ED Dramas
A patient arrives at the ED after suffering chemical burns while at work. What is the first priority of care for this patient?
What is immediate decontamination and or undress and wash.
Rationale: Immediate decontamination is essential to remove the chemical from the skin and prevent further tissue damage. This involves flushing the affected area with copious amounts of water and removing contaminated clothing. This step is crucial to minimize injury and protect both the patient and healthcare personnel from further harm.
On which side lying position should a 38-week pregnant patient be placed during assessment after a fall down a flight of stairs, unless contraindicated?
What is left side or left lateral recumbent position.
Rationale: Placing a pregnant patient in the left lateral recumbent position helps to relieve pressure on the inferior vena cava, improving venous return and cardiac output. This
position helps to prevent supine hypotensive syndrome, which can cause reduced blood flow to both the mother and the fetus. It is a standard practice for assessing and managing pregnant patients to ensure both maternal and fetal well-being.
This organ is most frequently injured in blunt abdominal trauma?
What is the Spleen?
Rationale: The spleen is the organ most frequently injured in blunt abdominal trauma due to its location in the left upper quadrant of the abdomen and its relatively fragile structure. Blunt force can easily cause splenic rupture, leading to internal bleeding and requiring prompt medical attention to prevent hemorrhagic shock and other complications.
This is the treatment of choice for patients with a pneumothorax?
Correct Answer: What is Chest tube insertion or (thoracostomy)
Rationale: The treatment of choice for patients with a pneumothorax is chest tube insertion (thoracostomy). This procedure involves inserting a flexible tube into the pleural space to remove air, allowing the lung to re-expand1. It is particularly used for larger or symptomatic pneumothoraxes to ensure effective and rapid re-expansion of the lung. Observation with supplemental oxygen therapy, needle aspiration, and VATS are other options, but chest tube insertion is the most common and effective treatment for significant pneumothoraxes.
A patient presents with sudden onset of unilateral facial droop, slurred speech, and arm weakness. This is the most appropriate immediate action?
Correct Answer What is activate stroke alert and prepare for a head CT scan.
Rationale: A head CT scan is essential to differentiate between ischemic and hemorrhagic stroke, which guides subsequent treatment. Immediate imaging is critical in the acute phase of stroke management.
This blood test is the most indicative of myocardial damage?
Correct Answer: What is Cardiac Enzymes or Troponin.
Rationale: Cardiac enzymes, specifically troponin, are the most indicative of myocardial damage. Troponin levels rise significantly in the blood within hours of a heart attack, making it a highly sensitive and specific marker for myocardial injury2. Elevated troponin levels are used to diagnose and assess the severity of myocardial infarction (heart attack)
This formula is used to calculate the total amount of IV fluids a burn patient requires in the first 24 hours after injury.
What is Parkland Formula. (we will also accept rule of nines as it relates to the formula for calculating surface area).
Rationale:
Burn injuries can cause significant fluid loss due to the damage to the skin's protective barrier. This can lead to hypovolemic shock, which is a life-threatening condition where the body does not have enough blood or fluid to circulate effectively. Proper fluid resuscitation is critical in the initial management of burn patients to prevent this.
The Parkland formula is a widely accepted method for calculating the amount of intravenous (IV) fluids needed in the first 24 hours post-burn. It helps ensure that patients receive adequate hydration to support their recovery and prevent complications.
The Rule of Nines helps quickly assess the burn extent (providing surface area context), and when combined with the Parkland formula, it ensures accurate fluid resuscitation for burn patients
You suspect this medical problem in a 24-year-old woman who complains of lower quadrant pain radiating to her shoulder, and whose last menstrual period (LMP) was 8 weeks ago.
What is Ectopic pregnancy?
Rationale: Given the patient's symptoms of lower quadrant pain radiating to her shoulder and her LMP being 8 weeks ago, an ectopic pregnancy is a likely concern. An ectopic pregnancy occurs when a fertilized egg implants outside the uterus, often in a fallopian tube. This can cause severe pain and shoulder pain due to referred pain from diaphragmatic irritation. Immediate medical evaluation is crucial to confirm the diagnosis and provide appropriate care.
A 45-year-old patient presents to the emergency department with severe, acute epigastric pain radiating to the back, nausea, and vomiting. Laboratory results show elevated serum amylase and lipase levels. This is the most likely diagnosis?
What is Acute pancreatitis.
Rationale:
Acute pancreatitis is diagnosed based on severe, acute epigastric pain radiating to the back, nausea, and vomiting, along with elevated serum amylase and lipase levels. Nurses prioritize managing the severe pain with opioid analgesics, monitoring lab values, and ensuring proper hydration to address fluid loss. Nutritional support, vigilant monitoring for complications, and patient education about lifestyle modifications are essential to promote recovery and prevent recurrence
This can happen to a chronic COPD patient when given high levels of oxygen?
Answer: What is decreased respiratory drive. (Chronic COPD patients rely on low oxygen levels to drive their breathing and giving them high levels of oxygen can suppress this drive.)
Rationale: Chronic COPD patients rely on low oxygen levels to drive their breathing, known as the hypoxic drive. When given high levels of oxygen, their respiratory drive can be suppressed, leading to decreased respiratory drive. This can result in hypoventilation, increased carbon dioxide levels (hypercapnia), and potentially respiratory acidosis. Oxygen therapy in COPD patients must be carefully managed to avoid these risks.
In a patient with increased ICP, this position should be avoided to prevent further elevation of intracranial pressure
Correct Answer: What is supine position or lying the patient flat in stretcher.
Rationale: Keeping the head flat can increase ICP by impeding venous outflow from the brain. Elevating the head at 30 degrees helps facilitate venous drainage and reduces ICP.
The resuscitation team is performing CPR on a patient. This rhythm will respond to defibrillation?
Correct Answer: What is Ventricular fibrillation (VF)
Rationale: Ventricular fibrillation (VF) is a chaotic and irregular heart rhythm that leads to the heart being unable to pump blood effectively. It is one of the most common rhythms that respond to defibrillation. Defibrillation delivers an electric shock to the heart, which can help restore a normal heart rhythm and improve the chances of survival in a cardiac arrest situation. Other rhythms like asystole and pulseless electrical activity do not typically respond to defibrillation and require different approaches for treatment.
This device is commonly used control epistaxis when standard measures like direct pressure and topical vasoconstrictors are ineffective.
What is rhino rocket?
Rationale: The Rhino Rocket is an essential tool in the management of epistaxis (nosebleeds), particularly when initial interventions such as direct pressure and topical vasoconstrictors fail to control the bleeding. This device provides immediate hemostasis by applying direct pressure to the bleeding site within the nasal cavity.
This is how long a woman at risk for postpartum preeclampsia after delivery?
What is 6 weeks?
Rationale: A woman is at risk for postpartum preeclampsia for up to six weeks after delivery. While most cases develop within the first 48 hours postpartum, the risk can extend throughout this period. Monitoring for symptoms such as high blood pressure, severe headache, visual disturbances, and edema is crucial during these six weeks to ensure timely detection and management of postpartum preeclampsia.
Your patient has been vomiting every 30-45 minutes for the past 8 hours. In addition to hypovolemia, the patient is at risk of developing this electrolyte imbalance?
Answer: What is hypokalemia (From loss of hydrochloric acid)
Rationale: Frequent vomiting leads to the loss of hydrochloric acid from the stomach. This can result in metabolic alkalosis, where the blood becomes too alkaline due to the loss of stomach acid. Additionally, vomiting causes significant losses of potassium, leading to hypokalemia. Both conditions require careful monitoring and management to restore electrolyte balance and maintain the patient's overall health.
This is the most serious injury associated with a fracture of the 1st or 2nd rib?
A
Correct Answer: What is Aortic rupture
Rationale: Fractures of the 1st or 2nd ribs are rare but can be associated with serious injuries such as aortic rupture. The proximity of these ribs to the great vessels, including the aorta, means that a fracture can cause life-threatening bleeding and require immediate medical intervention. Recognizing the potential for aortic rupture is crucial for timely diagnosis and management to prevent catastrophic outcomes.
A patient with a confirmed diagnosis of ischemic stroke is a candidate for thrombolytic therapy. According to Our Policy, this is the maximum critical time window for administering Tenecteplase (tnk)?
Correct Answer: What is within 4.5 hours of symptom onset or LKWT.
Rationale: The administration of tnk is most effective when given within 4.5 hours of symptom onset for ischemic stroke. Early administration can significantly improve outcomes. Reference: PolicyStat ID16544729
You are doing an EKG on a patient with a potassium level of 7.8 mEq/L. This EKG change will most likely be present.
Correct Answer: What is Peaked T waves
Rationale: A potassium level of 7.8 mEq/L indicates severe hyperkalemia, which is associated with characteristic EKG changes. These changes include peaked T waves and a widened QRS complex. These findings are due to the effects of high potassium levels on cardiac conduction and repolarization. Recognizing these EKG changes is crucial for the timely management of hyperkalemia to prevent serious cardiac complications.
A patient arrives at the ED after collapsing while running a 5K race. The core temperature is 105 degrees Fahrenheit, and the urine appears tea-colored. This is the reason for the tea-colored urine?
What is rhabdomyolysis?
Rationale: The tea-colored urine is indicative of myoglobinuria, which occurs in exertional rhabdomyolysis. This condition arises from muscle breakdown due to extreme physical exertion, releasing myoglobin into the bloodstream. Myoglobin is toxic to the kidneys and can lead to acute kidney injury, necessitating prompt treatment to prevent severe complications. Immediate interventions include aggressive hydration to flush out myoglobin and continuous monitoring of renal function.
This condition is suspected when a 32-week pregnant patient arrives at the ED complaining of painless bright red vaginal bleeding of sudden onset.
What is Placenta previa?
Rationale: Painless bright red vaginal bleeding in the third trimester is a hallmark sign of placenta previa. This condition occurs when the placenta is implanted low in the uterus and covers the cervical opening. Immediate assessment and management are necessary to ensure the safety of both the mother and the fetus, including possible delivery planning if the condition poses significant risks.
This sign is a common finding during the assessment of a patient with cholecystitis?
Correct Answer: What is a Positive Murphy's sign
Rationale: A positive Murphy's sign is a common finding during the assessment of a patient with cholecystitis. This sign is characterized by the cessation of inspiration due to pain when the right upper quadrant of the abdomen is palpated deeply. It indicates inflammation of the gallbladder, which is typical in cholecystitis. Recognizing this sign helps in the prompt diagnosis and management of the condition.
EXTRA: To assess for a positive Murphy's sign, follow these steps:
1. Position the Patient: Have the patient lie down on their back (supine position) on the examination table.
2. Locate the Right Upper Quadrant: Place your left hand on the patient's lower right rib cage, just below the costal margin (the lower edge of the rib cage).
3. Palpate During Inspiration: Ask the patient to take a deep breath. As they inhale, gently press your right thumb into the abdomen just below the right costal margin1.
4. Observe the Patient's Reaction: If the patient experiences pain and abruptly stops their inspiration, this indicates a positive Murphy's sign.
This condition is indicated by a "shark fin" pattern on a capnography waveform?
Correct Answer: What is Bronchospasm
Rationale: A "shark fin" pattern on a capnography waveform typically represents bronchospasm. This occurs when the airways are constricted, causing uneven and prolonged exhalation. The characteristic shape is due to the obstruction in the airways, making it difficult for the patient to exhale fully and efficiently. Recognizing this pattern is essential for timely intervention and management of conditions like asthma or chronic obstructive pulmonary disease (COPD).
True or False: According to our policy, consent is needed prior to administration of Tenecteplase (tnk)?
What is False
Correct Answer: FALSE
Rationale: TNK does not require consent. Our policy (Tenecteplase) states the following "does not require consent. However, the purpose of treatment and risks and benefits of treatment must be explained and assent obtained if possible. If the patient cannot give assent and does not have family available to give assent, treatment may still proceed" Reference: PolicyStat ID16544729
Your patient arrives by EMS with complaints of shortness of breath (SOB) and frothy pink sputum. Lung sounds reveal crackles and wheezing bilaterally. Vital signs are: BP 90/50 mmHg, pulse 120 bpm, RR 34 bpm, and the patient is afebrile. The patient has a history of diabetes mellitus (DMM), hypertension (HTN), and heart failure. As the primary RN you immediately suspect this condition
Correct Answer: What is Acute pulmonary edema or APE
Rationale: Given the patient's symptoms of shortness of breath, frothy pink sputum, crackles and wheezing on lung auscultation, along with a history of heart failure, the most likely diagnosis is acute pulmonary edema. This condition involves the accumulation of fluid in the lungs, making it difficult to breathe and often presenting with crackles and pink, frothy sputum1. The low blood pressure and high heart rate indicate the patient is in a critical state and requires immediate medical intervention
This condition is the most likely diagnosis for a patient who develops sudden chest pain, dyspnea, and tachycardia shortly after lower extremity orthopedic surgery.
What is PE (pulmonary embolism)?
Rationale:
A pulmonary embolism (PE) is a critical condition where a blood clot, usually originating from the deep veins of the legs (deep vein thrombosis), travels through the bloodstream and lodges in the pulmonary arteries, blocking blood flow to the lungs. This condition is particularly concerning after orthopedic surgeries, especially those involving the lower extremities, due to the increased risk of clot formation from immobilization and the nature of the surgical procedure. Key signs and symptoms of a PE include sudden, sharp chest pain that may worsen with deep breaths (pleuritic pain), shortness of breath or difficulty breathing, and tachycardia (rapid heart rate). Additional indicators might include coughing (potentially with blood), sweating, lightheadedness, or fainting. Immediate diagnosis and treatment are crucial to prevent serious complications or death.
At the time of delivery, for a neonate, this area should be suctioned first, and this tool should be used.
What is the Mouth and using a bulb syringe
Rationale: At the time of delivery, the initial suctioning of a neonate focuses on the mouth first, using a bulb syringe. Suctioning the mouth before the nose helps to clear any secretions and prevents the neonate from inhaling fluid into the lungs, which could happen if the nose is suctioned first. This practice ensures a clear airway and reduces the risk of aspiration and respiratory complications.
A patient complains of abdominal pain and distention, fever, tachycardia, and diaphoresis. An abdominal x-ray shows free air under the diaphragm. This condition is suspected?
Correct Answer: What is Perforated bowel
Rationale: The presence of free air under the diaphragm on an abdominal x-ray is a classic sign of a perforated bowel. This condition occurs when a hole develops in the wall of the intestine, allowing air to escape into the abdominal cavity. It is a medical emergency that requires immediate surgical intervention. The patient's symptoms of abdominal pain, distention, fever, tachycardia, and diaphoresis are consistent with this diagnosis.
You are providing ventilations using a bag-valve mask. Suddenly, you do not see the patient's chest rise with your ventilations. You reposition the airway and try to ventilate again. Still no chest rise. This is the most likely cause?
Correct Answer: What is Obstructed airway
Rationale: When you are providing ventilations using a bag-valve mask and the patient's chest does not rise despite proper repositioning of the airway, the most likely cause is an obstructed airway. This could be due to a foreign body, mucus plug, or anatomical obstruction that is preventing air from reaching the lungs. Immediate assessment and intervention are necessary to clear the obstruction and ensure effective ventilation.
This medication is commonly used to treat increased intracranial pressure in a patient?
Correct Answer: What is Mannitol.
Rationale: Mannitol is an osmotic diuretic used to reduce cerebral edema and lower ICP in patients with traumatic brain injury. It works by drawing fluid out of brain tissue, which decreases swelling and pressure inside the skull.
This part of the myocardium is most likely damaged by an occlusion of the left coronary artery, often referred to as the "widow maker."
Answer: What is left ventricle.
Rationale: The left coronary artery, often referred to as the "widow maker" due to its critical role in supplying blood to a large portion of the heart, primarily provides blood to the left ventricle. An occlusion in this artery can severely impact the left ventricle, which is responsible for pumping oxygenated blood to the entire body. Damage to the left ventricle can lead to significant and potentially fatal cardiac events, making prompt diagnosis and treatment crucial.