Shock and ACLS Overview Flashcards
ABCDE algorithm
Airway
Breathing
Circulation
Disability
Exposure
Airway Assessment
How do you know if the airway is adequate?
- pt is alert and oriented
- pt is talking normally
- no evidence of head/neck injury
- you assessed and reassessed for deterioration
Airway Assessment
signs and sx of airway compromise?
7
- high index suspicion
- change in voice/sore throat
- noisy breathing
- dyspnea and agitation
- tachypnea
- abnormal breathing pattern
- low O2 sat
Airway Assessment
what needs to be protected during airway management?
cervical spine
Airway Assessment
most common causes for obstruction of the airway in trauma
- tongue
- vomitus/food
- blood
- bone fragements
- foreign bodies
- dentures
Airway Assessment
two techniques to open the airway?
- chin-lift maneuver
- jaw-thrust maneuver
Breathing
steps to assessing
- assess along with airway
- determine whether respirations are adequate
- determine where both lungs are working equally
Breathing
if breath sounds are absent…
percuss to check for hemothorax vs pneumothroax
* hypo-resonance = hemothorax
* hyper-resonance = pneumothorax
Breathing
Signs and Sx of tension pneumothorax
6
- rapid, weak pulse
- hypotension
- trachel shift away from collapsed side
- jugular vein distension
- respiratory distress
- shock
Breathing
what to do with massive hemothorax?
- go to OR ASAP
- will likely need to give blood
Circulation
what is the purpose of circulation
ensuring the tissue has adequate oxygenation and delivery and blood volume
Circulation
what is shock in trauma almost always due to?
hemorrhage
Circulation
amount of blood loss classes 1 through 4
- 0-15%
- 15-30%
- 30-40%
- > 40%
Circulation
stopping external hemorrhage
- 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)
Circulation
delay of greater than 2s is suspicious for?
blood loss, even if BP is normal
Circulation
the blank is the first thing to change. it becomes blank.
- SVR
- higher
Circulation
heart rate can be an indicator of hemorrhagic shock in 50% of trauma patients except:
5 populations
- children
- elderly
- trained athletes
- pacemaker pts
- pregnant pts
Circulation
calculating BP in shock
BP = CO X SVR
Circulation
what to do if you can’t palpate a pedal or radial pulse?
- establish 2 large bore IVs
- 2-3cm below tibial prominence
Circulation
Indications for intraosseus infusion
- emergency intravascular access when other methods have failed
- cardiac arrest in infants and young children
- military applications
- blood for lab eval
Circulation
contraindications for intraosseus infusion
- osteoporosis and osteogenesis imperfecta
- fractured bone
- prior use of same bone for IO infusion
- cellulitis or burn overlying insertion site
Circulation
other methods for IV access:
take longer, 3
- 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