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Trauma and Neuro.CC
Delirium, Cold/hot weather, OD, head, chx, burns, neuromusc, palliative
| Question | Answer |
|---|---|
| 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
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