Tx/mgmt Flashcards

Question

Mgmt pt w head injury

Answer 1

Neuro and physical exam Imaging Assume spinal injury Stabilize resp and CV Control hemorrhage Surgery Monitor ICP Seizure, NGT, f and lytes, nutrition, pain, anxiety

Answer 2

Airway (HOB 30, suction, no cough, ABG, MV) CPP Body temp Skin I/O weights Lytes Decrease stimuli Sleep Avoid opioids (can effect pupils and respiration) Ambulate TID Fluids and pressors to keep good BP and CPP without increasing ICP No valsalva + other ICP considerations Increase calories and protein Seizure prevention

Answer 3

Immediate sitting position Cath, topical anesthetic and remove fecal mass, find cause Hydralazine

Answer 4

Respiratory and breathing (LS and cough) Motor and sensory Assess for spinal shock Temp (may be elevated due to inability to sweat)

Answer 5

Breathing, airway (suction with caution, O2, CPT, MV) Mobility (body alignment, boots and rolls, PROM QID) Skin Urine and bowel (cath, NGT, stool softeners) High cal, high protein, high fiber Pain Auto dys and other comps (DVT, pressure ulcer, spasticity) ECG MAP above 85 to prevent spinal shock

Answer 6

Bowel and bladder Speech and swallow Memory aids Activity and rest Mobility and injury prevention: Gait training and ambulatory aids Avoid extreme temps Interferon B1A and B1B Prednisone Glatiramer Mitoxatrone For spasticity: baclofen, benzo, Tizanidine, Dantrolene For fatigue: Amantadine, premoline, dalfampridine For ataxia: BB, Gabapentin, benzo For bowel and bladder: Anticholinergic, antispasmodic, alpha Adrenergic blockers

Answer 7

Therapeutic plasma exchange Thymectomy Cholinergics (pyridostigmine) IVIG Prednisone

Answer 8

MV I/O weights Lytes NG feedings Avoid sedatives IVIG, plasma, then back on Cholinergic

Answer 9

IVIG Therapeutic plasma exchange Assess for DVT, resp failure, dysrhythmia (ECG), PE Alpha Adrenergic blockers for high HR and BP MV, IS, CPT Mobility IV nutrition Turn q2h SCD Swallow and gag assessment Cath for urine retention G tube if no swallow

Answer 10

Surg Elevation Debridement

Answer 11

Botox Baclofen Diazepam Dantrolene Tizanidine Clonidine

Answer 12

Culture CSF Meningococcal vax Prophyl rifampin, cipro, cef if exposed IV Abx (penicillin and ceph) Dexamethasone Protect from injury rt altered LOC

Answer 13

Underlying Cultures before Abx Fluids O2 Decrease anxiety to decrease metabolic demands (sedation, pain meds) Maintain BP and perfusion MAP >65 Passive leg raising

Answer 14

Underlying Fluids Respiratory support/oral care for MV Nutrition (3000 cals/day) Rest and decrease stress, prevent PICS Insulin to get G around 180 Antacids, H2 blockers, PPI Thermoregulation

Answer 15

Fluid (3 ml for every ml blood lost) At least 2 large bore IVs Blood Underlying Vasoactive meds O2

Answer 16

Prevent, underlying (Thrombolytic, CABG, lyte imbalance, tx of pneumothorax/tamponade/effusion) First line tx: O2, morphine, art line, fluids (slowly), inotropes and vasodilators (dobutamine, nitro), anti arrhythmics Decrease load and increase contractility IVBP (ensure NV checks at legs) Furosemide, dopamine, NE, nitro

Answer 17

Restore sympathetic tone via… Stabilize spine Proper position

Answer 18

Remove antigen Fluids Epinephrine and Benadryl CPR Albuterol Intubation

Answer 19

VS q15m til stable Central line to prevent necrosis CLABSI prevention for central line Titration based on MAP Taper down- don’t stop abruptly

Answer 20

Increase CO, stroke volume, and contractility Epinephrine, dopamine, dobutamine, milrinone

Answer 21

Decrease O2 demand Decrease pre and after load Drop BP Nitro

Answer 22

Increase BP via vasoconstriction NE Epinephrine Dopamine Angio 2 Phenylephrine Vasopressin

Answer 23

Remove from source Stop the flame Cool the burns Irrigate chemical burns ABC O2 and IV Remove restrictive Cover wound Remove diapers Primary assessment Assume SCI with electrical

Answer 24

100% O2 Fluids with TBSA > 20% (central line for large volumes) Foley NGT ECG for electrical IV pain meds Stabilize and monitor Bronchodilator and mucolytics Looks for polytrauma (TBI, SCI) Remove restrictive clothes and jewelry Monitor temp Tetanus prophylaxis Cover with clean sheets Escharotomy

Answer 25

Partial at least 10% Face, hands, feet, genitalia, peri, major joints 3rd degree Electrical, chemical, inhalation Pre existing condition With trauma Kids if no peds in facility Those needing long term rehab

Answer 26

UOP 0.5 to 1 mL/kg/hr (75-100 for electrical) Keep sodium normal ABA (2 ml LR x kg x TBSA) 4 for electrical 1/2 in 8 hrs, 1/2 in 16 hrs Parkland (4 mL x kg x TBSA) Hypertonic saline formula (first hour = 0.5 x kg x TBSA) Adjust each hour based on UOP Inverse titration UOP and fluids

Answer 27

Prevention of infection (includes precautions like no flowers or fruit) Wound care Pain mgmt Early mobility, DVT prophylaxis Increased calorie demands, increased protein, increased carbs Monitor f and lytes, GI, renal, temp, respiratory, circulatory Oxandrolone and propranolol VAP prevention if MV

Answer 28

Cultures, Abx, labs (lactic), fluids, O2 within 1 hour Nutrition (3000 cals/day) Within 1 hour Find cause of infection- remove lines/start new ones, collect labs and cultures, change urine cath, drain abscess, debridement Abx Fluids, pressors, PRBC, sedation DVT prophylaxis Nutrition SOFA score (VS, labs, mental) Thermoregulation (Tylenol for fever) Monitor albumin for protein requirements

Answer 29

Early weaning and ambulation Delirium mgmt Sleep Limit stress

Answer 30

Fluids til pee isn’t red Bicarbonate to alkalize urine Surgical debridement Assume SCI

Answer 31

Protect Immobilize Avoid pressure Elevate Start exercises 5-7 days post op Infection prevention at graft site and donor site (donor site will heal 7-14 days)

Answer 32

Be alert for numbness and paresthesia Q1h pulse checks Phentolamine mesylate 5-10 mg in 10 mL NS

Tx/mgmt Flashcards

(56 cards)