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critical care > test 4 > Flashcards

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
Q

distributive shock- septic

A

from microorganisms

management=prevention

treatment- abx, glycemic control, temp control

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26
Q

multiple organ dysfunction syndrome (MODS)

A

progressive dysfunction of 2 or more organ systems

commonly caused by sepsis

organs severely affected- lungs, splanchnic bed, liver, kidneys

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27
Q

MODS S/S

A

tachypnea/hypoxemia
petechiae/bleeding
jaundice
abdominal distention
oliguria-anuria
tachycardia
hypotension
change in LOC

pulmonary is affected first

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28
Q

MODS treatment

A

abx
provide adequate tissue o2
support organ function

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29
Q

level 1 trauma

A

highest level of trauma

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30
Q

level 2 trauma

A

can take trauma but may transfer to level 1 if needed

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31
Q

level 3 trauma

A

community hospital, no trauma

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32
Q

level 4 trauma

A

can do ACLS, will stabilize then transfer

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33
Q

prevention

A

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

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34
Q

golden hour in trauma

A

first hour of emergent care, focusing on rapid assessment, resuscitation, and treatment

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35
Q

mass casualty incident triage

A

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

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36
Q

blunt trauma

A

Level of impact- sports, MVA, falls

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37
Q

penetrating trauma

A

impalement of foreign objects in body

the higher the velocity the higher the force

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38
Q

blast trauma

A

caused by explosive force

tissue and organ injury
gas containing organs- eardrums, lungs, intestines

39
Q

primary survey for trauma

A

done in 1-2 mins

Airway
Breathing
circulation
disability
expose pt, warm

identify life threatening injuries

40
Q

secondary survey

A

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
Q

tension pneumothorax intervention

A

needle decompression, chest tube

42
Q

pneumothorax intervention

A

chest tube

43
Q

open chest wound intervention

A

seal the wound on 3 sides
prepare for chest tube insertion

44
Q

pulmonary contusion intervention

A

early intubation, mechanical ventilation

45
Q

frail chest

A

from broken ribs

early intubation and mechanical ventilation

46
Q

spinal cord injury intervention

A

avoid movement of neck and immobilize
observe RR and accessory muscle use
monitor for signs of neurogenic shock (bradycardia, hypotension)

47
Q

decreased level of consciousness interventions

A

raise HOB
CT to rule out stroke
intubation and mechanical vent

48
Q

intraosseous procedure (IO)

A

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
Q

ongoing s/s of shock

A

tachycardia, tachypnea
narrowing pulse pressure
falling Pa02 (less than 60)
decreasing urine output
increased serum lactate levels
falling hematocrit

50
Q

Massive fluid protocol/resuscitation (MTP)

A

large amount of blood in a small amount of time. If pt is getting this its very concerning and they are near death

51
Q

Hypothermia complications

A

myocardial dysfunction, dysrhythmias, coagulopathies, reduced perfusion, decreased metabolic rate

52
Q

what do we want cerebral contusion pressure at

A

above 50 mm Hg

53
Q

what shock to think of with spinal cord injury

A

neurogenic. vasopressors may be needed

54
Q

basilar skull fracture

A

Raccoon eyes, CSF leakage, battle sign, halo sign

base of cranium involving 5 bones

don’t use nasopharyngeal airway for this

55
Q

cardiac temponade

A

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
Q

aortic disruption

A

life threatening injury requiring emergency surgery

s/s- weak pulses, pain, hoarseness

57
Q

tension pneumothorax

A

increased pressures cause compression of heart and great vessels, cardiovascular collapse

58
Q

hemothorax

A

blood in pleural space
will cause hypotension and resp distress

chest tube needed, monitor blood volume output

59
Q

open pneumothorax

A

air in pleural space

hypoxia and hemodynamic instability

3 side occlusion dressing, chest tube

60
Q

pulmonary contusion

A

bruising of lung tissue ultimately leads to ARDS
long term mechanical ventilation needed

61
Q

compartment syndrome 5 Ps

A

pain
pallor
pulses
paresthesia
paralysis

62
Q

rhabdomylosis

A

muscle breakdown- increased myoglobin and potassium

can result in AKI

we want IV fluids to cause UO above 100 mL/hr

63
Q

fat embolism

A

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
Q

DIC

A

Microthrombi, then body can’t clot then will bleed out.

high mortality rate

65
Q

damage control surgery

A

First surgery is only for stabilization then they will eventually come back and do repairs

66
Q

highest morbidity of burns

A

burns covering more then 50% of body
inhalation injuries
very young and elderly pts

67
Q

first thing to do w chemical burn

A

remove the agent

68
Q

what can electric burn effect

A

heart rhythm

69
Q

when does mx edema occur post burn

A

24-48 hours

70
Q

when to give fluids to burn pts

A

if more then 20% TBSA is burned

give 4 mL/%
admin half of fluids over 8 hours, then other half over 16 hours

71
Q

what do we want to prevent in burns

A

infections

72
Q

if pt has facial burns, how often do we give oral care

A

q4h

73
Q

grafts

A

biological- from your skin

biosynthetic- from lab. more likely to reject

used for partial thickness and full thickness burns

74
Q

sole source of energy for cerebral metabolism

A

glucose

75
Q

how many segments in spinal cord

A

31

76
Q

Glasgow coma

A

eye opening, verbal response, motor response

best score 15
comatose 8
near death 3

77
Q

normal ICP

A

0-15 mmHg

78
Q

normal cerebral perfusion (CPP)

A

CPP= MAP-ICP

Normal: 60-100

79
Q

cushings triad

A

set of signs indicative to ICP

elevated systolic BP
widening pulse pressure
bradycardia
irreg respirations

80
Q

most common ICP monitor

A

ventricular

81
Q

nursing management in ICP

A

HOB elevated
don’t suction unless needed
cluster care
decrease stimulation
control BP

82
Q

targeted temp control

A

When they induce hypothermia on a pt to help the body rest and heal

83
Q

basilar fracture

A

raccoon eyes/battle sign
bruising behind ears
runny nose
fluid from ears

83
Q

what is the worst TBI

A

Contusion

84
Q

stroke types

A

ischemic- from clot
hemorrhagic - from bleed

85
Q

stroke management

A

immediate CT
2 IVS
ABC
blood sugar- make sure its not hyperglycemia
manage BP

85
Q

BEFAST

A

balance
eyes
face
arms
speech
time

86
Q

drug for ischemia less then 3 hours of symptoms

A

tPA
TNK- not yet approved

87
Q

subarachnoid hemmorhage

A

Usually from aneurysm. Treated by clipping or coiling

“worst headache of my life”

88
Q

status epilectus

A

Continuously having seizures

First drug given is Ativan, then Keppra

assess BG, Neuro, resp, cardio

89
Q

bacterial meningitis

A

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
Q

spinal shock vs neurogenic

A

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
Q

what happens if auto-regulation is lost

A

hypertension increasing cerebral blood flow

critical care (4 decks)

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