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Natsumi - NPLEX 2 > DONE: Emergency Medicine, Injections, and Phlebotomy > Flashcards

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
  1. Assess the scene for safety
  2. Activate EMS and get AED
  3. Check for Pulse
  4. Begin CPR
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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
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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

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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

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5
Q

what is the CPR ratio and how many BPM should you perform at?

A

30 compressions : 2 breaths at 100 bpm

allow recoil each time

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6
Q

how many cm or inches should you push down with each compression?

A

5 cm or 2 inches

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7
Q

which finger(s) should be used to lift the jaw in a head tilt-chin lift?

A

4 fingers - NOT the thumb

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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

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9
Q

how many seconds should each breath last?

A

1 second each

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10
Q

the nose should be unplugged during breaths - T/F?

A

FALSE. plug da nose silly!

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11
Q

you give a rescue breath, but fail to see the chest rise, what are your next steps?

A
  1. re-open the airway and attempt 2 breaths (1 sec ea) again
  2. if it still does not rise, perform a finger sweep to clear any obstruction
  3. if still unsuccessful, return to chest compressions
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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

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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
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14
Q

how do you check for responsiveness in a child from 0 yo - puberty?

A

tap the bottom of their foot

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15
Q

what is the compression : ventilation ratio in 1 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

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16
Q

what is the compression technique for someone 1 yo - puberty?

A

one hand on chest, one on forehead

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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

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18
Q

what are the factors that constitute “no pulse felt”

A

no pulse, HR < 60 bpm with signs of poor perfusion

call 911 after 5 cycles

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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

infants: 4 cm/1.5 inches

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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

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21
Q

how does rescue breath technique change for an infant

A

mouth covers infants nose and mouth

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22
Q

T/F: one should still give rescue breaths in someone who has a pulse but is not adequately breathing

A

TRUE

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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)

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24
Q

how often should the pulse be checked in lone rescue breathing?

A

every 2 minutes

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25
Q

what are the risks of giving breaths too quickly or forcefully or with too much volume?

A

vomiting, aspiration, or pneumonia

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26
Q

what are the differences between a mild and severe airway obstruction?

A

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

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27
Q

steps to takes when someone has a mild airway obstruction?

A

encourage continued coughing and breathing efforts, dont interfere with their own attempts, stay with them and monitor conditions, activate EMS

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28
Q

steps to take when someone has a severe airway obstruction?

A

ask them if they are choking > if nodding yes > heimlich

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29
Q

the heimlich is used in adults and infants, T/F?

A

false, only adults

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30
Q

T/F - in heimlich, the fist should be placed directly under the sternum

A

F - it needs to be well below the sternum, but above the navel. Quick, forceful upward thrust in a J motion.

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31
Q

your heimlich patient becomes unresponsive, so you lower them to the ground and beging CPR - what is the first step?

A

do not check the pulse > start with compressions at 30:2

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32
Q

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?

A

false: yes, you should check for a foreign object every time, but should only remove something with your fingers if you can see it

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33
Q

how to perform heimlich on a pregnant or obese victim

A

chest thrusts with backward thrusts

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34
Q

how many back slaps and chest thrusts are performed in relief of choking in infants?

A

5 back slaps (each is a separate attempt to dislodge), 5 chest thrusts (1/second) until unresponsive

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35
Q

when is it ok to perform a blind finger sweep?

A

NEVERRRR

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36
Q

you are performing chest thrusts/back blows on an infant and they become unresponsive, what is your next step?

A

stop giving back slaps and begin CPR starting with compressions

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37
Q

when we are alone, when do we activate EMS? how about when there is someone else?

A

after 2 minutes of CPR

before starting CPR

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38
Q

what are the two forms of heat exhaustion? what signs/sxs tell us which one?

A

water depletion: excessive thirst, weakness, headache, LOC

salt depletion: nausea and vomiting, frequent muscle cramps, dizziness

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39
Q

above what body temperature do we enter heat exhaustion and stroke?

A

> 104 or 40.5 celcius

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40
Q

are coma and seizures seen in heat exhaustion or stroke?

A

stroke

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41
Q

treatment of heat exhaustion

Tx for orthostatic hypotension

A

rest in a cool environment, fluid rehydration, IV normal saline if orthostatic hypotension

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42
Q

treatment of heat stroke

A

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

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43
Q

what medication to avoid in heat stroke

A

antipyretics

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44
Q

can alcohol cause hypo or hyperthermia?

A

hypo

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45
Q

temps categorizing mild/mod/severe hypothermia

A

89-94 (32-34.9 C), 82-88 (28-31.9 C), <82(28 C)

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46
Q

in what stage of hypothermia does the pt stop shivering?

A

moderate (they do shiver in mild)

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47
Q

in what stage of hypothermia do we see muscle rigidity? flaccidity?

A

moderate > severe

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48
Q

does acidemia or alkalemia occur in severe hypothermia?

A

acidemia

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49
Q

2 heart signs seen in severe hypothermia

A

v fib, asystole

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50
Q

hypo or hypertension in severe hypothermia?

A

hypo

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51
Q

pupils dilated or constricted in moderate hypothermia?

A

dilated

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52
Q

tx of hypothermia in all classes

A

fluid replacement with warm drinks and electrolyes

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53
Q

passive external rewarming

A

cover pt with an insulating blanket (external) so the body can generate its own (passive) heat

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54
Q

active external rewarming

A

application of warming blankets or heat baths (active and external)

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55
Q

risk associated with active external rewarming

A

warming the extremities can cause vasodilation > cool pooled blood moves back to the core > drop in core temperature > cardiac arrest

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56
Q

active core rewarming

A

rewarm with IV fluids and warmed humidified O2

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57
Q

how to transport someone who has hypothermia

A

head lower than feet

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58
Q

when to NOT do CPR in someone who is hypothermic?

A

cardiac arrest (pulse very low or absent) - must defibrillate up to a maximum of 3 shocks

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59
Q

in what degree of frost bite do we see numbness and blistering?

A

2nd degree

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60
Q

in what degree of frost bite do we see itching?

A

1st degree

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61
Q

in what degree of frost bite do we see hyperemia?

A

1st degree

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62
Q

in what degree of frost bite do we see hemorrhagic blisters?

A

third

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63
Q

in what degree of frost bite do we see necrosis?

A

third

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64
Q

in what degree of water should we immerse frostbitten areas and for how long?

A

104-106 (40-42 C) degrees, for 10-30 minutes

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65
Q

what medication is applied to blisters after debridement of frostbite?

A

penicillin G

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66
Q

describe the rule of 9s in adults and kids

A

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

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67
Q

which layers of skin are involved in 1/2/3 degree burns?

A

1: (mild partial) superficial layer of epidermis
2: (partial) superficial dermis, hair, sweat glands
3: (full) all layers

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68
Q

in which degree of burn could pain be absent?

A

3rd

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69
Q

in which degree of burn does the skin blanch with pressure

A

1st

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70
Q

in which degree of burn do blisters develop?

A

2nd

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71
Q

in which degree of burn is skin tough and leathery?

A

3rd

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72
Q

how to treat 1st degree burns

A

immerse in cool water, rinse everything off/out and cover with a sterile dressing

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73
Q

1st degree burns should be washed copiously with water except when due to which chemical?

A

phenol - this should be water diluted with alcohol first

74
Q

how to treat 2nd degree burns

A

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
Q

how to treat a 3rd degree burn

  • Administer __
  • what kind of IV
  • what else?
A 
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
Q

in what percent of body surface area burns do we refer to hospital in adults? children? elderly?

A

adults: 75% 1st, > 10% 2nd or third

children and elderly: 75% 1st, > 10% 2nd, > 2-3% third

77
Q

signs and symptoms of an inhalation injury? CO, smoke, or toxic inhalants..

A

decreased Level of Consciousness, SOB, confusion

78
Q

how do we tell the difference between CO poisoning and other inhalation injuries?

A

PO2 might be normal, while oxygen saturation is low

79
Q

what kind of O2 do we give someone with CO poisoning?

A

100% by mask

80
Q

T/F we should use constriction bands in snake bites to prevent the venom from reaching the heart

A

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
Q

which position should someone be put in after an ingested poison?

A

lateral recumbent

82
Q

what can we give to induce vomiting in an ingested poisoning? and how much based on age?

A

activated charcoal
3-5 TBSP in < 5 yo
10-20 TBSP in > 5 yo

83
Q

in what instances do we NOT give activated charcoal to someone?

A

cyanide poisoning, corrosives, ethanol, methanol, petroleum distillates, organic solvents, mineral acids, iron

84
Q

what to give someone in inhaled poison?

A

100% oxygen by mask

85
Q

what to do for someone with contact poisoning? how long do we flush the eye based on substance type?

__ min acidic
__ min alkaline

A

copious water
5 min for acidic
15-20 for alkaline

86
Q

t/f: remove the blade in a stab wound

A

FALSE, have you never watch greys anatomy?

87
Q

what do we assume in a head injury?

A

cervical spine injury

88
Q

how do we gauge the severity of a head injury?

A

LOC, altered pupil size, lateralizing signs (speech, vision, etc)

89
Q

after a head trauma what is ordered?

A

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
Q

at what degree do we elevate the head in a head trauma?

A

20 degrees

91
Q

what do we rinse the eye with if there is a foreign body?

A

saline

92
Q

how to tell the size of a needle?

A

bigger numbers = smaller needles

93
Q

which gauge needle do we use in rapid infusions of thin and thick fluids?

A 
thin = 20
thick = 18
94
Q

which gauge needle do we use in long infusions of thin fluids? in elderly with poor veins? infants? someone with a needle phobia?

A

long infusions of thin fluids? 22
in elderly with poor veins? 24
infants? 24
someone with a needle phobia? 22/24

95
Q

which of the following solutions are isotonic?

3% saline, 
D5W, 
LR, 
normal saline, 
1/2 NS, 
sterile water, 
5% saline
A

normal saline, LR

96
Q

which of the following solutions are hypotonic? LR, 1/2 NS, 3% saline, D5W, sterile water, normal saline, 5% saline

A

1/2 NS, D5W, sterile water

97
Q

which of the following solutions are hypertonic? D5W, LR, 3% saline, normal saline, 1/2 NS, sterile water, 5% saline

A

3% saline, 5% saline

98
Q

which solution is contraindicated in renal disease, why?

what other 2 conditions is this substance contraindicated in?

A

LRs - it contains K and can lead to hyperkalemia in those with renal impairment

dont use in lactic acidosis or liver disease

99
Q

which solution is used for diabetic ketoacidosis/metabolic acidosis?

A

LRs

100
Q

which solution is used for fluid loss due to burns and trauma?

A

LRs

101
Q

which solution is used for metabolic alkalosis?

A

normal saline

102
Q

which solution is used for hyperacute dehydration? 2-3 day dehydration?

A

NS or LR, LR

103
Q

which solution is used for sodium replacement?

A

NS

104
Q

which solution is used for post-anaphylaxis?

A

NS

105
Q

which solution is used for blood transfusion?

A

NS

106
Q

which solution is used for severe diarrhea, vomiting, shock?

A

NS

107
Q

which solution is used for electrolyte replacement?

A

LR

108
Q

which solutions are used for intracellular dehydration/hypernatremia?

A

1/2 NS, D5W

109
Q

cautions in using NS?

A

cardiac or renal disease > fluid volume overload

110
Q

which solution is contraindicated with rapid rehydration?

A

1/2 NS

111
Q

solution contraindicated in those with increased intracranial pressure, burns, liver disease

A

1/2 NS - due to depletion of intravascular volume

112
Q

which solution can cause hypovolemia and hypotension?

A

1/2 NS

113
Q

1/2 NS and D5W are both hypotonic solutions, however only 1 of them is indicated in dehydration and fluid loss? who is it?

A

D5W

114
Q

which solution is contraindicated in resuscitation?

A

D5W

115
Q

sterile water should only be used when?

A

ONLY for diluting or dissolving drugs for injection, make it isotonic prior to use

116
Q

hypotonic solutions are ? and are contraindicated in?

A

1/2 NS, D5W, sterile water = circulatory collapse and hypotension

117
Q

which solution is indicated in severe hyponatremia? hypotonic dehydration?

A

3 or 5% saline

118
Q

when is 3 or 5% saline contraindicated?

A

circulatory overload, CHF, renal failure

119
Q

what is the goal of oxygenation therapy? when can cyanosis be detected? frank cyanosis?

A

SaO2 > 90%
SaO2 < 85%
SaO2 of 67%

120
Q

in which condition is therapeutic O2 cautioned?

A

COPD - they have a high PO2, therapeutic O2 could increase the PCO2 and drive respiratory failure

121
Q

how do you work an o2 tank?

A

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
Q

three complications of O2 therapy?

A

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
Q

ZZZ: flow rate and O2 concentration for nasal cannula

A

1-6 L/m

24-45%

124
Q

your patient is breathing, but has COPD and a low O2 concentration, which delivery system of O2 do you use?

A

nasal cannula or venturi mask or non-rebreathing mask

125
Q

ZZZ: flow rate and O2 concentration for pocket mask w O2

A

6-8 L/min

44-55%

126
Q

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?

A

21%
16%
21%

127
Q

would you use a pocket mask w/ O2 with a pt who is breathing or not breathing?

A

both

128
Q

ZZZ: flow rate and O2 concentration for simple face mask

A

6-10 L/min
40-60%

used when a pt is breathing and in mild-mod respiratory distress

129
Q

ZZZ: flow rate and O2 concentration for a venturi mask

A

4-15 L/min, can also control for humidity

24-40%

130
Q

which mask would you use in someone with asthma?

A

venturi

131
Q

which masks can be used in CPR? which is the best suitable?

A

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
Q

flow rate and O2 concentration for a bag-valve mask resus W O2

A

10-15 L/min

90-100%

133
Q

ZZZ: flow rate and O2 concentration for partial rebreathing mask

A

8-15 L/min

60-80%

134
Q

ZZZ: flow rate and O2 concentration for a non-rebreathing mask

A

10-15 L/min

90-100%

135
Q

what mg and form of diphenhydramine would be given in severe anaphylaxis? mild anaphylaxis?

A

severe: 50 mg IV with epinephrine
mild: 25-50 mg oral every 8 hours for 24 hours

136
Q

dose of epinephrine for adults IM

A

0.3-0.5 mL of (1:1000) every 5-10 minutes

137
Q

dose of epinephrine for adults subQ

A

0.3-0.5 mL of (1:1000) every 15-20 minutes

138
Q

dose of epinephrine for adults IV

A

0.5-1 mL of (1:10,000) until response achieved (slow infusion)

139
Q

dose of epinephrine for adults SL

A

0.3-0.5 mL of (1:1000) every 15-20 minutes

140
Q

when should the sharps container be sealed?

A

when 3/4 full

141
Q

what should be used to to wash your or your patient’s skin if exposed to blood or bodily fluids?

A

NOT alcohol - use antibacterial or plain soap with running water

142
Q

T/F gloves protect against needle stick injuries

A

False

143
Q

when are eye protection and protective clothing needed

A

if blood splashes are expected

144
Q

after how many hours is PEP no longer effective after a needle stick?

A

72 hours

145
Q

response to a needle-stick

A

wash area with running water and soap, allow area to bleed freely, immediate risk assessment + PEP if necessary

146
Q

response to blood or bodily fluid exposure on intact skin VS broken skin

A

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
Q

response to blood or bodily fluid exposure on eyes

What do you flush with and how long

A

invert eyes to keep them open and flush with water or saline for a minimum of 15 minutes

148
Q

response to blood or bodily fluid exposure on mouth

A

immediately spit out fluids and rinse mouth with water several times, do NOT use disinfectant

149
Q

response to blood or bodily fluid exposure on nose

A

immediately blow nose and wash with water or saline several times, do NOT use disinfectant

150
Q

risk of using too large/too small a needle with an injection?

A

tearing vein > hematoma

damage of cells during sampling > invalid result

151
Q

which gauge needles are used for adults, peds, and neonatal for injections?

A

16, 17, 18, 21, 22, 23 butterfly
22, 23 butterfly
23 butterfly

152
Q

what kind of injection is TB skin test or allergy skin test?

A

intradermal

153
Q

why do we use slow absorption technique for intradermal and subQ injection?

A

dermal tissue has poor blood flow and lack of vasculature, slow admin reduces risk of anaphylaxis

154
Q

what gauge needle is used for intradermal injections? at what angle do we inject? what do we look for?

A

26-28
10-15 deg
a wheal. if no wheal forms, we injected into subQ

155
Q

what is the fastest form of injection?

A

IV

156
Q

when is IV injection contraindicated?

A

compromised blood flow, collapsed veins

157
Q

which needle gauge do we use for IV injections? where do we inject?

A

20
median cubital
basilic, cephalic (susceptible to rolling, and basilic is more risky and painful)
dorsal veins of the hand

158
Q

what form of injection do we use for insulin and growth hormone?

A

subQ

159
Q

why is it important to rotate injection site for subQ?

A

not rotating can lead to lipodystrophy

160
Q

what range of needle gauges are used in subQ injections? what locations do we inject? at which angle do we inject?

A

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
Q

what angle are epipens delivered at?

A

90 degrees

162
Q

for which two subQ meds do we NOT need to aspirate before administering?

A

insulin and heparin

163
Q

which forms of injection are fast/slow absorbing?

A 
IV = fast(est)
IM = fast - well-vascularized
subQ = slow
intradermal = slow
164
Q

are B12 or other vitamins usually given subQ or IM?

A

IM ( in the case of B12), but others can be given IV too

165
Q

what needle gauges are used IM in < 18 mo? what locations are used?

A

25-27, vastus lateralis, rectus femoris

166
Q

what needle gauges are used IM in 18 mo-18 yo? what locations are used?

A

22-25, vastus lateralis, ventrogluteal (just below ASIS), deltoid

167
Q

what needle gauges are used IM in > 18 yo? what locations are used?

A

19-25, vastus lateralis, ventrogluteal, deltoid, dorsogluteal (between PSIS and greater trochanter, avoid in obese)

168
Q

at what angle do we insert IM injections?

A

90 degrees

169
Q

what is the color order of phlebotomy tubes?

A

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
Q

which color tube as broth as an additive?

A

Yellow/Culture - cultures microbial pathogens for identification

171
Q

which color tube as sodium citrate as an additive?

A

Blue - coagulation tests, PTT, PT

172
Q

which color tube has no additive?

A

Red - chemistry, immunology, serology, blood bank matching, BUN, bilirubin

173
Q

which color tube as serum separator as an additive?

A

Tiger top - chemistry, hormones, immunology, serology

174
Q

which color tube as heparin as an additive?

A

dark Green - lithium or ammonia levels

175
Q

which color tube as PST plasma separator as an additive?

A

light Green - chemistry

176
Q

which color tube as EDTA as an additive?

A

Lavendar - hematology, blood bank matching, CBC, platelets

177
Q

which color tube as acid-citrate-dextrose as an additive?

A

pale yellow - HLA typing, paternity testing, DNA studies

178
Q

which color tube as oxalate or fluoride as an additive?

A

light gray - glucose, lactose, ethanol

179
Q

at what angle do we insert phlebotomy needles?

A

30 degrees

180
Q

when do we remove a tourniquet for a phlebotomy procedure?

A

ALWAYS before removing the needle or else blood bathhhhh

Natsumi - NPLEX 2 (37 decks)

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