Emergency Flashcards
The preferred site for an emergency airway is (check one)
- the thyrohyoid membrane
- the cricothyroid membrane
- immediately below the cricoid cartilage
- through the first and second tracheal rings
- at the level of the thyroid isthmus
the cricothyroid membrane
Fortunately, emergency tracheotomy is not often necessary, but should one be necessary the best site for the incision is directly above the cricoid cartilage, through the cricothyroid membrane. Strictly speaking, this is not a tracheotomy, because it is actually above the trachea. However, it is below the vocal cords and bypasses any laryngeal obstruction. The thyrohyoid membrane lies well above the vocal cords, making this an impractical site. The area directly below the cricoid cartilage—which includes the second, third, and fourth tracheal rings, as well as the thyroid isthmus—is the preferred tracheotomy site under controlled circumstances, but excessive bleeding and difficulty finding the trachea may significantly impede the procedure in an emergency.
When draining a felon, which one of the following incisions is recommended? (check one)
A “fishmouth” bilateral incision
A “hockey stick” J-shaped incision including the distal and lateral aspects of the digit
A transverse volar incision
A high lateral incision
A high lateral incision
When draining a felon, a volar longitudinal incision or a high lateral incision is recommended. Incisions that are not recommended are the “fish-mouth” incision, the “hockey stick” (or “J”) incision, and the transverse palmar incision.
You are on a commercial aircraft at cruising altitude. One of the passengers rises from his seat and passes out on the aisle floor beside you. You offer your services as a physician and the flight attendant arrives at the patient’s side. You find the scene safe and the patient unresponsive, not breathing, and without a carotid pulse. You request the automated external defibrillator (AED).
The most appropriate next step would be to (check one)
attach the AED
begin chest compressions at a rate of 100/min
give two slow breaths using the mouth-to-mouth technique
give two slow breaths with a bag-valve mask
tell the flight crew to land as soon as possible
begin chest compressions at a rate of 100/min
The American Heart Association recommends starting immediate chest compressions when a lack of responsiveness, pulse, and breath are confirmed after 10 seconds. This can be followed by ventilation attempts in a ratio of 30 compressions to 2 breaths. In the most recent guidelines, the traditional A-B-C model has been revised to C-A-B to emphasize the early institution of compressions.
It is appropriate to attach the automated external defibrillator (AED) as soon as it arrives, but it is not the most appropriate next step. Two minutes of good-quality compressions are required before analyzing the cardiac rhythm with the AED.
A medical professional on board can make a recommendation to land, but the pilot will follow established protocols for in-flight medical emergencies. The flight crew will be in contact with an emergency consulting agency on the ground within minutes of an in-flight medical emergency.
An unhoused 63-year-old male is brought to the emergency department in a state of agitation and confusion. He is found to be hypothermic with a body temperature of 31.1°C (88.0°F). He has a blood pressure of 90/70 mm Hg and a heart rate of 120 beats/min.
While undergoing warming, which one of the following should be given to this patient? (check one)
Normal saline at room temperature
Normal saline that has been warmed
Lactated Ringer solution at room temperature
Lactated Ringer solution that has been warmed
50% dextrose in water at room temperature
Normal saline that has been warmed
When fluid resuscitation is necessary in hypothermia, normal saline is preferred because hypothermic patients cannot metabolize lactate. The fluid should be warmed to 38°C–42°C (100.4°F–107.6°F.) Lactated Ringer solution and 50% dextrose in water would not be appropriate.
