Emergency Flashcards
What are signs of shock?
hypotension (systolic blood pressure < 90 mmHg), pallor, sweating, cold, clammy extremities, confusion or impaired consciousness.
What are the first steps in any emergency?
ABCDE
What is the CPR ratio in adults?
30:2
What are shockable rhythms?
VF Pulseless VT
What are non-shockable rhythms?
Asystole PEA - pulseless electrical activity
After shocking a collapsed patient how long do you then carry on CPR before another shock?
2 minutes, then reassess rhythm
What reversible causes could have caused a cardiac arrest collapse? 4 Hs, 4Ts
Reversible Causes: Hypoxia Hypovolaemia Hypo-/hyperkalaemia/metabolic Hypothermia Thrombosis - coronary or pulmonary Tamponade - cardiac Toxins Tension pneumothorax
What is a precordial thump? Is it useful?
Single blow to sternum A single precordial thump has a very low success rate for cardioversion of a shockable rhythm and is only likely to succeed if given within the first few seconds of the onset of a shockable rhythm.
What are the steps in adult BLS?
Check safety Unresponsive? Shout for help Open airway Not Breathing? Call 999 30 chest compressions 2 rescue breaths 30:2
What rate should chest compressions be given in?
100-120 a minute
When do you continue resuscitation until?
- qualified help arrives and takes over, - the victim starts to show signs of regaining consciousness, such as coughing, opening his eyes, speaking, or moving purposefully AND starts to breathe normally, OR - you become exhausted.
What compression depth should be achieved in an adult?
5-6 cm
If a person is choking, what suggests severe airway restriction?
Response to question ‘Are you choking?’ Victim unable to speak Victim may respond by nodding Other signs Victim unable to breathe Breathing sounds wheezy Attempts at coughing are silent Victim may be unconscious
Describe what the algorithm is of an adult choking.
Describe how to give 5 black blows for Choking
Stand to the side and slightly behind the victim.
Support the chest with one hand and lean the victim well forwards so that when the obstructing object is dislodged it comes out of the mouth rather than goes further down the airway.
Give up to five sharp blows between the shoulder blades with the heel of your other hand.
Describe how you would give 5 abdo thrusts in an adult choking
Stand behind the victim and put both arms round the upper part of his abdomen. o Lean the victim forwards.
Clench your fist and place it between the umbilicus (navel) and the bottom end of the sternum (breastbone).
Grasp this hand with your other hand and pull sharply inwards and upwards.
How likely, when a shocking someone in VT, is it for a normal rhythm to return?
If a patient in a shockable cardiac arrest rhythm is defibrillated within the first 90 seconds of the arrest there is a high (80%) chance that the rhythm will be terminated and replaced by one which will return cardiac output.
However with each passing minute the patients’ chance of survival drops by 10%
What drug should be given when dealing with a cardiac arrest collapse?
1 mg IV adrenaline
Is survival likely from a non-shockable rhythm cardiac arrest?
Survival following cardiac arrest with asystole or PEA is unlikely unless a reversible cause can be found and treated effectively.
How often should IV adrenaline be given in an arrest situation?
Every 3-5 minutes
What is the algorhythm for peadiatrics BLS?
Unresponsive?
Shout for help
Open airway
Not breathing?
999
5 rescue breaths
No sign of life?
15 chest compressions
Continue 15:2
In a peadiatric situation and you are alone, when should you go for help?
Do CPR for one minute before going for help
How deep should your chest compressions be in a peadiatric situation?
1/3 body depth
2 fingers in infant under 1
one hand in small child
How long should you listen for normal breathing for in a peadiatric case?
no more than 10seconds
What position should an infants head be in when giving rescue breaths?
Neural position
Where should you apply chest compressions in a child or infant?
1 fingersbreadth above the xiphiod sternum
What defines a newborn, neonate, infant and child?
A newborn is a child just after birth.
A neonate is a child in the first 28 days of life.
An infant is a child under 1 year.
A child is between 1 year and puberty.
What are general signs of choking (esp. in a child)
Witnessed episode
Coughing or choking
Sudden onset
Recent history of playing with or eating small objects
What signifies ineffective coughing in a child who has choked?
Unable to vocalise
Quiet or silent cough
Unable to breathe
Cyanosis
Decreasing level of consciousness
What reassures you that a child has an effective cough after choking/
Crying or verbal response to questions
Loud cough
Able to take a breath before coughing
Fully responsive
What is the Paediatric Choking Treatment Algorithm ?
Should you use abdominal thrusts in a choking infant?
NO
How do you give chest thrusts to infants?
Turn the infant into a head-downwards supine position. This is achieved safely by placing your free arm along the infant’s back and encircling the occiput with your hand.
Support the infant down your arm, which is placed down (or across) your thigh.
Identify the landmark for chest compression (lower sternum approximately a finger’s breadth above the xiphisternum).
Deliver up to 5 chest thrusts. These are similar to chest compressions, but sharper in nature and delivered at a slower rate.
The aim is to relieve the obstruction with each thrust rather than to give all 5.
How is the airway measured for a gudel/oropharengeal airway?
The oropharyngeal airway is measured from the edge of the mouth to the tragus.
If a patient is unresponsive and can’t protect their airway what can you use?
An endotracheal tube
How can you ensure you have inserted the endotracheal tube correctly?
capnograph
What are the AVPU parameters?
AVPU Assessment :-
A - Alert
V - Responding to Voice
P - Responding to Pain
U - Unresponsive
What are the steps in the Glasgow Coma Scale GCS?
Eye Opening Response
4 - Spontaneous
3 - To Speech
2 - To Pain
1 - No Eye Opening
Best Verbal Response
5 - Orientated
4 - Confused Conversation
3 - Inappropriate Words
2 - Incomprehensible Sounds
1 - No Response
Best Motor Response
6 - Obeys commands
5 - Appropriate localising response to pain
4 - Withdrawal response
3 - Abnormal flexion response (Decorticate Rigidity)
2 - Extension response (Decerebrate rigidity)
1 - No Response
How much of an adult body is water?
45-80%
around 45 L
Of the total body’s water content, how much is intracellular and how much extracellular?
2/3 intra - 30L
1/3 intra - 15L
Of the intracellular fluid, how much is interstitial fluid and how much intravascular?
10L - intersitial
5L intravascular
What fluids are seen as isotonic?
Normal saline (150 mmol NA/l)
Hartmann’s solution (131 mmol NA/l)
IV infusion of an isotonic solution maininly increases the volume of what compartment?
ECF - extraceullar fluid
Where will IV infusion of dextrose solution be distributed?
Between ECF and ICF
- as glucose in it is metabolised, so leaves just water, which reduces the ECF osmolality, so fluid leaves it to the ICF until balence is regained
What are symptoms of hypovolaemia?
Lethargy, weakness
Postural dizziness
Thirst
Dry mouth
Reduced urine output
Feeling cold
Shivering
Panting
Altered mental state
What are clinical signs of hypovolaemia?
Colour – pallor
Peripheral temperature – cool
Peripheral perfusion – delayed capillary refill time greater than 2 secs
Dry mucous membranes
Dry furrowed tongue
Sunken eyes
Reduced skin turgor
Pulse - tachycardia
- or postural rise in pulse rate greater than 30 bpm on standing
BP - reduced
- or postural fall in BP greater than 20mmHg on standing
JVP - low or absent
What investigations may confirm hypovolaemia
Urea, creatinine, sodium
Haemoglobin, haematocrit
Urinary sodium, osmolarity
ECG, CXR, ABG
Central venous pressure monitoring
What are causes of shock?
Hypovolaemia
Cardiogenic (MI, PE)
Septicaemia
Anaphylaxis
Neurogenic (spinal injury - loss of sympathetic tone - vasodilation)
Tension pneumothorax
Addisonian crisis
What amount of fluid would you give initially in shock?
Rapid bolus
1-2l in adults
20mls/kg in a child
What type of fluid would you use initially in shock?
Isotonic crystalloids - hartmanns, normal saline
If pt is bleeding - blood if available, other fluids while waiting
