Neuro
Explain the common symptoms/side-effects of a TBI and preventative measures we implement with patients.
What is...
Mild-Mod: Headache, Nausea, Drowsiness, Blurred vision, Photosensitivity, Sound sensitivity, balance issues.
Mod-Sev: Repeated vomiting, LOC, seizures, unequal pupil dilation, profound confusion, slurred speech.
Prevention: side rails on patients bed as needed, non-slip socks, bed alarm, crutches/walker, supervision.
A patient enters the ER with complaints of asthma exacerbation/worsening symptoms. List a couple of asthma triggers that could be affecting this patient.
Cold air, Exercise, Airborne allergens such as pollen or dander, stress, anxiety.
A patient enters the ER with complaints of chest pain, shooting pain down the left arm, numbness and tingling sensation in the left arm, nausea, and jaw pain. Your immediate action is to start an EKG. Explain where to place the leads for a 12-lead EKG.
V7-10 on extremities
V1 Fourth intercostal space on the right sternum
V2 Fourth intercostal space at the left sternum
V3 Midway between placement of V2 and V4
V4 Fifth intercostal space at the midclavicular line
V5 Anterior axillary line on the same horizontal level as V4
V6 Mid-axillary line on the same horizontal level as V4 and V5
Your patient has a family history of melanoma and is asking about a large mole on their arm. What patient teaching would you provide for them, specifically what to watch out for regarding the mole?
Changes in shape, size, border, color, sensation, etc.
The RICE method is a popular approach for managing and treating minor injuries, particularly those involving muscles, ligaments, and tendons. Describe the definition of RICE and the benefit this method provides.
It stands for Rest, Ice, Compression, and Elevation.
Reducing swelling, pain, promote healing, avoiding re-injury
Spinal cord injuries can present in many ways. Some common signs or symptoms of a spinal cord injury include loss of movement, loss of sensation, change of sensations, urinary or bowel incontinence, spasms, pain, or difficulty breathing. List at least two medication classifications that may be prescribed to a patient with a spinal cord injury.
What is...
Corticosteroids: minimize inflammation and reduce damage in early stages
NSAIDS: reduce pain and inflammation
Anticonvulsants: Prevent or aid seizures and nerve pain
Antispasmodics or Muscle relaxants: Reduce muscle spasms and spasticity.
Antidepressants: Nerve pain
You have a post-op patient that is having difficulty taking a full breath/catching their breath. What interventions can you implement to promote effective breathing and prevent complications such as pneumonia?
Deep breathing exercises, raise the head of bed to at least 45 degrees, provide O2 if needed, incentive spirometer.
Provide a simple explanation of the difference between Defibrillation and synchronized cardioversion.
Defibrillation is an emergency procedure used to treat life-threatening arrhythmias.
Cardioversion is a planned procedure used to convert abnormal heart rhythms back to normal in non-emergency situations.
The rule of nines regarding burns divides the body into percentages that are, for the most part, multiples of nine. You have a patient that has burns covering both arms entirely and the posterior portion of their torso. What is the TBSA for this patient?
36
Each upper limb: 9%
Back of torso: 18%
Explain the difference between a compound Fx, Closed Fx, and oblique (non-displaced) Fx.
Compound- Bone completely broken, that has broken through the skin
Closed- Bone completely broken but has not damaged the skin
Non-displaced oblique- diagonal Fx through the bone, but the bone is still in-line and not moved.
What are the two main causes of a stroke (types of strokes)? What are the risk factors and symptoms associated with both types of strokes?
What is...Ischemic and Hemorrhagic stroke.
Risk Factors: Hypertension, hyperlipidemia, diabetes, obesity, age, CVD
Symptoms: Paralysis, memory loss, aphasia, numbness, pain, unilateral facial drooping.
Describe the signs/symptoms of a pneumothorax. (collapsed lung)
Tachypnoea (rapid breathing)
Tachycardia (rapid heart rate)
Hypoxia (low oxygen levels)
Reduced or absent breath sounds on the affected side
Hyperresonance on the affected side
Tracheal deviation away from the affected side (in tension pneumothorax)
Acute chest pain
Dyspnea (shortness of breath)
Altered mental status
Low blood pressure
Blue discoloration of the skin (in severe cases)
CPR, AED (Defibrillation)
Medications: Epinephrine, Adenosine, Atropine, Amiodarone
Your patient has a large laceration to their left thigh from a dirty kitchen knife. What would you look for if you are concerned about infection?
Purulent (yellow) discharge, Redness surrounding the wound, increased swelling, warmth, fever, aches/pains, red streaks on the skin.
Shoulder dislocation occurs when the humerus partially or completely pops out of its socket, which is attached to the shoulder blade. A patient presents to the ER with a dislocted right shoulder. What complications are you concered about with this patient?
damage to the axillary artery, the large blood vessel that carries oxygenated blood to the upper arm
humerus Fx
Recurring dislocation
Damage to the rotator cuff
Your patient is having a tonic-clonic seizure (grand mal), presenting as body stiffness, shaking, jerking, violent muscle contractions and LOC. What course of action would you take at the immediate notice of the seizure?
What is...
Remove anything around them that may cause harm
Lay them down/assist to the ground, turn them on their side
Attempt to record the length of the seizure
Take note of type of seizure occurring and anything you notice.
You are caring for a patient that has inhalation damage. What potential complications are you concerned about, associated with inhalation injury?
Infection, Pulmonary Edema, Respiratory failure, chronic respiratory conditions
Orthostatic hypotension is a drop in BP when transitioning positions, supine to standing. Orthostatic hypotension is associated with a significant increase in cardiovascular risk and falls, and up to a 50% increase in relative risk of all-cause mortality.
Your provider asks you to assess your patient for orthostatic hypotension, how would you perform this assessment?
Have the patient lie down for 5 minutes
Measure blood pressure and pulse rate
Have the patient stand
Repeat blood pressure and pulse rate measurements after standing 1 and 3 minutes.
Abnormal: BP >20 mm Hg, Diastolic >10 mm Hg, dizziness, lightheaded
Patient presents with a burn that has damaged the epidermis, dermis, and subcutaneous tissue. Pain is not present because the nerve endings in the skin have been destroyed. The skin appears deep red with some charred-black, leathery, dry portions. Scar formation is likely. There is no damage to bone, tendon, or ligament. What degree is this burn?
A patient presents to the ER after an intense workout with the following symptoms:
-Extreme Dehydration
-Muscle swelling/pain
-Dark pee that’s brown, red or tea-colored
-Weakness
-Decreased urination
-Nausea
You present these findings to your provider, and they ask what condition you think your patient is experiencing.
Rhabdomyolysis
Neuropathy happens when the nerves that are located outside of the brain and spinal cord (peripheral nerves) are damaged. This condition often causes weakness, numbness, tingling or burning pain, and/or loss of sensation. A patient enters the ER with complaints of loss of sensation that align with neuropathy in their feet. What initial questions will you ask this patient and what are you concerned about (safety wise)?
What is...
Questions to ask: How long ago did this start? At what point can you feel sensation? Have you had any recent injuries? What kind of prior medical history do you have? What medication are you on?
Concerns to report: Bilateral strong pedal pulses?, needs assistance with walking or moving, temperature of extremities, injuries, neuropathy spreading/worsening.
You are caring for a patient with tuberculosis. What PPE should you wear prior to any contact with this patient?
A. Surgical mask and gloves
B. Particulate respirator, gown, protective eyewear, and gloves
C. Particulate respirator and protective eyewear
D. Surgical mask, gown, and protective eyewear
B
Provide two life threatening arrhythmias that require defibrillation and two arrhythmias that typically require synchronized cardioversion.
Life threatening: V-fib and pulseless V-tach
Cardioversion: A-Fib, A-flutter, and SVT
You a caring for a patient with third degree burns, 36% TBSA. What interventions would you implement while caring for this patient?
use intravenous fluids to help prevent dehydration
antibiotic ointments in the case of an infection as needed
pain medications
covering the affected area with a loose bandage or cloth
raising the injured body part above the heart, if possible
placing a light sheet or blanket over them
Which statement by a patient, who just received a cast on the right arm for a fracture, requires you to notify the physician immediately?
A. “It is really itchy inside my cast!”
B. “My pain is so severe that it hurts to stretch or elevate my arm.”
C. “I can feel my fingers and move them.”
D. “I’ve been using ice packs to reduce swelling.”
B. This statement is very concerning and may represent a condition called compartment syndrome. Compartment syndrome is where the nerves and blood vessels are becoming compromised due to increasing pressure in the compartments within the fascia.