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CMT > Shock and ACLS Overview > Flashcards

Shock and ACLS Overview Flashcards

1
Q

ABCDE algorithm

A

Airway
Breathing
Circulation
Disability
Exposure

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2
Q

Airway Assessment

How do you know if the airway is adequate?

A
  1. pt is alert and oriented
  2. pt is talking normally
  3. no evidence of head/neck injury
  4. you assessed and reassessed for deterioration
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3
Q

Airway Assessment

signs and sx of airway compromise?

7

A
  1. high index suspicion
  2. change in voice/sore throat
  3. noisy breathing
  4. dyspnea and agitation
  5. tachypnea
  6. abnormal breathing pattern
  7. low O2 sat
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4
Q

Airway Assessment

what needs to be protected during airway management?

A

cervical spine

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5
Q

Airway Assessment

most common causes for obstruction of the airway in trauma

A
  1. tongue
  2. vomitus/food
  3. blood
  4. bone fragements
  5. foreign bodies
  6. dentures
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6
Q

Airway Assessment

two techniques to open the airway?

A
  1. chin-lift maneuver
  2. jaw-thrust maneuver
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7
Q

Breathing

steps to assessing

A
  1. assess along with airway
  2. determine whether respirations are adequate
  3. determine where both lungs are working equally
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8
Q

Breathing

if breath sounds are absent…

A

percuss to check for hemothorax vs pneumothroax
* hypo-resonance = hemothorax
* hyper-resonance = pneumothorax

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9
Q

Breathing

Signs and Sx of tension pneumothorax

6

A
  1. rapid, weak pulse
  2. hypotension
  3. trachel shift away from collapsed side
  4. jugular vein distension
  5. respiratory distress
  6. shock
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10
Q

Breathing

what to do with massive hemothorax?

A
  1. go to OR ASAP
  2. will likely need to give blood
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11
Q

Circulation

what is the purpose of circulation

A

ensuring the tissue has adequate oxygenation and delivery and blood volume

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12
Q

Circulation

what is shock in trauma almost always due to?

A

hemorrhage

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13
Q

Circulation

amount of blood loss classes 1 through 4

A
  1. 0-15%
  2. 15-30%
  3. 30-40%
  4. > 40%
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14
Q

Circulation

stopping external hemorrhage

A
  • usually just needs pressure
  • coagulating agents may be helpful
  • suture closed quickly, don’t worry about cosmesis
  • tourniquets can be used on extremities (not more than 1 hr)
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15
Q

Circulation

delay of greater than 2s is suspicious for?

A

blood loss, even if BP is normal

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16
Q

Circulation

the blank is the first thing to change. it becomes blank.

A
  1. SVR
  2. higher
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17
Q

Circulation

heart rate can be an indicator of hemorrhagic shock in 50% of trauma patients except:

5 populations

A
  1. children
  2. elderly
  3. trained athletes
  4. pacemaker pts
  5. pregnant pts
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18
Q

Circulation

calculating BP in shock

A

BP = CO X SVR

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19
Q

Circulation

what to do if you can’t palpate a pedal or radial pulse?

A
  • establish 2 large bore IVs
  • 2-3cm below tibial prominence
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20
Q

Circulation

Indications for intraosseus infusion

A
  1. emergency intravascular access when other methods have failed
  2. cardiac arrest in infants and young children
  3. military applications
  4. blood for lab eval
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21
Q

Circulation

contraindications for intraosseus infusion

A
  1. osteoporosis and osteogenesis imperfecta
  2. fractured bone
  3. prior use of same bone for IO infusion
  4. cellulitis or burn overlying insertion site
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22
Q

Circulation

other methods for IV access:

take longer, 3

A
  • central lines: femoral, subclavian, or jugular
  • femoral is easiest, but not best option in hip fracture or abd trauma
  • jugular is not accessible if pt is in a cervical collar
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23
Q

Circulation

fluid resuscitation

give what initially? then what if that doesn’t work?

A
  1. balanced crystalloid solution
  2. if still hypotensive, then give whole blood
24
Q

Circulation

how to give component therapy

A

1:1:1
PRBC:FFP:PLATELETS

25
Q

Circulation

what is the “bloody vicious cycle”

A

hemorrage to resuscitation to demodilution and hypothermia to coagulopathy back to hemorrhage

26
Q

Circulation

how to break the bloody viscious cycle

A
  • prevent hemodilution
  • treat coagulopathy
  • control hemorrhage
  • use best resuscitation methods
  • prevent hypothermia
27
Q

Circulation

signs and sx of pericardial tamponade

A
  1. Beck’s Triad: hypotension, jugular vein distension, muffled heart sounds
  2. ECG Triad: sinus tachy, low voltage, electrical alternans
  3. POCUS Triad: pericardial fluid, RV diastolic collapse, dilated IVC
28
Q

Circulation

tx of pericardial tamponade

A

subxiphoid approach

29
Q

Circulation

where else can there be occult blood loss?

A
  • pelvis
  • most common is pelvic fracture to bleed
30
Q

Circulation

describe REBOA catheter

A
  • requires advanced training, temporizes pelvic fractures (less than 30 min)
31
Q

Circulation

if pt is still hypotensive after all of this:

A

they are still bleeding!

32
Q

Circulation

trauma in pregnancy

5 things

A
  • delayed gastric emptying (NGT tube consideration)
  • O neg= RHOGAM
  • Call OB early
  • fetal distress could be a sign of hemorrhage
  • pelvic exam to check for blood, premature labor, placental abruption
33
Q

Circulation

hematological changes during pregnancy?

A
  1. increase in plasma volume (increase RBC volume)
  2. dilutional reduction in Hb converstion
  3. neutrophilia
  4. 10-15% reduction in platelet count
  5. hypercoagulable state
34
Q

Circulation

physiological respiratory changes in pregnancy?

A
  1. increase in RR and tidal volume
  2. increase in minute volume
  3. mild respiratory alkalosis
  4. decreases diaphragmatic mobility
35
Q

Disability

primary survey of disability

A
  1. assess pupils
  2. level of consciousness
  3. response to stimuli
  4. AVPU scale
  5. Glasgow Coma Scale
36
Q

Disability

components of AVPU scale

A
  1. alert
  2. responsive to voice stimuli
  3. responsive to painful stimuli
  4. unresponsive
37
Q

Disability

what to do when GCS less than 8

A
  1. intubate if not already done
  2. frequently repeat neuro exam and document
  3. CT scan ASAP
  4. early neurosurgical consultation
38
Q

Exposure

primary survey for exposure

A
  1. remove all clothes and blankets
  2. thorough physical exam
  3. re-cover with warm blankets
  4. prevent hypothermia
39
Q

Resuscitation

describe the components of resuscitation

A
  1. initital resuscitation begins when pt hits the door
  2. obtain IV access and start IVF
  3. if unresponsive to 1000ccs, begin blood transfusion
  4. consider Tranxemic Acid (clot stabilizer, loading dose 1g)
40
Q

Resuscitation

what type of blood do you use?

A
  • emergent: type O (Rh- negative on females of child bearing age)
  • type specific: avail within 10 min
  • crossmatched: takes 45 min
41
Q

adjuncts to primary survey

A
  1. ECG
  2. vital signs
  3. ABGs
  4. pulse ox & CO2
  5. urinary/gastric catheters
  6. urinary output
42
Q

contraindication to NG tube placement

A

severe midface trauma

43
Q

Stroke

Cincinnati prehospital stroke scale

A
  1. facial symmetry
  2. motor weakness
  3. asphasia

any 1 of 3 is +72% likelihood

44
Q

Stroke

workup

A
  • vitals
  • CBC
  • CMP
  • accu check
  • ECG
  • PT
  • PTT
  • INR
  • tox screen
  • ABG
  • blood EtOH
  • hcg
  • NIHSS
45
Q

absolute contraindications to thrombolytic therapy

A
  1. prior intracranial hemorrhage
  2. known intracranial malformation
  3. ischemic stroke < 3 mo
  4. suspected dissection
  5. recent surgery
  6. recent head trauma
  7. bleeding diathesis
46
Q

Circulatory Shock

4 types

A
  1. hypovolemic
  2. cardiogenic
  3. obstructive
  4. distributive
47
Q

Circulatory Shock

presentation

A
  • altered mental status
  • decreased peripheral pulses
  • tachy
  • cool/mottled skin
  • hypotension
48
Q

Circulatory Shock

work up

A
  • CBC
  • CMP
  • lactate
  • PT
  • PTT
  • INR
  • ABGs
  • ECG
  • Blood Cult
  • x-ray EFAST
49
Q

describe Cardiogenic Shock

A

decreased cardiac output, decreased perfusion, increased systemic vascular resistance

50
Q

Cardiogenic Shock

etiology

A
  • MI
  • myocarditis
  • valvular disease
  • CHD
  • cardiomyapothy
  • arrhythmia
51
Q

Cardiogenic Shock

presentation

A
  • decreased CO
  • hypotension
  • vasoconstriction
52
Q

Obstructive Shock

describe

A

decreased blood flow due to physical obstruction of heart or great vessels- pressure decreases heart’s ability to pump blood

53
Q

Obstructive Shock

Etiologies

A
  1. massive PE
  2. pericardial tamponade
  3. tension pneumothroax
  4. aortic dissection
54
Q

Obstructive Shock

management and treatment

A
  1. oxygen
  2. fluids
  3. inotropic support
  4. mechanical support
  5. treat underlying cause
55
Q

Distributive Shock

describe

A

excess vasodilation and altered distribution of blood flow
decreased CO, SVR, PCWP

56
Q

Distributive Shock

4 types

A
  1. spetic
  2. anaphylactic
  3. neurogenic
  4. endrocrine

CMT (72 decks)

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