Abbrev - Emergency Nursing Core Curriculum by ENA Flashcards
Subjective data collection during primary assessment
Brief one-line statement:
chief complaint, precipitating event/onset of s/s, MOI
Progression
- location of problem
- duration of s/s
- characteristics
- aggrevating and relieving factors
- treaments prior to arrival
when is airway not patent
if they can speak but their voice is muffled. also if uncontrolled secretions
ankylosing spondylitis
inflammation that fuses the vertebrae into the spine.
- back pain, stiffness, hunched posture,r
regular, rapid, deep labored respirations
Kussmaul’s respirations
alternation s between hypervention and apnea
Cheyne-STokes
2 options to open airway
head tilt chin lift,
jaw thrust
2 criteria used to clear c-spine
NEXUS & Canadian rule
- Canadian may be better…picks up almost 100% while NEXUS misses 1 in 10
NEXUS criteria
Clear c-spine w/o rads
- no midline cervical tenderness
- no focal deficits
- normal alertness
- no intoxication
- no painful distracting injury
7 P’s of intubation
preparation
preoxygenat e(100% O2)
pretreament (LOAD)
paralysis
protection/positioning
placement w/proof
postintubation management
“Pretreatment” of the 7 P’s
preoxygenate w/100% O2,
pretreatment = :LOAD
lidocaine, opioids, atropine, defasciculating agent
option for intubation when you can’t find the cords
use bougie…place blindly and confirm tracheal positioning when you feel the “click” of the tracheal rings
airway management option that inserts blindly into the posterior pharynx (esophagus”
combitube
- occludes the oronnaspharynx
contraindications for combitube
concious pt,
intact gag reflex,
ingestion of caustic substances,
latex sensitive
complications of needle crics
blood aspiration,
esophageal laceration,
hematoma,
SC emphysemaq
goal after a cric is done
should convert to permanent trach within 24hrs
age that is an absolute contraindication to cric
under 12. funnel shaped larynx
complication of cric
aspiration,
false passage into tissue,
laceration of esophagus,
tracheal laceration,
mediastinal emphysema
% of pneumothorax that’ll need a chest tube
10%
Beck’s Triad
muffled heart tones,
distended neck veins, hypotension,
options to control bleeding
direct pressure,
hemostatic agents,
tourniquet,
elevate limb,
clamp/ligate bleeding vessles
when would you use a traction splint
mid-shaft femur fracture with
calculation of fluid/blood for pediatric patients
crystalloids = 20ml/kg
blood = 10ml/kg
problem of using Trandelenberg position for shock
not been shown to work better than leg elevation along (modified trandelenberg) and can cause respiratory distress and increased ICP
overdose reversal agents
Narcan,
flumazenil for benzos
“FGHI” of the secondary assessment
full set of vitals/facilitate family presence,
get resuscitation adjucts (LMNOP)
History/H2T
inspect posterior surfaces
what vital sign is not reliable in children
BP
- bc children are able to maintain normal BP until they are severely compromised
calculate MAP
systolic + 2DP
divided by
3
reflections of central pulses
apical, femoral, carotid
FLACC
faces, legs, arms, cry, consolability
CIAMPEDS
chief complaint,
immunizaitons/isolation,
alleregies,
medications/medical hx
parent/caregiver impression,
events surrounding condition<diet/diapers
symptoms
mneumonic to triage or get a hx on children
CIAMPEDS
mneumonic to integrate ethnocultural considerations into data gathering
CLIENT OUTCOMES
Character of symptoms
Location/radiation
Impacts on life/ADLS
Expectations of pt/careviver
Neglect/abuse
Timing (onset, duration,frequency,)
other s/s
Understanding of family/pt about hte possible causes
Complementatry medication
Optiosn for care that are important to the pt (advaned directives)
Modulating factors that precipitate/worsen/alleviate s/s
Exposure to infectious/enviornmental agents
Spirituality needs
baseline unequal pupils
anisocoria
can’t open eyes/excessive blinking
blepharospasm
collection of blood in tey anterior chamber of the eye
hyphema
bulging of hte eye
exopthalamosis/proptosis
ecchymosis behind the ear
Battle Sign
- might not be present for 6hrs
sound of rhonchi
coarse rumbling
how to tell if a crackle is truly a crackle
if it doesn’t clear w/coughing
child suddenly starts stridor or wheezing
consider foreign body
S3
left ventricular (systolic) dysfunction/CHF
- normal in kids and some young adults
S4
diastolic dysfunction
- noncompliant ventricle. HTN
heart sound is creaky/scratchy
pericardial rub due to inflammation
- post MI or pericarditis
percussion
resonance = normal lung tissue
hyperresonance = hyperinflated lung tissue/air filled
dull/flat - fluid-filled
percussion of air
hyperresonance
percussion of fluid-filled
dullness/flat
pt has abdominal pain and desires to lie still
suspect peritonitis
pt has abdominal pain and cannot sit still
renal/biliary colic
flank bruise
grey turner. late sign of retroperitoneal bruising
periumbilical bruise
cullen sign
- late sign of intraperitoneal bleeding
bowel sounds of an obstruction
hyperactive (high pitched)
bowel sounds of hypoperfusion
hypoactive bowel sounds in all
referred pain to right shoulder
Kehr sign
Rovsing sign
palpate LLQ and it elicts pain in the RLQ idnicating appy
psoas sign
flexion of right hip against resistnace
appy site of tenderness
Mcburney point
Murphy Sign
palpate below right coastal margin
- pain w/deep breath
- acute cholye, hepatitis, hepaatomegaly
s/s of pyloric stenosis
olive shaped mass in RUQ
s/s of intussepption
tense abdomen, colicky pain, vomiting
red currant jelly stool
peak 3-12m
narrowest part of pediatric airway
cricoid cartlidge
how do neonates breathe
obligate nose breathers until 6-8months of age
how is a pediatric heart not able to tolerate high IVF amounts?
less contracticle mass and less compliant ventricles…can’t increase SV to accommodate large increases in preload
how do pediatrics primarily maintain CO
increased HR and vasoconstriction.
total blood volume of a neonate
80ml/kg
late sign of shock in newborns
hypotension
- might not appear until circulating volume is at 50%
check pulse in children
brachial/apical
age of stranger danger onset
7-9m
when to add FAST exam into the TNP
“F” - full set of vitals and FAST
sizing intubate tube
7 females
8 males
size of small finger any age
intervention over sucking chest wound
square gauze taped on 3 sides to create a valve
chest tube site
2nd ICS mid clavicular
5th ICS mid axillary
options for hemothorax
chest tube & autotransfusion
what does rate of infusions depend on
length & diameter of catheter NOT vein size
good candidate for permissive hypotension
suspected active bleeding, SBP over 90, good mentation
intervention if head injury and hypotensive
3% hypertonic saline
why should blood be warmed for trauma patients
aggravate acidosis, induce arrythmias, shift oxygemoglobin dissociation curve left, impair plt function
when do you start massive transfusion protocol
after 6th unit PRBC
when do you suspect cardiogenic shock?
trauma pt with shock in absence of blood loss
examples of conditions that cause cardiogenic shock
cardiac tamponade, myocardial contusion, tension peneumothorax, air embolism, MI
when do air embolisms happen in trauma
following injureis to major veins, lungs, low pressure cardiac chammbers. insertion of ventral venous line
trauma patient suddenly deteriorates after injuries to major veins, lungs, or low pressure cardiac chambers
suspect air embolism
interventions for air embolisms
Trendelenberg post9oin, thoracotomy, direct aipirate air from lungs
- if lung injury, cross clamp the hilum to control source of air embolism
FAST
focused assessment with sonograpy for trauma
importance of full head to toe in trauma
don’t let distracting injruies
important care management when treating head/brain injuries
correct conditions that may led to secondary damage
important thing to remember about c-spine clearance
c-spine clearence is not an emergency as long as the airway is protectioed
closed head injury & hypotension
closed head injuries alone rarely produce hypotension EXCEPT inneonates and terminal stages
- so look for a source of bleeding, cardiogenic shock, associated c-spien injury
outcomes of immobilizing fractures
reduce pain,
decrease bleeding, reduce fat embolism, minimize neurovascular damage
what traumatic injuries should you be picky about placement of IVs
side of extremity/neck injury or femoral vein line in penetrating abd trauma and hypotension
- may cause extravasation of any administered fluids from a prossible proximal venous injury
what happens if you pack a sucking chest wound before chest tube is inserted?
could cause a tension pneumo. use a 3 taped covering
concussions
no gross pathology
transient LOC
normal head CT
brain contusion dx
seen on CT
problem of brain edema
may be initially missed by CT. late CT or MRI can show
- can cause increased intracranial pressure which can impair brain circulation or result in brain herniation
secondary brain dmage
later stage due to tissue hypoperfusion/hypoxia
- preventable and reversible
**shock, hypoxia, electrolyte abnormaliteis, hematoma, infection, edema, hydrocephalus
calculate CPP
CPP = mean arterial pressure - ICP
normal = 5-15
minimum cerebral perfusion pressure
Mean arterial pressure - ICP
normal = 5-15
- minimum of 70 in adults (50 in kids) is critical to maintain adequate brain perfusion and minimzing secondary brain damage
cause of epidural hematoma
laceration of middle meningeal artery
epidural hematoma on CT
hyperdense biconvex shaped lesion
subdural hematoma
bleeding from bridging veins
subdural hematoma on CT
crescent shape
s/s of meningism
HA
photophobia
neck stiff
fever
mental status confusiont to coma
s/s of subarachnoid hemorrhage
meningism (HA, photophobia, neck stiff, fever,)
confusion to coma
herniation s/s
s/s of herniation
ipsilateral pupil dilation, decreased LOC, contralateral hemiparesis, bradycardia, elevated BP, irergular respirations
important thing to remember about closed head injuries and vital signs
closed head injuries rarely produce hypotension alone (unless terminal or there is also a cervical spine injury)
- will need to look fgor other sources of bleeding
PCO2 in head injuries
32-35 mm hg
- too low or high is harmful
maximum GCS for an intubated patient
11T
GCS eye opening
spontaneous
voice
pain
none
GCS motor response
follows commands
localizes pain
withdraws from pain
decorticae
decerebrate
flaccid
GCS verbal reponse
oriented
confused
inappropriate words
incomprehensible sounds
none
minimum acceptable cerebral perfusion pressure
70 in adults
50 in pediatrics
interventions for basilar skull fracture
single dose abx
do’t pack nose/ears to stop CSF flow b/c dangeer of meningitis
semi-sitting
normal ICP
should be under 15 in adults and 5 in kids
when do you initiate treatment for high ICP
when it is over 20
(15 and under is normal)
how to handle drainage of CSF
intraventricular catheterization
IV medication/fluid given for ICP patients
mannitol (0.5-1g/kg over 20min to keep serum osmolarity under 320) if hemodynamically stable
hypertonic saline 3% if hyptensive
pCo2 strategy in high ICP
32-35 via hyperventilation
(hypocapniaconstrict the cerebral vessels to decrease ICP)
- too much constriction = brain hypoxia
hypocapnia and cerebral vessels
hypocapnia constricts cerebral vessles thus deceasing ICIP
therapies fo rrefractory intracranial hypertension
barbiturate coma
hypothermia
depresive craniectomy
causes of restlessness in LOC patients
distended bladder,
tight casts/applicants,
hypoxia
how often does diabetes insipitus occur in trauma
15% of severe blunt
40% severe pendtrating
labs of DI
polyuria
high serum osmolarity
low urine osmolarity
treat DI
vadopressin and fluid replacement
SIADH dx
low serum osmolarity
high urine osmolarity high
treat SIADH
fluid restriction
hypertonic saline
dieuretics
dx salt wasting syndrome
excessive lost of Na in urine
hynatremia
rx that helps with survival post severe subarachnoid hemorrhage
nicardipine (Ca Ch B)
why is coagulation monitored post severe head injuries
bc DIC is common. so monitor coagulation and plts
complications of SIADH and salt wasting syundrome
hyponatremia which can worsen brain edema
post concussive syndrome
HA
dizzy
poor concentration
memopry
collection of CSF that builds up in the subdural space around the brain (after traumas/TBI, infection, venous congestion)
subdural hygroma
why does hydrocephalus happen in brain hemorrhage
b/c obstruction of CSF circulation
s/s of carotid cavernosus fistula
HA
“noises” in the head
proptosis of hte eye
- usually very ill
when should mannitol be given for head injuries
avoid doing it routinely
- consider if intracranial hypertension or with neurological deteroiration. patient should not be low BP
- if no mannitol, can use hypertonic 3%
common complications of head trauma
DIC, DI, salt wasting, SIADH, seizures
head injuries that should get seizure prophylaxis
no longer than 7 days but can do for intracranial hemorrhage
