Shock and Trauma Review

Flashcards covering shock types, perfusion assessment, sepsis and septic shock, trauma primary and secondary surveys, fracture complications, and burn assessment and management.

Hypovolemic and Cardiogenic Shock

Types of shock caused either by blood/fluid loss presenting with tachycardia, cool skin, and low preload (hypovolemic), or by pump failure presenting with hypotension and pulmonary congestion (cardiogenic).

Obstructive Shock

A type of shock resulting from a physical obstruction to circulation, such as pulmonary embolism (PE), cardiac tamponade, or tension pneumothorax.

Septic Shock (Etiology)

A form of distributive shock caused by a dysregulated host response to infection resulting in profound vasodilation.

Septic Shock (Clinical Presentation)

A shock state where the patient may initially present with warm skin along with fever or hypothermia.

Anaphylactic and Neurogenic Shock

Distributive shock states presenting either with hypotension, bronchospasm, swelling, and urticaria due to a severe allergic reaction (anaphylactic), or with hypotension, bradycardia, and warm skin due to loss of sympathetic tone (neurogenic).

Mental Status (Perfusion Assessment)

A clinical perfusion assessment parameter used to monitor the adequacy of cerebral blood flow.

Mean Arterial Pressure (MAP) Target

A hemodynamic perfusion parameter commonly targeted at $\ge 65\,\text{mmHg}$ in septic shock and individualized according to patient needs.

Heart Rate and Blood Pressure (HR and BP)

Core vital signs assessed during perfusion monitoring to evaluate systemic hemodynamics and cardiovascular compromise.

Capillary Refill and Pulses

Physical assessment findings evaluated during perfusion monitoring to assess peripheral vascular blood flow and volume status.

Urine Output Target

A renal perfusion marker commonly targeted at $\ge 0.5\,\text{mL/kg/hr}$ in many critical care contexts.

Lactate

A laboratory marker measured during perfusion assessment to evaluate tissue hypoperfusion and anaerobic metabolism.

Skin Temperature (Perfusion Assessment)

A clinical examination metric assessed to evaluate peripheral perfusion, distinguishing cool, vasoconstricted skin from warm, vasodilated skin.

Treatment of Hypovolemic Shock

Resuscitation strategy focused on replacing fluid or blood and stopping ongoing losses.

Treatment of Cardiogenic Shock

Management focused on treating pump failure utilizing individualized fluid administration and inotropes.

Treatment of Obstructive Shock

Immediate intervention focused directly on relieving the physical obstruction to circulation.

Treatment of Septic Shock

Management focused on administering antibiotics, infusing intravenous fluids when appropriate, and starting vasopressors.

Treatment of Anaphylactic Shock

Emergency medical therapy requiring prompt administration of intramuscular (IM) epinephrine first.

Treatment of Neurogenic Shock

Management consisting of cautious fluid administration, vasopressors, and treating bradycardia when indicated.

Sepsis

Life-threatening organ dysfunction caused by a dysregulated host response to infection.

Septic Shock (Clinical Definition)

Sepsis accompanied by persistent circulatory and metabolic dysfunction requiring vasopressors to maintain MAP $\ge 65\,\text{mmHg}$ and lactate $> 2\,\text{mmol/L}$ despite adequate fluid resuscitation.

Systemic Inflammatory Response Syndrome (SIRS) Distinction

An inflammatory state that can occur without infection, triggered by sterile insults such as burns, pancreatitis, or trauma.

Nursing Priority: Sepsis Identification

The essential initial nursing action to promptly recognize the co-occurrence of infection plus organ dysfunction.

Nursing Priority: Perfusion and Airway

An urgent clinical priority in sepsis to systematically assess patient perfusion status and ensure airway patency.

Nursing Priority: Diagnostic Sampling in Sepsis

A critical early nursing action to obtain blood lactate levels and diagnostic cultures promptly.

Nursing Priority: Antimicrobial Therapy in Sepsis

An urgent intervention requiring the prompt initiation of ordered broad-spectrum intravenous (IV) antibiotics.

Nursing Priority: Fluid Resuscitation in Sepsis

The administration of prescribed intravenous (IV) crystalloids to correct hypoperfusion.

Nursing Priority: Post-Resuscitation Reassessment

Continuous evaluation after initial resuscitation to reassess volume responsiveness, mean arterial pressure (MAP), and urine output.

Norepinephrine in Septic Shock

A vasopressor initiated as a nursing priority when indicated to maintain perfusion pressure despite fluid therapy.

Nursing Priority: MODS Surveillance

Continuous clinical monitoring in septic patients for the development of multi-organ failure.

Multiple Organ Dysfunction Syndrome (MODS)

The progressive failure of multiple organ systems resulting from severe systemic illness.

Trauma Primary Survey: A

Airway maintenance with cervical spine protection.

Trauma Primary Survey: B

Breathing evaluation consisting of assessing chest expansion, lung sounds, and oxygenation.

Trauma Primary Survey: C

Circulation evaluation focused on controlling external hemorrhage and evaluating tissue perfusion.

Trauma Primary Survey: D

Disability assessment evaluating Glasgow Coma Scale (GCS), pupils, neurological status, and blood glucose when indicated.

Trauma Primary Survey: E

Exposure and environmental control involving inspecting the entire body for injuries while preventing hypothermia.

Trauma Secondary Survey

A comprehensive full head-to-toe physical assessment and detailed history conducted after all primary life threats are addressed.

Pain Out of Proportion to Injury

A hallmark clinical presentation and early warning sign of compartment syndrome following a fracture.

Pain with Passive Stretching

A classic diagnostic sign indicating ischemic muscle stretch within an affected compartment.

Paresthesias and Tense Compartment

Physical findings in compartment syndrome indicating sensory nerve compromise and elevated intramuscular pressure.

Pulselessness and Paralysis

Late and ominous clinical signs in compartment syndrome indicating advanced neurovascular compromise and tissue necrosis.

Priority Actions for Compartment Syndrome

Notify surgeon immediately, avoid constriction, position limb near heart level, and prepare for an urgent fasciotomy if needed.

Fat Embolism Syndrome (Onset Window)

A serious fracture complication that classically develops $24\text{--}72\,\text{hours}$ after a long-bone fracture.

Respiratory Distress (Fat Embolism)

A pulmonary manifestation of fat embolism syndrome caused by embolized fat droplets occluding the pulmonary vascular bed.

Neurological Changes (Fat Embolism)

Central nervous system manifestations such as confusion or altered mental status occurring in fat embolism syndrome.

Petechial Rash (Fat Embolism)

A characteristic cutaneous finding classically distributed over the upper body in fat embolism syndrome.

Secondary Fracture Complications

Additional clinical risks following skeletal injury, including hemorrhage, infection, DVT/PE, and neurovascular compromise.

Superficial Burn

A burn limited to the epidermis that presents as red and painful without blister formation.

Partial-Thickness Burn

A burn extending into the dermis characterized by blisters, a moist wound bed, and pain.

Full-Thickness Burn

A severe burn through the dermis presenting as leathery, charred, or pale skin with reduced sensation at the center.

Rule of Nines: Head and Neck

The anatomical region of the head and neck, which accounts for $9\%$ of total body surface area (%TBSA).

Rule of Nines: Anterior Trunk

The anterior surface of the torso, which accounts for $18\%$ of total body surface area (%TBSA).

Rule of Nines: Perineum

The perineal anatomical region, which accounts for $1\%$ of total body surface area (%TBSA).

Parkland Formula

A traditional resuscitation calculation expressed as $4\,\text{mL} \times \text{kg} \times \%\text{TBSA}$ used to estimate initial fluid resuscitation in burns.

Parkland Formula: First 8-Hour Fluid Delivery

The schedule requirement dictating that half of the total calculated resuscitation volume be given in the first $8\,\text{hours}$ from the time of injury.

Parkland Formula: Following 16-Hour Fluid Delivery

The administration schedule requiring the remaining half of the calculated resuscitation volume to be infused over the subsequent $16\,\text{hours}$.

Parkland Formula: Fluid Titration Principle

The clinical rule that the formula provides an initial fluid estimate rather than a fixed final rate, requiring titration based on clinical response.

Modern Burn Resuscitation Protocols

Contemporary resuscitation guidelines that may begin fluid replacement with lower-volume estimates compared to traditional formulas.

Burn Priority: Airway and Inhalation Injury

The primary assessment priority in acute burn care to identify thermal, chemical, or soot-related respiratory compromise.

Burn Priority: Hypovolemic Shock

An urgent assessment priority to identify and manage intravascular fluid loss and massive fluid shifts following burn trauma.

Urine Output Target in Adult Burns

A key fluid resuscitation endpoint commonly targeted at $\ge 0.5\,\text{mL/kg/hr}$ in adult burn patients.

Burn Priority: Pain and Wound Infection

Ongoing clinical assessments focused on providing adequate analgesia and identifying signs of burn wound sepsis.

Burn Priority: Temperature and Nutrition

Essential supportive assessments aimed at preventing burn-induced hypothermia and meeting the massive hypermetabolic caloric requirements.

Inhalation Injury Clues

Clinical warning signs including facial burns, soot in the mouth, hoarseness, stridor, and enclosed-space fires that indicate anticipating early airway intervention if deteriorating.

Medication Master Review Focus

A pharmacology review framework evaluating why a medication is given, pre-administration assessment, serious side effects, and signs of therapeutic efficacy.