Emergency Action Drills

Question 1

Difficult access in a critically ill patient

Answer 1

If no IV w/in 1 minute -> IO -> if no IO on first attempt -> crash femoral line

Question 2

Hypotension: SBP 70 or less

Answer 2

Crack code cart, give 0.5 cc of cardiac epi

Question 3

Precipitous delivery

Answer 3

Bed intact, support baby’s head, check for nuchal cord & reduce

Question 4

Shoulder dystocia

Answer 4

McRoberts, suprapubic pressure

Question 5

Postpartum hemorrhage

Answer 5

Bimanual uterine compression, pit -> methergine -> hemabate -> miso, MTP, TXA

Question 6

Unannounced cardiac arrest

Answer 6

Start CPR, start bagging, IV access, place defib, give epi

Question 7

Dropoff GSW to the chest

Answer 7

IV, O2, manual BP, CABs

Question 8

STEMI loses pulses

Answer 8

Place defib & shock if VT/VF

Question 9

Dropoff GSW to the chest loses pulses

Answer 9

Start CPR, start bagging, IV/IO, thoracotomy, MTP

Question 10

GSW to the abdomen loses pulses

Answer 10

Start CPR, start bagging, MTP, thoracotomy

Question 11

Unannounced blunt trauma arrest

Answer 11

Start CPR, start bagging, IV/IO, MTP, b/l chest tubes, pelvic binder, echo

Question 12

Unannounced massive extremity hemorrhage

Answer 12

Put single finger on bleeder, place tourniquet

Question 13

Floppy baby

Answer 13

Start bagging, IV, give 5 cc/kg D10, 20 cc/kg IVF bolus
IO if no IV w/in 1 minute
If no IO on first attempt -> UVC vs crash femoral line

Question 14

Unannounced respiratory distress

Answer 14

Nasal cannula at flush rate, BVM w/ PEEP valve w/ good two-hand seal
i. Call for bipap if awake enough to tolerate
ii. If not, continue w/ above and plan for intubation

Question 15

Unannounced unresponsive

Answer 15

Start bagging, IV/IO, place on monitor, check glucose, +/- Narcan

Question 16

Severe agitation

Answer 16

No IV: ketamine 3 mg/kg IM
Yes IV: ketamine 2 mg/kg IV

Question 17

Massive hemoptysis

Answer 17

Sit patient up, give patient suction, IV, MTP, TXA neb

Question 18

Massive hematemesis

Answer 18

Sit patient up, give patient suction, IV, MTP, ketamine-assisted awake intubation

Question 19

Crashing anaphylaxis

Answer 19

Crack code cart, give 0.5-1 cc cardiac epi, one attempt at intubation, then cric
i. RSI w/ paralytics as priority

Question 20

Pregnant trauma patient loses pulses

Answer 20

Start CPR, start bagging, manually displace uterus to the left, MTP, prepare for perimortem C/S within 4 minutes

Question 21

Cyanotic baby <10 days old

Answer 21

IV, O2, monitor, start PGE1 0.05 mcg/kg/min, prepare to intubate

Question 22

Floppy newborn

Answer 22

Stimulate, open airway, suction, CPAP

Question 23

Cardiac arrest in the hospital lobby

Answer 23

Start CPR, AED

Question 24

Exsanguinating HD fistula

Answer 24

Place one finger on bleeder, tourniquet above and below fistula

Question 25

Crashing bleeding trach

Answer 25

Place cuffed trach (if not already in place), hyperinflate balloon

Question 26

Crashing hypoxic trach patient

Answer 26

100% O2 to patients face and stoma, pass suction or EtCO2 catheter to confirm trach patency

Question 27

Unannounced adult seizure

Answer 27

Jaw thrust, 4 mg Ativan IV or 5 mg Versed IM

Question 28

Pregnant seizure

Answer 28

O2, jaw thrust
If IV: mag 6 g IV, Ativan 4 g IV
If no IV: mag 10 mg IM in each butt cheek, Versed 5 mg IM

Question 29

Unannounced pediatric seizure

Answer 29

Jaw thrust, 0.1 mg/kg Ativan IV or 0.2 mg/kg Versed IM/IN

Question 30

Unannounced newborn seizure

Answer 30

Open airway, phenobarb 20 mg/kg IV or Versed 0.2 mg/kg IM

Question 31

Fracture/dislocation without pulses

Answer 31

Ketamine 1-2 mg/kg IV, reduce, splint

Question 32

New headache, AMS, or nausea/vomiting in a stroke patient who received thrombolytics

Answer 32

Stop lytics, ABCs, STAT CT head

Question 33

Unstable tachycardia

Answer 33

Attach defibrillator, etomidate 0.1 mg/kg, synchronized cardioversion

Question 34

Unstable bradycardia

Answer 34

Attach defibrillator, start transcutaneously pacing, crack code cart, give 0.5 cc
cardiac epi