Emerg Med

Question 1

What type of fluid is isotonic with blood and used after blood loss due to trauma, surgery, or burns? What is the usual administration dosage?

Answer 1

Ringer’s lactate

20-30 ml/kg/hour

Question 2

What type of fluid is used after post-op?

Answer 2

D5-W

5% dextrose in water, achieves balance between starvation reactions and hyperglycemia.

Question 3

What are the signs that birth is imminent?

Answer 3

Contractions < 3min apart (beg to beg)
Mother feels urge to push
Crowning

Question 4

T/F: Fundal massage is indicated in placental delivery and is done passively.

Answer 4

T

Question 5

What is the first lab you should do in an acute abdomen in a female in child-bearing years?

Answer 5

Hcg

Question 6

What are uterotonic medications?

Answer 6

Oxytocine, Methergine, Hemabate, misoprostol

Question 7

What are the four T’s of post partum hemorrhage management?

Answer 7

Tone - uterine massage, bimanual massage between vagina and uterine fudus, empty bladder (promote oxytocin - infant suckling)
Trauma - laceration, inversion
Tissue - retained placenta
Thrombin - clotting disorder

Question 8

Two primary causes of neonatal encephalitis/meningitis. How is it prevented?

Answer 8

Grp B Strep (more pathogenic) E.coli

Prophylactic antibiotics - Penicillin

Question 9

What’s the first thing you do in an emergency scene?

Answer 9

Survey the scene

Question 10

If you HAVE to move a victim (for safety), what are you most careful not to move or move minimally?

Answer 10

Head/neck

Question 11

What does RAP mean?

Answer 11

Responsiveness
Activate EMS
Position - for compression, unless suspected head/neck trauma.

Question 12

Difference in CPR for infants.

Answer 12

Total coverage of nose/mouth infant.

Use two fingers to perform shallow compressions.

Question 13

For hydration or emergency purposes, what would you select as far as size for infusion catheter?

Answer 13

18-20 gauge (bigger, infuses more quickly)

Use an isotonic solution

Question 14

What should an IV solution pH be?

Answer 14

6.6-7.6

Question 15

What should IV solution osmolarity be?

Answer 15

150-450 low risk phlebitis
450-600 moderate risk
600 + 100% risk of some phlebitis

Question 16

What are some IV changes that can help reduce risk of phlebitis?

Answer 16

Slow the IV
Increase solution/dilution
Buffer (Bicarb or HCl)
Use largest vein
Watch catheter tip placement

Question 17

Who is at increased risk for fluid overload with IV infusion? How is it avoided?

Answer 17

Elderly with impaired heart or kidney function.

Slow infusion, heat to dilate peripheral circulation, O2 administration

Question 18

How big of an air embolism does it take to cause death in a human?

Answer 18

10-60cc

Question 19

What is the antidote to Mg overdose or speed shock?

Answer 19

1 gram of calcium

Give additional grams depending on how they respond.

Question 20

What is the treatment for a hypoglycemic emergency?

Answer 20

Administer high dose Vit C IV with food. EDTA can also cause.

Infuse D5W or slow push D50.

Question 21

What is the treatment for hyperglycemic emergency?

Answer 21

Steroid injection
Administer NS or 1/2NS
Insulin (SQ or IV)

Question 22

What is the minimal pulse and correlating peripheral BP for radial, femoral, carotid?

Answer 22

Radial = 80 systolic
Femoral = 70 systolic 
Carotid = 60 systolic

Question 23

What is the IM/SQ epinephrine concentration and dose?

What is the IV epinephrine concentration and dose?

Answer 23

1: 1000, 0.3-1 cc immediately
1: 10000, 3cc and wait May give 10cc

Question 24

What is the dose of benadryl for anaphylaxis?

Answer 24

50mg IV stat

Question 25

What other medications would you include in treatment anaphylaxis?

Answer 25

Steroids - dexamethasone, prednisone, hydrocortisone
Ca Gluconate
Mg Sulfate
Albuterol

Question 26

What fluid do you never give to hydrate a patient?

Answer 26

Sterile water - will kill the pt.

Question 27

What is CI in a toxic child with epiglottitis?

Answer 27

Moving the neck or opening mouth.

Question 28

When is oxygen required in an adult? In a child? An infant?

Answer 28

An adult breathing fewer than 12 rpm or more than 20 rpm.

A child is breathing fewer than 15 rpm or more than 30 rpm.

A infant is breathing fewer than 25 rpm or more than 50 rpm.

Question 29

T/F: Always go beyond 2-3L per minute of oxygen with a COPD pt.

Answer 29

F. Never, use nasal cannula.

Question 30

What is something all head injury pts require?

Answer 30

100% oxygen

Question 31

What is important to consider in facial/eye trauma?

Answer 31

Small bone fractures

Question 32

Dosages for epi: 
Subcut
IV
IM
Subling

Answer 32

0. 5-1 ml IV

0. 3-0.5 ml for the rest