Exam 4 Review PDF

Exam 4 review **Environmental emergencies** - Heat stroke vs heat exhaustion - Stroke is worse, they are not able to sweat at all, **To treat heat stroke** - Lower core temp, by cold water emersion if possible, pack them with ice packs and administer cold fluids, continue to monit...

Exam 4 review **Environmental emergencies** - Heat stroke vs heat exhaustion - Stroke is worse, they are not able to sweat at all, **To treat heat stroke** - Lower core temp, by cold water emersion if possible, pack them with ice packs and administer cold fluids, continue to monitor their temperature, monitor for dysrhythmias, put them on a monitor. 100% oxygen remember you ABCs! If they can't breathe nothing else matters. - Keep them from shivering, it can make the body work harder which can make their body work harder - Watch their urine output, they are de3hydrated and you watch for tea colored urine (think rhabdo and dehydration ) **Hypothermia** - It makes their blood thick, can cause clots, heart attacks, PEs, - Take off cold clothes, warm blankets, - Active warming- warm fluids, bear huggers, all the active stuff to warm them up - Passive warming- warm blankets, taking cold clothes off, warming room temperature - We want their body to be 86 to 90, we want them to be warmed up, before we call time of death, you have to be warm and dead not cold and dead. - Monitor ABCs, cardiac monitor, watch urine output because of dehydration and they are acidotic. **Cold water/warm water drowning** - You want to drown in cold water because it slows everything down and you have the possibility to be brought back. - Drowning injuries think pulmonary edema and ARDS, decreased surfactant, alveoli cap membrane is affected= pulmonary edema and ARDS. What type of water they drown in - Treatment: anybody who is a drowning victim, they need to have a c collar on, we never know if they have harmed their neck in the drowning issue, think air way and breathing too. Oxygen and control ABCS and warm them up if they were in cold water. **Bites** - Cat bites are bad, their teeth are sharp and pointy and can cause deep puncture wounds, we get concerned for infection. And we always give prophylactic antibiotics - Dog bites cause more issues, think dog bites and biting bigger areas due to their big mouths - Puncture wounds, 6 to 12 hours old, wounds over joints, on hands or feet have to have antibiotics! - Rabies most of the time it comes from wild animals, know what the animal was and what their vaccine status is, wild animal always gets prophylactic. **Stings** - Remove with something flat or a blade, - How many times were the person stung? Are they allergic, - Give them epi, antihistamine, steroids, - Make sure you take anything restrictive off like rings and watches, so you don't swell and then have to have them cut off **Poisoning** - Decontaminate, brush off powder before you shower them in case the powder and water interact, give them a shower, but take care of ABCs first, if they are having breathing issues, or cardiac issues fix those first (DUH) - Ingesting poison- call poison control! Its not a one stop shop, call them they can tell you all the things you need, and then will call you back to check on the patient. - Charcoal binds to toxins, you can take it rectally, orally and through an NG, the charcoal binds with the toxins and you poop it out. But not everybody can have charcoal, if they have issues with their belly do not give charcoal, think hypoactive bowel sounds, a bowel obstruction, etc., if they have any abdominal issues or issues with their bowels do not give it because they cannot get rid of it. **Opioid overdose** - Pinpoint pupils, LOC, watch respiratory depression, seizure activity, hypoxia, - Give them NARCAN and monitor ABCs **Spinal cord injuries** - More common in males, (because they do dumb things) and automobile accidents - Primary injuries are the obvious ones, the head lacerations and things you can see. - Secondary injuries are more concerning you can't usually outwardly see and can lead to permanent damage- edema, ischemia and inflammation - Edema to spinal cord, compresses it and cuts off blood flow, (above and below injury site) - Phrenic nerve- suppresses diaphragm which can mess with breathing - If not fixed in 24 hours it can cause permanent damage **Spinal shock-** - Loss of deep tendon reflex and sphincter reflex, loss of sensation and paralysis below the level of injury, happens quickly after the injury and we don't really know the true injuries until the swelling goes down, then we can see how extensive the damage is. So, when a patient asks will I get the feeling back in my legs, sorry captain we won't know until your swelling goes down, which can take days, or weeks. **Neurogenic shock** - T6 and above injuries, sympathetic nervous system issues, decreased cardiac output, venous pooling, bp systolic is below 90,, temp dysregulation, flushed warm skin in extremities then cold and clammy, your body cannot regulate your temperature. - **Respiratory issues from c3 to c5** - C3, c4, c5- keep the diaphragm alive! Need respiratory help - T6 and up- brady cardia, any increase in vagal stimulation can cause the patient to code, they are very orthostatic - Anomic dysreflexia - life threatening t6 injury or above, God awful worst headache ever, nausea, high high blood pressure. A lot a lot a lot of vaso constriction! - Bowel and bladder (impacted and distended bladder) pressure injuries, - Sit these people up to at least 45 degrees and make sure their bladder is empty. **Trauma** - Tension pneumo is the deadliest, the media stinus is shifted away (tracheal deviation), affects respiratory and cardiac, needle decompress and chest tube, JVD, dyspnea, trachea deviation! Is the big big one! Decreased cardiac output and venous return. - Pneumo- chest tube - Flail chest- paradoxical chest wall movement, multiple broken ribs together. **Abdominal injuries** - Do not pull out the impaled object - Fast- focuses abdominal sonography for trauma (it's an ultrasound) - Know your abdominal trauma stuff. **Fractures** - Long bone fractures can cause a lot of blood loss, open fracture think infection, compartment syndrome= large bone fractures and crush injuries= The 5 Ps think compartment syndrome which can lead to rhabdo- which can cause AKI- their urine looks like sweet Tea. **TBI- know traumatic brain injury** - Can be a lifelong process, severe they will need help for the rest of their life. - PTSD can go along with TBI - Get good sleep and have a routine, and write things down and recognize triggers, hobby, support groups, and try to avoid things that can mess with symptoms, cold medicines, alcohol etc. **Trauma Nursing** - ESI - 5 levels, - 1 is the worse - Depending on what they need will depend on what level they are, **Primary/secondary surveys** **Know primary and secondary survey** - Primary - Airway, Alertness and Cspine - Jaw Thrust - Breathing - Circulation and uncontrolled circulation - Take care of uncontrolled circulation first fix the bleed then fix the other things - Disability- GSC and pupils - Exposure to environment get them naked! Increase tempts to room, if you are not sweating in a trauma room you are not doing it right - Full set of vitals and family - Get more monitoring, fix all the things first then move on to the next issue. - L- lab work - m- monitor - n- ng or Og tube if they have facial trauma do a go tube - o-- oxygen - p- pain, pharm and non-pharm - no dumping law, they have to be stabilized until they move on to another facility, - Good Samaritan law- protects you, we do not have to stop if we see a wreck, but if we do stop then we have to stay there until there are big dogs to come help **Sepsis-** - Sirs - Sepsis - Severe sepsis - Sepsis shock - MODS - Pay attention to what is in each category (**think Winn and clinicals)** - Lactate rises due to hypoxic- level greater than 4 is bad juju- severe sepsis - Respiratory system gets hit hard, think ARDS and they will end up on the vent usually - Gi is affected- paralytic ileus - Kidney failure- no blood flow to the kidneys,.5 ml/kg/hr. **Oncology emergencies** - Neutropenia- wbc count is down - Infections are bad mmmkay - Wash your nasty hands - Antibiotic therapy, make sure you watch if they show a temperature its too late, - Thrombocytopenia- bleeding, watch for activity that can cause injury, we do not want them to bear down that's why we give them stool softeners, don't let them bleed - Hypercalcemia- bad but common in cancer pts, calcium level is greater than 12 that's bad juju, especially if they have a bone cancer, we need to excrete this with saline, pee that calcium out! - Decreased temp, dehydrated, ek changes! Can go into renal failure. - Give them fluids, do iv hydration! They can give bisphosphonates sit helps keep the calcium in the bone, be mobile! It keeps the calcium in check as well. - Anemia- chemo can harm all the cells, check all the blood levels before you give chemo! - Epogen- Give red blood cell growth factors but these can cause issues as well, hypertension and blood clots **Tumor lysis syndrome-** - chemo is killing cells,- hyperkalemia, hyperphosphatemia but hypocalcemia24 to 48 hours after receiving the treatment- they can go into metabolic acidosis - Kidneys are in DANGER! - Make sure they are hydrated prior to chemo. - Cardiac monitor, watch for fluid and electrolyte issues, **SIADH** **Know what it is** - Excessive water gain, mental status change, decrease reflexes, if sodium is less than 125 big no no, correct sodium water balance. Do not correct it too quickly. **Superior vena cava syndrome** - Obstruction of the blood flow, bp will be higher in upper extremities rather than lower extremities. Depending on where it is it can cause dyspnea and sob. **Spinal cord compression- tumor in spinal cord DUH** - Neuro emergency due to rapid deterioration - The pain is worse when the person is supine, that's usually the first symptom. Pain is better when sitting up. - MRI is the gold standard for seeing what's going on - Corticosteroids - Radiation therapy or surgery, chemo **Burns** - Parkland formula - Rule of nines - Intubate, don't wait! - Any issues with burns in the mouth and throat intubate them, they can have swelling in the esophagus and then its too late and you'll have to trache them.