Trauma Queens
Name the components of primary trauma assessment
Airway
Breathing
Circulation
Disability (GCS)
Exposure
Pump failure - decreased contractility leading to decreased CO = poor tissue perfusion
Name 3 types of distributive shock
Septic shock
anaphylactic shock
neurogenic shock
*distributive = vasodilation and decreased SVR = HUGE tank, no forward pressure
Pulmonary embolisms, pneumothorax & cardiac tamponade may cause this type of shock
Obstructive shock
What are key vital sign characteristics in neurogenic shock?
Bradycardia, hypotension, decreased SVR
Crush injuries commonly lead to this serious complication
Rhabdomyolysis
How does the intraaortic balloon pump improve cardiac output?
Balloon inflates in aorta during diastole to build up diastolic pressure, balloon deflates during systole to allow forward pressure.
What is the significance of increased capillary permeability?
intravascular fluids begin to leak into tissues, out of vessels, due to microscopic holes in vessels; causes a relative hypovolemia
What is the primary difference between anticoagulants & thrombolytics?
Anticoagulants stop clots from forming or getting larger; thrombolytics break down and "lyse" any existing clot
Neurogenic shock: cold/clammy/pale OR warm/dry/flushed?
Warm, dry, flushed
You are caring for a patient following MVC, unrestrained driver who was ejected from vehicle approx 20 yards. Pt arrives with periorbital ecchymosis, clear drainage from nose and ears - which nursing action is contraindicated?
A. IV insertion and IV fluid bolus
B. Intubation for airway protection
C. Cervical spine immobilization
D. NG tube placement
How do catecholamines and RAAS work to improve cardiac output?
Increase stroke volume, increase heart rate, increase, SVR, increase preload
What type of shock do you anticipate?
WBC - 24,000, BP 86/42, HR 130, RR 22, Temp 100.0F
Pt is 6 days post op from multiple orthopedic surgeries following motorcycle accident with 2 open fractures requiring wash out and external fixation
Septic Shock
place arrows (up or down) for obstructive shock
HR, BP, Urine output, CO, SvO2
HR - up
BP - down
UO- down
CO - down
SvO2 - down
How do we manage neurogenic shock?
vasopressors, fluid resuscitation, temperature management, atropine
Name 5 labs/images that would be relevant for a patient with thoracic trauma
chest XR, chest CT, pericardial ultrasound, CBC, CK, troponin, EKG, cardiac monitoring
Mechanism of action for inotropic medications
Increased cardiac contractility
How many mL's of crystalloid would you anticipate for resuscitation if your patient is 214lbs?
214lbs = 97kg
97kg x 30mL = 2910mL
practice tip *you can round to 3L*
*name at least 4*
chest pain, jugular vein distention, hypoxia, muffled heart sounds, absent breath sounds, tracheal deviation, peripheral edema, hepatomegaly
What is spinal shock?
temporary pause in nerve stimulation below level of injury - pt loses motor, sensory, reflex activity
What is compartment syndrome? Name the 6 P's
pain, palor, pulselessness, paresthesia, paralysis, pressure
Your patient is admitted with signs of cardiogenic shock secondary to CHF with EF 15%. You note that morning Cr level is 2.6. What is the cause of this AKI? Pre, intra or post renal?
pre renal injury from decrease perfusion to end organs, secondary to pump failure
We need to draw _____ prior to any antibiotic administration for sepsis treatments!
Blood Cultures!
G.M. is 68yo, PMH of breast cancer and osteoporosis, presents to ED after falling down 4 stairs, landing on L side. Assessment findings: GCS 13, reports L sided chest wall tenderness, pain 8/10, crepitus on palpation to L chest, resps labored and deep, RR 24, HR 125, BP 74/30, trachea deviated right, diminished breath sounds on L side. What is a potential diagnosis & intervention?
tension pneumothorax requiring needle decompression
List 4 priority nursing care for patients with spinal cord injuries
VTE prevention, skin care, manage vital signs, pulmonary toileting, psychosocial care, bowel/bladder function