Why is universal screening for domestic violence important in the ED?
- universal screening normalizes these important questions that should be asked
- opens lines of communication
- ED may be only access point in healthcare for individuals who are victims of violence
- patients who are experiencing violence may not necessarily come in for issues related to the violence
Barriers to domestic violence screening in the ED:
- language barriers
- privacy issues
- lack of staff training (how to ask)
- patients may not share risk of violence due to shame or fear
What are some risk factors for an ectopic pregnancy?
- previous tubal surgery or tubal abnormality
- previous ectopic pregnancy
- in utero DES exposure
- history of PID, chlamydia or gonorrhea
- current IUD use
What are the treatment options for an ectopic pregnancy?
- Methotrexate (IM) - requires close monitoring after dose for effectiveness (serial hCG measurements) and strict criteria for use
- Surgical treatment (salpingostomy or salpingectomy)
What are the three stages of shock?
compensated, uncompensated, and irreversible
What is compensated shock?
The body has activated hormonal and chemical compensatory mechanisms to maintain cardiac output and stroke volume
What is uncompensated shock?
The body’s compensatory mechanisms are starting to fail
- O2 supply and demand become imbalanced
- signs of shock begin to show (Vital signs, symptoms…)
What is irreversible shock?
Stage at which the amount of cellular damage and cell death is so great that permanent and significant organ damage has occurred and death is inevitable
What are some causes of hypovolemic shock?
hemorrhage, burns, trauma
What are some causes of obstructive shock?
tension pneumothorax, pericardial tamponade, pulmonary embolism
What are some causes of cardiogenic shock?
MI, coronary vessel rupture, chamber injury due to trauma
What are some causes of distributive shock?
sepsis, anaphylaxis, neurogenic (spinal cord injury)
Vasoconstriction is an early compensatory mechanism of hypovolemic shock. Why does this occur?
decreased BP triggers baroreceptors to activate the sympathetic nervous system, this causes increased sympathetic tone and release of catecholamines (epinephrine and norepinehrine), which result in increased HR, increased venous tone, increased myocardial contraction, and increased cardiac output
What is the trauma triad of death?
hypothermia, acidosis, and coagulopathy
What does SIRS stand for?
Systemic inflammatory response syndrome
What is the SIRS criteria?
HR > 90
RR > 20
Temp < 36 or > 38
WBC > 12 or < 4 or 10% increased band cellls
What is the individualized care when deciding how much fluid to resuscitate a patient with?
30 mL/kg
What are the benefits of rapid sequence intubation (RSI)?
- when quick securement of airway is needed and you are unsure of when patient ate last
What are the 7 P’s of RSI
Prepare Preoxygenate Pretreat Paralysis and Induction Protection and position Proof of Position Post Intubation Care
What is the main concern regarding the use of Succinylcholine as a paralytic?
- increased risk of hyperkalemia
- contraindicated in crush injuries, burns, traumas, long codes, and status epileptics
Which induction agent would you not want to use in a patient that is hypotensive?
propofol
What does BURP stand for and what is the purpose of this technique?
Backwards, upwards, right, and pressure
- the purpose of this technique is to manipulate a patients trachea to occlude the esophagus and better visualize the vocal cords for ET tube placement.
