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114 Cards in this Set
- Front
- Back
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Describe components of both Primary & Secondary Assessment (Pneumonic)
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Primary:
A- Airway w/ simultaneous cervical spine protection B- Breathing C- Circulation D- Disability (neurologic status) E- Expose/environmental (Remove clothing and keep pt. warm) Secondary: F- Full set VS/ focused adjuncts (cardiac monitor, urinary catheter, gastric tube) family presence G- Give comfort measures (verbal reassurance, touch, pain management) H- History and Head to Toe Assessment I- Inspect posterior surfaces |
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If situation is critical, what history information is most important?
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Brief statement composed of patient's Major Injuries or Chief Complaints and the Mechanism of Injury.
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What to look for when assessing airway...
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Vocalization- Is pt able to talk? Cry/Moan?
Tongue obstructing airway Loose teeth or foreign objects Blood, vomit, or other secretions Edema |
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Maintain _______ ______ ________ for any patient whose mechanism of injury, symptoms, or physical findings suggest a spinal injury
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Maintain CERVICAL SPINE PROTECTION for any patient whose mechanism of injury, sympomts, or physical findings suggest a spinal injury
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Before proceeding with cervical spine protection, ensure that interventions do not compromise the patient's _______ status.
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breathing
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If the airway is totally or partially obstructed, place the patient in ______ position. While maintaining ______ spine protection, ______ the patient onto his or _____. Carefully and gently remove any ______ if necessary to allow access to the airway and cervical spine. _________ing wounds may cause disruption of the integrity of the airway, and ______ trauma may lead to injury of the larynx or other upper structures, causing partial or complete _______.
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If the airway is totally or partially obstructed, place the patient in SUPINE position. While maintaining CERVICAL spine protection, LOGROLL the patient onto his or BACK. Carefully and gently remove any HEADGEAR if necessary to allow access to the airway and cervical spine. PENETRATING wounds may cause disruption of the integrity of the airway, and BLUNT trauma may lead to injury of the larynx or other upper structures, causing partial or complete OBSTRUCTION.
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Review protection of cervical spine info...
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p. 35
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Complete spinal immobilization includes...
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Complete spinal immobilization includes...
application of a rigid cervical collar placing patient on a backboard and appropriately strapping patient to backboard |
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When should complete spinal immobilization be done?
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at the completion of the secondary assessment, depending on the degree of resuscitation required and availability of team members
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4 Techniques to open or clear an obstructed airway during primary assessment
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jaw thrust
chin lift removal of loose teeth or foreign objects suctioning |
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When attempting to clear the airway, maintain cervical spine in a _____ position. Do not hyperextend, flex, or rotate the neck during these maneuvers.
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When attempting to clear the airway, maintain cervical spine in a NEUTRAL position. Do not hyperextend, flex, or rotate the neck during these maneuvers.
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Suction gently to prevent stimulation of the ___ reflex.
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gag
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Prepare for endotracheal intubation:
_____ the patient with a _______ device before ET intubation. A_________ m______ to facilitate ET intubation. Use an _____ ______ if the patient's airway can't be managed with ET intubation. |
Prepare for endotracheal intubation:
VENTILATE the patient with a BAG-MASK device before ET intubation. ADMINSITER MEDICATIONS to facilitate ET intubation. Use an ALTERNATIVE AIRWAY if the patient's airway can't be managed with ET intubation. |
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If there are any life-threatening compromises in airway status, stop and intervene to correct the problem. What are 4 examples of life-threatening airway conditions?
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If there are any life-threatening compromises in airway status, stop and intervene to correct the problem. What are 4 examples of life-threatening airway conditions?
LOBE loose teeth or foreign objects obstruction by tongue (partial or complete) blood, vomit, or other secretions edema |
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Life-threatening compromises in _______ may occur with a history of:
-blunt or penetrating injuries of the _____ -acceleration, deceleration, or a combination of both types of forces, such as ______ ________ ________, f______, or ____ injuries. |
Life-threatening compromises in BREATHING may occur with a history of:
-blunt or penetrating injuries of the THORAX -acceleration, deceleration, or a combination of both types of forces, such as MVC'S, FALLS, or CRUSH injuries. |
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Once the patency of the airway is ensured, what are some ways to assess the quality of breathing?
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spontaneous breathing
rise and fall of chest rate and pattern of breathing use of accessory muscles diaphragmatic vs. abdominal breathing color integrity of soft tissues & bony structures of chest wall bilateral breath sounds |
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______ _____ and _____ _______ _______ are considered late signs of considered late signs of breathing compromise.
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TRACHEAL DEVIATION and JUGULAR VEIN DISTENTION are considered late signs of considered late signs of breathing compromise.
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All trauma patients should receive _______, regardless of their preexisting history.
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All trauma patients should receive OXYGEN, regardless of their preexisting history.
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It is best to deliver oxygen to an alert trauma patient via ....
Supplemental oxygen should be administered at a flow rate sufficient to keep the reservoir bag inflated/deflated during expiration/inspiration. |
It is best to deliver oxygen to an alert trauma patient via a tight-fitting nonrebreather mask.
Supplemental oxygen should be administered at a flow rate sufficient to keep the reservoir bag inflated during inspiration. |
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Proper administration of oxygen via a nonrebreather mask usually requires a flow rate of at least ___ l/min and up to ____ l/min
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Proper administration of oxygen via a nonrebreather mask usually requires a flow rate of at least 12 l/min and up to 15 l/min
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When spontaneous breathing is present but ineffective, the following signs may indicate a life-threatening condition:
Altered _____ status _____ especially around the mouth ____________ or paradoxical expansion of the chest wall Use of __________ or abdominal muscles or both or diaphragmatic breathing(?) ________ chest wounds _______ or diminished breath sounds If breathing is _______: Administer O2 via a non rebreather mask or assist ventilations with a bag mask device, as indicated Anticipate definitive airway management to support ventilation. |
When spontaneous breathing is present but ineffective, the following signs may indicate a life-threatening condition:
Altered mental status Cyanosis, especially around the mouth assymetrical or paradoxical expansion of the chest wall Use of accessory or abdominal muscles or both or diaphragmatic breathing(?) Sucking chest wounds Absent or diminished breath sounds If breathing is ABSENT: Administer O2 via a non rebreather mask or assist ventilations with a bag mask device, as indicated Anticipate definitive airway management to support ventilation. |
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If there are any life-threatening injuries that compromise compromises breathing, stop and intervene to correct the problem before proceeding to _______ assessment. What are 4 examples of life-threatening injuries that compromise breathing?
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If there are any life-threatening injuries that compromise compromises breathing, stop and intervene to correct the problem before proceeding to CIRCULATION assessment. What are 4 examples of life-threatening injuries that compromise breathing?
Tension Pneumothorax Open Pneumothorax Flail Chest with pulmonary contusion Hemothorax These conditions may require simultaneous assessment and immediate intervention (e.g. needle thoracentesis or covering an open chest wound) |
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What are some methods of assessing circulation?
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Pulses (central- coratid, femoral, brachial < 1 y)
Skin- color, temperature, moisture CRT Inspect for obvious signs of uncontrolled external bleeding Blood Pressure (Delay until secondary assessment if other trauma team members are not available to auscultate BP) |
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If circulation is effective, proceed with assessment. Then what?
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If circulation is effective, proceed with assessment. Then what?
Obtain vascular access with a large-caliber IV catheter and administer warmed isotonic crystalloid solution at a rate appropriate for patient's condition |
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If you do feel a pulse, what are some other signs that indicate inadequate circulation?
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tachycardia
altered loc uncontrolled external bleeding pale, cool, moist skin distended or abnormally flat external jugular veins distant heart sounds |
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Control any uncontrolled external bleeding by
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applying direct pressure over bleeding site
elevate bleeding extremity apply pressure over arterial pressure points (The use of a tourniquet is rarely indicated, however it is a last resort if other methods are ineffective / operative control not available) |
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Whether circulation is effecitive or ineffective, it is important to start _____ to IV's using large-caliber catheters. Use a warmed isotonic, crystalloid solution. Use ______ bags to increase speed of infusion.
Infuse ______ _____ through ______ administration tubing. Venous cannulation may require a surgical cutdown, insertion of a central line, or both. When starting IV's, obtain a _____ to determine.... |
Whether circulation is effecitive or ineffective, it is important to start TWO to IV's using large-caliber catheters. Use a warmed isotonic, crystalloid solution. Use PRESSURE bags to increase speed of infusion.
Infuse NORMAL SALINE through BLOOD administration tubing. Venous cannulation may require a surgical cutdown, insertion of a central line, or both. When starting IV's, obtain a a blood sample to determine ABO and RH group and to facilitate additional lab studies. |
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Consider the use of a pneumatic ________ garment for intra-________ or _______ bleeding with ________.
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Consider the use of a pneumatic antishock garment (PASG) for INTRA-ABDOMINIAL or PELVIC bleeding with HYPOTENSION.
There are controversies surrounding their use, but the American College of Surgeons recommends their use to control bleeding from pelvic an lower extremity fractures. However, their use should not interfere with fluid resuscitation. |
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Review p. 37 about thoracotomies..
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..
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If any life threatening conditions compromise circulation, stop and intervene before proceeding to _________ assessment. What are 5 examples of these conditions?
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If any life threatening conditions compromise circulation, stop and intervene before proceeding to NEUROLOGICAL assessment. What are 5 examples of these conditions?
Pericardial Tamponade Uncontrolled external bleeding Shock r/t hemorrhage Shock r/t massive burns Direct Cardiac Injury |
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After the primary assessment of ABC's, conduct a brief neurological assessment to determine degree of ______ (D) as measured by the patient's _______ of _______.
This is determined by using what assessment technique? |
After the primary assessment of ABC's, conduct a brief neurological assessment to determine degree of DISABILITY (D) as measured by the patient's LEVEL OF CONSCIOUSNESS
This is determined by using what assessment technique? AVPU (mneumonic) |
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Describe AVPU assesment.
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A- ALERT V-Verbal P-PAIN U-Unresponsive
Speak to patient. The patient who is alert and responsive is considered A forl ALERT The patient who responds to verbal stimuli is considered V for VERBAL. P- Apply a painful stimulus. The patient who does not respond to painful stimuli but does respond to a painful stimulus is considered P for Pain U- The patient who does not respond to a painful stimulus is considered U for unresponsive |
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Review Glasgow Coma Scale P. 37
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...
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The recommendation of the American College of Surgeons Committee on Trauma is that patients with any of the following 4 criteria should be triaged to a trauma center.
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GSC of less than 14
SBP < 90 RR >29 or <10 total Revised Trauma Score of 11 or less |
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Assess neurological status using _____ and ______. Assess pupils for ____, ____, ______, and ______ to light. Determine the presence of lateralizing signs. What are lateralizing signs?
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Assess neurological status using AVPU and GCS. Assess pupils for SIZE, SHAPE, QUALITY, and REACTIVITY to light. Determine the presence of lateralizing signs (neurological assessment findings on one side of body). These include unilateral deterioration in motor movements or unequal pupils, symptoms that help locate the are of injury in the brain.
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If the disability assessment indicated a decreased LOC, conduct investigation during secondary focused assessment. If patient is not alert or verbal, continue to monitor for any compromise in ABC's. What are some signs of herniation or neurologic deterioration?
The Brain Trauma Foundation guidelines recommend the use of ___________ ONLY if the patient is exhibiting signs of herniation or neurologic deterioration that are nonresponsive to other resuscitation measures and ______. |
If the disability assessment indicated a decreased LOC, conduct investigation during secondary focused assessment. If patient is not alert or verbal, continue to monitor for any compromise in ABC's. What are some signs of herniation or neurologic deterioration?
Unilateral or bilateral pupillary dilation asymmetric pupillary reactiviy motor posturing The Brain Trauma Foundation guidelines recommend the use of HYPERVENTILATION ONLY if the patient is exhibiting signs of herniation or neurologic deterioration that are nonresponsive to other resuscitation measures and MANNITOL. |
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The patient's clothing should be carefully removed so that all injuries can be quickly identified. Ensure appropriate decontamination procedures if the patient has been exposed to a hazardous substance. Keep the patient warm by using warm blankets, heat lamps, or turning up the room heat to prevent hypothermia.
Hypothermia in trauma patients has been associated with increased mortality rates as a result of ___________s, ____, _______pathy, and decreased ____ _____. |
The patient's clothing should be carefully removed so that all injuries can be quickly identified. Ensure appropriate decontamination procedures if the patient has been exposed to a hazardous substance. Keep the patient warm by using warm blankets, heat lamps, or turning up the room heat to prevent hypothermia.
Hypothermia in trauma patients has been associated with increased mortality rates as a result of dysrhythmias, coma, coagulopathy, and decreased cardiac output. |
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During the primary/secondary assessment, enough information may be collected that would indicate if a patient has such severe injuries that they may need to be transferred to another facility. The earlier/later the patient transfer is initiated, the quicker the patient can be transported to a center that can provide the most appropriate care.
Arrangements for transfer and support should follow ______ (Emergency Medical Treatment and Active Labor Act) Guidelines. To safely and legally transfer a patient, there should, at a minimum: (3) |
During the primary assessment, enough information may be collected that would indicate if a patient has such severe injuries that they may need to be transferred to another facility. The earlier the patient transfer is initiated, the quicker the patient can be transported to a center that can provide the most appropriate care.
Arrangements for transfer and support should follow EMTALA (Emergency Medical Treatment and Active Labor Act) Guidelines. To safely and legally transfer a patient, there should, at a minimum: (3) an accepting physician an available bed AND resources to care for the patient an appropriate mode of transport used to transfer the patient based on the patient's injury and needs |
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Review Table 3-2 Interhospital transfer criteria when the patient's _______ exceed available _______.
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Review Table 3-2 Interhospital transfer criteria when the patient's needs exceed available resources.
P. 39 |
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After each component of the primary assessment has been addressed and ________ interventions have been initiated, begin the secondary assessment. What is the purpose of this assessment?
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After each component of the primary assessment has been addressed and lifesaving interventions have been initiated, begin the secondary assessment. What is the purpose of this assessment?
The secondary assessment is a systematic process to identify all injuries as well as collect any additional information about the patient and become aware of any comorbid factors that can affect the patient's care and resucitation. it's a brief, sys |
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Review table 3-1 Suggestive indications for resuscitative thoracotmy in patients with traumatic cardiac arrest
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p. 38
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The F of the assessment mneumonic stands for...
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Full set of VS
Focused adjuncts Family presence |
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After the nurse completes the ABDCDE of the assessment, intervenes for life-threatening conditions, and obtains a complete set of vital signs, what's next?
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After the nurse completes the ABDCDE of the assessment, intervenes for life-threatening conditions, and obtains a complete set of vital signs, what's next?
Critical decision making will determine whether to continue secondary assessment or perform additional interventions. Availability of members to perform focused interventions will influence the decision. |
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If the patient sustained significant trauma and required lifesaving interventions during primary assessment, perform (or have a team member perform) the following interventions before beginning secondary assessment:
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Cardiac leads
Pulse Ox (continuous) If pt. is intubated, connect to an exhaled CO2 detected Insert a Foley NG tube Diagnostics: Facilitate radiographic and diagnostic studies that are adjuncts to the primary assessment and initial resuscitation of the patient Labs Determine need for tetanus prophylaxis |
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A urinary catheter provides for bladder drainage, allows for frequent monitoring of output, and is necessary for any patient preparing for surgery. What is a contraindication to insertion of a urinary catheter (and indications of this contraindication)?
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A urinary catheter provides for bladder drainage, allows for frequent monitoring of output, and is necessary for any patient preparing for surgery. What is a contraindication to insertion of a urinary catheter?
Suspected injury to urethra. Indications: blood at urethral meautus palpation of a displaced prostate gl during rectal exam blood in scrotum suspicion of an anterior pelvic fracture |
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Gastric distention may lead to vomiting, aspiration, or both. Distention may stimulate the vagus nerve, which can lead to bradycardia. Insertion o fa gastric tube provides for evacuation of stomach contents, relieves gastric distention, and prevents vagal stimulation. What is a contraindication to placing an NG tube?
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Gastric distention may lead to vomiting, aspiration, or both. Distention may stimulate the vagus nerve, which can lead to bradycardia. Insertion of a gastric tube provides for evacuation of stomach contents, relieves gastric distention, and prevents vagal stimulation. What is a contraindication to placing an NG tube?
Possibility of midfacial fractures. |
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If a head injury is suspected, insert an orogastric/nasogastric tube.
After insertion, test the aspirated contents for presence of ____ and for _____. The tube must be places carefully by maintaining protection of cervical spine, minimizing stimulation of the ____ _____, and having _____ equipment available. |
If a head injury is suspected, insert an orogastric tube.
After insertion, test the aspirated contents for presence of BLOOD and for pH. The tube must be places carefully by maintaining protection of cervical spine, minimizing stimulation of the GAG REFLEX and having SUCTION equipment available. |
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What are some indications for a chest radiograph?
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What are some indications for a chest radiograph?
life-threatening injuries ( pneumothorax/ hemothoraces) confirm position of tubes and lines presence of a widened mediastinum** presence of diaphragmatic injuries |
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Diagnostic _______ _______ is done to aid in the diagnosis of hemoperitoneum or ruptured viscus. Once a common procedure, its use has decreased with the emergence of other types of diagnostic tests such as Focused Assessment Sonography for Trauma (FAST) and CT scans. However, it is recommended that this diagnostic exam be performed on the following hemodynamically stable/unstable patients:
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Diagnostic peritoneal lavage is done to aid in the diagnosis of hemoperitoneum or ruptured viscus. Once a common procedure, its use has decreased with the emergence of other types of diagnostic tests such as Focused Assessment Sonography for Trauma (FAST) and CT scans. However, it is recommended that this diagnostic exam be performed on the following hemodynamically UNSTABLE patients:
-changes in snesorium r/t alcohol or drug use -changes in sensation from a spinal cord injury -injury to adjacent structures such as lower ribs, pelvis, lumbar spine -patients with equivocal physical examination -patients who may require lengthy diagnostic testing or surgery for other injuries -patients with lap-belt sign |
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Focused Assessment Sonography for Trauma (FAST) can be performed rapidly in the ER to determine the presence of....
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Focused Assessment Sonography for Trauma (FAST) can be performed rapidly in the ER to determine the presence of free fluid in the peritoneum.
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True or False: Blood typing is the highest priority lab.
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true
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When getting a patient's history, obtain prehospital information from prehospital personnel as indicated by the circumstances of the injury event. Use the mnemonic MIVT as a guide, which means...
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When getting a patient's history, obtain prehospital information from prehospital personnel as indicated by the circumstances of the injury event. Use the mnemonic MIVT as a guide, which means...
M- Mechanism of injury I- Injuries sustained V-Vital Signs T-Treatment initiated and response |
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Explain the assessment of a patient's history in regard to Mechanism and Pattern of Injury
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Explain the assessment of a patient's history in regard to Mechanism and Pattern of Injury
Knowledge of the mechanism of injury and specific injury patterns (e.g.) type of motor vehicle impact) will help to predict certain injuries. If prehospital personnel transported the patient, have them describe pertinent on-scene info to the trauma team such as the location of the patient on their arrival, length of time since the injury event, and extent of extrication or reasons for extended on-scene time. |
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When assessing a patient's history in regard to Injuries suspected, ask prehospital personnel to describe the patient's ______ condition, level of _______, and _____ injuries.
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When assessing a patient's history in regard to Injuries suspected, ask prehospital personnel to describe the patient's apparent condition, level of consciousness, and apparent injuries.
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Explain the assessment using patient generated information and past medical history.
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If patient is responsive, ask questions to evaluate LOC & pain. If domestic violence is suspected, ask appropriate questions while providing comfort and a sense of security.
Gather info from patient or family regarding: Age Preexisting medical conditions Current Medications Allergies Tentanus immunization hx Previous hospitalizations & Surgeries Recent use of drugs/alcohol LMP if applicable Comorbid factors |
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Comorbid factors place a patient who has sustained trauma at greater risk of having complications related to the injury. What are some examples of of comorbid factors?
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Hx of Smoking
Hx of Substance Abuse Age > 55 Age < 5 Cardiovascular Disease Respiratory Disease Diabetes Hemophilia or other blood disorders Morbid Obesity Pregnancy Immunosuppression Use of Anticoagulants |
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Which comorbid factor is can be a deadly factor a significant amount of time?
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Use of Anticoagulants
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H stands for _______ and _______
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History
Head to Toe assessment |
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_______ sign is ecchymosis behind the ear and is a ____ sign of head injury.
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Battle's sign is ecchymosis behind the ear and is a late sign of head injury.
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True or False: If there is drainage from the ear such as blood or clear fluid, pack the ear to stop the drainage.
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False!
DO NOT pack the ear, it could be CSF Same goes for the nose |
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If clear fluid is draining from the nose, it would be a bad idea to insert a....
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NG tube
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Priapism
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persistent abnormal erection
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Throughly Review Assessment Techniques pages 43- 46
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PRACTICE PRACTICE PRACTICE
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Review Focused Adjuncts to Secondary Assessment p. 46
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...
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The evaluation of a trauma patient is that phase of the nursing process when the nurse evaluates the patient's response to the injury event and the effect of all interventions. The achievement of the expected outcomes is evaluated, and the treatment/intervention plan is adjusted to enhance these outcomes. To evaluate the patient's progress, monitor the following...
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Airway patency
Effectiveness of breathing Arterial pH, PaO2, and PaCO2 O2 Sat LOC Skin temperature, color, moisture Pulse rate and quality Blood Pressure Urinary Output Pain Response to analgesia and sedation (Also important to regularly reassess) Ongoing assessment of these parameters is an essential component of the trauma nursing process. |
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Review screening questions for a victim of a sexual assault.
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p. 47
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What are some signs of possible physical abuse separate from other injuries?
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Bruising/contusions to head, neck, chest, face
Defensive wounds- Injuries that suggest a defensive posture (bruises on back of a patient's arms) Bruising around wrists, ankles (possible restraint) Burn marks on face, chest, genitals Bite marks Injuries that don't equate with reported mechanism of injury Substantial delay from time of injury to seeking tx Evidence of drug or alcohol use Inspect perineum- bleeding, lacerations/tears, fluids, swelling |
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Head trauma... What radiology exam?
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CT of head
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The Revised Trauma Score measures the patient's response to injuries. What are the three values collected to calculate the score?
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Glasgow Coma Scale score
Systolic Blood Pressure Respiratory Rate (Pt. initiated, not artificial ventilations) |
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Describe the values of the Revised Trauma Score.
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Systolic BP
>89 4 76-89 3 50-75 2 1-49 1 0 0 Respiratory Rate 10-29 4 >29 3 6-9 2 1-5 1 0 0 GCS Score 13- 15 4 9 - 12 3 6 - 8 2 4 - 5 1 3 0 |
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Maintaining oxygenation and preventing _______ are critical in managing the trauma patient. Preventing this _______ is especially important as it can be very detrimental to the patient with a ____ injury.
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Maintaining oxygenation and preventing HYPERCAPNIA are critical in managing the trauma patient. Preventing this HYPERCAPNIA is especially important as it can be very detrimental to the patient with a HEAD injury.
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True or False: It should be assumed that most trauma patients have a full stomach and will vomit.
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True
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The patient may have an unobstructed airway but still have problems with ventilation. Factors that may contribute to impaired ventilation may include:
__________ mental status loss of ____________ ___________ injury _______ ____ injury (may result in diaphragmatic breathing and cause hypoxia) _______ injury (may cause abnormal breathing patterns and interfere with ventilation) ______ trauma resulting in ____ fractures and ______ _____ instability _______ caused by rib fractures (may cause ______ respirations resulting in _______) _________ trauma (may cause bleeding or pneumothorax, which can compress the lungs and interfere with ventilation and oxygenation) Preexisting history of ________ disease Increased _____ |
The patient may have an unobstructed airway but still have problems with ventilation. Factors that may contribute to impaired ventilation may include:
Altered mental status loss of consciousness Neurologic injury Spinal cord injury (may result in diaphragmatic breathing and cause hypoxia) Intracranial injury (may cause abnormal breathing patterns and interfere with ventilation) Blunt trauma resulting in rib fractures and chest wall instability Pain caused by rib fractures (may cause shallow respirations resulting in hypoxia) Penetrating trauma (may cause bleeding or pneumothorax, which can compress the lungs and interfere with ventilation and oxygenation) Preexisting history of respiratory disease Increased age |
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When obtaining a history, what are some pertinent questions specific to ask patients with airway and ventilation problems?
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Hx of facial, neck, or thoracic injury?
Hx of inhalation injury that could lead to airway obstruction Hx of a loss of consciousness? Any ingestion of alcohol or other drugs that could impair ability to protect the airway? Hx of nausea or witnessed vomiting that may lead to aspiration risk? Hx of respiratory disease or COPD? Hx of tobacco use? What type, how much, how long? What are the patient's complaints? Dyspnea, dysphagia, dyphonia? |
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____________ may be a sign of hypoxia, and a patient may be _________ because of hypercapnia.
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Agitation may be a sign of hypoxia, and a patient may be obtunded because of hypercapnia.
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g
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remove any devices. Check that they are placed properly and are not interfering with patient's ability to protect the airway.
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Describe techniques to open or clear an obstructed airway during the primary assessment.
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Jaw thrust: The angles of the lower jaw are grasped on each side with index fingers and thumbs on the cheekbone to move the mandible forward. This method can be used with the bag-mask device to provide a good seal for ventilation.
Chin Lift- the fingers of one hand are placed under the mandible, gently lifting upward o raise the chin while the thumb pulls the lower lip to open the mouth. This maneuver must be performed carefully to avoid hyperextending the neck. Removal of loose objects or foreign debris- remove secretions manually or with suctioning as needed Suctioning and other manipulations of oropharynx- These procedures must be done gently to prevent stimulation of the gag reflex and subsequent vomiting, aspiration, or both |
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If the patient has an altered mental status and can't keep his or her airway open, what should be done?
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Insert an
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Medications such as sedatives and ____________ blocking agents may be used to facilitate intubation. The types of medications used are determined by institutional protocols and the experience level of the personnel performing the procedure. The _____ pneumonic can be used to describe the pretreatment drugs for rapid sequence intubation, which include....
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Medications such as sedatives and neuromuscular blocking agents may be used to facilitate intubation.
The types of medications used are determined by institutional protocols and the experience level of the personnel performing the procedure. The LOAD pneumonic can be used to describe the pretreatment drugs for rapid sequence intubation, which include Lidocaine Opioids Atropine Defasiculating Agents |
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Rapid Intubation Steps
Preparation: Gather equipment. Ensure access to ________ airways, additional skilled personnel such as anesthesia staff, or an airway cart with equipment if the airway cannot be secured. Pre_________: Use 100% Oxygen. It is best if pt can spontaneously breathe to prevent risk of aspiration Pretreatment: Administer Drugs to decrease effects associated with intubation Paralysis with induction: An ________ agent is administered so the pt loses consciousness. This is followed by administration of a _______ ________ agent, usually succinylcholine. Protection and Positioning: Apply pressure over the cricoid cartilage (_______ maneuver). This pressure should be continuously applied to minimize likelihood of vomiting and aspiration. Placement with proof: Each attempt should not exceed ____ seconds, max ___ attempts. If more than one attempt is needed, _______ for ___-____ seconds in between. After intubation, ______ the cuff. Confirm placement with.... Postintubation management: _______ ET tube Set ________________ settings. Obtain a ______ _______. Continue to medicate. Recheck..... |
Rapid Intubation Steps
Preparation: Gather equipment. Ensure access to alternative airways, additional skilled personnel such as anesthesia staff, or an airway cart with equipment if the airway cannot be secured. Preoxygenation: Use 100% Oxygen. It is best if pt can spontaneously breathe to prevent risk of aspiration Pretreatment: Administer Drugs to decrease effects associated with intubation Paralysis with induction: An INDUCTION agent is administered so the pt loses consciousness. This is followed by administration of a NEUROMUSCULAR BLOCKING agent, usually succinylcholine. Protection and Positioning: Apply pressure over the cricoid cartilage (SELLICK maneuver). This pressure should be continuously applied to minimize likelihood of vomiting and aspiration. Placement with proof: Each attempt should not exceed 30 seconds, max 3 attempts. If more than one attempt is needed, VENTILATE for 30-60 seconds in between. After intubation, inflate the cuff. Confirm placement with an exhaled CO2 detector Postintubation management: Secure ET tube Set ventilator settings. Obtain a chest x-ray. Continue to medicate. Recheck VS and O2 sat. |
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True or False: Blind nasotracheal intubation is indicated when the patient is apneic or when there are signs of major midface fractures such as maxillary.
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False. Blind nasotracheal intubation is NOT indicated when the patient is apneic or when there are signs of major midface fractures such as maxillary. Basilar skull fractures or fractures of the frontal sinus or cribiform. plate are considered relative contraindications
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If the patient is not adequately ventilating, respirations should be supported by.... Because of the risk of vomiting with this, a _____ _____ should be delivered to produce rise and fall of chest.
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If the patient is not adequately ventilating, respirations should be supported by using a bag mask device. Because of the risk of vomiting with this, a tidal volume should be delivered to produce rise and fall of chest.
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A percutaneous transtracheal ventilation, or __________ may be performed as a _______ solution. It is indicated when other methods of airway management have failed and the patient cannot be adequately ventilated and oxygenated. Further intervention must be provided within ___ to ___ min.
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A percutaneous transtracheal ventilation, or CRICOTHYROTOMY may be performed as a TEMPORARY solution. It is indicated when other methods of airway management have failed and the patient cannot be adequately ventilated and oxygenated. Further intervention must be provided within 30-45 min.
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How can an ET tube or other alternative airway be confirmed?
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visualization of tube passing through cords
fiberoptic bronchoscope Breath sounds while ventilating patient Connect an exhaled CO2 detection device Attaching an esophageal detection device (only confirms initial placement) Chest X-ray |
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True or False: All trauma patients should receive some supplemental oxygen.
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True
administer through a nonrebreather mask at a flow rate sufficient to keep reservoir bag inflated, during inspiration, this usually requires a flow rate of at least 12 l/min and may require 15 /l m or more |
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To inspect and palpate the anterior neck region (jugular veins, trachea) _______ the front portion of the cervical collar. Another team member must hold patient's ____ while collar is being removed and replaced.
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To inspect and palpate the anterior neck region (jugular veins, trachea) REMOVE the front portion of the cervical collar. Another team member must hold patient's HEAD while collar is being removed and replaced.
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When assisting with needle thoracentesis if the patient has signs and symptoms of a tension pneumothorax,
what is the insertion site? Insert needle on same side as the decreased or absent breath sounds and _____ to tracheal shift. |
2nd intercostal space, midclavicular line
Insert needle on same side as the decreased or absent breath sounds and _____ to tracheal shift. A large-caliber IV (10-14 gauge) over the needle catherter, 3 to 6 cm in length, over the top of the third rib into the pleural space until air escapes. Air should exit under pressure. Remove needle and leave catheter in place until it is replaced by a chest tube. |
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True or False: a chest x-ray can confirm placement of an ET tube
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False. It can help assess position, but can't exclude esophageal intubation.
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True or False: A chest x-ray can determine presence of a hemothorax or pneumothorax.
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true
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When assessing chest tubes and artificial airways, monitor respiratory status. Reassess interventions such as occlusive dressings and chest tube drainage to determine amount and any change in drainage characteristics. Use the _____ mneuomonic to evaluate chest tube function.
Evaluate pain status to ensure the patient is able to take sufficiently deep breaths. Collaborate with team to manage ventilator status of patient. Monitor patients closely on the ventilator. Monitor ABGS. Utilize the _____ mneumonic to troubleshoot ventilator alarms. What does that mean? |
When assessing chest tubes and artificial airways, monitor respiratory status. Reassess interventions such as occlusive dressings and chest tube drainage to determine amount and any change in drainage characteristics. Use the DOPE mneuomonic to evaluate chest tube function.
Evaluate pain status to ensure the patient is able to take sufficiently deep breaths. Collaborate with team to manage ventilator status of patient. Monitor patients closely on the ventilator. Utilize the DOPE mneumonic to troubleshoot ventilator alarms. D- Displaced Tube O- Obstruction: Check for secretions or patient biting tube P- Pneumothorax: Condition may occur from original trauma or barotrauma from ventilator E- Equipment Failure: Patient may have become detached from equipment, or there may be a kink in the tubing. |
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True or False: The position of the ET tube must be reassessed EVERY time the patient is moved to ensure that adequate airway and ventilation support is provided.
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true
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True or False: No lab or diagnostic study indicates a diagnosis of shock
What is the most common cause of shock in injured patients? Most common type of shock in trauma patients? |
true. It must be recognized by presence of inadequate tissue perfusion such as cold, moist skin & Altered LOC
hemorrhage hypovolemic |
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What kind of shock is caused by a burn?
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hypovolemic
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________ shock is a syndrome that results from ineffective perfusion caused by inadequate contraction of cardiac muscle.
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CARDIOGENIC shock is a syndrome that results from ineffective perfusion caused by inadequate contraction of cardiac muscle.
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_____ shock results from an inadequate circulating blood volume because of an obstruction or compression of the great veins, aorta, pulmonary arteries, or the heart itself. What are some examples?
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OBSTRUCTIVE shock results from an inadequate circulating blood volume because of an obstruction or compression of the great veins, aorta, pulmonary arteries, or the heart itself.
Examples: cardiac tamponade tension pneumothorax air embolus |
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__________________ shock results from a disruption in the SNS control of the tone of blood vessels, which leads to vasodilation and maldistrubition of blood volume and flow. Examples include..
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Distributive shock results from a disruption in the SNS control of the tone of blood vessels, which leads to vasodilation and maldistrubition of blood volume and flow. Examples include neurogenic shock (upper spinal cord injury) and septic shock.
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In distributive shock, autonomic sympathetic functions are lost, results in...
-Loss of vasomotor tone regulated by SNS, which results in peripheral ___________ and maldistribution of blood volume in peripheral vessels, especially veins, leading to _______. -Loss of cutaneous control of sweat glands, resulting in an inability to sweat, loss of thermoregulatory control, and warm/cool, wet/dry skin. -Increased parasympathetic control of heart rate, resulting in _________ ________ shock is a phrase used to describe the areflexia and flaccidity associated with lower motor neuron involvement in complete cord injuries; reflexes return with resolution of spinal shock. Septic shock from bacteremia is another example of distributive shock. ________ and other inflammatory mediators cause vasodilation, shunting of blood in the microcirculation, and other perfusion abnormalities. |
In distributive shock, autonomic sympathetic functions are lost, results in:
-Loss of vasomotor tone regulated by SNS, which results in peripheral VASODILATION and maldistribution of blood volume in peripheral vessels, especially veins, leading to HYPOTENSION. -Loss of cutaneous control of sweat glands, resulting in an inability to sweat, loss of thermoregulatory control, and WARM, DRY skin. -Increased parasympathetic control of heart rate, resulting in BRADYCARDIA SPINAL shock is a phrase used to describe the areflexia and flaccidity associated with lower motor neuron involvement in complete cord injuries; reflexes return with resolution of spinal shock. Septic shock from bacteremia is another example of distributive shock. ENDOTOXINS and other inflammatory mediators cause vasodilation, shunting of blood in the microcirculation, and other perfusion abnormalities. |
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Due to the metabolic state in the shock patient, the outcome is metabolic/respiratory alkalosis/acidosis
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Metabolic Acidosis
(building up lactic acid from anaerobic metabolism)) |
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What is pulse pressure?
It narrows as ________ _____ falls and blood vessels ______. A __________ pulse pressure is an ______ sign. |
difference between systolic and diastolic
It narrows as CARDIAC OUTPUT falls and blood vessels CONSTRICT. A NARROWING pulse pressure is an OMINOUS sign. |
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Describe the Color Coded Disaster Triage Categories
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Red =
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Using percussion to assess a patient in shock
______ of chest or abdomen may indicate presence of blood. Early identification of sources of internal blood loss is essential. |
Using percussion to assess a patient in shock
Percussion of chest or abdomen may indicate presence of blood. Early identification of sources of internal blood loss is essential. |
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What is a central pulse?
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Adult: coratid or femoral
< 1 year old: Brachial |
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For a patient in suspected shock, administer 1-2 liters of warmed (what temp?) fluid IV boluses as fast as possible of either _______ _______ (#1)or _____ ______(#2). If pt. does not adequately respond, consider a blood transfusion. What should be monitored throughout these infusions?
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For a patient in suspected shock, administer 1-2 liters of warmed (102.2 F or 39 C) fluid IV boluses as fast as possible of either LACTATED RINGERS (#1)or NORMAL SALINE (#2). If pt. does not adequately respond, consider a blood transfusion. What should be monitored throughout these infusions?
LUNG SOUNDS URINE OUTPUT BP & HR NEUROLOGIC STATUS Also important to monitor for fluid overload. Monitor the above to differentiate between a true hypovolemic shock and neurogenic shock (which is normovolemic). |
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How should a patient in shock be positioned?
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Legs elevated
Modified trendelenburg if no head/neck injury suspected (supine, legs elevated) This assists venous return to R atrium, but abdominal viscera remain in their normal position. When BP is stabilized, the patient's legs may be lowered gradually while monitoring BP for changes. |
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After initial resuscitative interventions have been completed, Insert these 2 things for a patient in hypovolemic shock:
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Gastric Tube
Distention may lead to vomiting, aspiration, or both. Distention may stimulate vagus nerve, resulting in bradycardia. Insertion provides for evacuation of stomach contents, relieves gastric distention, and prevents vagal stimulation. Test aspirated contents for presence of blood. Foley Allows bladder drainage & accurate I & O necessary for preop |
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Peripheral vasoconstrictors are ________________ in a hypovolemic patient.
Prepare patients for _____ if bleeding (internal or external) is suspected, diagnosed, or uncontrolled. |
Peripheral vasoconstrictors are CONTRAINDICATED in a hypovolemic patient. But th be considered in patients who present in neurogenic shock with no other injuries causing hypovolemia.
Prepare patients for SURGERY if bleeding (internal or external) is suspected, diagnosed, or uncontrolled. |
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How to calculate CPP?
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(CPP= Cerebral Perfusion Pressure)
CPP = MAP - ICP |
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Early signs of increased ICP
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Headache
Nausea & Vomiting Amnesia regarding events surrounding injury Altered LOC Restlessness, drowsiness, changes in speech, or loss of judgment |
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Late signs of Increased ICP
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dilated, nonreactive pupil
unresponsiveness to verbal or painful stimuli abnormal posturing widening pulse pressure increased Systolic BP changes in respiratory rate or pattern Bradycardia |
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Herniation of the brain occurs as a result of uncontrolled increases in ICP.
Significant symptoms include |
unilateral or bilateral pupillary dilation
assymetric pupillary reactivity abnormal motor posturing other evidence of neurologic deterioration |
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True or False, a minor head trauma is usually defined as as an injury that produces a GCS 13-15.
If any of the following symptoms post head injury are present, these patients are considered high risk patients... assymetric pupils loss of consciousness > 2 min vomiting seizure activity after injury headache skull fracture recent alcohol ingestion anticoagulant therapy Low Risk: asymptomatic normal pupils no change in mentation/consciousness memory intact no other injuries accurate hx trivial mechanism reliable home observers |
True
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As CCP increases/decreases, CPP increases/decreases, leading to cerebral ischemia and potential for hypoxia and lethal secondary insult. In a hypo/hypertensive patient, even small elevations in ICP can be harmful. A slightly elevated BP could protect against brain ischemia in a patient with a high ICP.
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As CCP increases, CPP decreases, leading to cerebral ischemia and potential for hypoxia and lethal secondary insult. In a hypotensive patient, even small elevations in ICP can be harmful. A slightly elevated BP could protect against brain ischemia in a patient with a high ICP.
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Review GCS P 103
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..
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Cullen's sign & Grey Turner's Sign
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Cullens- ecchymosis around navel
Grey Turneres- ecchymosis of flank suggest retroperitoneal bleed may be very late signs |
