Relative Fi02 Mouth to Mask
17%
Relative fi02 Mouth to Mask with oxygen supplement
50%
Relative Fi02 Bag valve with oxygen supplement
80%
Relative fi02 demand valve
100%
Relative fi02 ET tube
<90%
Relative fi02 Nasal cannula
30-44%
Relative fi02 Simple face mask
40-60%
Relative fi02 venturi mask
24% most likely
Relative fi02 partial rebreather
35-60%
Relative fi02 total non rebreather
90%
Mild shock
rapid thread pulse, rapid shallow breathing, pale skin, cool clammy, sweaty skin, weakness, dizziness, confusion, decrease in mental status
Moderate shock
Anxiety, agitation, Nausea, Thirst
Late shock
Vomiting, glassy eyes, decrease in mental status(further), Drop in blood pressure, Altered respirations, cyanosis, dilated pupils, coma
Status Asthmaticus
anxiety, wheezing, tachypnea, tachycardia, dyspnea, possible chest tightness(usually no pain), accessory muscle use, prolonged expiratory phase -forcing each breath out, "pursed lip breathing", coughing, does not respond to usual treatment
Acute Asthma attack
anxiety, wheezing, tachypnea, tachycardia, dyspnea, possible chest tightness(usually no pain), accessory muscle use, prolonged expiratory phase -forcing each breath out, "pursed lip breathing", coughing,
COPD
anxiety, may "tripod, dsypena, has trouble getting air in, accessory muscle use, pursed lip breathing, prolonged expiratory phase, abnormal breath sounds (wheezes, or rhonci), cyanosis or ruddiness, barrel chest
Pulmonary Edema
typically starts as mild or pronounced agitation, tachycardia, pale, cool, clammy skin, persistent cough usually non productive, crackles (in the lung base), severe dyspnea especially when lying down, eventually develop cyanosis, productive cough and poss
Pulmonary Embolus
sudden onset of dramatic agitation, Aphrension, sudden dramatic hyperventilation, sudden and dramatic dyspnea with congestion and shortness of breath, pleuretic chest pain (stabbing) especially on inhalation, tachypnea, tachycardia, hemoptysis, cyanosis,
Pneumonia
history of respiratory infection, fever, productive cough (possibly rust colored or greenish mucus) possibly some wheezing, chest discomfort of chest pain
FLU
sudden onset of fever and chills (out of nowhere 102-104), sever headache (photophobia), severe muscle aches and pain (legs and back mostly) cough (with substernal burning), worst symptoms last for 3-7 days but feel dragged down for weeks
Hyperventilation syndrome
usually severe agitiation, anxiety or fright, hyperventilation, progressive signs and symptoms of alkalosis, (light headedness dizziness, numbness, feeling of tightness, muscle twitching, carpal-pedal spasms, tetany, seizures, loss of consciousness
Epiglottis
fever, sore throat (difficulty swallowing, drooling) dyspnea, accessory muscle use, coughing
pleurisy
pleuritic chest pain, cough, history of respiratory infection
Adult Respiratory Distress Syndrome
Dyspnea and tachycardia,crackles
Angina Pectoris
Brought on by exercise, stress or eating to much, Feels like pressure or chest tightness, usually substernal or epigastric, sudden onset (usually 3-5 minutes) not past 10
Myocardial infarction
brought on by exercise, activity or stress (but sometimes nothing), feels like pressure or chest tightness , a weight on the chest, usually feels substernal or epigastric (usually on the left), usually lasts 30 minutes or longer, nausea, diaphoresis, dysp
Left-Sided CHF
slow onset, often over several days- may not be noticed till acute
Dyspnea, Shortness of Breath (SOB), productive cough
Orthopnea difficulty breathing when lying straight (supine)
Sitting up- often found propped p on pillows- may have spent the last eveni
Right sided CHF
Dependent Edema (pedal edema)
Jugular Vein Distention (JVD)
Liver engorgement (ascites)
Hypertensive Crisis
Hypertension with Angina, Pulmonary Edema, Pregnancy or signs of cerebral edema (such as usually severe headache blurred vision/visual disturbances, nausea and vomiting, altered mental status, focal neurological sign or deficits, paresthesias, dizziness,
Hypertensive Emergency
Pulse that is strong bounding
Tinnitus
headache
nosebleed
nausea/vomiting
Dissecting Aortic Aneuryism
P-Lifting heavy weights straining
Q-tearing knife like
R- pain on anterior chest but boring through the back
S very severe, and hits maximum at onset
T Sudden onset
CVA
altered level of cosiousness
hemiparesis, hemiplegia
ataxia, asymmetry of face
unequal pupils, dysarthria
aphasia, dysphagia
incontinence, sudden blurred vision
intense vertigo, hypertension
Bell's Palsy
One sided facial droop
Alert and Oriented
No other neurological deficiets
Grand Mal Seizure
They may have an "aura"
Tonic-Clonic phase
Loss of consciousness
clenched teeth, biting the cheek or tongue, incontinence
post-itcal phase
Absence Seizure
staring into space
little to no body movement (beyond an eye flutter exc)
1-3 seconds "lapses in awareness" but no falling down usually
Focal Motor Seizure
Starts in a group of muscles a "focus"
May progress to include the whole entire arm
May progress to a Grand Mal Seizure
Complex Partial Seizure
attacks of confusion,& loss of awareness with semi purposeful movements, often refusion
Gastric ulcer
persistent pain in the upper abdomen, often described as burning
pain is somewhat or completely relieved by eating bland foods
often have hematernesis or melana
Abdominal Aortic Aneurysm
P-Lifting heavy weights straining
Q-tearing knife like
R- pain on Abdomen but boring through the back
S very severe, and hits maximum at onset
T Sudden onset
Appendicitis
Fever
Anorexia
Nausea/or vomiting
sharp right lower quadrant pain, guarding rebound tenderness
increases over several hours
Esophageal Varices
Massive hematemesis
dramatic hemoptysis- bright red blood
life threatening hypovolemic
Gallbladder inflammation/ cholecystitis
history of recent ingestion of a meal with a lot of fat
gradual onset of sharp pain in right upper quadrant, possibly the right shoulder area after fatty meal
Kidney stone
tremendous pain in the lower quadrants, radiating in pulse-like waves from the rear flank, downward toward the pubic symphysis worsens as the stone is pushed along
anxiety, restlessness
nausea and or vomiting
hematuria
bowel obstruction
crampy pain in the abdomen, usually diffuse
often has abdominal distention
anorexia, nausea and or vomiting
fever
Chronic liver disease
jaundice, ascities, pedal edema, muscle atrophy, decreased clotting, petechiae, varicose veins
pacreatitis
sudden severe LUQ epigastric pain -steady boring through to the back
usually with a history of chronic alcohol abuse
may have abdominal tenderness and or distention
nausea/vomiting
may develop shock
Irritable Bowel syndrome
Abdominal pain, abdominal cramping, gas, bloating, diarrhea or constipation. The pain is described as "worse than childbirth" "a sudden knife like pain that can double you over" can bring you to your knees
Diverticlitis
Abdominal pain (usually LLQ)
Fever
Vomiting
Constipation
GERD
Presents as heartburn
Type 1 diabetes
The patient needs to inject insulin several times per day
an auto immune disease where the body produces antibodies that attack and destroy the pancreatic islet cells
these produce no insulin
Type 2 diabetes
pateints control their disease through diet and exercise and weight loss (they are usually obese or through oral medications that increase the pancreas production of insulin
Diabetic Coma
Gradual onset- often over several days
flushed- dry warm skin (mild fever)
intense thirst dry mouth (if he complains at all)
rapid weak pulse (tachycardia)
hypotension
kussmaul respirations
decreased level of consciousness
nausea, vomiting, abdominal pain
Insulin shock
Rapid onset (often too sudden to react)
headache
pale, cool, wet skin (often soaking wet)
tachycardia pulse may be strong/bounding
weakness, dizziness
agitated restless, uncooperative abnormal behavior, syncope, ALOC
Anaphylaxis
tachypnea, tachycardia, hypotension
red or pale, itchy
dyspnea, wheezing, stridor from bronchospasm
respiratory distress (wheezes)
sigs of hypovolemic with normal skins
Hymenoptera
pain, located swelling, redness
"bully's eye" mark
itching
watch for airway swelling
Asprin Overdose
mild overdose-tinnitus
Larger overdoes it produces gastrointestinal pain & cramping ad hyperventilation to blow of the acidosis
Tylenol overdose
Acute- Few if ay symptoms (possibly a good night's sleep)
Later phase (after a few days maybe a week) general malaise, anorexia possibly cyanosis, followed by acute liver failure
Tricylic Antidepressants
Decreased LOC
Seizures
Cardiac Dysrhythmia
Beta blockers
Cardiac dysthymias
hypotension, bradycardia, cardiac arrest
Narcotics/opiates
decreased LOC
respiratory depression/ hypoventilation
pinpoint pupils
hypotension
Nausea/vomiting
Depressants
decreased LOC
respiratory depression/hypoventilation
loss of muscle coordination
slurred speech
nystagmus (especially alchohol)
bradycardia/hypotension
Stimulants
increased LOC
Tachycardia/HTN
rapid speech
dilated pupils or normal
seizures, muscle twitching, tremors
Chest pain
Hallucinogens
Altered LOC,
tachycardia/ HTN
Visual halluctinations
Seizures
Nystagumus -especially with PCP
hot flashes
Hydrocarbons
Altered LOC
coughing choking
Toxic inhalations
dyspnea, tachypnea
nausea/vomiting
aloc
airway irritation, wheezes or crackles
sore throat, cough
Smoke inhalation
Dyspnea, tachypnea
cough
abnormal breath sounds- stridor, wheezes crackles
watery, irritated eyes
singed facial hairs, eyebrows, nasal hairs
Carbon Monoxide Inhalation
headache- rapid onset out of nowhere
ALOC, confusion, coma
nausea/vomiting
dyspnea, tachypnea, tachycardia
flushed skin
dizziness
Cyanide Gas Inhalation
sudden onset-within minutes of inhalations, within 30 minutes of ingestion
the patient becomes rapidly uncounscious, often falling
respirations are rapid and convulsions at first then slow and gasping
hypotension, seizures, incontinence, cardiovascular co
Chlorine Gas Inhalations
instant onset of burning in lungs and mouth
dyspnea, tachypnea
sever cough
abnormal breath sounds, stridor wheezes
watery, irritated eyes
Phosgene Gas inhalation
An extremely corrosive gas from burning plastics. Does tremendous tissue damage/total destruction of lung tissue and eyeballs on contact
Ammonia Inhalation
A corrosive or irritating gas (used in manufacturing ) and some refrigerator units, tanker trucks on the freeway or railcars.
organophosphate poisoning
Constricted Pupils, Diarrhea, urination, Muscle weakness, Bradycardia, Bronchospasm, Bronchorrhea, Emesis, Lacrimation, Sweating, Salivation, Seizures, GI cramping
Pelvic Inflammatory Disease
Tremendous pain in the lower quadrants
often has a fever
anxiety, restlessness
Nausea/vomiting
abnormal vaginal discharge
Ectopic Pregnancy
abrupt onset of sever, stabbing pain in lower quadrants
abdominal distention, guarding, rigidity
may or may not know she is pregnant
signs/symptoms of shocks
nausea/vomiting
vaginal bleeding may occur
Abrasion
Small amounts of blood loss, with a large amounts of tissue damage
Puncture
Usually very little external blood loss, but there may be significant internal bleeding
Avulsion
A torn loose or torn off piece of flesh (partial or complete avulsion) Often with considerable blood loss Although the vessels pinch off quickly
Incision
A smooth edged cut, typically done with a sharp blade, often they bleed a lot
laceration
A jagged-edged cut, typically done with a somewhat duller blade or piece of metal, ripping the skin rather than cutting it, often they bleed alot
Evisceration
a type of laceration where internal body parts are exposed on the surface of the body(like intestines)
Fractured larynx/ trachea
Obvious signs of injury, edema, hoarseness, stridor, subcutaneous emphysema
1st degree burn
Thermal damage to the first layer of skin only (epidermis), lower layers heated and react by turning red and becoming tender and uncomfortable to touch
2nd degree burn
thermal damage to the first & second layers of the skin (epidermis and dermis) Blisters will appear, and may break making the skin appear moist. Can be red or white color depending on the thermal agent. (hot water may make them appear pale)
3rd degree burn
thermal damage to all three layers of the skin, also cooks blood vessels, so it appears to be dry and leathery- color depends on agent
Minor Burns
No critical areas burned
No respiratory involvement
2nd degree burns to less than 15% of BSA or
3rd degree burns to less than 2% of BSA
Moderate Burns
No Critical areas burned
No Respiratory involvement
2nd degree burns to 15%-25% of BSA
3rd degree burns to 2%-10% of BSA
Severe Burns
Respiratory involvement or inhalation injury
Involvement of "Critical Areas"
2nd degree burns to greater than 25% of BSA
3rd degree burns to greater than 10% of BSA
Airway Burns
burns around face, mouth
Singed facial hair- eyebrows, eyelashes, nasal hair
productive cough-sooty sputum
hoarseness when they try to talk
dyspnea
Dysphagia
history of a burn in an enclosed area
Electrical Burns
frequently associated with significantly greater internal injuries than would be suspected from the appearance of entrance and exit wounds. May cause arrest through ventricular fibrillation activity
Concussion
usually with a transient decrease in level of consciousness followed by complete, and prompt recovery Often the patient will complain of a headache, some light-headedness, dizziness, "grogginess" and some nausea. Patient recovery is measured in minutes an
Cerebral contusion
All those present for a concussion except they are more sever here, and tend to last longer. Usually there are also some of the sign/symptoms of increased intracranial pressure. Patient recovery is measured in hours or more likely days. There may be perma
Epidural hematoma
All the signs of a concussion
ALOC with a lucid interval
S/s may be delayed 1-4 hours
S/s of ICP
Subdural hematoma
All the signs of a concussion
S/s may be delayed up to 2-4 Weeks
Signs of ICP
Intra-cerebral hemorrhage
Sudden onset of an extremely severe headache (sometimes described as the worst headache they have ever felt) then rapid losss of consciousness without regaining it- suddenly falling out of their chair
s/s of ICP
ICP
-increasing systolic blood pressure
-Widened pulse pressure
-Brady cardia (Baroreceptor reflex)
-Altered, abnormal Respiratory patterns
-Deteriorating level of consciousness
-Nausea/Vomiting
-Severe, Persistent Headache
-Pulpillary changes, unequal or dil
Cervical spine trauma
-pain especially upon palpation
-swelling deformity at injury site
-neck muscle spasm and stiffness
-neurological deficits
respiratory compromise
neurogenic shock
loss of bowel control
priapism
Rib fracture
sharp stabbing pleuritic CP, made worse by inspiration
may have an abrasion or contusion (seatbelt)
patient will attempt the splint his own arm
may be hypoventilating due to pain
Flail chest
dyspnea, tachypnea
Floating chest wall segment
cyanosis
subcutaneous emphysema
Pneumothorax
dyspnea, tachypnea
diminished breath sound on one side
sharp stabbing chest pain
Tension Pneumothorax
progressive dyspnea, tachypnea
absent lung sounds on the affected side
JVD
narrow pulse pressure
unequal chest expansion seen on deviation
tracheal deviation
Pericardial tamponade
distended neck veins
dyspnea
narrow pulse pressure
muffled heart sounds
myocardial contusion
CP
bruising over sternum
dyspnea, tachypnea
irregular pulse, dysrthymia
signs of shock
commotion cordis
Sudden death directly following blunt force trauma
Pulmonary contusion
CP
bruising over sternum
Progressive dyspnea
decreased breath sounds on one side
hemoptysis
irregular pulse-dysrthymia
tracheobronchial rupture/laceration
severe respiratory distress
stridor, hoarsness (if able to talk)
subcutaneous crackling sensations to touch
decreased or unequal breath sounds
hemotypsis
tachycardia, hyptension
cyanosis
hemothorax
signs of severe shock
respiratory distress
decreased or absent breath sounds on one side
Blunt abdominal trauma
pain and tenderness often diffuse, sometimes local "point" tenderness
abdominal "guarding" abdominal rigidity
abdominal distention
signs of surface wounds abrasions, discoloration, bruising
nausea and or vomiting
s/s of shock
Sprain
May have "heard" the injury
Pain and tenderness often significant enough to prevent walking
swelling often significant especially of the ankle
discoloration often delayed sometimes by 24 hours
strains
may have "heard" the injury
Pain and tenderness can be significant but usually "discomfort" is more likely- extreme point tenderness
Dislocation
Usually dramatic deformity
Pain usually extreme
swelling occurs but takes time, and may be masked by the deformity
discoloration occurs but may take time possibly many hours
Inability to move
Fracture
Deformity often present, but not always
pain and tenderness usually significant pain
swelling edema occurs but takes time
discoloration occurs but takes time
Usually can be moved, it isn't moved because it hurts to much to do so
Crepitus
Patient heard it
Frostbite
pale, waxy appearing cold skin
usually painless(clubbing= using their hand as a club beating it against their thigh)
very delayed or more likely, no capillary refill
usually also hypothermic
Heat Syncope
Very similar to Heat Exhaustion but body temperature, Water & salt balance are all normal
Heat Exhaustion
Fatigue, malaise, drowsiness, headache, confusion, weakness,dizziness, syncope, rapid thread pulse, hypotension, pale,soaked skin, usually cool, thirst, muscle cramps, abdominal cramps, nausea/vomiting/possibly diarrhea
Heat Cramps
Muscle cramps of legs and muscles being used the most, and sometimes in the abdomen, history of prolonged heavy exertion in high heat, nausea, body temperature normal
Heat Stroke
Hot dry skin. All other s/s are exterional
Exertional heat stroke
Hot,wet, pale skin, ALOC-bizarre behavior, tachycardia/hypotension, seizure, dilated pupils
Air embolism
Dizziness, confusion, headache, dyspnea, chest discomfort or chest pain, neuro deficits which can mimic CVA( unequal pupils, ataxia, dysarthria, unconsciousness, seizures or Cardiopulmonary arrest
Barotrauma
tinnitus or ruptured eardrum, small amounts of blood leaking from the ear,nosebleed, can be coughing up small amounts of blood
Decompression Sickness
Join pain- May be "bent" over, "Diver's itch" Paresthesias, Headache, general fatigue, malaise, dyspnea, dysarthria, ataxia, nausea, Vomiting, vertigo (dizziness)
Acute Mountain Sickness (AMS)
Headache, Dyspnea, Nausea, Vomiting, Anorexia, Insomnia
High Altitude Pulmonary Edema
Delayed onset of symptoms-usually developing on 2nd or 3rd night after working strenuously for 1-2 days, Dyspnea and SOB (after significant rest), Crackles, fatigue, tachypnea, tachycardia at rest, hypotension
HACE
Delayed onset of symptoms(likely 1-3 days after arrival), ataxia is primary identifier, sever lack of energy, impaired mental function, confusion or hallucinations, focal neurologic deficits
Black Widow Bite
Usually no reaction, little or no redness or pain, symptoms delayed 1/2 to 2 hours, systemic muscle pain, extreme abdominal pain, muscle cramping, chest tightness, dyspnea, abdominal rigidity, may develop hypertensive crisis, seizures
Brown Recluse Bite
Minimal pain initially, symptoms usually delayed 2-8 hours, fever/chills, nausea/vomiting joint pain, local tissue necrosis
Scorpion Sting
little or no redness, no discoloration, instant onset of fairly sever pain, muscle cramps, paresthesias, muscle twitching, possible seizures, excessive salivation, nausea/vomiting, hypertensive crisis is possible as is circulatory collapse
Jellyfish sting
Instant burning pain at site, shock is possible, but rare
Stingray sting
instant burning pain at site, muscle spasm and pain, can cause partial paralysis, shock is possible
Rattlesnake bite
puncture wounds (1-4), progressive rapid swelling in the area, pain in the area, weakness, diaphoresis, metallic or rubbery taste in mouth, discoloration below the surface due to bleeding
Rabies
Incubation period is 9 days to under 1 year (2 weeks to 4 months is normal), Although the "furious dog" type is most common a large percentage of animals present with the "paralytic or "dumb dog" type that is they are not snarling or attacking, but are la