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Test 1 Flashcards

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1
Q

Disaster`

A

Any time there is an increase in injuries or illness that are greater than available resources in hospital or community

Keys: injuries or illness greater than available resources in hospital or community

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2
Q

Internal Disaster

A

Fire
Violence
Staffing Issues
Flooding
Power OUtage

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3
Q

External Disaster

A

Natural Disaster
Plane Crash
Terrorism (nuclear, biological, chemical)
Pandemics (reduces resources)

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4
Q

Hospital Incident Command System

A

Chain of hierarchy during disasters

Emergency Officer Command: ER Physician
Nurse Superviser
ER Charge Nurse
Disaster Teams

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5
Q

Role Emergency Officer Command

A

Role of the ER physician - based on title, NOT name
Takes on responsibility of hospital activity

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6
Q

ER Nurse Supervisor Role during Disaster

A

Controls all patients moving in hospital
Calls all charge nurses and tells them the floor needs to come pick up a patient
Communicates alongside ER charge nurse and physician

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7
Q

ER Charge Nurse Role during Disaster

A

Controls patients moving within ER
Tells someone to go down list and start calling people in
Takes on responsibility of triage

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8
Q

Disaster Team A`

A

Disaster just hit or is impending, immediate responders

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9
Q

Disaster Team B

A

24 to 36 hours post disaster
Care for anyone who came in during disaster

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10
Q

Disaster Team C

A

72-hours post disaster
Recovery Team
After disaster is over, they are the ones who put everything back in order

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11
Q

The Join Commission Disaster Prep Rules

A

Require hospitals to perform 2 mock drills per year - 1 city wide, 1 hospital wide

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12
Q

Mass Casualty

A

Overwhelms community or hospital
Requires more than 1 community or hospital involvement
Greater severity of injuries/events

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13
Q

Mass Casualty Triage

A

Makes decisions baed on greater good within the field
Patients tagged Red, yellow, green or black

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14
Q

Mass Casualty: Red Patient

A

Emergent, immediate care is needed or death will result

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15
Q

Mass Casualty: Yellow Patient

A

Urgent, if not fixed within 30 minutes to an hour then they will likely become red
i.e. gunshot wound walking around, wound in arm but eventually may lose too much blood despite being okay now

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16
Q

Mass Casualty: Green

A

Walking wounded
Typically can wait 4 to 6 hours before intervention

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17
Q

Mass Casualty: Black

A

We expect you to die and will allow you to die

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18
Q

Emergency Severity Index

A

Triage occurs within the hospital
Placement is dependent on VITAL SIGNS
ALWAYS LOOK AT VITALS

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19
Q

Emergency Severity Index: Level 1

A

Red/black status
Emergent - life, limb, or eyesight
If you came in during a code then you are automatically level 1 or am I about to have to code you?

Examples: Open femur fracture with unstable vital signs

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20
Q

Emergency Severity Index: Level II

A

Yellow
Urgent, VS are abnormal, but can still talk
Patients can still wait 30 minutes, if intervention does not occur then they usually turn into life, limb eyesight
Possibly septic
Needs to see specialist

Ex) Open femur fracture with stable VS, closed humorous fracture w/ unstable VS, newborn with fever, immunocompromised patients, unstable stroke with abnormal VS

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21
Q

Emergency Severity Index: Level III

A

Green, walking wounded but can wait 5 to 6 hours

ex) chest pain with normal ECG/VS, abdominal pain (from last 2-3 days), pelvic pain, closed humorous fracture with stable VS, stable stroke with normal VS (normal since lat night)

Ask: How many resources are needed - xray, blood, meds

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22
Q

Emergency Severity Index: Level IV

A

Blue, non-urgent
Only 1 resource needed (urine sample OR something else)

ex) sore throat, earaches, sprained ankles, UTI (uncomplicated),

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23
Q

Emergency Severity Index: Level V

A

Pink, no resources needed

Patients with medication refill, work release, splinter in finger, stubbed toe, stable remover

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24
Q

Multi Casualty

A

Same amount of injuries, but many minor injuries (cuts, bruises), only handful, requiring surgery or major injuries

Very few must go to hospital

Handled within 1 hospital or community

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25
ER Characteristics
Short-term Trauma 4:1 or 5:1 ratio Range of acuity levels CEN, TNCC or CCRN certification Vulnerable population - homeless, elderly, kids, uninsured due to lack of access to resources/funding
26
4 Phases of Disaster Prep
Mitigation Preparedness Response Recovery
27
ICU Characteristics
Long-term care higher patient acuity 2:1 ratio CCRN
28
Characteristics ICU and ER Share
Teamwork High Acuity ACLS/BLS Certified
29
Sound Clinical Judgment Outcomes
Improves pt outcomes Decreases LOS Decreases Readmission Rates
30
Poor Clinical Judgment Outcomes
Failure to Rescue Death
31
Failure to Rescue (FTR)
Occurs when we don't notice a decline in status, must call rapid response team (RRT)
32
When do patients start to exhibit signs of death? What is a common contributing factor?
There were usually signs/symptoms 1 to 3 days earlier of declining status Typically multisystem organ system failure dysfunction (MODS) may contribute
33
Where are patient death reports sent?
AHRG, CNS, TJC to perform root cause analysis (RCA)
34
Early Warning Signs/Patient Safety Indicators
BP, respirations, - increase/decrease (different from baseline) LOC - change in status UOP, O2 Sats - decrease Crackles in Lungs Dysrhythmias Pain Fever Seizure (if no known history)
35
Who is on the rapid response team (RRT)?
Respiratory Therapist Critical Care RN (ICU/ER) Intensivist (board certified doctor) - only work in ICU Emergency MD - board certified and only works in ER
36
When do we call rapid response team?
patient is ALIVE Change in status EWS present More resources needed or education If family/pt wants them to come
37
What does the rapid response team do?
Assess ABCs Intervene - ACLS, lifesaving drugs protocols without orders, establish IV access or EKG, rapid sequence intubation (RSI), educate, start labs quickly w/out dr orders
38
Code Team
Different from rapid response team EVERYONE responds, 12-14 people Called when someone is dead
39
EMTALA Laws/Emergency Medical Treatment and Labor Act
Emergency medical treatment and labor act If in active labor or experiencing medical emergency, hospital cannot turn you away Pt must be examined 1st or stabilized before releasing If no resources to deal with case, send to next best equipped location
40
Triage
"To Sort" Rapidly determines patient acuity and categorizes patients so most critical are treated first Represents critical assessment skill
41
ABCDEFGH
Alertness and airway Breathing Circulation Disability Exposure and environmental control Facilitate adjuncts and family Get resuscitation adjuncts history and head to toe1
42
Primary Survey
Focus is on ABCDE Initial Assessment Addressed before moving on to next steps If hemorrhaging, then priority shifts to CAB...
43
Primary Survey: Uncontrolled External Hemorrhage
Reprioritized to CAB Apply direct pressure and apply pressure dressing
44
Alertness and Airway
Determines LOC Assess patient response to verbal and/or painful stimuli AVPU - alert, voice, pain, unresponsive
45
Signs/Symptoms of Compromised Airway
Dyspnea Inability to speak gasping/agonal breath Foreign body in airway trauma to face/neck
46
Treatment of Compromised Airway
Open airway using jaw-thrust maneuver - do not hyperextend neck Suction/remove foreign body Insert NG or OG tube unconscious patient Endotracheal intubation
47
Rapid Sequence Intubation
Preferred procedure for unprotected airway Involves sedation or anesthesia and paralysis
48
When do we suspect cervical spine trauma?
Face, head or neck trauma Significant upper chest injury Treatment: - Cervical collar - cervical immobilization device (CID)
49
Primary Survey: Breathing Interventions
High-flow O2 via nonrebreather mask
50
Primary survey: Breathing Interventions for Life Threatening Conditions
Bag-valve-mask with 100% O2 Needle decompression intubation treat underlying cuase
51
Primary survey: Circulation Assessment
Check for central pulse - peripheral may be absent Assess quality and rate Assess skin color, temp, moisture Assess for signs of chock
52
Signs of shock
Change in mental status delayed cap refill
53
Cirulation Intervention
Insert 2 large-bore IV catheters Initiate aggressive fluid resuscitation using normal saline or LR
54
Disability Assessment
Measured by LOC Glasgow Coma Scale Pupils
55
What to do in cases of exposure and environmental control?
Remove clothing to perform physical assessment Do NOT remove impaled object Prevent heat loss maintain privacy
56
Secondary Survey
Brief, systematic process to identify all injuries - history, head, neck and face; chest, abdomen and flanks, pelvis and perineum, extremities, posterior surfaces Includes FGH of ABCDEFG
57
Resuscitation Adjuncts: LMNOP
Laboratory Studies Monitor ECG Nasogastric tube or orogastric tube Oxygenation and ventilation assessment Pain Management
58
Secondary Survey: SAMPLE
Symptoms Allergies Medication History Past Health History Last meal/oral intake Events or environmental factors leading to illness/injury
59
Pulseless Extremity
time-critical emergency
60
Compartment Syndrome
Limb-threatening complication causing severe vascular impairment Early Signs: Increase in Pain Paresthesias (numbness, painful tingling)

Complex (12 decks)

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