Emergency Care
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| What are the steps in CPR adults and children 8 years older | tap and shout, call for help, establish airway head tilt chin lift, check breathing, give 2 breaths, check for pulse, if no pulse chest compressions, provide 100% o2, draw abg
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| What are the complications of CPR | gastric distentions, pneumothorax, gastric rupture, cross contamination, aspiration
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| What are the complications of external cardiac compressions | rib fractures, fractured sternum and clavicle, contusions to heart and or lungs, lacerated liver and or spleen due to xiphoid compression, pulm/fat embolism, pneumothorax/hemothorax
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| How do you evaluate the effectiveness of cardiopulmonary resuscitation | carotid pulse should be felt during compressions, color normal
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| What are the various methods of emergency ventilation | mouth to mouth, mouth to nose, mouth to tube or mask, mouth to valve/mask, bag and mask, cricothyrotomy and transtracheal catheter, intubation/tracheotomy
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| When trouble shooting problems with manual ventilation high resistance/low compliance a pneumothorax presents | air in the pleural space, trachea deviated to opposite side, hyperresonant percussion note and decreased breath sounds on the affected side, recommend insertion of chest tube
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| When trouble shooting problems with manual ventilation high resistance/low compliance a hemothorax presents | blood in the pleural space, trachea deviated to opposite side, dull percussion note and decreased breath sounds on the affected side recommend insertion of the chest tube
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| When trouble shooting problems with manual ventilation high resistance/low compliance endotracheal tube obstruction presents | unable to pass suction catheter, decreased breath sounds, remove tube and use alternative form of ventilation (bag valve mask unit)
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| When trouble shooting problems with manual ventilation high resistance/low compliance, right mainstem intubation presents | trachea deviated to the left, hyper resonant on the right, dull on the left, increased chest movement on the right, decreased on the left, withdraw tube slightly and listen for bilateral breath sounds
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| What are the steps for CPR for unwitnessed cardiopulmonary arrest in children 1 to 8 years old | tap and shout, establish airway, check breathing, 2 full breaths, check pulse, compressions and ventilations for 1 minute or 20 cycles, 100% o2 abg
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| What are the steps for CPR for infants less than a year old | tap and shout, establish airway, check breathing, give 2 breaths, mouth to mouth and nose ventilation, check pulse brachial, if no pulse compressions 1 minute or 20 cyles 5:1 ratio with a pause after 5th compression, call for help, 100% o2 abg
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| How do you perform resuscitation birth to 1 month airway | sniffing position
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| How do you perform resuscitation birth to 1 month breathing | 3-5 seconds listen for sounds of ventilation at the neonates mouth and nose while looking at the chest and abdomen for movement, give 2 slow breaths
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| How do you perform resuscitation birth to 1 month cardiac compressions | use thumbs or 2 fingers perpendicular on the lower third of sternum below nipple line neonate, 1/2-3/4 inch at 90/min and 30 ventilations
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| What is the ratio for neonate | 3:1
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| Adult 8 yrs to adult CPR | head tilt ching lift, 10-12 breaths per min every 5-6 sec, heel bottom of hand 1 1/2-2 inches, 100/min ratio 30:2
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| Child 1-8 years old CPR | head tilt chin lift, 12-20 breaths, heel of 1 hand, 1-1 1/2 inches 100/min ratio 15:2
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| Infant under 1 year CPR | head tilt chin lift, 12-20 breaths per min, 2-3 fingers 1/2-1 inch 100/min ratio 15:2
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| Newborn birth to 1 month CPR | head slightly extended, 40-60 breaths, 2 fingers or thumbs 1/2-3/4 inch 90/min ratio 3:1
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| What is hypotension | low blood pressure, poor capillary refill, weak thready pulse
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| What do you treat hypotension with | fluid, dopamine, dobutamine
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| What is bradycardia | hr less than 60 adult, less than 100 in infant
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| What is bradycardia treated with | atropine, dopamine and epinephrine for an adult, epinephrine and atropine for children, external pacemaker
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| What is ventricular arrhythmias | PVC treat with oxygen and lidocaine, ventricular tachycardia treat with defibrillation 360 joules or epinephrine, amiodarone, or lidocaine
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| What do you treat ventricular fibrillation with | defib 360 joules, epinephrine, amiodarone, or lidocaine, if patient has metabolic acidosis administer sodium bicarbonate
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| What asystole | confirm 2 leads treat with epinephrine, atropine, DO NOT defibrillate
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| What is cardioversion | therapeutic procedure that involves administering a low voltage current to the heart tissue in an attempt to convert a cardiac dysrhythmia to normal sinus rhythm, synchronizing switch is on, 50-100 joules, o2 should be present
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| In cardioversion, if ventricular fibrillation occurs then | check pulse first, then turn off synchronizing switch, increase to 200 joules and defibrillate
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| What strong short acting sedative is given prior to the cardioversion | midazolam(versed)
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| What is defibrillation | used when emergency cardiac dysrhythmias are present
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| What are the indications for defibrillation | pulseless ventricular tachycardia, ventricular flutter, ventricular fibrillation
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| How many joules are sufficient for defibrillation | 360 joules
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| Criteria for the ideal resuscitation bag self inflating, ideal stroke volume | adult 800 ml(1000-1800) infant 200 ml
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| What are the safety features for the self inflating resuscitation bag | true non rebreathing valve, universal connector with a 22 mm OD and 15 mm ID, patient valve that does not jam at 15 liters per minute, oxygen inlet flow to provide that highest FIO2 possible
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| What does the mask look like for a self inflating resuscitation bag | well fitting, shapeable, transparent
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| What does the reservoir give | 95-100% oxygen (at 15 L/min), quick attachment, non bulky
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| When trouble shooting a self inflating bag excessively high flow may cause | valves to jam, use 15 L/min or low range of flush
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| What are the advantages of the mouth to valve mask ventilation | eliminates direct contact with the patient, supplemental o2 can be administered up to 50% oxygen concentration with a flow rate at 10L/min, a one way valve between the mask and the practitioners mouth eliminates the exposure to exhaled air
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| What is the criteria for pneumatically pwered resuscitation device | flowrate of 100 LPM, pressure relief set at 50 cmH2O(audible alarm), 100% oxygen delivered from gas source, inspiration can be started by using a manual button or by the patient generating negative pressure
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| What are the limitations of pneumatic resuscitation devices | no detect changes in patients lung compliance and resistance, possible self triggering and premature termination of inspiration during chest compressions, high turbulent flows may create high resistance to ventilation, gastric insufflation, 50 psi
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| What equipment is needed for the transport of a patient | intubation equipment, portable o2, resuscitation device, transport vent if patient in on ventilator, pulse ox, medications, portable ECG monitor, stethoscope and spirometer for tidal volume assessment
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| For land air transport use | helicopter for >150 miles fixed wing aircraft
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| What happens to the oxygen during air transport | o2 partial pressure will decrease as altitude increases during air transport
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| What is pulmonary edema/CHF | left ventriculat failure and lung reaction, excessive fluids in the lungs that affect ventilation and oxygenation
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| What is the assessment of pulmonary edema/CHF | orthopnea, pitting edema, distended neck veins and increased respiratory distress, pink frothy watery secretions, fine crepitant audible rales or crackles
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| What is the treatment for pulmonary edema/CHF | 100% os via non rebreather, IPPB with 100% o2 and ethanol, PEEP/CPAP if necessary, increase the strength of the heart contraction(inotropy) by giving digitalis, decrease venous return by giving lasix, body position fowlers
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| What is pulmonary emboli | deadspace disease ventilation without perfusion, clood clots in the lungs and will affect oxygenation and circulation
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| How do you assess pulmonary emboli | sudden onset of dyspnea, tachypnea, patient appears to be hyperventilating but in not, anxious, chest pain, ventilation/perfusion scan shows no perfusion with ventilation=deadspace disease
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| What is the treatment for pulmonary emboli | anticoagulation therapy, heparin and coumadin, o2 therapy, thrombolytic drugs/screens/surgery
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| What is pneumothorax | presence of gas in the pleural space that can seriously affect ventilation
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| How do you assess pneumothorax | sudden onset of dyspnea with decreased breath sounds and tracheal shift away from the affected side, decreased vocal fremitus, percussion is hyperresonant or tympanic, xray shows hyperlucency without vascular markings and a flattened diaphragm
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| What is the treatment for a pneumothorax | 100% o2 via non rebreather, immediate chest tube/thoracentesis, relieve pressure with needle and tubing inserted into a glass of water
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| What is co poisoning | inability of hemoglobin to bind with oxygen due to the binding of carbon monoxide
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| What is the assessment of CO poisoning | present illness, redness of the skin, breathing labored and deep(tachypnea, hyperpnea), tachycardia with normal ABG, increase COHb on co-oximeter >20%, DO NOT rely on pulse ox
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| What is status asthmaticus | sustained asthma attack unresponsive to bronchodilator therapy, marked affect on ventilation and oxygenation
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| How do you assess status asthmaticus | diagnosis made by history, retractions and pulsus paradoxus, abg indicating respiratory acidosis or respiratory failure (PCO2>45)
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| What is the treatment for status asthmaticus | 100% o2 therapy via non rebreather, subcutaneous epinephrine x 3, mechanical ventilation(sedate, paralyze, control), bronchodilator therapy and steroids
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| What is trauma | Head trauma, chest trauma, neck trauma, vurn victums, near drowning
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| What is the treatment for trauma | start airway breathing and circulation, administer 100% o2, drugs and fluids based upon bedside and lab assessment, remainder based on patient assessment
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