2 inbetweens
77
What is the normal speed of ECG paper?
25mm per sec
78
Positive electrode = what flex on ekg:
Positive charges look at what side of heart:
= + flex on ekg: LL & lead 2 positive
=+ charges look at inferior side of heart
79
Positive electrode makes wave:
Negative electrode makes wave:
= makes inverted wave "U"
= makes wave positive "/\"
80
!!!Einthoven's triangle: green electrode:
Blue electrode:
Red electrode:
=neutral/ground “ground grass”
= Negative “feeling blue”
= Positive
81
!!!Einthoven's triangle: Lead 1 & view:
Lead 2 & view:
Lead 3 & view:
= negative RA → positive LA (Left lateral camera view)
= negative RA→ positive LL (Inferior camera view)
= negative LA→ positive LL (slight lateral Inferior camera view)
82
(Einthoven's triangle) BiPolar Limb Leads:
= 2 electrodes, + & -, “+looks to -”,
83
Unipolar Limb Leads:
aVR:
aVL:
aVF:
= Augmented by the cardiac monitor
= Right Arm positive (inferior)
= Left Arm positive (lateral )
= Left Leg positive (inferior)
84
(EKG) Horizontal Boxes: Each small box ?secs:
5 small boxes equal:
Each large box is ?secs:
= 0.04 sec
= 1 large box
= 0.20 sec
85
Vertical Boxes Each small box is:
Each small box also equals:
5 small boxes equal:
Each large box is:
2 large boxes equal: 1 mV
= 0.1mV
= 1 mm
= 1 large box
= 0.5 mV
= 1 mV
86
ECG Heart waves – P wave:
QRS complex:
T wave:
= Atrial depolarization
= Ventricular depolarization
= Repolarization of ventricles
87
P Wave- Morphology:
Interval P Wave Duration:
PRI wave duration:
Amplitude in the limb leads:
Amplitude in the precordial leads:
= Smooth hump, Upright in limb lead:1-3, Biphasic(2 waved) in V1, should have same morphology
= <0.12secs
= 0.12-0.20secs 3-5 small boxes >5 boxes (Atrium depolarizing)=
= < 2.5 mm in the limb leads
= < 1.5 mm in the precordial leads
88
QRS Complex- Morphology- Q Wave is:
R Wave is:
S wave is:
Interval Duration:
= 1st negative deflection after the P wave
= 1st positive flection after the P wave
= any negative deflection after the R wave
= 0.04 – 0.12 sec/ 1-3 small boxes
89
T Wave- Morphology:
Interval Duration:
Amplitude in limb leads:
Amplitude in precordial leads:
= Upright in all leads except aVR & V1, Normally downslope>upslope
= Variable (QT Calculation)
= < 5 mm/ 5 small boxes in the limb leads
= < 10 mm in the precordial leads
90
Oxyhemoglobin is:
Carbaminohemoglobin:
Methemoglobin:
Deoxyhemoglobin:
Carboxyhemoglobin:
Sulfhemoglobin:
Glycated Hemoglobin (HbA1c):
= oxygen carrying Hemoglobin
= carbon dioxide on hemoglobin amino-acid
= Hemoglobin not picking up ( w/ iron in ferric (Fe3+) vs oxy)
= Hemoglobin not bound to oxygen.
= Hemoglobin bound to carbon monoxide (CO).
= Hemoglobin irreversibly bound to sulfur.
= Hemoglobin bound to glucose for measuring long-term BGL control
91
Cranial nerves name mnemonic:
Cranial nerve names:
= “Oh, Oh, Oh, To Touch And Feel A Girl’s Vagina, Such Heaven!
1. Olfactory
2. Optic
3. Oculomotor
4. Trochlear
5. Trigeminal
6. Abducens
7. Facial
8. Vestibulocochlear (or Auditory)
9. Glossopharyngeal
10. Vagus
11. Spinal Accessory
12. Hypoglossal
92
Tracheal Stenosis:
=narrowing of trachea from injury/ scarring often caused by Cricothyrotomy
93
“Coffee grounds” in mouth suggests:
Pink sputum indicates:
Green/Yellow phlegm suggests:
= upper gastrointestinal (GI) bleed.
= acute pulmonary edema
= a respiratory infection
94
Heart sounds)Ejection Click:
Opening Snap:
Pericardial Friction Rub:
Murmur:
=a stiff or stuck valve.
= stenotic bi/tricuspid valve’s leaflets recoiling abruptly after diastole.
=inflammation causing visceral & parietal surfaces to rub w/ each heartbeat.
= Rumbling/vibrating noise from turbulent blood flow through heart valves, a large artery, or a septal defect.
95
Heart sounds)Ejection Click:
Opening Snap:
Pericardial Friction Rub:
Murmur:
=a stiff or stuck valve.
= stenotic bi/tricuspid valve’s leaflets recoiling abruptly after diastole.
=inflammation causing visceral & parietal surfaces to rub w/ each heartbeat.
= Rumbling/vibrating noise from turbulent blood flow through heart valves, a large artery, or a septal defect.
96
Can loose testie from torsion in how many hours:
6 hours
97
ABDMN consistent pain for how many hours is a surgical emergency:
=6 hours
98
1957, Dr. J. Frank Pantridge & his colleague Dr. John Geddes made:
= modern concept of cardiopulmonary resuscitation (CPR) for the early treatment of cardiac arrest.
99
The 3 types of ECG leads are:
bipolar, augmented "unipolar", and precordial.
100
(Bipolar leads) impulse moving toward + electrode creates:
Impulse moving toward -electrode causes:
= + deflection (upward) on the ECG paper or monitor.
= a - (downward) deflection on ECG paper/monitor.
101
Artifacts on ECG produce:
Common causes of artifacts include:
=deflections by factors other than heart’s electrical activity
= Muscle tremor/Shivers, PT m-vt, Loose electrodes, 60-hertz interference, Machine malfunction
102
Chronically ill=
frail=
feeble=
robust=
vigorous=
= Can't do basic human necessities
= sick soreness
= lack of strength
= energetic
= VERY energetic
103
(eye H-test) Direct response:
Indirect (consensual):
accommodation:
H test actual name:
= observe same pupil
= observe opposite pupil
= crossing eyes when going to nose
= Ocular eye motor movement test
104
Bristol stool chart & types:
= type 4 healthy, type1 hard deer pebbles, type 8 liquid
105
Aaron’s signs:
Rovsing’s sign:
Psoas sign:
= Epigastric pain during palpation to McBurney’s point
= RLQ pain w/ palpation to LLQ
= RLQ pain when PT tries to raise R-leg against resistance
106
Priapism penis causes:
= sickle cell anemia, meds, spinal damage
107
Cranial nerve types mnemonic:
Nerve types:
= "Some Say Marry Money, But My Bitch Says Big Boobs Matter Most."
= 1. Olfactory - Sensory
2. Optic - Sensory
3. Oculomotor - Motor
4. Trochlear - Motor
5. Trigeminal - Both
6. Abducens - Motor
7. Facial - Both
8. Vestibulocochlear (or Auditory) - Sensory
9. Glossopharyngeal - Both
10. Vagus - Both
11. Spinal Accessory - Motor
12. Hypoglossal - Motor
108
Cranial nerve location mnemonic:
Nerve locations:
= "Sexy EMTs Play Erotic Jokes, Exciting Their Erotic Lover's Asshole Stimulating Them."
= Sniffer- smells (Olfactory)
= Eyes - Eyesight (Optic)
= Pupils - Pupils & eye movement (Oculomotor)
= Eyes = eyes movement (Trochlear)
= Jaw -mastication (Trigeminal: sense face & motor jaw)
= Eyes - Eye movement (Abducens)
= Taster - Taste & facial expression (Facial)
= Ears - Ears hearing & balance (Vestibulocochlear)
= Licker- tongue taste & swallow (Glossopharyngeal)
= ABDMN- Autonomic control thorax & ABDMN (Vagus)
= Shoulders -shrug & neck m-nt (Spinal Accessory)
= Tongue - Tongue movement (Hypoglossal)
109
Endotracheal intubation indications:
= breathing fail/arrest, cardiac arrest, airway closing/needs to be protected
110
Endotracheal intubation indications:
= breathing fail/arrest, cardiac arrest, airway closing/needs to be protected
111
Surgical cric indication:
= severe facial trauma & other airways not patent
112
Trachea bifurcates @?
Carina
113
where does the gases exhange in the lungs
Aveoli
114
Identify the differences between the visceral and parietal pleura
V=has no nerves P= has nerves
115
How does the airway of an adult differ from that of a pediatric patient?
Pediatric airway = funnel & floppy
116
What is the difference between ventilation and respiration?
Vent= mechanical Respi= gas exchange
117
Difference w/ cellular (internal) & (external) pulmonic respiration:
Internal = cells external= lungs
118
calculate alveolar volume:
minute volume:
Alveolar minute volume:
AV= TIDAL-DEAD
MINUTE = RR X TIDAL VOL
AVMV= AV x RR
119
What signals us to breathe→ Central chemoreceptors:
Increase in arterial CO2:
Hypercarbic & hypoxic drives & dif/s:
= pH receptors
= hypercarbic drive
=too much CO2 so initiates from high PACO2 &hypoxic= not enough oxy so initiates from low PAO2
120
How does CO2 get transported throughout our body:
Bicarbonate 70%, then hemoglobin 23% , then dissolved in blood <7%
121
What reflex stops us from over ventilating ourselves:
What receptors are involved?
What is a V/Q mismatch?
= Hering-Breuer
= Stretch receptors
= Ventilation Perfusion mismatch
122
DISS fitting on an oxygen therapy regulator:
What PIN system does an oxygen tank/therapy regular use:
= Diameter Index Sizing System
= 2:5
123
(Supplemental oxygen devices & FiO2%) Nasal cannula:
NRB:
BVM:
Pocket-mask
= (lpm x 4) + 20 ,ex 1lpm=24%
= 80% 15LPM
= (90-95)per book 100% LPM
= 16%
124
What makes an OPA a better airway adjunct over an NPA?
Aspiration, displaces tongue, & can suction
125
4 ways that you can ventilate a PT & which is best & worst:
mouth to pocket mask(best), 2 person BVM, demand valve/FROPVD, 1 person BVM (worst)
126
Suction times for the different age groups:
Suction time limits for suctioning an ET or Trach tube:
= 5,10,15secs
= 5-10secs
127
What is “LEMONS?”
= Looks, Exam 3-3-2, Mallampati, obstruction, neck mobility, saturation
128
3-3-2 Rule=
= 3 fingers (Mouth opening): PT should be able to open their mouth wide enough to fit three fingers vertically.
= 3 fingers (Chin to hyoid): distance from the chin to the hyoid bone should be at least the width of three fingers.
= 2 fingers (Hyoid to thyroid notch): distance from hyoid bone to the thyroid notch should be at least the width of two fingers.
129
Mallampati Scores: Class 1
Class 2
Class 3
Class 4
Class I: Everything in the back of the mouth is easily seen.
Class II: Most structures are seen, but the back pillars are not.
Class III: Only the uvula and soft palate are seen.
Class IV: Only the roof of the mouth (hard palate) is seen.
130
CPAP and how does it help a patient with either CHF or asthma/COPD?
= Continuous Positive Air Pressure → forces PT’s lungs take in more air
131
Cormack/LeHane Classification system: Grade 1:
Grade 2:
Grade 3:
Grade 4:
= entire glottic opening & vocal cords may be seen
=epiglottis & post/ glottic opening pos/ seen w/ partial vocal cord view
= only epiglottis & (sometimes) posterior cartilages seen
= neither epiglottis nor glottis seenw/ a partial view of vocal cords
132
Parts of the ET tube:
How should a stylet be used?
What is the distal lateral hole called?
o When is a good time to use a bougie?
§ What is the distal curved tip of a bougie called?
= cuff, piolet, balloon,
= in ETT for structure strength to prevent flimsyness
= Murphy's eye
= Need to feel cartilage rings, Cric/, Trach intubat/, Pedi oral intubat/
= Coude tip
133
estimate ET tube size for a PEDI PT: Pedi (uncuffed) ETT form:
Pedi (cuffed) ETT form:
= (age/4) +4 or (age +16)/4
= (age/4) +3.5
134
estimate weight of a PEDI PT:
(age+4)x2=Kg (age X 3) +7=Kg
135
equipment used to help successful placement of a nasal ET tube?
BAAM Beck Airway Airflow Monitor→ high pitch on inhale
136
Measuring NG tube:
Measuring OG tube:
= tip of nose, around ear, & down to xiphoid process (make a “?”)
= corner of mouth, around ear, & down to xiphoid process (make a “?”)
137
(BURP for neck pressure) B:
U:
R:
P:
= Backward: pressure posteriorly (toward back) on thyroid cartilage
= Upward: pressure superiorly (toward head) on thyroid cartilage
= Rightward: pressure laterally (toward R-side) on thyroid cartilage
= Pressure: keep BUR pressure to improve view of vocal cords
138
Laryngeal Airways sit @:
Dif airways: 1.
2.
3.
4.
5.
lumens=
= supra glottic airways (above glottis)
1. LMA:commonly OR setting,
2. LMA Supreme: updated LMA design w/o need for fingers in mouth
3. LMA Fastrach(saxophone) designed to aid blind endotrac/ intubat/
4. CookGas air-Q(tongue w/ tube) pedi/ sizes & shape allows intubat/ w/ ETT introducer & w/ direct tube placement.
5. I-Gel= most common, has a built-in bite block & passageway allows insertion of a gastric tube to decompress the stomach
= “pigtails” PT vent & provider vent
139
Delayed Sequence intubation(DSI):
Rapid Sequence Intubation (RSI):
Sedation-Facilitated Intubation (SFI):
Medication-Assisted Intubation (MAI):
= use of sedative w/o paralytic allows better mask-seal & preoxygenation during intubation
= use of potent induction med followed by a rapid neuromuscular blocker (NMBA) to sedate & paralysis for "quicker" intubation
= med/ admin, but no paralytics are administered.
= RSI & SFI
140
type of cric/ for PEDIs years ?&<:
= needle cric/ for 8yrs old & younger
141
PEEP and how much do we usually use?
= Positive expiratory end pressure 5cmH2o
142
different ways monitor a PT’s ETCO2?
Colorimetric, capnometry, capnography
143
purpose of a chest drainage system?
Water is required to maintain a patent one-way valve?
Most common complications of a chest tube?
= Restore and keep negative gas pressure
= Distal tube in 2cm of water
= Tubes disconnecting or kinking & air leaks
144
What does Boyle’s Law state?
When/how does Boyle's law apply in EMS?
What does Henry’s Law state?
When/how does Henry's law apply in EMS?
= Vol/ of gas is inversely proportional to pressure of it (more pressure less volume)
= BVM Ventilations to PT
= amount of a dissolved gas in given amount of fluid is directly proportional to amount of pressure on top of that gas
=supplemental oxygen therapy
145
What does Charles’s Law state?
When/how does Charle's law apply in EMS?
What is Gay-Lussac’s Law?
When/how does it apply in EMS?
=At a constant temp/, the volume of a gas is directly proportional to gas temp
= Ensuring oxy/ cylinders & other gas containers are stored at appropriate temp/s to maintain consistent gas delivery.
=As you heat gas, the pressure is going to go up.
=Gas Storage: gas containers stored @ stable temp/s to avoid pressure changes & PT Care: Recognize PT hyper/hypothermic conditions might altered resp/circulatory from changes in gas pressures w/in body
146
What is Dalton’s Law?
When/how does it apply in EMS?
=Total pressure of a mixture of gases = the sum of the partial pressure of the individual gases.
=Resp/ Gas Exchange: how partial pressures of oxygen & CO2 affect diffusion across the alveolar-capillary membrane.
& Hyperbaric Oxygen Therapy: Utilizing increased partial pressure of oxy/ to treat conditions like carbon monoxide poisoning by displacing CO from hemoglobin.
147
shock index:
quick & easy way to assess shock index:
= ratio of HR-SBP. #s over 0.9 suggest impending hypotension.
= if HR>SBP, shock index must be over 1 & should anticipate peri-intubation hypotension.
148
Needle Cricothyrotomy:
Open Cricothyrotomy:
= 14-gauge needle into trachea @crico-thyroid membrane
= ETT/shiley tube into trachea through incision @ crico-thyroid
149
transtracheal jet ventilation/ insufflation:
Barotrauma:
= vent/ing through 14-gauge needle from needle cricothyrotomy
= damage to lungs by changes/increasing pressure. (can also occur from over ventilation)
150
lowest residual tank pressure:
D cylinder form:
E cylinder form:
M cylinder form:
= 200 PSI
= (tank PSI x 0.16) / LPM
= (tank PSI x 0.28) / LPM
= (tank PSI x 1.56) / LPM
151
Bone usually fractured in basilar skull fracture:
= Cribriform plate
152
Retroglottic airway devices: 1.
2.
3.
= King LT: large silicone cuff; disperses pressure over mucosal surface
=King LT-D: disposable 1-lumen latex-free retro glottic airway
=King LTS-D: 1-lumen retro airway w/ channel for placing gastric tube
153
(atelectasis) alveolar collapse can occur:
surfactant:
Parenchyma:
= surfactant is insufficient or if the alveoli are not inflated
= Alveoli "lube" to create surface tension in pleurals
= Core structure of lung
154
PaO2) & normal range
= partial pressure of oxygen dissolved in plasma & 80–100% (mmHg)
155
pre-Botzinger complex:
VRG ventral respiratory group:
DRG dorsal respiratory group:
Pontine resp group=
= “Sa node” of the RR
= transmits signals via phrenic nerve & intercostal nerves
= keeps in check w/ VRG "Backhand man"
= smooths out transition of inhalation & exhalation
156
Angionecrosis Edema:
Trimsmis:
Mentim:
= angioedemna
= Locked jaw
= tip of chin
157
Needle cric/ Potential Complications:
= Barotrauma, Pneumothorax, Hypercarbia
158
Site for pneumo decompression:
needs:
Never go under a rib b/c:
Locating decompression site:
Digital thoracostomy:
= Anterior 2nd ICS midclavicular/3rd rib & b/c air is always up/rising
= At least 3in catheter, attach 1way valve: Could use 3way valve, glove,
= vascular; have major thoracic arteries & nerves
= palp/ then slide over 3rd rib
= 1-2in incision between 4th & 5th ICS, ( “cut finger tube” )
159
(Paralysis w/ RSI Induction med pushes) Etomidate
Midazolam 0.1-0.3 mg/kg IV/IO
Ketamine 1-2 mg/kg IV/IO
Propofol 1-2 mg//kg IV/IO
(Push paralytic med RIGHT after med induction): Succinylcholine
Rocuronium
= 0.2-0.4 mg/kg IV/IO
= 0.1-0.3 mg/kg IV/IO
= 1-2 mg/kg IV/IO
= 1-2 mg//kg IV/IO
= 1-1.5 mg/kg IV/IO
= 0.6-1.2 mg/kg IV/IO (If succinylcholine is contraindicated)
