Emergency Response Procedures Flashcards

A patient receiving a blood transfusion develops fever (39.5°C), hypotension, flank pain, and hemoglobinuria 15 minutes into the transfusion. What is the FIRST action?

Answer: Stop the transfusion and return the blood bag to the blood bank

These signs indicate an acute hemolytic transfusion reaction; the transfusion must be stopped immediately and the blood bag returned to the blood bank for re-crossmatch verification.

In the ICU, a patient with a long-term central venous catheter develops sudden onset chest pain, hypotension, and a mill-wheel murmur on auscultation. What complication should be suspected?

Answer: Venous air embolism

A mill-wheel murmur (churning cardiac sound) combined with cardiovascular collapse and a central line strongly suggests venous air embolism from air entraining the catheter.

During a hospital surge in disaster conditions, Crisis Standards of Care (CSC) allow ICU teams to do which of the following that would be unacceptable under normal conditions?

Answer: Reallocate a ventilator from a patient unlikely to survive to one with better prognosis

Crisis Standards of Care permit ventilator reallocation using pre-established triage protocols when supply is critically exceeded, with oversight by an independent triage team, not the bedside clinician.

A nurse disconnects a patient's arterial line during a position change, resulting in arterial hemorrhage. After immediately applying direct pressure, what is the NEXT step?

Answer: Apply a tourniquet proximal to the site

If direct pressure is insufficient to control arterial hemorrhage, a tourniquet proximal to the site is the next step to limit life-threatening blood loss while help is summoned.

In a patient with refractory status epilepticus who has failed two benzodiazepines, which third-line agent is recommended per current US guidelines?

Answer: IV valproate, IV fosphenytoin, or IV levetiracetam

After failure of two benzodiazepines, IV valproate, fosphenytoin/phenytoin, or levetiracetam are recommended as second/third-line agents for benzodiazepine-refractory status epilepticus.

Which parameter best guides fluid resuscitation during the initial management of septic shock to avoid fluid overload while maintaining perfusion?

Answer: Dynamic indices such as pulse pressure variation (PPV) or stroke volume variation (SVV)

Dynamic indices like PPV and SVV are superior to static measures (CVP) for predicting fluid responsiveness and guiding resuscitation in mechanically ventilated septic shock patients.

When an ICU patient has a do-not-resuscitate (DNR) order in place and suffers a cardiac arrest, what is the appropriate action if family members present at the bedside demand CPR?

Answer: Explain that the DNR reflects the patient's own documented wishes and withhold CPR

A valid DNR order reflects the patient's autonomous decision and is legally and ethically binding; family members cannot override a competent patient's prior directive.