DAANCE: scenarios exam questions and correct answers

DAANCE: scenarios airway obstruction - ANSWER 100% O2 via nasal mask; put patient in Trendellenburg position; retract tongue ( hemostat, suture or tongue forcep); suction oropharynx; if tongue still occludes airway, insert nasopharyngeal/ oral airway- advanced airway if necessary foreign bodies - ANSWER Digital removal of object ONLY IF WELL VISULAIZED; Chest compressions if no airflow, in supine position; attempt direct laryngoscopy (macgill forceps) for visualization and removal of object; cricothyrotomy may be necessary of obstruction persists Cricothyrotomy - ANSWER Call 911/ activate EMS; locate crocothyroid membrane by palpitation; utilize cricothyrotomy needle/cannula kit or large gauge needle to enter trachea beneath the vocal chords through the cricothyroid membrane; attach tube of cricothyrotomy device to an O2 source (or Ambu bag) and ventilate with 100% O2 laryngospasm - ANSWER 100% O2 via nasal hood; establish proper head position/ airway; suction (yankauer); positive pressure, 100% O2 via bag/mask; administer succinylcholine; manually breathe via bag/mask until effects of drug dissipated and strong spontaneous respiration resumes bronchospasm - ANSWER 100% O2 via bag/mask; Albuterol via inhaler every 20 minutes for up to 4 hours, then every 1-4 hours as needed; ipratropium bromide (Atrovent) 2 puffs stat; repeat every 4 hours; epinephrine injection; intubation, steriod injection (decadron); Benadryl; activate EMS if none of the above resolve issue Emesis with Aspiration - ANSWER Activate EMS; 100% O2 via bag/mask; turn patient in RIGHT side in Trendellenburg position; suction tonsils/oral cavity/oropharynx (yankaeur); remove foreign bodies with macgill and laryngoscope; intubation Hyperventilation - ANSWER Stop treatment, remove foreign bodies from mouth and surgical instruments from view; maintain airway; verbally attempt to calm patient; monitor vital signs; DO NOT GIVE OXYGEN; have patient breathe into paper bag to recapture exhaled CO2/ nonsedated: administer IV midazolam, diazepam, propofol etc. monitor breathing and vital signs; activate EMS if condition deteriorates heart attack (myocardial infarction) - ANSWER Activate EMS; 100% O2; attach AED; asprin 325mg; establish IV access with saline drip; morphine for pain (repeat every 5-10 minutes as needed) ONAM - ANSWER Rapid identification of interventions necessary to treat acute coronary syndrome. *Oxygen, nitroglycerin, aspirin, and morphine* Supraventricular tachycardia - ANSWER Place patient in supine position; administer Adenosine 6mg rapid IV over 1-3 seconds, immediate flush of saline; possible period of asystole lasting 6- 12 seconds and up to 30 seconds; after 1-2 minutes, administer Adenosine 12mg, rapid saline flush; third dose can be given in 1-2 minutes as needed Symptomatic Bradycardia - ANSWER Patient experiencing chest pain, shortness of breath and heart rate below 60-100 BPM; administer 100% O2, establish IV; administer Atropine .5mg; May repeat to total dose of 3mg; transport patient to ER for transcutaneous pacing Ventricular tachycardia (V-tach) - ANSWER Wide, blunt, rapid waveforms with no P waves: QRS and T waves cannot be determined; if patient stable, 100% O2, Amiodarone 150mg IV over 10 minutes. Maximum dose 2.2 grams in 24hrs. Prepare for synchronous cardioversion Ventricular fibrillation (V-fib) - ANSWER rapid, irregular, and useless contractions of the ventricles; blood not pumping; BEGIN HIGH QUALITY CPR; attach AED, deliver shock, continue CPR, establish IV, give epinephrine and amiodarone alternately while continuing CPR until EMS arrives Asystole - ANSWER absence of contractions of the heart; administer CPR; epinephrine 1mg every 3-5 minutes Severe hypoglycemia - ANSWER Activate EMS; establish IV access; measure blood sugar with glucometer; 1 amp of IV glucose ( 50ml of 50% glucose solution); IV infusion is dextrose Acute adrenal insufficiency - ANSWER Severe hypotension, vomiting, abdominal pain and fever; monitor vital s