Emerg

Question 1

Which of the following can primary care paramedics NOT perform:\n12 leak EKG\nIV starts\nSymptom relief meds\nAdvanced first aid\nSemi–automatic defibrillator\nPneumothorax decompression

Answer 1

Pneumothorax decompression – must be performed by advanced care paramedic

Question 2

Paramedics are not regulated health care professionals. How do they perform regulated health acts?

Answer 2

Offline medical control – treatment algorithms\nOnline medical control – physician on call to provide advice or direction (for decompression of pneumothorax, etc.)

Question 3

What valuable information can you gain from a paramedic?

Answer 3

Is the house safe to go home to, is there food in the fridge? any concerns about how the person is being cared for?\nIn the case of a car crash – how bad was the crash?

Question 4

List the four types of shocks, and provide an example for each.

Answer 4

Hypovolemic (hemorrhage)\nCardiogenic (MI)\nObstructive (PE, cardiac tamponade)\nDistributive (sepsis, liver failure)

Question 5

SIRS Criteria (4)

Answer 5

Temperature below 36 or over 38\nHR over 90\nRR over 20\nWBC under 4 or over 12

Question 6

Define sepsis, and severe sepsis

Answer 6

Sepsis: 2 sirs criteria, and infection source\nSevere sepsis: sepsis with signs of end organ damage, hypotension, or elevated lactate (lactate suggests hypoperfusion)

Question 7

Define septic shock

Answer 7

Severe sepsis with persistent signs of end organ damage (i.e., hypotension despite fluid challenge)

Question 8

How would a patient in septic shock present?

Answer 8

Hypotension\nTachycardia (>90)\n\nPeripheral hypo–perfusion\nSigns of end organ dysfunction: encephalopathy, ARDS, ARF/ATN, DIC, cardiovascular dysfunction

Question 9

How is qSOFA used in the emerg?

Answer 9

Prognostication – determine if this person can go home\nNot used to identify sepsis

Question 10

What are the indications to intubate? Think of the mnemonic ABCDEF

Answer 10

Airway (failure to protect)\nBreathing (failure to oxygenate/ventilate)\nCirculation (unload resp muscles)\nDisability (LOC, Sz, weakness, CNS catastrophe such as cerebral hemorrhage)\nExpected course (anticipated decline)\nFeral (need aggressive sedation to protect patient/staff)

Question 11

What is the purpose of delayed sequence intubation?

Answer 11

Stabilize agitated patient with pre–oxygenation before intubating (use Ketamine to help patient tolerate preoxygenation)

Question 12

Management of Sepsis (3 components)

Answer 12

Supplemental O2, Intubate once more stable if needed\n40–60cc/kg fluid, then vasopressors if not stabilized\nTreat infection: Abx and source control

Question 13

In which patients should you limit supplemental O2

Answer 13

MI patients\nCOPDers

Question 14

Alpha 1 adrenergic receptors – what do they do?

Answer 14

Vascular constriction (general constriction throughout body)

Question 15

Beta 1 adrenergic receptors – what do they act on and what do they do?

Answer 15

Heart: increased chronotropy, inotropy

Question 16

Beta 2 adrenergic receptors – what do they act on and what do they do?

Answer 16

Lungs: bronchodilation, vasodilation

Question 17

When would you use phenylephrine?

Answer 17

Have it ready to push during intubation in case BP drops

Question 18

When would you use Levophed?

Answer 18

Levophed is the “go to” vasopressor. It increases SVR (and as a result BP). It also increases chronotropy and inotropy

Question 19

When would you use epinephrine?

Answer 19

Vasopressor used in pediatrics. It increases SVR, chronotropy, inotropy.

Question 20

Which line should be used for for vasopressors

Answer 20

IV can be used in the short run, but in the long run (days), a central line is needed

Question 21

What are the 6 steps in a general approach to a trauma patient.

Answer 21

preparation\nprimary survey resuscitation\nadjuncts to primary survey\nsecondary survey\nadjuncts to secondary survey\ndefinitive care

Question 22

Who do you call for a trauma patient

Answer 22

The trauma team!

Question 23

When the black “patch” phone in the emerg is ringing, who is calling?

Answer 23

Paramedics

Question 24

When the “bat” phone is ringing, who is calling?

Answer 24

911 dispatch

Question 25

What information should you request when dispatch/paramedic calls to let you know a trauma patient is coming?

Answer 25

mechanism of injury\nscene details\ntime to transfer patient to hospital\nnumber of patients\nvital signs\nobvious injuries\nwhat has been done in field

Question 26

What are the components of the primary survey (ABCDE)

Answer 26

airway\nbreathing\ncirculation\ndisability\nexposure (perform this survey while resuscitating)

Question 27

How do you treat a tension pneumothorax? How do you treat an open pneumothorax?

Answer 27

Tension pneumothorax: Needle in second intercostal space in midclavicular line, then place a chest tube\nOpen pneumothorax (i.e., sucking chest wound): Place occlusive dressing taped on three sides, then place a chest tube with an occlusive dressing

Question 28

What is a code orange, and when would you call it?

Answer 28

Code orange represents a “disaster” external to the hospital that is going to overwhelm the hospitals current capacity.

Question 29

Which five compartments can a patient bleed into? What additional compartment is a concern in infants?

Answer 29

thorax\nabdomen\nretroperitoneum (pelvic fracture)\nlong bones (femur)\n”the street”\nInfants: the head (baby’s have relatively large heads, and their suture lines are open)

Question 30

How do you treat a bleed?

Answer 30

Direct pressure or tourniquet proximal to wound

Question 31

How do you manage intra–abdominal bleeding (as identified with point of care ultrasound showing dark fluid between liver and kidney)

Answer 31

Surgery

Question 32

How would you manage a retroperitoneal bleed suggested by a wide–open broken pelvis on x ray?

Answer 32

Bind the pelvis using ties

Question 33

How would you manage bleeding from a long bone?

Answer 33

Splint the fracture to prevent the two ends from moving across each other and causing more bleeding

Question 34

In the emerg, what are your four options for vascular access? List in order from most to least preferred

Answer 34

Large bore IV\nInterosseous (fast to place)\n\nCordis with sheath introducer (large central line)\nTriple lumen central line (long and thin means decreased flow rate)

Question 35

Which fluid is best for trauma resuscitation?

Answer 35

Blood\nUse crystalloid if no immediately available blood

Question 36

Why is it important to follow the massive hemorrhage control protocol?

Answer 36

Large blood transfusions can dilute out coagulation factors, the protocol ensures they are provided back.

Question 37

What is the most common cause of shock in trauma patients?

Answer 37

Bleeding

Question 38

Your trauma patient has a headache, back pain, is vomiting but is not feeling nauseated, also their level of consciousness is declining. Fundoscopy shows papilledema (see pic). What do you do?

Answer 38

https://images.cram.com/images/upload-flashcard/53/63/95/33536395_m.jpg

Question 39

What two intracranial bleeds are associated with trauma?

Answer 39

Subdural and epidural.

Question 40

How can you tell the difference between subdural and epidural bleeds?

Answer 40

Subdural: between the dura and the arachnoid matter –– crescent shaped on ct\n\n\nEpidural: between the dura and the skull –– lentiform shaped on ct, meaning convex on both sides

Question 41

What are you worried about with epidural bleeds? How do you manage them?

Answer 41

Epidural bleeds are fast bleeds and can increase intracranial pressure to the point of herniation.\nTo manage: \nstat call to neurosurg\nmanitol\nhypertonic NS

Question 42

What imaging would you order for a trauma patient? How would this differ for a pediatric patient?

Answer 42

Adult: cxr, pelvic xray, c–spine, injured extremities, head–to–toe CT\nPeds: see above, but be selective with what parts of the kid get CT’ed

Question 43

What would cue you to consider inhalation injuries in a burn patient?\nWhat do you need to do for such a patient?

Answer 43

Presentation:\nfacial burns, singed nasal hair, carbon in sputum, hx of “trapped in confined space” \n\n\nTreatment:\nFluids (parkland formula), intubate early due to edema risk

Question 44

What rule would you use to calculate the percentage of the body covered in burns?

Answer 44

Rule of 9s \n\nhead: 9% \nback: 18%\nfront of torso: 18% \nlegs: 18% (9% each side)\narms: 9% (4.5% each side)

Question 45

1st degree burn, presentation

Answer 45

sunburn

Question 46

Superficial second degree burn, presentation

Answer 46

blisters, pain, no intervention required

Question 47

Deep second degree burns, presentation

Answer 47

yellow tissue, heals in 3 to 8 weeks, require intervention

Question 48

third degree burn presentation and treatment

Answer 48

charred, leathery, insensate, require skin grafting

Question 49

4th degree burn presentation

Answer 49

deep, muscle and bone affected

Question 50

Criteria for referral to burn center

Answer 50

It exists, look it up when you need it

Question 51

STEMI treatment

Answer 51

fluids and vasopressors for low BP\nPCI if at PCI centre, or within an hour travel of centre, otherwise thrombolysis

Question 52

Management of unstable supraventricular tachycardia

Answer 52

Fluids\nElectrical cardioversion (ketamine for pain, then cardiovert)