Emergency Medicine/Public Health High-Yield Biomedical Sciences Flashcards

Biomedical Sciences, Sourced from carmenaguayo on Quizlet

What are the three components of a primary survey?

- circulation

- airway

- breathing

What are the four types of shock?

Hypovolemic, Cardiogenic, Obstructive, & Distributive

What are causes of hypovolemic shock?

Hemorrhage

Severe burns

High output fistula

Dehydration

What are the causes of cardiogenic shock?

MI

Dysrhythmia

CHF

cardiomyopathy

cardiac valve problems

What are the causes of distributive shock?

Septic

Anaphylactic

Neurogenic

What are the signs of obstructive shock?

Cardiac tamponade

Tension pneumothorax

PE

Aortic stenosis

Constrictive pericarditis

Which of the following is not a sign/symptom of shock?

A) Narrow pulse pressure, tachypnea

B) Narrow pulse pressure, tachycardia

C) Reduced capillary refill, hypotension

D) Reduced urine output, altered mental state

E) Reduced urine output, hypertension

E) Reduced urine output, hypertension (htn is not seen in shock)

When is the secondary survey done?

A) After hemodynamically stable

B) After patient is neurologically stabilized

C) after you identify major injury

D) A+ B

D

What is the secondary survey?

SAMPLE

S - signs and symptoms

A - Allergies

M - meds

P - past medical history

L - last meal

E - event leading to emergency

What physical exams will you start with in a secondary survey?

Head & neck for injuries

Chest - position of tach, rib fractures

Abdomen - intraabdo hemorrhage, peritonitis

MSK - fractures, contusions

Neurological - GCS

When can you clear a patient for cervical spine injuries?

A) After secondary survey

B) no cervical tenderness

C) no focal neuro deficit

D) pt oriented x 3

E) no long bone fractures

F) A-D

G) B-E

E (no long bone fractures bc that pain would distract from cervical pain)

What is the landmark of a scaphoid fracture?

Pain in anatomical snuffbox

What is the landmark for a colle's fracture?

A) FOOSH

B) Dorsal displacement

C) Distal radius fracture

D) All of the above

D) (type of broken wrist)

What is the classic triad of preeclampsia?

A) HTN, edema, headache

B) HTN, proteinuria, edema

C) HTN, headache, edema

D) HTN, proteinuria, headache

B)

Your 29-year-old patient is in labor. During childbirth the OBGYN informs the patient that there is a limb presentation. What is the next step in the care of this patient?

A) Using acupuncture to turn the breech baby

B) Watchful waiting

C) Emergency C-section

D) Specific massage techniques to turn the breech baby

C)

What does triage code red indicate?

Bleeding

What does triage code green indicate?

minor injuries and walking wounded

What does triage code yellow indicate?

Anything that does not fit the red and green

What does triage code black mean?

lifeless

A 73-year-old female is in your office when she collapses. After the primary survey you realize that the patient has no pulse. You immediately ask your receptionist to call 911 and start:

A)The secondary survey

B)Start cardio-pulmonary resuscitation concurrently as the primary survey

C)Start cardio-pulmonary resuscitation concurrently as the secondary survey

D)Administer oxygen

E)Place the patient in the recovery position

B)

A 73-year-old female is in your office when she collapses. After the primary survey you realize that the patient has no pulse. You immediately ask your receptionist to call 911. The patient starts vomiting, how would you manage the situation?

A)Place the patient in the recovery position to open the airway

B)Continue the cardio-pulmonary resuscitation

C)Continue with the chest compressions without pulmonary resuscitation

D)Extend the patient's neck and tilt her head back to open the airway

A)

Which one of these patients would you treat first?

A)Patient presenting with flail chest

B)Patient presenting with absent vital signs

C)Patient who is hyperventilating

D)Patient presenting with blood in the stool

A)

Which one of these patients would you treat first?

A)Patient presenting with a radius fracture

B)Patient presenting with a scaphoid fracture

C)Patient presenting with a femur fracture

D)Patient presenting with tachycardia

C) (blood loss)

A child is presenting to your clinic with absent circulation and breathing, at the same time a 73-year-old female patient that you were treating stops breathing but after performing the primary survey you realize that she has circulation. Which one of these patients do you treat first?

The 73-year-old patient

You are driving to work, when you see a car accident. A middle-aged male is severely bleeding from his ankle because of a piece of metal that is stuck above his external malleolus. He' presents with tachypnea and tachycardia. A bystander has already called 911. What would be your first step in managing the situation?

A)Removing the piece of metal to manage the bleeding.

B)Assessing for signs of internal bleeding

C)Assessing for airway and breathing

D)Applying pressure on the wound

D)

Is consent needed when the patient is in immediate risk and obtaining consent will increase risk or is no possible?

NO

Consent is not needed when there is immediate risk, what are the exceptions to this rule?

Competent patient refused the same treatment before and their decision did not change

DNR

T/F: Refusal for help in a suicidal patient is considered no consent, therefore do not treat

F

What do you do if treatment is lifesaving for a child but parents refuse treatment?

Contact CAS

A 53-year-old male presents to your office with the chief complaint of IBS. He mentions that he has been experiencing bloating and abdominal pain after eating meals. He denies any undigested foods or mucous in the stools but mentions that he sometimes notices some blood in the stool once in a while, he assures you that it does not happen frequently and denies any night sweats and WL. What is the first step in your treatment plan for this patient?

A)Peppermint oil to manage his IBS

B)Referring to the ER immediately as any amount of blood in the stool can indicate CRC

C)Referring to an MD for a colonoscopy

D)FODMAP diet

C

You are treating an 80-year-old female with an acupuncture protocol to treat Yin deficiency. After 5 minutes of inserting the needles, the patient faints. What is the first step in the management of this case?

A)Call 911

B)Place the patient in the Trendelenburg position

C)Place the patient in the recovery position

D)Remove the needles

D

You are eating at a restaurant when you realize that a child is crying and coughing. The mother asks if there are any doctors in the restaurant, explaining that there is big chunk of food stuck in her kid's throat. You volunteer to help. What is the first step in managing this emergency situation?

A) Performing abdominal thrusts until the patient "pops or drops"

B) Performing 5 back blows and 5 abdominal thrusts and repeat until patient "pops or drops"

C) Encourage coughing and go back to your table and enjoy your meal

D) Encourage coughing until the obstruction is dislodged or until the child develops poor air exchange

D

After running the primary survey on a patient of yours who is conscious but presents with hypoxia (oxygen saturation of 80%), what is your first step?

A)Administering oxygen

B)ND's are not authorized to administer oxygen in Ontario

C)ND's are not authorized to administer oxygen in Ontario if they don't have their prescribing license

D)Call 911

A

What is the definition of hypoxia?

A)Less than 85% oxygen saturation

B)Less than 80% oxygen saturation

C)Less than 90% oxygen saturation

D)Less than 95% oxygen saturation

E)All of the above

C

What is considered high concentration of O2 therapy?

A)Concentrations above 90%

B)Concentrations above 95%

C)Concentrations above 80%

D)Concentrations above 85%

A

What are options for oxygen delivery devices?

•Non-rebreather mask

•Nasal cannula

•CPR pocket mask

•Simple face mask

•Bag-valve mask (BVM)

•Venturi mask

In which one of the following situations can you use a Non-rebreather mask?

A)Patient presents with no signs of breathing

B)Patient is breathing

C)Patient presents with no vital signs

D)All of the above

B

When using a Non-rebreather mask, what setting do you set the flow meter on the O2 tank ?

A)10 - 15 lit/ min

B)20-30 lit/ min

C)10-50 lit/ min

D)20-35 lit/ min

A

When using a Non-rebreather mask, what is the concentration of O2 delivered to the patient?

A)100%

B)80%

C)90%

D)85%

C

Which one of the following devices delivers the lowest concentrations of O2?

A)Non-breather mask

B)Nasal cannula

C)A CPR pocket mask attached to the tank

B

what concentration of oxygen is delivered from a non-rebreather?

90%

What concentration of oxygen is delivered from a nasal cannula?

24-36%

What concentration of oxygen is delivered from a CPR pocket mask?

44-50%

Which one of the following conditions do you have to be cautious about when administrating oxygen?

A)Absorption atelectasis

B)Retrolental fibroplasia

C)COPD

D)Retinopathy of prematurity

E)All of the above

E (B and D are the same condition)

Which one of the following devices would you consider using in a COPD patient?

A)Non-breather mask

B)Nasal cannula

C)A CPR pocket mask attached to the tank

B

What is the concentration of O2 delivered to the patient with a bag valve mask that is not attached to an O2 reservoir?

A)90%

B)21%

C)80%

D)22%

B (atmospheric O2)

After injecting an IM B12 shot to your patient, you experience a needle stick injury while trying to recap the needle with both hands. What is the next step?

A)Washing the area with soap and water after encouraging bleeding

B)Going to the ER

C)HIV post-exposure prophylaxis within the first 2 hours of the injury

D)HIV post-exposure prophylaxis after you are done with seeing your patients for the day

E)A+B+C

F)A+B+D

E

A 60-year-old male presents to your office with severe fatigue, a 38 degrees C fever, headache and joint pain and neck stiffness. He reports camping for 4 days last weekend. What is your duty to report?

A)This can be a simple flue, no need to report

B)This is the presentation of West Nile virus, report to public health

C)This is the presentation of West Nile virus, report to health Canada

D)This is Lyme disease, report to local public health

B

When performing urinary catheterization, you must:

A)Use sterilized techniques

B)Disinfect the equipment

C)Wash the area with soap and water

D)A and B

A

What is moist heat sterilization?

Autoclave, 121 degrees celsius, 15-30 min

More effective than dry heat

What is dry heat sterilization?

Hot air over, 160 degrees for 2 hours or 170 for 1 hour

Less effective than moist can melt some objects

What is the boiling method for sterilization?

100 degrees celsius for 30 mins

To kill spores needs to be repeated 3 times

T/F: A pressure cooker at 121 degrees for 30 minutes can be as effective as an autoclave for sterilization

T

How are chemical vapours used for sterilization?

131 degrees, 20-40 minutes

How is ethyl oxide used for sterilization?

10-16 hours, room temp, carcinogenic, risk of explosion

What is the difference between disinfection and sterilization?

Eliminates most recognized pathogens but not all of them

Chemical procedure

90% isopropyl alcohol kills ___% of bacteria on a surface if left for ____ mins

90, 2

Sodium hypochlorite (bleach) kills most viruses and bacteria but not....

slow growing and resistant bacteria like giardia

2% iodine in 50%ethanol is ___________ and kills most skin pathogens except _________

betadine, spores

Chlorhexidine is antibacterial but does not kill _______

viruses

Glutaraldehyde kills all microbes but has to be applied for ____ hours

16

Define sensitivity

Proportion of the people with a specific disease who test positive

The ability of the test to correctly identify those with a specific disease

Define specificity

Proportion of all people with a disease who test negative

The ability of a test to correctly identify those without a disease

Define positive predictive value

Probability that the person who tested positive for a disease actually has the disease.

Define negative predictive value

Probability that the person who tested negative for a disease actually does not have the disease

What is the difference between precision and accuracy

Precision = how consistent a test it, absence of random variations

Accuracy = how close test results are to the true value

What is the goal of oxygen therapy?

maintain O2Sat over 90%

Cyanosis can occur with O2sat under __%, frank cyanosis under __%

85, 67

How can oxygen toxicity occur?

O2 supplementation over 60%concentration for 3 - 24 hours

What are the symptoms of O2 toxicity?

-substernal chest pain with inspiration

-tachypnea

-non productive cough

by 24 hrs

-anorexia

-paresthesia

-HA

-nausea

Oxygen therapy in infants can lead to.....

Retrolental fibroplasia (permanent blindness)

Oxygen therapy can replace nitrogen and lead to abnormal surface tension inside alveoli, what does this lead to?

Absorption atelectasis

What is the flow rate, concentration and indication for nasal cannula?

Flow: 1-6L/min

Oxygen concentration: 24-45%

Indications: Breathing patients, COPD

What is the flow rate, concentration and indication for pocket mask without oxygen?

Flow: manual

Oxygen concentration: 16% from mouth to mouth or 21% on room air

Indication: breathing or non-breathing, used in trauma

What is the flow rate, concentration and indication for pocket mask with oxygen?

Flow: 6-8 L/min

Concentration: 44-55%

Indication: breathing or non-breathing, used in trauma

What is the flow rate, concentration and indication for simple face masks?

Flow: 6-10L/min

Oxygen concentration: 40-60%

Indication: breathing but in respiratory distress (mild or moderate)

What is the flow rate, concentration and indication for venturi masks?

Flow rate: 4-15L/min

Oxygen concentration: 24-40%

Indication: breathing, COPD, asthma, stable patients

What is the flow rate, concentration and indication for bag-valve mask?

Flow rate: manual/CPR

Oxygen concentration: 21% (atmospheric)

Indication: best for non-breathing pts but can be used for breathing, apnea or inadequate respiration (positive pressure room air delivery)

What is the flow rate, concentration and indication for bag valve mask resuscitator with oxygen?

Flow: 10-15 litres per min

Oxygen concentration: 90-100%

Indication: manual delivery of supplemental oxygen with positive pressure for apnea or inadequate respirations

What is the flow rate, concentration and indication for partial rebreathing mask?

Flow rate: 8-15L/min

Oxygen concentration: 60-80%

Indication: breathing or non-breathing patients

What is the flow rate, concentration and indication for non-rebreathing mask?

Flow rate: 10-15L/min

Oxygen concentration: 90-100%

Indications: chronic airway limitation (COPD), smoke inhalation, carbon monoxide poisoning, high flow oxygen but do not need breathing assistance

What are the initial streps of life support?

1. Scene assessment and safety

2. activate emerg response and get AED

3. Pulse check

4. begin CRP

What does scene assessment and safety entail?

1. assess scene for hazards

2. tap patient and shout (are you OK)

3. check for breathing (if absent activate emergency response system)

How deep should each compression be in CPR?

at least 5cm/2inches

When is a jaw-thrust maneuver used?

to open the airway of an unconscious patient with suspected head, neck, or spine injury or unknown MOI

How is the jaw thrust maneuver done?

1. be behind the patient

2. hands on each side of thee head, elbows on surface they are lying on

3. fingers under angle of jaw and life with both hands to push jaw fwd

4. use thumb to open lower lip

What are the key differences between CRP in a child vs adult?

In a child:

- tap bottom of foot for responsiveness

- if two rescuers are present use a 15:2 ratio, if only one, stick to 30:2

- compress with one hand on chest and the other on the forehead

- palpate carotid or femoral artery for circulation check

How is CPR done on an infant?

1. check for response by tapping bottom of the foot

2. send someone else to active emergency response system and get AED

3. check infants brachial or femoral pulse

4. if not pulse is felt, start CPR with compressions 30:2 ratio, or 15:2 if there are two rescuers

5. after 5 cycles activate emergency response and AED if alone and nobody else did it

What is the rate and depth for compressions in CPR on an infant?

100/min

4cm/1.5 inches

How should an infants head be positioned in CPR?

external ear canal level with shoulder (tilted too far back can block airway)

What is the key difference with administering breaths to an infant?

place mouth over infants mouth and nose to create airtight seal

When is it indicated to give breaths without compressions?

Adult, child or infant has a pulse but is not breathing effectively

What are the rescue breath rates for adults vs. children/infants?

Adults: 1 breath every 5-6sec

Children/infant: 1 breath every 3-5 sec

In infants and children is oxygenation and ventilation is okay but pulse is under ____ with signs of ______ _________, start CPR

60, poor perfusion

What is the next step when a patient becomes unresponsive during choking?

Start CPR and activate emergency response system

How is choking relief done in infants?

Alternate between 5 back slaps and 5 chest thrusts, always keep head lower than trunk

What are the two types of heat exhaustion?

Water depletion (thirst, weakness, HA, loss of consciousness)

Salt depletion (nausea, vomiting, muscle cramps, dizziness)

What is the difference between heat stroke and head exhaustion?

Heat stroke is life threatening and body temp is over 40.5 degrees celsius

No coma or seizures in exhaustion but can occur in heat stroke

What are the classes of hypothermia?

Mild - 32-34.9degrees

Moderate - 28-31.9degrees

severe - under 28 degrees

Tachypnea, tachycardia, ataxia, dysarthria and shivering are which stage of hypothermia?

Mild