Emergency Care
What is the Organization?
Directions: Read each passage and determine the pattern of organization
p. 174
“Airway Physiology”
In the upper airway, air enters the body through the mouth and nose. The nose is specifically designed
to accept air and through a series of turns and curves air is warmed and humidified as it proceeds
through the nasal passages. The mouth is primarily designed to be the entrance to the digestive system,
but is also an entryway for air, especially in an emergency situation. Distal to the mouth and nasal
passages, air enters the throat or pharynx.
p. 177
“Is the Airway Open?”
You can determine the presence or absence of airway in most patients simply by saying hello. The
patient’s ability to speak is an immediate indicator that he is capable of moving air. At the same time a
person who is unable to speak, or one who speaks in an unusually raspy voice may be indicating to you a
difficulty moving air. ……….
Often it is not immediately apparent if an airway is present. In your CPR class you learned about the
Look, Listen and Feel method. If a person is unconscious, you may need to employ this method to
ensure the airway is present. In this case, look at the chest to see if it is rising and falling. The airway
should be visually inspected for foreign bodies including objects and fluids. You should listen at the
mouth for sounds of breathing, while placing your hands on the chest to feel for movement
p. 179
“The Sounds of a Partially Obstructed Airway”
A partially obstructed airway can often be identified by the sounds of limited air movement.
Understanding these sounds can help you better understand the pathophysiology of the obstruction.
Stridor is typically caused by severely obstructed air movement in the upper airway. As air is forced by
pressure through a partial obstruction, a high pitched almost whistling sound can sometimes be heard.
Typically stridor indicates a severely narrowed passageway of air and suggests near obstruction. In
stridor the obstruction can be a foreign body such as a toy or or it can be caused by swelling of the
upper airway tissue as in infection. The development of hoarseness is often an ominous sign.
For example, in a person whose airway is swelling after a burn, you may note a normal voice to begin
with, but a raspy voice as swelling builds up around the vocal cord. Snoring is the sound of the soft
tissue of the upper airway creating an impedance (or partial obstruction) to the flow of air. Many
persons normally snore while asleep, but snoring in the case of injury or illness can often indicate a
decrease in mental status such as airway muscle tone is diminished. It is also an indication that the
airway needs to stay open. Gurgling is the sound of fluid obstructing the airway. As air is forced
through the liquid, the gurgling sound is made. Common liquid obstructions include vomit, blood and
other airway secretions. Gurgling is a sign that immediate suctioning is necessary.
p. 297
“Skin”
The color, temperature and condition of the skin can provide valuable information about your patient’s
circulation. There are many blood vessels in the skin. Since the skin is not as important to survival as
some of the other organs (like the heart and brain), the blood vessels in the skin will receive less blood
when a patient has lost a significant amount of blood, or the ability to adequately circulate blood.
Constriction (growing smaller) of the blood vessels causes the skin to become pale. For this reason, the
skin can provide clues to blood loss as well as a variety of other conditions.
Phlebotomy text
Coagulation Factors and Pathways
“The Role of Thrombin” (p. 180)
The enzyme, thrombin, plays the major role in coagulation. It is generated at the injured site from
prothrombin (facot II), its precursor form present in the blood. The primary role of thrombin is to
convert fibrinogen to soluble fibrin. Thrombin also amplifies(intensifies) coagulation, supports platelet
plug formation, activates factor XIII to cross link fibrin, and controls its own formation and the
coagulation process by activating protein C, a substance that helps stop thrombin formation. Once
healing has occurred thrombin initiates the breakdown of the fibrin reinforced clot by its role in the
production of an enzyme that causes clotlysis. Thrombin is also thought to play a role in inflammation
and wound healing.
p. 471
Definition
“Acute Coronary Syndrome”
Acute Coronary Syndrome (ACS) sometimes called cardiac compromise, is a blanket term that refers to
any time the heart may not be getting any oxygen. There are many different ways in which patient’s
hearts show that they are in trouble. A coronary artery may become narrowed and blocked , or a one
way valve may stop working properly, or the specialized tissues that carry electrical impulses may
function abnormally.
p. 162 from Phlebotomy text
“Capillaries”
Capillaries are microscopic one cell thick vessels that connect the arterioles and venules, forming a
bridge between the arterial and venuous circulation. Blood in the capillaries is a mixture of both venous
and arterial blood.
p. 166
Phlebotomy Related Vascular Anatomy
Antecubital Fossa
Antecubital means in front of the elbow. Fossa means a shallow depression. The antecubital fossa is
the shallow depression in the arm that is anterior to and below the bend in the elbow. It is the first
choice location for venipuncture because several major arm veins lie close to the surface in this area,
making them relatively easy to locate and penetrate with a needle. These major superficial veins are
referred to as antecubital veins. The anatomical arrangement of antecubital veins varies slightly from
person to person;however, two basic vein arangements, referred to as the H-and M-shaped pattern are
seen most often
p. 159
Phlebotomy text
Listing of Definitions
“Heart Rate and Cardiac Output”
The heart rate is the number of beats per minute. The normal adult rate averages 72 beats per minute.
The volume of blood pumped in one minute is called the cardiac output and averages five liters per
minute. An irregularity in the heart’s rate or rhythm is called arrhythmia. A slow rate, less than 60 beats
per minute is called bradycardia. A fast rate over 100 beats per minute is called tachycardia. Extra
beats before the normal beat are called extrasystoles. Rapid uncoordinated contractions are called
fibrillations