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Med Surg II - Exam 3 > Trauma & Shock > Flashcards

Trauma & Shock Flashcards

1
Q

Which fluid solution most closely resembles the composition of plasma?

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A

Lactated Ringers (LR)

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2
Q

Primary Survey with Resuscitation (ABCs of Trauma)

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A

Airway maintenance
* with C-spine protection

Breathing & ventilation

Circulation

Da neuro
* obtain Glasow Coma Scale (GCS) & repeat regularly

Exposure
* expose entire patient
* remove clothing so an injury isn’t missed

Farenheit
* control temperature & enviornment

Get vital signs & tubes
* NG, foley, etc.

History

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3
Q

When there is a risk of C-spine injury, how can a clear upper airway be established?

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A

jaw thrust or chin lift

  • in combination with manual in-line stabilization (MILS) of the head & neck by an assistant
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4
Q

What is involved in a secondary survey of a trauma patient?

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A

Allergies
Medications
Past illnesses
Last meal
Events / environment

  • head-to-toe exam
  • full set of vitals
  • complete diagnostic & radiologic exams
  • emotional support
  • pain management
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5
Q

What is the trauma triad of death? (Also known as: trauma triad of death)

A

1.) Coagulopathy
* coagulation factors are not working = ↑ bleeding

2.) Metabolic Acidosis
* due to lactic acid build up
* pH < 7.35 – (pH less than 7.35)
* HCO3 < 22 – HCO3 less than 22)

3.) Hypothermia
* caused by lak of perfusion & lack of cardiac output

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6
Q

What is the hallmark sign of compartment syndrome?

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A

unrelenting pain

pain out of proportion to the original injury

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6
Q

What is the treatment for compartment syndrome?

A

fasciotomy

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7
Q

Compartment Syndrome
* Signs
* Treatment

A

Unrelenting Pain (pain out of proportion to injury)

Tx = fasciotomy

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8
Q

Signs & Symptoms of Fat Embolism Syndrome (FES)

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A
  • Respiratory failure
  • Cerebral dysfunction
  • Skin petechiae (does not blanch)

Occurs within a few hours - up to 3-4 days

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9
Q

What is the most common location of rupture in the aorta?

A

Ligamentum arteriosum

  • due to blunt force trauma
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10
Q

If a patient has a L rib fracture between ribs 10-12, what injury should you be concerned about?

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A

Spleenic injury

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11
Q

What is a pneumothorax?

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A

Accumulation of air in the pleural space

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12
Q

What are the signs & symptoms of a pneumothorax?

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A
  • Hyperresonance on injured side
  • Decreased or absent breath sounds on the injured side
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13
Q

What is a pneumothorax & what are the signs & symptoms associated with it?

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A

Accumulation of air in the pleural space

S/S:
* Hyperresonance on injured side
* Decreased / absent breath sounds on injured side

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14
Q

What is a Tension Pneumothorax?

A

air collects in the pleural space on inspiration, but cannot escape on expiration

  • compromises respiration

collapsed lung

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15
Q

What are the signs & symptoms of a tension pneumothorax?

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A

Tracheal deviation - shift of trachea toward the uninjured side

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16
Q

What is a hemothorax?

A

accumulation of blood in pleural space

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17
Q

What are signs & symptoms of a hemothorax?

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A
  • Signs of shock
  • Decreased (↓) breath soudns on the injured side
  • Dullness to percussion of the injured side
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18
Q

What is pericardial tamponade?

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A

Collection of blood in the pericardial sac

  • usually due to a penetrating injury
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19
Q

What are the signs & symptoms of pericardial tamponade?

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A

Beck’s Triad
* Distended jugular veins (+ JVD)
* muffled heart sounds
* hypotension

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20
Q

What does pericardial tamponade lead to?

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A
  • Impaired diastolic filling
  • ↓ stroke volume
  • ↓ cardiac output
  • Narrowing pulse pressure
21
Q

1.) What is Pericardial Tamponade?

2.) What are the signs & symptoms of pericardial / cardiac tamponade?

3.) What can pericardial / cardiac tamponade result in?

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A

1.) Collection of blood in pericardial sac

2.) S/S = Beck’s Triad
* distended jugular veins
* muffled heart sounds
* hypotension (widening pulse pressure)

3.) Can lead to:
* impaired diastolic filling
* ↓ stroke volume
* ↓ cardiac output
* narrowing pulse pressure

22
Q

What is pulsus paradoxus?

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A

exaggerated fall in SBP during inspiration (greater than 10)

  • fall of 2-4 mmHg is normal
23
Q

Which nerve innervates the diaphragm?

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A

phrenic nerve

24
Q

Patients with a spine fracture in what location will need asistance with most ADLs?

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A

C5-C6

25
Q

Pataients with a fracture of the spine in what location can complete most of their ADLs independently?

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A

C7

26
Q

What types of shock can a patient with a spinal cord injury experience?

A
  • Neurogenic shock
  • Spinal shock
27
Q

Signs & Symptoms of Neurogenic Shock

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A
  • Hypotension (↓ BP)
  • Bradycardia (↓ HR)
  • Vasodilation

(HBV)

28
Q

What is neurogenic shock?

A
  • loss of sympathetic tone
  • BRADYCARDIA
  • cushing’s triad
    * wide pulse pressure
    * bradycardia
    * irregular respirations

Loss of vasomotor tone & sympathetic innervation to the heart

29
Q

What is the difference between neurogenic & hypovolemic shock?

A

Neurogenic shock = bradycardia

Hypovolemic shock = tachycardia

30
Q

What is autonomic dysreflexia?

A

overreaction of ANS

  • can cause ↓ HR, ↓ BP, pounding headache, ↑ sweating, bowel or bladder problems, etc.
31
Q

When do fat embolisms often occur? What is a fat embolism?

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A
  • Often occur as a result of long-bone fractures
  • Non-blanching skin petechiae
32
Q

Which part of the aorta is most vulnerable to injury?

A

proximal aorta

33
Q

What are the 3 types of Distributive Shock?

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A
  • Neurogenic
  • Anaphylactic
  • Septic

SAND = Septic Anaphylactic Neurogenic Distributive

34
Q

What is hypovolemic shock?

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A
  • Decreased (↓) preload (inadequate fluid volume in intravascular space)
  • Decreased (↓) tissue perfusion
35
Q

Signs & Symptoms of hypovolemic shock

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A
  • Cool, clammy skin
  • Anxiety or agitation
  • Confusion
  • ↓ urine output
  • ↑ RR
  • ↑ HR
  • pale skin

  • leads to ↑ ADH (in attempt to retain water) & ↑ thirst
36
Q

What is cardiogenic shock?

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A

failure of the heart to pump effectively

  • ↓ stroke volume
  • ↓ cardiac output
  • ↓ tissue perfusion (impaired)

Can be caused by:
* MI
* Acute Coronary Syndrome
* overdose
* myocarditis

37
Q

Signs & Symptoms of Cardiogenic Shock

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A

Respiratory alkalosis
* attempting to improve oxygenation

Rales (crackles)
Rhonchi
CVP > 15

Hypoxemia is end result as systems fail at compensating
* metabolic acidosis
* renal failure
* cerebral hypoperfusion

38
Q

What is obstructive shock?

A

inability for the heart to pump adequately despite normal intravascular volume & cardiac function

39
Q

What are 3 potential causes (etiologies) of obstructive shock?

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A
  • Cardiac tamponade
  • Massive pulmonary embolism
  • Tension pneumothorax
40
Q

Signs and symptoms of obstructive shock based on the etiology

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A

Cardiac Tamponade:
* muffled heart sounds
* + JVD
* Paradoxical pulse

Tension Pneumothorax
* ↓ or absent breath sounds on affected side
* Hyperresonance on percussion of affected side
* Tracheal deviation AWAY from affected side

41
Q

What is neurogenic shock?What s/s are associated with it?

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A
  • los sof sympathetic tone

S/S
* profound hypotension (requires vasopressors)
* bradycardia (↓ HR)

due to a spinal cord injury

42
Q

What is anaphylactic shock? What are the associated signs & symptoms? What is the treatment?

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A

antigen/antibody reaction

S/S:
* Vasodilation
* ↑ capillary membrane permeability
* ↓ venous return

Tx: 1:1,000 epinephrien IM or SQ

43
Q

What is the usual cause of septic shock? What are the associated signs & symptoms?

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A

Distribution of infection / bacteria

S/S:
* warm, flushed skin
* tachycardia (↑ HR)
* respiratory alkalosis (from ↑ RR)
* confusion

44
Q

What is the difference in primary and secondary Multi Organ Dysfunction Syndrome (MODS)?

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A

Primary MODS: caused by initial disease or infectious process resulting in injury to an organ system

Secondary MODS: organ dysfunction caused by widespread systemic inflammation or sepsis
* results in dysfunction of organs NOT involved in the initial insult / injury

  • Primary = clear original insult that led to injury of organ system(s)
  • Secondary = SIRS or Sepsis
45
Q

What is Disseminated Intravascular Coagulation (DIC)?

Know this

A

Blood clots throughout the body due to overactivation of coagulation proteins

46
Q

What happens to the following labs in Disseminated Intravascular Coagulation (DIC)?

  • Platelets
  • PT
  • aPTT
  • Fibrinogen

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A
  • ↓ Platelets
  • ↑ PT
  • ↑ aPTT
  • ↓ Fibrinogen
47
Q

List potential caues / eitiologies of Disseminated Intravascular Coagulation (DIC).

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A
  • Massive transfusions
  • Hypothermia (due to recent surgery)
  • Trauma (burns)
48
Q

What is the difference in Systemic Inflammatory Response Syndrome (SIRS) & Sepsis?

**

A

Sepsis is ALWAYS SIRS, but SIRS is NOT always sepsis

49
Q

What is Systemic Inflammatory Response Syndrome (SIRS)?

A

similar response to sepsis but caused by a stressor like trauma, infection, burns, pancreatitis, ischemia, etc.

50
Q

What is the diagnostic criteria for Systemic Inflammatory Response Syndrome (SIRS)?

A

Must have 2 or more of the following clinical manifestations:
* Fever or hypothermia
* Elevated or decreased WBCs
* Tachycardia – HR over 90 (↑ HR)
* Tachypnea (↑ RR)

Med Surg II - Exam 3 (9 decks)

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