Chapter 12- 15 EMT - 12 lead EKG cheat sheet acls class paramedic paper work sheet for anyone that PDF

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12 lead EKG cheat sheet acls class paramedic paper work sheet for anyone that needs some extra help...

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Chapter 12- Shock Shock and Resuscitation Applies a fundamental knowledge of the causes, pathophysiology, and management of shock, respiratory failure or arrest, cardiac failure or arrest, and post-resuscitation management.

Pathophysiology • Perfusion is the circulation of an adequate amount of blood to meet the cells’ current needs. – The body is perfused via the circulatory system. – Organs, tissues, and cells must have adequate oxygenation or they may die. •

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These three parts can be referred to as the “perfusion triangle.” (Heart, Blood Vessels, blood) – When a patient is in shock, one or more of the three parts is not working properly. Blood pressure is the pressure of blood within the vessels at any moment in time. – Systolic: peak arterial pressure ( left ventricle, contraction or pressure) – Diastolic: pressure in the arteries while the heart rests between heartbeats (Systemic vascular resistance- this is your constant pressure in your body) Pulse pressure is the difference between the systolic and diastolic pressure

Pulse pressure is the difference between the systolic and diastolic pressures. – Pulse pressure signifies the amount of force the heart generates with each contraction. A pulse pressure less than 25 mm Hg may be seen in patients with shock •

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Perfusion requires more than just having a working cardiovascular system. – Adequate oxygen exchange in the lungs – Adequate nutrients in the form of glucose in the blood – Adequate waste removal, primarily through the lungs

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Hormones are triggered when the body senses pressure falling. (epinpherine and norepinephrine) – Cause an increase in: • Heart rate • Strength of cardiac contractions • Peripheral vasoconstriction

Shock – CO=HR x SV Balance- homeostasis

Cardiogenic Shock • • • • •

Caused by inadequate function of the heart A major effect is the backup of blood into the lungs. Resulting buildup of pulmonary fluid is called pulmonary edema. Cardiogenic shock develops when the heart cannot maintain sufficient output to meet the demands of the body. (think traffic jam on 95) Edema is the presence of abnormally large amounts of fluid between cells in body tissues, causing swelling.

Obstructive Shock • Caused by a mechanical obstruction that prevents an adequate volume of blood from filling the heart chambers. (if It can’t expand well, it wont contract well) • Three of the most common examples: – Cardiac tamponade ( Sack around the heart will collect blood and it will not rupture) Collection of fluid between the pericardial sac and the myocardium (pericardial effusion) becomes large enough to prevent ventricles from filling with blood. – Caused by blunt or penetrating trauma – Signs and symptoms are referred to as Beck triad.

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Tension pneumothorax (collapsed lung)- with tension squeezing heart – Caused by damage to lung tissue – The air normally held within the lung escapes into the chest cavity. – The lung collapses, and air applies pressure to the organs, including the heart and great vessels. – Pulmonary embolism – A blood clot that blocks the flow of blood through pulmonary vessels – If massive: • Can result in complete backup of blood in the right ventricle • Leads to catastrophic obstructive shock and complete pump failure

Distributive Shock • Results from widespread dilation of small arterioles, small venules, or both • The circulating blood volume pools in the expanded vascular beds. • Tissue perfusion decreases. • Septic Shock (severe infection, toxins damage vessel walls) • Neurogenic Shock (usually result of high spinal cord injury, brain conditions, tumors, pressure on spinal cord, spina bifida…Muscles in the blood vessel walls are cut off from the nerve impulses that cause them to contract.) • Anaphylactic Shock (lift threatening allergic reaction) • Psychogenic Shock (usually caused by own brain, fear, self-induced)

Hypovolemic Shock • Result of an inadequate amount of fluid or volume in the circulatory system • Hemorrhagic causes and nonhemorrhagic causes • Occurs with severe thermal burns Intravascular plasma is lost • Dehydration, the loss of water or fluid from body tissues, can cause or aggravate shock. – Fluid loss may be a result of severe vomiting and/or diarrhea. The Progression of Shock • The stages in the progression of shock: – Compensated shock: early stage when the body can still compensate for blood loss – Decompensated shock: late stage when blood pressure is falling – No way to assess when effects are irreversible • Must recognize and treat shock early

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blood pressure may be the last measureable factor to change in shock. – When a drop in blood pressure is evident, shock is well developed. – Particularly true in infants and children – Expect shock in many emergency medical situations – Also expect shock if a patient has any one of the following conditions: – Multiple severe fractures – Abdominal or chest injury – Spinal injury – A severe infection – A major heart attack – Anaphylaxis

Emergency Medical Care for Shock • As soon as you recognize shock, begin treatment. – Follow standard precautions. – Control all obvious bleeding. – Make sure the patient has an open airway. – Maintain manual in-line stabilization if necessary, and check breathing and pulse. – Comfort, calm, and reassure the patient. – Never allow patients to eat or drink anything prior to being evaluated by a physician. – If spinal immobilization is indicated, splint the patient on a backboard. – Provide oxygen and monitor patient’s breathing – Place blankets under and over the patient. – Consider the need for ALS. – Do not give the patient anything by mouth, no matter how urgently you are asked. – Accurately record the patient’s vital signs approximately every 5 minutes throughout treatment and transport.

Treating Cardiogenic Shock Neurogenic Shock- Provide spinal immobilization Anaphylaxis- administer epinephrine, a mild reaction may worsen suddenly Psychogenic Shock- In uncomplicated case of fainting Hypovolemic shock- control all obvious external bleeding, recognize internal bleeding Older patients – have more serious complications than do younger ones. -illness is not just a part of aging -many older patients take medications that mask or mimic signs of shock -Treating an older patient in shock is no different than treating any other shock patient.

Chapter 14 Patient AssessmentFocused on: NOI (nature of illness) Symptoms (subjective, once you can prove it it’s a sign) Chief complaint Assessment may be difficult with uncooperative or hostile patients. - Maintain a professional, calm, nonjudgmental demeanor - Refrain from labeling patients - A frequent caller may have a different complaint this time. - Establish an accurate medical history. - Use dispatch information to guide initial response. - Do not get locked into a preconceived idea of the patient’s condition. - Injuries may distract from the underlying condition. History Taking • Determine what the problem is or what may be causing the problem. • Gather a thorough history from: – The patient – Any family, friends, or bystanders • For an unconscious patient, survey the scene for medication containers or medical devices. • Obtain a SAMPLE history and use the OPQRST mnemonic • Record any allergies, medical conditions, and medications. • Some patients take numerous medications; take the medications with you to the hospital.

TACOS • • • • • •

Tobacco Alcohol Caffeine Over-the-counter medications/herbal supplements Sexual and street drugs Scan the scene for clues about the patient’s medical history.

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Infectious Diseases General assessment principles: – Approach like any other medical patient. – Perform scene size-up, take standard precautions, and complete primary assessment. Gather patient history using OPQRST to elaborate on the patient’s chief complaint Epidemic and Pandemic Considerations Epidemic: new cases of a disease in a human population substantially exceed what is expected Pandemic: a disease outbreak that occurs on a global scale

Chapter 15 – Respiratory Emergencies Respiratory Distress -Still good - Adequate rate and tidal volume - Patient is compensating - Administer oxygen to maintain an Spo2 of 94% or higher Consider CPAP or BVM - Rate, tidal volume or both are inadequate - May deteriorate to respiratory arrest - If they are not breathing do not put them on CPAP -Cessation of respiratory effort -Leads to cardiac arrest in minutes -Immediately intervene with bag-valve-mask, ventilations and supplemental oxygen. THERE ARE MANY CAUSES OF RESPIRATORY DISTRESS, BUT ASSESSMENT AND BASIC EMERGENCY CARE IS THE SAME Abnormal breath sounds: Wheezing Rales Rhonci

Metered- Dose Inhalers and Small-Volume Nebulizers -Beta2 Bronchodilators -MDIs or SVNs -Broncholdialtors cause relaxation of the bronchial smooth muscle Side Effects: Tachycardia, tremors, nervousness, dry mouth, nausea, vomiting

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Chronic Obstructive Pulmonary Disease (COPD) Slow process of dilation and disruption of airways and alveoli Caused by chronic bronchial obstruction May be the result of lung and airway damage from infection or inhalation of toxic gases Tobacco smoke can create chronic bronchitis. Emphysema is most common type of COPD. • Loss of elastic material in the lungs • Excess mucus is produced, obstructing small airways and alveoli • Causes include inflamed airways, smoking. Most patients with COPD have elements of both chronic bronchitis and emphysema. Patients with pulmonary edema will have “wet” lung sounds. Patients with COPD will have “dry” lung sounds. Can be easily confused with congestive heart failure

Emphysema- “Pink Puffer” Barrel chest Anxious Dyspnea Orthorpnic ( positional breathing ) Thin Appearance Speaks in short jerky sentences Purse lip breathing Minimal Cyanosis

Chronic Bronchitis “Blue Bloater” Airway flow problem Color Dusky to cyanotic Recurrent cough Hypoxia Cardiac Enlargement Leads to right side heart failure: Bilateral Pedal Edema Hypercapnia -Elavated pco2 -permanent....