Exam 1 Emergency and Disaster Flashcards
Who falls in the Immediate (RED) triage category?
tension pneumothorax
respiratory distress
major external hemorrhage
airway injuries
What is the primary survey in triage
Alertness and airway
Breathing and ventilation Circulation and control of hemorrhage
Disability
Exposure and environment
Why is alertness part of the airway assessment?
Assessment of alertness helps in the evaluation of the patient’s ability to protect the airway
What are the components of airway assessment?
Bony deformity
Burns
Edema
Fluids (blood, vomit, or secretions)
Foreign objects
Inhalation injury (burns,singed facial hair,soot)
Loose or missing teeth
Sounds (snoring, gurgling, stridor)
Tongue obstruction
Vocalization
What is oropharyngeal airway intervention?
-temporary measure
-for patient breathing spontaneously but unconscious
-this airway prevents tongue from falling back against posterior pharynx and obstructing the airway
-for patients without gag reflex
-providers able to suction secretions
What should be assumed with patients who have multiple traumatic injuries?
spinal cord injury unless proven otherwise
What are the goals of treatment when caring for trauma patients
Determine extent of injuries and establish priorities of treatment
What do you do if the patient is unable to open their mouth or responds only to pain
perform the jaw thrust maneuver
What are steps to jaw thrust maneuver?
Stand at the head of the bed.
Place your index fingers under the angle of the lower jaw on each side of the patient’s face, your palms close to or on each cheekbone for stabilization.
Gently move the mandible upwards (vertically) and towards the patient’s feet (horizontally).
How is insertion performed for OPA?
Measure the correct size by placing the proximal end (flange) of the OPA at the corner of the mouth. The tip should just reach the angle of mandible.
Depress the tongue using a tongue blade or a rigid suction device. Advance the OPA straight over the tongue, or insert the OPA at a 90-degree angle, and then turn the OPA while avoiding trauma to the palate.
With either method, it is essential to take care not to push the tongue backward, causing it to occlude the airway.
After insertion, reassess airway patency, ventilation, and oxygenation, and anticipate the need for a definitive airway. If ventilation or oxygenation is inadequate, consider the use of bag-mask ventilation to support the patient.
Why is nasopharyngeal airway used?
to open the airway
enables air to pass behind the tongue
used in patients with gag reflex
When is NPA absolutely contraindicated?
facial trauma or a known or suspected basilar skull fracture
How to verify placement of ETT?
Attachment of a CO2 detector device. After 5 to 6 breaths, assess for the presence of exhaled CO2
Observation of adequate rise and fall of the chest with assisted ventilation
Auscultation, first for absence of gurgling over the epigastrium, and then for presence of bilateral breath sounds
What assessments should be performed to assess for BREATHING and ventilation?
Breath sounds
Depth, pattern, rate
Increased work of breathing
Open wounds or deformities
Skin color
Spontaneous breathing
Subcutaneous emphysema
Symmetrical chest rise and fall
Tracheal deviation or JVD
What is the next step if the breathing assessment reveals adequate ventilation?
Continue oxygen via an appropriate device for the ordered flow rate.
What is the next step if your breathing assessment reveals absent or inadequate ventilation?
Open the airway using a jaw-thrust maneuver while maintaining SMR and insert an airway adjunct
If the patient remains apneic or without adequate ventilation, assist ventilations with a bag-mask device.
What assessments should be performed to assess CIRCULATION?
Inspect and palpate
Color
Temperature
Moisture
Palpate a pulse
Control of hemorrhage
What interventions should be anticipated for hypovolemic shock due to hemorrhage?
control of hemorrhage with direct pressure, application of a tourniquet, balanced resuscitation, damage control resuscitation, FAST exam, and pelvic binder.
What assessment is part of DISABILITY?
Glasgow Coma Scale
Best eye opening
Best verbal response
Best motor response
Pupils
Glucose if indicated
What assessments and interventions should be performed during EXPOSURE and ENVIRONMENTAL control?
Remove all clothing
Inspect for injuries
Warming measures
Blankets
Increase room temperature
Warmed IV fluids
Warming lights
What does the “F” stand for?
Full Set of Vital Signs and Family Presence
Obtain a full set of vital signs
Facilitate family presence
What does G stand for?
Get adjuncts and give comfort leading to
L: Laboratory analysis
M: Cardiac monitor; consider 12-lead ECG
N: Consider naso- or orogastric tube
O: Oxygenation and capnography; consider weaning oxygen
*P: Assess pain using appropriate scale
Consider analgesia
Nonpharmacologic comfort
What does I stand for?
Inspect posterior
Unless contraindicated by known or suspected spine or pelvic injury
Turn, inspect and palpate
Remove backboard
When might it be unsafe to turn the patient?
If the patient has signs or symptoms suggestive of a spine or pelvic injury, logrolling can cause more trauma or worsen bleeding from pelvic fractures.
