Emergency Medicine Flashcards
Monitoring vital signs with a cardiac monitor
HR, BP, RR, O2
Oropharyngeal airway insertion
Video
https://www.youtube.com/watch?v=Hzc_T4QBp4E
OROPHARYNGEAL AIRWAY (OPA) INSERTION
· Take Body Substance Isolation precautions
· Measure for correct size
The OPA is sized by measuring from the center of the mouth to the angle of the jaw, or from the corner of the mouth to the earlobe.
· Open the mouth
The mouth is opened using the “crossed or scissors” finger technique.
· Insert the OPA without pushing the tongue back
The OPA is inserted in the patient’s mouth upside down so the tip of the OPA is facing the roof of the patient’s mouth. As the airway is inserted it is rotated 180 degrees until the flange comes to rest on the patient’s lips and/or teeth. The OPA may be inserted with the pharyngeal curvature if a tongue blade is used to depress the tongue.
If patient begins to retch/gag, remove the OPA!
Pulsoximetry
Pulse oximetry is a test used to measure the oxygen level (oxygen saturation) of the blood. It is an easy, painless measure of how well oxygen is being sent to parts of your body furthest from your heart, such as the arms and legs.
Management of the external bleeding
Guidelines
- Apply pressure on the wound
- Elevate the extremities
- Use a tourniquet for max 2 hours, 1:30 h recommended, with 10 min break then another 30 min of the tourniquet and so on.
- If systolic blood pressure is 90 (shock), turn on blood pressure cuff to 150.
Emergent limb immobilization; selecting types of required fixations in typical clinical cases
Don’t know
Performing anterior nasal packing
Video
https://www.youtube.com/watch?v=9i8qIZ-G1GM
Nasal packing is a common medical procedure that is performed to control epistaxis (bleeding from the nose).
Nasal packing may be “anterior” nasal packing that is done by using a gauze inserted inside the nasal cavity after numbing the nasal area. The doctor will douse the gauze in an antibiotic ointment and a medication that squeezes the blood vessels shut.
In case of extensive bleeding, the doctor may need to supplement the anterior nasal pack with the posterior nasal pack. Posterior packing is done with a sterile gauze covered in an antiseptic ointment, a rubber balloon called a catheter or a nasal sponge/tampon.
Most modern posterior nasal packs contain a balloon that can be inflated with a syringe. This arrangement helps in applying an adjustable direct pressure to the site of the nosebleed.
Sometimes both the nasal cavities may need occlusion. The nasal pack is kept inside the nose for 24-48 hours.
Conducting electrical cardioversion and defibrillation
Bag-valve-mask ventilation
Video
https://www.youtube.com/watch?v=sTfoh0vRA08
Indications for BVM Ventilation
- Emergency ventilation for apnea, respiratory failure, or impending respiratory arrest
- Pre-ventilation and/or oxygenation or interim ventilation and/or oxygenation during efforts to achieve and maintain definitive artificial airways (eg, endotracheal intubation)
Contraindications to BVM Ventilation
Absolute contraindications:
- There is no medical contraindication to providing ventilatory support to a patient; however, a legal contraindication (do-not-resuscitate order or specific advance directive) may be in force.
Relative contraindications:
- None
Knowing the basic principles of conducting artificial (mechanical) ventilation
Info
Performing the ultrasound examination in life-threatening conditions, especially in case of the splenic rupture
Video
CSM classes:
Call a surgeon if there is a splenic rupture
Otherwise just use the ultrasound examination to find and treat reversible causes [4 Hs and 4 Ts] of cardiac arrest (e.g., cardiac tamponade, hypovolemia etc.)
Pericardial drainage
Video/Guidelines
Lumbar puncture
Position of patient
Before inserting the spinal needle
Location of insertion of spinal needle
When is the spinal needle in the right spot?
Collect what?
What can we also measure?
https://www.youtube.com/watch?v=7tcrSd5lLoc
https://en.wikipedia.org/wiki/Lumbar_puncture
The person is usually placed on their side (left more commonly than right). The patient bends the neck so the chin is close to the chest, hunches the back, and brings knees toward the chest. This approximates a fetal position as much as possible. Patients may also sit on a stool and bend their head and shoulders forward. The area around the lower back is prepared using aseptic technique.
Once the appropriate location is palpated, local anaesthetic is infiltrated under the skin and then injected along the intended path of the spinal needle. A spinal needle is inserted between the lumbar vertebrae L3/L4, L4/L5 or L5/S1 and pushed in until there is a “give” as it enters the lumbar cistern wherein the ligamentum flavum is housed. The needle is again pushed until there is a second ‘give’ that indicates the needle is now past the dura mater.
The arachnoid membrane and the dura mater exist in flush contact with one another in the living person’s spine due to fluid pressure from CSF in the subarachnoid space pushing the arachnoid membrane out towards the dura. Therefore, once the needle has pierced the dura mater it has also traversed the thinner arachnoid membrane. The needle is then in the subarachnoid space.
The stylet from the spinal needle is then withdrawn and drops of cerebrospinal fluid are collected. The opening pressure of the cerebrospinal fluid may be taken during this collection by using a simple column manometer. The procedure is ended by withdrawing the needle while placing pressure on the puncture site.
Recognizing agony and pronouncing the patient dead
Video, guidelines, rehearsal?
Oxygen therapy
Guidelines
