WEEK SIX Flashcards
Disability:
Assess Conscious level AVPU GCS Pupillary response The eyes are the window to the soul!!
Exposure:
Expose your patient looking for: Needle marks Wounds Abrasions Anything else
Decorticate posturing:
- Indicates that there may be damage to areas including the cerebral hemispheres, the internal capsule, and the thalamus.
- An ominous sign of severe brain damage, and may also indicate lesion(s) in the lower brainstem.
- Normally people displaying decorticate or decerebrate posturing are in a coma and have poor prognoses, with risks for cardiac arrythmia or arrest and respiratory failure
Decerebrate posturing:
- It is exhibited by people with lesions or compression in the midbrain lesions in the cerebellum.
- Progression from decorticate posturing to decerebrate posturing is often indicative of tonsilar brain herniation.
Tazopip
Antibacterial combination medication
Broad spectrum semisynthetic penicillin
Active against Gram-positive and Gram-negative aerobic and anaerobic bacteria
Used for: LTI’s, UTI’s, intra abdominal infections, skin infections, gynae infections
Peak plasma levels immediately following IV infusion
Contraindications
Previous allergic reactions to penicillin/cephalosporins
Reactions
Anaphylactic/anaphylactoid, Bleeding manifestations including clotting problems, Raised liver enzymes
Resistance to therapy in prolonged use
Interactions
Other antibiotics, Vecuronium, Methotrexate, Heparin and anticoagulants, False positives for glucose in urine
Dosage
Slow IV infusion (20-30mins)
4g piperacillin/0.5g tazobactum (Tazopip)
Every 8 hours
Max daily dose 12G (4G TDS)
Minimum 5 day therapy – continued for 2 days resolution of symptoms
Trauma teams
Multidisciplinary Team Leader A B C Nurse 1 Nurse 2 Nurse 3 Scribe Specialities
trauma
Mechanism of injury Energy kinetics Blunt injury OR Penetrating Blunt injury Combination of forces Acceleration Deceleration Shearing Compression
Skeletal trauma
Fat embolism Rhabdomyolysis Potential blood losses Humerus 500-1500mL Elbow 250-750mL Radius/ulna 250-500mL Pelvis 500-3000mL Femur 250-2000mL Tibia/Fibula 250-2000mL Ankle 250-1000mL
Primary survery
Airway c-spine Breathing Circulation & haemorrhage control Disability Exposure Farenheit
Airway
Airway management with c-spine control
Airway always takes precedence
C-spine – 1.5 – 3 % of all trauma cases
Risk of aspiration
Breathing
Breathing RIPPA Respiration rate Inspection Palpation Percussion Auscultation
Life threatening chest injuries
Airway obstruction Tension pneumothorax Open pneumothorax Massive haemothorax Flail chest Cardiac tamponade
Circulation and haemorrhage control
Direct pressure to control haemorrhage
Fluid resuscitation
Haemo-dilution
Inter hospital transfer
Airway stabilisation Fluid resuscitation Medical records and relevant information Patient monitoring Airway O2/suction Drugs Monitoring Adverse events
