Intro

Question 1

numerical pt rating severity scale

Answer 1

1-5, 1 most severe(Chest pain/SOB/CVA) to 5 (well check)

Question 2

fast track is used for….

Answer 2

4 or 5s

urgent care/ nonemergent situations

Question 3

the main is used for….

Answer 3

3s and above

Question 4

what do you do in an initial assessment during an emergency?

Answer 4

Airway
Breathing
Circulation
Disability
Exposure and environment
CABDE for a patient in cardiac arrest.

Question 5

what do you do if a pt has no pulse?

weak pulse?

Answer 5

CPR!

no CPR

Question 6

if speaking and airway is clear you can start with

Answer 6

nasal canula

If that doesn’t bring it up enough then you can use a non-rebreather, then bipap can be used, then intubation

Question 7

when should you intubate?

Answer 7

• if there is any doubt about the patient’s ability to maintain airway
• Loss of gag/cough reflex e.g. head injury with GCS <8 (to prevent massive aspiration)

Question 8

best option for a bleed?

Answer 8

• direct pressure

- last option is tourniquet

Question 9

Glasgow Coma Scale

Answer 9

• Eye opening response
• best verbal response
• best motor response

Question 10

eye opening response score

Answer 10

4-opens spontaneously
3-to speech
2-to pain
1-no response

Question 11

verbal response score

Answer 11

5-oriented to time, place, and person
4-confused
3-inappropriate words
2-incomprehensible sounds
1-no response

Question 12

motor response score

Answer 12

6-obeys commands
5-moves to localized pain
4-flexion withdrawal from pain
3-abnormal flexion (decorticate)
2-abnormal extension (decerebrate)
1-no response

Question 13

you can easily order a VBG, but when would you consider an ABG?

Answer 13

Inability to obtain venous sample

Inability to utilize pulse oximeter

Question 14

when can you send a pt home?

Answer 14

once you rule out an emergency

Question 15

what tests should you order for any cardiac/respiratory complaint?

Answer 15

O2 sat and EKG

Question 16

what is important to order asap for pregnant pts?

Answer 16

fetal heart monitor

Question 17

what are some red flags or reasons to keep a pt?

Answer 17

Abnormal vital signs
AMS
Young and elderly
Failure to improve 
Significant health problems
Potential or known immune compromise
asplenic, diabetes, HIV, IVDA, chemo
Known trauma/multiple injury

Question 18

what is your main goal as an emed provider?

Answer 18

stabilize the pt

Question 19

most important part of discahrging a pt?

Answer 19

ALWAYS WRITE DOWN SYMPTOMS THAT SHOULD MAKE A PATIENT RETURN TO THE ER IMMEDIATELY.

Question 20

what is shock?

Answer 20

an emergency in which the organs and tissues of the body are not receiving an adequate flow of blood. This deprives the organs and tissues of oxygen (carried in the blood) and allows the buildup of waste products.

Question 21

first sign of shock? (stage 1)

Answer 21

tachycardia

Question 22

what happens in stage 2 of shock?

Answer 22

hypotensive, AMS

Question 23

what happens in stage 3 of shock?

Answer 23

end organ damage, no urinary output from kidney failure

Question 24

types of hypovolemic shock

Answer 24

Hemorrhage (injury?)
Third spacing(severe burns)
dehydration

Question 25

types of cardiogenic shock

Answer 25

``` Papillary muscle rupture(chordae tendonae) Massive MI Arrhythmia Myocarditis CHF ```

Question 26

types of distributive shock

Answer 26

Anaphylaxis Sepsis Neurogenic (diving into pool) Overdose of narcotics, sedatives, antihypertensive

Question 27

types of obstructive shock

Answer 27

Pulmonary embolus Tension pneumothorax Cardiac tamponade Aortic stenosis

Question 28

what test should you order if you think the pt is in shock?

Answer 28

lactate, normal is ~2 | Normal is aerobic metabolism your body compensates and starts anaerobic metabolism

Question 29

CO

Answer 29

SV x HR | the volume of blood pumped by the heart per minute

Question 30

BP

Answer 30

CO x PVR

Question 31

main goal when pt is in shock

Answer 31

Restore adequate tissue perfusion and identify and treat the underlying cause

Question 32

as soon as you think pt is in shock what should you do?

Answer 32

give fluids then add vasopressors

Question 33

best tx for hemorrhagic shock

Answer 33

blood transfusion

Question 34

dobutamine dopamine NE

Answer 34

systolic BP over 100 systolic BP 70-100 systolic BP <70

Question 35

you should suspect septic shock if the pts shows any of these signs....

Answer 35

temperature above 38 degrees C(100.4)(warm dry skin) or below 36 degrees C(96.8), systolic bp below 90 mm Hg, and evidence of inadequate tissue perfusion (tachycardia)

Question 36

2 or more of the following indicates SIRS (sudden inflammatory response syndrome)

Answer 36

- temp >38 or <36 - HR 90 - RR >20 - PaCO2 <32 - WBCs > 12000 or <4000

Question 37

septic shock meds

Answer 37

vanco and zosyn | 3rd gen cephalosporin or B-lactamase susceptible PCN

Question 38

troponin levels at onset peak duration

Answer 38

3-12 hours 18-24 hours up to 10 days

Question 39

anaphylactic shock tx

Answer 39

- diphenhydramine and H2 blocker (ranitidine 50mg IV) or PPI(pepcid) - steroids

Question 40

neurogenic shock is seen....

Answer 40

after a fall, diving into a shallow pool

Question 41

signs and symptoms of neurogenic shock

Answer 41

Hypotensive, with warm, dry skin. bradycardia, peripheral vasodilation THE HIGHER THE INJURY THE MORE SEVERE THE SYMPTOMS

Question 42

MC fluid for initial tx

Answer 42

normal saline

Question 43

when to use lactated ringers

Answer 43

for major trauma/blood loss bc you are giving electrolytes (Na, Ca, K)