Medical Emergencies (Ch. 15-25)
Terms
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- COPD
- chronic obstructive pulmonary disease; chronic bronchitis - bronchiole lining inflamed, excess mucus formed; emphysema - walls of alveoli break down; HYPOXIC DRIVE (not in asthma)
- ulcer/internal bleeding
- bleeding from w/in digestive tract (from GI tract in vomit or from rectum); bleeding into peritoneal cavity (irritation of peritoneum = abdominal pain and tenderness)
- Stomach
- HOLLOW/DIGESTIVE; expandable organ below diaphragm, connected to esophagus and small intestine, begins breakdown of foods
- generalized seizure
- tonic-clonic/grand mal: unconsciousness and major motor activity, tonic = body stiff, clonic = jerk violently, postictal = convulsions stop; absence seizure/petit mal: brief, temporary loss of concentration or awareness
- renal colic (kidney stones)
- kidney forms stones that go thru ureter on way to bladder; severe flank pain that radiates to anterior area of groin; severe visceral pain w/ nausea and vomiting
- hernia
- protrusion of intestine thru abdominal wall; from heavy lifting or straining; sudden pain; palpated as mass or lump on abdominal wall or creases of groin; only life threatening if causes obstruction or twisting of intestine
- humidified O2
- connected to flowmeter, for long-term, or COPD/child
- Gallbladder
- HOLLOW/DIGESTIVE; stores bile before it enters intestine
- AED Advantages
- allows defibrillators to determine whether pt's rhythm is shockable quickly and accurately; speed of procedure (1. Access interval, 2. Dispatch interval, 3. Ambulance response interval, 4. Assessment and shock interval); safer and more accurate and consistent electrode placement w/ pads
- Inadequate breathing (assessment)
- Rate: Above or below normal; Rhythm: Irregular; Quality: Breath Sounds dim./uneq./absent, Chest Exp. inad./uneq., Efforts labored, accessory muscle use, nasal flaring, seesaw breathing, grunting, retractions; Depth: too shallow
- ventricular fibrillation (VF)
- heart has electrical E, but is totally disorganized
- inspiration (inhalation)
- increasing the size of the chest cavity; intercostal (rib) muscles and diaphragm contract, diaphragm lowers and ribs move up and out
- Symptoms of a heart problem
- chest pain (10-20% cases have none), pain radiates along arms/to upper abdomen/to jaw, dyspnea, anxious (feeling of impending doom), epigastric pain, vomiting, loss of consciousness (heart beating too slow or too fast)
- pocket face mask
- w/ high concentration O = 50%, w/o = 16%
- Nonshockable rhythms
- Pulseless electrical activity (PEA) and asystole
- cholecystitis/gallstones
- inflammation of the gallbladder; severe, sudden epigastric and/or RUQ pain which may radiate to shoulder or back; may be caused or worsened by hi fat foods
- congestive heart failure
- CHF, excessive fluid build-up in lungs because of inadequate pumping; causes edema (swelling); 1. AMI, left ventricle myocardium dies, 2. pulmonary edema (fluid build up in lungs), dyspnea; frothy sputum, 3. right side of heart congested, fluid in feet or ankles (pedal edema), abdomen distended
- expiration (exhalation)
- relaxation of rib muscles and diaphragm; ribs move down and in, diaphragm rises
- Adult chain of survival
- ACDA: Early Access, Early CPR, Early Defibrillation, Early Advanced Care
- Large intestine (colon)
- HOLLOW/DIGESTIVE; absorbs fluid from contents; creates fecal waste
- acute myocardial infarction
- AMI, narrowing or occlusion of coronary artery that supplies heart w/ blood (sometimes b/c of aneurysm of coronary artery); sudden death = cardiac arrest w/in 2 hours of symptoms
- Appendix
- HOLLOW/LYMPHATIC; dead-ended sac of bowel rich in lymphatic tissue
- Small intestine
- HOLLOW/DIGESTIVE; duodenum, jejunum, ileum; removes nutrients from stomach contents as it passes them to colon
- monophasic
- single shock from neg. pad to pos. pad
- Liver
- SOLID/DIGESTIVE/BLOOD REGULATION AND DETOX; regulates carbs, etc. in blood; bile secretion for fat digestion; detox.
- asystole
- ceased generating electrical impulses altogether; from VF, sick heart, terminal illness, severe blood loss
- Causes of seizures
- toxic, brain tumor, congenital brain defects, infection, metabolic, trauma, idiopathic
- AED
- stops heart automaticity so it can start again; Transport: 3 shocks, 3 consec. NSI messages, regains pulse; 2 minutes (5 cycles) CPR; Contraindications: pts < 1 yr. age, hypothermia
- signs of stroke
- hemiparesis, headache (from bleeding from ruptured vessel)
- abdominal aortic aneurysm (AAA)
- ballooning or weakening in wall of aorta as it passes thru abdomen; tearing of internal layer of vessel, blood escapes into weaker, outer layers; developing abdominal pain (sharp or tearing; may radiate to back); sudden rupture = sudden pain; possible inequality btw. femoral or pedal pulses
- stridor
- high-pitched sound heard on inspiration; upper-airway sound indicating partial obstruction of the trachea or larynx
- nasal cannula
- 24-44% O2, 1-6 lpm
- angina pectoris
- pain in the chest (heart muscle deprived of O2 b/c of coronary artery narrowing)
- Conditions requiring O2
- R/C Arrest - CPR 25-33% as effective as circulation; Heart attacks and strokes; Shock; Blood loss; Lung diseases
- retroperitoneal space
- outside peritoneum, btw. abdomen and back; kidneys, aorta, pancreas
- hemorrhagic stroke
- bleeding from ruptured blood vessel in the brain; from hypertension, aneurysm
- Oxygen cylinders
- D = 350 L, E = 625 L, M = 3,000 L, G = 5,300 L, H = 6,900 L; safe residual = 200 psi
- wheezes
- high-pitched sounds, musical, air moving thru narrowed passages in lungs; asthma, chronic bronchitis and emphysema
- Kidneys
- SOLID/URINARY; filter and excrete waste; regulate H2O, blood, electrolyte levels; assist liver w/ detox.
- transient ischemic attack
- small clots temporarily blocking circulation to part of brain; when clot breaks up, symptoms resolve (only short period of hypoxia to affected brain tissue)
- syncope
- fainting; brief loss of consciousness with spontaneous recovery; palpitations, tachycardia/bradycardia, headache
- pediatric airways
- smaller/more easily obstructed, proportionally larger tongue, smaller/softer/more flexible trachea, cricoid cartilage less developed and less rigid, diaphragm heavily depended on
- 4 Rights
- Right PT, RIght Medication, Right Dose, Right Route
- aneurysm
- weakened sections in arterial walls dilate (rupture = stroke)
- appendicitis
- infection of the appendix; nausea and vomiting, pain in area of umbilicus, persistent pain in RLQ
- FROPVD
- 100% O2 at 40 lpm max., every 5 seconds
- epilepsy
- best-known for causing seizures
- crackles
- fine crackling or bubbling sound heard on inspiration, fluid in alveoli or opening of closed alveoli
- oral glucose
- INDICATIONS: pt w/ AMS and Hx of diabetes; CONTRA: pt unresponsive, known diabetic who has not taken insulin for days, unable to swallow; DOSAGE: one tube; ACTIONS: increases blood sugar; SIDE EFFECTS: none when given properly; aspiration in pt w/ gag reflex
- Bladder
- HOLLOW/URINARY; collects urine from kidney prior to urination
- biphasic
- sends shock in one direction and then the other
- thrombus
- formed by clot and debris from plaque; occlusion of blood flow or embolism (move to occlude elsewhere) (heart = attack, brain = stroke)
- stroke
- cerebral vascular accident (CVA); death or injury of brain tissue that is deprived of oxygen; blockage of artery to brain or bleeding from ruptured blood vessel
- CAD
- coronary artery disease
- arteriosclerosis
- stiffening or hardening of artery wall from calcium deposits
- BVM
- oxygen inlet flow of 15 lpm; w/o supp. O2 = 50%, w/ = 100%, bag = 1000-1600 mL air
- atherosclerosis
- build-up of fatty deposits on inner walls of arteries (restricted blood flow)
- hypoglycemia
- low blood sugar; from too much insulin, reduced sugar intake, overexertion, vomiting; AMS; rapid onset, sweaty skin
- dysrhythmia
- irregular, or absent, heart rhythm
- ventricular tachycardia (V-tach)
- organized but rapid rhythm (even pulseless)
- parietal peritoneum
- attached to abdominal wall
- Causes of dizziness and syncope
- hypovolemic (low fluid/blood volume), metabolic (something wrong w/ brain or nearby structures), environmental/toxicological, cardiovascular (tachycardia and bradycardia)
- cardiac compromise
- any problem with the heart
- hazards of O2
- oxygen toxicity, infant eye damage, respiratory depression or arrest (HYPOXIC DRIVE)
- Spleen
- SOLID/LYMPHATIC TISSUE; removes abnormal blood cells and is involved in immune response
- Signs of a heart problem
- diaphoresis, abnormal pulse or BP, palpitations, hypotensive (systolic BP <90), hypertensive (systolic BP >150, diastolic >90)
- visceral pain
- originates from the organs; dull/achy (solid), intermittent (hollow), few nerve endings
- Esophagus
- HOLLOW/DIGESTIVE; carries food from mouth to pharynx to stomach
- parietal pain
- from parietal peritoneum (peritoneal tenderness); direct result of local irritation
- Pulseless electrical activity (PEA)
- muscle itself fails although electrical activity is normal (heart sick or lost too much blood)
- referred pain
- pain felt in a place other than where it originates (gallbladder disease; pain felt in area of Rt. shoulder blade)
- Adequate breathing (assessment)
- Rate: Adult 12-20, Child 15-30, Infant 25-50; Rhythm: Regular; Quality: Breath Sounds P&E, Chest Exp. Ad.&E, Efforts unlabored; Depth: Adequate
- ischemic stroke
- stroke caused by a blockage of an artery supplying blood to brain
- Cincinnati Stroke Scale
- Facial Droop, Arm Drift, Speech
- Shockable rhythms
- ventricular fibrillation and ventricular tachycardia
- NRB
- reservoir bag must first be inflated, flow 12-15 lpm, 80-100% O2
- hemiparesis
- one-sided weakness
- diabetes mellitus
- from decreased insulin production or inability of body's cells to use insulin properly, resulting in hi blood sugar
- Order of Preference for Assisted Ventilation
- 1. Pocket face mask w/ supp. O2, 2. 2-Resc. BVM w/ supp. O2, 3. FROPVD, 4. 1-Resc. BVM w/ supp. O2
- hyperglycemia
- high blood sugar; decrease in insulin, leaving sugar in bloodstream; slower onset, H2O-urination cycle, nausea, acetone-like breath, warm/red/dry skin
- pancreatitis
- inflammation of the pancreas, common in pts w/ chronic alcohol problems, pain in epigastric area, may radiate to back/shoulders
- insulin
- hormone required in order for blood sugar to enter body's cells; produced by pancreas
- suctioning
- intake of 30 lpm air, 300 mmHg vacuum; rigid = Yankauer/tonsil sucker (stimulate vagus nerve), catheters = French (larger); never for longer than 15 sec. (hyperventilate). suction on the way out
- stoma
- clear mucus plugs or secretions, head in neutral position, seal w/ pedi mask
- Pancreas
- SOLID/DIGESTIVE; enzymes assisting in food break down in large intestine; secretes blood sugar regulating hormones into blood
- visceral peritoneum
- covers the organs
- Signs and Symptoms of CHF
- tachycardia, dyspnea, normal or ↑BP, cyanosis, diaphoresis/cool and clammy, pulmonary edema/sputum, anxiety or confusion from hypoxia, pedal edema; LATE = engorged, pulsating neck veins; enlarged liver and spleen, w/ abdominal distention
- tearing pain
- uncommon; tearing sensations; from AAA
- hypoxia
- insufficiency of oxygen to the body's tissues (fire, emphysema, OD on depressant, heart attack); AMS, cyanosis
- prescribed inhaler
- INDICATIONS - resp. emergency, prescribed, med. direction; CONTRA - unable to use, not prescribed, no med. direction, maximum dose taken; ACTIONS - Beta agonist bronchodilator dilates bronchioles, reducing airway resistance; SIDE EFFECTS - increased HR, tremors, nervousness
- inadequate breathing
- breathing that is not sufficient to support life
- partial seizure
- simple: tingling/stiffening/jerking in ONE part of the body, aura; complex: aura, glassy stare, confusion, moving, combative, develop into tonic-clonic
- rhonchi
- lower-pitched sounds like snoring or rattling, secretions in larger airways (pneumonia, bronchitis, aspiration)
- Pediatric chain of survival
- PCAA: Early Prevention, Early CPR, Early Access, Early Advanced Care