Triaging,initial Assessment Of Medically Ill Patients Flashcards
What is an emergency,what is emergency medicine
What is the aim of emergency medicine
What Is triaging
An emergency is anything that’ll cause anyone to come to you for your attention
So when they come you determine what kind of emergency
Emergency medicine is a branch of medicine that seeks to take care of patients who are acutely Ill
Aim of emergency medicine is to stop patients from dying so others can manage them long term
Triaging is a reliable way of sorting out patients into their level of acuity so you can see them in order of which is more pressing
Triage is derived from the French trier, meaning ‘to sort or sieve’. In medicine, this is the process of sorting patients in order of priority for treatment and evacuation.
Case scenario:
A 65yr old hypertensive patient w headache and neck pain
A 50 yr old woman w left breast pain
A 35yr old involved in an RTA w chest pain and breathlessness
Which will you treat first
How will you determine who you treat first
Patient w headache and neck pain has subarachnoid bleeding
Has a stroke
The guy has a pneumothorax
But the woman won’t die of the pain
In the case of a mass casualty what should be your aim?
What triaging tool is used in ghana
State some diseases that can score red
Why is facial burns red patient?
What are the features of a facial burns patient
Why will you not leave a patient alone after correcting hypoglycemia in a patient ?
What should you do then after correcting it?
If a diabetic who takes her medications regularly and eats well or eats the usual diet gets hypoglycemia where is the problem coming from?
What must you do for the person
Hypoglycemia can present as stroke. How will you see it?
To save as many as can be saved
Not to save the most Ill patient or sickest patient
South African triage score
Cardiac arrest
Airway obstruction
Facial burns probably due to a gas explosion
Hypoglycemia especially in a patient on oral medications
The face is what everyone sees so everything must be done to take care of your face
This is because the airway can be compromised (assume it)
The airway can swell from inhalation of the steam or heat
Hair in nose is burnt
Cough out soot
Voice changes if person is female the person talks like a male
Hypoglycemic agents stay longer in the blood so after correcting the hypoglycemia don’t assume all is well else patient will come back w hypoglycemia because when you give glucose your insulin level spikes up and eats the glucose in the body while the insulin level is still high
So when you give glucose to someone w hypoglycemia it increases the persons likelihood of getting hypoglycemia if maintenance treatment isn’t given
So after correcting it ,make patient eat a complex diet or give the 15mins thing
There’s a problem w the kidneys
Cuz the kidneys metabolize insulin and the liver as well so when there’s diabetic nephropathy the kidneys have reduced rate of metabolising insulin so there’s more insulin in the blood increasing patients chance of getting hypoglycemia so you must do RFT to check the kidneys before making person go home
Patient will present w hemiparesis and you’re thinking they have a stroke but when you check RBS it’s very low
Once you correct the sugar level,the stroke will go or the symptoms will resolve or disappear
So make sure anyone who comes w stroke doesn’t have hypoglycemia cuz it can cause patient to come w stroke
What are orange cases
Give example of cases that are orange
Why is chest pain orange ?
What’s the max time to see a patient under orange
What are yellow cases
What’s the max time you have to see a patient under yellow
Any case that isn’t red
Chest pain
Breathlessness
Cuz a chest pain can be a Myocardial infarction
An MI will not kill you immediately but it’ll kill you eventually
So do the evaluation for MI (ECG and troponins)
Within ten minutes
Yellow cases are patients who can’t go home but aren’t OPD
See patient within an hour
Ten minutes
A patients condition Is dynamic
A patient under yellow May not stay yellow
Patient can suddenly become red
True or false
In the context of a mass casualty incidence
What must youo do
Which triage is used for mass casualty
Which three things should be carried out under this type of triage
A Respiratory rate of how many cpm is considered red?
What are the normal and abnormal values for the three things you’ll look for
All those who pass the assessment under START triage fall under which colour?
Patients who do not pass only one of the assessment (so may pass all and not pass one or may pass two but not pass one) are under which colour)
True
Call for help(ambulance and police service) for them to disconnect electrical stuff,lift heavy things and remove patients to safer places
Count the number of people in the problem
Determine the severity of the illness to decide how much help to bring to them
Use START (simple triage and rapid treatment) triaging for mass casualty
First thing to look out for Is the walking wounded
Using a megaphone,direct all walking wounded to one side
Then use RPM to see which are red or yellow or black
Remember these three things(you have thirty seconds to carry this out)
R-respiratory rate
P-pulse rate or capillary refill
M-mental state
Respiratory rate of thirty cpm more or less than thirty
Pulse whether present or not present
Capillary refill more than two seconds or less than two second
Mental state:patient can obey commands or not
No pulse-black(dead or expectant dead)
Pulse is present(red)
Capillary refill more than two seovnds(red)
Respiratory rate more than thirty is red
All those who pass RPM assessment are yellow cases
All those who pass only one or who don’t pass any of the RPM are red
The START (simple triage and rapid treatment) triage system classifies patients as red/immediate if the patient fits one of the following three criteria: 1) A respiratory rate that's > 30 per minute; 2) Radial pulse is absent, or capillary refill is > 2 seconds(Capillary refill time Normal CRT is 1 to 2 seconds. So less than three seconds is normal) and 3) Patient is unable to follow simple commands.
Then you use this to determine how many people are red or yellow or green
Send red patients to a bigger hospital where they can get adequate resources like CCTH
Then yellow to metro hospital
Green also to
Metro
Initial assessment of the medically ill patient
What is the aim of this?
What is the assessment done
How will you know if a patients airway is compromised or who Has a risk of airway obstruction (if patient is conscious and unconscious)
What do you do when the airway is compromised
Do not blind sweep anyones mouth by putting your finger in the mouth to check while you don’t know if something is there cuz I’m doing so you can cause a complete obstruction
True or false
Airway obstruction can be partial or complete true or false
How do you fix airway obstruction
When are the two types of airway adjuncts used or when will you not want to use it
What happens when you use it for the wrong reasons
Why should you use the appropriate size tube for it
What happens if you use a bigger or a smaller one
How do you size the tube or oropharyngeal airway adjunct
When do you not use the nasopharyngeal airway adjunct ?
What’s the C spine
Which movements does C1,2,3 control
What do you do when you realize the patient has an airway problem and you want to open the airway before you put in adjuncts
In trauma Which airway patency maneuver is the only one done at the bedside
When airway problems return even after airway patency maneuver,give adjuncts true or false
When you give adjuncts and still
,intubate. True or false
To stop patient from dying now
Find out what is killing the patient now and solve it
To buy patient enough time for you to take history and physical exam
A-Airway(An unresponsive or unconscious patient will have decreased muscle tone, allowing the tongue and epiglottis to fall back and obstruct the pharynx and larynx.)
B-breathing(If you see obstructing material, use a McGill forceps or clamp to remove it. If this equipment is not available, slide your index finger down the inside of the cheek to the base of the tongue and dislodge any foreign bodies using a hooking action. Use caution to avoid pushing any obstructing material further down the airway)
C-pulse
D-GCS
E-
Conscious-if patient can’t talk when you ask questions or they can’t complete sentences,if there’s inspiratory stridor (you hear this cuz you’re breathing in and the air isn’t going in cuz the airway is compromised) Stridor, a high-pitched inspiratory sound, may be associated with partial airway obstruction at the level of the larynx (inspiratory stridor) or the trachea (expiratory stridor). Snoring usually indicates partial airway obstruction at the pharyngeal level, while hoarse- ness suggests a laryngeal process. Aphonia in the conscious patient is an extremely worrisome sign; a patient who is too short of breath to speak is in grave danger of impending respiratory collapse.
Drooling especially in kids
Respiratory distress
If the the tongue is covering the airway
If there is bleeding in the nose or if something in the nose has blocked the airway
Airway congestion
Obese patients
Swollen tongues
Vomiting patients
Blunt and penetrating neck injury
Unconscious-assume that the airway is compromised
Suction airway
If unconscious use appropriate airway adjuncts
Oro pharyngeal airway adjunct:
Don’t use in conscious patients
Don’t use in patients w gag reflex or cough reflex else it’ll stimulate laryngospasm or vomiting
Don’t use in a patient whose GCS is above 8
Use in patient whose GCS is less than or equal to 8
The oropharyngeal airway (OPA) is an S-shaped device designed to hold the tongue off the posterior pha- ryngeal wall while providing an air channel and suction conduit through the mouth (Figure 2.6). It is most effective in patients who are spontaneously breathing but lack a gag or cough reflex.
They will gag,retch,aspirate and vomit
Use appropriate sized tube for it
Purpose for putting in oropharyngeal airway adjunct is to remove or pull tongue from oropharynx
The tongue lies on the oropharynx when you become unconscious and covers the airway so you use the oropharyngeal airway adjunct to by pass the tongue
If you I use a big adjunct where will it enter
If you use a small adjunct where will it enter
Nasopharyngeal airway :
When you have nose trauma
Facial trauma
Nose bleeds
Base of skull injury else it’ll enter into the brain
When there’s bleeding in the nose assume there’s a base of skull injury
Use in conscious ,semiconscious or intoxicated patients
Use in patients whose gag reflex or cough reflex are intact but still have airway issues
It is also effective when trauma, trismus (“clenched teeth”) or another obstacle (e.g., wiring of the teeth) pre- clude the placement of an OPA.
Proper NPA length is determined by measuring the distance from the tip of the nose to the tragus of the ear.
The proper OPA size is estimated by placing the OPA’s flange at the corner of the mouth; the distal tip of the device should reach the angle of the jaw.
You need to mobilize the C spine or cervical spine
The cervical spine, or neck, begins at the base of the skull and through a series of seven vertebral segments connects to the thoracic, or chest, region of the spine.(C1 is the atlas,C2 is axis then the C3,4,5,6,7)
Cervical nerves C1, C2 and C3 control your forward, backward and side head and neck movements.
Airway patency maneuver
Head tilt
Chin lift
Jaw thrust :tries to move tongue away from the airway
Jaw thrust is the only one
But in a medically I’ll patient you can do all three but in trauma you can do only jaw thrust
To protect the C spine cuz it may be affected in trauma
Look at the case scenario to determine if it’s a trauma scenario or a medical scenario
Your first vertebra (C1), also called the atlas, is a ring-shaped bone that begins at the base of your skull. It’s named after Atlas, of Greek mythology, who held the world on his shoulders. The atlas holds your head upright. Your second vertebra (C2), also called the axis, allows the atlas to pivot against it for the side-to-side “no” rotation of your head.
True or false
C1-C7 are connected to the skull by a joint called
In trauma why should u be mindful of the C spine(functions of the C spine)
What do you Check for under breathing
State the types of respiratory failure and explain(both wil present w respiratory distress)
Give examples of cases that present as types of respiratory failure
Patient w ventilation problems needs what?
What is the target SpO2 in someone w breathing problem
What is the normal spo2 for a COPD patient and why (this is an example of when oxygen can be toxic)
What do you ask yourself for assessing
breathing
State the oxygen delivery devices,the amount of max oxygen they deliver
State in order of ascending order with regards to the amount of oxygen they deliver
What are the types of positive pressure ventilation
When can’t someone use positive pressure ventilation
Which patients will it be hard to get them to the target spo2
Anytime you are assessing and the patient has a problem at any level,fix it and reasses(start all over again)
Example if patient has airway obstruction and you suction the airway
Go back and reassess if the obstruction is better or not
If it’s gone then move to the next letter
If you’re checking maybe at C and the bp drops or something changes in the patients condition ,start afresh from A to find the problem
True or false
True
Facet joint
Protecting your spinal cord:The nerves of your spinal cord pass through a large hole (called the vertebral foramen) that passes through the center of all of your vertebrae — from the base of your skull through the cervical vertebrae, the thoracic (middle back) vertebrae and ending between the first and second lumbar (lower back) vertebrae. Taken together, all the stacked vertebrae of your spine form a protective central canal that protects your spinal cord.
Supporting your head and allowing movement. :Your cervical spine supports the weight of your head (average weight of 10 to 13 pounds). It also allows your head and neck to tilt forward (flexion), backward (extension), turn from side to side (rotation) or bend to one side (ear-to-shoulder; lateral flexion).
Providing a safe passageway for vertebral arteries:Small holes in cervical spine vertebrae C1 to C6 provide a protective pathway for vertebral arteries to carry blood to your brain. This is the only section of vertebrae in the entire spine that contains holes in the bone to allow arteries to pass through.
other words, because the T1-T5 segments of the spinal cord control heart rate, individuals with cervical or high-thoracic spinal cord injury may sustain cardiac dysfunctions such as tachycardia, where the resting heart rate is over 100 beats per minute. (Average heart rate is 60-100 beats per minute.)
Distinguish between oxygen and ventilation
Type 1 and type 2
Type 1: you don’t get enough oxygen into the body parts
Problem w oxygenation
Example:heart failure cuz there’s air in the alveolar space oxygen isn’t able to get through the alveolar space into the blood so low oxygen in blood
Patient w pneumonia
Initial phase of asthma-airway is narrowed,there’s reduced air entry to the lungs,reduced oxygen
Covid-19
Type 2: unable to breath in and out
Patient w neuromuscular disorder (muscles are paralyzed so they can’t breath out)
A gasping patient
Some patients need you to help them ventilate
Some need you to help get oxygen
So giving oxygen to someone w ventilation problem won’t help
Patient w ventilation problem needs ambu bag(used for manual ventilation ) to help them breathe cuz they can’t breathe
Above 95percent
About 88percent
Don’t push for them to get 100percent
Cuz they’re respiratory system is driven by hypoxia so If you remove the hypoxia you’re telling they’re system to stop breathing
For a normal person carbon dioxide drives the respiratory system
- Is patient able to breathe well or not
- Does patient require assisted ventilation or not
- What’s the spo2 of the patient
Nasal prongs or nasal cannula : 1-6litres per minute (flow rate) or 21percent or 24-44 percent oxygen(like you’re giving room air to the patient or room oxygen)
Anything more than 6 litres through the nasal prongs is a waste of oxygen
If nasal prongs isn’t making patients spo2 rise,you switch to a higher oxygen delivery device then you reassess to check if the new delivery device is working or not
Face mask: 6-10 litres per minute,gives 40 percent oxygen or 35-60 percent
Non re-breather mask(face mask w a balloon):
If this doesn’t push the spo2 above 95 then you may have to refer cuz the patient will need positive pressure ventilation
When that fails,intubate patient
Continuous positive pressure ventilation (c-pav)
Bi level positive pressure ventilation (bi-pav)
An unconscious patient
A claustrophobic patient so you sedate them to make em semi conscious to get the oxygen
Patient who has just had gastric surgery,facial surgery or has facial trauma
Heart failure patients
So when you find what is causing it and you treat it,spo2 is supposed to get better
Example of a patient comes w a high blood pressure and you treat it, the high blood pressure and use lasix which will clean the lungs,the spo2 will get better
Ambu bag or bag valve mask Provides the highest inspired O2 concentration at 15L/min and 100 percent concentration true or false?
What does inspired oxygen concentration depend on in nasal cannula
What can the simple face mask promote
What’s another name for non re breather face mask?
How many litres per minute can it deliver,how much concentration of oxygen can it deliver?
Which oxygen delivery device is given to babies or infants or young child who will not tolerate face
mask or cannula?
Ambu bags can be used to deliver positive pressure ventilation true or false
True
Flow rate and patients tidal volume
promote CO2 retention at lower flow rates
Another name for it is face mask with oxygen reservoir
12-15L/min
60-90percent
It provides high oxygen concentration but the ambu bag provides highest oxygen concentration
Blow by oxygen delivery technique(gives 6-10 litres)
So nasal cannular to face mask (simple face mask and venturi face mask),non rebreather mask or face mask w oxygen reservoir,bag valve mask or ambu bag which gives positive pressure ventilation
What are you looking for in the C assessment
What are the types of shock
What are the types of shock under the major types of shock
What’s the difference between neurogenic and spinal shock
When you have high c spine injury Your sympathetic trunk may be chopped off
What is it’s function
What do you do to help in tension pneumothorax? And where is the procedure done
Tension pneumothorax is a clinical diagnosis so what will cause it
What are features of tension pneumothorax
What’s the difference between P-E and massive PE
Which five places can blood collect in to cause haemorrhagic shock and low blood pressure
Pulses,capillary refill ,and determine what kind of shock the patient may ha e and treat appropriately
C is where you’d want to use big cannulas and take samples on stand by cuz you don’t know what’s happening
Don’t use blue or yellow cannulas cuz in case of emergency you’ll need to push more medicine but the small cannulas won’t help
Use pink and above
Or use biggest cannula possible
Distributive shock:
Anaphylactic shock-due to allergic reactions
Septic shock
Hypovolemic-low blood volume or low body fluids
Cardiogenic-heart isn’t pumping blood properly or due to heart problems
Neurogenic -caused by damage to nervous system. Neurogenic shock is a condition in which you have trouble keeping your heart rate, blood pressure and temperature stable because of damage to your nervous system after a spinal cord injury. It is commonly seen when the level of the injury is above T6.
Spinal shock -refers to loss of all sensation below the level of injury and is not circulatory in nature. Spinal shock is the altered physiologic state immediately after a spinal cord injury (SCI), which presents as loss of spinal cord function caudal to the level of the injury, with flaccid paralysis, anesthesia, absent bowel, and bladder control, and loss of reflex activity
Obstructive:examples of cases w it Pulmonary Embolism Pericardial tamponade Tension pneumothorax
Spinal shock is when patient comes w paralysis and recover after some medication
Neurogenic shock has everything to do w blood pressure
Increased heart rate,vaso cosntriction
The network of nerves supplying the heart is called the cardiac plexus. It receives contributions from the right and left vagus nerves, as well as contributions from the sympathetic trunk. These are responsible for influencing heart rate, cardiac output, and contraction forces of the heart.
So if the trunk is cut off,there won’t be constriction,there’ll be unopposed vasodilation causing spinal shock
With distributive shock,the sim is to cause constriction of blood vessels cuz they have dilated and because they have dilated,the blood that is flowing through it isn’t enough anymore cuz the vessels have over dilated
This reduces the pressure
Use the pressures to shrink the vessels while giving adequate fluids
W obstructive shock-no amount of fluids will help
You need to remove the obstruction
Needle decompression
Second intercostal space ,midclavicular line at the affected side
Don’t do X ray before you do this needle decompression
Trauma can cause it
Patient can also get spontaneous pneumothorax without trauma example Marfans syndrome ,TB patients cuz of crepitations in lungs
Distended neck veins
Trachea deviation towards contralateral side (if it occurred in the left side,the pressure buildup pushes the trachea towards the right side and vice versa )
Air entry is reduced or absent
You may palpate emphysema (small small balloons) to warn you that the lung is punctured
Do not close laceration when lung is punctured (could be a simple pneumothorax) else it can cause buildup of pressure will cause or make it worsen into tension pneumothorax
Massive PE blood moves to the lungs and when there’s an obstruction blood isn’t moving so cardiac output reduces causing obstructive shock
Treatment is giving a drug (thrombolytics) that’ll dissolve the obstruction which is usually a clot
Now don’t the time for anticoagulants(example clexane)
Deal w the blockage now before you give the other things to prevent the clots from forming
Massive PE is PE with hypertension
Cardiac tamponade:blood or fluid around heart makes it unable to open and squeeze. No IV fluids will help unless you remove the fluid to remove the obstruction
Aim. when there’s shock is to find out what kind of shock is it and deliver treatment
When you’re not sure,In trauma all shock are hypovolemic shock (specifically haemorragic shock) until proven otherwise
So when you make sure it’s not a hypovolemic shock then you check out the other types of shock
1.floor on the site of accident
2. Lungs (haemothorax)
3.abdomen(haemoperitonium)
4.pelvis when there’s open pelvis fracture. Up to 3L of blood can hide in your pelvis (blood volume normal is 5L)
5. Long bones: one femur fracture can collect up to 1.5L of blood
If both femurs are fractured that’s 3L of blood
Splinting of the long bone fracture will help prevent pooling of blood
This person doesn’t need bunch IV fluids but needs more blood
I’m the context of trauma when there’s shock,give max 1L fluid plus blood
What is the lethal triad of trauma or triad of death or shock traid(as in these things are what makes someone w shock die or the pathway through which someone w shock would die)
What do you look for in D assessment
What do you look for in E assessment
While doing the ABCDE assessment if you find a problem fix it ,reassess before you proceed
Don’t wait till the problem is fixed before your proceed
Example is patients oxygen levels is low,don’t stand waiting for the oxygen levels to get better before,give the oxygen delivery device ,reassess B to check if problem has been fixed or not don’t move to C
Not that you start all over unless you’re about to end then the patients condition starts deteriorating then you have to start from A again
Hypothermia
Acidosis
Coagulopathy
Give warm fluids in patients w trauma
This prevents hypothermia
When you go into shock you enter into anaerobic respiratory phase and your blood produces more lactic acid and oH of blood changes and your blood hormones work under a constant pH acidosis also causes it has a negative effect on the proteins in the blood stream that are responsible for clotting the blood and stopping further hemorrhage ,clotting enzymes are affected and when there’s hypothermia enzymes work at a constant temperature so low temperature doesn’t make em work so Coagulopathy occurs cuz clotting factors aren’t working well
If you don’t break the cycle the Coagulopathy will lead to bleeding this leads to more shock this leads to more acidosis
Break cycle by stopping hypothermia by giving warm fluids
Look for GCS assessment,RBS ,check pupils ,if one pupil is bigger than the other (something is symmetrical or asymmetrical) it shows that some thing is happening in the brain
There can be focal herniation or increased intracranial pressure
Check if there’s any focal neurological deficit(facial deviation,patient moving one side more than the other,seizures(even rapid blinking. Eye could be seizure?
Check for asymmetry and limb movement
Expose patient completely yet control the environment
1.check for hypothermia ,prevent and treat hypothermia
Give warm fluids in a bleeding trauma patient
2. Examine other parts of the body for trauma bites (snake bite,insect bite,etc,child abuse,belt marks,external injuries
Turn patient so you can see the back of the patient
Make sure you maintain C spine when turning patient (E line verses C spine something)
Get at least three people to help you)
Make sure you prepare in advance before patients come to the emergency,how to you prepare ?
What are the Chains of survival in the hospital
With principles of rescuscitation what are the 5Hs and 5Ts to look out for to prevent cardiac arrest or to prevent death
These are reversible causes of cardiac arrest or death so you can treat it and save the person
How do you recognize cardiac arrest
How much must you push the chest in CPR
How many compressions must you do
Where will you put your hand during chest compressions
Get necessary skills needed to do procedures
Make sure all medications are available and machines are working properly and there’s provision in case of light out or something
All things are where they’re supposed to be and everything is available
Prepare your team(example some can be responsible for helping in assessing A, some can be responsible for assessing B ,some for C and so on
Know when to call for help(from specialists if you’re already in a referral center,if you’re not in one,refer )
Know your limitations
Behave as though you’re preparing to save yourself
Know what you have and know what you don’t have available
Know where everything is
Anticipate when a patient is dying so you prepare
- Screen,identify people at risk of getting it and reverse all causes of death
Prevent cardiac arrest
First chain of survival is to stop cardiac arrest or prevent it
Your chain of survival is as strong as your weakest link
- Surveillance and prevention of cardiac arrest
- Organize and admitting emergency response or call for help or recognition and activation of emergency response system
- start CPR
- Use your de febrillator or rapid defibrillation
- Send patient to ICU or advanced life support and patient care
So if you don’t have an ICU,your chain is as strong as your ICU since that’s your weakest link
The highest potential survival rate from cardiac arrest can be achieved when there is recognition of early warning signs, activation of the emergency medical system (EMS), rapid ini- tiation of basic CPR, rapid defibrillation and Advanced Cardiovascular Life Support (ACLS), including definitive airway management and intravenous (IV) medications. These steps are known as the “chain of survival.”
Every one minute you delay in shocking the chest back to its sinus rhythm you lose ten percent chance of survival
Failure to recognize these can cause death
CPR just buys you time ,it doesn’t keep patient alive
Surveillance and prevention of cardiac arrest: H’s: Hypovolemia Hypoxia Hydrogen ions or acidosis Hyperkalemia or hypokalemia Hypothermia Hypoglycemia
5T’s Toxins Tamponade Tension pneumothorax Thrombose cardiac -MI Thrombose pulmonary -PE or thromboembolism Trauma (blunt chest trauma)
Primary ABCD survey
Before CPR:
Check if Patient is unresponsive
Call for help or a defibrillator
Assess airway (A)
If Patient is not breathing or has abnormal breathing(B)
Give two small breaths or give an oxygen delivery device near you
Assess pulse . If Patient has no pulse (C) (in this case it’s carotid pulse not radial pulse)
Start chest compressions (C) or CPR
When you see these,start CPR immediately
After the normal time stop and check if patient has a pulse again
If no pulse CPR continues
(D)Defibrillation: Identify and shock ventricular fibrillation
(VF) and ventricular tachycardia (VT)
Check page 68
1/3rd AP diameter of the chest (front and back diameter or anterior posterior diameter)
Or as deep as 5-6cm of the chest
100-120 compressions per minute
You need to allow for chest recoil each minute
Pause only after every two minutes to check the pulse
You have a max of thirty seconds to check for the pulse
Don’t allow for unnecessary interruptions
Stop CPR after thirty minutes for adults and after 15 minutes for children
After thirty min then give up
For a male,use the nipple line from one nipple to the other and in the middle region ,where the sternum is is where you put your hand
For females divide sternum into three
(Parts of the sternum and where they end )
Don’t do compressions w your elbows
Once you succeed in CPR
Make sure all the things that can cause the cardiac arrest are removed
Do your ABCDE
Keep
Your MAP above 65, this is what is needed to perfusé your organs
Don’t Stop after thirty minutes if there is Return of continuous circulation
If the outcome of the cardiac arrest is unfavorable factor it into whether you’ll save patient or not w CPR
For females:divide sternum into three abd use the distal 1/3 of the sternum
To ade- quately perform chest compressions, the heel of one hand should be placed in the midline on the lower part of the sternum (just above the notch where the ribs meet the lower sternum). The other hand is placed on top of the first hand and the fingers interlocked and kept off of the chest. Position your shoulders directly over your hands and lock your elbows. Depress the sternum about 1.5–2 inches approximately 100 times per minute, while allowing another member of the team to give rescue breathing after every five compres- sions. Properly performed compressions can produce a systolic blood pressure of 60 mmHg.
If patient is cold don’t presume patient dead
Make sure patient is warm then you start counting countdown for death
Cuz I’m cold metabolism slows down
This is targeted temperature control management of GCS isn’t 15/15
What is the pathophysiology behind CPR (cardiopulmonary resuscitation)
After how many minutes is the brain dead in an arrest state?
What’s the goal of CPR
Cardiac arrest results in cessation of blood flow throughout the body. Anaerobic metabo- lism begins almost immediately. A cascade of metabolic events is created, including calcium release, generation of free radicals, and activa- tion of catabolic enzymes that further injure the body’s cells. The brain is most susceptible to the absence of circulation and traditionally suffers irreversible damage after 5 minutes in an arrest state. Restoration of pre-arrest neurologic func- tion rarely occurs in patients with untreated car- diac arrest of longer than 10 minutes duration. The heart is the second most susceptible organ. Patients who suffer cardiac arrest from a non- cardiac cause remain at risk for secondary cardiac ischemia in the post-resuscitation period.
CPR, even utilizing maximal chest compres- sions, can only generate 30% of baseline cardiac output. The resuscitation period, therefore, still contributes to ongoing global ischemia. The goal of CPR is to preferentially direct blood flow to the heart and brain in order to adequately restore organized myocardial electrical activity while minimizing ischemic brain injury. There are two main theories to explain how this happens. In the cardiac compression model, the heart is squeezed between the sternum and the thoracic spine cre- ating a pressure gradient between the ventricles and the great vessels. This causes blood to flow into the systemic and pulmonary arterial circula- tion. In the thoracic pump model, chest compres- sions cause a rise in the intrathoracic pressure that creates a pressure gradient between the intrathoracic vascular bed and the extrathoracic arterial bed, which causes blood to flow down the pressure gradient.
If you still cannot effectively administer res- cue breathing and suspect an obstructed airway,
What do you do
Why must you use carotid pulse in assessing C?
perform abdominal thrusts. These abdominal thrusts elevate the diaphragm and increase airway pressure. The resulting air escape from the lungs can effectively dislodge an obstructing foreign body from the upper airway.
It’s the most central of the peripheral arteries. A carotid pulse may persist even in the presence of poor perfusion.
What us a mass casualty incident
Mass casuakty incident isnt realy a number but it’s dependent on the capacity if the hospitak to handle the cases true or false
Whats another name for CPR
A pulse of what bpm in children means the child has a cardiac arrest
Who is a vulnerable person
What are the 8 principles that govern managing a disaster and explain em
What are the classifications of diasters
What should be your objectives jn managing diasters
When the number of cases presenting to the facility is more than the hospitals capacity to handle the cases
True
External cardiac compression
60bpm
Diminished capacity of an individual to anticipate ,cope with,resist and recover from the natural or man made hazard
1.Disaster plan must be comprehensive. Attempt to modify all modifiable risk . Ask yoursekf whats the worst that could happen and plan for worst case scenarios. Consider all the hazards that could happen
2. Plan must be progressive
It should take into account future occurrences
It should be able to solve other similar situations that may happen
Example your plan for sixth march should be able to be used for an Afcon game or match
3. Planning must be risk driven:
Assess the risk on the ground and attempt to modify them
4.should be integrated : collaborate with nearby facilities concerning what youve planned
5. Collaboration
6. Coordination: yoj should be able to coordinate and make sure everything is being done the way its supposed to or plans will be set in motion in case of anything
7.plan should be flexible: plan should have alternatives in case plan A fails
It shouldnt be rigid. It should be well thought through. Example if your plans were to be in a dry weather or sunny weather if it rains,your plan shouldnt be spoiiled but it should still work even with the rain
8. Professional :
Man made:Technology,industrial,warfare
Natural:environmental,topographic,meteorological
To reduce the hazard
To prevent diasters
To prepare for emergencies
In the disaster management cycle whats very important
Whats mitigation
Whats yhe disaster management cycle
What is emergency response plan(what questions will you ask yourself)
What is surge capacity and surge capability
Mitigation
All the things you’ll do to prevent the occurrence of an anticipated disaster
Mitigation
Prepare for the worst case scenario
Response should be immediate and specific to evaluate the level of damage and how to help things
Then you lead them to recovery. Fixing light snd water to make sure the environment goes back to its normal state
Recovery can be short term or long term
Short term:lifeline systems (power,communication) to acceptable standards
Basic human needs (example food clothing ,crisis counseling)
Long term:restoring economic activity (buildings. Community facilities)
Emergency resp plan:
What are the risks in the environment you find yourselves in
What can you do to mitigate these risks or hazards
Surge capacity:ability of a facility to rise up to the occasion to neet the need of the unexpected high demand that has been placed on them
Example you have five beds in your facility,but you need six beds
Your ability to get the extra beds needed means you have the capacity to respond to the surge
If you cant get the extra beds ,you dont have yhe capacity
Capability:has to do with skill
Example:if your hospital doesnt have a paediatrician ,when it becomes necessary to get one,can you get one?
If yes,you have surge capability
If no,you dont
Whether for short term or long term
As long as youre able to get it at that moment to meet the needs you have surge capability
What is triaging based on
START assessment is based on three things name them
How is it done
Absent radial pulse may mean?
Dont count respiratory rate for one minute cuz youre to finish all three in thirty seconds
Once patient scored red in any one dont move to the next criteria
Whats the assessment used to triage children in MCI
Hows it done(whats the normal cpm for kids,when child isn’t breathing do you score black?
If a man has a pulse but he’s not breathing,he’s red ,dont start CPR
true or false
Its based on limited data START is based on RPM Respiratory rate Pulse rate Mental state
After making sure all green patients are moved away
Get a count of the number of patients
Do same for the rest of the patients after sorting them into the other colours or is it before
For the rest of the patients on each patient
Check if patient is breathing
If breathing,check if its more than or less than 30cpm
If not breathing ,check the state or the situation (whether its a trauma or you can do all three patency maneuvers) to consider the mode of airway patency maneuver to do. In order to protect the C spine .
If still not working, then patient is black
Move to pulse
Pulse present move on
Pulse absent,red
Refill more than 2 secs red
Less than 2 secs or less than three seconds,move to mentale state
If obeys commands yellow
If doesnt red
The count is done after everything
There may shock
For children you use JumpSTART
Its the same as START for adults
The only difference is that if the child isnt breathing you dont score red
You check their pulse and if its present,give five rescue breaths
And if theyre still not breathing score red and in kids,the respiratory rate is 15-45
If its less than 15,red
If more than 45,red
And for mental state if theyr not alert,the VPU is all red
Using AVPU:Alert,responds to verbal stimuli,to pain,unresponsive
