Lectures

• Determining level of distress(mild, moderate and severe) through: LOAs, work of breathing, position and skin(colour/condition/temp)
• Sweating without any labour is really bad.
• Auscultation is a very important assessment and should be done earlier on
• Good medical history: recent illness, hospitalizations, changes to mental status, changes in physical ability, changes in medications, recent injuries or traumas, surgeries, medical devices and disabilities
• If someone is altered, ask if that's how they always present
• Ask about over the counter medications
• Ask how allergies present and what type of reactions you may have
• These calls warrant the cardiac monitor: VSA, unconscious/altered, collapse, suspected cardiac ischemia, moderate to severe SOB, CVA, overdose, multisystem trauma, electrocution/submersion injuries, environment injuries, abnormal vitals and if requested by receiving staff
• Medical patients typically involve a single body system
• Tell PTs what you're doing, what you've found and what your treatment plan is
• Medical scenarios must have 6 auscultations minimum
• Wheezing is heard louder in the bronchi than the periphery because the bronchi contain more smooth muscle
• Capnography is the vital sign for ventilation
• capnography helps in: ensuring SGAs and ETs are placed in the correct position, cardiac arrests/predicting viability and ROSC, management of TBI and respiratory assessments(especially asthma)
• Capnogram: waveform of the CO2 in gases
• Capnograph: capnogram waveform + numerical value
• Qualitative measure of ETCO2 includes litmus paper that changes colour upon contact with exhaled air
• Sidestream of ETCO2 is connected to a cardiac monitor
• The order for ETCO2 attachment on a BVM goes: mask -> filter -> ETCO2 -> BVM
• Hyperventilation leads to hypocapnia while hypoventilation leads to hypercapnia
• An increase in CO2 during CPR can be an early indicator of a ROSC
• A ETCO2 of less than 10 mmHg eludes to non-survival within an arrest while a value greater than 30 mmHg eludes to survival
• For patients who injured their head, maintain ETCO2 between 30 to 35 mmHG
• In a ROSC, maintain ETCO2 between 30-40 mmHg, don't hyperventilate
• ETCO2 measures Metabolism, Perfusion and Ventilation
• Pulse oximetry measures oxygenation(respiration) while capnography measures ventilation
• If over you hyperventilate in a ROSC, you may cause free oxygen radicals
• Capnography and Pulse oximetry should be used in Tandem
• In qualitative Capnometry, the litmus paper changes from purple to brown to yellow in that order
• Phase 1 is the beginning of exhalation and it represents most of the anatomical dead space within the lung
• There are 4 phases to a capnogram
• Phase 2 represents when the alveolar gas mixes with the gas in the dead space and CO2 begins to shoot up
• Phase 3 is the elimination of CO2 from the alveoli and it's where the waveform proceeds upwards slowly but starts leveling off
• ETCO2 is measured at the apex of phase 3
• Phase 4 represents inspiration
• A increased phase 3 slope indicates an obstructive lung disease

  
• Release of a tourniquet and admin of sodium bicarbonate can cause a sharp increase in ETCO2
• Sloping of the capnogram correlates to bronchospasm and obstructive lung disease
• Pulmonary embolism increases the dead space in the lungs which decreases ETCO2
• If you have to squint to see v-fib, it's asystole/fine v-fib so don't shock