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Block IV - Exam 1 > Emergency > Flashcards

Emergency Flashcards

(52 cards)

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1
Q

Triage Basic System

A

Emergent - life threatening
Urgent - serious but non life-threatening
Nonurgent - episodic illness, i.e. strep, UTI

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2
Q

Triage Emergency Severity Index (ESI)

A

Level 1 (emergent) - requires lifesaving interventions

Level 2 - high-risk situation (may become unstable), new altererd mental status, severe pain/distress

Level 3 (urgent) –> most pt’s in hospital, i.e. small bowel obstruction

Level 4

Level 5 (nonurgent)

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3
Q

What is a Primary Survey?

A

Focuses on stabilizing life-threatening conditions
ABCDE

Airway - establish
Breathing - adequate ventilation
Circulation - control hemorrhage, prevent shock, restore cardiac output
Disability - assess neuro function; AVPU (alert, verbal, pain, unresponsiveness)
Exposure - undress to assess wounds/injuries

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4
Q

What is a Secondary Survey?

A

After stabilization

Health history
Head-to-toe assessment
Diagnostics, labs
Monitoring - EKG, a-lines, catheters

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5
Q

What is AVPU

A

Quick way to assess neuro status during primary survey

Alert - is pt alert?
Verbal - does pt respond to verbal stimuli?
Pain - does pt respond to painful stimuli?
Unresponsive - is pt unresponsive to all stimuli?

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6
Q

What is an oropharyngeal airway?

A

semicircular tube that is inserted over back of tongue into lower posterior pharynx in a pt who is breathing spontaneously but unconscious

**prevents tongue from obstructing airway & allows for suction

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7
Q

What is a nasopharyngeal airway?

A

Same as OA but inserted through nares
*NOT TO BE USED if there is facial trauma or skull fx d/t risk of entering brain cavity

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8
Q

Endotracheal Intubation

A

Used on a pt who cannot be adequately ventilated with OA or NPA, to bypass upper airway obstruction, prevent aspiration, connect to ventilator, or for removal of tracheobronchial secretions

**placed by specially trained personnel, physicians

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9
Q

King Tube/Laryngeal Mask Airway

A

Typically used outside of hospital setting

Less invasive than ET tube

Balloon occludes esophagus

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10
Q

Cricothyroidotomy

A

Opening of cricothyroid membrane to establish an airway, used in emergencies where ET tube is not possible or CI (facial trauma, c-spine injury, laryngospasm, laryngeal edema)

Replaced with formal tracheostomy once stable

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11
Q

How do we assess adequate ventilation?

A

Bilateral breath sounds
O2 sats
Rise and fall of chest
ABG’s
Capnography (visual representation of exhaled Co2)

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12
Q

Patho of partial airway obstruction

A

Hypoxia –> Hypercarbia (high co2 in blood) –> respiratory arrest –> cardiac arrest

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13
Q

Patho of complete airway obstruction

A

Permanent brain injury or death occurs within 3-5 minutes

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14
Q

Causes of airway obstruction

A
  • aspiration of foreign bodies
  • anaphylaxis
  • viral/bacterial infection
  • trauma
  • inhalation of chemical burns
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15
Q

Signs/symptoms of airway obstruction

A

Universal distress signal, refusing to lie flat, labored breathing, flaring nostrils, anxiety

Partial: pt is able to breathe and cough spontaneously; encourage coughing

Complete: weak, ineffective cough; high-pitched inhale, increasing respiratory difficulty, cyanosis

LATE signs of obstruction: cyanosis, loss of consciousness

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16
Q

Interventions for Airway Obstruction

A

ESTABLISH AIRWAY!
- reposition head to prevent obstruction with tongue
- head-tilt/chin-lift, insertion of equipment (OA, NPA, ET)

Monitor breathing
- chest movement, listen/feel for air movement

If partial obstruction - encourage pt to cough

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17
Q

Multiple Trauma
- what is it
- what to do

A

Single event that causes life-threatening injuries to at least two organs or organ systems

  • ALWAYS assume c-spine injury until able to r/o
  • establish priorities - ABC’s
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18
Q

What are intra-abdominal injuries?
Which organs are mostly affected?

A

Penetrating or blunt trauma to the abdomen
(GSW, stabs — MVAs, falls, blows, explosions)

hollow organ - small bowel
solid organ - liver

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19
Q

Intra-abdominal injuries
Assessment

A

Assess abdomen
Assess for external/internal bleeding (signs of shock, exp. if liver or spleen has been traumatized)
Referred pain –> left shoulder pain = spleen, right shoulder pain = liver
Intraperitoneal injury
Assess for GU injury - no indwelling catheter until after exam

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20
Q

Intra-abdominal injuries
Diagnostics

A

Labs - H&H trends, ABG’s, INR, WBC (increased w trauma)
CT abdomen
FAST - focused assessment w/ sonography for trauma: detects intraperitoneal bleeding
DPL - diagnostic peritoneal lavage: 1L of LR or NS into abdominal cavity, min. of 400mL return, send to lab, positive if high RBCs, WBCs, or presence of bile, feces, or food (no longer standard [CT preferred] but good+easy during mass casualties)

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21
Q

Intra-abdominal injuries
Management

Study These Flashcards
A

ABC’s!!
Document all wounds
Maintain c-spine until injury is ruled out
If protruding viscera, cover w sterile, moist saline to keep wet and protect from infection
Keep NPO (no water)
GI suction to decrease risk of aspiration and decompress stomach for procedures/surgery
Give prophylactic tetanus and broad-spectrum abx
Rapid transport to surgery if needed

22
Q

Crush Injuries

Assessment and Management

Study These Flashcards
A

Assess:
- hypovolemic shock
- spinal cord injury
- fractures
- AKI !!
- hyperkalemia (crush injuries cause K+ to leave the cell)

Management:
- ABC’s
- observe for AKI
- severe muscle damage may cause rhabdo
- elevate injured extremity to relieve swelling & pressure

23
Q

Hemorrhage

Study These Flashcards
A

STOP BLEEDING!
Internal hemorrhage may not be visible
Assess for shock: low BP, tachycardia, delayed cap refill, decreased UO

External hemorrhage: direct firm pressure, elevate to stop venous bleeding, tourniquet

Give IV fluids or blood products

24
Q

Heat Stroke
what is it? different types?

Study These Flashcards
A

Acute medical emergency caused by failure of heat-regulating mechanisms of the body

Nonexertional - prolonged exposure to temps < 102.5

Exertional - strenuous activity in hot temps

Most at risk - old, very young, ill

25
Heat Stroke Signs/Symptoms
Elevated body temp 105 F or higher Delirium, confusion, seizures Hot, dry, skin Anhidrosis (absence of sweating) Hypotension, tachycardia, tachypnea (shock)
26
Heat Stroke Management
Reduce temp AS FAST AS POSSIBLE to 102 F - cool sheets/towels, cooling blankets - ice pack to neck, groin, chest, axillae - immersion in cold water Monitor CORE TEMP STOP cooling at 100.4 F Monitor VS, ECG, LOC IV Fluids to replace fluid loss Meds: anticonvulsants/benzos (seizures), potassium (hypokalemia), sodium bicarb (metabolic acidosis)
27
Frostbite what is it? affects?
Trauma from freezing temps, freezing of intracellular fluid Affects feet, hands, nose, ears
28
Frostbite Assessment
Assessment: - extremity may be hard, cold, insensitive to touch, may be white or mottled blue-white - extent not always known - get history: how cold, how long exposed, presence of wet conditions
29
Frostbite Management
Goal: restore normal body temp Controlled, rapid rewarming - 37-40 C (98.6-104) circulating bath x 30-40 mins, repeat until circulation restored Analgesics - very painful DO NOT MASSAGE! Hourly active motion after rewarming Walking on affected extremities may exacerbate tissue damage Hyperkalemia & hypovolemia are common with frostbite
30
Hypothermia what is it? who is at risk? hypothermia vs frostbite?
Internal core temp of 35 C (95 F) or less Older adults, infants, ill, homeless, trauma victims Hypothermia must be managed before frostbite!!
31
Hypothermia Assessment
Physiologic changes occur in all organ systems Shivering may be suppressed at temp < 32.2C (90F) CO & BP may be so weak peripheral pulses become undetectable Cardiac arrhythmias Hypoxemia, acidosis
32
Hypothermia Management
ABC's, remove wet clothing, supportive care Rewarming - Active internal rewarming - Passive external rewarming Monitor core temp Continuous ECG (cold-induced myocardial irritability leads to v-fib) - cold blood returning from extremities has high levels of lactic acid and can cause dysrhythmias and electrolyte disturbances
33
Active Internal Rewarming
Used for moderate-severe hypothermia 28-32.2 C (82.5 - 90 F) - cardiopulmonary bypass - warm fluid administration - warm humidified oxygen by ventilator - warm peritoneal lavage **Monitoring for v-fib as temp increases from 31-32C is essential
34
Passive Internal Rewarming
Used for mild hypothermia 32.2 - 35 C (90-95F) - over-the-bed heaters to extremities
35
Poisoning - what is poison Corrosive poisons Treatment
Any substance that when ingested or inhaled injures the body by its chemical action Corrosive poisons - alkaline and acid agents that can cause tissue destruction Treatment - remove or inactivate before absorbed - provide supportive care - administer antidotes if available
36
Poisoning Assessment
ABCs Monitor VS, LOC, ECG Determine what, when, how much was ingested Age and weight (for wt-based dosing)
37
Poisoning Management
Measures to remove toxin or decrease absorption - Emetics to induce vomiting (except with corrosives*) - Gastric lavage - Activated charcoal *corrosive agents (acids and alkaline) cause destruction of tissues, DO NOT INDUCE VOMITING as this will cause further damage to upper airway; give milk or water to dilute
38
Carbon Monoxide Poisoning - how does it happen - signs/symptoms
Inhaled carbon monoxide binds to hemoglobin (which transports oxygen) into carboxyhemoglobin which does NOT transport oxygen S/S: CNS --> headache, muscular weakness, palpitations, dizziness, confusion; may appear intoxicated **skin color and pulse ox NOT valid bc there may be high hgb but it is saturated with carbon monoxide, not oxygen
39
Carbon Monoxide Poisoning Management
Goal: reverse cerebral and myocardial hypoxia Get fresh air ASAP! CPR if necessary 100% oxygen given, preferably under hyperbaric pressures - until carboxyhemoglobin is less than 5% Prevent chilling, wrap in blankets
40
Chemical Burns - what to do - if dry chemical? - follow up care
Immediately flush with water If dry chemical (lye or white phosphorus), brush off skin before flushing Always use PPE to protect self Follow up care at 24 hrs, 72 hrs, 7 days [d/t risk of underestimating extent of injury]
41
Food Poisoning Management
ABC's --> botulism may results in respiratory paralysis or death Determine source Treat fluid and electrolyte disturbances Control nausea and vomiting Clear liquid diet and progression
42
Drug Overdose Management
Support respiratory and cardiovascular function
43
Acute Alcohol Intoxication Management
Maintain airway Observe for CNS depression Rule out other causes - head injury, hypoglycemia, hypoxia, hypovolemia Nonjudgmental, calm
44
Trauma - collection of evidence
Document description of all wounds, mechanism of injury, time of events, collect evidence Be careful with removing clothing - try to maintain evidence Place items in paper bag; plastic bags retain moisture & can destroy evidence Cover pt's hands with paper bags to protect evidence on hands/under fingernails Document pt's words in quotations
45
Sexual Assault Management
Provide support Reduce emotional trauma Gather available evidence (paper bags) SANE nurses - sexual assault nurse examiners Treat consequences - STIs, prophylactic treatment - pregnancy, antipregnancy meds Encourage follow up care
46
Human Trafficking - signs to look out for - common complaints
Pt may be accompanied, look to them for answers Hx of chronic runaway, homelessness, self-mutilation Common behavior: cowering, frightened, agitated Common complaints: injuries, poor healing, abd pain, dizzy, HA, rashes, sores
47
Psychiatric Emergencies
Maintain safety, gain control of situation Determine if pt is at risk for injuring self or others
48
Nonfatal Drowning - define - management
Survival for at least 24 hours after submersion that caused respiratory arrest Maintain cerebral perfusion and adequate oxygenation
49
Decompression Sickness - define - s/s - treatment
Occurs in pt's who have enaged in diving, high-altitude flying, or flying in commercial aircraft within 24 hours after diving S/S: joint pain, numbness, loss of ROM Must transfer to hyperbaric chamber
50
Animal and Human Bites
Cat bites have high risk of infection (pasteurella in saliva) Human bites contain more bacteria than that of most other animals - high risk of infection Assess for infection, collect evidence, cleanse with soap and water, abx and tetanus
51
Snakebites
Medical emergency S/S: edema, ecchymosis, necrosis, n/v, numbness, metallic taste Tx: lie down, remove constricting items, cleanse wound, cover with sterile dressing, immobilize below heart Antivenin most effective given within 4 hours, no greater than 12 hours
52
Spider bites - brown recluse - black widow
Brown recluse - painless - sx develop within 24-72 hrs: fever, chills, n/v, joint pain - necrosis in 2-4 days Black widow - system effects occur within 30 mins - s/s: abdominal rigidity, n/v, hypertension, tachycaardia - severe pain: analgesics and benzos

Block IV - Exam 1 (5 decks)

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