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543 Cards in this Set
- Front
- Back
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normal PH
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7.35-7.45
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major source of energy for all body functions
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ATP
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conduct electrical impulses away from cell
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AXON
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recieves impulses from axons and other nerve cells
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dendrite
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endo
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within
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epi prefix
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Above
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peri
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around
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myo
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muscle
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cardi
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heart, cardiac
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cyto
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cell
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connects bone to bone
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ligament
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connects osteo to myo
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tendon
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solutes dispersing in solvent
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diffusion
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solutes moving from higher to lower concentration
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diffusion
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solvent equalizing across a membrane
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osmosis
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mitosis
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cell division
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meiosis
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cell division at conception
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ICF
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intracellular fluid
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ECF
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extracellular fluid
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hypo-
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low
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hyper-
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high, above normal
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adipose
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fat
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subcutaneous
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below skin, adipose layer
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forms bone
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osteo blast
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destroys bone
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osteoclast
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how many ribs
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12
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how many floating fibs
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2
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how many fixed ribs
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7
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outer layer of skin
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epidermis
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-natremia
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sodium
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-kalemia
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pottasium
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inner layer of skin
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dermis
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outer layer of skin
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epi-dermis
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bone shaft
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diaphysis
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osteo growth plate
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epiphyseal plate
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In order to relieve the bronchospasm associated with an acute asthma attack, the paramedic would give a/an:
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beta-2 agonist
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include medications such as atropine and cause an increase in heart rate
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Muscarinic cholinergic antagonists
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Muscarinic cholinergic antagonists have what chronotropic effect
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lowers heart rate
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a Muscarinic cholinergic antagonists that blocks vagus nerve stimulation and cause an increase in heart rate
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atropine
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class of drug that can be used to treat parkinsons by blocking central cholinergic activity
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Muscarinic cholinergic antagonists
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Enfuviritide is a protease inhibitor used to treat?
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HIV
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Alpha 2 receptors control the release of
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nor-epi and ACh
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Fetanyl is what class of drug
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Opioid analgesic
narcotic analgesic |
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isoniazid is uaed to treat
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tuberculosis
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fentanyl AKA
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Sublimaze
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amount of medication that is still active when it reaches its target organ is the drugs ____
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bioavailability
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The interaction between medications that causes one medication to enhance the effects of the other is called
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potentiation
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A patient experiencing a cough and fever is taking isoniazid. You should suspect that he or she has
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tuberculosis
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what drugs Block norepinephrine and serotonin from being reabsorbed in the brain
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tricyclic antidepressants
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The study of the metabolism and action of medications within the body, with particular emphasis on absorption, duration of action, and method of excretion, is called
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pharmacokinetics
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The two major types of peripheral nerves are the
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afferent and efferent nerves
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Pancuronium, Vecuronium, Rocuronium are all what class of drugs
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nondepolarizing neuromuscular blocking agents
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Most psychotherapeutic medications work by blocking __________ receptors in the brain
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dopamine
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A dilute alcoholic extract that is commonly used as a skin antiseptic is called a/an:
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tincture
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the dominant system during rest and relaxation
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parasympathetic nervous system
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A medication is called an antagonist if
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it has a higher affinity for the receptor site than the chemical mediator
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group of pharmaceuticals that are used primarily in treatment of hypertension and congestive heart failure
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ACE inhibitors
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inhibitors of Angiotensin-Converting Enzyme,
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ACE inhibitors
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______ inhibitors lower arteriolar resistance and increase venous capacity; increase cardiac output and cardiac index, stroke work and volume, lower renovascular resistance, and lead to increased natriuresis (excretion of sodium in the urine).
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ACE
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_____ blocks the conversion of angiotension 1 into angiotension 2
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ACE inhibitors
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beta-adrenergic blocking agents, beta-adrenergic antagonists, or beta antagonists.
Are all catorgerized as |
Beta blockers
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class of drugs that block the action of endogenous catecholamines (epinephrine (adrenaline) and norepinephrine (noradrenaline) in particular on beta andrenergic receptors
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beta blockers
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beta blockers are used to manage what sign/symptom
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cardiac arrythmias
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Narcan, Nalone, and Narcanti AKA
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Naloxone
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drug used to counter the effects of opioid overdose, can be given with the use of a MAD
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Naloxone
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sildenafil AKA
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viagra
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a antihistamine and antiemetic medication.
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phenergan
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_______ is a phenothiazine derivative that competitively blocks histamine H1 receptors without blocking the secretion of histamine
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phenergan
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Promethazine AKA
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Phenergan
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otherwise known as sensory or receptor neurons
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Afferent nerves
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carry nerve impulses from receptors or sense organs toward the central nervous system
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Afferent nerves
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ascending nerves AKA
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Afferennt nerves
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Efferent nerves AKA
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descending nerves
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otherwise known as motor or effector neurons – carry nerve impulses away from the central nervous system to effectors such as muscles or glands
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Efferent nerves
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____ acts as a depolarizing neuromuscular blocker.
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succinylcholine, scoline
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coenzyme in metabolism of carbs and protiens
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magnesium/ Mg++
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HCO3
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biocarbonate
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chloride helps regulate
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ph of stomach
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sodium potassium pump has the added benefit of what
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moving glucose into cell
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tubules in kidneys use _____ to clean blood
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filtration
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effects of osmotic pressure on cell membrane
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tonicity
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avg person loses how much fluid per day thru uria, respiration and evaporation
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2-2.5L
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inadequate total fluid volume
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dehydration
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sign/symptoms of dehydration
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posterial hypotension, tachypnea, flushed dry skin
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extracellular fluid makes up__% of body weight
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15
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% total body weight of interstitial fluid
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10.5
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% of body weight of intravascular fluid
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4.5
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what regulates cellular K+
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insulin
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hypokalemia signs/symptoms
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decreased muscle funtion,gi disturbance, altered cardiac function
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hyperkalemia sign/symptoms
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hyperstimulation of neuralcell transmission, results in cardiac arrest
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priciple cation for bone growth
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calcium
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hypocalcemia signs/symptoms
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cramps,hypotension,vasoconstriction
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sign/symptoms hyperalcemia
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weakness,lethargy, ataxia, vasodilation, hot flushed skin
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vasodilation cause what skin condition
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hot and flushed
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signs/ symptoms of overhydration
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SOB, edema, polyuria, rales
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3 main causes of overhydration
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unmonitored IV, kidney failure, hypoventilation
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5% DEXTROSE IN WATER IS A____TONIC FLUID
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ISO
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blood products are___tonic
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hypo
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albumin is ____tonic
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hypo
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effects of fluid overload
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increases preload & cardiac workload, results in pulmonary edema
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IV treatment for pt with large blood loss
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LR
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How does LR assit pt with large blood loss
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Lactate is metabolized into bicarbonate
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key buffer that combats intracellular acidosis
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bicarbonate
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what pt should not be given LR and why
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pt with liver problem, liver cant metabolize lactate of no benefit
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an isotonic fluid that quickly becomes hypotonic in the body
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D5W
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hypotonic fluid causes cells to
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swell
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hypertonic fluid causes cells to
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shrink
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fluid that hydrates cells while depleting the vascular compartment
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hypotonic
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___tonic fluid causes cardio collapse and intercranial pressur
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hypo
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_____tonic fluid can cause sudden fluid shift
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hyper
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giving D5W for extended periods can cause
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intercranial pressure
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____tonic fluid should not be given to burn, trauma headtrauma, stroke, or liver diease pt's
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hypotonic
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adbnormal shift of fluid into interstitial compartment
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third spacing
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___tonic fluid shift fluid into intrvascular and help stabilize BP
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hyper tonic
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__tonic fluids increase uria and reduce edema
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hyper
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what type fluid contains dissolved salts or sugars
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crystalloid
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best fluid choice for injured pt who needs fluid replacement
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crystalloid
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how much crystalloid fluid is needed to replace each ml of pt's blood
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3ml crystalloid fluid for every 1ml blood loss
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how much of a given crystalloid solution will leave the vascular space within an hr
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2/3
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can a crystalloid solution carry oxygen
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no
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how much fluid should be given to trauma pt ml/kg
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20ml/kg
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when giving fluid to trauma pt you are trying to maintain,
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radial pulses and mental status
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IV solution that contains protiens
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colloids
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IV solution that contains molecules to large to pass through capillary membranes
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colloids
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IV fluid that helps reduce edema
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colloids
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IV fluid that has high osmalarity and shifts fluid from interstitial space into intracellular and intravascular compartments
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colloids
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albbumin, dextran, plasmante, and hetastarch are all what type of fluid
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colloid
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best fluid to replace lost blood
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whole blood
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universally compatible blood type
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O-
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2 types of fluid usually available in prehospital setting
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NS and LR
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once bag is opened IV fluid must be used within
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24hrs
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once pigtail is removed over sterile access port on IV bag it must be used within
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immediatley
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volume of bags used for mixing and administering meds
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250-100ml
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___ moves fluid from IV bag to PT's vascular system
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administration set
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macrodrip set used to rapidly infuse blood and iv fluids thhrough multiple ports
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blood tubing
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drip set that allows you to fill a 100-200ml chamber and administer only that amount
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volutrol
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drip set that is typically used on peds to prevent inadvertant fluid overload
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volutrol
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small bumps in veins indicate
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valves
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usually a sign of sclerosis caused by frequent cannulization of vein
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track marks
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leg veins have a greater risk of
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venous thrombosis and PE
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most common length of IV cath
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1 1/4 - 2 1/4"
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vein that provides best IV access for cardiac arrest or hemodynamically unstable pt
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AC
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cath size for fluid replacement
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14-16
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IV insertion begin at a ___ angle
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45 degree
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After seeing flash adjust IV angle to
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15 degrees
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what can help make veins more visible in dark skinned pt's
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iodine
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when starting IV constricting band should be placed how far qwqy from insertion site
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6-8 inches
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four things to document an IV
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guage, site, type of fluid, rate
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allows you to maintain an actice IV site with out running fluids
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saline lock
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when should you change an IV bag
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with about 25ml remaining
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what vein ends at the subclavian vein
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EJ
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risk involved with EJ cannulation
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puncture of carotid, air embolism, rapidly expanding hematoma
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local reactions to IV
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infiltration, thrombophlebitis
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systemic complications of IV insertion
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anaphylaxis, circulatory overload
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escape of fluid into surronding tissue at IV site
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infiltration
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most common veins for infiltration
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large veins
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pain & tenderness along a vein, redness and swelling at venipuncture site
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thrombophlebitis
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physical bloackage of vein or catheter
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occlusion
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decreasing drip rate or presence of blod in IV tubing may indiacate
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occlusion
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if a pt experiences vein irritation what should be done with IV equipment
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saved for later inspection at hospital
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what should you do if after inserting an IV a hematoma develops, the vein still flows and the hematoma is controlled
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monitor IV site and leave in place
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treatment if you accidentally Place IV cath in artery
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remove and apply direct pressure for 5 minutes or until bleeding stoppped
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best way to avoid pyrogenic reactions when giving pt fluids
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careful inspection of bag
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how much extra fluid can a healthy adult handle without comprimise
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2-3L extra
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most common cause of fluid overload
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failure to readjust drip rate after fluid bolus
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how much air can be injected in most healthy aduts without compromise
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200ml
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if pt begins to have SOB, and unequl breath sounds after IV insertion you should suspect
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Air embolism
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what to do if you suspect catheter shear
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place pt in L recumbent, head up feet down
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what to do if you suspect air embolis
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place pt on l side with head up
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what size syringe is needed to get blood sample
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15-20ml
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what needs to be listed on all tubes if you take blood sample
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time,date, pt's name, your name
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what color tube used to take blood sample must you be careful not to shake
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red topped
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how should crystalloid boluses be given in peds when using IO
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use a syringe
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how should IO crystalloid bluses be given
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with use of pressure infuser
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congenital disease resulting in fragile bones
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osteogenisis imperfecta
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unit of measure equal to one drop of water
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grain
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on celcius scale water freezes at__ and boils at ___
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0 and 100
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fahrenheit scale water freeses at ___and boils at ___
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32 and 212
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desired dose (mg) X concentration of drug on hand (mg/ml)=
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volume to be administered
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practice of preventing contamination by using ascepitic technique
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medical asepsis
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used to clean area before invasive procedure
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antiseptics
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used to clean equipment and ambulance
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disinfectant
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refers to any route in which meds are absorbed through GI tract
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enteral
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used to decompress stomach
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G tube or NG tube
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refers to any route other than absorbtion of meds through GI system
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perental route
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small glass or plastic vials with rubber stopper top
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vials
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tubex, aboject, carpujet are all axamples of
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single dose disposable medication certridges
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size syringe for intradermal injection of med
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1ml
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size syringe for SQ injection of meds
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3ml
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size syring for IM injection
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3-5ml
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amount of room for error in IV drug administration
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none
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single dose usually given by IV
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bolus
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meds applied to and absorbed through the skin are using what route of administration
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parcutaneous or transdermal
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MAD
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mucosal atomizer device
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most commonly used methods of inhaled drug administration in prehospital setting
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nebulizers
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schedule 1 drugs have what abuse potential and are used medically for what
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highest abuse potential , no nedical uses, severe dependence
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schedule 2 drugs abuse potential
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very high , severe addiction
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schedule 5 drug abuse potential
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lowest
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difference in the abuse or end result of abuse of schedule 1 & 2 drugs
|
schedule 1 severe dependence
schedule 2 addiction |
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schedule of drug that has low to moderate physical dependence and high psychological dependence
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schedule 3
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schedule of drug that is completely outlawed ( only used for research & instruction)
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schedule 1
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Mg++
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magnesium
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cation that plays an important role in the metabolsm of carbs and protiens
|
magnesium
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anion that helps regulate the ph of the stomach
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chloride
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tubules of the kidneys use what process to clean blood
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filtration
|
|
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sodium / potassium pump has added bebefit of
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moving glucose into the cell
|
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effects of osmotic pressure on a cell
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Tonicity
|
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what happens to the tonicity of D5W once infused into the body
|
sugar is quickly metabolized and the fluid becomes hypotonic
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synthetic blood substitutes have what added benefit over other fluid treatments
|
ability to carry oxygen
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approximately how much of an isotonic crystalloid fluid will leave the vascular space in one hr
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2/3
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universal blood
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o-
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electrolyte that has an active role in metabolism
|
magnesium
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most commonly used IV fluid in prehospital setting
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isotonic, LR and NS
|
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type of IV solution that contains protiens that are to large to pass through capillary membranes
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Colloids
|
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electrolyte needed for bone growth and blood clotting
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calcium
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posturl hypotension, dry mucous membranes and dry flushed skin indicate
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dehydration
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3 questions that should be asked when determining most appropriate IV solution for pt
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is condition critical, need for meds, need for fluid replacement
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once a pigtail has been removed from the sterile access port of an IV solution, it must be used within
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immediately
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Administering large amounts of an isotonic crystalloid solution to a patient with internal bleeding can
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increase the severity of internal bleeding by interfering with hemostasis
|
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cardinal sign of overhydration
|
edema
|
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composition of dissolved elements and water
|
solution
|
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drip set that dlivers 1ml for every 60 drops is called a
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microdip set/ 60gtt set
|
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principal extracellular cation that regulates water distrubtion in the body
|
sodium
|
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administration set that helps to avoid fluid overload in peds
|
volutrol (burterol)
|
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what type of pt will LR not help
|
pt with liver problems
|
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water moves from an area of low solute concentration to an area of higher concentration
|
osmosis
|
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common cause of overhydration
|
kidney failure
|
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hetastarch, dextran, plasmante are all examples of what type of solution
|
colloid
|
|
|
healthy person loses approximately how much fluid through uria and exhalation each day
|
2-2.5l
|
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net effect of osmosis
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equilize solute concentration on both sides of cell membranes
|
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____ results in hyperstimulation of neurol cell transmission
|
hyperkalemia
|
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|
once an IV soluton is removed from its protective sterile bag it must be used within
|
24 hrs
|
|
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____ % of adult males weight constituted by water
|
60%
|
|
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primary buffer in all circulating body fluids
|
bicarbonate
|
|
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___ solutions hydrate cells while depleting the vascular compartment
|
hypotonic
|
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macrodrip infusion set that allows manual infusion of multiple IV bags or combo of IV fluids and blood
|
blood tubing
|
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solution that is beneficial to pt's that have lost large amounts of blood
|
LR
|
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IV fluid that can help combat intracellular acidosis
|
LR
|
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represents the chemical combining power of the ion
|
The milliequivalent (mEq)
|
|
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number of available ionic charges in an electrolyte solution
|
The milliequivalent (mEq)
|
|
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percent of body weight of the extracellular fuid
|
15%
|
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percent of body weight of interstitial fluid
|
10.5%
|
|
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percent of body weight intravascular fluid
|
4.5
|
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pt's has altered mental status, flushed dry skin, tachypnea, and posterial hypotension, most likely Dx
|
dehydration
|
|
|
what helps regulates cellular K+
|
insulin
|
|
|
causes decreased skeletal muscle function, GI upset, altered cardiac function
|
hypokalemia
|
|
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can cause hyperstimulation of neurons, and cardiac arrest
|
hyperkalemia
|
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priciple ion for bone growth
|
ca++/ calcium
|
|
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pt presents with muscle cramps, hypotension , and vasoconstriction possible Dx
|
hypocalcemia
|
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vasodilation results in what skin sign
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hot and flushed
|
|
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Pt presents with SOB, rales, polyuria, edema Possible Dx
|
overhydration
|
|
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prolonged hypoventilation can cause what SE
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overhydration
|
|
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blood products are ___tonic fluid
|
hypo
|
|
|
increases preload on the heart, increases cardiac work load, and pulmonary edema
|
fluid overload
|
|
|
fluid that causes cells to swell
|
hypotonic
|
|
|
fluid that cause cells to shrink
|
hypertonic
|
|
|
giving D5W for extended periods can cause
|
intercranial pressure
|
|
|
___tonic fluid can cause cardiac collapse and/or intercranial pressure
|
hypotonic
|
|
|
an abnormal fluid shift into the interstitial compartment
|
third spacing
|
|
|
pt presents with sudden weight loss, night sweats, fever, blood tinged sputum, Dx
|
Tb/ tuberculosis
|
|
|
class of drug that dries secretion, and are not indicated for asthma
|
antihistamines
|
|
|
class of drug that supresses cough
|
antitussives
|
|
|
OTC bronchodilators usually use what type medication
|
weak or diluted epi
|
|
|
Treatment for lower airway infection
|
supportive care and transport
|
|
|
___ states that resistance increases greatly when tube diameter is narrowed
|
pouiselles law
|
|
|
#1 cause of pneumonia
|
streptococcus pneumoniae bacillus
|
|
|
respiratory problem that accounts for 10% of hospital admissions
|
pneumonia
|
|
|
pneumonia has a mortality rate of __-___
|
5-10%
|
|
|
#1 cause of pneumonia in HIV pt
|
Pneumonia cystis carinii
|
|
|
pnuemonia usually infects lungs where
|
lower lung bases usually one side
|
|
|
aveolar collapse
|
atelectasis
|
|
|
atelectasis
|
aveolar collapse
|
|
|
device that allows pt's to quantify how deep they are breathing
|
incentive spirometer
|
|
|
woman account for __% of all new lung cancer cases
|
45%
|
|
|
blood in sputum
|
hemoptysis
|
|
|
hemopytisis
|
blood in sputum
|
|
|
naloxone ( narcan ) should be used in what way to treat opoid OD
|
titrated, only enough to improve respirations, do not completely reverse effects of opoids
|
|
|
a highly water soluble toxin that effects the upper airway
|
ammonia
|
|
|
name 2 inhaled toxins that will not show signs for up to 24 hrs
|
phosgene, and nitrogen dioxide
|
|
|
tissues that make up the walls of the capillaries and aveoli
|
parenchyma
|
|
|
most common cause of pulmonary edema
|
left sided heart failure
|
|
|
sound heard on lower lobes of pt with pulmonary edema
|
crackles
|
|
|
pt is coughing up pink foamy sputum, no fever Dx
|
severe pulmonary edema
|
|
|
weak spots on lungs that can cause spontaneous pneumotharax
|
blebs
|
|
|
name 3 types of pt prone to blebs
|
smokers, severe asthmatics, tall thin people
|
|
|
accumulation of fluid between the visceral and parietal pleural membranes
|
plerual effusion
|
|
|
also known as a lung blister
|
effusion
|
|
|
one of the most misdiagnosed condition in EMS
|
PE
|
|
|
pt with thrombophlebitis in a lower extremities is at a high risk of
|
PE
|
|
|
Homans sign
|
calf pain on dorsirlexion
|
|
|
Homans sign indicates
|
thrombolphlebitis
|
|
|
device that opens like large umbrella in a large vein to catch clots and hopefully prevent PE
|
Greenfeild filter
|
|
|
large emboli lodged at the bifurcation of the R&L pulmonary arteries
|
saddle embolus
|
|
|
saddle embolus usually results in
|
sudden death
|
|
|
deep cyanosis of face, neck, chest, and back
|
cape cyanosis
|
|
|
best measurement of ventilation
|
Co2 level
|
|
|
normal Paco2 range
|
3.5-4.5 mm/hg
|
|
|
respiratory acidosis sign
|
hypoventilation
|
|
|
pt with hyperventilation may be compensting for respiratory ___
|
alkolosis
|
|
|
what happens to Ph if Co2 levels fall
|
raises Ph
|
|
|
pickwickin syndrome
|
respiratory compromise due to obesity
|
|
|
guillian bare syndrome
|
progressive weakness that moves up the body slowly from the feet
|
|
|
A fatal progressive muscle weakness
|
amytrophic lateral sclerosis
|
|
|
results from food poisoning or giving an infant raw honey
|
botulism
|
|
|
most common cause of hyopoventilation crisis in EMS
|
heroin OD
|
|
|
fallling Co2 will give the pt what symptom
|
SOB
|
|
|
respiratory alkolosis causes what symptom
|
munbness and tingling in hands or feet
|
|
|
a pt that is hyperventilating due to respiratory alkolosis may experience
|
numbness or tingling in hands or feet
|
|
|
carpopedal spasm
|
hands and feet lock up in a claw like position
|
|
|
severe respiratory alkolosis will present with
|
carpopedal spasms, and possible chest pain
|
|
|
what should be done before and after giving a pt a fluid bolus
|
listen to lung sounds
|
|
|
what class of drug may seem like a good idea to give to ashma and pneumonia pt but might actually worsen condition
|
diuretic
|
|
|
what should be the last treatment option for asthma pt
|
intubation
|
|
|
when using MDI the best particle distribution comes from what type of airflow
|
smooth low pressure laminar flow
|
|
|
rescue inhaler uses
|
beta 2 blocker
|
|
|
thrush
|
annoying fungal infection
|
|
|
MDI inhaler should have airflow of __lpm
|
6
|
|
|
Nebulizer O2 flow rate
|
6 lpm
|
|
|
normal glucose level
|
70-110
|
|
|
cholinergic AKA
|
parasympathetic
|
|
|
parasympathetic AKA
|
cholinergic
|
|
|
2 classes of respiratory medication that pt may be taking in powdered form
|
corticol steroid, and slow acting brochodilator
|
|
|
most common fast acting _____
are beta 2 agonist |
bronchodilators
|
|
|
most common beta 2 agonist
|
albuterol
|
|
|
most common parasympathetic (cholnergic) blocker
|
atropine
|
|
|
A once a day anticholinergic (antiparasympathetic) used by COPD pt in powdered form
|
tiotropium
|
|
|
salmeterol (serevent) and cromolyn (intal, nasalcrom) are popular long acting ___
|
bronchodilators
|
|
|
Aminophylline and theophylline are both
|
methlyxanthines
|
|
|
drug of last resort for severe asthma attack
|
MAG 0.5-2g
|
|
|
class of drug used to reduce bronchoswelling
|
corticosteroid
|
|
|
cushings syndrome can be caused by long term ___ use
|
corticosteroid
|
|
|
pt has moon face and generalized edema ___ syndrome
|
cushings syndrome
|
|
|
possible SE of oral corticosteroid use
|
makes blood sugar go haywire
|
|
|
name 2 corticosteroids given via IV that are not solu-medrol
|
methlyprednisolone, and hydrocortisone
|
|
|
guaifenesin is the main ingredient in what type of drug
|
expectorant
|
|
|
drug used to supress cough
|
antitussive
|
|
|
over use of ___ can cause sedation, reduce respiratory drive and cause excessive secretions
|
antitussives
|
|
|
drug used in aresol form to supress cough in end stage cancer pt's
|
fentanyl
|
|
|
name 2 loop diurectis
|
lasix and bumex
|
|
|
low potassium can cause
|
dysrythmias and muscle cramps
|
|
|
pt has pulmonary edema, pitting edema and renal failure what drug seems like a good idea but will probably be ineffective and why
|
loop diuretic, renal insuffiecency loop diurectic will not have an effect
|
|
|
a narcotic vasodilator that reduces cardiac preload and allows fuid to leave the lungs
|
morphine
|
|
|
CPAP may empty a d cylinder in as little as
|
5-10 minutes
|
|
|
why is it ill advised to use a CPAP machine on a pt with low BP
|
CPAP can stop venous blood return, causing sudden further drop in blood pressure
|
|
|
Automated transport ventilators provide ___l/min
|
40
|
|
|
What is the optimal flow for ventilating cardiac arrest pt
|
40lpm
|
|
|
contraindication for the use of automated transport ventilator
|
conscious pt and hypotension
|
|
|
nose bleed
|
epitaxis
|
|
|
oropharynx
|
mouth
|
|
|
severe swelling to the mouth or lips: usually caused by allergic reaction
|
angioedema
|
|
|
good question to ask pt that may be having an allergic reaction
|
If their tongue feels thick
|
|
|
back of the throat where the oropharynx and nasopharynx meet
|
hypopharynx/ or posterior pharynx
|
|
|
gag refelx is most sensitive in what part of pharynx
|
hypopharynx
|
|
|
voicebox
|
larynx
|
|
|
external landmark of the larynx
|
thyroid cartilage
|
|
|
___ appear as two pearly white lumps at the distal end of each vocal chord
|
arytenoid cartilages
|
|
|
sometimes NG tubes and ET tubes will get stuck in this space during placement
|
piriform fossa
|
|
|
forms a complete ring and maintains the trachea in an open position
|
cricoid cartilage
|
|
|
cricoid pressure
|
sellicks maneuver
|
|
|
small space between the thyroid and cricoid cartilage
|
cricothyroid membrane
|
|
|
surgical opening into the trachea
|
tracheostomy
|
|
|
typically anatomic dead space in the lungs is __ml/lb
|
1 ml/lb
|
|
|
the carina is located about the ___ cervical vertebra
|
6th
|
|
|
the bronchi bifurcate at the
|
carina
|
|
|
straighter of the two bronchi
|
right
|
|
|
if you insert an et tube to far it almost always ends up where
|
right lung
|
|
|
aspirated foriegn materials almost always end up in which lung
|
right
|
|
|
the lobar bronchi, segmenttal bronchi, subsegmental bronchi, bronchioles account for approx. how many branchings
|
15
|
|
|
hair like structures that help move particulate matter up and out of airway
|
cilia
|
|
|
cells that produce mucus that cover the linings of airway
|
goblet cells
|
|
|
the first __ branchings of the bronchial tree are covered with cilia
|
15
|
|
|
terminal airways include which branches of the bronchial tree
|
16-24
|
|
|
terminal bronchioles are made up of branches ___
|
16-24
|
|
|
capilaries cover the alveoli and bronchial tubes from__ level to __ level
|
16-24
|
|
|
terminal brochioles and alveoli are collectively known as
|
lung parenchyma
|
|
|
what hapens to foriegn particulate matter once it gets below the 16th bronchiole tree branch
|
stays forever, no method of removal
|
|
|
substance lining alveoli
|
surfacant
|
|
|
surfacant reduces surface tension and
|
helps to keep alveoli open
|
|
|
the only aterey that carries deoygenated blood
|
pulmonary artery
|
|
|
there is signifacantly more blood circulation at the lung__ than the __
|
bases,apices
|
|
|
surplus of red blood cells
|
polycythemia
|
|
|
what side of the heart is most effected by polycythemia
|
right side, blood is to thick and difficult to push through pulmonary capillaries
|
|
|
right heart failure secondary to chronic lung disease
|
cor pulmonale
|
|
|
hypoventilating cause carbon dioxide levels to
|
rise
|
|
|
to much carbon dioxide in the blood
|
hypercapnic
|
|
|
hypoventilation causes what to happen to Ph balance
|
fall ? acidosis
|
|
|
often seen when infants and small children are using accessory muscles to breathe
|
retractions
|
|
|
difficulty exhaling usually indicates what type of problem
|
obstructive airway disease/ ie COPD/asthma
|
|
|
difficulty inhaling usually indicates what type respiratory problem
|
upper airway obstruction
|
|
|
how many parts of the brain are responsible for breathing
|
at least 4
|
|
|
most respiratory controls are located in and around
|
the brain stem
|
|
|
apneustic center regulates
|
inspiratory pause
|
|
|
grossly irregular breathing pattern RATE
|
biots
|
|
|
breathing pattern DEPTH of breathing gradually increases and then decreases followed by period of apnea
|
cheyne stokes
|
|
|
breathing pattern commonly found in deep sleepers or intoxicated people
|
cheyne stokes
|
|
|
breathing pattern: irregular gasps that are few and far between
|
agonal
|
|
|
when the pneumotaxic center of brain is damaged the ___ takes over
|
apneustic
|
|
|
prolonged inspiratory breathing: fish breathing or guppy breathing
|
apneustic
|
|
|
unusually slow respirations
|
bradypnea
|
|
|
forced exhalation against a closed glottis
|
cough
|
|
|
normal breathing
|
eupnea
|
|
|
spasmodic contraction of the diaphragm causing short exhalations
|
hiccup
|
|
|
unusally deep breathing: affects depth not rate: may be seen in OD pt
|
hyperpnea
|
|
|
unusually shallow respirations
|
hypopnea
|
|
|
deep sighing resprations, usually accompanied by acetone breath
|
kussmauls
|
|
|
breathing pattern typically seen in pt with ketone acidosis
|
kussmauls
|
|
|
___ forces open alveoli that close in the course of day to day events
|
sighing
|
|
|
causes you to cough if you take to deep a breath
|
hering breur reflex
|
|
|
keeps you from over infalting your lungs
|
hering breur reflex
|
|
|
an expression of how many free H+ ions are in a solution
|
Ph
|
|
|
hyperventilation results in
|
alkalosis
|
|
|
early neurolgic sign of reduced levels of oxygen
|
anxiety
|
|
|
late neurologic sign of lack of oxygen
|
confusion, lethargy, coma
|
|
|
dizziness and tingling extremities are often seen in a ____ PT
|
hyperventilating
|
|
|
type of disease that attacks the nerves that supply the respiratory muscles
|
polio
|
|
|
body's immediate response to mild hypoxia
|
increased heart rate
|
|
|
severe hypoxia will have what effect on heart rate
|
slows
|
|
|
classic presentation of pt with emphysema
|
barrel chest, pink skin , pursed lips
|
|
|
due to the classic signs of emphysema , pt's with emphysema are commanly refered to as
|
pink puffers
|
|
|
pt that sleeps in chair, has urinal beside chair to avoid frequent trips to bathroom, usually obese, and spit cup for secretions probably suffers from
|
chronic bronchitis
|
|
|
what should a pt in repiratory distress that is willing to lie flat tell you
|
possible sign of sudden deterioration
|
|
|
bony retractions most commonly seen in
|
infants and small children
|
|
|
whensoft tissue is pulled in around the bones during inhalation
|
soft tissue retractions/ Retractions
|
|
|
head bobbing in a pt with respiratory compromise is usually considered what type of behavior
|
preterminal
|
|
|
sign when the thyroid cartilage is pulled up and the area just above the sternal notch is sucked inward with inhalation
|
tracheal tugging
|
|
|
when the epigastrium is pulled in and the abdomen is pushed out with inhalation
|
paradoxical movement
|
|
|
when pulses are easier to palpate during exhalation
|
pulsus paradox
|
|
|
condition where intrathoracic pressure weakens peripheral pulses
|
pulsus paradox
|
|
|
as a rule any breath sound heard wihout a stethoscope is considered
|
abnormal
|
|
|
quiet tachypnea may indicate
|
hyperventilation syndrome, acidosis, shock
|
|
|
increase in Paco2 has what effect/ sign
|
sedative
|
|
|
decrease in Paco2 will manifest as what signs
|
restlessness, confusion, combative behavior
|
|
|
harsh high pitched sound usually heard on inspiration
|
stridor
|
|
|
sound that indicates narrowing or swelling of airway
|
stridor
|
|
|
healthy adults have a hemoglobin level of
|
12-14g/dl
|
|
|
pt's with chronic bronchitis are commonly refered to as
|
blue bloaters
|
|
|
skin sign in pt with high levels of methemoglobin: from
toxic esposure to nitrates |
chocolate brown skin
|
|
|
right sided heart failure usually occurs at what speed compared to left heart fauilure
|
slow, days to weeks vs sudden onset
|
|
|
dyspnea that comes on suddenly in the middle of the night
|
paroxsymal nocturnal dyspnea
|
|
|
paroxsymal nocturnal dyspnea may indicate
|
Left sided heart failure , worseing COPD or both
|
|
|
JVD provides a rough measure of___ when seen in pt sitting up
|
pressure in the right atrium
|
|
|
JVD may indicate what if pt is in respiratory distress
|
High thoracic pressure
|
|
|
if you apply mild pressure to pt's liver and it cause JVD this is called ___ and indicates__
|
hepatojugular reflex, indicates right heart failure
|
|
|
condition when you palpate pt's extremity and you fingers leave depression in the skin
|
pitting edema
|
|
|
vibrations that can be palpated as a person breathes
|
tactile fremitus
|
|
|
stethoscope with 2 parrallel tubes
|
spraque-rapport
|
|
|
diaphragm of stethascope is used to listen to
|
high pitched sounds
|
|
|
bell on stethascope is used to listen to
|
low pitched sounds: heart tones
|
|
|
to hear lower lung sounds listen
|
at the pt's back
|
|
|
to hear upper lung lobes listen
|
anterior chest
|
|
|
to hear middle lung lobes listen
|
beneath or lateral to r beast
|
|
|
the best place to compare r & l lung sounds
|
midaxilllary
|
|
|
best place to listen for lung sounds after ET placement
|
midaxillary line
|
|
|
lung sounds move better through fluid or air?
|
fluid
|
|
|
adventitious means
|
abnormal
|
|
|
sound caused by popping open of are spaces: usually associated with fluid accumulation
|
crackles , rales, ronchi
|
|
|
low wheeze or death rattle
|
rhonchus
|
|
|
low pitched continuous lung sound
|
rhonchus
|
|
|
low pitched crackle : caused by thick secretions in airway
|
rhoncus
|
|
|
blood tinged sputum may indicate
|
TB, or pulmomary edema
|
|
|
purulent
|
puslike
|
|
|
oxygen saturation greater than ___ is considered normal
|
95%
|
|
|
low hemoglobin will cause the pulse oximetry to read
|
high
|
|
|
normal pulse oximerty reading for COPD pt may be as low as
|
89-90%
|
|
|
most people may have what percent carbonmonoxide level at all times
|
1-2%
|
|
|
smokers nay have what level of Co saturation at all time
|
3-4%
|
|
|
Pao2 means
|
amount of oxygen dissolved in plasma
|
|
|
ETCO2 means
|
end tidal carbon dioxide
|
|
|
a measure of exhaled carbon dioxide
|
ETCO2
|
|
|
properly placed ET tube should contain what percentage of carbon dioxide in exhaled air
|
4-5%
|
|
|
a properly placed a ET tube will turn a colorimetric device ____
|
yellow
|
|
|
if using a colorimetric device what color reading will you get if ET tube is placed improperly
|
purple
|
|
|
when using an ETCO2 detector how many breathes should it take to confirm positive placement
|
6
|
|
|
maximum flow rate that a person can expel air from the lungs
|
peak expiratory flow rate
|
|
|
a lower value when using a peak expiratory flowmeter indicates
|
larger airways are constricted
|
|
|
many pts with pulmonary disease check their peak expiratory flow rate how often
|
twice a day
|
|
|
peak expiratory flow rate below ___ signals significant distress
|
150 l/m
|
|
|
normal peak expiratory flow rates
|
350/700 lpm
|
|
|
most common infection that cause upper airway swelling
|
croup
|
|
|
what should you avoid doing in peds pt with epigotitis or croup
|
do not manipulate the airway, may cause it to slam shut
|
|
|
if peds pts airway is completely constricted what size tube should you use for intubation and how many attempts should be made
|
at least 2 sizes smaller than normal, and 1 attempt
|
|
|
if pt's airway is completely closed and you have attempted one intubation with a tube 2 sizes smaller than normal without success, what is your next move
|
cricothyrotomy
|
|
|
viral infection around glottis most common in pt 6 months- 3 yrs of age
|
croup
|
|
|
pt presents drooling, fever, hoarse voice, with purposeful hyperextension
|
epiglottitis
|
|
|
pt is young adult presents with fever and sore throat, visual inspection of throat reveals lateral abscess
|
peritonsillar abscess
|
|
|
common cause of pmeumonitis in older pt's
|
aspiration of food
|
|
|
3 most common obstructive airway diseases
|
chronic bronchitis emphysema, asthma
|
|
|
chronic bronchitis and emphysema are collecively classified as
|
COPD
|
|
|
condition of reversible airway narrowing
|
asthma
|
|
|
pt's with ___ have large amounts of dead air trapped in their lungs
|
COPD
|
|
|
typical inspiratory to expiratory ratio for healthy pt
|
1:2
|
|
|
Pt with COPD may have I:E ratio of
|
1:6 or 1:8
|
|
|
I:E ratio means
|
Inspiratory to expiratory ratio
|
|
|
greek means panting
|
asthma
|
|
|
condition that reults from widespread (reversible) narrowing of airways
|
asthma
|
|
|
approximately ___ people will die of asthma
|
5000 or 1 in 5 admissions
|
|
|
overall mortality rate for asthma
|
5%
|
|
|
fasting growing asthma rates occur in what population group
|
children younger than 5
|
|
|
asthma is more likely to be deadly in pt under ___ yrs of age
|
35
|
|
|
caused by constriction of the smooth muscle that surrounds the larger bronchi
|
bronchoconstriction
|
|
|
treat increased mucus poduction with
|
water and expectorants
|
|
|
treat bronchospasm with
|
bronchodilator
|
|
|
treat airway edema with
|
corticosteroids
|
|
|
steroids that reduce swelling usually take how long to act
|
few hrs
|
|
|
expectorants are also known as
|
mucolytics
|
|
|
severe prolonged asthma attack that cant be broken up with conventional treatment
|
status asthmaticus
|
|
|
chronic weakening of the terminal bronchioles and alveoli
|
emphysema
|
|
|
most common cause of emphysema
|
smoking
|
|
|
cardiac asthma AKA
|
left heart failure
|
|
|
pt with barrel chest from chronic lung hyerventilation
|
emphysema pt
|
|
|
defined as sputum production most days of the month for 3 months or more
|
chronic bronchitis
|
|
|
pink puffer
|
emphysema
|
|
|
blue bloater
|
chronic bronchitis
|
|
|
COPD pt's are at high risk of
|
sudden cardiac event: l heart failure
|
|
|
sudden weight loss, blood tinged sputum, fever, night sweats
|
TB
|
|
|
CPAP
|
constant positive airway pressure
|
|
|
BiPAP
|
bilevel positive airway pressure
|
|
|
regulation if ventilation is controlled primarily by Ph of CSF
|
pneumotaxic center
|
|
|
what does the hering-breur reflex do
|
terminates inhalation, stops from over infalation of lung
|
|
|
avg ET tube size for adult male
|
7.5-8.5
|
|
|
avg ET tube size for adult female
|
7.0-8.0
|
|
|
avg ET tube size for peds
|
2.5-4.5
|
|
|
size of the proximal end of ET tube
|
15/22
|
|
|
quick way to estimate size of airway opening
|
size of lttle finger, internal diameter of nares, thumbnail
|
|
|
straight laryngoscope blade
|
miller
|
|
|
curved laryngascope blade
|
macintosh
|
|
|
when preparing to intubate how many tubes should you have and why
|
3 tubes, the size you think, 1 smaller, 1 larger just in case you guessed wrong
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macintosh blade is inserted where and directly lift what
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inserted in vallecula, and directly lifts glottis
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miller blade is placed where
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beneath the epiglottis
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3 laryngascope blade sizes most common for peds
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0,1,2
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most common blades sizes for intubating adult
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3,4
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avg ET depth for adult pt
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21-25cm
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clenched teeth
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trismus
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when do you advance tube during nasotracheal intubation
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during inhalation
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drug used as last resort for asthma
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mag sulfate
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MAG dose for asthma
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0.5-2g
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most common diuretics overused by pt's
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beverages
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atelectasis
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alveoli destruction/collapse
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blood in sputum
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hemoptysis
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common site for metastasis of cancer
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lungs
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if hospice pt has narcotic OD what is the proper treatment
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titrate narcan, just enough to restore repiratory drive, do not fully reverse narcotic effects
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one of the most common causes of pulmonary edema
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heart failure resulting from left side AMI
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pt coughing up foamy pink sputum, and crackles asculated in upper lung lobes dx
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pulmonary edema
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