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Baloney > Emergency Medicine - Airway/O2/Shock/Trauma/Burns/Catheter/Eye > Flashcards

Emergency Medicine - Airway/O2/Shock/Trauma/Burns/Catheter/Eye Flashcards

1
Q

Croup - What is inflamed?

A

Inflamation of larynx, trachea, bronchi

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2
Q

Croup - how old is the child?

A

Between 3 months and 3 years - usually in sleep

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3
Q

Croup - Signs and symptoms?

A 
Complication of viral infxn
Difficulty breathing
Crowing sound on inspiration (inspiratory stridor)
Seal like barking cough
NO BIG FEVER - tonsils not swollen
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4
Q

Croup - What to do?

A

Breath cool moist air for 5 minuts
If no improvement after 5 minutes continue to monitor
Watch for fever, increased breathing troubles
If condition worsens transport to hospital

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5
Q

Croup - DDx of Seal like barking cough?

A

SLBC - means inspiratory stridor

Croup
Airway obstruction - more serious
Asthma - more serious

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6
Q

Croup - Xray findings?

A

Steeple sign

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7
Q

Epiglottitis - how old is child?

A

Usually between 3 and 10 yo

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8
Q

Epiglottitis - causes?

A

H. influenza or could be GABHS

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9
Q

Epiglottitis - signs and sx?

A 
High fever
toxic appearance
Difficulty breathing
Inspiratory stridor
Swollen epiglottitis
Head tipped to side and drooling
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10
Q

Epiglottitis - what to do?

A

Do not move neck or open mouth

Must go to ER in EMS transport
Cannot go in parent’s car

Airway management
Antibiotics

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11
Q

Epiglottitis - X-ray?

A

Thumbprint sign in trachea

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12
Q

O2 - when to consider for adult, child, infant?

KNOW THIS

A

O2 needed when bradypnic or tachypnic

Adult - fewer than 12 brpm, more than 20 brpm

Child - fewer than 15 brpm, more than 30 brpm

Infant - fewer than 25 brpm, more than 50 brpm

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13
Q

O2 - Which devices for which victims?

A

Nasal cannula - Breathing victims only w/ minor breathing problems

Non-rebreather - Breathing victims only

Resuscitation mask - Breathing and non-breathing victims - can be used with emergency oxygen

Bag Valve Mask - Breathing and non-breathing victims

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14
Q

O2 - Nasal cannula - flow rate, concentration?

A

Low flow rate, low concentration
Flow Rate: 1-6 LPM
O2 Concentration: 24-44 %

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15
Q

O2 - Resuscitation mask - flow rate, concentration?

A

Second lowest flow rate and concentration
Flow Rate: 6-15 LPM
O2 Concentration: 35-55 %

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16
Q

O2 - Non-rebreather mask - flow rate, concentration?

A

Flow Rate: 10-15 LPM

O2 Concentration: 90+ %

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17
Q

O2 - Bag-valve mask - flow rate, concentration?

A

Flow Rate: 15 LPM or more

O2 Concentration: 90-100%

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18
Q

O2 - What is a non-rebreather mask?

A

Face mask, O2 reservoir bag, one way valve for high concentrations of O2 to a breathing victim

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19
Q

O2 - How to apply non-rebreather mask?

A

Reservoir bag should be sufficiently inflated about 2/3rds full by covering one way valve with your thumb before placing it on victim’s face

If begins to deflate when victim inhales, increase flow rate of O2 to refill the reservoir bag

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20
Q

O2 - Blow by technique for non-rebreather mask?

A

Kids and infants may be frightened so use blow by technique - hold non rebreather mask approximately 2 inches from child / infant face - allows O2 to pass over face and be inhaled

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21
Q

O2 - How to help deliver more O2 with Bag Valve mask?

A

Squeeze the bag as victim inhales to deliver more oxygen

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22
Q

Upper airway obstruction - Treatment?

A

Determine if obstruction mechanical or infectious

  • If mechanical - Heimlich
  • If infectious - consider Epiglottitis (sudden onset in child, can’t swallow, drooling, tripod position, swollen airway, infectious signs)
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23
Q

Choking - Causes?

A

Tongue - most common in unconscious - use head tilt - chin lift or put in Berman / Oral airway C shaped device retracts tongue forward

Vomit - place in rescue position on side

Foreign body - balloons - food

Swelling - allergic rxn/irritant

Spasm - water inhaled suddenly

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24
Q

Choking - how to recognize?

A

Can you hear breathing or coughing? No - may hear high pitched breathing sounds

Is coughing strong or weak? Can’t speak breath or cough

Clutches neck - Turns blue

Treat partial airway obstruction as complete blockage

If coughing strongly, do not intervene as long as conscious

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25
Q

Choking - Heimlich maneuver - how many thrusts, where to place fist in non-pregnant, in pregnant/obese?

A

Don’t call 911 till become unconscious

Non-pregnant/non-obese

  • 5 upward and inward abdominal thrusts-
  • Fist just above umbilicus

Pregnant/obese

  • 5 chest thrusts
  • Fists on sternum
  • if unsuccessful, support chest with one hand and give back blues with other

Continue till successful or till unconscious

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26
Q

Choking - After victim unconscious - How to support victim and what to do while waiting for EMS?

A

Call 911 only when become unconscious
Try to support victim w/ knees while lowering to floor
Assess
- Begin CPR
- After chest compressions check for object before giving breaths

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27
Q

Unconscious victim - What to do when you find someone unconscious?

A

Assess - RAPCAB
R - Responsiveness? Hit floor, speak loud A - Activate EMS
P - Position (side-lying position)
C - Circulation (pulse)
A - Airway (jaw thrust)
B - Breathing (rise fall chest, listen for breath)

If no circulation - CPR - after giving compressions look for object in throat - then give breaths

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28
Q

Choking - Conscious infant?

A

Rescuer seated
Position infant prone on your arm resting on your knee, w/ head downward
5 back blows - check for expelled object
5 chest thrusts - check for expelled objects
Repeat

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29
Q

Choking - Unconscious infant?

A

RAPCAB (Check for responsiveness, activate EMS)

  • Do 2 rescue breaths
  • If breaths don’t go in check for object in throat - then try 2 more breaths
  • If neither set of rescue breaths goes in suspect choking
  • Begin 30 compressions
  • Check throat for objects
  • DO NOT blind finger sweep - only finger sweep if an object is visible
  • Give 2 breaths
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30
Q

Shock - What is it?

A

State of metabolic failure that may be caused by (1) inadequate delivery of oxygen to tissues or (2) improper metabolism of oxygen at tissue site

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31
Q

Shock - What is Early or Compensated Shock?

A

Early / Compensated Shock: Reversible, general SNS reaction, body is compensating to permit organ perfusal

Tachycardia, anxiety, restlessness, apprehension, delayed cap refill, diaphoresis, widened pulse pressure

Treatment preventative, ABC interventions

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32
Q

Shock - What is Late or Decompensated Shock?

A

Late/ Decompensated Shock: Difficult to reverse - system unable to maintain SNS response, starts to decompensate and go into failure - organs not perfused, death follows

Hypotension, confusion, LOC, oluguria, academia

Treatment aggressive, rapid volume resuscitation, medications and invasive procedures

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33
Q

Shock - earliest sign and late sign?

A

Tachycardia earliest sign

Hypotension late sign

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34
Q

Shock - adrenergic responses of autonomic system (SNS) trying to keep you alive?

A

Restless, agitated
Cool clammy skin
Livedo reticularis - mottled skin

35
Q

Loss of Consciousness - Glasgow coma scale?

A

Scale rates:
Eye opening
Verbal responsiveness
Motor responses

36
Q

Shock: Anaphylaxis - 2 KEY Signs and sx?

A

Key signs - Tachycardic + Hypotensive = SHOCK

37
Q

Shock: Anaphylaxis - Signs and sx?

A

Initial signs / sx are apprehension, urticarial, edema, throat sensation

Severe signs / sx are hypotension, LOC, Mydriasis, incontinence, convulsion, sudden death

38
Q

Shock: Anaphylaxis - What to do if giving IV when anaphylactic shock starts?

A

Stop infusion but do not disconnect the line

Change bag and line to NS infusion and run in

39
Q

Shock: Allergic rxns vs. anaphylaxis signs and treatment?

A

Type I IgE allergic rxn: You don’t have the tachycardia + hypotension
- - Treat w/ beta blocker or H1 blocker like diphenydhramine or Steriids

If it keeps going and going, will turn into anaphylaxis

Once you see the tachycardia + hypotension, you have anaphylaxis shock - - you need epinephrine first, then H1 blocker and steroids

40
Q

Shock: Anaphylaxis - What to do?

A

Patient to recumbent position
ABC
- Airway must be patent - inset oral Berman if have, or intubate
- If not breathing, administer Ambu or Rescue breaths

Assess peripheral / emergency BP - if you don’t have a BP cuff - PALPATE

  • Radial - at least 80 systolic - if not then
  • Femoral - at least 70 systolic - if not then
  • Carotid - at least 60 systolic

SO you can see if Heart Rate climbing and Blood Pressure dropping - and if the pulses disappear then it’s a BP crash

41
Q

Shock: Anaphylaxis - Epinephrine IM and Subcutaneous concentration vs. IV concentration?

A

1: 1000 for IM / Subcutaneous / Intratrachial
- IM: 0.5 - 1.0 mg/mL (1:1000)
- SQ: 0.3 - 0.5 ml (1:1000)
- Stronger dose because taken up at slow rate - takes 2 to 10 mins or longer before see pt respond to dose

1: 10,000 for IV only
- IV push 0.1 - 0.2 mg (1-2 mL) (1:10,000)
- Can repeat each 3-5 minutes
- Weaker dose because taken up quickly so would over tax heart - can see pt respond to dose in 1 minute

42
Q

Shock: Anaphylaxis - Diphenhydramine dosage and administration?

A

Diphenhydramine: 50 mg (1 mL) IV stat done after Epinephrine

In allergy may start with 12.5 to 25 mg IV push

43
Q

Shock: Anaphylaxis - Oxygen concentration and administration?

A

Start Oxygen at HIGH concentration right away
~ 15 L / min by mask
If they have COPD - don’t go over 3 L / min in COPD (not based on scientific data but doctors refuse to drop it)

44
Q

Shock: Anaphylaxis - Steroids when and how?

A

Steroids after Epinephrine, Benadryl, Oxygen - by this time will be at hospital and steroids there

If scenario says you are in woods and what to do after Epi, Benadryl, Oxygen - then next treatment is steroids

Steroids keep cytokine storm stabilized s

45
Q

Shock: Anaphylaxis - Steroids and dosages?

A

Dexamethasone: 10 - 20 mg (2.5 - 5 mL)
Hydrocortisone / Solu-Cortef: 100 - 500 mg
Prednisone / Solu-Medrol: 30 - 60 mg

Can be given by IM injection or IV

46
Q

Bioterror: Infection control - How to respond to unknown powder scenario?

A

Typically Anthrax spores

First - Get every one else away immediately
Second - Put on protective mask, gloves goggles, etc
Third - Get the exposed person out of the area and treat them as an exposed person - keep them isolated, keep the powder isolated

Once have signs/sx it is too late to treat - so treat presumptively without doing testing or anything

Tx: Ciprofloxacin first choice, Doxycycline/Minocycline effective

47
Q

Trauma and Triage: Mass casualty scenario basics for real life

A

Basics:

  • Center yourself - remember I am the responder and I need to keep it together
  • Remember your training, gather equipment
  • Your differentials are rule by Hemorrhage and ABCs of airway, breathing and circulation
48
Q

Trauma and Triage: Mass casualty scenario: Who is the last priority?

A

Rule: THE DEAD STAY DEAD :eave them alone even if they look like they need the most help. Leave them to the end.

  • Non-breathing, pulse-less victim is the last priority
  • Victim underwater for 10 or 20 minutes is last priority
  • Kids with open skull fractures are last priority - even if still breathing! You cannot save them unless you are a neurosurgeon in a neurosurgery theater
49
Q

Trauma and Triage: Mass casualty scenario: Order of assessment of scene and victim

A

First - Scene survey (if not asked about, then move on)
Second - Hemorrhage - ABCs are irrelevant if patient is bleeding out of a limb
Third - ABCs

  • Before triaging anyone
  • Hemorrhage first
  • Airway - check and open - if a kid, give 2 rescue breaths
  • Compressions

See www.emergency.cdc.give/masscasualties for flow chart

START Algorithm - - SALT Algorithm

50
Q

Emergency Seizure Tonic-Clonic: DDx for seizure? What to do?

A

Epilepsy - a clinical diagnosis of exclusion to ensure seizure is not from infection, mass or cancer, electrolyte imbalance

Febrile seizures - most common
Toxin ingestion

Don’t put anything in their mouths

Protect patient - get them away from danger - get follow up care - in post ictal state keep them there, don’t let them go anywhere

51
Q

Emergency Head Injury / Trauma: First rule?

A

All patients w/ head injuries and trauma treated as if positive for cervical spinal injury

  • C Spine immobilization
  • Cervical collar
  • Head blocks
  • Long board
52
Q

Emergency Head Injury / Trauma: Treatment?

A

ABCs
Glasgow Coma scoring
Neurological exam
Monitor blood pressure (hypertensive crisis possible)
ALL Pt’s REQUIRE 100% 02 therapy
- - Conscious pt w/ adequate respiration - non rebreather mask
- - Unconscious or impaired respiration - bag valve mask

53
Q

Emergency neck and spinal trauma?

A

Never move head and neck - immobilize

Keep airway open

Throat trauma (eg baseball hit to throat) - throat could swell up and airway

LEAVE IT THERE RULE - don’t pull anything out

54
Q

Emergency trauma and bleeding - what to do and in what order?

A

Primary Survey / Circulation

  • Establish homeostasis
  • Assess obvious hemorrhage
  • Apply pressure to wound - graded pressure w/ pressure bandages
  • Elevate injury above level of heart
  • Vasoconstrictive measures - not more than 30 mm Hg
55
Q

Emergency wound assessment - detailed information about the wound?

A

Time of occurrence

  • reduced bacteria in first 6 hrs (closure)
  • Increased blood supply lengthens exposure time (facial wounds up to 24 hrs)

Exposure of wound
- Possible environmental contaminants

Mechanism of injury

  • Instrument of injury
  • Fragmental mechanism
  • Chemical exposure
  • Cold can extend tissue integrity
56
Q

Emergency wound assessment - Risk of infections of Lacerations, Punctures, Bites?

A

Bites - Highest risk of infection (irrigation necessary, may require delayed closure to allow drainage)

Punctures - High risk of infection (check for foreign bodies)

Lacerations - Reduced risk of infection w minimal tissue injury

57
Q

Emergency wound assessment - highest level of tissue necrosis w/ what type of injury?

A

Crush/Compression injury has highest level of necrosis and hemorrhage risk
Difficult for tissue to heal d/t trauma

58
Q

Burns: Burn size Rule of Nines for adults?

A

Anterior and Posterior head and neck - 9% (4.5 front, 4.5 back)
Anterior and Posterior Arm - 9% per arm (4.5 front, 4.5 back)
Anterior and Posterior Leg - 18% per leg (9 front, 9 back)
Anterior trunk - 18%
Posterior trunk - 18%
Perineum / Genitalia - 1%
————————————-
100%

59
Q

Burns: Burn size Rule of Nines for kids?

A

Anterior and Posterior head and neck - 18% (9 front, 9 back)
Anterior and Posterior Arm - 9% per arm (4.5 front, 4.5 back)
Anterior and Posterior Leg - 14% per leg (7 front, 7 back)
Anterior trunk - 18%
Posterior trunk - 18%
Perineum / Genitalia - 0%
————————————-
100%

60
Q

Burns: 1st - 2nd - 3rd degree?

A

1st Degree = Superficial - mild erythema, heals spontaneously

2nd Degree = Partial thickness - blistering, erythema - deep ones might need grafting to decrease contractures and hypertrophic scarring

3rd Degree = Full thickness - deep past skin layers - damage to nerves, vessels - loss of sensation - needs grafting

61
Q

Burns: What are major burns?

A

2nd degree / Partial thickness burns

  • Major if more than 25% of BSA adults
  • Major if more than 20% of BSA pediatrics

3rd Degree / Full thickness -
- Major if more than 10% BSA

Most burns of face, hands, eyes, ears, feet, perineum

Burns caused by inhalation, electrical, major trauma

Burns to high risk patients (over 55, under 5)

62
Q

Burns: What are moderate uncomplicated burns?

A

2nd degree / Partial thickness burns

  • 15-25% of BSA adults
  • 10-20% of BSA pediatrics

3rd Degree / Full thickness -
- Less than 10% BSA

63
Q

Burns: Circumferential burns damage circulation and tissues how?

A

Circumferential burns are considered major injury

  • Lymphatic / venous obstruction
  • Increased tissue pressure / edema
  • Look at structures affected in area
64
Q

Burns: Inhalational burns damage signs and symptoms?

A

Associated w/ confined spaces

  • Look for soot around nares
  • Sx of stridor, hoarseness, respiratory distress
  • Carboxyhemoglobin level > 10%
  • Consider intubation quickly
65
Q

Burns: Steps in dealing with chemical burns?

A
  • Determine type of chemical exposure
  • Protect yourself first! Wear face mask and gloves
  • Remove chemical if possible (Powder: Brush off / don’t wash off if liquid )
  • Remove associated clothing if smoldering or exposed to chemical
  • Consider inhalation injury (treat airway)
  • Treat wound appropriately to protect skin and underlying structures
66
Q

Burns: How to administer oxygen?

A

Burns are always given O2

  • Non rebreather 100% 15 lpm
  • If impeded respiration use BVM
  • If inhalation injury - intubation to protect airway
67
Q

Burns: When is IV access necessary?

A

IV access necessary in pt w/ 15% or more BSA burns

  • Because cellular fluid loss
  • At lest one large bore IV (> 16 gauge)
  • Inset through non-burned skin
  • Central venous access used for large burns
68
Q

Burns: Fluid Loss - When does maximum fluid loss happen?

A

Burns result in large loss of fluids, electrolytes and proteins through increased capillary permeability

First 6 to 8 hrs after burn is when most loss occurs

69
Q

Burns: Fluid Loss - How much should be given?

A

1/2 of fluid volume in first 8 hrs

Remaining 1/2 over next 16 hrs

70
Q

Burns: Fluid Loss - What fluids are given?

A

Parkland (Baxter) - Lactated Ringers - 4 ml/kg per BSA burned adults

Modified Brooke - Lactated Ringers 2 ml/kg per BSA burned adults - - 3 ml/kg per BSA burned kids

71
Q

Heat Stroke: DDx from heat exhaustion and signs and symptoms?

A

If after spending time in heat outdoors you feel woozy and can still walk, talk and breath - this is heat EXHAUSTION - treat with fluids and rest and will recover

Heat stroke: Lost fluids to the point that you are dry
Loss of thermoregulation - CANNOT SWEAT
Tissue damage
Multi organ failure
Hyperpyrexia
CNS dysfunction
72
Q

Heat Stroke: Response and treatment?

A

Mortality of 10-20% even with treatment - must diagnose and treat immediately

ABCs
RAPID cooling
Replace fluid and electrolyte loss
Treat complications - shivering, seizures, rhabdomyolysis

73
Q

Catheter: Equipment required for urinary catheter?

A

Prepared Foley insertion tray with:

  • Foley catheter (rubber) OR 14-18 French catheter double walled lumen with a 5 mL balloon
  • Urine drain bag
  • Sterile lubricant
  • Sterile syringe (5-10 mL NS)
74
Q

Catheter: Urinary catheter placement procedure?

A
  • Thoroughly cleanse area
  • Lubricate catheter
  • Insert till urine is visualized in tube
  • Advance another 4-5 cm past urine return for balloon placement - full in men
  • Inflate balloon with sterile H2O
  • Attach bag and tape tube to medial thigh for security
75
Q

Catheter: What constitutes significant urinary retention ? What is the risk associated? How to drain safely?

A

No urination for more than 12 hours / urine volume > 500 mL

Risk of SHOCK if rapid bladder drainage when distension present

Drain 300 - 400 mL and let bladder relax for 30 - 60 minutes - then drain balance

76
Q

Eye Trauma: What do you do if there’s a nail or other object in the eyeball?

A

LEAVE IT THERE

Refer to emergency

77
Q

Eye Trauma: General basics when trauma to one eye?

A
  • Let the eye close
  • Put gauze around wound
  • COVER THE NON-WOUNDED EYE to diminish movement of both eyes
78
Q

Eye Trauma: Open globe injuries and what to do?

A

Open Globe

  • Rupture
  • Penetrating laceration
  • Perforating laceration

Less serious - stabilize and send to ER

79
Q

Eye Trauma: Closed globe injuries and what to do?

A

Closed Globe (DANGER OF VISION LOSS)

  • Burn
  • Contusion
  • Laceration (Lamellar)

Danger of bleeding/hemorrhage -> blindness (Hyphema - ant chamber of eye - can result in angle closure glaucoma)

Danger of optic nerve swelling -> blindness

80
Q

Eye Trauma: Assessment of closed globe injury? What are signs of optic nerve swelling?

A
  • Examine wound
  • Examine visual acuity
  • Examine for signs of internal bleeding - Hyphema etc
  • If visual acuity 20-20 and no bleeds, can let them go
  • Optic nerve swelling if Increasing pain and decreasing vision - advise to go to ER immediately
81
Q

Eye Trauma: Chemical burn to eye requires what immediately?

A

Irrigation ALWAYS

  • closest water is best water
  • if no water, put ointment or oil (any kind of oil at hand, in perfect world Vitamin A oil, but even that is second to water) to prevent palpebral and bulbar conjunctiva from sticking together
  • Refer to Emergency
82
Q

Eye Trauma: Flash burn common in what type of work? Treatment for flash burn?

A

Flash burn common in welding

  • Direct cold for 10 mins as hydrotherapy
  • Shredded raw potato poultice used by welders everywhere
  • Vitamin A oil eye application
83
Q

Eye Trauma: Corneal abrasion vs Ulceration?

A

Slit Lamp and Fluorescein Stain Photography to distinguish abrasion from ulceration - so only eye specialist and in ER can do it. In NPLEX, we refer.

Ulceration

  • Damage to cornea
  • Ciliary flush injection in eye
  • Risk of infection, scarring, opacity, blindness
  • Pain management important
  • Lubricate and patch eye and transport to ER

Abrasion

  • Patch worn for 24 hrs to maintain lid closure unless injury < 1mm
  • May need Antibiotics
  • MUST RULE OUT FOREIGN BODY RETENTION before sending patient home (use irrigation and careful examination)

Baloney (37 decks)

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