Emergency Medicine PN FC Flashcards
Rescue breaths contain what percentage of oxygen?
16%
At what angle should a subcutaneous needle be injected?
30 degrees
Why are steroids given during anaphylaxis?
To prevent a cytokine storm and rebound anaphylaxis because epinephrine and diphenhydramine don’t last a long time
Describe the sequence of treatment in anaphylaxis
- ) CAB
- ) IV or Intramuscular Epinephrine
- ) Oxygen
- ) Recumbent position with legs raised
- ) IV Saline replacement
- ) IV or Oral Diphenhydramine
- ) Possible use of rantidine (H2 antagonist), glucagon (if taking beta blocker), glucocorticoids
What is the standard treatment for anthrax exposure?
Doxycycline or Ciprofloxacin
When performing chest compressions, what depth should be achieved in children and adults?
Adults = 2 inches
Children = 1/2 chest depth
What is the oxygen concentration and flow rate of nasal cannulas?
1-6 Litres per min with up to 44% oxygen concentration
In anaphylaxis, what position should be patient be placed in?
Trendelenberg position (supine with legs elevated)
What is the only circumstance in which a compressions to breaths ratio should be 15:2?
Two person rescue of a child or infant
Is 5% dextrose in water (D5W) hyper-, hypo-, or isotonic?
Isotonic (250-375 mOsm/L)
For rehydration in IV, what size of a catheter should be used? What type of solution should be used?
The largest possible (i.e. the smallest gauge) using an isotonic solution (0.9% NaCl, ringer’s, D5W)
Croup can be an emergency scenario.
- ) How do you identify croup?
- ) What is your initial treatment and at what point do you call an ambulance?
- ) Croup usually occurs in children under 3 years of age. It presents with an inspiratory stridor and seal-like barking cough.
- ) Breathe in cool and humid air for 5 mins. If there is no significant improvement, activate EMS
At what angle should an intradermal needle be oriented?
10-15 degrees
What compression rate should be achieved during CPR?
100/min
In the management of anaphylaxis, epinephrine can be given intravenously or intramuscularly. What is the difference in concentration?
IV is less potent, but is given continuously over several mins.
Intramuscularly is more potent, but given once every 5 mins
Is ringer’s lactate hypo-, hyper-, or isotonic?
Isotonic (250-375 mOsm/L)
What IV ingredients must you be concerned with when a patient is on a calcium channel blocker?
Magnesium & EDTA (will potentiate CCB’s effects)
0.9% Sodium Chloride is a normal saline solution. Is it hypo-, hyper-, or isotonic?
Isotonic (250-375 mOsm/L)
What oxygen delivery system provides the greatest concentration of oxygen?
Non-rebreather mask or Bag valve mask (90%)
What is the most common adjuvant to epinephrine during anaphylaxis? What dose should it be given in?
Diphenhydramine (Benadryl) given IV at 50mg over 1mL
Antihistamine medication
How do you prevent speed shock in IV administration?
- ) Give slow pushes
2. ) Dilute the mixture
What is the formula used to calculate osmolarity?
[ (Volume)(mOsm/mL) / (Volume) ] x 1000 = Osmolarity (mOsm/L)
At what blood pressure do you administer epinephrine in anaphylaxis?
Radial BP < 80 mmHg systole
Femoral BP < 70 mmHg systole
Carotid BP < 60 mmHg systole
Is 0.45% sodium chloride hyper-, hypo-, or isotonic?
Hypotonic (< 250 mOsm/L)
What is the earliest sign of shock?
Tachycardia
What is the dose of epinephrine given to an anaphylactic patient IV?
0.1-0.2 mg in a 1:10,000 solution IV push every 3-5 mins
A resuscitation mask, non-rebreather mask, and bag valve mask all have the same maximum flow rate. What is it?
15 litres per minute
If a patient does not have a fever or asthma but has stridor what is the most likely cause?
Upper Airway Obstruction
Note: fever in the presence of inspiratory stridor is most likely croup (also look for a seal-barking cough)
What are the normal vital signs for: 0-1, 1-5, 5-10 years of age?
0-1 years old
i. ) HR = 120 ii. ) BP = 80/40 iii. ) RR = 40
1-5 years old
i. ) HR = 100 ii. ) BP = 100/60 iii. ) RR = 30
5-10 years old
i. ) HR = 80 ii. ) BP = 120/80 iii. ) RR = 20
What is the treatment for an air embolism?
- ) Left Lateral Decubitus Position
- ) Provide Oxygen (air may go to the pulmonic valve and occlude flow to the lung)
- ) Activate EMS
At what osmolarity of an IV mixture do you need to be concerned about phlebitis?
450-600 = moderate risk
> 600 = Severe risk of phlebitis
If you are alone with an infant and you need to perform CPR, at what point should you activate EMS?
After 2 mins of resuscitation
When should emergency oxygen be given (wrt respiration rate)?
Adult breathing rate is < 12 or > 20 bpm
Child breathing rate is < 15 or > 30
Infant breathing rate is < 25 or > 50
What is the most common sign of decompensated (late) shock?
Hypotension
In determining the severity of a burn, what rule is used?
Rule of 9s (adults) or 5s (peds)
Each arm = 9% (10% peds)
Head/Neck = 9% (15% peds; 20% infant)
Each leg = 18% (10% peds)
Torso = 18% (20% peds)
Rehydration formulas are usually calculated to a maximum of what volume per day?
2 L
When might a Mill Wheel Murmur be present?
Air embolism that collects in the right ventricle of the heart
- ) What is the definition of osmolarity?
2. ) What osmolarity qualifies as isotonic, hypotonic, and hypertonic?
1.) The concentration of solute in a volume of solution
2.) Isotonic = 250-375 mOsm/L
Hypotonic < 250 mOsm/L
Hypertonic > 375 mOsm/L
Where should epinephrine be injected and at what dose?
Injected intramuscularly into the mid anterolateral thigh or as an intratracheal injection
The recommended dose is 0.5-1.0 mg in a 1:1,000 solution intramuscularly
If epinephrine is being injected into subcutaneous tissue the dose is 0.3-0.5 mg
Effective CPR provides what percent of normal blood flow?
25-33%
What is the purpose of a non-rebreather mask?
It vents out expired air that way a patient does not breathe in previously exhaled air (that has less oxygen concentration)
At what point is brain damage certain without medical intervention (CPR)?
10 mins
