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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

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2
Q

age range of geriatric pt

A

55-80

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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

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4
Q

w/o significant atherosclerotic coronary artery disease and 80 yo has this much CO of 20 yo?

A

50 percent

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5
Q

Maximal heart rate and cardiac output (increase/decrease) with age

A

Maximal heart rate and cardiac output decrease with age

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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

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7
Q

Deterioration of the cardiac conduction system leads to

A

atrial fibrillation & bundle-branch blocks

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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

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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%

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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.

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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

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12
Q

what is first and second most common cause of injury in elderly

A

falls then motor vehicle crashes

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13
Q

most common cause of fatal and nonfatal injury in people >65

A

falls

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14
Q

what is the most common fracture of elders

A

hip fracture

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15
Q

age related changes that contributes to falls in elderly

A

postural stability / balance / motor strength / coordination / reaction time

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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

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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

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18
Q

Beux score in elderly in futility of treatment and 50% risk of mortality

A

160 rather than 100 (futility)

110 score

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19
Q

at >65 yo this body surface area has anticipated mortality of 50%

A

bsa if 28%

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20
Q

inhalation burn injury adds this many points to Baux score

A

17 years or points

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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

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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

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23
Q

what may mask tachycardia in elderly

A

beta blockers

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24
Q

what may mask the signs of respiratory failure

A

Elderly have blunted responses to hypoxia, hypercarbia, and acidosis

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25
Q

must use a (higher/lower) cutoff for hypotension than in younger patients

A

must use a higher cutoff for hypotension than in younger patients

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26
Q

hypotension in elderly patients

A

systolic blood pressures below 110 mm Hg and heart rates above 90 beats/min

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27
Q

known baseline or a falling trend; a marker of instability

A

decrease in blood pressure of 30 mm Hg below = known baseline or a falling trend; a marker of instability

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28
Q

As the brain mass decreases with age this happens to bridging veins

A

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.

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29
Q

why might diagnosis of intracranial bleeding may be delayed in elderly

A

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

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30
Q

what head injury imaging is recommended for elderly patients taking warfarin

A

Immediate noncontrast head CT = recommended for patients who take warfarin

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31
Q

why should INR should be checked in elderly with head injury

A

degree of anticoagulation correlates with the risk of adverse outcome

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32
Q

concern in elderly head injury patient on antiplatelet medication clopidogrel

A

an increased risk of intracranial bleeding after head injury

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33
Q

United Nation’s Disaster Management Training Program’s definition of disaster

A

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

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34
Q

Disaster that affects the hospital grounds

internal
external

A

internal

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35
Q

power failure

internal
external

A

internal

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36
Q

Disaster that affect the surrounding community

internal
external

A

external

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37
Q

Riots

internal
external

A

external

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38
Q

What is the hospital centered model of disaster

A

determined if the disaster happens on or off hospital grounds

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39
Q

What is advantage and disadvantage of hospital centered model

A

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)

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40
Q

Acronym of man-made disasters (4)

A 
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
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41
Q

Local Emergency Medical Services (EMS) and hospital are able to respond

Level I
Level II
Level III

A

Level I

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42
Q

Single area hospital activated

Level I
Level II
Level III

A

Level I

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43
Q

Multijurisdictional aid is needed

Level I
Level II
Level III

A

Level II

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44
Q

Several local hospitals activated

Level I
Level II
Level III

A

Level II

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45
Q

State or federal aid is needed

Level I
Level II
Level III

A

Level III

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46
Q

Request for aid based on state and federal regulations

Level I
Level II
Level III

A

Level III

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47
Q

What is PICE of disaster response

A

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.

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48
Q

Potential for additional casualties

PICE prefix A
PICE prefix B
PICE prefix C

A

PICE prefix A

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49
Q

Static – no more potential for additional casualties

PICE prefix A
PICE prefix B
PICE prefix C

A

PICE prefix A

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50
Q

Dynamic – potential for additional casualties

PICE prefix A
PICE prefix B
PICE prefix C

A

PICE prefix A

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51
Q

Ability of local resources to respond

PICE prefix A
PICE prefix B
PICE prefix C

A

PICE prefix B

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52
Q

Controlled : local resources able to respond without augmentation

PICE prefix A
PICE prefix B
PICE prefix C

A

PICE prefix B

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53
Q

Disruptive : local resources overwhelmed but able to respond with augmentation of resources

PICE prefix A
PICE prefix B
PICE prefix C

A

PICE prefix B

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54
Q

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

A

PICE prefix B

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55
Q

Geographical involvement of event

PICE prefix A
PICE prefix B
PICE prefix C

A

PICE prefix C

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56
Q

local, regional, national, international

PICE prefix A
PICE prefix B
PICE prefix C

A

PICE prefix C

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57
Q

controlled, disruptive, paralytic

PICE prefix A
PICE prefix B
PICE prefix C

A

PICE prefix B

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58
Q

static, dynamic

PICE prefix A
PICE prefix B
PICE prefix C

A

PICE prefix A

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59
Q

no need for outside aid and is inactive

PICE Stage 0
PICE Stage I
PICE Stage II
PICE Stage III

A

PICE Stage 0

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60
Q

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

A

PICE Stage I

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61
Q

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

A

PICE Stage II

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62
Q

local resources are overwhelmed and need immediate dispatch of
outside aid

PICE Stage 0
PICE Stage I
PICE Stage II
PICE Stage III

A

PICE Stage III

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63
Q

What is PICE stages used for?

A

projected need for any status of outside aid

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64
Q

Phases of Disaster (4 in order)

A

mitigation, planning, response, recovery

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65
Q

Its effectiveness is dependent on an accurate assessment of the kind of disasters most likely to affect the community

mitigation
planning
response
recovery

A

mitigation

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66
Q

continued threat analysis

mitigation
planning
response
recovery

A

mitigation

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67
Q

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

A

planning

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68
Q

occurs throughout the interdisaster period and involves establishing an Emergency Operations Plan (EOP)

mitigation
planning
response
recovery

A

planning (general)

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69
Q

Providing information to the public about what steps they should take to ensure their safety

mitigation
planning
response
recovery

A

planning (event-specific)

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70
Q

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

A

response

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71
Q

Begins shortly after the disaster has started / Requires the efforts of both emergency response agencies as well as public resources

mitigation
planning
response
recovery

A

recovery

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72
Q

components of disaster response

A

local level disaster response
state level disaster response
federal disaster response
military disaster response

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73
Q

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

A

local level disaster response

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74
Q

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

A

state level disaster response

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75
Q

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

A

federal disaster response

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76
Q

PH has this many typhoons anually

A

22 typhoons

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77
Q

PH has this many earthquakes daily

A

5 earthquakes

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78
Q

what is the primary government instrumentality for health concerns

A

the DOH

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79
Q

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,”
A

“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,”
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80
Q

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,”
A

“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,”
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81
Q

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,”
A

“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,”
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82
Q

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,”
A

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,”
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83
Q

What are the 5 sectors of management in health emergency and disaster response

A 
mangement of event/incident
…service providers
…non-human resources
…information system
…of victim
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84
Q

what is Incident Command System (ICS)

A

. 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

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85
Q

what is purpose of ICS and best practices

A

. Safety of responders and others
. Achievement of tactical objectives
. Efficient use of resources

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86
Q

what are the 5 primary ICS management functions

A

command, operations, planning, logistics, finance/admin

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87
Q

what are the command staff positions

A

information officer, safety officer, liaison officer

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88
Q

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

A

information officer

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89
Q

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

A

safety officer

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90
Q

Acts as point of contact for assisting agencies / Acts as Diplomat / Works with private contractors to address needs

information officer
safety officer
liaison officer

A

liaison officer

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91
Q

ICS Response GOALS (8)

A
  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
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92
Q

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”
A

Command “Boss”

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93
Q

Conducts tactical operations / Develops the tactical objectives and organization / Directs ALL resources

Command “Boss”
Operations “Do-ers”
Planning “Thinkers”
Logistics “Getters”
Finance/ Admin “Payers”
A

Operations “Do-ers”

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94
Q

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”
A

Planning “Thinkers”

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95
Q

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”
A

Logistics “Getters”

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96
Q

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”
A

Finance/ Admin “Payers”

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97
Q

personnel + equipment

Single Resource
Strike Team
Task Force

A

Single Resource

Single Resource – personnel + equipment
Strike Team – combination of same kind
and type (same ambulance)
Task Force – Combi. of single resources

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98
Q 
combination of same kind
and type (same ambulance)

Single Resource
Strike Team
Task Force

A

Strike Team

Single Resource – personnel + equipment
Strike Team – combination of same kind
and type (same ambulance)
Task Force – Combi. of single resources

99
Q

Combi. of single resources

Single Resource
Strike Team
Task Force

A

Task Force

Single Resource – personnel + equipment
Strike Team – combination of same kind
and type (same ambulance)
Task Force – Combi. of single resources

100
Q

What is the span of control?

A

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
Q

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
A

incident command post

102
Q

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
A

staging areas

103
Q

Location where helicopters may be
parked, maintained, fueled, and loaded

incident command post
staging areas
helibase/s
helispots
camps/bases
A

helibase/s

104
Q

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
A

helispots

105
Q

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
A

camps/bases

106
Q

When organizing a hospital incident command group, consider including representatives from the following
services (12)

A

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
Q

. 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

A

surge capacity

108
Q

question

A

answer

109
Q

top two toxic agents for adult consult

A

paracetamol, sodium hypochlorite

110
Q

top three toxic agents for pedia consult

A

paracetamol, sodium hypochlorite, kerosene

111
Q

top three toxic agents for adult inpatient

A

meth, sodium hypochlorite, alcohol/ethanol

112
Q

top three toxic agents for pedia inpatient

A

kerosene, sodium hypochlorite, paracetamol

113
Q

which is worse? Alkaline poisoning or acidic poisoning

A

alkaline - coagulation

114
Q

Treatment for toxic patient (ABC)

A 
airway
breathing
circulation
disturbances of cns: coma and seizure
enhanced elimination
forcused therapy
get tox help
115
Q

What is the likely hint that can cause inability to swallow

hydrocarbon
 caustic
iron ingestions
isoniazid overdose
carbon monoxide
pesticide poisoning
A

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
Q

What is the likely hint that can cause protracted coughing?

hydrocarbon
 caustic
iron ingestions
isoniazid overdose
carbon monoxide
pesticide poisoning
A

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
Q

What is the likely hint that can cause hematemesis?

hydrocarbon
 caustic
iron ingestions
isoniazid overdose
carbon monoxide
pesticide poisoning
A

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
Q

What is the likely hint that can cause intractable seizures?

hydrocarbon
 caustic
iron ingestions
isoniazid overdose
carbon monoxide
pesticide poisoning
A

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
Q

What is the likely hint that can cause loss of conscious especially in fire?

hydrocarbon
 caustic
iron ingestions
isoniazid overdose
carbon monoxide
pesticide poisoning
A

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
Q

What is the likely hint that can result from spraying in farm?

hydrocarbon
 caustic
iron ingestions
isoniazid overdose
carbon monoxide
pesticide poisoning
A

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
Q

What is the mnemonic for toxic agents that cause bradycardia?

A

PACED

122
Q

What is the mnemonic for toxic agents that cause tachycardia?

A

FAST

123
Q

What is the mnemonic for toxic agents that cause hypothermia?

A

COOLS

124
Q

What is the mnemonic for toxic agents that cause hyperthermia?

A

NASA

125
Q

What is the mnemonic for toxic agents that cause hypotension?

A

CRASH

126
Q

What is the mnemonic for toxic agents that cause hypertension?

A

CT SCAN

127
Q

What is the mnemonic for toxic agents that cause rapid respiration?

A

PANT

128
Q

What is the mnemonic for toxic agents that cause slow respiration?

A

SLOW

129
Q

PACED toxic substances display what vital signs? What are the substances?

A

BRADYCARDIA (PACED)

  • Propranolol (beta-blockers), poppies (opiates), propoxyphene, physostigmine
  • Anticholinesterase drugs, antiarrhythmics
  • Clonidine, calcium channel blockers
  • Ethanol or other alcohols
  • Digoxin, digitalis
130
Q

FAST toxic substances display what vital signs? What are the substances?

A

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
Q

COOLS toxic substances display what vital signs? What are the substances?

A

HYPOTHERMIA (COOLS)

  • Carbon monoxide
  • Opioids
  • Oral hypoglycemics, insulin
  • Liquor (alcohols)
  • Sedative-hypnotics
132
Q

NASA toxic substances display what vital signs? What are the substances?

A

HYPERTHERMIA (NASA)

  • Neuroleptic malignant syndrome, nicotine
  • Antihistamines, alcohol withdrawal
  • Salicylates,
    sympathomimetics, serotonin
    syndrome
  • Anticholinergics, antidepressants, antipsychotics
133
Q

CRASH toxic substances display what vital signs? What are the substances?

A

HYPOTENSION (CRASH)

  • Clonidine, calcium channel blockers
  • Rodenticides (containing
    arsenic, cyanide)
  • Antidepressants, aminophylline, antihypertensives
  • Sedative-hypnotics
  • Heroin or other opiates
134
Q

CT SCAN toxic substances display what vital signs? What are the substances?

A

HYPERTENSION (CT SCAN)

  • Cocaine
  • Thyroid supplements
  • Sympathomimetics
  • Caffeine
  • Anticholinergics, amphetamines
  • Nicotine
135
Q

PANT toxic substances display what vital signs? What are the substances?

A

RAPID RESPIRATION (PANT)

- PCP, paraquat, pneumonitis (chemical),
phosgene
- ASA and other salicylates
- Noncardiogenic pulmonary edema, nerve agents
- Toxin-induced metabolic acidosis
136
Q

SLOW toxic substances display what vital signs? What are the substances?

A

SLOW RESPIRATION (SLOW)

  • Sedative-hypnotics (barbiturates, benzodiazepines)
  • Liquor (alcohols)
  • Opioids
  • Weed (marijuana)
137
Q

bitter almonds breath order is likely caused by

  • cyanide
  • DKA, isopropranolol
  • methylsalicylate
  • sulfur dioxide, hydrogen sulfide
  • chloral hydrate
  • organophosphate, arsenic
    mothballs: camphor
A

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
Q

fruity breath order is likely caused by

  • cyanide
  • DKA, isopropranolol
  • methylsalicylate
  • sulfur dioxide, hydrogen sulfide
  • chloral hydrate
  • organophosphate, arsenic
    mothballs: camphor
A

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
Q

oil of wintergreen breath order is likely caused by

  • cyanide
  • DKA, isopropranolol
  • methylsalicylate
  • sulfur dioxide, hydrogen sulfide
  • chloral hydrate
  • organophosphate, arsenic
    mothballs: camphor
A

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
Q

rotten eggs breath order is likely caused by

  • cyanide
  • DKA, isopropranolol
  • methylsalicylate
  • sulfur dioxide, hydrogen sulfide
  • chloral hydrate
  • organophosphate, arsenic
    mothballs: camphor
A 
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
Q

breath order is likely caused by

  • cyanide
  • DKA, isopropranolol
  • methylsalicylate
  • sulfur dioxide, hydrogen sulfide
  • chloral hydrate
  • organophosphate, arsenic
    mothballs: camphor
A

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
Q

pear breath order is likely caused by

  • cyanide
  • DKA, isopropranolol
  • methylsalicylate
  • sulfur dioxide, hydrogen sulfide
  • chloral hydrate
  • organophosphate, arsenic
    mothballs: camphor
A

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
Q

garlic smelling breath order is likely caused by

  • cyanide
  • DKA, isopropranolol
  • methylsalicylate
  • sulfur dioxide, hydrogen sulfide
  • chloral hydrate
  • organophosphate, arsenic
    mothballs: camphor
A

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
Q

mothballs smelling breath order is likely caused by

  • cyanide
  • DKA, isopropranolol
  • methylsalicylate
  • sulfur dioxide, hydrogen sulfide
  • chloral hydrate
  • organophosphate, arsenic
    mothballs: camphor
A

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
Q

sympathomimetics will cause the skin to be

  • diaphoretic
  • red skin
  • blue skin
A

diaphoretic

diaphoretic skin: sympathomimetics, organophosphates, salicylates
red skin: CO, boric acid
blue skin: cyanosis methemoglobinemia

146
Q

organophosphates will cause the skin to be

  • diaphoretic
  • red skin
  • blue skin
A

diaphoretic

diaphoretic skin: sympathomimetics, organophosphates, salicylates
red skin: CO, boric acid
blue skin: cyanosis methemoglobinemia

147
Q

salicylates will cause the skin to be

  • diaphoretic
  • red skin
  • blue skin
A

diaphoretic

diaphoretic skin: sympathomimetics, organophosphates, salicylates
red skin: CO, boric acid
blue skin: cyanosis methemoglobinemia

148
Q

CO will cause the skin to be

  • diaphoretic
  • red skin
  • blue skin
A

red skin

diaphoretic skin: sympathomimetics, organophosphates, salicylates
red skin: CO, boric acid
blue skin: cyanosis methemoglobinemia

149
Q

boric acid will cause the skin to be

  • diaphoretic
  • red skin
  • blue skin
A

red skin

diaphoretic skin: sympathomimetics, organophosphates, salicylates
red skin: CO, boric acid
blue skin: cyanosis methemoglobinemia

150
Q

cyanosis methemoglobinemia will cause the skin to be

  • diaphoretic
  • red skin
  • blue skin
A

blue skin

diaphoretic skin: sympathomimetics, organophosphates, salicylates
red skin: CO, boric acid
blue skin: cyanosis methemoglobinemia

151
Q

toxidrome for anticholinergics

A 
. hot as a hare
. dry as a bone
. blind as a bat
. red as a beet
. mad as a hatter
152
Q

toxidrome for cholinergic drugs

A

DUMBELLS

diarrhea
urination
miosis
bradycardia
emesis
lacrimation
lathergy
salivation
153
Q

toxidrome for nicotinic

A

(days of week) SSMTWThF

seizures
somnolent
miosis
tachycardia
weakness
tremors
fasciculations
154
Q

toxidrome for sympathomimetic

A

GoD PuT STaSH

goosebumps
delusions/paranoia
pupil dilation
temperature
sweating
tachycardia
hypertension
155
Q

toxidrome for opioid

A

CPR

consciousness depressed
pupils pinpoint
respiration depressed

(hypotension, bradycardia)

156
Q

substances and diseases that will cause an elevated anion gap metabolic acidosis

A

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
Q

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
A

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
Q

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
A

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
Q

what substance is suspected if urine sample test turns brown

  • Copper sulfate or Methylene blue
  • Rifampin, Mercury, Chronic lead
    poisoning
  • Chloroquine
  • Ampicillin or Cephalosporin
A

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
Q

what substance is suspected if urine sample test turns pink?

  • Copper sulfate or Methylene blue
  • Rifampin, Mercury, Chronic lead
    poisoning
  • Chloroquine
  • Ampicillin or Cephalosporin
A

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
Q 
Agents potentially visible on
abdominal radiographs (COINS)
A 
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
Q

for what substances should oxygen NOT be given?

A

paraquat and wantosee

163
Q

in hypotensive adult toxic patients what fluid is given?

A

D5NSS

164
Q

in hypotensive pedia toxic patients what fluid is given?

A

D50.3NaCl

165
Q

What is given to coma toxic patients?

A

DON’T

dextrose
oxygen
noloxone
thiamine

166
Q

What is given to a toxic patients with convulsions?

A

diazepam
lorazepam
phenytoin
pyridoxine

167
Q

For gastric lavage, which side decubitis is preferred?

A

left lateral decubitus

168
Q

moa of cathartics in toxic patients

A

hasten intestinal elimination of
the unabsorbed toxic agent thereby
reducing contact time of the poison in the
gut

169
Q

what is the antidote for acetaminophen

A

acetylcysteine

170
Q

what is the antidote for anticholinergics

A

physostigmine

171
Q

what is the antidote for benzodiazepines

A

flimazenil

172
Q

what is the antidote for Ca channel blockers

A

calcium chloride

173
Q

what is the antidote for cyanide

A

hydroxocobalamin, amyl nitrite, sodium nitrite, sodium thiosulfate

174
Q

what is the antidote for digoxin

A

digoxin immune Fab

175
Q

what is the antidote for heparin

A

protamine sulfate

176
Q

what is the antidote for iron

A

deforoxamine

177
Q

what is the antidote for insulin

A

glucagon

178
Q

what is the antidote for lead

A

dimercaptosiccinic acid/EDTA

179
Q

what is the antidote for opioids

A

naloxone

180
Q

what is the antidote for warfarin

A

vitamin k

181
Q

what is the antidote for pt with hematemesis

A

Hematemesis > iron ingestions >deforoxamine

182
Q

what are the possible antidotes for pt with bradycardia?

A

calcium chloride > calcium channel blockers

digoxin immune Fab > digoxin

183
Q

what is the possible antidote for hyperthermia?

A

physostigmine > anticholinergics

184
Q

what are the possible antidotes for hypotension?

A

calcium chloride > calcium channel blockers

naloxone > opioids

185
Q

most

important determinants of morbidity and mortality in geriatric bleeding and head injury

A

volume of intracranial blood and hematoma expansion

186
Q

what should be done right away for geriatric patients with bleeding and head injury in geriatric pt

A

Rapidly reverse anticoagulation

187
Q

if pt on warfarin has normal CT scan, do not repeat

true or false

A

false, repreat in 24 hours

188
Q

in geriatric pts, severe thoracic injuries can lead to

A

decompensation especially those with baseline respiratory

insufficiency

189
Q

consideration for pain control after chest wall trauma in geriatric patient

A

. to reduce atelectasis and the risk of infection
. challenging because the elderly may have decreased
tolerance for opioid analgesic

190
Q 
what provides early insight into respiratory
function and reserve in geriatric patient
A

Serial arterial blood gas analysis

191
Q

indication for prompt tracheal intubation and use of mechanical
ventilation in geriatric patient

A

. 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
Q

initial treatment for shock in geriatric patient

A

early placement (within 2.2 hours) of a pulmonary artery
catheter followed by goal-directed volume resuscitation and
inotropic support

193
Q

what is used for volume in geriatric shock patient

A

small volumes of isotonic crystalloid (normal

saline or lactated Ringer’s)

194
Q

when would we consider switching to blood transfusion

A

after 1 to 2 L of

crystalloid resuscitation

195
Q

associated with aging = more susceptible to

pressure sores and hypothermia

A

decreased lean muscle mass and impaired peripheral

circulation

196
Q

most common pelvic fracture

A

Pubic ramus fractures

197
Q

most common mechanism of pelvic fracture

A

Lateral compression

198
Q

indication for cross-sectional imaging

A

tenderness of the posterior pelvis

199
Q

most common injury diagnosis that leads to

hospitalization in the elderly

A

hip fracture

200
Q

which occurs most?

. Femoral neck (intracapsular)
. Intertrochanteric fractures
. Subtrochanteric fractures

A

. Femoral neck (intracapsular)
. Intertrochanteric fractures
equally most common

201
Q

when to use MRI

A

hip fracture

202
Q

most common

fractures in women up to age 75

A

Distal radius fractures (Colles’ fractures

203
Q

common upper extremity injury after falls from standing

A

Fractures of the proximal humerus and humeral shaft

204
Q

how to assess for axillary nerve injury

A

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
Q

initial indicators of shock; serial

measurements can guide resuscitation progress

A

Base deficit and lactate levels

206
Q

Elevated lactate levels correlate with

A

systemic hypoperfusion,

intensive care unit and hospital length of stay, and mortality

207
Q

base deficit of –3 to –5

. “normal” or mild base deficit
. moderate base deficit
. severe base deficit

A

. “normal” or mild base deficit

208
Q

correlates with 24%
mortality

. “normal” or mild base deficit
. moderate base deficit
. severe base deficit

A

. “normal” or mild base deficit

209
Q

base deficit of –6 to –9

. “normal” or mild base deficit
. moderate base deficit
. severe base deficit

A

. moderate base deficit

210
Q

correlates with 60% mortality

. “normal” or mild base deficit
. moderate base deficit
. severe base deficit

A

. moderate base deficit

211
Q

correlates with 80% mortality

. “normal” or mild base deficit
. moderate base deficit
. severe base deficit

A

. severe base deficit

212
Q

base deficit of ≤–10

. “normal” or mild base deficit
. moderate base deficit
. severe base deficit

A

. severe base deficit

213
Q

why are Creatine kinase levels checked?

A

assess for rhabdomyolysis in patients
who have fallen and been unable to receive assistance for a
prolonged perio

214
Q

most common in order

. epidural hematomas
. subdural hematoma
. intraparenchymal hematoma

A

Higher incidence of subdural and intraparenchymal
hematomas

Less prone to develop epidural hematomas

215
Q

why are geriartric pts less prone to develop epidural hematomas

A

Due to the denser fibrous bond between the dura

mater and the inner table of the skull

216
Q

most common cervical spine injury in geriatric patients

A

Odontoid fractures

217
Q

Hyperextension injuries = may develop

. anterior cord syndrome
. central
. posterior

A

central cord

syndrome

218
Q

area of most common spinal fractures

A

THORACOLUMBAR SPINAL INJURIES; almost half of all osteoporotic fractures

219
Q

most common places for spinal injuries

A

Thoracolumbar junction (T12-L1) & midthoracic areas (T7-T8)

220
Q

most common thoracolumbar spinal injury

. Anterior wedge compression fractures
. Central
. Posterior

A

Anterior wedge compression fractures

221
Q

ICS RA number

A

RA 10121, s-2010

222
Q

WHAT IS ICS?

A

A standard, on-scene, all-hazard incident
management concept that can be used by all
DRRMCs/emergency management and response
agencies

223
Q

ICS PURPOSES

A
  1. The safety of responders and others
  2. The achievement of tactical objectives
  3. The efficient use of resources
224
Q

ICS BENEFITS

A
  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
Q

PRINCIPLES AND FEATURES OF ICS

A
  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
Q

Primary ICS Management Functions

A

command: operations, logistics, planning, finance/admin

227
Q

Management by Objectives

top down or bottom up

A

top down

achieve goal > perform tactical directoin > select appropriate strategy > establish incident objectives > understand policy and direction

228
Q

Establishes a clear line of
supervision

. Unity of Command
. Chain of Command

A

. Unity of Command

229
Q

every individual has a
designated supervisor to
whom they report at the
scene of the incident

. Unity of Command
. Chain of Command

A

. Unity of Command

230
Q

Orderly ranking of
management positions in line
of authority

. Unity of Command
. Chain of Command

A

. Chain of Command

231
Q 
refers to
the orderly line of authority
within the ranks of the
incident management
organization

. Unity of Command
. Chain of Command

A

. Chain of Command

232
Q

To ensure individual accountability, the following principles
must be adhered to:

A
  1. Check-in
  2. Incident Action Plan
  3. Unity of Command
  4. Span of Control
  5. Resource Tracking
233
Q

Provides overall
leadership for on-scene
response operations

. INCIDENT COMMANDER
. RESPONSIBLE OFFICIAL

A

. INCIDENT COMMANDER

234
Q

• Takes policy direction
from Responsible Official
and establishes incident
objectives

. INCIDENT COMMANDER
. RESPONSIBLE OFFICIAL

A

. INCIDENT COMMANDER

235
Q

• Ensures incident safety

. INCIDENT COMMANDER
. RESPONSIBLE OFFICIAL

A

. INCIDENT COMMANDER

236
Q

• Maintains liason with
participating response
agencies

. INCIDENT COMMANDER
. RESPONSIBLE OFFICIAL

A

. INCIDENT COMMANDER

237
Q

• Keeps Responsible
Official and DRRMC
informed of all important
matters pertaining

. INCIDENT COMMANDER
. RESPONSIBLE OFFICIAL

A

. INCIDENT COMMANDER

238
Q

Provides overall policy direction and strategic
objectives for the
response

. INCIDENT COMMANDER
. RESPONSIBLE OFFICIAL

A

. RESPONSIBLE OFFICIAL

239
Q

• Delegates authority of
resources

. INCIDENT COMMANDER
. RESPONSIBLE OFFICIAL

A

. RESPONSIBLE OFFICIAL

240
Q

• Ensures availability of
resources

. INCIDENT COMMANDER
. RESPONSIBLE OFFICIAL

A

. RESPONSIBLE OFFICIAL

241
Q

• Serves as link to higher
authorities

. INCIDENT COMMANDER
. RESPONSIBLE OFFICIAL

A

. RESPONSIBLE OFFICIAL

242
Q

− Has the most incident

resources

A

OPERATIONS SECTION

243
Q

LOGISTICS SECTION responsible for

A 
Facilities
o Transportation
o Communications
o Supplies
o Equipment maintenance and fuel
o Food services
o Medical services

E Med (13 decks)

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