What are some common signs and symptoms of allergic reactions regarding the respiratory system? They are shortness of breath (dyspnea), sneezing or an itchy runny nose, tightness in the throat or chest, irritating dry cough, hoarseness, respirations that become rapid, labored, or noisey, and wheezing and/or stridor (progressing to a silent chest with anaphylaxis). 15 airway allergy breathing emergencies immunologic respiratory What is the leading cause of death in the United States among people under 40? Traumatic Injuries are the leading cause of death for this group. 24 emergencies overview statistics trauma What causes trauma emergencies? They occur as a result of physical forces applied to the body. 24 emergencies overview trauma What are the three concepts of energy typically associated with injury (excluding thermal)? They are potential energy, kinetic energy, and work. 24 emergencies overview trauma What is Newton's first law? Newton's first law states that objects at rest tend to stay at rest and objects in motion tend to stay in motion, unless acted on by some force. 24 definition emergencies overview trauma What is Newton's second law? It is that Force (F) equals Mass (M) times acceleration (A), that is: F=M(A) 24 definition emergencies overview trauma What is Newton's third law? It is that for every action, there is an equal and opposite reaction. 24 definition emergencies overview trauma What is work? It defined as force acting over a distance. 24 definition emergencies overview trauma What is kinetic energy? It is the energy of a moving object. 24 definition emergencies overview trauma What is the equation for kinetic energy? The equation is:

KE=m/2 x v²

24 emergencies overview trauma What is relation between energy and speed regarding energy available to cause injury? Notice that the energy available to cause injury doubles when an object's weight doubles, but quadruples when an object's speed doubles. 24 emergencies overview trauma What is potential energy? It is the product of mass, force of gravity, and height, and is mostly associated with the energy of falling objects. 24 definition emergencies overview trauma What are some examples of significant MOIs? They include multi-system trauma, falls from heights, motor vehicle and motorcycle crashes, car versus pedestrian, gunshot wounds, and stabbings. 24 emergencies overview trauma What are the two types of traumas? They are blunt trauma and penetrating trauma. 24 emergencies overview trauma What is blunt trauma? It is the result of force (or energy transmission) to the body that causes injury without penetrating the soft tissues or internal organs and cavities. 24 definition emergencies overview trauma What is penetrating trauma? It is caused by objects that primarily pierce and penetrate the surface of the body and cause damage to soft tissues, internal organs, and body cavities. 24 definition emergencies overview trauma What are the five classifications of car crashes? They are classified as frontal (head-on), rear-end, lateral (T-bone), rollovers, and rotational (spins). 24 emergencies overview trauma What are the three collisions in a typical vehicular impact? They are: The collision of the car against another car, a tree, or another object; The collision of the passenger against the interior of the car; and the collision of the passenger's internal organs against the solid structures of the body. 24 emergencies overview trauma What are some common passenger injuries in a vehicular crash? They include lower extremity fractures (knees into the dashboard), flail chest (rib cage into the steering wheel), and head trauma (head into the windshield). 24 emergencies overview trauma What is coup-contrecoup brain injury? It is a result of trauma to the head that causes a compression injury (or bruising) to the anteior portion of the brain and streching (or tearing) of the posterior portion of the brain. 24 definition emergencies overview trauma What should you suspect if you see a contusion on the patient's forehead and the windshield is starred? In this situation you should strongly suspect an injury to the brain. 24 emergencies overview trauma What should you always suspect whenever there is a significant impact to the head? In this situation, you should also suspect a spinal injury. 24 emergencies overview trauma If one or more of the passengers in a vehicular crash are dead, what action must be taken? In this situation, you should suspect that the other passengers have sustained serious injuries. 24 emergencies overview trauma What should you initially determine when investigating a frontal crash? In this event, you should determine whether the passenger was restrained by a full and properly applied three-point restraint, as well as whether the airbag deployed. Identifying the types of restraints used and whether the airbags were deployed will help you identify injury patterns related to the supplemental restraint systems. 24 emergencies overview trauma "Where should children shorter than 4'9"" sit in a car." This kind of person should ride in the rear seat or, in the case of a pickup truck or other single-seated vehicle, the air bag should be turned off. 24 emergencies overview trauma Where are seatbelts designed to be worn? They are designed to be worn over the iliac crest of the pelvis in order to distribute the force over the bony surface. 24 emergencies overview trauma What type of injuries are associated with rear-end impacts? This type of impact is known to cause whiplash-type injuries, particularly when the passenger's head and/or neck is not restrained by an appropriately placed headset. 24 emergencies overview trauma What is one type of injury to be aware of in a lateral (T-bone) collision? In this type of collision, the car is typically struck above its center of gravity and begins to rock away from the side of the impact. This results in the passenger sustaining a lateral whiplash injury. The cervical spine has little tolerance for lateral bending. 24 emergencies overview trauma What is the most common life-threatening event in a rollover? In this event, the most common life-threatening event is ejection or partial ejection of the passenger from the vehicle. 24 emergencies overview trauma What should the first step be when evaluating the MOI in a car-versus-pedestrian collision? In this event, your first step should be to estimate the speed of the vehicle that struck the patient; next determine whether the patient was thrown through the air and at what distance or whether the patient was pulled under the vehicle. 24 emergencies overview trauma What should you presume in a bicycle collision? In this event, you should presume that the patient has sustained an injury to the spinal column, until proven otherwise at the hospital. 24 emergencies overview trauma What are the four types of motorcycle impacts? The four types are head-on collision, angular, ejection, and controlled crash. 24 emergencies overview trauma At what height should a fall be considered significant? More than 15' or 3 times the patient's height is considered significant. 24 emergencies overview trauma What is something to consider in older patients who have suffered a fall? In this situation, remember that the patient may have osteoporosis, and may have actually sustained a fracture before the fall. 24 emergencies overview trauma What part of our nervous system controls our voluntary activities? This is called the somatic or voluntary nervous system. 26 head injury spinal What part of our nervous system controls many of our body's vital organs, over which the brain has no voluntary control? This is called the autonomic nervous system. 26 head injury spinal What are the names of the two parts of the autonomic nervous system? They are called the sympathetic and the parasympathetic. 26 head injury spinal What is the name of the groups of bones that compose the skull? They are called the cranium, which protects the brain, and the facial bones. 26 head injury spinal What is the cranium occupied by? It is occupied by 80% brain tissue, 10% blood supply, and 10% CSF. 26 head injury spinal What are the four major bones that make up the cranium? These are the occiput in the posterior, temple or temporal regions at the lateral portions, the parietal regions between the occiput and temporal regions, and forehead anteriorly. 26 head injury spinal What is the body's central supporting structure? It is the spinal column. 26 head injury spinal How many bones or vertebrae does the spinal column have? It has 33 bones or vertebrae. 26 head injury spinal What are the five sections of the spinal column, and how many vertebrae in each? They are the cervical (7), thoracic (12), lumbar (5), sacral (5), and coccygeal (4). 26 head injury spinal What connects and separates the vertebrae? They are connected by ligaments and separated by cushions known as intervertebral disks. 26 head injury spinal How many people in the US experience head injuries each year? Approximately 4 million people experience this. 26 head injury spinal How many death occur annually as a result of head injury? 52,000 of these occur annually. 26 head injury spinal What percentage of traumatic deaths are a result of head injuries? 50% of all traumatic deaths result from this. 26 head injury spinal What are closed head injuries? These are injuries in which the brain has been injured but there is no opening into the brain. 26 definition head injury spinal What is an open head injury? This is an injury in which an opening from the brain to the outside world exists. 26 definition head injury spinal What percentage of people involved in motor vehicle crashes experience a head injury? More than 2/3s of people in motor vehicle crashes experience this. 26 head injury spinal What are the general signs and symptoms of a head injury? The general signs and symptoms of this are:

Lacerations, contusions, or hematomas to the scalp;

Soft area or depression on palpation;

Visible fractures or deformities of the skull;

Decreased mentation;

Irregular breathing pattern;

Widening pulse pressure;

Slow heart rate;

Ecchymosis about the eyes or behind the ear over the mastoid process;

Clear or pink CSF leakage from a scalp wound, the nose, or the ear;

Failure of the pupils to respond to light;

Unequal pupil size;

Loss of sensation and/or motor function;

A period of unconsciousness;

Amnesia;

Seizures;

Numbness or tingling in the extremities;

Irregular respirations;

Dizziness;

Visual complaints;

Combative or other abnormal behavior;

Nausea or vomiting;

Posturing (decorticate or decerebrate)

26 head injury spinal Where is a skull fracture diagnosis usually made? This is usually made in a hospital with a computed tomographic, or CT, scan. 26 head injury spinal What are some signs of a skull fracture? Some signs of this are ecchymosis (bruising) that develops under the eyes (aka raccoon eyes) or behind one ear over the mastoid process (aka battle's sign). 26 head injury spinal What % of skull fractures are linear skull fractures (aka nondisplaced skull fractures)? Appromixately 80% of all skull fractures are these kind. 26 head injury spinal What causes compressed skull fractures? These result from high-energy direct trauma to the head with a blunt object (such as a baseball bat to the head). 26 head injury spinal What are basilar skull fractures? These are associated with high-energy trauma, and usually occur following diffuse impact to the headj (e.g. falls, motor crashes). These injuries generally result from extension of a linear fracture to the base of the skull and can be difficult to diagnose with radiography (X-ray). 26 definition head injury spinal What are the signs of a basilar skull fracture? Signs of this include CSF drainage from the ears (a risk for bacterial meningitis), which indicates rupture of the tympanic membrane in the ear. Other signs include raccoon eyes or battle's sign. 26 head injury spinal What is a traumatic brain injury (TBI)? "These are defined as ""a traumatic insult to the brain capable of producing physical, intellectual, emotional, social, and vocational changes"" (from the National Head Injury Foundation)." 26 definition head injury spinal What are the two broad catagories of TBI? These are primary (direct) injuries and secondary (indirect) injuries. 26 head injury spinal What are primary (direct) injuries? These are injury to the brain and its associated structures that results instantaneously from impact to the head. 26 definition head injury spinal What are secondary (indirect) brain injuries? These refer to a multitude of processes that increase the severity of a primary brain injury and therefore, negatively impact the outcome. 26 definition head injury spinal What are the two most common causes of secondary injuries to the brain? The two most common causes of this are hypoxia and hypotension. 26 head injury spinal What are some causes of secondary injuries to the brain? These may be caused by cerebral edema, intracranial hemorrhage, increased intracranial pressure, cerebral ischemia, infection, and hypoxia and hypotension (the two most common causes). 26 head injury spinal How long after a TBI can secondary brain injuries occur? They can occur anywhere from a few minuters to several days following the injury. 26 head injury spinal What is coup-contrecoup injury? This is when the brain strikes the front and back of the skull due to rapid deceleration. 26 definition head injury spinal What is cerebral edema? This is swelling of the brain, and may not develop until several hours after the initial injury. 26 definition head injury spinal What aggravates and improves cerebral edema? This is aggravated by low oxygen levels in the blood, and improved by high ones. This is especially true if the patient is unconscious. 26 head injury spinal Why is it not uncommon for a patient with a head injury to have a seizure? This is not uncommon for a patient with a head injury as a result of excessive excitability of the brain, caused by direct injury or the accumulation of fluid within the brain (edema). 26 head injury spinal What can lead to a rapid increase in intracranial pressure? This can be caused by an accumulation of blood within the skull or swelling of the brain. 26 head injury spinal What are the signs and symptoms of a mild elevation of intracranial pressure? The signs and symptoms of this are:

Increased blood pressure and decreased pulse rate;

Pupils that are still reactive;

Cheyne-Strokes respirations (respirations that are fast and then become slow, with intervening periods of apnea);

Patient initially attempts to localize and remove painful stimuli, followed by withdrawal and extension;

[EFFECTS ARE REVERSIBLE WITH PROMPT TREATMENT]

26 head injury spinal What are the signs and symptoms of moderate elevation in intracranial pressure? The signs and symptoms of this are:

Widened pulse pressure and bradycardia;

Pupils that are sluggish or nonreactive;

Central neurogenic hyperventilation (deep, rapid respirations);

Decerebrate posturing;

[SURVIVAL IS POSSIBLE BUT NOT WITHOUT PERMANENT NEUROLOGIC DEFICIT]

26 head injury spinal What are the signs and symptoms of marked elevation in intracranial pressure? The signs and symptoms of this are:

Unilateral fixed and dilated pupils;

Ataxic respirations (characterized by irregular rate, pattern, and volume of breathing with intermittent periods of apnea), or absent respirations;

Flaccid response to painful stimuli;

Irregular pulse rate;

Diminished blood pressure;

NB: This level of ICP indicates that the lower portion of the brain stem is involved

[MOST PATIENTS DO NOT SURVIVE THIS LEVEL OF INTRACRANIAL PRESSURE]

26 head injury spinal What is an epidural hematoma? This is an accumulation of blood between the skull and dura mater. 26 definition head injury spinal What is a common cause of epidural hematoma? These are nearly always the result of a blow to the head that produces a linear fracture of the thin temporal bone, where the middle meningeal artery runs along and is vulnerable in the event of a fracture. 26 head injury spinal What is the patients condition immediately following an injury that causes an epidural hematoma? In this situation, the patient often loses consciousness immediately following the injury; this is often followed by a brief period of consciousness (aka lucid interval), after which the patient lapses back into unconsciousness. 26 head injury spinal What is a subdural hematoma? This is an accumulation of blood beneath the dura mater but outside the brain. They are more common than epidural hematomas and may or may not be associated with a skull fracture. 26 definition head injury spinal Why do subdural hematomas and the signs of ICP develop more gradually than epidural hematomas? These develop more gradually than epidural hematomas because these are associated with venous bleeding. 26 head injury spinal What is an intracerebral hematoma? This involves bleeding within the brain tissue itself. They have a high mortality rate. 26 definition head injury spinal What is a subarachnoid hemorrhage? This is when bleeding occurs into the subarachnoid space, where the CSF circulates. 26 definition head injury spinal What are common causes of subarachnoid hematoma? The common causes of this condition include trauma or rupture of an aneurysm. 26 head injury spinal What is a common symptom of a subarachnoid hematoma? A common symptom of this is a sudden, severe headache. Mortality rates are high, and permanent neurologic impairment is common. 26 head injury spinal What is a concussion? This is a mild TBI caused by a blow to the head or face. It is in general a closed injury with a temporary loss of alteration of part or all of the brain's abilities to function without demonstrable physical damage to the brain. 26 definition head injury spinal What percentage of patients who sustain a concussion experience a loss of consciousness? Apprixmiately 10% of these patients experience a loss of consciousness. 26 head injury spinal What is retrograde amneisa? This is when the patient can remember everything but the events leading up to the injury. 26 definition head injury spinal What is anterograde (posttraumatic) amnesia? This is when a patient is unable to remember events after the injury. 26 head injury spinal What are some additional signs and symptoms you may see in concussion patients? With these patients, you may see nausea or vomiting, ringing in the ears, slurred speech, and an inability to focus. 26 head injury spinal What should you always assume with patients with symptoms of a concussion? You should always assume that these patients have a more serious injury. 26 head injury spinal What is a brain contusion? A contusion involves physical injury to the brain tissue, and is therefore more serious than a concussion. 26 definition head injury spinal What often causes spinal compression injuries? These can occur as a result of a fall, regardless of whether the patient landed on his or her feet, coccyx, or on top of the head. 26 head injury spinal What is a distraction? This is when the spine is pulled along its length. 26 definition head injury spinal What is subluxation? This is an incomplete dislocation of a joint. 26 definition head injury spinal What is the best way to protect a patient with a spinal injury's airway? The best way to do this is to use advanced airway techniques employed by AEMT and paramedics. 26 head injury spinal What does the absence of pain and/or the ability to move and feel extremities tell you about spinal injuries? This does NOT rule out spinal injuries. 26 head injury spinal What does a gradual and progressive deterioration in the patient's response to stimuli indicate? This usually indicates serious brain injury that may need surgical treatment; physicians at the hospital will need to know when a loss of consciousness occurs. 26 head injury spinal What is another name for Cushing's triad? Another name for this is herniation syndrome. 26 head injury spinal What are the signs of Cushing's triad? The signs of this are: hypertension, bradycardia, irregular respirations (for example Cheyne-Stokes respirations), central neurogenic hyperventilation, and Biot respirations (irregular rate, pattern, and depth of breathing). 26 head injury spinal What is Cushing's triad / herniation syndrome? This is when the intracranial pressure is so great that it forces the brain stem and the midbrain through the foramen magnum. 26 head injury spinal What is the prime concern for the patient when you perform the four-person log roll? The prime concern in this situation is to ensure that the head, torso, and pelvis move as a unit, with your teammates controlling the movement of the body. 26 head injury spinal What should you do with a patient wandering around after an accident whom you suspect of having a skull or spinal injuries? In this situation, you should NOT have them lie down; immobilize them with a long backboard in the upright position. 26 head injury spinal When should a helmet be left on an injured trauma patient? This should always be left on provided: There are no impending airway or breathing problems; it does not interfere with assessment and treatment of airway or ventilation problems; and you can properly immobilize the spine. 26 head injury spinal When should a helmet be removed? This should be removed from a trauma patient if:
1) It makes assessing or managing airway problems difficult and removing of the face guard is not possible.
2) It prevents you from properly immobilizing the spine.
Or 3) It allows excessive head movement.
Remember to always remove in the event of cardiac arrest, and, most importantly:

ALWAYS CONSULT WITH MEDICAL CONTROL IF YOU DECIDE TO REMOVE THIS.

26 head injury spinal What is an additional consideration for children with helmets and skull or spinal injuries? In this situation, they may require additional padding to maintain the in-line neutral position due to their smaller airways and larger heads. 26 head injury spinal What is the most common cause of shock following trauma? Bleeding is the most common cause of this after trauma. 25 bleeding How long can cells in the brain, spinal column, and heart live without blood? These can only survive for no more than a few minutes without blood. 25 bleeding How long can cells in organs such as the kidneys and lungs survive without blood? These cells can survive for almost an hour without blood. 25 bleeding How long can skeletal muscle cells survive without blood? These can survive for 2 hours without blood. 25 bleeding What are the 3 main parts of the cardiovascular system? These 3 parts are:

1) The pump (heart)

2) Containers (blood vessels that reach every cell in the body)

3) Fluid (Blood and body fluids)

25 bleeding What does the heart and its muscles absolutely need at all times to function? This requires a rich and well-dsitributed blood supply to function. 25 bleeding From where does blood enter the right atrium? Blood enters here from the vena cava. 25 bleeding Where does the blood go as the right ventricle contracts? From there, the blood flows into the pulmonary artery and the pulmonary circulation. 25 bleeding Through what does oxygenated blood return to the left atrium? The blood returns to here through the pulmonary veins. 25 bleeding Why is the left side of the heart more muscular than the right? This side of the heart is more muscular because it must pump blood into the aorta and on to the arteries throughout the body. 25 bleeding Which chamber is responsible for providing 100% of the body with oxygen-rich blood? The left ventricle is responsible for all of this. 25 bleeding What are the five types of blood vessels? These are:

1) Arteries

2) Arterioles

3) Capillaries

4) Venules

5) Veins

25 bleeding Where does blood pass into as it leaves the left ventricle? It passes into the aorta, the largest artery in the body. 25 bleeding What are arterioles? These are smaller vessels that connect the arteries and capillaries. 25 bleeding definition What are capillaries? These are small tubes, with the diamter of a single red blood cell, that pass among all the cells in the body, linking the arterioles and the venules. 25 bleeding definition What are venules? These are small, thin-walled vessels that connect the capillaries with the veins. 25 bleeding definition What are veins? These are blood vessels that return blood to the heart (usually through the vena cava) 25 bleeding definition What are platelets? These are found in the blood and are responsible for forming blood clots. 25 bleeding definition What is fibrinogen? This is a substance in the body that reinforces clumping red blood cells, helping to form a clot. 25 bleeding What is one thing the autonomic nervous system does during emergencies? This automatically redirects blood away from other organs to the heart, brain, lungs, and kidneys. 25 bleeding How fast must blood pass through the cardiovascular system? This must pass through the system at a speed that is fast enough to maintain adequate circulation throughout the body and slow enough to allow each cell time to exchange oxygen and nutrients for carbon dioxide and other waste products. 25 bleeding When does one require a minimal blood supply? When one is asleep is a good example of this. 25 bleeding When does the gastrointestinal tract require a high flow of blood? It requires a high flow after a meal. 25 bleeding When may an organ or tissue be better able to resist damage from hypoperfusion? In this situation, considerably colder temperatures may help resist damage. 25 bleeding What is hemorrhage? This another word for bleeding. 25 bleeding What are some signs and symptoms of hypovolemic shock? These signs include:

Rapid, weak pulse;

Changes in mental status (AMS);

Cool, clammy skin;

cyanosis;

low blood pressure (late sign).

25 bleeding Up to what percentage of total blood volume loss can the body tolerate? The body can not tolerate an acute loss of this greater than 20%. 25 bleeding How much blood does the average person have per kilogram of body weight? The average person has 70ml of this per kilogram. 25 bleeding Appromixately how much blood does a person weighing 80 kg (175 lbs.) have A person weighing this much has approximately 6 L (10-12 pints) of blood. 25 bleeding At what level of blood loss will a typical adult experience significant changes in vital signs, including increasing heart rate, increasing respiratory rates, and decreasing blood pressure? A typical adult will experience these changes if they lose more than 1 L (2 pints) of blood. 25 bleeding How much total blood volume does a 1 year old infant have? They have a total blood volume of only 800 mL. 25 bleeding At what level of blood loss will significant symptoms appear in 1 year old infants? Significant symptoms will occur in them after only 100 to 200 mL of blood loss (a soft drink can holds 355 mL) 25 bleeding How much is 1 unit of blood? This is 500 mL of blood. 25 bleeding What are the characteristics of arterial bleeding? Typically, this kind of bleeding results in brighter red blood (high in oxygen) and spurts in time with the pulse. 25 bleeding What are the characteristics of venous bleeding? This kind of bleeding results in blood that is darker (lower in oxygen) and flows slowly or severely, depending on the size. 25 bleeding On its own, how quickly does manageable bleeding stop itself? On its own, internal mechanisms can stop this within about 10 minutes. 25 bleeding What is vasoconstriction? This is a narrowing of blood vessels, a possible response to bleeding. 25 bleeding What is coagulation? This is a process whereby clots form and seal injured portions of the blood vessel. 25 bleeding What can interfere with clotting? A number of medications, including aspirin, can interfere with this. 25 bleeding What is one common cause of severe internal blood loss? Broken bones, and especially broken ribs, may cause this. 25 bleeding What can easily result in the loss of 1 L or more of internal bleeding? A broken femur can result in this amount of internal bleeding into the thigh. 25 bleeding What are some of the only signs of internal bleeding? Sometimes the only signs of this are local swelling and bruising. 25 bleeding What is one way to assist the body's clotting process? Keeping the patient's body as still and quiet as possible will aid in this process. 25 bleeding At least how long should you hold uninterrupted pressure on an external wound to stop the bleeding? You should hold uninterrupted pressure here for at least 5 minutes. 25 bleeding What are some methods to control external bleeding? These methods are:

Direct, even pressure and elevation;

pressure dressings and/or splints;

tourniquets

25 bleeding What blood pressure should alert you to the presence of hypoperfusion? A systolic blood pressure of less than 100 mm Hg with a weak, rapid pulse should suggest this to you. 25 bleeding What are common potential bleeding sources for a fall from a ladder striking the head? A common potential internal bleeding source for this MOI are head injury and hematoma. 25 bleeding What are common potential bleeding sources for a fall from a ladder striking the extremities? A common potential internal bleeding source for this MOI are possible fractures or the possibility of chest injury 25 bleeding What are common potential bleeding sources for a child struck by a car? A common potential internal bleeding source for this MOI are head trauma, chest and abdominal pain, or leg fractures. 25 bleeding What are common potential bleeding sources for a fall on an outstreched arm? A common potential internal bleeding source for this MOI are possible broken bones or joint injury. 25 bleeding What are common potential bleeding sources for a child thrown or falling from a great height? A common potential internal bleeding source for this MOI are head injury, owing to their top-heaviness. 25 bleeding What are common potential bleeding sources for an unrestrained driver in a head-on collision? A common potential internal bleeding source for this MOI are head and neck, chest, abdomen injuries, as well as knee, femur, hip, and pelvis injuries. 25 bleeding What are common potential bleeding sources for an unrestrained front-seat passenger in a side impact collision with intrusion into the vehicle? A common potential internal bleeding source for this MOI are broken humeruses exposing the chest wall (possible flail chest) and pelvis and acetabulum injuries. 25 bleeding What are common potential bleeding sources for an unrestrained driver crushed against the steering column? A common potential internal bleeding source for this MOI are chest and abdomen injuries, ruptured spleen, and neck trauma. 25 bleeding What are common potential bleeding sources for a bike injury? A common potential internal bleeding source for this MOI are fractured clavicles, road rash, and head trauma (esp. if not helmet is present). 25 bleeding What are common potential bleeding sources for an abrupt motorcycle stop? A common potential internal bleeding source for this MOI are fractured femur and head and neck injuries. 25 bleeding What are common potential bleeding sources for diving into the shallow end of a swimming pool? A common potential internal bleeding source for this MOI are head and neck injuries. 25 bleeding What are common potential bleeding sources for an assault or fight?

A common potential internal bleeding source for this MOI are punching or kicking injury to the chest, the abdomen, or the face.

25 bleeding What are common potential bleeding sources for a blast or explosive?

A common potential internal bleeding source for this MOI are injury from direct strike with debris, indirect and pressure wave in enclosed space; external injuries are dependent upon the anatomic area of the body injured. Internally, air-containing organs such as the middle of the ears and lungs are the most susceptible to injury.

25 bleeding What is a good rule of thumb when entering a scene where you suspect there are multiple patients with bleeding? In a situation such as this, place several pairs of gloves in your pocket for easy access. 25 bleeding What is hemoptysis? This is the coughing up of bright red blood. 25 bleeding What are the later signs of hypoperfusion that suggest internal bleeding? These signs include:

tachycardia;

weakness, fainting, or dizziness at rest;

thirst;

nausea and vomiting;

cold, moist skin;

shallow, rapid breathing;

dull eyes;

slightly dilated pupils that are slow to respond to light;

capillary refill of more than 2 seconds infants and children;

weak, rapid pulse;

decreasing blood pressure;

altered level of consciousness.

25 bleeding What is hematemesis? This is vomited blood. 25 bleeding What is melena? This is a black, tarry stool that contains digested blood. 25 bleeding What are some of the common causes of nontraumatic internal bleeding? These include bleeding ulcers, bleeding from the colon, ruptured ectopic pregnancy, and aneurysms. 25 bleeding What are some possible signs of internal bleeding? These include abdominal tenderness, guarding, rigidity, pain, and distention. 25 bleeding What is the second leading cause of trauma death in the United States? Penetrating trauma is the second leading cause of this in the United States. 24 trauma What is a proijectile's trajectory? This is the path the projectile takes, and may be difficult to determine, as medium and high-velocity projectiles may flatten out, tumble, or even ricochet within the body. 24 trauma What is temporary cavitation? This is caused by the acceleration of the bullet and causes a streching of the tissues. 24 trauma What is permanent cavitation? This is caused by the bullet path and remains once the projectile has passed through the tissue. 24 trauma What is drag? This is another term for air resistance, and over distance will slow the projectile, decreasing the depth of penetration and thus reducing damage to the tissues. 24 trauma What is one reason that exit wounds are often many times larger than entrance wounds? One reason for this is that, much like a boat moving through water, the bullet disrupts not only the tissues that are directly in its path but also those in the wake. 24 trauma What is one of the first signs of hypoperfusion? One of the first signs of this is a change in mental status, such as anxiety, restlessness, or combativeness. 25 bleeding What are the later signs of hypoperfusion suggesting internal bleeding? Later signs of this include:

Tachycardia

Weakness, fainting, or dizziness at rest

Thirst

Nausea and vomiting

Cold, moist skin

Shallow, rapid breathing

Dull eyes

Slightly dilated pupils that are non-reactive to light

Capillary refill of more than 2 seconds in infants and children

Weak, rapid (thready) pulse

Decreasing blood pressure

Altered level of consciousness

25 bleeding When dealing with multiple bleeding patients, what should you remember to do? When doing this, remember to place several pairs of gloves in your pocket for easy access. 25 bleeding What does a systolic blood pressure of less than 100 mg Hg with a weak, rapid pulse suggest? This suggests the presence of hypoperfusion in a patient who may have significant bleeding. 25 bleeding When the MOI is a fall from a ladder striking the head, what is a potential internal bleeding source? A potential internal bleeding source from this MOI is a head injury or hematoma. 25 bleeding When the MOI is a fall from a ladder striking the extremities, what is a potential internal bleeding source? A potential internal bleeding source from this MOI is possible fractures, and also possible chest injuries. 25 bleeding When the MOI is a child striking a car, what is a potential internal bleeding source? A potential internal bleeding source from this MOI is head trauma, chest and abdominal injuries, and leg fractures. 25 bleeding When the MOI is a fall onto an outstretched arm, what is a potential internal bleeding source? A potential internal bleeding source from this MOI is possible bone fractures and joint injuries. 25 bleeding When the MOI is a child thrown or falls from a height, what is a potential internal bleeding source? A potential internal bleeding source from this MOI is head injury. 25 bleeding When the MOI is an unrestrained driver in a head-on collision, what is a potential internal bleeding source? A potential internal bleeding source from this MOI is head and neck, chest, abdominal injuries, and knee, femur, hip, or pelvis injuries. 25 bleeding When the MOI is an unrestrained front-seat passenger or side-impact collision with intrusion into the vehicle, what is a potential internal bleeding source? A potential internal bleeding source from this MOI is a broken humerus exposing the chest wall (possible flail chest), as well as pelvic and acetabulum injuries. 25 bleeding When the MOI is an unrestrained driver crushed against the steering column, what is a potential internal bleeding source? A potential internal bleeding source from this MOI is a chest or abdomen injury, a ruptured spleen, and neck trauma. 25 bleeding When the MOI is a fall over the handlebars of a bike, what is a potential internal bleeding source? A potential internal bleeding source from this MOI are a fractured clavicle, road rash, and head trauma if there was no helmet. 25 bleeding When the MOI is an abrupt motorcycle stop, and the patient went over the handlebars, what is a potential internal bleeding source? A potential internal bleeding source from this MOI are fractured femurs, and head or neck injuries. 25 bleeding When the MOI is diving into the shallow end of a swimming pool, what is a potential internal bleeding source? A potential internal bleeding source from this MOI are head and neck injuries. 25 bleeding When the MOI is an assault or fight, what is a potential internal bleeding source? A potential internal bleeding source from this MOI is injury to the abdomen, chest, and face. 25 bleeding When the MOI is a blast or explosion, what is a potential internal bleeding source? A potential internal bleeding source from this MOI is: injury from direct strike with debris; an indirect pressure wave in an enclosed space; and, internally, air-containing organs, such as the middle of the ears and lungs, are the most susceptible to injury. 25 bleeding With a patient with obvious external bleeding, what is the very least PPE needed? With these patients, BSI includes at the very least gloves and eye protection, and often a mask and possibly a gown. 25 bleeding What are the methods available to control external bleeding? The most commonly used method to do this include:

1) Direct, even pressure and elevation

2) Pressure dressings and/or splints

and

3) Tourniquiets

25 bleeding How long (minimum) should you hold uninterrupted pressure on an open wound to stop bleeding? You should do this for at least 5 minutes. 25 bleeding What is a pressure point? This is a spot where a blood vessel lies near a bone. 25 bleeding What is one way to assist in the body's natural clotting process? One way to do this is to keep the patient as still and quiet as possible. 25 bleeding What are the signs and symptoms of blunt or penetrating trauma to the neck? Signs and symptoms of this are: Noisy or labored breathing, and swelling of the face or neck. 24 overview trauma What is the index of suspicion of blunt or penetrating trauma to the neck? The index of suspicion of blunt or penetrating trauma to the neck is:
Significant bleeding or foreign bodies in the upper or lower airway, causing obstruction;
Be alert for airway compromise 24 overview trauma What are the signs and symptoms of significant chest wall, blunt trauma from motor vehicle crashes, car-versus-pedestrian accidents, other crashes, and penetrating trauma to the chest wall? Signs and symptoms of this are: Significant chest pain, shortness of breath, and asymmetrical chest wall movement. 24 overview trauma What are the signs and symptoms of any significant blunt force trauma from motor vehicle crashes or penetrating injury? Signs and symptoms of this are: Blunt or penetrating trauma to the neck, chest, abdomen, or groin, blows to the head sustained during motor vehicle crashes, falls, or other incidents, producing loss of consciousness, altered mental status, inability to recall events, combativeness, or changes in speech patterns, and difficulty moving extremities and headaches, especially with nausea and vomiting. 24 overview trauma What are the signs and symptoms of any significant blunt force trauma, falls from a significant height, or penetrating trauma? Signs and symptoms of this are: Severe back and/or neck pain, a history of difficulty moving extremities, and loss of sensation or tingling in the extremities. 24 overview trauma What is the index of suspicion of significant chest wall, blunt trauma from motor vehicle crashes, car-versus-pedestrian accidents, other crashes, and penetrating trauma to the chest wall? The index of suspicion of this is:
Cardiac or pulmonary contusion;
Pneumothorax or hemothorax;
Broken ribs, causing breathing compromise 24 overview trauma What is the index of suspicion of any significant blunt force trauma from motor vehicle crashes or penetrating injury? The index of suspicion of this is:
Injuries in these regions may tear and cause damage to the large blood vessels located in these body areas, resulting in significant internal and external bleeding.
Be alert to the possibility of bruising to the brain and bleeding in and around the brain tissue, which may cause the development of excess pressure inside the skull around the brain. 24 overview trauma What is the index of suspicion of any significant blunt force trauma, falls from a significant height, or penetrating trauma? The index of suspicion of this is:
Injury to the bones of the spinal column or to the spinal cord. 24 overview trauma What organ system is most sensitive to blast injuries? The ear is the organ system most sensitive to this. 24 overview trauma What happens to the tympanic membrane when hit by a pressure wave? This has evolved to detect minor chasnges in pressure and will rupture at pressures of 5 to 7 pounds per square inch above atmosphere pressure. 24 overview trauma What are pulmonary blast injuries? These are defined as pulmonary trauma (consisting of contusions and hemorrhages) that results from short-range exposure to the detonation of explosives. 24 overview trauma What should you avoid with victims of blast injuries with suspected lung injury? With these patients, avoid giving oxygen under positive pressure (that is by demand valve), because that may simply increase the damage to the lungs. 24 overview trauma What is an arterial air embolism? This is one of the most concerning pulmonary blast injuries, and occurs on alveolar disruption with subsequent air embolization into the pulmonary vasculature. This can produce disturbances in vision, changes in behavior, changes in state of consciousness, and a variety of other neurologic signs. 24 overview trauma What are petechiae? These are pinpoint hemorrhages that show up on the skin, and are the dominant form of pathology for hollow organs injured by blast pressure waves. 24 definition overview trauma What are the most common causes of death from blast injuries? Neurologic injuries and head trauma are the most common causes of death from this. 24 overview trauma What can trigger instant but transient unconsciousness, with or without retrograde amnesia? This can be triggered not only by head trauma, but also by cardiovascular problems. 24 overview trauma What is something to remember about body armor in blast injury treatment? "This may limit or prevent shrapnel from entering the body, but it also ""catches"" more energy from the blast wave, possibly resulting in the victim being thrown backward, thus increasing the potential for spine and spinal cord injury." 24 overview trauma What is multisystem trauma? This is a term that describes a preson who has been subjected to multiple traumatic injuries involving more than one body system. 24 overview trauma What kind of care do most patients with multisystem trauma require? "With these patients, definitive care requires surgical intervention; therefore, on-scene time should be limited to 10 minutes or less; this is referred to as the ""platinum 10 minutes""." 24 overview trauma What can a crushing injury to the upper part of the neck cause? This injury can cause the cartilages of the upper airway and larynx to fracture. The can lead to the leakage of air into the soft tissue of the neck. 24 overview trauma What is subcutaneous crepitation? This is when air is trapped in subcutaneous tissue. 24 overview trauma What is the appropriate use of emergency air medical services for trauma patients? This medical service is appropriate for the following situations:

1) There is an extended period required to access or extricate a remote or trapped patient.

2) The distance to the trauma center is greater than 20 to 25 miles

3) The patient needs medical care and stabilizatio at the ALS level, and there is no ALS-level ground ambulance service available within a reasonable time frame.

4) Traffice conditions or hospital availability make it unlikely that the patient will get to a trauma center.

5) There are multiple patients who will overwhelm resources at the trauma center reachable by ground.

6) EMS systems require bringing a patient to the nearest hospital for initial evaluation and stabilization.

7) There is a mass-casualty incident.

24 overview trauma What key elements are in a Level I trauma center? Key elements of this are:

1) 24 hour in-house coverage by general surgeons

2) Availability of care in specialties such as orthopaedic surgery, neurosurgery, anesthesiology, emergency medicine, radiology, internal medicine, and critical care

3) Should also include cardiac, hand, pediatric, and microvascular surgery and hemodialysis.

4) Provides leadership in prevention, public education, and continuing education of trauma team members.

5) Committed to continued improvement through a comprehensive quality assessment program and organized research to help direct new innovations in trauma care.

24 overview trauma What key elements are in a Level II trauma center? Key elements of this are:

1) 24 hour in-house coverage by general surgeons

2) Availability of care in specialties such as orthopaedic surgery, neurosurgery, anesthesiology, emergency medicine, radiology, internal medicine, and critical care

3) Committed to trauma prevention and continuing education of trauma team members.

4) Provides continued improvement in trauma care through a comprehensive quality assessment program.

24 overview trauma What key elements are in a Level III trauma center? Key elements of this are:

1) 24 hour in-house coverage by general surgeons

2) Committed to continued improvement through a comprehensive quality assessment program

3) Has developed transfer agreements for patients requiring more comprehensive care at a Level I or Level iI trauma center.

4) Committed to continuing education of nursing and allied health personnel or the trauma team.

5) Must be involved with prevention and have an active outreach program for its referring communities.

24 overview trauma What key elements are in a Level IV trauma center? Key elements of this are:

1) Include basic emergency department facilities to implement ATLS protocols and 24-hour laboratory coverage.

2) Transfer to higher level trauma centers follows the guidelines outlined in formal transfer agreements.

3) Committed to continued improvement of these trauma care activities through a formal quality assessment program.

4) Involved in prevention, outreach, and education within its community.

24 overview trauma What is a trauma score? This is a way to calcualte a number from 1 to 16, that accurately evaluates the extent of trauma in a patient. 24 overview trauma In the Glasgow Coma Scale, how do you rate eye opening? For this evaluation:

4 - Spontaneous

3 - To Voice

2 - To Pain

1 - None

24 overview trauma In the Glasgow Coma Scale, how do you rate verbal response? For this evaluation:

5 - Oriented

4 - Confused

3 - Inappropriate Words

2 - Incomprehensible Words

1 - None

24 overview trauma In the Glasgow Coma Scale, how do you rate motor response? For this evaluation:

6 - Obeys Commands

5 - Localizes Pain

4 - Withdraws (pain)

3 - Flexion (pain)

2 - Extension (pain)

1 - None

24 overview trauma What is the American College of Surgeons' Criteria for a Level I Patient? Criteria for this are:

1) Confirmed blood pressure of less than 90 mg Hg at any time in adults, and age-specific hypotension in children.

2) Respiratory compromise, obstruction, and/or intubation

3) Receiving blood to maintain vital signs

4) Emergency physician's discretion

5) Glasgow Coma Scale (GCS) score of less than or equal to 8 with mechanism attributed to trauma

6) Gunshot wound to the abdomen, neck, or chest.

24 overview trauma What does the parasympathetic nervous system do? This directly opposes the other system, it slows the heart and respiratory rates, constricts blood vessels in the muscles, and dilates blood vessels in the digestive system. 06 anatomy definition nervous What is congestive heart failure

This is when the ventricular heart muscle is so damaged that it can no longer keep up with the return flow of blood from the atria. Blood backs up in the pulmonary veins, increasing pressure in the capillaries of the lungs and forcing water into the alveoli, causing pulmonary edema. 15 cardiovascular definition emergencies What is dyspnea? Shortness of breath or difficulty breathing 09 13 15 breathing emergencies respiratory What structures make up the upper airway? This consists of the nose, mouth, jaw, oral cavity, pharynx, and larynx. 10 airway anatomy breathing definition respiratory What divides the upper and lower airway? These are divided by the larnyx. 06 10 airway breathing respiratory What is carbon dioxide retention? This is the failure of the respiratory center in the brain to respond normally to a rise in arterial levels of carbon dioxide. 15 breathing definition emergencies respiratory What is the hypoxic drive? This is a secondary drive which stimulates the respiratory center. 15 breathing definition emergencies respiratory What is the normal breathing rate of an adult patient? This is 12-20 BPM. 15 emergencies respiratory What are the signs and symptoms of asthma? Signs and symptoms of this include:

Wheezing on inspiration / expiration

Bronchospasm

15 emergencies respiratory What are the signs and symptoms of anaphylaxis? Signs and symptoms include:

Flushed skin or hives

Generalized edema

Decreased blood pressure

Laryngeal edema with dyspnea

15 emergencies respiratory What are the signs and symptoms of bronchitis? Signs and symptoms include:

Chronic cough

Wheezing

Cyanosis

Productive cough

15 emergencies respiratory What are the signs and symptoms of congestive heart failure? Signs and symptoms include:

Dependent edema

Rales

Paroxysmal nocturnal dyspnea

15 emergencies respiratory What are the signs and symptoms of croup? Signs and symptoms include:

Fever

Barking cough

Mostly seen in pediatric patients

15 emergencies respiratory What are the signs and symptoms of emphysema? Signs and symptoms include:

Barrel chest

Pursed lip breathing

Dyspnea on exertion

15 emergencies respiratory What are the signs and symptoms of pneumonia? Signs and symptoms include:

Dyspnea

Chills, fever

Cough

Dark sputum

15 emergencies respiratory What are the signs and symptoms of pneumothorax? Signs and symptoms include:

Sudden chest pain with dyspnea

Decreased lung sounds/affected side

15 emergencies respiratory What are the signs and symptoms of pulmonary embolism? Signs and symptoms include:

Sharp, pinpoint pain

Dyspnea

Sudden onset

After childbirth or surgery

15 emergencies respiratory What are the signs and symptoms of tension pneumothorax? Signs and symptoms include:

Progressive shortness of breath

Increasing altered level of consciousness

Neck vein distention

Tracheal deviation

15 emergencies respiratory What are the signs and symptoms of pertussis? "Signs and symptoms include:

Coughing spells

""Whooping"" sound

Fever

Mostly seen in pediatric patients

" 15 emergencies respiratory As you treat patients with disorders of the lungs, what situations should you be aware of? While treating these kinds of patients, be aware of these situations:

Gas exchange between alveoli and pulmonary circulation is obstructed by fluid in the lung, infection, or collapsed alveoli (atelectasis)

The alveoli are damaged and cannot transport gases properly across their own walls

The air passages are obstructed by muscle spasm, mucus, or weakened floppy airway walls

Blood flow to the lungs is obstructed by blood clots

The pleural space is filled with air or excess fluid, so the lungs cannot properly expand

15 emergencies respiratory What is atelectasis? This is the collapse of the alveolar space in the lungs. 15 breathing definition emergencies respiratory What are the characteristics of bronchitis? Characteristics of this are:

An acute or chronic inflammation of the air passages (bronchi and bronchioles) often due to infection, usually associated with productive cough, and usually presents without fever

Accumulation of fluid within the air passages, as well as swelling of the walls, resticts air flow and may lead to signs of asthma such as wheezing. It is often associated with rhonchi. Crackles are not usually present unless pneumonia has developed.

The breathing pattern in bronchitis does not indicate major airway obstruction, but the patient may experience tachypnea, an increase in the breathing rate, which is an attempt to compensate for the reduced amount of normal lung tissue and for the buildup of fluid.

15 emergencies respiratory What is the pathophysiology of the common cold?

A viral infection usually associated with swollen nasal mucous membranes and the production of fluid from the sinuses and nose.

15 emergencies respiratory What are the characteristics of TB? Characteristics of this are:

A disease that can lay dormant in a person's lungs for decades, then reactivate.

Dangerous because many TB strains are resistant to many antibiotics.

Spread by cough. Droplet nuclei can remain intact for decades.

Use a high-efficiency air particulate, or HEPA, respirator.

15 emergencies respiratory What are the characteristics of diphtheria? Characteristics of this are:

Highly contagious and serious when it occurs

The formation of diphtheritic membrane lining the pharynx that is composed of debris, inflammatory cells, and mucus. This membrane can rapidly and severely obstruct the passage of air into the larynx.

15 emergencies respiratory What are the signs and symptoms of pneumonia?

dyspnea

chills fever

cough

green red or rust colored sputum

localized wheezing or crackles

15 breathing emergencies respiratory What are the characteristics of epiglottitis? Characteristics of this are:

An inflammation of the epiglottis due to bacterial infection that can produce severe swelling of the flap over the larynx.

Can swell to two or three times its normal size, especially in young children.

The airway may become almost completely obstructed, sometimes quite suddenly.

Stridor (harsh, high-pitched, continued rough, barking inspiratory sounds) may be heard late in the development of airway obstruction.

Characterized in adults by a severe sore throat.

15 emergencies respiratory What is the pathophysiology of croup?

Inflammation and swelling of the whole airway (pharynx, larynx, and trachea) typically seen in children 6 months - 3 years old.

Rarely seen in adults because that airways are larger.

15 emergencies respiratory What is the pathophysiology of respiratory syncytial virus?

Causes an infection of the lungs and breathing passages; can lead to other serious illnesses that affect the lungs or heart, such as bronchiolitis and pneumonia.

Highly contagious and spread through droplets

15 emergencies respiratory What is the pathophysiology of pertussis?

An airborne bacterial infection that affects mostly children younger than 6 years.

Highly contagious through droplet infection.

Does not cause the typical whooping illness in adults. It causes a severe upper respiratory infection that could be an entry pathway to pneumonia in older people.

15 emergencies respiratory What are the characteristics of Severe Acute Respiratory Syndrome (SARS)?

Characteristics of this are:

A serious, potentially life-threatening viral infection caused by a recently discovered family of viruses best known as the second most common cause of the common cold.

Usually starts with flu-like symptoms, and may progress to pneumonia, respiratory failure, and, in some cases, death.

SARS is thought to be transmitted primarily by close person-to-person contact.

15 emergencies respiratory What are the characteristics of Influenza type A? Characteristics of this are:

A virus that has crossed the animal/human barrier and has infected humans.

A flu that has the potential to spread at a pandemic level.

15 emergencies respiratory What are the characteristics of Meningococcal meningitis? Characteristics of this include:

An inflammation of the meningeal coverings of the brain and spinal cord that can be highly contagious.

The bacteria can be spread through the exchange of respiratory and throat secretions through coughing and sneezing.

The effects are lethal in some cases. Victims who survive can be left with brain damage, hearing loss, or learning disabilities.

Patients may present with flulike symptoms, but unique to this are high fever, severe headache, photophobia, and a stiff neck in adults. Patients soemtimes have an altered level of consciousness and can have red blotches on skin.

Use respiratory protection, and report and potential cases.

15 emergencies respiratory What is pulmonary edema? This is a build up of fluid between the alveoli and the pulmonary capillaries, which interferes with the exchange of carbon dioxide and oxygen. It can result from heart muscle so injured after a heart attack or other illness that it cannot circulate blood properly; in these cases, the left side of the heart cannot remove blood from the lung as fast as the right side delivers it. Patients with this usually experience dyspnea with rapid, shallow respirations, or frothy pink sputum at the nose in mouth in severe cases. 15 emergencies respiratory What is chronic obstructive pulmonary disease (COPD)? The is the slow process of dilation and disruption of the airways and alveoli caused by chronic bronchial obstruction. An estimated 12.1 million adults are reported to have this disease, and is the fourth leading cause of death. 15 emergencies respiratory What is chronic bronchitis? This is an ongoing irritation of the trachea and bronchi; excess mucus obstructs small airways and alveoli. This can lead to right-sided heart failure and fluid retention, such as edema in the legs. 15 emergencies respiratory What is emphysema? This is a loss of the elastic material around the air spaces as a result of chronic stretching of the alveoli when inflamed airways (due to smoking for example) obstruct easy explusion of gases. 15 emergencies respiratory What are the characteristics of COPD? Characteristics of this are:

A disease of the lung characterized by shortness of breath and wheezing.

Home oxygen, bronchodilators, and steroids for treatment.

Breathing progressively worse over time.

Usually in long-term smokers

Shortness of breath mostly on exertion

Chronic coughing

Sputum may be thick

No jugular vein distention or dependent edema

Patient usually thin with a barrel chest

15 emergencies respiratory What are the characteristics of Congestive Heart Failure? Characteristics of this are:

A disease of the heart characterized by shortness of breath, edema, and weakness.

Diuretics prescribed to help promote cardiac function and to reduce fluid loads on the heart.

Sudden onset of shortness of breath.

Patient may or may not smoke.

Shortness of breath all the time.

Coughing

Sputum may be pink and frothy.

Jugular vein distention and dependent edema.

May have distended abdomen.

15 emergencies respiratory What is the sequence of events in anaphylaxis? The sequence of events for this is:

A. The antigen is introduced to the body.

B. The antigen-antibody reaction at the surface of a mast cell.

C. Release of a cell chemical mediators.

D. Chemical mediators exert their effects on end organs.

15 emergencies respiratory What is pneumothorax? This is a partial or complete accumulation of air in the pleural space. It is often caused by trauma. 15 emergencies respiratory When may spontaneous pneumothorax occur? This tends to occur in patients with certain chronic lung infections or in young people born with weak areas of the lung, and often during severe coughing. 15 emergencies respiratory What is pleuritic chest pain? This is a sharp, stabbing pain on one side that is worse during inspiration and expiration or with certain movements of the chest wall. 15 emergencies respiratory What is a pleural effusion? This is a collection of fluid outside the lung on one or both sides of the chest. Patients will have decreased lung sounds and will feel better sitting upright. 15 emergencies respiratory What is a tonic-clonic seizure? This, also called a grand mal seizure, is one in which the patient has a sudden loss of consciousness, rapid muscle movement of the body, and often incontinence. This type of seizure typically only lasts minutes. 15 emergencies respiratory What is status epilipticus? This is when a patient continues to have seizures every few minutes without regaining consciousness, and/or the seizure lasts longer than 30 minutes. It could be life threatening. 15 emergencies respiratory What is an embolus? This is anything in the circulatory system that moves from it's point of origin to a distant site and lodges there, obstructing subsequent blood flow in that area. 15 emergencies respiratory What is a pulmonary embolism? This is the passage of a blood clot formed in a vein, usually in the legs or pelvis, that breaks off and circulates through the venous system, enters the pulmonary artery, where it becomes lodged, significantly decreasing or blocking blood flow. Arterial carbon dioxide rises, and oxygen level may drop enough to cause cyanosis. 15 emergencies respiratory What are the signs and symptoms of pulmonary embolisms? Signs and symptoms of these include:

Dyspnea

Acute chest pain

Hemoptysis (coughing up blood)

Cyanosis

Tachypnea

Vary degrees of hypoxia

15 emergencies respiratory What is acidosis? This is the buildup of excess acid in the blood or body tissues that results from the primary illness. 15 emergencies respiratory What is alkalosis? This is the buildup of excess base in the body fluids. 15 emergencies respiratory What is Methicillin-resistant Staphylococcus aureus (MRSA)? This is a bacterium that can cause infection in different parts of the body and is transmitted by different routes. It is resistant to many commonly used antibiotics. 15 emergencies respiratory What is tuberculosis (TB)? This is an infection most commonyl found in the lungs but can also affect any organ of the body, including the kidneys, bones, and meninges. 15 emergencies respiratory What are adventitious breath sounds? These are abnormal, decreased, or absent breath sounds. 15 emergencies respiratory What are vesicular breath sounds? These are normal breath sounds in a patient. 15 emergencies respiratory What are some risk factors for congestive heart failure? Risk factors for this include hypertension and a history of coronary artery disease and/or atrial fibrillation, a condition in which the atria no longer contract, but quiver. 15 emergencies respiratory What are some signs and symptoms of congestive heart failure? Signs and symptoms of this are:

cool, diaphoretic, and/or cyanotic skin

Adventitious breath sounds such as crackles, wheezing, or rales

A tachycardiac pulse.

15 emergencies respiratory What is cystic fibrosis (CF)? This is a genetic disorder that affects the lungs and digestive system. This disrupts the normal function of cells that make up the sweat glands in the skin and that also line the lungs and digestive and reproductive systems. 15 emergencies respiratory How is croup treated? This often responds well to humidified oxygen. 15 emergencies respiratory What is proper treatment for hyperventilation? Proper treatment for this consists of: reassuing the patient, supplying supplemental oxygen, and providing prompt transport to the emergency department. 15 emergencies respiratory What is the proper treatment for pulmonary embolism? Proper treatment for this consists of: Placing the patient in a comfrotable position, be aware of possible hemoptysis as an airway obstruction, and transport promptly, as this may cause cardiac arrest. 15 emergencies respiratory What should you watch for in patients with COPD? Oftentimes these patients will overuse their inhalers, so watch for side effects. 15 emergencies respiratory What does PASTE stand for? This stands for:

Progression: You want to know if the problem started suddenly or has worsened

Associated chest pain: Dyspnea can be a significant symptom of a cardiac problem.

Sputum: Mucus like sputum could indicate a respiratory infection, while frothy pink sputum indicates fluid in the lungs.

Talking tiredness: How many words a patient can saw between breaths.

Exercise tolerance: What activity was the patient doing before the problem started.

15 abbreviations emergencies respiratory What is wheezing? This is a sound that is generally heard on exhalation as a high-pitched, almost whistling sound. It is extremely common in patients with asthma and sometimes in patients with COPD; it indicates constriction and/or inflammation in the bronchus. 15 breathing definition emergencies respiratory What are rales? "These are the sounds of air trying to pass through fluid in the alveoli. It is a crackling or bubbling sound typically heard on inspiration. There are high-pitched ""fine"" sounds and low-pitched ""coarse"" sounds. These often indicate congestive heart failure, pulmonary edema, or other fluid in the lungs." 15 breathing definition emergencies respiratory What are rhonchi? "These are lower pitched sounds caused by secretions or mucus in the larger airway. The sound resembles rattling or is sometimes referred to as ""junky"" lung sounds. It indicates infections, pneumonia, or bronchitis." 15 breathing definition emergencies respiratory What is stridor? This is a high-pitched sound heard on inspiration as air tries to pass through obstruction in the upper airway. This indicates a partial obstruction of the trachea and is seen in patients with anatomic or foreign body airway obstruction. 10 15 breathing definition emergencies respiratory What is an example of an endocrine condition? An example of this kind of condition is diabetes mellitus. 12 medical overview What are the 5 major components of patient assessment? These are:

Scene size-up

Primary assessment

History taking

Secondary assessment

Reassessment

09 medical overview What is the index of suspicion? This is your awareness and concern for potentially serious underlying and unseen injuries or illness. 12 definition medical overview Where can the pulse be most stronly palpated? This can be most strongly palpated at the carotid artery. 12 medical overview What kinds of patients are always considered in serious condition and should be transported immediately? These kinds of patients include:

Patients who are unconscious or who have an altered mental status

Patients with airway or breathing problems

Patients with obvious circulation problems such as severe bleeding or signs of shock

12 medical overview transport How often should you recheck vitals? You should recheck these every 5 minutes for unstable patients or every 15 minutes for stable patients. 12 medical overview How much time should you spend on scene? You should spend no more than 10 minutes here. 12 medical overview What should you remember about stable patients who are also very old or very young? You should remember that these types of patients should still be considered critical. 12 medical overview What are some typical chief complaints? Typical kinds of these include fever. nausea, rash, pleuritic chest pain, and difficulty breathing. 12 medical overview What are some general management principles? Some of these include:

Place the patient in the position of comfort on the stretcher to keep warm.

Be empathetic.

Always show respect for the feelings of the patient and family members.

12 medical overview What is herpes simplex? This is a common virus strain carried by humans. 80% of individuals carrying it are asymptomatic. 12 medical overview What other virus is far more contagious than HIV? Hepatitis B is far more contagious than this. 12 medical overview How is syphilis transmitted? This disease is transmitted both sexually and via bloodborne vectors. 12 medical overview What is a common symptom of initial syphilis infection? An initial infection of this disease is a lesion called a chancre, commonly located in the genital region. 12 medical overview What is virulence? This is the strength or ability of a pathogen to produce disease. 12 medical overview How long can Mycobacterium tuberculosis remain alive? As long as they are shielded from ultraviolet light, these bacterium can stay alive for decades. 12 medical overview What is another name for H1N1? "Another name for this is the ""swine flu""." 12 medical overview What are the characteristics of of Hepatitis A? Characteristics of this are:

Route infection via fecal-oral, infected food, or drink

An incubation period of 2-6 weeks

A vaccine is available, and no treatment is available

Mild illness, approx. 2% or people die.

After infection, patient has life-long immunity

12 medical overview What are the characteristics of of Hepatitis B? Route of infection via blood, sexual contact, saliva, urine, breast milk

4-12 week incubation period

Chronic infection affect up to 10% of pateints and 90% of newborns

Vaccine available, treatment is minimally effective.

Up to 30% of patients may become chronic carriers; patients are asymptomatic and without signs of liver disease. Approx. 1-2% of patients die.

12 medical overview What are the characteristics of of Hepatitis C? Route of infection via blood or sexual contact

2-10 week of incubation

Chronic infection affects 90% of patients

No vaccine available, treatment minimally effective

Cirrhosis of the liver develops in 50% of patients; chronic infection increases the risk of liver cancer

12 medical overview What are the characteristics of of Hepatitis D? Route of infection via blood or sexual contact

4-12 weeks of incubation

Chronic infection common

No vaccine or treatment available

Occurs only in patients with active hepatitis B infection; fulminant disease may develop in 20% of patients.

12 medical overview What are the characteristics of of Toxin-induced Hepatitis? Characteristics of this are:

route of infection via inhalation, skin or mucus membrane exposure, oral ingestion, or intravenous administration

Incubation hours to days after exposure

Some chemicals may initiate an inflammatory response that continues to cause liver damage long after the chemical is out of the body.

No vaccine available.

Patients may have jaundice.

12 medical overview What is the hantavirus? This is a newly recognized disease, transmitted via rodent urine and droppings 12 medical overview How is the West Nile Virus transmitted? This virus' vector is the mosquito. 12 medical overview What is the order of BLS if you suspect cardiac arrest? If this is suspected, BLS order becomes CAB. 13 BLS resuscitation What is the chain of survival? This is:

1. Early access (ie Access EMS by calling 911)

2. Early CPR (keeps blood flowing)

3. Early defibrillation

4. Early advanced care

5. Integrated post-arrest care (including controlling temperature and maintaining glucose levels in the patient who is hypoglycemic)

13 BLS definition resuscitation What is important to remember regarding time and CPR? It's important to remember regarding this that few patients survive cardiac arrest if this is not administered within the first few minutes, and if the time from cardiac arrest to defibrillation is more than 10 minutes, the chance of survival is minimal. 13 BLS resuscitation What is arrhythmia? This is sudden cardiac rhythm disturbance. 13 BLS resuscitation What is ventricular fibrillation? This is the disorganized twitching of the ventricles, resulting in no blood flow and a state of cardiac arrest. 13 BLS resuscitation For each minute the patient remains in V-fib or pulseless V-tach, how much does the chance of survival decrease? For each minute in these states, there is a 7% to 10% less chance of survival. 13 BLS resuscitation What is a common cause of cardiac arrest in children? Respiratory failure is usually the cause of this in children. 13 BLS resuscitation Where should you place the AED electrode on patients with an implanted defibrillator or pacemaker? If you see a patient with one of these, you should place the AED electrode at least 1 inch to the side of the device. 13 BLS resuscitation On average, how much blood is pumped through the body when external chest compressions are performed as proficiently as possible? Only one third of the blood that is normally pumped by is circulated through this method. 13 BLS resuscitation Where should the patient's head be while administring chest compressions? This should not be elevated at a level above the heart because this will further reduce blood flow to the brain. 13 BLS resuscitation What kind of surface should a patient receiving chest compressions be placed on? During this, the patient should be placed on the floor or have a board placed under the back. 13 BLS resuscitation When performing CPR on an adult, how many chest compressions should be given a minute? Give at least 100 compressions per minute for this type of patient. 13 BLS resuscitation What is the recovery position? This is a side-lying position (patient's hand under their head) used to maintain a clear airway in unconscious patients without injuries who are adequately breathing. 13 BLS definition resuscitation What is the focus of pediatric BLS? The focus of BLS for these types of patients is airway and breathing. 13 BLS resuscitation Where do you check the pulse on infants? You check the pulse on the brachial artery for these patients. 13 BLS resuscitation Where do you check the pulse on children (1-12 years)? You check the pulse on the carotid or femoral artery for these patients. 13 BLS resuscitation What is the compression rate for infants and children in CPR? For these patients, the compression rate is at least 100/min. 13 BLS resuscitation What is the compression-to-ventilation ratio in CPR for infants and children? For these patients, the compression-to-ventilation ratio is 30:2 for one rescuer, and 15:2 for 2 rescuers. 13 BLS resuscitation With infants and children, what is the ventilation rate during CPR? With these patients, the ventilation rate is 1 breath every 3-5 seconds. 13 BLS resuscitation What should you do with a patient who has a mild airway obstruction? With these patients, you should encourage him or her to cough or to continue coughing if they are already doing so. 13 BLS resuscitation What is homeostasis? This is a balance of all systems and conditions of the body; as shock progresses, this degrades. 12 definition shock What are the three parts of the cardiovascular system? The three parts of this system are:

A pump,

A set of pipes,

and the contents of the container.

12 cardiovascular shock What is systolic pressure? This is the peak arterial pressure, or pressure generated every time the heart contracts. 10 12 assessment cardiovascular definition vitals What is diastolic pressure? This is the pressure maintained within the arteries while the heart rests between the heartbeats. 10 12 assessment cardiovascular definition vitals What are sphincters? These are circular muscles that encircle and, by contracting, constrict a duct, tube, or opening. 12 definition shock What are the three basic causes of shock? The three basic causes of this are:

1. Pump failure (caused by: heart attack, trauma to heart, and obstructive causes).

2. Low fluid volume (caused by: trauma to vessels or tissues, and fluid loss from GI tract),

and,

3. Poor vessel function (caused by: infection, drug overdose, spinal cord injuries, and anaphylaxis).

12 shock What does pump failure cause? Cardiogenic and obstructive shock are caused by this kind of failure. 12 shock What kinds of shock does poor vessel function cause? Distributive shock, septic shock, neurogenic shock, anaphylactic shock, and psychogenic shock are caused by this kind of failure. 12 shock What kinds of shock does low fluid volume cause? Hypovolemic shock, hemorrhagic shock, and nonhemorrhagic shock are caused by this kind of failure. 12 shock What causes cardiogenic shock? This is caused by inadequate functioning of the heart, or pump failure. 12 shock What is edema? This is the presence of abnormally large amounts of fluid between cells in body tissues, causing swelling of the affected area. 12 definition shock When does cardiogenic shock develop? This develops when the heart cannot maintain sufficient output (or cardiac output) to meet the demands of the body. 12 shock What is myocardial contractility? This is the ability for the heart to contract. 12 definition shock What is preload? This is the precontraction pressure in the heart as the volume of blood builds up. 12 definition shock What is afterload? This is the force or resistance against which the heart pumps. 12 definition shock What is obstructive shock? This results when conditions that cause mechanical obstruction of the cardiac muscle also impact pump function. 12 definition shock What are two of the most common examples of obstructive shock? Two of the most common examples of this are cardiac tamponade and tension pneumothorax. 12 shock What is a cardiac tamponade (A.K.A. a pericardial tamponade)? This is a collection of fluid between the pericardial sac and the myocardium. It is caused by blunt or penetrating trauma and can progress rapidly. 12 shock What happens during a cardiac tamponade? When this occurs, blood leaks into the tough fibrous membrane known as the pericardium, causing an accumulation of blood within the pericardial sac. This accumulation leads to compression of the heart. Because the pericardium has a limited ability to stretch, each contraction of the heart allows more blood accumulation between the heart and the sac. The accumulated blood prevents the heart from opening up to allow complete refilling. 12 shock What are the signs and symptoms of cardiac tamponade? The signs and symptoms of this are referred to as Beck's Triad. They are:

1) Jugular vein distention.

2) Muffled heart sounds,

and

3) The merging of systolic and diastolic blood pressure.

12 shock What causes tension pneumothorax? This is caused by damage to the lung tissue. This damage allows air normally held within the lung to escape into the chest cavity. If this condition is allowed to continue untreated, a sufficient amount of air will accumulate within the chest cavity and begin applying pressure to the structures in the mediastinum. The trapped air begins to shift the chest organs toward the uninjured side, which creates the condition. 12 shock What is distributive shock? This is when there is widespread dilation of the small arterioles, small venules, or both. 12 definition shock What is septic shock? This is a result of severe infections, usually bacterial, in which toxins are generated by the bacteria or by infected body tissues; the toxins damage the vessel walls, causing increased cellular permeability. The vessel walls leak and are unable to contract well. Widespread dilation of vessels, in combination with plasma loss through the injured vessel walls, resulting in shock. 12 definition shock What is usually the cause of neurogenic shock? This is usually caused by damage to the spinal cord, particularly at the upper cervical level, which damages the part of the nervous system that controls the size and muscular tone of the blood vessels. 12 shock What is an important consideration in patients in neurogenic shock? One important consideration in these kinds of patients is that these patients lack the ability to regulate body temperature. 12 shock What are signs of anaphylactic shock on the skin, in the circulatory system, and in the respiratory system? Signs of this include:

On the skin:

Flushing, itching, or burning, especially over the face and upper part of the chest.

Urticaria, which may spread over large areas of the body.

Edema, especially of the face, tongue, and lips.

Pallor.

And,

Cyanosis about the lips.

In the circulatory system:

Dilation of peripheral blood vessels.

Increased vessel permeability.

A drop in blood pressure.

A weak, barely palpable pulse.

Dizziness.

And,

Fainting and coma.

In the respiratory system:

Sneezing or itching.

Tightness in the chest, with a persistent dry cough.

Wheezing and dyspnea.

Secretions of fluid and mucus into the bronchial passages, alveoli, and lung tissues, causing coughing.

Constriction of the bronchi.

Forced expiration accompanied by wheezing.

And,

Eventual cessation of breathing.

12 shock What is psychogenic shock? This is when a patient has had a sudden reaction of the nervous system that produces a temporary, generalized vascular dilation, resulting in fainting, or syncope. 12 definition shock What are some causes of syncope that are potentially life threatening? Causes of this that are potentially life threatening are an irregular heartbeat or brain aneurysm. 12 shock What is hypovolemic shock? This is the result of inadequate amount of fluid or volume in the system. 12 definition shock What are some causes of hypovolemic shock? Some causes of this kind of shock include hemorrhagic causes, non-hemorrhagic causes (such as vomiting and diarrhea), as well as severe thermal burns; in those cases, it is intravascular plasma that is lost, leaking from the circulatory system into the burned tissues. 12 burn shock How does carbon monoxide affect the ability of cells to metabolize or carry oxygen? This substance has a 250 times greater affinity for hemoglobin than oxygen. If a patient is in an environment with this substance, it will bind to the blood's hemoglobin, preventing oxygen from binding. 12 shock What is compensated shock? This is the early stage of shock, when the body can still compensate for blood loss. Signs and symptoms include:

Agitation,

Anxiety,

Restlessness,

Feeling of impending doom,

A.M.S.,

Weak, rapid, or absent pulse,

Clammy skin,

Pallor with cyanosis around the lips,

Shallow, rapid breathing,

Shortness of breath,

Nausea or vomiting,

And,

Marked thirst.

12 definition shock What is decompensated shock? This is a later stage of shock, when blood pressure falls. Signs and symptoms include:

Falling blood pressure (systolic blood pressure of 90 mm Hg or lower in an adult),

Labored or irregular breathing,

Ashen, mottled, or cyanotic skin,

Thready or absent peripheral pulses,

Dilated pupils,

And,

Poor urinary output.

12 definition shock What is irreversible shock? This is the last stage of shock, when shock has progressed to a terminal stage. A transfusion during this stage will not save the patient's life. 12 definition shock What should you remember about blood pressure drops in children and infants? Remember that these patients can maintain their blood pressure until they have lost more than half their blood volume. By the time their blood pressure drops in shock, they are close to death. 12 shock Which conditions in patients should make you suspect shock? You should expect this if a patient has any one of the following conditions:

Multiple severe fractures,

Abdominal or chest injury,

Spinal injury,

A severe infection,

A major heart attack,

And,

Anaphylaxis.

12 shock What is the only real effective treatment for a severe, acute allergic reaction? The only real effective treatment for this is to administer epinephrine. 12 shock What are the signs and symptoms of cardiogenic shock, and how should you treat it? Signs and symptoms of this include:

Chest pain,

Irregular pulse,

Weak pulse,

Low blood pressure,

Cyanosis of the lips and under the nails,

Cool, clammy skin,

Anxiety,

Rales,

and pulmonary edema.

Treat this by:

Positioning the patient comfortably, administering oxygen, assisting with ventilations, and transporting promptly.

12 shock What are the signs and symptoms of obstructive shock, and how should you treat it? Signs and symptoms of this are dependent on the cause, and include:

Dyspnea,

A rapid, weak pulse,

Rapid, shallow breaths,

Decreased lung compliance,

Unilateral, decreased, or absent breath sounds,

Decreased blood pressure,

Subcutaneous emphysema,

Cyanosis,

Tracheal deviation towards the unaffected side,

and,

Beck's Triad, which are: Muffled heart sounds, Jugular vein distention, and, The merging of systolic and diastolic blood pressure.

Treatment of this is also dependent on the cause, and includes:

ALS assist, and / or rapid transport.

12 shock What are the signs and symptoms of septic shock, and how should you treat it? Signs and symptoms of this include:

Warm skin,

Tachycardia,

and, low blood pressure.

Treatment for this includes:

Transporting promptly, administering oxygen en route, providing full ventilatory support, keeping the patient warm, and considering elevating the legs.

12 shock What are the signs and symptoms of neurogenic shock, and how should you treat it? Signs and symptoms of this include:

Bradycardia,

Low blood pressure,

and,

Signs of neck injury.

Treatment of this includes:

Securing the airway,

stabilizing the spine,

assisting ventilations,

administering high-flow oxygen,

preserving body heat,

and,

transporting promptly.

12 shock What are the signs and symptoms of anaphylactic shock, and how should you treat it? Signs and symptoms of this include:

Mild itching or rash,

Burning skin,

Vascular dilation,

Generalized edema,

Coma,

and,

rapid death.

Treatment for this includes:

Managing the airway,

Assisting ventilations,

administering high-flow oxygen,

assisting with administration of epinephrine,

and,

transporting promptly.

12 shock What are the signs and symptoms of psychogenic shock, and how should you treat it? Signs and symptoms of this include:

A rapid pulse,

and,

Normal or low blood pressure.

Treatment for this includes:

Determining the duration of unconsciousness,

Recording initial vitals and mental status,

Suspecting head trauma if the patient is confused or slow to regain consciousness,

and,

Transporting promptly.

12 shock What are the signs and symptoms of hypovolemic shock, and how should you treat it? Signs and symptoms of this include:

A rapid, weak pulse,

Low blood pressure,

A change in mental status,

Cyanosis of the lips and / or nails,

Cool, clammy skin,

and,

An increased respiratory rate.

Treatment for this includes:

Securing the airway,

Administering high-flow oxygen,

Controlling external bleeding,

Keeping the patient warm,

Possibly elevating the legs,

and,

Transporting promptly.

12 shock How should you treat tension pneumothorax? Treat this with high-flow oxygen via non-re-breathing mask. Be cautious about providing positive-pressure ventilation to a patient with this condition. Usually the only action that can prevent eventual death from this is decompression of the injured side of the chest. This can be performed by ALS personnel. 12 shock What position should you place patients with neurogenic shock? With these patients, slight elevation of the foot end spine board may help bring the blood that is pooling in the vessels of the legs to the vital organs. Placing the patient's arms across his or her chest without moving the spine will also return some pooled blood. 12 shock When will brain tissue start to die without oxygen? This will begin to die within 4 to 6 minutes. 13 airway breathing respiratory resuscitation What anatomic structures make up the upper airway? The nose, mouth, jaw, oral cavity, pharynx, and larynx are located here. 10 15 airway breathing definition respiratory What is the major function of the upper airway? The major function of this is to:

Warm, filter, and humidify air as it enters the body.

10 airway breathing respiratory What is the pharynx and what is it composed of? This is a muscular tube that extends from the nose and mouth to the level of the esophagus and trachea. It is composed of the nasopharynx, oropharynx, and the laryngopharynx (A.K.A. the hypopharynx). 06 10 airway anatomy definition respiratory What is the lowest portion of the pharynx? This is the laryngopharynx. At its base, it splits into two lumens, the larynx anteriorly, and the esophagus posteriorly. 10 15 airway breathing definition respiratory What is the nasopharynx? This is formed by the union of the facial bones, and is lined with a cilated mucous membrane that keeps contaminants such as dust and other small particles out of the respiratory tract. The membrane also warms and humidifies air as it enters the body. 10 15 airway breathing definition respiratory What is the oropharynx? This forms the posterior portion of the oral cavity, which is bordered superiorly by the hard and soft palates, laterally by the cheeks, and inferiorly by the tongue. 06 10 airway anatomy definition respiratory What is the larynx? This marks where the upper airway ends and the lower airway begins. 10 15 airway breathing definition respiratory What is the thyroid cartilage? "This is a shield-shaped structure formed by two plates that join in a ""V"" shape anteriorly to form the larnygeal prominence known as the Adam's apple." 10 airway anatomy definition respiratory What is the cricoid cartilage? This lies inferiorly to the thyroid cartilage; it forms the lowest portion of the larynx. It is the only airway structure that forms a complete ring. 10 airway anatomy definition respiratory What is the glottis? This is space in between the vocal cords and the narrowest portion of the adult's airway. 10 airway anatomy definition respiratory What is the trachea? This is the conduit for air entry into the lungs. It is approximately 10 to 12 centimeters in length and consists of C-shaped cartilaginous rings. It descends anteriorly into the thoracic cavity. 10 airway anatomy definition respiratory What is the carina? This is the point at which the trachea bifurcates into the left and right mainstream bronchi. 10 airway anatomy definition respiratory What is visceral pleura? This is a thin, slippery outer membrane that covers all lung tissue. 10 airway anatomy definition respiratory What is the parietal pleura? This lines the inside of the thoracic cavity. 10 airway anatomy definition respiratory What lies between the visceral pleura and the parietal pleura? Between these is a small amount of fluid, which serves as a lubricant to prevent friction during breathing. 10 airway anatomy breathing definition What should you remember about children's airways? With these patients' airway, remember that:

They have a proportionately smaller mandible and a proportionately larger tongue, both of which increase the incidence of airway obstruction.

They have a proportionately larger occipital lobe, so when positioning the airway, place a folded towel under the shoulders to maintain a neutral position.

In general, the airway of these patients are smaller and narrower at all levels.

10 airway anatomy breathing pediatric What is the mediastinum? This is the space between the lungs, and is surrounded by tough, connective tissue. This space contains the heart, great vessels, esophagus, trachea, major bronchi, and nerves. 10 airway definition respiratory What is the phrenic nerve? This is one of the most important nervous structures in the body. It innervates the diaphragm muscle. 10 airway definition neurologic respiratory What is ventilation? This is the physical act of moving air into and out of the lungs. 10 airway breathing definition respiratory What is oxygenation? This is the process of loading oxygen molecules onto hemoglobin molecules in the bloodstream. 10 airway breathing definition respiratory What is respiration? This is the actual exchange of oxygen and carbon dioxide in the alveoli as well as the tissues of the body. 10 airway breathing definition respiratory What is inhalation? This is the active, muscular part of breathing. 10 airway breathing definition respiratory How much air does 1 breath draw in? This is approximately 500 ml in an adult. 09 10 airway breathing What is partial pressure? This is the term used to describe the amount of gas in air or dissolved in fluid, such as blood. It is measured in millimeters of mercury (Hg). 10 airway breathing definition respiratory What is the partial pressure of oxygen in air in the alveoli? This pressure is 104 mm Hg. 10 airway respiratory What is the partial pressure of carbon dioxide in air in the alveoli? This pressure is 40 mm Hg. 10 airway respiratory What is alveolar ventilation, and how is it determined? This is the volume of air that reaches the alveoli, and is determined by subtracting the amount of dead space air from the tidal volume. 10 airway respiratory What is tidal volume? This is the amount of air that is moved into or out of the lungs during a single breath. The average volume for an adult man is approximately 500 ml. 10 airway respiratory What is dead space? This is the portion of tidal volume that does not reach the alveoli and thus does not participate in gas exchange. It contains the air that remains in the mouth, nose, trachea, bronchi, and larger bronchioles. This can add up to approximately 150 mL in adults. 06 10 airway anatomy breathing definition respiratory What is minute ventilation (A.K.A. minute volume)? This is the amount of air moved through the lungs in 1 minute minus the dead space. An average adult male patient might have a rate of 4200 mL , (12 breaths per minute, a tidal volume of 500 mL per breath, and a dead space of 150 mL) 10 airway respiratory What is vital capacity? This refers to the amount of air that can be forcibly expelled from the lungs after breathing deeply. 10 airway respiratory What is residual volume? This is the air that remains after maximal expiration. It is approximately 1200 mL in the average adult male. 10 airway respiratory What is exhalation? This is the passive part of the breathing process, in which the diaphragm and the intercostal muscles relax, forcing air out of the lungs. 10 airway respiratory How are ventilation changes primarily regulated? These are regulated primarily by the pH of the cerebrospinal fluid, which is directly related to the amount of carbon dioxide dissolved in the plasma portion of the blood. 09 airway respiratory What is the hypoxic drive? This is a condition in which chronically low levels of oxygen in the blood stimulate the respiratory drive; it is seen in patients with end-stage C.O.P.D. 10 airway respiratory What is COPD? "This is when patients have difficulty eliminating carbon dioxide through exhalation; thus, they always have higher levels of carbon dioxide. This potentially alters their drive for breathing. The body uses a ""backup system"", the hypoxic drive, to control breathing. This is different from the primary control of breathing that uses carbon dioxide. Caution should be taken when administering high concentrations of oxygen to these kinds of patients, as providing high concentrations of oxygen over time will increase the amount of oxygen dissolved in plasma; this could potentially negatively affect their body's drive to breathe." 10 airway respiratory What is dyspnea? This is shortness of breath. 10 airway respiratory What is another name for metabolism? Another name for this is cellular respiration. 10 airway respiratory What is the chemical composition of air on average? On average, the chemical composition of this is about 21% oxygen, 78% nitrogen, and 0.3% carbon dioxide. 10 airway respiratory What is surfactant? This is a liquid protein substance that coats the alveoli in the lungs, decreases alveolar surface tension, and keeps the alveoli expanded; a low level in a premature infant contributes to respiratory distress syndrome. 10 airway respiratory Under normal conditions, what percentage of hemoglobin receptor sites contain oxygen? Under normal conditions, 96% to 100% of these contain oxygen. 10 airway respiratory What is aerobic respiration? This can proceed only in the presence of oxygen. Energy in the form of adenosine triphosphate (A.K.A., A.T.P.) is produced through a series of processes known as the Krebs cycle and oxidative phosphorylation. Together, these chemical processes yield nearly 40 molecules of energy-rich ATP for each molecule of glucose metabolized. 10 airway respiratory What are chemoreceptors? These monitor the levels of O2, CO2, and the pH of the cerebrospinal fluid and then provide feedback to the respiratory centers to modify the rate and depth of breathing based on the body's needs at any given time. 10 airway definition respiratory How will an elevation in carbon dioxide levels affect the pH balance in CSF? This will decrease the pH of the cerebrospinal fluid. 09 airway respiratory What is the normal resting minute ventilation? The normal rate of this is approximately 6000 mL per minute. About a third of this volume fills dead space; therefore, resting alveolar ventilation is approximately 4000 mL per minute. 10 airway respiratory What is intrapulmonary shunting? This is the bypassing of oxygen-poor blood past nonfunctional alveoli to the left side of the heart, inhibiting diffusion and perfusion. 09 airway respiratory What is a bag-mask device? This is a device with a one-way valve and a face mask attached to a ventilation bag; when attached to a reservoir and connected to oxygen, this delivers more than 90% supplemental oxygen. 02 10 airway breathing equipment PPE respiratory What is the normal respiratory rate of adults? For this group, the average respiratory rate is 12 to 20 breaths per minute. 10 airway respiratory What is the normal respiratory rate of children? The normal respiratory rate of this group is 15 to 30 breaths per minute. 10 airway respiratory What is the normal respiratory rate of infants? The normal respiratory rate of this group is 25 to 50 breaths per minute. 10 airway respiratory What are retractions? This is when the skin pulls in around the ribs or above the clavicle during respiration. It is a sign of inadequate breathing. 10 airway definition respiratory What are agonal gasps? These are occasional gasping breaths that occur after the heart has stopped. They occur when the respiratory center in the brain continues to send signals to the respiratory muscles. 10 airway definition respiratory What are Cheyne-Stokes respirations? This is an irregular respiratory pattern in which the patient breathes with an increasing rate and depth of respirations that is followed by a period of apnea, or lack of spontaneous breathing, followed again by a pattern of increasing rate and depth of respiration. 10 airway definition respiratory What is ataxic respirations? This is a pattern of irregular, ineffective respirations that may or may not have an identifiable pattern. 10 airway respiratory What are Kussmaul respirations? This is an irregular breathing pattern characterized as deep, gasping respirations commonly seen in patients with metabolic acidosis. 10 airway definition respiratory What maneuver should you use on a patient if you suspect a cervical spine injury to open the airway? In this situation, use the the jaw-thrust maneuver.
10 airway respiratory What are the principle purposes of an oropharyngeal airway? The principle purposes of this are to:

1) Keep the tongue from blocking the upper airway.

and 2) Make it easier to suction the the oropharynx if necessary.

06 10 airway equipment respiratory What is the only acceptable method of inserting an oral airway in children? With this group, the only acceptable method of inserting an oral airway is to use a tongue blade to hold the tongue down. 10 airway respiratory When should you consult medical control about inserting a nasopharyngeal airway? You should consult medical control about this when a patient has sustained severe trauma to the head or face. 10 airway respiratory How much airflow and vacuum should a suctioning unit be able to generate? This should generate airflow of more than 40 L per minute, and a vacuum of more than 300 mm Hg when the tubing is clamped. 09 airway respiratory What is a suction catheter? This is a hollow cylindrical device used to remove fluid from the patient's airway. 10 airway respiratory How long should you suction a patient's mouth or nose? You should never do this for more than 15 seconds at a time for adults, 10 seconds for children, and 5 for infants. 09 airway respiratory What is the recovery position? This position is used to maintain a clear airway in an unconscious patient who is not injured and is breathing on his or her own with a normal respiratory rate and adequate tidal volume. The patient is rolled onto their left sidewith a hand underneath the head for support. Never put a patient in this position if you suspect spinal trauma. 10 airway respiratory What is the pin-indexing system? This is a system established for portable cylinders to ensure that a regulator is not connected to a cylinder containing the wrong type of gas. 10 airway respiratory What is the flow rate and percent of oxygen delivered for a nasal cannula? This device has a flow rate of 1000 to 6000 mL per minute, and delivers 24% to 44% oxygen. 10 airway respiratory What is the flow rate and percent of oxygen delivered for a nonre-breathing mask? This device has a flow rate of 10 to 15 L per minute, and delivers up to 90% oxygen. 10 airway respiratory What is the flow rate and percent of oxygen delivered for a bag-mask device with reservoir? This device has a flow rate of 15 litres per minute, and delivers nearly 100% oxygen. 10 airway respiratory What is the flow rate and percent of oxygen delivered for a mouth-to-mask device? This device has a flow rate of 15 litres per minute, and delivers nearly 55% oxygen. 10 airway respiratory What is a partial rebreathing mask? This is similar to a nonrebreathing mask except that there is no one-way valve between the mask and reservoir. Consequently, patients rebreathe a small amount of their exhaled air. This is advantageous for patients who you think are suffering from hyperventilation syndrome. You can easily convert a nonrebreathing mask to this by removing the one-way valve between the mask and the reservoir bag. 10 airway definition respiratory What is the nature of air movement in normal ventilation versus positive-pressure ventilation? Regarding this, in normal ventilation:

air is sucked into the lungs due to the negative intrathoracic created when the diaphragm contracts.