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104 Cards in this Set
- Front
- Back
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What are signs that birth is imminent
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contractions - 2-3 min
urge to push crowning |
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What 3 things should be sent to the hospital after a out of hospital surprise birth
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Baby
Mommy Placenta |
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What complications can occur during birth
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- Twins
- Prematurity: More prone to airway/breathing problems & heat loss - Breech (Tush and feet appear first Footling breech- arm or leg appears first) - True obstetrical emergency - Nuchal cord – cord around infant’s neck (Slip over baby’s head) - Prolapsed cord – cord comes out first (True obstetrical emergency) |
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What is the priority in triage
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Must 1st check scene for SAFETY!!!
Hemorrhage trumps all!!! ABCs No pulse or breath - bottom of the list b/c they are most likely dead |
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Make slides up to 88 from child birth
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add
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What is key in IV sterile water
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NEVER infuse alone!!! Lysis of RBCs will occur!!!
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What is suggested by a increasing ht and decreasing bp
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anaphylaxis
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What are the different size masks and O2 capacities for each
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Nasal Cannula - Lowest flow rates-up to 6 lpm=20-40% O2
Simple Mask - 6-10 lpm gives approximately 40-60% O2 Partial/Non Rebreather Mask- 60-100% O2 Venturi Mask (specific flow) - Valves for 25-50% O2 Ambu Bag/Mask (Emergency situations requiring manual ventilation of pt) |
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Epiglatitis
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Usually between 3 –10 years
Caused by H. influenza (or occasionally a beta hemolytic Strep) infection High fever / Toxic Child Difficulty breathing Inspiratory stridor Drooling |
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What is the difference btw heat stroke and heat exhaustion
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Heat stoke has dried out and needs extensive cooling to recover whereas heat exhaustion is still wet and needs to be dehydrated and cooled.
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What does postictal mean and what needs to be done during this time
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This is post seizure time. you want to ensure pt is stable and refer to hospital
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How much O2 does a head injury need
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100% -therefore need a Partial/Non Rebreather Mask
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Can a Foley catheter be removed?
What about a french? |
Foley - Only when the balloon isn't inflated
French- no bag, can just be pulled out |
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What is important to do in the case of a eye trauma
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1. No obvious trauma or penitration
2. Check visual acuity 3. If no obvious broken anything or punctured anything and vision is ok can go home but needs to be watching for - Dec in vision, inc in pain - suggests optic n inflammation |
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What are the three things that cause corneal inflammation
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1. Abrasion
2. Infection 3. Acute Glaucoma |
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What is the 1st physial exam to do with a spontaneous nose bleed
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Take BP
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When is time to refer a nose bleed
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Won't stop bleeding after 10-15 min
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What are the most common acute rxns to IV
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Anxiety
Vaso valgal rxn Speed Shock Anaphylactic Shock |
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What will happen to the vitals of someone in an anxiety attack
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Both BP and HR will go up
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What are the most common causes of Speed shock from IV
What is the antidote for them |
Mg and DMPS
Mg antidote with Ca DMPS ? |
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What will happen to the vitals of someone in a Speed Shock
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Pulse and BP both go down
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What will happen to the vitals of someone in Vaso Vagal Syncope
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Pulse and BP both go down
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What will happen to the vitals of someone in anaphylaxis
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Pulse goes up and BP goes down
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What is the order of tx for anaphylaxis
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Epi 1st --> Beni 2nd --> steroids 3rd!!!
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What strength of Epi is used for IM administration.
What dose do you give, what is the max total dose |
1:1000 strength NON-IV Routes ONLY – dose 0.3 – 0.5 mL per administration, up to 1 mL (1 mg) total dose.
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What strength of Epi is used for IV administration.
What dose do you give, what is the max total dose |
1:10,000 strength IV Use ONLY – dose 1 to 3 mL per IV push administration to a total of 10 mL (1mg) total dose.
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What side effect can you cause by too rapidly administering Epi
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V tack then V fib
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What should be done between each dose of epi and what should be done after final dose
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CHECK ABC’s between doses. Start Oxygen: 15L by mask unless COPD then 3L.
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Following epinephrine dose, what medication is administered in anaphylactic shock and what dose is given
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50 mg IV or IM diphenhydramine ALWAYS.
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Descrive IV Steroid Administration for anaphylactic shock
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(Usually done by EMS, you will do if pt can't get to help for hours)
Administer ONE of the following: a. Dexamethasone @ 10-20 b. Hydrocortisone @ 100 – 500 mg c. Prednisone @ 30-60 mg |
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When do you cut the cord from the placenta and the baby and how do you do it
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After drying and breathing has started
Make two ties: 4 inches from baby and 6 inches from baby cut cord |
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When do you do mouth to nose breathing
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Can’t open mouth
Can’t make a good seal Severely injured mouth Stomach distension |
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When should you move a pt to do CPR
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threat of fire or explosion
victim must be on a hard surface Place victim level or head slightly lower than body |
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What does RAP stand for in an emergency response situation
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Check Responsiveness
Activate EMS Postion on their back |
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How are compressions for CPR done
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- Using both hands, give 30 chest compressions
- Count 1, 2, 3 … - Depth of compressions: 1 .5 to 2 inches - For children: ½ to 1/3 of chest depth and use 1 or 2 hands (keep one hand on forehead if possible) |
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What is the pattern used for CPR
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30 chest compressions then 2 breaths
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When can you stop CPR
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Victim revives
Trained help arrives Too exhausted to continue Unsafe scene Physician directed (do not resuscitate orders) Cardiac arrest of longer than 30 minutes (controversial) |
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What are the most common complications of CPR
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Rib fractures
Laceration related to the tip of the sternum Liver, lung, spleen |
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What do you do if a victim vomits while you are doing CPR on them
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- Aspiration
- Place victim on left side - Wipe vomit from mouth with fingers wrapped in a cloth - Reposition and resume CPR |
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How do you Prevent Stomach Distension
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Don’t blow too hard
Slow rescue breathing Re-tilt the head to make sure the airway is open Use mouth to nose method |
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How do you remove something that is causing someone to choke
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- Give 5 abdominal thrusts (Heimlich maneuver)
- Place fist just above the umbilicus (normal size) - Give 5 upward and inward thrusts - Pregnant or obese? 5 chest thrusts - Fists on sternum - If unsuccessful, support chest with one hand and give back blows with the other - Continue until successful or victim becomes unconscious |
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What do you do if someone passes out when you are doing chest thrusts
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Call 911
Try to support victim with your knees while lowering victim to the floor Assess Begin CPR After chest compressions, check for object before giving breaths breaths |
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How do you do CPR on an infant < 1y/o
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Same procedures (RAPAB) except:
Seal nose and mouth or nose only Give shallow “puffs” RAPAB Give CPR Press sternum 1/2 to 1/3 depth of the chest Use middle and ring finger 30 compressions to 2 If alone, resuscitate for 2 minutes then call 911 |
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How do you care for a Choking: Conscious Infants
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Position with head downward
5 back blows (check for expelled object) 5 chest thrusts (check for expelled object) Repeat |
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How do you care for an Unconscious Infants Choking
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f infant becomes unconscious:
RAPAB When the first breaths don’t go in, check for object in throat then try 2 more breaths. If neither set of breaths goes in, suspect choking Begin 30 compressions Check for object in throat (no blind finger sweep) Give 2 breaths |
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Why is it important to not bury the needle up the to the hub when injecting
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If it were to break it would require surgery to remove
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What IV nutrient causes problems with using a glucometer
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Vit C
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What two things interfere with glucose when injected or given via IV
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Cortico steroids and Vit C
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What are the three best mm to inject into
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Deltoid
Vastus Lateralus Gluteous Maxiums |
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What angle is a subQ injection done at
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30 degrees
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What angle is a intradermal injection done at
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10-15 degrees
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What type of injection is used for TB test
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intradermal
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What is the best pH for IV solutions
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6.6 - 7.6, however you can do 5-9
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What is the optimal osmolarity to prevent phlebitis during IVs
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150-450 (around 300 is best)
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T/F If you have the correct osmolarity you will have the correct pH
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F - they need to be assessed separately
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Who is at risk for hematomas during IVs and how can you prevent them
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Fragile veins, elderly pt., poor technique.
Use small gauge device (catheter whenever possible) Educate high risk patients Pressure bandage |
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How can you tell if a thromubs has formed during an IV and how do you deal with it
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Watch for slow / stopped flow rate.
D/C the line, apply ice / pressure. This is rare in short term infusions. |
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What leads to phlebitis
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Osmolarity, flow rate, catheter size and placement all play a role
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What is the protocol for flushing a IV line
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Saline:
Slow flush through port with flow of IV stopped. No smaller than 10 cc syringe!! Procaine / Lidocaine: 1 or 2% drug (1cc.) in 9 cc NS. SLOW push!!!! |
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What needs to be done to assess septicemia in a pt
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blood cultures
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How does a pt get fluid overload, who is most susceptible and what are the sn/sx
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- Infusing an ISOTONIC solution too quickly.
- elderly and compromised kidney function. - Edema, Hypertension, Pulmonary edema (SOB & Crackles) |
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What is the tx for fluid overload
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Slow fluid infusion
Heat to dilate peripheral circulation O2 administration |
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How much air does it take to cause an air embolism
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10 to 60 cc
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what is the tx for an air embolism
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Place pt in LEFT LATERAL DECUBITUS POSITION! O2. Monitor vitals. EMS transport to ER.
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What is the procedure for catheter embolism
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Save the rest of the catheter.
Digital pressure proximal from the site / and-or tourniquet application. Radiological exam / ER visit needed. |
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What is Electrolyte (Macro-mineral) Shift
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Administration of Ca / K / Mg individually typically can predispose a patient to a “hyper” state of these ions (also chelation therapy)
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How do you reverse a glycemic crisis caused by IV vit C or EDTA
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D5W infusion, or slow push of D50 (5cc D50 in 5 cc sterile water) will reverse.
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How do you deal with Syncope
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Patient in Trendelenberg position
DO NOT D/C THE I.V. LINE!!! Slow (stop) infusion rate Talk to them (if conscious) Have them move their feet |
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How do you tx speed shock
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Trendelenberg position in some cases
STOP the infusion – do not D/C the line! Infuse NS Treat acute symptoms of the overdose Administer antidote if necessary |
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What are the sn/sx of anaphylaxis
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Apprehension / urticaria / edema / throat sensation
Severe cases: Hypotension LOC Mydriasis Incontinence Convulsion Sudden Death |
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How do you assess BP with pulse
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Radial pulse = AT LEAST 80 Systolic
Femoral pulse = AT LEAST 70 Systolic Carotid pulse = AT LEAST 60 Systolic |
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What do you use to reverse reverse hypocalcemia
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Calcium Gluconate
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What do you give for spasm or Ca overdose
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Magnesium Sulfate
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What are the different osmolarities of different types of solutions
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Isotonic: 250 – 375 mOsm/L
Hypotonic: Below 250 mOsm/ml Hypertonic: Above 375 mOsm/L |
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What happens from injecting a hypertonic solution
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Shift fluid into the plasma compartment – can cause circulatory overload
IRRITATING TO THE VEIN WALLS MAY BE PAINFUL |
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What type of solution is sterile water
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hypotonic
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When are lactate ringers or “Hartmann’s solution” CI
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Do not use in Addison’s or liver disease where lactate metabolism is impaired
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What can cause heart block when given via IV
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Calcium channel blockers and EDTA, & Mg
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What are cautions and CI in chelation
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Renal insufficiency
Liver disease Congestive heart failure Pregnancy |
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What is croup
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- inflammation of the larynx, trachea, and bronchi
- 3 mo - 3 yrs - Complication of viral infection - Difficulty breathing - Crowing sound on inspiration (inspiratory stridor) - Seal-like barking cough |
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Describe Compensated Shock
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Tachycardia, anxiety, restlessness, apprehension, delayed capillary refill, diaphoresis, widened pulse pressure
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Describe Decompensated Shock
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Hypotension, confusion, Loss of consciousness, oliguria, acidemia
(Tx is aggressive and rapid volume resuscitation, medications and invasive procedures) |
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Signs of shock
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Tachycardia- Earliest signs of shock
Hypotension- Late sign of shock Adrenergic responses “livedo reticularis”-mottled skin Altered Mental Status Orthostatic Vital Signs |
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What is hypovolemic shock
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Shock d/t loss of fluids
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What is Cardiogenic Shock
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Cardiac obstruction or pump failure, MI
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What is Obstructive Shock
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Significant fall in cardiac output, CHF
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What is Distributive Shock
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Loss of intravascular and decreased vascular volume; Neurogenic, sepsis, infectious problem
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What type of O2 support should be given to someone with head trauma
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100% O2 therapy:
- Conscious pts with adequate respirations-Non-rebreather - Unconscious or impaired respirations-Bag valve mask |
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If someone becomes combative after a head injury what should you assess for
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Evaluate for hypoxia, hypoglycemia, hypotension and pain
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How long does it often take for whiplash sx to manifest
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12-24 hours
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How much pressure should you apply to establish vasoconstrictive measure in the case of trauma
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With a BP cuff don't do more than 30 mmHg
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What type of wound has the greatest risk for infection
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Bites
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What wounds are Contra-indications to closure
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Heavy bacterial infection
Foreign body Devitalized tissue Major tissue defects |
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What are primary and secondary closure
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Primary Closure: Suture or butterfly adhesive suture closure
Secondary Closure: Wound heals from inside No primary closure done due to infection risk |
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What is the rule of 9 for burns
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Rule of Nines (adults)=100
9=each arm, head/neck 18=each side of torso, each leg Genitalia and perineum=1 |
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What is the rule of 5 for burns
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Rule of Fives (pediatrics)=100
10=each arm, and infant leg 15=head/neck of child and each leg 20=infant head/neck, child side of torso No value for peds genitalia |
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What are the regions of the adult body that are worth 9%
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Head
Upper body Lower body Both arms together each leg Genitals are 1% |
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What are the areas of the child's body worth in reference to burns
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Body - 18% (front and back each)
Head - 18% Each arm - 4 1/2 % Each leg - 7% |
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What are the areas of the infant's body worth in reference to burn
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Legs (each) - 14%
Arms (each) - 9% Face - 18% Each half of the body (front and back) - 18% Genitals - 1% |
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When do pts need a central line started in the case of burns
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If a burn covers more than 15%
At least one large bore IV (>16 gauge) Insert thru non-burned skin Central venous access used for large burns |
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How should O2 be administered in Burn tx
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Non-rebreather, 100%-15 lpm or Bag Valve mask if impeded respiration
If inhalation injury suspected, consider intubation to protect airway |
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How should fluids be administered to a burn victum
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One half of fluid volume given in the first 8 hrs, the remainder over next 16 hrs
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What assessment should be done on a burn victim
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- Labs - CBC, carboxyhemoglobin levels, CMP, urine electrolytes, ABG
- Nasogastric Tube - Urinary Catheter |
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What urine output should be maintained in a burn victim
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Urine output show be maintained at 0.5-1.0mL/kg/h adults, 1.0 mL/kg/h peds <10kg
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