FINAL EXAM Flashcards
Because of Boyle’s law, there must be careful management of air filled cuffs and pneumothoraces when transporting a patient via helicopter because…
Volume of gases will expand
T/F: Croup has a gradual onset, caused by a viral pathogen, while Epiglottitis is rapid onset with infection from a bacterial pathogen.
True
Which of the following is a rapid, non-invasive, non-threatening way to easily determine the physiologic stability of the pediatric patient?
a. pediatric assessment triangle
b. pediatric primary survey
a. pediatric assessment triangle
A child has been diagnosed with moderate croup (ltb) and stridor. What is your recommendation for treatment in addition to steroids?
Racemic epinephrine
T/F: Mottled skin and cyanosis are indicators of poor or abnormal appearance on the PAT.
False.
Mottled skin and cyanosis are indicators of abnormal circulation.
The appropriate treatment of epiglottitis involves keeping the child/parents calm while alerting the care team and:
Prompt intubation.
Epiglottitis is an emergency situation and securing an airway is a priority.
During the primary survey, exposure would include:
- exposing the skin (cutting the clothes)
- keeping the patient warm
- checking for evidence of new injury or old
- petechiae or purpura
- exposing the skin (cutting the clothes)
- keeping the patient warm
- checking for evidence of new injury or old
- petechiae or purpura
1, 2, 3, and 4
Besides abnormal breath sounds, what is a visual cue that your pediatric patient is having abnormal work of breathing?
Nasal flaring
Air medical transport is reserved for situations which:
a. must overcome terrain or environmental obstacles
b. are time sensitive or require longer tracel distances
c. require advanced care at another facility
d. all of these options
d. all of these options
Which is considered the single most important factor in the pediatric assessment?
Appearance
A 3 yo male is brought to the ER because the parents are worried “they just don’t look right.” Upon exam you find the child sitting in the upright position leaning forward and drooling. The RCP should immediately suspect:
Epiglottitis
An example of a patient who should NOT be transported via ambulance would be:
Patient in cardiopulmonary arrest
Terminally ill
Patient in isolation due to a contagion, or exposure to hazardous material
Combative patient
Stable patient that can be transported by other means
Which patient would likely have the most significant complications as a result of air transport?
a. ischemic stroke
b. intubated asthmatic with pneumothorax
c. lung transplant recipient
d. pulmonary fibrosis with sepsis
b. intubated asthmatic with pneumothorax
T/F: Early recognition and intervention is key in pediatric emergencies due to their tendency to compensate longer.
True
The GCS is primarily used to:
Assess level of brain injury
Traumatic brain injury can cause changes in the following:
- thinking/memory
- mood
- speech
- autonomic functions
1,2,3,4
You are called to assess a patient newly admitted to the ED. Upon exam you note:
LOC: obtunded HR: 129/min f: 7 / min SpO2: 86% via NRB Appearance: cyanotic
The pt is mostly incoherent, minimally cooperative and is barely able to hold her head or limbs off the bed. She keeps falling asleep while you try to obtain further medical history and has tremors. You should suspect:
Benzodiazepine Overdose
Coma, convulsions, and cardiac toxicity are signs of Tricyclic Anti-depressant overdose.
True
When a patient has sustained a head injury which results in physical bruising of the brain, this is called:
Cerebral contusion
When testing for clinical brain death, the test which look for an increase in arterial carbon dioxide and with the absence of respiratory movements is called:
Apnea test
The normal range for ICP is:
0-10 mmHg
T/F: Treatment for drowning can include: warming techniques BAL, prone positioning, oxygen, intubation and ventilation.
True
What does GCS stand for?
Glasgow Coma Scale
Excessive intake or administration of nitrates will lead to increased:
MetHb
Which term is used to describe unequal diameter of the pupils?
Anisocoria
You are called to assess newly admitted patient in the ED.
LOC: Awake, confused HR: 142/min rr: 34/min SpO2: 95% - RA Appearance: distressed
Tachypneic and respirations are deep. Blood glucose is measured at 536 mg/dl and his breath smells slightly like acetone.
Administration of insulin.
Patient is likely experiencing DKA
Which acronym is used to help you assess pupillary function?
P-E-R-R-L-A
All of the following are S/S of foreign body aspiration except:
- acute onset
- cough
- dyspnea, tachycardia, tachypnea
- bilateral wheezing
UNILATERAL wheezing, not bilateral. All except 4.
Possible stridor
Although intracranial hemorrhages (ICHs) fall into many categories, they all have the potential to increase:
ICP
T/F: Naloxone can be instilled down ETT if needed.
True
Which therapeutic technique for preserving cerebral perfusion may be indicated after 24 hours?
Hyperventilation
The most important sign which would indicate worsening of head injury/increased ICP:
Deterioration in mental status
Which term is used to describe excessive constriction of the pupils?
Miosis
The simultaneous presence of bradycardia, bradypnea, hypertension and Biot’s breathing are known as:
Late signs of increased ICP
The extremely sensitive piece of equipment used to monitor electrical activity of the brain during death evaluation is called
EEG
LOC: AAO x 4 HR: 97 / min f 19 / min SpO2 95% RA Appearance: Jaundice
The patient is pleasant but they report right upper quadrant pain and vomiting. You suspect:
Acetaminophen OD
RUQ pain, jaundiced skin, vomiting, nausea, and abnormal elevated liver function tests.
The treatment for Acetominophen OD is:
Acetylcysteine infusion (mucomyst)
A patient requires intubation if their GCS is:
8 or less
T/F: There is only one phrenic nerve.
False, there are 2 phrenic nerves - one for each hemidiaphragm
When evaluating a trauma patient, which acronym is useful for assessment in a systematic approach?
ABCDE
Airway, Breathing, Circulation, Disability, and Exposure
Which protective, isolation procedures should be followed when caring for a patient that has radiation burns?
Contaminated patient should be isolated from the environment
Wear all PPE necessary for radiation precaution
Why is the SpO2 in CO poisoning falsely high?
CO will bind more easily than O2 onto hemoglobin
Hbg has about ___ times the affinity for CO than O2
200
Treatment for pneumothorax include:
Chest tub & occlusive dressing
Other treatments for pneumothorax (depending on severity include) as needed:
- Supportive care
- Supplemental O2
- Pulse ox
- ABG
True
In determining the extent of a burn injury, which assessment is used to calculate total body surface area?
Lund-Browder Chart
Most accurate assessments for calculating TBSA in burn injuries
T/F: Small pneumothoraces may not require invasive treatment, some resolve on their own.
True
During assessment, you notice that the water seal chamber in chest tube drainage system is bubbling.
Inspect the drainage system for air leaks
Prioritizing treatment for patients with critical injury and delaying treatment for non critical injury is known as:
Triage care or “triaging”
T/F: Durinng needle decompression the needle is inserted above the rib, 2nd intercostal space in the mid-clavicular line.
True
Which trauma may require specialized care or modifications?
- children or elderly
- patients with bleeding disorders
- patients that receive dialysis
- patients with allergies
1, 2, 3
Tissue appears white and waxy. Some muscle and connective tissue is visible.
3rd degree
skin is waxy white to charred black through all dermal layers, above fascia may expose muscles/organs/bones PAINLESS because nerve endings are burnt away eschar is formed hard
T/F: Skin grafting is required for 3rd degree burns.
True
RCP priority is identifying life threatening problems and:
Provide airway and breathing support
Respiratory support
AIRWAY & BREATHING
T/F: Early tx for burns includes: establishing an airway and fluid resuscitation.
True
What change in a ped patient would indicate that this child has become unstable, critical, and needs immediate intervention?
Bradycardia
Ominous sign in children
Where are chest tubes placed?
4th or 5th intercostal space
Patient presents to the trauma unit after side impact MVC with significant shortness of breath, hypoxemia, and hemoptysis. Right side rib fractures and paradoxical movements of the chest wall or noted. This is most likely a:
Flail chest
Paradoxical movement of chest all
Multiple rib fractures
Decreased breath sounds on affected side
T/F: Late treatment of burn include: surgical debridement, wound care, skin grafts, vent and airway management.
True
RCPs are tasked with removing cervical collars in order to perform trach care.
False - let the MD make the call/do it
T/F: Unilateral diaphragmatic paralysis paralysis can be noted on an xray by visualizing an elevated hemi-diaphragm.
True
One of the indicated treatments for CO poisoning is:
100% fiO2 via nonrebreather mask
Triage order:
- patient that is in cardiac arrest and ongoing cpr is primary priority even if theyre not in the ER
- ICU patient that has advance airway and is on ventilator
- patient on high flow nasal cannula
- patient on general floor Q4 albuterol and not on supplemental O2
Ideal route for emergency situations is:
peripheral IV line
Normal appearance + increased work of breathing =
Respiratory distress
Abnormal appearance + increased WOB
Respiratory fatigue/failure
Circulation to skin reflects overall adequacy of ______.
Perfusion
Poor color (pale, ashen, dusky) along with visual mottling are reflective of:
Circulation to skin
Normal appearance + poor circulation to skin =
Observe
Abnormal appearance + poor circulation to skin =
Shock
Abnormal appearance + normal WOB + normal circulation =
Brain dysfunction
T/F: Croup causes sub-glottic edema.
True
T/F: The glottis is the narrowest point in pediatric patients.
True
T/F: Croup is viral, epiglottitis is bacterial.
True
The typical age group for croup is:
6 mo - 6 yrs
T/F: If complete airway obstruction occurs in children with epiglottitis, intubation is nearly impossible.
Treu
With Broselow tape, sizes of equipment and doses of drugs are determined based on color.
True
How many PALS books are there in the hospital?
At least one in very ER along with a radiant warmer and in all pediatric units
Treatment for drowning can include
- O2 and bronchoilators
- intubation and mechanical ventilation
- bronchoscopy with BAL
- warming techniques
- prone positioning
True
if ARDS develops, follow ARDS guidelines
Scuba divers must worry about:
Decompression sickness (ascending too quickly from depth)
Free divers must worry about:
Ascent Hypoxia
T/F: Decompression sickness and gas narcosis are the same thing.
False. Gas narcosis/raptures of the deep are deteriorations in mental status associated with the narcotic properties of certain gases at high partial pressures.
T/F: Wound healing in a hyperbaric chamber promotes neovascularization.
True
FiO2 1.0 at 3 ATA would have a ___ min half life
23 minute half life
Your patient has decreased respirations, decreased LOC, decreased bowel sounds, miosis and is hypothermic and hypotensive. What overdose is this patient experiencing and what would the initial treatment be?
Opiod OD
Tx - Narcan
Your patient has decreased respirations, decreased airway protective reflexes, decreased LOC, is hypotensive, cyanotic, weak, and has tremors and stupor. What overdose does this patient likely have and what would the initial treatment be?
Benzodiazepine OD - big giveaway is TREMORS
Tx - Ramazicon (Flumazenil)
Hypothermia indicates injury to the:
Hypothalamus
from truama/stroke, low thyroid, SEPSIS
Hyperthermia indicates:
Infection.
Increased body temp = increased O2 consumption, WOB, O2 demand, CO2
T/F: Reasons causing hypothermia can include
- sweating
- blood loss
- exposure to cold
- excessive heat loss
True
Your patient comes in with mydriasis, hypotension, hyperthermia, tachycardia, and the EKG shows a widened QRS complex. She had a seizure and is now in a coma. She is likely overdosing from what medication and what is the initial treatment?
Tricyclic Antidepressants (TCA) - antidepressant OD
Giveaway: Convulsions, Coma, Cardiotoxicity
Tx - fluids, electrolyte correction, sodium bicarb, gastric lavage, cooling bath/blankets, activated charcoal, intubation and MV if necessary
Your patient has jaundice, QUQ pain, is nauseous and vomiting. What is the suspected overdose and initial treatment?
Acetaminophen OD
Tx - NAC infusion
Your patient has mydriasis, delirium/hallucination, is flushed, hyperthermic, and has urinary retention along with intestinal paralysis and tachycardia. What is the suspected overdose along with the initial treatment?
Anticholinergic OD - giveaway is FLUSHED and URINARY retention
Tx - activated charcoal
What is the initial treatment for Coumadin OD?
Vitamin K
Treatment for “rusted” chocolate/orange blood (increased MetHb) is IV administration of:
Methylene Blue - converts MetHb to O2Hb
Organophosphate acronym:
DUMBBELS
Cholinergic excess
Tx - atropine
Normal range for blood glucose is:
70 - 139 mg/l
Lines between bones are called:
Stuyres
___ cranial nerve is a parasympathetic nerve.
3rd
T/F: 3rd cranial nerve causes distinct changes in pupil size and reactivity.
True
When sutures of the skull widen, what is it called? Common in young children.
a. linear
b. depressed
c. diastatic
d. basilar
c. diastatic
____ fractures occur at the base of the skull
Basilar
Arterial bleeding, quick onset, less common, between dura and cranial bone. This intracranial hematoma is:
Epidural
Venous bleeding, wide range of onset time, between dura and arachnoid layers. This intracranial hematoma is:
Subdural
An acquired brain injury can be traumatic and non-traumatic
True
Diffuse Anoxal brain Injury (DAI) is caused by:
Shaken baby, shear force effect
One of the most common injuries
Decorticate posturing indicates problems with:
- midbrain
- pons
- cervical spinal tract
- cerebral hemisphere
- cervical spinal tract
- cerebral hemisphere
Giveaway - all C’s are together!
Decorticate is a FLEXOR
Decerebrate posturing indicates problems with:
- midbrain
- pons
- cervical spinal tract
- cerebral hemisphere
- midbrain
- pons
dEcErEbrate - arms are like Es
EXTENSOR
Glasgow Coma Scale is a scale from:
3-15
at 8 you intubate
Most accurate method for monitoring ICPs and can monitor pressure as well as drain CSF:
Intraventricular catheter (ventricuolostomy)
Breathing pattern associated with early signs of increased ICP:
Cheyne-Stokes
T/F: Late signs of increased ICP include Biots respirations and cushing reflex/triad
True
Last ditch effort to keep brain perfused
T/F: Presence of Cushing’s Triad indicates impending brain stem herniation and carries poor prognosis.
True
hypertension with widened pulse pressure
bradycardia
bradypnea (biots)
“Doll eye” reflex where patient is turned from side to side and eyes should move in the opposite direction of head field, is what kind of reflex?
Ocuolocephalic reflex
During brain death testing, pt is allowed to accumulate CO2 in order to create a huge stimulus to breathe. This test is called the:
Apnea test
Unilateral diaphragmatic paralysis uses what test to determine definitive diagnosis?
Fluoroscopy “sniff test”
