Uh Oh
What is the first step to stop a hemorrhage associated with an amputated extremity?
WHAT Is A tourniquet
A urinary tract infection that develops in a patient who has a urinary catheter inserted
A bloodstream infection that occurs in a patient who has a central venous catheter (a catheter inserted into a large vein, such as the jugular or subclavian vein).
What ate CAUTI & CLABSI
Patient presents with Heart Rate 188- Medications failed attempts
EKG is Afib RVR rate 188-200
Cardioversion w/ Conscious Sedation
2 unsuccessful IV attempts on a patient in cardiac arrest and Trauma Arrest
What would you do?
What would you do to administer High Volume Fluids?
What is I/O access & Large Bore access (Cordis)
Belmont/Level I
Demonstrate
Cardiologist suspects a STEMI and is symptomatic. The EKG x2 is not indicating a STEMI nor rapid Troponin testing.
What do you anticipate the cardiologist to order?
Right Sided or Posterior EKG
Show the difference
Posterior leads are helpful in suspected posterior myocardial infarction. They are performed by placing V4, V5 and V6 electrodes in the same intercostal space, but continuing into the patient's back.
Right-side leads are recommended in patients with inferior myocardial infarct, when right ventricular infarct is suspected. RCA occlusion
They are also useful in patients with dextrocardia, situs inversus or in some cases of congenital heart disease
Patient complains of numbness to LE's and decrease sensation 2 days after ATV rollover
What would you do and suspect?
What is C Spine Injury Apply Cervical Collar?
shower rails, coat hooks, pipes, and radiators, bedsteads, window and door frames, ceiling fittings, handles, hinges and closures.
What are Environmental Risks/Ligature?
Upon arrival at the ED as you are doing your assessment, the patient becomes pulseless and apneic. The EKG monitor shows ventricular fibrillation. This was not a witnessed rhythm change You yell out for assistance.
What are you going to do?
What is CPR for 2 minutes & defibrillate @ 200 j, Epi 1 mg
Suppose this was a Pediatric pt
The patient presents 16 hours after having a TAVR procedure right femoral artery access. Pt has bleeding from site and swelling noted as well. What would you consider using?
What is the FemoStop?
How do you use this?
EMS arrives with mother in active labor, no prenatal care and delivery in progress. She believes she is around 32 weeks. What should quickly initiate?
Condition O-Emergency, Delivery kit, panda, and the giraffe warmer.
Show me the proper use
What is the appropriate technique to palpate the pelvis for stability and what would you apply for an unstable pelvis?
What is apply gentle pressure over the iliac crests downward and medially? You would apply a pelvic binder/T Pod.
30 minutes post Succinylcholine administration from a Conscious Sedation, the patient develops:
High fever (over 104°F or 40°C), Muscle rigidity, Elevated end tidal CO2, Rapid heart rate and irregular heartbeat, Sweating, & Confusion
What is Malignant hyperthermia? (MH) is a rare, inherited disorder that causes a severe reaction to certain anesthetic drugs used during surgery or other medical procedures.
What are you go to do?
Chest pain that is sudden, severe, and lasts for more than a few minutes, Pain that spreads to the arm, shoulder, neck, or jaw, SOB
EKG has ST elevation in leads II, III, AVF
STEMI
What are you going to do?
20 Weeks Pregnant s/s of:
Headaches that don't go away, Swelling in the face and hands, Vision changes
BP 158/96
What is OB HTN/Preeclampsia?
What are you going to do?
Your patient has a Massive GI Bleed due to esophageal varices... How would you control bleeding until GI can arrive?
What is Minnesota Tube?
Demonstrate
EMS alert for Pri-1 stabbing multiple wounds to head, neck, and chest. Bp 60/palp, pt being bagged not able to intubate (2 unsuccessful attempts), tachy
What are you going to do?
Trauma Team Alert, Level 1, blood, C Mac, Emergency Trach, RSI, Chest Tube, Suction, Lucas, Art Line, US for FAST
Required per JC annually to prevent the spread...
What are Infection Control Bundles
Handwashing, PPE, Safe Needle Injection, Semi Critical and Critical Disinfect, Pre Klenz
Accu Check POC
Hazmat
Paradoxical chest wall movement - the flail segment moves in during inspiration and out during expiration.
What is a pneumothorax
What are you going to do to correct this?
A 78 y/o M presents with acute onset of left arm and leg weakness which started 1 hour prior to arrival.
Your exam reveals male, appearing his stated age with the following vitals: P 101 BP 190/100 RR 18 O2 100% WT- 73 kgs. Left sided arm and leg hemiparesis.
What are you going to do?
Stroke Page- Charge RN to pull TNK, Huddle for TeleStroke initiated, Accu Check, to CT, Obtain accurate WT, NIH/Yale
TNK advised- Dose
How often v/s and neuro
Your patietn has a femur fracture and is not expected to get surgery until tomorrow.
What intervention would you anticipate the ortho to order?
What is Bucks traction?
Show me the set up
Patient arrived EMS- fell from a tree stand approximately 20 feet. Landed on grassy area left side. C/O left hip pain. Patient needs transferred for a radial head femur fx. What would you use to stabilize the extremity?
What is Hare Traction splint?
Show us the correct placement
Patient arrives to ED as a result of visit reason: Patient placed in gown all belongings secured and patient has 1:1 sit.
Pt is being treated for a Behavioral Health Concern, Suicidal Ideation, Detox, OD, Withdraw from a substance.
Patient's V/S 98.2 34, 28, 70/40 (40)
O2 NRB 15L, lethargic clammy
Did not respond to or medications
What's your next 2 steps
What is Transcutaneous and Transvenous Pacing?
How do you prepare?
Is a antifibrinolytic, meaning it enhances clot formation by preventing breakdown
What is TXA
How do you give it?
Patient had a cast placed to left forearm 2 days prior. Swelling noted to hand and patient complains of hand/forearm feeling tight.
What is compartment SX?
Classic s/s: pain, pallor, paresthesia, poikilothermia (cold skin) and pulselessness.