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86 Cards in this Set
- Front
- Back
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What does the primary survey for emergency nursing focus on?
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A=Airway c cervical spine stabilization &/or immobilization
B=Breathing C=Circulation D=Disability LOC |
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What does the secondary survey for emergency nursing focus on?
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E=exposure/environmental control
F=Full set of v/s; Five interventions; facilitate Family presence G=Give comfort measures H=Hx and Head-to-toe assess. I=Inspect the posterior surfaces |
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What are the types of trauma?
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Minor- abrasions
Major/Multiple-MVA Blunt Penetrating-stab wound, impalement Other |
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Dyspnea, inability to vocalize, presence of foreign body in the airway, and trauma to face or neck
symptoms that indicate what? which emergency survey category does this fall into? |
pt with compromised airway
primary suvery: A* Airway c cervical spine stab/immob. |
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Any patient with face, head, or neck trauma and/or significant upper torso should always be suspected of what?
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cervical spine trauma
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Dyspnea, paradoxic or asymmetric chest wall movement, decreased or absent breath sounds on affected side, visible wound to chest wall, cyanosis, tachycardia, and hypotension
symptoms indicate what? which emergency survey category do these fall into? |
B=Breathing
symptoms are caused by many conditions |
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what causes breathing alterations?
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symptoms are caused by many conditions, including fractured ribs, pneumothorax, penetrating injury, allergic reactions, pulmonary emboli, and asthma attacks
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What patients are at risk for airway comprimise?
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seizures
near-drowning anaphylaxis FBO cardiopulmonary arrest |
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What is the tx for pt with compromised AIRWAY?
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-jaw-thrust maneuver (avoiding hyperextension of the neck)
-suctioning/removal of FBO -insertion of nasopharyngeal or oropharyngeal airway (will cause gagging if conscious) -endotracheal intubation |
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what is the tx for pt with BREATHING alterations?
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high flow oxygen 100% via a non-rebreather mask
for life-threatening conditions (ie:tension pneumothorax, flail chest) BVM(bag-valve-mask) ventilation with 100% O2, intubation, and tx of underlying cause |
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What should you assess for C (circulation on primary emergency survey)?
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-Central pulse (carotid) should be checked bc peripheral pulses may be absent as a result of direct injury or vasoconstriction
-skin for color, temperature, and moisture |
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What are the most significant signs of shock?
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altered mental status
CRT>3sec |
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Tx of circulatory issues
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-IV catheters should be inserted and aggressive fluid resuscitation initiated using NS or LR
-Direct pressure to obvious bleeding sites |
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What is PASG & what is it used for?
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pneumatic antishock garment is a three chambered suit that is applied to pt legs & abd and inflated with a foot pump
-increases peripheral vascular resistance= increase in BP, and is a temporary strategy that may be considered for pelvic fracture bleeding |
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What is AVPU??
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AVPU stands for
A=Alert V=responsive to Voice P=responsive to Pain U=Unresponsive for assessment of LOC in determining degree of disability |
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How do you assess for the degree of disability?
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Disability=LOC
-AVPU -Glasgow Coma Scale -Pupils should be assessed for size, shape, response to light, and equality |
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Explain E on the secondary survey
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Exposure/Environmental control
Expose pt (take their clothes off) to do a more thorough physical assessment, limit heat loss and prevent hypothermia |
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F (secondary survey) consists of three steps, explain Full set of v/s
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Full set of v/s should be obtained after the pt is exposed, and includes BP, HR, RR, & Temp (BP should be taken in both arms if pt is suspected of sustained chest trauma or BP is abnormally high or low)
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F (secondary survey) consists of three steps, explain Five Interventions
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1. pt should be monitored by ECG for HR & rhythm
2.monitor pulse ox 3.insert indwelling cath unless urethral tear is suspected to monitor urine output/characteristics 4. OG or NG tube (NO NG if suspected facial fractures or basiliar skull fractures)inserted to provide gastric decompression and emptying to reduce risk of aspiration & test contents for blood 5. lab studies for cross-matching, H&H, BUN, creat, blood alcohol, electrolytes, coag studies, tox screen, ABGs, liver enzymes, cardiac enzymes, & preg test |
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what are the lab studies that should be done on a patient to determine if additional interventions are needed?
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cross-matching, H&H, BUN, creat, blood alcohol, electrolytes, coag studies, tox screen, ABGs, liver enzymes, cardiac enzymes, & preg test
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Touch on G=Give comfort measures of the secondary survye.
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Pain is primary complaint
NSAIDS, IV opiods, and nonpharmacologic(distractions, imagery) |
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Why is Hx so important in pt with trauma?
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Details of incident are extremely important bc the mechanism of injury and injury patterns can predict specific injuries
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What questions are included in taking pt history? (5)
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1. What is chief complaint? What caused to pt to seek attention?
2. What are the subjective complaints? 3.What is pt's description of pain (e.g.location, duration, quality, character)? 4.What are the witnesses (if any) descriptions of the pts behavior since onset? 5.What is pt's health hx/AMPLE? Allergies Medication hx Past health hx Last meal Events/environment preceding illness/injury |
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What is NHBD?
What is OPO? |
NHBD non-heart beating donation (ie: corneas, heart valves, skin, bone, kidneys)
OPO Organ Procurement Organization to asist in screening potiential donors, counseling donor families, obtaining informed consent, and harvesting organs from expired patients |
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What is the most common injury-related admissions >65?
What are the three most common causes of falls in the elderly? |
fractures resulting from falls
1.generalized weakness 2.environmental hazards (loose mats, furniture) 3.orthostatic hypotension (s/e of med, dehydration) |
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Describe heat rash.
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heat rash (miliaria or prickly heat)is fine, red, papular rash that occurs on the torso, neck, &skinfolds.
occurs when sweat ducts are obstructed & become inflamed so that sweat excretion does not occur |
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What is heat syncope?
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Heat syncope is associated with prolonged standing and heat exposure.
Manifestations: dizziness, orthostatic hypotension, and syncope. |
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Tell me about heat edema.
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Heat edema is characterized by swelling of the hands, feet, and ankles, usually in nonacclimatized ppl as a result of prolonged sitting or standing.
Tx Rest, elevation, support hose |
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Heat cramps are?
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severe cramps in large muscle groups fatigued by heavy work.
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Pt presents with fatigue, light-headedness, N/V, diarrhea, and feelings of impending doom.
Suspect what? |
These are s/s of heat exhaustion
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Heat exhaustion also presents with..
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tachypnea, hypotension, tachycardia, elevated body temp, dilated pupils, mild confusion, ashen color, and profuse diaphoresis
hypotension & mild-severe temp d/t dehydration |
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Tx for heat exhaustion
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place pt in cool area, and remove constrictive clothing
oral fluid & electrolyte replacement unless pt is nauseated (IV NS if oral not tolerated) |
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What is the most serious form of heat distress?
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heatstroke! ahhhhh!!!
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pt presents to ER with hallucinations, combativeness, and hot, dry, ashen skin
indicative of what? |
heatstroke!
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What does heatstroke result from?
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results from failure of hypothalamic thermoregulatory process and is considered a medical EMERGENCY!!
its directly related to amount of time that the pts body temp remains elevated |
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How does heatstroke occur & what are the manifestations?
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increased sweating, vasodilation, & increased RR deplete fluids&electrolytes, specifically Na.
Eventually sweat glands stop fxning & core temp inc rapids in 10-15min. core temp>104, altered mentation, absence of perspiration, circulatory collapse, hallucinations, combativeness, loss of muscle coordination, cerebral edema & hemorrhage |
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tx for heatstroke..
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-stabilize ABC's
-100% O2 -correct F/E imbalance -cool pt aggressively until temp@102; monitor temp & control shivering -monitor for signs of rhabdomyolysis and DIC |
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How do you control shivering when treating a pt for heatstroke? Why do you want to control shivering?
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Chlorpromazine (Thorazine) IV is drug of choice to suppress shivering.
Shivering increases body temp (d/t associated heat generated by muscle activity) and complicates cooling efforts. |
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What localized cold injury is described as "true tissue freezing?"
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FrOstBiTe
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What is frostbite?
What is the difference b/t superifical and deep frostbite? |
frostbite is the formation of ice crystals in the tissues and cells, peripheral vasoconstriction is initial response to cold stress and results in decrease in blood flow and vascular stasis
superficial-skin & subcu (usually ears, nose, fingers, &toes) deep-muscle, bone, &tendon |
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tx of superficial frostbite..
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submerge 102-108
blisters form in a few hrs; they should be debrided & sterile guaze applied rewarming is EXTREMELY painful! analgesics as appropriate& tetanus evaluate for systemic hypothermia |
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tx of deep frostbite..
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submerge 102-108 until distal flush occurs
elevate after rewarming to reduce edema; severe edema may begin within 3hrs & blistering in 6hr-days IV analgesics PAINFUL!!! & tetanus evaluate for systemic hypothermia amputation if untreated or tx unsuccessful (frostbite-> gangrene) |
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Hypothermia temps
mild & profound |
mild <95
profound <86 |
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greatest loss of heat is from..
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55-60% from radiant energy
mostly head, thorax & lungs (with each breath) |
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Why are elderly more prone to hypothermia?
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decreased body fat
diminished energy reserves decreased BMR dec sensory perception chronic medical conditions medications drugs/alcohol, & DM are risk factors |
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fun facts.. well not so fun
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shivering disappears at <92
coma <82.4 death <78 thats effin cold |
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pt presents with shivering, lethargy, confusion, &minor HR changes..
suspect.. |
mild hypothermia
may also present with rational to irrational behaviors |
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pt presents with rigidity, bradycardia, slowed RR, BP obtainable only by doppler, metabolic &resp acidosis, & hypovolemia
suspect.. |
moderate hypothermia
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pt presents to ER appears dead, reflexes are absent and pupils are fixed, and dilated
suspect |
profound hypothermia
profound bradycardia, asystole, or vfib may be present every effort is made to warm the pt to at least 90 before pronouncing dead COD is usually vfib |
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passive or active rewarming are used for pt with ___ hypothermia
what the diff? |
mild
passive: blankets,etc. active:skin-to-skin,etc. |
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What type of rewarming is used on moderate to profound hypothermia?
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Active-core rewarming
heat is directly applied to the core (ie: humidified O2, warmed IV fluids) |
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What is afterdrop?
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a further drop in core temp during rewarming, its when cold peripheral blood returns to the central circulation
rewarming shock can cause hypotension and dysrhythmias thus mod-profound should warm core before extremities |
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When should re-warming be D/C'd?
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when temp reaches 95
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when does immersion syndrome occur?
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with immersed in cold water, which leads to stimulation of the vagus nerve and potentially fatal dysrhythmias(bradycardia)
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What is the focus of tx of submersion victims?
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correcting the hypoxia, acid-base balance, and fliud balance; supporting basic psychiologic fxn; and rewarming when hypothermia is present
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What does the initial assessment of a submersion victim include?
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airway, cervical spine, and circulation
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What is delayed pulmonary edema(secondary drowning)?
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death from drowning due to pulmonary complications, developed later in near-drowning pts
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Emergency Severity Index (ESI) is a triage system to categorize pts into 5 levels based on what 4 categories?
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Stability of vital fxns (ABCs)
Life threat or organ threat How soon should pt be seen by physican Expected resource intensity |
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ESI-1
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ESI-1
Vital fxns (ABCs) are unstable Obvious threat to life/organ Pt should be seen by MD IMMEDIATELY High resource intensity; staff at bedside continuously; often mobilization of team response (ie: cardiac arrest, intubated trauma pt, severe overdose, SIDS |
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ESI-2
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threatened stability of vital fxns (ABC's)
Threat to life/organs are likely but not always obvious Pt should be seen by MD within minutes High resource intensity; multiple, often complex diagnostic studies; frequent consultation; continuous (remote) monitoring ie: CP; mult trauma; child with fever&lethargy; disruptive psych pt |
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ESI-3
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stable vital fxns (ABC's)
unlikely but possible threat to life/organ pt should be seen by MD up to 1hr med/high resource intensity; mult dx studies or brief observation; or complex procedure ie: abd pain, gyno probs, hip fract in elderly |
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ESI-4
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stable vital fxns (ABCs)
no threat to life/organs pt being seen by MD could be delayed low resource intensity; one simple dx study; or simple procedure ie: closed extremity trauma, simple laceration, cystitis, typical migraine |
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ESI-5
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stable vital fxns (ABCs)
no threat to life/organ pt being seen by MD could be delayed low resource intensity; examination only ie: cold symptoms, minor burn, recheck |
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How do you treat a pt with a tick bite?
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tx requires removal of tick using forceps or tweezers
then clean bite with soap and water |
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tx for a black widow bite..
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cooling the area to slow the action of the neurotoxin
IV access should be established and O2 administration PRN wounds should be cleaned & tetanus given as appropriate muscle spasms tx with calcium gluconate, diazepam (valium), or robaxin antivenom is only used for severe reactions, in young children, or adults with HTN or cardiac disease |
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tx for a brown recluse bite..
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depends on the severity of the reaction; necessary when there is a bleb or bulla formation, intense pain & sx of rapidly progressive ischemia or necrosis
inital interventions include cleansing the bite with mild antiseptic soap, cool compress, & elevating the affected extremity pt with systemic manifestations are hospitalized and monitored for hemolysis, DIC, & ARF |
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pt present with H/A, stiff neck, fatigue, and bulls-eye rash
suspect.. |
inital sx of lyme disease from bite of ixodid (hard) tick
sx will disappear in 2weeks if untreated monoarticular arthritis, meningitis, and neuropathies occurs days-wks after inital sx tx is vibramycin& cefuroxime |
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pt presents with pink, macular rash on palms, wrists, soles, feet, and ankles, fever, chills, malaise, myalgia, H/A
suspect.. |
Rocky Mnt Fever from bite of ixodid tick
without tx can be fatal tx doxycycline (Vibramycin) |
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Is tick paralysis life threatening??
tell me all about it |
YES tick paralysis occurs 5-7days after exposure of neurotoxin from wood or dog tick
sx: flaccid ascending paralysis over 1-2days without tick removal pt dies as resp muscles become paralyzed tick removal leads to return of muscle movement, usually within 48-72hrs |
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treatment of a snakebite focuses on...
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preventing the spread of venom, rings/watches and restrictive clothing should be removed; & affected limb should be immobilized at the level at heart
ice & tourniquets are not recommended caffeine, alcohol, and smoking increase the spread of venom & should be avoided |
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pt with snakebite is complaining of pain.. what do you give them
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tylenol
aspirin & NSAIDS should be avoided, they may exacerbate bleeding & opoids may cause resp depression |
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what type of bite carries the highest risk of infection?
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humans... friggin gross
so dont bite anybody |
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What are some options for decreasing absorption of poisons?
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-activated charcoal
-dermal cleansing -eye irrigation -gastric lavage |
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When would gastric lavage be contraindicated?
When is it preformed |
contraindicated:
-in pts with altered LOC or diminshed gag reflex must be intubated first -pts who ingested caustic agents, co-ingested sharp objects, or nontoxic substances preformed within 2hrs to be effective |
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what is the most effective management for poisionings?
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activated charcoal orally or via gastric tube within 60min of ingestion
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Contraindications to charcoal administration..
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charcoal can absorb s & neutralize antidotes [mucomyst- tylenol tox] so antidote should not be given immediately before, with, or shortly after charcoal
diminished bowel sounds, ileus, & ingestion of susbtances poorly absorbed by charcoal charcoal does not absorb: ethanol(alcohol), hydrocarbins, alkali, iron, boric acid, lithium, methanol, or cyanide |
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How do you remove toxins from pt?
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FIRST dust off patient.. with the exception of mustard gas, water or saline
decontamination takes priority over all interventions besides basic life supporting techniques |
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What is given with activated charcoal and why?
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cathartics such as sorbitol, given with first dose to stimulate intestinal mobility and increase elimination
mult doses should be avoided bc potential fatal electrolyte abnormalities |
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tell me about whole-bowel irrigation..
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whole-bowel irrigation is controversal because high risk of electrolyte imbalance d/t losses of F/E
involves admin of a nonabsorbable bowel evacuant solution (ie:GoLYTELY) its administered q4-6hrs until stools are clear; can be effective for swallowed objects (ie:cocaine filled balloons/condoms, heavy metals lead/mercury) |
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why would a pt receive hemodialysis or hemoperfusion for poisoning?
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reserved for pts who develop severe acidosis from ingestion of toxic substance like aspirin
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which agents are likely to be used as weapon of bioterrorism?
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anthrax, plague, tularemia, smallpox, botulism, & hemorrhagic fever
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which disease pathogens that may be used as bioterrorism can be effectively treated with commerically available AB?
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anthrax, plague, & tularemia
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What can you do for a patient with smallpox or botulism?
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smallpox: can be prevented or ameliorated by a vaccine even when first given after exposure
botulism:can be tx with anti-toxin |
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What is the tx for hemorrhagic fever?
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NO TX (its caused by a virus)
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What is Phosgene?
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a colorless gas normally used in chemical manufacturing, if inhaled in large concentrations for long enough period it causes severe RDS, pulm edema, & DEATH
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your at war, fighting on the line, a gas bomb goes off & you smell garlic.. what does it mean?
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OH DAMN its MUSTARD GAS
it irritates your eyes, & causes skin burns & blisters |
