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Adult 2 > Test 3 > Flashcards

Test 3 Flashcards

1
Q

Triage is french for

A

To sort

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2
Q

Red tag characteristics

A

absent breath sounds with a pulse –> needs critical attention !

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3
Q

Yellow tag characteristics

A

Broken bone. needs to be seen but not immediately (would be sent to an outlying hospital)

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4
Q

Green card characteristics

A

Minor injuries–> send to another hospital

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5
Q

Black card

A

close to dying or already dead –> no hope

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6
Q

at the scene of a disaster (plane crash) which of the following patients would get the CC bed?

  • bruised and confused
  • closed fx
  • bleeding with open wound and absent breath sounds
  • 4 month old lethargic and pulse of 30
A

bleeding with open wound and absent breath sounds

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7
Q

Primary Survey

A

A: Airway & C-spine stabilization/immobilized
B: Breathing
C: Circulation
D: Disability (Pupil assessment, neuro assessment–> what is your name/ where are you?)
E: Exposure/Environmental Control (look for impalements)

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8
Q

You encounter a bad accident on the side of the road and decide to stop. Where do you park your car?

A

Put hazards on, drive past scene, and run back

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9
Q

Primary Survey “A”

A

Airway and C-spine stabilization

Obstruction (blood, saliva, vomit, direct trauma)
Primary S&S:

Cervical spine injury?- Jaw-thrust maneuver
Back board and/or rigid C-Collar/ head blocks
C spine–> houses brain stem. Use hands on side of face and hold still. Don’t move head if it is moved

Suction/removal of FB/ oral airway

Oxygen (least to most invasive)
NC to ETT (RSI) to cricohthyroidotomy
Depending if awake or not

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10
Q

Primary survey B

A

Breathing – Stop, Look and Listen

100% oxygen via whatever route needed

Why? Fx ribs, PE, Pneumothorax, flail chest, Hemopneumothorax, direct injury

Interventions: O2 by assist BVM, needle decompression, intubation and treat underlying cause

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11
Q

Primary Survey C

A 
Circulation
Note:  No BP now, later
Cardiac Output
Pulses (carotid, femoral)?
AMS? Cap refill?  Neck Veins?
Think Bleeding!! Interventions
Control hemorrhage/start IVs (two 14 G)
External – direct pressure to site
Internal – IV fluids, transport
Consider Rapid infuser
Obtain sample for T&C
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12
Q

Primary Survey D

A

(D) Disabilty – Mental Status Exam (brief)

LOC: AVPU?
For baseline assessment of neuro dissabilty

Pupils: size/shape/reactivity

MINI Glasgow Coma Scale
Eye opening
Speech
Motor function

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13
Q

Primary Survey E

A

Exposure/Environmental Control
Remove all clothing-May require cutting off
Watch for evidence (dont cut through GSW or stab would)
Assess blunt vs. penetrating trauma
- Impalement
NOTE: DO NOT REMOVE OBJECT
Cover with warm blankets/may need other warming measures
Monitor scene: Safety first.

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14
Q

Secondary Survey F

A

Full Set of Vital Signs (Only have pulse and RR up to this point now you will get BP and O2 sat and temp)

Family presence
Maybe saw what happened 
History 
Facilitate interventions 
EKG: 
O2 saturation:
Portable CXR:
Foley Catheter/NGT/OGT: to see if bleeding is present 
Labs/Diagnostics
Consider Tetanus ( ask when last one was )
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15
Q

Secondary Survey G

A 
Give comfort
Pain management
Reduce anxiety
Reassurance/establish trust
Environment control

Physical first! Meet physical needs then psychosocial

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16
Q

Secondary Survey H

A

Obtain History

– Head to Toe Physical Exam

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17
Q

Secondary Survey I

A

(I)- Inspect Posterior Surfaces

Look for pooling blood, bruises, exit wounds, burns, impailments. Do not move backboard until cleared by DR.
Rolling on a board you want at lest 4 people

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18
Q

trachea is deviated to the right. what can this indicate?

A

Possible tension pneumo which is life threatening!

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19
Q

Abdominal assessment

A

Inspect, auscultate, palpate

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20
Q

abdominal lavage

A

iced saline or ice to constrict blood vessels

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21
Q

what can loss of rectal sphincter tone indicate?

A

Spinal cord injury

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22
Q

Do you use NS or LR’s for resuscitation?

A

NS. LR contains electrolytes and you dont know their status.

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23
Q

For hypovolemic shock, which blood product are you going to give?

A

PRBCs because they carry O2

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24
Q

When would you give FFP?

A

Help with clotting deficiencies without adding extra volume

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25
Q

what are you at risk for with a liver lac? What dont you want to give?

A

Liver is responsible for balancing lactic levels (broken down) if lactic acid is rising then you don’t want to give LR

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26
Q

What are you watching for in a possible splenic lac?

A

Distended abd. Obtain ultrasound

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27
Q

universal donor

A

O-

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28
Q

who is at most risk for heat related injury?

A

athletes and elderly

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29
Q

Heat Stoke

A

MOST SERIOUS
Failure of hypothalamus which regulates sweating/ temperature–> pt is dry because they don’t sweat!

Initial S/S
Increased sweating, vasodilation & RR
Secondary S/S
105 degrees
LOC changes
No perspiration
Skin – dry, hot, ashen
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30
Q

Why do you give thorazine to someone with heat related injury?

A

Shivering increases tem–> bad

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31
Q

Someone is found down for an unknown amount of time, What are they at risk for?

A

rhabdomyolysis/myoglobinuria

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32
Q

heat related interventions

A

Oxygen
Fluids & Electrolyte balance correction
Cooling methods
Cooling blankets
Ice packs
Ice water lavage
Cold water peritoneal dialysis
Cardiopulmonary bypass
No antipyretic USED
A lot of times unconscious and need to be intubated
That high of a temperature proteins in your brain are denatured and cannot go back –leading to seizures
Cool as quickly as possible! Pack groin and underarms with ice.
Ice lavage is the best way to cool the body  ice water in the stomach and then pull back out

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33
Q

Frost bite

A

Superficial (skin/subcutaneous tissue):
ears/nose/fingers/toes
Waxy yellow to blue mottled, crunchy tissue
Rx: Warm water immersion

Deep 
bone, muscle, tendon
White, hard skin; insensitive to touch
Rx: Warm water immersion, edema reduction;  tetanus shot; possible amputation
Amputation gangrene
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34
Q

If someone is hypothermic, why do you want to warm them slowly?

A

At risk for re-profusion arrythmia

not dead until you are warm and dead

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35
Q

Hypothermia

A

Elderly are more prone to hypothermia
Mild (90-95 degrees F)
Moderate (87 to 90 degrees F)
Profound (< 86 degrees F) life threatening

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36
Q

Cold related goals

A

Rewarm
Correct dehydration, acidosis
Protect Airway
Treat cardiac rhythms

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37
Q

Active core rewarming (profound)

A 
Humidified oxygen
Warm IV fluids
Lavage (bladder, gastric)
Peritoneal dialysis, Hemodialysis
Cardiopulmonary bypass
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38
Q

Submersion injury goals

A

Correct hypoxia
Correct acid-base
Correct fluid
ABC

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39
Q

Submersion injury interventions

A

Oxygen, consider vent?
LOC changes? Mannitol, Lasix?
Monitor 4-6 hours post
Delayed pulmonary edema (fluid shifting NOT cardio)
Fluid moving to the Alvioli aka area has been injured like when you bang your elbow and it swells –>dry drowning

Systemic inflammation response (fluid shifting)

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40
Q

What is the worst type of bite?

A

Human

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41
Q

What does activated charcoal do?

A

Binds to toxin neutralizing it and inducing diarrhea

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42
Q

If someone drinks antifreeze, what intervention will they need?

A

hemodialysis

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43
Q

poisoning medications

A

Mucomyst (Tylenol)

Ca+ channel blockers (Verapamil)

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44
Q

Emergency

A

extraordinary event requiring a rapid and skilled response

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45
Q

MCI

A

natural or manmade disaster that overwhelms the resources of a community

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46
Q

CERT

A

community emergency response team

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47
Q

DMAT

A

Disaster Medical Assistance Team

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48
Q

where do you level an ICP pressure transducer?

A

mid-ear or monroe foreaman

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49
Q

ICP range

A

0-15 mm hg

sustained =tx

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50
Q

total Volume in the skull

A

1900 ml

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51
Q

Monroe Kelly doctrine Factors influencing ICP

A 
Arterial and Venous pressure
Intraabdominal pressure
Intrathoracic pressure
Posture
Temperature (hypo)
CO2 level (ABG)
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52
Q

Monroe Kellie doctrine

A 
Dura expansion
Increase venous outflow
Decrease CSF production
Change blood volume
Constriction
Dilation
Brain tissue compression
Compensate – UP TO A POINT
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53
Q

how many mL flow through 100g of brain tissue in 1 minute ?

A

50 mL / min

54
Q

what is the purpose of automatic alteration of cerebral blood vessels diameter in response to systemic arterial pressure changes

A

Consistent blood flow
Metabolic needs
Maintain CPP

55
Q

Cerebra pulse pressure formula

A 
CPP= MAP-ICP
CPP= flow X resistance
56
Q

What CPP indicates ischemia incompatible with life ?

A

<30 mm hg

57
Q

Cushings triad

A

loss of auto autoregulation

58
Q

Wide pulse pressure, bradycardia, and decreased RR are sx’s of what ?

A

Cushing’s triad

59
Q

vasogenic cerebral edema

A

Most common
White matter
Cerebral cap endothelial lining leaks into extracellular space

60
Q

cytotoxic cerebral edema

A

Gray matter
Cell membrane dysfunction
Extracellcular fluid shifts into cell

61
Q

interstitial cerebral edema

A

Diffusion of ventricular CSF

62
Q

Increased Intracranial Pressures etiology

A

Mass Lesion: hematoma, tumor, abscess
Cerebral Edema: hydrocehpalus, inflammation
Metabolic Insult
Result: hypercapnia, impaired autoregulation,
acidosis, hypoxia and systemic hypertension.
Untreated could result in herniation and death

63
Q

IIP manifestations depend on what ?

A

Depend on location, cause and rate of pressure increase

64
Q

clinical manifestations of IIP

A 
LOC Change
VS (esp temp)
Cushing’s triad (later)
Ocular signs
Cranial nerves
Pupils changes
Motor changes
Decorticate (flex = in)
Decerebrate (extend = out)
Brainstem involvement (more serious)
Headache
Vomiting
Spontaneous/projectile
65
Q

complications of IIP

A 
Inadequate CPP
Sustained ICP > 20 mm Hg
Decreasing CPP
Herniation
Cingulate 
Lateral, Beneath Falx
Central/transtentorial
Downward
Uncal
Lateral, Downward
Reversible then Irreversible????
Fatal – compression of brainstem and CN = RR arrest
66
Q

Ventriculostomy

A

Measuring ICP

67
Q

diagnostic tests for IIP

A 
CT/MRI 
EEG
 cerebral angiogram 
cerebral blood flow 
transcranial doppler 
PET scan
68
Q

Why can you not do an LP with IIP ?

A

CSF decreasing too quickly can cause cerebral herniation

69
Q

Nursing goals for IIP

A 
Identify cause/treat
Adequate CPP
Normothermic
Pain control
Recognize early changes
Cognitive
Motor
Sensory
Prevent complications, i.e., infection
70
Q

Nursing interventions for IIP

A 
ABC’s: Monitor Respiratory Pattern
ABG: (PaO2, PCO2, pH)
Elevate HOB 30 degrees
Proper alignment, no neck flexion
Neuro assessment
Glasgow Coma Scale: evaluation q 1h
Eye opening (1-4 scale)
Best Verbal response (1-5 scale)
Best Motor response (1-6 scale)
ICP monitor, EVD
SBP – diagnosis/patient specific: daily goals
F&amp;E  balance
Temperature management
(Hypothalamus)
decrease metabolic needs (89.6 – 91.4)
Quiet environment
Labs (frequent)
CBC, Lytes
ABG
Na, Osm (frequently)
ICU –  Cardiac Monitor 
PA, AL (MAP), ICP (CPP), EVD
I/O, foley
71
Q

Mannitol

A

Osmotic Diuretic
hypertonic solution to remove cerebral tissue fluid
25% Osmitrol (rapid administration, plasma expansion, osmotic effect)

72
Q

Lasix, Bumex with IIP

A

loop diuretics decrease NACL reabsorption and CSF production

73
Q

Corticosteroids

A

tumor / abscess, not head injuries

decadron
side effects: GI bleeding, hyperglycemia, infection

74
Q

increased IIP interventions limited hyperventilation

A

Limited Hyperventilation
PaCO2 < 25 mm Hg
PaCO2 is a potent vasodilator
Suction – minimal (increase ICP)

75
Q

IIP nutrition interventions

A

TPN/lipds (glucose)
Enteral Feedings
DBHT, NGT
Nutritional consult

76
Q

Increased IIP F&E interventions

A 
Fluid/electrolyte balance
Fluid – ½ or .9 NS
Meds
Diabetes insipidus (DI)
DDAVP
Pitressin
Paralytics (Norcuron)
Sedation  (Propofol, Fentanyl – short acting)
Decrease metabolic demand/anxiety
77
Q

increased IIP infection interventions

A

aseptic technique

78
Q

psychosocial issues (patient and family ) with IIP

A

possible death, organ donation

79
Q

TBI

A 
Craniocerebral trauma
Alteration in LOC
TBI: 1.1 million treated; 235,000 die
High potential for poor outcome
Immediate death
2 hours after injury
3weeks after injury
80
Q

scalp lac

A

minor, direct pressure; staples, sutures

81
Q

skull fx

A

Linear or depressed
Simple, Comminuted, Compound
Open or closed

82
Q

CSF leakage

A

Glucose test strip, +
4 x 4 gauze, “halo” – yellow ring around blood area
Both - Blood in fluid, false +
Basilar skull fracture – fracture in skull floor
Battle sign? Raccoon eyes?

83
Q

minor head trauma

A 
Concussion
Sudden transient neural activity disruption
Headache
Retrograde amnesia
LOC change
No loss of LOC or Loss of LOC < 5 minutes
Short duration
Discharge instructions
84
Q

major head trauma- contusions

A

Brain bruising at site
Level of Consciousness changes
Seizure (common complication)

85
Q

Major head trauma - lacerations

A

Lacerations – Brain tissue bleeding at site = intracerebral hemorrhage

Blood slowly reabsorbed
Depth of injury
Unconscious, hemiplegia (contralateral) and dilated pupil (ipsilateral)
Increase ICP

86
Q

blunt trauma

A

Penetrating
High velocity objects (I.e., bullet)
Low velocity object (I.e., pole, fence)

Coup-contrecoup
a coup injury occurs under the site of impact with an object, and a contrecoup injury occurs on the side opposite the area that was hit. Coup and contrecoup injuries are associated with cerebral contusions, a type of traumatic brain injury in which the brain is bruised.

87
Q

epidural hematoma

A

Bleed between dura and skull inner surface

Venous (develops slow)

Arterial (develops fast)

+ LOC at scene, lucid, + LOC

Surgical evacuation

Commonly seen in elderly and ETOH patients

88
Q

Subdural Hematoma

A

Bleed between dura and arachoid layer of meningeal brain covering

Usually venous (slower)

Acute: 24-48 hrs following an injury
Subacute: 2-14 days after injury
Chronic: weeks to months after injury

Tx: Surgical evacuation for large acute SDH

89
Q

Skull fx interventions

A

Craniotomy
Remove or elevate loose fragments
Craniectomy/cranioplasty

90
Q

Hematoma interventions

A

Craniotomy to control venous/arterial bleed site
Decompression via drain
Burr Hole (emergent cases)
Continuous monitoring Neuro

91
Q

General head injury interventions

A

Tetanus toxoid

Antibiotics prophylactic

92
Q

Chronic problems post brain injury

A 
Bowel and bladder
Nutrition (chewing, swallowing)
Respiratory (trach)
Speech
Personality changes
Seizures
ABOVE (Temporary or Permanent)
93
Q

Brain death criteria

A

No spontaneous movement (paralytics, sedation off)

No brainstem reflexes
Fixed and dilated pupils
No corneal reflexes
No gag reflex
No vestibular response to caloric stimulation

No spontaneous RR on 100% O2 test, ABG

94
Q

Stroke

A

ischemia to part of the brain resulting in brain cell death

95
Q

Brain attack

A

synonym used to convey the urgency necessary for recognition and treatment of clinical symptoms.

96
Q

modifiable risk factors for stroke

A 
Hypertension-  most important
Heart disease/Diabetes/Hyperlipidemia
Smoking
Excessive alcohol consumption
Obesity/Physical inactivity/Sleep Apnea
Drugs: Cocaine/ Birth Control pills
97
Q

Types of ischemic stroke

A

thrombotic
embolic
ischemic cascade

98
Q

Thrombotic stroke

A

Injury to a vessel and formation of a blood clot; most common cause of stroke

99
Q

Embolic stroke

A

Embolus lodges and occludes an artery; Causes include: AF, MI, Endocarditis , ASD, RHD, Atherosclerosis

100
Q

Ischemic cascade

A

metabolic events in response to ischemia; including inadequate ATP, release of AA & free radical formation and cell death

101
Q

Two types of hemorrhagic strokes

A
  1. inter cerebra hemorrhage

2. subarachnoid hemorrhage

102
Q

intercerebral hemmorage

A

Intracerebral Hemorrhage: Bleeding within the brain caused by a ruptured blood vessel
Poor prognosis:
50% die within the first 48 hours
40-80% have 30 day mortality
Hemiplegia to complete paralysis
Coma: body posturing, fixed pupils hyperthermia
by location and degree
Intracereberal can be anywhere where you have vasculature which can erupt

103
Q

In an intercerebral hemorrhage, where is it the most serious if the bleeding is?

A

Bleeding into Pons is most serious

104
Q

Subarachnoid Hemorrhage

A

Bleeding into the CSF filled space between the arachnoid and pia mater membranes
Most commonly caused by rupture of a cerebral aneurysm
Also caused by AVM (arteriovenous malformation) , trauma, drug abuse
Patient c/o “Worst headache of one’s life”
Sx: N/V, focal deficits, seizures, stiff neck, light is nauseating

105
Q

Pt states “I have the worst headache of my life.” What do you suspect they have ?

A

Subarachnoid Hemorrhage

106
Q

What causes an anoxic brain injury?

A

Swelling the brain casques decreased perfusion

107
Q

Clinical manifestations of hemorrhage: Motor functions

A

Mobility, Respiratory, Speech & Swallowing, Self-care abilities

108
Q

Clinical manifestations of hemorrhage: communication

A

Aphasia and Dysphasia

109
Q

Aphasia

A

I cant speak

110
Q

Dysphagia

A

I cant swallow

111
Q

Clinical manifestations of hemorrhage: Affect

A

Control of emotions

112
Q

Clinical manifestations of hemorrhage: Intellectual funciton

A

memory and judgment

113
Q

Clinical manifestations of hemorrhage: **Spatial-perceptual alterations **

A

(NB**) homonymous hemianopsia –> same side of both eyes half without vision–> ex you don’t want a patient with this condition to turn their head to the door because that will increase ICP

114
Q

homonymous hemianopsia

A

same side of both eyes half without vision–> ex you don’t want a patient with this condition to turn their head to the door because that will increase ICP

115
Q

Clinical manifestations of hemorrhage: elimination

A

Both bladder and bowel

116
Q

diagnostic studies for stroke

A 
CT
CTA
MRI
Angiography: Gold standard -Carotid Arteries
TCD: Transcranial Doppler
EEG
LP
117
Q

primary stroke prevention

A 
Healthy Diet
Weight Control
Regular Exercise
No smoking
Limiting Alcohol consumption
Routine check-up
118
Q

Stroke risk reduction

A

Drug Therapy
Antiplatlet drugs for TIA/atherosclerosis
ASA is most common
Also: Plavix/Persantine/Coumadin

Surgical Therapy
For know carotid disease:
-CEA(stripping of carotid arteries)/ Angioplasty/ Stenting/EC-IC Bypass

119
Q

Acute care management (stroke)

A 
ABC
NVS q 1 hr X 24-48 hrs (get them up and moving out of there to rehab) 
Blood pressure management
Fluid &amp; electrolyte balance
HOB @ 30 degrees
Head &amp; Neck alignment
EVD
Pain management/Subarachnoid hemorrhage  precautions
120
Q

Drug therapy for stroke

A 
Osmotic Diuretics -> mannitol 
Hypertonic Saline
tPA – within 3 hours of onset of stroke 2 hours for hearts 
ASA
Nimodipine
Tylenol
Anti-seizure
121
Q

Surgical therapy for stroke (Aneursyms and Hemmorhage)

A

Coiling done in interventional radiology
Clipping
Surgical resection of AVM
Removal of bone flap

122
Q

Surgical therapy for ischemic stroke

A

Ischemic Stoke

-MERCI: Mechanical embolus retrival in cerebral ischemia

123
Q

Coiling and clipping

A

Wall is thin so it is at risk for leaking or bursting. The neck has been determined to be narrow and then the coils of metal and glue are put in the pocket. If the neck is wide then if comes back out so you would clip it

124
Q

AVM

A

Vessel walls are thin and they are high risk for bleeding. Commonly congenital and seen in pediatric patients. c/o headaches. Surgeon can come tie off and take out the middle

125
Q

CT of brain should show _____

A

Cat scan should show symmetry … The picture on the power point shows a bleed with swelling which has smooshed the tissue to the other side. When the left side hits the bone it will herniate and drop down killing them.

126
Q

Craniectomy

A

Must place a sign saying no bone flap on effected side. Do not turn patient on that side. Make sure space is protected and reflected.

127
Q

collaborative rehab for stroke

A 
Stable 12-24 focus shifts to rehab and disability prevention
PT/OT
Speech and Swallow assessment
Case Mgt/Social Worker
Family involvement and education
Rehab facility and/or home care
128
Q

Orthodox Jewish law after death

A

orthodox Jewish law does not allow for anything to be removed from the body after death (if an endotracheal tube or any lines are in place the patient will be buried with them)

129
Q

Extubation death

A

Increased carbon dioxide levels quickly lead to loss of consciousness = peaceful death.

130
Q

dehydration and dying

A

Rather than causing suffering, dehydration can actually help dying patients to achieve a painless death.

-Feeding and hydrating during the actively dying phase can actually cause discomfort.
131
Q

Lazarus sign

A

probably triggered by hypoxia, in which certain spinal motor neurons fire and a brain dead patient may move or even sit up.

Adult 2 (2 decks)

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