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Lucy Knox - OSSE > Emergency > Flashcards

Emergency Flashcards

1
Q

What are signs of shock?

A

hypotension (systolic blood pressure < 90 mmHg), pallor, sweating, cold, clammy extremities, confusion or impaired consciousness.

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2
Q

What are the first steps in any emergency?

A

ABCDE

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3
Q

What is the CPR ratio in adults?

A

30:2

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4
Q

What are shockable rhythms?

A

VF Pulseless VT

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5
Q

What are non-shockable rhythms?

A

Asystole PEA - pulseless electrical activity

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6
Q

After shocking a collapsed patient how long do you then carry on CPR before another shock?

A

2 minutes, then reassess rhythm

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7
Q

What reversible causes could have caused a cardiac arrest collapse? 4 Hs, 4Ts

A

Reversible Causes: Hypoxia Hypovolaemia Hypo-/hyperkalaemia/metabolic Hypothermia Thrombosis - coronary or pulmonary Tamponade - cardiac Toxins Tension pneumothorax

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8
Q

What is a precordial thump? Is it useful?

A

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.

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9
Q

What are the steps in adult BLS?

A

Check safety Unresponsive? Shout for help Open airway Not Breathing? Call 999 30 chest compressions 2 rescue breaths 30:2

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10
Q

What rate should chest compressions be given in?

A

100-120 a minute

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11
Q

When do you continue resuscitation until?

A
  • 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.
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12
Q

What compression depth should be achieved in an adult?

A

5-6 cm

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13
Q

If a person is choking, what suggests severe airway restriction?

A

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

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14
Q

Describe what the algorithm is of an adult choking.

A
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15
Q

Describe how to give 5 black blows for Choking

A

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.

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16
Q

Describe how you would give 5 abdo thrusts in an adult choking

A

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.

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17
Q

How likely, when a shocking someone in VT, is it for a normal rhythm to return?

A

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%

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18
Q

What drug should be given when dealing with a cardiac arrest collapse?

A

1 mg IV adrenaline

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19
Q

Is survival likely from a non-shockable rhythm cardiac arrest?

A

Survival following cardiac arrest with asystole or PEA is unlikely unless a reversible cause can be found and treated effectively.

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20
Q

How often should IV adrenaline be given in an arrest situation?

A

Every 3-5 minutes

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21
Q

What is the algorhythm for peadiatrics BLS?

A

Unresponsive?

Shout for help

Open airway

Not breathing?

999

5 rescue breaths

No sign of life?

15 chest compressions

Continue 15:2

22
Q

In a peadiatric situation and you are alone, when should you go for help?

A

Do CPR for one minute before going for help

23
Q

How deep should your chest compressions be in a peadiatric situation?

A

1/3 body depth

2 fingers in infant under 1

one hand in small child

24
Q

How long should you listen for normal breathing for in a peadiatric case?

A

no more than 10seconds

25
Q

What position should an infants head be in when giving rescue breaths?

A

Neural position

26
Q

Where should you apply chest compressions in a child or infant?

A

1 fingersbreadth above the xiphiod sternum

27
Q

What defines a newborn, neonate, infant and child?

A

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.

28
Q

What are general signs of choking (esp. in a child)

A

Witnessed episode

Coughing or choking

Sudden onset

Recent history of playing with or eating small objects

29
Q

What signifies ineffective coughing in a child who has choked?

A

Unable to vocalise

Quiet or silent cough

Unable to breathe

Cyanosis

Decreasing level of consciousness

30
Q

What reassures you that a child has an effective cough after choking/

A

Crying or verbal response to questions

Loud cough

Able to take a breath before coughing

Fully responsive

31
Q

What is the Paediatric Choking Treatment Algorithm ?

A
32
Q

Should you use abdominal thrusts in a choking infant?

A

NO

33
Q

How do you give chest thrusts to infants?

A

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.

34
Q

How is the airway measured for a gudel/oropharengeal airway?

A

The oropharyngeal airway is measured from the edge of the mouth to the tragus.

35
Q

If a patient is unresponsive and can’t protect their airway what can you use?

A

An endotracheal tube

36
Q

How can you ensure you have inserted the endotracheal tube correctly?

A

capnograph

37
Q

What are the AVPU parameters?

A

AVPU Assessment :-

A - Alert
V - Responding to Voice
P - Responding to Pain
U - Unresponsive

38
Q

What are the steps in the Glasgow Coma Scale GCS?

A

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

39
Q

How much of an adult body is water?

A

45-80%

around 45 L

40
Q

Of the total body’s water content, how much is intracellular and how much extracellular?

A

2/3 intra - 30L

1/3 intra - 15L

41
Q

Of the intracellular fluid, how much is interstitial fluid and how much intravascular?

A

10L - intersitial

5L intravascular

42
Q

What fluids are seen as isotonic?

A

Normal saline (150 mmol NA/l)

Hartmann’s solution (131 mmol NA/l)

43
Q

IV infusion of an isotonic solution maininly increases the volume of what compartment?

A

ECF - extraceullar fluid

44
Q

Where will IV infusion of dextrose solution be distributed?

A

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
45
Q

What are symptoms of hypovolaemia?

A

Lethargy, weakness

Postural dizziness

Thirst

Dry mouth

Reduced urine output

Feeling cold

Shivering

Panting

Altered mental state

46
Q

What are clinical signs of hypovolaemia?

A

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

47
Q

What investigations may confirm hypovolaemia

A

Urea, creatinine, sodium

Haemoglobin, haematocrit

Urinary sodium, osmolarity

ECG, CXR, ABG

Central venous pressure monitoring

48
Q

What are causes of shock?

A

Hypovolaemia

Cardiogenic (MI, PE)

Septicaemia

Anaphylaxis

Neurogenic (spinal injury - loss of sympathetic tone - vasodilation)

Tension pneumothorax

Addisonian crisis

49
Q

What amount of fluid would you give initially in shock?

A

Rapid bolus

1-2l in adults

20mls/kg in a child

50
Q

What type of fluid would you use initially in shock?

A

Isotonic crystalloids - hartmanns, normal saline

If pt is bleeding - blood if available, other fluids while waiting

51
Q
A

Lucy Knox - OSSE (9 decks)

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