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Questions and Answers
Questions and Answers
What are signs of clinical deterioration that would prompt activation of the rapid response system? (Select all that apply)
What are signs of clinical deterioration that would prompt activation of the rapid response system? (Select all that apply)
- Seizure (correct)
- Symptomatic hypertension (correct)
- Unexplained agitation (correct)
- Stable vital signs
What happens when teams rapidly assess and intervene when a patient's vital signs are abnormal?
What happens when teams rapidly assess and intervene when a patient's vital signs are abnormal?
The number of in-hospital cardiac arrests decreases
What is the maximum amount of time you should simultaneously perform pulse and breathing checks?
What is the maximum amount of time you should simultaneously perform pulse and breathing checks?
10 seconds
What does the BLS assessment stress?
What does the BLS assessment stress?
What action in the primary assessment should you perform first when the AED does not recommend a shock?
What action in the primary assessment should you perform first when the AED does not recommend a shock?
What action should you perform next if the initial assessment reveals a conscious patient with a patent airway?
What action should you perform next if the initial assessment reveals a conscious patient with a patent airway?
What action is part of the secondary assessment of a conscious patient?
What action is part of the secondary assessment of a conscious patient?
What are the 'H' causes of reversible cardiac arrest?
What are the 'H' causes of reversible cardiac arrest?
What are the 'T' causes of reversible cardiac arrest?
What are the 'T' causes of reversible cardiac arrest?
What is the most common symptom of myocardial ischemia and infarction?
What is the most common symptom of myocardial ischemia and infarction?
What is the time goal for completing a fibrinolytic checklist once the patient arrives in the emergency department?
What is the time goal for completing a fibrinolytic checklist once the patient arrives in the emergency department?
What class of medications commonly given to patients with acute coronary syndromes may be adversely affected by morphine administration?
What class of medications commonly given to patients with acute coronary syndromes may be adversely affected by morphine administration?
What electrocardiographic finding is suggestive of high-risk non-ST segment elevation acute coronary syndrome?
What electrocardiographic finding is suggestive of high-risk non-ST segment elevation acute coronary syndrome?
What clinical finding represents a contraindication to the administration of nitroglycerin?
What clinical finding represents a contraindication to the administration of nitroglycerin?
Within the first 10 minutes, what should your first actions include for a patient showing symptoms suggestive of myocardial ischemia?
Within the first 10 minutes, what should your first actions include for a patient showing symptoms suggestive of myocardial ischemia?
What additional questions help you determine next steps?
What additional questions help you determine next steps?
What treatment can you repeat for a patient who continues to say he has chest discomfort, as long as it is not contraindicated by vital signs?
What treatment can you repeat for a patient who continues to say he has chest discomfort, as long as it is not contraindicated by vital signs?
What is the time goal for initiation of fibrinolytic therapy after hospital arrival?
What is the time goal for initiation of fibrinolytic therapy after hospital arrival?
What is the door-to-needle time goal for 85% or more of acute ischemic stroke patients treated with IV thrombolytics?
What is the door-to-needle time goal for 85% or more of acute ischemic stroke patients treated with IV thrombolytics?
What is the highest level of stroke center certification?
What is the highest level of stroke center certification?
What is the door-to-device goal for direct-arriving patients with acute ischemic stroke treated with endovascular therapy?
What is the door-to-device goal for direct-arriving patients with acute ischemic stroke treated with endovascular therapy?
What is the diastolic blood pressure threshold for withholding fibrinolytic therapy to otherwise eligible patients with acute ischemic stroke?
What is the diastolic blood pressure threshold for withholding fibrinolytic therapy to otherwise eligible patients with acute ischemic stroke?
What is the maximum time from last known normal when endovascular therapy can be performed?
What is the maximum time from last known normal when endovascular therapy can be performed?
What is the maximum time from last known normal when intra-arterial thrombolysis for select patients can be used for treatment?
What is the maximum time from last known normal when intra-arterial thrombolysis for select patients can be used for treatment?
What is the systolic blood pressure threshold for withholding fibrinolytic therapy to otherwise eligible patients with acute ischemic stroke?
What is the systolic blood pressure threshold for withholding fibrinolytic therapy to otherwise eligible patients with acute ischemic stroke?
What blood glucose level should trigger the administration of IV or subcutaneous insulin for a patient with acute ischemic stroke?
What blood glucose level should trigger the administration of IV or subcutaneous insulin for a patient with acute ischemic stroke?
What is the most effective way to deliver bag-mask ventilation?
What is the most effective way to deliver bag-mask ventilation?
When performing the jaw-thrust maneuver on patients with suspected cervical spine injury, where should you place your fingers?
When performing the jaw-thrust maneuver on patients with suspected cervical spine injury, where should you place your fingers?
When you use a bag-mask device, you should deliver approximately __________ mL tidal volume?
When you use a bag-mask device, you should deliver approximately __________ mL tidal volume?
What is a contraindication to the use of an oropharyngeal airway?
What is a contraindication to the use of an oropharyngeal airway?
What is the first step in the use of an oropharyngeal airway?
What is the first step in the use of an oropharyngeal airway?
What is a potential complication of inserting an oropharyngeal airway that is too small?
What is a potential complication of inserting an oropharyngeal airway that is too small?
The length of a correctly sized nasopharyngeal airway is the same as the distance from the tip of the patient's nose to the __________
The length of a correctly sized nasopharyngeal airway is the same as the distance from the tip of the patient's nose to the __________
What is a potential complication of using a nasopharyngeal airway that is too long?
What is a potential complication of using a nasopharyngeal airway that is too long?
What is the maximum length of suction catheter that should be inserted into the patient's oropharynx beyond the tongue?
What is the maximum length of suction catheter that should be inserted into the patient's oropharynx beyond the tongue?
When should you occlude the side opening of a suction catheter when performing oropharyngeal suctioning?
When should you occlude the side opening of a suction catheter when performing oropharyngeal suctioning?
What action is not part of the acute stroke pathway?
What action is not part of the acute stroke pathway?
What tidal volume typically maintains normal oxygenation and elimination of carbon dioxide?
What tidal volume typically maintains normal oxygenation and elimination of carbon dioxide?
How would you categorize a 75 year old patient with a history of emphysema who is drowsy, having difficulty breathing with increased respiratory effort, bilateral wheezing on auscultation, RR 38 bpm, SpO2 is 85% and PETCO2 is 49 mm Hg?
How would you categorize a 75 year old patient with a history of emphysema who is drowsy, having difficulty breathing with increased respiratory effort, bilateral wheezing on auscultation, RR 38 bpm, SpO2 is 85% and PETCO2 is 49 mm Hg?
What is the term for the rise in arterial carbon dioxide levels typically associated with respiratory failure?
What is the term for the rise in arterial carbon dioxide levels typically associated with respiratory failure?
What is the most reliable method of confirming and monitoring correct placement of an endotracheal tube?
What is the most reliable method of confirming and monitoring correct placement of an endotracheal tube?
What initial actions should be taken?
What initial actions should be taken?
What should your initial action include if your patient is unresponsive and not breathing but has a strong pulse?
What should your initial action include if your patient is unresponsive and not breathing but has a strong pulse?
Questions and Answers
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Study Notes
Study Notes
Clinical Deterioration and Rapid Response
- Signs prompting rapid response activation: unexplained agitation, seizure, symptomatic hypertension.
- Rapid assessment and intervention can decrease in-hospital cardiac arrests.
Vital Signs Assessment
- Pulse and breathing checks should not exceed 10 seconds.
- High-quality CPR and early defibrillation are crucial during the BLS assessment.
Primary Assessment Actions
- Check airway patency first when initiated high-quality CPR and ventilation assistance.
- If the patient is conscious with a patent airway, administer oxygen as needed.
Secondary Assessment
- Formulate a differential diagnosis for conscious patients during the secondary assessment.
Reversible Causes of Cardiac Arrest
- "H" causes include hypoxia, hypothermia, hypovolemia, hyperkalemia/hypokalemia, and acidosis.
- "T" causes include tension pneumothorax, cardiac tamponade, coronary thrombosis, pulmonary thrombosis, and toxins.
Myocardial Ischemia
- Most common symptom: retrosternal chest pain.
- Fibrinolytic checklist should be completed within 10 minutes upon ED arrival.
Medication Considerations
- Morphine administration may adversely affect oral antiplatelet medications in acute coronary syndromes.
Electrocardiographic Features
- Dynamic T-wave inversion on ECG suggests high-risk non-ST elevation acute coronary syndrome.
Contraindications for Treatments
- Confirmed right ventricular infarction contraindicates nitroglycerin administration.
Initial Actions for Myocardial Ischemia Symptoms
- Actions include administering aspirin, using the fibrinolytic checklist, notifying receiving hospitals, and obtaining a 12-lead ECG.
Repeating Treatments
- Nitroglycerin (sublingual/translingual) can be repeated every 3 to 5 minutes as long as vital signs allow.
Time Goals for Treatment
- Initiate fibrinolytic therapy within 45 minutes after hospital arrival.
- Door-to-needle time goal for IV thrombolytics in acute ischemic stroke is 60 minutes.
Stroke Center Certification and Protocols
- Highest level of stroke center certification: comprehensive stroke center.
- Door-to-device time goal for acute ischemic stroke patients treated with endovascular therapy is 90 minutes.
Blood Pressure Considerations
- Diastolic BP > 110 mm Hg and systolic BP > 185 mm Hg can withhold fibrinolytic therapy in ischemic stroke.
Blood Glucose Management
- IV or subcutaneous insulin is indicated for acute ischemic stroke patients with blood glucose > 180 mg/dL.
Bag-Mask Ventilation Technique
- Most effective delivery method is using a two-person technique for bag-mask ventilation.
Airway Management Techniques
- Haw-thrust maneuver placement should be just under the angle of the lower jaw in suspected cervical spine injury cases.
- Approximately 500-600 mL tidal volume should be delivered using a bag-mask device.
- Oropharyngeal airway is contraindicated in conscious patients, and the airway must be cleared before its use.
Aspirating and Airway Devices
- Maximum length for a suction catheter into the oropharynx should coincide with the distance from the tip of the nose to the earlobe, measuring potential complications if too long or small.
Stroke Pathway
- Seizure prophylaxis is not included in acute stroke pathway actions.
- Tidal volume of 6 to 8 mL/kg maintains normal oxygenation and carbon dioxide elimination.
Respiratory Failure
- A patient with emphysema exhibiting increased respiratory effort and wheezing falls into the category of respiratory failure.
- Hypercapnia refers to the rise in arterial carbon dioxide levels associated with respiratory failure.
Endotracheal Tube Confirmation
- Quantitative waveform capnography is the most reliable method for confirming endotracheal tube placement.
- Initial actions in emergencies should assess airway, breathing, circulation, check responsiveness, and call for additional help.
Patient Management for Unresponsive Cases
- For unresponsive patients with a strong pulse, begin by opening the airway through head tilt-chin lift or jaw thrust.
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