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NCTC Emergency med &
NCTC Emergency meds and Disaster
| Question | Answer |
|---|---|
| What are your *3 responsibilities as an ER nurse? | * triage-assess ABC’s stabilization and/or resuscitation: CPR c. interventions-assess for injuries, systematically |
| What does PRIMARY assessment include? | a. Airway b. Breathing c. Circulation If no shock, look for injuries, swelling bruising and drainage |
| What is the purpose of your primary assessment? | * Identify and treat life threatening problems or injuries |
| When is a secondary assessment done and what does it consist of? | * After life threatening problems are stabilized * Consists of full assessment to identify all injuries and take full history |
| Expressed consent | Pt comes & asks for care i.e. “Please don’t let me die” |
| Implied consent | Pt is in need of life saving measures & arrives in the ER |
| Involuntary consent | Pt is considered mentally incompetent from: ETOH abuse, OD, attempted suicide, psychotic episode, schizophrenia, Alzheimer’s, unconscious |
| Consent for a minor | Parental consent necessary for pt’s <18 y.o. except for life saving measures |
| * PVC’s & couplets indicate ventricular electrical irritability | * Potential for V-Tach |
| why would a KVO rate be ordered? 20-30 | * vascular access necessary in case of emergency |
| Why would a 12 lead EKG ordered if the pt was already on a cardiac monitor? | * portable cardiac monitor only shows one –two views view of the heart * 12 leads gives you several different views of the heart and increases the ability to locate the damage |
| What cardiac enzyme tests are there and what do they tell you? | * Definite MI or not * Troponin * CPK * CKMB |
| cardiac rhythm suddenly changes from couplets and triplets to V-Tach. He loses consciousness. *There is no pulse or BP. What is this situation called? | * *Cardiopulmonary arrest |
| What nursing diagnoses are appropriate for the pt undergoing CPR? | * altered tissue perfusion * ineffective breathing pattern |
| What *outcome criteria is desired after CPR? | * adequate oxygenation * return to spontaneous HR & respirations |
| When you assess someone’s breathing what specifically are you checking? | * Respiratory rate * Depth of breath * Air movement * Use of accessory muscles * cyanosis, color * symmetry of chest wall movement * change in LOC * JVD * Tracheal shift * Breath sounds |
| Whenever you assess a breathing problem, what is ALWAYS your INITIAL treatment? | * Maintain airway |
| What is a pneumothorax and what are the *S/S? | * Collapsed lung * *dyspnea * *asymmetric chest wall mvmt * absent breath sounds * cyanosis * JVD |
| How does air in the pleural space prevent lung expansion? | * Lungs can’t expand against air |
| What is the treatment for a tension pneumothorax? | * Needle thoracostomy * Emergency care: needle decompression * Chest tube insertion |
| What will you need to set up for a chest tube insertion and what are your nursing responsibilities? | * Chest tube tray, chest tube, pleurovac, wall suction * Assist with CT insertion * Monitor VS & O2 sat * Administer meds & O2 as ordered * X-ray, ABG’s after insertion |
| What is an open pneumothorax ? | Collapsed lung caused by a penetrating chest wound |
| What is the other name for an open pneumothorax? Why is it called this? | * “sucking chest wound” * you can hear air passing through the chest wall |
| How do you bandage a sucking chest wound? | * Vented dressing |
| . What would the treatment be for an open pneumothorax? | * Cover the hole in the chest with vaseline gauze * Allow air to vent – tape only 2-3 sides * Chest tube insertion * Usually intubation is required |
| Which is more dangerous; a tension pneumothorax or an open pneumothorax and why? | * Both can be fatal * Open due to risk of infection and bleeding * Tension due to mediastinal shift, compression of vital organs |
| What is a hemothorax? | * Blood in the pleural space &/or thoracic cavity |
| Where else can blood accumulate to create a life threatening situation? | * Pericardial sac * leads to decreased CO * *cardiac tamponade |
| What is the worst complication of a hemothorax? | * Shock |
| What causes shock? | * *Acute circulatory failure |
| What are the S/S of shock?* *Compensatory Stage | * Increased HR, may be thready or bounding * Cool, pale, clammy skin, decreased BP * Increased respiratory rate & depth |
| What are the S/S of shock?* Progressive Stage | * Tachycardia, hypotension, tachypnea * Oliguria, cyanosis |
| What are the s/s of shock Refractory Stage | * Bradycardia, hypotension, bradypnea, anuria * *Neurological progression in shock: Restlessness, anxiety, fear, followed by listlessness and unconsciousness |
| What nursing diagnosis is appropriate for shock? | * *Decreased C.O. R/T low arterial pressure and hypovolemia |
| . What *outcomes (goals) are optimal for the pt with shock? | * Increase CO * Increase cerebral blood flow * Decrease fear |
| List the priority & *interventions appropriate for the pt with shock: | * Priority-to maintain blood flow to the brain * Elevate legs only * *Contraindicated if shock caused by heart failure, head or neck is bleeding, risk of possible spinal cord injury, increased ICP or SOB |
| What causes the skin to feel cool in a pt with shock? | * *Blood is shunted to vital organs * Do not warm pt too much * leads to vasodilation and takes blood away from vital organs |
| What are the 3 standardized treatments for external bleeding in prioritized order? | * Direct pressure * Elevation * Pressure Points |
| What are pressure points & where are they located? | * Pulse site between the heart and laceration * Carotid * Axillary * Brachial * Radial * Femoral * Popliteal * Pedal |
| Why is a tourniquet used ONLY as a last resort? | * Can cause tissue death Can lead to amputation |
| What complication of uncontrolled bleeding can be fatal? | * Shock |
| How much blood pressure is needed to maintain kidney function? | 60 mmHg systolic |
| What are the differences in the 4 designated levels of trauma centers? | * Level 1 – 24 hour CT, angio and surgery, all specialties available in <30 min, falls >15 ft * Level 2 – falls <15 ft, surgeon available in <30 min, specialists >30 min * Level 3 – no CT, need to transfer surgical patient at evening & night, no MRI |
| Which universal precautions are especially needed to protect the ER staff in cases of uncontrolled bleeding? | * Gloves, gowns, masks, goggles, shoe covers Must wash hands even if they wear gloves |
| Laceration | jagged cut in skin |
| Abrasion | scrape |
| Incision | sterile surgical cut in skin |
| Puncture | narrow penetrating wound |
| Contusion | bruise |
| Amputation | severing of extremity |
| What lab work do you need before you transfuse blood safely? | * Type and Cross |
| What are the guidelines for a properly applied splint? | * Immobilize joints on both sides of possible fracture * *Splint in the position found |
| There are 4 interventions that the nurse should do for all fractures. What are they? | * Check pulses * Immobilize * Ice * Elevate |
| What “5 P’s” must the nurse include when assessing and charting a fracture? | * Pain * Pallor * Pulses * Paresthesia * nerve damage, numbness & tingling * Paralysis |
| What is the purpose of Buck’s traction? | * Decreases muscle spasms |
| Why is it essential to delay narcotics before informed consents are signed? | * Consent may be contested if patient is impaired |
| What laws may protect against liability when someone renders first aid at an accident? | * *Good Samaritan laws * Protects citizens who stop for accidents * Does not always protect Nurses, Dr.’s, Paramedics, or EMT’s HIPPA laws still apply! |
| What circumstances should Ipecac not be given? | * Patient was unconscious * When petroleum products or caustic substances are ingested * Patient already vomiting * Having seizures |
| Although Ipecac is commonly given in the field for OD’s, why is it not appropriate to give it in the ER? | * Ipecac leads to vomiting which delays activated charcoal |
| *What is an antidote? | * Blocks or reverses affects of other substances |
| What is the antidote for an ASA overdose? | Activated charcoal |
| overdosed on Tylenol, what would the antidote be? | * *Mucomyst - may also give this with liver pts, who are having dye's etc.... * acidic with ice |
| What is the purpose of administering Mg Citrate or Sorbital after activated charcoal? | To aid in elimination of activated charcoal |
| After administering activated charcoal, what GI reaction is expected? | * Black diarrhea |
| What coagulation lab tests are essential for you to monitor with an ASA overdose? | * PT/PTT |
| . What is carbon monoxide? | A colorless, odorless gas emitted from an auto engine, gas ovens, or stoves, burning charcoal |
| What are the *S/S of carbon monoxide poisoning? | * HA with mild exertion * Dizziness * Vomiting * Mental changes * Cherry red lips * Dyspnea * O2 sats are going to be great |
| What is the goal of emergency treatment for the pt with CO poisoning? | * *Adequate oxygenation |
| What causes food poisoning? | * Ingesting contaminated foods * May be caused by: * Bacteria * Chemicals * Natural toxins |
| What are the *common S/S of food poisoning? | * Nausea, vomiting, diarrhea * Abdominal cramping |
| What steps can be taken to prevent food poisoning? | * Proper storage and prep of perishable foods * Good hand washing * Cook food well |
| What *serious problems can be caused by bites or stings? | * Anaphylactic shock * Infection and tissue destruction |
| What is anaphylactic shock (anaphylaxis)? | * Hypersensitivity reaction to an allergen which leads to massive histamine release |
| Death from anaphylactic shock has been known to occur within ________ minutes of the initial onset of S/S. | * 5-10 minutes |
| What are the S/S of anaphylaxis? | * Rapid shallow breathing * *Bronchospasms * Dyspnea with cyanosis * Restlessness * Laryngeal edema * *Hypotension * Rapid thready pulse * Swelling & itching at site * *Decreased blood volume * *Peripheral vasodilation |
| What is the INITIAL, CRITICAL treatment to prevent the progress of anaphylaxis? | * *Epinephrine injection * *Benadryl, Medrol dose pack, aminophylline, hydrocortisone * Go to ER, call 911, if SOB or throat swelling |
| What patient teaching is imperative for clients with hypersensitivity reactions? | * *Buy an Epi pen * Medic alert bracelet |
| * Poisonous snakebites can also be life threatening. The different types of poisonous snakes are rattle, copperhead, cottonmouth & water moccasin, all of which are in Texas. What type of venom affects nerves & what are the *S/S? | * Neurotoxic * N/V * Dizziness * Tachycardia * Muscle twitching * Respiratory distress |
| What is the primary objective of treatment after a snake bite? | * Limit absorption of venom * Keep the extremity below the heart * Immobilize the body part * Keep the pt still |
| What is always the FIRST critical action when treating a burn pt? | * *Stop the burn to limit extent of injury * then assess ABC’s |
| How would you assess a flame burn | * Look at airway first for respiratory distress from potential smoke inhalation |
| * Heat exhaustion – | * inadequate peripheral circulation due to dehydration & electrolyte imbalance * *S/S: HA, fatigue, dizziness, muscle cramping, pale, ashen, moist skin, temp 101-104, decreased BP, increased RR & HR |
| * Heat Stroke | * advanced heat exhaustion * *occurs when mechanisms in the brain fail to regulate body temp * *S/S: temp >106F, confusion, delirious, skin hot & dry, decreased BP, increased RR & HR, may become comatose |
| What *drugs can increase the risk of heat stroke? | * Diuretics * Anticholinergics |
| What are appropriate *nursing diagnoses for a pt. w/heat exhaustion? | * Hyperthermia R/T heat exposure, dehydration & inappropriate clothing * Risk for FVD R/T excessive fluid loss |
| After treating for the ABC’s, what are your *treatment goals when you have a pt with heat exhaustion or heat stroke? | * Reduce temp to <101 * Decrease risk of FVD * Increase intake & retention of fluids * Normal pulse and RR * Decrease risk of injuries |
| How would you perform cooling measures on a heat stroke or exhaustion pt? | * Remove clothes * Cover with cool, wet towels * Use of electric fans * Apply ice packs to pulse points * Use of cooling blanket * Move pt to cooler environment/shade |
| If your initial non-invasive cooling measures are inadequate, what invasive interventions could the ER staff try next? | * Iced saline lavage * Cool water bladder irrigations * Cool fluid PO |
| What does CPR stand for? | * Cardiopulmonary resuscitation |
| When is CPR done? | * In the absence of spontaneous respirations |
| Describe the one man CPR method. | * Establish unresponsiveness * Call 911/obtain AED * Check breathing * Give 2 breaths * Check carotid * Start compressions: 30:2 |
| *When can CPR be interrupted to check a pulse, rhythm, or change rescuers? | * After 5 cycles, or after approximately 2 minutes of CPR |
| When one-man CPR converts to two-man CPR at the hospital, what is the ratio of compressions to breaths? | * 15:2 |
| Why are pts intubated during a code? | * To provide adequate oxygenation |
| What cardiac stimulant drug is ALWAYS the first drug given for asystole? | * Epinephrine |
| What SA node stimulant drug is given after epinepherine for asystole? | * Atropine |
| What is the most appropriate treatment goal for a pt in resp. arrest? | * Return of spontaneous respirations |
| Why is IV access so difficult to obtain in hypothermia pt’s? | * Return of spontaneous respirations |
| Why is IV access so difficult to obtain in hypothermia pt’s? | The cold causes vasoconstriction |
| Other than arms, hands and legs, where can IV access be obtained? | * Subclavian * Jugular * Femoral |
| What are the *areas most affected by cold injuries? | * Hands * Feet * Nose * Cheeks |
| What are some of the *S/S of cold injury? | * Pain first * then Tingling * last: Numbness |
| Rapid re-warming of a hypothermia victim is essential for survival. How is total body re-warming accomplished? | * Warm blankets * Warm oral fluids * Warm IV fluids |
| *Who is at the highest risk for hypothermia and why? | * Elderly * More susceptible because of loss of subcutaneous fat, diminished circulation, and reduced neural control of circulation |
| What *treatment goals do you wish to accomplish when treating the hypothermic pt? | * Temp >95 * Good circulation and warmth to tissues without tissue cellular damage |
| What are the *S/S of severe hypothermia? | * Bradycardia, irregular heart rhythm * Bradypnea, or irregular respirations * Hypotension * Will progress to cardiac arrest if untreated |
| Anthrax | an infectious disease caused by bacteria called Bacillus anthracis. Infection in humans most often involves the skin, the gastrointestinal tract, or the lungs. |
| Vesicant | A substance that causes tissue blistering. A blister agent. Also called a vesicatory.Vesicants are highly reactive chemicals that combine with proteins, DNA, and other cellular components to result in cellular changes immediately after exposure. |
| Smallpox | Backache Delirium Diarrhea Excessive bleeding Fatigue High fever Malaise Raised pink rash -- turns into sores that become crusty on day 8 or 9 Severe headache Vomiting |
| Neurotoxic | Poisonous to nerves or nerve tissue. Mercury and lead are neurotoxic. |
| Botulism | Botulism is caused by botulinum toxin, Botulinum toxin blocks motor nerves' ability, and flaccid paralysis occurs. As botulism progresses, the muscles that control the airway and breathing fail |
| Nerve Gas | any of several poison gases intended for military use, e.g., tabun, sarin, soman, and VX. These gases generally cause death by asphyxiation, often preceded by such symptoms as blurred vision, excessive salivation, and convulsions. |
| Radiation | High doses cause intense diarrhea and dehydration and extensive skin necrosis. |
| Disaster | Public health Any unanticipated event that requires urgent response, bringing people and/or property out of harm's way in order to minimize loss of life or destruction of property; |
| Dirty Bomb | an explosive device that disperses radioactive material over a wide area, contaminating land, buildings, and people. Its purpose is to cause fear and to make an area unusable for a long time. |
| ARS-Acute Radiation Syndrome | nausea, vomiting, and diarrhea. will last for minutes up to several days, and may come and go. Then looks and feels healthy for a short time, then will become sick again, and possibly even seizures and coma. may last from a few hours up to several months. |
| Triage | A process for sorting injured people into groups based on their need for or likely benefit from immediate medical treatment. |
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