case 1

Question 1

what does DRSABCs stand for

Answer 1

danger, responsiveness, send for help, airways, breathing, CPR

Question 2

what is shock

Answer 2

shock is a state of circulatory failure that impairs tissue perfusion and may lead to tissue hypoxia

Question 3

what are our 5 types of shock

Answer 3

cardiogenic, hypovolaemic, septic, anaphylactic, neuroplastic

Question 4

what is cardiogenic shock

Answer 4

a type of distributive shock whgereby low blood pressure and poor perfusion is caused by the malfunctioning of the cardiac muscle

Question 5

what is hypovolaemic shock

Answer 5

low blood pressure due to a large scale loss of blood

Question 6

what is anaphylactic shock

Answer 6

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

Question 7

what is septic shock

Answer 7

body becomes infected with widespread infection which results in widespread inflammation, vasodilation, microvascular thrombosis and endothelial dysfunction

Question 8

what is neuroplastic shock

Answer 8

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.

Question 9

why is the periosteum key in bone healing

Answer 9

this is when the osteogenic protenitor cells are contained. so the new bone growth occurs from here

Question 10

potential adverse effects of morphine and how do we monitor

Answer 10

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

Question 11

how does morphine relieve pain in a person

Answer 11

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.

Question 12

define analgesia

Answer 12

inability to feel pain
analgesic is a drug that removes pain sensations

Question 13

why is morphine usually IV delivered

Answer 13

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

Question 14

what do we do if the effects of the analgesic are too much

Answer 14

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

Question 15

what are treatment options for a compound fracture

Answer 15

Debride the wound: stabilise the fracture, remove any foreign material,
Debridement: Clean wounds by flushing with saline - doesn’t hurt as much as water

Question 16

what lifestyle choices reduce bone healing rate

Answer 16

Nutrition, healing, smoking, poor sleep,
smoking as it inhibits blood flow to the area

Question 17

what are some ways to test the tissue purfusion

Answer 17

getting them to do the joint movements, taking pulse of the area, warmth, sensation,

Question 18

what do we need to talk about in blood loss physiology

Answer 18

the stuff related to the MABP, so MABP = CO x TPR. CO = Sv x Hr

Question 19

what are the three types of bad news delivery.

Answer 19

non disclosure:
full disclosure
individualised disclosure

Question 20

what are the three assumptions in non disclosure

Answer 20

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.

Question 21

what are the three assumptions of full disclosure

Answer 21

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.

Question 22

what are the assumptions of individualised exposure

Answer 22

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.

Question 23

give some reccomended steps of giving bad news

Answer 23

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.

Question 24

first step of bone wound healing

Answer 24

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.

Question 25

second step of bone wound healing

Answer 25

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

Question 26

third step of bone wound healing

Answer 26

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.

Question 27

whats the forth step of bone healing

Answer 27

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