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Royal College: Emergency Medicine flashcards
1
Q

croup

A

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!

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2
Q

xray finding of croup

A

steeple sign

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3
Q

epiglottitis

A

cause by H. influenza

drooling

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4
Q

drooling seen ing epiglottitis …what NOT to do? what TO do?

A

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)

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5
Q

xray finding of epiglottitis?

A

thumbprint sign

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6
Q

when should oxygen be given in an adult?

A

fewer than 12 breaths or more than 20 breaths per minute

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7
Q

when should oxygen be given in a child?

A

fewer than 15 breaths or more than 30 breaths per minute

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8
Q

when should oxygen be given in an infant?

A

fewer than 25 breaths or more than 50 breaths per minute

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9
Q

nasal cannula

A

slow flow rate and low percent oxygen

  • flow rate 1-6 LPM,
  • 24-44 percent oxygen concentration,
  • breathing victims only (minor breathing problems)
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10
Q

Resuscitation mask

A

moderate flow rate and low percent oxygen

  • flow rate 6 -15 LPM,
  • 35-55 percent oxygen concentration,
  • breathing and non-breathing victims
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11
Q

Non-rebreather mask

A

good flow rate and high percent oxygen

  • flow rate 10-15 LPM,
  • 90+ percent oxygen concentration,
  • breathing victims only
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12
Q

Bag valve mask (BVM)

A

high flow rate and highest percent oxygen

  • flow rate 15 LPM or more,
  • 90+ percent oxygen concentration,
  • breathing and non-breathing victims
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13
Q

upper airway obstruction- what does it look like?

A
  • 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
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14
Q

upper airway obstruction- what to do?

A
  • Determine if obstruction is mechanical or infectious!
  • If mechanical; Do Heimlich procedure
  • If infectious; consider Epiglottitis (drooling, tripod position)
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15
Q

Choking - causes?

A
  • 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)
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16
Q

How To Recognize Choking

A
  • Can you hear breathing or coughing sounds?
  • High pitched breathing sounds?
  • Can’t speak, breathe or cough
  • Universal distress signal (clutches neck)
  • Turning blue
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17
Q

Conscious Choking 
(Adult Foreign Body Airway Obstruction)

A
  • 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
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18
Q

If Victim Becomes Unconscious After Giving Thrusts

A
  • 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
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19
Q

you enter a room and find an unconscious victim..what to do?

A

Assess patient
Perform CPR
(after compressions check airway before giving breaths)

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20
Q

chocking infant…what to do?

A
  • position downward on arm facing floor
  • 5 back blows (check airway)
  • 5 chest thrusts (check airway)
  • repeat
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21
Q

Signs of Shock

A
  • 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
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22
Q

most important indicators of anaphylaxis?

A

tachycardia and falling BP

23
Q

if allergy… how to treat? (no signs of respiratory or CV shock)

A

benadryl (diphenhydramine)

24
Q

if anaphylaxis …how to treat? (respiratory and/or CV shock)

A

Epinephrine, benadryl and steroids

25
Q

assessing peripheral blood pressure (emergency)

A

Radial pulse = AT LEAST 80 Systolic
Femoral pulse = AT LEAST 70 Systolic
Carotid pulse = AT LEAST 60 Systolic

26
Q

ratio of epi for IM/SubQ and intratrachial?

A

1:1000

27
Q

ratio of epi for IV?

A

1:10,000

28
Q

dose of diphenhydramine IV?

A

50 mg (1 mL)

29
Q

epilepsy is a dx of exclusion, first rule out which conditions?

A

Infection
Mass / CA
Electrolyte imbalance
Toxic ingestion

30
Q

all people with head injury should be treated as if they have what condition by default?

A

cervical spinal injury

31
Q

All head injury patients require which intervention?

A

100% O2 therapy

Also (C-spine immobilization, Cervical Collar, Head blocks, Long board)

32
Q

hyphema vs subconjunctival hemmorage

A

hyphema = can cause acute glaucoma

subconjunctival hemmorage = looks bad but isn’t

33
Q

chemical burn…what to do?

A

IRRIGATION and emerg referral

34
Q

flash burn…what to do?

A

common in welders….potato poultice

35
Q

whats worse? Corneal abrasion or corneal ulceration?

A

An ulcer is worse—blindness!

In cases of abrasion you must rule out foreign body before sending home!

36
Q

Survey the scene and RAP…stands for?

A 
R = responsiveness (tap and shoulder "are you OK?"
A = activate EMS (if unresponsive)
P = position on back (keep head and neck in same position)
37
Q

CAB..stand for?

A 
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)

38
Q

in doing CPR, should you give breaths or compressions first???

A

Compressions! (C-A-B rather than A-B-C)

39
Q

ratio of compressions to breaths?!

A

30:2 for all ages if one rescuer

40
Q

ratio of compression to breaths if two rescuers?

A

Adults- 30:2

Infant/Child- 15:2

41
Q

don’t move a victim until after CPR is given and qualified help arrives EXCEPT in the following case::

A

-threat of fire/explosion

42
Q

most victims even with CPR won’t exist unless they have ACLS..what does it stand for?

A

Advanced cardiac life support which includes oxygen, defibrillation, drug therapy

43
Q

when can I stop giving CPR?

A

victim revives
EMS arrives
too exhausted to continue
unsafe scene

44
Q

delivering emergency birth…when to clear airways?

A

after head is out but not shoulders…this is done because once shoulders are out they take their first breath and would aspirate meconium

45
Q

after baby is delivered what should you do?

A 
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
46
Q

APGAR stands for?

A 
A = appearance
P = pulse
G = grimace (reflex)
A = activity (muscle tone)
R = respiration
47
Q

ointment given to newborns prophylactically to prevent transmission of GC/CT?

A

0.5% erythromycin base or 1% tetracycline hydrochloride

48
Q

when giving an IM injection what do you want to make sure to do?

A

aspirate to make sure you aren’t injecting into blood supply

49
Q

angle for
IM
SQ
ID

A 
IM = 90
SQ = 30-45
ID = 5-10
50
Q

when administering IV solution what is the pH range you want? what’s idea?

A

5-9

ideal 6.6 - 7.6

51
Q

when administering IV solution what osmolality is low, moderate and high risk of phlebitis?

A

low- 150-450
mod-450-600
high- >600

52
Q

isotonic solution

A

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

53
Q

syncope…what to do?

A
  • 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
54
Q

glycemic crisis…what to do?

A

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.

Emergency Medicine Boards (1 decks)

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