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Trauma and Neuro.CC

Delirium, Cold/hot weather, OD, head, chx, burns, neuromusc, palliative

QuestionAnswer
what is polytrauma? trauma affecting more than one body system. This usually happens in battlefield injuries or motor vehicle accidents and usually requires a "trauma series" or X-ray, CT, to determine injuries.
What is stroke? Stroke is brain damage caused by a blocked blood vessel or bleeding in the brain. The signs of a stroke may include weakness, numbness, blurred vision, confusion, and slurred speech. Getting to a hospital quickly is vital for a good outcome with a stroke.
What is a heat casulty? casualty determined by climate, season, weather, terrain, pressure, age, health, fatigue, pre-existing med. conditions, medications, resulting in increase of core temp, perspiration, and cardiac output, fluid/electrolyte imbalance, body system failure
What is expected to happen in Attempted suicide? Attempted suicide patients are either treated as in or outpatient depending on clinical measures, sociodemographic, and differentiated physician concern. Mental Health Act, Competent, Advanced Care Dir. pharm. care resist leads to inpt suicide attempts
Describe End of Life Care Palliative, treating for pain, comfort measures, death is expected and pt/family teaching concerns grieving, Advance Care Directives, Spiritual consultation
failure to detect what conditions may result in pt complication due to obscure clinical picture? CVA, MI,Hypoglycemia, peritonitis
failure to detect what conditions may result in pt complication due to obscure clinical picture? CVA, MI,Hypoglycemia, peritonitis
what is the analgesic pyramid? NSAIDS, mild opiod analgesics, strong opiod analgesics
what are six steps to analyse arterial blood gases? 1. PaO2&FiO2, 2. Assess PH, 3. resp component(PaCO2- 4.5-6kPa or 35-45mmHG), 4. metabolic component (HCO3 23-33mmol/L), 5. determine compensation, 6. consider anion gap
what on earth is the anion gap? the difference between the sum of serum sodium and potassium ion concentration (cations) and sum of serum chloride and bicarb ions (anions)reflecting excreted phosphates (mineral acids)
what does an increased Anion gap indicate? > 12-14 mmol/L accumulation of keto,lactic, exogenous acids (salicylates).
what is a normal or reduced AG indicative of? < 10 mmol/L of anions due to hyperchloramic acidosis, loss of bicarb or renal tubular acidosis
what is the flenley nomagram? a useful diagram to diagnose type of disturbance if pH and PCO2 fall within a band.PH measured on vertical axis(acidic above/alkalotic below and PaCO2 measured on horizontal axis(alkalitic left) shows relationship diagram between Resp/Metab/acidos/alkalos
what might cause a mixed resp/metabolic acid base disorder? resp acidosis due to resp failure combined with a metabolic acidosis due to associated hypoxia
what are four examples of a stage three analgesic? Tramadol, Morphine, Fentynal, Alfentanil and remifentanil
what barbiturate is used sometimes with a penothiazine to treat an agitated pt? Haloperidol
what are the two main types of paralytics? depolarizing and non depolarizing neuromuscular agents
suxamethonium/succinylcholin depolarizing neuromuscular, chemically resembles acetylcholine though it is not metabolized by acetylcholinesterases, but by plasma cholinesterases, associated Potassium release with the extended depolarization. Vagal stimulation prevents continuous use
Atracurium, rocuronium occupy ACH binding sites preventing depolarization. may result in myopathy, vagal blockade, bronchospasm
what are three possible causes of metabolic acidosis with a normal anion gap? thiazide diuretic induced renal tubule acidosis, hyperparathyroid/ileostomy/diarrhea loss of bicarb, decreased renal H+ secretoion from hypoaldosteronism or distal tubule acidosis
what are three possible causes of metabolic acidosis with an increased anion gap? alcohol overdose, hypotension, sepsis, cardiac arrest resulting in lactic acidosis, starvation or DKA, and exogenous acids from
what may cause metabolic alkalosis? vomiting, renal loss in hypokalemia/hypoaldosteronism, diuretics low Cl- states, lactate or citrate administration
what may cause resp acidosis? obstruction, ARDS, pneumonia edema, trauma, opiates, head trauma
what may be an indication of resp alkalosis? excessive mech. vent, altitude, salicylate overdose, asthma, pulmonary embolism
what is the diagnostic hallmark of acute myocardial infarction? ST segment elevation (>0.1mV in two chest leads or >0.2 mV in 2 limb leads) and requires revascularization
what type of EKG reading does not benefit from throbolytic therapy? ST segment depression and T wave inversion with raised CE
What is a non specific EKG that would require Cardiac Troponin to determine myocardial necrosis? Left bundle branch block
what is the only Calcium channel Antagonist that may be used as monotherapy when beta blockers are contraindicated? diltiazem. Other CCA's relieve coronary vasospasm, but may cause tachycardia i.e.nifedipine, or exacerbate heart failure (negative inotrope)
What is an indication of Sinus Tach? normal complex
indication of atrial flutter? sawtooth p wave, 2:1, 3:1, or 4:1
SVT? p waves buried in QRS
V tach wide QRS occasional p wave
Atrial Tach inverted p waves
atrial fib no distinguishable p wave or poor pwaves
WPW short p-r interval, D wave
V fib wide chaotic QRS
HB is due to ischemia of what possible anatomies? AVN or conducting tissue common in inferior MI, where the right coronary artery supplies it. anterior MI needs pacemaker
what indicates a 1 degree HB on EKG? prolonged p-r interval >0.2 seconds
what indicated 2nd degree HB on EKG? progressive P-r interval lengthening in type 1, in the his-purkinje system, every 2nd or 3rd impulse intiates vent contraction: 2:1, 3:1 Block type 2
what indicates 3rd degree HB on the EKG? p waves and QRS complexes have no relation and operate
what is PEEP? alveolar pressure above atmospheric pressure and the end of expiration (Positive End Expiratory Pressure or PEEP) can build up if expiration is obstructed or expiration is not fully completed. this can hyperinflate the alveoli.
what is auto PEEP and applied PEEP aka intrinsic and extrinsic, naturally occuring PEEP is auto, while ventilated PEEP is applied
what are common causes of normal anion gap? FUSEDCARS (fistula (pancreatic), uretero-enterostomy, saline administration, endocrine (hyperparathyroidism), diarrhea, carbonic anhydrase inhibitors (acetazolamide), ammonium chloride, renal tubular acidosis, spironolactone)
what is low anion gap caused by? hypoalbuminemia, hemorrhage, nephrotic syndrome, liver cirrosis, multiple myeloma
what happens in sepsis? invasive microorganisms, bacterial endotoxins, cytokine release that activates polymorphs, endothelium, platelets, complement and coagulaiton pathways, activates wbc's adhere/damage vascular endothelium, fluid leakage, thrombos impairs tissue perfusion
what causes sepsis? wrong antibiotic, abscess drainage, infected line removal
Early sepsis low sVR, hypotension reduced Left Vent afterload increases CO, inappropriate distribution causes ischemia. treat with vasopressor
late sepsis toxic myocarditic impairs contractility reducing CO. inotropic agent increases contractility to maintain CO
SIRS inflammatory response to pancreatits, trauma, burns includes: temp, increased HR, increased resp rate, decreased PaCO2, wbc >12000
what are complications related to mechanical ventilation decreased CO, barotrauma, nosocomial pneumonia (VAP), Positive water balance, decreased renal perfusion, increased intracranial pressure, hepatic congestion, worsening intracardiac shunts, alarms turned off, abcsess, stenosis, lesions, sinusitis
how is CO decreased? venous return to the right atrium impeded by the increased intrathoracic pressures during inspiration from PPV. Also reduced sympatho-adrenal stimulation leading to a decrease in peripheral vascular resistance and reduced blood pressure.
How does Mechanical ventilation cause SIADH leading to positive water balance? due to vagal stretch receptors in right atrium sensing a decrease in venous return and see it as hypovolemia, leading to a release of ADH from the posterior pituitary gland and retention of sodium and water. Treatment is aimed at decreasing fluid intake.
when related to positive water balance in mechanical ventilated patients, what is decrease in normal sensible water loss? closed ventilator circuit preventing water loss from lungs. This fluid overload evidenced by decreased urine specific gravity, dilutional hyponatremia, increased heart rate and BP.
baroreceptors located in blood vessel walls send signals to The nucleus tractus solitarius in the medulla oblongata which influences cardiac output and systemic vascular resistance through changes in the autonomic nervous system.
chemoreceptors direct class: central chemoreceptors are located on the ventrolateral surface of medulla oblongata and detect changes in pH of csf. They respond to hypercapnic hypoxia (elevated CO2, decreased O2), and eventually desensitize
volutrauma damage to the lung caused by overdistension by a mechanical ventilator set for an excessively high tidal volume. It results in a syndrome similar to adult respiratory distress syndrome.
barotrauma, most often associated with scuba diving also happens in mechanical ventilation: absolute pressures used in order to ventilate non-compliant lungs. shearing forces, particularly associated with rapid changes in gas velocity. alveolar rupture can lead to pneumothorax, pulmonary interstitial emphysema (PIE) and pneumomediastinum.
Lung ventilation is critical for COPD patients because their lungs have a reduced capacity to transmit oxygen into the bloodstream. How do CPAP and BiPAP differ? Both machines are designed to keep your lungs ventilated. There are times when a COPD patient is short of breath and cannot exert enough exhalation against the CPAP's steady stream, which is when BIPAP machines are used. They adjust to pts breathing.
Created by: redhawk101