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Emma's NPLEX II Conventional Tx > Emergency Medicine PN FC > Flashcards

Emergency Medicine PN FC Flashcards

1
Q

Rescue breaths contain what percentage of oxygen?

A

16%

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2
Q

At what angle should a subcutaneous needle be injected?

A

30 degrees

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3
Q

Why are steroids given during anaphylaxis?

A

To prevent a cytokine storm and rebound anaphylaxis because epinephrine and diphenhydramine don’t last a long time

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4
Q

Describe the sequence of treatment in anaphylaxis

A
  1. ) CAB
  2. ) IV or Intramuscular Epinephrine
  3. ) Oxygen
  4. ) Recumbent position with legs raised
  5. ) IV Saline replacement
  6. ) IV or Oral Diphenhydramine
  7. ) Possible use of rantidine (H2 antagonist), glucagon (if taking beta blocker), glucocorticoids
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5
Q

What is the standard treatment for anthrax exposure?

A

Doxycycline or Ciprofloxacin

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6
Q

When performing chest compressions, what depth should be achieved in children and adults?

A

Adults = 2 inches

Children = 1/2 chest depth

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7
Q

What is the oxygen concentration and flow rate of nasal cannulas?

A

1-6 Litres per min with up to 44% oxygen concentration

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8
Q

In anaphylaxis, what position should be patient be placed in?

A

Trendelenberg position (supine with legs elevated)

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9
Q

What is the only circumstance in which a compressions to breaths ratio should be 15:2?

A

Two person rescue of a child or infant

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10
Q

Is 5% dextrose in water (D5W) hyper-, hypo-, or isotonic?

A

Isotonic (250-375 mOsm/L)

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11
Q

For rehydration in IV, what size of a catheter should be used? What type of solution should be used?

A

The largest possible (i.e. the smallest gauge) using an isotonic solution (0.9% NaCl, ringer’s, D5W)

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12
Q

Croup can be an emergency scenario.

  1. ) How do you identify croup?
  2. ) What is your initial treatment and at what point do you call an ambulance?
A
  1. ) Croup usually occurs in children under 3 years of age. It presents with an inspiratory stridor and seal-like barking cough.
  2. ) Breathe in cool and humid air for 5 mins. If there is no significant improvement, activate EMS
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13
Q

At what angle should an intradermal needle be oriented?

A

10-15 degrees

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14
Q

What compression rate should be achieved during CPR?

A

100/min

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15
Q

In the management of anaphylaxis, epinephrine can be given intravenously or intramuscularly. What is the difference in concentration?

A

IV is less potent, but is given continuously over several mins.

Intramuscularly is more potent, but given once every 5 mins

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16
Q

Is ringer’s lactate hypo-, hyper-, or isotonic?

A

Isotonic (250-375 mOsm/L)

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17
Q

What IV ingredients must you be concerned with when a patient is on a calcium channel blocker?

A

Magnesium & EDTA (will potentiate CCB’s effects)

18
Q

0.9% Sodium Chloride is a normal saline solution. Is it hypo-, hyper-, or isotonic?

A

Isotonic (250-375 mOsm/L)

19
Q

What oxygen delivery system provides the greatest concentration of oxygen?

A

Non-rebreather mask or Bag valve mask (90%)

20
Q

What is the most common adjuvant to epinephrine during anaphylaxis? What dose should it be given in?

A

Diphenhydramine (Benadryl) given IV at 50mg over 1mL

Antihistamine medication

21
Q

How do you prevent speed shock in IV administration?

A
  1. ) Give slow pushes

2. ) Dilute the mixture

22
Q

What is the formula used to calculate osmolarity?

A

[ (Volume)(mOsm/mL) / (Volume) ] x 1000 = Osmolarity (mOsm/L)

23
Q

At what blood pressure do you administer epinephrine in anaphylaxis?

A

Radial BP < 80 mmHg systole
Femoral BP < 70 mmHg systole
Carotid BP < 60 mmHg systole

24
Q

Is 0.45% sodium chloride hyper-, hypo-, or isotonic?

A

Hypotonic (< 250 mOsm/L)

25
Q

What is the earliest sign of shock?

A

Tachycardia

26
Q

What is the dose of epinephrine given to an anaphylactic patient IV?

A

0.1-0.2 mg in a 1:10,000 solution IV push every 3-5 mins

27
Q

A resuscitation mask, non-rebreather mask, and bag valve mask all have the same maximum flow rate. What is it?

A

15 litres per minute

28
Q

If a patient does not have a fever or asthma but has stridor what is the most likely cause?

A

Upper Airway Obstruction

Note: fever in the presence of inspiratory stridor is most likely croup (also look for a seal-barking cough)

29
Q

What are the normal vital signs for: 0-1, 1-5, 5-10 years of age?

A

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
30
Q

What is the treatment for an air embolism?

A
  1. ) Left Lateral Decubitus Position
  2. ) Provide Oxygen (air may go to the pulmonic valve and occlude flow to the lung)
  3. ) Activate EMS
31
Q

At what osmolarity of an IV mixture do you need to be concerned about phlebitis?

A

450-600 = moderate risk

> 600 = Severe risk of phlebitis

32
Q

If you are alone with an infant and you need to perform CPR, at what point should you activate EMS?

A

After 2 mins of resuscitation

33
Q

When should emergency oxygen be given (wrt respiration rate)?

A

Adult breathing rate is < 12 or > 20 bpm

Child breathing rate is < 15 or > 30

Infant breathing rate is < 25 or > 50

34
Q

What is the most common sign of decompensated (late) shock?

A

Hypotension

35
Q

In determining the severity of a burn, what rule is used?

A

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)

36
Q

Rehydration formulas are usually calculated to a maximum of what volume per day?

A

2 L

37
Q

When might a Mill Wheel Murmur be present?

A

Air embolism that collects in the right ventricle of the heart

38
Q
  1. ) What is the definition of osmolarity?

2. ) What osmolarity qualifies as isotonic, hypotonic, and hypertonic?

A

1.) The concentration of solute in a volume of solution

2.) Isotonic = 250-375 mOsm/L
Hypotonic < 250 mOsm/L
Hypertonic > 375 mOsm/L

39
Q

Where should epinephrine be injected and at what dose?

A

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

40
Q

Effective CPR provides what percent of normal blood flow?

A

25-33%

41
Q

What is the purpose of a non-rebreather mask?

A

It vents out expired air that way a patient does not breathe in previously exhaled air (that has less oxygen concentration)

42
Q

At what point is brain damage certain without medical intervention (CPR)?

A

10 mins

Emma's NPLEX II Conventional Tx (8 decks)

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