KNES 375 Exam 1 (Burnett)

Anaphylactic shock

Shock caused by an allergic reaction (Pipe failure)

Cardiogenic shock

Conditions affecting the heart (Heart fails to pump blood; pump failure)

Hypovolemic shock

Blood loss from bleeding (Pump failure because there isn't enough blood to return to the heart)

Metabolic shock

Fluid loss from diarrhea, vomiting, urination (Fluid failure because there is not enough fluids in the body to go to the blood)

Neurogenic shock

Vasodilation of peripheral blood vessels due to neurologic injury (Pipe failure because the blood vessels is unable to constrict, leading to the accumulation of blood in the dilated blood vessels)

Psychogenic shock

Vasodilation of the peripheral blood vessels due to psychological response (Pipe failure because the emotion causes the vessels to dilate which reduces blood flow to the brain -> syncope)

Septic shock

Blood pressure drops due to organ damage caused by infection (Fluid failure because there is not enough blood and oxygen to get around to all the organs)

Respiratory shock

Lungs are unable to supply enough oxygen to the circulating blood (Pipe failure

Compensated Stage of Shock

Body's compensatory mechanisms are able to maintain some degrees of tissue perfusion

Decompensated Stage of Shock

Body's compensatory mechanisms fail to maintain tissue perfusion

Irreversible Stage of Shock

Tissue and cellular is so massive the organism dies even if the perfusion is restored

Shock Management and Treatment

Assess CAB Sx3

Elevate lower extremities

Maintain the athlete's body heat

Treat fractures and bleeding

Document and monitor vitals

Limit fluids and blood loss

Pulse (Circulation Assessment)

Pressure wave in the artery

Sites: carotid, radial, dorsal pedal, posterior tibialis, femoral, brachial

Aspects: Rate (fast/slow), Quality (strong/weak), Rhythm (regular/irregular)

Respiration

Rate, Quality, Rhyhtm, Adequate?

Blood pressure

Systolic: 90-140 mm/Hg

Diastolic: 60-90 mm/Hg

Methods to measure: Auscultation and palpation

Temperature

Sites: Rectal, Oral, Axilla (armpit), Tympanic (ear)

Skin

CTM acronym:

Color- Pale, Red, blue

Temperature: Cool, Cold, Warm, Hot

Moisture: Dry, Moist

Capillary refill: should refill within 2secs

Pulse Oximetry

Tool that determines how adequately oxygen is perfusing throughout the body

Measures oxygen saturation

Pupils

PERRLA:

Pupils

Equal

Round

React to

Light

Accomodation

Internal Bleeding

Bleeding from a damaged organ or blood vessels due to trauma

External Bleeding

Visible bleeding

-Direct pressure should be placed on the bleeding

-Pressure points

-Elevation

-Ice increases vasoconstriction and blood viscosity

-Tourniquet is last resort

-Hemostatic agents

Universal Precautions

1991 OSHA (Occupational Safety and Health Administration) established standards for employer to follow that govern occupational exposure to blood-borne pathogens

Dressings

Occlusive (Stops bleeding) dressing: seals a wound with a waterproof bandage

Non-occlusive dressing: porous gauze dressing that neither seals out air nor water

Wound Closure Techniques

Deeper wounds may need:

-Steri-strips

-Butterfly bandage

-Sutures

-Skin glue

Helps facilitate healing and minimize scarring

Choking

5 backblows 5 abdominal thrusts

Establishing an airway

-No breathing, no C-spine injury

Technique:

person is in supine position

head-tilt chin-lift (hands on the chin and forehead)

Establishing an airway

-No breathing, c-spine injury suspected

Technique:

person is in supine position

jaw thrust (hands should be on the angle and body of the mandible)

Rescue breathing

Administered via:

-CPR mask or bag-valve mask

-Adults: 1 breath every 5 seconds

-Children: 1 breath every 3 seconds

Clearing the airway

Airway must be cleared in case the patient vomits

Airway Adjunct Principles

-Unconscious patients only

-Open airway manually

-Do not push tongue into throat

-Remove if gag reflex returns

- Use infection control practices

-Types: OPA, NPA

Airway Adjuncts

-Oropharyngeal Airway (OPA)

Oropharyngeak Airway (OPA)

-choose the size based on the distance between the tip of the ear to the corner of the mouth

-Insert and rotate 180 degrees

-For children: use a tongue depressor to hold, push the tongue back and insert

Airway Adjuncts

-Nasopharyngeal Airway

For conscious or unconscious victim with gag reflex

- select size based on the diameter of nostril or patient's pinky finger

-Patient should be in supine position with the C-spine in neutral

-Tube should be lubricated

Supplemental Oxygen

-Increases the concentration of oxygen inhaled

-Aids in the prevention and management of hypoxia and shock

-Should be administered to:

-Adults respiratory rate: < 12 or > 20 per minute

-Child respiratory rate: < 15 or > 30 per minute

-Infant respiratory rate: < 25 or > 50 per minute

Hypoxia

Normal: 95-100% SPO2 (Delivery device: None)

Mild Hypoxia: 91-94% SPO2 (Delivery device: Nasal cannula or resuscitation mask)

-Moderate: 86-90% SPO2 (Delivery device: Non-rebreather mask or Bag-valve mask [BVM])

-Severe: < 85% SPO2 (Delivery device: Non-breather mask or BVM

Sudden death in youth

Cardiac related

Pre-participation Physical Exam (PPE)

Primary objective is to:

- Detect life-threatening or disabling conditions

- Conditions which predisposes the athlete to injury or disability

- Meet administrative requirements

Secondary objective is to:

- Document athletic eligibility

- Obtaining parental consent for participation and emergency treatment

-Improving athletic performance

- Determine general health

Cardiac Artery Anomalies

Defect in one or more of the arteries in the heart

-Congenital

Hypertrophic cardiomyopathy

abnormal enlargement of the left ventricular wall

-best predictor is syncope

Marfan Syndrome

Connective tissue disorder affecting the CV and MS systems, as well as the eyes

-Distinguished by aortic insufficiency murmur

-Long, spidery fingers

-Arms span is greater than height

-High-arched palate

-Kyphosis

-Lentricular dislocation

-Mitral valve prolapse

-Pectus Excavatum

-Myopia (nearsightedness)

Aortic Rupture

Usually happens in car accidents

-Patients die quickly

Aortic Stenosis

-Aortic stenosis (narrowing of aortic valve which prevents heart from fully opening)

Myocarditis

Acute inflammation of the heart

Arrhythmogenic right ventricular cardiomyopathy

Progressive fibro-fatty replacement of the right ventricular myocardium

Valvular dysfunction

Mitral valve prolapse: mitral valve doesn't close properly so blood leaks back into the left ventricular chamber

Long QT Syndrome

Rare inborn heart condition in which delayed repolarization of the heart following a heartbeat increases the risk of episodes of torsade de pointes and other life threatening arrhythmias. Prolongation of the QT interval is a diagnostic of the condition.

Wolff-Parkinsons-White (WPW) syndrome

A condition in which there is an extra electrical pathway in the heart. The condition can lead to periods of rapid heart rate (tachycardia)

Brugada syndrome

a genetic disorder in which the electrical activity within the heart is abnormal

cardiac arrhythmia

Abnormal heart rhythm due to the malfunction in the heart's electrical system

Commotio Cordis

A blunt chest injury caused by a sudden, direct blow to the chest that occurs only during the critical portion of a person's heartbeat.

Cardiac tamponade

pressure on the heart caused by fluid in the pericardial space which prevents it from pumping effectively

Myocardial infarction

The occlusion (blockage) of one or more coronary arteries caused by plaque buildup (heart attack)

angina pectoris

chest pain that results when the heart does not get enough oxygen due to blockage of the coronary arteries (ischemia)

Strokes

Stroke: Lack of oxygen to the brain

Ischemic Stroke: most common form of stroke where blood vessel is blocked and not enough oxygenated blood gets to the brain

Hemorrhagic stroke: occurs when an artery carrying blood to the brain ruptures

Embolism

Clot travels through blood vessels until it reaches a vessel that is too small

Thrombosis

formation of a blood clot inside a blood vessel, obstructing the flow of blood through the circulatory system

Sudden cardiac death

The sudden, abrupt loss of heart function in a person who may or may not have diagnosed heart disease

*Leading cause of death in young athletes

Recommendations for Sudden Cardiac Arrest

Prevention:

1) Review EAP and access to early defibrillation

2) Early defibrillation -> less than 3-5 mins between collapse to delivery of 1st shock

Recognition:

3) SCA should be suspected for any athlete that has collapsed and is unresponsive

4) Myoclonic jerk or seizure-like activity is present

Management:

5) CPR should be provided while AED is being retrieved