EMERGENCY MEDICINE Flashcards
adult oxygen
<12bpm or >20bpm
child O2
<15bpm or >30bpm
infant O2
<25bpm or >50bpm
shock
tachycardia and hypotension
what order of meds for anaphalaxys (shock?_
epinephrine > diphenhydramine > steroids
Epi Dilution for im?
1:1000, so stronger dilution when the epi is shallower
epi dose for IM?
0.5-1mg/ml (1:1000)
epi dose for sq
Epi pen: 0.3-0.5ml (1:1000)
Epidilution for IV
1:10,000, so more dilute because its getting put deeper into a vein
How much IV epi?
IV push: 0.1-0.2mg (1-2ml) repeated every 3-5 minutes (x3?)
what happens after IV eppi
IV epi, 1-2ml (1:10,000) followed by:
- greatest concentration of oxygen.
- Then steroids of No EMS is availalable.
what steroids for after epi IV?
Hydrocortison or prednisone or
dexamethazone
flow rate of O2 for COPD
under 3LPM
Rules for bioterrisim
1: minimize exposure
2: control infection
proper protection for bioterrism, anthroax
PPE, mask, gloves
how to treat anthrax?
Presumptively
CiprofloXacin or doxycycline before there are symptoms.
Who do you help first in in triage
Those who are not dead:
- 1st: Uncontrolled bleeding
- 2nd: ABC, airway, breathing, circulation
who should you not help in triage if there are others who need you
- dead (assume so if)
- pulseless breathless
>20 minutes under water - kids with open skull fracture.
Difference between burns
1st degree: minor
2nd degree: partial thickness
3rd degree: Full thickness
How to determine degree of burn by area covered?
2nd degree: - >25% of adult > 20% of child 3rd degree: >10%
what is rule of 9 for burn
whole arm: 9 Whole leg: 18 (9 front/9back) Abdomen: 9 Chest: 9 Back: 18 (9 lumbar/9 thorasic) Head: 9 groin: 1%
when should you start IV for a burn victom?
When >15% of body is burned. (they’ll be losing hydration through burn area)
For inhalation injury?
Highest O2 flow with highest outflow.
What O2 delivery for the LOW FLOW (1-6L)
Nasal canula 1-6
Venturi mask: 4-8L
what O2 delivery for LOW Concentration: under 45%
All but the non rebreather mask can delever less than 45% oxygen
Nasal Canula (25-45)
Simple face mask 35-60)
Venturi rebreather: allb but the green mask.
what mask gives the highest % of O2?
Non rebreather mask gives higest O2: 60-80%
at the highest flow: 10-15:
what masks if you want to be precise about oxygen delivery
Venturi mask: 4-8 L /24-60% O2
When to use simple face mask?
Higher % of O2 with lower flow rate.
35-60%
6-10 liters.
Chemical burns:
Don’t add water except to flush Eye:
avoid self exposure.
Heat stroke
Not able to sweat. 1- ABC 2 - rapid cooling 3: replace fluids/electrolytes 4: treat complications
Short term catheter
French short term
Long term catheter
Foley
When to catheter?
Urinary retention: >12 hours
Urinary volume: >500ml
caution in catheterizing people?
If you drain more than 300-400 could cause shock: wait 30-50 minutese to continue draining.
what are the most dangerous eye injuries
Closed globe injuries are more dangerous.
Why are glosed globe injuries more dangerous:
Could also have orbital or skull fruactures, and optic nerve damage
why is increasing eye pain and decreasing vision over time dangerous?
can be swelling to optic nerve.
why should you check visual aquity
if its wrong can be sign on internal bleeding.
hyphema
Problem in Anterior chamber can cause acute glaucoma
Can be seen in direct trauma.
subconjunctival hemorrage.
Bruise that is self limited, if vision is stable then its ok.
what to do for chemical burn.
Irrigate with water
if no water put ointment or oil
then send to ER
what if there is damage to cornea
Send to ER:
lubricate, patch for 24 hours, keep lid closed. Foreign body must be ruled oute
how can you see corneal ulceration?
Fourescein die and
slit lamp
what about welding flash burn?
Shreaded raw potato pultice,
vitamin A oil.
Hydrotherapy.
cold water X 10 min direct
Rules of basic live support
RAP
R- responsiveness: trap squeeze
A- Activate EMS
P: postion on back,
order of resussitation
Compression first (30)
Airway: head tilt, chin lift.
Breath: Occlued nose, 2 breaths.
what if chest tdoesn’t rise
air in stomach or obstruction
what if person is unconcious but their vitals are good
Place on left side.
how deep chest compression
Adult: 2 inch/100/min - 30/2 adult and alone. Alone: 15/2 child: 15/2, infant: 2 fingers, 1/2in deep. 15/2 if 2, 30/2 if alonw
When do you activate AED?
Adult: immediately
Infant: after 2 minutes of CPR if alone. In this case do 30/2
when can you stop doing CPR
Unsafe
to exhaused
help arrives
patient moves.
when does brain damage start
At 4-6 minutes
complications of CPR
Vomiting: put on left side, wipe vomit from mouth, continue.
what type of O2 for CPR?
Bag-valev- mask.
signs birth is imminent?
contractions every 2-3 min or less
crowning
urge to push
how to prep mom
- get her comportable
- Drap over abdomen and legs
- Drape under her.
- Wash hands**
how does baby come out
- Head down
- head rotate 90 deg
- one shoulder after the other.
- clear airway
- baby turns up
- feet come last.
- check airway
- dry baby
- wrap baby.
- put bably on mom
how to clear baby airway
compress chest, lungs expand
After Birth: compress chest, or 2 breaths.
check pulse, CPR if needed. EMS aftr 2 min.,
what goes to hospital?
Mom
Baby
placenta
most concerning for baby?
airway
breathing
prevent heat loss
when is cord cut?
2 ties 4 and 6 inches from baby, cut between, not sooner thant 3 minutes.
when is placenta passed
30-60 minuts post birth. Ensure its intact.
what is apgar based on.
Airway Grimace pulse activity respiration
what if nuchal cord
cord around neck, unwind it if possible.
no pushing baby back in.
prolapsed cord
cord out first: EMERGENCY. C section
meds for uterine hemorrage
Oxytocin
misoprostal
what can cause uterine hemorrage
Clotting disordrders
retained tissues.
lacerations of genitals
Soft boddy uterus
why is group B strep a concern
neonatal sepsis and meningits
neonatal eye infx
GC/CT:
- .5 erythromycin
- 1% tetracycline
how to screen for eptopic
serum HCG
full pelvic exam
TVUS
EMS, Treat shock
normal ABC for infant
0-1: 120-80/40-40rmp
1-5: 100, 100/60, 30 RPM
5-10: 80, 120/80, 20
child abusee
Proximal threat: call 911 have them come to office
Non proximal: Call Protective services or 911, high suspicion
what should you not forget with lacerations and abrasion
Tetanus status
broken nose:
Check for head injury
Ice
Sent ot ED for imaging.
bloody nose and concerns.
Firm pressure for 10-15 minutes.
Cancer, medication and hypertensive crisis if spontaneous.
what throat conditions should you send to ER
- peritonsilar abscess
- epiglottitis
- retropharyngeal abscess
fractured tooth
tooth knocked out
Fractured: Dentist NOW
Kncked out: Dentist 1 HOUR.
PH of blood?
7.35 - 7.45
can IV from 5-9 but 6.6-7.6 is best
Osmolarity of blood
290,
IV <450 to reduce risk of phlebitis.
isotonic fluids
250-375 osm (close to normal blood at 290)
- normal saline 9%
- 5% destrose D5W
- ringer lactate.
what are isotonic fluids best
won’t cause fluid shits into or out of fcells.
what can be dangerous about isotoic
can cause fluid overload.
hypotonic
<250: fluid will go into cells, can cayse HYPOtension
hypertonic
> 375, fluid will leave cells,
painfull,
Flow rate for hypertonic solution >375
1-5mL/minute, slow to prevent pain
what causes plebitis
PH that is to far off.
what if there is infliltration
Stop infusion, light pressure and Apis
systemic complications of IV
Air emboli, septicemia, shick, catheter embolism, electrolyte shift
glycemic emergency,
fluid overload
what can be a problem if taking CCB’s
EDTA
Magnesium
can lead to heart block becausee they act as CCB
What can be a problem with rauwolfia
IV
Mg
EDTA
Ca
cant respont to hypotension adewuates.
Problem with BB and IV
Mg
can compound evvects of BB
IV with syncope
Keep IV in Lay them down Smelling salts Blanket reassurance
Hypoglycemia with IV?
Have pt eat if giving high dose vitamin C or EDTA.
use D5W to reverse
what is speed shock iwth IV
infusing to quickly often mg.
antidote for mg
Ca antidotes Mg
Mg antidoees CA
what IV can cause fluid overload.
ISOTONIC to quick, Eldery Kidney compromised CHF. Hypertonic solution.
sx of fluid overload
edema
Pulmonary edma: crackles and SOB
Sx of fluid overload
Slow transfusion
heat person: dilate dirculation
O2
what is side effect of hypertonic solution
Dehydration, because fluid leaves cells.
catheter size for rehydration?
Largest catheter (smallest #)
solution type for rehydration
Isotonic** (slightly hypotinic )
- 9%NS
- ringer lactate
- D5W
what will happen if you use sterile water
Death
how much can you rehydrate per day
- 5-2 liters only. slow and stead so no fluid overload, especiall in
- elderly
- CHF
- Kidney issues
what IV med can change clotting times
EDTA
