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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
**Patients with a spine fracture in what location will need asistance with most ADLs?** | **KNOW THIS!!!! IN RED!**
C5-C6
25
**Pataients with a fracture of the spine in what location can complete most of their ADLs independently?** | **KNOW THIS!!!!! IN RED!**
**C7**
26
**What types of shock can a patient with a spinal cord injury experience?**
* Neurogenic shock * Spinal shock
27
**Signs & Symptoms of Neurogenic Shock** | **KNOW THIS!!!!! IN RED!**
* **H**ypotension (↓ BP) * **B**radycardia (↓ HR) * **V**asodilation **(HBV)**
28
**What is neurogenic shock?**
* **loss of sympathetic tone** * **BRADYCARDIA** * **cushing's triad** * wide pulse pressure * bradycardia * irregular respirations Loss of vasomotor tone & sympathetic innervation to the heart
29
**What is the difference between neurogenic & hypovolemic shock?**
Neurogenic shock = bradycardia Hypovolemic shock = tachycardia
30
**What is autonomic dysreflexia?**
overreaction of ANS * can cause ↓ HR, ↓ BP, *pounding headache*, ↑ sweating, bowel or bladder problems, etc.
31
**When do fat embolisms often occur? What is a fat embolism?** | **KNOW THIS!!!!**
* Often occur as a result of **long-bone fractures** * **Non-blanching skin petechiae**
32
**Which part of the aorta is most vulnerable to injury?**
**proximal aorta**
33
**What are the 3 types of Distributive Shock?** | **KNOW THIS!!!!!!!!! IN RED!!!!**
* **Neurogenic** * **Anaphylactic** * **Septic** ## Footnote **SAND = S**eptic **A**naphylactic **N**eurogenic **D***istributive*
34
**What is hypovolemic shock?** | **KNOW THIS!!!!! IN RED!!**
* **Decreased (↓) preload** (inadequate fluid volume in intravascular space) * **Decreased (↓) tissue perfusion**
35
**Signs & Symptoms of hypovolemic shock** | **KNOW THIS!!!!**
* Cool, clammy skin * Anxiety or agitation * Confusion * ↓ urine output * ↑ RR * ↑ HR * pale skin ## Footnote * leads to ↑ ADH (in attempt to retain water) & ↑ thirst
36
**What is cardiogenic shock?** | **KNOW THIS!!!!! IN RED!**
**failure of the heart to pump effectively** * ↓ stroke volume * ↓ cardiac output * ↓ tissue perfusion (impaired) ## Footnote Can be caused by: * *MI* * *Acute Coronary Syndrome* * *overdose* * *myocarditis*
37
**Signs & Symptoms of Cardiogenic Shock** | **KNOW THIS!!!!! IN RED!**
**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
**What is obstructive shock?**
inability for the heart to pump adequately despite normal intravascular volume & cardiac function
39
**What are 3 potential causes (etiologies) of obstructive shock?** | **KNOW THIS!!!!!!! IN RED!!!!!**
* **Cardiac tamponade** * **Massive pulmonary embolism** * **Tension pneumothorax**
40
**Signs and symptoms of obstructive shock based on the etiology** | **KNOW THIS!!!!! IN RED!!!!**
**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
**What is neurogenic shock?What s/s are associated with it?** | **KNOW THIS!!!! IN RED!!**
* los sof sympathetic tone **S/S** * **profound hypotension** (requires vasopressors) * **bradycardia (↓ HR)** due to a spinal cord injury
42
**What is anaphylactic shock? What are the associated signs & symptoms? What is the treatment?** | **KNOW THIS!!!!! IN RED!!**
antigen/antibody reaction **S/S:** * **Vasodilation** * **↑ capillary membrane permeability** * **↓ venous return** *Tx:* 1:1,000 epinephrien IM or SQ
43
**What is the usual cause of septic shock? What are the associated signs & symptoms?** | **KNOW THIS!!!!! IN RED!!**
Distribution of infection / bacteria **S/S:** * **warm, flushed skin** * **tachycardia (↑ HR)** * **respiratory alkalosis** (from ↑ RR) * **confusion**
44
**What is the difference in primary and secondary Multi Organ Dysfunction Syndrome (MODS)?** | **KNOW THIS!!!!!! IN RED!!!!**
**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 ## Footnote * **Primary =** clear original insult that led to injury of organ system(s) * **S**econdary = **S**IRS or **S**epsis
45
**What is Disseminated Intravascular Coagulation (DIC)?** | **Know this**
**Blood clots throughout the body due to overactivation of coagulation proteins**
46
**What happens to the following labs in Disseminated Intravascular Coagulation (DIC)?** * **Platelets** * **PT** * **aPTT** * **Fibrinogen** | **KNOW THIS!!!!! IN RED!!!!**
* **↓ Platelets** * **↑ PT** * **↑ aPTT** * **↓ Fibrinogen**
47
**List potential caues / eitiologies of Disseminated Intravascular Coagulation (DIC).** | **KNOW THIS!!!! IN RED!!!**
* **Massive transfusions** * **Hypothermia** (due to recent surgery) * **Trauma** (burns)
48
**What is the difference in Systemic Inflammatory Response Syndrome (SIRS) & Sepsis?** | ****
Sepsis is **ALWAYS** SIRS, but SIRS is *NOT* always sepsis
49
**What is Systemic Inflammatory Response Syndrome (SIRS)?**
similar response to sepsis but caused by a stressor like trauma, infection, burns, pancreatitis, ischemia, etc.
50
**What is the diagnostic criteria for Systemic Inflammatory Response Syndrome (SIRS)?**
**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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