Exam 3 - Emergency Flashcards
the triage process means to ___
sort
process of rapidly determining pt acuity using emergency severity index (ESI)
after initial focused assessment, what assessment approach is used
H2T
ABCDEFGH
airway
breathing
circulation
disability
exposure
facility adjuncts, family
get resuscitation adjuncts
hx, H2T assessment
primary survey focuses on
ABCDEFGH
uncontrolled external hemorrhage reprioritized ABC to
CAB
applied direct pressure, pressure dressing
what must be done prior to moving past primary survey
interventions must be started
___ ___ protection is always a priority
cervical spine
AVPU
alert
responds to voice
responds to pain
unresponsive
must know Glasgow coma scale
must know Glasgow coma scale
s/sx of compromised airway
dyspnea
inability to speak
gasping, agonal breathing
foreign body in airway
trauma to face or neck
nasopharyngeal or oropharyngeal airway is obtained on ___ pts only
unconscious
what can indicate partial open airway
minor talking
no coughing or talking = true airway obstruction
what should be applied with suspected face, head, or neck trauma
c-collar
universal donor
O -
universal receiver
AB
where to assess the central pulse
carotid artery
should impaled objects be removed
no
when removing clothing, what do you need to be mindful of/assess?
what environment they were in - water, hot, chemicals, snow
T or F. family is allowed in the room during trauma or code settings
true
resuscitation adjuncts - LMNOP
lab studies
monitor EKG
NGT, or orogastric tube
O2 and vent assessment
Pain management
what kind of medication is used re: pain managment
start with NSAID, move to opioids later (do not want to compromise LOC)
what occurs during secondary survery
when you begin to identify all injuries
SAMPLE - secondary survery
symptoms
allergies
medication hx
PMH
last mean/PO in take
events, environment factors leading up to injury
how to apply a bandage with sunken chest wounds
close off only on 3 sides
abdominal assessment order
look
listen
percuss
palpate
Turners vs. McCullens bruising
T: flank bruising
M: around umbilicus
how many people must assist with log rolling
3-4 people
where must lungs be assessed during secondary survery
posterior
do you asses above or below injury
both
what must you ask regarding tetanus
has this been administered within the last 10 years
when are autopsies performed
upon family request
death within 24 hours of ED admission
suspected trauma or violence
all children
do nurses speak with families about organ donation
No, only the organ donation center - must contact them whether the pt is an organ donor or not
when does heat stress occur
themoregulatory mechanisms can not compensate for exposure to increase temps
heat-related compensating measures
sweating
vasodilation
causes of hyperthermia
environment
trauma
metabolic
drugs (tranquilizers, anticholinergics, BB, diuretics)
alcohol
CVD
DM
CNS disorders (ie: stroke)
severe cramps in large muscle groups fatigued by heavy work often seen in healthy athletics with inadequate fluid intake
heat cramps
how to resolve heat cramps
resolves rapidly with rest
oral, parental replacement of Na, water
elevate, gental massage, analgesia
avoid strenuous activity x12 hours
this occurs with prolonged exposure to heat over hours or days
heat exhaustion
s/sx of heat exhaustion
fatigue
N/V
extreme thirst
feelings of anxiety
tachycardia
dilated pupils
mild confusion
ashen color
profuse diaphoresis
hypotension
temp: 99.6-105.8
heat exhaustion interventions
cool (NOT cold) area, remove restrictive clothing
IVF: NS
moisture sheet
fan spiriting water
most serious form of heat stress
heat stroke
heat stroke temp
> 105.8
core temp with heat stroke will rise within __ to __ minutes
10 to 15 minutes
s/sx of heat stroke
temp > 105.8
AMS
absent perspiration
circulatory collapse
-hot, dry, ashen skin
-range of neuro symptoms
are antipyretics effective with heat stroke
No
why should reducing temperature with heat stroke be done gradually
to prevent hypothermia
what to monitor for with a heatstroke
rhabdo
myoglobinuria
DIC
what occurs with tissue in the vascular space with frostbite
fluid is actually freezing
most common areas for frostbite
hands
feet
toes
ears
nose
depth of frostbite depends on which 4 things
ambient temp
length of exposure
type of condition (wet/dry)
contact with metal surface
superficial frostbite s/sx
waxy, pale yellow to blue, mottled
feels crunchy and frozen
tingling, numbness, burning
superficial frostbite interventions
immerse area in circulating water (98.6-100.4)
warm soaks for facial areas
blisters form within hours
avoid heavy blankets, clothing
feels warm, stinging as it thaws
rewarming is extremely painful
never squeeze, massage or scrub
remove clothing, jewelry
deep frostbite s/sx
muscle, bone, tendon
skin is white, hard, insensitive to touch
mottling gradually turns to gangrene
deep frostbite interventions
immerse in temp controlled bath (98.6-104)
elevate (significant edema within 3 hours)
blisters in 6 hrs to days
IV analgesia
tetanus
evaluate for hypothermia
—hospitalization may be indicated; amputation
hypothermia core temp is < ___
95
where is most body heat lost
head
thorax
lungs
wet clothing
core temp < __ is life threatening
89.6
mild hypothermia
temp: 96.8
shivering**
lethargy
confusion
rational to irrational behavior
minor HR changes
moderate hypothermia
temp: 89.6-93.2
rigidity
bradycardia, bradypnea
BP only by doppler
metabolic, respiratory acidosis
when will shivering decrease
core temp of 89.6
severe hypothermia makes the person appear ___
dead
every effort is made to warm the pt to at least 86 before pronouncing dead
goal for moderate and severe hypothermia
raise core temp
mild hypothermia: passive external (spontaneous) rewarming
move to warm, dry place
remove damp clothes
radiant lights
warm blankets
mild hypothermia: active external (surface) rewarming
fluid, air filled warming blankets
warm water immersion
what is afterdrop
drop in core temp after rewarming
rewarm the ___ before extremities
core
risks of rewarming
afterdrop
hypotension
dysrhythmias
when to DC rewarming
once core temp reaches 89.6-93.2
submission injury is aka
nonfatal drowning or near drowning
do victims of drowning aspirate liquid
no, d/t laryngospasms
assessment finding/end result of drowning
compromised pulmonary and cardiac function
submission injuries require hospital admission for at least __ hour observation
23
hymenopteran stings occur from what
bees
yellow jackets
hornets
wasps
fire ants
hymenopteran stings venom can be which 4 things
cytotoxic
hemolytic
allergenic
vasoactive
when may symptoms of hymenopteran stings occur
immediately or delayed for 48 hours
who is at greatest risk for animal bites
children
which animal bite is most common
dog
which animal bite has greatest incidence of infection
cat
Pasteurella organism
what infection can occur d/t cat bites
septic arthritis
osteomyelitis
tenosynovitis
abx for cat bite
Augmentin
human bites can cause __ and __ infection or ___ virus
staph, strep
hepatitis
infection rate is __% if human bite is not treated within 24 hours
50%
prophylactic abx for any bite at risk for infection
wounds over joints
wounds > 6-12 hours old
puncture wounds
bites on hands, feet
all warm blooded mammals can carry ___
rabies
how is rabies spread
saliva, secretions
when must rabies treatment begin
before symptoms appear
when is human diploid cell vaccine administered for rabies
day 0, 3, 7, 14
active immunity
2 injection sites for rabies meds
deltoid
anteriolateral thigh
should you administer rabies meds in the gluteal
No
what should be administered within 1 hour of poison ingestion
gastric lavage
gastric lavage contraindications
caustic agents
co-ingested sharp objects
ingested nontoxic substances
most affective intervention for posioning
activated charcoal
gastric lavage within 60 minutes of ingestion
activated charcoal contraindications
diminished bowel sounds
paralytic ileus
ingestion of substance poorly absorbed by charcoal
can mustard gas be irrigated
No
what do you use to flush eyes
NS
does decontamination take priority over all interventions except basic life support measures
Yes
what must be done prior to flushing the eye of chemicals
wiping way dry substances
remember to review the ppt for additional information
remember to review the ppt for additional information
