Electrical conduction system of the heart Depolarization and repolarization produce pumping action SA node AV nodebundle of His purkinje fibers ventricles Layers of blood vessels and their functions Locations of pulses on a human body and how to palpate them Carotid artery pulse –upper neck Femoral artery pulse – groin Radial artery pulse – wrist, at base of thumb Brachial artery pulse – on the medial aspect of the arm, midway between the elbow and shoulder Posterior tibial artery – behind and slightly below medial malleolous Dorsalis pedis pulse – on top of the foot Inhalation, exhalation, respiration, ventilation Anatomy of the upper and lower airway Sternal notch (Jugular notch), Xiphoid process Sternal notch – p. 195 Xiphoid process – p.195 Spinal Column (Total and individual vertebrae) 33 bones in total Cervical – C1 to C7, Thoracic – T1 to T12, Lumbar – L1 to L5, Sacral – S1 to S5, Coccygeal – C1 to C4 Three types of muscle in the human body 1) Skeletal muscle – also known as voluntary muscle. Striped appearance 2) Smooth muscle – found in blood vessels and intestines. Also known as involuntary muscle. 3) Cardiac muscle – can generate its own electrical pulses Anatomy of lung, how many lobes each lung has Right lung – upper, middle, lower lobe Left lung – upper and lower lobe Mechanism of breathing (how do we breath)/ negative pressure breathing Inhalation – diaphragm contracts and moves down slightlyenlarging thoracic cage from top to bottom intercostal muscles contract move ribs up and outs pressure in cavity falls and air rushes in (negative pressure) Exhalation – diaphragm and intercostal muscle relaxvolume of chest cavity decreases, increasing pressure air pushed out Parts of the skull p.194 Blood flow through the heart Right side of heart receives bloom from veins of body (enters from superior and inferior vena cava) right atriumtricuspid valveright ventriclepulmonary arteryblood oxygenated in lungs Oxygenated blood in lungspulmonary veinsleft atriumleft ventricleaortic valveaortaarteries Major coronary arteries and what they supply Supply blood to heart Signs of normal and abnormal breathing Adults (12-20 breaths/min) Normal Children (12-40 breaths/min) Normal Infants (30-60 breaths/min) Normal Characteristics of Normal Breathing o Normal rate and depth (tidal volume) o Regular rhythm or pattern of inhalation and exhalation o Clear, audible breath sounds on both sides of chest o Regular rise and fall movement on both sides of the chest o Movement of the abdomen Inadequate Breathing Patterns in Adults Labored breathing Muscle retractions Pale, cyanotic (bluish or grayish skin tone), cool, damp skin Tripod position Agonal gasps Types of lung sounds Crackles(rales)– a crackling, rattling breath sound that signals fluid in the air space of the lungs. (Congestive heart failure, pulmonary edema) Rhonchi – coarse, low-pitched breath sounds heard in patients with chronic mucous in the upper airways. (COPD, Pneumonia)…sounds like snoring. Stridor – a harsh, high-pitched respiratory sound, generally heard during inspiration, that is caused by partial blockage or narrowing of the upper airway; may be audible without a stethoscope. Location of organs in the abdomen (quadrants) p.227 Functions of the liver, pancreas, bile ducts, appendix, pancreas, urinary system, gallbladder Pancreas – below and behind liver. Exocrine portion secretes 2L of pancreatic juice daily, that aids in digestion of fat, starch, and protein. Endocrine portion (islets of Langerhans), produces insulin and glucagon (regulate glucose levels) Liver – beneath diaphragm, rids body of toxins, produces bile which aids in digestion of fat, stores sugar and starch for immediate use. Bile ducts – ducts connect liver to intestine. Appendix – small tubular structure in lower right quadrant of abdomen. Gallbladder – stores bile. Factors that impair ventilation Intrinsic factors: infections, allergic reactions, tongue obstruction, medications, Extrinsic factors: trauma, foreign body airway obstruction Ventilation/perfusion (V/Q) mismatch Ventilation/perfusion ration and mismatch o Air and blood flow must be directed to the same place at the same time. o Ventilation and perfusion must be matched. o Failure to match is the cause of most abnormalities of oxygen and carbon dioxide exchange. o Gas exchange does not take place. o Lack of O2 in the bloodstream. o CO2 is recirculated within bloodstream. o Severe hypoxemia can occur. What is respiratory compromise and what negative effects does it have on the human body Types of shock with signs and symptoms for each along with treatment Refer to Block 2 homework Anaerobic and aerobic metabolism Aerobic – metabolism in prescence of oxygen Anaerobic – metabolism in the presence of oxygen Functions of central chemoreceptors in the medulla Respond to increases in CO2 and changes to pH in the CSF. Tripod position and what does it indicate Indicates dyspnea Trouble breathing Surfactant Fluid in alveoli that helps reduce surface tension of alveoli, keeps them expanded, making it easier for gas echange between carbon dioxide and oxygen. Steps for insertion of an OPA/NPA and indications and contraindications for each OPA Intrapulmonary shunting How can toxic chemical inhalation cause pulmonary edema Most significant complications associated with oropharyngeal suctioning Proper suctioning techniques (15 sec -2 min rule) Anaphylaxis characteristics Respiratory alkalosis vs acidosis Acute hyperventilation syndrome signs and symptoms and treatment What happens if your initial treatment fails, what next? Dyspnea Hypoxic drive External respiration Acute Coronary Syndrome Ischemic heart disease EMT treatment for rales with respiratory distress Passive ventilation Mouth-to-mask technique with a one-way valve Primary assessment/secondary assessment End tidal Carbon dioxide (ETCO2/capnography) Tuberculosis Treatment for active bleeding (Hint: what are the steps to stop the bleeding) Know indications, contraindications, side effects, and dosage of all medications an EMT would administer to a patient. How to calculate the appropriate dosage for activated charcoal How does medications affect geriatric patients Field treatment for Pts with low BP Functions of the sympathetic and parasympathetic nervous system What happens when the heart requires more oxygen? Alupent is used for Steps of CPR adult and pediatric patients (You should know this from your BLS CPR card….depth compression to ventilation ratio, compressions per minute, one person and two person CPR) Visceral and parietal peritoneum What is an abdominal aortic aneurysm (AAA) and S/S Kussmaul respirations Proper EPI administration with auto injector S/S of sympathomimetic drug overdose Side effects of atropine administration How are airborne substances diluted? Silent heart attack Functions of the brain stem Functions of the kidney Pulmonary Embolism and associated risk factors Osteoporosis and how it increases an elderly Pts chance of broken bones Melena Hematemesis Guarding Rebound tenderness Last vital sign to change from compensated to decompensated shock Pulsus Paradoxus Venturi Mask Function of the spleen 12 pairs of ribs attach to which section of the spinal column Beta blockers drugs and how they mask shock Subcutaneous emphysema What is jugular venous distention and why does it occur Carbon monoxide poisoning and Pt treatment What happens to the patients respiratory pattern when the level of arterial carbon dioxide rises above normal Signs and symptoms of a patient on an opioid OD and your treatment for the patient. Methicillin-resistant Staphylococcus aureus (MRSA) ****Remember if the patient is conscious and alert, denies pain but automatic blood pressure reading is high, take a manual blood pressure.****** S/S of compensated and decompensated shock Layers of the skin and what’s contained in each layer Most cardiac arrest in the field occur as a result of what Airway obstruction treatment for an adult, pediatric patients, and pregnant or large individuals (Partial airway obstruction and full airway obstruction) How can cardiac output decrease if the heart rate beats too fast What two things are cardiac output affected by V-tach, V-fib and treatment Nitroglycerin administration prior to EMS arrival 12 lead placement of the electrodes V1-V6. How to avoid gastric distention when bagging a patient Treatment for gastric distention in a patient that’s receiving positive pressure ventilation Asthma Peripheral vasoconstriction Communicable disease CHF right vs left Bones that form the pelvis Proximal, distal, medial, lateral Pertinent negative and pertinent positive Why is BP not taking on patients younger than 3 Routes of medications Mucosal atomizer device (MAD) Hypoglycemia, hyperglycemia, hypotension, hypertension Difference between viral hepatitis and toxic-induced hepatitis? Methicillin-resistant Staphylococcus aureus (MRSA)
