Trauma in specialty groups

Question 1

Geriatrics are defined as…

Answer 1

Persons over 65 years of age

Question 2

What are some CNS considerations for geriatric pts?

Answer 2

• Brain atrophy (more space available)
• Slower cognitive functions and reaction times
• More permeable blood-brain barrier (consider therapeutic implications)
• Less recognition of pain and temp stress
• Dementia/cognitive impairment
• Poor thermoregulation

Question 3

What are some cardiovascular considerations for geriatric pts?

Answer 3

• Decreased contractility
• Decreased chronotropic repsonse
• Decreased vasocontriction ability
• Often hypertensive

Question 4

What are some respiratory considerations for geriatric pts?

Answer 4

• Generally less effective
• Reduced compliance
• Cannot increase TV to meet demands
• Decreased O2 diffusion ability

Question 5

What are some gastrointestinal considerations for geriatric pts?

Answer 5

• Less effective (easily malnourished)
• Decreased saliva production
• Decreased oesophageal motility
• Reduced peristalsis (predisposes to constipation)

Question 6

What is an immunological consideration for geriatric pts?

Answer 6

Reduced antibody levels (decreased ability to fight infections)

Question 7

What are some musculoskeletal and integumentary considerations for geriatric pts?

Answer 7

• Reduced bone density
• Muscular atrophy
• Poor skin integrity
• Slower healing

Question 8

What are some medication considerations for geriatric pts?

Answer 8

• Often on anticoagulants, beta-blockers, analgesia, sedatives
• Possibly dependent on long-term medications

Question 9

Paediatrics covers the period of rapid growth and development from the age of ____ to ____.

Answer 9

Birth to 14 years.

Question 10

The age range of a neonate is ____ to ____.

Answer 10

Birth to one month.

Question 11

What are some considerations with neonate pts?

Answer 11

• Easily hyperextended or hyperflexed neck that can occlude airway
• Open fontanelles
• Cartilaginous ribs
• Diaphragmatic and nasal breathers
• Soft cranial bones
• Predisposed to hypothermia

Question 12

The age range of an infant is ____ to ____.

Answer 12

One to twelve months

Question 13

What are some considerations with infant pts?

Answer 13

• Obligatory nose breathers
• Diaphragmatic breathers
• Cartilaginous vocal chords
• Posterior fontanelle closed by 8-10 weeks
• Anterior fontanelle closed by 10-14 weeks
• Underdeveloped cervical structures

Question 14

The age range of a toddler is ____ to ____.

Answer 14

One to three years

Question 15

What are some considerations with toddler pts?

Answer 15

• Small short tracheas
• Thin chest walls
• High centre of gravity (prone to falls)
• Poor thermoregulation

Question 16

What are some considerations with pts aged 4-5?

Answer 16

• Cannot sustain rapid respiratory rate for extended period due to immature intercostal muscles
• Have oxygen requirement twice that of an adult
• Small functional residual capacity (hypoxia can develop rapidly)

Question 17

What is the equation used to calculate tidal volume in paediatric pts?

Answer 17

Tidal volume = 5-7mLs/kg

Question 18

What is the equation used to calculated circulating blood volume of a neonate/infant?

Answer 18

Circulating volume = 90mL/kg

Question 19

What is the equation used to calculated circulating blood volume of a child?

Answer 19

Circulating volume = 80mL/kg

Question 20

What is the equation used to calculated circulating blood volume of an adult?

Answer 20

Circulating volume = 70mL/kg

Question 21

What are the symptoms of shock in a paediatric pt?

Answer 21

• Tachypnoea
• Mottled, cold, pale skin
• Agitation/inconsolable
• Lethargy

Question 22

True or false: distal pulses are an accurate tool in paediatric pts.

Answer 22

False - distal pulses are inaccurate due to vasoconstriction ability.

Question 23

What are some preterminal signs in paediatric pts?

Answer 23

• Silent chest
• Bradycardia <60bpm
• Central capillary refill >2 seconds
• Hypotension
• Lethargy
• Cyanosis/pallor
• Gasping/grunting (indicated medulla involvement)
• C-spine injuries

Question 24

What are the three sides to the paediatric assessment triangle?

Answer 24

Appearance, work of breathing, and circulation to skin.

Question 25

What cardiovascular changes occur in pregnancy?

Answer 25

• Hypervolaemia (plasma volume by 45%, RBC’s by 20%)
• Dilutional anaemia
• Heart rate increases (10-20bpm by term)
• Blood pressure falls (10-15mmHg first two trimesters, normalises by term)
• Heart displacement
• Coagulopathy and DIC
• Increased vasculature in uterus, kidneys, and skin

Question 26

What respiratory changes occur in pregnancy?

Answer 26

• Tidal volume increases by 40%
• Oxygen transfer increases by 40%
• Increased oxygen demand
• Lower oxygen reserve

Question 27

What abdominal changes occur in pregnancy?

Answer 27

• Uterus becomes an abdominal organ

- Bladder, diaphragm, bowel displaced

Question 28

What is supine hypotensive syndrome in pregnant pts?

Answer 28

Gravid uterus on the inferior vena cava impedes venous return.

Question 29

What is placental abruption?

Answer 29

As a result of direct trauma, the placenta may completely or partially shear away from the wall of the uterus

Question 30

What are the signs/symptoms of placental abruption?

Answer 30

• Constant pain
• Rigid uterus
• Contractions/tightening/PV bleeding/haematoma
• Reduced foetal movements

Question 31

What are the signs/symptoms of uterine rupture?

Answer 31

• Extreme pain
• PV bleeding
• Abdominal bruising
• Absent foetal movements
• DIC

Question 32

What is disseminated intravascular coagulation (DIC)?

Answer 32

Pathological activation of coagulation resulting from over-stimulation of blood clotting mechanisms in response to disease/injury/infection/burns/trauma. Small clots form inside vessels throughout the body, exhausting all clotting factors and causing severe haemorrhage and massive blood volume loss.