Emergency and acute situations

most common cause of death for individuals between the ages 1 and 44 years

trauma

annual medical cost from trauma injuries is

200 billion

level 1 trauma have to admit

1200 admissions per year or 240 major trauma patients per year

physicians trauma assessment

1. cardiac status- cardiac arrest (cessation of heartbeat)

2. respiratory status- respiratory arrest (cessation of breathing)

3. spinal trauma- Danger of paralysis

radiographic protocols for trauma

Usually Portable Chest, Pelvis, & Lateral C-spine

emergency response team usually consist of

physicians, nurses, respiratory therapist, and electrocardiographers

5 example supplies for a crash cart

1. defibrillator

2. stethoscope

3. emergency medications

4. ventilation equipment

5. suction catheters

nasal cannula; liters per minute and oxygen concentration?

simplest and most frequent device for longer term O2 administration

delivered at a rate of 1-6 liters per minute

provides 24%-45% oxygen concentration

oxygen face mask; oxygen concentration?

provides both oxygen and humidity

provides 40% to 60% oxygen concentration

non rebreathing mask'; oxygen concentration?

has an attached reservior bag that fills with 100% O2 and a valve to prevent exhaled gas from being inhaled again

can supply up to 100% oxygen concentration

intubation

tube placement of an airway into the trachea then connected to a ventilator

tube that protects the patients airway and ensures that air can reach the lungs

endotracheal tube

tracheostomy

surgical opening through the anterior neck into the trachea

can be connected to oxygen supply or to a ventilator

ventilator

mechanical respirator devices that controls respiratory rate, volume, and oxygen content

mechanical suction

used when a patient is unable to clear the mouth and throat of secretions

reactive airway disease

general term to describe conditions characterized by coughing, wheezing, or shortness of breath with an undetermined cause

asthma

difficulty breathing caused by bronchospasms

treatment for reactive airway disease is usually

O2 administration, epinephrine injections, or a bronchodilating medication

Acute coronary syndrome (ACS)

umbrella term used to cover a group of clinical symptoms that can indicate acute myocardial ischemia

myocardial ischemia

insufficient blood supply to the heart muscles that results from coronary artery disease

myocardial infarction (MI)

heart attack: the heart muscle supplied by the occluded artery will die if blood flow is not restored quickly

angina pectoris

episodes of chest pain precipitated by exertion or stress

coronary arteries are unable to supply the heart with sufficient oxygen

defibrillator

machine that administers electric shock to correct an ineffectual cardiac rhythm

2 feet distance is good

concussion

caused by head injury; minimal damage

hemothorax

blood in the pleural space

pneumothorax + what does it reduce

air in the pleural space, reduces available surface for 02 exchange

thoracotomy

surgical opening made through chest wall for tube placement

treatment for both hemo and pneumothorax

thoracentesis

removal of fluid from the pleural space

hemorrhage

excessive bleeding

cardiac tamponade

pericardial sac fills with fluid, preventing the heart from expanding and soon results in critical situation

wound dehiscence

occurs when suture lines part

• can be partial (involving the outer layers of the wound

• or complete (involving all layers of the wound)

evisceration

loss of organs through the body cavity, may be caused by complete wound dehiscence

Burns are frequently associated with respiratory complications such as

1. respiratory edema: swelling of the respiratory tract

2. pleural effusion: fluid in the pleural space

3. pneumonia: inflammation of the lungs

degrees of burns

1. degree burn: involves the epidermis only

2. degree burn: involves the dermal layer

3. degree burn: extend deep into the subcutaneous tissue and destroy nerve endings

shock

general term used to describe a failure of circulation in which blood pressure is inadequate to support oxygen perfusion of vital tissues and is unable to remove the byproducts of metabolism

signs of shock

pallor, increased heart rate and respirations, restlessness, fall in BP, decreased urination, cool clammy skin, and confusion

5 types of shock

1. hypovolemic: loss of blood from injury or internal bleeding

2. neurogenic: injury to the nervous system caused by head or spinal trauma

3. cardiogenic: cardiac failure caused by interference with heart function

4. septic: massive infection, usually by gram-negative bacteria

5. anaphylactic: contact with substance that patient is allergic to

syncope

fainting- mild form of shock that can occur which fright, pain, or unpleasant events beyond the coping ability of the patients nervous system

how does fainting occur

Diameter of blood vessels increases, causes BP to fall, heart rate slows, BP is too low to supply the brain with oxygen, patient faints

to relieve patient from fainting

place patient in dorsal recumbent position with feet elevated

can use spirits of ammonia under patients nose

severe contrast reactions are not common and occur only

1 in 14000 cases

patients that are allergic to food and airborne particles are

twice as likely to have a reaction to contrast when compared to patient that doesn’t have these allergies

patients with asthma are

3 times more likely to have a reaction with contrast

Intermediate Reactions

• Erythema: reddening of the skin

• Urticaria: hives

• Bronchospasms

normal contrast reactions

• Feeling of warmth

• Feel flushed for 1-3 minutes

• Metallic taste in the mouth

• Nausea, vomiting, cough

Vasovagal Reactions:

injection stimulates vagus nerve causing cardiovascular

changes

may be life threatening, place patient in supine position with feet elevated about 20 degrees and head elevated 10 degrees

reactions to vasovagal

diaphoresis

• Hypotension

• Sinus bradycardia

Diabetes Mellitus (DM):

inability to metabolize blood glucose

Hyperglycemia

Insufficient production of insulin from the pancreas causes glucose levels in the blood to rise

Type I diabetes

Insulin dependent diabetes –typically lean individual under the

age of 25 who produces little or no insulin- insulin is administered

parenterally

type 2 diabetes

Most commonly in obese individuals over the age of 40-

sometimes manageable with changes in diet and lifestyle as well as oral

hypoglycemic medications

Hypoglycemia

low blood sugar

CEREBROVASCULAR ACCIDENTS (STROKE

interruption of the blood supply to the brain

seizures

Occur as a result of a focal or generalized brain function disturbance and are

accompanied by a change in the level of consciousness

vertigo

sensation that the room is spinning

nausea may occur

Orthostatic Hypotension

transient dizziness that sometimes occurs with a

sudden change in position

Epistaxis

nose bleed

tell patient to squeeze firmly against nasal spetum for 10 minutes

how to help a nauseous patient

focusing on breathing can prevent vomiting