finals Flashcards
1
Q
geriatric patients are (more/less) susceptible to (low/high) energy mechanisms
A
More susceptible to serious injury from low-energy mechanisms
2
Q
age range of geriatric pt
A
55-80
3
Q
myocytes are lost and replaced by (xxx) and therefore….
A
myocytes are lost & replaced by collagen therefore decreased contractility & compliance for any given preload
4
Q
w/o significant atherosclerotic coronary artery disease and 80 yo has this much CO of 20 yo?
A
50 percent
5
Q
Maximal heart rate and cardiac output (increase/decrease) with age
A
Maximal heart rate and cardiac output decrease with age
6
Q
with aging myocardium there is (increased/decreased) chronotropic response to catecholamines & dependent on preload (intravascular
volume). This leads to…
A
hypovolemia then shock
7
Q
Deterioration of the cardiac conduction system leads to
A
atrial fibrillation & bundle-branch blocks
8
Q
these impair the tachycardic response to catecholamines (3)
which leads to…
A
Digoxin, β-blockers, and calcium channel blockers
both impairing the body’s inability to compensate for hemorrhage and making heart rate an unreliable predictor of hypovolemia
9
Q
Chest wall compliance, respiratory muscle strength, and the capacity for oxygen exchange all (increase/decrease) with age and response to hypoxia may decline by (x%) & to hypercarbia by (x%)
A
Chest wall compliance, respiratory muscle strength, and the capacity for oxygen exchange all (decrease) with age and response to hypoxia may decline by 50% & to hypercarbia by 40%
10
Q
Maximum inspiratory and expiratory force may be decreased by up to (x%) compared with younger patients.
A
Maximum inspiratory and expiratory force may be decreased by up to 50% compared with younger patients.
11
Q
can limit older patients’ ability to compensate for chest injuries
A
Agerelated reductions in vital capacity, functional residual capacity, and forced expiratory volume
12
Q
what is first and second most common cause of injury in elderly
A
falls then motor vehicle crashes
13
Q
most common cause of fatal and nonfatal injury in people >65
A
falls
14
Q
what is the most common fracture of elders
A
hip fracture
15
Q
age related changes that contributes to falls in elderly
A
postural stability / balance / motor strength / coordination / reaction time
16
Q
what should we check for in elderly who have fallen and unable to get help for a prolonged period
A
promp investigation for rhabdomyolysis and
dehydration with a check of the creatinine kinase and electrolytes
17
Q
this is the sum of age and body surface area burned yield the percentage likelihood of mortality
A
Baux Score - sum of age and body surface area burned yield the percentage likelihood of mortality
18
Q
Beux score in elderly in futility of treatment and 50% risk of mortality
A
160 rather than 100 (futility)
110 score
19
Q
at >65 yo this body surface area has anticipated mortality of 50%
A
bsa if 28%
20
Q
inhalation burn injury adds this many points to Baux score
A
17 years or points
21
Q
warning signs of elder abuse
A
untreated decubitus ulcers / injuries not explained by the reported mechanism / subacute injuries in various stages of healing
22
Q
What vital signs may be blunted in elderly trauma patients?
A
tachycardic response to pain, hypovolemia, or anxiety may be absent or blunted in the elderly trauma patient
23
Q
what may mask tachycardia in elderly
A
beta blockers
24
Q
what may mask the signs of respiratory failure
A
Elderly have blunted responses to hypoxia, hypercarbia, and acidosis
25
must use a (higher/lower) cutoff for hypotension than in younger patients
must use a higher cutoff for hypotension than in younger patients
26
hypotension in elderly patients
systolic blood pressures below 110 mm Hg and heart rates above 90 beats/min
27
known baseline or a falling trend; a marker of instability
decrease in blood pressure of 30 mm Hg below = known baseline or a falling trend; a marker of instability
28
As the brain mass decreases with age this happens to bridging veins
As the brain mass decreases with age = greater stretching & tension of the bridging veins that pass from the brain to the dural sinuses
Bridging veins = more susceptible to traumatic tears.
29
why might diagnosis of intracranial bleeding may be delayed in elderly
brain atrophy increases intracranial free space, allowing blood to accumulate without initial signs or symptoms / blunt headtrauma patients taking warfarin who were experiencing no or minimal symptoms found w/ injury on head
30
what head injury imaging is recommended for elderly patients taking warfarin
Immediate noncontrast head CT = recommended for patients who take warfarin
31
why should INR should be checked in elderly with head injury
degree of anticoagulation correlates with the risk of adverse outcome
32
concern in elderly head injury patient on antiplatelet medication clopidogrel
an increased risk of intracranial bleeding after head injury
33
United Nation’s Disaster Management Training Program’s definition of disaster
A disaster is a serious disruption of the functioning of a society, causing widespread human, material or environmental losses that exceed the ability of the affected society to cope using only its own resources
34
Disaster that affects the hospital grounds
internal
external
internal
35
power failure
internal
external
internal
36
Disaster that affect the surrounding community
internal
external
external
37
Riots
internal
external
external
38
What is the hospital centered model of disaster
determined if the disaster happens on or off hospital grounds
39
What is advantage and disadvantage of hospital centered model
Advantage
. Ability of institution to determine if their infrastructure has been affected.
. If there is an immediate threat to the safety of the patient and employees.
Disadvantage
. It is not useful to other agencies.
. Many events are both internal and external. (Ex. Earthquake, flood or hurricane)
40
Acronym of man-made disasters (4)
```
CBRE
C – Chemical
ex. Release of Sarin gas by terrorists
B – Biological
ex. Anthrax-laced letters sent through the mail
R – Radiologic / Nuclear
ex. Explosion at a nuclear plant (Chernobyl)
E – Explosive incidents
ex. Improvised explosive device
```
41
Local Emergency Medical Services (EMS) and hospital are able to respond
Level I
Level II
Level III
Level I
42
Single area hospital activated
Level I
Level II
Level III
Level I
43
Multijurisdictional aid is needed
Level I
Level II
Level III
Level II
44
Several local hospitals activated
Level I
Level II
Level III
Level II
45
State or federal aid is needed
Level I
Level II
Level III
Level III
46
Request for aid based on state and federal regulations
Level I
Level II
Level III
Level III
47
What is PICE of disaster response
Relatively new term that has been suggested as a way of eliminating the broad term “Disaster” and using a multi-tiered system to instead focus on the needed response / May suit institutional needs / An event is described on the basis of 3 different prefixes and by a PICE stage.
48
Potential for additional casualties
PICE prefix A
PICE prefix B
PICE prefix C
PICE prefix A
49
Static – no more potential for additional casualties
PICE prefix A
PICE prefix B
PICE prefix C
PICE prefix A
50
Dynamic – potential for additional casualties
PICE prefix A
PICE prefix B
PICE prefix C
PICE prefix A
51
Ability of local resources to respond
PICE prefix A
PICE prefix B
PICE prefix C
PICE prefix B
52
Controlled : local resources able to respond without augmentation
PICE prefix A
PICE prefix B
PICE prefix C
PICE prefix B
53
Disruptive : local resources overwhelmed but able to respond with augmentation of resources
PICE prefix A
PICE prefix B
PICE prefix C
PICE prefix B
54
Paralytic : local resources overwhelmed and augmentation alone will not suffice. Complete reconstruction of the system is needed
PICE prefix A
PICE prefix B
PICE prefix C
PICE prefix B
55
Geographical involvement of event
PICE prefix A
PICE prefix B
PICE prefix C
PICE prefix C
56
local, regional, national, international
PICE prefix A
PICE prefix B
PICE prefix C
PICE prefix C
57
controlled, disruptive, paralytic
PICE prefix A
PICE prefix B
PICE prefix C
PICE prefix B
58
static, dynamic
PICE prefix A
PICE prefix B
PICE prefix C
PICE prefix A
59
no need for outside aid and is inactive
PICE Stage 0
PICE Stage I
PICE Stage II
PICE Stage III
PICE Stage 0
60
small chance that outside aid is needed and aid should be on alert
PICE Stage 0
PICE Stage I
PICE Stage II
PICE Stage III
PICE Stage I
61
moderate chance that outside aid is needed and aid should be on
standby (prepared to dispatch quickly)
PICE Stage 0
PICE Stage I
PICE Stage II
PICE Stage III
PICE Stage II
62
local resources are overwhelmed and need immediate dispatch of
outside aid
PICE Stage 0
PICE Stage I
PICE Stage II
PICE Stage III
PICE Stage III
63
What is PICE stages used for?
projected need for any status of outside aid
64
Phases of Disaster (4 in order)
mitigation, planning, response, recovery
65
Its effectiveness is dependent on an accurate assessment of the kind of disasters most likely to affect the community
mitigation
planning
response
recovery
mitigation
66
continued threat analysis
mitigation
planning
response
recovery
mitigation
67
To prepare the emergency response agencies and the population to minimize the loss of life and the societal impact of a disaster
mitigation
planning
response
recovery
planning
68
occurs throughout the interdisaster period and involves establishing an Emergency Operations Plan (EOP)
mitigation
planning
response
recovery
planning (general)
69
Providing information to the public about what steps they should take to ensure their safety
mitigation
planning
response
recovery
planning (event-specific)
70
Immediate efforts to prevent the loss of life both during and after a disaster / Minimize the economic and societal impact of the disaster by providing basic needs to disaster victims.
mitigation
planning
response
recovery
response
71
Begins shortly after the disaster has started / Requires the efforts of both emergency response agencies as well as public resources
mitigation
planning
response
recovery
recovery
72
components of disaster response
local level disaster response
state level disaster response
federal disaster response
military disaster response
73
Disaster Response Committee / Local Emergency Planning Committee / ICS (Incident Command System) headed by local executives / Intergovernment agreements / Other community medical resources / National Voluntary Organizations active in disaster / State Medical Societies / National Government Assistance
local level disaster response
state level disaster response
federal disaster response
military disaster response
local level disaster response
74
Coordination – via state Emergency Operation Center (EOC) of activities of multiple localities when multiple local jurisdiction are affected
local level disaster response
state level disaster response
federal disaster response
military disaster response
state level disaster response
75
Disaster Medical Assistance Team (DMAT) / Disaster Mortuary Operations Response Team (DMORT)
local level disaster response
state level disaster response
federal disaster response
military disaster response
federal disaster response
76
PH has this many typhoons anually
22 typhoons
77
PH has this many earthquakes daily
5 earthquakes
78
what is the primary government instrumentality for health concerns
the DOH
79
What is DOH A.O. No. 168 s. 2004
- “National Policy on Health Emergencies and Disasters,”
- “Implementing Guidelines for Managing Mass Casualty Incidents (MCI) During Emergencies and Disasters,”
- “Guidelines on the Acceptance and Processing of Foreign and Local Donations During Emergency and Disaster Situations,”
- “Policies and Guidelines on Hospitals Safe from Disasters,”
“National Policy on Health Emergencies and Disasters,”
- DOH A.O. No. 168 s. 2004: “National Policy on Health Emergencies and Disasters,”
- DOH A.O. No. 155 s. 2004: “Implementing Guidelines for Managing Mass Casualty Incidents (MCI) During Emergencies and Disasters,”
- DOH A.O. No. 0017 s. 2007: “Guidelines on the Acceptance and Processing of Foreign and Local Donations During Emergency and Disaster Situations,”
- DOH A.O. No. 2013-0014: “Policies and Guidelines on Hospitals Safe from Disasters,”
80
What is DOH A.O. No. 155 s. 2004:
- “National Policy on Health Emergencies and Disasters,”
- “Implementing Guidelines for Managing Mass Casualty Incidents (MCI) During Emergencies and Disasters,”
- “Guidelines on the Acceptance and Processing of Foreign and Local Donations During Emergency and Disaster Situations,”
- “Policies and Guidelines on Hospitals Safe from Disasters,”
“Implementing Guidelines for Managing Mass Casualty Incidents (MCI) During Emergencies and Disasters,”
- DOH A.O. No. 168 s. 2004: “National Policy on Health Emergencies and Disasters,”
- DOH A.O. No. 155 s. 2004: “Implementing Guidelines for Managing Mass Casualty Incidents (MCI) During Emergencies and Disasters,”
- DOH A.O. No. 0017 s. 2007: “Guidelines on the Acceptance and Processing of Foreign and Local Donations During Emergency and Disaster Situations,”
- DOH A.O. No. 2013-0014: “Policies and Guidelines on Hospitals Safe from Disasters,”
81
What is DOH A.O. No. 2013-0014
- “National Policy on Health Emergencies and Disasters,”
- “Implementing Guidelines for Managing Mass Casualty Incidents (MCI) During Emergencies and Disasters,”
- “Guidelines on the Acceptance and Processing of Foreign and Local Donations During Emergency and Disaster Situations,”
- “Policies and Guidelines on Hospitals Safe from Disasters,”
“Policies and Guidelines on Hospitals Safe from Disasters,”
- DOH A.O. No. 168 s. 2004: “National Policy on Health Emergencies and Disasters,”
- DOH A.O. No. 155 s. 2004: “Implementing Guidelines for Managing Mass Casualty Incidents (MCI) During Emergencies and Disasters,”
- DOH A.O. No. 0017 s. 2007: “Guidelines on the Acceptance and Processing of Foreign and Local Donations During Emergency and Disaster Situations,”
- DOH A.O. No. 2013-0014: “Policies and Guidelines on Hospitals Safe from Disasters,”
82
What is DOH A.O. No. 0017 s. 2007
- “National Policy on Health Emergencies and Disasters,”
- “Implementing Guidelines for Managing Mass Casualty Incidents (MCI) During Emergencies and Disasters,”
- “Guidelines on the Acceptance and Processing of Foreign and Local Donations During Emergency and Disaster Situations,”
- “Policies and Guidelines on Hospitals Safe from Disasters,”
Guidelines on the Acceptance and Processing of Foreign and Local Donations During Emergency and Disaster Situations,
- DOH A.O. No. 168 s. 2004: “National Policy on Health Emergencies and Disasters,”
- DOH A.O. No. 155 s. 2004: “Implementing Guidelines for Managing Mass Casualty Incidents (MCI) During Emergencies and Disasters,”
- DOH A.O. No. 0017 s. 2007: “Guidelines on the Acceptance and Processing of Foreign and Local Donations During Emergency and Disaster Situations,”
- DOH A.O. No. 2013-0014: “Policies and Guidelines on Hospitals Safe from Disasters,”
83
What are the 5 sectors of management in health emergency and disaster response
```
mangement of event/incident
…service providers
…non-human resources
…information system
…of victim
```
84
what is Incident Command System (ICS)
. Standardized, on-scene all-hazard incident management concept
. Allows its users to adopt an intergrated
organizational structure
. Matching the complexities and demands of single or multiple incidents
. Not hindered by jurisdictional boundaries
85
what is purpose of ICS and best practices
. Safety of responders and others
. Achievement of tactical objectives
. Efficient use of resources
86
what are the 5 primary ICS management functions
command, operations, planning, logistics, finance/admin
87
what are the command staff positions
information officer, safety officer, liaison officer
88
Coordinates the release of information to the public and responders / Responsible for interface with the media / Works in cooperation with E/DOC Information
Officer
information officer
safety officer
liaison officer
information officer
89
Formulates measures to protect personnel safety / Takes immediate action to stop or prevent unsafe acts when conditions or time do not permit going through lines of authority
information officer
safety officer
liaison officer
safety officer
90
Acts as point of contact for assisting agencies / Acts as Diplomat / Works with private contractors to address needs
information officer
safety officer
liaison officer
liaison officer
91
ICS Response GOALS (8)
1. Provide safety and health of all responders
2. Save lives
3. Reduce suffering
4. Protect public health
5. Protect gov’t infrastructure
6. Protect property
7. Protect the environment
8. Reduce economic and social losses
92
Sets objectives and priorities / Single Command: Responsible for all incident or event activity / There will always be an Incident Commander
```
Command “Boss”
Operations “Do-ers”
Planning “Thinkers”
Logistics “Getters”
Finance/ Admin “Payers”
```
Command “Boss”
93
Conducts tactical operations / Develops the tactical objectives and organization / Directs ALL resources
```
Command “Boss”
Operations “Do-ers”
Planning “Thinkers”
Logistics “Getters”
Finance/ Admin “Payers”
```
Operations “Do-ers”
94
Collects, evaluates, and displays incident information / Maintain status of resources / Prepares Incident Action Plan (IAP) / Prepares other incident related documentation / Incident Planning Considerations / Dividing an Incident
```
Command “Boss”
Operations “Do-ers”
Planning “Thinkers”
Logistics “Getters”
Finance/ Admin “Payers”
```
Planning “Thinkers”
95
Provides services and support to meet the incident or events’ needs / Provides resources / Provides other services
```
Command “Boss”
Operations “Do-ers”
Planning “Thinkers”
Logistics “Getters”
Finance/ Admin “Payers”
```
Logistics “Getters”
96
Keeps track of incident related expenses: Equipment records, Procurement contracts, Other financial related expenses of the incident / Monitor costs
```
Command “Boss”
Operations “Do-ers”
Planning “Thinkers”
Logistics “Getters”
Finance/ Admin “Payers”
```
Finance/ Admin “Payers”
97
personnel + equipment
Single Resource
Strike Team
Task Force
Single Resource
Single Resource – personnel + equipment
Strike Team – combination of same kind
and type (same ambulance)
Task Force – Combi. of single resources
98
```
combination of same kind
and type (same ambulance)
```
Single Resource
Strike Team
Task Force
Strike Team
Single Resource – personnel + equipment
Strike Team – combination of same kind
and type (same ambulance)
Task Force – Combi. of single resources
99
Combi. of single resources
Single Resource
Strike Team
Task Force
Task Force
Single Resource – personnel + equipment
Strike Team – combination of same kind
and type (same ambulance)
Task Force – Combi. of single resources
100
What is the span of control?
Span of Control: is the number of resources that one supervisory level can effectively manage.
In ICS span of control ranges from 3 to 7. (1:3, 1:7)
101
Location where primary command functions are performed / Only one per incident / May be located with other facilities / Normally not relocated
```
incident command post
staging areas
helibase/s
helispots
camps/bases
```
incident command post
102
Temporary locations for resources awaiting assignments / Resources on a three minute available status / May include fueling and sanitation / Staging Area Manager is required / May be designated for certain kinds of resources
```
incident command post
staging areas
helibase/s
helispots
camps/bases
```
staging areas
103
Location where helicopters may be
parked, maintained, fueled, and loaded
```
incident command post
staging areas
helibase/s
helispots
camps/bases
```
helibase/s
104
Temporary locations where helicopters
can safely land and take off / Used to load or off-load personnel, equipment, and
supplies
```
incident command post
staging areas
helibase/s
helispots
camps/bases
```
helispots
105
Temporary locations to provide services to incident personnel / Primary support activity / Logistics Section located at Base / Out-of-service equipment and personnel
normally located here
```
incident command post
staging areas
helibase/s
helispots
camps/bases
```
camps/bases
106
When organizing a hospital incident command group, consider including representatives from the following
services (12)
1) Hospital Administration
2) Communications
3) Security
4) Nursing Administration
5) Human Resources
6) Pharmacy
7) Infection control
8) Respiratory Therapy
9) Engineering and Maintenance
10) Laboratory
11) Nutrition
12) Laundry, Cleaning, and Waste Management
107
. Defined as the ability of a health service to expand beyond normal capacity to meet
increased demand for clinical care
. Is an important factor of hospital disaster response and should be addressed early in the planning process
surge capacity
108
question
answer
109
top two toxic agents for adult consult
paracetamol, sodium hypochlorite
110
top three toxic agents for pedia consult
paracetamol, sodium hypochlorite, kerosene
111
top three toxic agents for adult inpatient
meth, sodium hypochlorite, alcohol/ethanol
112
top three toxic agents for pedia inpatient
kerosene, sodium hypochlorite, paracetamol
113
which is worse? Alkaline poisoning or acidic poisoning
alkaline - coagulation
114
Treatment for toxic patient (ABC)
```
airway
breathing
circulation
disturbances of cns: coma and seizure
enhanced elimination
forcused therapy
get tox help
```
115
What is the likely hint that can cause inability to swallow
```
hydrocarbon
caustic
iron ingestions
isoniazid overdose
carbon monoxide
pesticide poisoning
```
caustic
```
Protracted coughing hydrocarbon
Inability to swallow or drooling caustic
Hematemesis iron ingestions
Intractable seizures isoniazid overdose
LOC/ rescued from fire carbon monoxide
Spraying in farm pesticide poisoning
```
116
What is the likely hint that can cause protracted coughing?
```
hydrocarbon
caustic
iron ingestions
isoniazid overdose
carbon monoxide
pesticide poisoning
```
hydrocarbon
```
Protracted coughing hydrocarbon
Inability to swallow or drooling caustic
Hematemesis iron ingestions
Intractable seizures isoniazid overdose
LOC/ rescued from fire carbon monoxide
Spraying in farm pesticide poisoning
```
117
What is the likely hint that can cause hematemesis?
```
hydrocarbon
caustic
iron ingestions
isoniazid overdose
carbon monoxide
pesticide poisoning
```
iron ingestions
```
Protracted coughing hydrocarbon
Inability to swallow or drooling caustic
Hematemesis iron ingestions
Intractable seizures isoniazid overdose
LOC/ rescued from fire carbon monoxide
Spraying in farm pesticide poisoning
```
118
What is the likely hint that can cause intractable seizures?
```
hydrocarbon
caustic
iron ingestions
isoniazid overdose
carbon monoxide
pesticide poisoning
```
isoniazid overdose
```
Protracted coughing hydrocarbon
Inability to swallow or drooling caustic
Hematemesis iron ingestions
Intractable seizures isoniazid overdose
LOC/ rescued from fire carbon monoxide
Spraying in farm pesticide poisoning
```
119
What is the likely hint that can cause loss of conscious especially in fire?
```
hydrocarbon
caustic
iron ingestions
isoniazid overdose
carbon monoxide
pesticide poisoning
```
carbon monoxide
```
Protracted coughing hydrocarbon
Inability to swallow or drooling caustic
Hematemesis iron ingestions
Intractable seizures isoniazid overdose
LOC/ rescued from fire carbon monoxide
Spraying in farm pesticide poisoning
```
120
What is the likely hint that can result from spraying in farm?
```
hydrocarbon
caustic
iron ingestions
isoniazid overdose
carbon monoxide
pesticide poisoning
```
pesticide poisoning
```
Protracted coughing hydrocarbon
Inability to swallow or drooling caustic
Hematemesis iron ingestions
Intractable seizures isoniazid overdose
LOC/ rescued from fire carbon monoxide
Spraying in farm pesticide poisoning
```
121
What is the mnemonic for toxic agents that cause bradycardia?
PACED
122
What is the mnemonic for toxic agents that cause tachycardia?
FAST
123
What is the mnemonic for toxic agents that cause hypothermia?
COOLS
124
What is the mnemonic for toxic agents that cause hyperthermia?
NASA
125
What is the mnemonic for toxic agents that cause hypotension?
CRASH
126
What is the mnemonic for toxic agents that cause hypertension?
CT SCAN
127
What is the mnemonic for toxic agents that cause rapid respiration?
PANT
128
What is the mnemonic for toxic agents that cause slow respiration?
SLOW
129
PACED toxic substances display what vital signs? What are the substances?
BRADYCARDIA (PACED)
- Propranolol (beta-blockers), poppies (opiates), propoxyphene, physostigmine
- Anticholinesterase drugs, antiarrhythmics
- Clonidine, calcium channel blockers
- Ethanol or other alcohols
- Digoxin, digitalis
130
FAST toxic substances display what vital signs? What are the substances?
TACHYCARDIA (FAST)
- Free base or other forms of cocaine, freon
- Anticholinergics, antihistamines, antipsychotics, amphetamines, alcohol withdrawal
- Sympathomimetics (cocaine, caffeine, amphetamines, PCP), solvent abuse, strychnine
- Theophylline, TCAs, thyroid hormones
131
COOLS toxic substances display what vital signs? What are the substances?
HYPOTHERMIA (COOLS)
- Carbon monoxide
- Opioids
- Oral hypoglycemics, insulin
- Liquor (alcohols)
- Sedative-hypnotics
132
NASA toxic substances display what vital signs? What are the substances?
HYPERTHERMIA (NASA)
- Neuroleptic malignant syndrome, nicotine
- Antihistamines, alcohol withdrawal
- Salicylates,
sympathomimetics, serotonin
syndrome
- Anticholinergics, antidepressants, antipsychotics
133
CRASH toxic substances display what vital signs? What are the substances?
HYPOTENSION (CRASH)
- Clonidine, calcium channel blockers
- Rodenticides (containing
arsenic, cyanide)
- Antidepressants, aminophylline, antihypertensives
- Sedative-hypnotics
- Heroin or other opiates
134
CT SCAN toxic substances display what vital signs? What are the substances?
HYPERTENSION (CT SCAN)
- Cocaine
- Thyroid supplements
- Sympathomimetics
- Caffeine
- Anticholinergics, amphetamines
- Nicotine
135
PANT toxic substances display what vital signs? What are the substances?
RAPID RESPIRATION (PANT)
```
- PCP, paraquat, pneumonitis (chemical),
phosgene
- ASA and other salicylates
- Noncardiogenic pulmonary edema, nerve agents
- Toxin-induced metabolic acidosis
```
136
SLOW toxic substances display what vital signs? What are the substances?
SLOW RESPIRATION (SLOW)
- Sedative-hypnotics (barbiturates, benzodiazepines)
- Liquor (alcohols)
- Opioids
- Weed (marijuana)
137
bitter almonds breath order is likely caused by
- cyanide
- DKA, isopropranolol
- methylsalicylate
- sulfur dioxide, hydrogen sulfide
- chloral hydrate
- organophosphate, arsenic
mothballs: camphor
cyanide
```
bitter almonds: cyanide
fruity: DKA, isopropranolol
oil of wintergreen: methylsalicylate
rotten eggs: sulfur dioxide, hydrogen sulfide
pears: chloral hydrate
garlic: organophosphate, arsenic
mothballs: camphor
```
138
fruity breath order is likely caused by
- cyanide
- DKA, isopropranolol
- methylsalicylate
- sulfur dioxide, hydrogen sulfide
- chloral hydrate
- organophosphate, arsenic
mothballs: camphor
DKA, isopropranolol
```
bitter almonds: cyanide
fruity: DKA, isopropranolol
oil of wintergreen: methylsalicylate
rotten eggs: sulfur dioxide, hydrogen sulfide
pears: chloral hydrate
garlic: organophosphate, arsenic
mothballs: camphor
```
139
oil of wintergreen breath order is likely caused by
- cyanide
- DKA, isopropranolol
- methylsalicylate
- sulfur dioxide, hydrogen sulfide
- chloral hydrate
- organophosphate, arsenic
mothballs: camphor
methylsalicylate
```
bitter almonds: cyanide
fruity: DKA, isopropranolol
oil of wintergreen: methylsalicylate
rotten eggs: sulfur dioxide, hydrogen sulfide
pears: chloral hydrate
garlic: organophosphate, arsenic
mothballs: camphor
```
140
rotten eggs breath order is likely caused by
- cyanide
- DKA, isopropranolol
- methylsalicylate
- sulfur dioxide, hydrogen sulfide
- chloral hydrate
- organophosphate, arsenic
mothballs: camphor
```
bitter almonds: cyanide
fruity: DKA, isopropranolol
oil of wintergreen: methylsalicylate
rotten eggs: sulfur dioxide, hydrogen sulfide
pears: chloral hydrate
garlic: organophosphate, arsenic
mothballs: camphor
```
141
breath order is likely caused by
- cyanide
- DKA, isopropranolol
- methylsalicylate
- sulfur dioxide, hydrogen sulfide
- chloral hydrate
- organophosphate, arsenic
mothballs: camphor
sulfur dioxide, hydrogen sulfide
```
bitter almonds: cyanide
fruity: DKA, isopropranolol
oil of wintergreen: methylsalicylate
rotten eggs: sulfur dioxide, hydrogen sulfide
pears: chloral hydrate
garlic: organophosphate, arsenic
mothballs: camphor
```
142
pear breath order is likely caused by
- cyanide
- DKA, isopropranolol
- methylsalicylate
- sulfur dioxide, hydrogen sulfide
- chloral hydrate
- organophosphate, arsenic
mothballs: camphor
chloral hydrate
```
bitter almonds: cyanide
fruity: DKA, isopropranolol
oil of wintergreen: methylsalicylate
rotten eggs: sulfur dioxide, hydrogen sulfide
pears: chloral hydrate
garlic: organophosphate, arsenic
mothballs: camphor
```
143
garlic smelling breath order is likely caused by
- cyanide
- DKA, isopropranolol
- methylsalicylate
- sulfur dioxide, hydrogen sulfide
- chloral hydrate
- organophosphate, arsenic
mothballs: camphor
organophosphate, arsenic
```
bitter almonds: cyanide
fruity: DKA, isopropranolol
oil of wintergreen: methylsalicylate
rotten eggs: sulfur dioxide, hydrogen sulfide
pears: chloral hydrate
garlic: organophosphate, arsenic
mothballs: camphor
```
144
mothballs smelling breath order is likely caused by
- cyanide
- DKA, isopropranolol
- methylsalicylate
- sulfur dioxide, hydrogen sulfide
- chloral hydrate
- organophosphate, arsenic
mothballs: camphor
camphor
```
bitter almonds: cyanide
fruity: DKA, isopropranolol
oil of wintergreen: methylsalicylate
rotten eggs: sulfur dioxide, hydrogen sulfide
pears: chloral hydrate
garlic: organophosphate, arsenic
mothballs: camphor
```
145
sympathomimetics will cause the skin to be
- diaphoretic
- red skin
- blue skin
diaphoretic
diaphoretic skin: sympathomimetics, organophosphates, salicylates
red skin: CO, boric acid
blue skin: cyanosis methemoglobinemia
146
organophosphates will cause the skin to be
- diaphoretic
- red skin
- blue skin
diaphoretic
diaphoretic skin: sympathomimetics, organophosphates, salicylates
red skin: CO, boric acid
blue skin: cyanosis methemoglobinemia
147
salicylates will cause the skin to be
- diaphoretic
- red skin
- blue skin
diaphoretic
diaphoretic skin: sympathomimetics, organophosphates, salicylates
red skin: CO, boric acid
blue skin: cyanosis methemoglobinemia
148
CO will cause the skin to be
- diaphoretic
- red skin
- blue skin
red skin
diaphoretic skin: sympathomimetics, organophosphates, salicylates
red skin: CO, boric acid
blue skin: cyanosis methemoglobinemia
149
boric acid will cause the skin to be
- diaphoretic
- red skin
- blue skin
red skin
diaphoretic skin: sympathomimetics, organophosphates, salicylates
red skin: CO, boric acid
blue skin: cyanosis methemoglobinemia
150
cyanosis methemoglobinemia will cause the skin to be
- diaphoretic
- red skin
- blue skin
blue skin
diaphoretic skin: sympathomimetics, organophosphates, salicylates
red skin: CO, boric acid
blue skin: cyanosis methemoglobinemia
151
toxidrome for anticholinergics
```
. hot as a hare
. dry as a bone
. blind as a bat
. red as a beet
. mad as a hatter
```
152
toxidrome for cholinergic drugs
DUMBELLS
```
diarrhea
urination
miosis
bradycardia
emesis
lacrimation
lathergy
salivation
```
153
toxidrome for nicotinic
(days of week) SSMTWThF
```
seizures
somnolent
miosis
tachycardia
weakness
tremors
fasciculations
```
154
toxidrome for sympathomimetic
GoD PuT STaSH
```
goosebumps
delusions/paranoia
pupil dilation
temperature
sweating
tachycardia
hypertension
```
155
toxidrome for opioid
CPR
consciousness depressed
pupils pinpoint
respiration depressed
(hypotension, bradycardia)
156
substances and diseases that will cause an elevated anion gap metabolic acidosis
metalacid gap
```
methanol, metformin
ethylene glycol
toluene
alcoholic ketoacidosis
lactic acidosis
aminoglycosides, other uremic agents
cyanide, carbon monoxide
isoniazid, iron
diabetic ketoacidsosis
generalized seizure-producing toxins
ASA or other salycylates
paraldehyde, phenformin
```
157
what substance is suspected if urine sample test turns greenish-blue?
- Copper sulfate or Methylene blue
- Rifampin, Mercury, Chronic lead
poisoning
- Chloroquine
- Ampicillin or Cephalosporin
Greenish-blue: Copper sulfate or Methylene blue
Greenish-blue: Copper sulfate or Methylene blue
Orange to Red-orange: Rifampin, Mercury, Chronic lead
poisoning
Brown: Chloroquine
Pink: Ampicillin or Cephalosporin
158
what substance is suspected if urine sample test turns orange to red-orange?
- Copper sulfate or Methylene blue
- Rifampin, Mercury, Chronic lead
poisoning
- Chloroquine
- Ampicillin or Cephalosporin
Orange to Red-orange: Rifampin, Mercury, Chronic lead
poisoning
Greenish-blue: Copper sulfate or Methylene blue
Orange to Red-orange: Rifampin, Mercury, Chronic lead
poisoning
Brown: Chloroquine
Pink: Ampicillin or Cephalosporin
159
what substance is suspected if urine sample test turns brown
- Copper sulfate or Methylene blue
- Rifampin, Mercury, Chronic lead
poisoning
- Chloroquine
- Ampicillin or Cephalosporin
Brown: Chloroquine
Greenish-blue: Copper sulfate or Methylene blue
Orange to Red-orange: Rifampin, Mercury, Chronic lead
poisoning
Brown: Chloroquine
Pink: Ampicillin or Cephalosporin
160
what substance is suspected if urine sample test turns pink?
- Copper sulfate or Methylene blue
- Rifampin, Mercury, Chronic lead
poisoning
- Chloroquine
- Ampicillin or Cephalosporin
Pink: Ampicillin or Cephalosporin
Greenish-blue: Copper sulfate or Methylene blue
Orange to Red-orange: Rifampin, Mercury, Chronic lead
poisoning
Brown: Chloroquine
Pink: Ampicillin or Cephalosporin
161
```
Agents potentially visible on
abdominal radiographs (COINS)
```
```
Chloral hydrate, cocaine packets,
calcium
Opium packets
Iron; other heavy metals, such as lead,
arsenic,mercury
Neuroleptic agents
Sustained-release or enteric-coated
agents (salicylate)
```
162
for what substances should oxygen NOT be given?
paraquat and wantosee
163
in hypotensive adult toxic patients what fluid is given?
D5NSS
164
in hypotensive pedia toxic patients what fluid is given?
D50.3NaCl
165
What is given to coma toxic patients?
DON'T
dextrose
oxygen
noloxone
thiamine
166
What is given to a toxic patients with convulsions?
diazepam
lorazepam
phenytoin
pyridoxine
167
For gastric lavage, which side decubitis is preferred?
left lateral decubitus
168
moa of cathartics in toxic patients
hasten intestinal elimination of
the unabsorbed toxic agent thereby
reducing contact time of the poison in the
gut
169
what is the antidote for acetaminophen
acetylcysteine
170
what is the antidote for anticholinergics
physostigmine
171
what is the antidote for benzodiazepines
flimazenil
172
what is the antidote for Ca channel blockers
calcium chloride
173
what is the antidote for cyanide
hydroxocobalamin, amyl nitrite, sodium nitrite, sodium thiosulfate
174
what is the antidote for digoxin
digoxin immune Fab
175
what is the antidote for heparin
protamine sulfate
176
what is the antidote for iron
deforoxamine
177
what is the antidote for insulin
glucagon
178
what is the antidote for lead
dimercaptosiccinic acid/EDTA
179
what is the antidote for opioids
naloxone
180
what is the antidote for warfarin
vitamin k
181
what is the antidote for pt with hematemesis
Hematemesis > iron ingestions >deforoxamine
182
what are the possible antidotes for pt with bradycardia?
calcium chloride > calcium channel blockers
| digoxin immune Fab > digoxin
183
what is the possible antidote for hyperthermia?
physostigmine > anticholinergics
184
what are the possible antidotes for hypotension?
calcium chloride > calcium channel blockers
| naloxone > opioids
185
most
| important determinants of morbidity and mortality in geriatric bleeding and head injury
volume of intracranial blood and hematoma expansion
186
what should be done right away for geriatric patients with bleeding and head injury in geriatric pt
Rapidly reverse anticoagulation
187
if pt on warfarin has normal CT scan, do not repeat
true or false
false, repreat in 24 hours
188
in geriatric pts, severe thoracic injuries can lead to
decompensation especially those with baseline respiratory
| insufficiency
189
consideration for pain control after chest wall trauma in geriatric patient
. to reduce atelectasis and the risk of infection
. challenging because the elderly may have decreased
tolerance for opioid analgesic
190
```
what provides early insight into respiratory
function and reserve in geriatric patient
```
Serial arterial blood gas analysis
191
indication for prompt tracheal intubation and use of mechanical
ventilation in geriatric patient
. more severe injuries
. respiratory rates >40 breaths/min
. when the partial pressure of arterial oxygen is <60
mm Hg
. the pressure of arterial carbon dioxide is >50 mm Hg
192
initial treatment for shock in geriatric patient
early placement (within 2.2 hours) of a pulmonary artery
catheter followed by goal-directed volume resuscitation and
inotropic support
193
what is used for volume in geriatric shock patient
small volumes of isotonic crystalloid (normal
| saline or lactated Ringer’s)
194
when would we consider switching to blood transfusion
after 1 to 2 L of
| crystalloid resuscitation
195
associated with aging = more susceptible to
| pressure sores and hypothermia
decreased lean muscle mass and impaired peripheral
| circulation
196
most common pelvic fracture
Pubic ramus fractures
197
most common mechanism of pelvic fracture
Lateral compression
198
indication for cross-sectional imaging
tenderness of the posterior pelvis
199
most common injury diagnosis that leads to
| hospitalization in the elderly
hip fracture
200
which occurs most?
. Femoral neck (intracapsular)
. Intertrochanteric fractures
. Subtrochanteric fractures
. Femoral neck (intracapsular)
. Intertrochanteric fractures
equally most common
201
when to use MRI
hip fracture
202
most common
| fractures in women up to age 75
Distal radius fractures (Colles’ fractures
203
common upper extremity injury after falls from standing
Fractures of the proximal humerus and humeral shaft
204
how to assess for axillary nerve injury
by checking sensation at the area of deltoid muscle
insertion and deltoid muscle engagement with
shoulder abduction.
o initial 18 degrees of shoulder abduction are
generated by the supraspinatus muscle so movement
in this range may still be possibl
205
initial indicators of shock; serial
| measurements can guide resuscitation progress
Base deficit and lactate levels
206
Elevated lactate levels correlate with
systemic hypoperfusion,
| intensive care unit and hospital length of stay, and mortality
207
base deficit of –3 to –5
. "normal" or mild base deficit
. moderate base deficit
. severe base deficit
. "normal" or mild base deficit
208
correlates with 24%
mortality
. "normal" or mild base deficit
. moderate base deficit
. severe base deficit
. "normal" or mild base deficit
209
base deficit of –6 to –9
. "normal" or mild base deficit
. moderate base deficit
. severe base deficit
. moderate base deficit
210
correlates with 60% mortality
. "normal" or mild base deficit
. moderate base deficit
. severe base deficit
. moderate base deficit
211
correlates with 80% mortality
. "normal" or mild base deficit
. moderate base deficit
. severe base deficit
. severe base deficit
212
base deficit of ≤–10
. "normal" or mild base deficit
. moderate base deficit
. severe base deficit
. severe base deficit
213
why are Creatine kinase levels checked?
assess for rhabdomyolysis in patients
who have fallen and been unable to receive assistance for a
prolonged perio
214
most common in order
. epidural hematomas
. subdural hematoma
. intraparenchymal hematoma
Higher incidence of subdural and intraparenchymal
hematomas
Less prone to develop epidural hematomas
215
why are geriartric pts less prone to develop epidural hematomas
Due to the denser fibrous bond between the dura
| mater and the inner table of the skull
216
most common cervical spine injury in geriatric patients
Odontoid fractures
217
Hyperextension injuries = may develop
. anterior cord syndrome
. central
. posterior
central cord
| syndrome
218
area of most common spinal fractures
THORACOLUMBAR SPINAL INJURIES; almost half of all osteoporotic fractures
219
most common places for spinal injuries
Thoracolumbar junction (T12-L1) & midthoracic areas (T7-T8)
220
most common thoracolumbar spinal injury
. Anterior wedge compression fractures
. Central
. Posterior
Anterior wedge compression fractures
221
ICS RA number
RA 10121, s-2010
222
WHAT IS ICS?
A standard, on-scene, all-hazard incident
management concept that can be used by all
DRRMCs/emergency management and response
agencies
223
ICS PURPOSES
1. The safety of responders and others
2. The achievement of tactical objectives
3. The efficient use of resources
224
ICS BENEFITS
1. Meets the needs of incidents of any kind or size
2. Allows personnel from a variety of agencies to meld
rapidly into a common management structure
3. Provides accountability and a planning process
4. Provides logistical and administrative support to
operational staff
5. Is cost effective by avoiding duplication of efforts
225
PRINCIPLES AND FEATURES OF ICS
1. Primary ICS Management Functions
2. Management by Objectives
3. Unity of Command and Chain of Command
4. Organizational Flexibility
5. Common Terminology SENT HOME
6. SENT HOME
7. Accountability
8. Integrated Communications
9. Resources Management
10. Incident Action Plan
11. Use of Tools and Forms
226
Primary ICS Management Functions
command: operations, logistics, planning, finance/admin
227
Management by Objectives
top down or bottom up
top down
achieve goal > perform tactical directoin > select appropriate strategy > establish incident objectives > understand policy and direction
228
Establishes a clear line of
supervision
. Unity of Command
. Chain of Command
. Unity of Command
229
every individual has a
designated supervisor to
whom they report at the
scene of the incident
. Unity of Command
. Chain of Command
. Unity of Command
230
Orderly ranking of
management positions in line
of authority
. Unity of Command
. Chain of Command
. Chain of Command
231
```
refers to
the orderly line of authority
within the ranks of the
incident management
organization
```
. Unity of Command
. Chain of Command
. Chain of Command
232
To ensure individual accountability, the following principles
must be adhered to:
1. Check-in
2. Incident Action Plan
3. Unity of Command
4. Span of Control
5. Resource Tracking
233
Provides overall
leadership for on-scene
response operations
. INCIDENT COMMANDER
. RESPONSIBLE OFFICIAL
. INCIDENT COMMANDER
234
• Takes policy direction
from Responsible Official
and establishes incident
objectives
. INCIDENT COMMANDER
. RESPONSIBLE OFFICIAL
. INCIDENT COMMANDER
235
• Ensures incident safety
. INCIDENT COMMANDER
. RESPONSIBLE OFFICIAL
. INCIDENT COMMANDER
236
• Maintains liason with
participating response
agencies
. INCIDENT COMMANDER
. RESPONSIBLE OFFICIAL
. INCIDENT COMMANDER
237
• Keeps Responsible
Official and DRRMC
informed of all important
matters pertaining
. INCIDENT COMMANDER
. RESPONSIBLE OFFICIAL
. INCIDENT COMMANDER
238
Provides overall policy direction and strategic
objectives for the
response
. INCIDENT COMMANDER
. RESPONSIBLE OFFICIAL
. RESPONSIBLE OFFICIAL
239
• Delegates authority of
resources
. INCIDENT COMMANDER
. RESPONSIBLE OFFICIAL
. RESPONSIBLE OFFICIAL
240
• Ensures availability of
resources
. INCIDENT COMMANDER
. RESPONSIBLE OFFICIAL
. RESPONSIBLE OFFICIAL
241
• Serves as link to higher
authorities
. INCIDENT COMMANDER
. RESPONSIBLE OFFICIAL
. RESPONSIBLE OFFICIAL
242
− Has the most incident
| resources
OPERATIONS SECTION
243
LOGISTICS SECTION responsible for
```
Facilities
o Transportation
o Communications
o Supplies
o Equipment maintenance and fuel
o Food services
o Medical services
```
