Emergency Medicine Flashcards
compression ventilation for lone rescuer for children and adults
30 compressions to 2 breaths
push chest fast at a rate of 100 compressions/min
how to open airway for breaths
head tilt chin lift with one hand one forehead and two fingers under chin of lower jaw
- don’t use thumb
- don’t press into soft tissue under chin
when do you use jaw thrust
if head or neck injury is suspected
*need two people
place fingers under angles of jaw on both sides and lift
Complete secondary survey (SAMPLE)
Signs and sx Allergies Meds PMHx Last meal Events related to injury
differences between adult and child CPR
tap bottom of childs foot
compression vent ration for 2 rescuers is 15:2
one hand on chest, other on forehead for compressions
if adult, child, or infant has a pulse but is not breathing, you
give rescue breaths only at a rate of 1 breath every 5-6 seconds (10-12 breaths/min)
*check pulse every 2 minutes
if a choking victim becomes unresponsive
activate EMS
lie on ground and begin CPR 30:2
Do not check pulse
*if object can be visualized and easliy removed, go ahead, but if not visible, continue CPR
relief of choking infants
infant on lap
facedown with head lower than chest
5 back slaps between shoulder blade
Turn over and 5 quick downward chest thrusts in middel of chest over lower half of breastbone
Do you perfrom finger sweeps in infants and chidlren?
DO not perform blind finger sweeps
heat stroke (temp s/sx)
Temp over 104.9f dry hot skin altered mental status muscle cramps, nausea, vomitting rapid pulse
transport hypothermia pt with head and feet where
head lower than feet
rule of 9s for burns
arm = 9% each legs = 18% each torso = 18% front and 18% back head = 9%
second degree burns involve what skin layers
superficial dermis, hair follicles, sweat glands
tx 3rd degree burns
o2
Ringers lactate IV
clean with mild soap, water, sterile dressing
topical and systemic antibiotics
when do you refer burns to ER
1st degree >75% body
2nd degree >10%
3rd degree >10% or >2-3% in children or elderly
what suggests CO poisoinging
normal PO2 with low o2 saturation
tx for CO poisoning
100% o2 by mask
ER
Activated charcoal dose for poison tx
3-5 tbsp in children less than 5 years
10-20 tbsp >5 years
Do not use if cyanide, corrosives, ethanol, methanol, organic solvents, or iron
what gauge needle for infant or elderly with poor veins
24
when would you adminster normal saline 0.9%
hyperacute dehydration, severe diarrhea, vomiting, shock, post anaphylaxis
when would you administer lactated ringer
2-3 days of dehydration, elecrolyte replacement, burns, trauma, metabolic acidosis.
what IV solutions are isotonic
normal saline and lactated ringers
when would you use half normal saline 0.45%
intracellular dehydration - hypernatremia
*do not give for burns or liver disease
When would you give D5W 5% dextrose
dehydration, fluid loss, hypernatremia
*not for use in rescusitation
when would you give sterile water
diluting or dissolving drugs for IV, IM, or SubQ
3% or 5% saline - hyertonic when to use?
severe Na depletion
when would you give nasal cannula and what flow rate and o2 concentration
- indicated for breathing, COPD, pt with low O2 concentration
- flow rate: 1-6 L per min
- 02 concentration: 24-45%
when would you give pocket mask without o2 and what flow rate and o2 concentration
- breathing or non-breathing trauma victim
- manual/CPR use
- 16% o2
when would you give simple face mask and what flow rate and o2 concentration
breathign, mild or moderate respiratory distress
6-10 L/min
-40-60% o2
when would you give Venturi mask and what flow rate and o2 concentration
Breathing, COPD, asthma, stable
- 4-15 L/min
- 20-40%
when would you give bag-valve mask with O2 and what flow rate and o2 concentration
apnea or inadequate respiratirons
10-15L/min
90-100% o2
unconscious or conscious
when would you give partial rebreather mask and what flow rate and o2 concentration
breathing or non-breathing
8-15L/min
60-80%
when would you give non-rebreather mask and what flow rate and o2 concentration
COPD, smoke inhalation, CO2 poisoning
10-15L/min
90-100%
when do you administer o2 in an adult, child, and infant
adult: <12 breaths or > 20
child: <15 or >30
infant <25 or >50
signs of upper airway obstruction
cyanosis drooling LOC retraction insp or exp stridor
early compensated shock signs vs late decompensated shock signs
compensated: tachycardia, anxiety, diaphoreses, wide pulse pressure
decompensated: hypotension, confusion, LOC, oliguria, acidemia
radial, femoral, carotid pulses = BP
radial: 80
Femoral: 70
carotid: 60
Epi dosing IM, IV
Diphenhydramine dosing
steroids
IM: 1:1000 0.3 - 0.5ml
IV: 1:10,000 0.1-0.2mg repeat every 3-5 min
Diphenhydramine: 50mg IV
steroid dosing depends on form
how do you rehydrate a burn victim?
ringer lactate
lab for burns
see myoglobinemia with renal damage and severe tissue breakdown
If no urination for > 12 hours how do you cath
darain 300-400ml and let bladder relax for 30-60 min
which is worse hyphema or subconjunctival hem
hyphema can lead ot acute glaucoma
if suspected corneal abrasion
send to emergenct eye doc to rule out corneal ulceration
RAPCAB
R Activated EMS P compression airway breathing
pH level for IV
human blood
human blood 7.35-7.45
patient comfort 6.6-7.6
osmolarity
isotonic 250-375
hypo <250
hyerp >375
human body fluids 280-295
ca ch blockers can interact with what in IV
EDTA and Mg
Rauwolfia can interact with what in IV
Mg, Ca, EDTA
Beta blockers can interact with what in IV
Mg
when do you see hypoglycemic emergency and what do you do?
high dose vit C or EDTA chelation
D5W infusion
when do you see fluid overload
isotonic solution too quickly edema, hypertension, , pulm edema tx: slow fluid infusion heat to dilate 02
when do you see dehydration in IV therapy
with hypertonic solutions
rehydration
needle size
type of fluid
largest needle 20 or 24
use isotonic normal 0.9% soaline, ringer lactate, or D5W
main tx goal for AAA
decrease BP with propranolol
what position do put someone in shock in
supine with leg raised 8-12 inches
tx anthrax
cipro or doxy
important protective gear for anthrax
mask
what part of secondary survey is most important
watch face
most common complication of tibial fracture
compartment syndrome
sign of femoral neck hip injry
shortened, externally rotated
complication of hip fracture
DVT
