Medical Emergencies

Question 1

hemophilia types

Answer 1

-hereditary genetic disorder that impairs the body’s ability to control blood clotting

-Males:
>hemophilia A (Classic Factor 8 VIII)
>hemophilia B (Factor 9 IX)

-Both:
>Von Willebrand

Question 2

signs & treatment of hemophilia

Answer 2

-decreased LOC
-bleeding of soft tissues

-replace clotting factor or administer cryoprecipitate or FFP
-no IMs, hold pressure to venipun
-avoid ASA & NSAIDS

Question 3

Disseminated Intravascular Coagulation (DIC)

Answer 3

*elevated D-dimer & fibrin degradation products
*prolonged coagulation times (PT, PTT)
-low HgB,hematocrit, platelets, fibrinogen

Tx with TXA and platelet transfusion

Question 4

Idopathic Thrombocytopenia Purpura (ITP)

Answer 4

an autoimmune disorder seen after a viral infection in children 2-4 that causes low platelet count with normal bone marrow function

Question 5

Idopathic Thrombocytopenia Purpura (ITP)

Answer 5

an autoimmune disorder seen after a viral infection in children 2-4 that causes low platelet count with normal bone marrow function

epistaxis, bleeding gums, petechiae

Question 6

polycythemia

Answer 6

excess blood cells

Question 7

sickle cell disease

Answer 7

-congenital (meaning gene from both parents) sickling of RBCs
- pts take hydroxyurea to decreasing sickling
- triage a level 2

Question 8

what can SCC cause

Answer 8

-acute chest syndrome: chest pain & dyspnea is the main killer

-sequestration: the cells in the spleen cause abdominal pain

-vaso occlusive crisis: most common

-priapism

triggers- low O2, infection, dehydration, exposure to cold

Question 9

neutropenia

Answer 9

• low WBC count
• triage level 2
• caused by chemo or radiation, or leukemia
• tx by isolation, avoid invasive procedure, early abx, avoid raw meat, well water, and unwashed produce, & bone marrow stimulants

Question 10

What causes hyperkalemia?
+K > 5.0

Answer 10

renal failure
burns
crush injuries
ACE inhibitors
rhabdo

Question 11

What EKG changes happen in hyperkalemia

Answer 11

peaked T waves

widening QRS

loss of P waves

Question 12

Heat cramps

Answer 12

-Sweat induced electrolyte depletion causes muscle cramps
-TX: rest in a cool environment and fluid electrolyte replacement

Question 13

Heat exhaustion

Answer 13

-prolonged exposure to heat leads to heat cramps, anorexia and vomiting, headache syncope
-TX: with rest in a cool environment and fluid/electrolyte replacement

Question 14

Heat stroke

Answer 14

-young and elderly more vulnerable
-medication risk: thyroid meds, Haldol, antihistamines, anticholinergics
-tachycardia, tachypnea, hypotension, hot dry skin, decreased LOC
-rhabdomyolysis from muscle breakdown-dark brown urine
TX: cool patient quickly

Question 15

Frostbite

Answer 15

-TX: pain medication and quickly rewarm the affected part for 15-30 mins in 40-42 Celsius
-avoid any friction or rubbing
-NSAIDS to limit damage
-administer narcotics

Question 16

Rabies

Answer 16

-viral disease transmitted through the bite of infected animal
-S/S: delirium, hallucinations, excessive salivation
-TX: early, aggressive wound management, infiltrate rabies immunoglobulin in the wound if possible
-rabies vaccine given 1ml in deltoid
-days 0,3,7 & 14

Question 17

Lyme Disease

Answer 17

-S/S: nonpruritic, target like circular bulls-eye rash, flulike symptoms (malaise and headache)

-TX: antibiotics (doxycycline)

-risk if untreated: facial paralysis, arthritis, and myocarditis

Question 18

Rocky Mountain Spotted Fever

Answer 18

S/S: non pruritic, nonblanching macules of the palms wrist, forearms, soles and ankles,
N/V, fever, chills
TX: antibiotics (doxycycline)

Question 19

Measles (rubeola)

Answer 19

-highly contagious
-incubation periods of 8-12 days
-S/S: conjunctivitis, coryza(rhinitis), cough
-fever, eyelid edema, Koplik spots rash, maculopapular rash from head to trunk to lower extremities
-TX: supportive care, immunization for patient’s family

Question 20

DKA is what kind of shock?

Answer 20

-hypovolemic shock so priority is isotonic fluid resuscitation

Question 21

DKA causes what?

Answer 21

-metabolic acidosis
causing Kussmauls respirations to compensate by blowing of CO2
-ketones in urine and BUN elevated due dehydration
-monitor glucose and K level closely
-do not given insulin bolus to avoid risk of cerebral edema
-do not stop insulin infusion gap is closed

Question 22

Thyroid storm symptoms

Answer 22

tachycardia
restless
pulmonary edema
TSH low
T3 & T4 elevated

Question 23

How to treat thyroid storm

Answer 23

beta blockers initially
then PTU then iodine an hour after PTU

Question 24

What happens during an adrenal crisis

Answer 24

-hyponatremia <+Na sodium

-hypoglycemia

-hyperkalemia ^+K potassium

Question 25

signs of Hyperkalemia
^K+ potassium

Answer 25

-tall, tented T waves then widened complex

-treat initially with calcium gluconate

-insulin and dextrose to shift +K

Question 26

Hyponatremia
<+Na sodium

Answer 26

-risks of seizures
-treat with saline