Emerg Flashcards
(52 cards)
Which of the following can primary care paramedics NOT perform:\n12 leak EKG\nIV starts\nSymptom relief meds\nAdvanced first aid\nSemi–automatic defibrillator\nPneumothorax decompression
Pneumothorax decompression – must be performed by advanced care paramedic
Paramedics are not regulated health care professionals. How do they perform regulated health acts?
Offline medical control – treatment algorithms\nOnline medical control – physician on call to provide advice or direction (for decompression of pneumothorax, etc.)
What valuable information can you gain from a paramedic?
Is the house safe to go home to, is there food in the fridge? any concerns about how the person is being cared for?\nIn the case of a car crash – how bad was the crash?
List the four types of shocks, and provide an example for each.
Hypovolemic (hemorrhage)\nCardiogenic (MI)\nObstructive (PE, cardiac tamponade)\nDistributive (sepsis, liver failure)
SIRS Criteria (4)
Temperature below 36 or over 38\nHR over 90\nRR over 20\nWBC under 4 or over 12
Define sepsis, and severe sepsis
Sepsis: 2 sirs criteria, and infection source\nSevere sepsis: sepsis with signs of end organ damage, hypotension, or elevated lactate (lactate suggests hypoperfusion)
Define septic shock
Severe sepsis with persistent signs of end organ damage (i.e., hypotension despite fluid challenge)
How would a patient in septic shock present?
Hypotension\nTachycardia (>90)\n\nPeripheral hypo–perfusion\nSigns of end organ dysfunction: encephalopathy, ARDS, ARF/ATN, DIC, cardiovascular dysfunction
How is qSOFA used in the emerg?
Prognostication – determine if this person can go home\nNot used to identify sepsis
What are the indications to intubate? Think of the mnemonic ABCDEF
Airway (failure to protect)\nBreathing (failure to oxygenate/ventilate)\nCirculation (unload resp muscles)\nDisability (LOC, Sz, weakness, CNS catastrophe such as cerebral hemorrhage)\nExpected course (anticipated decline)\nFeral (need aggressive sedation to protect patient/staff)
What is the purpose of delayed sequence intubation?
Stabilize agitated patient with pre–oxygenation before intubating (use Ketamine to help patient tolerate preoxygenation)
Management of Sepsis (3 components)
Supplemental O2, Intubate once more stable if needed\n40–60cc/kg fluid, then vasopressors if not stabilized\nTreat infection: Abx and source control
In which patients should you limit supplemental O2
MI patients\nCOPDers
Alpha 1 adrenergic receptors – what do they do?
Vascular constriction (general constriction throughout body)
Beta 1 adrenergic receptors – what do they act on and what do they do?
Heart: increased chronotropy, inotropy
Beta 2 adrenergic receptors – what do they act on and what do they do?
Lungs: bronchodilation, vasodilation
When would you use phenylephrine?
Have it ready to push during intubation in case BP drops
When would you use Levophed?
Levophed is the “go to” vasopressor. It increases SVR (and as a result BP). It also increases chronotropy and inotropy
When would you use epinephrine?
Vasopressor used in pediatrics. It increases SVR, chronotropy, inotropy.
Which line should be used for for vasopressors
IV can be used in the short run, but in the long run (days), a central line is needed
What are the 6 steps in a general approach to a trauma patient.
preparation\nprimary survey resuscitation\nadjuncts to primary survey\nsecondary survey\nadjuncts to secondary survey\ndefinitive care
Who do you call for a trauma patient
The trauma team!
When the black “patch” phone in the emerg is ringing, who is calling?
Paramedics
When the “bat” phone is ringing, who is calling?
911 dispatch
