Medical Emergency

Question 1

cardiac and respiratory arrest

Answer 1

if outside hospital –> activate EMS (fire or police department and paramedics)

if in hospital –> cal code blue
chest compressions should maintain 100-120/minute

CPR must be initiated within 3-5 minutes after a cardiac or respiratory arrest

Question 2

cardiac and respiratory arrest hand placement

Answer 2

child: 2 hands on the lower half of the sternum
adult: same as child
infant: place 2 fingers just below the baby’s nipple line

Question 3

cardiac and respiratory arrest chest compressions depth

Answer 3

adults: at least 2 inches (5cm)
child: half the childs anterior-posterior diameter or about 2 inches (5 cm)
infant: at least one quarter of the anterior-posterior diameter or about 1.5 inches (4 cm)

interruptions should not last longer than 10 seconds

allow for complete recoil between compressions
should rotate who administers every 2 minutes

effective CPR requires you to maintain an open airway and so do the head tilt-chin lift method

Question 4

head tile-chin lift method

Answer 4

place one hand on the clients forehead and push with the palm to tilt the head back

if facial trauma is evident or a spinal cord injury is suspected, perform jaw thrust method

Question 5

compressions to ventilation ratio

Answer 5

adult: 30:2
child and infant:
- 30:2 with a single rescuer
- 15:2 with 2 rescuers

deliver air over one seond and watch clients chest wallrise
ventilation with an advanced airway will be performed at one breath every 6-8 seconds

Question 6

AED

Answer 6

to use it:
turn on and attach pads
for adults, use adult-size pads
for children and infants:
- use adult size pads ONLY WHEN children/infant pads are not available

Question 7

upper airway obstruction interventions

Answer 7

death can occur within 4-5 min

if conscious:

• 5 back blows between the shoulder blades with the heel of the hands
• 5 abdominal thrusts
• alternate until blockage is dislodged

if unconscious:

• begin CPR
• remove the object if it becomes visible

if airway intubation is needed:
- nurse will assist with placement of artifical airway using endotracheal tube or tracheostomy and suction as needed

Question 8

opioid-associated respiratory emergency

Answer 8

if they have a definite pulse, but no normal reathing or only gasping respirations then,

an approximately trained person (police officer, mental health professional) should administer naloxone IM or nasally without waiting for EMS to arrive

Question 9

upper airway obstruction for child manifestations

Answer 9

sudden coughing
gagging
wheezing
cyanosis
dyspnea
stridor

Question 10

upper airway obstruction for child diagnostic studies

Answer 10

chest x ray
fluroscopy
bronchoscopy

Question 11

upper airway obstruction for child care

Answer 11

direct laryngoscope and bronchoscopy may be require to remove objects

Question 12

upper airway obstruction for child management

Answer 12

recognize signs and symptoms of foreign body aspiration
administer back slaps and chest thrusts
perform heimleich maneuvers for children

Question 13

items most likely to be aspirated in children

Answer 13

peanut butter
balloon
aluminum tabs from soda cans
paper clips

Question 14

what is acute respiratory failure

Answer 14

not a disease but a symptom
hypoxemic respiratory failure = PaO2 level less than 60 mmHg
hypercapneic respiratory failure = PaCO2 level above 45 and pH less than 7.35

Question 15

causes of acute respiratory failure

Answer 15

extrapulmonary causes:

• neuromuscular and musculoskeletal disorders
• CNS dysfunction (stroke, opioids)

intrapulmonary causes:

• COPD
• pulmonary embolism
• pulmonary edema
• ARDs
• pneumothorax

Question 16

acute respiratory failure manifestation

Answer 16

restlessness
confusion
dyspnea
orthopnea
tachypnea
tachycardia
decreased pulse oximetry reading
ABG shoes:
- pH below 7.35
- PaCO2 greater than 5-
PaO2 less than 60

hypoxemia that persist even when 100% oxygen is given is a cardinal feature of respiratory failure due to ARDs

Question 17

acute respiratory failure diagnostic studies

Answer 17

physical examination
ABG
chest x ray

Question 18

acute respiratory failure management

Answer 18

administration of high flow oxygen until PaO2 or oxygentation saturation is greater than 80 and 90%

intubation and mechanical ventilation
administer meds for VTE and stress ulcer prophylaxis
administer anxiolytics with caution to avoid CNS depression and worsen hypoventilation

Question 19

acute myocardial infarction manifestation

Answer 19

chest pain that is severe, curshing and unrelieved by rest
pain may radiate to one or both arms, the jaw, neck or back

palpitations
nausea, vomiting and indigestion (heartburn)
apprehension, anxiety, restlessness “feeling of doom”
shortness of breath, crackles on auscultation

Question 20

myocardial infarction management

Answer 20

immediately stop activity that the client is doing
administer oxygen
administer nitrates
depending on setting, activate EMS

before giving nitrates, verify that the client did not take any phosphodietsterase inhibitors for erectile dysfunction like: sildenail, tadalfil, or vardenafil within the past 24-48 hours

Question 21

how to communicate with client information to rapid response team

Answer 21

situation - why the client is hosptialized and significant findings
allergies
meds
past med history
last meal
event - describe what happens and why RRT was called

Question 22

shock initial stage

Answer 22

slight decrease in MAP of 5-10 from clients baseline

Question 23

shock nonprogressive stage

Answer 23

decrease in MAP of 10-15

Question 24

shock progressive stage

Answer 24

decrease in MAP of greater than 20 and worsening acidosis

Question 25

shock refractory stage

Answer 25

severe hypotension

Question 26

types of shock

Answer 26

``` cardiogenic shock hypovolemic shock distributive shock, that includes: - anaphylactic shock - septic - spinal - neurogenic - burns ```

Question 27

what is neurogenic shock

Answer 27

decrease in tissue perfusion where cells that make up our organs and tissue dont receive enough oxygen type of distributive shock

Question 28

neurogenic shock causes

Answer 28

spinal cord injuries that are located cervical or upper thoracic locations drugs that affect ANS and SNS spinal anesthesia

Question 29

neurogenic shock manifestation

Answer 29

hypotension bradycardia hypothermia warm/dry extremities but cold body

Question 30

neurogenic shock interventions

Answer 30

manage patients ABC and spine protect spin by keeping imobilized may need intubation and mechanical ventilation maintain tissue perfusion - want MAP to be 85-90 give IV fluids - crystalloids (NaC; 0.9%, LR) give vasopressors - dopamine if they are bradycardic then give atropine give rewarming devices for hypothermia put in foely - want urinary output 30 cc/hr or higher prevent DVT - apply compressions stockings, ROM, anticoagulatns avoid crossing pt legs, or placing pillow under patient's kneeds

Question 31

what is anaphylactic shock

Answer 31

due to the release of histamines and other chemicals from allergies, they decrease tissue perfusion caushing shock

Question 32

anaphylactic shock manifestation

Answer 32

``` respiratory: dyspnea wheezing swelling of upper airways can't speak couhging stuffy nose watery eyes ``` cardiac; tachycardiac hypotension GI: nausea vomiting diarrhea skin: red, swollen, itchy hives

Question 33

anaphylactic shock interventions

Answer 33

remove allergen manage airway with high flow oxygen and continuous vital sign call rapid response and start CPR if needed trendelenburg position first line of drug: epinephrine administer IV fluids, albuterol, diphenhydramine and ranitidine stay and monitor patient closely teach - the use of epi pen - massage the injection site for 10 seconds

Question 34

what is septic shock

Answer 34

``` characterized by: persisten hypotension that doesn't respond to fluids needs vasopressors (norepinepherine) to maintain MAP >65 serum lactate >2 ```

Question 35

septic shock manifestations

Answer 35

``` early phase: low BP warm/flushed skin hyperthermia high cardiac output low SVR tachycardia high respiratory rate lethargic/anxious ``` ``` late stage: skin pale, cold, clammy severe hypotension increased HR hypothermia decreased cardiac output and increased SVR oliguria - less than 30 cc/hr coma ```

Question 36

septic shock interventions

Answer 36

start broad spectrum antibiotics enteral nutrition protein actiavated C "drotrecogin alpha" titrate vasopressors inotropics may be added with vasopressors crystalloids or colloids -albumin, hetastarch do this first, but if not working then do vasopressors steroids low dose hemodynamic monitoring oxygenate >95% obtain cultures before antibiotics keep glucose <180

Question 37

hypovolemic shock manifestations

Answer 37

``` tachycardiac hypotension cool/clammy skin weark peripheral pulses anxiety decreased urinary output decreased central venous pressure ```

Question 38

hypovolemic shock intervention

Answer 38

monitor oxygen and perfusion obtain IV access -at least 2 sites that are large - 18 gauge or bigger in large vein collect labs: - hgb, hct - lactate - ABGs - electrolytes - BUN, Cr administer normal saline or LR administer albumin, Hetastarch warm IV fluids administer blood products: - PRBCs PLTs - FFP

Question 39

what is cardiogenic shock

Answer 39

heart cannot pump enough blood to meet perfusion needs of the body main cause: acute myocardial infarction

Question 40

cardiogenic shock manifestation

Answer 40

``` pulmonary congestion crackles, dyspnea increased respiratory rate decreased oxygen increased heart rate distended neck veins chest pain hypotension weak peripheral pulses confusion, agitation, restlessness <30ml/hr urinary output decreased capillary refill cool, pale, clammy skin ```

Question 41

cardiogenic shock interventions

Answer 41

get cardiac markers - increased troponin, increased BN{P pulmonary artery pressure - in cardiogenic shock it will be >18 - normal is 4-12 increased central venous pressure ``` meds: - furosemide - norepinephrine - dobutamine, dopamine nitroglycerin or sodium nitroprusside ```