Cardiac Tamponade 1. Remember medical assessment when answering questions (order of operations!) a. Scene Size-up b. Primary Assessment c. History Taking d. Secondary Assessment e. Reassessment 2. Review the O2 cheat sheet a. 3. Know your lung sounds & what they indicate/where they’re heard a. Normal breath sounds. These are clear and relatively quiet during inspiration and expiration b. Snoring breath sounds. These usually indicate a simple, but potentially dangerous upper airway obstruction, usually caused by the tongue or a foreign body c. Wheezing breath sounds. These suggest an obstruction or narrowing of the lower airways, most prominent on expiration d. Crackles. Wet, crackling breath sounds, usually both inspiration and expiration, may indicate fluid in the lungs e. Rhonchi. Congested breath sounds may suggest the presence of mucus in the lungs. Expect to hear low-pitched, noisy soundsthat are most prominent on expiration f. Stridor. This is often heard before even listening with a stethoscope and may indicate that the patient has an airway obstruction in the neck or upper part of the chest. Expect to hear a brassy, crowing sound that is most prominent on inspiration 4. What is the difference between assisted & artificial ventilations? When do we use them? a. Assisted ventilation: purpose is to improve overall oxygenation and ventilatory status of the patient; use when a patient isin severe respiratory distress or respiratory failure and not breathing adequately b. Artificial ventilation: purpose isto give ventilation; use when patients who are in respiratory arrest 5. What is passive ventilation? a. Movement of air in and out through chest compressions 6. When would you use the mouth to mask technique for providing ventilations? a. Artificial Ventilation technique b. For patients who are in respiratory arrest 7. Know airway suctioning times for adults, children & infants a. Adults: <= 15 seconds b. Children: <= 10 seconds c. Infants: <= 5 seconds 8. What is external respiration? a. External respiration (pulmonary respiration) is 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 lOMoARcPSD|12263423 Downloaded by Anna Maina (annamurugijoe@gmail.com) 9. What do chemoreceptors sense? a. Chemoreceptors monitor the levels of oxygen, carbon dioxide, hydrogen ions, and the pH of the cerebrospinal fluid b. Central chemoreceptorsin the medulla respond quickly to slight elevationsin carbon dioxide or a decrease in the pH of the cerebrospinal fluid c. Peripheral chemoreceptors, in the carotid arteries and the aortic arch, are sensitive to decreased levels of oxygen in arterial blood as well as to low pH levels 10. What is the most significant issue with suctioning a patient’s airway? (*hint: what else are we suctioning out besides secretions?) a. Besides secretions or vomitus, suction units also have to deal with solid objects such as teeth, foreign bodies, and food 11. What is the hypoxic drive & what does it do? a. A secondary control of breathing that is based on levels of oxygen dissolved in plasma (usually for patients with COPD who always have high level of CO2) b. This is as opposed to the primary control of breathing that uses carbon dioxide as the driving force 12. Know the indications/contraindicationsfor using OPAs & NPAs a. OPA i. Indication (1) Unresponsive patients without a gag reflex (breathing or apneic) (2) Any apneic patient being ventilated with a BVM ii. Contraindication (1) Conscious patients (2) Any patient (conscious or unconscious) who has an intact gag reflex b. NPA i. Indication (1) Semiconscious or unconscious patients with an intact gag reflex (2) Patients who otherwise will not tolerate an OPA ii. Contraindication (1) Severe head injury with blood draining from the nose (2) History of fractured nasal bone 13. When would use of a CPAP be indicated? a. Alert and able to follow commands b. Obvioussigns of respiratory distress c. Breathing rapidly, >26 breaths/min d. Pulse oximetry reading <90>