emergency med Flashcards
What else needs to be ruled out besides croup for a seal like barking cough
air way obstruction
common age group and cause of croup
3months-3yo, post viral
protocol for decreasing croup cough
5min of breathing cool moist air, if no improvement take to hospital
radiographic finding on xray for croup
steeples sign
common age group for epiglottitis and common causes
3-10yo , H influenza and beta hemolytic strep
how to ID epiglotitis
stridor, toxic looking kid, fever, drooling, Tripod position
how to treat epiglottitis
DO NOT OPEN KIDS MOUTH, call 911, give antibiotics in hospital, imaging for thumbprint sign
When to give oxygen to an adult
RR less than 12 or greater than 20
when to give oxygen to a child
RR less than 15 or greater than 30
when to give oxygen to an infant
RR less than 25 or greater than 50
Flow rate of oxygen for COPD
MAX 3L/min
What type of patients can a nasal cannula be used for
a breathing patient with only minor distress, or breathing and does not want a mask
percent oxygen and flow rate for a nasal cannula
24-44% with 1-6LPM
who can use a resuscitation mask
any patient breathing or not
what technique is used for children who can not tolerate a resuscitation mask on their face
blow by
Percent oxygen and flow rate for resuscitation masks
35-55% at 6-10LPM
who can receive a non rebreather mask
only if patient is breathing
% oxygen and flow rate for non rebreather mask
90% 10-15LPM
bag valve masks are to be used on what kind of patient
anyone regardless of breathing or not
what two mask types can be used on anyone
resuscitation and bag valve masks
what is the oxygen % and flow rate for BVM
90-100%, 15LPM
how do you increase oxygen intake for a patient when using a bag valve mask
squeeze as they inhale
due rebreather masks have a higher or lower o2 saturation than non rebreathers
lower, due to patient breathing back in the CO2 they breathed out
what oxygen masks are used for higher flow rates from 10-15LPM
BVM and non rebreather
of the high flow oxygen mask which is to be used on only breathing patients
non rebreather
what masks are used at low flow rates of less than 6
nasal cannula, no others
what mask is used at moderate flow rate of 6-15LPM
resuscitation masks
what oxygen masks require the patient to be breathing for themselves
nasal cannula and non rebreather
signs of obstruction in the airway
cyanosis, stridor, retraction of chest, drooling, loss of consciousness
How to address a mechanical obstruction of the airway
if patient is conscious and able to cough allow them to, and encourage it.
If patient stops being able to cough or losing consciousness then 5 thrusts to the abdomen with fist above umbilicus.
how to do heimlich on obese or pregnant patient
5 chest thrusts with fists on the sternum followed by 5 back blows
if patient is choking and becomes unconcious what do you do
lower them to the flower, call 911, head tilt, chin lift and start CPR checking for the object in their mouth between sets of compressions
how to treat a choking infant
if concious , call 911, head down over knee, 5 back blows check mouth, 5 chest thrusts check mouth , repeat till dislodged
how to treat a choking infant if unconscious
911, assess, try first 2 rescue breaths if lungs due not fill then check mouth, repeat breaths, still not working they are for sure choking so start compressions
main signs of compensated shock
tachycardia with widened pulse pressure, skin is often cold, refill delayed, sweating and restless
main signs of decompensated shock
hypotension, LOC, confusion, oliguria
Types of shock
hypovolemic, cardiogenic, obstructive, distributive
First sign shock is occuring
BP dropping, HR increasing
Glasgow coma scale range and categories assessed
up to 15 points the higher the better, 0= dead.
eye opening
verbal response
motor response
RR
BP
Signs of anaphylaxis
HR goes up , BP drops, pt develops hives, edema, itching, throat concerns, LOC, incontinence, convulsion, sudden death
How to address anaphylaxis with IV involvement
stop IV drip, LEAVE LINE IN seitch to normal saline
Provide epinephrine either ( 1:1000 up to 1 ml IM, or 1:10,000 up to 2ml IV )
follow with diphenhydramine 50mg IV or ANY FORM
put patient in recumbent position
check ABCS
assess pulses: start with radial if gone pulse is <80
follow with femoral if gone pulse less than 70
check carotid if gone pulse is less than 60 and patient is about to die
monitor until EMS arrive, give more epi if needed after 5 minutes
Send to hospital for clearance and steroids
most common steroids given for anaphylaxis support
prednisone, hydrocortisone, and dexamethasone
dosage of the steroids for anaphylaxis
prednisone 30-60mg
hydrocortisone 100-500mg IV or IM
Dexamethasone 10-20mg
What do yo always assume an unknown powder is
anthrax
how to address anthrax
get yourself and everyone away if safe to do so
PPI to whoever is going into exposed area- especially a mask - eyes and gloves too
Remove exposed person from area
remove the powder
tx as if exposed even if you don’t know for sure- give ciprofloxacin or doxy
antibiotics for anthrax
ciprofloxacin and doxycycline, maybe minocycline
Mass casualty approach and triage
ensure scene is safe
PPI if available
assess all pts for hemmorage, CABS
If dead ( no pulse, no breath, unconcious, drowning etc. leave them) leave dead
If about to be dead- leave dead- BLACK TAG
order of concern from their is stabilize hemorrhages then CABS- first treat red, then yellow, then green.
what needs to be ruled out with sudden seizure presentation
infection, cancer, electrolytes, blood sugar
How to address head injuries
use C spine in all until told otherwise
stop hemorrhage if possible
assess CABS
provide o2 therapy with 100% O2- BVM or no rebreather if conscious
monitor BP
red flags from head injury
cerebral contusion, skull fracture, intracranial hematoma, penetrating head wound
Neck trauma approach
immobilize neck in original position found, keep airway open
do you ever remove objects from penetrating wounds
NO
Protocol for whiplash
xray to rule out fracture, expect sx in next 24hrs
how to address hemorrhage
apply firm pressure, elevate injury above heart, if needed apply vasoconstriction with 30mmhg in cuff
what information do you need for open wounds to address them
time, exposures, mechanism of injury
what wound has largest chance of infection
bite
what wound has the most tissue damage
crush
what wound are you unlikely to visibly see the damage
stretch
reasons a wound cannot be closed
high risk of infection- irrigate, pack, leave open, give antibiotics
major tissue damage-debride
foreign body- remove, irrigate,
dead tissue- remove
primary closures
closed same day with sutures
secondary closure
clean, left open to heal inside out
treatment for rabies
rabies immunoglobulin usp
how frequently due you need tetanus to have immunity
every 10 years
what constitutes a major second degree burn
over 55yo, under 5 yo
or
>20 % of body burned in child
>25% burned in adults
what constitutes a major third degree burn
over 55, or under 5yo
or
>10% of the body - especially eyes, ears, face, hands, feet, perineum, halation burns, or electrical
what does myoglobinuria signify
tissue damage to the kidneys
what is the rule of 9’s in adults
9% for each adult arm, and head
18% for each side of torso and each leg
1% for genitals
what is the rule of 5s for kids
10% for each arm if infant also applies to legs
15% for child Head and legs
20% for each side of torso or infant - head
how to treat a burn
use non rebreather mask 100% oxygen at 15LPM or BVM at 15LPM
intibate if they have inhalation burn
Place IV line with 16G or larger needle in non burned skin
start fluid resuscitation at 1/2 of 2 L over 8 hours followed by other half over 16 hr
How to recognize and treat heat stroke
prolonged heat exposure and no longer sweating , feel hot to touch
Assess CAB
rapidly cool them down
replace fluids and electrolytes
tx sx
send to ER
Catheter types, and how to place
foley which has retention bulb, french does not
clean hands and area to be treated
lubricate catheter
insert till urine visualized in tubing and advance another 5cm or fully in for men
inflate bulb if present with sterile H20 , attach bag
tape to inner thigh
precautions with catheters
retention of urine greater than 12 hours or 500mL should be drained slowly
first 300-400 then wait an hour then repeat till empty
how to address eye trauma
leave objects in, cover both eyes , send to ER
if chemical rinse with whatever water you have and keep rinsing till in ED
if water not available place oil in the eyes
assume any major eye injury could result in blindness why?
damage to the optic nerve causing it to swell
sx of optic nerve swelling
increasing pain with decreasing visual accuity
if what part of the eye is damaged does the patient always have to go to the ER
cornea
flash burns to the eye
cold applied for 10min directly to eye
shredded raw potato poultice
Vit A oil
RAP-CAB
check for responsiveness
activate EMS
position on back
check for hemorrhage, airway, breathing, circulation
How to do CPR
once patient on back on hard surface
place one hand over sternum , interlace fingers, pump hard and fast 30 times
provide 2 rescue breaths
repeat
if infant do 2 min CPR before calling 911 IF A SOLO RESCUER
2 rescuer protocol for CPR
Adults 30:2 at 2 inch depth
child 15:2 at 1/3 of chest one hand
infant 15:2 2 fingers
when does brain damage start
after 10minutes even with CPR
reasons to stop CPR
unsafe to continue, pt revived, help arrives, too tired
how to recognize childbirth is about to happen
contractions 2-3min apart, mom wants to push , crowning
how to deliver baby
make mom comfortable, drape if possible, wash hands, get ready to catch
proper birthing sequence
head first, nose down
rotates for shoulders to come out one at a time
rotates further for abdomen
legs and feet
when do you clear the babies airway
between when the head emerges and the shoulders are delivered to prevent aspiration
when to cut the cord
after 3 minutes longer is fine
where to clamp and cut the cord
clamp at 4inch and 6 inches from baby, cut inbetween
main concerns with care for the baby after birth
get them dry, warm, and with mom, ensure they are breathing
how should the placenta be delivered
passively
what 3 things go to the hospital after a birth
mom, baby, placenta
complications of birth
twins, premature, breach, prolapsed cord
what is the only time you push something back into mom
prolapsed cord
when should you check for and remove the cord from around a babys neck
as soon as the head emerges
what antibiotic ointments are given topically to a babies eye
erythromycin or tetracycline
normal vitals for kids
HR starts at 120 and drops 20pt every 5 years till 10 yo
BP starts at 80/40 and goes up by 20 every 5 years till older than 10
RR starts at 40 and drops by 10 every 5 years
