Trauma & Shock Flashcards
Which fluid solution most closely resembles the composition of plasma?
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Lactated Ringers (LR)
Primary Survey with Resuscitation (ABCs of Trauma)
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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
When there is a risk of C-spine injury, how can a clear upper airway be established?
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jaw thrust or chin lift
- in combination with manual in-line stabilization (MILS) of the head & neck by an assistant
What is involved in a secondary survey of a trauma patient?
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Allergies
Medications
Past illnesses
Last meal
Events / environment
- head-to-toe exam
- full set of vitals
- complete diagnostic & radiologic exams
- emotional support
- pain management
What is the trauma triad of death? (Also known as: trauma triad of death)
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
What is the hallmark sign of compartment syndrome?
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unrelenting pain
pain out of proportion to the original injury
What is the treatment for compartment syndrome?
fasciotomy
Compartment Syndrome
* Signs
* Treatment
Unrelenting Pain (pain out of proportion to injury)
Tx = fasciotomy
Signs & Symptoms of Fat Embolism Syndrome (FES)
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- Respiratory failure
- Cerebral dysfunction
- Skin petechiae (does not blanch)
Occurs within a few hours - up to 3-4 days
What is the most common location of rupture in the aorta?
Ligamentum arteriosum
- due to blunt force trauma
If a patient has a L rib fracture between ribs 10-12, what injury should you be concerned about?
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Spleenic injury
What is a pneumothorax?
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Accumulation of air in the pleural space
What are the signs & symptoms of a pneumothorax?
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- Hyperresonance on injured side
- Decreased or absent breath sounds on the injured side
What is a pneumothorax & what are the signs & symptoms associated with it?
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Accumulation of air in the pleural space
S/S:
* Hyperresonance on injured side
* Decreased / absent breath sounds on injured side
What is a Tension Pneumothorax?
air collects in the pleural space on inspiration, but cannot escape on expiration
- compromises respiration
collapsed lung
What are the signs & symptoms of a tension pneumothorax?
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Tracheal deviation - shift of trachea toward the uninjured side
What is a hemothorax?
accumulation of blood in pleural space
What are signs & symptoms of a hemothorax?
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- Signs of shock
- Decreased (↓) breath soudns on the injured side
- Dullness to percussion of the injured side
What is pericardial tamponade?
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Collection of blood in the pericardial sac
- usually due to a penetrating injury
What are the signs & symptoms of pericardial tamponade?
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Beck’s Triad
* Distended jugular veins (+ JVD)
* muffled heart sounds
* hypotension
What does pericardial tamponade lead to?
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- Impaired diastolic filling
- ↓ stroke volume
- ↓ cardiac output
- Narrowing pulse pressure
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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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
What is pulsus paradoxus?
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exaggerated fall in SBP during inspiration (greater than 10)
- fall of 2-4 mmHg is normal
Which nerve innervates the diaphragm?
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phrenic nerve
Patients with a spine fracture in what location will need asistance with most ADLs?
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C5-C6
Pataients with a fracture of the spine in what location can complete most of their ADLs independently?
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C7
What types of shock can a patient with a spinal cord injury experience?
- Neurogenic shock
- Spinal shock
Signs & Symptoms of Neurogenic Shock
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- Hypotension (↓ BP)
- Bradycardia (↓ HR)
- Vasodilation
(HBV)
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
What is the difference between neurogenic & hypovolemic shock?
Neurogenic shock = bradycardia
Hypovolemic shock = tachycardia
What is autonomic dysreflexia?
overreaction of ANS
- can cause ↓ HR, ↓ BP, pounding headache, ↑ sweating, bowel or bladder problems, etc.
When do fat embolisms often occur? What is a fat embolism?
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- Often occur as a result of long-bone fractures
- Non-blanching skin petechiae
Which part of the aorta is most vulnerable to injury?
proximal aorta
What are the 3 types of Distributive Shock?
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- Neurogenic
- Anaphylactic
- Septic
SAND = Septic Anaphylactic Neurogenic Distributive
What is hypovolemic shock?
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- Decreased (↓) preload (inadequate fluid volume in intravascular space)
- Decreased (↓) tissue perfusion
Signs & Symptoms of hypovolemic shock
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- Cool, clammy skin
- Anxiety or agitation
- Confusion
- ↓ urine output
- ↑ RR
- ↑ HR
- pale skin
- leads to ↑ ADH (in attempt to retain water) & ↑ thirst
What is cardiogenic shock?
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failure of the heart to pump effectively
- ↓ stroke volume
- ↓ cardiac output
- ↓ tissue perfusion (impaired)
Can be caused by:
* MI
* Acute Coronary Syndrome
* overdose
* myocarditis
Signs & Symptoms of Cardiogenic Shock
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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
What is obstructive shock?
inability for the heart to pump adequately despite normal intravascular volume & cardiac function
What are 3 potential causes (etiologies) of obstructive shock?
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- Cardiac tamponade
- Massive pulmonary embolism
- Tension pneumothorax
Signs and symptoms of obstructive shock based on the etiology
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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
What is neurogenic shock?What s/s are associated with it?
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- los sof sympathetic tone
S/S
* profound hypotension (requires vasopressors)
* bradycardia (↓ HR)
due to a spinal cord injury
What is anaphylactic shock? What are the associated signs & symptoms? What is the treatment?
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antigen/antibody reaction
S/S:
* Vasodilation
* ↑ capillary membrane permeability
* ↓ venous return
Tx: 1:1,000 epinephrien IM or SQ
What is the usual cause of septic shock? What are the associated signs & symptoms?
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Distribution of infection / bacteria
S/S:
* warm, flushed skin
* tachycardia (↑ HR)
* respiratory alkalosis (from ↑ RR)
* confusion
What is the difference in primary and secondary Multi Organ Dysfunction Syndrome (MODS)?
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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
What is Disseminated Intravascular Coagulation (DIC)?
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Blood clots throughout the body due to overactivation of coagulation proteins
What happens to the following labs in Disseminated Intravascular Coagulation (DIC)?
- Platelets
- PT
- aPTT
- Fibrinogen
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- ↓ Platelets
- ↑ PT
- ↑ aPTT
- ↓ Fibrinogen
List potential caues / eitiologies of Disseminated Intravascular Coagulation (DIC).
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- Massive transfusions
- Hypothermia (due to recent surgery)
- Trauma (burns)
What is the difference in Systemic Inflammatory Response Syndrome (SIRS) & Sepsis?
**
Sepsis is ALWAYS SIRS, but SIRS is NOT always sepsis
What is Systemic Inflammatory Response Syndrome (SIRS)?
similar response to sepsis but caused by a stressor like trauma, infection, burns, pancreatitis, ischemia, etc.
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)
