Boards Flashcards
croup
seal-like bark = stridor
- Breath cool moist air for 5 minutes
- If no improvement after 5 minutes continue to monitor
- If condition worsens transport to hospital
*always assume the worst, airway compromise!
xray finding of croup
steeple sign
epiglottitis
cause by H. influenza
drooling
drooling seen ing epiglottitis …what NOT to do? what TO do?
DONT MOVE KNECK OR OPEN MOUTH
EMS transport to ER (don’t sent to ER in parent car because they don’t have airway management)
xray finding of epiglottitis?
thumbprint sign
when should oxygen be given in an adult?
fewer than 12 breaths or more than 20 breaths per minute
when should oxygen be given in a child?
fewer than 15 breaths or more than 30 breaths per minute
when should oxygen be given in an infant?
fewer than 25 breaths or more than 50 breaths per minute
nasal cannula
slow flow rate and low percent oxygen
- flow rate 1-6 LPM,
- 24-44 percent oxygen concentration,
- breathing victims only (minor breathing problems)
Resuscitation mask
moderate flow rate and low percent oxygen
- flow rate 6 -15 LPM,
- 35-55 percent oxygen concentration,
- breathing and non-breathing victims
Non-rebreather mask
good flow rate and high percent oxygen
- flow rate 10-15 LPM,
- 90+ percent oxygen concentration,
- breathing victims only
Bag valve mask (BVM)
high flow rate and highest percent oxygen
- flow rate 15 LPM or more,
- 90+ percent oxygen concentration,
- breathing and non-breathing victims
upper airway obstruction- what does it look like?
- inspiratory and/or expiratory Stridor (high pitched sounds)
- Possible retractions of the thorax
- Intercostal, suprasternal, supraclavicular
- Cyanosis (later stage)
- Drooling (common in pediatrics)
- LOC with full obstruction
upper airway obstruction- what to do?
- Determine if obstruction is mechanical or infectious!
- If mechanical; Do Heimlich procedure
- If infectious; consider Epiglottitis (drooling, tripod position)
Choking - causes?
- The tongue is the most common obstruction in the unconscious victim
- Vomit
- Foreign body
- Balloons
- Foods
- Swelling (allergic reactions/ irritants)
- Spasm (water is inhaled suddenly)
How To Recognize Choking
- Can you hear breathing or coughing sounds?
- High pitched breathing sounds?
- Can’t speak, breathe or cough
- Universal distress signal (clutches neck)
- Turning blue
Conscious Choking (Adult Foreign Body Airway Obstruction)
- Give 5 abdominal thrusts (Heimlich maneuver)
- Place fist just above the umbilicus (normal size)
- Give 5 upward and inward thrusts
- Pregnant or obese? 5 chest thrusts, Fists on sternum
- If unsuccessful, support chest with one hand and give back blows with the other
- Continue until successful or victim becomes unconscious
If Victim Becomes Unconscious After Giving Thrusts
- Call 911
- Try to support victim with your knees while lowering victim to the floor
- Assess
- Begin CPR
- After chest compressions, check for object before giving breaths breaths
you enter a room and find an unconscious victim..what to do?
Assess patient
Perform CPR
(after compressions check airway before giving breaths)
chocking infant…what to do?
- position downward on arm facing floor
- 5 back blows (check airway)
- 5 chest thrusts (check airway)
- repeat
Signs of Shock
- Tachycardia (Earliest signs of shock)
- Hypotension (Late sign of shock)
- Adrenergic responses (Restless, agitated, cool clammy skin, “livedo reticularis”-mottled skin)
- Altered Mental Status
- Orthostatic Vital Signs
- Problems occur in standing position, often resolve supine
most important indicators of anaphylaxis?
tachycardia and falling BP
if allergy… how to treat? (no signs of respiratory or CV shock)
benadryl (diphenhydramine)
if anaphylaxis …how to treat? (respiratory and/or CV shock)
Epinephrine, benadryl and steroids
assessing peripheral blood pressure (emergency)
Radial pulse = AT LEAST 80 Systolic
Femoral pulse = AT LEAST 70 Systolic
Carotid pulse = AT LEAST 60 Systolic
ratio of epi for IM/SubQ and intratrachial?
1:1000
ratio of epi for IV?
1:10,000
dose of diphenhydramine IV?
50 mg (1 mL)
epilepsy is a dx of exclusion, first rule out which conditions?
Infection
Mass / CA
Electrolyte imbalance
Toxic ingestion
all people with head injury should be treated as if they have what condition by default?
cervical spinal injury
All head injury patients require which intervention?
100% O2 therapy
Also (C-spine immobilization, Cervical Collar, Head blocks, Long board)
hyphema vs subconjunctival hemmorage
hyphema = can cause acute glaucoma
subconjunctival hemmorage = looks bad but isn’t
chemical burn…what to do?
IRRIGATION and emerg referral
flash burn…what to do?
common in welders….potato poultice
whats worse? Corneal abrasion or corneal ulceration?
An ulcer is worse—blindness!
In cases of abrasion you must rule out foreign body before sending home!
Survey the scene and RAP…stands for?
R = responsiveness (tap and shoulder "are you OK?" A = activate EMS (if unresponsive) P = position on back (keep head and neck in same position)
CAB..stand for?
C = compression A = airway (head tilt chin lift) B = breathing (pinch nose, seal lips with yours)
(if pulse not felt within 10 sec, advance to CPR and AED is available)
in doing CPR, should you give breaths or compressions first???
Compressions! (C-A-B rather than A-B-C)
ratio of compressions to breaths?!
30:2 for all ages if one rescuer
ratio of compression to breaths if two rescuers?
Adults- 30:2
Infant/Child- 15:2
don’t move a victim until after CPR is given and qualified help arrives EXCEPT in the following case::
-threat of fire/explosion
most victims even with CPR won’t exist unless they have ACLS..what does it stand for?
Advanced cardiac life support which includes oxygen, defibrillation, drug therapy
when can I stop giving CPR?
victim revives
EMS arrives
too exhausted to continue
unsafe scene
delivering emergency birth…when to clear airways?
after head is out but not shoulders…this is done because once shoulders are out they take their first breath and would aspirate meconium
after baby is delivered what should you do?
place baby on or next to mom and... clear airway towel dry and wrap in blanket if not breathing (crying) clear airway again and flick soles of feet if still not breathing perform CPR
APGAR stands for?
A = appearance P = pulse G = grimace (reflex) A = activity (muscle tone) R = respiration
ointment given to newborns prophylactically to prevent transmission of GC/CT?
0.5% erythromycin base or 1% tetracycline hydrochloride
when giving an IM injection what do you want to make sure to do?
aspirate to make sure you aren’t injecting into blood supply
angle for
IM
SQ
ID
IM = 90 SQ = 30-45 ID = 5-10
when administering IV solution what is the pH range you want? what’s idea?
5-9
ideal 6.6 - 7.6
when administering IV solution what osmolality is low, moderate and high risk of phlebitis?
low- 150-450
mod-450-600
high- >600
isotonic solution
250 – 375 mOsm/L
Normal Saline (0.9% Sodium Chloride / NS)
5% Dextrose in Water (D5W)
Ringer’s Lactate (Balanced electrolyte solution)
NEVER NEVER give sterile water
syncope…what to do?
- Patient in recumbent position
- DO NOT D/C THE I.V. LINE!!!
- Slow (stop) infusion rate
- Talk to them (if conscious)
- Have them move their feet
glycemic crisis…what to do?
typically due to high dose Vit C infusion or EDTA chelation
- D5W infusion (as a base solution for prevention) OR
- slow push of D-50 [50% Dextrose] (5 – 50 mL D50) will reverse.
