Emergency Medicine PN FC

Question 1

Rescue breaths contain what percentage of oxygen?

Answer 1

16%

Question 2

At what angle should a subcutaneous needle be injected?

Answer 2

30 degrees

Question 3

Why are steroids given during anaphylaxis?

Answer 3

To prevent a cytokine storm and rebound anaphylaxis because epinephrine and diphenhydramine don’t last a long time

Question 4

Describe the sequence of treatment in anaphylaxis

Answer 4

1. ) CAB
2. ) IV or Intramuscular Epinephrine
3. ) Oxygen
4. ) Recumbent position with legs raised
5. ) IV Saline replacement
6. ) IV or Oral Diphenhydramine
7. ) Possible use of rantidine (H2 antagonist), glucagon (if taking beta blocker), glucocorticoids

Question 5

What is the standard treatment for anthrax exposure?

Answer 5

Doxycycline or Ciprofloxacin

Question 6

When performing chest compressions, what depth should be achieved in children and adults?

Answer 6

Adults = 2 inches

Children = 1/2 chest depth

Question 7

What is the oxygen concentration and flow rate of nasal cannulas?

Answer 7

1-6 Litres per min with up to 44% oxygen concentration

Question 8

In anaphylaxis, what position should be patient be placed in?

Answer 8

Trendelenberg position (supine with legs elevated)

Question 9

What is the only circumstance in which a compressions to breaths ratio should be 15:2?

Answer 9

Two person rescue of a child or infant

Question 10

Is 5% dextrose in water (D5W) hyper-, hypo-, or isotonic?

Answer 10

Isotonic (250-375 mOsm/L)

Question 11

For rehydration in IV, what size of a catheter should be used? What type of solution should be used?

Answer 11

The largest possible (i.e. the smallest gauge) using an isotonic solution (0.9% NaCl, ringer’s, D5W)

Question 12

Croup can be an emergency scenario.

1. ) How do you identify croup?
2. ) What is your initial treatment and at what point do you call an ambulance?

Answer 12

1. ) Croup usually occurs in children under 3 years of age. It presents with an inspiratory stridor and seal-like barking cough.
2. ) Breathe in cool and humid air for 5 mins. If there is no significant improvement, activate EMS

Question 13

At what angle should an intradermal needle be oriented?

Answer 13

10-15 degrees

Question 14

What compression rate should be achieved during CPR?

Answer 14

100/min

Question 15

In the management of anaphylaxis, epinephrine can be given intravenously or intramuscularly. What is the difference in concentration?

Answer 15

IV is less potent, but is given continuously over several mins.

Intramuscularly is more potent, but given once every 5 mins

Question 16

Is ringer’s lactate hypo-, hyper-, or isotonic?

Answer 16

Isotonic (250-375 mOsm/L)

Question 17

What IV ingredients must you be concerned with when a patient is on a calcium channel blocker?

Answer 17

Magnesium & EDTA (will potentiate CCB’s effects)

Question 18

0.9% Sodium Chloride is a normal saline solution. Is it hypo-, hyper-, or isotonic?

Answer 18

Isotonic (250-375 mOsm/L)

Question 19

What oxygen delivery system provides the greatest concentration of oxygen?

Answer 19

Non-rebreather mask or Bag valve mask (90%)

Question 20

What is the most common adjuvant to epinephrine during anaphylaxis? What dose should it be given in?

Answer 20

Diphenhydramine (Benadryl) given IV at 50mg over 1mL

Antihistamine medication

Question 21

How do you prevent speed shock in IV administration?

Answer 21

1. ) Give slow pushes

2. ) Dilute the mixture

Question 22

What is the formula used to calculate osmolarity?

Answer 22

[ (Volume)(mOsm/mL) / (Volume) ] x 1000 = Osmolarity (mOsm/L)

Question 23

At what blood pressure do you administer epinephrine in anaphylaxis?

Answer 23

Radial BP < 80 mmHg systole
Femoral BP < 70 mmHg systole
Carotid BP < 60 mmHg systole

Question 24

Is 0.45% sodium chloride hyper-, hypo-, or isotonic?

Answer 24

Hypotonic (< 250 mOsm/L)

Question 25

What is the earliest sign of shock?

Answer 25

Tachycardia

Question 26

What is the dose of epinephrine given to an anaphylactic patient IV?

Answer 26

0.1-0.2 mg in a 1:10,000 solution IV push every 3-5 mins

Question 27

A resuscitation mask, non-rebreather mask, and bag valve mask all have the same maximum flow rate. What is it?

Answer 27

15 litres per minute

Question 28

If a patient does not have a fever or asthma but has stridor what is the most likely cause?

Answer 28

Upper Airway Obstruction Note: fever in the presence of inspiratory stridor is most likely croup (also look for a seal-barking cough)

Question 29

What are the normal vital signs for: 0-1, 1-5, 5-10 years of age?

Answer 29

0-1 years old i. ) HR = 120 ii. ) BP = 80/40 iii. ) RR = 40 1-5 years old i. ) HR = 100 ii. ) BP = 100/60 iii. ) RR = 30 5-10 years old i. ) HR = 80 ii. ) BP = 120/80 iii. ) RR = 20

Question 30

What is the treatment for an air embolism?

Answer 30

1. ) Left Lateral Decubitus Position 2. ) Provide Oxygen (air may go to the pulmonic valve and occlude flow to the lung) 3. ) Activate EMS

Question 31

At what osmolarity of an IV mixture do you need to be concerned about phlebitis?

Answer 31

450-600 = moderate risk | > 600 = Severe risk of phlebitis

Question 32

If you are alone with an infant and you need to perform CPR, at what point should you activate EMS?

Answer 32

After 2 mins of resuscitation

Question 33

When should emergency oxygen be given (wrt respiration rate)?

Answer 33

Adult breathing rate is < 12 or > 20 bpm Child breathing rate is < 15 or > 30 Infant breathing rate is < 25 or > 50

Question 34

What is the most common sign of decompensated (late) shock?

Answer 34

Hypotension

Question 35

In determining the severity of a burn, what rule is used?

Answer 35

Rule of 9s (adults) or 5s (peds) Each arm = 9% (10% peds) Head/Neck = 9% (15% peds; 20% infant) Each leg = 18% (10% peds) Torso = 18% (20% peds)

Question 36

Rehydration formulas are usually calculated to a maximum of what volume per day?

Answer 36

2 L

Question 37

When might a Mill Wheel Murmur be present?

Answer 37

Air embolism that collects in the right ventricle of the heart

Question 38

1. ) What is the definition of osmolarity? | 2. ) What osmolarity qualifies as isotonic, hypotonic, and hypertonic?

Answer 38

1.) The concentration of solute in a volume of solution 2.) Isotonic = 250-375 mOsm/L Hypotonic < 250 mOsm/L Hypertonic > 375 mOsm/L

Question 39

Where should epinephrine be injected and at what dose?

Answer 39

Injected intramuscularly into the mid anterolateral thigh or as an intratracheal injection The recommended dose is 0.5-1.0 mg in a 1:1,000 solution intramuscularly If epinephrine is being injected into subcutaneous tissue the dose is 0.3-0.5 mg

Question 40

Effective CPR provides what percent of normal blood flow?

Answer 40

25-33%

Question 41

What is the purpose of a non-rebreather mask?

Answer 41

It vents out expired air that way a patient does not breathe in previously exhaled air (that has less oxygen concentration)

Question 42

At what point is brain damage certain without medical intervention (CPR)?

Answer 42

10 mins