conditions and treatments Flashcards
Neonatal resuscitation
APGAR score
HR
(over 100) 2
(under 100) 1
( asystolic) 0
Breathing
(irregular) 2
(slow) 1
(absent) 0
irritability
( crying) 2
( grimace) 1
( none) 0
Tone
(active) 2
(flexion) 1
(none) 0
Color
( Pink) 2
( Pink body) 1
( cyanotic) 0
APGAR score under 7 indicates need for resuscitation measures
Stimulate baby
Heart rate below 100/apnea or gasping-
position and open airway, BVM OPA
1 breath every 2-3 seconds
heart rate still below 100 BPM-
check chest movement and ventilation consider adv airway
heart rate below 60-
start cpr- 1 person CPR 30:2 , 2 person CPR 15:2 unless adv airway in place then continuous compressions with 1 breath every 2-3 seconds
apply ecg pads
keep baby warm
IV/IO access if heart rate stays below 60 with other interventions
IV epi 1st dose 0.01 mg/kg 1:10,000 followed by saline flush
Post resuscitation care reassess APGAR every 5 min monitor vitals aim for HR above 100 and RR above 30 keep baby warm skin to skin with mom transport
Pediatric Anaphylaxis
Airway - assess and open airway, listen for wheezing and stridor
Breathing- assess resp rate and work of breathing
Circulation- check pulses and cap refill
unresponsive pt - GCS under 8 intubate due to rapid swelling and closure if the airway
administer EPI 0.01mg/kg 1:1,000 IM
load and go
in transport get vitals
IV/IO if not started on scene start fluid bolus 20mL/kg max 1 liter, conduct head to toe assessment and remove stinger if still attached. continue to ventilate and maintain appropriate vitals and perfusion
normal vitals peds
infant- HR-80-140, RR 20-30, BP systolic 70-100
toddler- HR- 80-130, RR 20-30, BP systolic 80-110
preschooler- HR- 80-120, RR- 20-30
BP systolic- 80-110
school age- HR- 70-110, RR- 20-30, BP systolic- 80-120
Adolescent- HR- 55-105, RR- 12-20, BP- 110-120
Adult Asthma or COPD exacerbation
- Mild respiratory distress ( mild wheezing, SOB cough)
- IV, 02, monitor
- NC 4-6 L
- consider NS bolus up to 1000mL
- Nebulize 5mg Albuterol with Ipratropium 500mcg
- may repeat 2.5-5mg albuterol for continued resp distress
- moderate to severe resp distress
(cyanosis, accessory muscle use, 2-3 word dyspnea, severe wheezing or SOB, decreased or absent air movement)
IV, 02, Monitor,
IV/IO NS up to 1000mL bolus
- Nebulize via CPAP/BIPAP 5mg Albuterol with Ipratropium 500mcg
- may repeat 2.5-5mg albuterol for continued resp distress
- status asthmaticus- 0.01mg/kg epi IM (max (0.5mg)
Adult CHF/ Pulmonary Edema
Mild signs and symptoms
IV, 02, monitor
NS TKO
Nitro 0.4mg SL may repeat every 5 min
do not administer in SBP under 100 or if pt taking erectile disfunction medication
Moderate to severe sings and symptoms IV, 02, monitor NS TKO Nitro 0.4mg SL if SBO100-150 0.8mg SL if SBP 150-200 may repeat every 5 mi
Adult Anaphylaxis
Airway - assess and open airway, listen for wheezing and stridor
Breathing- assess resp rate and work of breathing
Circulation- check pulses and cap refill
unresponsive pt - GCS under 8 intubate due to rapid swelling and closure if the airway
administer EPI 0.3mg 1:1000 IM
2 large bore IVs
NS 20mL/kg
Solu medrol- 125mg IV bolus slowly over 2 min
- Benedryl 50mg IV bolus
reassess
maintain appropriate vitals and perfusion
3 lead 12 lead
responsive with no signs of shock
assess breathing and apply oxygen NRB 10L or NC 4-6L
2 large bore IV’s
NS fluid bolus 20mL/kg
administer Solu-medrol 125mg bolus over 2 min followed by benedryl 50mg IV bolus
reassess
monitor vitals and maintain appropriate perfusion
3 lead 12 lead
Adult hypoglycemic emergency
AMS, agitation, focal neuro deficit, seizure, weakness, diaphoresis, decreased motor tone, pallor
ABC
IV, 02, monitor
BG less than 70
if pt can tolerate oral glucose administer 1 tube (15g) oral glucose and reassess pt
pt unable to follow simple commands
administer D10W
BG 40-69=125 mL
BG under 40= 250mL
reassess, 3 lead, 12 lead, maintain vitals and perfusion and transport
Adult abdominal pain and or vomiting
ABC's 02- titrate to 94% abdominal exam - palpate 4 quadrants for tenderness, guarding, rigidity, distention or pulsating mass - identify signs of shock or hypovolemia -SAMPLE OPQRST start IV - fluid bolus 20mL/kg signs of shock -4mg Zophran for N/V -consider analgesics for pain (Fentanyl 25-50 mcg) - head to toe assessment transport reassess
Adult seizure
ABC’s
titrate 02-94%
check BG for diabetic emergency, consider cause of seizure activity
actively seizing yes
- IV/IO access
- 1-5 mg of Versed
- maintain open airway
- if still actively seizing after 5 min repeat 1-5 mg of versed
not actively seizing check for pulse and maintain ABC's - assess neuro condition -cardiac monitor, 3 lead 12 lead - head to toe assesment
Universal seizure precautions
- ensure airway patency
- NPA if needed
- give oxygen
- suction as needed
- protect pt from injury
- check pulse immediately after seizure stops
- keep pt on side
possible causes of siezures
- Epilepsy
- EtOH withdrawl or intoxication
- hypoglycemia
- stimulant use
- trauma
- TCA OD
- Eclampsia
- Infection/Sepsis
Adult Shock and Sepsis
ABC's 02 titrate to 94% may need NRM at 15L min full monitoring 3 lead- 12 lead vitals
Signs of poor perfusion
(AMS, Tachycardia, cool clammy skin or hot skin)
IV/IO- 20mL /kg
consider etiology of shock state
- sepsis
- hemorrhage ( GI bleeding or internal bleeding)
- anaphylaxis
- OD
- cyanide or carbon dioxide poisoning
- PE, MI, Tension pneumo
ongoing hypotension poor perfusion or pulmonary edema start epi drip
1mg epi in 250 bag NS using 60 gtts drio set
4mcg/min =60gtts/min
Adult chest pain
consider life threats -ACS -PE aortic dissection - tension pneumo - ABC's -IV, 02, monitor - 3 lead -12 lead
- complete set of vital signs
- general appearance
- skin color
- diaphoresis
- cardiovascular exam
- irregular heart sounds?
- JVD
- murmur
- pulse asymmetry
- dependent edema
- Pulmonary exam
- crackles/rales and or wheezes/rhonki
- chest wall and abdominal tenderness
administer
- 4 81mg chewable aspirin
- Nitro 0.4mg SL if not contraindicated by inferior MI or erectile dysfunction medication within the last 24 hours
- Fentanyl 50-100mcg
