Emergency Medicine Straight answers for top results.
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Course
MEDICINE
Institution
MEDICINE
Initial steps in stabilizing a patient - Answer CDAB
* Circulation (rapid CPR to reestablish circulation)
* Defibrillaiton
- Airway
- Breathing
- the main goal is to restore effective oxygenation,ventilation and circulation until return of
spontaneous circulation or ACLS
Where do you check p...
Emergency Medicine Straight answers for top
results.
Initial steps in stabilizing a patient - Answer CDAB
* Circulation (rapid CPR to reestablish circulation)
* Defibrillaiton
- Airway
- Breathing
- the main goal is to restore effective oxygenation,ventilation and circulation until return of
spontaneous circulation or ACLS
Where do you check pulses - Answer Bilateral carotid and femoral pulses = most reliable
- No pulse, start CPR immediately (2 minutes fast and hard and then switch out)
- Never stop doing CPR until pulse is present (CPR while defibrillator is charging, stop for
electric discharge, and continue CPR)
What do you do with weak/thready pulses - Answer - Start IVF resuscitaiton - IV access
or IO as second option
- Thready pulses indicate hypotension and poor perfusion
- Check frequent BP to reassess
What is defibrillation - Answer Shock to electrically terminate abnormal heart rate and
restart.
- The earlier a fibrillating heart is defibrillated, the more successful (survival drops by 10% with
each minute)
How do you assess Airway? - Answer - HEAD TILT-CHIN LIFT: assess if airway is
obstructed vs. open - look for foreign body, vomit, blood.
- JAW THRUST - if C-spine injury suspected
- 30 compressions for every 2 breaths
- Give one breath every 5-6 sections (don't over-ventilate the patient)
- Cricothyroidotomy -surgical airway done as last resort when unable to maintain oxygenation
with other methods
Breathing - Answer - Pay attention to resp rate, breathing pattern (normal vs. agonic
breaths)
- O2 sats - goal is > 94%
- Chest rise/tidal volume
- Waveform Capnography: measures CO2 input and output. Best measure for assessing
ventilation
- Bag-valve-mask helps patients with poor or inadequate respiration.
** it saves lives!!
Supplemental O2 - Answer - All cardiac arrest patients get 100% O2
- Room air= 21%
- Nasal cannula O2 - raises FiO2 by 2-3% per liter. Normally give 1-6 Liters/minute
- Non-rebreather mask --> you are receiving 100% O2
How do you monitor CDAB? - Answer - Reassess circulation: compression, check cardiac
rhythm, pulse, give meds to help Bp or rhythm prn
- Monitor Oxygen and IV
- DDx -goalis to find and treat reversible causes
What should be done after CDAB's? - Answer - VITAL SIGNS!!
What are the vital signs - Answer - HR/pulse: 60-100
- Bp: 120/80
- Resp rate: 16-20
- Temp 97-99
- O2 sat > 94%
- Pain!!! - 6th vital sign
EMTALA - Answer Emergency Medical Treatment and Active Labor Act
- hospitals are obligated to screen/treat a patient in the ER regardless of insurance
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- if a emergency medical condition exists - they must stabilize the patient before transferring or
d/c the pt
- an emergency condition is anything with an abromal vital sign
Triage - Answer "trier" - to separate, sift or select based on priority of condition
Emergency Severity Index - Answer - Categorize based on severity: 1 to 5
1 - most severe: cyanotic/not breathing - unreseponsive or not talking
2 - MI (life threatening but talking)
3- appendicitis/ abdomino pelvic pain
4- ankle swelling, broken leg
5- suture removal
* Things you can physically see on a patient tent to be a category 4 or 5 = FAST TRACTS (ie
broken arm, small cut)
Types of GI bleeds - Answer - U GIB - ** DARK STOOLS - above the ligament of
Treitz: Esophageal varices, Dieulafoy lesion, PUD, Mallory Weiss Tear
- LGIB: ** BRight red blood - below lig of Treitz AVM (Atrio-venous
malformation),Divertriculitis, Meckel's divertriculum, colon CA, hemorrhoids/ anal fissures
* The color doesn't always differentiate
Common risk factors for UGIB - Answer - chronic anticoagulation - Coumadin,
Pradaxa/Dabigatran (no meds to reverse it), Lovenox
- ESLD / alcoholism (lack clotting factors)
- NSAIDS (increase risk PUD and blood thinning)
- Smoking
Common risk factors for LGIB - Answer - old age
- chronic anticoagulation
- divertriculosis
Common Presentation of GIB - Answer - Abd pain: varies, achy, burning
- Melena: dark, tarry stool (UGIB)
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