case 1 Flashcards
what does DRSABCs stand for
danger, responsiveness, send for help, airways, breathing, CPR
what is shock
shock is a state of circulatory failure that impairs tissue perfusion and may lead to tissue hypoxia
what are our 5 types of shock
cardiogenic, hypovolaemic, septic, anaphylactic, neuroplastic
what is cardiogenic shock
a type of distributive shock whgereby low blood pressure and poor perfusion is caused by the malfunctioning of the cardiac muscle
what is hypovolaemic shock
low blood pressure due to a large scale loss of blood
what is anaphylactic shock
this is when we get allergen activation of the mast cells, releasing histamine, which then results in widespread vasodilation of the blood vessels, thus extreme vascular leakage, and smooth muscle contraction so we get slowing of blood flow
what is septic shock
body becomes infected with widespread infection which results in widespread inflammation, vasodilation, microvascular thrombosis and endothelial dysfunction
what is neuroplastic shock
this is when we get damage to the CNS and damage to the Sympathetic vasomotor tone. so we see unregulated PNS activity so we get widespread vasodilation and bradycardia as the sympathetic innervation cannot increase the MABP.
why is the periosteum key in bone healing
this is when the osteogenic protenitor cells are contained. so the new bone growth occurs from here
potential adverse effects of morphine and how do we monitor
Drowsiness/CNS Depression – monitor the level of consciousness [LOC]
Respiratory Depression – Frequent monitoring of respiratory rate [>12b/min], rhythm,
depth
Nausea/Vomiting – Ask patient about symptoms and administer anti-emetics with the
morphine
Hypotension – Frequent blood pressure monitoring
Bradycardia – Frequent monitoring of heart rate and rhythm
how does morphine relieve pain in a person
Morphine binds to opioid receptors, specifically the μ, d, and k types for
analgesia, in the CNS (brain and spinal cord). Morphine’s receptor is a G-coupled
protein receptor that acts to inhibit adenylate cyclase, reducing concentrations of
the 2nd messenger cAMP. This in turn opens potassium channels which has the effect
of hyperpolarising neuronal cell membranes so they become unresponsive to action
potentials. Calcium entry into the same cells is also restricted so inhibiting
neurotransmitter release. Both mechanisms lead to a decrease in the transmission
of pain impulses.
define analgesia
inability to feel pain
analgesic is a drug that removes pain sensations
why is morphine usually IV delivered
fast, passes first pass metabolism, allows us to do small dose incriments as its fast acting. so we can give some, if it doesn’t work, give more
what do we do if the effects of the analgesic are too much
give an opiod antagonist, so something that fights it and binds to the drug so that they can no longer bind to their receptors
naloxone
what are treatment options for a compound fracture
Debride the wound: stabilise the fracture, remove any foreign material,
Debridement: Clean wounds by flushing with saline - doesn’t hurt as much as water
what lifestyle choices reduce bone healing rate
Nutrition, healing, smoking, poor sleep,
smoking as it inhibits blood flow to the area
what are some ways to test the tissue purfusion
getting them to do the joint movements, taking pulse of the area, warmth, sensation,
what do we need to talk about in blood loss physiology
the stuff related to the MABP, so MABP = CO x TPR. CO = Sv x Hr
what are the three types of bad news delivery.
non disclosure:
full disclosure
individualised disclosure
what are the three assumptions in non disclosure
1- it is appropriate for the doctor to decide whats best for the patient without referring to them, 2 that patients do not want to know bad news, 3 patients need to be protected from bad news.
what are the three assumptions of full disclosure
1- the patient has a right to know all information, 2: all patients want to know bad news about themselves, 3 that it is appropriate for patients to make their own decisions in health as it is them who has to live with the consequences.
what are the assumptions of individualised exposure
This model assumes a level of mutual trust and communication has been formed between patient and doctor already.
Assumes that people are different in the amount of information they want and their methods of coping, time Is needed to absrob and adjust to the bad news, and that relationship between doctor and patient Is in the best interests of the patient.
give some reccomended steps of giving bad news
ensure good privacy, give goo time fpr the discussion, assess understanding, provide the information simply and honestly, encourage patient to express feelings, give broad timeframe for disease, arrange review, discuss treatment options, offer assistance in telling others.
first step of bone wound healing
Immediately after a fracture there is a rupture of blood vessels that results in a haematoma ( a solid swelling of clotted blood within tissues), that fills and surrounds the area of the injury. This clot provides a fibrin mesh that seals the fracture site, but also provided a framework for the inflammatory cell influx, fibroblast growth and capillary proliferation which all signal the formation of granulation tissue.
second step of bone wound healing
once the granulation tissue has been formed growth factors are released by platelets and inflammatory cells in the site to activate osteoprogenitor cells in the periosteum, medullary cavity and soft tissues surrounding. This activation of these cells stimulates osteoclastic and osteoblastic activity, the soft callus thus forms. Some anchorage but no structural rigidity as of yet
third step of bone wound healing
after about 2 weeks of injury the osteoprogenitor cells deposit trabeculae into the bone. thus transforming the soft callus into the hard callus through ossificationn processes.
whats the forth step of bone healing
bone remoddling As a result of the hard callus formation the bone ends are bridged and with progressive mineralisation the stiffness and strength of the callus increases.
the bone is then remoddles by the osteogenic cells
