Complex II Exam 1 Flashcards
What is the purpose of the mitigation phase?
planning and identifying potential hazards
What is the purpose of the preparedness phase?
to practice the plan in order to save lives
What is the purpose of the emergency response phase?
implementation and assessment of the plan
What is the purpose of the recovery phase?
assessing damage and returning everything to normal
How quickly should you assess and intervene after a trauma?
in 60 seconds or less
What do you NEED TO KNOW for a trauma patient?
- VS
- GCS
- extent of injuries
When is reverse triage used?
mass casualty (100+ people)
Who should be treated first in reverse triage?
the less injured
What are some examples of airway obstructions?
- food
- blood
- tongue
- teeth
- vomit
- foreign objects
What is the priority intervention if the airway is obstructed?
- get it out/suction
- anticipate intubation
Which airway can only be used if the patient does not have a gag reflex?
oropharyngeal
What should you do if a patient is unresponsive WITHOUT trauma to the airway?
head tilt/chin lift
When should a jaw thrust be done?
if the patient is unresponsive WITH trauma to the airway
When is a head tilt/chin lift contraindicated?
if a CSI is suspected
What should you do if you suspect blunt force trauma?
stabilize the spine and log roll
What should you LOOK for when assessing breathing?
symmetrical chest rise and fall
What should you LISTEN for when assessing breathing?
lung sounds in all 5 lobes
What should you FEEL for when assessing breathing?
chest rise and fall and broken ribs
What can having 3 broken ribs and a collapsed lung cause?
flail chest
What should you do if the patient is not breathing or is breathing inadequately?
manual ventilation by a bag valve mask with supplemental O2
How are rescue breaths given?
ambu bag
What pulses should be assessed first when assessing circulation?
central (carotid, femoral)
How should bleeding be stopped?
direct pressure
What variables are assessed for circulation?
- HR
- BP
- pulses
- cap refill
- skin color
- LOC
- urine output
How can shock be identified when assessing circulation?
increased HR and hypotension
What does disability assess?
- LOC with GCS
- AVPU
- pupillary response
What does AVPU stand for?
A: alert
V: responsive to voice
P: responsive to pain
U: unresponsive
What is the priority when assessing exposure/environment?
- maintaining body heat
- maintaining privacy and dignity
What does the trauma triad of death include?
- hypothermia
- acidosis
- coagulopathy
What do the use of warm blankets, an increased room temperature, and warmed IV fluids help with?
hypothermia
What are the five adjuncts?
- foley catheter
- full set of labs
- cardiac monitor
- NG tube
- radiology (x-ray, CT)
What does AMPLE stand for?
- allergies
- meds
- past medical hx/menstrual period
- last I&O
- exposures
What does the absence of rectal tone suggest?
SCI
What is preload, and how is it measured?
- the amount of blood going into the RA
- CVP
What is normal CVP?
2-6
What does an elevated CVP indicate, and how should it be treated?
- too much fluid
- diuretics
What does a decreased CVP indicate, and how should it be treated?
- not enough fluids, need volume
- give fluids
What does PAWP measure?
pressure generated by the left ventricle
What is a normal PAWP?
6-15
What is afterload, and how is it measured?
- pressure the ventricle has to pump to move blood out of the heart
- PVR (lungs)
- SVR (body)
What is a normal SVR?
600-1200
What is a normal systolic PA pressure?
15-28
What is a normal diastolic PA pressure?
5-16
What is a normal SV?
50-100 mL/sec
How is SV calculated?
end diastolic volume - end systolic volume
What is a normal CO?
3-6 L/min
How is CO calculated?
SV x HR
What is ejection fraction, and what is a normal EF?
- the % of blood ejected with each beat
- 55-70%
What EF % would indicate acute HF?
<40%
What does a PA catheter measure?
- RA pressure (CVP)
- PA pressure (SVR)
- LV pressure (CO)
What can a HIGH PA pressure cause?
pulmonary HTN & edema
What medication can you give to a patient with high PA pressure?
sildenafil
Which is more accurate: CVP or PAWP?
PAWP
What is the biggest risk when using a PA catheter?
clots
Where is an arterial line most commonly placed?
radial artery
If you want to get continuous BP readings, frequent ABG’s, or put your patient on vasopressors, what should you put in place?
arterial line
What can NOT be given through an arterial line?
meds or IVF
What is the biggest risk with an arterial line?
cutting off blood flow to the hand
What is Allen’s test, and what result is ideal?
- occluding arteries in the arm to examine blood flow to the hand
- POSITIVE RESULT (WANT): color returns quickly when you let go
Why should the transducer for an arterial line be level with the atrium of the heart?
accurate pressure reading
- heart and pressure = same
- transducer and pressure = opposite
What is the first major sign you should worry about with shock?
hypotension
What drops with non-progressive (compensatory) shock? What increases?
- CO and BP drop
- HR increases
Does a high CVP or low CVP indicate JVD?
HIGH
What DECREASES with hypovolemic shock?
- BP
- CO
- CVP
What INCREASES with hypovolemic shock?
- HR
- SVR
What is the PRIORITY intervention for hypovolemic shock?
replace fluids (NS or blood)
What are the only fluids that can be given bolus?
LR and NS
What do digoxin and dobutamine (positive inotropes) do when used for hypovolemic shock?
- DO NOT treat shock
- increase contractility
- slow and strengthen, making pumping more efficient
What vasopressors can be used for hypovolemic shock?
- norephinephrine
- dopamine
- epinephrine
- vasopressin
What is the BEST med for hypovolemic shock? Why?
norepinephrine because it does not increase HR
What has to be present for vasopressors to work?
FLUIDS (CVP >2)
What should you give if extravasation occurs after administering vasopressors?
phentolamine
What vasodilators can you give for hypovolemic shock?
nitroglycerine and nitroprusside
In what situation would you transfuse whole blood?
if a patient has lost a large amount of blood
How quickly after collection does whole blood need to be transfused and why?
within 24 hours to avoid deterioration of coagulation factors