Prioritization & Emergencies
You have four patients. Which one is the highest priority: a patient with a BP of 88/46 or a post-op patient who is suddenly restless?
The restless post-op patient.
Restlessness is an early sign of hypoxia or internal hemorrhage (ABCs first).
The BP of 88/46 is significant, but ABCs take immediate priority.
What is the primary difference in pediatric versus adult airway anatomy that makes children more susceptible to airway obstruction?
A child's tongue is proportionally larger, and their airway is narrower and more pliable.
Which airway adjunct requires a patient to be completely unconscious with no gag reflex to avoid aspiration?
Oropharyngeal Airway (OPA)
When managing a "crashing patient," what simple adjunct is used inside a BVM mask to help maintain a patent airway during positive pressure ventilation?
An oral or nasal pharyngeal airway (OPA/NPA).
What is the defining hallmark sign of ARDS that differentiates it from typical respiratory failure?
Refractory hypoxemia (hypoxemia that is unresponsive to oxygen administration).
A patient has a potassium level of 6.2 mmol/L. Is obtaining a stat EKG or initiating an IV saline lock the first priority?
Obtaining a STAT EKG.
Hyperkalemia causes lethal arrhythmias (peaked T-waves); you must assess the heart before you treat the lab value.
What is the most appropriate oxygen delivery device for a 3-year-old child who needs a stable 5 L/min of oxygen?
A simple face mask or nasal cannula (if tolerated). Pediatric flow rates for masks often start at 5-10 L/min to flush out CO2
A semi-conscious patient with an intact gag reflex needs an airway assist due to partial obstruction. Which adjunct is indicated?
Nasopharyngeal Airway (NPA).
Name one fast-acting induction agent (sedative) and one paralytic agent commonly used during an RSI procedure.
Etomidate or Propofol (sedatives); Succinylcholine or Rocuronium (paralytics).
This is the core physiological insult in ARDS that prevents effective gas exchange at the alveolar level.
Capillary endothelial injury and diffuse alveolar damage/inflammation.
A patient with a chest tube suddenly stops bubbling and their trachea is visibly shifted. What is the immediate priority action?
Check for a tension pneumothorax. This is a surgical emergency; prepare for immediate needle decompression or chest tube repositioning.
A child presents to the ER in shock that progresses to ARDS. What physiological change is the underlying cause of this progression?
Reduced blood flow to the lungs interferes with surfactant secretion.
The King LT Airway is a supraglottic device used as an alternative to intubation. What does its distal cuff seal off?
The esophagus.
Before you administer any medications during RSI, you must ensure you have completed this critical step involving 100% O2.
Preoxygenation (providing high-flow O2 for several minutes).
Which assessment action is essential to identify hypoxemia in an ARDS patient: hourly SpO2 monitoring or daily chest X-rays?
Hourly SpO2 monitoring (along with ABGs) to detect changes rapidly.
A patient is hypotensive, tachycardic, and tachypneic after fluid resuscitation. What is the immediate next expected action by the team?
Initiating vasopressors (e.g., Norepinephrine). If fluids don't raise the MAP to > 65, pressors are next for shock management.
A patient is in ARDS and unresponsive to supplemental oxygen. Is this type of hypoxemia considered mild, moderate, or severe?
Severe (refractory) hypoxemia.
When assisting with BVM ventilation during an emergency, what maneuver is used to open the airway for a patient with a suspected spinal cord injury?
The jaw-thrust maneuver.
After a successful intubation, the nurse must secure the tube and prepare to initiate continuous administration of these two medication types.
Continuous sedation and analgesia medications.