Monitor: fluid intake, fluid replacement and pain
Managment: airway, O2, treat pain, bronchoscopy
Meds: morphine
Medical Management\u2022 ABC-oxygen, possible endotracheal intubation, ventilatory support\u2022
Replace fluid volume\u2022 Restore negative intrapleural pressure if needed\u2022 Needle decompression\u2022
Chest tube if needed\u2022 Hemothorax\u2022 Pneumothorax\u2022 Hemo-pneumothorax
Q: Crush injuries and trauma
Answer:
Hypovolemic shock
Spinal Cord Injury
Fractures
Acute Kidney Injury
Priority: ABC’s
SATA: Rhabdomyolysis: Triad: muscle cramps, muscle weakness, dark urine
Labs: CK levels, serum lactic acid levels
Compartment syndrome: elevate extremity, fasciotomy.
proper alignment of extremities, check peripheral pulses
Meds: pain, cephalosporins, penicillin
Q: Creatine Kinase (CK)
Answer:
Depend on age
30-200 men
30-170 women
Q: dissecting abdominal aneurysm
Answer:
medical emergency
get pdf at learnexams.com<\/strong><\/li>\n\n\n\n
Diffusing anger in the ED<\/a><\/p>\n\n\n\n Self safety is PRIORITY Heat Stroke **<\/a><\/p>\n\n\n\n Priority action: *Lower body temperature; O2, fluids, cool towel, cool bath (NO ICE BATH) elevate feet Alcoholic- first assessment<\/a><\/p>\n\n\n\n CAGE: Cut, Annoyed, Guilty, Eye-opener. Non-fatal drowning **<\/a><\/p>\n\n\n\n Priority: manage hypoxia, acidosis and hypothermia > airway, oxygen Serum Electrolytes<\/a><\/p>\n\n\n\n * Mg+ 1.5-2.5 Bite Priority<\/a><\/p>\n\n\n\n Human bite: know what to do first with a human bite! Poisoning in the house<\/a><\/p>\n\n\n\n Carbon Monoxide: 100% O2 Atmospheric\/hyperbaric chamber Overdose- multiply organ dysfunction syndrome<\/a><\/p>\n\n\n\n Find out what Patient OD’d on. Give antidote if there is one Abuse- interpersonal violence<\/a><\/p>\n\n\n\n Priority: ask questions IN PRIVATE, separate from person who is abusive\/neglectful PTSD- rape and stabbing<\/a><\/p>\n\n\n\n Keep patient comfortable Chest-Blunt trauma complications **<\/a><\/p>\n\n\n\n Flail chest: paradoxical chest movement, hypoxemia, resp acidosis Crush injuries and trauma<\/a><\/p>\n\n\n\n Hypovolemic shock Creatine Kinase (CK)<\/a><\/p>\n\n\n\n Depend on age dissecting abdominal aneurysm<\/a><\/p>\n\n\n\n medical emergency dissection aneurysm<\/a><\/p>\n\n\n\n hemorrhage into the vessel wall with longitudinal tearing of the vessel wall to forma a blood-filled channel PVC (Premature Ventricular Contraction)<\/a><\/p>\n\n\n\n Irregular rhythm. No Pwave. Wide,bizarre QRS. Hemorrhage -shock<\/a><\/p>\n\n\n\n Stop bleeding- pressure Shock- fluid**<\/a><\/p>\n\n\n\n two large-gauge IV Shock symptoms **<\/a><\/p>\n\n\n\n tachycardia Cardiogenic Shock S&S<\/a><\/p>\n\n\n\n heart pump fails Hypovolemic shock **<\/a><\/p>\n\n\n\n Reduction of intravascular volume by 15-30 % Hemoglobin normal range<\/a><\/p>\n\n\n\n 12-18<\/a><\/p>\n\n\n\n Hematocrit normal range<\/a><\/p>\n\n\n\n 40%-50%<\/a><\/p>\n\n\n\n Lactate normal range<\/a><\/p>\n\n\n\n 0.5-1 mmol\/L<\/a><\/p>\n\n\n\n Mechanical ventilation Shock<\/a><\/p>\n\n\n\n Mechanical ventilation may be needed for patients who experience shock Sepsis **<\/a><\/p>\n\n\n\n -BP Septic shock<\/a><\/p>\n\n\n\n Norepinephrine IV – increases BP (1st choice vasopressor) WBC normal range<\/a><\/p>\n\n\n\n 5,000-10,000<\/a><\/p>\n\n\n\n Sepsis Drug abuse<\/a><\/p>\n\n\n\n sharing of needles can cause sepsis due to infection<\/a><\/p>\n\n\n\n sepsis interventions<\/a><\/p>\n\n\n\n prevent infection: aseptic technique after careful hand hygiene Gastric bypass-MODS<\/a><\/p>\n\n\n\n hrly urine output, monitor + pulse. Septic shock medication<\/a><\/p>\n\n\n\n Fluid therapy alone is not effective give vasopressors MODS hypotension<\/a><\/p>\n\n\n\n Hypotension is a common complication of MODS Septic shock dopamine<\/a><\/p>\n\n\n\n do not give dopamine until fluids are replaced- Head injury (tree)<\/a><\/p>\n\n\n\n Assess Loss of consciousness ICP monitoring<\/a><\/p>\n\n\n\n maintaining adequate oxygenation ICP hazards<\/a><\/p>\n\n\n\n Vomiting with out nausea Closed head injury ICP<\/a><\/p>\n\n\n\n Concussion. Increased ICP treatment<\/a><\/p>\n\n\n\n mannitol – decreases ICP, give IV Traumatic brain injury- ICP<\/a><\/p>\n\n\n\n normal ICP– 0-15 (if above 20 then interventions are done) i.e. mannitol. need a MAP greater than 50<\/a><\/p>\n\n\n\n SCI- intermediate intervention<\/a><\/p>\n\n\n\n Immobilize neck SCI assessment<\/a><\/p>\n\n\n\n Monitor respirations and breathing pattern spinal shock<\/a><\/p>\n\n\n\n complete but temporary loss of motor, sensory, reflex, and autonomic function immediately after injury- lasts less than 48hrs- weeks Autonomic dysreflexia S&S **<\/a><\/p>\n\n\n\n *Pounding headache Auto. Dysreflexia document **<\/a><\/p>\n\n\n\n Document S&S Spinal Cord injury<\/a><\/p>\n\n\n\n Cervical: cant move (quad) DIC<\/a><\/p>\n\n\n\n Triggers: sepsis, trauma, shock, abruptio placentae, toxin, malignancy. D-dimer levels<\/a><\/p>\n\n\n\n 250<\/a><\/p>\n\n\n\n PT levels<\/a><\/p>\n\n\n\n 12 -13 sec<\/a><\/p>\n\n\n\n PTT levels<\/a><\/p>\n\n\n\n 25-35 seconds<\/a><\/p>\n\n\n\n Cardiac Tamponade- PEA<\/a><\/p>\n\n\n\n Medical emergency-collection of fluid around the heart Abdominal Aortic Aneurysm tests<\/a><\/p>\n\n\n\n Pulsatile mass in the middle or upper abdomen AAA post op<\/a><\/p>\n\n\n\n Lie supine for 6 hours dysrhythmias and calcium<\/a><\/p>\n\n\n\n Low calcium levels lead to: Calcium levels<\/a><\/p>\n\n\n\n 8.5-10.5<\/a><\/p>\n\n\n\n IV-mL\/hr lidocaine<\/a><\/p>\n\n\n\n know your dosage calculations.<\/a><\/p>\n\n\n\n Asystole treatment<\/a><\/p>\n\n\n\n CPR Endotracheal Tube(ETT) -assessment<\/a><\/p>\n\n\n\n Evaluate: Thoracotomy water seal functionality<\/a><\/p>\n\n\n\n Set at 20 cm Chest tube- deep breathing **<\/a><\/p>\n\n\n\n Encourage coughing and deep breathing Chest tube transport **<\/a><\/p>\n\n\n\n ensure tube remains in place Pneumothorax – action<\/a><\/p>\n\n\n\n Pneumothorax is a collapsed lung Pneumonectomy- chest tube<\/a><\/p>\n\n\n\n NO chest tube needed after this procedure Subcutaneous emphysema explanation **<\/a><\/p>\n\n\n\n *Crepitus Esophageal cancer- aspiration **<\/a><\/p>\n\n\n\n low Fowler Esophageal varices repair<\/a><\/p>\n\n\n\n Priority: airway. Liver failure<\/a><\/p>\n\n\n\n irreversible damage to liver Hepatic failure- ascites **<\/a><\/p>\n\n\n\n Increased abdominal girth.
gunfire- protect self
separate feuding individuals explains activities, eliminate triggers.<\/a><\/p>\n\n\n\n
+HR, +temp, confusion, headache, anxiety, cramps, gooseflesh, HOT,DRY skin, NO sweating<\/a><\/p>\n\n\n\n
Assess: psych, w\/drawal.
Mgt: blood glucose, benzo, barbiturate, seizure precautions.
Let them sleep if calm-
not calm- benzo’s-
check on patient regularly for – LOC
Blood glucose range: 70-110<\/a><\/p>\n\n\n\n
Management: CPR, core temp (rectal) rewarming procedures during CPR, trach\/PEEP, O2
Risks: ARDS> hypoxia, hypercarbia and respiratory acidosis can occur
Hypothermia> metabolic acidosis
NGT> decompress stomach and prevent aspirating gastric contents.
Monitor: ECG, ICP, I\/O
Labs: serum electrolytes
Highest risk: <5 yo, >85 yo
Freshwater: loss of surfactant- inability to expand lungs
Saltwater: pulmonary edema
Observe pt for 23 + hours<\/p>\n\n\n\n
* Phos 2.5-4.5
* K+ 3.5-5
* Ca 8.5-10.9
* Chl 95-105<\/a><\/p>\n\n\n\n
Animal: rabies prophylaxis
Snakebite: lie down, removing constrictive items, providing warmth, cleansing the wound, covering the wound with a light sterile dressing, and immobilizing the injured body part below the level of the heart.
CABs (Circulation, Airway Breathing)
NO: Ice, incision and suction, or a tourniquet
Tetanus and analgesia should be given as necessary.
Meds: FabAV or CroFAb: no limit on how much to give
S&S: necrosis, edema, ecchymosis
Tick: remove with tweezers, straight up pull, (try to get close to skin as possible)
S&S: bulls eye rash<\/p>\n\n\n\n
Ingested Poison: ABC, Call poison control, try to describe what was ingested
Charcoal: most effective, Do not use if heavy metals were ingested. Corrosives: give water\/milk
Cathartics: sorbitol: give w\/ 1st dose of charcoal
syrup ipecac: Induces vomiting, only give to alert patients-and NO patients who ingested a corrosive agent
Gastric emptying: intubate before lavage ( if -LOC\/-gag reflex) with in 1 hour of ingestion.<\/p>\n\n\n\n
Treatment goals for a patient with a drug overdose are to support the respiratory and cardiovascular functions, to enhance clearance of the agent, and to provide for safety of the patient and staff.<\/a><\/p>\n\n\n\n
referral to shelter
adults are free to accept or refuse help
safety plans should be explored
Mandatory report: children and elderly abuse – only need to suspect abuse, do not need to prove it<\/a><\/p>\n\n\n\n
Offer therapeutic communication -listen
Avoid triggers
**ask if patient plans to harm self-<\/a><\/p>\n\n\n\n
Pulmonary contusion: abnormal accumulation of fluid,
– lung sounds, cough, frank blood, mucus, chest pain, atelectasis, -BP, resp acidosis
Monitor: fluid intake, fluid replacement and pain
Managment: airway, O2, treat pain, bronchoscopy
Meds: morphine
Medical Management\u2022 ABC-oxygen, possible endotracheal intubation, ventilatory support\u2022 Replace fluid volume\u2022 Restore negative intrapleural pressure if needed\u2022 Needle decompression\u2022 Chest tube if needed\u2022 Hemothorax\u2022 Pneumothorax\u2022 Hemo-pneumothorax<\/p>\n\n\n\n
Spinal Cord Injury
Fractures
Acute Kidney Injury
Priority: ABC’s
SATA: Rhabdomyolysis: Triad: muscle cramps, muscle weakness, dark urine
Labs: CK levels, serum lactic acid levels
Compartment syndrome: elevate extremity, fasciotomy.
proper alignment of extremities, check peripheral pulses
Meds: pain, cephalosporins, penicillin<\/p>\n\n\n\n
30-200 men
30-170 women<\/a><\/p>\n\n\n\n
-chest or back pain is cardinal sign;
-hypotension;
-tachycardia
Weak pulses
treat with surgery stents
History: high blood pressure
can cause cardiac tamponade\/shock<\/a><\/p>\n\n\n\n![\"Image:](\"https:\/\/quizlet.com\/cdn-cgi\/image\/f=auto,fit=cover,h=100,onerror=redirect,w=120\/https:\/\/o.quizlet.com\/svl9INDPfPbYT0GDg99sHg.jpg\")
<\/figure>\n\n\n\n
Clinical manifestations: sudden onset of excruciating pain, described as TEARING or RIPPING<\/a><\/p>\n\n\n\n![\"Image:](\"https:\/\/quizlet.com\/cdn-cgi\/image\/f=auto,fit=cover,h=100,onerror=redirect,w=120\/https:\/\/o.quizlet.com\/K8b5UwOt9dpdZkGUxJDo0w.png\")
<\/figure>\n\n\n\n
Common and harmless
palpations, chest pain, SOB
not frequent- no treatment needed
frequent- medication is needed- amiodarone<\/a><\/p>\n\n\n\n![\"Image:](\"https:\/\/quizlet.com\/cdn-cgi\/image\/f=auto,fit=cover,h=200,onerror=redirect,w=240\/https:\/\/o.quizlet.com\/i\/QlzQwzLlgPcJKPIlTCaN0Q.jpg\")
<\/figure>\n\n\n\n
Identify and treat the cause
-BP, +HR, cool clam skin, -H\/H(Hgb -7 =Heaven),
Early: restless. Late: metabolic acidosis<\/a><\/p>\n\n\n\n
LR or NS
Blood products for blood loss-give RBC, Platelets, plasma, RBC (+ O2)<\/a><\/p>\n\n\n\n
hypotension
cool\/clammy skin
weak peripheral pulses
anxiety
decreased urinary output
low central venous pressure
increase in CO, heart rate
decrease stroke volume<\/a><\/p>\n\n\n\n
-BP
-Cardiac Output
+HR
narrow pulse pressure
S&S: Pain, angina, arrhythmias, fatigue
Correct the cause!
PRIORITY: O2, treat pain, fluids (monitored closely for overload)
Meds: dobutamine, Nitro, dopamine, vasodilator, diuretics, albuterol, quinidine. AE: photosensitivity, nausea, vomiting, CNS changes<\/a><\/p>\n\n\n\n
Treat underlying cause
Fluid and blood replacement
LR\/NS
Blood products: colloids
Vasoactive meds
O2
SS: pale, anxious
tachycardia
hypotension, narrowing pulse pressure
+RR
– Cardiac Out
-urine
Labs: H&H, lactate,
ABGS
Interventions:
Passive leg raise
NO Trendelenburg
Meds: insulin, anti D, antiemetics, vasopressors
first sign: patient bleeding* or loss of fluids
Causes: dehydration, ascites, edema
SPO2: forehead not finger!<\/p>\n\n\n\n
If patient is unable to breath on their own.<\/a><\/p>\n\n\n\n
cold clam skin
delay cap refill
confusion
high\/low temp
Mgt: lactate level, culture before antibiotics, antibiotics, crystalloid\/lactate, vasopressor
Med: Vasoconstrictor
Culture- to identify
aseptic technique and Hand hygiene
Labs: BUN, CRP, creatinine, WBC, H&H, platelet
serum albumin, prealbumin (protein)
no Trendelenburg<\/p>\n\n\n\n
IV corticosteroids 2nd choice
SS: -BP, +HR\/RR,
Labs: WBC -4, +12
Management: GCS + 2 points SOFA= organ dys.
Blood- colloids
antibiotics w\/ 1st hour (culture 1st) broad-spectrum antibiotic agents are started until culture and sensitivity reports are received
urine output
fluids (NS)
O2<\/p>\n\n\n\n
IV lines, arterial and venous puncture sites, surgical incisions, traumatic wounds, and urinary catheters must be monitored for signs of infection
First sign: confusion with or without agitation along with an increased respiratory rate
Labs: platelets, bilirubin, serum creatinine, urine output, serum levels of antibiotic agents, procalcitonin, CRP, BUN, creatinine, WBC count, hemoglobin, hematocrit, platelet levels, coagulation studies) and reports changes to the primary provider.
Glasgow Coma Scale (GCS)
MAP
Obtain specimen prior to giving antibiotics
hyperthermia: acetaminophen or applying a hypothermia blanket
IV fluids and meds<\/p>\n\n\n\n
SS: Lung: dyspnea, resp fail.
Hypermetabolic: +glycemia, +lactic acid, +BUN, -skeletal muscle mass.
Hepatic: +bilirubin\/liver test.
Renal: +creatinine, anuria.
Hematologic: immunocompromise, +bleed. Neuro: unresponsive, coma
Invasive procedures can introduce microorganisms inside the body that could lead to sepsis<\/p>\n\n\n\n
norepinephrine or dopamine = MAP of 65 mm Hg or higher.
Adequate fluid therapy is necessary for maximal pressor (increased blood pressure) effect.
Acidosis decreases the effectiveness of the drug.<\/a><\/p>\n\n\n\n
Decreased blood flow and O2 delivery to tissues<\/a><\/p>\n\n\n\n
If fluid therapy alone is not effective, give vasopressor<\/a><\/p>\n\n\n\n
Maintain airway<\/a><\/p>\n\n\n\n
elevating head of the bed
seizure prevention
fluid and electrolyte maintenance
nutritional support
management of pain and anxiety
ensure adequate oxygenation and protect the airway.
restlessness (without apparent cause), confusion, or increasing drowsiness, has neurologic significance<\/a><\/p>\n\n\n\n
no lumbar puncture
Cushing Triad: + BP, widen PP, – HR (bradypnea)<\/a><\/p>\n\n\n\n
Mild: brief LOC
Major: coup-contrecoup, expressive aphasia and vision problems<\/a><\/p>\n\n\n\n
restrict fluids
drain CSF
control fever
maintain systemic BP and O2
reduce metabolic demands
No cluster care, dim lights,\\<\/a><\/p>\n\n\n\n
stabilize patient
do not rotate or extend
maintain alignment<\/a><\/p>\n\n\n\n
Lung sounds and cough
Monitor for changes in motor or sensory function; report immediately
Assess for spinal shock
Monitor for bladder retention or distention, gastric dilation, and ileus
Temperature; potential hyperthermia<\/a><\/p>\n\n\n\n
s\/s: flaccid, bradycardia, hypotension, paralytic ileus<\/a><\/p>\n\n\n\n
cool and pale below the injury
redness and flushing above
High BP
low HR
High RR
diaphoresis
goose bumps (pyloric erections)
Correct the Cause!
Elevate HOB
*scan bladder-empty bladder(distended bladder is the cause)
remove constricting clothing
*occurs after spinal shock has resolved<\/a><\/p>\n\n\n\n
Interventions taken
Time seizure started
what triggered the episode<\/a><\/p>\n\n\n\n
Lumbar: legs (para)
Thoracic: trunk<\/a><\/p>\n\n\n\n
1st sign; bleeding gums.
+D-dimer
+ Pt\/PTT
Low fibrinogen\/- platelet
give Heparin<\/a><\/p>\n\n\n\n
Pressure on the heart prevents proper function
confusion
SOB
restlessness
decrease cardiac output
drop in BP
no oxygen to brain and vital organs
causes pulseless electrical activity<\/a><\/p>\n\n\n\n
Palpable during routine physical
may hear systolic bruit over mass
Duplex, ultrasonography, CTA
Small aneurysm: ultrasonography q 6 mon monitor until big enough for surgery
Do palpate<\/a><\/p>\n\n\n\n
HOB 45 degrees after 2 hours
use bedpan\/urinal
BEDREST
Vitals and doppler assessment of peripheral pulses q 15 min
Assess for bleeding, pulsation, swelling, pain and hematoma formation
Temp: Q 4 hours
after 6 hours, roll side to side, ambulate with assistance to bathroom
*NOTIFY HCP: pt constantly coughing, sneezing or has a BP > 180<\/p>\n\n\n\n
ventricular dysrhythmias, Prolonged QT, cardiac arrest. Ca= less than 8
Remember – changes in potassium and calcium and cause dysrhythmias<\/a><\/p>\n\n\n\n
**epinephrine and atropine
No defib<\/a><\/p>\n\n\n\n
physiologic status
coping w\/mechanical ventilation
vital signs,
respiratory rate
breath sounds
hypoxia
+ breath sounds :suction HOB 30 degrees or higher mechanical ventilator settings
endotracheal tube position
neurologic status and effectiveness of coping comfort level and communication
weaning requires adequate nutrition<\/p>\n\n\n\n
more water= more suction
intermittent bubbling in water seal chamber is normal
continuous bubbling = air leak
water-seal chamber has a one-way valve or water seal that prevents air from moving back into the chest when the patient inhales.<\/a><\/p>\n\n\n\n
Use of incentive spirometer
assist w\/ repositioning and ambulation
Breathing techniques: diaphragmatic and purse-lip breathing Q 2 hours<\/a><\/p>\n\n\n\n
drainage system remains below level of patients chest
prevents air or fluid from entering the chest cavity
no need to clamp during transport<\/a><\/p>\n\n\n\n
In the postoperative patient, pneumothorax is often accompanied by hemothorax
increasing shortness of breath, tachycardia, increased respiratory rate, and increasing respiratory distress
needle aspiration, chest tube insertion, nonsurgical repair or surgery.<\/a><\/p>\n\n\n\n
a patient is usually turned every hour from the back to the operative side and should not be completely turned to the unoperated side.
This allows the fluid left in the space to consolidate and prevents the remaining lung and the heart from shifting (mediastinal shift) toward the operative side<\/p>\n\n\n\n
Air trapped under the skin in the chest area (need to know!)<\/a><\/p>\n\n\n\n
Later in a Fowler position, prevent reflux of gastric secretions.
Complication is aspiration pneumonia.
incentive spirometry, sitting up in a chair, nebulizer treatments.
*Chest physiotherapy is avoided
Maintain NPO status and parenteral or enteral support is warranted
After each meal, the patient remains upright for at least 2 hours to allow the food to move through the GI tract.<\/p>\n\n\n\n
NO: NGT, strain.
Tx: Bblockers, balloon tamponade, shunt, TIPS<\/a><\/p>\n\n\n\n
liver transplant is only solution
jaundice
abdominal pain
confusion
swelling in legs\/abdomen +ammonia\/bilirubin\/PT\/PTT\/ALT\/AST. -albumin\/Ca\/platelets<\/a><\/p>\n\n\n\n
short of breath
striae and distended veins may be visible over the abdominal wall.
Umbilical hernias also occur frequently in those patients with cirrhosis.
Fluid and electrolyte imbalances are common.
sodium restriction
Spironolactone, K sparing
paracentesis- remove fluid<\/p>\n\n\n\n