BURNS
Environmental Emergencies
Trauma
Triage
Misc
100
Your patient has been exposed to a dry powder chemical. What is your first action?
Decontaminate them.
100
The dirtiest type of bite, most likely to lead to an infection.
How do you treat it?
HUMAN
Thoroughly cleanse. Prophylactic antibiotics. If you don't have to don't close them up.
100
During which part of your primary survey do you check for bleeding? Where does this fall in the order of operations?
X- exsanguination, first
100
You have a patient presenting with a chief complaint of chest pain that has been ongoing for two hours. His vital signs are stable on assessment and has no signs of a STEMI on a 12-lead. What ESI score would you apply to this patient and what are your top priority nursing interventions?
ESI 2 because of the higher potential for decompensation.
Aspirin and lab work.
100
Legally all patients seeking emergency services have to have a(n)....
Medical screening exam (MSE)
If someone comes to your ED asking for help you have to complete an MSE. You can not turn them away or decide their emergency isnt good enough without first screening them. They can "leave without being seen" by their own volition. Mothers in labor cannot be turned away either. They dont have to give birth at your facility, you can transfer them, but you can't not evaluate them
200
Circumferential full-thickness burns can create this dangerous effect where rigid eschar compresses vessels and impairs circulation.
Tourniquet Effect
200
For moderate hypothermia in the ED, this warming method uses devices like warming blankets or forced warm air systems.
Active External Rewarming.
Bonus point:
When do we stop active rewarming procedures?
200
What are the timeframes that patients most commonly die in related to trauma?
Within minutes
Within minutes to hours of arrival
Within weeks to months
200
Which patient matches which triage color?
-Decreased LOC, agonal breathing not relieved by airway reposition
-Closed right wrist fracture and scalp laceration
-BLE amputation, bleeding continues after a tourniquet applied to each limb
-Diabetic with a blg 400 and a severed ear.
Green--Closed right wrist fracture and scalp laceration
Yellow--Diabetic with a blg 400 and a severed ear.
Red--BLE amputation, bleeding continues after a tourniquet applied to each limb
Black--Decreased LOC, agonal breathing not relieved by airway reposition
200
A patient with hypotension, tachycardia and cool clammy skin after trauma is most likely experiencing this type of shock.
Hypovolemic shock.
Bonus Point: What are your priority interventions to address this?
300
Your patient used a propane stove to heat their small home. They are red, warm and dry. They VS are as follows:
HR 83
BP 117/76 What is your concern?
RR 18
pulse ox 100% on RA
Temp 98.7 F
Metabolic Asphyxiation
Your 02 sat is erroneous! Get that patient on 15L 02 with a nonrebreather mask! C02 binds to the oxygen carrying portion of the RBC and you are unable to obtain an accurate pulse oximetry. They need oxygen.
300
What are three methods of rewarming a patient who is hypothermic?
Warm blankets, bair hugger, body cavity lavage.
Bonus point: What is the proper approach to rewarming, and what complication arises if not followed?
300
How does hypothermia contribute to the trauma 'triad' of death?
Disrupts the clotting cascade and makes bleeding more difficult to stop.
Bonus point:
What nursing interventions can you implement to prevent hypothermia as a complication?
300
You are part of a medical response to a building collapse in a neighboring community. During your search efforts you find four persons in a ditch near the rubble. What is your first priority?
Scene Safety.
300
Secondary survey includes
Full set VS/family presence
Gadgets
History/head to toe
400
Three burn victims come into the ED at the same time. In what order will you evaluate them?
-40yo female with full thickness burns to BLE
- 76yo male with superficial burns but coughing up black sputum with singed nasal hair
-3 year old with partial thickness burns to their back
1. - 76yo male with no burns but coughing up black sputum with singed nasal hair
2. -40yo female with full thickness burns to BLE (note: 18% each leg and FULL thickness.
3. -3 year old with partial thickness burns to their back (note partial thickness and just to the back)
400
You have a patient who is currently unhoused. The temperatures overnight reached below 20 degrees F, thankfully the patient had many layers on over most of his body and has a core temp on arrival of 96.4 degrees F. The parts that were exposed were his L hand and nose and on assessment you note a blackened appearance to the fingers and nose with the area proximal having no display of blanching.
What condition are you concerned for and what are your first 3 nursing priorities?
Frostbite.
Remove all clothing, especially from the affected extremities, provide warm blankets to the patient, submerge affected extremity in warm water.
400
An unconscious patient is dropped off in the ambulance bay. You and several other members of the ED staff go to check them out. They have heavy bleeding to their RLE. Its coming out fast and isnt slowing down with pressure. What is your next move?
Apply a tourniquet
What are your follow up assessments? how do you know its on right
400
How is triage different in a disaster setting?
We use START triage based on a minimal set of criteria, and it is done faster.
400
Patients experiencing:
burns
puncture wounds
penetrating trauma
animal bites
All require this....
Tetanus vaccination.
500
A 182 cm 40 year old male who weights 198lb who sustained full thickness burns to 30% total surface area after eating 5.5 pancakes with 19gm of syrup.
What volume of fluids should this patient receive in the first 8 hours? And at what initial rate?
What is
338mL/hr for a total of 2,700mL in 8 hours
500
A 24-year-old marathon runner collapses at the finish line. The patient is confused, has hot dry skin, and a temperature of 105°F (40.5°C).
Which intervention should the ED nurse implement first?
Rapid cooling through:
Ice bath, cooled IV fluids, foley lavage, cooling pads, ice packs.
500
Your patient is brought in after a motor vehicle collision at 55 mph. Patient reports wearing their seatbelt, and airbags did deploy. On transfer to the gurney you note the following vitals:
BP 82/48
HR 132
88% despite oxygen therapy
26 breaths a minute
What type of injury do you have a high suspicion for?
(tension) pneumothorax
500
You are working in the ED and have just taken over an assignment from you coworker when you notice that order for all three of your patients were put in in the last five minutes. Which orders will you carry out first?
78 yo male who fell and hit his head, is on thinners, and CT is ready for them.
32 yo female with an elevated lactate level with fluids ordered.
26 yo female with fluids, benadryl, and toradol ordered IV.
Fluids for elevated lactic.
500
Patient brought in by ambulance was crossing a river when they slipped and fell, injuring their leg.
What measures do you anticipate taking to rewarm them?
Remove their wet clothes!
passive rewarming:
Active external rewarming:
Active internal:
What if your patient was too hot? how would you cool them down?