Critically Ill Flashcards
What are the two categories of assessment?
primary and secondary
What are the components of the primary survey?
CPR, Key vital assessment
How long does the primary survey take?
10-15 s
What does primary survey check?
immediate threat to life
What are the key vital functions assessment in the primary survey?
ABCDE a - airway b - breathing c - circulation d - disability e - expose
What do you do for airway in vital assess?
PROTECT C spin LOC ask to speak and to not stop talking airway patency open airway
What do you do for breathing in vital assessment?
observe chest rise and fall
RR and depth
auscultate
What do you do for disability in vital assessment?
Mental status
AVPU
What does AVPU stand for?
alert, responds to verbal, responds to pain, unresponsive
What do you do for exposure in vital assessment?
take all clothes off and look for shit
What vital signs do you get in primary assessment?
HR, RR, BP, mental status, temp, pulse ox
What do you do for CPR?
are you ok?, call for help Check pulse 10 s no pulse --> compressions 100/min 2 breaths/30 compression C A B
What does secondary survey check for?
conditions that could become life threatening
What is the CAB of CPR?
Compression
Airway
Breathing
What is the recommendation of chest compressions?
adult - 2 inches or 1/3 body wideth
kids 1.5 inches
When do you do compression on kids?
pulse
What are the parts of the secondary survey?
HX - SAMPLE
PE - Head/neck, chest, abdomen, pelvis, extremities, back
What hx do you get aka sample?
S - signs and symptoms A - allergies M - medications P - PMH L - last meal E - events preceding/related to illness
What causes blunt trauma?
MVA, falls, struck, sports
What causes paradoxical chest movement?
flail chest
What are the pulses you check?
radial, carotid, femoral
What does a radial pulse mean?
minim 80 systolic
What does cartoid pulse mean?
minim 60 systolic
What does femoral pulse mean?
minim 70 systolic
What is most commonly injured in blunt trauma?
spleen
What causes penetrating trauma?
firearm, stabbings, impalement, blasts
What is most commonly injured in penetrating trauma?
liver
What do you want to know about burns?
body surface and depth
What are the energy transfer rules?
20 miles/hour 20 feet/distance 20 minutes trapped Low velocity GSW 2000ft/s Shotgun wounds > or
What is ecchymotic discoloration around both eyes and what does it mean?
raccoon eyes - basilar skull fracture
What is bruising around umbilicus and what does it mean?
cullens, intraabdominal bleed
What is precordial crunching, clicking or knocking sound with heartbeat and what does it mean?
Hamman sign
mediastinsitis, pneumothorax, resp failure
What is ecchymoic disocloration behind ear and what does it mean?
Battle sign - basilar skull facture
What is discoloration and induration of skin of flanks and what does it mean?
grey-turner, retroperitoneal bleed or hemorrhagic pancreatitis
What is severe pain in the subscapular area on left and what does it mean?
Kehr - spleen rupture, ectopic preg, GI disease due to phrenic nerve irritation
What do you inspect on head?
face and scalp for trauma
ears - TM for blood or perf
Eyes - pup size and responsive, lens discoloration, EOM, hemorrhage
Nose - deformity, bleeding
Mouth - blood, vomit, foreign body, teeth
Face/scalp - tender, depressions, creptius, temp
What do you do for neck?
inspect JVD, trauma
Listen to carotids
C spine
palpate
What do you palpate anterior neck for?
deformity, crepitus, tenderness
What do you palpate posterior neck for?
tenderness, midline, step off
What do you do for chest?
inspect for trauma
Palpate - sternum, ribs, clavicles
Auscultate breath
Auscultate heart
What do you do for abdomen?
Inspect trauma, seat belt, cullen, grey turner, distention
Palpate each quadrant
What do you do for pelvis?
inspect - bruising over wings
Inspect - peritoneum for trauma
Assess stability - A to P on ASIS and pubic symph
DRE
What do you do for extremities?
Inspect - injury
Palpate
Motor and sensory
Palpate peripheral pulses in all and cap refill
How do you roll a person?
3 person log roll
What do you do for back?
Inspect - c spine, trauma
Palpate - entire midline, look for tenderness
What is the eye response in glasgow?
open spontaneously - 4
open to verb - 3
open to pain - 2
dont open - 1
What is the verbal response in glasgow?
oriented - 5 confused but answers -4 inappropraite response - 3 incomprehensive - 2 none - 1
What is the motor response for glasgow?
obeys command - 6 purposeful mvmt to pain - 5 withdraws from pain - 4 abnormal flexion, decort - 3 abnormal extension, deceb - 2 none - 1
What glasgow means coma?
3-8
When do you repeat primary survey?
every 5 min
What do you do for peds?
evaluate resp distress
evaluate for dehydration
What are signs of dehydration in kids?
mucous membrane dry skin turgor loss cool clammy skin sunken fontanelles eyes sunken, no tears cap refill >2 s
What are things to note in elderly?
Limited mobility of neck/TMJ
Weaker cough/gag reflex (increased risk of aspiration/obstruction)
Increased stiffness of rib cage (increased rate of rib fx)
Respiratory failure progresses quickly -decreased energy reserve
Lower cardiac output
Increased risk for MI with hypotension/hypovolemia (can not compensate)
Beta-blockers prevent compensation of HR in cases of shock or dehydration
Perception of pain reduced
Chronic mental status changes – assessment of responsiveness difficult
Hypothermia risk- skin thin and less subcutaneous fat
What is the most common cause of dehydration in kids?
vomiting and diarrhea
What is retraction at suprasternal notch?
obstruction above trachea
What is intercostal and subcostal retraction?
obstruction in bronchial tree or lower
What causes drooling?
obstruction of glottis
What does inspiratory stridor mean?
glottis or epiglottis
What does expiratory stridor mean?
obstruction below glottis
What is evidence of poor perfusion?
Weak distal pulses Pallor/pale Cyanosis Delayed capillary refill (>2 seconds) Tachycardia (based on patient’s age
What are the 5 p of neurovascular compromise?
paresthesia, pain, paralysis, pale, pulseless
What are signs of TBI?
Decreased level of consciousness (FROM BASELINE) Unequal pupils Blurred vision Severe or persistent headache Nausea or vomiting Change in Neurological status
What are MVA red flags?
Ejection Rollover Extrication > 20 minutes Death in same passenger compartment Evidence of high speed crash -Speed >40 mph -Major auto deformity (greater than 20 inches) -Intrusion into passenger compartment greater than 12 inches
