Medical Emergency Flashcards
cardiac and respiratory arrest
if outside hospital –> activate EMS (fire or police department and paramedics)
if in hospital –> cal code blue
chest compressions should maintain 100-120/minute
CPR must be initiated within 3-5 minutes after a cardiac or respiratory arrest
cardiac and respiratory arrest hand placement
child: 2 hands on the lower half of the sternum
adult: same as child
infant: place 2 fingers just below the baby’s nipple line
cardiac and respiratory arrest chest compressions depth
adults: at least 2 inches (5cm)
child: half the childs anterior-posterior diameter or about 2 inches (5 cm)
infant: at least one quarter of the anterior-posterior diameter or about 1.5 inches (4 cm)
interruptions should not last longer than 10 seconds
allow for complete recoil between compressions
should rotate who administers every 2 minutes
effective CPR requires you to maintain an open airway and so do the head tilt-chin lift method
head tile-chin lift method
place one hand on the clients forehead and push with the palm to tilt the head back
if facial trauma is evident or a spinal cord injury is suspected, perform jaw thrust method
compressions to ventilation ratio
adult: 30:2
child and infant:
- 30:2 with a single rescuer
- 15:2 with 2 rescuers
deliver air over one seond and watch clients chest wallrise
ventilation with an advanced airway will be performed at one breath every 6-8 seconds
AED
to use it: turn on and attach pads for adults, use adult-size pads for children and infants: - use adult size pads ONLY WHEN children/infant pads are not available
upper airway obstruction interventions
death can occur within 4-5 min
if conscious:
- 5 back blows between the shoulder blades with the heel of the hands
- 5 abdominal thrusts
- alternate until blockage is dislodged
if unconscious:
- begin CPR
- remove the object if it becomes visible
if airway intubation is needed:
- nurse will assist with placement of artifical airway using endotracheal tube or tracheostomy and suction as needed
opioid-associated respiratory emergency
if they have a definite pulse, but no normal reathing or only gasping respirations then,
an approximately trained person (police officer, mental health professional) should administer naloxone IM or nasally without waiting for EMS to arrive
upper airway obstruction for child manifestations
sudden coughing gagging wheezing cyanosis dyspnea stridor
upper airway obstruction for child diagnostic studies
chest x ray
fluroscopy
bronchoscopy
upper airway obstruction for child care
direct laryngoscope and bronchoscopy may be require to remove objects
upper airway obstruction for child management
recognize signs and symptoms of foreign body aspiration
administer back slaps and chest thrusts
perform heimleich maneuvers for children
items most likely to be aspirated in children
peanut butter
balloon
aluminum tabs from soda cans
paper clips
what is acute respiratory failure
not a disease but a symptom
hypoxemic respiratory failure = PaO2 level less than 60 mmHg
hypercapneic respiratory failure = PaCO2 level above 45 and pH less than 7.35
causes of acute respiratory failure
extrapulmonary causes:
- neuromuscular and musculoskeletal disorders
- CNS dysfunction (stroke, opioids)
intrapulmonary causes:
- COPD
- pulmonary embolism
- pulmonary edema
- ARDs
- pneumothorax
acute respiratory failure manifestation
restlessness confusion dyspnea orthopnea tachypnea tachycardia decreased pulse oximetry reading ABG shoes: - pH below 7.35 - PaCO2 greater than 5- PaO2 less than 60
hypoxemia that persist even when 100% oxygen is given is a cardinal feature of respiratory failure due to ARDs
acute respiratory failure diagnostic studies
physical examination
ABG
chest x ray
acute respiratory failure management
administration of high flow oxygen until PaO2 or oxygentation saturation is greater than 80 and 90%
intubation and mechanical ventilation
administer meds for VTE and stress ulcer prophylaxis
administer anxiolytics with caution to avoid CNS depression and worsen hypoventilation
acute myocardial infarction manifestation
chest pain that is severe, curshing and unrelieved by rest
pain may radiate to one or both arms, the jaw, neck or back
palpitations
nausea, vomiting and indigestion (heartburn)
apprehension, anxiety, restlessness “feeling of doom”
shortness of breath, crackles on auscultation
myocardial infarction management
immediately stop activity that the client is doing
administer oxygen
administer nitrates
depending on setting, activate EMS
before giving nitrates, verify that the client did not take any phosphodietsterase inhibitors for erectile dysfunction like: sildenail, tadalfil, or vardenafil within the past 24-48 hours
how to communicate with client information to rapid response team
situation - why the client is hosptialized and significant findings
allergies
meds
past med history
last meal
event - describe what happens and why RRT was called
shock initial stage
slight decrease in MAP of 5-10 from clients baseline
shock nonprogressive stage
decrease in MAP of 10-15
shock progressive stage
decrease in MAP of greater than 20 and worsening acidosis
shock refractory stage
severe hypotension
types of shock
cardiogenic shock hypovolemic shock distributive shock, that includes: - anaphylactic shock - septic - spinal - neurogenic - burns
what is neurogenic shock
decrease in tissue perfusion where cells that make up our organs and tissue dont receive enough oxygen
type of distributive shock
neurogenic shock causes
spinal cord injuries that are located cervical or upper thoracic locations
drugs that affect ANS and SNS
spinal anesthesia
neurogenic shock manifestation
hypotension
bradycardia
hypothermia
warm/dry extremities but cold body
neurogenic shock interventions
manage patients ABC and spine
protect spin by keeping imobilized
may need intubation and mechanical ventilation
maintain tissue perfusion
- want MAP to be 85-90
give IV fluids
- crystalloids (NaC; 0.9%, LR)
give vasopressors
- dopamine
if they are bradycardic then give atropine
give rewarming devices for hypothermia
put in foely
- want urinary output 30 cc/hr or higher
prevent DVT
- apply compressions stockings, ROM, anticoagulatns
avoid crossing pt legs, or placing pillow under patient’s kneeds
what is anaphylactic shock
due to the release of histamines and other chemicals from allergies, they decrease tissue perfusion caushing shock
anaphylactic shock manifestation
respiratory: dyspnea wheezing swelling of upper airways can't speak couhging stuffy nose watery eyes
cardiac;
tachycardiac
hypotension
GI:
nausea
vomiting
diarrhea
skin:
red, swollen, itchy hives
anaphylactic shock interventions
remove allergen
manage airway with high flow oxygen and continuous vital sign
call rapid response and start CPR if needed
trendelenburg position
first line of drug: epinephrine
administer IV fluids, albuterol, diphenhydramine and ranitidine
stay and monitor patient closely
teach
- the use of epi pen
- massage the injection site for 10 seconds
what is septic shock
characterized by: persisten hypotension that doesn't respond to fluids needs vasopressors (norepinepherine) to maintain MAP >65 serum lactate >2
septic shock manifestations
early phase: low BP warm/flushed skin hyperthermia high cardiac output low SVR tachycardia high respiratory rate lethargic/anxious
late stage: skin pale, cold, clammy severe hypotension increased HR hypothermia decreased cardiac output and increased SVR oliguria - less than 30 cc/hr coma
septic shock interventions
start broad spectrum antibiotics
enteral nutrition
protein actiavated C “drotrecogin alpha”
titrate vasopressors
inotropics may be added with vasopressors
crystalloids or colloids
-albumin, hetastarch
do this first, but if not working then do vasopressors
steroids low dose
hemodynamic monitoring
oxygenate >95%
obtain cultures before antibiotics
keep glucose <180
hypovolemic shock manifestations
tachycardiac hypotension cool/clammy skin weark peripheral pulses anxiety decreased urinary output decreased central venous pressure
hypovolemic shock intervention
monitor oxygen and perfusion
obtain IV access
-at least 2 sites that are large
- 18 gauge or bigger in large vein
collect labs:
- hgb, hct
- lactate
- ABGs
- electrolytes
- BUN, Cr
administer normal saline or LR
administer albumin, Hetastarch
warm IV fluids
administer blood products:
- PRBCs
PLTs
- FFP
what is cardiogenic shock
heart cannot pump enough blood to meet perfusion needs of the body
main cause: acute myocardial infarction
cardiogenic shock manifestation
pulmonary congestion crackles, dyspnea increased respiratory rate decreased oxygen increased heart rate distended neck veins chest pain hypotension weak peripheral pulses confusion, agitation, restlessness <30ml/hr urinary output decreased capillary refill cool, pale, clammy skin
cardiogenic shock interventions
get cardiac markers
- increased troponin, increased BN{P
pulmonary artery pressure
- in cardiogenic shock it will be >18
- normal is 4-12
increased central venous pressure
meds: - furosemide - norepinephrine - dobutamine, dopamine nitroglycerin or sodium nitroprusside
