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Module 7 (Critical Care) > Multi-System Trauma Part 1 > Flashcards

Multi-System Trauma Part 1 Flashcards

Spinal Cord Injuries, Care of the Emergency Patient beside bites

1
Q

Spinal Cord Injury cells do / do not regenerate

A

DO NOT regenerate

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2
Q

Spinal Cord Injury results from

A

trauma
- partial or complete damage to the spinal cord

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3
Q

SCI is the

A

degenerative loss of motor, sensory and autonomic function

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4
Q

What happens during SCI to the cells?

A

Apoptosis (programmed cell death)
- days to months after initial injury
- **sudden reoval of survival signals or disassociation from neighboring cells

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5
Q

T/F: SPINAL SHOCK is a true shock.

A

False

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6
Q

What can not be regained after a SCI?

A

central nervous system function

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7
Q

What 2 factors cause the SCI to excel

A

Edema secondary to inflammatory response is harmful because of lack of space for tissue expansion

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8
Q

Edema and inflammation of SCI result in

A

compression of cord and extension of edema above and below injury increase ischemic damage

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9
Q

The extent of injury and prognosis for recovery most accurately determined

A

at least 72 hours or more after injury
- up to 1 year after

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10
Q

Spinal Shock is

A

Temporary neurologic syndrome

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11
Q

Spinal Shock characterized by

A

loss of deep tendon and sphincter reflexes, loss of sensation, and flaccid paralysis below the level of injury.

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12
Q

Spinal shock masks

A

postinjury neurologic function** can have more mvmt ability later than when they first come in
- resolved when you get the reflexes back

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13
Q

Neurogenic shock occur where in the spine

A

T6 and higher

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14
Q

Neurogenic Shock occurs from

A

unopposed parasympathetic response due to loss of sympathetic nervous system (SNS) innervation

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15
Q

Neurogenic shock causes

A

peripheral vasodilation, venous pooling, and decreased cardiac output

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16
Q

Neurogenic shock s/s

A

significant hypotension (< 90 mmHg), bradycardia, and temperature dysregulation
- Warm and dry (PINK) due to blood in periphery

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17
Q

Neurogenic shock lasts

A

1-3 weeks

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18
Q

Neurogenic shock’s hypotension can cause

A

poor perfusion and oxygenation to the spinal cord and worsen spinal cord ischemia

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19
Q

Neurogenic shock is what type of problem

A

pipe problem
- vessel vasodilate into periphery
- low HR and BP
- no resistance

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20
Q

What can you do to determine if it is a neurogenic shock issue?

A

500 -1000mL OF FLUID if it does not work then you know it is neurogenic shock then give vasopressors but don’t drown them

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21
Q

What can you use to help the neurogenic shock pt with orders

A

TED hose, compression socks, SCD, belly binder and vasopressors

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22
Q

SCI is classified by the

A

(1) mechanism of injury, (2) level of injury, and
(3) degree of injury

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23
Q

Major mechanisms of SCI

A

flexion, flexion-rotation, hyperextension, vertical compression, extension-rotation, and lateral flexion

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24
Q

Flexion-rotation injury is the

A

most unstable because ligaments that stabilize the spine are torn. This injury most often contributes to severe neurologic deficits

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25
Q

Flexion injury of the cervical spine ruptures the

A

posterior ligaments

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26
Q

Hyperextension injury of the cervical spine ruptures the

A

anterior ligaments

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27
Q

Compression fractures

A

crush the vertebrae and force bony fragments into the spinal canal

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28
Q

Flexion-rotation injury of the cervical spine often results in

A

cervical spine often results in tearing of ligamentous structures that normally stabilize the spine - spinning car crash

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29
Q

In a MVA what should check first for a fx of the spinal column

A

Calcaneus heal bone as it is the “toughest” in the body

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30
Q

Skeletal level of injury

A

vertebral level where there is most damage to vertebral bones and ligaments

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31
Q

Neurologic level of injury

A

Lowest segment of spinal cord with normal sensory and motor function on both sides of the body

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32
Q

What injuries are most common in the spine?

A

cervical and lumbar
- greatest flexibility and mvmt

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33
Q

If the cervical cord is involved then paralysis

A

all four extremities occurs, resulting intetraplegia(formerly termedquadriplegia).

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34
Q

The lower the level of injury to the spine,

A

the more function is retained in the arms

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35
Q

If the thoracic, lumbar, or sacral spinal cord is damaged, the result

A

paraplegia(paralysis and loss of sensation in the legs).

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36
Q

C4 injury

A

tetraplegia
complete paralysis below the neck

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37
Q

C6 injury

A

partial paralysis of hands and arms and lower body
- tetraplegia

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38
Q

T6 injury

A

paraplegia
= paralysis below the waist

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39
Q

L1 injury

A

paraplegia

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40
Q

Which is shorter the spinal cord or the vertebral column?

A

spinal cord

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41
Q

Cervical vertebrae

A

7

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42
Q

Thoracic vertebrae

A

12

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43
Q

Lumbar vertebrae

A

5

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44
Q

Sacral vertebrae

A

5

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45
Q

Cervical cord

A

first cervical vertebra (the atlas) and the second cervical vertebra (the axis

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46
Q

Complete cord involvement injury

A

(decapitation – internal, GSW, stab, penetrating all the way across)
= Results in total loss of sensory and motor function below level of lesion (injury)

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47
Q

Incomplete (partial) cord involvement
Results in

A

Results in a mixed loss of voluntary motor activity and sensation and leaves some tracts intact

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48
Q

What is associated with incomplete injuries?

A

central cord syndrome, anterior cord syndrome, Brown-Séquard syndrome

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49
Q

Central cord syndrome damage to

A

Damage to central spinal cord

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50
Q

Central cord syndrome occurs most commonly in

A

cervical cord region

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51
Q

Central cord syndrome s/s

A

Motor weakness and sensory loss are present in both upper and lower extremities
- bone abnormality
- lower not affected
- burning pain in upper
- cant bear own weight

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52
Q

Central cord syndrome loss in

A

Greater loss in arms than in legs

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53
Q

Central cord syndrome is common in

A

older adults
Farmers

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54
Q

Does central cord syndrome last forever?

A

no, rehab can help them walk again with arm or leg braces sometimes
not able to feed themselves or button a shirt

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55
Q

Brown-Séquard syndrome damage to

A

one half of spinal cord

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56
Q

Brown-Séquard syndrome characterized by

A

loss of motor function and position and vibration sense on same side of injury
Paralysis on the same side as lesion
Opposite side has loss of pain and temperature sensation below level of lesion

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57
Q

Brown-Séquard syndrome caused by

A

penetrating injury to spinal cord

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58
Q

Proprioception

A

I cant tell you wear my arms are or how they look when not in my view (position)

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59
Q

Higher the injury, the

A

more serious the sequelae
- Proximity of cervical cord to medulla and brainstem

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60
Q

Patient with an incomplete lesion may demonstrate a

A

mixture of symptoms

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61
Q

S/S of SCI

A

direct result of trauma that causes cord compression, ischemia, edema, and possible cord transection.

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62
Q

Sequalae – 2nd things = complications

A

pneumonia, bed sores,

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63
Q

Priority to take care of in SCI

A

atelectasis = partial portion = IS, forced FiO2 if unable on their own, turn, suction, cough out

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64
Q

SCI S/S - respiratory system
C1-3

A

Apnea, inability to cough
Need intubation quickly

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65
Q

SCI S/S - respiratory system
C4

A

Poor cough, diaphragmatic breathing, hypoventilation
Assisted cough

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66
Q

SCI S/S - respiratory system
C5-6

A

↓ Respiratory reserve
Teaching

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67
Q

The most likely cause of death when a spinal cord injury occurs

A

respiratory arrest

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68
Q

Above C3 Loss of

A

phrenic nerve function

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69
Q

SCI @ C4-C5 loss

A

loss of diaphragmatic innervation

Spinal cord edema and hemorrhage can affect function of phrenic nerve and cause respiratory insufficiency
Hypoventilation almost always occurs with diaphragmatic breathing

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70
Q

SCI Between C6-T8 loss of

A

intercostals
Presents special problems because of total loss of respiratory muscle function
Mechanical ventilation is required to keep patient alive

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71
Q

Artificial airways have an increase of

A

direct access for pathogens
Important to ↓ infections

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72
Q

Pulmonary edema may occur in response

A

fluid overload

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73
Q

Forced assisted cough –

A

lay flat on their back then place hands under their diaphragm, when they take try to cough then press to help them to cough

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74
Q

SCI S/S - CV system

A

Above level T6 reduce influence of the sympathetic nervous system
Heart rate is slow (<60 beats per minute) because of unopposed vagal response
- DECREASE VAGAL STIM.

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75
Q

SCI Bradycardia tx

A

Vasopressors and IV fluids, atropine – temporary, pacemaker

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76
Q

SCI increase of vagal stimulation result in

A

cardiac arrest

77
Q

SCI has peripheral vasodilation resulting in

A

hypotension
- ↓ Venous return of blood to heart, ↓ Cardiac output
IV fluids or vasopressor drugs may be required to support BP

78
Q

Any increase of vagal stimulation help by

A

Turning
Suctioning, cough (but could arrest)
Temporary/permanent pacemaker

79
Q

Tx for CV SCI

A

Compression gradient stockings, Remove q 8 hours for skin care
Prophylactic heparin or low-molecular-weight heparin
Frequently assess vital signs
Anticholinergic for bradycardia
Phrenic nerve stimulators or electronic diaphragmatic pacemakers increase mobility
Teach cervical-level injury patients who are not ventilator dependent
Assisted coughing
Regular use of spirometry or deep breathing exercises

80
Q

S/S of SCI in the GU system

A

Urinary retention common
Bladder may become hyperirritable
- Loss of autonomic and reflex control of bladder and sphincter
- reflux into kidney with eventual renal failure

81
Q

SCI in the GU system Tx

A

INT cath program
prevent UTIs
Suprapubic cath

82
Q

S/S of SCI GI
above T5

A

primary GI problems related to hypomotility
- paralytic ileus
- gastric distension
- stress ulcers HCl excess

83
Q

S/S of SCI GI
T12 or lower

A

decreased sphincter tone

84
Q

As GI reflexes return, then

A

Bowel becomes reflexic
Sphincter tone is enhanced
Reflex emptying occurs

bowel program with laxative at desired routine time

85
Q

Dysphagia may be present in patients who need

A

mechanical ventilation, tracheostomy, and anterior spine surgery.

86
Q

Combined with increased anal sphincter tone and the inability to sense a full rectum, this causes

A

stool retention and constipation

87
Q

SCI at or below the conus medullaris causes the bowel to be

A

areflexic.

88
Q

The defecation reflex may be damaged and anal sphincter tone relaxed. This leads to

A

constipation, increased risk for incontinence, and possible impaction, ileus, or megacolon. Hemorrhoids can occur over time.

89
Q

What is a great way to get the pt GI system moving?

A

early ambulation
- stable and with help

90
Q

S/S of SCI skin system

A

Consequence of lack of movement is skin breakdown
- bony prominences and decreased/absent sensation of immobility
Pressure ulcers can occur quickly
Can lead to major infection or sepsis

91
Q

SCI skin breakdown prevention

A

Turn them and teach the support system
Case mgmt. gets them the correct supplies

92
Q

Poikilothermism

A
  • inability to maintain a constant core temperature, with the patient assuming the temperature of the environment.
93
Q

Thermoregulation of spinal cord disruption

A

Decreased ability to sweat
Decreased ability to shiver

94
Q

SNS prevents peripheral temperature sensations from reaching

A

hypothalamus

95
Q

___________ are associated with a greater loss of ability to regulate temperature than are thoracic or lumbar injuries.

A

cervical

96
Q

If temp gets high due to going outside, antipyretics

A

do not help this type of hyperthermia
- manage temp
if hot give cool drinks and fluids visa versa

97
Q

Nonoperative stabilization

A

traction or realignment
Eliminate damaging motion at injury site
Intended to prevent secondary damage

98
Q

ABC for SCI

A

A with C collar
Airway
Breathing
Circulation

99
Q

Criteria for SCI surgery

A

Evidence of cord compression
Progressive neurologic deficit
Compound fracture
Bony fragments
Penetrating wounds of spinal cord or surrounding structures

100
Q

What surgery is better compared to the other for a SCI?

A

Anterior first due to no access during a code in posterior

101
Q

the bone graft for the SCI surgery is taken from

A

iliac crest

102
Q

Proper immobilization involves maintenance of a neutral position

A

Skeletal traction
Kinetic therapy
Halo jackets

103
Q

Immobilization devices mgmt

A

correctly aligned
turn to prevent spinal mvmt
Clean twice daily
Realignment or reduction of injury
Provided by rope, pulley and weights
Traction must be maintained at all times
Stabilize head if dislodged and then call for help

104
Q

Kinetic Therapy

A

Uses a continual side-to-side slow rotation
Decreases pressure ulcers and cardiopulmonary complications

105
Q

Autonomic DYSREFLEXIA

A

spinal cord at T6 or higher/lower?

106
Q

Autonomic DYSREFLEXIA triggered by sustained stimuli from

A

restrictive clothing
full bladder
UTI
pressure areas
fecal impaction

107
Q

Nursing Interventions for Autonomic DYSREFLEXIA

A

Elevate head of bed at 45 degrees or sit patient upright (HIGH FOWLERS)
Notify physician
Assess cause
Immediate catheterization
Teach patient and family causes and symptoms
DIGITAL RECTAL FOR IMPACTION

108
Q

Autonomic DYSREFLEXIA S/S

A

high BP - severe and rapid
flushed and fever
HA
distended neck veins
low HR
high sweating
Vasodilation Above
Vasoconstriction Below
*pale.cool, no sweating

109
Q

Rehab and Home CARE

A

Organized around individual patient’s goals and needs
Patient expected
To be involved in therapies
To learn self-care
Can be very stressful
Frequent encouragement
SEXUAL ISSUES IN YOUNG AND ELDERLY - counseling

110
Q

Return of reflexes may complicate rehabilitation

A

Hyperactive
Exaggerated responses
Spasms
Patient or family may see this as return of function

111
Q

Grief and Depression for SCI

A

May feel an overwhelming sense of loss
May believe they are useless and burdens to their families
Patient’s family may also require counseling – hopeless, wish they died
Patient should be
Treated in an adult manner
Involved in decision-making process
- allow mourning and reality to set in but not hopelessness
- sympathy not helpful

112
Q

Scope of emergency nursing

A

Recognizing life-threatening illness or injury
- interventions to reverse or prevent
An emergency is whatever the patient or family considers it to be
The emergency nurse has special training, education, experience, and expertise in assessing and identifying health care problems in crisis situations

113
Q

factors result in chronic overcrowding and long wait times in ED

A

(1) the inability to see an HCP, (2) an aging population, (3) shorter hospital stays resulting in frequent readmissions, (4) acute mental health crises, (5) ED closures, and (6) lack of or inadequate health insurance or an HCP

114
Q

It is not your crisis, it is

A

their crisis = need help from personal events as you do not know their story

115
Q

Triage

A

Process of rapidly determining patient acuity
Represents a critical assessment skill
The triage system identifies and categorizes so the most critical are treated first.
First impressions are made here
EMERGENT (ASAP), URGENT, JUST NEED TO BE SEEN

116
Q

Initial Assessment - primary

A

– things that kill you the fastest –ABCD(NEURO) and environment/exposure, <Catastrophic></Catastrophic>

117
Q

Initial Assessment - secondary

A

Head-to-Toe, Hx, fractures, meshy spots, back

118
Q

catastrophic hemorrhage

A

Apply direct pressure with a sterile dressing followed by a pressure dressing to any obvious bleeding sites.

119
Q

Pediatric assessment triagle

A

Appearance - tone, interactions, consolability, gaze, speech
Breathing - sounds positioning, retractions, flaring, apnea
Circulation - pallor, mottling, cyanosis

120
Q

Target Temp MGMT is done within

A

at least 24 hours after the return of spontaneous circulation (ROSC) decreases mortality rates and improves neurologic outcomes in many patients

121
Q

3 Phases of TTM

A

induction, maintenance, and rewarming.

122
Q

Induction phase of of TTM

A

ED
- goal temp 89.6° to 96.8°F (32° to 36°C)

123
Q

Ways to cool down a pt in ED

A

cold saline infusions and surface cooling devices (e.g., Arctic Sun).
need intubation, mechanical ventilation, and invasive monitoring and require continuous assessment**

124
Q

Life before limb excluding

A

vision

125
Q

Who would you see first
Abdominal pain
22yo fracture wrist
Sore throat for 3 days 60yo
Chest pain

A

Chest pain
Abdominal pain
Sore throat for 3 days 60yo
22yo fracture wrist

126
Q

Death in the ED

A

importance of hospital rituals in preparing the bereaved to grieve
- comfort
private area
- chaplain visit
- personal belongings
- mortuary arrangements
- Determine if patient could be candidate for non–heart beating donation
= Have another person not providing care to the pt to as about organ donation
- Medical examiner: nothing removed if placed invasively only tidy up the area for the family

127
Q

An autopsy may be done at

A

family’s request, or if death occurred within 24 hours of ED admission, from suspected trauma or violence, or in an unusual way.

128
Q

Elderly are at high risk for injury due to

A

Decreased visual acuity and peripheral vision
Hearing loss
Especially to high frequency sounds
Pre-existing disease and medication use
R/O others before going to Dementia and cognitive impairment**
- generalized weakness, envirnoment hazards, syncope, orthostaic hypotension

129
Q

Heat Exhaustion

A

Prolonged exposure to heat
Occurs when the body is unable to cool itself
Symptoms may be vague

130
Q

S/S od heat exhaustion

A

Fatigue,
nausea,
vomiting,
extreme thirst,
feelings of anxiety
Hypotension,
tachycardia,
elevated body temperature 99.6° to 105.8° F [37.5° to 41° C]
dilated pupils,
mild confusion,
ashen color,
profuse diaphoresis

131
Q

Heat exhaustion usually occurs in

A

strenuous activity in hot, humid weather, but it also occurs in sedentary individuals

132
Q

Tx of heat exhaustion

A
  • cool area and removing constrictive clothing
  • ABCs, including heart dysrhythmias (caused by electrolyte imbalances
  • oral fluid and electrolyte replacement unless the patient is nauseated
  • Do not use salt tablets because of potential gastric irritation and hypernatremia
  • 0.9% normal saline IV solution if oral solutions are not tolerated
  • Always correlate fluid replacement to clinical and laboratory findings. - Place a moist sheet over the patient to decrease core temperature through evaporative heat loss
133
Q

Heat Exhaustion hospital admission if

A

the chronically ill, or those who do not improve within 3 to 4 hours.

134
Q

Heat Exhaustion if untx leads to

A

heat stroke

135
Q

Heat stroke s/s

A

anxiety
confusion AMA
no sweating
circulatory cllapse
hot, dry, and ashen skin
skin dry and hot
Na and K depletion
impaired sweating
listlessness
cerebral edema and hemorrhage
increase HR and RR
low BP

136
Q

Cerebral edema s/s

A

seizures
delirium
coma

137
Q

Heatstroke

A

failure of the hypothalamic thermoregulatory processes

138
Q

the body’s attempt to lower temperature depleteS

A

fluids and electrolytes, specifically sodium. Eventually, sweat glands stop functioning, and core temperature increases rapidly, within 10 to 15 minutes.

139
Q

Heatstroke temp

A

core temperature greater than 105.8° F (41° C)

140
Q

Who is more vulnerable to heatstroke?

A

Older adults and those with diabetes mellitus, chronic kidney disease, cardiovascular disease, pulmonary disease, or other physiologic compromise

141
Q

Mgmt of Heatstroke

A
  • stabilizing the patient’s ABCs and rapidly - reducing the core temperature.
    -Give 100% O2to compensate for the patient’s hypermetabolic state.
  • Ventilation with a BVM or intubation and mechanical ventilation may be needed.
  • Correct fluid and electrolyte imbalances and start continuous ECG - monitoring for dysrhythmias.
142
Q

Cooling methods for Heatstrokes

A

1 removing clothing, covering with wet sheets, and placing the patient in front of a large fan (evaporative cooling);
2 immersing the patient in a cool water bath (conductive cooling);
3 applying ice packs to the groins and axillae; and, in refractory cases,
4 peritoneal lavaging with iced fluids. Closely monitor the patient’s temperature and control shivering.
5 Shivering increases core temperature due to the heat generated by muscle activity. This complicates cooling efforts
Give chlorpromazine IV to control shivering
Antipyretics are not effective in this situation because the elevated temperature is not related to infection.

143
Q

What is given to control shivering?

A

chlorpromazine IV

144
Q

What should be monitored during heatstroke tx?

A

rhabdomyolysis
- Get a CK and CK-MB
The muscle breakdown leads to myoglobinuria. This places the kidneys at risk for acute kidney injury.
- Carefully monitor the urine for color (e.g., tea colored), amount, pH, and myoglobin.
- myoglubinuria
- clotting for DIC
- INSTRUCT ON S/S and hydration

145
Q

Rhabdomyolysis

A

a serious syndrome caused by the breakdown of skeletal muscle
- CK and CK-MB
- tea urine

146
Q

Aggressive temperature reduction until core temperature reaches

A

102º F

147
Q

Frostbite

A

true tissue freezing that results in the formation of ice crystals in the tissues and cells

148
Q

Initial repsonse to cold stress

A

Peripheral vasoconstriction
- results in a decrease in blood flow and vascular stasis

149
Q

As cellular temp decreases then ice crystals do

A

ice crystals form in intracellular spaces, the organelles are damaged, and the cell membrane destroyed
This results in edema.

150
Q

Superficial frostbiteinvolves

A

skin and subcutaneous tissue, usually the ears, nose, fingers, and toes.

151
Q

S/S of frostbite

A

edema
waxy pale yellow to blue to mottled
crunchy and frozen feel
tingleing
numbness
bruning

152
Q

Never do what when fristbite

A

never squeeze, massage, or scrub the injured tissue because it is easily damaged.
- no blankets

153
Q

Tx of frostbite

A

Immerse the affected area in circulating water that is temperature controlled (98.6° to 104° F) [37° to 40° C]) - till flush distal to area. Use warm soaks for the face. The patient often experiences a warm, stinging sensation as tissue thaws. Blisters form within a few hours. The blisters should be debrided and a sterile dressing applied. Avoid heavy blankets and clothing because friction and weight can lead to sloughing of damaged tissue. Rewarming is extremely painful. Residual pain may last weeks or even years. Give analgesia and tetanus prophylaxis as appropriate. Evaluate the patient with superficial frostbite for systemic hypothermia.
Bed cradle for blankets

154
Q

What should be given to the frostbite pt before rewarming them

A

analgesics on medical control warming

155
Q

Deep frostbiteinvolves

A

muscle, bone, and tendon
- gangrene
- insensitive to touch

156
Q

Mild hypothermia temp

A

(93° to 95°F [33.9° to 35°C])
- body can not compensate for heat lost
- s/s = shivering, lethargy, confusion, rational to irrational behavior, and minor heart rate changes.

157
Q

Moderate hypothermia temp

A

(86º to 93.º F [30º to 33.9º C])
- rigidity, bradycardia, slowed respiratory rate, BP obtainable only by Doppler, metabolic and respiratory acidosis, and hypovolemia.

158
Q

Severe hypothermia temp

A

(<86º F [30º C])
- S/S: appear dead and is a potentially life-threatening situation. Metabolic rate, heart rate, and respirations are so slow that they may be hard to detect. Reflexes are absent, and the pupils fixed and dilated. Profound bradycardia, ventricular fibrillation, or pulseless electrical activity

159
Q

Death usually occurs when core temperature is

A

<78º F (25.6º C)

160
Q

Most body heat is lost as ________ energy, with the greatest loss from the head, thorax, and lungs (with each breath).

A

radiant

161
Q

Shivering diminishes or disappears when core temp is at

A

86 degrees F

162
Q

Tx of hypothermia

A

Put a monitor on them for rewarming, give a tetanus shot, analegics, antibiotics maybe, get risd of wet clothes and apply warm blankets

163
Q

Hypothermia mimicks

A

metabolic and cerebral illnesses

164
Q

Physician Can not pronounce a patient dead until they are

A

> 90 degrees

165
Q

Mild hypothermia Tx

A

Passive or active external rewarming

166
Q

Moderate to Severe hypothermia Tx:

A

Active core rewarming

167
Q

Rewarming should be discontinued once the core temperature reaches

A

95º F (35º C)

168
Q

Passiveorspontaneous rewarminginvolves

A

moving the patient to a warm, dry place; removing damp clothing; using radiant lights; and placing warm blankets on the patient

169
Q

Active externalorsurface rewarminginvolves

A

fluid- or air-filled warming blankets,. Closely monitor the patient for marked vasodilation and hypotension during rewarming. - BLANKETS

170
Q

active internalorcore rewarming refers to

A

heat directly to the core. Techniques include (1) heated humidified O2; (2) warmed IV (3) peritoneal lavage with warmed fluids and (4) extracorporeal circulation with cardiopulmonary bypass, rapid fluid infuser, or hemodialysis. – enema and warm fluids in IV, NG

171
Q

**Rewarming places the patient at risk for

A

afterdrop**
cold peripheral blood returns to the central circulation. Rewarming shock can produce hypotension and dysrhythmias. – NEED MONITORS

172
Q

Hypothermic Pt teachings include

A

dressing in layers for cold weather, covering the head, carrying high-carbohydrate foods for extra calories, and developing a plan for survival should an injury occur when in an extreme environment.

173
Q

Submersion injury the pt becomes

A

hypoxic due to submersion in water

174
Q

Drowning:

A

Death from suffocation after submersion in water

175
Q

Immersion syndrome occurs with immersion in cold water, which **leads to

A

stimulation of the vagus nerve and potentially fatal dysrhythmias**

176
Q

Submersion in cold water (below 32° F [0° C]) may

A

slow the progression of hypoxic brain injury.

177
Q

Most drowning victims do not aspirate any liquid due to

A

laryngospasm

178
Q

If drowning victims do aspirate it is due to

A

lose consciousness

179
Q

aspirate water can develop

A

pulmonary edema
- leading to ARDS

180
Q

Near-drowning victims stay in hospital for

A

4-6 hours = pulmonary edema dry drowning

181
Q

Submersion injury Tx

A

Treatment ABCD, C-collar immobilization, rewarming, establish patent airway PRIORITY!
correcting hypoxia and fluid imbalances, supporting basic physiologic functions, and rewarming when hypothermia is present
- MECH VENT OR peep, CPAP

182
Q

What meds can be given to treat cerebral edema in submersion injuries

A

Mannitol (Osmitrol) or furosemide (Lasix)
- decrease free water

183
Q

Observe all victims of drowning for a minimum of

A

23 hours

184
Q

Submersion injury pt teachings

A

water safety and how to reduce the risks for drowning. Remind patients and caregivers to lock all swimming pool gates; use life jackets on all watercrafts, including inner tubes and rafts; and learn water survival skills (e.g., swimming lessons). Emphasize the dangers of combining alcohol and drugs with swimming and other water sports.

185
Q

Aspiration of any water develops

A

surfactant destruction and destruction of alveolar and capillary membranes
- noncardiogenic pulmonary edema and ARDS

186
Q

Aspiration of freshwater

A

water rapidly leaks to capillary bed and circualtion

187
Q

Aspiration of saltwater

A

draws fluid into alveoli

188
Q

Violence

A

The acting out of emotions of fear and/or anger
Emergency Departments are high-risk areas for workplace violence
Family and intimate partner violence
Human trafficking

Module 7 (Critical Care) (22 decks)

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