Medical Emergencies Flashcards
1
Q
Normal ICP
A
5-15 mmHg
2
Q
Increased ICP
A
above 20 for 20 mins call the dr
3
Q
What is inside the cranial vault?
A
- Blood
- Tissue
- CSF
4
Q
Monro-Kellie Doctrine
A
these 3 things interplay with each other but are confined to the cranial vault. If one increases the others (should) adjust as to prevent a rise in ICP (intracranial compliance). However, many times the body cannot compensate, leading to an increase in ICP.
5
Q
How often and how much spinal fluid does the brain make?
A
20 cc of csf every hour
6
Q
Increased ICP s/s
A
- Headache
- Blurred vision
- N/V
- Pupil changes
- Changes in LOC
7
Q
Causes of increased ICP
A
- Trauma
- Hemorrhagic stroke
- Hydrocephaly
8
Q
What is hydrocephaly?
A
Over production of CSF
9
Q
Issues with IICP: Herniation
A
organ protruding through hole (death) most common is cerebellum is pushed out; pt normally does not survive
10
Q
S/S of herniation
A
Cushings triad = wide pulse pressure (increase SBP and decrease DBP), bradycardia, irregular respirations
11
Q
Issues with IICP: Brain hypoxia
A
increase of pressure is causing inadequate blood flow
12
Q
Issues with IICP: Brain death
How is it diagnosed?
A
no blood flow to the brain despite heart beating.
-Bedside brain death studies and/or nuclear medicine scan
13
Q
Dangers of IICP
A
- Herniation
- Brain hypoxia
- Brain death
- Death
14
Q
Glasgow Coma Scale
A
Checks neuro status
Checks: eye opening response, best verbal response, motor response
15
Q
What is the lowest and highest on GCS?
-When do you intubate?
A
lowest: 3
Highest: 15
Intubate: 8
16
Q
Assessment for IICP
A
- Pupil check
- Extremities (do they only move one side or leg)
- Q1H ICP, CPP, VS, and urine output
17
Q
CPP
What is it?
Normal range?
How to monitor?
A
Cerebral Perfusion Pressure
Tells you how much blood is getting to the brain
75-100
MAP-ICP = CPP
18
Q
MAP formula
A
2 x DBP + SBP / 3
Normal MAP is 65 b/c we know everything is being perfused but also depends on pt (specifically the kidneys)
19
Q
Decorticate vs Decerebrate
A
Decorticate: hands and feet go in towards core
Decerebrate: Face out
20
Q
Types of burns
A
- Thermal
- Electrical
- Chemical
- Radiation
21
Q
Burns: Thermal
A
Heat sources
22
Q
Burns: Electrical
Severity depends on
A
Severity depends on strength of the current, duration of contact, path of current, and tissue resistance
-Bone and muscle has more resistance to electrical burns than fatty tissues
23
Q
Burns: Chemical
A
Caused by acids, alkalines, and organic compounds
-cement, gasoline, lime, bleach
24
Q
Burns: Radiation
Severity depends on?
A
Severity is dependent on type, dose, and length of exposure
25
First degree burn
How much damage?
Wound is?
Painful?
- Superficial
- Minimal damage to epidermis
- Wound is: dry; no blistering; pink or red; blanches
- Painful
- ex: sunburn
26
Second degree burn
How much damage?
Superficial vs deep wound?
Painful?
- Partial thickness
- Damage to entire dermis, can extend to the deep levels of the dermis.
- Superficial part of wound: : blisters (may be open or closed; weeping); pink or red; mild edema; blanches easily
- Deep part of the wound: blisters (may be open or closed); waxy appearance; cherry red; mottled; pale in the center; edema; sluggish or no blanching or blanch slowly
- Painful
27
Third degree burn
- How much damage?
- Wound is?
- Painful?
- Full thickness
- Destruction of entire dermis and epidermis, may involve subcutaneous tissue, muscle, and bone
- Wound is: Dry leathery; pale white, brown tan, black, charred; no blanching; may be contracted if muscle is involved
- Painful around edge and sensitive to pressure
28
Fourth degree burn
- How much damage?
- Wound is?
- Painful?
- Everything to the bone
- Total destruction of tissue to bone
- Wound is: Black; red charred
- No pain, nerves have been destroyed. May be painful around the edges as it is a lower degree
29
Burn Assessments
Lund and Browder Classification
Rule of nine
30
Burn assessment: Lunc and Browder Classification
-what is special about toddlers?
- Similar to Rule of Nines but takes age into consideration.
- More commonly used in hospital and burn center settings
Ex: toddlers will have a larger percentage of burn on head cause we grow from head to toe; so head is larger compared to body than adults
31
Burn Assessment: Rule of Nines
- Most commonly used for prehospital calculation of TBSA burned.
- Body surface is broken down into areas of 9%.
32
Poisoning Agent Examples
```
Acetaminophen
Sedative/hypnotics
Benzodiazepines
Antidepressants
CV meds =cardiovascular meds
ETOH = alcohol
```
33
Antidote of:
1. Acetaminophen
2. Benzos
3. SSRIs (list examples)
Antidotes:
Acetaminophen = acetylcysteine (also called Musca- mist)
Benzos = flumazenil
SSRIs (citalopram, escitalopram, fluoxetine, sertraline) = cyproheptadine
*Treatment includes decontamination and specific treatments dependent on poisoning agent.
34
Decontamination ex:
- NGT flushed and put to LIWS (low interment wall suction) gastric lavage
- Flushing skin/eyes with water to remove poisoning agent
- Cathartics (ingested poison's)
- Activated charcoal (ingested poison's)
35
Carhartics
stimulate bowels to excrete ingested poisons. Contraindicated in patients without bowel sounds.
36
Activated charcoal
binds to the poison to reduce absorption by the body. Should be initiated within 60 minutes of ingestion
37
Causes of hypovolemic shock
- Trauma
- Burns
- GI bleeds
- Severe diarrhea/vomiting
38
Clinical Manifestations: Hypovolemic shock
- Early
- Later
- End
Early:
- Tachycardia
- Confusion/restless
- Decreased urine output
- Pale, cool, clammy skin (b/c fluid is being shunted away to vital organs)
- Hyperventilation (which left untreated will lead to R. alkalosis b/c breathing off CO2)
Later:
- Lethargy
- Hypotension -will need vessopressers
- Metabolic and respiratory acidosis (makes lethargy and confusion worse b/c CO2 is building)
- Anuria
- Cold, cyanotic skin
End:
- Coma
- Severe hypertension
- Renal and hepatic failure
39
Management of hypovolemic shock
* Fluid resuscitation
- Isotonic fluids (NS or LR) for nonhemorrhagic hypovolemia
- Hemorrhagic hypovolemia 1:1:1 blood products (PRBCs, FFP, PLTs)
- Oxygenation (veni mask or intubate)
- Treat underlying cause
40
Nursing interventions for hypovolemic shock
1. VS
2. Monitor for signs of bleeding (bruising, dark tarry stools, coffee ground emesis, etc)
3. Establish at least 18g IVs
41
Labs for hypovolemic shock
1. H&H
2. CBC
3. ABGs
42
Near drowning risk factors
- ETOH use
- Assault
- Drug abuse
- Head trauma
- Inability to swim
43
With near drowning what happens with CO2 rises?
Become hypercarbic, hypoxemic, and acidotic because of the rise in CO2 cause ALOC leading to swallowing water
44
Near drowning nursing actions
- IV access
- Prepare of intubation
- Anticipate for coding (ACLS)
45
Water safety education:
Life jackets; importance of pool safety, swimming lessons, how to get out of riptides, etc.
46
Mild hypothermia
89.6F-95F
- Shivering
- Respiratory alkalosis – Tachypnea
- Hyperglycemia - decrease in insulin secretion
- Cold diuresis- vasocontriction
47
Moderate hypothermia
28F-32F
- Shivering becomes more violent but eventually stops
- Agitation
- Hallucinations
- Dilated pupils
- Hypotension
- Bradycardia
48
Severe Hypothermia
Less than 28F
- Compensatory mechanisms begin to fail
- CNS depression worsens
- Severe cerebral hypoperfusion
- Vasodilation – cause hypotension
- Death
49
TX of hypothermia
| For mild, moderate, and severe
*Focus on ABCs
* Passive external rewarming
- For mild hypothermia
- Move to warmer environment - (don't put in hot water = will burn skin)
- Remove all wet clothing and dry patient
- Cover with warm blankets and wrap head
Active external rewarming
- For mild to moderate hypothermia
- Heat lamps
- Forced air warming blankets
Active internal rewarming
- For severe hypothermia
- Humidified/warmed O2
- Warmed IVF
- Peritoneal, bladder, thoracic lavage with warmed fluids
50
Hyperthermia
Body temp above 103F
51
Heat exhaustion s/s
Fatigue; weakness; dizziness; headache; N/V; muscle cramps; tachycardia; hypotension; tachypnea.
**will be coherent
52
Heat stroke
red, dry skin; no sweating; s/s of heat exhaustion; confusion; delirium, seizures; irrational behavior, coma.
**Will not be coherent
53
Heat Exhaustion tx
- Move to cool environment
- Elevate feet = b/c want blood flow back to the heart b/c could be hypotensive
- Encourage cool liquids
- Remove extra clothing
- Apply cool cloths, take cool shower, cooling blanket, ice packs, fans.
- Cooled IVF if needed
54
Heat Stroke Interventions
- Cool body temp to at least 102.2 F is priority
- ABCs (worried about brain)
- Ice packs, cooling blankets
- Treat shivering with benzodiazepines (don't want them to shiver b/c could generate more heat)
- Avoid aggressive fluid resuscitation (pulmonary edema)
55
Allergen exposure causes
IgE production
56
IgE binds
to mast cells
57
Repeated allergen exposure causes
And what happens next
-This causes mast cells to degranulate – releasing histamine and other chemicals.
This causes vasodilation, increased vascular permeability (leaky cells), bronchoconstriction, and edema.
58
Clinical manifestations of allergy
- Dyspnea
- Wheezes/crackles
- Rash
- N/V/D
- Anxiety
- Flush of heat
- Angioedema
* Bronchospasms
* Stridor – high pitched inhaled sound
* Anaphylactic shock (tachycardia, hypotension)
* = severe cases
*
59
Anaphylaxis is a ______ response
systemic
60
Non-Pharmacological tx for anaphylaxis
- Avoid allergen
- O2
- Elevate HOB
- Intubation if needed
61
Pharmacology tx for anaphylaxis
-Diphenhydramine
-Prednisone
-Albuterol
I-M Epi
62
Hospital Preparedness
1. PPE:
- -Hazmat suits, PAPR, face shields, gloves, etc.
2. Decontamination:
- -All hospitals must have a designated area to remove contaminants from a patient’s skin and clothes. Outside of ER
3. Surge Capacity:
- -the ability for a hospital to expand rapidly and to obtain adequate staff, beds, supplies, and equipment to provide sufficient care to an influx of patients.
4. Hospital Evac:
- -May be necessary d/t natural disasters, fires, explosions, etc.
- -Be mindful that some patients may not be able to easily be placed (ICU patients, critical patients in the ER).
5. Readiness:
- -disaster drills, triage, evacuation protocols, safety/security, a supply of PPE/transportation/etc.
63
Active Shooter
- Law enforcement deployment is needed.
- Active shooters move around a buildings.
- They do not stop unless stopped by law enforcement, suicide, or other intervention.
64
Mass Casualty
- Large scale event in which emergency medical resources are overwhelmed by number and/or severity of cases.
- Requires disaster triage.
65
2 types of triage
- Simple Triage and Rapid Treatment (START)
| - Sort, Assess, Lifesaving Interventions, Treatment, and/or Transport (SALT)
66
START
- Anyone who can walk = fine
- Anyone who is not breathing - will they breathe if we position their air way? no = dead; if they do breathe if airway is positioned they need immediate medical intervention
*if dead leave them
***do NOT code
67
SALT
- Will break down who you will assess first
- WILL code in this one
* if dead leave them!
* If they can walk = walk to hospital
Goal : is to help as many people as possible
68
Anthrax: inhalation
- Clinical manifestation
- Transmission
- tx
- Abrupt onset; dyspnea, fever, cough, wide mediastinum
- Direct contact with bacteria and spores
- ABX, effective only if treated early (Cipro)
69
Cutaneous
| -Clinical manifestations
Small papule resembles insect bite, advances to depressed black ulcer; swollen lymph nodes, edema
70
GI: ingested of contaminated/ undercook meat
| -Clinical manifestations
- N/V
- Anorexia
- Hematemesis
- Diarrhea
- abdominal pain
- Ascites
- Sepsis
71
Small pox
- Clinical manifestations
- Transmission
- tx
- Sudden onset of symptoms: fever, myalgia, lesions that progress from macules to papules
- Direct person-to-person, air droplets, handling contaminated materials
- No known cure, vaccine for those exposed
72
Botulism
- Clinical Manifestations
- Transmission
- Tx
- Abdominal cramps, N/V/D, cranial nerve palsies, skeletal muscle paralysis, respiratory failure
- Spread through air or food, improperly canned foods, contaminated wound
- Induce vomiting, enemas, antitoxin, mechanical ventilation, PCN
