Emergency Medicine Flashcards
Etiology, presentation, and tx of croup
inflammation of larynx, trachea, and bronchi
3 mo - 3 yrs
complication of viral infxn
difficulty breathing (often while asleep)
crowing on inspiration (stridor)
seal like barking cough - NOT SPECIFIC TO JUST CROUP!!
“steeple sign” in radiographs
tx: breath cool moist air 5 min. no improvement > cont to monitor for fever, tonsils, worsening breathing. worsens > hospital
A parent calls and says their child has a seal like barking cough. What do you reccomend they do, why?
barking cough = stridor
could be croup but can also be other situations that are on their way to becoming airway compromise (obstruction to foreign object, epiglotttitis, asthma, etc)
assume the worst if no other info!
epiglottitis etiology, presentation, and tx
3-10
h flu (or BH strep)
high fever, toxic child
diff breathing
inspiratory stridor
drooling, head tipped
“thumbprint sign”
NEEDS ABX AND AIRWAY MGMT! DO NOT MOVE NECK OR OPEN MOTH > ER BY EMS WITH AIRWAY MGMT!
At what RR should emergency oxygen be considered in adults, children, and infants?
adults: < 12, > 20
child: < 15, > 30
infant: < 25, > 50
Flow rates, %, and uses for O2 devices
nasal cannula: 1-6 LPM, 24-44%, breathing victims
non-rebreather: 10-15 LPM, 90+%, breathing victims (can be used as a blow-by with children; inflate reservoir bag 2/3 full and cover valve with thumb)
resuscitation: 6-15 LPM, 35-55%, breathing and nonbreathing
BVM: 15+ LPM, 90+%, breathing and non-breathing (squeeze as victim inhales)
signs of upper airway obstruction
inspiratory and/or expiratory stridor
possible retractions of thorax (intercostal, suprasternal, supraclavicular)
cyanosis
drooling (esp in peds)
LOC with full obstruction
upper airway obstruction tx
determine if mechanical or infectious
mechanical: heimlich procedure
infectious (fever, pneumonia sx): consider epiglottitis
Reasons for choking
tongue in unconscious victim (head tilt, chin lift)
vomit
foreign body
swelling (anaphylaxis, irritants)
spasm (water inhaled suddenly)
tx for conscious choking/foreign body airway obstruction in adults
heimlich
- fist above umbilicus
- 5 upward and inward thrusts (if pregnant or obese, chest thrusts with fists on sternum or support chest and give back blows)
cont until successful or victim becomes unconscious
if victim becomes unconscious > call 911, support with knees while lowering them, assess, CPR > check for object before giving breaths
tx for choking conscious infants
position w head downward
5 back blows (check for expelled object)
5 chest thrusts (check for object)
repeat
tx choking: unconscious infants
when first breaths dont go in, check for object in throat then try 2 more breaths
if neither set goes in, suspect choking
30 compressions, check for object in throat (no blind finger sweep)
give 2 breaths
compensated vs decompensated shock
early (compensated); reversible
- tachy, anxiety, restlessness, delayed cap refill, diaphoresis, widened PP
- tx are preventative in nature w/ ABC interventions
late (decompensated): diff to reverse
- hypotension, confusion, LOC, oliguria, acidemia
- tx are aggressive and rapid volume resuscitation, meds, and invasive procedures
types of shock
hypovolemic
cardiogenic (pump failure, MI)
obstructive (fall in CO, CHF)
distributive (loss of IV and dec vascular vol; neurogenic, septic, infectious)
if you are giving an IV and the pt goes into anaphylaxis, what do you do?
STOP infusion but do NOT discontue line; change bag and line to NS infusion and run it
how to differentiate allergic rxn and anaphylaxis? how would you tx each?
shock sx; inc HR, low BP
if NO RR/cardio shock signs: allergic, tx with H1 blocker and maybe steroids
if R compromise and/or CV shock: anaphylaxis; epi, H1 blocker, and steroids
anaphylaxis tx
pt in recumbant position
ABCs
patent airway - oral berman or intubate (if not breathing > rescue breaths)
BP, or if in a hurry > peripheral/emergency BP (with palpation, not cuff)
- if you can feel a radial pulse = AT LEAST 80 systolic
- femoral = AT LEAST 70
- carotid = AT LEAST 60
epinephrine dosages / forms for emergency medicine
- 1:1000 (stronger) for IM/SQ and Intratrachial
- IM: 0.5-1 mg/mL, subQ: 0.3-0.5 ml
- can take 2-10+ min to show response
- 1:10,000 (more diluted) is IV form ONLY
- push 0.1-0.2 mg (1-2 mL)
- can repeat q 3-5 min
diphenhydramine dosing in emergency medicine
50 mg (1 ml) IV stat AFTER epi (even without seeing response if not IV)
in allergy may start with 12.5-25 mg
oxygen rate by mask in emergency medicine; how does it change with COPD?
15L/min by mask / highest conc
3 or less L/min in COPD
what is the next step in anaphylaxis after epi and diphenhydramine?
steroids to stabilize cytokine storm
dexamethasone 10-20mg (2.5-5mL)
hydrocortisone 100-500 mg
prenisone 30-60 mg
infxn control with unknown powders
unknown powder, assume to be anthrax
get away, put on PPE
by the time one has sn/sx of anthrax it is often too late to tx so presumptively tx - doxycycline, minocycline, OR ciprofloxacin
basics of mass casualty triage
hemorrhage > ABCs (my ABCs dont mean shit if im bleeding out of my missing leg…)
the dead stay dead (open skull fractures, pulseless, under water 20 min..)
scene survey > don’t respond if it is not safe!!!!
considerations for seizures (tonic-clonic) in emergency setting
most common are febrile
toxin ingestion
treat as any seizure and get follow up med care
- protect pt during seizure to degree possible - move stuff away, but DONT intervene, put hands/anything near mouth
approach to head injuries in emergency medicine
all pts with head injuries and trauma should be treated as if they are pos for cervical spine injury
-c spine immobilization (cerv collar, head blocks, long board)
-ABCs, glasgow coma scoring, neuro exam techniques
-100% o2 therapy (conscious with non-rebreather, unconscious or impaired breathing with bag valve mask)
head injury associations sx/considerations
seizures
combativeness (assess for hypoxia, hypoglycemia, hypotension, and pain)
pain control: sedatives-analgesics (narcotics, benzos)
sys HTN, signs of IC HTN (bradycardia & HTN)
approach to penetrating wounds of the neck and spine
leave sharp objects in
test canial nerves
approach to whiplash injuries/cervical strain
hyperextension most common
no associated fx
xray is dx
12-24 hrs for manifestation of sx
