Module 5 - Medical Emergencies I Flashcards
Identify the age ranges associated with the following terms:
Neonate, Infant, Toddler,
Pre-schooler, School age, Adolescent, Early adulthood, Middle adulthood, and Late
adulthood
Neonate : birth - 1 month
Infant: 1 month- 1 year
Toddler: 1-3 yo
Pre-schooler: 3-5 yo
School aged: 6-11 yo
Adolescent: 12-19 yo
Early adulthood: 20-40
Middle adulthood: 41-60
Late adulthood: 61
What are some chronic changes in elderly patients that may affect Chief Complaint, Mental Status, and the ABCs?
- Respiratory system changes diminish ability to cough, lung capacity, and gas exchange
- memory problems
- Cardiovascular system changes increase the myocardial workload
- depression, isolation and loss of independence can affect mental status
What are the 4 essential features & associated aspects of PTSD?
- Response:
veteran responds to the experience with feelings of anger, fear, horror, and helplessness
- Reliving:
Flashbacks, unwanted thoughts or nightmares
- Avoiding:
PT avoids anything that reminds them of the event
- Anxiety/hyperarousal:
Being on constant hypervigilance. When activated causes “Flight or Fight”
List the signs and symptoms of respiratory distress in pediatrics versus respiratory
failure.
Respiratory Distress:
- Normal appearance
- Normal Circulation to skin
- abnormal work of breathing
Respiratory Failure:
- Abnormal appearance and work of breathing
- normal or abnormal circulation to skin
Describe the anatomy of menstrual cycle :
- Cycle last 24-35 days with a average of 28 days
- Day 1 begans with menustration
- blood loss over 3-5 days is 60-80 mL
- Day 14: Ovalulation occurs and egg is released
- The egg takes 5-7 days to travel to the fallopian tubes and implants itself in the uterus
- Fertilization of the ovum typically occurs in last third of fallopian tube
- If not fertizilized, it is discharged with lining 14 days after ovulation
Describe the stages of labor:
1st Stage: Dilation Phase
- Most painful stage for mother and baby.
- Longest and hardest stage.
- Cervix begins to dilate and Uterus is contracting
- contractions start at 5-30 minutes apart
- contractions become 3-5 minutes
2nd Stage of labor: Expulsion Phase
- Shortest stage of labor
- Mother is fully dilated and baby will be crowning
- Contractions are 2-3 minutes apart (60-90 seconds each)
- Baby will be delivered
3rd Stage of Labor: Placenta Phase
- Once baby is done, placenta will detach from uterine wall and be expelled
- Happens within 5-20 minutes after birth of baby
Signs: - Increase bleeding in vagina
- uterus becomes smaller in size
- umbilical cord begins to lengthen
- Mother has urge to push to again
Describe the steps of assisting with a normal prehospital obstetric
deliver:
- Select a suitable location away from public view (first Surface PT can lay on)
- administer oxygen (2-4 lpm nasal cannula)
- Have the PT lay on her back with knees drawn up and spread apart
- Place towels under PT buttocks
- As head begins to emerge, apply gentle pressure with a gloved hand to prevent explosive delivery
- Support the head as it exits the vaginal canal
- Once head is out, instruct PT to stop pushing
- Inspect baby’s neck to make sure umbilical cord is not wrapped around the neck (nuchal cord)
- Suction airway only if obvious obstruction exist
- Instruct PT to began pushing again
- As the shoulders and full body is delivered, support baby with both hands
- DO NOT pull on umbilical cord
- Dry, wrap, and warm baby
- Clamp umbilical cord, Approximately 6 inches away from baby’s abdomen and again at 3 inches part first clamp
- Once cord has stopped pulsating, cut cord between clamps
- Observe for delivery of the placenta
- If placenta delivers, transport it with PT to hospital
- Place sanitary pad over vagina opening
- Record time of birth and transport to hospital
Define gravida and para:
Gravida:
Refers to # of times a PT has been pregnant
Para:
Refers to # of times PT has given birth (after 20 weeks)
Describe palliative care in regards to hospice:
specialized medical care that focuses on providing relief from pain and other symptoms rather than cure it
What is antepartum emergency?
emergencies are those that occur in the pregnant patient prior to the onset of labor
What are the 7 different types of Antepartum Emergencies?
- Spontaneous abortion
- Placenta Previa
- Abruptio placentae
- Rupture uterus
- Ectopic pregnancy
- Preeclampsia
- Supine hypotensive syndrome
What is the cause and findings of Spontaneous Abortion?
“Miscarriage”
Cause:
Delivery of the fetus and placenta before it is viable
Findings:
- Cramp like abdominal pain
- vaginal bleeding
- passage of tissue and blood clots
What is the treatment of Spontaneous Abortion?
- ABC’s
- Place a pad over vaginal opening
- Treat for shock
- Transport on her side
- Ask patient when last menstrual period began
- Emotional support
What is the cause and findings of Placental Previa?
Cause: Abnormal implantation of the placenta over or near the opening of the cervix
Findings:
- predisposing factors:
- Multiparity
- age 35 and up
- Previous placenta previa
- History of vaginal bleeding
- Bleeding after intercourse
- 3rd trimester painless bleeding
List and describe the 3 classifications Placental Previa may be listed as and
- Total: placenta completely covers cervical opening and blocks birth canal
- Partial: Placenta partially covers cervical opening
- Marginal : Placenta is implanted near neck of cervix and may tear
What is the cause and findings of Abruptio Placentae?
Cause:
- Separation of the placenta from the uterine wall prior to birth of baby
Findings:
- Abdominal pain
- Vaginal bleeding
- Uterine contractions
- Abdominal tenderness on palpation
- Signs of hypovolemic shock
- NOTE: Bleeding may not be visible if unable to exit uterus
Treatment:
- ABCs and prn O2
- sanitary pad
- Place PT on side
- treat for shock
What is the treatment of Abruptio Placentae, ruptured uterus, ectopic pregnancy, placenta previa ?
- ABC’s
- Place pad of vagina
- Treat for shock
- Transport of her side
What is the cause and findings of Ruptured Uterus?
Cause:
- Uterus tears as it enlarges during pregnancy possibly release fetus into abdominal cavity
Findings:
- Vaginal bleeding
- Tearing, sever abdominal pain
- Sings of hypovolemic shock
- Cessation of uterine contractions
- Ability to palpate the infant in the abdominal cavity
What is the cause and findings of Ectopic Pregnancy?
Cause:
- Fertilized egg implants somewhere other then the uterus
- symptoms occur within 4-8 weeks of conception
Predisposing factors:
- Previous ectopic pregnancies
- Pelvic inflammatory disease
- Adhesions from surgery
- Tubal surgery
- Intrauterine device use
assessment findings:
- vaginal bleeding
- poorly localized pain that becomes sudden and sharp
- abdominal pain that radiates to shoulder
- Bloating
- Signs of shock
- Discoloration around navel
What is the cause and findings of Preeclampsia?
Causes:
- Multisystem disorder not well understood
- Characterized by High blood pressure and swelling in extremities
Findings:
- abdominal pain
- History of hypotension
- Sudden weight gain
- Altered mental status
- Blurred vision
- Excessive swelling in the face, fingers, legs or feet
- Severe headache
- Elevated blood pressure
What is the treatment of Preeclampsia?
- ABC’s
- Transport on her side
- Be prepared to suction or to ventilate patient if needed
What is the cause and S/S of Supine Hypotensive Syndrome?
Causes:
- Complication late in pregnancy due to weight of fetus compressing the inferior vena cava when patient is lying supine
S/S:
- Dizziness or light headiness
- Decrease in blood pressure
- Tachycardia
- Pale, cool, clammy skin
What is the treatment of Supine Hypotensive Syndrome?
Transport patient either seated, on her side, or elevate her right hip if lying supine
When cutting the umbilical cord , it should be cut ____inches from the infant.
6 inches
What signs indicate delivery is going to happen within a few minutes?
- Crowning
- Contractions, every 2 minutes apart or less
- Urge to defecate
- Strong urge to push
List the 10 types of Abnormal Deliveries:
- Prolapsed cord
- Breech/Limb presentation
- Multiple Births
- Meconium Staining
- Premature Birth
- Post-Term Pregnancy
- Precipitous Delivery
- Shoulder Dystocia
- Pre-Term Labor
- Premature Rupture of membranes
What is the treatment of Prolapsed Cord?
- ABC’s and O2 prn
- Place PT in “Knee-chest” or supine position with hips elevated
- Insert Gloved hand into vaginal canal to remove pressure on the cord (It should be pulsating)
- Keep cord moist with wet to dry dressing
- Immediate transport
What is the Explanation and treatment of Breech/Limb Presentation?
- When arm/leg or buttock is first instead of head through birth canal
Findings:
- Buttocks or arm/leg presentation
- Position mother in “Knee-chest” position, pelvis elevated
- Insert gloved hand into vaginal canal to create space for respirations if the head cannot be delivered
- Immediate transport
- Avoid field delivery and mother not to push
What is the treatment of Multiple Births??
- ABC’s and O2 prn
- Same guidelines as normal birth, except if additional infant has delivered within 10 minutes immediately
- consider requesting back, to assist with additional patient(s)
What is the Explanation and findings of Meconium Staining?
- Fecal material in the amniotic fluid
- indicates fetal stress (hypoxic event) during gestation or delivery
Findings:
- Greenish to brownish amniotic fluid
What is the treatment of Meconium Staining?
- ABC’s and O2 prn
- Suction if meconium is present in infant’s airway or if infant is depressed prior to drying to stimulation
What is the Explanation and findings of Premature Birth?
Explanation:
- Delivery of an infant before 37th week of gestation or
- Neonate weighing less then 5 pounds
What is the treatment of Premature Birth?
Treatment:
- ABC’s and O2 prn
- Keep infant Warm
What is the Explanation and findings of Post-Term Pregnancy?
Explanation:
- Gestation extend past 42 weeks
- potential for decline in suitable environment for fetus
Findings:
- Increased risk of hypoxic incident
- difficult delivery
- meconium staining
What is the treatment of Post-Term Pregnancy?
Provide same care as normal delivery
What is the Explanation and findings of Precipitous Delivery?
Explanation:
- Birth of fetus in less then 3 hours
Findings:
- Increased risk of trauma to the fetus and mother
What is the treatment of Precipitous Delivery?
Provide same care as normal delivery
What is the Explanation and findings of Shoulder Dystocia?
Explanation:
- Fetal shoulders are larger then head caused a “Turtle sign” presentation
- upper shoulder cannot pass through pelvic opening
Findings:
- Difficulty in delivery of chin or head
- Baby fails to rotate
- Turtle neck
What is the treatment of Shoulder Dystocia?
- Place mother in McRobert’s Position
- Attempt normal delivery
Define Pre-Term labor:
Explanation:
- Onset of labor prior to 37th week of gestation
What is the treatment of Pre-Term labor?
- Keep mom calm and prevent mother from pushing
- Immediate transport
What is the Explanation and findings of Premature Rupture of membranes?
Explanation:
- Spontaneous Rupture of amniotic sac prior to onset of labor and the end of 37th week gestation
- Increase risk of infection to infant
What is the treatment of Premature Rupture of membranes?
- Keep mom calm and prevent mother from pushing
- Immediate transport
What are the two types of postpartum complications?
- Postpartum Hemorrhage
- Embolism
What is the Explanation and findings of Postpartum Hemorrhage?
Explanation:
- Blood loss of more then 500 ml following delivery
-Most often seen in multigravida patients or delivery of large baby - Caused by Uterus failing to regain its muscle tone
What is the Treatment of Postpartum Hemorrhage?
- O2 therapy
- Allowing baby to nurse on mothers breast
(Stimulates and causes release of oxytocin which causes uterine contractions) - Fundal massage (Place palm of hand just above the symphysis pubis and apply pressure in a circular or kneading motion)
- Immediate Transport
What is the Explanation and findings of Pulmonary Embolism (PE)?
a medical condition where a blood clot (embolus) travels to the lungs and blocks one or more pulmonary arteries
Findings:
- Sudden Shortness of breath
- cough, may produce blood
- sharp chest pain
- Edema
- dizziness
- pale, cool, clammy skin
What is the Treatment of Embolism?
- Managing ABC’s
- Provide O2 at 15 lpm NRB
- If ventilations are inadequate, provide PPV
- Expedite transport to hospital
Explain PT who has Gravida of 2, Para 1
PT has been pregnant two times but only given birth once
Describe what interventions would be needed if the neonate upon birth HR is between 60-100 and below 60?
- Between 60-100: Administer supplemental O2
- Below 60: Start chest compressions
What is the normal pulse rate for a Newborn child?
Between 100-180 BPM
What is the sequence of events that follow the delivery of a neonate?
- Delivery the child
- Suction the airway
- Cut Umbilical cord
- Dry the infant
- Calculate the first APGAR score
What is the 4 terms associated with newborns?
- Newly born:
At time of birth - New born:
Within first few hours of birth - neonate:
Within 28-20 days after birth - Infant:
28-30 days - 1 year
What is the APGAR score and what’s does it stand for ?
An Apgar score is a clinical assessment of a newborn’s health condition within minutes after birth. Measures 5 characteristics:
A - Appearance
P - Pulse
G - Grimmace
A - Activity
R - Respirations
What is the order of interventions for a new born ?
- Suction, dry, warm, stimulate, position
- Oxygen
- BVM ventilation
- Chest compression
- Beyond the scope of care
What is the compression rate for a neonate?
Compression is 3:1
What are the potential signs of malfunction in a CSF Shunt:
- Irritability
- Increased sleep
- Nausea and vomiting
- Fever
- Headache
- Blurred vision
- Seizures
- Altered mental status
- Signs of increasing ICP (Bradycardia, abnormal respiratory patterns)
What are the differences with pediatric airways:
- Head: In the supine position, a young child’s head will cause a natural flexion of the neck due to its large size. This neck flexion can create a potential airway obstruction.
- tongue is proportionally larger in the mouth then adults
Larynx: a child larynx is higher up than in an adult, creating a more anterior location - Epiglottis: The adult epiglottis is flat and flexible, while a child’s is U-shaped, shorter and stiffer
- Vocal cords: The anterior attachment of a pediatric patient’s vocal cords is lower than the posterior attachment, which creates an upward slant, whereas in adults, the vocal cords are horizontal
- Trachea: The trachea is shorter in pediatric patients, which increases the likelihood of right mainstem intubation.
- Cartilage of upper airway and trachea are softer
- Airway diameter: A child’s airway is narrowest at the cricoid ring.
-Residual lung capacity: Smaller lung capacity in pediatric patients means that a child can become hypoxic more quickly than an adult
What are the 4 guidelines from the CDC that state the MOI are a serious injury:
- Falls from over 10 feet or 2-3X times the height of the child
- Auto vs Pedestrian or bicyclist
- Motorcycle crashes at over 20 MPH
- High risk auto crashes: (ejection, Death of other occupant in same vehicle)
What is the Pediatric Assessment Triangle or “PAT” and its 3 main elements:
Hands off evaluation conducted entirely through visual observation of patients behaviors involving 3 elements:
- appearance
- work of breathing
- circulation
Under appearance in the “PAT” triangle, what is the “ticls” pneumonic :
T- Tone (how the child looks)
I - Interactiveness ( are they alert and interactive)
C - Consolability
L - Look /glaze
S - Speech or cry
What are the different Respiratory Rates for Infant, Toddler, Preschooler, School-age, and Adolescent:
Infant: 30-60 breaths per min.
Toddler : 24-40 breaths per min.
Preschooler: 22- 34 bpm
School-age : 18-30 bpm
Adolescent: 12-16 bpm
What are the different Pulse Rates for Infant, Toddler, Preschooler, School-age, and Adolescent:
Infant: 100-160 BPM
Toddler : 90-150 BPM
Preschooler: 80-140 BPM
School-age : 70-120 BPM
Adolescent: 60-100 BPM
How long should the capillary refill take in a child?
2-3 seconds
What vital signs are apart of the secondary assessment with pediatrics?
- Measured level of consciousness
- Skin findings
- Pulse rate and quality
- Breath rate and quality
- Blood pressure (3 YO and older)
- Pupillary response
- Temperature
- Quantitated measure of pain
- Pulse ox, end-tidal CO2, blood glucose, cardiac rhythm monitor if needed
What are the pulse Oximeter values for normal rate, mild, moderate and severe hypoxemia?
95-99 % :normal
91-94% : mild hypoxemia
86-90% : Moderate hypoxemia
<86% : severe hypoxemia
What are the two different type of pain assessment scales
Wong- baker faces scale : Faces are used to describe pain
Flacc scale : used for younger then 4 Yo
What is the Wong-Baker scale?
Pain scale that is meant for 4-12 yo using faces and numbers for pain
What is the FLACC scale?
Faces, Legs, Arms, Cry , Consolablity scale is used for PT under 4 yo old to determine the pain of the PT
What are the common Pediatric medical conditions?
- Croup
- Epiglottitis
- Asthma
- Bronchiolitis
- Pneumonia
- Congenital Hearth Disease
- Shock
- Cardiac Arrest
What is Croup? Signs and symptoms?
Croup - Common infection of the upper airway in children between 6 mo. - 4 yo
S/S: PT Sounds Hoarse and harsh “seal bark, Stridor upon inhalation, nasal flaring, tachycardia and cyanosis
What is Epiglottitis? Signs and symptoms?
Life threatening condition caused by bacterial infection of the epiglottis accompanied by rapid onset and high fever
S/S:
- Pain when swallowing
- High fever >102 F
- Drooling
- Tripod position
- Chin thrust forward
- Stridor
- Respiratory distress
What is Asthma? Signs and symptoms? Emergency care
a chronic lung condition that causes inflammation and narrowing of the airways, making it difficult to breathe
S/S:
- Wheezing
- Shortness of breath
- nonreproductive cough
- Tripod position
Emergency Care:
- Administer O2
- May need medication with severe attacks
(Albeuterol & Ipratropium)
What is Bronchiolitis? Signs and symptoms? Emergency Care?
Viral infection that is common in young children and infants that causes swelling and buildup of mucus in the small airways
S/S:
- Low grade fever
- Tachycardia
- Shortness of breath
- Wheezing
- Coughing
Emergency Care:
- Administer O2
- Position of comfort
What is Pneumonia? Signs and symptoms? Emergency care?
lung infection that causes the air sacs in the lungs to fill with fluid or pus, making breathing difficult
- Shortness of breath
- chest tightness
- diminished chest sounds
- Dry, Hacking, productive-sounding cough
- Tendency for child to lie on their side
Emergency Care:
- administer O2
- Position of comfort
What is Congenital Heart Defect? Signs and symptoms? Emergency care?
problem with the structure of the heart that is present at birth
S/S:
- cyanosis
- hypoxia
- shock
- Respiratory distress
What is Febrile Seizures?
Seizures that are result of a quick spike of fever
- common of children less then 6 yo.
What is emergency care for seizures?
- Maintain open airway
- administer O2
- Position PT on their side
- Transport
What is the emergency care for altered mental status?
- Maintain open airway
- administer O2
- Put PT on side and prepare to suction
- Transport
What is the mammalian dive reflex?
Response from the body in cold water that allows blood perfusion and metabolism to slow down thus allowing oxygen to stay in the body longer for brain and vital organs to use .
What are some wanting signs of meningitis?
A recent ear or respiratory tract infection
High fever
Lethargy and irritability
Vomiting
Loss of appetite
Bulging fontanelle unless the child is dehydrated
Pain on movement (infants crying when picked up)
Rash may or may not be present
What is Gastroenteritis?
Gastroenteritis is an infection of the gastrointestinal tract that is a leading cause of diarrhea in children
What are the S/S of appendicitis?
- Nausea and vomiting
- Low grade fever
- Diffuse cramping pain around the umbilicus
- Localized pain to the right lower quadrant
What is “BRUE” and the S/S of it ?
“BRUE” = Brief resolved unexplained events.
Describes a brief but now resolved event in a infant
S/S:
- Infant <1 yo
- Cyanosis or pallor
- Breathing that is irregular, decreased or absent
- Changes in muscle tone (flaccid or limp)
- Altered level of consciousness
What is the narrowest portion of the pediatric airway?
Cricoid cartilage
What is hypovolemia?
Hypovolemia is a condition where the body has a low volume of circulating fluids, such as blood, water, or lymphatic fluid
What are the S/S of hypovolemia?
Weakness
fatigue
dizziness
increased thirst
low blood pressure
high heart rate
little to no urine production
Explain the difference between the airway anatomy in a child and an adult?
- Head: In the supine position, a young child’s head will cause a natural flexion of the neck due to its large size. This neck flexion can create a potential airway obstruction.
- Tongue is proportionally larger in the mouth then adults
- Larynx: a child larynx is higher up than in an adult, creating a more anterior location
- Epiglottis: The adult epiglottis is flat and flexible, while a child’s is U-shaped, shorter and stiffer
- Vocal cords: The anterior attachment of a pediatric patient’s vocal cords is lower than the posterior attachment, which creates an upward slant, whereas in adults, the vocal cords are horizontal
- Trachea: The trachea is shorter in pediatric patients, which increases the likelihood of right mainstem intubation.
-Airway diameter: A child’s airway is narrowest at the cricoid ring.
-Residual lung capacity: Smaller lung capacity in pediatric PT
What Antepartum emergencies occur in the 1st and 3rd trimester?
- 1st Trimester:
Spontaneous abortion and ectopic pregnancy
- 3rd Trimester:
Placenta previa and Abruptio Placentae
Define Intrapartum Emergency:
is one that occurs during the period from the onset of labor to the actual delivery of the newborn.
Define prolapsed cord and treatment:
When the umbilical cord rather then the head of the fetus is the part to protrude from the vagina
Treatment:
- Instruct PT not to push
- Administer high concentration of O2 to PT via NRM
- Position PT on stretcher in “Knee-chest” position
- Cover the umbilical cord with sterile dressing moistened with a sterile saline solution
- Transport PT immediately while maintaining pressure off of cord
What are the 3 types of breech presentations?
- Frank breech:
Hips are flexed and knees are extended
- Complete Breech:
Hips and knees are flexed
- Incomplete breech:
Hips are flexed and either one or both feet are the presenting part
What are the 5 different Presentations in birth?
- Face presentation
- Brow presentation
- Chin presentation
- Compound presentation (head or butt with arm or leg)
- Limb Presentation
What two conditions should you not deliver a baby in the field
With breech or one of the 5 presentations (chin, brow, face, compound, limb, compound)
What is shoulder dystocia and the Treatment?
- when the shoulders are bigger then the head and the head delivers but shoulders are caught between the symphysis pubis and sacrum
Treatment:
- Place PT in McRoberts position
- if McRoberts doesnt work apply suprapubic pressure
- If neither dont work, Contact medical direction ( may be instructed to do Gaskin Maneauver)
- IF above steps dont work, must began emergency transport
(Instruct PT not to push)
What are the 4 signs of imminent delivery?
- Urge to push
- urge to deficate
- Crowning or other presentation in vaginal opening
- Mothers sense of imminent delivery
What are the 3 signs of true active labor
- contractions that increase in duration and frequency
- Membrane rupture (water breaks)
- Expulsion of the mucous plug (bloody show)
What is postpartum hemmoraging?
Blood loss of 500 mL or greater following delivery
What are the 3 postpartum complications?
- Postpartum hemorrhaging
- Pulmonary embolism
- Amniotic fluid embolism (AFE)
Interventions That Should be Conducted Within One Minute After Delivery:
- If Heart rate is >100 bpm, assess SpO2, tidal rate and volume
- Heart rate <100 bpm, immediately suction airway and began PPV (add oxygen and titrate until SpO2 met)
- If Heart rate is <60 bpm, immediately began chest compressions with PPV with O2 attached until SpO2 is met and reassess
With dialysis PT’s, you should never do a Blood pressure on …..
Any extremity that has a AV shunt, AV fistula, AV graft
Compare and contrast PE with myocardial infarction:
PE:
- Sudden chest of breath even when resting
- chest pain feels like sharp and stabbing
- chest pain worsens with exertion or deep breathing
MI:
- shortness of breath
- chest pain feels like squeezing, pressure, tighteness
- chest pain worsens over time and doesn’t not improve with rest
- pain radiates to arm, shoulder, back, neck
- nausea, indigestion, fatigue
