QUIZ 1 Flashcards
1
Q
AMLS patient assessment pathway
A
- advanced medical life support
- initial observations- scene size up, CC, primary assessment
- first impression- life threats, sick or not sick, differential diagnosis
- detailed assessment- history, secondary assessment, diagnostics
- refine differential diagnosis- life threats, critical, nonemergent
- ongoing management- reassess
- scene size up
- primary assessment
- history taking
- secondary assessment
- reassessment
2
Q
OPQRST
A
- onset- when did it start
- provocation- does anything you do make it better or worse
- quality- what does it feel like (tight, pressure)
- region/radiation/referral- does (pain) it go anywhere else
- severity- pain on a scale of 1-10
- time- how long has this been occurring
3
Q
SAMPLER
A
- signs and symptoms
- allergies
- medications
- pertinent past history
- last oral intake
- events that led to injury or illness
- risk factors- histories of disease
4
Q
two components of secondary assessment
A
- obtaining vital signs
- performing a head to toe survey
5
Q
AVPU
A
- alert
- verbal stimuli
- painful stimuli
- unresponsive
6
Q
pupils
A
- pinpoint pupils- overdoes
- fixed and dilated pupils- head trauma
- ones normal and the other is dilated- brain bleed
7
Q
glasgow coma scale
A
- eye opening- spontaneous (4), to verbal command (3), to pain (2), no response (1)
- verbal response- oriented and converses (5), disoriented conversation (4), speaking but nonsensical (3), moans or makes unintelligible sounds (2), no response (1)
- motor response- follows commands (6), localized pain (5), withdraws to pain (4) decorticate flexion (3), decerebrate extension (2), no response (1)
- higher GCS (15)- no neurologic disability
- 13-14- mild dysfunction
- 9-12- moderate to severe dysfunction
- 8 or less- severe dysfunction (lowest possible is 3)
8
Q
wheezing
A
- bronchoconstriction
- lungs are constricted
- lower airway constriction
- high pitch whistling
- vibrate
- bronchi are swollen and constricted
- COPD
- asthma
- foreign body lodged
9
Q
rales
A
- fluid that develops in the lung alveoli
- the sound of hair rolling between your fingers
- lower airway obstruction
- pneumonia
- congestive heart failure
10
Q
stridor
A
- high pitch lung sound
- happens in the throat
- constriction of the upper airway
11
Q
aortic aneurysm
A
- may be seen pulsating in the upper midline
- do not palpate an obvious pulsatile mass -> could burst
- dilates -> aneurysm
- wall of aorta burst or starts to expand
- bursts -> dissection (once it starts penetrating the wall
12
Q
bony crepitus
A
- you can feel the shattered bones under the skin
- usually for broken ribs
13
Q
capnography
A
-measure the CO2 you are breathing out
14
Q
pharynx
A
- nasopharynx- air passage with pharyngeal tonsil
- oropharynx- common rout for food and air
- laryngopharynx - extends to the larynx
- differing types of epithelial tissue here
15
Q
larynx
A
- keeps food and drink out of airway
- marks where the upper airway ends and the lower airway begins
- extrinsic muscles connect larynx and elevate it during swallowing
- intrinsic muscles control vocal cords
- epiglottis
- cartilage
- hypoid bone
- ligaments
16
Q
innervation for respiration
A
- phrenic nerve (C3,C4,C5) is innervated when CO2 increase and pH decreases
- detected by chemoreceptors in the CSF
- diaphragm contracts -> inhalation
17
Q
cell death without oxygen
A
- 0-1 min -> cardiac irritability
- 0-4 min -> brain damage not likely
- 4-6 min -> brain damage possible
- 6-10 min -> brain damage very likely
- more than 10 minutes -> irreversible brain damage
18
Q
COPD
A
- chronic obstructive pulmonary disease
- emphysema and chronic bronchitis
- trouble releasing CO2
19
Q
tidal volume
A
- amount inhaled or exhaled in one breath under resting conditions
- giving too much tidal volume can cause pneumothorax
- 500ml is average
- 5-6cc per kilo = tidal volume
20
Q
agonal respirations
A
-patient may appear to be breathing (gasping) after the heart has stopped
21
Q
cheyne stoke respirations
A
increased and decreased rate and depth with
- normal and then drops
- regular pattern
- seen in stroke and head injury patients
- spinal injury
22
Q
Biot’s respiration
A
- breathing normally and then dropping or raising
- irregular pattern
- may follow serious head injury
23
Q
kussmals respirations
A
- deep and fast gasping respirations
- lacking any apneic periods
- associated with metabolic/toxic disorders (diabetes mellitus)
24
Q
dyspnea durations
A
- chronic- usually related cardiac disease, asthma, COPD, or neuromuscular disease
- acute- asthma exacerbation, infection, pulmonary embolus, acute cardiac dysfunction, inhalation toxic substance, allergen, foreign body
- sudden- pulmonary embolism, spontaneous, pneumothorax
- slow- pneumonia, CHF, malignancy
25
tachypnea
- increased respiratory rate
- fever
- hypoperfusion
- metabolic acidosis triggers increase
26
bradypnea
- slower than normal respiratory rate
- drugs
- hypoperfusion
- CNS problem
27
physical exam
1. neurologic- assess mental status
| 2. neck exam- look for JVD when pt is sitting upright
28
tracheal deviation
-late sign of tension pneumothorax
29
OPA adjuncts
- oropharyngeal airways
| - unresponsive patients without gag reflex
30
NPA adjuncts
- nasopharyngeal airways
- intact gag reflex
- people who cant tolerate OPA
- do not do on suspected head injury patients
31
nonrebreathing masks
- moderate respiratory distress patients
- 10-15 L/min
- delivers oxygen at 60-95%
- preferred way to give oxygen in prehospital setting
32
nasal cannulas
- 24-44% oxygen delivered
- 1-6 L/min
- used for chronic illnesses
- mild respiratory distress
- calms patients with minimal oxygen levels
33
assisted ventilation
- CPAP
- assisted ventilation (BVM)
- used for patients in respiratory arrest and cannot breath on their own
34
bag mask device
- most common method used to ventilate patients in EMS and during initial respiratory failure in ER
- 10-15 L/min
- severe respiratory distress
- 75-100%
35
CPAP
- continuous positive airway pressure
- noninvasive ventilatory support for respiratory distress
- automatic BVM
- opens collapsed alveoli
- use with caution for people with low BP -> can cause pneumothorax
- increases intrathoracic pressure -> aspiration
- patient needs to be breathing with the machine
36
Nerve 1
- olfactory
| - sense of smell
37
Nerve 2
- optic
| - sense of sight
38
Nerve 3
- oculomotor
- size, symmetry, and shape of pupils
- eye movement
39
Nerve 4
- trochlear
| - downward gaze
40
Nerve 5
- trigeminal
- cheek
- jaw motion
- chewing
- facial sensation
41
Nerve 6
- abducens
| - lateral eye movement
42
Nerve 7
- facial
- strength of facial muscles
- taste
- saliva secretion
43
Nerve 8
- acoustic
- sense of hearing
- balance
44
Nerve 9
- glossopharyngeal
- tongue and pharynx sensation
- taste
- muscles of swallowing
45
Nerve 10
- vagus
- sensation of throat and trachea
- taste
- muscles for voice production
- heart rate
46
Nerve 11
- spinal accessory
- shoulder movement
- ability to turn head
47
Nerve 12
- hypoglossal
- speech articulation
- tongue movement
48
rhonci
- low pitched crackles
- caused by secretion in the larger airways
- can be a sign of chronic obstructive pulmonary disease or an infectious process such as bronchitis and pneumonia
49
apneustic
- long, gasping inspiration follow by very short expiration
- breath is not fully expelled
- chest is hyperinflated
- brain lesion
- causes hypoxemia
50
vesicular lung sounds
-auscultated over the anterior and posterior part of the chest
51
bronchovesicular lung sound
-auscultated over main bronchi
52
bronchial sounds
- heard over the trachea
| - near the manubrium of the sternum
53
adventitious lung sounds
- heard over the normal sound of breathing
- rales, rhonchi, wheezing
- lower airway disease
54
decorticate posturing
- arm at chest and angled in
- fists are clenched
- dysfunction of the cerebral cortex
- 3 on the glasgow scale
55
decerebrate posturing
- significant brain injury
- rigidity
- arms and legs are extended
- toes point downward
- head and neck are arched
- 2 on the glasgow
