HAN 416 Midterm

Resuscitation medicine

a branch of medicine that focuses on the management and treatment of patients in cardiac arrest or other life threatening conditions such as severe trauma or shock

2 fundamental predicaments during cardiac arrest

rapidly restart the heart after it ceases to beat and restart the brain while maintaining heart function

lucas device

delivers manual compressions

Targeted temperature management is a form of

post cardiac arrest management

what does ttm do

protects the brain and other organs, targeted temp 32C for at least 24 hours

TTM for patients with bleeding issues

higher temp

TTM for patients with cerebral edema and seizures

lower temp

is TTM performed in the pre hospital setting

no

percutaneous coronary intervention (PCI)

treatment to open a blocked artery

arteries

Blood vessels that carry oxygen rich blood through your body

most common cause of anesthesia related deaths in 1958 were because of

aspiration

Definition of Death

irreversible coma

ETCO2

end-tidal carbon dioxide

ETCO2 monitoring

provides an accurate assessment of arterial carbon dioxide retention values

bougie

plastic rod passed into trachea

Supraglottic Devices

can blindly be put in mouth. group of airway devices that can be inserted into the pharynx to allow ventilation, oxygenation, and administration of anesthetic gases without the need for endotracheal intubation

RSI

rapid sequence induction

medications used during rsi

etomidate, ketamine, rocuronium, midazolam

prevalence of stroke

number 5 cause of death in U.S, every 40 seconds someone in U.S has a stroke, leading cause of long term disability, cost of stroke care in 2010 was 71B and is estimated to be 183B by 2030

during a stroke 32,000 neurons lost

per second

during a stroke 1.9 million neurons lost

per minute

true or false, stroke accelerates again 3.1 weeks per minute

true

primary stroke center

ct capabilities, tpa administration, neurology staff available

comprehensive stroke center

verified by joint commissions, AHA, and ASA, specialized stroke care facilities, cerbrovascular capabilities, neurosurgical capabilities with neuro ICU, better rehab and outcomes for stroke patients

mobile stroke unit

specialty care ambulance equipped with portable CT scanner, mobile laboratory, and telemedicine unit

goal of mobile stroke unit

to rapidly assess and treat prehospital stroke patients

Implementation of MSU in Suffolk

contacted every dept in MSU primary response area, remsco/remac approval, working with SCEMS, NYS DOH and exec office, educational lecture

MSU staff includes

emt, paramedic, critical care RN, rad tech

NY state first, stony brook approved for

blood transfusions on ambulances

VAD

device that helps pump blood from the lower chambers of your heart to the rest of your body

VAD indications

bridge to transplant, bridge to recovery, and destination therapy

impella

percutaneous mechanical ventricular assist device

VADs provide circulatory support by

increasing cardiac output, increasing coronary perfusion, increasing end organ perfusion, decreasing ventricular workload, and decreasing myocardial O2 consumption

ECMO

blood is pumped outside of your body to a heart lung machine that removes carbon dioxide and sends oxygen filled blood back to tissues in the body

why is an ecmo done

for patients waiting for or recovering from a heart transplant and may be an option when other life support measures haven't worked

IABP

intra-aortic balloon pump consist of a think tube and balloon that a doctor inserts into the aorta leaving the heart. the inflation and deflation of the balloon pump help increase blood flow from the heart

EMS licensure levels

EMR, EMT, AEMT, Paramedic

Tiered Response

system where EMTs and paramedics respond separately

EMT description

automated external defibrillation, airway adjuncts, assisting patients with certain meds

AEMT description

IV therapy, administration of a limited number of emergency medications

Paramedic description

endotracheal intubation, emergency pharmacology, cardiac monitoring, other advanced assessment and treatment skills

History of EMS ancient times

emergency medici e

history EMS napolenic wars

birth of horse drawn ambulances, the first recorded use of aircraft for medical evacuation were hot air balloons at the Prussian siege of pari sin 1870

history of ems the US in the 19th century

1860s civillian ambulance services begin in Cincinnati and NYC, 1915 during serbian army retreat unmodified french fighter aircraft were used to ferry the injured. Crimean war: florence nightingale became known as the founder of the nursing profession

the medical director is responsible for

maintaining quality control

continuous quality improvement (CQI)

reviews and performs audits of the ems systems to identify areas of improvement and/or assign remedial training, minimizing errors is the goal

CQI uses a

plan-do-study act cycle

EMS works with public health agencies on

primary prevention and secondary prevention

In 2020the centers for medicare and medicaid services implemented a

pilot program called emergency triage, treat, and transport

online medical direction

talking directly to a medical director or agent authorized to give orders for the medical director

offline medical direction

using a book of protocols that give permission to do things without calling a doctor

just culture ems

duty to avoid causing unjustifiable risk or harm, duty to follow a procedural rule, and duty to produce an outcome

ET3

triage, treat, and transport

consent

permission to render care

expressed consent

the patient acknowledges he or she wants you to provide care or transport

implied consent

applies to patients who are unconscious or incapable or making an informed decision

involuntary consent

applies to patients who are mentally ill, in behavioral crisis, developmentally delayed. Obtain consent from guardian or conservator

If true emergency exists and no consent is available

treat the patient, consent is implied

forcible restraint

sometimes necessary with combative, legally permissible

the right to refuse treatment

conscious alert adults with decision making capacity, assess the patient's ability to make an informed decision, if the patient appears confused or delusional, you cannot assume that the decision to refuse is an informed refusal

before you leave a scene where a patient, parent, or caregiver has refused care

encourage the individual again to allow care, ask the individual to sign a refusal of care form, a witness is valuable in these situations, documents all refusals

advanced directive

specifies treatment should the patient become unconscious or unable to make decisions

a DNR order is an

advanced directive that gives permission not to resuscitate

presumptive signs of death

unresponsive to painful stimuli, lack of carotid pulse or heartbeat, absence of breath sounds, no deep tendon or corneal reflexes, absence of eye movement, no systolic blood pressure, profound cyanosis, lowered or decreased body temp

Definitive signs of death

decapitation, dependent lividity, rigor mortis, algor mortis, putrefaction

rigor mortis

stiffening, occurs between 2-12 hours after death

algor mortis

cooling of the body until it matches the ambient environment

putrefaction

occurs between 40-96 hours after death

scope of practice

outlines the care you are able to provide, usually defined by state law

standards of care

manner in which you must act or behave, it is defined as how a person with similar training would act under similar circumstances.

standards of care are established by

local custom, law, professional or institutional standards, textbooks, standards imposed by states

duty to act

individual's responsibility to provide patient care. Duty to act applies once your ambulance responds to a call, once treatment is begun

negligence

failure to provide same care that person with similar training would provide in same or similar situation

elements that must be present for negligence to apply

duty, breach of duty, damages, causation

abandonment

unilateral termination of care by health car provider without patient's consent and making provisions for continuing care

abandonment may take place

at the scene, in the emergency department

assault

unlawfully placing person in far of immediate bodily harm

battery

unlawfully touching a person

good samaritan law

if you reasonably help another orson, you will not be held liable for errors or omissions

special mandatory reporting requirements

abuse of children, dog bites

morality

it's what societies determine to be right and acceptable

ethics

philosophy of right and wrong, moral duties, and ideal professional behavior

general health, wellness, and resilience

physical, emotional, mental

wellness

active pursuit of a state of good health

resilience

capacity of an individual to cope with and recover from distress

burnout

syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed

code lavender stonybrook

can be whatever staff needs in that moment, code lavender is not formal debriefing or case review

patient safety has typically been

outcome dependent

error

failure of a planned sequence of mental or physical activities to achieve its intended outcome when these failures cannot be attributed to chance

a slip or lapse occurs when

the action conducted is not what was intended

a slip is observable

a lapse is not

human factor

an applied filed of study that examines human abilities, limitations, behaviors, and processes in order to inform human centered designs

psychophysiology of crisisL the crisis stress dynamic

homeostasis, stressor, disequilibrium

general adaptation syndrome

alarm stage, resistance stage, exhaustion stage

parasympathetic division

constricts pupil, stimulates tear glands, strong stimulation of salivary flow, inhibits heart, dilates arterioles, constricts bronchi, stimulates stomach motility and secretion, stimulates pancreas, stimulates intestinal motility, contracts bladder, stimulates erection

sympathetic division

dilates pupil, no effect on tear glands, weak stimulation of salivary flow, accelerates heart, constricts arterioles, dilates bronchi, inhibits stomach motility and secretion, inhibits pancreas and adrenals, inhibits intestinal motility, relaxes bladder, stimulates ejaculation

elder abuse is caused by

increased life expectancies, increased dependency on others, decreased productivity in later years, physical and mental impairments, limited resources for long term care of elderly, economic factors, etc

identification of elder abuse

acts of commission, acts of omission, subtle signs such as theft of victim's belongings, and obvious signs such as wounds, untreated decubitus ulcers, poor hygiene

characteristics of elder abuse

cuts across all demographic groups, people dependent on others for their care, especially among elders who are mentally or physically challenged, common causes involve elderly women abused by their sons, commonly live alone, may be mentally competent but fear asking for help, may be reluctant to give info about abusers for fear of retaliation