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what kind of agent is Sarin?
How does it kill you?
What are the 2 reversal agents?
- Nerve agent
- excess amounts of acetycholine "runny nose, crying, drooling, defecating, urinating and vomiting kind of poisoning"
KILLS cuz leads to respiratory muscle weakness
Atropine and 2-PAM
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Nerve agents like Sarin, VX, novicheck...
What kind if s/s would you see in those exposed?
- confusion
- pin-point pupils
- muscle twitching
- seizures
- flaccid paralysis
- coma
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What steps should you do in a nerve agent attack?
- First, stay calm!
- 1. get into open air
- 2. cover mouth with cloth (preferably wet)
- 3. dont lay down
- 4. shallow breathes
- 5. antidote
- 6. decontaminate (all clothes off, shower with soap and water)
- 7. flush eyes for 5-10 minutes each
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What is an example of a Toxic Asphyxiant?
s/s?
- Cyanide ( colorless liquid or gas)
- **smell of bitter almond odor
- initially tachy and hypertension, then hypotension and bradycardia
- increased RR
- SOB, chest tightness
- ab pain, n/v
- eye irritation and swelling
- cherry red skin color
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Cyanide TX
- decontaminate
- 100% oxygen
- sodium nitrate or sodium thiosulfate IV
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What kind of chemical is Phosgene, Ammonia, chlorine?
- pulmonary Irritants (causes direct lung injury)
- smells like mowed hay
- no antidote
- They must REST!!
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What are 2 Blistering Agents?
name a few s/s?
Sulfur Mustard, Lewisite
- red, itchy painful skin
- sore throat
- cough
- THEN SOB and eye damage
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Besides liver damage, what condition could show elevated bilirubin and hepatic enzymes, low albumin and HYPOXIA?
SEPSIS!!!
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What do the s/s of anthrax mimic?
antibiotics used to treat anthrax?
present with flu like symptoms
ciproflaxin, rafampin, clindomycin
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How is EBOLA transmitted?
All secretions! yuck!
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What is clinical incident stress debriefing? (CISD)
talk about what happened, and administrative review, which is plan for future interventions that needs to be taken.
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How do you triage?
What kind of questions
- age
- all vital signs
- PAIN, where and for how long?
- general appearance? (color of skin)
- behavior (restlessness)
- history of present illness (describe what and where they are at)
- meds?
- have any medical conditions?
- allergies?
- traveled?
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What are some common drugs that get overdosed on?
- alcohol
- acetaminophen
- aspirin
- antidepressants
- stimulants
- opioids
- sedative hypnotics
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ANTIDOTES please
1.Acetaminophen
2.Digoxin
3. benzodiazepine
- 1. mucomyst
- 2. digibind
- 3. Flumazenil (Romazicon)
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ANTIDOTES for...
1. Narcotic overdose
2. Coumadin
3. Heparin
- 1. narcan (0.2mg)
- 2. Vit. k
- 3. protamine sulfate
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First priority with an overdose?
monitor patients respirations!!
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Who are most risk for Endocarditis?
- IV drug users
- dental procedures
- trauma
- cardiac surgery
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What are Endocarditis clinical manifestations?
Treatments, how should we care for them?
- osler node
- Janeway lesion (flat and red)
- antibiotics, rest, if HF....treat, good hygiene for RN and Pt
- IF surgical...valve replacement or repair
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What is pericarditis?
s/s? nursing interventions?
what will the ECG look like?
inflammation of pericardium (sack around the heart)
bed rest, anti infammatories
- pericardial rub
- s/s of HF, like JVD
- hypotensive,muffled heart signs, cool skin IF from a cardiac tamponade
ECG will have PR depression and ST segment elevation in EVERY lead!!
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Who is at risk for developing SEPSIS?
- very young/old
- those with compromised immune system
- Have wounds or injuries
- from certain addictive habits
- from certain treatments
- anyone prone to develop sepsis because of genetic factors
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What IS Sepsis?
what is septic shock?
life threatening organ dysfunction due to dysregulated host response to infection.
subet of sepsis....profound circulatory, cellular and metabolic abnormalities substantially increase mortality.
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What are the most common pathogens associated with sepsis?
- gram neg bacteria...psedomoas aerguinosa, e-coli,
- gram pos bacteria.... staph and strep
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What is SEPTIC SHOCK?
multiple organ failure and uncontrolled bleeding
refractory hypotension (low BP despite lots of fluids)
- measure preload with CVP (central venous pressure) measures amount of fluid going into pt.
- use NS
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What is qSOFA?
quick sequential organ failure assessment
What are the warning signs (3) and how many of the 3 are needed to be priority?
- 1. alteration in mental status
- 2. is SBP equal or <100?
- 3. Respiration is greater than 22
2
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What is serum lactate level?
>2
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What is the order of treatment for surviving sepsis?
- First give FLUIDS, then vasopressors. Fill the tank first.
- Maintain MAP >60...measurement of perfusion
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Surviving Sepsis Campaign
What 4 things need to be done within 3 hours from presentation?
What should be done within 6 hours?
- 1. measure lactate levels... IF greater than 2, not good.
- 2. obtain blood cultures (from different sites) BEFORE giving antibiotics
- 3. administer broad spectrum antibiotics
- 4. Give 30ml/kg crystalloid (normal saline)for hypotension or lactate greater than 2
- 5. apply vasopressors (like epi or noriepi)to maintain MAP above 65
- 6. IfSTILL hypotensive and lactate >2, re-assess volume status and tissue perfusion.
- 7. Re-measure lactate level
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