Term
|
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
|
Definition
| existence of a specialized body of knowledge or expertise |
|
|
Term
|
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
|
Definition
| movement of air in and out of the lungs so that gases may be exchanged |
|
|
Term
|
Definition
Exchangement of gases in the capillaries of the lungs made between blood and tissue cells
"inside the body" |
|
|
Term
|
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
|
|
Term
|
Definition
|
|
Term
| Respiratory tract stems from the ______ to the ______ |
|
Definition
|
|
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
|
Definition
Nares
Septum
Palate
Turbinate
Ethmoid bone
Sphenoid bone |
|
|
Term
|
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
|
|
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
|
|
Term
| The right lung is ________ in comparison the the left lung because it has _______ lobes |
|
Definition
|
|
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
|
|
Term
| The outside of the larynx is known as the ________ |
|
Definition
|
|
Term
| The left lung is _______ than the right lung and has _______ lobes because it shares the ________ space with the _______ |
|
Definition
|
|
Term
|
Definition
membrane ON the lung
think visceral = "organ" |
|
|
Term
|
Definition
| membrane on the inside of the thoracic cavity |
|
|
Term
|
Definition
| air in the pleural space of the lung |
|
|
Term
| The functional unit of the lung... |
|
Definition
|
|
Term
| Deoxygenated blood is supplied to the lungs by the _______________ |
|
Definition
|
|
Term
| Freshly oxygenated blood is delivered to the heart by the ______________ |
|
Definition
|
|
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
|
|
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
|
Definition
| outside pressure/forces cause alveolar collapse |
|
|
Term
|
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
|
|
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
|
|
Term
| Functional Reserve Capacity |
|
Definition
residual and expiratory reserve volumes
"amount of air left after tidal expiration" |
|
|
Term
|
Definition
total amount of exchangeable air
tidal volume + inspiratory reserve volume + expiratory reserve volume |
|
|
Term
|
Definition
maximum lung capacity
amount of air in the lungs after maximal inhalation
vital capacity + reserve volume
aprx. 6000mL |
|
|
Term
|
Definition
tidal volume x Respiratory rate
shows the amount of air inhaled and exhaled in one minute |
|
|
Term
|
Definition
| air that is not exchanging gases |
|
|
Term
| Essential airway parameters |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
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
|
|
Term
| paradoxical motion should make you suspicious of a ________ |
|
Definition
|
|
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
|
|
Term
| artificial ventilations should increase tidal volume by _______ cc/kg |
|
Definition
|
|
Term
| Barrel trauma comes from _________ |
|
Definition
|
|
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
|
|
Term
| Vocal chords clamping together is a condition known as a... |
|
Definition
|
|
Term
|
Definition
| Insertion of a tube into the trachea in order to maintain a patent airway |
|
|
Term
|
Definition
| intubate when BLS skills are not working |
|
|
Term
|
Definition
| inadequate oxygenation of the blood |
|
|
Term
|
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
|
|
Term
| Digital intubation is used when... |
|
Definition
you cannot identify structures
(uses fingers to identify structures) |
|
|
Term
|
Definition
| suspension of external breathing |
|
|
Term
| Uncuffed endotracheal tubes have a diameter from ____ to ____ mm and are usually reserved for _____________ patients |
|
Definition
|
|
Term
| Average adult male uses what size ED tube? |
|
Definition
|
|
Term
| Average adult female uses what size ED tube? |
|
Definition
|
|
Term
| What size ED tube is generally accepted for both males and females? |
|
Definition
|
|
Term
|
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
|
|
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
|
|
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
|
|
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
|
|
Term
| Average tube depth in females is _____ |
|
Definition
|
|
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
|
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
|
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
|
|
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
|
|
Term
|
Definition
| dual lumen device requiring blind insertion that ventilates endotracheally or esophageally |
|
|
Term
| People 5ft and taller use a ________ size combitube |
|
Definition
|
|
Term
| People 4-5 ft in height use a ________ combitube |
|
Definition
|
|
Term
|
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
|
|
Term
| Combitube placement can be confirmed with... |
|
Definition
|
|
Term
| Lighted stylet intubation uses a ___________ technique and requires ___________ |
|
Definition
|
|
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
|
|
Term
| Gum Elastic Bougie cannot be used on ________ patients |
|
Definition
|
|
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
|
|
Term
|
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
|
|
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
|
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
|
|
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
|
|
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
|
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
|
|
Term
|
Definition
|
|
Term
| Does the combitube help protect against aspiration? |
|
Definition
|
|
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
|
Definition
prevent aspiration
facilitate intubation
prevent psychological trauma |
|
|
Term
| RSI ___________ the patient in order to facilitate endotracheal intubation |
|
Definition
|
|
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
|
Definition
Any condition preventing mask ventilation/intubation
allergies to meds
airway swelling with adequate respiration
anatomical abnormalities |
|
|
Term
| Paralytics do nothing for __________ |
|
Definition
|
|
Term
Poor technique
Anatomical variations
Coincident diseases
Trauma
are all indications of a... |
|
Definition
|
|
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
|
|
Term
| Medications used as sedatives in RSI |
|
Definition
etomidate (amidate)
propofol (diprivan) |
|
|
Term
|
Definition
|
|
Term
|
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
|
Definition
| the paralyzing agent acts like Ach and stimulates the muscle -> causes fasciculation (in depolarizing agents) |
|
|
Term
|
Definition
eyes, face, neck
extremities
abdomen
intercostals, glottis
diaphragm |
|
|
Term
| common Succinylcholine dosage is ____ via ____ |
|
Definition
|
|
Term
| Non-depolarizing agents compete with ____ for receptors but _______ them |
|
Definition
|
|
Term
| __________ is the second leading cause of death due to unintentional injuries among children and young adults (1-24) |
|
Definition
|
|
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
|
|
Term
| _____ are the leading cause of injury death among those 65 and older |
|
Definition
|
|
