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Define airway
Movement of air in or out with a single inspiration or exhalation.
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The name of the bifurcation in the trachea is called the ______ and it divides into the right and left ______.
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How far do you insert suction and what is the amount of time to suction?
- As far as you can see, to the base of the tongue.
- 15 seconds.
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What is the average alveolar ventilation in liters that a person will breathe in one minute?
4 to 4.5 L/minute
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What is one cause of wheezing?
- Lower airway obstruction
- Asthma
- Bronchitis
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List five structures of the upper airway
- Nasopharynx (nose)
- Orapharynx (mouth)
- Tongue
- Larynx
- Epiglottis
- Vocal Chords
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Name three complications of hyperventilating your patient.
- Increases intrathoracic pressure
- Barotrauma
- Decreased preload
- Decreased CO
- Gastric distension
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What are the two primary muscles used in respiration?
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Name two adjuncts used to maintain an open airway.
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List seven functions of the respiratory system.
- Transfer of oxygen to the body
- Removal of CO2 and waste
- Temperature
- Homeostasis
- Phonation
- Warm air
- Moisten air
- Filter
- Acid-base balance
- Oxygenation
- Ventilation
- Gas exchange
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List six structures in the lower airway.
- Trachea
- Mainstem Bronchus (L and R)
- Bronchi
- Bronchioles
- Alveolar ducts
- Alveoli
- Lungs
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What is the difference between the right and left lungs?
- Right has 3 lobes
- Left has 2 lobes
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Define oxygenation and ventilation.
- Oxygenation: Saturation of the body with oxygen.
- Ventilation: Movement of air in or out of the body in a single inspiration or expiration
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Name to maneuvers to open an airway.
- Head tilt chin lift
- Jaw thrust
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What is the best indicator that a BVM is working properly?
Equal chest rise and fall.
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What stimulates respiration?
Hypoxic / CO2 drive
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Define dead air space.
- Air between the mouth and alveoli.
- Air that never reaches the alveoli.
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Describe how to measure an OPA. What are two advantages and disadvantages?
- Measure: From the corner of the mouth to the ear.
- Advantages: Blocks tongue from back of the throat, bite block, better than an NPA, can suction through them.
- Disadvantages: Can trigger a gag reflex, cannot use on semi-conscious or conscious, can cause soft tissue trauma, may occlude airway
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Which structure prevents food from entering the trachea?
Epiglottis.
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List the flow rate for a nasal cannula, non-rebreather, and bag valve mask.
- NC: 2-6 L/min
- NRB: 8-15 L/min
- NVM: 15+
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Define respiratory distress.
Inadequate ventilation and oxygenation
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What is the maximum suctioning time and why is there a limit?
- Max: 15 seconds
- Limit: Removal of potential oxygen from patient
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How do you measure an NPA? What are two advantages and disadvantages?
- Measurement: Tip of the nose to tip of the ear.
- Advantages: Can be used on conscious and semi-conscious patients, can be used in patients with a gag reflex, doesn't block the airway, suction through it.
- Disadvantages: Soft tissue injury, epistaxis, easily occluded, may have troubling inserting with a piercing or abnormality, painful
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Define respiratory failure.
Inability to ventilate and oxygenate.
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What is the mechanism that allows for gas exchange at the alveolar level?
Diffusion
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What two techniques make for excellent BVM usage? What two ways can you hold the mask individually? What about with a partner?
- Two techniques: good seal, good technique
- Solo: EC and OK clamps
- Two person: Double EC and thumb method
- Always use two person ventilation if possible.
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What is the primary purpose of performing cricoid pressure when using a BVM?
Prevent gastric distension.
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How often do you ventilate a patient in respiratory arrest with a pulse? What is the rate per minute?
- Rate: 5-6 seconds
- Minute rate: 10-12 times per minute
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What are possible causes of stridor?
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What is the cause of rales/crackles
- Pulmonary edema
- Pneumonia
- Congestive Heart Failure (CHF)
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How do you check fremitus?
- Ask the patient to say "ninety-nine" several times in a normal voice
- Palpate using the ball of your hand
- You should feel the vibrations transmitted through the airways to the lung
- Increased tactile fremitus suggests consolidation of the underlying lung tissues
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How do you change a regulator?
- Check the bottle, make sure it's oxygen.
- Check the expiration date.
- Look for cracks, deformities etc.
- Check the seal of the bottle.
- Check the o-ring on the regulator.
- Crack the bottle.
- Attach the regulator to the tank.
- Turn the tank on, two full turns to the left.
- Apply apparatus to the tank.
- Apply apparatus to the patient.
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What are you assessing when determining a general impression?
Sick or not sick.
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AAOx4 stands for
Alert, awake, and oriented to persons, place, time, and event.
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List four points to note while performing a scene size up
- Scene safety
- BSI
- Number of patients
- Need for additional resources
- MOI or NOI
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The most important part of doing a medical assessment is to:
Get a good history
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What are the four areas checked when a patient has a decreased LOC?
- A: Alert
- V: Verbal
- P: Painful
- U: Unresponsive
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What are the six phases of an assessment?
- Scene size up
- Initial assessment
- Focused medical
- Focused trauma
- Detailed assessment
- Ongoing assessment
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List the three areas and the high and low score of each.
- Eyes: 1-4
- Verbal: 1-5
- Motor: 1-6
- Total: 3-15
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What are two causes of unequal pupils?
- Aniscoria
- Cerebral Vascular Accident (CVA)
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Define aniscoria
Unequal pupils that occur naturally.
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What is the pneumonic used in determining a patient's history?
- S: Signs and symptoms
- A: Allergies
- M: Medications
- P: Pertinent past medical history
- L: Last oral intake / last menses
- E: Events leading up to the problem
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List six findings to look for when assessing an airway
- Sounds
- Phonation
- Mentation
- Color
- Edema
- LOC
- If it is obstructed
- Position
- Patency
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The primary cause of cyanosis is
Hypoxia
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List five findings to look for when assessing breathing
- Rate
- Depth
- Strength
- Color
- Phonation
- Effort
- Sounds
- LOC
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List the five vital signs and the normal ranges for each
- Pulse: 60-100 bmp
- Respirations: 12-20 breaths/min
- Skin: Warm, pink, dry
- Pupils: PERRL
- Blood pressure: 120/80
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List five findings when assessing circulation
- Color
- Strength
- Central vs peripheral
- Temperature
- Bleeding
- LOC
- Rate
- Quality
- Texture
- Capillary refill
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What is the pneumonic that supplements SAMPLE?
- O: Onset
- P: Palliation and provocation
- Q: Quality
- R: Rate
- S: Severity
- T: Time
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What are the four senses and two findings of each used in an assessment?
- Sight - Smoke, DCAPBTLS, color, pupils
- Sound: Breath, lung, BP, history
- Touch: Pain, swelling, temperature, texture, deformity, rigidity
- Smell: Drugs, alcohol, fruity breath, GI bleed
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List five devices you can use to move a patient
- Stair chair
- Butt bucket
- Scoop stretcher
- Gurney
- Sheet
- Back board
- Slider board
- KED
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List 8 mechanisms of injury that lead to a high index of suspicion.
- Starred windshields
- Deployed airbags
- Ejection
- Car vs car
- Car vs human
- Fall from 2x height onto solid surface
- Death of another occupant
- Sudden deceleration
- Prolonged extrication
- Greater than 12 inches protrusion into a vehicle compartment
- Bent steering wheel
- Puncture to the core of the body
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What is bradycardia? List three causes.
- A slow heart rate.
- Hypothermia
- Late hypoxia
- Depressant drugs
- Coronary artery disease
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What does DCAPBTLS stand for?
- D: Deformity
- C: Contusion (scrape)
- A: Abrasion (bruise) or amputation
- P: Penetration or puncture
- B: Burn
- T: Tenderness
- L: Lacerations
- S: Swelling
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What is tachycardia? List three causes?
- High heart rate.
- Exercise
- Hyperthermia
- Hypoxia
- Stimulants
- Shock
- Coronary Artery Disease
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List 4 colors you may see on a patient and two causes of each
- Flushed: Hyperthermia, burns, high blood pressure, allergies, exertion
- Black: Necrosis, death, burns
- Cyanosis: Shock, hypothermia, hypoxia
- Pale: Shock, poor perfusion, hypothermia, burns, hypoxia
- Jaundice (yellow): Hepatitis, alcoholism, gall bladder and liver failure
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List five actions to prevent a back injury
- Consider the patient's weight
- Have appropriate number of people lifting
- Lift with the legs
- Keep feet a comfortable distance apart
- Keep back locked
- Don't reach more than 15 inches
- Bend at needs
- Tighten abdominal muscles
- Avoid twisting
- Keep back straight
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Decorticate posture is:
- Abnormal flexxion
- Arms rolled in, wrists bent
- Legs twisted inward
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List three reasons to do an assessment:
- Scene overview
- Identify life threats
- Identify the problem
- Dictate interventions
- Determine the interventions outcome
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Define decerebrate posture
- Abnormal extension
- Wrists pronated
- Legs stiff and straight
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What two parts of the assessment are done after the focused assessment?
Detailed and ongoing.
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List five devices used to lift and move a patient
- Backboard
- Scoop stretcher
- Gurney
- Stair chair
- Butt bucket
- Slider board
- Sheet
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List five actions to take when lifting a pt to prevent back injury
- When possible, use a stair chair
- Know weight to be lifted
- Ensure enough help is available.
- Use at least two people
- Use an even number of people to lift
- Keep back locked.
- Keep feet a comfortable distance apart
- Avoid reaching more than 15-20 inches
- Tighten your abdominal muscles
- Keep feet flat on the ground
- Keep the center of your body over the object
- Straighten your legs as you lift.
- Keep your back locked into position, don't twist
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List three emergency moves
- Feet drag
- Clothes drag
- Blanket drag
- Shoulder drag
- Forearm drag
- Cradle carry
- Two person carry
- Direct ground lift
- Extremity lift
- Direct carry
- Draw sheet transfer
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Describe why it is important to do a detailed and on going assessment.
In order to continue to identify any problems and also to note if there are any changes in the patient's status
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What does DCAPBTLS stand for?
- Deformity
- Contusion
- Abrasion or amputation
- Penetration or puncture
- Burns
- Tenderness
- Laceration
- Swelling
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What is the most important part of a focused trauma assessment?
Doing the hands on
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What is the most important part of a focused medical assessment?
Getting a good patient history
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List the four senses you must use during your assessment, and what you would note with each!
- Sight: Skin color; pupils; bleeding; facial expressions; posturing
- Smell: Diabetic keto Acidosis; vomit; blood; death; gangrene; GI bleed
- Touch: Diaphoresis; pulse; fracture; dislocation
- Hearing: Blood pressure; history; pain; breath sounds
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Six steps of the initial assessment
- General impression
- LOC
- A
- B
- C
- Priority
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Five findings for airway
- Phonation
- Color
- Position
- Sounds
- Rate
- LOC
- Obstruction
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Five findings when assessing breathing
- Rate
- Depth
- Volume
- Color
- Chest rise and fall
- Color
- Sounds
- Quality
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Five findings when assessing circulation
- Color
- LOC
- Mentation
- Temperature
- Bleeding
- Central vs peripheral
- Capillary refill
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Define ventilation
The amount of air moved in or out during one inspiration or expiration
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Define oxygenation
Saturation of the body with oxygen
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Define perfusion
A constant flow of blood through the capillaries
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How often do you retake vital signs?
- Every 5 minutes on an unstable patient
- Every 15 minutes on a stable patient
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Four colors you may find and two causes of each
- Pale: Shock, hypoxia, burns, poor perfusion
- Cyanosis: Hypoxia, hypothermia
- Red: Hyperthermia, CO poisoning, burns, exercise
- Mottling: Cardiogenic shock, septic shock, hypovelemic shock
- Yellow: Liver failure, gallbladder failure, hepatitis, alcoholism
- Black: Necrosis, burns, frostbite
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List three ways you may find pupils and two causes of each.
- Constricted: Light, narcotic overdose, organophosphates, barbiturates
- Dilated: Head injuries, shock, cocaine, meth
- Unequal: Aniscoria, head injuries
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List five causes of bradycardia and tachycardia
- Bradycardia: Narcotics, hypothermia, head injury, late hypoxia, cardiac disease, beta blockers, calcium channel blockers, ACS
- Tachycardia: Shock, anxiety, meth, cocaine, epinephrine, hyperthermia, dever, infection, exercise, ACS
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What does AVPU stand for? What is it used for?
- Determining the responsiveness of a patient who has decreased awareness.
- A: Alert
- V: Verbal
- P: Painful
- U: Unresponsive
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What does GCS stand for? What are the scores for each section?
- Eyes: Open - 4, Open to verbal command - 3, Open to painful stimuli - 2, No response - 1
- Verbal: Alert - 5, Disoriented - 4, Inappropriate - 3, Incomprehensible - 2, No response - 1
- Motor: Alert - Obeys command - 6, Localizes pain - 5, Withdraws from pain - 4, Decorticate (abnormal flexxion) - 3, Decerebrate (abnormal extension) - 2, None - 1
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