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3. E Med & Surgery > 1- PA's Role and Airway EM's > Flashcards

1- PA's Role and Airway EM's Flashcards

1
Q

Sudden onset of sx, cardiopulmonary sx, IMC, and frequent/ recent ER visits should alert you to what?

A

Have a heightened awareness (all are examples of warning signs in pt’s hx)

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2
Q

What is the most important 1st impression in the ED?

A

General appearance (respiratory rate also important)

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3
Q

What is the role of PAs in ED triage?

A

Can examine and discharge patients with minor conditions

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4
Q

EMTALA determines if an emergency medical condition exists or not and requires what?

A

Medical Screening Examination (MSE)

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5
Q

What is required for a PA to order a hospital transfer under EMTALA?

A

Consult w/ SP first, SP must co-sign order, w/in time frame specified by hospital policy (some hospitals do require Doc to Doc interaction)

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6
Q

Temperature and O2 saturation of what are defined as high acuity care?

A

Temp > 103F, O2 sat < 90% on room air

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7
Q

What roles can a PA have in EM?

A

Pre hospital (as part of EMS team/military), fast track, high acuity, trauma, rural, administration, teaching

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8
Q

What should be the focus of an ED chart/documentation?

A

Ruling out worst possible scenario, with thorough documentation to prove or disprove

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9
Q

What is the most important part of the ED note with respect to patient management?

A

Disposition (discharge, AMA, OR, obs, admit, transfer)

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10
Q

For a pt admitted to observation, what is the typical length of time?

A

24 hours, 72 hours max

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11
Q

What are the 4 exceptions to informed consent?

A

Unconscious, incapable of consenting, imminent harm from non-treatment, no surrogate available

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12
Q

What is required for a procedure note?

A

Pt Name & DOB, Date/time, indication, consent, description of procedure, estimated blood loss (EBL), complications (if any)

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13
Q

What does “ADC VANDISMAL” stand for and in what type of note is it utilized?

A

Used in admission note; admit, diagnosis, condition, vitals, allergies, nursing, diet, IV fluids, specials, meds (pre-hospital AND new meds), activity, labs

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14
Q

What 5 things are included in a discharge note?

A

Discharge dx, secondary dx, discharge meds, discharge instructions (ER precuations), follow up (appointment information if scheduled)

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15
Q

How will a patient in respiratory failure typically present clinically? (5)

A

Hypoxemia, hypercapnia, respiratory exhaustion, accessory muscle use, retractions

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16
Q

What is the timeframe of complete airway obstruction to onset of brain damage?

A

~4 minutes (varies)

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17
Q

What is the most common cause of airway obstruction?

A

The tongue (falls to the back of the throat and occludes airway)

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18
Q

What are the low-flow oxygen delivery devices? (2-8 L)

A

Nasal cannula (simple, partial rebreathing, non-rebreathing masks, tracheostomy collar)

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19
Q

What are the high-flow oxygen delivery devices? (up to 40 L)

A

Aerosol masks, T-pieces, venturi masks

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20
Q

What is the max oxygen flow rate for oxygen cannula (flow rate of 6L/min?)

A

~ 44%

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21
Q

What is the max oxygen flow rate for a simple face mask (flow rate of 7-8L/min?)

A

~ 60%

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22
Q

What is the max oxygen flow rate for a mask w/ reservoir bag (flow rate of 10L/min?)

A

>80%

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23
Q

What form of external oxygen support is used for resuscitation and manual ventilation?

A

Manual resuscitation bag (AMBU)

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24
Q

What is the max oxygen flow rate for a manual resuscitation bag/AMBU (flow rate of 10L/min?)

A

> 90% w/ tidal volumes up to 800 mL (oxygen flow into bag must be high flow)

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25
Q

What is the only form of external oxygen support that give a pt a “breath”?

A

Manual resuscitation bag (AMBU)

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26
Q

What forma of external oxygen support can deliver positive end expiratory pressure (PEEP)?

A

Manual resuscitation bag (AMBU)

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27
Q

What are the 3 types of airways?

A

Oral, nasal, laryngeal mask airway

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28
Q

What type of airway support lifts the tongue off the back of the oropharynx to provide a patent airway?

A

Nasal

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29
Q

Laryngeal mask airway support is great at managing airways but does not protect against what?

A

Aspiration (gastric fluid into lungs = dangerous)

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30
Q

What are the ABCs of trauma?

A

Airway, breathing, circulation

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31
Q

What is the DOC for anaphylaxis?

A

Epinephrine

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32
Q

What route of administration for epi is preferred?

A

IM better than SQ (IV if extremely serious)

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33
Q

When do you intubate in anaphylaxis?

A

Marked stridor or respiratory arrest (prepare if tongue/oropharyngeal swelling, voice alterations)

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34
Q

Sudden onset of persistent cough w/ unilateral wheezing and decreased breath sounds in a toddler is concerning for what?

A

FB aspiration (organic materials are radiolucent)

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35
Q

What is the most common location for a foreign body aspiration/ obstruction?

A

Right lung/ right main bronchus (60%)

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36
Q

Why is it important to manage airways/ intubate before a burn progresses?

A

Edema affects airways as burn progresses

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37
Q

What is the location of a Le Fort FX I?

A

Maxilla only

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38
Q

What is the location of a Le Fort FX II?

A

Into the nose, concern for cribriform plate fx

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39
Q

What is the location of a Le Fort FX III?

A

Into the orbit, concern for cribriform plate fx

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40
Q

What is absolutely contraindicated in a LeForte II and III fx?

A

Nasal airways (likely to have cribiform fx)

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41
Q

Battle’s sign (bruising of mastoid), raccoon eyes, and CSF from nose/ ears are indicative of what type of fracture?

A

Basilar skull

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42
Q

In pt w/ Le Fort FX II or III what might indicate cribriform plate fx?

A

CSF leaking from nose

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43
Q

What is an IgE mediated histamine release?

A

Anaphylaxis

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44
Q

What effect will histamine have on vessels, bronchioles, and mucous gland secretion?

A

Vasodilation, bronchial constriction, increased mucous gland secretion

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45
Q

Abx, ASA, NSAIDS, foods, insect stings, and grasses are common causes of what?

A

Anaphylaxis and acute allergic reactions

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46
Q

What are the clinical airway features of anaphylaxis? (9)

A

Angioedema, tightening sensation in throat & chest, laryngeal swelling, bronchial spasm, hoarseness, stridor, wheezing, respiratory distress, apnea

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47
Q

Is anaphylaxis a clinical DX?

A

Yes (usually)

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48
Q

What is the treatment for anaphylaxis/ acute allergic reactions aside from airway management and oxygen? (4)

A

Epinephrine if severe hypotension, antihistamines, B2 agonists, steroids

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49
Q

What is the typical dosing for IV epi in the treatment of anaphylaxis/ acute allergic reactions?

A

0.3-0.5 mg of 1:10,000

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50
Q

What is the typical dosing for SC epi in the treatment of anaphylaxis/ acute allergic reactions?

A

0.3-0.5 mg of 1:1,000

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51
Q

What is defined as an eruption similar to urticaria but with larger edematous areas?

A

Angioedema

52
Q

What is the cause of non-allergic angioedema?

A

Bradykinin

53
Q

What areas of the body are typically involved with angioedema?

A

Dermis and subcutaneous structures, head and neck

54
Q

If severe angioedema, how is pt intubated?

A

Fiberoptic intubation, blind nose intubation

55
Q

What are the possible causes of angioedema? (2)

A

Hereditary (insufficient synthesis of C1-esterase inhibitor) and acquired

56
Q

What medication is used to tx angioedema by increasing synthesis of C1-esterase inhibitor?

A

Danazol

57
Q

What angioedema medication is a Kallikrein inhibitor?

A

Ecallantide

58
Q

What angioedema medication is a bradykinin receptor antagonist?

A

Icatibant

59
Q

What condition is defined as bilateral, rapidly spreading submandibular cellulitis and usually originates from 2nd or 3rd molars?

A

Ludwig’s angina

60
Q

The following are signs/ sxs of what condition? Tongue elevated, hard/ firm induration of the floor of the mouth, perioral edema, pain, trismus (painful to open mouth), mediastinitis?

A

Ludwig’s angina

61
Q

What is the general tx for angioedema?

A

Airway managment, supportive care, epinephrine, antihistamines, steroids

62
Q

CT of pt w/ Ludwigs angina will show what?

A

Compromised airway (not round) and pocket of gas (from infection)

63
Q

What is the management for Ludwig’s angina?

A

Surgery (awake fiberoptic nasal intubation, sometimes awake tracheostomy)

64
Q

What is a localized collection of pus or blood in the retropharyngeal space?

A

Retropharyngeal abscess

65
Q

What is the classic sx of retropharyngeal abscess?

A

Odynophagia (painful swallowing) *also drooling if > 2 yrs

66
Q

Tonsilitis, otitis media, pharyngeal trauma, and a mixed G- /anaerobic bacterial infection cause lead to what?

A

Retropharyngeal abscess

67
Q

Pt presents w/ painful swallowing, increased drooling and fever. On exam you note torticollis, meningismus, neck swelling and stridor. What should you be concerned about?

A

Retropharyngeal abscess

68
Q

How is a retropharyngeal abscess diagnosed?

A

Clinical, soft tissue lateral neck xray (gas, mass), CT neck

69
Q

What is the treatment for a retropharyngeal abscess?

A

Airway management, abx, admission, surgical drainage

70
Q

What is defined as an infection of the supraglottic structures including epiglottis, lingual tonsillar area, epiglottic folds, and false vocal cords?

A

Epiglottis

71
Q

What is not indicated in the tx of bronchiolitis (RSV)?

A

Steroids

72
Q

In pt w/ bronchiolitis (RSV) bronchiolar obstruction from submucosal edema and bronchoconstriction will lead to what? Is this an emergency?

A

Lead to respiratory fatigue. Yes airway emergency

73
Q

When is a CXR indicated for pt w/ bronchiolitis (RSV)?

A

fever, choking, asymmetic chest exam, respirtatory distress, sudden deterioration

74
Q

What is concerning about an asthma pt w/ a “quiet chest”?

A

May have compelte occlusion resulting in NO gas exchange

75
Q

Stridor and cough are typically indicative of upper or lower airway disease?

A

Upper

76
Q

Wheezing is typically indicative of upper or lower airway disease?

A

Lower

77
Q

What sx is common to lwoer respiratory tract infection?

A

Hypoxemia > dyspnea, apnea, acute respiratory failure

78
Q

What clincal syndrome infancy is characterized by rapid respirations, chest retractions and wheezing?

A

Bronchiolitis (RSV)

79
Q

CXR for pt w/ bronchiolitis RSV will show what?

A

Hyperinflated lungs

80
Q

Pulse ox of pt w/ RSV will show what? Is the DX clincal?

A

Pulse ox will show hypoxia/ DX is clinical (CXR and viral cultures can be ordered)

81
Q

When should a pt with bronchiolitis (RSV) be hospitalized?

A

Mod-severe cases. (If pt is alert, playful, RR <50, no retractions/hypoxia, no significatn illness can be observed at home)

82
Q

What is the medication tx for severely ill or intubated bronchiolitis (RSV) pt?

A

Ribavirin

83
Q

What airway disease is characterized by mucous plugging, paroxysmal attacks of reversible bronchospasm, and inflammation of the tracheobronchial tree?

A

Asthma

84
Q

Pt presents with progressive dyspnea, chest tightness, wheezing, and cough. What disease are you concerned about?

A

Asthma

85
Q

What is the tx for asthma?

A

B2-agonists (Nebulized SVN albuterol), steroids (PO: Prednisone or IV: Solumedrol), anticholinergics (nebulized atrovent-ipratropium bromide)

86
Q

What is the timeframe for an admission for discharge decision for an pt present with acute asthma exacerbation?

A

Within 1 hr

87
Q

What is the tx protocol for acute asthma exacerbation?

A

Stacked SVN tx w/ bronchidilators

(0.5 cc albuterol in 2.5 cc normal saline, 3 treatments every 30 minutes

Measure peak flow before 1st and after 3rd txs)

88
Q

is Ipratroprium a rescure drug for asthma tx?

A

No, takes a long time to become therapeutic. B2-agonists are your rescue drugs

89
Q

What is status asthmaticus?

A

FEV1 that does not increase to > 40% of predicted value w/ tx

90
Q

What is the tx for pt w/ status asthmaticus?

A

Admit! B-agonists, high dose steroids, oxygen

91
Q

What complication is a pt w/ status asthmaticus at risk for?

A

Pneumothorax

92
Q

What is inflammation of the lung cause by infection that causes alveoli to become filled w/ pus so that air is excluded?

A

Pneumonia

93
Q

Pt presents with fever, cough, dyspnea, pleuritic chest pain, +/- respiratory failure. What are you concerned about?

A

Pneumonia

94
Q

Auscultation, CXR, Pulse Ox, blood gases, CBC, blood cultures, and Sputum Gram stain w/ C+S are the dx criteria for what disease?

A

PNA

95
Q

What is the tx for PNA? (4)

A

oxygen/airway managment, ABX, B-2 agonists, analgesics

96
Q

What is caused by a breech of the lung surface or chest wall allowing air to enter the pleural cavity resulting in lung collapse?

A

Pneumothorax

97
Q

Does a sea shore sign on US indicated a PTX?

A

No. PTX is indicated by barcode sign

98
Q

What are the common signs/ sxs of pneumothorax?

A

Chest pain on side of collapsed lung, dyspnea, occasional cough

99
Q

PTX w/ tracheal deviation to the ooposite side is concerning for what?

A

Tension PTX

100
Q

The treatment of pneumothorax is based on what?

A

% of involvement on CXR and overall presentation

101
Q

What is the treatment for pneumothorax with < 15-20% involvement on CXR?

A

Observation only, repeat CXR in 48 hrs

102
Q

Why is a chest tube tunneled from rib 6 to rib 4?

A

To create “z” track that will seal once the tube is removed

103
Q

How is a chest tube oriented once inserted?

A

Posterioly and superiorly. Held in place with sutures

104
Q

What is the treatment for pneumothorax with 20+% involvement on CXR?

A

Needle decompression for tension pneumothorax, simple aspiration, tube thoracostomy

105
Q

Inflammation of the larynx and subglottic airway most often caused by parainfluenza virus in children 6-36 mos is what?

A

Croup (usually benign and self limited)

106
Q

What sign will you find on PA/lateral neck XR for a pt with croup?

A

Steeple sign XR is not required, but helpful if clinical dx is uncertain

107
Q

What is the tx for croup besides airway management if needed?

A

Cool mist, nebulized epinephrine w/ obs 3-4 hrs after, steroids, +/- O2

108
Q

Is epiglottitis an emergency?

A

Yes! Possible airway obstruction

109
Q

What is the most common etiology of epiglottitis?

A

H influenzae type B (HIB) - rates are decrease due to vaccine

110
Q

Pt presents with dysphagia/ odynophagia, drooling, distress (tripod position), toxic appearance and cyanosis. What disease should you be concerned about?

A

Epiglottitis

111
Q

When examining the oropharynx of a pt with suspected epiglottitis, what should never be used?

A

A tongue blade (may induce spasm causing the oropharynx to close)

112
Q

If lateral neck XR is ordered on a pt w/ suspected epiglottitis, what sign will you seen?

A

Thumb sign

113
Q

What is the tx for epiglottitis? (2)

A
  1. Hospitalize for airway management (surgery likely)
  2. ABX once airway is secured - Ceftriaxone (3rd gen cephalosporin)
114
Q

Pertussis (aka whooping cough) is a contagious respiratory illness caused by what bacteria?

A

Bordetella pertussis (G- aerobe)

115
Q

What disease presents with URI sxs in early stage and absence of fever?

A

Pertussis

116
Q

What is the clinical course of pertussis?

A
  1. Incubation (5-10days) 2. Catarrhal stage (1-2 wks) 3. Paroxysmal stage (1-6) weeks 4. Convalescent stage (wks to months)
117
Q

What is the triad for pertussis?

A
  1. Paroxysms of cough (cough w/in the same breath)
  2. Inspiratory whoop/ stridor
  3. Post-tussive emesis

(may also note increased WBCs and lymphocytes)

118
Q

What is the gold standard for DX of pertussis?

A

Nasal culture (testing should not delay tx)

Other: PCR from nasopharyngeal swab/aspiration, IgG, serology

119
Q

What is recommended for the family/close contacts of pt dx w/ pertussis?

A

Post-exposure prophylaxis (erythro, azithro)

120
Q

What is the most common etiology and yearly season for bronchiolitis?

A

RSV = most common etiology, winter

121
Q

Pt with a 2-3 day hx of URI presents with a low grade fevere and gradual worsening “barking seal” cough (esp at night). On PE you note stridor, dyspnea, retractions and tachypnea. What are you concerned for?

A

Croup

122
Q

What steroids are used to treat croup?

A
  • Prednisone 1 mg/kg
  • Dexamethasone 0.15- 0.6 mg/kg given PO or IM
123
Q

When does the pertussis vaccine (DPT) no longer give complete protection?

A

~10 years

124
Q

Who is at the highest risk for pertussis?

A

Unvaccinated infants and toddlers (risk of sudden infant death and airway compromise)

125
Q

When is whooping cough most contagious?

A

Early stage

3. E Med & Surgery (19 decks)

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