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one rescuer Cpr for an unwitnessed cardiopulm arrest in Adults and children
- determine unresponsiveness
- call for help
- establish airway
- check for breathing
- give 2 full breaths
- check for pulse
- -if pulseless- begin chest compression
- provide 100% o2 and draw abg
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head tilt/ chin lift should not be used for pt with
- fractured neck
- suspicion of neck fracture
- any type of trauma
- bruised on side of pt neck
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jaw thrust/ modified jaw thrust (modified means better) allows for establishing patent airway in what type of pts
suspected neck fracture
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3 complications of ventilation
- gastric distention * most common
- pneumothorax
- gastric rupture
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3 complications of external cardiac compression
- rib fractures * most common (do not stop CPR)
- fractured sternum/ clavivle
- contusions to heart or lungs
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eval of effectiveness of cardiopulm resuscitation
- coratid pulse should be present during compreesion * best method
- color returns to normal
- do not remove cervical collar on during resuscitation- check femoral pulse
- ECG shows sinus rhythm with no pulse- cont CPR
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compression to ventilation ratio for Adult
30:2 both one and two rescuer
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compression to ventilation ratio for Child and Under 1 year
15:2 two rescuer
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compression to ventilation ratio for Newbown/Neonate
3:1 both one or two rescuer
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call 911 after
1 min or 20 cycles
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begin chest compressions if heart rate is less than
60
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causes of upper airway obstruction
- tongue/soft tissue * most common
- inspissated secretions * very thick, dehydrated, must hydrate pt
- laryngospasm
- laryngeal or subglottic edema
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how to treat severe airways obs in an infant
- 5 back blows with the heel of the hand btwn the infants shoulder blades
- 5 chest thrust
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if the infant becomes unresponsive, DO NOT perform
- blind finger sweep
- look for visible foreign objects
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hwo to treat severe airwas obs in a 1 year of age or older
wrap arams around waist with thumb side of one fist against abdomen slightly above navel, well below the xiphoid process
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if pt is ovese of a woman in the advanced state of pregnancy, what kind of thrusts whould you perform
chest thrusts
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how to treat hypotension
- fluid challenge
- dopamine
- dobutamine
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how to treat bradycardia
- atropine, dopamine, epi for adult
- epi and atropine for children
- external pacemaker
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how to treat pulseless ventricular tachycardia
- defib @ 360 jules
- if unsuccessful, start CPR and admit epi, amiodarone or lidocaine
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how to treat v-fib
- defib @ 360
- if unsuccessful, start CPR and admit epi, amiodarone or lidocaine
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how to treat asystole
- confirm 2 leads
- epi
- atropine
- DO NOT defib
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cardiovert is only used for
- a-flut
- a-fib
- v-tach with pulse
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cardiovert begin with ___ jules
50-100jules
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synchronizing switch should be ___ before cardioverting
ON
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electric shock is delivered on the ___ wave of ECG
R wave
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what type of sedation should you give while delivering cardiovert
midazolam - versed
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defib begins with ___ jules
360 jules
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synchronizing switch should be ___ before defib
OFF
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AED is only attached to a ____ victim
pulseless
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AED is only used when victim is
- no response
- no breathing
- no pulse
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criteria for the ideal resuscitation bag (self-inflating)
ideal stroke vol for adult/ infant
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mask design
- well fitting
- shapeable
- transparent
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reservoir gives
- 95-100% at 15 lpm
- quick attachment/non pulky
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if the resuscitation bag rapidly and collapses easily on minimal pressure, what should you check
inlet valve
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if the bag becomes difficult to compress and pt compliance is normal, pt valve may be
stuck open or closed
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TRACHEA DEVIATED to opposite side, HYPERRESONANT percussion note and decreased b/s on the AFFECTED side
pneumothorax
chest tube insert
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TRACHEA DEVIATED on the oppposite side, DULL percussion note and decreased b/s on the AFFECTED side
hemothorax
chest tube insert
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TRACHEA DEVIATED to the left, hyperresonant persuction on the right, dull percussion on the left, increased chest movement on the right and decreased on the left
right mainstem intubation
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mouth to valve mask vent technique has several advantages
- eliminates direct contact with the pt
- one way valve btwn the mask and the practioners mouth eliminates the exposure to exhaled air
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group of healthcare workers who respond to pts with declining conditions and can prevent potential emergencies before they occur
rapid response team
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transport vehicles 81-150=
helicopter
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transport >150
fixed wing aircraft (airplane)
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6 emergency pathologies
- pulm edema0 congestive heart failure
- pulm embolism
- pneymothorax
- status asthmaticus
- trauma
- co poisoning
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left ventricular failure and lung reaction. excessive fluid acculmates in the lungs and affects ventilation and especially oxygenation
pulm edem- CHF
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assessment of pulm edema
- orthopnea
- pitting edema
- distended neck veins
- increased resp distress
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secretions of pulm edema
pink frothy
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b/s of pulm edema
fine audible rales or crackles
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cxr of pulm edema
- fluffy infiltrates
- butterfly
- batwing
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tx of pulm edema
- 100% 02
- ippb and peep
- cpap
- increase strenth of heart contraction(inotrophy)- digitalis
- decrease venous return- lasix, fowlers position
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deadspace disease (ventilation w/o perfusion) caused by bloodclots in the lungs and will affect oxygenation and circulation
pulm. embolism
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what type of pt are at risk of pulm embolism
- post op
- bedridden
- hx of circulation prob DVT
- long periods at rest
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tx of pulm embolism
- o2 at 100%
- anticoagulation therapy- heparin/ coumadin
- thrombolytic drugs, screens, surgery
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presence of air in the pl space that can seriously affect ventilation
pneumothorax
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b/s of pneumothorax
- dec vocal fremitus
- percussion note is hyperresonant or tympanic (extra air)
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cxr of pneumothorax
hyperlucency w/out vascular marking and a flat diaphragm
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tx of trauma
- always start with ABC
- 100% o2
- durgs/fluids
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inability of hemoglobin to bind w/ o2 due to the binding of carbon monoxide. seriously affect oxygenation
co poisoning
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COHb on co oximeter would read
>20%
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tx of co poisoning
- 100% o2 via non-rebreather, cpap, ett
- hyperbaric oxygen
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