Managing an Emergency Situation

Question 1

Tests to assess airway patency

Answer 1

• ask the patient to talk
• patent = open
• look and listen for air passing in and out of thorax

Question 2

tests to assess protected airway (ie, can the patient prevent aspiration from occurring)

Answer 2

• ask the patient to cough
• assess the gag reflex
• is there evidence of gross aspiration or potential for this occurring?

Question 3

The airway can be compromised for
a number of reasons:

Answer 3

– Intrinsic obstruction: foreign body, vomitus – Extrinsic compression: tumour, bleeding – Decreased level of consciousness (GCS < 8)

Question 4

GSC of ___ is considered for intubation for airwau protection

Answer 4

• < 8 consider intubation for
airway protection

Question 5

if no concerns for c spine injury, can do ___ maneuver to open obstructed airway. If there is a neck compromization, consider ___ ___.

Answer 5

if no concerns for c spine injury, can do HEAD TILD CHIN LIFT maneuver to open obstructed airway. If there is a neck compromization, consider JAW THRUST.

Question 6

If unable to obtain patent
airway, insert an___ ___

Answer 6

If unable to obtain patent
airway, insert an endotracheal
tube

Question 7

4 indications for intubation

Answer 7

Question 8

when using BVM, what are ways to ensure that there is adequate ventilation?

Answer 8

• equal chest wlall expansion
• adeuqate chest wall excusion
• prescence of bilateral breath sounds

Question 9

• Does the presence of a pulse during CPR
indicate good quality CPR is being
performed?

Answer 9

NO

• The “pulse” may be venous backflow from
intrathoracic pressure changes

• Absence of pulsations are helpful, as
indicates no blood is moving despite CPR

Question 10

T/F central line is superior choice for IV access in an emergency situation

Answer 10

false. no superior choice. 2 large bore IVs in AC fossa more effective for volume resuscitation than most central lines

Question 11

2 large bore IVs (14 or 16 gauge) in AC
fossa more effective for volume
resuscitation than most central lines.

BUT If you can’t get IV access, use the ____ ___ and admister these 5 drugs (NAVLEL)

Answer 11

if you can’t get IV access, use endotracheal tube:

NARCAN, ATROPINE, VASOPRESSIN, EPI, Lidocaine

Question 12

you should usually give IV fluids to compesnate for hypotension. when should you not give IV fluids to an inresponsive patient?

Answer 12

if they have pulmonary edema/cardiogenic shock or obstructive shock

Question 13

cardioversion vs defibrillation

Answer 13

both are shocks. but if hypotense with an organized abrnoaml rhythm (ex/ Afib)— you cardiovert them. if disorganized rhythm like vfib– defibrillation

Question 14

Clues to suggest a
patient is sick

Answer 14

• Respiratory System
– RR
– Respiratory effort
– Position (sitting bolt upright,
tripoding) – Cyanosis – Wheeze, stridor – Accessory muscle use

• Different breathing patterns
– Tachypnea: fast
– Bradypnea: slow
– Kussmaul: rapid deep
– Cheyne-Stokes: rhythmic waxing
CRITICAL CAREClues to suggest a
patient is sick
abdomen moves in
and waning in both depth and rate including apneic periods
– Paradoxical: during inspiration,

URINE OUTPUT

CYANOSIS, RASH, LIVEDO reticularis.