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Flashcards in Emergency1 Deck (23):
1

Emergency treatment area should be equipped with:

 Oxygen delivery devices - Portable oxygen tanks, tubes, masks, oxygen chambers
 IV fluid administration supplies
 Suction apparatus
 Monitoring equipment -ECG, BP monitor, pulse oximeter, end-tidal carbon dioxide monitor
 Defibrillator
 Ventilator

2

Crash Cart

 If emergency supplies are likely to be used in different places throughout the hospital, a mobile emergency kit can be used
 Kit may consist of a fishing tackle box or a mobile tool chest with multiple drawers to allow for better organization
 Crash cart should be kept in a central area of the hospital for quick access

3

Standard emergency supplies/equipment in a crash cart should include:

 Airway access supplies
 Venous access supplies
Pharmaceutical Supplies
Miscellaneous supplies

4

Airway access supplies

 Laryngoscope w/ blade
 Endotracheal tubes (variety of sizes)
 Lubricating jelly
 Roll gauze
 Venous access supplies

5

Venous access supplies

 Butterfly catheters (variety of sizes)
 IV catheters (variety of sizes)
 Syringes (variety of sizes)
 Hypodermic needles (variety of sizes)
 Adhesive tape (variety of sizes)
 IV drip sets
 Tourniquet
 Emergency Supplies and Equipment

6

Pharmaceutical Supplies

 Atropine- increase heart rate, once it gets beating again
 Epinephrine or vasopressin- vasoconstriction- get heart to start beating again- improve blood flow (not stimulatory) to the heart
Coronary vessels- get blood flow to the heart muscle
 2% Lidocaine (w/o epinephrine)- arrhythmias
 Sodium bicarbonate- anaerobic metabolism- counteract acidosis
 Calcium chloride or gluconate- hypocalcaemia
 Doxapram- respiratory stimulant
 Mannitol- diuretic, swelling in CNS
 Lactated Ringer’s (and/or hypertonic saline, dextran 70 or hetastarch)

7

Miscellaneous supplies

 Gauze (3 X 3 inch)
 Stethoscope
 Minor surgery instrument pack
 Suture material (variety of sizes)
 Scalpel blades
 Sterile gloves

8

Fluids are used in the treatment of hospitalized patients for the following reasons:

 Replace hydration deficits
 Maintain normal hydration
 Correct hypovolemia
 Replace electrolytes and nutrients
 Serve as a vehicle for infusing IV medications

9

Body fluid compartments

Intracellular– 2/3 of total body fluid
Extracellular– 1/3 of total body fluid
 Interstitial– ¾ of extracellular fluid
 Intravascular fluid– ¼ of extracellular fluid,
Represents 1/12 of total body fluid

10

Routes of fluid administration

Maintenance needs or correction of non-life-threatening dehydration
 Oral
 Subcutaneous (isotonic fluid solutions)
 Intraperitoneal
Treatment of hypovolemia
 Intravenous
 Intraosseous

11

Crystalloids

 Water-based solutions containing small-molecular weight solutes that can pass freely through vascular endothelium
 Solutes include electrolytes ( e.g. Na+, K+, Mg2+, Ca2+, Cl-), dextrose, and alkalinizing agents (e.g. acetate, gluconate, lactate)
 Similar in composition to extracellular fluid
 Capillary membrane is permeable to these solutions

12

Isotonic, polyionic, replacement solutions

 Balanced solutions that contain solute concentrations similar to those in ECF
 Typically contain a number of electrolytes
 Have an osmolarity that is similar to the extracellular fluid compartment (280-310 mOsm/L)
 Examples include: Lactated Ringer’s Solution, Plasma-Lyte A and R, Normosol-R

13

Isotonic, polyionic, maintenance solutions

 Contain lower concentrations of Na+ and Cl-
 Used for fluid therapy that extends over a long period of time
 Examples include Normosol-M in 5% dextrose, Plasma-Lyte 56 in 5% dextrose

14

Normal saline solution (isotonic)

 Contains only Na+ and Cl- in water
 Unbalanced solution
 Sometimes used instead of isotonic, polyionic, replacement fluid solutions
 Also known as 0.9% NaCl, physiologic saline

15

Hypertonic saline solution (hypertonic)

 Have a greater osmolarity than extracellular fluid
 Creates an osmotic gradient that causes rapid movement of water into the vascular space
 Used in the treatment of shock
 Examples include 3% NaCl, 5% NaCl, 7.5% NaCl

16

Dextrose solutions (hypotonic or isotonic)

 Dextrose can be added to water or to another polyionic crystalloid fluid solutions to create solutions with dextrose concentrations of 2.5% to 5%
 Dextrose is rapidly metabolized into CO2 and water
 Examples include 5% dextrose, Normosol-M w/ 5% dextrose, Plasma-Lyte 56 w/ 5% dextrose

17

Colloids

 Water-based solutions containing large-molecular weight solutes that are not able to pass through vascular endothelium
 Increase osmotic pressure (oncotic pressure) in the intravascular space
 Oppose the movement of water from the intravascular space to the extravascular space
 Decrease the volume of crystalloid fluids needed to treat a patient by 40-60%
 Large-molecular weight solutes include synthetic molecules (dextran, pentastarch, hetastarch) and natural molecules (plasma, whole blood)

18

Crystalloid vs. Colloid use

 Use crystalloids whenever there is dehydration
 Synthetic colloids should never be given without also giving crystalloids
 A smaller volume of colloid is needed compared to crystalloid to increase the volume in the intravascular space
 Colloids stay in the intravascular space for a much longer period than crystalloids

19

Replacement doses in dehydrated patients

 % dehydration x body weight (kg) = liters of fluid to be replaced
 Replace fluid deficits over a period of 12-24 hrs.

20

Maintenance doses of fluids

 (30 X body weight in kg) + 70
 Ongoing fluid losses due to abnormal conditions (e.g. fever, vomiting, diarrhea, polyuria) must be included in fluid rate calculations

21

Clinical signs of overhydration

 Serous nasal discharge
 Respiratory problems– increased respiratory rate or effort, crackles, cough, bloody fluid from mouth
 Chemosis
 Tachycardia
 Dilution of PCV/TS
 Diarrhea/Vomiting

22

What are Constant Rate Infusions?

 Administration of fluid solutions intravenously continuously at a constant rate
 Drugs administered by constant rate infusion (CRI)
 Analgesic drugs
 Emergency drugs (e.g. diazepam, lidocaine, dobutamine, dopamine)

23

CRI’s of analgesic drugs becoming more common for pre-, intra-, and post-operative pain relief

 Provide stable plane of analgesia
 No peaks or troughs
 Lower drug dosage delivered at any point in time
 Greater control over drug administration