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test 4 Flashcards

1
Q

shock

A

imbalance between cellular o2 supply and demand.
inadequate tissue perfusion
life threatening response to alterations in circulation

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2
Q

microcirculatory system

A

portion of vascular bed between the arterioles and venules.

functions include:
-delivering o2 and nutrients into the cell
-removing metabolic waste products
-regulating blood volume
-constriction and dilation to regulate blood flow to cells in need of O2 and nutrients

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3
Q

shock pathophys

A

alteration in at least 1 of 4 components:
blood volume
myocardial contractility
blood flow
vascular resistance

if one component isn’t working another one will try to compensate

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4
Q

stage 1 shock: initiation

A

hypoperfusion: inadequate delivery or extraction of o2

no obvious clinical signs

reversible, we want to catch it in this stage

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5
Q

stage 2 shock: compensatory

A

sustained reduction in tissue perfusion

initiation of compensatory measures, often from hyperventilation

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6
Q

stage 3 shock: progressive

A

failure of compensatory mechanisms

profound cardiovascular effects- vasoconstriction, increased lactic acidosis, decreased cardiac output, interstitial edema

pt will show classic signs of shock

THIS STAGE RESPONDS POORLY TO FLUID REPLACEMENT

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7
Q

Stage 4 shock: refractory

A

prolonged inadequate tissue perfusion. organs begin failing

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8
Q

systemic inflammatory response syndrome (SIRS)

A

widespread systemic inflammatory response

most frequently associated with sepsis, but could be infection, trauma, shock, pancreatitis, ischemia

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9
Q

shock assessment- neuro

A

initially anxiety/restlessness, then coma

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10
Q

cardio shock assessment

A

tachycardia, hypotension

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11
Q

pulmonary shock assessment

A

early- rapid, deep respirations
later- shallow rr, poor gas exchange

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12
Q

shock hematology/integumentary assessment

A

DIC

cyanosis, temp

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13
Q

GI/liver shock assessment

A

slow intestinal activity

altered liver enzymes, clotting disorders, increased susceptibility to infection, inability to detox meds

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14
Q

serum lactate levels

A

measure of overall state of shock

indicator of decreased o2 to cells

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15
Q

general management of shock

A

treat underlying cause, fluids, pharmacotherapy, mechanical therapy, minimize o2 consumption

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16
Q

hypovolemic shock

A

inadequate intravascular blood volume

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17
Q

cardiogenic shock

A

heart fails to act as an effective pump

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18
Q

obstructive shock

A

physical impairment to adequate circulating blood flow

s/s- Chest pain, hypoxia, dyspnea, jugular vein distention

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19
Q

distributive shock

A

3 types: neurogenic, anaphylactic, septic

widespread vasodilation and decreased vascular tone resulting in a relative hypovolemia

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20
Q

hypovolemic shock management

A

eliminate underlying cause
fluids
blood
MAP 65-70
monitor lab values

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21
Q

cardiogenic shock management

A

decrease preload- diuretics, venous vasodilation
increase cardiac output
decrease afterload

Promote contractibility, decrease o2 demand, increase o2 supply

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22
Q

management of obstructive shock

A

treat the cause

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23
Q

disruptive shock- Neurogenic

A

interruption of sympathetic nervous system impulse

causes- upper spinal cord injury, spinal anesthesia, nervous system damage, vasomotor depression

s/s- BRADYCARDIA, hypotension, hypothermia

treatment- IV fluids, rewarm, vasopressors, immobilization of spinal injuries

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24
Q

distributive shock- anaphylactic

A

introduction of an antigen into a sensitive individual
caused by severe allergic reaction

treatment- epi, Benadryl, fluid

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25
distributive shock- septic
from microorganisms management=prevention treatment- abx, glycemic control, temp control
26
multiple organ dysfunction syndrome (MODS)
progressive dysfunction of 2 or more organ systems commonly caused by sepsis organs severely affected- lungs, splanchnic bed, liver, kidneys
27
MODS S/S
tachypnea/hypoxemia petechiae/bleeding jaundice abdominal distention oliguria-anuria tachycardia hypotension change in LOC pulmonary is affected first
28
MODS treatment
abx provide adequate tissue o2 support organ function
29
level 1 trauma
highest level of trauma
30
level 2 trauma
can take trauma but may transfer to level 1 if needed
31
level 3 trauma
community hospital, no trauma
32
level 4 trauma
can do ACLS, will stabilize then transfer
33
prevention
primary- preventing the event, ie; speed limits secondary- minimize the impact of the traumatic event, ie; helmet, seatbelt teritary- maximize pt outcomes after a traumatic event through emergency response teams
34
golden hour in trauma
first hour of emergent care, focusing on rapid assessment, resuscitation, and treatment
35
mass casualty incident triage
black tag- pts who are not breathing red tag- pts who are actively dying but could be saved, critical condition- treat first yellow tag- pts probably have a hour or so, actively dying but more stable then red tags green tags- no immediate treatment until others are treated
36
blunt trauma
Level of impact- sports, MVA, falls
37
penetrating trauma
impalement of foreign objects in body the higher the velocity the higher the force
38
blast trauma
caused by explosive force tissue and organ injury gas containing organs- eardrums, lungs, intestines
39
primary survey for trauma
done in 1-2 mins Airway Breathing circulation disability expose pt, warm identify life threatening injuries
40
secondary survey
SAMPLE- s/s, allergy, meds, past med history, last time eat, events leading up to cause full vitals, comfort measures, head to toe, labs, scans
41
tension pneumothorax intervention
needle decompression, chest tube
42
pneumothorax intervention
chest tube
43
open chest wound intervention
seal the wound on 3 sides prepare for chest tube insertion
44
pulmonary contusion intervention
early intubation, mechanical ventilation
45
frail chest
from broken ribs early intubation and mechanical ventilation
46
spinal cord injury intervention
avoid movement of neck and immobilize observe RR and accessory muscle use monitor for signs of neurogenic shock (bradycardia, hypotension)
47
decreased level of consciousness interventions
raise HOB CT to rule out stroke intubation and mechanical vent
48
intraosseous procedure (IO)
in bone marrow only in emergency situations when they can't get in IV or central lines this can only stay in for 24 hours
49
ongoing s/s of shock
tachycardia, tachypnea narrowing pulse pressure falling Pa02 (less than 60) decreasing urine output increased serum lactate levels falling hematocrit
50
Massive fluid protocol/resuscitation (MTP)
large amount of blood in a small amount of time. If pt is getting this its very concerning and they are near death
51
Hypothermia complications
myocardial dysfunction, dysrhythmias, coagulopathies, reduced perfusion, decreased metabolic rate
52
what do we want cerebral contusion pressure at
above 50 mm Hg
53
what shock to think of with spinal cord injury
neurogenic. vasopressors may be needed
54
basilar skull fracture
Raccoon eyes, CSF leakage, battle sign, halo sign base of cranium involving 5 bones don't use nasopharyngeal airway for this
55
cardiac temponade
bleeding into pericardial space. Pressure eventually stops heart. Drops Cardiac output s/s- low o2, restlessness, low bp, dizziness, tachycardia treatment- pericardiocentresis Becks triad- JVD, hypotension, muffled heart sounds
56
aortic disruption
life threatening injury requiring emergency surgery s/s- weak pulses, pain, hoarseness
57
tension pneumothorax
increased pressures cause compression of heart and great vessels, cardiovascular collapse
58
hemothorax
blood in pleural space will cause hypotension and resp distress chest tube needed, monitor blood volume output
59
open pneumothorax
air in pleural space hypoxia and hemodynamic instability 3 side occlusion dressing, chest tube
60
pulmonary contusion
bruising of lung tissue ultimately leads to ARDS long term mechanical ventilation needed
61
compartment syndrome 5 Ps
pain pallor pulses paresthesia paralysis
62
rhabdomylosis
muscle breakdown- increased myoglobin and potassium can result in AKI we want IV fluids to cause UO above 100 mL/hr
63
fat embolism
Fat can be released from bone marrow after fracture and travels to pulmonary circulation occurs 1-3 days after fracture s/s- resp distress, petechial rash, decreased LOC No definite treatment
64
DIC
Microthrombi, then body can't clot then will bleed out. high mortality rate
65
damage control surgery
First surgery is only for stabilization then they will eventually come back and do repairs
66
highest morbidity of burns
burns covering more then 50% of body inhalation injuries very young and elderly pts
67
first thing to do w chemical burn
remove the agent
68
what can electric burn effect
heart rhythm
69
when does mx edema occur post burn
24-48 hours
70
when to give fluids to burn pts
if more then 20% TBSA is burned give 4 mL/% admin half of fluids over 8 hours, then other half over 16 hours
71
what do we want to prevent in burns
infections
72
if pt has facial burns, how often do we give oral care
q4h
73
grafts
biological- from your skin biosynthetic- from lab. more likely to reject used for partial thickness and full thickness burns
74
sole source of energy for cerebral metabolism
glucose
75
how many segments in spinal cord
31
76
Glasgow coma
eye opening, verbal response, motor response best score 15 comatose 8 near death 3
77
normal ICP
0-15 mmHg
78
normal cerebral perfusion (CPP)
CPP= MAP-ICP Normal: 60-100
79
cushings triad
set of signs indicative to ICP elevated systolic BP widening pulse pressure bradycardia irreg respirations
80
most common ICP monitor
ventricular
81
nursing management in ICP
HOB elevated don't suction unless needed cluster care decrease stimulation control BP
82
targeted temp control
When they induce hypothermia on a pt to help the body rest and heal
83
basilar fracture
raccoon eyes/battle sign bruising behind ears runny nose fluid from ears
83
what is the worst TBI
Contusion
84
stroke types
ischemic- from clot hemorrhagic - from bleed
85
stroke management
immediate CT 2 IVS ABC blood sugar- make sure its not hyperglycemia manage BP
85
BEFAST
balance eyes face arms speech time
86
drug for ischemia less then 3 hours of symptoms
tPA TNK- not yet approved
87
subarachnoid hemmorhage
Usually from aneurysm. Treated by clipping or coiling "worst headache of my life"
88
status epilectus
Continuously having seizures First drug given is Ativan, then Keppra assess BG, Neuro, resp, cardio
89
bacterial meningitis
stiff neck, headache, petechial rash, photophobia, fever, vomitting positive kernig sign, positive brudzinski sign dx by lumbar test abx, neuro checks, droplet isolation, seizure precautions, anti-pyretic
90
spinal shock vs neurogenic
Spinal shock- electrical silence below injury Neurogenic shock- loose autonomic function both: Maintain good BP function, monitor breathing, temp, bowel and bladder function drug: Solu-Medrol. insulin will be needed with this
91
what happens if auto-regulation is lost
hypertension increasing cerebral blood flow

critical care (4 decks)

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