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133 Cards in this Set
- Front
- Back
During the primary assessment evaluate the _____?
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ABCDEs
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Conduct a ______ and _____ assessment of the general appearance in the first few seconds of the pt assessment
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Visual and auditory
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Once the child's condition has been stabilized, proceed with the _____ and _____ assessment
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Secondary and tertiary
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Central apnea is characterized by _____?
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absence of inspiratory muscle activity
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Respiratory rate is best evaluated before your _____?
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hands on assessment
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RR of Toddlers 1 to 3 yr
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24-40
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RR of preschoolers
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22 - 34
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You can decide what you need to do and implement the action or treatment at the end of this phase.
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primary assessment
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This assessment included vital signs and O2 saturation.
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Primary
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Here you assess cardiopulmonary and neurologic function to categorise a childs condition.
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primary
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This assessment is hands on
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primary
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The _____ assessment uses the ABCDE approach and means _____?
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primary
Airway, breathing, circulation, disability, exposure |
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Activating the ERS, starting CPR, obtaining the defibrillator, place pt on monitor, giving O2, and starting treatment fall under what step of the ACDA?
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Act
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In the ACDA the D stands for _____ and means what?
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Decide. Decide what to do based on your assessment and initial categorization of the clinical condition. Base these on your scope of practice.
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In the ACDA attempt to categorize the clinical condition by _____ and _____.
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type and severity
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Laboratory, radiorgaphic, and other advanced tests that help to establish a child's physiologic condition and diagnosis.
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Tertiary assessment (falls under the systemic approach)
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Under the systematic approach, the secondary assessment, you should do what?
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Focused medical and SAMPLE and a head to toe exam.
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A rapid hands-on ABCDE approach to evaluate cardiopulmonary and neurologic function. Includes vital signs and pulse ox
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The primary assessment of the systematic approach.
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The general assessment is what?
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A rapid, visual, and auditory assessment of a child's overall appearance, work of breathing and circulation.
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The 4 parts of the pediatric assessment?
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General
Primary Secondary Tertiary |
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The 4 parts of the APPROACH to pediatric assessment.
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ACDA (assess, categorize, decide, act)
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Cardiac arrest in children is rarely sudden cardiac arrest, instead it is most often _____?
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asphyxial
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Clinical signs of cardiac arrest
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apnea, or agonal gasps
no palpable pulses unresponsive |
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For VF/VT after 1 shock give _____?
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epinephrine 0.01 ml/kg 1 to 10,000 q 3 to 5 min
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antiarrhythmics used for pals CPR
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amiodarone 5mg/kg
lidocaine 1mg/kg |
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The 5 drugs used to treat tachyarrhythmias.
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adenosine: 0.1 mg/kg 2ns dose x2
amiodarone: 5 mg/kg (max 300) lidocaine: 1 mg/kg procainamide: 15 mg/kg sodium bicarb:1 mEq/kg |
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Respiratory distress is a clinical state characterized by ____?
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increased respiratory rate and effort. And may include sounds, skin color, and mental status.
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Respiratory failure is characterized by _____?
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inadequate oxygenation, ventilation or both.
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A true diagnosis of respiratory failure may require _____?
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laboratory testing
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RR for toddler
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24-40
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RR for preschool
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22-34
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RR for school age
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18-30
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RR for adolescent
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12 to 16
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_____ is the term used for tachypnea without the signs of increased respiratory rate.
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quiet tachypnea
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Quiet tachypnea results from an attempt to _____?
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maintain normal blood PH
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Quiet tachypnea commonly results from nonpulmonary conditions like ?
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high fever, pain, mild metabolic acidosis, sepsis
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central apnea is characterized by ?
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absence of inspiratory muscle activity or suppression of the brain or spinal cord
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An absence of airflow with no inspiratory muscle activity or a suppression of the spinal cord
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central apnea
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obstructive apnea
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inspirstory muscle activity without airflow
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Inspiratory muscle movement without airflow is called?
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obstructive apnea
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mixed apnea is characterized by?
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mixed central and obstructive apnea
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mixed apnea is?
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a combo of both obstructive and central apnea.
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signs of increased respiratory effort include?
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nasal flaring, chest retractions, head bobbing or seesaw respirations
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_____ is a serious sign and may indicate respiratory distress or respiratory failure.
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Grunting
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seesaw breathing usually indicates _____ airway obstruction.
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upper
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normal tidal volume is _____?
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5 to 7 mm/kg
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In the child with apparently normal or increased respiratory effort, diminished distal air entry suggests __________?
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airflow obstruction or lung tissue disease.
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significant airway abnormalties may be missed in the _____ child.
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obese
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RR X tidal volume =
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minute volume
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A course high pitched breathing sound.
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stridor
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Stridor sounds like
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a course high pitched sound. Typically heard on inspiration.
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Stridor is a sign of ____ airway obstruction.
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upper
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a sound that may indicate critical airway obstruction requiring immediate intervention
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stridor
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A low pitched sound heard on expiration.
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grunting
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Grunting occurs as the child exhales against a partially closed _____
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Glottis
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A sound that may indicate lung tissue disease of the small airway or alveolar collapse
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Grunting
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An upper airway sound heard due to airway secretions, vomit or blood.
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Gurgling
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A high pitched or low pitched whistling or sighing sound most often heard during expiration.
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Wheezing
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This sound indicates lower (intrathoracic) airway obstruction, especially of the smaller airway.
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Wheezing
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inspiratory wheezing suggests _____?
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a foreign body or other obstruction in the trachea or upper airway.
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A sharp crackling sound heard on inspiration may be wet or dry.
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Crackles (railes)
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A sound that indicates accumulation of alveolar fluid.
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crackles (railes)
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Dry crackles are most often heard with _____?
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atelectasis and interstitial lung disease.
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If the heart rate displayed on the pulse oximeter is not the same as that of the monitor the reading is _____?
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not reliable
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If a child is _____ saturation may be 100% but O2 delivery may be low.
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anemic
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Assessment of circulation includes evaluation of _____ and _____
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cardiovascular function and end organ function.
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Cardiovascular function is assessed by evaluation of the __________?
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skin color and temp.
heart rate heart rhythm BP pulse cap refill |
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End organ function is assessed by the evaluation of the _____?
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brain perfusion (mental status)
skin profusion renal perfusion |
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The most common cause of bradycardia in the child
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hypoxia
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Hypotension may occur with ____ to ____ % of blood loss
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20 to 25%
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Hypotension may be a sign of septic shock due to _-___-?
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vasodilation
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Pulsus paradoxus can occur in children with _____ or _____?
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severe asthma or pericardial tamponade
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Brain perfusion signs consist of?
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level of consciousness
muscle tone pupillary response |
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Sudden and severe cerebral hypoxia may present with these neurologic signs.
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loss of muscle tone
seizures pupillary dilation unconsciousness |
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Alterations in neurologic signs may be caused by conditions other than cerebral hypoxia name them.
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drugs,
ICP metabolic conditions |
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Petechiae appear as tiny dots and suggest a _________?
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low platelet count
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Purpura (discolorations caused from bleeding of capillaires and small vessels) appear as larger spots and may represent ______?
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septic shock
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Cyanosit is not apparent untill at least _____ d/dl of hemoglobin is desaturated.
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5
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Children with different _____ levels will be cyanotic at different levels O2 levels
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hemoglobin
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increased urine output may be due to _____?
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high glucose (hyperglycemia)
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A quick evaluation of the cerebral cortex and brain-stem is known as _____?
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The disability assessment
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The disability assessment consists of a quick assessment of ____?
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nervous system ( brain-stem and cerebral cortex)
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The Disability assessment should be done after the _____?
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primary assessment
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At the end of the primary assessment do the _____ assessment
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Disability assessment
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The _____ assessment establishes the childs level of sonsciousness.
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Disability
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The disability assessment consists of evaluating the ?
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AVPU pediatric response scale
GCS (Glasgow coma scale) Pupillary response to light |
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To rapidly evaluate the cerebral cortex function use the ______ scale
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AVPU
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The AVPU scale evaluates the _____?
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Cerebral cortex
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The most widely used method of defining a childs level of consciousness and neurologic status is ______?
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GCS
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The GCS is used to assess the ____
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Level of consciousness and neurologic function
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Pupil response to light is a good indicator of ____?
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brain-stem function
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The final component of the primary assessment is _____
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Exposure
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After the ABCDE assessment move on the the ____ assessment
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secondary
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The secondary comes after the _____ assessment.
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ABCDEF assessment
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The components of the secondary assessment focus on?
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Focused history
physical exam |
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The physical exam and focused history are part of the _____ assessment.
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secondary
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Use the ____ to identify important aspects of the childs history and presenting complaint
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SAMPLE
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The SAMPLE mnemonic is used to identify aspects of _____?
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focused history
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The tertiary assessment consists of ancillary studies to detect and identify the presence and severity of _____ and _____?
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respiratory and circulation abnormalities.
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To detect and identify the the presence and severity of respiratory and circulatory abnormalities use the _____ assessment.
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Tertiary
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The timing of the tertiary tests are dictated by the ___ ____?
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clinical situation
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Laboratory studies that help assess the respiratory abnormalities are?
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arterial blood gas
venous blood gas hemoglobin concentration |
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Non-laboratory studies to help determine respiratory abnormalities are?
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Pulse oximetry
CO2 monitoring Capnography Chest x-ray peak expiratory flow rate |
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ABG analysis measure the _____?
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partial pressure of atrial O2 (PaO2) and carbon dioxide (PaCO2) disolved in the plasma.
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The partial pressure of atrial O2 (PaO2) and carbon dioxide (PaCO2) disolved in the plasma is measured by the ___?
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the ABG
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The PaO2 measures ?
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Adequacy of oxygenation (of arterial blood not O2 content)
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The PaCO2 measures?
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Adequacy of ventilation
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The adequacy of ventilation is measured by the ?
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PaCO2
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The adequacy of oxygenation (of arterial blood not O2 content) is measured by ?
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PaO2
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A normal PaO2 does not confirm oxygen content of the blood because?
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It reflects only the O2 dissolved in the blood plasma
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Arterial saturation can be calculated by using the?
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PaO2 and pH
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PaO2 and pH can determine?
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arterial oxygenation saturation
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You would use a Co-oximeter to rule out?
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carbon dioxide or methemoglobinemia
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Respiratory failure is traditionally based on ?
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inadequate oxygenation (hypoxemia) or inadequate ventilation (hypercarbia)
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A low paO2 on the ABG is?
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hypoxemia
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Hypoxmia is diagnosed as ___ on the ABG results
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low PaO2
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A high PaCO2 on the ABG is ?
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Hypercarbia
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Hypercarbia is diagnosed as ___ on the ABG results
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High PaCO2
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A ___ is not requires to identify respiratory failure
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an ABG
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A normal PCO2 on the venous blood gas analysis is typically within ___- to ___ mmHg of the arterial PCO2
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4 to 6 mmHg
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On the venous blood gas a high PCO2 and a low pH may be due to ____ use
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tourniqet
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A ____ specimen is preferable to a _____ specimen for the source of a VBG
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Central venous
peripheral venous |
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Hemoglobin concentration helps determine adequacy of ____ _____ capacity
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oxygen carrying
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Oxygen content is determined largely by the ________?
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hemoglobin concentration (g/dL) and its saturation with oxygen (SaO2)
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____ provides a noninvasive estimate of SpO2 of the oxyhemoglobin saturation (SaO2)
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pulse oximetery
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Repeat assessments of PaCO2 by ABG analysis can be avoided using this
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Capnography
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This type of X-ray will NOT help determine tracheal vs. esophageal placement of the ET tube.
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anterior-posterior or posterior-anterior
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Arterial pH and bicarbonate (HCO3) concentrations obtained with ABG's may be useful in the diagnosis of _____?
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acid-base imbalances
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Normal venous oxygen saturation (vO2) is approximately ___ to ___ % if arterial oxygen saturation is 100%
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70 to 75%
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There should be a __ to __ % absolute difference between the central venous and atrial oxygen saturation.
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25 to 30%
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The total serum CO2 is the total amount of carbon dioxide in the blood. It is present in these 3 forms.
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Bicarbonate (HCO3)
Carbonic acid (H2CO3) Dissolved CO2 |
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Total CO2 can be used to evaluate the severity of an ____________ imbalance and determine whether the etiology is primarily metabolic.
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acid-base
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Hemoglobin concentration indicates the what?
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Oxygen carrying capacity of the blood.
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