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West Coast EMT Block 2 Study Guide
electrical conduction of the heart - The flow of electrical current causes smooth, coordinated heart contractions; they produce pumping action of the heart Depolarization - electrical charges on the surface of the muscle cell change from positive to negative Repolarization - the heart returns to its resting state, and the positive charge is restored to the surface Where do the electrical impulses begin? - Electrical impulses begin high in the atria in the sinoatrial node, travel to the atrioventricular node and bundle of His, and then move through the Purkinje fibers to the ventricles Three types of muscle - skeletal, cardiac, smooth Skeletal muscle - Voluntary muscle/Striated muscle (characteristic stripes): Movement of the body like waving or walking/ Skeletal muscle is attached to the bones of the skeleton Smooth muscle - Found within blood vessels and intestines Cardiac muscle - found only within the heart and is able to create and conduct its own electrical impulses
Ligaments - Connect bone to bone Tendons - Ropelike structures that connect muscles to bones Cartilage - Smooth connective tissue that covers the ends of bones at mobile joints Anatomy of lower airway: delivers oxygen to alveoli - Trachea (windpipe): conduit for air entry into the lungs; divides at the carina into two main stem bronchi, right and left Bronchioles: dilate and constrict as oxygen passes through them Small bronchioles connect to alveoli: site of oxygen and carbon dioxide exchange Thyroid cartilage (adam's apple): forms the anterior part of the larynx Cricoid cartilage: immediately below the thyroid Cricothyroid membrane Anatomy of upper airway - Nose, Mouth (Oral Cavity), Jaw (mandible), Tongue, Pharynx, and Larynx (Voice Box) The Larynx - Does not tolerate any foreign or liquid material and any contact will result in a violent episode of coughing
front and back Transverse (axial) plane - Top and bottom Saggital (lateral) - Left and right Midsagittal (midline) - Left and right (equal halves) Blood flow through the heart - Super Vena Cava --> Rt atrium --> Tricuspid --> Rt ventricle --> Pulmonic valve --> Lungs --> Lt atrium --> Mitral valve --> Lt ventricle --> aortic valve --> aorta --> Body The right (slower pressure) side of the heart pumps blood from the body through the lungs The left (high pressure) side of the heart pumps oxygen-rich blood to the rest of the body Arteries - carry blood away from the heart Veins - Blood vessels that carry oxygen-poor blood back to the heart Central pulses - Carotid artery pulse (at the upper portion of the neck) Femoral artery pulse (in the groin)
Peripheral pulses - Radial artery pulse (at the wrist at the base of the thumb) Brachial artery pulse (on the medial aspect of the arm, midway between the elbow and the shoulder) Posterior tibial artery pulse (posterior to the medial malleolus) - in the inside of the ankle) Dorsalis pedis artery pulse (on the top of the foot) White blood cells - Fights infection Red blood cells (hemoglobin) - transports oxygen Plasma - Transports carbon dioxide Plasma (water) - transports wastes and nutrients Platelets - clotting (coagulation) Chemicals within the plasma - controls (buffer) pH Organs in the right upper quadrant (RUQ) of abdomen -
Detoxification of blood Elimination of waste Pancreas - Exocrine: enzymes for protein, carbohydrate and fat breakdown Endocrine: (islets of Langerhans) produces insulin and glucagon to regulate the amount of glucose in the blood Bile ducts - Connects the liver to the intestine The major function of bile is the digestion of fat Gallbladder - stores and concentrates the bile produced in the liver urinary system - Eliminates nitrogenous wastes from the body. Regulates water, electrolyte and acid-base balance of the blood. Diffusion - Movement of molecules from an area of higher concentration to an area of lower concentration. Ventilation - the physical act of moving air into and out of the lungs
Oxygenation - the process of loading oxygen molecules onto hemoglobin molecules in the bloodstream Respiration - the actual exchange of oxygen and carbon dioxide in the alveoli as well as the tissues of the body Inhalation - The active, muscular part of breathing The diaphragm and intercostal muscles contract, allowing air to enter the body and travel to the lungs. The chest expands Thoracic cage expands and air pressure within the thorax decreases, creating a vacuum When air pressure outside equals air pressure inside, air stops moving. Gases, such as oxygen will move from an area of higher pressure to an area of lower pressure until the pressures are equal. Activated Charcoal - Action: absorbs toxic substances in digestive tract Indications: most oral poisonings Contraindications: decreased LOC; overdose of corrosives; causatics (substances such as acid or an alkali), or petroleum substances Side effects: nausea, vomiting, constipation, black stools Dose: adult dose is 1-2 g/kg of body weight (divide weight in lb by 2.2) Spinal column (total 33 bones) -
Side effects: hypertension, tachycardia, anxiety, restlessness Epinephrine (EpiPen) - Action: stimulates nervous system, causing bronchodilation Indications: Anaphylactic reaction Contraindications: chest pain of cardiac origin, hypothermia, hypertension Dose: 0.3 mg for adult; 0.15 mg for children Side effects: hypertension, tachycardia, anxiety, restlessness Naloxone (Narcan, EVZIO, auto-injector) - Action: Reverses respiratory depression secondary to Opioid overdose Indications: Opiod poisoning Contraindications: hypersensitivity Dose: Adult dose is 2 mg Intramuscular or IN Side effects: nausea, vomiting Nitroglycerin (Nitrostat, Nitromist) - Action: Dilates blood vessels Indications: chest pain of cardiac origin
Contraindications: hypertension, use of sildenafil (Viagra) or another treatment for erectile dysfunction Dose: 0.3-0.4 mg SL; 0.4 mg spray Side effects: Headache, burning under tongue, hypertension, nausea Oral glucose - Action: Provides glucose for cellular use Indications: low blood glucose (hypoglycemia) Contraindications: decreased LOC, nausea, vomiting Dose: 1/2-1 tube Side effects: vomiting, nausea Acetaminophen (Tylenol) - Action: analgesic and fever reducer Indications: relief of mild pain or fever, headache, muscle aches Contraindications: hypersensitivity Dose: 500-1,000 mg every 4 hours as needed; dose is weight-based for children Side effects: allergic reaction
Tidal volume - the amount of air (in mL) that is moved in or out of the lungs during one breath Residual volume - the air that remains in the lungs after maximal expiration Minute volume - the volume of air moved through the lungs in 1 minute; calculated by Tidal volume X respiratory rate Dead space - the portion of the tidal volume that does not reach alveoli and thus does not participate in gas exchange Metabolism (cellular respiration) - The biochemical processes that result in production of energy from nutrients within the cells. Respiration - the process of exchanging oxygen and carbon dioxide. Occurs by diffusion, in which a gas moves from an area of greater concentration to an area of lower concentration External Respiration (pulmonary respiration) - the process of breathing fresh air into the respiratory system and exchanging oxygen and carbon dioxide between the alveoli and the blood in the pulmonary capillaries Surfactant - A liquid protein substance that coats the alveoli in the lungs, decreases surface tension and keeps the alveoli expanded to make gas exchange easier A low level in the premature infant contributes to respiratory distress syndrome
anaerobic respiration - Respiration in the absence of oxygen. This produces lactic acid, and can't meet the metabolic demands of the cell aerobic respiration - Respiration that requires oxygen, where cells convert glucose into energy Ventilation/Perfusion Ratio and Mismatch - Air and blood flow must be directed to the same place at the same time (ventilation aka air flow, V and perfusion aka blood flow, Q must be matched) When ventilation is compromised but perfusion continues, blood passes over some alveolar membranes without gas exchange taking place. Carbon dioxide is recirculated within the blood stream, which could lead to hypoxemia When blood flow is compromised, less oxygen is absorbed in the blood stream and less carbon dioxide is removed Intrapulmonary shunting - blood entering the lungs from the right side of the heart bypasses the alveoli and returns to the left side of the heart in an unoxygenated state Respiratory compromise - The inability of the body to move gas effectively. Epiglottis - A flap of tissue that seals off the windpipe and prevents food from entering. Pharynx - throat; passageway for food to the esophagus and air to the larynx
Supplies the digestive system what do the Pulmonary arteries supply? - Carrie's oxygen poor blood to the lungs Snoring breath sounds - These suggest an obstruction or narrowing of the lower airways Wheezing breath sounds - These suggest an obstruction or narrowing of the lower airways. Wheezing is a high-pitched whistling sound that is most prominent on expiration. Crackling breath sounds (rales) - Wet, crackling breath sounds that indicate fluid in the lungs Rhonci breath sounds - Congested breath sounds that suggest mucus in the lungs Stridor breath sounds - high-pitched, harsh sound caused by a spasm or swelling of the larynx or an obstruction in the upper airway Spleen - filters out old red blood cells, produces some white blood cells, and removes pathogens and antigens your body has already attacked and killed Factors that impair ventilation - blocked airway impairment of the breathing muscles
obstructed airway (asthma) chest trauma change in altitude change in atmosphere allergic reaction impairment of movement of gas in cell membranes What are the pump failure types of shock? - Cardiogenic shock Obstructive shock what are the poor vessel types of shock? - Anaphylactic shock Psychogenic shock Neurogenic shock Septic shock what are the low fluid volume types of shock? - Hypovolemic shock Cardiogenic shock - Shock, or lack of perfusion, brought on not by blood loss, but by inadequate pumping action of the heart. It is often the result of a heart attack or congestive heart failure. Obstructive shock - Shock that occurs when there is a block to blood flow in the heart or great vessels, causing an insufficient blood supply to the body's tissues. -cardiac tamponade
vasodilatory shock - A type of shock related to relaxation of the blood vessels, allowing blood to pool and impairing circulation. Hypopoelemix shock - Abnormal decrease in blood volume tripod position - an upright position in which the patients lean forward onto two arms stretched forward and thrusts the head and chin forward. This suggests a difficulty in breathing Functions of chemo receptors in the medulla - montors levels of Oxygen CO Hydrogen ions pH of cerebrospinal fluid provide feedback to respiratory centers
