Mod 2 Study Guide Notes | Knowt (2024)

Mod Il Study Guide

(Ch 9-16)

Ventilation: Compliance/Elasticity, Airway Resistance Flashcards | Quizlet

Red = Notes from Rahaf’s study session Grey = notes from the lecture or textbook

1. Lung Sounds (Upper Airway Obstruction) Ch 7 slide 24;Ch 9 slide 13; book pg 249, 531

a. Upper airway obstructions are common caused by foreign bodies, infection, or trauma

b. Prolonged inspiration- possible upper airway obstruction

c. Prolonged expiration- possible lower airway obstruction

d. Sounds of a Partially Obstructed Airway

i. 4 sounds (indicative of limited air movement)

1. Stridor- High-pitched whistling sound, indicative of a severely narrowed air passage

2. Hoarseness- raspy change in voice, indicative of swelling around the vocal cords

a. Per lecture: fresh damage/ irritation of upper airway; can be caused by trauma

3. Snoring- similar to snore during sleep, indicative of diminished muscle tone

4. Gurgling- bubbling sound, indicative of vomit, blood, secretions in (upper) airway

e. Special Considerations Regarding Auscultation of Lung Sounds

i. Wheezes: high-pitched sounds, seems almost musical. Sounds created by air moving through narrowed passages in lungs. Common in asthma and sometimes COPD. Most often heard on exhalation. “Musical” whistle d/t narrowing or obstruction, heard on exhalation in lower airway; Asthma

ii. Crackles aka Rales: fine crackling/bubbling sound heard on inspiration in the lower airway. Caused by fluid in the alveoli or by opening of closed alveoli. Sound created by fluid in alveoli or collapsed alveoli; pulmonary edema; emphysema, CHF, pneumonia

iii. Rhonchi: lower-pitched sounds resembling snoring/rattling. Caused by secretions on larger airways. Might be seen with pneumonia or bronchitis, or when materials are aspirated into the lungs. Rhonchi are typically louder than crackles. “Rhonchi are junk-i” Low-pitched sound, similar to snoring d/t muscus and secretions or fluid; COPD & bronchitis

iv. Stridor: high pitched sound heard on inspiration. It is an upper airway sound indicating partial obstruction of the trachea or larynx. Usually audible w/o a stethoscope. High pitched whistle d/t partial blockage, heard on inhalation in upper-airway/ throat

v. Absent- no sound auscultated, can be d/t bronchoconstriction

vi. Normal/ clear lung sounds

2. Anatomy & Physiology of the Trachea (Carina, Bronchus, so on) Ch 9 slide 4, 29

a. Trachea lies below to larynx

b. Mainstem bronchi branch from the trachea

c. Alveoli lie at the end of bronchi

d. Pulmonary capillaries surround alveoli

i. O2 and CO2 exchanged at the capillaries

e. From my brain…

i. Pathway of air:

1. Nose/Mouth

2. Pharynx

3. Larynx

4. Trachea

5. Bronchi

6. Bronchioles

7. Alveolar sacs

8. Alveoli

f. From Mod 1 SG q82

i. Lower airway- anything lower than glottic opening (book pg 205)

1. Larynx

a. Protected by epiglottis

i. Seals off the trachea during swallowing / gag reflex

b. Supported and protected by thyroid cartilage

i. Forms Adam’s apple

c. Lower aspect formed by cricoid cartilage

i. Only full ring of cartilage in trachea

ii. Provides structure for superior trachea

2. Trachea

a. 16 rings of cartilage provide structure and protection

b. Branches into 2 main bronchi at the carina

3. Bronchial passages

a. Branches out from 2 main bronchi into 2ndary tertiary passages

b. Contains cartilage and smooth muscle which allows for changes in diameter to accommodate need

c. Ends at the alveoli

4. Alveoli

a. Site of gas exchange/ diffusion of O2 and CO2

b. Occur in grapelike sacs/bunches (aka alveolar sacs)

c. Surrounded by pulmonary capillaries. Through these membranes O2 and CO2 diffuse into and out of the bloodstream

3. Lower Airway Anatomy & Physiology

a. See q2

b. Lower airway is everything from the vocal cords and below (inferior to vocal cords

a. Upper Airway:

i. Nasal & Oral Cavity

ii. Nasopharynx & oropharynx

b. Lower Airway:

i. Trachea

ii. L/R mainstem bronchi

1. Separated by the carina (which is made of cartilage)

iii. Bronchioles

iv. Alveoli

c. Upper & lower airway separated by vocal cords

Mod 2 Study Guide Notes | Knowt (1)

4. Different types of airway obstructions Ch 16 slide 91, book pg 206-207, 212, 214

a. Epiglottitis

i. “in severe [epiglottitis], swelling can cause airway obstruction”

b. Airway Pathophys

i. Foreign Bodies (ie food & small toys, ect) common obstructions

ii. Fluids (ie blood and vomit) common obstruction

iii. Loss of intact muscle tone = collapse of airway

1. Often caused by AMS and neuro disorders

2. Tongue and epiglottis are common obstructions with this

3. Risk is greater in unconscious pts

iv. Airway obstruction can be acute (choking) or occur over time

v. Examples:

1. Foreign bodies (choking… can be nonsevere or severe)

a. Only treat “severe” choking abdominal thrusts, or backslaps & chest thrusts for an infant

b. If they become unconscious begin COR

2. Anaphylaxis

3. Burns

4. Blunt force trauma

5. Infections (swelling)

6. Asthma (bronchoconstriction- contraction of smooth muscle that lines the bronchial passages that results in a decreased internal diameter of the airway & increased resistance to airflow)

vi. Obstructions can be partial or complete

i. a. Epiglottis can be an obstruction

b. Foreign bodies (especially in children)

i. R lung is most at risk due to the larger and straighter R bronchus

c. Inflammation

d. Do not do blind finger sweeps & reconsider ever sticking your finger in someone’s mouth in general

5. Signs and symptoms of inadequate airways Ch 9 slides 17-18; book pg 209

a. No signs of breathing or air movement

b. Evidence of foreign bodies in the airway

i. Blood, vomit, objects ie broken teeth

c. No air felt or heard at the nose or mouth

i. Air exchange below normal amount

d. Inability to speak/ difficulty speaking

e. Unusual hoarse/ raspy quality to the voice

f. Absent, minimal, or uneven chest movement

i. Note: pts can have chest movement even with an obstructed airway

g. Breathing movement to the abdomen

i. Could mean pt is tired & losing muscle control

h. Diminished or absent breath sounds

i. Abnormal noises such as wheezing, crowing, stridor, snoring, gurgling, or gasping during breathing

j. In children: retractions above the clavicles and btwn & below the ribs

i. Nasal flaring!!

k. s/s of an inadequate airway = life threatening condition!!!

a. Easiest way to assess:

i. Are they talking? Yes, then their airway is open.

b. Look for

i. accessory muscle use (Retractions)

ii. Nasal flaring

iii. Shallow ventilations

1. Equal bilateral chest rise

iv. Low SPO2 (but treat the pt not the monitor

v. Positioning

1. Tripod

c. Signs are things YOU can see

d. Symptoms are what the pt feels/ reports

6. NPA vs OPA usage book pg 217-222

a. OPA & NPA main fxn keep tongue from blocking the airway

i. Helps maintain an open airway

b. NPA (nasopharyngeal airway)- airway inserted through the nose & rests in the pharynx; helps to position the tongue properly

i. Do NOT use when there is facial trauma, nasal trauma (ie nose bleeds)

ii. Caution when there are signs of basilar skull fracture

iii. Measure from nostril to tip of earlobe

iv. For pts with an intact gag reflex

v. Helpful when teeth are clenched & when there are oral injuries

c. OPA (oropharyngeal airway)- inserted into the mouth & help position the tongue properly

i. Only use when pt does NOT have a gag reflex!

ii. Measure from corner of mouth to earlobe

iii. Pedi note:

1. Larynx of infant/ young child is more anterior + superior than adult

2. OPA can be inserted straight in w/o need for rotation

3. Tongue depressor or Yankauer can be helpful to navigate the tongue

d. When using NPA/OPA maintain head-tilt/chin-lift / sniffing position

i. Suprasternal notch is even with the ear hold and face parallel with ceiling

Mod 2 Study Guide Notes | Knowt (2)

7. Pediatric Airway Management Ch 9 slide 7

a. Pedi Airway Phys

i. Airway structures of infants and children are shorter, narrower, less rigid

ii. Mouth + nose smaller = easily obstructed

iii. Tongue proportionately larger

iv. Newborns & infants are nose breathers

1. Means upper airway infections can be deadly

v. Trachea is softer, more flexible & narrower easily obstructed by swelling & foreign objects

1. Obstruction is an airway emergency

vi. Chest wall is softer

vii. Breathing is more dependent on the diaphragm

1. Accessory muscles are less developed

b. Mod 1 SG #61

i. Pediatric Note”

1. Vasoconstriction in pedi pts is effective and often sustained through massive blood loss

i. BP can often be normal even if circulatory volume is low (ie bleeding or dehydration)

b. Capillary refill is an important indicator of compensation

i. Should be <2 seconds

ii. Longer times suggest vasoconstriction and compensation

c. Pallor- pale skin

ii. Pediatric Compensation

1. Infants and young children rely on HR to compensate for poor perfusion

2. Very young hearts lack contractile muscle cells cannot regulate force of squeeze

3. May increase cardiac output by increasing HR

a. Child with fast HR compensation

a. Sniffing position is preferred over head-tilt, chin-lift

i. Head-tilt, chin-lift can actually occlude airway in children; sniffing is gentler

ii. Put a shallow towel or blanket roll under shoulders

b. Align airway so it is straight

8. Compliance with ventilations book pg 210, 239

a. As a refresher… book ch 6 pg 152; book pg 239

i. Ventilation- the process of moving gases (O2 & CO2) btwn inhaled air and the pulmonary circulation of blood

ii. Ventilation- breathing in and out (inhalation and exhalation), or artificial provision of breaths

a. Ventilations should be smooth and with ease

i. “Is there smooth & even chest rise and fall?”

b. If there is resistance, readjust airway

9. Hypoxia & S/S of Hypoxia ch 7 slide 29; ch 10 slide 13,14, 20, 54, 59, 76, 78; ch 12 slide 18

a. Hypoxia = low oxygen levels/a low level of O2 function; can be a result of respiratory dysfunction

i. Resp dysfxn can also result in hypercapnia (high CO2 lvls)

b. Signs of hypoxia calls for breathing acoRaVaCSOEmssistance

i. The brain experiences low O2 most sensitively/ first resulting in mood/ mental changes aka AMS

1. Agitation, nervousness, feeling uncomfortable, confusion

ii. Rapid breathing (body trying to compensate for cardiopulmonary failure)

iii. Heart rate increase

iv. Vasoconstriction

v. Cyanosis

vi. Shortness of breath

vii. Low O2 sat < 94% (but remember treat the pt not the monitor)

c. Common causes of hypoxia:

i. Trapped in fire

ii. Emphysema

iii. OD on respiratory suppressant

iv. Heart attack, stroke, embolism

d. Use a nonrebreather for s/s of hypoxia w/ SOB, chest px, and AMS

i. Signs of hypoxia calls for breathing assistance

a. Hypoxia is now O2 often measured in an SPO2 < 94%

b. s/s:

i. AMS (agitation, confusion, nervous; Check there A&O status)

ii. Low RR

iii. Low HR

iv. Cyanosis

v. Possible vasoconstriction & elevated BP…. But this is a long term s/s, not immediate so we don’t need to worry about it so much

c. Note: titrate O2 slowly up, do not start someone on high, aggressive O2

10. COPD & Respiratory Depression/Hypoxic Drive Ch 10 slide 74, book pg 307

a. Hazards of O2 Therapy

i. Oxygen toxicity or air sac collapse occurs when there is an overload of O2

1. Pts lungs react unfavorably to O2/ too high O2 conc for too long

ii. Eye damage in premies

1. Too much O2 for long time

iii. Respiratory Depression or Respiratory arrest when hypoxic drive is depressed in COPD pts

1. End stage COPD looses ability to use CO2 conc in blood as stimulus to breathe

2. Instead use low O2 conc to stimulate breathing = hypoxic drive

3. Use O2 with caution to avoid knocking out their drive to breathe

iv. Underlying conditions exacerbated ie MI or stroke

1. O2 can contribute to reperfusion injury

2. Pts with reliable, normal O2 sats & no signs of hypoxia do not need O2 therapy

11. Respiratory Distress, Arrest, & Failure book pg 243-246; pg 245 has a cool chart

a. Respiratory distress – increased work of breathing; a sensation of SOB

i. The have a challenge of breathing, but the body is compensating

ii. s/s indicate pts sx is is working extra hard

1. Normal mental status

2. Normal to slightly pale skin color

3. Normal SPO2 reading buuuutt

4. RR (and depth) may be increased but still adequate

5. Body positioning to easy breathing

6. HR may be increased (but WNL… within normal limits)

7. Increased resp muscle use

8. May hear some abnormal breath sounds

iii. Tx w/ supplemental O2

i. The body is still compensating

1. High RR & HR

2. SOB

3. Pale skin

ii. Tx with O2

b. Respiratory failure – the inadequacy of breathing to the point where O2 intake to the ventilation removal of CO2 is not sufficient to support life

i. Inadequate breathing… often precursor to respiratory arrest

ii. s/s

1. reduced level of responsiveness/ AMS

2. appearance of tiring

3. shallow ventilations

4. RR and depth ONL (outside normal limits)

5. Diminished breath sounds

6. Noises… crowing, stridor, ect

7. Cyanosis, ashy

8. Decreased minute vol

9. SPO2 < 95%

iii. Tx w/ assisted ventilations (not just O2) i. Body is no longer compensating

1. Low RR

2. Cyanosis

3. AMS

ii. Tx: be ready with the BVM

c. Respiratory arrest – when breathing completely stops

i. S/s

1. No chest or abdominal movement

2. No breath sounds

3. No evidence of air being moved

ii. Tx w/ artificial ventilations

1. Adult rate: 10-12 breaths/ min (q5-6 seconds)

2. Pedi rate: 12-20 breaths/min (q3-5 seconds)

3. Pedi note!!! DO NOT use O2 powered devices on infants or children

i. The body is tired and has given up emergency

1. No respiration

ii. Tx: BVM

d. Pedi Note:

i. Children use O2 twice as fast as adults (hence the naturally higher RR)

1. You must maintain oxygenation

ii. Children have a more pliable chest wall with ribs that flare out at the bottom

1. This mean’s their diaphragm is flatter and less effiecent

iii. Children rely heavily on RR for compensation and accessory muscle use is less effective

iv. Respiratory changes in pedis can be subtle and/or abrupt (“adults roll down a hill; kids fall off a cliff”) assess for HR; bradycardia = significant finding in resp distress

1. Cardiac arrest is coming quick

2. Immediately artificially ventilate

12. Life Over Limb (BVM vs. Other Treatments) book pg 259-261

a. You can live without a limb, but not without your life treat the ABCs before any other trauma/ injury

b. BVM aka bag valve mask- handheld device with self-refilling bag that can be squeezed to provide artificial ventilations to a pt.

i. With no O2 source it delivers ~ 21% O2

ii. With no reservoir it delivers ~ 50% O2

iii. With a reservoir it delivers ~ 100% O2

c. Note: with suspected spine trauma, DO NOT tilt head or neck (sniffing position or neutral position ok); use jaw-thrust to maintain seal

a. ABC’s are your #1 priority always. Treat them FIRST

13. Ventilating Stoma Patients book pg 262

a. Stoma – surgical opening in the neck for breathing

b. Pts with stoma in resp distress/ arrest oft have thick secretions blocking the stoma

i. Suction often in conjunction with BVM-stoma ventilations

ii. Stoma ventilation steps:

1. Clear mucous plugs/secretions

2. Leave head & neck in neutral position

3. Use a pedi mask to establish a seal around the stoma

4. Last ditch effort plug stoma and ventilate via mouth only works if still connected to trachea

a. Ventilate the stoma not the mouth

14. Oxygen Concentration using oxygen therapy book pg 275; table 10-6

Pedi note: consider blow-by for infants and children that do not tolerate a mask or nasal canula; use a cup & have child or parent hold. DO NOT use Styrofoam can break off and be inhaled.

Mod 2 Study Guide Notes | Knowt (3)

15. Assisting a paramedic with advanced airways book pg 281

a. Two types of devices:

i. Devices that require direct visualization of glottic opening (endotracheal intubation)

ii. Devices with blind insertion (King tube, iGel, LMA)

b. “The most important thing an EMT can do to further the success of the insertion and benefit to the pt is to assure a patent airway and quality ventilations prior to insertion of the device.”

i. May be asked to hyper oxygenate pt before insertion

ii. Use BVM or CPAP; high-flow NC can also be used but not typical

1. DO NOT increase RR (more than 20 breathes/ min); DO NOT increase force of ventilations

iii. May be asked to apply cricoid pressure to push vocal cords into view BURP maneuver

iv. In a trauma you may be asked to place a c-spine or manual stabilization during intubation

v. Note: hold tube against teeth when bagging an intubated pt; important to not accidently extubate pt

1. If tube moves, immediately inform paramedic

16. Scene Size Up book all of ch 11… seriously

a. “Steps taken when approaching the scene of an emergency call: checking scene safety, taking standard precautions, noting MOI/NOI, determining # of pts, & deciding what additional resources to call”

b. Per Ilyan… Scene size up is about the delegation of resources

c. Checking for scene safety is the most important step

d. The MOI / NOI leads your assessment and determines next steps

e. Always ask 3 questions to ensure scene is safe

i. Ie: Any HazMat? Are there pets? How is the lighting?

f. In establishing a danger zone, secure 50 ft in all directions (when there are no apparent hazards), or 100ft if hazards ie water/gas is involved

g. In penetrating trauma, the velocity determines the damage

h. Use by-standers for information

i. In falls consider distance:

i. Adults: 20 ft

ii. Children (esp under 15 years) more than 10 ft/ 2-3x their height

j. “PENMAN

i. PPE

ii. Environmental factors (stairs, dogs, fire etc)

iii. Number of patients

iv. Mechanism of action or nature of illness

v. Additional units (police, animal control, ALS, fire etc )

vi. Need for C-spine? (cervical collar)

k. “ENAMES

i. Extrication

ii. Number of pts

iii. ALS

iv. MOI / NOI

v. Equipment

vi. Spinal Injury

a. PENMAN

17. Primary Assessment book all of ch 12….

a. Per Ilyan, primary assessment is about treating life threats

b. Focus on the ABCs

i. Priority depends on initial impression of pt

1. Pt has signs of life ABC

2. Pt appears lifeless/ no pulse CAB

c. Vomit in airway = potentially fatal

d. Exsanguinating = stop immediately

e. How to assess:

i. Airway

1. Open & patent

2. Is the pt talking

ii. Breathing

1. Rate, Rhythm, Quality

2. SPO2

3. Lung sounds

iii. Circulation

1. Rate, Rhythm, Quality

2. Skin signs warm, pink, dry; pale, cool, moist

3. Bleeding

f. Performing Primary Assessment:

i. Form general impression (Stable, Potentially unstable, Unstable):

1. Assess Mental Status

a. Level of responsiveness (LOR): AVPU

i. Alert to stimulation (tracks you with eyes)

ii. Verbal stimulation

iii. Painful stimulation

iv. Unresponsive

b. Level of Consciousness (LOC) aka A&O

i. Who are you? / Person

ii. Where are you? / Place

iii. When is it? / Time

iv. What happened? / Event

2. Assess A, B, C

3. Determine pt acuity (pt priority) Code 2 (urgent) Code 3 (lights and sirens)

a. Treat ABC (life threatening) problems immediately

b. Stable = VS WNL

c. Threat to ABCs = NOT stable

d. Initiate priority transport & cont assessment en route if:

i. Life-threatening problem cannot be controlled

ii. Life-threatening problem threatens to reoccur

iii. If pt had decreased LOR

ii. Things to consider: Disabilities, psychiatrics, minors/ kids, previous neuro damage

iii. If unconscious w/ trauma, c-spine always, begin Spinal Motion Restriction (SMR)

18. Appropriate questions to ask in both. Ch 11 slides 34, 40 -41; Ch 14 slide 4

a. Scene Size up and Primary Assessment

b. What action/s must be taken to remain safe at a scene?

c. # of pts?

d. Sufficent resources?

e. MOI/NOI?

f. Open-Ended questions

g. Closed-ended when you need to me direct/ an immediate answer

h. Appropriate questions to ask in both a trauma and medical assessment

i. Scene size up PENMAN

ii. Primary assessment

19. Appropriate Early Warning Devices with Freeway Accidents Basically all of ch 11 slides

a. Look & listen for other emergency units

i. Signs of collision related power outage/ downed wires

ii. Traffic flow (Ilyan said this is BIG)

iii. Smoke

iv. Liquids ie gas/ water

b. Flares, reflective triangles

i. Used to build a perimeter and visibility

a. PPE on a freeway

i. High Visibility Jacket

ii. Standard precautions

20. 1. Scene Safety with Police & Staging ch 11 slide 8

a. Follow instructions of incident commander

b. Establish danger zone

c. Do no enter a scene until it is cleared

d. Do not approach with lights & sirens

e. Follow IC

f. The scene will be staged in zones:

i. Danger zone

ii. Triage zone

iii. Safe zone… ect

g. Deer skin gloves (it’s a thing, but we didn’t really learn about it in class) for HazMat (?)

h. The Danger Zone is always a minimum of 50ft; depends on type of incident

21. High Velocity, Low Velocity, Medium Velocity books pg 306; ch 11 slide 28

a. Penetrating trauma is classified by velocity of the item causing injury (velocity determines the damage)

i. Low-velocity items: propelled by hand ie knife

1. Injury usually limited to area of penetration

ii. Medium-velocity items: handguns (also compound bows & ballistic knifes)

1. Can cause damage almost anywhere in body

iii. High-velocity: high-powered rifles

1. Can cause damage almost anywhere in body

b. Bullet damage in 2 ways:

i. From projectile- its path, fragmentation, whether it deflected in the body

ii. Cavitation (pressure-related damage)- pressure wave created by energy of bullet

22. 1. General Impression ch 12 slide 6-8; book pg 316

a. An aspect of the primary assessment

i. Assess mental status

ii. ABC’s

iii. Determine pt priority (acuitiy)

b. Assess enviro & pt’s chief complaint + appearance

i. Helps determine pt severity/ acuity

ii. Helps set priorities for care & transport

c. Ex:

i. Approx age + gender

ii. Positioning

iii. LOC

Lvl of apperent distress (mild, mod, severe)

23. Mental Status/Level of Consciousness

a. See q 17

24. 1. Chief Complaint book pg 321

a. The reason EMS was called, and usually in pts own words

b. Their actual description of why EMS was called; can be different than the actual problem

i. Ie shoulder pain/ neck pain but the issue is an MI

c. Gives you a place to start with your hx and physical exam

25. Blood pressure; systolic vs diastolic

a. From exam 1 SG q75:

b. ch 6 lect slide 46; book pg 136

i. Systolic (upper reading)- arterial pressure when L. ventricle contracts

ii. Diastolic (lower reading)- arterial pressure with L. ventricle refills

1. When the L ventricle refills, it is relaxed. The pressure remaining in the arteries is at this point is the diastolic BP

26. Oxygen Saturation Percentages & their descriptions (Remember 95-100% and so on) book pg 249, book pg 359

a. “Low oxygen saturation reading (<95%)”

b. Treat O2 sats < 94% book pg 274, 360

c. Normal healthy sats: 96%-100%

d. Mild hypoxia: 91%-95%

e. Moderate hypoxia: 86%-90%

f. Severe hypoxia: < 85%

g. High-flow O2 by nonrebreather

i. moderate-severe hypoxia

ii. CO exposure

iii. severe resp distress (esp with low sats)

h. Low-flow O2 by NC:

i. Mild hypoxia

ii. Mild resp distress

27. Systolic Vs Diastolic

a. See q25

28. 1. Skin Signs from lab manual “Vital Signs Practice & Notes”

a. Assess

1) Color (pink, pale, mottled, flushed, jaundiced, ashen, cyanotic)

2) Temperature (warm, cool, hot)

3) Condition (moist, dry, diaphoretic)

29. PERRLA & Reactions to Light from lab manual “Vital Signs Practice & Notes”

a. Pupils

b. Equal

c. Round

d. Reactive to

e. Light

f. Accommodating

30. How to auscultate a blood pressure from lab manual “Vital Signs Practice & Notes”

1) Select an appropriately sized cuff and apply it to the patient's upper arm.

2) Inflate the cuff to the proper level.

3) Deflate & note systolic when you auscultate through your stethoscope the first full beat.

4) Note the diastolic when you auscultate through your stethoscope the last full beat before it is absent.

31. Focused Exam book pg 420

a. Physical exam focused just on the area of injury?

b. Not to be confused with a rapid trauma assessment (detailed pg 429-443)

i. Part of secondary assessment

c. Trauma pt with minor injury/low priority

i. Include hx of present illness, physical exam, set of baseline VS, & past medical history

32. Know your Mnemonics when it comes to Medical Assessment
ONLY

33. Differential Vs Working Diagnosis Ch 14, slide 38; book pg 393, 392

a. Differential:

i. Working to exclude unlikely conditions

ii. Things to further evaluation

iii. “a list of potential diagnoses compiled early in the assessment of the pt

b. Working:

i. “a description or label for a pt’s condition, based on the pt’s hx, physical exam, and vs, that assists the EMT in further evaluation and tx.”

34. Baseline Vital Signs Vs Trends ch 15 slide 8, 12

a. Baseline- the first set of VS we take to set the “bases” of where we start

b. Trends- the changes of your pts VS as you continue to reassess as your administer interventions

i. You compare later VS to the baseline

35. Medical Alert Jewelry lab manual “Patient Medical Assessment”

a. Look for during 2ndary assessment to help gather info

36. Secondary Assessments all of ch 15… lab manual “Patient Medical Assessment”

a. “Assessment of affected body parts and look for other signs”

b. 3 categories of pts: 1) Medical, 2) Trauma, 3) unknown

c. Components:

i. Physical exam

ii. Pt hx

1. Hx of present illness (HPI)

2. Past med hx (PMH)

iii. Vitals

d. Medical pt:

i. Responsive

1. Obtain hx base q’s on the chief complaint / obs (open ended)

a. “SAMPLE”

2. Physical exam

a. Brief and based on chief complaint

3. Baseline vitals

4. Interventions and transport

ii. Unresponsive

1. Begin with physical and Vitals

2. Then gather hx from relatives and bystanders

3. Rapid assessment of entire body

e. Trauma pt

i. Determine severity of injury based on location, mental status, MOI, general impression, & vitals

ii. Minor/Low Priority

1. Focus assessment on chief complaint

2. Conduct HPI

3. In physical exam assess based on chief complaint

a. 3 techniques: 1) observation, palpation, auscultation

b. DCAP-BTLS

iii. Serious/ Multisystem/ High Priority

1. Cont C-spine

2. Consider ALS

3. Rapid trauma assessment (head-to-toe)

4. Baseline Vitals & PMH

f. Continues into details physical exam

37. Reassessments All of ch 16…

a. Purpose: identify changes and trends

i. Repeat key elements of assessment procedure

ii. Do not skip except for lifesaving interventions

b. Reassess & record vital signs

i. Compare to baseline (include SPO2) to identify trends

c. Check interventions

i. Ensure adequacy

d. Stable pts reassess 15 mins

e. Unstable/ potentially unstables pts reassess q5mins

If you suspect a change in condition, reassess Secondary Assessments all of ch 15…

38. Airway suctioning book pg 228-233

a. “Suctioning Devices”

i. You must have:

1. Tubing

2. Suction tips

a. Yankauer/ rigid tip

i. Good for suctioning mouth and pharynx

ii. Caution may stimulate vagus nerve at the back of the pharynx (slows HR)

iii. Suction no more than 10 secs and no further than you can see

b. French tip/ suction catheters

i. Too small for vomit or thick secretions

ii. Used to suction tubes NPA/OPS

iii. Measure as you would and NPA/ OPA… corner nose/mouth to earlobe

3. Suction Catheters

4. Collection container

5. Container of clean or sterile H2O

a. Helps to clear clogged tubes

b. “Pediatric Suctioning”

i. Infants super sensitive to vagal stimulation

1. Minimize necessary suctioning time

2. Maintain careful assessment when suctioning

ii. Bulb syringe for infants and small children

c. PPE:

i. Protective eyewear, mask, gloves

d. Notes:

i. Pause ventilations to suction vomit you don’t want to force vomit into lungs

ii. Suction for no more than 10s at a time, no less than 5s…. But if they still vomiting cont to suction

iii. Suction only as far as you can see and in the “out” direction, moving in circles

iv. Preoxygenate whenever possible (but not in cases for vomit), ie before routine et-tube suctioning

v. Suctioning is best delivered on pt’s side use gravity to help!

Example scenario:

80 y/o M Respiratory call

The first thing you should be concerned about: ABC’s

- Are they breathing?

o What is the Rate, Rhythm, Quality?

- Possible interventions?

o O2 therapy, BVM…

Adequate Breathing Note: book pg 248 table 10-2

Normal Rates

Quality

Infant: 30-60/min

Minimal effort

Child: 18-30/ min

Chest expansion- equal and adequate

Adult: 12-20/min

Breath sounds: equal and present

General Vital Signs (for newborns through adults) Note: book ch 8

Heart Rate

Respiratory Rate

Systolic BP

Infant Vital Signs (0-12mos)

Newborn: 100-170

0mo - 12mo: 90-160

0mo – 6mo: 30-60

6mo – 12mo: 24-30

Newborn: 50-70 systolic

Up to 12mo: 90 systolic

Toddler Vital Signs (12mo-36mo)

80-140/ min

24-40/ minute

1yr-10yr: mean systolic pressure = 90+ (age in years * 2)

Preschool Age Vital Signs (3-5yrs)

70-120/ min

22-34/ min

1yr-10yr: mean systolic pressure = 90+ (age in years * 2)

School Age Vital Signs (6yr-12yrs)

65-120/ min

18-30/ min

1yr-10yr: mean systolic pressure = 90+ (age in years * 2)

Adolescence Vital Signs (13-18yrs)

60-100/ min

12-20/ min

~ 107-117 systolic

Adulthood

60-100/ min

12-20/ min

< 120 systolic

Mod 2 Study Guide Notes | Knowt (2024)
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