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Nursing 283 > Week 3 ED/Disaster > Flashcards

Week 3 ED/Disaster Flashcards

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1
Q

Most common patient safety issues

A

patient identification, fall risks, skin breakdown, medication errors and adverse events

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2
Q

Core competencies of emergency nursing

A

assessment, priority setting, clinical decision making, multitasking and communication

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3
Q

Emergent triage

A

a condition poses immediate risk to life or limb

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4
Q

Urgent triage

A

should be treated quickly but a threat to life does not exist
ex: new onset pneumonia, renal colic, complex lacerations, displaced fractures or dislocations and fever over 101

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5
Q

Nonurgent triage

A

can tolerate several hours without care

ex: sprains, simple fractures, cold sx and rashes

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6
Q

Emergency severity index (ESI)

A

categorizes PTs from level 1 (emergent) to level 5 (nonurgent)

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7
Q

Canadian triage acuity scale (CTAS)

A

uses lists of descriptors to establish a triage level

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8
Q

Mistriage

A

a PT safety risk that can delay care or cause inadequate care

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9
Q

Example of intentional trauma

A

assault, homicide, suidice

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10
Q

Blunt trauma

A

results from impact forces like in a car crash or fall from a height
Injury is caused by rapid acceleration-deceleration

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11
Q

Penetrating trauma

A

results from sharp objects or projectiles

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12
Q

Primary survey

A

the initial assessment of the trauma victim
Based on ABC plus D (disability) and E (exposure)
Resuscitation efforts occur at the same time as the survey

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13
Q

Airway intervention for a breathing PT

A

Non-rebreather mask

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14
Q

Airway intervention for someone needing ventilatory assistance

A

Bag valve mask with 100% O2

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15
Q

Airway intervention for someone with significantly impaired respirations and cognitive status

A

Intubation with an ET tube and mechanical ventilation

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16
Q

Breathing assessment

A

determines if ventilatory efforts are effective, not just if the PT is breathing

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17
Q

What to do if CPR is necessary on a ventilated PT

A

Disconnect the ventilator and manually ventilate with a BVM

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18
Q

What is the main indication to perform chest decompression and how is it done?

A

Tension pneumothorax

a needle or chest tube is used to vent trapped air

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19
Q

S/Sx of a tension pneumothorax

A

decreased or absent breath sounds, respiratory distress, hypotension, JVD and tracheal deviation (late sign)

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20
Q

BP estimates in trauma situations: presence of radial pulse

A

BP at least 80

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21
Q

BP estimates in trauma situations: presence of femoral pulse

A

BP at least 70

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22
Q

BP estimates in trauma situations: presence of carotid pulse

A

BP at least 60

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23
Q

Best IV access gauge and site in trauma

A 
16 gauge in the antecubital area (bend of the elbow)
Central catheters (8.5fr) can also be used in femoral, subclavian or jugular veins
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24
Q

IV solutions of choice in trauma

A

Ringers lactate and NS 0.9% warmed before administration to prevent hypothermia

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25
Q

AVPU test

A 
disability exam to provide neurologic baseline status
A: Alert
V: responds to Voice
P: responds to Pain
U: Unresponsive
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26
Q

Glasgow coma scale

A

A test to determine LOC based on eye opening, verbal response and motor response. Lowest score is 3 and a normal score is 15

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27
Q

Body temperature of hypothermia

A

=< 97F (36C)

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28
Q

Who is at risk for hypothermia?

A

Injured patients, especially with burns

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29
Q

S/Sx of hypothermia

A

vasoconstriction, difficulty with IV access, coagulopathy, increased bleeding and slowed drug metabolism

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30
Q

Interventions to prevent hypothermia

A

remove wet sheets/clothing, cover PT with blankets, infust warm IV solutions and blood, set room temp 75-80, use heating lamps and warming blankets

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31
Q

Glasgow coma scale of 8 or less

A

the PT is at risk for airway compromise, prepare for intubation and mechanical ventilation

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32
Q

Secondary survey

A

Done after immediate threats to life have passed to identify other injuries or issues that require tx

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33
Q

SBIRT

A

Screening
Brief Intervention
Referral to Treatment
A screening tool for alcoholics. Trauma centers are required to screen for alcoholics and refer/educate them

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34
Q

Delirium in the ED

A

older adults are most at risk, they need to be reoriented frequently
Undiagnosed delirium increases mortality risk

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35
Q

Proper maneuver to manually align the neck and open the airway

A

Jaw thrust maneuver

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36
Q

When to use O2 during resuscitation

A

All PTs receive O2 during resuscitation

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37
Q

When to remove PT clothing

A

Always remove clothing to allow for a through physical assessment

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38
Q

When to cut away PT clothing

A

When access to the body is needed rapidly
When limb manipulation would cause harm
When chemical burns have melted fabrics into skin

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39
Q

Disaster defined

A

an event in which illness or injury exceed resource capabilities of the health care facility or community

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40
Q

Internal disaster

A

event inside the healthcare facility that could endanger patients or staff such as fire. Evacuation is required and the desired outcome is safety

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41
Q

External disaster

A

Occurs in the community and activates the facilities emergency plan. The number of staff is not adequate for the number of incoming patients

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42
Q

Mulit vs mass casualty event

A

Multi casualty event can be managed using local resources

Mass casualty event overwhelms resources and requires collaboration of other agencies

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43
Q

Nurses roles in responding to a facility fire

A

D/C O2 for those who can breathe without it
Ventilate PTs manually while being moved
Ask ambulatory PTs to push PTs in wheelchairs

44
Q

Who may perform triage in the field?

A

EMS providers like EMTs, paramedics, nurses and doctors

45
Q

Disaster triage tag system

A

used in mass casualty triage and prioritizes patients by color and number

46
Q

Function of the hospital incident commander

A

is responsible for implementing the disaster plan, they are usually an MD or hospital administrator

47
Q

Function of the medical command physician

A

responsible for determining the number, needs and acuity of arriving victims and organizing appropriate specially trained providers for care such as trauma or burn surgens

48
Q

Function of the triage officer

A

evaluates each person that comes to the hospital, even those with triage tags in place

49
Q

MCI

A

mass casualty incident

50
Q

NIMS

A

National incident management system

51
Q

NRF

A

National disaster response framework

52
Q

ICS

A

Incident command system

53
Q

HICS

A

Hospital incident command system

54
Q

NIMS functions

A 
procedural
preparedness
resource management
communication
helps all responders know what to do when they get to the scene
55
Q

Who is the incident commander

A

house supervisor or administrative lea son

56
Q

First Responders scene assessment

A

looking for hazards in the environment

57
Q

First Responders scene size up

A

look at type of incident, how many victims, severity of injuries

58
Q

First Responders sending information

A

working to establish a command center

59
Q

First Responders scent set up

A

establish staging and treatment areas, look at best ways to get emergency vehicles in and out

60
Q

START triage step 1

A

Tell ambulatory PTs to walk away, they get a green tag

61
Q

START triage step 2

A 
Triage officer assesses patients in the order in which they are encountered
Assess for spontaneous respirations
If apneic, open airway
If patient remains apneic, tag as Black
If patient starts breathing, tag as Red
62
Q

START triage step 3

A

Assess respiratory rate
If ≤30, proceed to Step 4
If > 30, tag patient as Red

63
Q

START triage step 4

A

Assess capillary refill
If ≤ 2 seconds, move to Step 5
If > 2 seconds, tag as Red

64
Q

START triage step 5

A

Assess mental status
If able to obey commands, tag as Yellow
If unable to obey commands, tag as Red

65
Q

Who do you protect first in an exposure

A

yourself

66
Q

S/Sx of Sarin nerve gas

A

Neuromuscular - pinpoint pupils (highly indicative of nerve agent exposure), muscle twitching, confusion, seizures, flaccid paralysis, coma.
Ach accumulation-runny nose, crying, drooling, defecating, urinating, and vomiting

67
Q

Tx of Sarin nerve gas exposure

A

atropine IV/IM (IV preferred) or 2-PAM (Pralidoxime) IV/IM (IV preferred)

68
Q

Decontamination after Cyanide exposure

A

PTs exposed to gas need only to remove their outer clothing and hair washed. Other patients require full decontamination.

69
Q

Classification of Cyanide

A

Toxic asphyxiant

70
Q

Cyanide S/Sx- CNS

A

CNS signs and symptoms are typical of progressive hypoxia including headache, anxiety, agitation, confusion, lethargy, seizures and coma.

71
Q

Cyanide S/Sx- cardiovascular

A

Initially bradycardia and HTN, followed by hypotension and tachycardia. The terminal event is bradycardia and hypotension.

72
Q

Cyanide S/Sx- Respiratory

A

increased RR, SOB, and chest tightness. With progression, respirations become slow and gasping.

73
Q

Cyanide S/Sx- GI

A

abdominal pain, nausea and vomiting

74
Q

Cyanide S/Sx- Skin

A

A cherry red skin color may be present as the result of increased venous hemoglobin oxygen saturation.

75
Q

Cyanide Tx

A

100% oxygen STAT, sodium nitrite IV (or amyl nitrite) and sodium thiosulfate IV

76
Q

Phosgene, Ammonia, Chlorine classification

A

Pulmonary Irritants

77
Q

Phosgene, Ammonia, Chlorine early Sx

A

nose and throat irritation, cough, and chest pain, SOB & signs of pulmonary edema; signs of acute lung injury that are seen within four hours of the exposure predict a low likelihood of survival

78
Q

Phosgene, Ammonia, Chlorine late Sx

A

choking, chest tightness, cough, severe dyspnea, production of foaming bloody sputum, and pulmonary edema. Non-respiratory symptoms include nausea and anxiety

79
Q

Phosgene, Ammonia, Chlorine tx

A

rest

80
Q

Sulfur Mustard, Lewisite category

A

Blistering agents

81
Q

Sulfur Mustard, Lewisite early Sx

A

sore throat, cough, and hoarseness, skin redness, pain and itching

82
Q

Sulfur Mustard, Lewisite Late Sx

A

SOB within 12 hours (bacterial pneumonia on days three to four); Blisters by 16 hours and reach a max by day three; damage to the ocular surface & corneal scarring, eye pain, and eyelid swelling occur

83
Q

Sulfur Mustard, Lewisite Tx

A

steroids, antibiotic ointments, topical analgesics, keep skin clean, (it is a burn)

84
Q

Cutaneous Anthrax Sx

A

fever, swollen lymph nodes, small, raised macules that become fluid filled & form a black center

85
Q

Anthrax Tx

A

Combination antimicrobial therapy that must include Cipro

86
Q

GI anthrax Sx

A

mouth ulcers, sore throat, trouble swallowing, N&V, bloody diarrhea, fever, abdominal pain, can progress to shock

87
Q

Agent suspected when neurological sx are seeen

A

sarin or cyanide

88
Q

Agent suspected when pulmonary sx are seen

A

phosphogene, sarin or cyanide if sx are immediate

inhalation anthrax if sx are more delayed

89
Q

3 Sx seen with the use of a biologic agent

A

rash, GI bleeding, fever

90
Q

Sx of poor perfusion

A

cool pale skin, delayed cap refil, cyanotic, bradycardic, low BP

91
Q

Priority action with a suicidal Pt

A

find out if they have a feasible plan

92
Q

4 questions of the emergency severity index

A

is the pt dying?
is this a pt who shouldn’t wait?
how many resources will they need?
what are the VS?`

93
Q

Examples of ESI level 1

A

Cardiac arrest, anaphylactic reaction, flaccid baby, chest pain with poor perfusion,

94
Q

Examples of ESI level 2

A

New onset confusion, suicidal, possible ectopic pregnancy, pain 10/10

95
Q

Resource use with ESI level 3

A

2 or more

96
Q

Resource use with ESI level 4

A

1 resource

97
Q

Resource use with ESI level 5

A

none

98
Q

Examples of resources

A
  1. Labs (blood, urine)
  2. ECG
  3. X-rays, CT-MRI-ultrasound, angiography
  4. IV fluids (hydration)
  5. IV, IM or nebulized meds
  6. Specialty consultation
  7. Simple procedure = 1 (lac repair, Foley cath)
  8. Complex procedure = 2 (conscious sedation)
99
Q

Things that are not resources

A
  1. History & physical (including pelvic)
  2. Point-of-care testing
  3. Saline or heplock
  4. PO medications, Tetanus immunization, Prescription refills
  5. Phone call to PCP
  6. Simple wound care (dressings, recheck)
  7. Crutches, splints, slings
100
Q

Antidote for benzodiazepines

A

flumazenil or romazicon

101
Q

Antidote for narcotics

A

narcan

102
Q

Antidote for heparin

A

protamine sulfate

103
Q

antidote for coumadin

A

vitamin k

104
Q

PAT RR needing intervention

A

> 60

105
Q

PAT HR needing intervention

A

Child 180 bpm

Child >8: 160

Nursing 283 (10 decks)

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