EMERGENCY MEDICINE Flashcards
1
Q
adult oxygen
A
<12bpm or >20bpm
2
Q
child O2
A
<15bpm or >30bpm
3
Q
infant O2
A
<25bpm or >50bpm
4
Q
shock
A
tachycardia and hypotension
5
Q
what order of meds for anaphalaxys (shock?_
A
epinephrine > diphenhydramine > steroids
6
Q
Epi Dilution for im?
A
1:1000, so stronger dilution when the epi is shallower
7
Q
epi dose for IM?
A
0.5-1mg/ml (1:1000)
8
Q
epi dose for sq
A
Epi pen: 0.3-0.5ml (1:1000)
9
Q
Epidilution for IV
A
1:10,000, so more dilute because its getting put deeper into a vein
10
Q
How much IV epi?
A
IV push: 0.1-0.2mg (1-2ml) repeated every 3-5 minutes (x3?)
11
Q
what happens after IV eppi
A
IV epi, 1-2ml (1:10,000) followed by:
- greatest concentration of oxygen.
- Then steroids of No EMS is availalable.
12
Q
what steroids for after epi IV?
A
Hydrocortison or prednisone or
dexamethazone
13
Q
flow rate of O2 for COPD
A
under 3LPM
14
Q
Rules for bioterrisim
A
1: minimize exposure
2: control infection
15
Q
proper protection for bioterrism, anthroax
A
PPE, mask, gloves
16
Q
how to treat anthrax?
A
Presumptively
CiprofloXacin or doxycycline before there are symptoms.
17
Q
Who do you help first in in triage
A
Those who are not dead:
- 1st: Uncontrolled bleeding
- 2nd: ABC, airway, breathing, circulation
18
Q
who should you not help in triage if there are others who need you
A
- dead (assume so if)
- pulseless breathless
>20 minutes under water - kids with open skull fracture.
19
Q
Difference between burns
A
1st degree: minor
2nd degree: partial thickness
3rd degree: Full thickness
20
Q
How to determine degree of burn by area covered?
A
2nd degree: - >25% of adult > 20% of child 3rd degree: >10%
21
Q
what is rule of 9 for burn
A
whole arm: 9 Whole leg: 18 (9 front/9back) Abdomen: 9 Chest: 9 Back: 18 (9 lumbar/9 thorasic) Head: 9 groin: 1%
22
Q
when should you start IV for a burn victom?
A
When >15% of body is burned. (they’ll be losing hydration through burn area)
23
Q
For inhalation injury?
A
Highest O2 flow with highest outflow.
24
Q
What O2 delivery for the LOW FLOW (1-6L)
A
Nasal canula 1-6
Venturi mask: 4-8L
25
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.
26
what mask gives the highest % of O2?
Non rebreather mask gives higest O2: 60-80%
| at the highest flow: 10-15:
27
what masks if you want to be precise about oxygen delivery
Venturi mask: 4-8 L /24-60% O2
28
When to use simple face mask?
Higher % of O2 with lower flow rate.
35-60%
6-10 liters.
29
Chemical burns:
Don't add water except to flush Eye:
| avoid self exposure.
30
Heat stroke
```
Not able to sweat.
1- ABC
2 - rapid cooling
3: replace fluids/electrolytes
4: treat complications
```
31
Short term catheter
French short term
32
Long term catheter
Foley
33
When to catheter?
Urinary retention: >12 hours
| Urinary volume: >500ml
34
caution in catheterizing people?
If you drain more than 300-400 could cause shock: wait 30-50 minutese to continue draining.
35
what are the most dangerous eye injuries
Closed globe injuries are more dangerous.
36
Why are glosed globe injuries more dangerous:
Could also have orbital or skull fruactures, and optic nerve damage
37
why is increasing eye pain and decreasing vision over time dangerous?
can be swelling to optic nerve.
38
why should you check visual aquity
if its wrong can be sign on internal bleeding.
39
hyphema
Problem in Anterior chamber can cause acute glaucoma
| Can be seen in direct trauma.
40
subconjunctival hemorrage.
Bruise that is self limited, if vision is stable then its ok.
41
what to do for chemical burn.
Irrigate with water
if no water put ointment or oil
then send to ER
42
what if there is damage to cornea
Send to ER:
| lubricate, patch for 24 hours, keep lid closed. Foreign body must be ruled oute
43
how can you see corneal ulceration?
Fourescein die and
| slit lamp
44
what about welding flash burn?
Shreaded raw potato pultice,
vitamin A oil.
Hydrotherapy.
cold water X 10 min direct
45
Rules of basic live support
RAP
R- responsiveness: trap squeeze
A- Activate EMS
P: postion on back,
46
order of resussitation
Compression first (30)
Airway: head tilt, chin lift.
Breath: Occlued nose, 2 breaths.
47
what if chest tdoesn't rise
air in stomach or obstruction
48
what if person is unconcious but their vitals are good
Place on left side.
49
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
```
50
When do you activate AED?
Adult: immediately
Infant: after 2 minutes of CPR if alone. In this case do 30/2
51
when can you stop doing CPR
Unsafe
to exhaused
help arrives
patient moves.
52
when does brain damage start
At 4-6 minutes
53
complications of CPR
Vomiting: put on left side, wipe vomit from mouth, continue.
54
what type of O2 for CPR?
Bag-valev- mask.
55
signs birth is imminent?
contractions every 2-3 min or less
crowning
urge to push
56
how to prep mom
- get her comportable
- Drap over abdomen and legs
- Drape under her.
- Wash hands**
57
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
58
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.,
59
what goes to hospital?
Mom
Baby
placenta
60
most concerning for baby?
airway
breathing
prevent heat loss
61
when is cord cut?
2 ties 4 and 6 inches from baby, cut between, not sooner thant 3 minutes.
62
when is placenta passed
30-60 minuts post birth. Ensure its intact.
63
what is apgar based on.
```
Airway
Grimace
pulse
activity
respiration
```
64
what if nuchal cord
cord around neck, unwind it if possible.
| no pushing baby back in.
65
prolapsed cord
cord out first: EMERGENCY. C section
66
meds for uterine hemorrage
Oxytocin
| misoprostal
67
what can cause uterine hemorrage
Clotting disordrders
retained tissues.
lacerations of genitals
Soft boddy uterus
68
why is group B strep a concern
neonatal sepsis and meningits
69
neonatal eye infx
GC/CT:
- .5 erythromycin
- 1% tetracycline
70
how to screen for eptopic
serum HCG
full pelvic exam
TVUS
EMS, Treat shock
71
normal ABC for infant
0-1: 120-80/40-40rmp
1-5: 100, 100/60, 30 RPM
5-10: 80, 120/80, 20
72
child abusee
Proximal threat: call 911 have them come to office
| Non proximal: Call Protective services or 911, high suspicion
73
what should you not forget with lacerations and abrasion
Tetanus status
74
broken nose:
Check for head injury
Ice
Sent ot ED for imaging.
75
bloody nose and concerns.
Firm pressure for 10-15 minutes.
| Cancer, medication and hypertensive crisis if spontaneous.
76
what throat conditions should you send to ER
- peritonsilar abscess
- epiglottitis
- retropharyngeal abscess
77
fractured tooth
| tooth knocked out
Fractured: Dentist NOW
| Kncked out: Dentist 1 HOUR.
78
PH of blood?
7.35 - 7.45
| can IV from 5-9 but 6.6-7.6 is best
79
Osmolarity of blood
290,
| IV <450 to reduce risk of phlebitis.
80
isotonic fluids
250-375 osm (close to normal blood at 290)
- normal saline 9%
- 5% destrose D5W
- ringer lactate.
81
what are isotonic fluids best
won't cause fluid shits into or out of fcells.
82
what can be dangerous about isotoic
can cause fluid overload.
83
hypotonic
<250: fluid will go into cells, can cayse HYPOtension
84
hypertonic
>375, fluid will leave cells,
| painfull,
85
Flow rate for hypertonic solution >375
1-5mL/minute, slow to prevent pain
86
what causes plebitis
PH that is to far off.
87
what if there is infliltration
Stop infusion, light pressure and Apis
88
systemic complications of IV
Air emboli, septicemia, shick, catheter embolism, electrolyte shift
glycemic emergency,
fluid overload
89
what can be a problem if taking CCB's
EDTA
Magnesium
can lead to heart block becausee they act as CCB
90
What can be a problem with rauwolfia
| IV
Mg
EDTA
Ca
cant respont to hypotension adewuates.
91
Problem with BB and IV
Mg
| can compound evvects of BB
92
IV with syncope
```
Keep IV in
Lay them down
Smelling salts
Blanket
reassurance
```
93
Hypoglycemia with IV?
Have pt eat if giving high dose vitamin C or EDTA.
| use D5W to reverse
94
what is speed shock iwth IV
infusing to quickly often mg.
95
antidote for mg
Ca antidotes Mg
| Mg antidoees CA
96
what IV can cause fluid overload.
```
ISOTONIC to quick,
Eldery
Kidney compromised
CHF.
Hypertonic solution.
```
97
sx of fluid overload
edema
| Pulmonary edma: crackles and SOB
98
Sx of fluid overload
Slow transfusion
heat person: dilate dirculation
O2
99
what is side effect of hypertonic solution
Dehydration, because fluid leaves cells.
100
catheter size for rehydration?
Largest catheter (smallest #)
101
solution type for rehydration
Isotonic** (slightly hypotinic )
- 9%NS
- ringer lactate
- D5W
102
what will happen if you use sterile water
Death
103
how much can you rehydrate per day
1. 5-2 liters only. slow and stead so no fluid overload, especiall in
- elderly
- CHF
- Kidney issues
104
what IV med can change clotting times
EDTA
