chapter 20 - post resus care considerations

Question 1

Breathing and ventilation - injuries that impact

Answer 1

• CNS depression
• High C spine injuries (Above C3 or C4)
• thoracic injuries (rib injuries, hemothorax, pneumothorax)
• deep sedation
• analgesia

Question 2

Circulation + use of hypertonic solutions

Answer 2

• urine output is a very reliable indicator of results status. 0.5 to 1 ml per kg/hour.

Copious amounts of isotonic crystalloids used in the treatment of hypovolemia can result in fluid overload, cap leak syndrome ad fluid shift into the interstitial space

Question 3

Circulation + use of hypertonic solutions

Answer 3

Adjunct to fluid resus; they help to raise intravascular circulating volume without requiring the administration of large volumes of fluid. - draws the water into the vascular because of higher osmotic pressure.

Question 4

Hypothermia (unplanned)

Answer 4

CORE TEMP > 35*C

Associated with the following complications;

• development of coagulopathy
• delayed wound healing
• increased surgical site infections
• increased MI complications
• Increased blood loss

** Therapeutic hypothermia

Question 5

** Therapeutic hypothermia

Answer 5

Cooling pt. between 32 and 36*C.
> post-cardiac arrest patients after ROSC
> preserves neurological function

Question 6

Acidosis - what dose it do?

Answer 6

acidosis makes it harder for hemoglobin to bind to oxygen and decades of oxygen delivery to the cells.

** in combination with hypothermia it intensifies the adverse effects of coagulation and worsens clotting times

Question 7

Resp acidosis

Answer 7

Mechanisms
- occurs due to inadequate vent and retained c02
- can be caused by hypoventilation e.g. pt. with pain, change in mental status, sedation

TREATMENT
- improving vent. via bag value or adjusting vent settings + providing pain relief to improve RR and air exchange.

Question 8

Metabolic acidosis

Answer 8

Following mechanisms;
- A by-product of tissue hypoperfusion = associated with hemorrhagic shock
- when tissues are depleted of oxygen, cells shift to anaerobic metabolism which produces lactate acid and leads to acidosis
- kidney hypoperfusion leads to AKI and the kidneys lose the ability to excrete hydrogen ions = acidosis

Can cause = vasodilation, hypotension and worsened coagulopathy

TREATMENT
- restore tissue perfusion. control hemorrhage and balance resuscitation w IV fluid and blood

Question 9

How to treat rib fractures

Answer 9

-agressive pain management
- early mobilisation
- deep coughing

OPEN alveoli

Question 10

DVT

Answer 10

The classic traid
- stasis
- endothelial damage
- hypercoagulatbility

Question 11

Fat embolism

Answer 11

Common in ortho pt. manipulation of long bone can cause microemboli to break off and can break off and travel and cause blockages

Question 12

ARDS “shock lung”

Answer 12

pulmonary oedema not attributed to a cardiovascular origin.

** fluid shifts from the intravascular space to te intersistutal spce and into the alvoli.

Treatment
- supportive care and ventilation strategies. PEEP with lower tidal volumes can help

Question 13

Rhabdomyolysis

Answer 13

Common with crush injuries or burns

Damage to tissues results in cellular destruction, which in turn releases myoglobin into circulation. myoglobin an intracellular protein obstructions renal perfusion and glomerular filtration.

** dark red / brown urine

HyperK is also a complication of this; cell destruction releases intercellular K into the extracellular space. this causes serum K to rise dramatically.
> ECG changes
> alkalisation of the urine ph > 8
> may need moidialysis

TREATMENT
aggressive fluid matiencene to maintain 100-300 ml / hour