emergency care

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emergency care
2011-06-18 11:58:37
emergency care

emergency care
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  1. one rescuer Cpr for an unwitnessed cardiopulm arrest in Adults and children
    • determine unresponsiveness
    • call for help
    • establish airway
    • check for breathing
    • give 2 full breaths
    • check for pulse
    • -if pulseless- begin chest compression
    • provide 100% o2 and draw abg
  2. head tilt/ chin lift should not be used for pt with
    • fractured neck
    • suspicion of neck fracture
    • any type of trauma
    • bruised on side of pt neck
  3. jaw thrust/ modified jaw thrust (modified means better) allows for establishing patent airway in what type of pts
    suspected neck fracture
  4. 3 complications of ventilation
    • gastric distention * most common
    • pneumothorax
    • gastric rupture
  5. 3 complications of external cardiac compression
    • rib fractures * most common (do not stop CPR)
    • fractured sternum/ clavivle
    • contusions to heart or lungs
  6. eval of effectiveness of cardiopulm resuscitation
    • coratid pulse should be present during compreesion * best method
    • color returns to normal
    • do not remove cervical collar on during resuscitation- check femoral pulse
    • ECG shows sinus rhythm with no pulse- cont CPR
  7. compression to ventilation ratio for Adult
    30:2 both one and two rescuer
  8. compression to ventilation ratio for Child and Under 1 year
    15:2 two rescuer
  9. compression to ventilation ratio for Newbown/Neonate
    3:1 both one or two rescuer
  10. call 911 after
    1 min or 20 cycles
  11. begin chest compressions if heart rate is less than
  12. causes of upper airway obstruction
    • tongue/soft tissue * most common
    • inspissated secretions * very thick, dehydrated, must hydrate pt
    • laryngospasm
    • laryngeal or subglottic edema
  13. how to treat severe airways obs in an infant
    • 5 back blows with the heel of the hand btwn the infants shoulder blades
    • 5 chest thrust
  14. if the infant becomes unresponsive, DO NOT perform
    • blind finger sweep
    • look for visible foreign objects
  15. hwo to treat severe airwas obs in a 1 year of age or older
    wrap arams around waist with thumb side of one fist against abdomen slightly above navel, well below the xiphoid process
  16. if pt is ovese of a woman in the advanced state of pregnancy, what kind of thrusts whould you perform
    chest thrusts
  17. how to treat hypotension
    • fluid challenge
    • dopamine
    • dobutamine
  18. how to treat bradycardia
    • atropine, dopamine, epi for adult
    • epi and atropine for children
    • external pacemaker
  19. how to treat PVC
    • oxygen
    • lidocaine
  20. how to treat pulseless ventricular tachycardia
    • defib @ 360 jules
    • if unsuccessful, start CPR and admit epi, amiodarone or lidocaine
  21. how to treat v-fib
    • defib @ 360
    • if unsuccessful, start CPR and admit epi, amiodarone or lidocaine
  22. how to treat asystole
    • confirm 2 leads
    • epi
    • atropine
    • DO NOT defib
  23. cardiovert is only used for
    • a-flut
    • a-fib
    • v-tach with pulse
  24. cardiovert begin with ___ jules
  25. synchronizing switch should be ___ before cardioverting
  26. electric shock is delivered on the ___ wave of ECG
    R wave
  27. what type of sedation should you give while delivering cardiovert
    midazolam - versed
  28. defib is only used for
    • pulseless v-tach
    • v-fib
  29. defib begins with ___ jules
    360 jules
  30. synchronizing switch should be ___ before defib
  31. AED is only attached to a ____ victim
  32. AED is only used when victim is
    • no response
    • no breathing
    • no pulse
  33. criteria for the ideal resuscitation bag (self-inflating)

    ideal stroke vol for adult/ infant
    • adult- 800
    • infant- 200
  34. mask design
    • well fitting
    • shapeable
    • transparent
  35. reservoir gives
    • 95-100% at 15 lpm
    • quick attachment/non pulky
  36. if the resuscitation bag rapidly and collapses easily on minimal pressure, what should you check
    inlet valve
  37. if the bag becomes difficult to compress and pt compliance is normal, pt valve may be
    stuck open or closed
  38. TRACHEA DEVIATED to opposite side, HYPERRESONANT percussion note and decreased b/s on the AFFECTED side

    chest tube insert
  39. TRACHEA DEVIATED on the oppposite side, DULL percussion note and decreased b/s on the AFFECTED side

    chest tube insert
  40. TRACHEA DEVIATED to the left, hyperresonant persuction on the right, dull percussion on the left, increased chest movement on the right and decreased on the left
    right mainstem intubation
  41. mouth to valve mask vent technique has several advantages
    • eliminates direct contact with the pt
    • one way valve btwn the mask and the practioners mouth eliminates the exposure to exhaled air
  42. group of healthcare workers who respond to pts with declining conditions and can prevent potential emergencies before they occur
    rapid response team
  43. transport vehicles 81-150=
  44. transport <80
  45. transport >150
    fixed wing aircraft (airplane)
  46. 6 emergency pathologies
    • pulm edema0 congestive heart failure
    • pulm embolism
    • pneymothorax
    • status asthmaticus
    • trauma
    • co poisoning
  47. left ventricular failure and lung reaction. excessive fluid acculmates in the lungs and affects ventilation and especially oxygenation
    pulm edem- CHF
  48. assessment of pulm edema
    • orthopnea
    • pitting edema
    • distended neck veins
    • increased resp distress
  49. secretions of pulm edema
    pink frothy
  50. b/s of pulm edema
    fine audible rales or crackles
  51. cxr of pulm edema
    • fluffy infiltrates
    • butterfly
    • batwing
  52. tx of pulm edema
    • 100% 02
    • ippb and peep
    • cpap
    • increase strenth of heart contraction(inotrophy)- digitalis
    • decrease venous return- lasix, fowlers position
  53. deadspace disease (ventilation w/o perfusion) caused by bloodclots in the lungs and will affect oxygenation and circulation
    pulm. embolism
  54. what type of pt are at risk of pulm embolism
    • post op
    • bedridden
    • hx of circulation prob DVT
    • long periods at rest
  55. tx of pulm embolism
    • o2 at 100%
    • anticoagulation therapy- heparin/ coumadin
    • thrombolytic drugs, screens, surgery
  56. presence of air in the pl space that can seriously affect ventilation
  57. b/s of pneumothorax
    • dec vocal fremitus
    • percussion note is hyperresonant or tympanic (extra air)
  58. cxr of pneumothorax
    hyperlucency w/out vascular marking and a flat diaphragm
  59. tx of trauma
    • always start with ABC
    • 100% o2
    • durgs/fluids
  60. inability of hemoglobin to bind w/ o2 due to the binding of carbon monoxide. seriously affect oxygenation
    co poisoning
  61. COHb on co oximeter would read
  62. tx of co poisoning
    • 100% o2 via non-rebreather, cpap, ett
    • hyperbaric oxygen