Term
| An injury that requires immediate life saving interventions; would warrant an ESI score of? |
|
Definition
|
|
Term
| An injury that is a high risk situation, confused/lethargic/disoriented, or in severe pain; would warrant an ESI score of? |
|
Definition
|
|
Term
| An injury where the pt appears stable but has abnormal vital signs; would warrant an ESI score of? |
|
Definition
|
|
Term
| An injury where the pt appears stable with normal vital signs but requires many different resources; would warrant an ESI score of? |
|
Definition
|
|
Term
| An injury where the pt appears stable, has normal vital signs, and requires one resource; would warrant an ESI score of? |
|
Definition
|
|
Term
| An injury where the pt appears stable, has normal vital signs, and requires no resources; would warrant an ESI score of? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| What is the condition of ABCs in a pt with an ESI score of 1? |
|
Definition
|
|
Term
| What is the condition of ABCs in a pt with an ESI score of 2? |
|
Definition
|
|
Term
| What is the condition of ABCs in a pt with an ESI score of 3,4, or 5? |
|
Definition
|
|
Term
| What is the status of a threat to life to a pt with an ESI score of 1? |
|
Definition
|
|
Term
| What is the status of a threat to life to a pt with an ESI score of 2? |
|
Definition
| likely but not always obvious |
|
|
Term
| What is the status of a threat to life of a pt with an ESI score of 3? |
|
Definition
|
|
Term
| What is the status of a threat to life of a pt with an ESI score or 4 or 5? |
|
Definition
|
|
Term
| How soon should a pt with an ESI score of 1 be seen by a MD? |
|
Definition
|
|
Term
| How soon should a pt with an ESI score of 2 be seen by a MD? |
|
Definition
|
|
Term
| How soon should a pt with an ESI score or 3 be seen by a MD? |
|
Definition
|
|
Term
| How soon should a pt with an ESI score of 4 or 5 be seen by a MD? |
|
Definition
|
|
Term
| What is the expected resource intensity of a pt with an ESI score of 1? |
|
Definition
| high resource intensity; staff continuously at bedside; often mobilization of team response |
|
|
Term
| What is the expected resource intensity of a pt with an ESI score of 2? |
|
Definition
| high resource intensity; multiple complex diagnostic studies; frequent consultation; continuous monitoring |
|
|
Term
| What is the expected resource intensity of a pt with an ESI score of 3? |
|
Definition
| medium/high resource intensity; multiple diagnostic studies; brief observation; complex procedure |
|
|
Term
| What is the expected resource intensity of a pt with an ESI score of 4? |
|
Definition
| low resource intensity; one simple diagnostic study or simple procedure |
|
|
Term
| What is the expected resource intensity of a pt with an ESI score of 5? |
|
Definition
| low resource intensity; exam only |
|
|
Term
| what are example of ESI 1? |
|
Definition
| cardiac arrest, intubated trauma; overdose with bradypnea, severe respiratory distress, |
|
|
Term
| what are example of ESI 2? |
|
Definition
| chest pain probably resulting from ischemia multiple trauma unless responsive |
|
|
Term
| what are examples of ESI 3? |
|
Definition
| ABD pain, gynocological disorder unless in severe distress, hip fracture in elderly pt |
|
|
Term
| what are example of ESI 4? |
|
Definition
| closed extremity trauma, simple laceration, cystitis |
|
|
Term
| what are examples of ESI 5? |
|
Definition
| cold symptoms, minor burn, recheck wound, prescription refill |
|
|
Term
| what identifies and categorizes pts so that the most critical are treated first? |
|
Definition
|
|
Term
| what is the emergency severity index? |
|
Definition
| 5 level triage system that incorporates concept of illness severity and resource utilization to determine who should be treated first. |
|
|
Term
| What is the first assessment of an emergency pt? |
|
Definition
|
|
Term
| What is assessed in the emergency pt after no life threatening injury is found? |
|
Definition
| Number of anticipated resources they may need. |
|
|
Term
| What does the primary survey focus on? |
|
Definition
| airway, breathing, circulation, disability and exposure/environmental control. |
|
|
Term
| What is included with airway in the "A" of the primary survey? |
|
Definition
| Cervical spine stabilizations and/or immobilizations. |
|
|
Term
| what are examples of pts at risk for airway compromise? |
|
Definition
| seizures, near drowning, anaphylaxis, foreign body obstructions, or cardiopulmonary arrest. |
|
|
Term
| What are the primary S&S of a patient with airway obstruction? |
|
Definition
| Dyspnea, inability to speak, presence of foreign body in the airway, trauma to neck and face. |
|
|
Term
| What progression of interventions should you use with airway maintenance? |
|
Definition
| rapidly from least invasive to most. |
|
|
Term
| What are some initial interventions of airway compromise? |
|
Definition
| jaw thrust maneuver, suctioning, removal of foreign body, insertion of nasopharyngeal or oropharyngeal airway and ET intubation. |
|
|
Term
| What intervention is performed if unable to intubate? |
|
Definition
| emergency cricothyroidotomy or tracheotomy |
|
|
Term
| What drugs are used for rapid sequence intubation? |
|
Definition
| Versed (sedation), Amidate (anesthesia), Anectine (paralysis) |
|
|
Term
| What must be done along with drug therapy during rapid sequence intubation? |
|
Definition
| cricoid pressure applied to reduce the risk of aspiration and airway trauma. |
|
|
Term
| What would cause you to suspect cervical spine trauma? |
|
Definition
| Face, head, neck or upper chest injuries. |
|
|
Term
| How is the neck immobilized? |
|
Definition
| Cervical immobilization device and forehead straps to the backboard. |
|
|
Term
| Should sandbags be used to immobilize the pt neck? |
|
Definition
| No, because the weight of the bags could move the head if logrolled. |
|
|
Term
| What are some things to look for in assessing airway patentcy? |
|
Definition
| missing teeth, bleeding, vomitus or edema. |
|
|
Term
| what are some examples that cause breathing alterations excluding upper airway? |
|
Definition
| Fractured ribs, pneumothorax, penetrating injury, allergic reactions, pulmonary emboli and asthma attack. |
|
|
Term
| What are some S&S of breathing alterations? |
|
Definition
| Dyspnea, paradoxic chest wall movement, decreased or absent breath sounds, visible wound to chest wall, cyanosis, tachycardia, and hypotension. |
|
|
Term
| what type of oxygen do you administer to a critically ill or injured pt? |
|
Definition
| 100% oxygen via non-rebreather mask. |
|
|
Term
| Why do critically ill or injured pts need oxygen? |
|
Definition
| All critically ill or injured pts have increased metabolic and oxygen demand. |
|
|
Term
| What are some assessment techniques for the pt with compromised breathing? |
|
Definition
| Look for paradoxic chest movement, note use of accessory or abdominal muscles, listen for air thru nose or mouth, feel for air being expelled, count RR, note color of nail beds, mucous membranes and skin, auscultate lungs, assess for JVD, and position of trachea. |
|
|
Term
| What are some interventions for a pt with compromised breathing? |
|
Definition
| Supplemental oxygen, ventilate with Ambu bag, intubation, suction, thoracentisis or chest tube. |
|
|
Term
| Where should the pulses be assessed on the emergency pt? |
|
Definition
| a central pulse should be checked (carotid or femoral) |
|
|
Term
| What are the assessments made when checking the circulatory system of the emergency pt? |
|
Definition
-check a central pulse (carotid or femoral)
-palpate pulse for quality and rate
-assess color, temp, and moisture of skin
-check cap refill
-assess for external bleeding
-measure BP |
|
|
Term
| What are the most significant signs of shock? |
|
Definition
| altered mental status and delayed cap refill |
|
|
Term
| What can environmental factor make normal cap refill appear slow? |
|
Definition
|
|
Term
| Where should IV lines be inserted in the emergency pt? |
|
Definition
| into veins in the upper extremities unless contraindicated |
|
|
Term
| What interventions should be initiated if the pt shows signs of shock or hypotension? |
|
Definition
| insert 2 large bore IVs (16-14 gauge) and initiate aggressive fluid resuscitation using normal saline or LR |
|
|
Term
| What type of dressing is applied with pressure to any obvious signs of bleeding? |
|
Definition
|
|
Term
| What is the "D" in the primary survey? |
|
Definition
|
|
Term
| What three components make up the disability assessment of the primary survey? |
|
Definition
1. brief neurological assessment
2. identify deformities
3. brief pain assessment |
|
|
Term
| What assessments are made doing the neuro check of the primary survey? |
|
Definition
-Glascow coma scale
-AVPU
-assess pupils for REEDA |
|
|
Term
| What does AVPU stand for when doing your neuro assessment? |
|
Definition
| alert; response to voice; responce to pain; unresponsive |
|
|
Term
| What is the "E" in the primary survey? |
|
Definition
| exposure/environmental control |
|
|
Term
| What is done during the exposure/environmental control portion of the primary assessment? |
|
Definition
| remove pt clothing to perform a full physical assessment; protect from heat loss |
|
|
Term
| The secondary survey consists of "FGHI"; what do these stand for? |
|
Definition
-full set of VS/focused adjuncts/facilitate family presence
-give comfort measures
-history and head-to-toe assessment
-inspect posterior surfaces |
|
|
Term
| What would warrant checking the BP in both arms? |
|
Definition
-sustained or suspected chest trauma
-abnormal reading in one arm |
|
|
Term
| What are some focused adjuncts for pts who sustained significant trauma or require life saving interventions during the primary survey? |
|
Definition
-continuous ECG monitoring
-continuous pulse ox
-portable chest xray to check placement of tubes
-insert Foley
-insert NG or orogastric tube
-lab and diagnositc studies
-tetanus prophylaxis |
|
|
Term
| What is the risk of placing an NG tube in a pt with face trauma? |
|
Definition
| tube could enter the brain |
|
|
Term
| What is included in providing comfort measures during the secondary survey? |
|
Definition
|
|
Term
| What should the prehospital information focus on during the history? |
|
Definition
| mechanisms and pattern of injury, injuries suspected, VS, treatments initiated, and pt responses |
|
|
Term
| The mnemonic AMPLE can be used for taking the history of an emergency pt. What does it stand for? |
|
Definition
A-allergies: food, drugs, environment
M-medication history
P-past health history
L-last meal
E-events/environment leading up to illness or injury |
|
|
Term
| What are some questions, other than AMPLE, included in the history of an emergency pt? |
|
Definition
-cheif complaint?
-pt subjective complaints?
-pt description of pain?
-witness description of event |
|
|
Term
| What is Battle's sign? What does it indicate? |
|
Definition
-bruising directly behind the ears
-may indicate a fracture of the base of the posterior portion of the skull |
|
|
Term
| What is "Raccoon eyes"? What does it indicate? |
|
Definition
-periorbital ecchymosis
-indicates a fracture of the base of the frontal portion of the skull |
|
|
Term
| What should be done about clear drainage of the ears or nose? |
|
Definition
| DO NOT BLOCK THIS DRAINAGE |
|
|
Term
| What can subcutaneous emphysema be an indication of? |
|
Definition
| laryngotracheal disruption |
|
|
Term
| How is the cervical spine protected? |
|
Definition
| use a rigid collar and SUPINE positioning; use logrolling |
|
|
Term
| What are the chest assessments for the emergency pt? |
|
Definition
-examine for paradoxic chest movements and large sucking chest wounds
-palpate sternum, clavicles, and ribs for deformities or tenderness
-ascultate breath sounds (pneumothorax)
-obtain 12 lead ECG for pt with heart disease or suspected MI |
|
|
Term
| What do bowel sounds in the chest indicate? |
|
Definition
|
|
Term
| If tympany is percussed in the abd, what does this indicate? |
|
Definition
| excessive air; distention |
|
|
Term
| If dullness is percussed in the abd, what does this indicate? |
|
Definition
| excessive fluid; distention |
|
|
Term
| What are some interventions for a fractured extremety? |
|
Definition
-splint above and below the injury to decrease soft tissue damage
-immobilize, elevate, and apply ice
-ASSESS DISTAL PULSES OFTEN |
|
|
Term
| What is the reason and procedure for inspecting the posterior surfaces of the emergency pt? |
|
Definition
-logroll the pt
-assess for ecchymosis, cuts, punctures, spinal alignment |
|
|
Term
| What are some ongoing assessments made to ensure ABC function? |
|
Definition
-RR
-O2 sat
-ABGs
-LOC
-VS
-peripheral pulses
-UOP
-skin temp, color, and moisture |
|
|
Term
| How long following a cardiac event can therapeutic hypothermia be used and what is the rationale? |
|
Definition
-24 hrs
-improves mortality and neurologic outcomes |
|
|
Term
| What are the three stages of therapeutic hypothermia? |
|
Definition
| induction, maintenance, rewarming |
|
|
Term
| Where is induction of therapeutic hypothermia started? What is the core temp in this stage? |
|
Definition
-ED
-89.6-93.2 degrees Farenheit |
|
|
Term
| What are some methods used to cool pts for therapeutic hypothermia? |
|
Definition
| cold saline infusions and cooling devices |
|
|
Term
| What type of monitoring do pts receiving therapeutic hypothermia receive? |
|
Definition
| invasive monitoring (arterial or central pressures) and continuous assessment |
|
|
Term
| What is the tetanus prophylaxis for an emergency pt with unknown or less than 3 doses? |
|
Definition
| Td or Tdap for any wounds |
|
|
Term
| What is the tetanus prophylaxis for an emergency pt with 3 or more doses and 5 years or less since last dose? |
|
Definition
| none required for any wounds |
|
|
Term
| What is the tetanus prophylaxis for an emergency pt with 3 or more doses and 6-10 years since the last dose? |
|
Definition
| no prophylaxis for minor wounds; Td or Tdap for major wounds |
|
|
Term
| What is the tetanus prophylaxis for an emergency pt with 3 or more doses and more than 10 years since the last dose? |
|
Definition
| Td or Tdap for any wounds |
|
|
Term
| Describe heat rash, why it occurs, and treatment? |
|
Definition
-a fine, red, papular rash that occurs on the torso, neck, and skinfolds
-obstructed sweat glands that become inflamed when sweat can not escape
-cooling |
|
|
Term
| What causes heat syncope? |
|
Definition
| heat exposure and prolonged standing |
|
|
Term
| Where is heat edema usually located? What causes this? What is the treatment? |
|
Definition
-hands, feet, and ankles
-prolonged sitting or standing in nonacclimated persons
-rest, elevation, and support hose |
|
|
Term
| What are S&S of heat cramps? |
|
Definition
-severe muscle ctx
-thirst
-nausea
-tachycardia
-pallor
-weakness
-profuse diaphoresis |
|
|
Term
| What are S&S of heat exhaustion? |
|
Definition
-pale/ashen skin
-fatigue/weakness
-profuse sweating
-extreme thirst
-anxiety
-hypotension
-tachycardia
-weak, thready pulse
-temp 99.6-104 |
|
|
Term
| What are S&S of heat stroke? |
|
Definition
-hot, dry skin
-confusion-coma
-hypotension
-tachycardia
-weakness
-temp greater than 104 |
|
|
Term
| What are the initial interventions for the pt with hyperthermia? |
|
Definition
-manage ABCs
-provide high-flow O2 via non-rebreather or Ambu bag
-IV access and fluid replacement
-cool environment
-ECG
-serum electrolytes and CBC
-Foley |
|
|
Term
| What are the ongoing interventions for the pt with hyperthermia? |
|
Definition
-monitor ABCs, VS, and LOC
-monitor cardiac rhythm and UOP
-electrolyte replacement
-monitor for DIC |
|
|
Term
| What are treatments for heat cramps? |
|
Definition
-rest
-sodium replacement and water
-elevation and gentle massage of muscle
-analgesia |
|
|
Term
| How long should the pt with heat cramps avoid strenuous activity? |
|
Definition
|
|
Term
| What are treatments for heat exhaustion? |
|
Definition
-cool environment, remove constrictive clothing
-oral fluid and electrolyte replacement
-monitor for dysrhythmias
-IV saline if oral not tolerated
-Bolus fluids may be needed for hypotension |
|
|
Term
| Are salt tablets used as part of the treatment for heat exhaustion? Why? |
|
Definition
| no, because of possible gastric irritation and hypernatremia |
|
|
Term
| What type of pt could be admitted to the hospital with heat exhaustion? |
|
Definition
| elderly, chronically ill, or symptoms that do not improve within 3-4 hrs |
|
|
Term
| What is heatstroke a result of? |
|
Definition
| failure of the hypothalamic thermoregulatory processes |
|
|
Term
| Why is high-flow oxygen or possible intubation given to the pt suffering heat stroke? |
|
Definition
| to compensate for the hypermetabolic state |
|
|
Term
| What is the drug of choice for controlling shivering? |
|
Definition
|
|
Term
| Why is shivering a bad thing for the pt recovering from heatstroke? |
|
Definition
| shivering is caused by the rapid cooling process and heat is generated from the muscles impairing the cooling process |
|
|
Term
| Which class of antipyretics are used for heatstroke pts? |
|
Definition
| none; they are not effective because the fever is not infection related |
|
|
Term
| What does skeletal muscle breakdown in the pt with heatstroke put the pt at risk for developing? |
|
Definition
|
|
Term
| What are S&S of rhabdomyolysis? |
|
Definition
-tea colored urine
-myoglobinuria
-acidic urine ph |
|
|
Term
| What is a localized cold injury? |
|
Definition
|
|
Term
| What is a systemic cold injury? |
|
Definition
|
|
Term
| What effects does alcohol have r/t cold exposure? |
|
Definition
-peripheral vasodilation
-increases warmth sensation
-decreases shivering |
|
|
Term
| What effects does smoking have r/t cold exposure? |
|
Definition
|
|
Term
|
Definition
| true tissue freezing that results in the formation of ice crystals in the tissues and cells |
|
|
Term
| Does cold cause vasoconstriction or vasodilation? |
|
Definition
|
|
Term
| What does the formation of ice crystals in the intracellular spaces lead to? |
|
Definition
| the organelles are damaged and the cell membrane is destroyed; this leads to edema |
|
|
Term
| What demographic is at a greater risk of frostbite? |
|
Definition
|
|
Term
| What layers of skin are involved in superficial frostbite? |
|
Definition
| the skin and subcutaneous layer; usually the ears, nose, fingers, and toes |
|
|
Term
| What does the skin look and feel like for the person with superficial frostbite? |
|
Definition
-skin color ranges from waxy pale yellow to blue to mottled
-skin will feel crunchy and frozen
-pt may complain of tingling, numbness, or a burning sensation |
|
|
Term
| How should the RN handle the area of superficial frostbite? |
|
Definition
-never squeeze, massage, or scrub the area as it is easily damaged
-remove clothing and jewelry because they may constrict the extremity and decrease circulation |
|
|
Term
| What temperature range should the water be that superficial frostbite is submersed in? |
|
Definition
|
|
Term
| How are blisters resulting from superficial frostbite treated? |
|
Definition
| debridement and sterile dressing applied |
|
|
Term
| Why are analgesics needed for the pt being treated for superficial frostbite? |
|
Definition
| rewarming is extremely painful |
|
|
Term
| What layers are involved in deep frostbite? |
|
Definition
|
|
Term
| What is the appearance and feel of deep frostbite? |
|
Definition
-the skin is white, hard, and insensitive to touch
-the area appears of deep thermal injury with mottling gradually progressing to gangrene |
|
|
Term
| The limb affected with deep frostbite with immersed in 102-108 F water until when? |
|
Definition
| flushing occurs distal to the injured area |
|
|
Term
| How soon after rewarming can deep frostbite lead to edema? to blisters? |
|
Definition
-edema within 3 hrs
-blisters from 6 hrs to days |
|
|
Term
| What can help prevent edema in the pt rewarming from deep frostbite? |
|
Definition
| elevating the affected limb after rewarming |
|
|
Term
| Below what core temp is considered hypothermia? |
|
Definition
|
|
Term
| Why are elderly people at a greater risk for hypothermia? |
|
Definition
-decreased body fat
-diminished energy reserves
-decreased basal metabolic rate
-decreased shivering response
-decreased sensory perception
-chronic medical conditions
-meds that alter body defenses |
|
|
Term
| What is the body's first mechanism to conserve heat? |
|
Definition
| peripheral vasoconstriction |
|
|
Term
| After vasoconstriction what are the body's only other mechanisms for conserving heat? |
|
Definition
|
|
Term
| What is the temp range considered for mild hypothermia? |
|
Definition
|
|
Term
| What are the S&S of mild hypothermia? |
|
Definition
-shivering
-lethargy
-confusion
-irrational behaviors
-minor heart rate changes |
|
|
Term
| What are the core temp ranges for moderate hypothermia? |
|
Definition
|
|
Term
| What are the S&S of moderate hypothermia? |
|
Definition
-rigidity
-bradycardia
-slowed RR
-weak BP
-metabolic and resp acidosis
-hypovolemia |
|
|
Term
| At what core temp does shivering diminish or disappear? |
|
Definition
|
|
Term
| What can result from the myocardium becoming cold? |
|
Definition
| the myocardium becomes irritable and susceptible to dysrhythmias |
|
|
Term
| By what mechanisms does hypothermia lead to dehydration? |
|
Definition
| decreased renal blood flow (vasoconstriction and blood stasis from cold) decreases GFR which impairs water reabsorption and causes dehydration |
|
|
Term
| Does Hct increase or decrease in moderate hypothermia? |
|
Definition
| increases as intravascular volume decreases |
|
|
Term
| As blood thickens due to hypothermia what are the adverse effects this has on the body? |
|
Definition
-thrombus
-stroke
-MI
-PE
-renal failure |
|
|
Term
| What core temp is considered severe hypothermia? |
|
Definition
|
|
Term
| What is the state of the metabolic rate, HR, and respirations in the pt with severe hypothermia? |
|
Definition
| slowed to the point they are barely detectable |
|
|
Term
| What are the probable heart rhythms of the pt with severe hypothermia? |
|
Definition
-profound bradycardia
-V-fib
-asystole |
|
|
Term
| What temp must the pt be at before they will be pronounced dead? |
|
Definition
|
|
Term
| What type of rewarming is used for mild hypothermia? |
|
Definition
| passive or active external rewarming |
|
|
Term
| What are examples of passive external rewarming? |
|
Definition
-placing pt in a warm, dry place
-remove damp clothing
-warm blankets |
|
|
Term
| What are examples of active external rewarming? |
|
Definition
-body to body contact
-fluid or air filled warming blankets
-radiant heat lamps |
|
|
Term
| What type of rewarming is used for moderate to severe hypothermia? |
|
Definition
|
|
Term
| What are examples of active core rewarming? |
|
Definition
-heated/humidified oxygen
-warmed IV fluids
-cardiopulmonary bypass
-continuous arteriovenous rewarming |
|
|
Term
| What is the progression for warming the pt with moderate to severe hypothermia? |
|
Definition
-warm the core first then the extremities
-this lowers the risk for hypotension and dysrhythmias |
|
|
Term
| At what temp is active rewarming discontinued? |
|
Definition
|
|
Term
| What actual process causes the injury in submersion events? |
|
Definition
|
|
Term
| Immersion syndrome is a result of submersion in cold water. What causes adverse events? What are those adverse events? |
|
Definition
-caused by vagal stimulation
-causes potentially fatal dysrhythmias, bradycardia, cardiac arrest |
|
|
Term
| What are potentially fatal complications that can develop from a near drowning where the person did not aspirate water? |
|
Definition
| bronchiospasm and airway obstruction |
|
|
Term
| What can result from a near drowning where water is aspirated? |
|
Definition
| pulmonary edema which leads to ARDS |
|
|
Term
| What is the mechanism by which injury occurs when freshwater is aspirated? |
|
Definition
| hypotonic freshwater is actively absorbed into circulation through the alveoli. This causes the breakdown of lung surfactant, fluid seepage, and pulmonary edema |
|
|
Term
| What is the mechanism by which injury occurs when saltwater is aspirated? |
|
Definition
| hypertonic saltwater draws fluid from the vascular space into the alveoli impairing alveolar ventilation and resulting in hypoxia |
|
|
Term
| What vent setting will be used if the pt with a submersion injury is intubated? |
|
Definition
-PEEP
-keeps the alveoli open in cases of significant pulmonary edema |
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Term
| What can a deterioration in neurological function indicate in the pt with submersion injury? |
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Definition
-cerebral edema
-worsening hypoxia
-profound acidosis |
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Term
| How long should pts of near drowning be observed to prevent secondary drowning? |
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Definition
| minimal 23 hrs post event |
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Term
| What is the name for the group of bugs that includes bees, yellow jackets, hornets, wasps, and fire ants? |
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Definition
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Term
| What is the time span in which a reaction can occur to an insect bite/sting? |
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Definition
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Term
| What are the treatments for a mild reaction to an insect bite/sting? |
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Definition
-elevate injury
-cool compresses
-antipruritic lotions
-oral antihisamines |
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Term
| What are treatments for a severe reaction to an insect bite/sting? |
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Definition
-IM or IV antihistamines
-subcutaneous epinephrine
-corticosteroids |
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Term
| How long will a tick release neurotoxins into the person? |
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Definition
| until the head is removed |
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Term
| Lymes disease, caused by a tick bite, shows what clinical manifestations? |
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Definition
-flu like symptoms
-bulls eye raah |
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Term
| What is the treatment for early stage Lymes disease? |
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Definition
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Term
| What are possible long term conditions that can arise from Lymes disease? |
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Definition
-monoarticular arthritis
-meningitis
-neuropathies |
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Term
| What is the treatment for later staged Lymes disease? |
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Definition
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Term
| What are the S&S of Rocky Mountain Spotted fever? |
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Definition
-pink macular rash to the palms, wrists, soles, feet, and ankles within 10 days of exposure
-fever
-chills
-malaise
-myalgias
-HA
-**can be fatal if not treated** |
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Term
| What is the treatment for Rocky Mountain Spotted Fever? |
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Definition
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Term
| Tick paralysis occurs within how long from exposure? |
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Definition
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Term
| How would you describe the progression of tick paralysis? |
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Definition
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Term
| How can tick paralysis be fatal? |
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Definition
| paralysis of respiratory muscles if tick is not removed |
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Term
| What is the time frame for return of muscle movement following tick removal of the pt with tick paralysis? |
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Definition
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Term
| Pertaining to animal or human bites, what should the RN do for a puncture wound? |
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Definition
-leave it open
-splint wounds over joints
-facial wounds are the only ones initially closed |
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Term
| What is the course of rabies vaccine administration? |
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Definition
-initial rabies immune globulin (RIG) dose is weight-based
-follow RIG with a series of 5 injections of human diploid cell vaccine (HDCV) at days 0,3,7,14,28 |
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Term
| Describe a gastric lavage. |
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Definition
-insertion of a large diameter gastric tube for irrigation of copious amounts of saline
-elevate the HOB or lay on side to prevent aspiration
-pts with altered LOC or diminished gag reflex are intubated prior to lavage |
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Term
| What is the time frame post ingestion that a gastric lavage can be performed? |
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Definition
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Term
| Ingestion of what types of things contraindicate a gastric lavage? |
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Definition
-caustic agents
-sharp objects
-nontoxic substances |
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Term
| What is the usual dose of activated charcoal for adults? |
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Definition
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Term
| What is the antidote for acetaminophen? |
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Definition
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Term
| Why should you not give antidotes immediately before, with, or after activated charcoal? |
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Definition
| it will be absorbed by the charcoal too |
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Term
| What happens if mustard gas mixes with water? |
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Definition
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Term
| What is given with the first dose of activated charcoal? |
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Definition
| a cathartic such as sorbitol |
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Term
| What can be given in the event of ingestion of cocaine-filled balloons? How often? |
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Definition
-GoLYTELY
-given q 4-6 until stools are clear |
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Term
| What are the S&S of NSAID OD? |
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Definition
-abd pain
-drowsiness
-liver/renal damage |
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Term
| What are the treatments for NSAID OD? |
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Definition
-activated charcoal
-gastric lavage |
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Term
| What are the S&S of Tricyclic antidepressants OD? |
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Definition
-low dose: anticholinergic effects, agitation, HTN, tachycardia
-high dose: CNS depression, dysrhythmia, hypotension, resp depression |
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Term
| What are the treatments for Tricyclic antidepressants OD? |
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Definition
-multidose activated charcoal
-gastric lavage
-sodium bicarbonate
-intubation and mechanical ventilation
-**NEVER INDUCE VOMMITTING** |
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Term
| When is phase 1 of Acetaminophen toxicity and what are the S&S? |
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Definition
-within 24 hrs
-malaise, diaphoresis, NV |
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Term
| When is phase 2 of Acetaminophen OD and what are the S&S? |
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Definition
-24-28 hr after ingestion
-RUQ pain, decreased UOP, decreased nausea, increase in LFTs |
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Term
| What is phase 3 of Acetaminophen OD and what are the S&S? |
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Definition
-72-96 hrs s/p ingestion
-NV, malaise, jaundice, hypoglycemia, enlarged liver, possible coagulopathies including DIC |
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Term
| What is phase 4 of Acetaminophen OD and what are the S&S? |
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Definition
-7-8 days s/p ingestion
-recovery, LFTs return to normal |
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Term
| What are treatments for Acetaminophen OD? |
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Definition
-activated charcoal
-Mucomyst |
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Term
| Which biochemical agents can be treated with antibiotics? |
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Definition
-anthrax
-plague
-tularemia |
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Term
| When does the smallpox vaccine need to be given to be effective? |
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Definition
| -before exposure gives immunity, can be effective after exposure as well |
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Term
| What is the pathology of inhaled Anthrax? |
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Definition
-bacterial spores multiply in the alveoli
-toxins cause hemorrhage and destruction of lung tissue |
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Term
| How is Anthrax transmitted? |
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Definition
-no person to person
-spread through direct contact with bacteria and spores |
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Term
| What is the incubation period for Anthrax? |
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Definition
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Term
| What are the S&S of Anthrax inhalation? |
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Definition
-abrupt onset
-dyspnea
-diaphoresis
-fever
-cough
-chest pain
-septicemia
-shock
-meningitis
-resp failure |
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Term
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Definition
-Cipro **TREATMENT OF CHOICE**
-Penicillin
-doxycycline
-postexposure prophylaxis 30 days with vaccine 60 days without vaccine |
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Term
| What is the pathology of cutaneous Anthrax? |
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Definition
| spores enter through cuts in skin |
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Term
| What are S&S of cutaneous Anthrax? |
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Definition
-papule resembling insect bite that advances to a depressed black ulcer
-swollen adjacent lymph nodes
-edema |
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Term
| What are S&S of ingested Anthrax? |
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Definition
-NV
-anorexia
-hematemesis
-diarrhea
-abd pain
-ascites
-sepsis |
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Term
| What is incubation period for smallpox? |
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Definition
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Term
| What are the S&S of smallpox? |
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Definition
-sudden onset
-fever
-HA
-myalgia
-lesions that progress
-malaise
-back pain |
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Term
| How is smallpox transmitted? |
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Definition
-air droplets
-direct person to person
-highly contagious |
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Term
| What is the patho of Botulism? |
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Definition
-spore-forming anaerobe
-found in soil and dented can foods
-can die within 24 hrs |
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Term
| What is the incubation period of Botulism? |
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Definition
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Term
| What are the S&S of Botulism? |
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Definition
-abd cramps
-NVD
-cranial nerve palsies (dysphagia, dysarthria, dysphonia, dysplopia)
-skeletal muscle paralysis
-resp failure |
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Term
| How is Botulism transmitted? |
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Definition
-through food or air
-no direct person to person
-improperly canned foods |
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Term
| How is Plage transmitted? |
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Definition
-direct person to person
-flea bite |
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Term
| What is the incubation period for Plague? |
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Definition
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Term
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Definition
-hemoptysis
-cough
-high fever
-chills
-myalgia
-HA
-resp failure
-lymph node swelling |
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Term
| What are treatments for Plague? |
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Definition
-antibiotics **IF ADMINISTERED IMMEDIATELY**
-strepomycin or gentamicin
-isolation |
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Term
| How is Tularemia transmitted? |
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Definition
-no person to person
-aerosol or intradermal route
-spread by rabbits and ticks |
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Term
| What is the incubation period for Tularemia? |
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Definition
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Term
| What are the S&S of Tularemia? |
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Definition
-sudden onset
-fever
-swollen lymph nodes
-fatigue
-sore throat
-weight loss
-pneumonia
-pleural effusion
-ulcerated sore from tick bite |
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Term
| What are treatments for Tularemia? |
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Definition
-Gentamicin **drug of choice**
-streptomycin, doxycycline, Cipro |
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Term
| What viruses cause Hemorrhagic fever? |
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Definition
-Marburg
-Ebola
-Lassa fever
-Yellow fever
-Rift Valley fever |
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Term
| What are the S&S of Hemorrhagic fever? |
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Definition
-fever
-conjunctivitis
-HA
-malaise
-prostration
-hemorrhage of tissues and organs
-NV
-hypotension
-organ failure |
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Term
| How is Hemorrhagic fever transmitted? |
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Definition
-rodents and mosquitos
-direct person to person via body fluids
-can be aerosolized |
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Term
| What are treatments for Hemorrhagic fever? |
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Definition
-NO IM INJECTIONS
-NO ANTICOAGULANTS
-isolation
-supportive only for most
-Virazole effective in some cases
-vaccine available for Yellow fever only |
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Term
| What is the requirement for an event to qualify as a Mass Casualty Event (MCI)? |
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Definition
| the community resources must be depleted and aid must come from an outside organization such as Red Cross or FEMA |
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Term
| What is the goal time to triage a pt at the scene of a MCI? |
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Definition
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