Emergency Module

Front 1

What is the "airway hierarchy"?

Back 1

1) Supplemental oxygen
2) Noninvasive airway devices
3) Recommended invasive airway devices

Front 2

How can supplemental oxygen be given

Back 2

1) Nasal cannula
2) Face masks

Front 3

What are the non-invasive airway devices?

Back 3

1) nasopharyngeal airway
2) Oropharyngeal airway
3) bag-Mask ventilator

Front 4

What are the recommended airway devices

Back 4

1) Laryngeal mask airway
2) Esophageal-tracheal (combitube) tube
3) Tracheal tube

Front 5

What's the purpose of ventilation during CPR?

Back 5

1) maintain adequate oxygenation
2) elimination of CO2

Front 6

IRT CPR and V-fib sudden cardiac arrest (VF SCA), what is the most important part of CPR? Why?

Back 6

1) Chest compressions
2) Because O2 delivery to tissues (ie- heart & brain) is limited more by blood flow than arterial O2 content

Front 7

What ventilation rate is critical during CPR for providers to maintain?

Back 7

8-10 breaths / min

Front 8

During CPR & ventilating the patient what should the provider(s) ensure doesn't happen?

Back 8

Do Not Over Ventilate

Front 9

What components make up the primary survey?

Back 9

A= Airway
B= Breathing
C= Circulation
D= Defibrillation

Front 10

What is the "focus" of basic CPR & defibrillation?

Back 10

1) check responsiveness
2) activate EMS
3) call for defibrillator

Front 11

What is the most common cause of airway obstruction when trying to ventilate a patient?

Back 11

The tongue, or epiglottis

Front 12

What are the two approved methods to open the airway for ventilations?

Back 12

1) Jaw thrust
2) Head tilt-chin lift

Front 13

For what type of patient are oropharyngeal airways reserved for?

Back 13

1) unconscious (unresponsive)
2) pt's w/no cough/gag-reflex

Front 14

What can happen if an oropharyngeal airway tube is too short for the patient it is meant to aid in ventilation?

Back 14

Displace the tongue into the hypopharynx = airway obstruction

Front 15

In a patient that is not deeply unconscious what type of airway is the best tolerated?

Back 15

Nasopharyngeal airway

Front 16

Whichh of the following is better at oxygenating the patient:
- mouth to mask ventilation
- bag mask ventilation

Back 16

Mouth to mask ventilation

Front 17

What type of rescuer should use the "mouth to mask ventilation"?

Back 17

Small-handed rescuers

Front 18

When using the mouth to mask ventilation method, what is the proper hand placement for the resucuer?

Back 18

C-clamp shape & jaw-thrust
E-clamp & head tilt-chin lift

Front 19

When using the bag-mask ventilations, what volume should the patient be ventilated w/on each breath?

Back 19

"Enough to produce obvious chest rise"

Front 20

What procedure can be implemented during ventilations to prevent gastric inflation & decrease the risk of regurgitation & aspiration?

Back 20

Cricoid pressure

Front 21

What are potential complications with the bag-mask ventilation method?

Back 21

1) hypoventilation
2) gastric inflation

Front 22

What [oxygen] does a nasal cannula provide?

Back 22

24% - 44%

Front 23

What [oxygen] does a face mask w/oxygen reservoir provide?

Back 23

60% - 100%

Front 24

What are the current advanced airways?

Back 24

1) Esophageal-Tracheal combitube
- King Airway
2) Laryngeal Mask airway
- Cobra Airway
3) Endotracheal intubation

Front 25

What are the primary/secondary criteria for confirmation of tracheal tube placement?

Back 25

1) physical exam criteria
2) devices to detect esophageal placement
3) end-tidal CO2 detection

Front 26

T/F:
After an advanced airway is in place 2 rescuers must still provide cycles of CPR.

Back 26

False.
- The compressing rescuer should give continuous compressions @ 100/min.
- The ventilating rescuer provides 8-10 breaths/min.

Front 27

What are the advantages of the Combitube & endotracheal tube?

Back 27

1) Isolation of airway
2) Reduced risk of aspiration
3) More reliable ventilation

Front 28

T/F:
The "face mask" provides a more secure & reliable means of ventilation than the Laryngeal Mask Airway.

Back 28

False
The Laryngeal Mask Airway provides a more secure & reliable means of ventilations than the face mask.

Front 29

T/F:
After successful insertion of the Laryngeal Mask Airway all patients can be successfuly ventilated.

Back 29

False
There is a small proportion of pt's that can't be ventilated, thus an alternate plan must be in place.

Front 30

IRT secondary ABCD survey, when should providers defer insertion of an advanced airway?

Back 30

1) Until the pt, fails to respond to initial CPR
2) Defibrillation attempts, or demonstrates return of spontaneous circulation

Front 31

What equipment is used for intubation?

Back 31

1) laryngoscope w/blades
2) tracheal tubes
3) malleable stylet
4) 10ml syringe
5) Magill forceps
6) Water-soluble lubricant
7) suction unit, catheters & tubing

Front 32

Which hand is the laryngoscope held in when intubating a pt?

Back 32

Left hand

Front 33

What are the advantages of tracheal intubation?

Back 33

1) protects against aspirating foreign material
2) facilitates ventilation/oxygenation
3) facilitates suctioning of trachea & bronchi
4) provides route for drug admin
5) prevents gastric inflation if used w/cuff
6) allows faster chest compressions

Front 34

What are the indications for tracheal intubation?

Back 34

1) inability to ventilate an unconscious pt.
2) after insertion of pharyngeal airway
3) inability of pt to protect own airway (ie- coma, areflexia, cardiac arrest)
4) need for prolonged mechanical ventilation

Front 35

IRT tracheal intubation, what are the recommendations?

Back 35

1) should be done by most experienced person
2) don't take longer than 30-sec/attempt
3) auscultate thorax/epigastrium after intubation

Front 36

What are the common areas traumatized during intubation?

Back 36

1) teeth
2) lips
3) tongue
4) mucosa
5) vocal cords
6) trachea

Front 37

What are some complications of tracheal intubation?

Back 37

1) esophageal intubation
2) vomiting & aspiration
3) HTN & arrhythmias
4) hypoxemia from long attempts
5) high risk of tube misplacement, displacement, or obstruction

Front 38

How is tracheal tube placement confirmed?

Back 38

1) visualize chest expansion bilaterally
2)listen over epigastrium (breath sounds should NOT be heard)
3) auscultate lung fields bilaterally (breath sounds should be equal & adequate)

Front 39

IRT an esophageal detector device (EDD), what is a (+) test?

Back 39

If the tube is in the esophagus, the suction will collapse the lumen of the esophagus, or pull the esophageal tissue against the tip of the tube & the bulb won't re-expand

Front 40

What can providers do to reduce the risk of unrecognized tube misplacement, or displacement?

Back 40

Use a CO2 detector

Front 41

What does it indicate if CO2 is detected on a CO2 detector?

Back 41

This is a reliable indicator that the tube is correctly positioned in the trachea

Front 42

What assistive device can be implemented to decrease the chance of accidental tube displacement?

Back 42

A tracheal tube holder

Front 43

After the tracheal intubation tube is placed, how is the correct depth determined?

Back 43

As marked at the front teeth

Front 44

When should correct placement of advanced airways be verified?

Back 44

1) after correct placement
2) whenever the pt, is moved

Front 45

IRT defibrillation, what is the approximate % of survival after 5 minutes?

Back 45

50%

Front 46

If no CPR is provided at what rate does survival decrease every minute?

Back 46

7% - 10% per min.

Front 47

What are the 4 universal control steps in the operation of AED's?

Back 47

1. Power on the AED
2. Attach pads
3. Analyze rhythm
4. Shock if advised

Front 48

What is the ratio of compressions to breaths for BLS CPR?

Back 48

30:2

Front 49

How many cycles of CPR is given before a rhythm is checked?

Back 49

5-cycles of CPR

Front 50

For children 1-8yrs, what should a rescuer use if one is available IRT defibrillation?

Back 50

A pediatric dose-attenuator system.

Front 51

T/F:
If a rescuer is providing CPR to a child and doesn't have an AED w/an pediatric dose attenuator, they can NOT use a standard AED.

Back 51

False.
They CAN use a standard AED.

Front 52

What must be done to a victim who is either wet, or lying in water before defibrillation can occur?

Back 52

1. Remove from water
2. Wipe water off briskly before attaching electrodes and shocking

Front 53

If a pt., has an implantable pacemaker, where should AED pads be put in relation to the pacemaker?

Back 53

1-inch (2.5cm) away from the device.

Front 54

If a pt., has a transdermal med patch, where should AED pads be put in relation to the med patch?

Back 54

Take the med patch off, wipe off the area and apply AED pads.

Front 55

What 4 rhythms produce pulseless cardiac arrest?

Back 55

1) VF
2) VT
3) PEA
4) Asystole

Front 56

The foundation of ____ care is good ___ care.

Back 56

- ACLS
- BLS

Front 57

If a cardiac arrest is NOT witnessed, what should be the first form of tx?

Back 57

5-cycles of CPR

Front 58

IRT defibrillator settings, what does "biphasic" mean?

Back 58

200J for 1st shock and =, or > than 200J for second /subsequent shocks

Front 59

T/F:
Providers should give 1-shock instead of 3-stacked shocks.

Back 59

True

Front 60

Name the 3-types of advanced airways.

Back 60

1) Endotracheal tube
2) Esophageal-tracheal
combitube
3) Laryngeal mask airway

Front 61

What is the compression rate if an advanced airway is in place?

Back 61

100 compressions/min

Front 62

When an advanced airway is in place, what is the ventilation rate?

Back 62

8-10 breaths/min

Front 63

What are the primary drugs used for VF/VT?

Back 63

1) Epinephrine 1mg/3-5min
2) Vasopressin 40 U.IV
3) Amiodarone 300mg IV
4) Lidocaine 1-1.5mg
5) Mag.Sulf. 1-2mg load dose

Front 64

What rhythm is Mag.Sulf. specifically used for?

Back 64

Torsades

Front 65

When administering drugs for cardiac arrhythmias be administered?

Back 65

ASAP after rhythm analysis

Front 66

What are the 6 H's that may cause arrhythmias

Back 66

1) Hypovolemia
2) Hypoxia
3) Hypo/Hyperkalemia
4) H+ ion acidosis
5) Hypoglycemia
6) Hypothermia

Front 67

What are the 5 T's IRT arrhythmias?

Back 67

1) Toxins
2) Tamponade (cardiac)
3) Thrombosis (cor./pulm.)
4) Tension PTX
5) Trauma

Front 68

When should pulse checks be done?

Back 68

only if an organized rhythm is observed.

Front 69

Which meds should be used to maintain BP & HR?

Back 69

Dopamine & Dobutamine

Front 70

Which meds should be avoided when maintaining BP & HR?

Back 70

- Epi
- Norepi
- Isoproterenol

Front 71

What 3-criteria describe good chest compressions?

Back 71

1) Adequate rate & depth
2) Allow complete recoil of chest btwn compressions
3) Minimize interruptions in chest compressions

Front 72

T/F:
Patients who have either asystole, or PEA will benefit from defibrillation attempts.

Back 72

False.

Front 73

T/F:
insertion of advanced airways & pharmacologic support increase the rate of survival

Back 73

False

Front 74

What drugs are associated w/PEA and Asystole?

Back 74

1) Epinephrine
2) Vasopressin
3) Atropine

Front 75

For pt's chest discomfort (ischemia) what are the first meds they should get?

Back 75

M- Morphine IV
O- Oxygen 4 L/min
N- Nitroglycerin SL/spray/IV
A- ASA 160-325mg