Chapter 8 Flashcards
emergency situations + hazard prep
who recognizes indicators of emergency situations
STSR
who assess the emergency situation and provides instruction
surgeon/ anesthesia
priorities in emergency situation
preserve life
prevent further deterioration of patient
try to get them higher care
CABD
care priority
chest compression
airway
breathing
definitive treatment (OR/ER)
how long with no air until your brain dies
(clinical death)
4-6 minutes (CPR)
anesthesia role in CPR
in charge, airway management
CN role in CPR
provide crash cart + support
surgeon role in CPR
continue surgery to “safe” stopping point
life threatening, acute pharmacogenic disorder.
malignant hyperthermia
developed during/ after anesthesia
50 events per year
stsr role in CPR
protect the sterile field, if not aid in resuscitation
what code is cardiac arrest
code blue
malignant hyperthermia death rates
50% die without meds
5% die with meds started immediately
what is malignant hyperthermia
fatal hypermotabolic state of muscles due to defect in calcium transport.
skeletal muscles can’t relax
what triggers MH
genetic, mostly males
halogenated agents that ends in “ane”
perchance strenuous exercise
MH signs
tachycardia
increase c02 levels
unstable BP
muscle contraction
high temp -107F
MH emergency protocol for anesthesia
stops what they’re infusing
introduce chilled IV + ice pack
place Foley catheter
what does the anesthesia administer during MH
dentrolene sodium
sodium bicarbonate
insulin
mannitol
heparin
disseminated intravascular coagulation (DIC)
happens when blood begins to coagulate
uses up all coagulation factors and platelets, does blood EVERYWHERE
severe and life threatening
what causes DIC
infection of blood
liver disease
cancer
severe trauma
post delivery complications
DIC treatment
determine underlying cause
treat with transfusion
cryoprecipitate
heparin (prevent thrombosis)
anaphylactic reaction # 1 fixer
epinephrine
causes of anaphylaxis in the OR
anesthetics
codeine
antibiotic
insulin
latex
where can you not put epinephrine
eyes ears fingers nose penis toes
S+S of anaphylactic reactions
hives, bronchospasm, vascular collapse, cardiovascular failure
anaphylactic treatments
supplement o2 - prevent resp arrest
steroids - stabilize cells
iv and plasma -restore fluid vol
vasopressin agents - increase bp
anaphylactic patient ID
identify chart
patient ID band
history noted on chart
skin test performed to ID
categories of Richter scale
1-5
hot zone
central area where disaster occured
warm zone
300 ft or more from hot zone
cold zone
triage near the warm zone, patients evacuated for injuries
best thing to do for radiological burn
take clothes off (90% of contamination)
most variety of physical trauma requiring Surg from
factory explosion
most likely bioterrorism risk
anthrax
NIMS
national incident management system
what does NIMS do
provides national response to emergency
LEMA
local emergency management agency
local coordination
EOP
emergency operations plan
predetermines location of emergency operations center
ICS
incident command system
ensures responders know their roles
unified command groups
operations
planning
logistics
finance + administration
FEMA
federal emergency management agency
requested via LEMA
what is a Brach of FEMA
department of homeland security (DHS)
NRF
national response framework
pulls all the coordinating and communication together
developed by homeland security
NDMS
national disaster medical system
over 100 med teams and 1000 hospitals
rapidly deployed in case of national emergency
three branches of NDMS
DMAT- disaster medical
DMORT- disaster mortuary operation
NPRT- pharmacy response teams
Health care facility emergency response
develops action plan for hospital
practice 2X a year
four components of health care facility emergency response
mitigation - ID hazards
preparedness - develop EAP
response - all responsibilities
recovery - plan for rebuilding
HICS
hospital incident command center
chain of commands
written responsibilities
evacuation plan
shelter in place
transport of patients
back up medical records
first to arrive to scene
1st responders/ firefighters
PPE levels
determined by incident command
A,B,C,D
A= spacesuit
D=mask, eyewear and gloves
decontamination areas
for anyone who’s had contact with the scene
clothes disposed of
what is chemical contacted skin washed with
0.5% sodium hypochlorite- skin and wounds
1:9 ratio of household bleach ^
decontamination area is for
radiological
chemical
blankets available
triage of victims
sorting through victims according to injuries
maximize medical resources
goal of triage
provide treatment to as many patients as possible while spreading out + making most of medical resources
triage personnel
EMT
ER physicians- most experienced and best suited
ST
triage system DIME
delayed- (yellow), have a couple hours
immediate- (red), need to prevent death asap
minimal- (green), ambulatory, minor injuries
expectant- (black)- survival unlikely, burns + head inj.
triage of victims
tags patients without giving care
1 minute per person
chemical nuclear disaster triage
separate into zones for contamination
hot- level A PPE
warm
cold
points of distribution POD
store people - mass prophylaxis
SNS
strategic national stockpile
stores medication and vaccines
2 phases of strategic national stockpile
1- masses, get them antibiotics
2- individual needs, chronic illness
who packages and distributes meds in a POD
NPRT, national pharmacy repsonse team
distribution in POD:
“pull” patients come in
“push” patients delivered to house
PIO Risk Communications With Public
public information center
where correct media is produced, eliminates rumors
adress barriers
volunteer health professions
ESAR- VHP: emergency system for the advanced registration of volunteer health professionals
who is VHP deployed by (volunteered health professionals)
EMAC (emergency management assistance compact)
CERT
community emergency response team
community members completing training with fire/ police
ie. search and rescue
