Don't go outside
A patient comes into the ED with heatstroke; what are the first steps to begin treating them?
Remove clothing, begin cooling (environmental, external, internal), treat shivering, closely monitor CORE temp, monitor for complications
Why must someone with profound hypothermia be warmed before being declared dead?
In cases of profound hypothermia, the body's core temperature drops significantly, which can lead to severe depression of physiological functions. This extreme cold can slow down or even temporarily stop heart and brain activity, making it difficult to determine if a person is truly deceased.
What is the definition of a mass casualty event?
Manmade or natural event that overwhelms community’s ability to respond with existing resources.
A patient with an inhalation injury is receiving 100% oxygen via a non-rebreather mask. Why is pulse oximetry unreliable in assessing oxygenation status?
Carbon monoxide (CO) binds to hemoglobin with greater affinity than oxygen; pulse ox can't distinguish between O2 and CO
According to the rule of nines, what percentage of total body surface area (TBSA) is represented by the anterior surface of one leg and one arm?
13.5%
What electrolyte imbalance are we concerned about when a patient comes in with severe dehydration?
Hypernatremia; in severe dehydration, hypernatremia occurs because there is a significant loss of water from the body while sodium levels remain relatively stable or elevated.
A patient is brought to the ER by a friend after being found laying in a yard outside in the rain while at a party. Vitals show that he has mild hypothermia, but he isn't shivering; what question or questions would you ask to determine why?
Ask about potential alcohol or drug use; alcohol cause increased sensation of warmth and depresses shivering. Other drugs to the same thing
You are a triage nurse during an MCI caused by a building collapse. You have a limited number of stretchers. Which patient would you prioritize for immediate transport to the hospital?
a) A patient with multiple contusions and abrasions.
b) A patient with a possible spinal cord injury who is conscious but complaining of neck pain.
c) A patient with a fractured femur, in severe pain.
d) A patient with an amputated leg, actively bleeding.
D; active bleeding from an amputation is a life-threatening emergency that requires immediate transport for potential blood transfusion and definitive surgical care.
A patient arrives with an inhalation injury after a house fire. Which assessment finding is MOST indicative of significant airway involvement?
a) Singed nasal hairs
b) Soot in the sputum
c) Elevated respiratory rate
d) Hoarseness and persistent cough
D; hoarseness and persistent cough are specific to airway damage, signifying edema or inflammation in the airways
A 30 year old female patient has deep partial thickness burns on the back of the right arm, posterior trunk, front of the left leg, anterior head and neck, and perineum. The patient weighs 150 lbs. Use the Parkland Burn Formula to calculate the total amount of Lactated Ringers that will be given over the next 24 hours?
10,064 mL
A young child is BIB ambulance for a submersion injury after he was found by parents in a natural pond. Resuscitation efforts by medics were successful, and patient is now breathing spontaneously. The plan is to monitor them for the next several hours; what short and long term complication are you most concerned about?
Short term is ARDS if there was water aspirated, long term is bacterial pneumonia due to stagnant water potentially being aspirated
Three patients come into the ER with chief complaints of frostbite; in what order will you see the patients?
Patient A: A 22-year-old homeless male who presents with frostbite on his hands. He is shivering and disoriented, with a heart rate of 100 bpm and a blood pressure of 95/64 mmHg. His temperature is 93°F. No known medical history.
Patient B: A 47-year-old female, a known diabetic with frostbite on her hands. She is alert but has labored breathing, with a heart rate of 120 bpm and a blood pressure of 88/58 mmHg. Her temperature is 94°F, and she has a recent hemoglobin A1c of 9.5%.
Patient C: A 35-year-old male with frostbite on his hands due to a winter camping trip. He is alert with stable vital signs (BP 130/85, HR 80 bpm), but he has a history of hypertension and is currently on medication. His temperature is 96°F.
In Scenario 3, the priority should be given to Patient A, the 22-year-old homeless male with frostbite on his hands. Patient B is a close second priority due to the risk of worsening heart failure and potential complications from diabetes. Patient C is last; though he is stable and alert, he has a history of hypertension but presents fewer immediate concerns compared to Patients A and B.
Which ethical principle is MOST important when making triage decisions during an MCI?
a) Beneficence
b) Autonomy
c) Justice
d) Non-maleficence
Justice; justice in triage implies fairness in allocating scarce resources. While beneficence (doing good), autonomy (respecting patient choices), and non-maleficence (avoiding harm) are crucial, justice is paramount in ensuring fair resource distribution in MCI scenarios.
A patient with 50% TBSA burns is undergoing fluid resuscitation. What is the MOST important parameter to monitor?
Urine output; 0.5 mL/kg/hr
A 30 year old female patient has deep partial thickness burns on the front and back of the right and left leg, front of right arm, and anterior trunk. The patient weighs 63 kg. Use the Parkland Burn Formula: What is the flow rate during the FIRST 8 hours?
921 mL/hr
A 16 year old patient is brought into the ER by parents after an accidental overdose of pain meds for a persistent headache; during your assessment, what questions are you going to ask?
What med was taken, what concentration of med, how much was taken, and when did the overdose occured.
What are the priority steps and considerations to take when assessing someone affected with frostbite?
Handle carefully; NEVER squeeze, massage, or scrub the injured tissue as it is easily damaged.
Remove jewelry/clothing
Immerse the affected area in warm water; blisters will form in a few hours (rewarming is EXTREMELY painful; give analgesics and tetanus)
You have two patients with similar injuries: one is a young child, the other is an elderly person. Both need immediate attention. According to MCI triage guidelines, how should this be approached?
a) Prioritize the child due to the child’s developmental vulnerability
b) Prioritize the elderly person based on age and expected mortality rate
c) Both should be given equal priority for treatment
d) The person who is the most stable should be triaged first
C; in MCI triage, prioritization is based on the immediate severity of the injury and likelihood of survival, not on age or other factors.
A lineman is BIB ambulance after being electrocuted while working; they have been cleared of any cardiac abnormalities. What are we concerned about next?
Potential physical trauma from falling, being thrown, or from muscle contractions
A 59 year old male patient has full thickness burns on both of the legs on the back, front and back of the trunk, both arms on the front and back, and front and back of the head and neck. The patient weighs 186 lbs. Use the Parkland Burn Formula: You've already infused fluids during the first 8 hours. Now what will you set the flow rate during the next 16 hours (mL/hr)?
861 mL/hr
A patient comes into the ED with large bite wounds to the hand; the bite occurred around 24 hours previously and is showing signs of infection. Last tetanus injection was 6 years previously. What treatment steps are you anticipating?
BONUS 100
What would you give for an overdose of antidepressants?
Copious amount of cleaning/ irrigation, antibiotic therapy, tetanus injection, and doing some work to find out what vaccines (if any) the dog had.
Activated charcoal
Why do we give tetanus boosters to patients with frostbite?
Which of the following is NOT an assessment you would do during a triage during a MCI?
a) Respiratory rate
b) Pulse rate
c) Blood pressure
d) Mental status
C; blood pressure is typically not assessed due to time constraints.
A patient with electrical burns has developed metabolic acidosis. Which electrolyte imbalance is MOST likely associated with this condition?
Hyperkalemia; muscle damage from electrical burns releases potassium into the bloodstream, resulting in hyperkalemia.
A 45 year old female patient is en route to the hospital and has superficial partial thickness burns on the posterior head and neck, front of the left arm, front and back of the right arm, posterior trunk, front and back of the left leg, and back of right leg. The patient weighs 231 lbs. Burns occurred 1 hour ago, and the medics have given 1 L of NS; what fluid rate will you initiate?
1747 mL/hr