Shocking Information
List 4 kinds of shock
Hypovolemic (Hemorrhagic)
Cardiogenic
Anaphylactic
Neurogenic
The goal 90 - 90 - 9 for a head injured patient represents what?
BP
Oxygen
GCS
What is the #1 cause of bradycardia in a child?
Hypoxia
30 yr old female fell down stairs and has a closed head injury. She is unresponsive and breathing. Her BP is 200/110. Why?
BP typically rises in head injury patients to maintain perfusion to the brain.
Use this for uncontrolled bleeding
What is a tourniquet
A patient with a closed head injury has the following vitals. P 80, RR 24, BP 160/90.
Elevating his head is an appropriate intervention.
True / False
•True
Name the reason children are more prone to head injuries & hypothermia than adults.
Larger head size (weak neck muscles)
Large BSA relative to mass
Employee was hit by a car in the parking lot. He is awake but cannot move or feel his legs. He has no other obvious injuries. He is complaining that it is hard to get his breath. Lungs are clear but diminished. There is no chest injury.
Identify the probable cause of his difficulty breathing.
Damage to his spinal cord has decreased the number of muscles he can use for breathing.
List different ways to control bleeding
Direct pressure
Pressure points
Tourniquet
Splinting
Describe the difference between a subdural and an epidural hematoma.
Name the cardinal sign of an epidural hematoma and double your points.
•Subdural (below the dura, venous bleed)
•Epidural (above the dura, arterial bleed)
•Brief period of consciousness after being unconscious
This is the most reliable indicator of shock in a child.
Tachycardia
List the areas which are assessed when performing a Glasgow Coma Scale
Identify the highest (best) value for each component and double your points
Eye Opening - 4
Verbal Response - 5
Motor Response - 6
What are the vital signs for a patient in compensated shock?
Increased pulse
Increased respirations
Normal BP
Name the condition present in head trauma patients who have an increased systolic pressure, widened pulse pressure, bradycardia, and altered respiratory pattern.
Identify what this indicates and double your points!
•Cushing’s Reflex
•Brain Stem Herniation
Most common cause of seizures in a pediatric patient.
What is a Fever
Management of the head trauma patient should include hyperventilating when?
State the correct hyperventilation rate in adults and double your points!
•Patient exhibits signs & symptoms of brain stem herniation.
–Unequal pupils
–Cushing Reflex
–Fixed and dilated pupils
20 bpm adults, 30 bpm children, 35 bpm infants
A 40 yr old male fell from the loading dock. He is unresponsive with a head injury. He is bleeding from a 4 inch laceration on his scalp. His Pulse is 130, BP is 70/30, Respirations are 8, Pupils are 5 mm and reactive.
* Explain the cause of his current vital signs.
* Identify treatments to improve each of his vital signs and double your points!
Resp 8: Head injury - BVM at a rate of 10
Pulse: Shock - Internal injury - Keep warm/calm
BP: Shock - Internal injury - Keep warm/calm
Name the condition present in head trauma patients who have an increased systolic pressure, widened pulse pressure, bradycardia, and altered respiratory pattern.
Identify what this indicates and double your points!
•Cushing’s Reflex
•Brain Stem Herniation
When back boarding a child, it is essential to remember these 2 positioning techniques
•Placing linen under the shoulders to keep neck from becoming flexed.
•Pad the voids
A 36 yr old women has been stabbed with a knife in the back of her neck. She is unable to feel anything from the shoulders down. Her pulse is easy to palpate at 120, Resp are 24, BP is 80/40. Name this condition and explain why it occurred.
•Spinal Cord / Neurogencic Shock
•Loss of innervation to the spinal cord prevents the sympathetic nervous system from constricting the blood vessels.