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RN Spring 2021 > Medical Emergencies > Flashcards

Medical Emergencies Flashcards

1
Q

Normal ICP

A

5-15 mmHg

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2
Q

Increased ICP

A

above 20 for 20 mins call the dr

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3
Q

What is inside the cranial vault?

A
  • Blood
  • Tissue
  • CSF
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4
Q

Monro-Kellie Doctrine

A

these 3 things interplay with each other but are confined to the cranial vault. If one increases the others (should) adjust as to prevent a rise in ICP (intracranial compliance). However, many times the body cannot compensate, leading to an increase in ICP.

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5
Q

How often and how much spinal fluid does the brain make?

A

20 cc of csf every hour

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6
Q

Increased ICP s/s

A
  • Headache
  • Blurred vision
  • N/V
  • Pupil changes
  • Changes in LOC
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7
Q

Causes of increased ICP

A
  • Trauma
  • Hemorrhagic stroke
  • Hydrocephaly
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8
Q

What is hydrocephaly?

A

Over production of CSF

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9
Q

Issues with IICP: Herniation

A

organ protruding through hole (death) most common is cerebellum is pushed out; pt normally does not survive

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10
Q

S/S of herniation

A

Cushings triad = wide pulse pressure (increase SBP and decrease DBP), bradycardia, irregular respirations

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11
Q

Issues with IICP: Brain hypoxia

A

increase of pressure is causing inadequate blood flow

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12
Q

Issues with IICP: Brain death

How is it diagnosed?

A

no blood flow to the brain despite heart beating.

-Bedside brain death studies and/or nuclear medicine scan

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13
Q

Dangers of IICP

A
  • Herniation
  • Brain hypoxia
  • Brain death
  • Death
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14
Q

Glasgow Coma Scale

A

Checks neuro status

Checks: eye opening response, best verbal response, motor response

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15
Q

What is the lowest and highest on GCS?

-When do you intubate?

A

lowest: 3
Highest: 15
Intubate: 8

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16
Q

Assessment for IICP

A
  • Pupil check
  • Extremities (do they only move one side or leg)
  • Q1H ICP, CPP, VS, and urine output
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17
Q

CPP
What is it?
Normal range?
How to monitor?

A

Cerebral Perfusion Pressure

Tells you how much blood is getting to the brain

75-100

MAP-ICP = CPP

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18
Q

MAP formula

A

2 x DBP + SBP / 3

Normal MAP is 65 b/c we know everything is being perfused but also depends on pt (specifically the kidneys)

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19
Q

Decorticate vs Decerebrate

A

Decorticate: hands and feet go in towards core
Decerebrate: Face out

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20
Q

Types of burns

A
  • Thermal
  • Electrical
  • Chemical
  • Radiation
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21
Q

Burns: Thermal

A

Heat sources

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22
Q

Burns: Electrical

Severity depends on

A

Severity depends on strength of the current, duration of contact, path of current, and tissue resistance

-Bone and muscle has more resistance to electrical burns than fatty tissues

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23
Q

Burns: Chemical

A

Caused by acids, alkalines, and organic compounds

-cement, gasoline, lime, bleach

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24
Q

Burns: Radiation

Severity depends on?

A

Severity is dependent on type, dose, and length of exposure

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25
Q

First degree burn
How much damage?
Wound is?
Painful?

A
  • Superficial
  • Minimal damage to epidermis
  • Wound is: dry; no blistering; pink or red; blanches
  • Painful
  • ex: sunburn
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26
Q

Second degree burn
How much damage?
Superficial vs deep wound?
Painful?

A
  • Partial thickness
  • Damage to entire dermis, can extend to the deep levels of the dermis.
  • Superficial part of wound: : blisters (may be open or closed; weeping); pink or red; mild edema; blanches easily
  • Deep part of the wound: blisters (may be open or closed); waxy appearance; cherry red; mottled; pale in the center; edema; sluggish or no blanching or blanch slowly
  • Painful
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27
Q

Third degree burn

  • How much damage?
  • Wound is?
  • Painful?
A
  • Full thickness
  • Destruction of entire dermis and epidermis, may involve subcutaneous tissue, muscle, and bone
  • Wound is: Dry leathery; pale white, brown tan, black, charred; no blanching; may be contracted if muscle is involved
  • Painful around edge and sensitive to pressure
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28
Q

Fourth degree burn

  • How much damage?
  • Wound is?
  • Painful?
A
  • Everything to the bone
  • Total destruction of tissue to bone
  • Wound is: Black; red charred
  • No pain, nerves have been destroyed. May be painful around the edges as it is a lower degree
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29
Q

Burn Assessments

A

Lund and Browder Classification

Rule of nine

30
Q

Burn assessment: Lunc and Browder Classification

-what is special about toddlers?

A
  • Similar to Rule of Nines but takes age into consideration.
  • More commonly used in hospital and burn center settings

Ex: toddlers will have a larger percentage of burn on head cause we grow from head to toe; so head is larger compared to body than adults

31
Q

Burn Assessment: Rule of Nines

A
  • Most commonly used for prehospital calculation of TBSA burned.
  • Body surface is broken down into areas of 9%.
32
Q

Poisoning Agent Examples

A 
Acetaminophen
Sedative/hypnotics
Benzodiazepines
Antidepressants
CV meds =cardiovascular meds
ETOH = alcohol
33
Q

Antidote of:

  1. Acetaminophen
  2. Benzos
  3. SSRIs (list examples)
A

Antidotes:
Acetaminophen = acetylcysteine (also called Musca- mist)
Benzos = flumazenil
SSRIs (citalopram, escitalopram, fluoxetine, sertraline) = cyproheptadine

*Treatment includes decontamination and specific treatments dependent on poisoning agent.

34
Q

Decontamination ex:

A
  • NGT flushed and put to LIWS (low interment wall suction) gastric lavage
  • Flushing skin/eyes with water to remove poisoning agent
  • Cathartics (ingested poison’s)
  • Activated charcoal (ingested poison’s)
35
Q

Carhartics

A

stimulate bowels to excrete ingested poisons. Contraindicated in patients without bowel sounds.

36
Q

Activated charcoal

A

binds to the poison to reduce absorption by the body. Should be initiated within 60 minutes of ingestion

37
Q

Causes of hypovolemic shock

A
  • Trauma
  • Burns
  • GI bleeds
  • Severe diarrhea/vomiting
38
Q

Clinical Manifestations: Hypovolemic shock

  • Early
  • Later
  • End
A

Early:

  • Tachycardia
  • Confusion/restless
  • Decreased urine output
  • Pale, cool, clammy skin (b/c fluid is being shunted away to vital organs)
  • Hyperventilation (which left untreated will lead to R. alkalosis b/c breathing off CO2)

Later:

  • Lethargy
  • Hypotension -will need vessopressers
  • Metabolic and respiratory acidosis (makes lethargy and confusion worse b/c CO2 is building)
  • Anuria
  • Cold, cyanotic skin

End:

  • Coma
  • Severe hypertension
  • Renal and hepatic failure
39
Q

Management of hypovolemic shock

A
  • Fluid resuscitation
  • Isotonic fluids (NS or LR) for nonhemorrhagic hypovolemia
  • Hemorrhagic hypovolemia 1:1:1 blood products (PRBCs, FFP, PLTs)
  • Oxygenation (veni mask or intubate)
  • Treat underlying cause
40
Q

Nursing interventions for hypovolemic shock

A
  1. VS
  2. Monitor for signs of bleeding (bruising, dark tarry stools, coffee ground emesis, etc)
  3. Establish at least 18g IVs
41
Q

Labs for hypovolemic shock

A
  1. H&H
  2. CBC
  3. ABGs
42
Q

Near drowning risk factors

A
  • ETOH use
  • Assault
  • Drug abuse
  • Head trauma
  • Inability to swim
43
Q

With near drowning what happens with CO2 rises?

A

Become hypercarbic, hypoxemic, and acidotic because of the rise in CO2 cause ALOC leading to swallowing water

44
Q

Near drowning nursing actions

A
  • IV access
  • Prepare of intubation
  • Anticipate for coding (ACLS)
45
Q

Water safety education:

A

Life jackets; importance of pool safety, swimming lessons, how to get out of riptides, etc.

46
Q

Mild hypothermia

A

89.6F-95F

  • Shivering
  • Respiratory alkalosis – Tachypnea
  • Hyperglycemia - decrease in insulin secretion
  • Cold diuresis- vasocontriction
47
Q

Moderate hypothermia

A

28F-32F

  • Shivering becomes more violent but eventually stops
  • Agitation
  • Hallucinations
  • Dilated pupils
  • Hypotension
  • Bradycardia
48
Q

Severe Hypothermia

A

Less than 28F

  • Compensatory mechanisms begin to fail
  • CNS depression worsens
  • Severe cerebral hypoperfusion
  • Vasodilation – cause hypotension
  • Death
49
Q

TX of hypothermia

For mild, moderate, and severe

A

*Focus on ABCs

  • Passive external rewarming
  • For mild hypothermia
  • Move to warmer environment - (don’t put in hot water = will burn skin)
  • Remove all wet clothing and dry patient
  • Cover with warm blankets and wrap head

Active external rewarming

  • For mild to moderate hypothermia
  • Heat lamps
  • Forced air warming blankets

Active internal rewarming

  • For severe hypothermia
  • Humidified/warmed O2
  • Warmed IVF
  • Peritoneal, bladder, thoracic lavage with warmed fluids
50
Q

Hyperthermia

A

Body temp above 103F

51
Q

Heat exhaustion s/s

A

Fatigue; weakness; dizziness; headache; N/V; muscle cramps; tachycardia; hypotension; tachypnea.

**will be coherent

52
Q

Heat stroke

A

red, dry skin; no sweating; s/s of heat exhaustion; confusion; delirium, seizures; irrational behavior, coma.

**Will not be coherent

53
Q

Heat Exhaustion tx

A
  • Move to cool environment
  • Elevate feet = b/c want blood flow back to the heart b/c could be hypotensive
  • Encourage cool liquids
  • Remove extra clothing
  • Apply cool cloths, take cool shower, cooling blanket, ice packs, fans.
  • Cooled IVF if needed
54
Q

Heat Stroke Interventions

A
  • Cool body temp to at least 102.2 F is priority
  • ABCs (worried about brain)
  • Ice packs, cooling blankets
  • Treat shivering with benzodiazepines (don’t want them to shiver b/c could generate more heat)
  • Avoid aggressive fluid resuscitation (pulmonary edema)
55
Q

Allergen exposure causes

A

IgE production

56
Q

IgE binds

A

to mast cells

57
Q

Repeated allergen exposure causes

And what happens next

A

-This causes mast cells to degranulate – releasing histamine and other chemicals.

This causes vasodilation, increased vascular permeability (leaky cells), bronchoconstriction, and edema.

58
Q

Clinical manifestations of allergy

A
  • Dyspnea
  • Wheezes/crackles
  • Rash
  • N/V/D
  • Anxiety
  • Flush of heat
  • Angioedema
  • Bronchospasms
  • Stridor – high pitched inhaled sound
  • Anaphylactic shock (tachycardia, hypotension)
  • = severe cases
    *
59
Q

Anaphylaxis is a ______ response

A

systemic

60
Q

Non-Pharmacological tx for anaphylaxis

A
  • Avoid allergen
  • O2
  • Elevate HOB
  • Intubation if needed
61
Q

Pharmacology tx for anaphylaxis

A

-Diphenhydramine
-Prednisone
-Albuterol
I-M Epi

62
Q

Hospital Preparedness

A
  1. PPE:
    - -Hazmat suits, PAPR, face shields, gloves, etc.
  2. Decontamination:
    - -All hospitals must have a designated area to remove contaminants from a patient’s skin and clothes. Outside of ER
  3. Surge Capacity:
    - -the ability for a hospital to expand rapidly and to obtain adequate staff, beds, supplies, and equipment to provide sufficient care to an influx of patients.
  4. Hospital Evac:
    - -May be necessary d/t natural disasters, fires, explosions, etc.
    - -Be mindful that some patients may not be able to easily be placed (ICU patients, critical patients in the ER).
  5. Readiness:
    - -disaster drills, triage, evacuation protocols, safety/security, a supply of PPE/transportation/etc.
63
Q

Active Shooter

A
  • Law enforcement deployment is needed.
  • Active shooters move around a buildings.
  • They do not stop unless stopped by law enforcement, suicide, or other intervention.
64
Q

Mass Casualty

A
  • Large scale event in which emergency medical resources are overwhelmed by number and/or severity of cases.
  • Requires disaster triage.
65
Q

2 types of triage

A
  • Simple Triage and Rapid Treatment (START)

- Sort, Assess, Lifesaving Interventions, Treatment, and/or Transport (SALT)

66
Q

START

A
  • Anyone who can walk = fine
  • Anyone who is not breathing - will they breathe if we position their air way? no = dead; if they do breathe if airway is positioned they need immediate medical intervention

*if dead leave them

***do NOT code

67
Q

SALT

A
  • Will break down who you will assess first
  • WILL code in this one
  • if dead leave them!
  • If they can walk = walk to hospital

Goal : is to help as many people as possible

68
Q

Anthrax: inhalation

  • Clinical manifestation
  • Transmission
  • tx
A
  • Abrupt onset; dyspnea, fever, cough, wide mediastinum
  • Direct contact with bacteria and spores
  • ABX, effective only if treated early (Cipro)
69
Q

Cutaneous

-Clinical manifestations

A

Small papule resembles insect bite, advances to depressed black ulcer; swollen lymph nodes, edema

70
Q

GI: ingested of contaminated/ undercook meat

-Clinical manifestations

A
  • N/V
  • Anorexia
  • Hematemesis
  • Diarrhea
  • abdominal pain
  • Ascites
  • Sepsis
71
Q

Small pox

  • Clinical manifestations
  • Transmission
  • tx
A
  • Sudden onset of symptoms: fever, myalgia, lesions that progress from macules to papules
  • Direct person-to-person, air droplets, handling contaminated materials
  • No known cure, vaccine for those exposed
72
Q

Botulism

  • Clinical Manifestations
  • Transmission
  • Tx
A
  • Abdominal cramps, N/V/D, cranial nerve palsies, skeletal muscle paralysis, respiratory failure
  • Spread through air or food, improperly canned foods, contaminated wound
  • Induce vomiting, enemas, antitoxin, mechanical ventilation, PCN

RN Spring 2021 (7 decks)

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