Pink Puffer = Emphysema-dominant COPD Why “pink”? - These patients maintain near-normal oxygenation (pink skin) early in the disease. - They compensate with increased respiratory rate → less cyanosis. Why “puffer”? - They breathe with pursed lips to keep airway pressure up and prevent alveolar collapse. - They are thin, barrel-chested, and work hard to breathe (air trapping). Key physiology - Loss of alveolar walls → decreased elastic recoil - Destruction of alveoli → “pink puffer” Blue Bloater = Chronic Bronchitis–dominant COPD Why “blue”? - Chronic bronchitis leads to poor oxygenation → cyanosis - Low O₂ + high CO₂ → “blue” Why “bloater”? - Chronic hypoxia → pulmonary vasoconstriction → cor pulmonale (right-sided CHF) - This causes fluid retention, edema, and a “bloated” appearance. Key physiology - Chronic cough + mucus production for ≥3 months for 2 consecutive years - Airways filled with mucus → V/Q mismatch → cyanosis and hypercapnia 🚨 Modern EMS / medicine perspective These terms are outdated and overly simplistic because: - Many COPD patients have a mixture of chronic bronchitis and emphysema. - Not everyone fits the “pink” or “blue” image. But for exams, they still test well, and the physiology holds.

Which finding suggests a retroperitoneal hemorrhage after blunt trauma?

A hiker lands feet first after jumping from a height, injuring the underside of his foot. Which anatomical term describes the injured area?

You arrive at the scene where a 5-year-old boy fell off a jungle gym. His forearm near the wrist is swollen, tender, and visibly deformed. Distal circulation and sensation are intact. Which term best describes the location of this fracture?

1️⃣ It lowers cerebral perfusion pressure (CPP). CPP = MAP – ICP When you sit a patient straight up (60–90°): - Blood drains out of the brain too quickly - MAP drops - This causes CPP to fall, meaning less oxygen and blood reach the brain Patients with increased ICP are already at risk of brain ischemia → high Fowler’s makes this worse. 2️⃣ It can decrease venous return too much. High Fowler’s: - Reduces central venous pressure - Reduces preload - Can cause a drop in cardiac output - Which again → lowers CPP The brain needs stable blood flow, not sudden drops. 3️⃣ The recommended position is instead 30° (semi-Fowler’s). This is the sweet spot: - Promotes venous drainage from the brain - Reduces ICP - Does NOT significantly lower MAP or CPP This is why nearly all trauma/neuro guidelines recommend: Head of bed elevated 30°, head midline, spine neutral. ⚠️ High Fowler’s may be harmful if the patient is hypotensive. In trauma, TBI, or shock: - Sitting upright worsens hypotension - Hypotension + ICP = catastrophic drop in CPP - CPP < 60 mmHg → brain ischemia and secondary injury