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NPLEX botanical > EMERGENCY MEDICINE > Flashcards

EMERGENCY MEDICINE Flashcards

1
Q

adult oxygen

A

<12bpm or >20bpm

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2
Q

child O2

A

<15bpm or >30bpm

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3
Q

infant O2

A

<25bpm or >50bpm

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4
Q

shock

A

tachycardia and hypotension

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5
Q

what order of meds for anaphalaxys (shock?_

A

epinephrine > diphenhydramine > steroids

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6
Q

Epi Dilution for im?

A

1:1000, so stronger dilution when the epi is shallower

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7
Q

epi dose for IM?

A

0.5-1mg/ml (1:1000)

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8
Q

epi dose for sq

A

Epi pen: 0.3-0.5ml (1:1000)

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9
Q

Epidilution for IV

A

1:10,000, so more dilute because its getting put deeper into a vein

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10
Q

How much IV epi?

A

IV push: 0.1-0.2mg (1-2ml) repeated every 3-5 minutes (x3?)

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11
Q

what happens after IV eppi

A

IV epi, 1-2ml (1:10,000) followed by:

  • greatest concentration of oxygen.
  • Then steroids of No EMS is availalable.
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12
Q

what steroids for after epi IV?

A

Hydrocortison or prednisone or

dexamethazone

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13
Q

flow rate of O2 for COPD

A

under 3LPM

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14
Q

Rules for bioterrisim

A

1: minimize exposure
2: control infection

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15
Q

proper protection for bioterrism, anthroax

A

PPE, mask, gloves

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16
Q

how to treat anthrax?

A

Presumptively

CiprofloXacin or doxycycline before there are symptoms.

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17
Q

Who do you help first in in triage

A

Those who are not dead:

  • 1st: Uncontrolled bleeding
  • 2nd: ABC, airway, breathing, circulation
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18
Q

who should you not help in triage if there are others who need you

A
  • dead (assume so if)
  • pulseless breathless
    >20 minutes under water
  • kids with open skull fracture.
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19
Q

Difference between burns

A

1st degree: minor
2nd degree: partial thickness
3rd degree: Full thickness

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20
Q

How to determine degree of burn by area covered?

A 
2nd degree: 
- >25% of adult
> 20% of child
3rd degree:
>10%
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21
Q

what is rule of 9 for burn

A 
whole arm: 9
Whole leg: 18 (9 front/9back)
Abdomen: 9
Chest: 9
Back: 18 (9 lumbar/9 thorasic) 
Head: 9
groin: 1%
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22
Q

when should you start IV for a burn victom?

A

When >15% of body is burned. (they’ll be losing hydration through burn area)

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23
Q

For inhalation injury?

A

Highest O2 flow with highest outflow.

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24
Q

What O2 delivery for the LOW FLOW (1-6L)

A

Nasal canula 1-6

Venturi mask: 4-8L

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25
Q

what O2 delivery for LOW Concentration: under 45%

A

All but the non rebreather mask can delever less than 45% oxygen
Nasal Canula (25-45)
Simple face mask 35-60)
Venturi rebreather: allb but the green mask.

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26
Q

what mask gives the highest % of O2?

A

Non rebreather mask gives higest O2: 60-80%

at the highest flow: 10-15:

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27
Q

what masks if you want to be precise about oxygen delivery

A

Venturi mask: 4-8 L /24-60% O2

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28
Q

When to use simple face mask?

A

Higher % of O2 with lower flow rate.
35-60%
6-10 liters.

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29
Q

Chemical burns:

A

Don’t add water except to flush Eye:

avoid self exposure.

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30
Q

Heat stroke

A 
Not able to sweat.
1- ABC
2 - rapid cooling
3: replace fluids/electrolytes
4: treat complications
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31
Q

Short term catheter

A

French short term

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32
Q

Long term catheter

A

Foley

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33
Q

When to catheter?

A

Urinary retention: >12 hours

Urinary volume: >500ml

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34
Q

caution in catheterizing people?

A

If you drain more than 300-400 could cause shock: wait 30-50 minutese to continue draining.

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35
Q

what are the most dangerous eye injuries

A

Closed globe injuries are more dangerous.

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36
Q

Why are glosed globe injuries more dangerous:

A

Could also have orbital or skull fruactures, and optic nerve damage

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37
Q

why is increasing eye pain and decreasing vision over time dangerous?

A

can be swelling to optic nerve.

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38
Q

why should you check visual aquity

A

if its wrong can be sign on internal bleeding.

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39
Q

hyphema

A

Problem in Anterior chamber can cause acute glaucoma

Can be seen in direct trauma.

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40
Q

subconjunctival hemorrage.

A

Bruise that is self limited, if vision is stable then its ok.

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41
Q

what to do for chemical burn.

A

Irrigate with water
if no water put ointment or oil
then send to ER

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42
Q

what if there is damage to cornea

A

Send to ER:

lubricate, patch for 24 hours, keep lid closed. Foreign body must be ruled oute

43
Q

how can you see corneal ulceration?

A

Fourescein die and

slit lamp

44
Q

what about welding flash burn?

A

Shreaded raw potato pultice,
vitamin A oil.
Hydrotherapy.
cold water X 10 min direct

45
Q

Rules of basic live support

A

RAP
R- responsiveness: trap squeeze
A- Activate EMS
P: postion on back,

46
Q

order of resussitation

A

Compression first (30)
Airway: head tilt, chin lift.
Breath: Occlued nose, 2 breaths.

47
Q

what if chest tdoesn’t rise

A

air in stomach or obstruction

48
Q

what if person is unconcious but their vitals are good

A

Place on left side.

49
Q

how deep chest compression

A 
Adult: 2 inch/100/min
- 30/2 adult and alone.
Alone: 15/2
child: 15/2, 
infant: 2 fingers, 1/2in deep. 15/2 if 2, 30/2 if alonw
50
Q

When do you activate AED?

A

Adult: immediately
Infant: after 2 minutes of CPR if alone. In this case do 30/2

51
Q

when can you stop doing CPR

A

Unsafe
to exhaused
help arrives
patient moves.

52
Q

when does brain damage start

A

At 4-6 minutes

53
Q

complications of CPR

A

Vomiting: put on left side, wipe vomit from mouth, continue.

54
Q

what type of O2 for CPR?

A

Bag-valev- mask.

55
Q

signs birth is imminent?

A

contractions every 2-3 min or less
crowning
urge to push

56
Q

how to prep mom

A
  • get her comportable
  • Drap over abdomen and legs
  • Drape under her.
  • Wash hands**
57
Q

how does baby come out

A
  • Head down
  • head rotate 90 deg
  • one shoulder after the other.
  • clear airway
  • baby turns up
  • feet come last.
  • check airway
  • dry baby
  • wrap baby.
  • put bably on mom
58
Q

how to clear baby airway

A

compress chest, lungs expand
After Birth: compress chest, or 2 breaths.
check pulse, CPR if needed. EMS aftr 2 min.,

59
Q

what goes to hospital?

A

Mom
Baby
placenta

60
Q

most concerning for baby?

A

airway
breathing
prevent heat loss

61
Q

when is cord cut?

A

2 ties 4 and 6 inches from baby, cut between, not sooner thant 3 minutes.

62
Q

when is placenta passed

A

30-60 minuts post birth. Ensure its intact.

63
Q

what is apgar based on.

A 
Airway
Grimace
pulse
activity
respiration
64
Q

what if nuchal cord

A

cord around neck, unwind it if possible.

no pushing baby back in.

65
Q

prolapsed cord

A

cord out first: EMERGENCY. C section

66
Q

meds for uterine hemorrage

A

Oxytocin

misoprostal

67
Q

what can cause uterine hemorrage

A

Clotting disordrders
retained tissues.
lacerations of genitals
Soft boddy uterus

68
Q

why is group B strep a concern

A

neonatal sepsis and meningits

69
Q

neonatal eye infx

A

GC/CT:

  • .5 erythromycin
  • 1% tetracycline
70
Q

how to screen for eptopic

A

serum HCG
full pelvic exam
TVUS
EMS, Treat shock

71
Q

normal ABC for infant

A

0-1: 120-80/40-40rmp
1-5: 100, 100/60, 30 RPM
5-10: 80, 120/80, 20

72
Q

child abusee

A

Proximal threat: call 911 have them come to office

Non proximal: Call Protective services or 911, high suspicion

73
Q

what should you not forget with lacerations and abrasion

A

Tetanus status

74
Q

broken nose:

A

Check for head injury
Ice
Sent ot ED for imaging.

75
Q

bloody nose and concerns.

A

Firm pressure for 10-15 minutes.

Cancer, medication and hypertensive crisis if spontaneous.

76
Q

what throat conditions should you send to ER

A
  • peritonsilar abscess
  • epiglottitis
  • retropharyngeal abscess
77
Q

fractured tooth

tooth knocked out

A

Fractured: Dentist NOW

Kncked out: Dentist 1 HOUR.

78
Q

PH of blood?

A

7.35 - 7.45

can IV from 5-9 but 6.6-7.6 is best

79
Q

Osmolarity of blood

A

290,

IV <450 to reduce risk of phlebitis.

80
Q

isotonic fluids

A

250-375 osm (close to normal blood at 290)

  • normal saline 9%
  • 5% destrose D5W
  • ringer lactate.
81
Q

what are isotonic fluids best

A

won’t cause fluid shits into or out of fcells.

82
Q

what can be dangerous about isotoic

A

can cause fluid overload.

83
Q

hypotonic

A

<250: fluid will go into cells, can cayse HYPOtension

84
Q

hypertonic

A

> 375, fluid will leave cells,

painfull,

85
Q

Flow rate for hypertonic solution >375

A

1-5mL/minute, slow to prevent pain

86
Q

what causes plebitis

A

PH that is to far off.

87
Q

what if there is infliltration

A

Stop infusion, light pressure and Apis

88
Q

systemic complications of IV

A

Air emboli, septicemia, shick, catheter embolism, electrolyte shift
glycemic emergency,
fluid overload

89
Q

what can be a problem if taking CCB’s

A

EDTA
Magnesium
can lead to heart block becausee they act as CCB

90
Q

What can be a problem with rauwolfia

IV

A

Mg
EDTA
Ca
cant respont to hypotension adewuates.

91
Q

Problem with BB and IV

A

Mg

can compound evvects of BB

92
Q

IV with syncope

A 
Keep IV in
Lay them down
Smelling salts
Blanket
reassurance
93
Q

Hypoglycemia with IV?

A

Have pt eat if giving high dose vitamin C or EDTA.

use D5W to reverse

94
Q

what is speed shock iwth IV

A

infusing to quickly often mg.

95
Q

antidote for mg

A

Ca antidotes Mg

Mg antidoees CA

96
Q

what IV can cause fluid overload.

A 
ISOTONIC to quick,
Eldery
Kidney compromised
CHF.
Hypertonic solution.
97
Q

sx of fluid overload

A

edema

Pulmonary edma: crackles and SOB

98
Q

Sx of fluid overload

A

Slow transfusion
heat person: dilate dirculation
O2

99
Q

what is side effect of hypertonic solution

A

Dehydration, because fluid leaves cells.

100
Q

catheter size for rehydration?

A

Largest catheter (smallest #)

101
Q

solution type for rehydration

A

Isotonic** (slightly hypotinic )

  • 9%NS
  • ringer lactate
  • D5W
102
Q

what will happen if you use sterile water

A

Death

103
Q

how much can you rehydrate per day

A
  1. 5-2 liters only. slow and stead so no fluid overload, especiall in
    - elderly
    - CHF
    - Kidney issues
104
Q

what IV med can change clotting times

A

EDTA

NPLEX botanical (14 decks)

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