Prehospital Emergency Care Chapter 10

Front 1

pulmonary ventilation

Back 1

the mechanical process of moving air in and out of the lungs

Front 2

external respiration

Back 2

gas exchange between alveoli and surrounding capillaries

Front 3

internal respiration

Back 3

gas exchange between cells and systemic capillaries

Front 4

cellular metabolism

Back 4

glucose broken down in presence of o2 to produce atp and release carbon dioxide and water

Front 5

cricoid cartilage

Back 5

inferior portion of larynx
-is only completely circular cartilaginous ring of upper airway

Front 6

serous fluid (in pleural space)

Back 6

acts as a lubricant to reduce friction when layers of pleura rub against each other

Front 7

chemoreceptors

Back 7

continously montor levels of o2, co2, and ph in arterial blood to stimulate an increase or decrease in resp rythym center to control rate and depth of inhalation.

Front 8

hypoxia

Back 8

inadequate amounts of oxygen being delivered to cells

Front 9

signs of mild to mod hypoxia

Back 9

tachnypnea
-dyspnea (shortness of breath)
-pale, cool, clammy skin
-tachycardia
-elevation in bp
-restlessness and agitation
-confusion
-headache

Front 10

signs of sever hypoxia

Back 10

tachypnea
-dyspnea
-cyanosis
-tahycardia that can lead to dysaritmia
-head bobbing
-sleepy appearance
-slow reaction time
-altered loc

Front 11

hemoglobin picks up what percent of o2 in blood

Back 11

97 percent

Front 12

infants and child and o2 reserves

Back 12

-smaller and limited reserves also faster metabolism so they use oxygen at a much faster rate

Front 13

signs of an open airway

Back 13

air can be felt and heard moving in and out of the mouth and nose
-the patient is speaking in full sentences with little difficulty
-sound of voice normal for patient

Front 14

snoring

Back 14

upper airway parially obstructed by tongue (do head tilt chin lift to fix)

Front 15

crowing

Back 15

sounds like a crow cawing from when larynx muscles spasm and narrow opening into the trachea

Front 16

gurgling

Back 16

sound of gargling, usually indicates some type of fluid in airway (blood, vomit, secretions)
immediately suction

Front 17

stridor

Back 17

high pitched sound during inhalation
-characteristic of significant upper airway obstruction from swelling in larynx

Front 18

head tilt chin lift

Back 18

-place on head on forhead apply firm backward pressure with palm, place tip of fingers of other hand underneath bony part of lower jaw
-head tilted back lift jaw upward
-continue to press other hand on forehead to keep head back
-lift chin and jaw so teeth are brought nearly together

Front 19

when to do head tilt chin lift

Back 19

-unresponsive no suspicion of trauma
-a patient tin cardiac arrest not from trauma
-an apneic patient with no sign of trauma

Front 20

head tilt chin lift for child + infants

Back 20

tilt head back to neutral position
index finger of 1 hand lifts jaw

Front 21

jaw thrust

Back 21

open airway for a spinal injury
-kneel at top of patients head
-grasp angle of patients jaw, move jaw fwd with both hands
-retract lower lip with thumb
-if not effective reposition jaw, if still not effective drop an opa or npa

Front 22

suctioning when?
what ppe?

Back 22

-if hear gurgling sound when assesing airway or providing ventilation suction airway
mask, gloves, protective eyewear

Front 23

types of suction unite

Back 23

-mounted on ambulance
-portable= electric, o2 powered, or hand powered

Front 24

types of suction catheters

Back 24

hard or rigid- called yankuer- inserted to base of tongue or no farther than you can see

-soft suction (french) for nose or nasopharynx more or when hard suction cannot be used (stoma or tracheostomy)

Front 25

applying suction techniques

Back 25

-suction on way out and no more than 15 seconds, infants and children no more than 5 seconds
-if neccesary rinse by applying to suction into bottle of water

Front 26

special suctioning considerations

Back 26

-if secretions cannot be remove quickly, log roll patient on side and finger sweep
-secreting frothy secretions as fast as they're suctioned, suction for 15 seconds vent for two minutes and suction for another 15
-if hr drops stop suctioning and admin o2 prepare to bag
-

Front 27

opa

Back 27

holds tongue away from back of airway
-must have no gag reflix
insert into mouth and twist 180 degrees, flange should rest on teeth(can also do 90 degrees)
-tongue depressor method preferred of insertion in infants and children

Front 28

npa

Back 28

hollow tube with a flange at top and bevel at disatal end
-use in patients who cannot tolerate opa because of gagging or injuries to maxilla, clenched teeth
-do not use of facial trauma to base of skull

Front 29

npa insertion key points

Back 29

-lubricate with water soluable lubricant
-bevel should be facing septum
-if meet resistance rotate it gently from side to side
-

Front 30

auscultation lung sounds

Back 30

2 inches below clavicle on midclavicular and also 4th or 5th intercostal on midaxilary line
breath sounds should be present and equal bilaterally

Front 31

breathing rates (adequate)

Back 31

adult (12-20)
child( 15-30)
infant ( 25-50)

Front 32

breathing rhythm
quality
depth

Back 32

each breath same volume and at regular intervals

-equal full bilateral lung sounds

-chest rise and fall with each inhalation

Front 33

inadequate breathing organs effected most

Back 33

brain, heart, liver
brain will begin to die 4 to 6 minutes without adequate o2

Front 34

respiratory failure

Back 34

rate or tidal volume insufficient

Front 35

respiratory arrest

Back 35

(apnea) pateint stops breathing

Front 36

agonal respiration

Back 36

gasping type breaths, totally ineffective respirations

Front 37

any signs of inadequate breathing do what?

Back 37

ppv

Front 38

methods of artificial ventilation

Back 38

mouth to mask
-bvm 2 person
-frovpd
-bvm one person

Front 39

rates for venting

Back 39

adult 10-12 per minute every 5 or 6 seconds
-infants and children every 3 to 5 seconds 12-20
-newborn 40 to 60

Front 40

indications of good venting

Back 40

tidal volume must be consistent, and sufficient to chest rise and fall
-hr returns to normal
-color improves

Front 41

cricoid pressure

Back 41

can reduce ppv complications associated with ppv, used only in unresponsive patient, reduces gastic distention, regurgitation, and aspiration of gastric contents
-collapses espoghagus behind it against c spine

Front 42

mouth to mouth what percent air?

Back 42

16
not recommended nor is mouth to nose

Front 43

chest rise and fall when delivering vent

Back 43

700-1000 ml

Front 44

advanced airway vent at what rate? (et tube etc)

Back 44

8-10 per minute every 7.5 to 6 seconds, and 100 compressions per minute not pausing for ventilation

Front 45

most common difficulty with ventilation

Back 45

improper head position

Front 46

bvm liters delivered adult and children

Back 46

1-2 liters adult
450-500 ml
(8 or older use adult)

Front 47

what percent o2 for bvm

Back 47

100 percent (close to)

Front 48

couplings on bvm

Back 48

15 to 22 mm that attaches to mask, et tubes, tracheostomy tubes, lma, and combitubes

Front 49

possible bvm problems if inadequate chest rise and fall

Back 49

-check position of head and chin
-check mask seal
-asses for obstruction
-check bvm system
-if still none use alternative ppv
-insert opa or npa

Front 50

FROPVD

Back 50

100 percent o2 delivered
-only adults
-improper use can rupture lungs
-activate valve by button as soon as chest rises left off button

Front 51

Automatic Transport Ventilator

Back 51

-shown to provide and maintain excellent constant rate and tidal volume during vent
100 percent o2
-some cannot be used on children less than 5 yrs old
-must be specially trained on how to use
-appropriate inspiration to exhalation ratio of 1 to 2 seconds

Front 52

stoma

Back 52

surgical opening in front of neck that may be temporary or permanent
(one reason for is tracheostemy)

Front 53

tracheostomy

Back 53

stoma created by cutting through skin to relieve obstruction higher in trachea
-usually temporary

Front 54

laryngectomy

Back 54

stoma because cancer. all or part of patients larynx removed
-permanent

Front 55

bvm to stoma

Back 55

-bvm will connect to
-first suction stoma no more than 3 to 5 inches

Front 56

o2 cylinders

Back 56

under 2000 psi full

Front 57

o2 cylinder letters by size

Back 57

D- 350 liters
E- 625
M- 3000
G- 5300
H- 6900

Front 58

oxygen regulators

Back 58

high pressure - 1 gauge 50 psi to fropvd

therapy- admin o2 o.5 to 25 lpm (one we most often use) 2 gauges

Front 59

o2 humidfier

Back 59

if patient needs to be on o2 longer than 1 hr

Front 60

nonrebreather mask

Back 60

has reservoir bag
-90 percent o2 delivered

Front 61

nasal cannula

Back 61

24 to 44 percent
-use for patient unable to tolerate non rebreather mask and patient who requires low o2
-1 to 6 lpm (4 to 6 national reg)

Front 62

simple face mask

Back 62

60 percent o2
10 to 6 lpm rate

Front 63

partial rebreather

Back 63

looks like nonrebreather but has 2 way valve to allow patient to rebreath 1 third of exhaled air
6 to 10 lpm
35 to 60 %

Front 64

venturi mask

Back 64

common for COPD patients

Front 65

tracheostomy mask

Back 65

* less than 50 % o2
advantages-less traction on on airway assocaited with t tube
-secretions can escape from tube