stabilization of patients

Question 1

primary survey and initial stabilization

Answer 1

initial evaluation: visual and palpable

Follow ABCDE

airway, breathing, circulation, disability, external assessment

Question 2

airway (primary survey)

Answer 2

visual: respiratory effort, upper airway stridor/stertor, hemorrhage
palpable: trachea (SQ emphysema, larynx mobility), rib cage (fx, flail chest)

Question 3

airway initial stabilization

Answer 3

oxygen: flow-by, face mask, nasal catheter, E collar tent, oxygen cage, intratracheal catheter
intubation: ET tube

tracheostomy

Question 4

breathing primary survey

Answer 4

visual: RR and effort, abducted elbows, flaring of nares, extended neck, open mouth breathing
palpation: auscultation breathing sounds and patterns

Question 5

breathing patterns

Answer 5

inspiratory

rapid, shallow synchronous

labored assynchronous

expiratory push

Question 6

breathing initial stabilization

Answer 6

oxygen

medications: diuretics, bronchodilators, steroids, analegsics

pleural space thoracocentesis

chest tube

intubation with mechanical ventilation

Question 7

mechanical ventilation

Answer 7

provides positive pressure ventilation to the alveoli increasing the ability of oxygen delivery to the tissues

Question 8

barriers to appropriate circulation

Question 9

circulation primary survey

Answer 9

perfusion parameters

MM color

CRT

pulse rate/strength/synchronous

jugular vein distension

heart rate/rhythm/strength

Question 10

circulation initial stabilization

Answer 10

fluids: improve delivery of oxygen and nutrients to metabolically active cells; IV, IO

Question 11

isotonic crystalloids

Answer 11

simple electrolyte similar to plasma: LRS, Plasmalyte, Normosol, 0.9% NaCl

fluid rapidly redistributive into extracellular compartments, indications: deh, adverse effects: disrupted endothelium

initial resuscitative fluid: bolus dose: 20 to 30 ml/kg over 15 min to 30 min, reassess consider further boluses

Question 12

adverse effects of isotonic crystalloids

Question 13

hypertonic crystalloids

Answer 13

high osmolarity -vascular volume expansion 3x greater

good options for brian trauma, when need rapid intravsascular volume expansion

CI: dehydrated patients, hyperosmolar patients, uncontrolled hemorrhage

Question 14

colloids

Answer 14

synthetic: large molecules, minimal move across capillary membrane

increase oncotic pressure resulting in fluid movement into vascular space: fluid responsive shock, patients with low colloid oncotic pressure, remains intravascular space for about 24 hours

3-5 ml/kg boluses or 20 to 40 ml/kg/day

Question 15

blood products

Answer 15

indications in critical patient-persistent clinical cardiovascular instability

hemorrhage, anemia, coagulopathy