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401 > Unit 2 > Flashcards

Unit 2 Flashcards

1
Q

Shock

A
  • Inadequate tissue perfusion
  • Progression is neither liner, nor predictable.
  • Any insult/injury or disease process can cause the body to go into shock
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2
Q

Compensatory Stage of Shock: Clinical Findings

A
  • BP: Normal
  • HR: >100
  • RR: >20
  • Skin: Cold/clammy
  • Urinary output: Decreased
  • LOC: Anxious/confused
  • PaCO2: less than 32
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3
Q

Progressive Stage of Shock: Clinical Findings

A
  • BP: Systolic less than 80
  • HR: 150+
  • Resp: Rapid, shallow, crackles
  • Skin: mottled, petichiae
  • UO: 0.5 mg/kg/hr
  • LOC: lethargy (*think pt safety)
  • PaO2: less than 80
  • PaCO2: 45+
  • ABG: Metabolic Acidosis
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4
Q

Refractory Stage of Shock: Clinical Findings

A
  • BP: Requires support
  • HR: Erratic, asystole
  • Resp: Requires support
  • Skin: Jaundice
  • UO: Anuric
  • LOC: Unconcious
  • ABG: Profound Acidosis
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5
Q

Early sign of Shock

A

*Decreased pulse pressure

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6
Q

Elderly Adult: Your First Thought

A

Give them O2

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7
Q

Hypovolemic Shock: Management

A
  • 2 large bore IV for fluid replacement
  • Fluid should be a crystalloid solution (*NS is safe)
  • Monitor ABG and H/H
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8
Q

Main Causes of Death for Spinal Cord Injury

A

Pneumonia, PE, and Sepsis

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9
Q

Autodestruction

A

Cell death that continues for weeks-months after injury

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10
Q

SCI: Spinal Shock

A
  • *Temporary
  • Loss of ALL reflexes
  • Loss of sensation
  • Flaccid paralysis below injury
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11
Q

SCI: Neurogenic Shock

A
  • Loss of vasomotor tone

- HypoTN, warm/dry skin (opposite of hypovolemic shock), decreased CO, loss of SNS, bradycardia

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12
Q

SCI: Neurogenic Shock Interventions

A

-SCDs, TEDs, Dopamine (vasopressor)

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13
Q

SCI: Hyperflexion

A

-Sudden, forceful, forward acceleration of head (chin to chest)

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14
Q

SCI: Hyperextension

A
  • Head snapped back.
  • Ex: a fall, where the pt hits their chin on the counter on the way down.
  • Vertebrae may fracture or subluxate
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15
Q

Axial Loading

A
  • Vertical force
  • Vertebrae shatters from force
  • Common in diving accidents
  • If pt has a heel fx, check for axial loading as well.
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16
Q

Complete Cord Involvement

A

Total loss of sensory and motor fxn below level of injury

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17
Q

Incomplete Cord Involvement

A

Mixed loss of voluntary motor fxn and sensation, and leaves some traits in tact

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18
Q

Central Cord Syndrome

A
  • Most commonly in C spine

- *Motor weakness and sensory loss present in upper and lower extremities, but more pronounced in upper.

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19
Q

Brown-Sequard Syndrome

A
  • Result of damage to one half of the spinal cord
  • *Paralysis, loss of motor fxn, position and vibration sense on SAME side as injury
  • *Loss of pain and temp sensation on OPPOSITE side, below injury
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20
Q

SCI: Respiratory System Manifestations

A
  • Above C3: Near total ventilatory muscle paralysis
  • C3-C5: Loss of Phrenic nerve fxn
  • C6-T8: Loss of Intercostals
  • T7-T12: Loss of abd muscles
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21
Q

SCI: Cardiovascular System Manifestations

A
  • HR slow (less than 60)

- ANY increase in vagal stimulation can cause arrest

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22
Q

Poikilothermism

A

-The inability to regulate ones own body temperature (think of reptiles)

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23
Q

Hypovolemic Shock

A
  • Caused by decreased blood volume
  • External loss due to hemorrhage, surgery, or D/V
  • Internal loss due to burn, ascities, dehydration, or the pancreas storing fluid
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24
Q

Hypovolemic Shock: Management

A
  • Replace fluid (NS) and blood

- heart monitor, and labs: ABGs, H and H, serum lactate, glucose, electrolyte levels

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25
Q

Cardiogenic Shock

A
  • Impaired pump fxn

- Caused by MI, valve failure, and dysrhythmias

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26
Q

Cardiogenic Shock: Management

A
  • O2, pain control, labs, dopamine
  • Monitor CT, EKG, Echocardiogram
  • *only a little fluid
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27
Q

Hypovolemic Shock: Vicious Triad

A
  • Acidosis R/T shock and tissue injury
  • Hypothermia from fluid loss and exposure (causes increased O2 consumption adn arrythmias)
  • Hemodilution
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28
Q

Obstructive Shock: Beck’s Triad

A
  • HypoTN
  • Distended neck veins
  • Muffled heart sounds
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29
Q

Obstructive Shock: Caused by

A
  • Non-cardiac obstruction to blood flow

- PE, tension pneumothorax, pericardial tamponade

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30
Q

Distributive Shock: Types

A

Anaphylactic, Neurogenic, and Septic

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31
Q

ICP: Components and Percentages

A
  • Brain tissue: 78%
  • Blood: 12%
  • CSF: 10%
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32
Q

Normal ICP Range

A

10-15 mm Hg

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33
Q

Monroe-Kellie Doctrine

A

The cranial compartment is a fixed compartment; because of limited space, if any one component increases in volume, another must decrease in volume.

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34
Q

ICP: Component Displacement

A
  • CSF is easiest to displace
  • Blood is 2nd easiest
  • Brain is the hardest component to displace and a big problem b/c it herniates.
35
Q

Calculating MAP

A
  • (2D+S)/3 = MAP
  • 2 times the diastolic, plus the systolic
  • divide that by 3 = MAP
36
Q

Calculating Cerebral Perfusion Pressure (CPP)

A

MAP - ICP = CPP

37
Q

MAP: Perfusion Parameters

A
  • MAP must be at least 60 to perfuse coronary arteries
  • 70+ for brain and kidneys
  • If MAP is below 50, the brain is unable to autoregulate
38
Q

Types of Cerebral Edema

A
  • Vasogenic (most common, occurs in white matter)
  • Cytotoxic (comes from a local disruption in functional integrity of the cell)
  • Interstitial
39
Q

Causes of Increased ICP

A
  • Mass lesion
  • Cerebral edema
  • Head injury
  • Brain inflammation (can be due to bacterial meningitis)
  • Metabolic insult
40
Q

Increased ICP: Clinical Manifestations

A
  • Constant or worsening HA
  • Changes in LOC
  • *Restlessness/Confusion (early sign)
  • Weakness in one extremity
41
Q

Increased ICP: Cushing’s Triad

A
  • Bradycardia
  • HTN
  • Bradypnea
  • At this point, herniation of brain stem and occlusion of cerebral blood flow occur if interventions are not initiated.
42
Q

Complications of Increased ICP

A
  • Inadequate cerebral perfusion
  • Cerebral herniation
  • Both cause brain to be hypoxic
43
Q

Increased ICP: Diagnosing

A

Cerebral angiography is the standard

44
Q

Measuring ICP

A
  • Drill a hole

- Ventricular monitor is best

45
Q

Indications to Monitor ICP

A
  • *Pt admitted w/ Glasgow Coma Scale of 8 or less
  • Abnormal CT or MRI
  • Hx of neurological insult
46
Q

Increased ICP: Meds

A
  • Mannitol: Osmotic diuretic (turns your plum into a prune)

- Corticosteroids: decrease inflammation

47
Q

Increased ICP: Management

A
  • Maintain airway
  • Adequate O2
  • Monitor neuro assessment for changes
  • Document and report any changes
48
Q

Triage Process

A

-Pts with a threat to life, vision, or limb are seen first

49
Q

Emergency: Primary Survey (ABCD)

A
  • Airway
  • Breathing
  • Circulation
  • Disability
50
Q

Emergency: Secondary Survey (EFGHI)

A
  • Identifies Injuries
  • Exposure/Environmental control
  • Full set of vitals/Family presence
  • Give comfort measures
  • Hx and head-to-toe assessment
  • Inspect posterior surfaces (need three people, one to hold C-spine)
51
Q

Death in ED

A
  • Follow hospital rituals
  • Determine if pt can be donor
  • If pt dies w/in 24 hours of arrival, you must call ME (leave lines intact)
52
Q

Mallory Weiss tears

A

Bleeding from tears in mucosa at junction of stomach and esophagus due to ETOHism, coughing, or vomiting

53
Q

GI Emergency: Upper GI Bleed

A

-Caused by: PUD, Varicies, Mallory Weiss tears, SRES (Stress-Related Erosive Syndrome)

54
Q

Upper GI Medical Emergencies

A
  • Varicies: pt can bleed to death (constant swallowing)
  • Gastric perforation: stomach contents will leak into abd cavity, and cause peritonitis
  • GP s/s: severe upper abd pain radiating to shoulder and rebound tenderness
55
Q

GI Emergency: Lower GI Bleed

A

-Caused by: Diverticula, CA, or Inflammatory bowel disease

56
Q

Heat Exhaustion: S/S

A
  • Prolonged exposure to heat
  • General malaise, N/V, profuse diaphoreses, dilated pupils, hypoTN
  • *Temp range: 99.6-104
57
Q

Heat Exhaustion: Tx

A

-Moist sheet, remove restrictive clothing, replace fluids and electrolytes orally if possible, *if not use NS only

58
Q

Heat Stroke: S/S

A
  • Pt stops sweating
  • *Temp >104
  • Altered LOC
59
Q

Heat Stroke: Types

A
  • Classic: Environmental (non-exertional)

- Exertional: Occurs in healthy individuals in extreme heat/humidty

60
Q

Heat Stroke: Tx

A
  • Ice bags on armpits and genitalia
  • Ice bath
  • Wet blanket + fan
  • Get IV access early b/c of circulatory collapse
  • Give Chlorpromazine to stop shivering
  • Aggressive temp reduction until core reaches 102
  • Monitor for Rhabdo (CK will be 5x normal)
61
Q

Frostbite: Tx

A
  • Immerse in 102-108 degree bath water

- Keep sheets off frozen tissue

62
Q

Mild Hypothermia: S/S

A

-Temp 93.2-96.8, shivering, lethargy, decreased LOC, minor HR changes

63
Q

Moderate Hypothermia: S/S

A
  • Temp 86-93.2

- Core temp

64
Q

Profound Hypothermia: S/S

A

-Temp

65
Q

Mild Hypothermia: Tx

A

Passive or active external rewarming: Warming blankets, heat lamps

66
Q

Moderate-profound Hypothermia: Tx

A

Active core rewarming: Periorbital, gastric, or colonic lavage w/ warm fluid

67
Q

Hypothermia: Rewarming Risks

A
  • Rewarming should be d/c at 95
  • Heart monitor for possible arrhythmias while rewarming
  • *Watch for after drop: colder blood in peripherals is returned to core after shunting is reversed and can cause a sudden drop in core temp
68
Q

Submersion Injury

A
  • Pt becomes hypoxic due to submersion

- Alveolar damage leads to respiratory failure (ARDS)

69
Q

Submersion Injury: Tx

A
  • ABCD
  • Correct hypoxia
  • Use PEEP to keep alveoli open
  • *Heart monitor
  • *Pt should be monitored for minimum of 4-6 hrs for delayed pulmonary edema
70
Q

Animal Bites: Who-dun-it?

A
  • Dogs: Tearing bite, will have muscle and tissue damage

- Cats: Puncture wounds, high risk for infection, septic arthritis, tensynovitis, osteomylitis

71
Q

Animal Bites: Tx

A
  • Dog: Loosely suture to leave access for cleaning

- Cats: Never close bites

72
Q

Animal/Human Bites: Tx

A
  • Splint wounded joints

- Rabies prophylaxis

73
Q

Spider Bites

A
  • Black Widow: Neurotoxic, can mimic appendicitis, causes abd pain, anti-venom only given for hypoTN and systemic rxn
  • Brown Recluse (Fiddle-back): Cytotoxic, causes tissue necrosis, fever, chills, nausea, joint pain
74
Q

Poisonings: Decontamination

A

Takes priority over all interventions EXCEPT basic life support

75
Q

Explosion Damage

A
  • Causes Blast, Crush, and Penetrating damage
  • Bleeding ears are a sign that a person was close to explosion
  • Hollow organs take more damage
76
Q

First Rule of Emergency Preparedness

A

Keep staff safe!

77
Q

Burns: Superficial Partial Thickness

A
  • Sunburn
  • Blanches
  • Uncomfortable to touch
  • Complete recovery with no intervention
78
Q

Burns: Deep Partial Thickness

A
  • Epidermis and portion of dermis
  • Pain
  • Sensitive to air currents
  • Blistered
  • Mottled, red base
  • Weeping and edema
  • Hair follicles in tact
  • Takes 2-4 weeks to heal
79
Q

Burns: Full Thickness

A
  • Full dermal layer
  • White, cherry-red, charred, leather-like texture
  • No pain
  • Require grafting
  • No blisters
80
Q

Burns: Inhalation Injury

A
  • Look for: Singed nasal hairs, soot around nose/mouth, burnt/dry oral mucosa
  • Transfer to burn unit
81
Q

Burns: Zones of Injury

A
  • Zone of Coagulation: cell death has occurred, requires graft
  • Zone of Stasis: Compromised blood supply, tissue may survive
  • Zone of Hyperemia: Complete recovery expected
82
Q

Burns

A
  • 25-40% requires fluid resuscitation

- Assess for other injuries

83
Q

Referral to Burn Unit

A
  • 2nd and 3rd degree burns over more than 10% TBSA
  • All 3rd degree burns greater than 5% TBSA
  • Suspected inhalation injury
  • Any pt with other disease process
  • Any pt with burns on hands, feet, face, or genitalia
84
Q

Burns: Resuscitative Phase

A
  • Time starts from time of burn, lasts 24 hours
  • Fluid replacement
  • Ask how much fluid EMTs gave
  • Intubate if necessary
  • Labs: CBC, CMP, BUN, ABG, clotting studies, urinalysis

401 (4 decks)

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