Term
| Euphoria and complications associated with cocaine/meth and ecstasy are related to the release of what? |
|
Definition
|
|
Term
| How can cocaine/meth/ecstasy be taken? |
|
Definition
IV, snorting or smoking
repeated use leads to prolonged effects and toxicity |
|
|
Term
| What are the S/S and complications of cocaine/meth/ecstasy toxicity? |
|
Definition
S/S: chest pain, tachypnea, agitation, HTN, tachycardia and diaphoresis
Complications: dysrhythmias, angina/MI, aoritc rupture, coronary artery dissection, seizures, psychosis, CVA, hyperthermia, rhabdomyolosis and acute renal failure |
|
|
Term
| How do you dx cocaine/meth/ecstasy toxicity? |
|
Definition
| EKG, pulse oximetry, urine toxicology, UA, CMP, ABGs, creatinine kinase, cardiac enzymes, maybe head CT |
|
|
Term
| How do you treat cardiac and CNS symptoms (including seizures)? (associated with cocaine/meth/ecstasy intoxication)? |
|
Definition
Ativan (Lorazepam) 2 mg IV
Valium 5-10 mg IV
Seizures: phenobarbital (15-20 mg/kg)
Cardiac: avoid beta blockers
avoid antipsychotics as they can trigger seizures, hyperthermia and arrhythmias |
|
|
Term
| How do you treat cocaine induced wide complex tachydysrhytmia? |
|
Definition
| sodium bicarbonate 1-2 mEq IV titrated to maintain normal pH |
|
|
Term
| How do you treat HTN that is unresponsive to benzos? |
|
Definition
Nitroprusside 0.3 mcg/kg/min IV
Phentolamine 2.5-5 mg IV |
|
|
Term
| How do you treat "body packers"? |
|
Definition
Polyethylene glycol whole bowel irrigation
Admit |
|
|
Term
| Ecstasy is a "club drug" and is a slang term for what? |
|
Definition
MDMA, short for 3,4-methylenedioxymethamphetamine
-man-made, doesn't come from a plant like marijuana does |
|
|
Term
| Ecstasy is a __________, and makes everyone feel like everyone is his or her friend, even when that's not the case. |
|
Definition
|
|
Term
| What can sometimes be added to ecstasy tablets? |
|
Definition
caffeine
dextromethorphan
amphetamines
PCP
cocaine |
|
|
Term
|
Definition
| Taking more than one ecstasy pill, tablet or capsule at a time |
|
|
Term
| Is ecstasy use decreasing or increasing? |
|
Definition
| decreasing.. from 2.4 % to 1.7 % in one year |
|
|
Term
How long does MDMA last?
once swallowed, how long does it take to reach the brain? When is the high reached?
How long can side effects last (sadness, memory difficulties)? |
|
Definition
3-6 hrs
15 mins
45 mins
several days-week |
|
|
Term
| What are some adverse effects of MDMA? |
|
Definition
anxious, agitated, sweating, chills, dizziness
muscle tension, nausea, blurred vision, increased heart rate and BP
dehydration through vigorous activity (dancing)
hyperthermia--> serious heart and kidney problems
increased risk of seizures |
|
|
Term
| What are some risks that MDMA causes to the brain? |
|
Definition
| may affect serotonin neurons, which has a direct role on our mood, aggression sexual activity, sleep and sensitivity to pain and memory loss. |
|
|
Term
| What kind of acidosis do alcohols cause? |
|
Definition
| anion gap metabolic acidosis |
|
|
Term
| How fast do nondrinkers eliminate alcohol from their bloddstream? chronic drinkers? |
|
Definition
non-drinkers: 15-20 mg/dl/hr
chronic drinkers: ~30 mg/dl/hr |
|
|
Term
| What are some non-obvious S/S of alcohol? |
|
Definition
CNS depression
increase HR and BP
nYSTAGMUS |
|
|
Term
| How is alcohol intoxication diagnosed? |
|
Definition
Head injury, stroke, hypoglycemia, medications/or side-effects, primary psychosis,
Bedside glucose, urinary toxicology screen, CMP/Liver panel, serum alcohol level |
|
|
Term
| How do you treat alcohol intoxication? |
|
Definition
observation, careful physical exam
IV of normal saline
~tx hypoglucemia with IV 50% dextrose 50 ml
continuous infusion of 10% dextrose at 100 mg/dl or higher
Thiamine 100 mg IV or TM
Agitation or seizure activity: 1-2 mg Ativan IM or IV |
|
|
Term
| Where is isopropanolol found? |
|
Definition
rubbing alcohol, solvents, paint thinners, skin and hair products and antifreeze
principle toxic metabolite is Acetone |
|
|
Term
| What is the clinical presentation of isopropanolol intoxication? |
|
Definition
similar to ETOH
-Longer and deeper CNS depression, smell of rubbing alcohol or ketones on breath
-if severe presents with coma, respiratory depression or hypotension |
|
|
Term
| Isopropanolol intoxication can cause hemorrhagic gastritis, how might this present? |
|
Definition
| nausea, vomting, ABD pain and upper GI bleed |
|
|
Term
| How is isopropanolol toxicity diagnosed? |
|
Definition
serum alcohol level and acetone level
urine toxicology screen |
|
|
Term
| How is isopropanolol toxicity treated? |
|
Definition
IV normal saline
vasopressors: dopamine 5-20 mcg/kg/min, dobutamine 2-20 mcg/kg/min or norepinepherine 0.5-30 mcg/min
~dialysis if alcohol level above 400 mg/dl
~hospital admission
~psych referral |
|
|
Term
|
Definition
| solvents, paint products, windshield washing fluids and antifreeze--> metabolizes into formaldehyde and formic acids |
|
|
Term
| Where is ethylene glycol found? |
|
Definition
coolants, polishes and detergents
metabolizes into toxic glycolic and glyoxylic acid |
|
|
Term
| What is the clinical presentation of ingestion of methanol and ethylene glycol? |
|
Definition
12-24 hrs after ingestion:
CNS depression and visual disturbances (looking at a snow storm)
Significant anion gap acidosis
Nausea, vomiting and abd pain
Fundoscopic exam: retinal edema or hyperemia of optic disc
can progress to more severe symptoms within next 12-24 hrs of increased heart rate, resp rate and BP, resp distress, CHF, circulatory collapse, CVA tenderness and kidney failure |
|
|
Term
| How is the ingestion og methanol and ethylene glycol diagnosed? |
|
Definition
| serum levels of both forms of alcohol, CMP, ABGs, urine toxicology, EKG, serum acetone |
|
|
Term
| How is the ingestion og methanol and ethylene glycol treated? |
|
Definition
Fomepizole 15 mg/kg IV load--> 10 mg/kg Q 12 hrs
if not available use ethanol 800 mb/kg IV load with continuous infusion at 100 mg/kg/hr
monitor glucose, treat if needed
dialysis
ALSO:
methanol poisoning: Folate 50 mg IV
ethylene glycol poisoning: Pyridoxine 100 mg IV and thiamine 100 mg IV
both: sodium bicarb for low pH and calcium gluconate or calcium chloride for hypocalcemia
admit, monitor, consult medical toxicologist |
|
|
Term
| What is EMTALA, and what do they do? |
|
Definition
| Emergency Medical Treatment and labor Act to ensure public access to emergency services regardless of ability to pay. |
|
|
Term
| The social security act imposes specific obligations on Medicare participating hospitals that offer what regardless of an individual's ability to pay? |
|
Definition
Medical screening examination when requestes
Treatment for an emergency medical conditon, including active labor |
|
|
Term
| Why is EMTALA referred to as the anti-dumping law? |
|
Definition
| to preventhospitals from transferring uninsured/Medicaid patients to public hospitals without at a minimum a medical screening examination. |
|
|
Term
| EMTALA, is thus the de facto national health care policy for who? |
|
Definition
|
|
Term
| EMTALA requires that these screenings and treatment of emergency medical conditions be what? |
|
Definition
non-discriminatory
.. integrated with HIPPA, and are always on the table for change and development |
|
|
Term
| How does EMTALA define an emergency? |
|
Definition
a condition manifesting itself by acute symptoms of sufficient severity such that the absence of immediate medical attention could reasonably be expected to result in placing the individual's health or the health of an unborn child in serious jeoprady, serious impalment ro bodily fxns or serious dysfxn of bodily organs
example: pregnant woman with emergency must be treated until delivery unless a transfer under statute is appropriate |
|
|
Term
| EMTALA applies when an individual does what? |
|
Definition
| comes to the emergency dept. |
|
|
Term
| Do hospital based outpatient clinics not equipped to handle medical emergencies have to follow EMTALA? |
|
Definition
| no, they can simply refer to a nearby ED |
|
|
Term
| According to EMTALA, what are the three main obligations of EMTALA hospitals? |
|
Definition
1. Any individual who requests it, must receive medical screening examination to determine whether an emergency exists. No delay to enquire about methods of payment. Signs must be posted about this.
2. if an emergency medical condition exists, tx must be provided until condition is resolved/stabilized. If incapable, an appropriate transfer must be made
3. hospitals with specialized capabilities must accept transfers. Hospitals must report EMTALA violations made during transfers. |
|
|
Term
| If a pt is unstable, what is required for this pt to be transferred? |
|
Definition
a physician must certify the medical benefits expected from the transfer outweigh the risks
OR
pt makes the transfer request in writing after being informed of the hospital's obligations under EMTALA and risks of transfer |
|
|
Term
| In what 4 ways is a transfer considered appropriate? |
|
Definition
1. The transferring hospital must provide ongoing care within it capability until transfer to minimize transfer risks
2. Provide copies of medical records
3. Must confirm that the receiving facility has space and qualified personnel to treat the condition and has agreed to accept the transfer
4. The transfer must be made with qualified personnel and appropriate medical equipment. |
|
|
Term
| What are the penalties for violating EMTALA? |
|
Definition
2 YR statute of limitations for civil enforcement of any violation, penalties may include:
-termination of hospital or physician's medicare provider agreement
-hosp fines up to $50,000 per violation (25,000 if fewer than 100 beds)
-physician fines $50,000 per violation
-hosp may be sued for personal injury in civil court under a "private cause of action"
-A receiving facility, having suffered financial loss as a result of another hospital's violation of EMTALA, can bring suit to recover damages |
|
|
Term
|
Definition
|
|
Term
|
Definition
| that insurance covers patient based on presenting symptoms and not on final dx. |
|
|
Term
| Informed consent is needed from pt before procedures if they are competent. What 2 things are required to be considered informed consent? |
|
Definition
-signature of pt
-significant information given to pt to base decision on |
|
|
Term
| What are the 4 exceptions to informed consent? |
|
Definition
age (marriage, military or pregnancy)
intoxication
acute mental status change
underlying medical conditions |
|
|
Term
| What treatments must be done for minors regardless of a consenting adult? |
|
Definition
STI
pregnancy
drug, alcohol, dependency
rape
mental illness |
|
|
Term
| What is the process when a pt decides to go AMA (against medical advice) |
|
Definition
-have capacity to make decision
-discover why pts want to leave
-discuss tx option and potential for worsening symptoms/death
-sign AMA form with witness/family
-DOCUMENT pt's mental capacity and your discussion with patient |
|
|
Term
|
Definition
preventing the pt from leaving a tx, when leaving could harm them
-usually mental status and emergency issues |
|
|
Term
| If a DNR is not available, what should be done? |
|
Definition
| resume care (varies state to state) |
|
|
Term
| What is usually more specific than a general DNR? |
|
Definition
| Advanced directive and power of attorney |
|
|
Term
| Criminals retain the right to refuse medical tx unless what? |
|
Definition
|
|
Term
| The laws vary, but do patients in prison usually have to consent before release of medical records? |
|
Definition
|
|
Term
| When dealing with criminal justicce, what 4 things must clinicians do? |
|
Definition
-report domestic violence
-comply with subpoena
-avoid destroying evidence
-provide MSE (Medical screeing examination) |
|
|
Term
| What constitutes malpractice? |
|
Definition
breached duty to treat
breach was cause of injury
plaintiff suffered actual inury |
|
|
Term
| How can malpractice be avoided? |
|
Definition
interpersonal relationship
DOCUMENT!!! |
|
|
Term
| What are the most common malpractice claims? |
|
Definition
20%-Trauma
14%-Abd pain
10%- Infection
9%- Vaginal bleed
8%- chest pain
other: HA, informed consent refusal, AMA |
|
|
Term
| What are the most common malpractice claims result in? |
|
Definition
20% Missed foreign body, Fracture, Wound infection.
14% Missed appendicitis, AAA.
10% Missed meningitis, pneumonia.
9% Missed ectopic pregnancy.
8% Missed MI and PE |
|
|
Term
| What are the 4 categories of behavioral disorders that qualify as medical emergencies? |
|
Definition
1. suicidal
2. homicidal
3. violent
4. rapidly deteriorating medical condition resulting in abnormal behavior |
|
|
Term
| When a behavioral problem presents to the ER, must determine if it is one of two following types? |
|
Definition
medically induced psychosis/behavioral problems
primary underlying psychiatric illness |
|
|
Term
| What is the most common type of suicide attempt? |
|
Definition
|
|
Term
| With regards to hallucinations, which kind are most commonly associated with psychiatric causes? |
|
Definition
| auditory, all others are usually organic in nature |
|
|
Term
| Schizophreniform is diagnosed when dbhavior is less than ___ mos. |
|
Definition
|
|
Term
| Brief psychotic disorder is psychosis less than _____ weeks, and is usually as a result of a traumatic life experience. |
|
Definition
|
|
Term
| Major depression is diagnosed if lasts longer than ____ weeks. |
|
Definition
|
|
Term
|
Definition
| consists of recurrent episodes of severe anxiety and sudden extreme autonomic symptoms that peak within 10 minutes and last up to one hour. |
|
|
Term
| What is Generalized Anxiety Disorder? |
|
Definition
| persistent worry or tension for at least 6 months without panic symptoms |
|
|
Term
|
Definition
| Characterized by a global impairment in cognitive function, usually acute in onset with fluctuating severity of symptoms: diminished level on consciousness, inattention, sensory misperceptions, visual hallucinations. |
|
|
Term
|
Definition
| a gradual onset of pervasive disturbance in cognition that impairs memory, abstraction, judgment, personality, and higher critical functions such as language. |
|
|
Term
| What is the definition of assessment with regards to behavioral conditions? |
|
Definition
| third party accounts of pt's change in behavior |
|
|
Term
| What is needed with regards to violent pts who need restraint? |
|
Definition
security personnel
five people (one for each limb and head) |
|
|
Term
| What medications can be used for violent patients? |
|
Definition
Lorazepam or Haldol
Lorazepam-, benzo sedating agent (1-2 mg IM)
Haldol- neuroleptic sedating agent (5-10 mg IM or 5 mg IV) |
|
|
Term
| What organizations impose restrictions on how facilities may use chemical or physical restraints? |
|
Definition
| JCAHO and Federal Medicare |
|
|
Term
| Most laws require the restraint to be what 3 things? |
|
Definition
-authorized in writing by a physician
-used for only a specified period of time
-applied only by a physician/ or other qualified person under the supervision of the physician |
|
|
Term
| Restraints cannot be used for greater than 24 hours without what? |
|
Definition
| physician's reassessment of the patient's condition and need for further restraint |
|
|
Term
| In all cases of restraints, the physician needs to state what? |
|
Definition
| that the patient's life or health could be seriously jeopardized unless restraints are used, and that there is no less alternative that is realistically possible |
|
|
Term
| Are use of punitive or convenience restraints allowed? |
|
Definition
| no, they are prohibited expressly by most state laws, Maedicare and JCAHO |
|
|
Term
| How can liability be further reduced? |
|
Definition
| By having the incompetent pt's guardian or family member sign a release form |
|
|
Term
| What three things need to be considered before the use of constraints? |
|
Definition
1. is the patient competent about his/her health care?
2. duty to protect the pt and other ED staff
3. protection of third parties (protecting the people in which the pt threatens to do harm) |
|
|
Term
| Whose responsibility is it to make sure that restraints are not negligently performed? |
|
Definition
|
|
Term
| Why did the HCFA have to publish regulations for the use of "restraints for acute medical and surgical care"? |
|
Definition
| due to number of patient deaths while inrestraints |
|
|
Term
|
Definition
placing a pt in a locked room, from which he or she cannot leave.
-considered a restraint and needs to be monitored (usually by video surveillance
-considered the least restrictive but most ED's do not have the space |
|
|
Term
| What are examples of chemical restraints? |
|
Definition
|
|
Term
| ED physican may use good faith physical constraints to evaluate and tx who? |
|
Definition
| uncooperative incompetent patients (such as those with dementia) |
|
|
Term
| The use of physical constraints uses a team approach of how many people? |
|
Definition
usually 6, one for each limb and head and one to apply restraints
-all harmful objects should be removed from pt
-protective gear should be worn |
|
|
Term
| Generally all violent pts need ___ limb restraints. |
|
Definition
4
-emphasize the therapeutic needs for the restraints, do not negotiate |
|
|
Term
| What might be useful to minimize a violent pt from head banging and biting? |
|
Definition
|
|
Term
| Where should a physically restrained pt be kept? |
|
Definition
in an open area, where he can be observed and monitored
-change his position often and check for neurovascular fxn
-make this a team effort, like a cardiac code, with assigned fxns. |
|
|
Term
| Do emergency medical doctors work in the ICU also? |
|
Definition
|
|
Term
|
Definition
American College of Emergency Physicians
-first assembly held in 1969 |
|
|
Term
| Where did the first university emergency medicine reidency arise? |
|
Definition
|
|
Term
|
Definition
a hospital equipped to provide comprehensive emergency medical services ot patients suffering traumatic injuries
-First one: Birmingham Accident Hospital in England (1941) |
|
|
Term
| In the US how does a trauma center receive verification? |
|
Definition
| by meeting specific criteria established by the American College of Surgeons (ACS) and passing a site review by the Verification Review Committee |
|
|
Term
| Trauma centers vary in their specific capabilities and are identified by Level designation, level 1 being the ______ and level 3 being the _______. |
|
Definition
|
|
Term
| The operation of a trauma center is very expensive, and thus some areas are ______ |
|
Definition
|
|
Term
|
Definition
the rights of individuals to self determination
-respecting pt's wishes |
|
|
Term
| What is the basis for informed consent and advanced directives? |
|
Definition
respect for autonomy
-practitioner needs to provide pt with as much info as needed in order to make a decision
-practitioner needs to not use his or her own personal value system to judge what is best for the pt |
|
|
Term
|
Definition
actions that promote the wellbeing of others.
taking others actions that serve the best interests of patients
-this may entail risks, so must still consider the principle of non-malficence |
|
|
Term
|
Definition
first, do no harm
-make sure the cost-benefit ratio is patient centered
-acting in the best interests of the patient while respecting autonomy |
|
|
Term
| What can modern EMS trace its roots to? |
|
Definition
| medical practitioners that went to war with Roman Legions. |
|
|
Term
| In the 1790's, the first "wheeled" ambulances transported who? |
|
Definition
| French soldiers awaiting physicians |
|
|
Term
Where was the 1st field surgical unit?
1st organized medical corpsman response teams?
1st organized medical response package?
1st civilian corpsman concept implementation? |
|
Definition
US Civil War
WWI
WWII
Mid-1950s |
|
|
Term
| What was the catalyst prompting federal leadership toward an organized approach to EMS and trauma care? What did it authorize states to do? |
|
Definition
-"white paper" (1965) entitled Accidental Death and Disability: The Neglected Disease of Modern Society
-set standards for providers, implement training programs designed to reduce injury, regulate EMS |
|
|
Term
| In 1966, what further reinforced the transition to emergency medicine by refining and improving pre-hospital systems of care? |
|
Definition
|
|
Term
| What governmental department are EMS under? |
|
Definition
| Department of Home Land Security |
|
|
Term
| Emergency medical services started as a certificate program, now it is an associate degree with what tiered system of providers? |
|
Definition
First responders
Emergency Medical Techs
Emergency Medical Techs- IV techs
Emergency Medical Techs- Paramedic |
|
|
Term
| The success of what EMT program helped support the development of the PA profession? |
|
Definition
|
|
Term
| What are the training levels of each of the tiers of EMS? |
|
Definition
First Responder: 60 – 70 hour certification course
EMT – Basic : 120 - 150 hour course
EMT - IV Tech: 160 – 180 hour course
EMT – Paramedic: All the above + 1200 – 1500 hours Advanced Instruction + 1700 hours of Clinical Rotations |
|
|
Term
| What is an opioid? An opiate? |
|
Definition
-any drug that is active at the opiate receptor.
-naturally occurring derivative of the opium plant (morphine and codeine) |
|
|
Term
| What are the clinical features of opiates? |
|
Definition
lethargy
resp depression
pinpoint pupils |
|
|
Term
| What are the most common opioids? |
|
Definition
| morphne, codeine, hydrocodone, oxycodone, MS-contin, oxycontin, heroin |
|
|
Term
| How do you diagnose someone with opioid intoxication? |
|
Definition
| urine and/or serum toxicology screen, UA, CMP, monitor, pulse oximetry, ekg, OXYGEN |
|
|
Term
| How do you treat opioid intoxication? |
|
Definition
Narcan (naloxone) treats resp depression and CNS depression
-give 2 mg IV, SC or IM for apnea
-give 0.4 mg IV for resp or CNS depression
-for large OD, give 2/3 the dose needed to wake them up per hour
Normal Saline
Admit and monitor |
|
|
Term
| What is the RAPID mnemonic to manage an EM patient? |
|
Definition
Resuscitation
Analgesia and Assessment (Hx and physical exam)
Patient needs (non-medical)
Interventions (Diagnostic and Therapeutic)
Disposition |
|
|
Term
|
Definition
vital signs and chief complaint
-all abn vital signs must be explained
quick look at the pt: ABCD
-Airway
-Breathing
-Circulation
-Disability (altered mental status (assess Glascow Coma scale and blood sugars)) |
|
|
Term
|
Definition
**Treat Pain and Nausea!!!!**
Hydration
IV Normal Saline 1-2L bolus (age dependent/CHF)
Mild to Moderate Pain (*also for fever)
*Acetaminophen (Tylenol) 325-975mg PO Q4H
*Ibuprofen (Advil) 200-800mg PO Q6H
Ketorolac (Toradol) 30-60mg IV Q6H
Chest Pain/Angina/Epigastric Pain
Nitroglycerine 0.3mg spray PRN
G.I. Cocktail (Mylanta, viscous lidocaine and prilosec/zantac/pepcid mix)
Anxiety/Panic
Ativan 1-2mg PO/SL/IV PRN
Moderate to Severe Pain
Hydromorphone (Dilaudid) 1-4mg PO PRN
Morphine 1-10mg IV PRN
Fentanyl 25-100mg IV PRN
Nausea
DimenhyDRINATE (Gravol) 25-50mg PO/IV Q4H
Maxeran 10mg PO/IV Q6H
Ondansetron (Zofran) 2-4mg PO/IV Q6H
Phenergan 25mg PO/IV
Compazine 10mg PO/IV |
|
|
Term
|
Definition
try to determine underlying motivations or stressors
-domestic violence, drug seekers |
|
|
Term
| What are sources of salicylates? |
|
Definition
aspirin
pepto bismol
topical salicylates: ben gay, salicylic acid, methyl salicylate (oil of wintergreen, 1 tsp=7000 mg of salicylate) |
|
|
Term
| What are symptoms or signs of salicylate overdose? |
|
Definition
alkalosis or acidosis
coma
diaphoresis
disorientation
hyponatremia
hyperglycemia or hypoglycemia
hypervantilation
nausea and vomiting
renal failure
seizures
tinnitus
deafness |
|
|
Term
| What lab value would you need to see when suspecting a salicylate overdose? |
|
Definition
|
|
Term
| At what level does serious toxicity occur? what are the therapeutic levels? |
|
Definition
ingestion > 150 mg/ kg
pasma salicylate level <10 mg/dl: analgesic effect
10-20 mg.dl: anti-inflammatory
20-45 mg/dl: asymptomatic mild toxicity
45-65: mild symptomatic toxicity (tinnitus, hyperventilation)
65-90 mg/dl: moderate (fever)
90-110 mg/dl: severe (coma, cardiovascular instability)
>110: lethal (renal and resp failure) |
|
|
Term
| How is a salicylate overdose managed? |
|
Definition
gastric decontamination (lavage) in early presentation or large ingestin
load crystalloid to maintain urine output (maximizes urine salicylate excretion) adult: 1-2 liter bolus)
alkalinizing urine increases salicylate excretion (sodium bicarb ampules)
monitor: urine ph, serum potassium and mental status |
|
|
Term
| When would you start someone on hemodialysis after a salicylate od? |
|
Definition
acute toxicity: salicylate levels > 100 mg/dl
chronic toxicity: salicylate level > 60 mg/dl
worsening mental status
if pt requires intubation |
|
|
Term
| What are the S/S of a TCA overdose? |
|
Definition
coma
confusion
delirium
mydriasis (dilated pupils)
dry mouth
hypotension
seizures
tachycardia
urinary incontinence |
|
|
Term
| What all should be avoided when someone ODs on TCAs? |
|
Definition
physostigmine
Antiarrhytmics
barbituates and phenytoin |
|
|
Term
| How should the seizures be managed in a person that overdosed on TCAs? |
|
Definition
|
|
Term
| How should the prolonged QRS interval be managed in someone who overdosed on TCAs? |
|
Definition
| alkalinize urine with sodium bicarbonate |
|
|
Term
| How should the hypotension be managed in someone who overdosed on TCAs? |
|
Definition
| dopamine or norepinepherine until BP is normal and there is adequate critical end-organ perfusion |
|
|
Term
| What does LEMON stand for when intuating? |
|
Definition
Look externally
Examine
Mallampati grade
Obstruction (Obesity)
Neck mobility |
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Term
| What is the 332 rule when an evaluating an airway while intibating? |
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Definition
3 fingers should fit in mouth
3 fingers should be the length of the mandible (bw mentum and hyoid bone)
2 fingers in bw the thyroid cartilage and mandible |
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Term
| During an endotracheal intubation, what should you always do? |
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Definition
pre-oxygenate
-O2,BP, ECG, & %O2 sat. monitor, IV access |
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Term
| What kind of medication should be used for an ET intubation? |
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Definition
proporfol, etomidate, ketamine
-sedative (midazolam) and/or narcotic (fentanyl, morphine)
-muscle relaxants (paralyzing)
-all may cause resp depression or paralyze the pt
-topical anesthetics |
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Term
| A _______ affects consciousness, whereas a ________ relaxes your muscles only and does nothing to thinking or awareness. |
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Definition
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Term
| When is an RSI (Rapid sequence intubation) contraindicated? |
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Definition
difficulty or failure with mask ventilation
inadequate time to prepare (crashing or hypoxic pt)
known or anticipated difficult intubation |
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Term
| What prep is required for an RSI? |
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Definition
Time to evaluate pt. ascertain no emergency
Not likely difficult intubation
No Contraindications
Gather equipment
Check equipment
Assemble personnel
Prepare medications for administration |
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Term
| 3 medication groups need to be used in a specific sequence during RSI. What are they? |
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Definition
1. pretreatment: O2 (preoxygenations 4-5 mins)
-gives a longer time to not breathe them so there O2 sat does not crash
2. Induction (quickly followed by #3)
3. Paralysis
Now, Intubate!!!!! |
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Term
| Induction agents are used for the rapid loss of conscuiousness, what agents are used? |
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Definition
etomidate- CV stability, rapid!R
propofol- rapid, but drogp BP and C.O.
ketamine- may increase BP and HR, LONGER DURATION
or
midazolam |
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Term
| For the paralysis portion of an RSI, which agent is used for the quickest onset? which is slower? |
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Definition
succinylcholine
rocuronium |
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Term
| what are the advantages of an RSI? |
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Definition
Patient comfort- sedated or amnestic
Easier intubating conditions- pt. paralyzed, so-
Increased intubation success rate
If done properly & quickly- minimizes risk of vomiting & aspiration
Less airway trauma
If done quickly- shorter period of apnea |
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Term
| What are the disadvantages of an RSI? |
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Definition
polypharmacy
med side effects
requires time for implementation
if intubation fails, can be BAD bc have rendered the pt with apnea and without cough reflexes |
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