DONE: Emergency Medicine, Injections, and Phlebotomy Flashcards
best when done in order, not random, as the questions build off one another
1
Q
Identify the initial four steps of BLS
A
- Assess the scene for safety
- Activate EMS and get AED
- Check for Pulse
- Begin CPR
2
Q
what components are part of step 1 of BSL - assess the scene for safety?
A
- look for dangers - electrical wires, fire, weapons, glass, toxins, etc
- shout R U OK to victim
- check to see if they are breathing and call for help if you’re alone
3
Q
during step 2 of BSL (activate emergency response system and get the AED), what would you do before calling 911 if someone has drowned/suffered asphyxia arrest?
A
provide 5 cycles or 2 minutes of CPR before calling 911
4
Q
during step 3 of BSL - pulse check - for how many seconds should you feel the pulse for?
A
at least 5, no more than 10
5
Q
what is the CPR ratio and how many BPM should you perform at?
A
30 compressions : 2 breaths at 100 bpm
6
Q
how many cm or inches should you push down with each compression?
A
5 cm or 2 inches
7
Q
which finger(s) should be used to lift the jaw in a head tilt-chin lift?
A
4 fingers - NOT the thumb
8
Q
when would we use a jaw thrust instead of a head tilt-chin lift?
A
if a head or neck injury is suspected, 2 individuals are needed for this
9
Q
how many seconds should each breath last?
A
1 second each
10
Q
the nose should be unplugged during breaths - T/F?
A
FALSE. plug da nose silly!
11
Q
you give a rescue breath, but fail to see the chest rise, what are your next steps?
A
- re-open the airway and attempt 2 breaths again
- if it still does not rise, perform a finger sweep to clear any obstruction
- if still unsuccessful, return to chest compressions
12
Q
in the middle of CPR, the patient begins breathing, what do you do until EMS arrives?
A
roll them to their side and monitor vitals, provide O2, complete a secondary survey
13
Q
your pt is now breathing, and we will perform a secondary survey until EMS arrives. what are the components?
A
SAMPLE S: signs and sxs A: allergies M: medications P: past medical hx L: last meal E: events related to injury
14
Q
how do you check for responsiveness in a child from 0 yo - puberty?
A
tap the bottom of their foot
15
Q
what is the compression : ventilation ratio in 0 yo- puberty if there are 2 rescuers? 1 rescuer? what is the compression depth for someone 1yo - puberty? 0-1 yo?
A
2 = 15:2 1 = 30:2
same as adults: 5 cm/2 inches
infants: 4 cm/1.5 inches
16
Q
what is the compression technique for someone 1 yo - puberty?
A
one hand on chest, one on forehead
17
Q
which artery(ies) are valid for a pulse check in someone 1yo - puberty? how about someone < 1 yo?
A
carotid or femoral
brachial or femoral
18
Q
what are the factors that constitute “no pulse felt”
A
no pulse, HR < 60 bpm with signs of poor perfusion
19
Q
what is the compression technique for someone 0-1 yo?
A
2 fingers just below the nipple line in the center of the chest do not press the bottom of the breast bone
if there are 2 rescuers, they can take both hands around the baby’s abdomen and place both thumbs to compress
20
Q
which position should an infant’s head be in for maximal airway?
A
neck in neutral so the ear canal is level with the top of the infant’s shoulder, can use 1 finger to stabilize the chin if needed
21
Q
how does rescue breath technique change for an infant
A
mouth covers infants nose and mouth
22
Q
T/F: one should still give rescue breaths in someone who has a pulse but is not adequately breathing
A
TRUE
23
Q
lone rescue breathing rate/minute in adults? infants? children?
A
adults: 1 every 5-6 seconds (10-12 bpm)
infants and children: 1 every 3-5 seconds (12-20 bpm)
24
Q
how often should the pulse be checked in lone rescue breathing?
A
every 2 minutes
25
what are the risks of giving breaths too quickly or forcefully or with too much volume?
vomiting, aspiration, or pneumonia
26
what are the differences between a mild and severe airway obstruction?
good VS poor/no air exchange
can cough forcefully VS weak or no cough present
wheezing might be heard VS increased resp difficulty
severe also has cyanosis, unable to speak, clutching neck
27
steps to takes when someone has a mild airway obstruction?
encourage continued coughing and breathing efforts, dont interfere with their own attempts, stay with them and monitor conditions, activate EMS
28
steps to take when someone has a severe airway obstruction?
ask them if they are choking > if nodding yes > heimlich
29
the heimlich is used in adults and infants, T/F?
false, only adults
30
T/F - in heimlich, the fist should be placed directly under the sternum
F - it needs to be well below the sternum , but above the navel
31
your heimlich patient becomes unresponsive, so you lower them to the ground and beging CPR - what is the first step?
do not check the pulse > start with compressions at 30:2
32
T/F - every single time you give breaths to someone with a foreign object, you should check for the object and perform a finger sweep?
false: yes, you should check for a foreign object every time, but should only remove something with your fingers if you can see it
33
how to perform heimlich on a pregnant or obese victim
chest thrusts instead with backward thrusts
34
how many back slaps and chest thrusts are performed in relief of choking in infants?
5 back slaps (each is a separate attempt to dislodge), 5 chest thrusts (1/second)
35
when is it ok to perform a blind finger sweep?
NEVERRRR
36
you are performing chest thrusts/back blows on an infant and they become unresponsive, what is your next step?
stop giving back slaps and begin CPR starting with compressions
37
when we are alone, when do we activate EMS? how about when there is someone else?
after 2 minutes of CPR
| before starting CPR
38
what are the two forms of heat exhaustion? what signs/sxs tell us which one?
water depletion: excessive thirst, weakness, headache, LOC
| salt depletion: nausea and vomiting, frequent muscle cramps, dizziness
39
above what body temperature do we enter heat exhaustion and stroke?
> 104 or 40.5 celcius
40
are coma and seizures seen in heat exhaustion or stroke?
stroke
41
treatment of heat exhaustion
rest in a cool environment, fluid rehydration, IV normal saline if orthostatic hypotension
42
treatment of heat stroke
cool body with water mist and standing fans, immerse in ice water bath (prepare for hypothermia), apply cold packs to axilla and groin, IV fluids if still hypotensive after previous TXS, monitor vitals and send to hospital
43
what medication to avoid in heat stroke
antipyretics
44
can alcohol cause hypo or hyperthermia?
hypo
45
temps categorizing mild/mod/severe hypothermia
89-94, 82-88, <82
46
in what stage of hypothermia does the pt stop shivering?
moderate (they do shiver in mild)
47
in what stage of hypothermia do we see muscle rigidity? flaccidity?
moderate > severe
48
does acidemia or alkalemia occur in severe hypothermia?
acidemia
49
2 heart signs seen in severe hypothermia
v fib, asystole
50
hypo or hypertension in severe hypothermia?
hypo
51
pupils dilated or constricted in moderate hypothermia?
dilated
52
tx of hypothermia in all classes
fluid replacement with warm drinks and electrolyes
53
passive external rewarming
cover pt with an insulating blanket (external) so the body can generate its own (passive) heat
54
active external rewarming
application of warming blankets or heat baths (active and external)
55
risk associated with active external rewarming
warming the extremities can cause vasodilation > cool pooled blood moves back to the core > drop in core temperature > cardiac arrest
56
active core rewarming
rewarm with IV fluids and warmed humidified O2
57
how to transport someone who has hypothermia
head lower than feet
58
when to NOT do CPR in someone who is hypothermic?
cardiac arrest (pulse very low or absent) - must defibrillate up to a maximum of 3 shocks
59
in what degree of frost bite do we see numbness and blistering?
2nd degree
60
in what degree of frost bite do we see itching?
1st degree
61
in what degree of frost bite do we see hyperemia?
1st degree
62
in what degree of frost bite do we see hemorrhagic blisters?
third
63
in what degree of frost bite do we see necrosis?
third
64
in what degree of water should we immerse frostbitten areas and for how long?
104-106 degrees, for 10-30 minutes
65
what medication is applied to blisters after debridement of frostbite?
penicillin G
66
describe the rule of 9s in adults and kids
head, arm, arm are all 9% each
front, back, leg, and leg are all 18% each
genitals are 1%
arm and arm are 9% each
head, front, back are 18%
leg and leg are 14% each
67
which layers of skin are involved in 1/2/3 degree burns?
1: (mild partial) superficial layer of epidermis
2: (partial) superficial dermis, hair, sweat glands
3: (full) all layers
68
in which degree of burn could pain be absent?
3rd
69
in which degree of burn does the skin blanch with pressure
1st
70
in which degree of burn do blisters develop?
2nd
71
in which degree of burn is skin tough and leathery?
3rd
72
how to treat 1st degree burns
immerse in cool water, rinse everything off/out and cover with a sterile dressing
73
1st degree burns should be washed copiously with water except when due to which chemical?
phenol - this should be water diluted with alcohol first
74
how to treat 2nd degree burns
immerse with cool water and cover with a cool compress for 30 minutes, cover the blister with a sterile dressing then elevate the extremity
75
how to treat a 3rd degree burn
administer O2, IV ringers lactate, clean with mild soap and water to prevent an infection, sterile dressing. topical and systemic ABX, morphine infusion for pain.
76
in what percent of body surface area burns do we refer to hospital in adults? children? elderly?
adults: 75% 1st, > 10% 2nd or third
| children and elderly: 75% 1st, > 10% 2nd, > 2-3% third
77
signs and symptoms of an inhalation injury? CO, smoke, or toxic inhalants..
decreased LOC, SOB, confusion
78
how do we tell the difference between CO poisoning and other inhalation injuries?
PO2 might be normal, while oxygen saturation is low
79
what kind of O2 do we give someone with CO poisoning?
100% by mask
80
T/F we should use constriction bands in snake bites to prevent the venom from reaching the heart
Falsetto: can actually be harmful, as when the toxic bolus forming becomes more lethal with band release
but what you should do is contact poison control center for a consultation
81
which position should someone be put in after an ingested poison?
lateral recumbent
82
what can we give to induce vomiting in an ingested poisoning? and how much based on age?
activated charcoal
3-5 TBSP in < 5 yo
10-20 TBSP in > 5 yo
83
in what instances do we NOT give activated charcoal to someone?
cyanide poisoning, corrosives, ethanol, methanol, petroleum distillates, organic solvents, mineral acids, iron
84
what to give someone in inhaled poison?
100% oxygen by mask
85
what to do for someone with contact poisoning? how long do we flush the eye based on substance type?
copious water
5 min for acidic
15-20 for alkaline
86
t/f: remove the blade in a stab wound
FALSE, have you never watch greys anatomy?
87
what do we assume in a head injury?
cervical spine injury
88
how do we gauge the severity of a head injury?
LOC, altered pupil size, lateralizing signs (speech, vision, etc)
89
after a head trauma what is ordered?
non contrast CT to rule out an intracranial mass lesion
cervical spine imaging with a head and neck CT
skull XR for fractures and to localize a foreign body
90
at what degree do we elevate the head in a head trauma?
20 degrees
91
what do we rinse the eye with if there is a foreign body?
saline
92
how to tell the size of a needle?
bigger numbers = smaller needles
93
which gauge needle do we use in rapid infusions of thin and thick fluids?
```
thin = 20
thick = 18
```
94
which gauge needle do we use in long infusions of thin fluids? in elderly with poor veins? infants? someone with a needle phobia?
22, 24, 24, 22/24
95
which of the following solutions are isotonic? 3% saline, D5W, LR, normal saline, 1/2 NS, sterile water, 5% saline
normal saline, LR
96
which of the following solutions are hypotonic? LR, 1/2 NS, 3% saline, D5W, sterile water, normal saline, 5% saline
1/2 NS, D5W, sterile water
97
which of the following solutions are hypertonic? D5W, LR, 3% saline, normal saline, 1/2 NS, sterile water, 5% saline
3% saline, 5% saline
98
which solution is contraindicated in renal disease, why?
| what other 2 conditions is this substance contraindicated in?
LRs - it contains K and can lead to hyperkalemia in those with renal impairment
dont use in lactic acidosis or liver disease
99
which solution is used for diabetic ketoacidosis/metabolic acidosis?
LRs
100
which solution is used for fluid loss due to burns and trauma?
LRs
101
which solution is used for metabolic alkalosis?
normal saline
102
which solution is used for hyperacute dehydration? 2-3 day dehydration?
NS or LR, LR
103
which solution is used for sodium replacement?
NS
104
which solution is used for post-anaphylaxis?
NS
105
which solution is used for blood transfusion?
NS
106
which solution is used for severe diarrhea, vomiting, shock?
NS
107
which solution is used for electrolyte replacement?
LR
108
which solutions are used for intracellular dehydration/hypernatremia?
1/2 NS, D5W
109
cautions in using NS?
cardiac or renal disease > fluid volume overload
110
which solution is contraindicated with rapid rehydration?
1/2 NS
111
solution contraindicated in those with increased intracranial pressure, burns, liver disease
1/2 NS - due to depletion of intravascular volume
112
which solution can cause hypovolemia and hypotension?
1/2 NS
113
1/2 NS and D5W are both hypotonic solutions, however only 1 of them is indicated in dehydration and fluid loss? who is it?
D5W
114
which solution is contraindicated in resuscitation?
D5W
115
sterile water should only be used when?
ONLY for diluting or dissolving drugs for injection, make it isotonic prior to use
116
hypotonic solutions are ? and are contraindicated in?
1/2 NS, D5W, sterile water = circulatory collapse and hypotension
117
which solution is indicated in severe hyponatremia? hypotonic dehydration?
3 or 5% saline
118
when is 3 or 5% saline contraindicated?
circulatory overload, CHF, renal failure
119
what is the goal of oxygenation therapy? when can cyanosis be detected? frank cyanosis?
SaO2 > 90%
SaO2 < 85%
SaO2 of 67%
120
in which condition is therapeutic O2 cautioned?
COPD - they have a high PO2, therapeutic O2 could increase the PCO2 and drive respiratory failure
121
how do you work an o2 tank?
open valve one full turn, check the pressure gauge to see how much O2 is in it, open the flow meter based on pt specification
122
three complications of O2 therapy?
oxygen toxicity (>60% O2 concentration for 3-24 hours): sxs are substernal CP, cough, SOB
retrolental fibroplasia: irreversible blindness in premature infants
absorption atelectasis: alveolar collapse due to the replacement of nitrogen with O2
123
flow rate and O2 concentration for nasal cannula
1-6 L/m
| 24-45%
124
your patient is breathing, but has COPD and a low O2 concentration, which delivery system of O2 do you use?
nasal cannula or venturi mask or non-rebreathing mask
125
flow rate and O2 concentration for pocket mask w O2
6-8 L/min
| 44-55%
126
how much % o2 is in room air? what % is in mouth to mouth when using a pocket mask for CPR use? what % when using a bag-valve mask resuscitator?
21%
16%
21%
127
would you use a pocket mask w/ O2 with a pt who is breathing or not breathing?
both
128
flow rate and O2 concentration for simple face mask
6-10 L/min
40-60%
used when a pt is breathing and in mild-mod respiratory distress
129
flow rate and O2 concentration for a venturi mask
4-15 L/min, can also control for humidity
| 24-40%
130
which mask would you use in someone with asthma?
venturi
131
which masks can be used in CPR? which is the best suitable?
pocket mask without O2 or w O2, bag-valve mask resuscitator without or with O2, partial rebreathing mask
bag-valve without O2 is most suitable
132
flow rate and O2 concentration for a bag-valve mask resus W O2
10-15 L/min
| 90-100%
133
flow rate and O2 concentration for partial rebreathing mask
8-15 L/min
| 60-80%
134
flow rate and O2 concentration for a non-rebreathing mask
10-15 L/min
| 90-100%
135
what mg and form of diphenhydramine would be given in severe anaphylaxis? mild anaphylaxis?
severe: 50 mg IV with epinephrine
mild: 25-50 mg oral every 8 hours for 24 hours
136
dose of epinephrine for adults IM
0.3-0.5 mL of (1:1000) every 5-10 minutes
137
dose of epinephrine for adults subQ
0.3-0.5 mL of (1:1000) every 15-20 minutes
138
dose of epinephrine for adults IV
0.5-1 mL of (1:10,000) until response achieved (slow infusion)
139
dose of epinephrine for adults SL
0.3-0.5 mL of (1:1000) every 15-20 minutes
140
when should the sharps container be sealed?
when 3/4 full
141
what should be used to to wash your or your patient's skin if exposed to blood or bodily fluids?
NOT alcohol - use antibacterial or plain soap with running water
142
T/F gloves protect against needle stick injuries
False
143
when are eye protection and protective clothing needed
if blood splashes are expected
144
after how many hours is PEP no longer effective after a needle stick?
72 hours
145
response to a needle-stick
wash area with running water and soap, allow area to bleed freely, immediate risk assessment + PEP if necessary
146
response to blood or bodily fluid exposure on intact skin VS broken skin
wash area immediately with soap and running water, do not rub the area
wash area immediately with soap and running water, do not rub the area, do not use disinfectant
147
response to blood or bodily fluid exposure on eyes
invert eyes to keep them open and flush with water or saline for a minimum of 15 minutes
148
response to blood or bodily fluid exposure on mouth
immediately spit out fluids and rinse mouth with water several times, do NOT use disinfectant
149
response to blood or bodily fluid exposure on nose
immediately blow nose and wash with water or saline several times, do NOT use disinfectant
150
risk of using too large/too small a needle with an injection?
tearing vein > hematoma
| damage of cells during sampling > invalid result
151
which gauge needles are used for adults, peds, and neonatal for injections?
16, 17, 18, 21, 22, 23 butterfly
22, 23 butterfly
23 butterfly
152
what kind of injection is TB skin test or allergy skin test?
intradermal
153
why do we use slow absorption technique for intradermal and subQ injection?
dermal tissue has poor blood flow and lack of vasculature, slow admin reduces risk of anaphylaxis
154
what gauge needle is used for intradermal injections? at what angle do we inject? what do we look for?
26-28
10-15 deg
a wheal. if no wheal forms, we injected into subQ
155
what is the fastest form of injection?
IV
156
when is IV injection contraindicated?
compromised blood flow, collapsed veins
157
which needle gauge do we use for IV injections? where do we inject?
20
median cubital
basilic, cephalic (susceptible to rolling, and basilic is more risky and painful)
dorsal veins of the hand
158
what form of injection do we use for insulin and growth hormone?
subQ
159
why is it important to rotate injection site for subQ?
not rotating can lead to lipodystrophy
160
what range of needle gauges are used in subQ injections? what locations do we inject? at which angle do we inject?
26-30
anterolateral thigh, abdomen (at least 2 inches away from belly button), upper buttocks (b/w PSIS and greater trochanter), outer triceps (although not ideal)
45 degree angle
161
what angle are epipens delivered at?
90 degrees
162
for which two subQ meds do we NOT need to aspirate before administering?
insulin and heparin
163
which forms of injection are fast/slow absorbing?
```
IV = fast(est)
IM = fast - well-vascularized
subQ = slow
intradermal = slow
```
164
are B12 or other vitamins usually given subQ or IM?
IM ( in the case of B12), but others can be given IV too
165
what needle gauges are used IM in < 18 mo? what locations are used?
25-27, vastus lateralis, rectus femoris
166
what needle gauges are used IM in 18 mo-18 yo? what locations are used?
22-25, vastus lateralis, ventrogluteal (just below ASIS), deltoid
167
what needle gauges are used IM in > 18 yo? what locations are used?
19-25, vastus lateralis, ventrogluteal, deltoid, dorsogluteal (between PSIS and greater trochanter, avoid in obese)
168
at what angle do we insert IM injections?
90 degrees
169
what is the color order of phlebotomy tubes?
Y/Culture, lightB, R, Tiger/Gold, darkG, lightG, Lav, paleY, lightGrey
You Better Remember Tigers Graze(grass is green) at night (Dark) before Light. LeAVE PALE Young LIGeRs alone.
170
which color tube as broth as an additive?
Yellow/Culture - cultures microbial pathogens for identification
171
which color tube as sodium citrate as an additive?
Blue - coagulation tests, PTT, PT
172
which color tube has no additive?
Red - chemistry, immunology, serology, blood bank matching, BUN, bilirubin
173
which color tube as serum separator as an additive?
Tiger top - chemistry, hormones, immunology, serology
174
which color tube as heparin as an additive?
dark Green - lithium or ammonia levels
175
which color tube as PST plasma separator as an additive?
light Green - chemistry
176
which color tube as EDTA as an additive?
Lavendar - hematology, blood bank matching, CBC, platelets
177
which color tube as acid-citrate-dextrose as an additive?
pale yellow - HLA typing, paternity testing, DNA studies
178
which color tube as oxalate or fluoride as an additive?
light gray - glucose, lactose, ethanol
179
at what angle do we insert phlebotomy needles?
30 degrees
180
when do we remove a tourniquet for a phlebotomy procedure?
ALWAYS before removing the needle or else blood bathhhhh
