Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

TO KNOW > Patient Assessment/Management > Flashcards

Patient Assessment/Management Flashcards

1
Q

In the setting of cardiac arrest, the approach of ABCDE changes to what? (2)

A
  • “the CABs”: chest compressions, airway, and breathing
  • CAB can also be applied in massive trauma situations, in the setting of massive blood loss to treat hypovolemic shock
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Name: Signs of Airway Obstruction (4)

A
  • Agitation, confusion,“ universal choking sign”
  • Respiratory distress
  • Failure to speak, dysphonia, stridor
  • Cyanosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Describe: (A) Airway (4)

A
  • assume a cervical injury in every trauma patient and immobilize with collar
  • assess ability to breathe and speak
  • can change rapidly, thereforere assess frequently
  • assess for facial fractures/edema/burns (impending airway collapse)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Describe: Airway management (14)

A
    1. Basic Airway Management
      * protect the C-spine
      * head-tilt (if C-spine injury not suspected) or jaw thrust to open the airway
      * sweep and suction to clear mouth of foreign material
    1. Temporizing Measures
      * nasopharyngeal airway (if gag reflex present, i.e.conscious)
      * oropharyngeal airway (if gag reflex absent, i.e. unconscious)
      * “rescue” airway devices (e.g. laryngeal mask airway, Combitube®)
      * transtracheal jet ventilation through cricothyroid membrane (last resort)
    1. Definitive Airway Management
      * ETT intubation within-line stabilization of C-spine
      * orotracheal ± RSI preferred
      * nasotracheal may be better tolerated in conscious patient
      * relatively contraindicated with basal skull fracture
      * does not provide 100% protection against aspiration
      * surgical airway (if unable to intubate using oral/nasal route and unable to ventilate)
      * cricothyroidotomy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Name: Contraindications to Intubation (2)

A

supraglottic/glottic pathology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Name Indications for Intubation (5)

A
  • Patent airway
  • Protects against aspiration
  • Positive pressure ventilation
  • Pulmonary toilet (suction)
  • Pharmacologic administration during hemodynamic instability
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Name Rescue Techniques in Intubation (4)

A
  • Bougie (used like a guidewire)
  • Glidescope®
  • Lighted stylet (uses light through skin to determine if ETT in correct place)
  • Fiberopticintubation – (uses fiber optic cable for indirect visualization)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Describe: (B) Breathing (5)

A
  • Look
    • mental status (anxiety, agitation, decreased LOC), colour, chest movement (bilateral vs. asymmetrical), respiratory rate/effort, nasal flaring
  • Listen
    • auscultate for signs of obstruction (e.g. stridor), breath sounds, symmetry of air entry, air escaping
  • Feel
    • tracheal shift, chest wall for crepitus, flail segments, sucking chest wounds, subcutaneous emphysema
  • Breathing Assessment: objective measures of respiratory function: rate, oximetry, ABG, A-agradient
  • Management of Breathing
    • nasal prongs→ simple face mask → non-rebreather mask→ CPAP/BiPAP (in order of increasing FiO2)
    • Bag-Valve mask and CPAP to supplement in adequate ventilation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Definition of Shock (1)

A

inadequate organ and tissue perfusion with oxygenated blood (brain, kidney, extremities)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Name categories of shock (4)

A
  • Hypovolemic
  • Cardiogenic
  • Distributive (vasodilation)
  • Obstructive
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Name examples: Hypovolemic shock (4)

A
  • Hemorrhage (external and internal)
  • Severe burns
  • High output fistulas
  • Dehydration (diarrhea, DKA)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Name examples: Cardiogenic shock (5)

A
  • Myocardial ischemia
  • Dysrhythmias
  • CHF
  • Cardiomyopathies
  • Cardiac valve problems
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Name examples: Distributive (vasodilation) shock (3)

A
  • Septic
  • Anaphylactic
  • Neurogenic (spinal cord injury)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Name examples: Obstructive shock (5)

A
  • Cardiac tamponade
  • Tension pneumothorax
  • PE
  • Aortic stenosis
  • Constrictive pericarditis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Shock in a trauma patient is ___ until proven otherwise

A

Shock in a trauma patient is hemorrhagic until proven otherwise

17
Q

Describe EARLY and LATE Clinical Evaluation of shock

A
  • Early:
    • tachypnea, tachycardia, narrow pulse pressure, reduced capillary refill, cool extremities, and reduced central venous pressure
  • Late: hypotension and altered mental status, reduced urine output
18
Q

Describe: Estimation of Degree of Hemorrhagic Shock

A
19
Q

Describe: Management of Hemorrhagic Shock (6)

A
  • clear airway and assess breathing either first or simultaneously
  • apply direct pressure on external wounds while elevating extremities. Do not remove impaled objects in the emergency room setting as they may tamponade bleeds
  • start TWO LARGE BORE (14-16G ) IVs in the brachial/cephalic vein of each arm
  • run 1-2 L bolus of IV Normal Saline/Ringer’s Lactate (warmed, if possible)
  • if continual bleeding or no response to crystalloids, considerp RBC transfusion, ideally crossmatched.
  • If crossmatched blood is unavailable, consider O- for women of childbearing age and O+ for men. Use FFP, platelets or tranexamic acid in early bleeding consider common sites of internal bleeding (abdomen, chest, pelvis, long bones) where surgical intervention may be necessary
20
Q

Describe: (D) Disability (4)

A
  • assess LOC using GCS
  • pupils
    • assess equality, size, symmetry, reactivity to light
  • unequal or sluggish suggests local eye problem or lateralizing CNS lesion
  • relative afferent pupillary defect (swinging light test) – optic nerve damage
    • extraocular movements and nystagmus
    • fundoscopy (papilledema, hemorrhages)
    • reactive pupils + decreased LOC: metabolic or structural cause
    • non-reactive pupils + decreased LOC: structural cause (especially if asymmetric)
21
Q

Name items in Glasgow Coma Scale ()

A

Eyes+Verbal+Motor=Total

22
Q

Describe: Exposure/Environment (5)

A
  • expose patient completely and assess entire body for injury; log roll to examine back
  • Digital rectal exam
  • keep patient warm with a blanket ± radiant heaters; avoid hypothermia
  • warm IV fluids/blood
  • keep providers safe (contamination,combative patient)
23
Q

Describe 3:1 rule in use of isotonic crystalloids

A

Since only 30% of infused isotonic crystalloids remains in intravascular space, you must give 3x estimated blood loss

24
Q

Name: Common Sites of Bleeding (5)

A
  • External(e.g.scalp)
  • Chest
  • Abdomen (peritoneum, retroperitoneum)
  • Pelvis
  • Long bones
25
Q

Describe rules in Fluid Resuscitation (6)

A
  • Give bolus until HR decreases,urine output increases, and patient stabilizes
  • Maintenance: 4:2:1 rule
  • 0-10 kg: 4 cc/kg/h
  • 10-20 kg: 2 cc/kg/h
  • Remaining weight: 1 cc/kg/h
  • Replace ongoing losses and deficits (assume 10% of body weight)
26
Q

If Unilateral, Dilated, Non-Reactive Pupil, Think what? (3)

A
  • Focal mass lesion
  • Epidural hematoma
  • Subdural hematoma
27
Q

Describe: Resuscitation (7)

A
  • done concurrently with primary survey
  • attend to ABCs
  • manage life-threatening problems as they are identified
  • vital signs q5-15 min
  • ECG, BP, and O2 monitors
  • Foley catheter and NG tube if indicated
  • tests and investigations: CBC, electrolytes, BUN, Cr, glucose, amylase, INR/PTT, β-hCG, toxicology screen, cross and type
28
Q

Contraindications to Foley Insertion (3)

A
  • Blood at urethral meatus
  • Scrotal hematoma
  • High-riding prostate on DRE
29
Q

Name: NG Tube Contraindications (2)

A
  • Significantmid-face trauma
  • Basal skull fracture
30
Q

Describe: AHA CPR Guidelines with 2015 updates

A
31
Q

Describe: Secondary Survey (3)

A
  • done after primary survey once patient is hemodynamically and neurologically stabilized
  • identifies major injuries or areas of concern
  • full physical exam and x-rays (C-spine, chest,and pelvis required in blunt trauma, consider T-spine and L-spine if indicated)
32
Q

Describe HISTORY of Secondary survey (6)

A

“SAMPLE”:

  • Signs and symptoms
  • Allergies
  • Medications
  • Past medical history
  • Last meal
  • Events related to injury
33
Q

Describe: Four areas of FAST (Figure)

A
34
Q

Describe PHYSICAL EXAM in secondary survey (17)

A
  • Head and Neck: palpation of facial bones,scalp
  • Chest
    • inspect for midline trachea and flail segment: ≥ 2 rib fractures in ≥ 2 places; if present look for associated hemothorax, pneumothorax, and contusions
    • auscultate lung fields
    • palpate for subcutaneous emphysema
  • Abdomen
    • assess for peritonitis, abdominal distention, and evidence of intraabdominal bleeding
    • DRE for GI bleed, high riding prostate, and anal tone
  • Musculoskeletal
    • examine all extremities for swelling, deformity, contusions, tenderness, ROM
    • check for pulses (using Doppler probe) and sensation in all injured limbs
    • log roll and palpate thoracic and lumbar spines
    • palpate iliac crests and pubic symphysis and assess pelvic stability (lateral, AP, vertical)
  • Neurological
    • GCS
    • full cranial nerve exam
    • alterations of rate and rhythm of breathing are signs of structural or metabolic abnormalities with
    • progressive deterioration in breathing indicating a failing CNS
    • assess spinal cord integrity
    • conscious patient: assess distal sensation and motor function
    • unconscious patient: response to painful or noxious stimulus applied to extremities
35
Q

Describe INITIAL IMAGING in secondary survey (17)

A
  • non-contrast CT head/face/C-spine (rule out fractures and bleeds)
  • chest x-ray
  • FAST or CT abdomen/pelvis (if stable)
  • pelvis x-ray
36
Q

Name the best imaging modality for intracranial injury (1)

A

Non-contrast head CT

37
Q

Describe ethical considerations with: Jehovah’s Witnesses (7)

A
  • Capable adults have the right to refuse medical treatment
  • May refuse whole blood, pRBCs, platelets, and plasma even if life-saving
  • Should be questioned directly about the use of albumin, immunoglobulins, hemophilic preparations
  • Do not allow autologous transfusion unless there is uninterrupted extra corporeal circulation
  • Usually ask for the highest possible quality of care without the use of the above interventions (e.g. crystalloids for volume expansion, attempts at bloodless surgery)
  • Patient will generally sign hospital forms releasing medical staff from liability
  • Most legal cases involve children of Jehovah’s Witnesses; if life-saving treatment is refused, contact CAS

TO KNOW (42 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions