Emergency Care and Patient Assessments

Surgical Procedures

• Coronary bypass, also known as coronary artery bypass graft (CABG), is a surgery for coronary artery disease. It's used to improve quality of life and prolong life by relieving symptoms.
• Angioplasty is a technique to mechanically widen narrowed arteries, often caused by atherosclerosis, using a balloon catheter.
• Skin grafting is a surgical procedure involving transplanting skin tissue to treat extensive wounds, trauma, burns, or areas of skin loss due to infections.

Coronary Bypass

• Coronary artery bypass surgery (CABG) is a surgical procedure to relieve angina and prevent death from artery disease.
• Arteries or veins from elsewhere in the body are grafted onto the coronary arteries to improve blood supply to the myocardium (heart muscle).

Coronary Artery Bypass Sources

• Internal mammary artery
• Radial artery
• Gastroepiploic artery
• Saphenous vein

Postoperative Pulmonary Management

• Pulmonary dysfunction and hypoxemia can occur after surgery, potentially leading to complications like atelectasis and pulmonary infection. Prolonged intubation (>24 hours) may increase the risk.
• Pain from sternotomy (chest incision) can impair breathing. Shivering may increase carbon dioxide levels or lead to lactic acidosis. Adequate oxygenation and ventilation should be maintained.

Intraoperative Myocardial Ischemia

• Myocardial ischemia, a potential cause of low cardiac output (CO), is assessed continuously for cardiac dysfunction and hemodynamic instability.
• Factors like heart rhythm, rate, preload, afterload, contractility, and myocardial compliance are monitored.
• Blood pressure monitoring is essential to maintain tissue perfusion and prevent disruption of anastomoses (surgical connections).

Dysrhythmias Post-CABG

• Dysrhythmias, common after CABG surgery, are assessed constantly, with ventricular dysrhythmias being more common in the early postoperative period and supraventricular dysrhythmias more likely after 24-5 days post-op.
• Treatment depends on the type of dysrhythmia and involves addressing blood pressure (BP) and cardiac output (CO) effectiveness.

Bleeding Post-CABG

• Assessing potential bleeding sites (e.g., internal mammary site, chest wall, chest tube sites) is crucial.
• Heparin anticoagulation may increase postoperative bleeding risk, particularly in patients with high adipose tissue composition. Aprotinin may be used to minimize bleeding by inhibiting fibrinolysis and possibly having anti-inflammatory potential.

Neurologic Complications Post-CABG

• Neurologic complications are a risk. Frequent neurologic assessment, including pupil observation, is essential due to the risk of stroke caused by hypoperfusion or emboli.

Renal Dysfunction Post-CABG

• Advanced age, hypertension, diabetes, and prolonged cardiopulmonary bypass (CPB) time may lead to potential renal dysfunction.
• Monitoring hourly urinary output (at least 0.5mL/kg/hr) during the initial postoperative period evaluates renal perfusion. Serum potassium levels are maintained within normal limits; abnormal serum potassium levels warrant cardiac dysrhythmia monitoring.

Gastrointestinal Complications Post-CABG

• Common post-op complications include peptic ulcer disease, perforated ulcer, pancreatitis, acute cholecystitis, bowel ischemia, diverticulitis, and liver dysfunction.
• Antiemetics are administered to manage nausea. Maintaining sternal dressing sterility and using histamine blockers are measures for minimizing acid secretion.

Pain Post-CABG

• Postoperative pain can arise depending on the surgical approach, and can impact cardiovascular function (heart rate and blood pressure).
• Effective pain control, vital for patient comfort and hemodynamic stability, also reduces the risk of pulmonary complications.

Angioplasty

• Angioplasty mechanically widens narrowed arteries blocked by atherosclerosis using a balloon catheter inside the artery.
• The balloon, after being passed into the affected area and positioned, is inflated to expand the artery. It is then deflated, and the balloon is removed. A stent may be inserted to keep the artery open.

Nursing Management (PTCA)

• Inform the patient thoroughly about the procedure, its duration, and required supine position. Encourage deep breathing.
• Post-procedure cardiac intensive care unit (ICU) monitoring is critical until the patient is stable. Peripheral pulses must be monitored frequently.
• Discharge instructions to patients should include instructions for reporting any complications like abnormal sensations or persistent pain, especially chest pain.

Skin Grafting

• Skin grafting involves transplanting skin tissue to treat extensive wounds or trauma, burns, infections, like necrotizing fasciitis, or skin conditions.
• Skin grafts help with healing, scar formation, and wound function. Surgical removal (excision and debribement) of affected areas often precedes grafting.

Additional Procedures

• Cardiopulmonary resuscitation (CPR) is a set of basic life-support interventions for oxygenating the brain and heart during a medical emergency. Management of foreign body obstruction may be necessary.
• Mechanical ventilation, either invasive or noninvasive, is a method of assisting or replacing spontaneous breathing. The two methods differ in how air is introduced into the lungs (e.g., positive pressure vs. negative pressure ventilation).

Emergency Care & Assessment

• Emergency care is crisis-oriented, episodic care for seriously/potentially life-threatening injuries or illnesses.
• A systematic approach to the assessment of the patient is essential.
• The primary survey (a rapid assessment) helps identify immediate life-threatening problems (airway, breathing, circulation), and the secondary survey examines associated injuries.
• History (chief complaint, accident, illness, prehospital mechanism, circumstances of injury, time of injury, symptom onset, consciousness, how patient reached hospital, previous medical conditions, medications, allergies, prehospital treatment) is necessary.

Triage

• Emergency department (ED) triage prioritizes patients based on the severity of their injuries or illnesses.
• Categorizing patients (e.g., emergent [red], urgent [yellow], non-urgent [green], dead [black]) helps ensure immediate attention is given to those with the most urgent or life-threatening needs.
• Conditions like airway compromise, cardiac arrest, severe shock, spinal injury, multi-system trauma, altered consciousness, and eclampsia are urgent.

Heat stress

• Heat cramps, heat exhaustion, and heat stroke are conditions arising from inadequate water intake and/or electrolyte imbalance, heat, and humidity.
• Heat cramps cause painful muscle cramps. Heat exhaustion involves symptoms like, sweating, fatigue, weakness, nausea, skin abnormalities, and collapse. Heat stroke presents with hot, dry skin, high body temperatures, and mental status changes (confusion, delirium, loss of consciousness, convulsions, coma).

Bleeding

• Arterial bleeding is characterized by spurting blood. Venous bleeding is a steady, dark red flow. Capillary bleeding is a slow, oozing flow. Wound types in an open injury: abrasions, incisions, lacerations, punctures, avulsions, and crushing injuries. Managing bleeding involves direct pressure, elevation, pressure points, and tourniquets.

Head injuries

• Concussion causes a temporary loss of consciousness from a brief brain interruption. Contusion is a brain tissue bruising. Intracranial hemorrhage involves bleeding within the skull. Classifications are further subdivided into epidural, subdural, and subarachnoid.

Eye injuries

• If irritating substances get in the eye, flush generously with water. In case of a foreign object, use a sterile bandage over both eyes. Seek professional medical help.

Sprains and dislocations

• Elevation, cold packs, splinting, and seeking medical attention are essential for sprains and dislocations.
• Severe injuries may require intravenous (IV) fluids, antibiotic treatment, medical assessment, pain management, immobilization, and possibly surgical intervention.

Blisters

• A blister is a collection of fluid under the outer skin layer. Remove and apply a dressing. First aid varies based on pain level and blister state (broken or unbroken).
• For unbroken, non-painful blisters, cut a doughnut shape, secure it with tape and cover with "Spenco Second Skin." For a broken blister, clean the area and apply an antibiotic ointment; cover with sterile gauze pad or non-stick pad.

Nose injuries

• Most nosebleeds stop on their own.
• To manage a nosebleed, the victim should sit up, lean slightly forward, pinch both nostrils for 5 minutes. Seek professional help if bleedings continues.

Muscle injuries

• In "RICE" treatment for muscle injuries, resting the injured area, applying ice, using compression with an elastic bandage and elevating the affected limb minimizes potential swelling.

STINGS and BITES

• Stings and bites, stemming from insects, can cause pain at the injury site with potential for allergic reactions. Seek medical attention immediately if symptoms include, swelling around eyes, tongue, throat, difficulty breathing, dizziness, rash, hives, stomach cramping or loss of consciousness.

Shock

• Shock is a critical condition characterized by a lack of adequate tissue perfusion resulting from inadequate blood flow. Hypovolemic shock, cardiogenic shock, septic shock, neurogenic shock, anaphylactic shock, and hypoglycemic shock are common types.
• Specific treatment depends on the underlying cause of shock.

Poisoning

• Poisoning occurs when toxic substances are ingested or absorbed through the skin or respiratory system.
• Identification of the toxin and treatment depends on the type and amount of exposure and the affected organs or systems.

Drowning and Near-Drowning

• Drowning is usually caused by a liquid submersion resulting in asphyxia.
• Immediate rescue efforts (e.g., basic life support/CPR) should be made followed by professional care and ongoing evaluation.

Foreign Body Airway Obstruction

• Foreign body obstruction in the airway can be life-threatening; immediate action is essential.
• The method involves placing one hand on the abdomen just above the navel and using the other hand to press firmly inward and upward several times, which dislodges the obstruction.

###Substance/Drug Abuse

• Substance abuse involves the use of specific substances intended to alter mood or behavior.
• Drug abuse is the misuse of drugs not for their intended medical use.
• Primary intervention in case of substance abuse comprises evaluating respirations, controlling airway, providing ventilation/oxygenation, and administering CPR if needed.

CNS stimulants (amphetamine, cocaine, ecstasy)

• These substances cause severe physiological reactions, including palpitations, hypertension, dysrhythmias, and potentially myocardial ischemia/infarction.
• Secure ABCs, monitor vital signs closely, and provide appropriate medication like diazepam if needed.
• Monitor ECG continuously, and administer IV fluids.

Hallucinogens (LSD, psilocybin mushroom, Jimson weed seeds)

• The symptoms include anxiety, confusion, hyperactivity, hallucinations, or behaviors that may be harmful.
• Medical intervention involves calming the patient by providing a safe, reassuring environment and monitoring the patient for hypertensive crisis and signs of trauma.

Burns

• Burns are injuries to the skin or flesh caused by heat, electricity, chemicals, friction, or radiation.
• Treatment varies depending on the severity (first, second, or third degree). First-degree burns are superficial, while second-degree involves damage extending into some of the underlying layers, and third-degree involves damage to all layers of the skin. Fourth-degree burns also affect deeper tissues like muscle or bone.

Intravenous Therapy

• Intravenous (IV) therapy is a method for delivering fluids and medications directly into a person's vein.
• Common complications include phlebitis (vein inflammation), occlusion (clot formation), infiltration (fluid leaking into surrounding tissue), extravasation (tissue damage from vesicant fluids), and infection.

Veins of the Upper Extremities

• Various veins in the upper extremities are suitable for insertion of IV catheters.
• Anatomical features and patient characteristics influence the selection of appropriate venous access points for different IV therapies.

Purposes of IV Therapy

• IV therapy serves several purposes, including providing parenteral nutrition, dialysis/apheresis, transfusions, hemodynamic monitoring, diagnostic testing, and medication administration.

Starting a Peripheral IV

• Finding an appropriate vein for IV insertion can be challenging, and various factors may influence vein selection and site selection ( e.g., hand/arm location, patient condition).
• Warm compresses and gentle immobilization assist blood flow. Compression devices like tourniquets may be used, but should be used according to protocol to avoid undue risk of complications.

Post-Traumatic Stress Disorder (PTSD)

• PTSD involves a range of symptoms, such as anxiety, anger, aggression, depression, and suspicion, that arise after traumatic experiences.
• These reactions can impede daily functioning and overall well-being. Associated events like rape, family violence, torture, combat stress, and terrorism are risk factors.

This quiz tests your knowledge on essential aspects of emergency care and patient assessments. Covering topics from patient consciousness to surgical procedures, you'll evaluate your understanding of critical medical concepts. Perfect for healthcare professionals and students in medical training.