Shock and ACLS Overview Flashcards
1
Q
ABCDE algorithm
A
Airway
Breathing
Circulation
Disability
Exposure
2
Q
Airway Assessment
How do you know if the airway is adequate?
A
- pt is alert and oriented
- pt is talking normally
- no evidence of head/neck injury
- you assessed and reassessed for deterioration
3
Q
Airway Assessment
signs and sx of airway compromise?
7
A
- high index suspicion
- change in voice/sore throat
- noisy breathing
- dyspnea and agitation
- tachypnea
- abnormal breathing pattern
- low O2 sat
4
Q
Airway Assessment
what needs to be protected during airway management?
A
cervical spine
5
Q
Airway Assessment
most common causes for obstruction of the airway in trauma
A
- tongue
- vomitus/food
- blood
- bone fragements
- foreign bodies
- dentures
6
Q
Airway Assessment
two techniques to open the airway?
A
- chin-lift maneuver
- jaw-thrust maneuver
7
Q
Breathing
steps to assessing
A
- assess along with airway
- determine whether respirations are adequate
- determine where both lungs are working equally
8
Q
Breathing
if breath sounds are absent…
A
percuss to check for hemothorax vs pneumothroax
* hypo-resonance = hemothorax
* hyper-resonance = pneumothorax
9
Q
Breathing
Signs and Sx of tension pneumothorax
6
A
- rapid, weak pulse
- hypotension
- trachel shift away from collapsed side
- jugular vein distension
- respiratory distress
- shock
10
Q
Breathing
what to do with massive hemothorax?
A
- go to OR ASAP
- will likely need to give blood
11
Q
Circulation
what is the purpose of circulation
A
ensuring the tissue has adequate oxygenation and delivery and blood volume
12
Q
Circulation
what is shock in trauma almost always due to?
A
hemorrhage
13
Q
Circulation
amount of blood loss classes 1 through 4
A
- 0-15%
- 15-30%
- 30-40%
- > 40%
14
Q
Circulation
stopping external hemorrhage
A
- usually just needs pressure
- coagulating agents may be helpful
- suture closed quickly, don’t worry about cosmesis
- tourniquets can be used on extremities (not more than 1 hr)
15
Q
Circulation
delay of greater than 2s is suspicious for?
A
blood loss, even if BP is normal
16
Q
Circulation
the blank is the first thing to change. it becomes blank.
A
- SVR
- higher
17
Q
Circulation
heart rate can be an indicator of hemorrhagic shock in 50% of trauma patients except:
5 populations
A
- children
- elderly
- trained athletes
- pacemaker pts
- pregnant pts
18
Q
Circulation
calculating BP in shock
A
BP = CO X SVR
19
Q
Circulation
what to do if you can’t palpate a pedal or radial pulse?
A
- establish 2 large bore IVs
- 2-3cm below tibial prominence
20
Q
Circulation
Indications for intraosseus infusion
A
- emergency intravascular access when other methods have failed
- cardiac arrest in infants and young children
- military applications
- blood for lab eval
21
Q
Circulation
contraindications for intraosseus infusion
A
- osteoporosis and osteogenesis imperfecta
- fractured bone
- prior use of same bone for IO infusion
- cellulitis or burn overlying insertion site
22
Q
Circulation
other methods for IV access:
take longer, 3
A
- central lines: femoral, subclavian, or jugular
- femoral is easiest, but not best option in hip fracture or abd trauma
- jugular is not accessible if pt is in a cervical collar
23
Q
Circulation
fluid resuscitation
give what initially? then what if that doesn’t work?
A
- balanced crystalloid solution
- if still hypotensive, then give whole blood
24
Q
Circulation
how to give component therapy
A
1:1:1
PRBC:FFP:PLATELETS
25
# Circulation
what is the "bloody vicious cycle"
hemorrage to resuscitation to demodilution and hypothermia to coagulopathy back to hemorrhage
26
# Circulation
how to break the bloody viscious cycle
* prevent hemodilution
* treat coagulopathy
* control hemorrhage
* use best resuscitation methods
* prevent hypothermia
27
# Circulation
signs and sx of pericardial tamponade
1. Beck's Triad: hypotension, jugular vein distension, muffled heart sounds
2. ECG Triad: sinus tachy, low voltage, electrical alternans
3. POCUS Triad: pericardial fluid, RV diastolic collapse, dilated IVC
28
# Circulation
tx of pericardial tamponade
subxiphoid approach
29
# Circulation
where else can there be occult blood loss?
* pelvis
* most common is pelvic fracture to bleed
30
# Circulation
describe REBOA catheter
* requires advanced training, temporizes pelvic fractures (less than 30 min)
31
# Circulation
if pt is still hypotensive after all of this:
they are still bleeding!
32
# Circulation
trauma in pregnancy
| 5 things
* delayed gastric emptying (NGT tube consideration)
* O neg= RHOGAM
* Call OB early
* fetal distress could be a sign of hemorrhage
* pelvic exam to check for blood, premature labor, placental abruption
33
# Circulation
hematological changes during pregnancy?
1. increase in plasma volume (increase RBC volume)
2. dilutional reduction in Hb converstion
3. neutrophilia
4. 10-15% reduction in platelet count
5. hypercoagulable state
34
# Circulation
physiological respiratory changes in pregnancy?
1. increase in RR and tidal volume
2. increase in minute volume
3. mild respiratory alkalosis
4. decreases diaphragmatic mobility
35
# Disability
primary survey of disability
1. assess pupils
2. level of consciousness
3. response to stimuli
4. AVPU scale
5. Glasgow Coma Scale
36
# Disability
components of AVPU scale
1. alert
2. responsive to voice stimuli
3. responsive to painful stimuli
4. unresponsive
37
# Disability
what to do when GCS less than 8
1. intubate if not already done
2. frequently repeat neuro exam and document
3. CT scan ASAP
4. early neurosurgical consultation
38
# Exposure
primary survey for exposure
1. remove all clothes and blankets
2. thorough physical exam
3. re-cover with warm blankets
4. prevent hypothermia
39
# Resuscitation
describe the components of resuscitation
1. initital resuscitation begins when pt hits the door
2. obtain IV access and start IVF
3. if unresponsive to 1000ccs, begin blood transfusion
4. consider Tranxemic Acid (clot stabilizer, loading dose 1g)
40
# Resuscitation
what type of blood do you use?
* emergent: type O (Rh- negative on females of child bearing age)
* type specific: avail within 10 min
* crossmatched: takes 45 min
41
adjuncts to primary survey
1. ECG
2. vital signs
3. ABGs
4. pulse ox & CO2
5. urinary/gastric catheters
6. urinary output
42
contraindication to NG tube placement
severe midface trauma
43
# Stroke
Cincinnati prehospital stroke scale
1. facial symmetry
2. motor weakness
3. asphasia
any 1 of 3 is +72% likelihood
44
# Stroke
workup
* vitals
* CBC
* CMP
* accu check
* ECG
* PT
* PTT
* INR
* tox screen
* ABG
* blood EtOH
* hcg
* NIHSS
45
absolute contraindications to thrombolytic therapy
1. prior intracranial hemorrhage
2. known intracranial malformation
3. ischemic stroke < 3 mo
4. suspected dissection
5. recent surgery
6. recent head trauma
7. bleeding diathesis
46
# Circulatory Shock
4 types
1. hypovolemic
2. cardiogenic
3. obstructive
4. distributive
47
# Circulatory Shock
presentation
* altered mental status
* decreased peripheral pulses
* tachy
* cool/mottled skin
* hypotension
48
# Circulatory Shock
work up
* CBC
* CMP
* lactate
* PT
* PTT
* INR
* ABGs
* ECG
* Blood Cult
* x-ray EFAST
49
describe Cardiogenic Shock
decreased cardiac output, decreased perfusion, increased systemic vascular resistance
50
# Cardiogenic Shock
etiology
* MI
* myocarditis
* valvular disease
* CHD
* cardiomyapothy
* arrhythmia
51
# Cardiogenic Shock
presentation
* decreased CO
* hypotension
* vasoconstriction
52
# Obstructive Shock
describe
decreased blood flow due to physical obstruction of heart or great vessels- pressure decreases heart's ability to pump blood
53
# Obstructive Shock
Etiologies
1. massive PE
2. pericardial tamponade
3. tension pneumothroax
4. aortic dissection
54
# Obstructive Shock
management and treatment
1. oxygen
2. fluids
3. inotropic support
4. mechanical support
5. treat underlying cause
55
# Distributive Shock
describe
excess vasodilation and altered distribution of blood flow
decreased CO, SVR, PCWP
56
# Distributive Shock
4 types
1. spetic
2. anaphylactic
3. neurogenic
4. endrocrine
