Multisystem Trauma
what is multisystem trauma?
trauma affecting multiple body systems
SIRS criteria (2 or more of these +infection=sepsis)
temp >100.5 or < 96.8
HR>90
RR>20 or PACO2 <32
WBC >12,000 or <4,000 or >10% band cells
what is the main antibiotic used before blood cultures when treating sepsis?
rocephin, use broad spectrum until you know what is causing it
MAP and blood loss in stage 1 (early shock)
<10% below normal, <500mL loss of blood
what does lactic acid show?
cells with lack of O2
diagnostic tests for multisystem trauma
CT first, MRI, x-ray, ultrasounds, EEG (seizures)
early sepsis manifestations
BP: WNL or low
HR: high (thready), kids (bounding)
RR: high (deep)
skin: warm, diaphoretic, flushed
LOC: anxious, A&O
UOP: WNL
temp: increased, chills
n/v/d
vasopressors used in sepsis
dopamine and levophed (norepinephrine)
what are some compensatory mechanisms that your body activates during early shock?
increases HR, RR and BP
kids: cold, mottled skin, tachycardia, cap refill >3 sec
MAP and blood loss in stage 3 shock (decompensated)
MAP falls 20% below normal, blood loss of 30-40%
compensatory mechanisms are no longer working
signs and symptoms of mild head injury?
treatment?
s/s:headache, change in memory, nausea, sensitivity to light, blurred vision, balance problems
tx: dim lights, HOB at 30 degrees, ice, CT, MRI, EEG
late manifestations of sepsis
HR: increased, arrhythmias
RR: increased, shallow
skin: cool, clammy,edema
LOC: lethargic/comatose
UOP: oliguria or anuria
temp: decreased or WNL
what is refractory septic shock?
when there is no response to treatment including vasopressors and IVF
MAP and blood loss in stage 2 (compensatory shock)
MAP 10-15% below normal and blood loss of 15-30% (1000mL)
stage 4 of shock (refractory shock) (cell death)
BP can be restored, acidic state, tx will not reverse
signs and symptoms of TBI?
tx?
s/s: confusion, seizures, coma, n/v
tx: mannitol, anticonvulsants, surgery if needed, PT,ST
what is MODS? and what should the RN watch for?
multi-organ dysfunction syndrome
once the liver fails the patient is typically beyond recovery
watch for crackles, no UOP, wheezing, dyspnea, edema in lungs
what is septicemia?
bacteria in the bloodstream
what VS do pediatric patients maintain till profound shock?
BP
signs and symptoms of hypovolemic shock
pale, cool to touch, hypotension, tachycardic, increased CO, tachypnea, change in LOC, ascites
tx?
s/s: neck stiffness and pain, ringing in ears, problems with concentration, dizziness, blurred vision
tx: muscle relaxers, immobilization, pain meds, ice and heat
labs done for sepsis?
blood cultures (1st) (2 sites for adults, 1 for kids)
lactate (greater than 2 is sticky, over 4 is critical)
CBC w/ diff
ESR and CRP
BUN and Creatinine
ABGs (RT)
MAP needed for organs to be perfused
>65
tx for stage 2 shock?
IVF, treat problem
poor survival
tx, meds and labs to monitor for hypovolemic shock
tx: IV fluids, blood, NPO until GI system is WNL
meds: diuretics to treat 3rd spacing, antidysrhythmics, vasopressors, thoracentesis if needed for ascites
labs: H&H, ABGs, BUN and Creatinine, electrolytes