Sepsis
immunosuppression, large open wounds, invasive procedures, malignancy, over 80, less than 1, DM, kidney disease, hepatitis, HIV/AIDS, alcoholism, splenectomy, transplant recipient, chronic ABX use, bacteremia, pneumonia, urosepsis
what are the risk factors for sepsis
tissue and organs are starved for O2 which will lead to MODS
what is septic shock
progressive dysfunction of 2 or more organs/systems
what is MODS
damage to the brain from trauma, not congenital or neurodegenerative
what is a TBI
no feeling (innervation) below the injury
what is a complete SCI
infection, fever, hypothermia, tachycardia, tachypnea, hypoxemia, AMS
what are the general manifestations of sepsis
blood vessels shunt blood to vital organs falsely increasing COP, normal/slightly decreased BP, warm skin, increased pulse pressure, AMS, decreased UOP, hyperglycemia, hyperdynamic state
what is the early/warm phase
usual cause of MODS
what is sepsis/septic shock
focal, diffuse, closed, acceleration, deceleration, coup-contrecoup, mild, moderate, severe
what are the types of primary brain injuries
some feeling/movement below the injury
what is an incomplete SCI
2 units of PRBC, rapid fluid replacement, draw lactate level, ABX
what is Dr. Elmore's top 4 management of sepsis
organ failure because of decreased perfusion, hypothermia, tachycardia, decreased pulse pressure, cool pale skin, decreased LOC leading to unresponsiveness, anuria, extremely low COP, cyanosis, hypoglycemia, hypodynamic state
what is the late/cold phase
increased RR, hyper metabolism, hypoxia, lactic acidosis, azotemia
what is the manifestations of MODS
post-concussion syndrome, chronic traumatic encephalopathy, brain herniation syndrome, hypotension, hypoxia, increased ICP, hemorrhage
what are the types of secondary brain injuries
hyperflexion, hyperextension, axial loading, excessive rotation, penetrating trauma
what are the 5 primary mechanisms with a SCI
WBC, lactate level, d-dimer
what are the labs that are elevated with sepsis
ABCs, mechanical vent, remove source of infection, blood cultures, ABX, fluid resuscitation, dopamine, norepinephrine, dobutamine, nipride, corticosteroids, insulin, thrombolytics/anticoagulants, antipyretic NO ASA
what is the management for septic shock
#1 goal is to prevent, treat/remove source of infection, keep O2 high to maintain perfusion, keep Hgb 10-12, fluid resuscitation, meds if fluid isn't effective, enteral feeding maybe TPN, CRRT
what is the management of MODS
neuro assessment, airway assessment, ICP monitoring, hemodynamic monitoring, control ICP
what are the nursing interventions for a TBI
hemorrhage, ischemia, hypovolemia, impaired tissue perfusion, local edema
what are the secondary mechanisms with a SCI
dopamine, dobutamine, norepinephrine, vasopressin, NS, LR, colloid fluids
what are the meds used with sepsis
phenobarbital, mannitol, craniotomy, bone fragments, evacuate hematoma, foreign body removal
what are the medical interventions for a TBI
neuro, hemodynamic, GI, autonomic dysfunction, skin, airway, cardio, GI decompression, elimination, halo vest, plates, rods, high dose glucocorticoids, vasopressors, LR, PPIs
what is the management for a SCI