Emergency Response: Practice Questions & Explanations

Cardiac arrest requires immediate action. The current AHA Basic Life Support sequence (C-A-B): (1) Check for responsiveness; (2) Activate emergency response (call code blue, ask for AED if available); (3) Begin chest compressions immediately — 100-120 per minute, 2-2.4 inches deep on adults, allowing full recoil; (4) Open airway and provide ventilations after 30 compressions (in two-rescuer CPR, alternate). The change from A-B-C (Airway-Breathing-Circulation) to C-A-B (Compressions-Airway-Breathing) reflects evidence that early chest compressions are the single most important intervention. Don't waste time checking for breathing extensively or attempting ventilation first. The pulse check should be 5-10 seconds maximum. Continue CPR until: the client recovers, the code team takes over, you are physically exhausted, or the situation becomes unsafe. After arrest, monitor for return of spontaneous circulation (ROSC) and prepare for post-arrest care.

The RACE acronym is the standard fire response in healthcare facilities: R — Rescue any client in immediate danger; A — Activate the fire alarm (pull station) or call the emergency code; C — Contain the fire by closing doors and windows to limit oxygen and smoke spread; E — Extinguish the fire if small and contained, or Evacuate per facility policy if the fire is large or spreading. The PASS acronym applies to fire extinguisher use: Pull the pin; Aim at the base of the fire; Squeeze the handle; Sweep side to side. Healthcare evacuation is complex because many clients cannot ambulate independently — facilities have horizontal evacuation plans (move clients to a different fire zone through smoke doors) before vertical evacuation (down stairs) is attempted. Knowing the fire response is required of all healthcare staff and tested at hire and during periodic drills.

Anaphylaxis is a life-threatening systemic allergic reaction requiring immediate action. Signs: hives, urticaria, swelling (face, lips, tongue, throat), wheezing, stridor, hypotension, shock. Priority interventions: (1) Stop the offending agent — discontinue IV infusion, remove contact; (2) Assess and maintain the airway — anaphylaxis can cause rapid airway swelling; (3) Administer epinephrine IM (epinephrine auto-injector or 1:1000 solution, 0.3-0.5 mg adult dose, IM in vastus lateralis) — epinephrine is the first-line treatment, given immediately; (4) Call rapid response or code team; (5) Position supine with legs elevated unless respiratory distress requires sitting up; (6) Administer high-flow oxygen; (7) Establish IV access for fluids and additional medications; (8) Prepare for possible intubation. Secondary medications: antihistamines (diphenhydramine), corticosteroids (methylprednisolone), bronchodilators if wheezing. Epinephrine works within minutes; a second dose may be needed in 5-15 minutes.

Mass casualty events overwhelm normal resources and require triage — sorting clients to allocate limited care effectively. The START (Simple Triage and Rapid Treatment) system is widely used: clients are categorized in less than 60 seconds each into four groups identified by colored tags: Red (Immediate) — life-threatening injuries requiring immediate care to survive (severe bleeding, airway compromise); Yellow (Delayed) — serious injuries but stable, can wait for care; Green (Minor) — walking wounded, minor injuries; Black (Deceased/Expectant) — dead or so severely injured that survival is unlikely given resource constraints. The goal is greatest good for the greatest number. This contrasts with day-to-day triage where the most severely injured client receives the most aggressive care. Mass casualty triage requires accepting that some clients who might survive with full resources may be tagged black or yellow because resources cannot be diverted. Repeat triage occurs as conditions change.

TENSION PNEUMOTHORAX is a potentially fatal complication of central line placement (and other thoracic procedures). It occurs when air enters the pleural space and cannot escape, progressively compressing the lung and eventually shifting the mediastinum (tension). CLINICAL PRESENTATION: Sudden chest pain; acute dyspnea; hypotension; decreased or absent breath sounds on one side; tracheal deviation (late sign, shifting away from the affected side); hypoxia; tachycardia progressing to cardiovascular collapse. PRIORITY ACTIONS — TIME IS CRITICAL: (1) STAY WITH CLIENT — do not leave; (2) ACTIVATE RAPID RESPONSE or code team per facility protocol; (3) SUPPLEMENTAL OXYGEN — high-flow via non-rebreather mask; (4) CALL PHYSICIAN STAT — tension pneumothorax requires immediate needle decompression (needle thoracostomy) by the physician, followed by chest tube; (5) PREPARE FOR EMERGENCY INTERVENTION — anticipate needle decompression and chest tube setup; (6) CONTINUOUS MONITORING — SpO2, blood pressure, respiratory status every few minutes. WHY NOT WAIT FOR X-RAY: Tension pneumothorax is a clinical diagnosis in an emergency — waiting for X-ray while the client decompensates can result in cardiac arrest. Clinical findings of tension pneumothorax require immediate treatment. The physician will typically perform needle decompression based on clinical presentation before X-ray confirmation. NURSE'S ROLE: The nurse cannot perform needle thoracostomy — that is a physician/advanced practice procedure — but the nurse's rapid recognition, notification, and preparation are what determine the outcome.

RAPID RESPONSE TEAMS (RRTs) exist to bring critical care expertise to deteriorating patients on general wards BEFORE they progress to cardiac arrest. Research consistently shows that most in-hospital cardiac arrests are preceded by 6-8 hours of deteriorating vital signs and clinical condition that were either not recognized or not acted upon. RRT ACTIVATION CRITERIA (typical, varies by facility): RESPIRATORY: Rate below 8 or above 30 breaths/min; SpO2 below 90% on any oxygen; new or increasing oxygen requirement; CARDIOVASCULAR: Heart rate below 40 or above 130 bpm; systolic BP below 90 mmHg; new chest pain; NEUROLOGICAL: Acute change in mental status or level of consciousness; seizure; new focal neurological deficit; URINE OUTPUT: Less than 50 mL over 4 hours without explanation; GENERAL: Staff is worried about the patient even if they can't identify a specific parameter — this is officially recognized as a valid RRT trigger at most institutions ('failure to rescue' research shows nurses' subjective concern is diagnostically valid). DO NOT WAIT: Call the RRT before calling the primary team if the situation is urgent — RRT and primary team communication can happen simultaneously; delay to confirm with a team that may not be immediately available is dangerous. AFTER CALLING RRT: Stay with the patient; have chart and medication list ready; be prepared to give an SBAR report; document the call and all actions.