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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
What is the only form of external oxygen support that give a pt a "breath"?
Manual resuscitation bag (AMBU)
26
What forma of external oxygen support can deliver positive end expiratory pressure (PEEP)?
Manual resuscitation bag (AMBU)
27
What are the 3 types of airways?
Oral, nasal, laryngeal mask airway
28
What type of airway support lifts the tongue off the back of the oropharynx to provide a patent airway?
Nasal
29
Laryngeal mask airway support is great at managing airways but does not protect against what?
Aspiration (gastric fluid into lungs = dangerous)
30
What are the ABCs of trauma?
Airway, breathing, circulation
31
What is the DOC for anaphylaxis?
Epinephrine
32
What route of administration for epi is preferred?
IM better than SQ (IV if extremely serious)
33
When do you intubate in anaphylaxis?
Marked stridor or respiratory arrest (prepare if tongue/oropharyngeal swelling, voice alterations)
34
Sudden onset of persistent cough w/ unilateral wheezing and decreased breath sounds in a toddler is concerning for what?
FB aspiration (organic materials are radiolucent)
35
What is the most common location for a foreign body aspiration/ obstruction?
Right lung/ right main bronchus (60%)
36
Why is it important to manage airways/ intubate before a burn progresses?
Edema affects airways as burn progresses
37
What is the location of a Le Fort FX I?
Maxilla only
38
What is the location of a Le Fort FX II?
Into the nose, concern for cribriform plate fx
39
What is the location of a Le Fort FX III?
Into the orbit, concern for cribriform plate fx
40
What is absolutely contraindicated in a LeForte II and III fx?
Nasal airways (likely to have cribiform fx)
41
Battle's sign (bruising of mastoid), raccoon eyes, and CSF from nose/ ears are indicative of what type of fracture?
Basilar skull
42
In pt w/ Le Fort FX II or III what might indicate cribriform plate fx?
CSF leaking from nose
43
What is an IgE mediated histamine release?
Anaphylaxis
44
What effect will histamine have on vessels, bronchioles, and mucous gland secretion?
Vasodilation, bronchial constriction, increased mucous gland secretion
45
Abx, ASA, NSAIDS, foods, insect stings, and grasses are common causes of what?
Anaphylaxis and acute allergic reactions
46
What are the clinical airway features of anaphylaxis? (9)
Angioedema, tightening sensation in throat & chest, laryngeal swelling, bronchial spasm, hoarseness, stridor, wheezing, respiratory distress, apnea
47
Is anaphylaxis a clinical DX?
Yes (usually)
48
What is the treatment for anaphylaxis/ acute allergic reactions aside from airway management and oxygen? (4)
Epinephrine if severe hypotension, antihistamines, B2 agonists, steroids
49
What is the typical dosing for IV epi in the treatment of anaphylaxis/ acute allergic reactions?
0.3-0.5 mg of 1:10,000
50
What is the typical dosing for SC epi in the treatment of anaphylaxis/ acute allergic reactions?
0.3-0.5 mg of 1:1,000
51
What is defined as an eruption similar to urticaria but with larger edematous areas?
Angioedema
52
What is the cause of non-allergic angioedema?
Bradykinin
53
What areas of the body are typically involved with angioedema?
Dermis and subcutaneous structures, head and neck
54
If severe angioedema, how is pt intubated?
Fiberoptic intubation, blind nose intubation
55
What are the possible causes of angioedema? (2)
Hereditary (insufficient synthesis of C1-esterase inhibitor) and acquired
56
What medication is used to tx angioedema by increasing synthesis of C1-esterase inhibitor?
Danazol
57
What angioedema medication is a Kallikrein inhibitor?
Ecallantide
58
What angioedema medication is a bradykinin receptor antagonist?
Icatibant
59
What condition is defined as bilateral, rapidly spreading submandibular cellulitis and usually originates from 2nd or 3rd molars?
Ludwig's angina
60
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?
Ludwig's angina
61
What is the general tx for angioedema?
Airway managment, supportive care, epinephrine, antihistamines, steroids
62
CT of pt w/ Ludwigs angina will show what?
Compromised airway (not round) and pocket of gas (from infection)
63
What is the management for Ludwig's angina?
Surgery (awake fiberoptic nasal intubation, sometimes awake tracheostomy)
64
What is a localized collection of pus or blood in the retropharyngeal space?
Retropharyngeal abscess
65
What is the classic sx of retropharyngeal abscess?
Odynophagia (painful swallowing) \*also drooling if \> 2 yrs
66
Tonsilitis, otitis media, pharyngeal trauma, and a mixed G- /anaerobic bacterial infection cause lead to what?
Retropharyngeal abscess
67
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?
Retropharyngeal abscess
68
How is a retropharyngeal abscess diagnosed?
Clinical, soft tissue lateral neck xray (gas, mass), CT neck
69
What is the treatment for a retropharyngeal abscess?
Airway management, abx, admission, surgical drainage
70
What is defined as an infection of the supraglottic structures including epiglottis, lingual tonsillar area, epiglottic folds, and false vocal cords?
Epiglottis
71
What is not indicated in the tx of bronchiolitis (RSV)?
Steroids
72
In pt w/ bronchiolitis (RSV) bronchiolar obstruction from submucosal edema and bronchoconstriction will lead to what? Is this an emergency?
Lead to respiratory fatigue. Yes airway emergency
73
When is a CXR indicated for pt w/ bronchiolitis (RSV)?
fever, choking, asymmetic chest exam, respirtatory distress, sudden deterioration
74
What is concerning about an asthma pt w/ a "quiet chest"?
May have compelte occlusion resulting in NO gas exchange
75
Stridor and cough are typically indicative of upper or lower airway disease?
Upper
76
Wheezing is typically indicative of upper or lower airway disease?
Lower
77
What sx is common to lwoer respiratory tract infection?
Hypoxemia \> dyspnea, apnea, acute respiratory failure
78
What clincal syndrome infancy is characterized by rapid respirations, chest retractions and wheezing?
Bronchiolitis (RSV)
79
CXR for pt w/ bronchiolitis RSV will show what?
Hyperinflated lungs
80
Pulse ox of pt w/ RSV will show what? Is the DX clincal?
Pulse ox will show hypoxia/ DX is clinical (CXR and viral cultures can be ordered)
81
When should a pt with bronchiolitis (RSV) be hospitalized?
Mod-severe cases. (If pt is alert, playful, RR \<50, no retractions/hypoxia, no significatn illness can be observed at home)
82
What is the medication tx for severely ill or intubated bronchiolitis (RSV) pt?
Ribavirin
83
What airway disease is characterized by mucous plugging, paroxysmal attacks of reversible bronchospasm, and inflammation of the tracheobronchial tree?
Asthma
84
Pt presents with progressive dyspnea, chest tightness, wheezing, and cough. What disease are you concerned about?
Asthma
85
What is the tx for asthma?
B2-agonists (Nebulized SVN albuterol), steroids (PO: Prednisone or IV: Solumedrol), anticholinergics (nebulized atrovent-ipratropium bromide)
86
What is the timeframe for an admission for discharge decision for an pt present with acute asthma exacerbation?
Within 1 hr
87
What is the tx protocol for acute asthma exacerbation?
**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
is Ipratroprium a rescure drug for asthma tx?
No, takes a long time to become therapeutic. B2-agonists are your rescue drugs
89
What is status asthmaticus?
FEV1 that does not increase to \> 40% of predicted value w/ tx
90
What is the tx for pt w/ status asthmaticus?
Admit! B-agonists, high dose steroids, oxygen
91
What complication is a pt w/ status asthmaticus at risk for?
Pneumothorax
92
What is inflammation of the lung cause by infection that causes alveoli to become filled w/ pus so that air is excluded?
Pneumonia
93
Pt presents with fever, cough, dyspnea, pleuritic chest pain, +/- respiratory failure. What are you concerned about?
Pneumonia
94
Auscultation, CXR, Pulse Ox, blood gases, CBC, blood cultures, and Sputum Gram stain w/ C+S are the dx criteria for what disease?
PNA
95
What is the tx for PNA? (4)
oxygen/airway managment, ABX, B-2 agonists, analgesics
96
What is caused by a breech of the lung surface or chest wall allowing air to enter the pleural cavity resulting in lung collapse?
Pneumothorax
97
Does a sea shore sign on US indicated a PTX?
No. PTX is indicated by barcode sign
98
What are the common signs/ sxs of pneumothorax?
Chest pain on side of collapsed lung, dyspnea, occasional cough
99
PTX w/ tracheal deviation to the ooposite side is concerning for what?
Tension PTX
100
The treatment of pneumothorax is based on what?
% of involvement on CXR and overall presentation
101
What is the treatment for pneumothorax with \< 15-20% involvement on CXR?
Observation only, repeat CXR in 48 hrs
102
Why is a chest tube tunneled from rib 6 to rib 4?
To create "z" track that will seal once the tube is removed
103
How is a chest tube oriented once inserted?
Posterioly and superiorly. Held in place with sutures
104
What is the treatment for pneumothorax with 20+% involvement on CXR?
Needle decompression for tension pneumothorax, simple aspiration, tube thoracostomy
105
Inflammation of the larynx and subglottic airway most often caused by parainfluenza virus in children 6-36 mos is what?
Croup (usually benign and self limited)
106
What sign will you find on PA/lateral neck XR for a pt with croup?
Steeple sign XR is not required, but helpful if clinical dx is uncertain
107
What is the tx for croup besides airway management if needed?
Cool mist, nebulized epinephrine w/ obs 3-4 hrs after, steroids, +/- O2
108
Is epiglottitis an emergency?
Yes! Possible airway obstruction
109
What is the most common etiology of epiglottitis?
H influenzae type B (HIB) - rates are decrease due to vaccine
110
Pt presents with dysphagia/ odynophagia, drooling, distress (tripod position), toxic appearance and cyanosis. What disease should you be concerned about?
Epiglottitis
111
When examining the oropharynx of a pt with suspected epiglottitis, what should never be used?
A tongue blade (may induce spasm causing the oropharynx to close)
112
If lateral neck XR is ordered on a pt w/ suspected epiglottitis, what sign will you seen?
Thumb sign
113
What is the tx for epiglottitis? (2)
1. Hospitalize for airway management (surgery likely) 2. ABX once airway is secured - Ceftriaxone (3rd gen cephalosporin)
114
Pertussis (aka whooping cough) is a contagious respiratory illness caused by what bacteria?
Bordetella pertussis (G- aerobe)
115
What disease presents with URI sxs in early stage and absence of fever?
Pertussis
116
What is the clinical course of pertussis?
1. Incubation (5-10days) 2. Catarrhal stage (1-2 wks) 3. Paroxysmal stage (1-6) weeks 4. Convalescent stage (wks to months)
117
What is the triad for pertussis?
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
What is the gold standard for DX of pertussis?
Nasal culture (testing should not delay tx) Other: PCR from nasopharyngeal swab/aspiration, IgG, serology
119
What is recommended for the family/close contacts of pt dx w/ pertussis?
Post-exposure prophylaxis (erythro, azithro)
120
What is the most common etiology and yearly season for bronchiolitis?
RSV = most common etiology, winter
121
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?
Croup
122
What steroids are used to treat croup?
* Prednisone 1 mg/kg * Dexamethasone 0.15- 0.6 mg/kg given PO or IM
123
When does the pertussis vaccine (DPT) no longer give complete protection?
~10 years
124
Who is at the highest risk for pertussis?
Unvaccinated infants and toddlers (risk of sudden infant death and airway compromise)
125
When is whooping cough most contagious?
Early stage

3. E Med & Surgery (19 decks)

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