Chapter 16 - Textbook

What is a medical emergency?

A serious, unexpected event that demands immediate attention

What is an acute situation?

Sudden deterioration in the status of any patient under your care and requires an appropriate response

What is the relationship – in regards to healthcare – with the poor and uninsured and the ED?

These demographic groups will often go to the ED as it serves an additional function of family physicians

What happens as a result of the poor and uninsured patients consistently using the ED the way that they do?

Rapidly overloads both the staff and facilities, especially in urban areas

What is a trauma team?

Group of individuals from multiple disciplines who work together to assess and stabilize a trauma patient

What is the golden hour?

First hour after the accident where there’s a greater chance of recovery if the patient’s condition can be stabilized

For trauma patients, they are evaluated by a physician who looks at these 3 things first…

• Cardiac status

• Respiratory status

• Possibility of vertebral fracture

Why are spinal fractures checked for directly after cessation of breathing and heartbeat?

Danger of paralysis is high for trauma patients

What imaging modalities are commonly done for trauma patients?

Imaging is primarily done with CT

What is a disaster?

An emergency of huge magnitude that creates an unforeseen, serious, or immediate threat to public health

What are 5 examples of a natural disaster?

• Tornado

• Earthquake

• Flood

• Hurricane 

• Pandemic

What are 2 examples of an accidental disaster?

Plane crash or train wreck

What are disaster drills?

Regularly scheduled exercises that prepare the hospital staff to function effectively if the disaster plan must be used

What is a triage process?

Process of identifying the victims, performing initial examinations, and assigning priorities for further care

Who is the main triage officer in a disaster?

Normally an ED physician

What is a phone tree that is commonly used during a disaster situation?

Special communication network, established in advance, is used to notify all the necessary personnel who aren’t on duty

What is code blue?

Designated group of healthcare workers who respond to a cardiac emergency

What healthcare members make up a code blue team?

Code team consists of one or more physicians, several nurses, a respiratory therapist, and an ECG technician

What is the role of the radiographer during a code blue?

• Tell the code team the history of the situation and then stand by to follow their directions 

• Record keeping is essential

What is the rapid response team?

Teams that are trained to intervene and assist caregivers before a patient’s condition deteriorates to the point of a full-blown code condition

What are emergency carts (or crash carts)? (pertaining to what they contain – 8 things)

Carts that contain essential items such as air-ways, artificial ventilation equipment, emergency medications and the equipment needed to administer them, board to slip under the patient when giving chest compressions, a blood pressure cuff, a stethoscope, and a defibrillator that can serve as a cardiac monitor

How often should the crash carts be checked?

Should be inspected daily to ensure that supplies are available for instant use

What’s the importance of double checking the labels of items in the crash cart?

Items may be stored incorrectly – not good to grab something solely based on location

Which patients are at greater risk when an invasive procedure is performed?

Patients with chronic cardiac or pulmonary disease

We need to check a patient’s history before injecting with contrast or conducting an invasive procedure. What are the 4 things we look for in their history?

• Previous cardiac events 

• Allergies 

• Chronic conditions

• Medication

Who is responsible for deciding when a patient is to receive treatment?

ED physician

In what situation may it be appropriate to administer a low flow rate of oxygen to a patient?

If the patient hasn’t been seen by a physician and are experiencing acute anxiety accompanied by a rapid heart rate and shortness of breath

What is the recommended normal level of oxygen saturation for an adult?

90%

Name the 6 common ways oxygen can be administered

• Nasal prongs (nasal cannula) 

• Oxygen mask (simple face mask) 

• Nonrebreathing mask 

• Partial rebreathing masks

• High flow mask (Venturi mask)

• Oxygen tent

What are nasal prongs (nasal cannula)?

Simplest and most frequently used device for longer-term oxygen administration

At what rate is oxygen being administered in nasal prongs? What’s the oxygen concentration?

Oxygen should be delivered at a rate of 1 to 6 L/min providing a 24% to 45% oxygen concentration

What is an oxygen mask (simple face mask)?

Mask shaped to the patient’s face and held by an elastic to provide both oxygen and humidity and is a short-term therapy

At what rate is oxygen being administered in an oxygen mask (simple face mask)? What’s the oxygen concentration?

Delivery of oxygen at 1 to 10 L/min providing a 40 to 60% oxygen concentration

What is a nonrebreathing mask? (also tell me the percentage of oxygen given)

Has an attached reservoir bag that fills with 100% oxygen and a valve to prevent exhaled gas from being inhaled again

What is a partial rebreathing mask? (also tell me the percentage of oxygen given)

Masks that allow some exhaled air to enter the reservoir bag and can deliver 40 to 70% oxygen concentration

What is a high flow mask?

Designed to more accurately control the concentration and administration of the oxygen volume required by the patient

What is an example model of a high flow mask?

Venturi mask

How much oxygen concentration can a high flow mask deliver? Who are the recommended patients to use this type of mask?

• 24 to 60%

• COPD patients

What is an oxygen tent?

Used when a higher rate of humidity and oxygen is necessary than is available in the ambient air

In what healthcare setting would we often see an oxygen tent?

Most frequently used in the pediatric setting because children tolerate them better

What is chronic obstructive pulmonary disease (COPD)?

Group of lung conditions, including emphysema and chronic bronchitis, that make it difficult for the patient to breathe

What is a tracheostomy as a form of intubation?

Or endotracheal intubation, is commonly used by patients who require long-term respiratory support and airway management

What is the purpose of a tracheostomy in terms of airway management?

Maintains an open airway for oxygen administration

What does it mean when a patient undergoes an intubation?

Refers to the placement of any tube, it is most commonly used to indicate the placement of an airway tube into the trachea

What is the typical placement for intubation? Can you elaborate on how it’s done?

Usual placement is via orotracheal intubation – assistance of a laryngoscope, an endotracheal tube is passed through the oral cavity into the trachea

Which tube is most often used and regarded as the most reliable method for intubation?

The endotracheal tube as it protects the patient’s airway and ensures that air can reach the lungs

What is a tracheostomy in terms of surgery?

• Surgical opening through the anterior neck into the trachea

• Artificial airway that can be connected to the oxygen supply is inserted into the trachea through the tracheostomy

What is a ventilator?

A mechanical respiratory device powered by compressed air that controls respiratory rate, volume of inspiration, and oxygen content

What is a pulse oximeter commonly used for? (2 ways it’s used)

• Used to monitor patients whose oxygen levels may be compromised

• Or who have recently been removed from a ventilator

What are the 2 valves used on an oxygen tank?

• On/Off valve 

• Valve used to adjust the flow rate of the gas

What is the common flow rate of oxygen for most patients?

2 to 5 L/min

What is the recommended oxygen flow rate for patients who are compromised or have a trauma?

Up to 10 L/min

What is mechanical suction used for?

Used when a patient is unable to clear their mouth and throat of secretions, blood, or vomitus

When should you be alerted to use suction for a patient?

Whenever a patient feels nauseated, is bleeding from the mouth or nose, or unable to swallow and cope with secretions because of low level of consciousness

What is the recommended position if a patient begins to aspirate mucus or vomitus?

Lateral recumbent position

What is the recommended suction tip to use?

Yankauer tip