Exam 3 - Emergency Flashcards by Ashley Burkhalter

the triage process means to ___

sort

process of rapidly determining pt acuity using emergency severity index (ESI)

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after initial focused assessment, what assessment approach is used

H2T

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ABCDEFGH

airway
breathing
circulation
disability
exposure
facility adjuncts, family
get resuscitation adjuncts
hx, H2T assessment

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primary survey focuses on

ABCDEFGH

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uncontrolled external hemorrhage reprioritized ABC to

CAB

applied direct pressure, pressure dressing

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what must be done prior to moving past primary survey

interventions must be started

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___ ___ protection is always a priority

cervical spine

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AVPU

alert
responds to voice
responds to pain
unresponsive

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must know Glasgow coma scale

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s/sx of compromised airway

dyspnea
inability to speak
gasping, agonal breathing
foreign body in airway
trauma to face or neck

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nasopharyngeal or oropharyngeal airway is obtained on ___ pts only

unconscious

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what can indicate partial open airway

minor talking

no coughing or talking = true airway obstruction

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what should be applied with suspected face, head, or neck trauma

c-collar

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universal donor

O -

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universal receiver

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where to assess the central pulse

carotid artery

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should impaled objects be removed

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when removing clothing, what do you need to be mindful of/assess?

what environment they were in - water, hot, chemicals, snow

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T or F. family is allowed in the room during trauma or code settings

true

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resuscitation adjuncts - LMNOP

lab studies
monitor EKG
NGT, or orogastric tube
O2 and vent assessment
Pain management

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what kind of medication is used re: pain managment

start with NSAID, move to opioids later (do not want to compromise LOC)

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what occurs during secondary survery

when you begin to identify all injuries

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SAMPLE - secondary survery

symptoms
allergies
medication hx
PMH
last mean/PO in take
events, environment factors leading up to injury

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how to apply a bandage with sunken chest wounds

close off only on 3 sides

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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

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 < ___

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

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

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

what do you use to flush eyes

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