Intro Flashcards
Which triage ESI is the following patient?
14-year-old male with left ankle pain and swelling
4
Which triage ESI is the following patient?
29-year-old female requesting a prescription refill.
5
Which triage ESI is the following patient?
66-year-old male presenting with crushing 10/10 chest pain. HR 110. BP 104/60.
2
Which triage ESI is the following patient?
58-year-old female with abdominal pain for two days. Normal vital signs.
3
Which triage ESI is the following patient?
75-year-old male found down, pulseless and unresponsive.
1
What is the basic principle of EMTALA?
if you are a federally funded facility (e.g. Medicare) you cannot decline to evaluate a patient
What percentage of adults with out of hospital cardiac arrest will be discharged with good functional status?
8%
only a total of 10% get discharged!
What percentage of adults with IN-hospital cardiac arrest will be discharged with good functional status?
20%
What is the initial step in resuscitation?
a. airway
b. breathing
c. compressions
d. defibrillator
c. compressions
CDAB***
During an acute resuscitation what is the ONLY modality that saves lives.
defibrillation
A 24-year-old female is on the floor in the hospital lobby. You are walking by on your way to your first shift as a PA student! What should you do?
a. start CPR
b. check responsiveness
c. establish airway
d. defibrillate
b. check responsiveness
What does AVPU scoring system stand for when checking responsiveness?
A - patient is awake
V - only responds to verbal stimuli
P - only responds to painful stimuli
U - completely unconscious
T/F: The presence of a pulse does not correlate to blood pressure
True
How does your management change in a patient with no pulse vs. a weak pulse?
- no pulse = CPR rate 100-120/min
- weak pulse = supportive measures, develop differential
Defibrillation is defined as using _________ energy to terminate a lethal arrhythmia
unsynchronized
What are the 2 rhythms in which defibrillation is indicated?
- V-fib
- V-tach without a pulse
Why is a biphasic defibrillator more commonly used than a monophasic one?
- they are equally as effective
- biphasic has less risk of burn and decreased energy use
What is the main difference between a implantable cardioverter (ICD) vs. a permanent pacemaker?
- ICD = for when a patient has an arrhythmia
- pacemaker = to maintain a regular heart beat
Cardioversion is defined as using ___________ energy to convert an arrhythmia back to sinus rhythm.
synchronized
Cardioversion is used in patients with or without a pulse?
with a pulse
T/F: It is safe to cardiovert a pregnant patient or a patient with a pacemaker/ICD.
True
What are the 3 primary examples of SVT?
- AVNRT
- AVRT
- Atrial tachycardia
What is the easiest way to differentiate ST and SVT?
- ST = HR < 140
- SVT = HR > 140
What is the appropriate management for a hemodynamically STABLE SVT? (4 lines of treatment)
- vagal maneuvers
- adenosine 6 mg IV
2a. repeat adenosine 12 mg IV - B-blocker or CCB
- cardioversion
What is the treatment for a hemodynamically unstable SVT?
cardioversion
What is the best vagal maneuver to use for a SVT?
modified valsalva
“U” wave on ECG is pathognomonic for what abnormality?
hypokalemia
“J” wave on ECG is pathognomonic for what abnormamility?
hypothermia
What are the Hs and Ts of pulseless electrical activity (PEA)?
Hs
- hypoxia
- hypovolemia
- hypo/hyperkalemia
- hypothermia
- hydrogen ion (acidosis)
Ts
- thrombosis
- thromboembolism (PE)
- tension pneumothorax
- tamponade
- toxins/tablets
What is the best treatment for hyperkalemia?
give calcium!
What is the most common maneuver to assess the airway?
What maneuver is used in the instance of a C-spine injury?
- most common = head tilt/chin lift
- c-spine injury = jaw thrust
What are airway adjuncts (such as oropharyngeal airway or nasopharyngeal airway) used for?
remove the tongue which is the main cause of airway obstruction
What are the 3 indications for tracheal intubation?
- failure to oxygenate or failure to ventilate
- unable to protect the airway
- predicted clinical course
What are the 7 P’s of rapid sequence intubation (RSI)?
- Preparation
- Preoxygenation
- Pre-intubation optimization
- Paralysis
- Positioning
- Placement with proof
- Post intubation management
Why is preoxygenation important in RSI?
How is it done?
- increases time to desaturation by minutes
- high flow O2 at the highest possible concentration for 3 minutes
What is the most hemodynamically stable induction agent (sedative) for RSI?
- etomidate
propofol - decreases BP
ketamine - increases BP
What is the most rapid paralytic agent we have for RSI?
When is it contraindicated?
- succinylcholine (onset 30-45s)
- contraindicated = hyperkalemia
What is the main reason we need to rapidly paralyze a patient vs. a more slow progression seen in surgery?
decrease risk of aspiration d/t patient not being on NPO
What is the best way to confirm ETT placement?
- capnography
wave > color
What are the 3 main causes of respiratory arrest?
- airway obstruction from choking
- decreased respiratory effort from opiates
- respiratory muscle weakness
What are the 2 methods to monitor breathing?
- O2 saturation
- waveform capnography
This is used to assist patients with inadequate or absent respirations while awaiting advanced airway or further management (if reversible cause).
bag valve mask
What is goal O2 sat?
> 94%
After performing ABCs what should be assessed next?
vital signs!
Where can you place intraosseous (IO) access?
a. proximal tibia
b. femur
c. proximal humerus
d. manubrium
e. all of the above
e. all of the above
Once you obtain IO access how long do you have before you need to remove the access point?
What is the main risk with IO access?
- need to remove in 24 hours
- high risk for osteomyelitis
A 50-year-old male with a history of ESRD is brought to the emergency department by BLS after being found unresponsive. He has no pulses and is not breathing. CPR is in progress. Rescue breaths are being administered via BVM. The cardiac monitor shows sinus tachycardia. What is the next best step?
A. Defibrillate B. Establish advanced airway C. Place IV for blood transfusion D. Cardioversion E. Cease resuscitation efforts
B. Establish advanced airway
The patient is successfully intubated with an endotracheal tube. The CO2 detector changes from purple to yellow and the waveform reveals CO2 of 35-45. The patient remains pulseless, and CPR is in progress. The cardiac monitor continues to show sinus tachycardia. What is next?
A. Portable chest x-ray to confirm ETT placement
B. Explore reversible causes (Hs and Ts)
C. Cease resuscitation efforts
D. Defibrillate
E. Remove ETT given esophageal intubation
B. Explore reversible causes (Hs and Ts)
You begin exploring Hs and Ts and EMS informs you that the patient missed dialysis yesterday. What is the best medication to order?
A. Oxygen B. Sodium bicarbonate C. Magnesium D. Calcium E. Potassium
D. Calcium
A nurse grabs you to see a 45-year-old male in the waiting room is not responding. You walk into the room and patient is seated in a chair with his eyes closed and is not moving. What is the first thing you should do?
check responsiveness!
A nurse grabs you to see a 45-year-old male in the waiting room. You check responsiveness and the patient is not responding to verbal or painful stimuli. You assess CABs:
C: Weak pulse
A: Airway is patent
B: RR 6, O2 sat 88%/RA
What is the next best step?
A. Start CPR B. BVM and supplemental oxygen C. Explore Hs and Ts D. Intubate E. Cardiovert
B. BVM and supplemental oxygen
For each minute that passes with a heart in ventricular fibrillation, survival drops by ____%.
10%
