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Critically Ill Flashcards

1
Q

What are the two categories of assessment?

A

primary and secondary

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2
Q

What are the components of the primary survey?

A

CPR, Key vital assessment

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3
Q

How long does the primary survey take?

A

10-15 s

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4
Q

What does primary survey check?

A

immediate threat to life

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5
Q

What are the key vital functions assessment in the primary survey?

A 
ABCDE
a - airway
b - breathing
c - circulation
d - disability
e - expose
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6
Q

What do you do for airway in vital assess?

A 
PROTECT C spin
LOC
ask to speak and to not stop talking
airway patency
open airway
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7
Q

What do you do for breathing in vital assessment?

A

observe chest rise and fall
RR and depth
auscultate

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8
Q

What do you do for disability in vital assessment?

A

Mental status

AVPU

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9
Q

What does AVPU stand for?

A

alert, responds to verbal, responds to pain, unresponsive

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10
Q

What do you do for exposure in vital assessment?

A

take all clothes off and look for shit

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11
Q

What vital signs do you get in primary assessment?

A

HR, RR, BP, mental status, temp, pulse ox

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12
Q

What do you do for CPR?

A 
are you ok?, call for help
Check pulse 10 s
no pulse --> compressions 100/min
2 breaths/30 compression
C A B
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13
Q

What does secondary survey check for?

A

conditions that could become life threatening

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14
Q

What is the CAB of CPR?

A

Compression
Airway
Breathing

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15
Q

What is the recommendation of chest compressions?

A

adult - 2 inches or 1/3 body wideth

kids 1.5 inches

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16
Q

When do you do compression on kids?

A

pulse

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17
Q

What are the parts of the secondary survey?

A

HX - SAMPLE

PE - Head/neck, chest, abdomen, pelvis, extremities, back

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18
Q

What hx do you get aka sample?

A 
S - signs and symptoms
A - allergies
M - medications
P - PMH
L - last meal
E - events preceding/related to illness
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19
Q

What causes blunt trauma?

A

MVA, falls, struck, sports

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20
Q

What causes paradoxical chest movement?

A

flail chest

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21
Q

What are the pulses you check?

A

radial, carotid, femoral

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22
Q

What does a radial pulse mean?

A

minim 80 systolic

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23
Q

What does cartoid pulse mean?

A

minim 60 systolic

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24
Q

What does femoral pulse mean?

A

minim 70 systolic

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25
What is most commonly injured in blunt trauma?
spleen
26
What causes penetrating trauma?
firearm, stabbings, impalement, blasts
27
What is most commonly injured in penetrating trauma?
liver
28
What do you want to know about burns?
body surface and depth
29
What are the energy transfer rules?
``` 20 miles/hour 20 feet/distance 20 minutes trapped Low velocity GSW 2000ft/s Shotgun wounds > or ```
30
What is ecchymotic discoloration around both eyes and what does it mean?
raccoon eyes - basilar skull fracture
31
What is bruising around umbilicus and what does it mean?
cullens, intraabdominal bleed
32
What is precordial crunching, clicking or knocking sound with heartbeat and what does it mean?
Hamman sign | mediastinsitis, pneumothorax, resp failure
33
What is ecchymoic disocloration behind ear and what does it mean?
Battle sign - basilar skull facture
34
What is discoloration and induration of skin of flanks and what does it mean?
grey-turner, retroperitoneal bleed or hemorrhagic pancreatitis
35
What is severe pain in the subscapular area on left and what does it mean?
Kehr - spleen rupture, ectopic preg, GI disease due to phrenic nerve irritation
36
What do you inspect on head?
face and scalp for trauma ears - TM for blood or perf Eyes - pup size and responsive, lens discoloration, EOM, hemorrhage Nose - deformity, bleeding Mouth - blood, vomit, foreign body, teeth Face/scalp - tender, depressions, creptius, temp
37
What do you do for neck?
inspect JVD, trauma Listen to carotids C spine palpate
38
What do you palpate anterior neck for?
deformity, crepitus, tenderness
39
What do you palpate posterior neck for?
tenderness, midline, step off
40
What do you do for chest?
inspect for trauma Palpate - sternum, ribs, clavicles Auscultate breath Auscultate heart
41
What do you do for abdomen?
Inspect trauma, seat belt, cullen, grey turner, distention | Palpate each quadrant
42
What do you do for pelvis?
inspect - bruising over wings Inspect - peritoneum for trauma Assess stability - A to P on ASIS and pubic symph DRE
43
What do you do for extremities?
Inspect - injury Palpate Motor and sensory Palpate peripheral pulses in all and cap refill
44
How do you roll a person?
3 person log roll
45
What do you do for back?
Inspect - c spine, trauma | Palpate - entire midline, look for tenderness
46
What is the eye response in glasgow?
open spontaneously - 4 open to verb - 3 open to pain - 2 dont open - 1
47
What is the verbal response in glasgow?
``` oriented - 5 confused but answers -4 inappropraite response - 3 incomprehensive - 2 none - 1 ```
48
What is the motor response for glasgow?
``` obeys command - 6 purposeful mvmt to pain - 5 withdraws from pain - 4 abnormal flexion, decort - 3 abnormal extension, deceb - 2 none - 1 ```
49
What glasgow means coma?
3-8
50
When do you repeat primary survey?
every 5 min
51
What do you do for peds?
evaluate resp distress | evaluate for dehydration
52
What are signs of dehydration in kids?
``` mucous membrane dry skin turgor loss cool clammy skin sunken fontanelles eyes sunken, no tears cap refill >2 s ```
53
What are things to note in elderly?
Limited mobility of neck/TMJ Weaker cough/gag reflex (increased risk of aspiration/obstruction) Increased stiffness of rib cage (increased rate of rib fx) Respiratory failure progresses quickly -decreased energy reserve Lower cardiac output Increased risk for MI with hypotension/hypovolemia (can not compensate) Beta-blockers prevent compensation of HR in cases of shock or dehydration Perception of pain reduced Chronic mental status changes – assessment of responsiveness difficult Hypothermia risk- skin thin and less subcutaneous fat
54
What is the most common cause of dehydration in kids?
vomiting and diarrhea
55
What is retraction at suprasternal notch?
obstruction above trachea
56
What is intercostal and subcostal retraction?
obstruction in bronchial tree or lower
57
What causes drooling?
obstruction of glottis
58
What does inspiratory stridor mean?
glottis or epiglottis
59
What does expiratory stridor mean?
obstruction below glottis
60
What is evidence of poor perfusion?
``` Weak distal pulses Pallor/pale Cyanosis Delayed capillary refill (>2 seconds) Tachycardia (based on patient’s age ```
61
What are the 5 p of neurovascular compromise?
paresthesia, pain, paralysis, pale, pulseless
62
What are signs of TBI?
``` Decreased level of consciousness (FROM BASELINE) Unequal pupils Blurred vision Severe or persistent headache Nausea or vomiting Change in Neurological status ```
63
What are MVA red flags?
``` Ejection Rollover Extrication > 20 minutes Death in same passenger compartment Evidence of high speed crash -Speed >40 mph -Major auto deformity (greater than 20 inches) -Intrusion into passenger compartment greater than 12 inches ```

Patient Assessment (23 decks)

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