general.txt

automated external defibrillator

• Contact
• Airborne
• Vehicle
• Vector

Blood settling in lowest point of body in death

• implied: PT unable to consent for some reason, but they would want it.
• Informed: PT gives consent

Face down

on yer back

body is laid flat on the back (supine position) with the feet higher than the head

Back/Head Horizontal, legs raised

• Prone
• Supine
• Trendelenburgs
• Modified Trendelenburgs / Shock
• Fowlers position
• Right Lateral Recumbent
• Left Lateral Recumbent
• Recovery Position

• L/R
• Medial/Lateral
• Posterior/Anterior
• Dorsal/Ventral
• Superior/Inferior
• Proximal/Distal
• Planar/Planter

• Ilium
• Ischium
• Pubis

• Skeletal (aka striated)
• Smooth
• Cardiac

Carina

The space between the pleural membranes that surround the lungs and the chest cavity.

21%

3% ~ 5%

16%

• form of respiratory drive in which the body uses oxygen chemoreceptors instead of carbon dioxide receptors to regulate the respiratory cycle.
• The hypoxic drive is so weak that unconsciousness will develop before respiratory distress is noted.

• CO2
• Hypoxic

12-20

15-30

25-50

60-100

80-100

70-150

100-160

S90-140 D60-80

S80-110

S50-95

• 1 breath per 5 seconds (12 / min)
• 1 breath per 3 seconds (20 / min) if ICP suspected

1 breath per 3 seconds (20/ min)

1 breath per 3 seconds (20/ min)

• 1~6 L/min
• provides 24~44% inspired O2

• 10~15 L/min
• provides 90% inspired O2 @15 L/m

provides 16% inspired O2

• 15 L/min
• provides 55% inspired O2

• 15 L/min
• ~100% inspired O2

Chronic obstructive pulmonary disease

shortness of breath

Intramuscular (IM)

Intraosseous (IO)

Intravenous (IV)

Per Os (PO)

Per Rectum (PR)

Subcutaneous (SQ) or (SC)

Sublingual (SL)

Metered Dose Inhaler

Crackling rattling breath sounds: Fluid in alveoli.

Course gurgling breath sounds: Chronic mucus in airways

Harsh high pitched barking resps: Upper airway obstruction

• Whistle-like tone: caused by air passing through partially obstructed respiratory passages.
• Originating: in smaller lower passages.
• Conditions: Asthma or COPD

Tongue obstructing airway in supine position

• Small clicking, bubbling, or rattling sounds in the lung: Fluid is in the lung in some form.
• They are believed to occur when air opens closed air spaces.

• Air bubbling through fluid in upper airway.
• low pitched and loud: caused by air passing through respiratory passages that have narrowed or been partially obstructed by secretions, edema, tumors, etc
• Gurgles are and often alter in quality after the patient coughs.
• Rhonchi is the older term for gurgles.

harsh and scratchy, somewhat like two pieces of sandpaper being rubbed together: Caused by the rubbing together of inflamed and roughened pleural surfaces.

• located in the left upper quadrant of the abdomen.
• It removes old red blood cells recycling iron.
• Holds a reserve of blood in case of hemorrhagic shock

Movement of limb towards midline

Pt standing facing you, arms at their sides, palms forward.

Ridge on the Sternum lying where the second rib attaches to sternum.

Angle of louis.

Anterior Superior Iliac Spines

Between the Wrist and Metacarpals and the thumb

First part of large intestine into which the ileum opens.

• Thyroid Cartilage (top)
• Cricothyroid membrane (middle)
• Cricoid Cartilage (bottom)

Dorsalis Pedis Artery

Hole in base of skull for spinal cord

Foramen Magnum

Greater trochanter

a band running from the pubic symphysis to the anterior superior iliac spine.

Manubrium

• a conical prominence projecting from the undersurface of the mastoid portion of the temporal bone and is roughly pyramidal or conical in shape.
• A point of attachment for several muscles

a fusion of two bones along the palatal fissure that form the upper jaw.

• Lower jaw
• a fusion of two halves at the mental symphysis.

Vertical line through Axilla (armpit).

Midaxillary line?

Vertical line through clavical

heart muscle

most posterior portion of cranium

visible ear

Sebum

Muscles that act to flex and rotate the head.

small cartilaginous process (extension) of the lower part of the sternum

Xiphoid process

Cheek bones

Sweaty Mofo

Irregular and inadequate respirations

• Sellick manouver
• pressure on the cricoid cartilage to occlude the osophagus when ppv'ing

Shortness of breath

accumulation of fluid in the space between the aveoli and pulmonary capillaries

• inflammation of the lungs
• cough & production of sputum
• Fluid accumulates in lung tissue
• Ability to exchange gasses reduced
• tachypnea

• sore throat, low fever, and an adherent membrane on the tonsils, pharynx, and/or nasal cavity that obstructs the passage of air.
• contagious but rare

• Acute infection with fever, cough, and sputum
• Fluid accumulates in lung tissue
• Ability to exchange gasses reduced
• Tachypnea

• Bacterial infection of Epiglottis
• Pre-shool & school aged kids can have Epiglottis swell to 2 or 3 times size
• Stridor heard
• Sore throat

• Inflammation and swelling of whole airway
• Stridor
• Seal bark cough
• drooling as too painful to swallow

• co-occurrence of chronic bronchitis and emphysema, in which the airways become narrowed.
• Dyspnea

• Dyspnea on exertion
• barrel chestedness
• accessory muscles usage
• Tachypnea
• They may have trouble coughing and lowered amounts of sputum.
• Caused by destruction of structures feeding the alveoli, airflow is impeded and air becomes trapped

• An accumulation of air in the pleural space
• aka a collapsed lung

a buildup of fluid between the layers of tissue that line the lungs and chest cavity.

• Dyspnea
• Acute chest pain
• Hemoptysis
• Cyanosis

• Pro re nata
• "as needed"

Loss of consciousness

• 1. Open the AIRWAY with either head tilt/chin lift or modified jaw thrust, if the airway is clear, check for a gag reflex and maintain the airway with an OPA/NPA
• 2. Check for BREATHING for 10 secs by look, listening and feeling for the rate, rhythm and depth
• 3. lf no breathing, give 2 breaths with a BVM @ 15 L/m
• 4. Check pulse
• 5. If there IS a pulse, continue rescue breathing at 1:5 (12/min) for an adult, or 1:3 (20/min) for a child/infant or a patient with suspected ICP
• 6. If there is NO pulse start compressions 30:2
• 7. Apply the AED while compressions are going on
• 8. After 2 minutes of CPR (5 cycles) analyze using the AED
• 9. If shock advised, deliver 1 shock and then start directly into 2 minutes of CPR starting with chest compressions. No pulse check at this time
• 10. If no shock advised, check pulse,
• a) If no pulse continue with compression for 2 minutes then analyze again (start back at line 6)
• b) If there is a pulse, continue with rescue breathing (start back at line 5)
• Things to remember:
• If in a moving ambulance, stop the ambulance and turn the engine off before analyzing
• If hypothermic (body temp below 35deg) only 1 shock is to be delivered on scene, no more than 3 shocks delivered, or 3 no shock advised

• Color
• Clarity
• Concentration
• Expiry Date

• Medicine
• Dose
• Documentation - of the other 5
• Route
• Time
• Pt

Adult: 15 seconds

Child: 10 seconds

Infant: 5 seconds

exhaling

• nasal flaring
• pursed lips
• cyanosis
• inability to talk
• accessory muscle usage
• tripod position
• unusual breath sounds
• ---wheezing
• ---stridor
• ---rales
• ---rhonchi

• sharp & stabbing
• worsened by deep breaths or chest wall movement
• often caused by inflamation of pleura

partial or complete accumulation of air in pleural space

• Right Atrium to...
• Right Ventrical to...
• Pulmonary Artery to...
• Lungs to...
• Pulmonary Veins to...
• Left Atrium to...
• Left Ventrical to...
• Body to...
• Superior & Inferior Vena Cava to...
• Right Atrium
• repeat for 76 years

Calcium and Cholesterol plaques form on walls of blood vessels obstructing flow and dilation/contraction.

blockage

• inside space of a tubular structure, such as an artery or intestine.
• So, not the lining per se, but the space it encapsualtes, aka "hole".

• Death of tissue.
• not just MI

• 3 - 8 minutes
• rarely longer than 15mins

• dyspnea
• Nausea
• Chest pain
• Diaphoresis

• Pulse: increases & arrhythmias
• BP: could do anything really
• Resps: Normal or dyspnea for Pts with congestive heart failure
• LOC: syncope
• pulmonary edema
• pain/discomfot/pressure in: Chest / Back / neck / lower jaw / arms / abdomen
• without an obvious cause, the sudden onset of...
• --- weakness
• --- N/V
• --- Cold Diaphoresis
• --- mild cyanosis or grey skin,
• --- feelings of impending doom
• --- DEATH!

• MI pain may or may not: be caused by exertion
• MI pain may or may not: be relieved by Nitro
• Does not resolve in a few minutes
• 1/3 of people never seek help (cardiac denial)
• Older women, being the hags that they are, sometimes just think it's "indigestion"

• Ventricular tachycardia (VT)
• 150-200bpm!
• electrical activity starts in Ventricle instead of Atrium.

Ventricular Fibrillation: Disorganized quivering of the Ventricles. Defibrillation resets the fucker.

• Flatline: No electrical activity in the heart.
• Take their wallet, they wont need it.

Heart isn't able to pump enough blood around the body causing lack of perfusion.

• Anxiety & Restlessness
• Air hunger (Pt says they “cant breath” yet they obviously can, their brain is sensing lack of O2)
• Pallor & diaphoresis
• Pulse increases
• N/V
• Dyspnea
• Final stage: BP drops

• Semi fowlers, or if low BP, then supine
• O2
• PPV prn
• Blankets

• Sitting up makes it easier to breath: lying down causes more blood to return to RV and lungs increasing pulmonary edema
• Pt agitated
• Chest pain
• JVD when sitting
• Edema in legs
• High BP
• Rapid Resps
• Rapid pulse
• Accessory muscle usage
• Rales / crackles breath sounds

• NRB 15lpm
• Sit or gurney, legs hanging down
• Reassure

Ventricles not strong enough to pump blood around the body causing buildup of fluid in lungs

Swelling of fluid in body closest to the ground due to CHF

• Hemorrhagic
• Ischemic

Swelling or enlargement of an artery that can burst

• Facial droop: Have the person smile or show his or her teeth
• Abnormal: One side of face does not move as well as the other (or at all)
• ---
• Arm drift: Have the person close his or her eyes and hold his or her arms straight out in front palms up for about 10 seconds.
• Abnormal: One arm does not move, or one arm drifts down compared with the other side
• ---
• Speech: Have the person say, "You can't teach an old dog new tricks," or some other simple, familiar saying.
• Abnormal: Slurred or inappropriate words or mute

• LLR or RLR: paralyzed side down with plenty of padding.
• Elevate the head about 6”

• Eye opening
• Verbal response
• Motor response

• Alert (opens eyes spontaneously): 4
• Verbal (opens eyes to words): 3
• Pain (opens eyes to pain): 2
• Unresponsive: 1

• Oriented conversation: 5
• Confused conversation: 4
• Inappropriate words: 3
• Incomprehensible sounds: 2
• None: 1

• Obeys commands: 6
• Localizes pain (tries to swat your hand): 5
• Withdraws/pulls away from pain: 4
• Abnormal flexion from pain: 3
• Abnormal extension from pain: 2
• None: 1

• They may have a seizure
• They may charge you for a psychic reading

Cerebrovascular Accident: Any interruption of blood flow to the brain resulting in loss of brain function

Brain injury on opposite side of original impact

Coup-contrecoup brain injury

Inability to pronounce speech clearly as a result of the brain not being able to control small muscles of the larynx

They can understand, but not speak back properly

They can speak clearly, but not understand

As a result of fevers

Grand mal

Weakness in one side of the body

Period after a seizure (5 to 30 mins) with laboured breathing and some AMS

Seizures reoccur every few minutes or last more than 30 mins

Rhythmic back and forth motion of and extremity and body stiffness

Lines the abdominal cavity

Covers the organs

Irritation of the peritoneum

Severe intermittent cramping abdominal pain

Pain felt in one body area yet caused by a different area

Pelvic inflammatory disease: generic term for inflammation of the uterus, fallopian tubes, and/or ovaries as it progresses to scar formation with adhesions to nearby tissues and organs.

Sudden onset of pain usually indicating Peritonitis

Loss of appetite

Inflammation of gall bladder

Inflammation of the bladder

• Diverticulitis is swelling (inflammation) of an abnormal pouch (diverticulum) in the intestinal wall.
• These pouches are usually found in the colon

Paralysis of the bowels, stopping peristalsis

Inflammation of the Pancreas

• Polyuria: Frequent and Plentiful pissing
• Polydipsia: Frequent drinking
• Polyphagia: Frequent eating because the cells are starving for glucose

• Diabetic Ketoacidosis: Acids accumulate in the boy when insulin is not available. Caused by Hyperglycemia
• N/V
• Abdominal pain
• Kussmaul respirations: Deep rapid resps

Deep rapid resps: from DKA

Fruity sweet

Hyperglycemia caused

• Hypoglycemia shock
• Insufficient glucose in the blood

Allows glucose to enter the cells

Hives

Urticaria

Released during anaphylaxis. Increase badness or reaction.

Raised swollen well defined area from an insect bite or reaction.

• Inhalation
• Absorption
• Ingestion
• Injection