finals Flashcards
geriatric patients are (more/less) susceptible to (low/high) energy mechanisms
More susceptible to serious injury from low-energy mechanisms
age range of geriatric pt
55-80
myocytes are lost and replaced by (xxx) and therefore….
myocytes are lost & replaced by collagen therefore decreased contractility & compliance for any given preload
w/o significant atherosclerotic coronary artery disease and 80 yo has this much CO of 20 yo?
50 percent
Maximal heart rate and cardiac output (increase/decrease) with age
Maximal heart rate and cardiac output decrease with age
with aging myocardium there is (increased/decreased) chronotropic response to catecholamines & dependent on preload (intravascular
volume). This leads to…
hypovolemia then shock
Deterioration of the cardiac conduction system leads to
atrial fibrillation & bundle-branch blocks
these impair the tachycardic response to catecholamines (3)
which leads to…
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
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%)
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%
Maximum inspiratory and expiratory force may be decreased by up to (x%) compared with younger patients.
Maximum inspiratory and expiratory force may be decreased by up to 50% compared with younger patients.
can limit older patients’ ability to compensate for chest injuries
Agerelated reductions in vital capacity, functional residual capacity, and forced expiratory volume
what is first and second most common cause of injury in elderly
falls then motor vehicle crashes
most common cause of fatal and nonfatal injury in people >65
falls
what is the most common fracture of elders
hip fracture
age related changes that contributes to falls in elderly
postural stability / balance / motor strength / coordination / reaction time
what should we check for in elderly who have fallen and unable to get help for a prolonged period
promp investigation for rhabdomyolysis and
dehydration with a check of the creatinine kinase and electrolytes
this is the sum of age and body surface area burned yield the percentage likelihood of mortality
Baux Score - sum of age and body surface area burned yield the percentage likelihood of mortality
Beux score in elderly in futility of treatment and 50% risk of mortality
160 rather than 100 (futility)
110 score
at >65 yo this body surface area has anticipated mortality of 50%
bsa if 28%
inhalation burn injury adds this many points to Baux score
17 years or points
warning signs of elder abuse
untreated decubitus ulcers / injuries not explained by the reported mechanism / subacute injuries in various stages of healing
What vital signs may be blunted in elderly trauma patients?
tachycardic response to pain, hypovolemia, or anxiety may be absent or blunted in the elderly trauma patient
what may mask tachycardia in elderly
beta blockers
what may mask the signs of respiratory failure
Elderly have blunted responses to hypoxia, hypercarbia, and acidosis
must use a (higher/lower) cutoff for hypotension than in younger patients
must use a higher cutoff for hypotension than in younger patients
hypotension in elderly patients
systolic blood pressures below 110 mm Hg and heart rates above 90 beats/min
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
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.
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
what head injury imaging is recommended for elderly patients taking warfarin
Immediate noncontrast head CT = recommended for patients who take warfarin
why should INR should be checked in elderly with head injury
degree of anticoagulation correlates with the risk of adverse outcome
concern in elderly head injury patient on antiplatelet medication clopidogrel
an increased risk of intracranial bleeding after head injury
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
Disaster that affects the hospital grounds
internal
external
internal
power failure
internal
external
internal
Disaster that affect the surrounding community
internal
external
external
Riots
internal
external
external
What is the hospital centered model of disaster
determined if the disaster happens on or off hospital grounds
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)
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
Local Emergency Medical Services (EMS) and hospital are able to respond
Level I
Level II
Level III
Level I
Single area hospital activated
Level I
Level II
Level III
Level I
Multijurisdictional aid is needed
Level I
Level II
Level III
Level II
Several local hospitals activated
Level I
Level II
Level III
Level II
State or federal aid is needed
Level I
Level II
Level III
Level III
Request for aid based on state and federal regulations
Level I
Level II
Level III
Level III
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.
Potential for additional casualties
PICE prefix A
PICE prefix B
PICE prefix C
PICE prefix A
Static – no more potential for additional casualties
PICE prefix A
PICE prefix B
PICE prefix C
PICE prefix A
Dynamic – potential for additional casualties
PICE prefix A
PICE prefix B
PICE prefix C
PICE prefix A
Ability of local resources to respond
PICE prefix A
PICE prefix B
PICE prefix C
PICE prefix B
Controlled : local resources able to respond without augmentation
PICE prefix A
PICE prefix B
PICE prefix C
PICE prefix B
Disruptive : local resources overwhelmed but able to respond with augmentation of resources
PICE prefix A
PICE prefix B
PICE prefix C
PICE prefix B
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
Geographical involvement of event
PICE prefix A
PICE prefix B
PICE prefix C
PICE prefix C
local, regional, national, international
PICE prefix A
PICE prefix B
PICE prefix C
PICE prefix C
controlled, disruptive, paralytic
PICE prefix A
PICE prefix B
PICE prefix C
PICE prefix B
static, dynamic
PICE prefix A
PICE prefix B
PICE prefix C
PICE prefix A
no need for outside aid and is inactive
PICE Stage 0
PICE Stage I
PICE Stage II
PICE Stage III
PICE Stage 0
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
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
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
What is PICE stages used for?
projected need for any status of outside aid
Phases of Disaster (4 in order)
mitigation, planning, response, recovery
Its effectiveness is dependent on an accurate assessment of the kind of disasters most likely to affect the community
mitigation
planning
response
recovery
mitigation
continued threat analysis
mitigation
planning
response
recovery
mitigation
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
occurs throughout the interdisaster period and involves establishing an Emergency Operations Plan (EOP)
mitigation
planning
response
recovery
planning (general)
Providing information to the public about what steps they should take to ensure their safety
mitigation
planning
response
recovery
planning (event-specific)
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
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
components of disaster response
local level disaster response
state level disaster response
federal disaster response
military disaster response
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
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
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
PH has this many typhoons anually
22 typhoons
PH has this many earthquakes daily
5 earthquakes
what is the primary government instrumentality for health concerns
the DOH
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,”
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,”
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,”
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,”
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
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
what is purpose of ICS and best practices
. Safety of responders and others
. Achievement of tactical objectives
. Efficient use of resources
what are the 5 primary ICS management functions
command, operations, planning, logistics, finance/admin
what are the command staff positions
information officer, safety officer, liaison officer
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
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
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
ICS Response GOALS (8)
- Provide safety and health of all responders
- Save lives
- Reduce suffering
- Protect public health
- Protect gov’t infrastructure
- Protect property
- Protect the environment
- Reduce economic and social losses
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”
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”
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”
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”
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”
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
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
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
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)
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
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
Location where helicopters may be
parked, maintained, fueled, and loaded
incident command post staging areas helibase/s helispots camps/bases
helibase/s
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
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
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
. 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
question
answer
top two toxic agents for adult consult
paracetamol, sodium hypochlorite
top three toxic agents for pedia consult
paracetamol, sodium hypochlorite, kerosene
top three toxic agents for adult inpatient
meth, sodium hypochlorite, alcohol/ethanol
top three toxic agents for pedia inpatient
kerosene, sodium hypochlorite, paracetamol
which is worse? Alkaline poisoning or acidic poisoning
alkaline - coagulation
Treatment for toxic patient (ABC)
airway breathing circulation disturbances of cns: coma and seizure enhanced elimination forcused therapy get tox help
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
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
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
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
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
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
What is the mnemonic for toxic agents that cause bradycardia?
PACED
What is the mnemonic for toxic agents that cause tachycardia?
FAST
What is the mnemonic for toxic agents that cause hypothermia?
COOLS
What is the mnemonic for toxic agents that cause hyperthermia?
NASA
What is the mnemonic for toxic agents that cause hypotension?
CRASH
What is the mnemonic for toxic agents that cause hypertension?
CT SCAN
What is the mnemonic for toxic agents that cause rapid respiration?
PANT
What is the mnemonic for toxic agents that cause slow respiration?
SLOW
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
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
COOLS toxic substances display what vital signs? What are the substances?
HYPOTHERMIA (COOLS)
- Carbon monoxide
- Opioids
- Oral hypoglycemics, insulin
- Liquor (alcohols)
- Sedative-hypnotics
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
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
CT SCAN toxic substances display what vital signs? What are the substances?
HYPERTENSION (CT SCAN)
- Cocaine
- Thyroid supplements
- Sympathomimetics
- Caffeine
- Anticholinergics, amphetamines
- Nicotine
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
SLOW toxic substances display what vital signs? What are the substances?
SLOW RESPIRATION (SLOW)
- Sedative-hypnotics (barbiturates, benzodiazepines)
- Liquor (alcohols)
- Opioids
- Weed (marijuana)
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
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
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
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
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
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
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
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
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
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
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
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
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
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
toxidrome for anticholinergics
. hot as a hare . dry as a bone . blind as a bat . red as a beet . mad as a hatter
toxidrome for cholinergic drugs
DUMBELLS
diarrhea urination miosis bradycardia emesis lacrimation lathergy salivation
toxidrome for nicotinic
(days of week) SSMTWThF
seizures somnolent miosis tachycardia weakness tremors fasciculations
toxidrome for sympathomimetic
GoD PuT STaSH
goosebumps delusions/paranoia pupil dilation temperature sweating tachycardia hypertension
toxidrome for opioid
CPR
consciousness depressed
pupils pinpoint
respiration depressed
(hypotension, bradycardia)
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
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
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
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
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
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)
for what substances should oxygen NOT be given?
paraquat and wantosee
in hypotensive adult toxic patients what fluid is given?
D5NSS
in hypotensive pedia toxic patients what fluid is given?
D50.3NaCl
What is given to coma toxic patients?
DON’T
dextrose
oxygen
noloxone
thiamine
What is given to a toxic patients with convulsions?
diazepam
lorazepam
phenytoin
pyridoxine
For gastric lavage, which side decubitis is preferred?
left lateral decubitus
moa of cathartics in toxic patients
hasten intestinal elimination of
the unabsorbed toxic agent thereby
reducing contact time of the poison in the
gut
what is the antidote for acetaminophen
acetylcysteine
what is the antidote for anticholinergics
physostigmine
what is the antidote for benzodiazepines
flimazenil
what is the antidote for Ca channel blockers
calcium chloride
what is the antidote for cyanide
hydroxocobalamin, amyl nitrite, sodium nitrite, sodium thiosulfate
what is the antidote for digoxin
digoxin immune Fab
what is the antidote for heparin
protamine sulfate
what is the antidote for iron
deforoxamine
what is the antidote for insulin
glucagon
what is the antidote for lead
dimercaptosiccinic acid/EDTA
what is the antidote for opioids
naloxone
what is the antidote for warfarin
vitamin k
what is the antidote for pt with hematemesis
Hematemesis > iron ingestions >deforoxamine
what are the possible antidotes for pt with bradycardia?
calcium chloride > calcium channel blockers
digoxin immune Fab > digoxin
what is the possible antidote for hyperthermia?
physostigmine > anticholinergics
what are the possible antidotes for hypotension?
calcium chloride > calcium channel blockers
naloxone > opioids
most
important determinants of morbidity and mortality in geriatric bleeding and head injury
volume of intracranial blood and hematoma expansion
what should be done right away for geriatric patients with bleeding and head injury in geriatric pt
Rapidly reverse anticoagulation
if pt on warfarin has normal CT scan, do not repeat
true or false
false, repreat in 24 hours
in geriatric pts, severe thoracic injuries can lead to
decompensation especially those with baseline respiratory
insufficiency
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
what provides early insight into respiratory function and reserve in geriatric patient
Serial arterial blood gas analysis
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
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
what is used for volume in geriatric shock patient
small volumes of isotonic crystalloid (normal
saline or lactated Ringer’s)
when would we consider switching to blood transfusion
after 1 to 2 L of
crystalloid resuscitation
associated with aging = more susceptible to
pressure sores and hypothermia
decreased lean muscle mass and impaired peripheral
circulation
most common pelvic fracture
Pubic ramus fractures
most common mechanism of pelvic fracture
Lateral compression
indication for cross-sectional imaging
tenderness of the posterior pelvis
most common injury diagnosis that leads to
hospitalization in the elderly
hip fracture
which occurs most?
. Femoral neck (intracapsular)
. Intertrochanteric fractures
. Subtrochanteric fractures
. Femoral neck (intracapsular)
. Intertrochanteric fractures
equally most common
when to use MRI
hip fracture
most common
fractures in women up to age 75
Distal radius fractures (Colles’ fractures
common upper extremity injury after falls from standing
Fractures of the proximal humerus and humeral shaft
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
initial indicators of shock; serial
measurements can guide resuscitation progress
Base deficit and lactate levels
Elevated lactate levels correlate with
systemic hypoperfusion,
intensive care unit and hospital length of stay, and mortality
base deficit of –3 to –5
. “normal” or mild base deficit
. moderate base deficit
. severe base deficit
. “normal” or mild base deficit
correlates with 24%
mortality
. “normal” or mild base deficit
. moderate base deficit
. severe base deficit
. “normal” or mild base deficit
base deficit of –6 to –9
. “normal” or mild base deficit
. moderate base deficit
. severe base deficit
. moderate base deficit
correlates with 60% mortality
. “normal” or mild base deficit
. moderate base deficit
. severe base deficit
. moderate base deficit
correlates with 80% mortality
. “normal” or mild base deficit
. moderate base deficit
. severe base deficit
. severe base deficit
base deficit of ≤–10
. “normal” or mild base deficit
. moderate base deficit
. severe base deficit
. severe base deficit
why are Creatine kinase levels checked?
assess for rhabdomyolysis in patients
who have fallen and been unable to receive assistance for a
prolonged perio
most common in order
. epidural hematomas
. subdural hematoma
. intraparenchymal hematoma
Higher incidence of subdural and intraparenchymal
hematomas
Less prone to develop epidural hematomas
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
most common cervical spine injury in geriatric patients
Odontoid fractures
Hyperextension injuries = may develop
. anterior cord syndrome
. central
. posterior
central cord
syndrome
area of most common spinal fractures
THORACOLUMBAR SPINAL INJURIES; almost half of all osteoporotic fractures
most common places for spinal injuries
Thoracolumbar junction (T12-L1) & midthoracic areas (T7-T8)
most common thoracolumbar spinal injury
. Anterior wedge compression fractures
. Central
. Posterior
Anterior wedge compression fractures
ICS RA number
RA 10121, s-2010
WHAT IS ICS?
A standard, on-scene, all-hazard incident
management concept that can be used by all
DRRMCs/emergency management and response
agencies
ICS PURPOSES
- The safety of responders and others
- The achievement of tactical objectives
- The efficient use of resources
ICS BENEFITS
- Meets the needs of incidents of any kind or size
- Allows personnel from a variety of agencies to meld
rapidly into a common management structure - Provides accountability and a planning process
- Provides logistical and administrative support to
operational staff - Is cost effective by avoiding duplication of efforts
PRINCIPLES AND FEATURES OF ICS
- Primary ICS Management Functions
- Management by Objectives
- Unity of Command and Chain of Command
- Organizational Flexibility
- Common Terminology SENT HOME
- SENT HOME
- Accountability
- Integrated Communications
- Resources Management
- Incident Action Plan
- Use of Tools and Forms
Primary ICS Management Functions
command: operations, logistics, planning, finance/admin
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
Establishes a clear line of
supervision
. Unity of Command
. Chain of Command
. Unity of Command
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
Orderly ranking of
management positions in line
of authority
. Unity of Command
. Chain of Command
. Chain of Command
refers to the orderly line of authority within the ranks of the incident management organization
. Unity of Command
. Chain of Command
. Chain of Command
To ensure individual accountability, the following principles
must be adhered to:
- Check-in
- Incident Action Plan
- Unity of Command
- Span of Control
- Resource Tracking
Provides overall
leadership for on-scene
response operations
. INCIDENT COMMANDER
. RESPONSIBLE OFFICIAL
. INCIDENT COMMANDER
• Takes policy direction
from Responsible Official
and establishes incident
objectives
. INCIDENT COMMANDER
. RESPONSIBLE OFFICIAL
. INCIDENT COMMANDER
• Ensures incident safety
. INCIDENT COMMANDER
. RESPONSIBLE OFFICIAL
. INCIDENT COMMANDER
• Maintains liason with
participating response
agencies
. INCIDENT COMMANDER
. RESPONSIBLE OFFICIAL
. INCIDENT COMMANDER
• Keeps Responsible
Official and DRRMC
informed of all important
matters pertaining
. INCIDENT COMMANDER
. RESPONSIBLE OFFICIAL
. INCIDENT COMMANDER
Provides overall policy direction and strategic
objectives for the
response
. INCIDENT COMMANDER
. RESPONSIBLE OFFICIAL
. RESPONSIBLE OFFICIAL
• Delegates authority of
resources
. INCIDENT COMMANDER
. RESPONSIBLE OFFICIAL
. RESPONSIBLE OFFICIAL
• Ensures availability of
resources
. INCIDENT COMMANDER
. RESPONSIBLE OFFICIAL
. RESPONSIBLE OFFICIAL
• Serves as link to higher
authorities
. INCIDENT COMMANDER
. RESPONSIBLE OFFICIAL
. RESPONSIBLE OFFICIAL
− Has the most incident
resources
OPERATIONS SECTION
LOGISTICS SECTION responsible for
Facilities o Transportation o Communications o Supplies o Equipment maintenance and fuel o Food services o Medical services
