Management & Abuse Flashcards
<p>Name 5 differences to consider when triaging</p>
<p><strong>Pediatric vs adult triage:</strong></p>
<ul> <li>Care giver effect/perceptions</li> <li>Difficult histories</li> <li>Pain scales</li> <li>Normal vital signs</li> <li>Physiological info more important</li> <li>Special situations (e.g., neonate with fever <3 months)</li> <li>Serious illnesses in pediatrics: <ul> <li>Less frequently encountered by triage staff</li> <li>May progress more quickly</li> </ul> </li> <li>More frequent reassessment required</li> </ul>
<p><em>What might you get started on these patients? (max 3 each)</em></p>
<p><strong>Patient A</strong> 59 M: 1 hr of central chest pain, with SOB, nausea</p>
<p> <em>- High acuity bed/CRM, ASA (no allergies), ECG, trop </em></p>
<p><strong>Patient B</strong> 26 F: 1st trimester ‘heavy’ PV bleeding, normal vitals</p>
<p> <em>- Frequent vitals, CBC, T+S, BHCG, prep for PV exam</em></p>
<p><strong>Patient E</strong> 5M: 2 days of diarrhea and vomiting, normal vitals</p>
<p> <em>- vitals rechecked, PO antiemetic </em></p>
<p><strong>Patient D</strong> 68 M: bitten on finger today when feeding a squirrel</p>
<p> <em>- irrigate/cleanse wound, Td status, analgesia</em></p>
What are the typres of blast injuries
<p><strong>Primary</strong>:</p>
<ul> <li>Direct effect of blast wave on gas containing structures “blast lung, brain, eye, ear”, etc.</li> </ul>
<p><strong>Secondary</strong>:</p>
<ul> <li>Collateral damage from flying objects</li> </ul>
<p><strong>Tertiary:</strong></p>
<ul> <li>Flying through (from blast wind/fall) and striking stationary objects</li> </ul>
<p><strong>Quaternary:</strong></p>
<ul> <li>Burns, smoke inhalation, chemical explosive, PTSD</li> </ul>
<p><strong>Decontamination of toxic chemicals:</strong></p>
<ul> <li>Perform decontamination outside of ED, when possible</li> <li>Hospital personnel PPE (Level C)</li> <li>Brush off adherent matter</li> <li>Remove all clothing, jewelry, piercings, contact lenses</li> <li>Warm water is the universal decontamination fluid</li> <li>Collect contaminated run off</li> <li>Additional/continuous eye irrigation, as needed</li> <li>Provide clean hospital gowns after decontamination</li> </ul>
<ul> <li>How can an Emergency Department be better prepared for disaster situations? (5)</li> </ul>
<ul> <li>Consideration of local high-risk settings and the required response (factory, industries, etc.)</li> <li>Disaster planning team</li> <li>Implementing disaster plans, codes, protocols</li> <li>Staff contact systems (paging, apps, calls)</li> <li>Disaster Simulations (team-based)</li> <li>Individual physician’s practice, reading, visualization</li> <li>Equipment available, staff knowledge of location</li> <li>Early and continued communication with EMS</li> <li>Protocols for transfer, consultations</li> </ul>
<ul> <li>What can be communicated to EMS regarding what can be done prior to arrival in ED? (3)</li> </ul>
<ul> <li>Complete in-field triage</li> <li>Bring most unstable patients first</li> <li>Consider deferral to other hospitals</li> <li>Review/suggest initial treatments</li> <li>Potential delay of transport of those most stable patients</li> </ul>
<p><strong>DISASTER PREPARATION</strong></p>
<ul> <li>Call “Mass Casualty” Code (eg. Code Orange)</li> <li>Prepare the team <strong>(Staff)</strong> <ul> <li>Call in help ASAP: <ul> <li>MDs: ER, anaesthesia, ENT, surgery, ICU, IM, etc</li> <li>RNs: ED, ICU, floor, OR</li> <li>RT, LPN/RPN/RA, SW</li> <li>Ancillary staff: Lab, XR, CT, housekeeping</li> <li>Managers, supervisors, admin</li> </ul> </li> <li>Delineate roles and tasks</li> </ul> </li> <li>Prepare the space <strong>(Space)</strong> <ul> <li>Clear the trauma/acute areas</li> <li>Try to empty the rest of the department as much as possible</li> <li>Offload delay/ divert other ambulances when possible</li> </ul> </li> <li>Prepare equipment <strong>(Stuff)</strong> <ul> <li>Airway - incl. advanced kit, video, extras, peds</li> <li>IV/IO access, fluid pumps</li> <li>Medications – esp RSI, analgesia, sedation</li> <li>Trauma equipment – splints, chest tubes, casting</li> </ul> </li> </ul>
<p>Notify your receiving hospital to prepare for potential transfers</p>
<p>What specific information is important for you to elicit from EMS providers (in general)? (8)</p>
<ul> <li>Focused history of patient <ul> <li>Age, gender, chief complaint, allergies, etc</li> <li>Mechanism of injury, details of scene, time of symptoms, spent on scene or enroute</li> </ul> </li> <li>Stability of patient <ul> <li>Vital signs</li> <li>Obvious injuries, abnormalities on exam</li> </ul> </li> <li>Interventions provided <ul> <li>Analgesia</li> <li>Initial treatments</li> </ul> </li> <li>Patient’s ongoing status <ul> <li>Changes enroute</li> <li>Response to treatments</li> </ul> </li> </ul>
What factors to consider when deciding to transfer a critically ill payient?
<ul> <li>Length and distance of transport</li> <li>Expected patient course</li> <li>Available personnel <ul> <li>Pilot, EMS, Air Care crew</li> <li>Who can go with patient? RN, RT, MD, etc</li> <li>Who will stay behind?</li> </ul> </li> <li>Local trauma protocols, pathways</li> <li>Weather</li> </ul>
<ul> <li>What are some advantages and disadvantages to choosing air over ground transport? (5)</li> </ul>
<p><strong>Advantages</strong></p>
<ul> <li>Decreased out of hospital time</li> <li>Not limited by traffic/road quality</li> <li>Care givers with critical care capabilities</li> <li>Maintaining local staff in hospital</li> </ul>
<p><strong>Disadvantages</strong></p>
<ul> <li>Overall higher risk</li> <li>More weather dependent</li> <li>Difficult/noisy environment to perform procedures</li> <li>Altitude considerations</li> <li>Higher cost</li> </ul>
<p><strong>Physical interventions to consider prior to air evacuation (4):</strong></p>
<ul> <li>Chest tube placement with secure taping</li> <li>Intubation with secure taping <ul> <li>use sterile water to inflate cuff</li> <li>monitor cuff pressure enroute</li> </ul> </li> <li>Repeat CXR after above and prior to leaving facility</li> <li>2nd or 3rd site of IV access</li> <li>NG tube placement</li> <li>Foley placement</li> <li>Splinting of injured extremities with padding of all pressure points, avoid circumferential casting</li> <li>Remove spine board</li> </ul>
