Emergency Response Procedures Flashcards

During resuscitation of a patient in hypovolemic shock from a ruptured abdominal aortic aneurysm, what resuscitation strategy is recommended before surgical hemorrhage control?

Answer: Permissive hypotension targeting systolic BP 80–90 mmHg with 1:1:1 blood product ratio

Damage control resuscitation targets permissive hypotension (SBP ~80–90 mmHg) with balanced blood product ratios (1:1:1 pRBC:FFP:platelets) to avoid dilutional coagulopathy and clot disruption before surgical control.

An ICU patient receiving therapeutic anticoagulation with unfractionated heparin develops a new arterial thrombosis and a 55% platelet drop from baseline over 5 days. What is the most likely diagnosis and immediate treatment?

Answer: Heparin-induced thrombocytopenia (HIT); stop heparin and start a non-heparin anticoagulant

A >50% platelet drop with new thrombosis on day 5–10 of heparin is classic HIT; all heparin products must be stopped and a non-heparin anticoagulant (e.g., argatroban) started immediately.

In a patient with acute severe asthma who is mechanically ventilated and develops sudden rise in peak airway pressure with hemodynamic deterioration, what should be done first?

Answer: Perform a brief disconnection from the ventilator to relieve dynamic hyperinflation

Brief disconnection from the ventilator allows trapped gas (auto-PEEP/dynamic hyperinflation) to escape, immediately relieving high intrathoracic pressure and restoring venous return and hemodynamics.

Which bedside test most rapidly confirms correct endotracheal tube placement in a pulsatile cardiac arrest patient where end-tidal CO2 may be unreliable?

Answer: Esophageal detector device (bulb or syringe aspiration test)

The esophageal detector device (EDD) uses negative pressure to detect esophageal vs. tracheal placement and is reliable even in cardiac arrest when ETCO2 waveform may be absent due to lack of perfusion.

During a cardiac arrest, a team member performing chest compressions shows signs of fatigue after 3 minutes. When should compressor rotation occur to maintain high-quality CPR?

Answer: Every 2 minutes, synchronized with rhythm checks

AHA guidelines recommend rotating compressors every 2 minutes (aligned with rhythm checks) because compression quality degrades significantly after 90–120 seconds of continuous chest compressions.

A patient with suspected carbon monoxide poisoning has an SpO2 of 99% on pulse oximetry but a cherry-red skin appearance and altered mental status. What explains the discrepancy and what is the correct treatment?

Answer: The pulse oximeter cannot distinguish oxyhemoglobin from carboxyhemoglobin; administer 100% normobaric O2 immediately

Standard pulse oximetry reads carboxyhemoglobin as oxyhemoglobin, giving a falsely normal SpO2; treatment is 100% oxygen to accelerate CO dissociation (or hyperbaric O2 if available and indicated).

An ICU nurse discovers a patient has self-extubated and is now in respiratory distress with a GCS of 8. The patient has a history of difficult airway with prior Grade III laryngoscopy. Which approach is most appropriate?

Answer: Call for video laryngoscope and prepare surgical airway backup simultaneously

A known difficult airway requires video laryngoscopy for the best chance of first-pass success while having a surgical airway immediately available, following the difficult airway algorithm.