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NPLEX2 review of modalities > emergency med > Flashcards

emergency med Flashcards

1
Q

What else needs to be ruled out besides croup for a seal like barking cough

A

air way obstruction

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2
Q

common age group and cause of croup

A

3months-3yo, post viral

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3
Q

protocol for decreasing croup cough

A

5min of breathing cool moist air, if no improvement take to hospital

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4
Q

radiographic finding on xray for croup

A

steeples sign

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5
Q

common age group for epiglottitis and common causes

A

3-10yo , H influenza and beta hemolytic strep

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6
Q

how to ID epiglotitis

A

stridor, toxic looking kid, fever, drooling, Tripod position

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7
Q

how to treat epiglottitis

A

DO NOT OPEN KIDS MOUTH, call 911, give antibiotics in hospital, imaging for thumbprint sign

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8
Q

When to give oxygen to an adult

A

RR less than 12 or greater than 20

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9
Q

when to give oxygen to a child

A

RR less than 15 or greater than 30

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10
Q

when to give oxygen to an infant

A

RR less than 25 or greater than 50

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11
Q

Flow rate of oxygen for COPD

A

MAX 3L/min

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12
Q

What type of patients can a nasal cannula be used for

A

a breathing patient with only minor distress, or breathing and does not want a mask

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13
Q

percent oxygen and flow rate for a nasal cannula

A

24-44% with 1-6LPM

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14
Q

who can use a resuscitation mask

A

any patient breathing or not

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15
Q

what technique is used for children who can not tolerate a resuscitation mask on their face

A

blow by

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16
Q

Percent oxygen and flow rate for resuscitation masks

A

35-55% at 6-10LPM

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17
Q

who can receive a non rebreather mask

A

only if patient is breathing

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18
Q

% oxygen and flow rate for non rebreather mask

A

90% 10-15LPM

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19
Q

bag valve masks are to be used on what kind of patient

A

anyone regardless of breathing or not

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20
Q

what two mask types can be used on anyone

A

resuscitation and bag valve masks

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21
Q

what is the oxygen % and flow rate for BVM

A

90-100%, 15LPM

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22
Q

how do you increase oxygen intake for a patient when using a bag valve mask

A

squeeze as they inhale

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23
Q

due rebreather masks have a higher or lower o2 saturation than non rebreathers

A

lower, due to patient breathing back in the CO2 they breathed out

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24
Q

what oxygen masks are used for higher flow rates from 10-15LPM

A

BVM and non rebreather

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25
Q

of the high flow oxygen mask which is to be used on only breathing patients

A

non rebreather

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26
Q

what masks are used at low flow rates of less than 6

A

nasal cannula, no others

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27
Q

what mask is used at moderate flow rate of 6-15LPM

A

resuscitation masks

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28
Q

what oxygen masks require the patient to be breathing for themselves

A

nasal cannula and non rebreather

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29
Q

signs of obstruction in the airway

A

cyanosis, stridor, retraction of chest, drooling, loss of consciousness

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30
Q

How to address a mechanical obstruction of the airway

A

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.

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31
Q

how to do heimlich on obese or pregnant patient

A

5 chest thrusts with fists on the sternum followed by 5 back blows

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32
Q

if patient is choking and becomes unconcious what do you do

A

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

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33
Q

how to treat a choking infant

A

if concious , call 911, head down over knee, 5 back blows check mouth, 5 chest thrusts check mouth , repeat till dislodged

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34
Q

how to treat a choking infant if unconscious

A

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

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35
Q

main signs of compensated shock

A

tachycardia with widened pulse pressure, skin is often cold, refill delayed, sweating and restless

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36
Q

main signs of decompensated shock

A

hypotension, LOC, confusion, oliguria

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37
Q

Types of shock

A

hypovolemic, cardiogenic, obstructive, distributive

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38
Q

First sign shock is occuring

A

BP dropping, HR increasing

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39
Q

Glasgow coma scale range and categories assessed

A

up to 15 points the higher the better, 0= dead.
eye opening
verbal response
motor response
RR
BP

40
Q

Signs of anaphylaxis

A

HR goes up , BP drops, pt develops hives, edema, itching, throat concerns, LOC, incontinence, convulsion, sudden death

41
Q

How to address anaphylaxis with IV involvement

A

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

42
Q

most common steroids given for anaphylaxis support

A

prednisone, hydrocortisone, and dexamethasone

43
Q

dosage of the steroids for anaphylaxis

A

prednisone 30-60mg
hydrocortisone 100-500mg IV or IM
Dexamethasone 10-20mg

44
Q

What do yo always assume an unknown powder is

A

anthrax

45
Q

how to address anthrax

A

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

46
Q

antibiotics for anthrax

A

ciprofloxacin and doxycycline, maybe minocycline

47
Q

Mass casualty approach and triage

A

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.

48
Q

what needs to be ruled out with sudden seizure presentation

A

infection, cancer, electrolytes, blood sugar

49
Q

How to address head injuries

A

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

50
Q

red flags from head injury

A

cerebral contusion, skull fracture, intracranial hematoma, penetrating head wound

51
Q

Neck trauma approach

A

immobilize neck in original position found, keep airway open

52
Q

do you ever remove objects from penetrating wounds

A

NO

53
Q

Protocol for whiplash

A

xray to rule out fracture, expect sx in next 24hrs

54
Q

how to address hemorrhage

A

apply firm pressure, elevate injury above heart, if needed apply vasoconstriction with 30mmhg in cuff

55
Q

what information do you need for open wounds to address them

A

time, exposures, mechanism of injury

56
Q

what wound has largest chance of infection

A

bite

57
Q

what wound has the most tissue damage

A

crush

58
Q

what wound are you unlikely to visibly see the damage

A

stretch

59
Q

reasons a wound cannot be closed

A

high risk of infection- irrigate, pack, leave open, give antibiotics
major tissue damage-debride
foreign body- remove, irrigate,
dead tissue- remove

60
Q

primary closures

A

closed same day with sutures

61
Q

secondary closure

A

clean, left open to heal inside out

62
Q

treatment for rabies

A

rabies immunoglobulin usp

63
Q

how frequently due you need tetanus to have immunity

A

every 10 years

64
Q

what constitutes a major second degree burn

A

over 55yo, under 5 yo
or
>20 % of body burned in child
>25% burned in adults

65
Q

what constitutes a major third degree burn

A

over 55, or under 5yo
or
>10% of the body - especially eyes, ears, face, hands, feet, perineum, halation burns, or electrical

66
Q

what does myoglobinuria signify

A

tissue damage to the kidneys

67
Q

what is the rule of 9’s in adults

A

9% for each adult arm, and head
18% for each side of torso and each leg
1% for genitals

68
Q

what is the rule of 5s for kids

A

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

69
Q

how to treat a burn

A

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

70
Q

How to recognize and treat heat stroke

A

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

71
Q

Catheter types, and how to place

A

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

72
Q

precautions with catheters

A

retention of urine greater than 12 hours or 500mL should be drained slowly
first 300-400 then wait an hour then repeat till empty

73
Q

how to address eye trauma

A

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

74
Q

assume any major eye injury could result in blindness why?

A

damage to the optic nerve causing it to swell

75
Q

sx of optic nerve swelling

A

increasing pain with decreasing visual accuity

76
Q

if what part of the eye is damaged does the patient always have to go to the ER

A

cornea

77
Q

flash burns to the eye

A

cold applied for 10min directly to eye
shredded raw potato poultice
Vit A oil

78
Q

RAP-CAB

A

check for responsiveness
activate EMS
position on back
check for hemorrhage, airway, breathing, circulation

79
Q

How to do CPR

A

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

80
Q

2 rescuer protocol for CPR

A

Adults 30:2 at 2 inch depth
child 15:2 at 1/3 of chest one hand
infant 15:2 2 fingers

81
Q

when does brain damage start

A

after 10minutes even with CPR

82
Q

reasons to stop CPR

A

unsafe to continue, pt revived, help arrives, too tired

83
Q

how to recognize childbirth is about to happen

A

contractions 2-3min apart, mom wants to push , crowning

84
Q

how to deliver baby

A

make mom comfortable, drape if possible, wash hands, get ready to catch

85
Q

proper birthing sequence

A

head first, nose down
rotates for shoulders to come out one at a time
rotates further for abdomen
legs and feet

86
Q

when do you clear the babies airway

A

between when the head emerges and the shoulders are delivered to prevent aspiration

87
Q

when to cut the cord

A

after 3 minutes longer is fine

88
Q

where to clamp and cut the cord

A

clamp at 4inch and 6 inches from baby, cut inbetween

89
Q

main concerns with care for the baby after birth

A

get them dry, warm, and with mom, ensure they are breathing

90
Q

how should the placenta be delivered

A

passively

91
Q

what 3 things go to the hospital after a birth

A

mom, baby, placenta

92
Q

complications of birth

A

twins, premature, breach, prolapsed cord

93
Q

what is the only time you push something back into mom

A

prolapsed cord

94
Q

when should you check for and remove the cord from around a babys neck

A

as soon as the head emerges

95
Q

what antibiotic ointments are given topically to a babies eye

A

erythromycin or tetracycline

96
Q

normal vitals for kids

A

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

NPLEX2 review of modalities (7 decks)

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