Base Emerg stuff Flashcards by E Papazova

How do you know if a pt is deadvs alive?

pulse
breathing
responsiveness

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Pt is dead (no pulse, breathing, responsiveness) steps

1) start compressions
- if 2 ppl - BVM 30:2
- 5 cycles of 2 min

2) Apply pads and defibrillate shockable rhythms ASAP
-check pulse when pads applied
- resume CPR post-shock

3) Admin EPI 1mg IV

4) Consider reversible causes

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Shockable rhythms

V Fib
Pulseless Ventricular tachycardia (p V-tach)

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Non shockable rythms

Pulselsse electrical activity

Asystole

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Two things for reversible causes

1L bolus of crystalloid

1 amp of calcium chloride or 3 amps of calcium gluconate (hyperK)

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PE or MI tx cardiac arrest

TNK (tenecteplase)

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Tension pneumothorax tx

thoracostomy - chest tube insertion

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tamponade tx

pericardiocentesis

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ROSC first minute steps (5)

SBAR - summary for all
Reassess vitals
target normal vitals
obtain ancillary tests - ECG, Chest XR labs
Call ICU

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Full set of vitals (6)

HR
RR
BP
Sats
Temp
Glucose

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What to give to an agressive patient

Ketamine or midazolam

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Agressive pt ketamine dose (more agressive)

2-4mg/kg IM

so 75kg male - 150 mg of ketamine

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Agressive pt (mild) midazolam dose

1-5mg midazolam IM/IV (versed)

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midazolam brand name

versed

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Seizing pt medications

No IV:
- Midazolam (versed) 10mg IM q 5-10min until seizure stopped

IV:
- midazolam 1-2mg IV q1-2 min until seizure stopped
- lorazepam 2-4mg IV possible

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Hypoglycemia cut off

<4mmol /L

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Hypoglycemia tx

Dextrose 50% in water (D50W) 50 mL IV push once

= 1 ampoule D50W

= 50% dextrose in water (D50W), which contains 50 mL and provides 25 grams of dextrose

ok to give up to 2 ampoules

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Airway assessment (3)

AVPU
Changing airway - oedema: anaphylaxis, infx, burns
Stuff in airway

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Change in airway red flags (4)

Visible Swelling
Change in voice
stridor
drooling / inability to tolerate oral secretions

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stuff that could obstruct the airway

food, vomit, tongue, foreign object

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quick airway management if pt alert (3)

position
jaw trust
Nasal prolongs
Nasopharyngeal airway (NOT oropharyngeal - cause pt still has a gag reflex)

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quick airway mngmt if pt is P or U

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1) jaw trust
2) OPA - oropharyngeal ok cause no gag
OR NPA nasopharygeal if TRAUMA or trismus
3) + BVM

Angioedema/anaphylaxis rx to give

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1) Epinephrine 0.5mg IM

2) Epi 3mg nebulised

if pt has stuff in airway what to do

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roll to the side
sunction

Acute hypoxia - how much time the pt has

5 min 4-6 min

hypercapnea - how much time the pt has and what occurs

accumulation hours to days; decreased LOC, acidosis, increased ICP, seizures

Resp triangle

O2 (sat SPO2) Co2 VBG; tidal volume x RR Effort: # of words, accessory muscles, position, RR

Breathing interventions (4)

1) Support - Sit up; suction, jaw trust prn 2) O2 - NP, Non rebreather, High flow Nasal canula 3) AUSCULTATE - crackles: nitro vs Abx - Wheeze: ventolin + atrovent if no PTX: 4) NIPPV - non invasive positive pressure ventilation: BVM or CPAP or BiPAP

O2 escalation

1) nasal prolongs ad 15L 2) add non rebreather at flush (mask) 3) ask for help 4) High flow nasal canula = can go up to 60L, humid air

Ventolin + Atrovent max puffs and repeated how much

8 puffs q 15 min = '' back to back'' MDI with aerochamber / spacer

If pt requires Ventoliln, atrovent but is so severely impared he does not move air enough, use

NEBULIZER

If crackles 2/2 CHF consider giving

NITRO if SBP >110

NIPPV - non invasive positive pressure ventilation CONTREINDICATION

PNEUMOTX

Secondary markers of hypoperfusion: 5 systems and sx

neuro: confused/drowsy/difficult to rouse cardiac: hypotension, tachycardia, bradycardia, chest pain resp: elevated RR, increased WOB, hypoxia skin: cool mottled extremities, flushed, poor perfusion nephro: low or no urine

how to ask for vitals

FULL vitals with GLUCOSE and TEMP

unstable tachyarrhitmia - what to do

synced cardioversion

narrow QRS tachyarrhytmia (3)

SVT Aflutter Afib

narrow QRS less than sec / squares

120 = 3 small squares

wide QRS more than sec / squares

120

wide QRS tachy is called

V-tach - monomorphic or polymorphic

confusion + brady OR tachy = pt is ...

UNSTABLE

severe CP or SOB and BRADY or TACHY =

unstable

causes of bradycardia (DIE)

Drugs - ccb, bbc, digoxin, alpha blockers Infarct - check ECG Electrolytes K abnormalities

Bradycardia types

1st degree - long PR interval 2nd degree type 1 - longer PR each cycle and eventually drops 1 QRS 2nd degree type 2 - fixed PR with regularly dropped QRS 3rd degree / complete - no communication between P and QRS

2 types of distributive shock and treatment

anaphylactic - epi septic - antibio

2 types of hypovol shock and tx

fluid loss blood loss replace

2 types of distributive shock

PE - systemic thrombolysis Tamponade - help pericardiocentesis (needle aspiration) or a pericardial window (surgical procedure)

2 types of cardiogenic shock

MI - ACS treatment Arrhytmia

how long coudl you give pressors through a peripheral vein

6h max make sure it is in the vein if not - it might lead to vasoconstriciton and death!!!

NEURO assessment

pupils ? moving the limbs ? moving all 4 extremities symetrically?

pinpoint pupils causes

narcotics EtOH Benzos

pt is sleepy with small pupils treatment?

NARCAN - opioid antagonist

how to increase O2 ?

increase FiO2 or peep or both!!

Base Emerg stuff Flashcards

(54 cards)