Emergency

Question 1

Signs of potential airway obstruction

Answer 1

• agitation, restlessness, panic & confusion, progressing to lots of consciousness
• gasping for air & chocking
• clutching upper chest or throat
• progressive cyanosis (cyanosis is a late sign of airway obstruction)
• high pitched stridor, wheezing crowing or whistling on inspiration
• noisy or gurgling inspiration
• snoring respirations

Question 2

what do the aplha receptors do?

Answer 2

• alpha causes vasoconstriction, oxygenated blood from least important to most important (least important is the periphery- that’s why important to check cap refills (will cause ulceration & necrosis)) then GI tract that is not getting enough blood empties, vomits & incontinent of stool, will not have bowel sounds), also liver is part of digestive systtem
• Next the kidneys (decreased urine output, if less than 30ml/hr kidneys may not be adequately perfused)

Question 3

what do the aplha receptors do? beta 1 receptors? and Beta 2 recpetors?

Answer 3

• alpha receptors cause vasoconstriction
• B1 heart increases HR & contractility
• B2 lungs (bronchodilation to get as much oxygen as can)

Question 4

what are interventions for an airway problem?

Answer 4

• Open airway (techniques are head tilt chin lift-which manipulates spine a lot) (modified jaw thrust maneuver-then bag valve mask)
• Oral airway insertion- holds tongue up from back of throat, but oral airway increases risk of aspiration

Question 5

what are the three causes of hypoxia?

Answer 5

problems with:

• ventilation
• diffusion
• perfusion

Question 6

what are some interventions for breathing problems?

Answer 6

• nasal prongs (oxymizer)
• face mask (turn up till not fogging, fogging means re breathing carbon dioxide)
• BVM for ventilating someone

Question 7

In the primary survey how do you check if there C- circulation is good?

Answer 7

• do they have adequate cardiac output
• palpable radial pulse is cardiac output
• Brisk capillary refill?

Question 8

what are three things that cause circulation problems?

Answer 8

problems with:

• Heart
• Vessels
• Volume

Question 9

what are some interventions for circulation problems

Answer 9

-volume resuscitation (isotonic solution - NS or LR)

Question 10

what does D stand for in ABCD?

Answer 10

disability assessment: what is there neurological status (AVPU- awake, verbal stimulus, physical stimulus, unresponsive even to pain)

discomfort assessment:

Question 11

what is wrong with a patient that has a decreased LOC, what are you worried about with someone that has a GCS of 8 or lower

Answer 11

Airway

Question 12

What are some airway findings of concern?

Answer 12

• absence of breathing
• trauma to the face, mouth, pharynx, neck or chest
• inability to speak (age appropriate)
• substernal or intercostal retractions
• depressed level of cnsiousness
• inspiratory or expiatory stridor
• pale, cyanotic or dusky-gray skin color or ruddy or bright purple colouring

Question 13

what is trauma?

Answer 13

-trauma is an injury to human tissues & organs resulting form the transfer of energy from the environment

Question 14

trauma is _________ potential problems may become actual problems

Answer 14

insidious

Question 15

With Trauma if ABC’s aren’t kept stable than body’s cells being to metabolize anaerobically which can lead to

Answer 15

Multi-organ failure (Kidneys, liver, pancreas)

Question 16

what is the priority if a patient is burned?

Answer 16

-you need to put the fire out stop the burning (why do we run burns under water stop the burn, chemical burns need to be flushed)

Question 17

what is mannatol?

Answer 17

used as a diuretic to decrease volume of brain (decrease water in brain) with increasing ICP
it is a high molecular weight sugar that sucks water from interstitial to intravascular able to pee out,
mannatol doesn’t work with leaking capillaries

Question 18

what are the first sign s of increasing ICP?

Answer 18

agitation & restlessness, which then leads to a decrease in LOC

Question 19

when do vital signs change with ICP

Answer 19

-vital signs change (cushings traid) right before almost dead

Question 20

what is shock

Answer 20

-inadequate perfusion of body tissues with oxygenated blood

Question 21

If mean arterial pressure is 70 or above that means that?

Answer 21

all organs are perfusing

Question 22

what does a person look like that is adequately perfused (not experiencing shock)

Answer 22

NS: awake & alert
RS: spo2 greater than 94% on RA
CVS: palpable radial pulse, brisk cap refill 
GI: BS
GU: urine output greater than 30ml, hr

Question 23

what does a person that is inadequately perfused look like? (experiencing shock)

Answer 23

NS: agitation & restlessness (always assume cerebral hypoixa until proven otherwise)
RS: cannot maintain spo2 greater than 94%, may need rebreather mask
CVS: delayed cap refill, no radial pulse,then go to carotid
-GI: no BS, N&V& incontinence
-GU: urine output is less than 30 ml/hr

Question 24

pulse pressure is what? and what number should it be above? and if it is not what does that indicate?

Answer 24

• systolic-diastolic
• should be above 40
• if not above 40,
• loosing stroke volume or volume, therefore not adequately perfused

Question 25

what are the 3 types of shock

Answer 25

• hypovolemic
• cardiogenic
• distributive

Question 26

what are the causes of hypovolemic shock?

Answer 26

-external losses (a break, loose through vascular)
-internal losses (bleeding into thoracic cage, abdomen, retro-peritoneal space)
-blacked venous return (not important)
could be whole blood loss (hemorrhaging) fluid volume loss (vomiting & diarrhea) plasma loss (burns)

Question 27

what are the signs & symptoms of Hypovolemic shock?

Answer 27

• evidence of internal or external losses
• organ hypoperfusion
• stages of compensation

Question 28

what is the management of hypovolemeic shock

Answer 28

• early recognition (notice changes, & notice when body is compensating)
• stop the losses
• replace the losses if indicated (fluid resuscitation)

Question 29

with cardiogenic shock what is the problem?

Answer 29

the pump is the problem (usually the left side of the pump)

Question 30

what are the S&S of cardiogenic shock

Answer 30

• foward flow, so backward pressure ( heart cannot pump, blood backs up into lungs, so patient will have pulmonary edema, crackles
• the stages of compensation are the same

Question 31

what is the management of cardiogenic shock?

Answer 31

• early recognition
• increase myocardial contractility (whole bunch of drugs do this POSITIVE INOTROPES)
• reduce myocardial oxygen demands

Question 32

what are three types of distributive shock?

Answer 32

• septic shock
• anaphylactic shock
• neurogenic shock

Question 33

what is the management of cardiogenic shock?

Answer 33

• early recognition
• increase myocardial contractility (whole bunch of drugs do this POSITIVE INOTROPES - increase contractility of the heart)
• reduce myocardial oxygen demands

Question 34

what is the problem with distributive shock

Answer 34

• vasodilation (will have low diastolic pressure)

- dilated so cannot fill properly (can vasoconstrict, but treating symptom not cause)

Question 35

septic shock S&S

Answer 35

• evidence of infection
• organ hypoperfusion
• tx: give antiboitic

Question 36

anaphylactic shock S&S

Answer 36

• evidence of exposure
• airway reactivity
• organ hypoperfusion
• no alpha SNS compensation
• histamine released causing vasodilation
• need antihistamine and may need epinephrine for vasoconstriciton

Question 37

Neurogenic shock S&S

Answer 37

• evidence of injury
• no SNS compensation
• organ hypoperfusion