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MEDS 577 PC FINAL > Lecture 9&10: Emergencies and Sleep > Flashcards

Lecture 9&10: Emergencies and Sleep Flashcards

1
Q

T/F even with advanced, aggressive care, 10-20% of major trauma patients will die. Why or why not?

A

True

  • often young
  • Don’t have an advanced directive
  • family unprepared, become surrogate under terrible circumstances
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2
Q

What is the primary goal of Mass Casualty Event (MCE) management?

A

Maximize the number of lives saved?

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3
Q

What is the secondary goal of Mass Casualty Event (MCE) management?

A

Minimize physical and psychological suffering of those whose lives will be shortened.

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4
Q

What are the two types of MCE?

A

“Big Bang” and “Rising Tides”

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5
Q

Describe “Big Bang” single incidents.

A

Immediate or sudden impact (earthquakes, tsunamis, hurricanes, tornadoes, terrorist bombings)

large number of casualties at outset, few overtime

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6
Q

Describe “Rising Tide” incidents.

A

Prolonged impact
-2Extensive exposures to chemical, biological and nuclear agents, pandemic flu outbreaks
Gradual increase in people affected, rising to catastrophic levels
Necessitate prolonged response

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7
Q

What are some things to consider with palliative care in mass casualty events?

A
  • people in need of pc not directly affected by mce (ex. end-of-life, non-end-of-life) are less likely to receive resources
  • health workers unfamiliar with pc may be in charge of providing it
  • may have to provide bad news to patients with curative conditions
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8
Q

Where does good PC happen?

A

Wherever the patient is

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9
Q

List the five types of spontaneous abortion.

A
  1. Threatened
  2. Inevitable
  3. Incomplete
  4. Complete
  5. Septic
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10
Q

Threatened Spontaneous Abortion

A

Characteristics: Abdominal pain or bleeding in first 20 weeks of gestation

Cervical Os: closed

Passage of fetal tissue: None

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11
Q

Inevitable Spontaneous Abortion

A

Characteristics: Abdominal pain or bleeding in first 20 weeks of gestation

Cervical Os: Open

Passage of Fetal Tissue: None

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12
Q

Incomplete Spontaneous Abortion

A

Characteristics: Abdominal pain or bleeding in first 20 weeks of gestation

Cervical Os: Open

Passage of Fetal Tissue: Yes (some products of conceptions still remain in uterus)

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13
Q

Complete Spontaneous Abortion

A

Characteristics: Abdominal pain or bleeding in first 20 weeks of gestation

Cervical Os: Closed

Passage of Fetal Tissue: Complete passage of fetal parts and placenta, uterus contracted

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14
Q

Septic Spontaneous Abortion

A

Characteristics: Infection of uterus during miscarriage, fever and chills. Usually due to S. aureus

Cervical Os: Open with purulent cervical discharge, uterine tenderness

Passage of Fetal Tissue: none or may be incomplete

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15
Q

What are some risk factors for spontaneous abortion?

A

Demographic and Socioeconomic (Maternal age, maternal and paternal education, occupation, number of people in household)
Prior pregnancy history (parity, miscarriages and stillbirths, number of live-born infants who have died)
Exposures and morbidity during pregnancy (work activity, alcohol and tobacco use, food frequency, two prospective seven-day recalls and postpartum recall of severe illnesses in 3rd trimester)
Characteristics of labour and delivery (place of delivery, who delivers baby, length of labour, tools/procedures during labour, whether placenta was delivered w/o assistance, how long after delivery placenta was delivered)

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16
Q

What are some pediatric conditions that may resolve with treatment, but may also require pc?

A

allergies
scabies
acute injuries (not life-threatening)
dental issues

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17
Q

List the broad categories for pediatric PC needs.

A
  • conditions causing pain/discomfort, but resolves with treatment
  • conditions where curative treatment may fail
  • progressive conditions
  • severe, non-progressive disability, causing extreme vulnerability to health complications
  • trauma
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18
Q

What are examples of conditions where curative treatment may fail?

A
  • Advanced or progressive cancer or cancer with a poor prognosis
  • Complex and severe congenital or acquired heart disease
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19
Q

List some examples of conditions requiring intensive long-term care aimed at maintaining quality of life

A
  • Human immunodeficiency virus infection
  • Cystic fibrosis & Asthma
  • Severe gastrointestinal disorders or malformations
  • Severe epidermolysis bullosa
  • Renal failure in cases in which dialysis/transplantation not possible
  • Chronic or severe respiratory failure
  • Muscular dystrophy
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20
Q

What are some progressive conditions in which treatment is exclusively palliative after diagnosis?

A
  • Progressive metabolic disorders
  • Certain chromosomal abnormalities such as trisomy 13 or trisomy 18
  • Severe forms of osteogenesis imperfecta
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21
Q

Identify some severe, non-progressive disability, causing extreme vulnerability to health complications.

A
  • Severe cerebral palsy with recurrent infection or difficult-to-control symptoms
  • Extreme prematurity
  • Severe neurologic sequelae of infectious disease
  • Hypoxic or anoxic brain injury (choking, drowning, etc)
  • Severe brain malformations
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22
Q

What are the challenges to pediatric PC?

A
  • kids have a limited understanding of death
  • parents may be in denial
  • a poor diagnosis or terminal illness may be unexpected
  • parents have unrealistic expectations
  • lack of physician experience
  • lack of ICU facilities for children
  • lack of appropriate drugs and equipment
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23
Q

What are the essential elements of pediatric palliative care?

A
  1. Physical Concerns (identify pain and symptoms to develop a treatment plan)
  2. Psychosocial Concerns (identify child/family concerns and fears, child’s coping and communication styles, discuss death and dying, assess bereavement resources)
  3. Spiritual Concerns (assess child’s hopes and dreams, values, beliefs, ritual and prayer habits)
  4. Advance Care Planning (identify decision makers, discuss illness trajectory, goals of care, end of life concerns)
  5. Practical Concerns (establish means of communication, become familiar with child’s home and school environments, address current and future financial status, inquire about financial burden on family)
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24
Q

Development in Death Concepts in 0-2 years old + intervention

A

Characteristics: sensory and motor relationship w/ environment, limited language skills, may sense that something is wrong

Concept of Death: None

Spiritual Development: faith is dependent on trust in others, require love

Intervention: provide max. physical comfort , incorporate familiar persons and transitional objects (fave toys), use simple communication

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25
Q

Development in Death Concepts in >2-6 years old + intervention

A

Characteristics: magical and animistic thinking, egocentric, thinking irreversible

Concept of death: believes in temporary death and doesn’t personalize it, may think death is caused by thoughts

Spiritual Development: faith is magical and imaginative, participation in ritual important, need for courage

Intervention: minimize separation from parents, correct perception of illness as punishment, evaluate feelings of guilt, use precise language

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26
Q

Development in Death Concepts in >6-12 years old + intervention

A

Characteristics: has concrete thoughts

Concept of death: develop “adult” concepts of death and dying, understands that death may be personal, interested in physiology of death

Spiritual Development: concerned w/ right v. wrong, may accept external interpretations as truth, connects ritual with personal identity

Intervention: evaluate child’s fears of abandonment, be truthful, provide concrete details to questions, support child’s efforts to achieve control and mastery, allow child to participate in decision making, maintain access to peers

27
Q

Development in Death Concepts in >12-18 years old + intervention

A

Characteristics: reality becomes objective, self-reflection, body image and self-esteem paramount

Concept of Death: explores nonphysical explanations

Spiritual Development: begins to accept internal interpretations as truth, evolution of relationship w/ God or higher power, search for meaning, purpose, hope, and value of life

Intervention: reinforce self-esteem, allow child to express strong feelings, promote child’s independence, promote access to peers, be truthful, allow child to participate in decision making

28
Q

Questions that Suggest Incomplete Understanding: Irreversibility (dead things will not live again)

A

How long do you stay dead?
When is my (dead pet) coming back?
Can I “un-dead” someone?
Can you get alive again when you are dead?

29
Q

Questions that Suggest Incomplete Understanding: Finality or nonfunctionality (all life-defining functions end at death)

A

What do you do when you are dead?
Can you see when you are dead?
How do you eat underground?
Do dead people get sad?

30
Q

Questions that Suggest Incomplete Understanding: Universality (all living things die)

A

Does everyone die?
Do children die?
Do I have to die?
When will I die?

31
Q

Questions that Suggest Incomplete Understanding: Causality (realistic understanding of the causes of death)

A

Why do people die?
Do people die because they are bad?
Why did my (pet) die?
Can I wish someone dead?

32
Q

Implications of incomplete understanding

A
  • prevents detachment of personal ties, first step in mourning
  • preoccupation with potential for physical suffering or the dead
  • may view death as punishment for actions or thoughts of the child or dead person
  • may lead to guilt and shame
  • may cause excessive guilt
33
Q

What Not to say to someone experience a miscarriage

A 
It wasn't a proper baby
You'll be fine, you'll get over it
At least you know you can get pregnant, you can just try again
In my day we just treated it like a heavy period
It's nature's way
What did you do to make it happen
It wasn't your time
Everything Happens for a reason
34
Q

What are some positive and empathetic messages for parents who are experiencing a miscarriage?

A

“Yes, it’s shit. It will be shit for a while, but it will get better.”
It wasn’t your fault.
I’m here if you need to talk.
Even though it was early, “it” was still your baby and “it” was loved.
I’m sorry for your loss.
He/she will always be with you.
It’s okay to be angry/sad/cry.
I love you.
“The bad news is you will never be the same/whole. Your daughter is gone. The good news: as soon as you accept that, as soon as you allow yourself to suffer/grieve, you’ll be able to visit her in your mind and remember the joy she gave you. All of the love she knew…If you shy away from the pain of it, then you rob yourself of [her memory]…”

35
Q

Burns are characterized as injury to skin and other tissues caused by:

A 
heat
cold
electricity
chemicals
radiation
friction
36
Q

What is the cause of most burns due to heat?

A

liquids (scalds)
solids (contact burns)
fire (flame burns)

37
Q

What are the common risk factors for burns in the developing world?

A

open cooking fires/unsafe stoves
flammable houses, kerosene lanterns/stoves
alcoholism & smoking
child abuse and torture
self-harm
acid attacks; easy to access chemicals
occupations w/ fire exposure
poverty, overcrowding, lack of proper safety measures (unsafe wiring, no smoke alarms/extinguishers, fire codes, unsafe wiring)
placement of young girls in household roles (cooking, caring for small children)
underlying medical conditions (epilepsy, peripheral neuropathy, and physical and cognitive disabilities)

38
Q

How has burn management progressed over the years?

A

For thousands of years, the care for burns has been consistent. Focus is largely on nourishing the patient, keeping them and their wounds clean, and treating pain. There was no special treatment plan or formal discipline instated until recently.

Timeline Highlights:
1500 BCE Egyptians honey & resin
400 BCE Hippocrates pig fat dressings w/ vinegar and oak bark tanning solution
150 ACE Galen vinegar & exposure to open air
1607 “De Combustionbus” published, outlined pathophysiology and treatment of contractures
1797 Edward Kent pressure dressings to relieve pain and blisters
Early 1800s Guillaume developed burn classifications and made association with severe burns and gastric ulcers
1843 Edinburgh Royal Infirmary for burn patients opens
147 Truman Blocker and Texas City Disaster in Galveston, thousands killed and injured when 2 freighters w/ ammonium nitrate exploded, Blocker worked with UoT students to treat wounded, had to develop long-term care for patients (cleaning/debridement, air exposure, feeding patients)

39
Q

T/F: Majority of burn deaths are in low and middle-income countries, which have a 7x higher death rate than higher-income countries.

A

TRUE

40
Q

What region(s) has the highest burden of burn deaths?

A

Africa and South East Asia

41
Q

Are females or males more at risk of burns? Why?

A

Females due to time spent cooking or working near fires/stoves.

42
Q

Where are men most likely to be burned? Where are women most likely to be burned?

A

Men: work

Women&kids: home

43
Q

What are some long-term consequences of burn injuries?

A
  • lots of indirect costs
  • prolonged hospitals stay
  • disfigurement and disability (contractures)
  • stigma and rejection
  • pain
  • infection (cellulitis, pneumonia, UTIs, sepsis)
  • compromised lung function
  • blindness
  • anemia
  • DVTs
  • Compartment syndrome
  • Keloids
  • Psychological trauma
44
Q

What are some ways to treat and manage burns?

A
  • stop the burning, remove clothing and irrigate the body with water
  • extinguish flames, allow patient to roll on ground, with blanket or by using water or other fire-extinguishing liquids
  • reduce burn temperature by running cool water over injury
  • wrap the patient in a clean cloth or sheet for transport
  • pain control
  • fluid/electrolyte
  • infection prevention/management
  • debridement
  • nutrition (feed patient as much as possible)
  • skin graft
  • physiotherapy/PT
45
Q

What are some things not to do for/to burn management?

A
  • do not start first aid before ensuring your own safety (wear gloves, shut off electricity)
  • don’t apply paste, oil, haldi (tumeric), raw cotton to the burn
  • avoid prolonged cooling –> (hypothermia)
  • don’t open blisters (sterile underneath) until topical antimicrobial can be used
  • don’t apply material directly to wound
  • avoid application of topical medication until the patient has been placed under appropriate medical care
46
Q

In what countries are acid attacks common?

A 
India
Bangladesh
Pakistan
Cambodia
Nepal
London
47
Q

What country is the acid attack capital of the world?

A

London

48
Q

Who is the most targeted group for acid attacks and why?

A

Women

  • Angry husbands or jealous wives
  • Rejected suitors
  • stalkers
49
Q

Name the parts of the body commonly affected by acid attacks.

A

Face, neck, torso, and hands (from protecting face)

50
Q

What are some consequences of acid attacks?

A
  • blindness
  • ostracization & isolation
  • family abandonment due to medical costs or shame
  • high suicide risk
51
Q

T/F: We spend 1/3 of our lives asleep

A

TRUE

52
Q

All animals with a _____ sleep (even flatworms), but ____ is only in birds and mammals.

A

brain

REM

53
Q

What are the 4 mammals with the most REM sleep?

A

Platypus
Echidna
Armadillo
Ferret

54
Q

Why is it important to ask a patient of they are sleeping?

A

It is critical to have an understanding of how and if a patient is sleeping and exploring why they may not be. Sleep is tied to behavior and cognitive changes and lack of sleep impacts health.

55
Q

List the three sleep phases

A

light non-REM
Deep non-REM
REM

56
Q

Describe the light non-REM sleep phase

A
  • aroused state

- transition to deep non-REM in 2-5 minutes

57
Q

The deep non-REM sleep phase _____ gradually with increasing age. Children have much ____ non-REM sleep. During this phase, _______ is common.

A

decreases
deeper
sleepwalking (occurs when deep non-REM is disturbed into light non-REM –> spinal cord memory takes over)

58
Q

During REM, our bodies are ______ and paralyzed. REM is a sleep portal for infants. The need for REM sleep is age-related, gradually _______ until age 17-18. We should not enter REM _ 90 minutes or _ 120 minutes.

A

coldblooded
decreasing
<
>

59
Q

T/F: Melatonin is a sleeping aid that you can take at different times of the day.

A

FALSE; melatonin is NOT a sleeping aid. It resets your circadian rhythm. It is only effective when taken at the same time every day, preferably 30 minutes before you want to sleep.

60
Q

How does light impact our circadian rhythm?

A

We have light-sensitive cells in our retinas that “reset” our circadian rhythm. Once lights stop hitting the retina, our bodies being to produce melatonin, which resets the biological clock (aka circadian rhythm).

61
Q

How can we reset our circadian rhythm?

A
  • melatonin
  • blackout sheets
  • full spectrum light bulb + timer (to wake up)
  • blue filter/light/blockers for smartphones or iPads
62
Q

What are some consequences of poor sleep?

A
  • reduced HGH production
  • reduced wound healing
  • high blood sugar
  • mood changes
  • impaired balance
  • weakened immunity
  • weakened immunity
  • worsening cognitive ability
  • worsening pain
  • death
63
Q

How can we ensure good sleep for pc patients?

A
  • physical comfort (bed, pillows, blankets, diapers, bedside commode, temperature, prophylactic treatment, bug protection)
  • calm cerebral cortex (limit sensory input-reduce ambient noise and light, control innate intrusive thoughts)
  • reduce/avoid or use other drugs/behaviors to counter effects of drugs that affect REM
  • avoid unnecessary late night procedures
  • manage/prevent Obstructive or Central sleep apnea (OSA & CSA)
  • –OSA from alcohol, benzodiapines, muscle relaxants CSA from opioids and neuromuscular disease
64
Q

Common Sleep misconceptions

A

-Don’t need 8 hours; avg= 7.5 years
-Distracted kids have ADD/ADHD; may just be tired, easily get OSA
-Dreaming while sleepwalking; NO, only dream while paralyzed in REM
-Erection while sleeping means you are dreaming of sex, NO, penile and clitoral erections occur during REM naturally
Night terrors are bad dreams, NO occur in on-REM sleep

MEDS 577 PC FINAL (6 decks)

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