KAAP 608 - Exam II

S1

Mitral valve and tricuspid valve closing

S2

Aortic Valve and pulmonary artery closing

S2 spits into ______ sounds

two

Diaphragm lowers, increases venous blood to the....

right atrium and right ventricle

Pulmonary valve is heart after the

aortic valve

S1 is...

systole

S2 is...

diastole

What does START stand for?

Simple Triage and Rapid Treatment

What is important during triage?

RPM

SALT Triage

Sort

Assess

Life saving interventions

Treatment/transport

In emergencies _________ is redirected to critical organs

blood

Perfusion and hypoperfusion is apart of the

circulatory system

Components of the circulatory system

Plasma, red blood cells, white blood cells, and platelets

Perfusion

Oxygen and nutrients provided to tissue to remove metabolic waste products via circulating blood

Reduction in perfusion leads to...

impaired cellular function

Hemorrhage

excessive bleeding

Acute and significant loss of blood results in

decreased blood volume

Blood volume loss and duration of bleeding dicatates

severity

Life threatening hemorrhage can lead to...

sepsis or multiple organ failure

What are complications of hemorrhaging?

DVT and hypercoagulation

Hemmoraging is responsible for ____ of pre-hospital deaths

35%

Army considers _____________ a preventable cause of death on battlefield

hemorrhage

Factors Contributing to Hemorrhage Severity

• Patient's age

• Severity of injury, with special attention to type and anatomic location of injury

• Time lapse between injury and initiation of treatment

• Pre-hospital treatment available

• Medications used for chronic conditions

External hemorrhage is when

bleeding is visible

How to control a external hemorrhage

Direct pressure or pressure bandage

Internal hemorrhage is when

bleeding is not visble

Internal hemorrhaging is identified _________ in the assessment

later

Internal hemorrhaging is controlled by

a surgeon

Signs and sx of hemorrhage

• Ecchymosis

• Epistaxis - nose bleed

• Hematemesis - vomiting blood

• Hemoptysis - coughing up blood

• Purpura - small blood vessels burst, causing blood to pool under the skin

Process of hemostatsis

- Vascular spasm

- Formation of platelet plug

- Development of clot

Hemostasis can be impaired by

- drugs affecting coagulation

- DVT

- Hemophilia

The heart rate and cardiac input ________ when the hormone responds to constrict vessels when responding to an acute hemorrhage

increases

Systemic Responses to Acute Hemorrhage

Urine output decreases and thirst signaled

• Mental status changes: weakness, dizziness, anxiety

• Catecholamines released

• Respiratory rate increases to offset metabolic acidosis (increased CO2 in blood)

Assessment of Patient With Hemorrhage

• Rapid assessment to determine source of bleeding

• Thorough physical exam

• Large-scale bleeding locations:

- External hemorrhage (anywhere on body)

- Thoracic cavity

- Peritoneal cavity

- Retroperitoneal space

- Muscle or subcutaneous tissue (long-bone fracture)

Internal Hemorrhage

Signs and symptoms onset can be delayed

• Result from trauma to thorax, abdomen, or retroperitoneum

• Patient will require prompt transport to emergency facility

Two types of trauma to type internal hemorrhage is

- blunt

- penetrating

Most Serious Internal Bleeding

- Intracranial hemorrhage

- Hemothorax

- Hemopericardium

- Aorta, superior and inferior vena cava

- Organ damage (liver and spleen)

Delayed Signs and Symptoms of Internal Hemorrhage

•Lightheadedness, dizziness, or fainting

• Headache, seizures, loss of consciousness

• Large area of ecchymosis

• Swelling, tightness, and pain in extremities or abdomen

Kehr's sign indicates

internal hemorrhaging

Kehr's sign

Acute pain in the tip of the shoulder due to the presence of blood or other irritants in the peritoneal cavity when a person is lying down and the legsare elevated.

Kehr's sign in the left shoulder is considered a classic symptom of

a ruptured spleen

More Delayed Signs and Symptoms of Internal Hemorrhage

McBurney's point• Hematemesis

- vomiting blood

• Hemoptysis - coughing up blood

• Melena - black stool, usually from GI

• Hematochezia - fresh blood in stool, ususally from colon

Clinical Skills: Steps for Controlling External Bleeding

Use standard precautions

• Maintain the airway with spinal motion restriction if spinal injury is suspected

• Apply direct pressure over the wound with a dry, sterile dressing

• If bleeding continues, do not remove the dressing; instead, apply additional dressing with manual pressure

If bleeding continues, apply a ___________ bandage

pressure

Check __________ pulse (on injured extremity) before and after applying dressing

distal

If direct pressure and a pressure dressing are not immediately effective, apply a ________________ above the level of the bleeding or use a hemostatic agent

tourniquet

If a tourniquet is not possible because the bleeding is too far or a hemostatic agent is unavailable...

apply direct pressure and maintain pressure until the patient is transferred to the ED

Do not remove the dressing until a _____________ has evaluated the patient

physician

Hemostatic Agents

• Anatomical areas difficult to apply direct pressure

• The granules or dressing absorb water from blood to concentrate the clotting factors

• Non prescription topical product

• Can be removed by soaking it with H2O2 (hydrogen peroxide)

Wound Closure

Determines severity

Clean wound

1:10 mixture of povidone/iodine solution and isotonic saline

Debridement

Removal of foreign bodies, dead and/or devitalized tissue

Closure

Skin adhesives, adhesive strips, metal staples, or sutures

Sutures

• Suture sizes

• Needles

• Technique

• Knot tying: two-handed square knot

• After suture care and complications

• Suture removal

Tourniquets

Do not apply directly over a joint; apply proximal and adjacent to injury

• Tighten securely

• Never use wire, rope, a belt, or other narrow material

• Use wide padding under tourniquet if possible

• Never cover tourniquet with a bandage; leave it open and in full view

• Write the day and time the tourniquet was applied on the tourniquet or the patient's skin

Shock

Resulting form inadequate tissue perfusion (hypoperfusion)

• Results from uncontrolled hemorrhage

Shock can result in

Inadequate oxygenation

- Mechanical obstruction

- Neurologic dysfunction

- Cardiac dysfunction

Pre-shock or compensated shock

decrease tissue profusion

Uncompensated shock

Tachycardia, dyspnea, restlessness

Reperfusion

Ischmic

Fourth stage of shock

ischemic

Fifth stage of shock

death

Hypovolemic

decreased blood volume

Distributive

vasodilatory

Cardiogenic

heart can't pump

Obstructive

blocked vessel

Red flags for recognition of shock

Cool, clammy skin, diaphoresis, pallor, cyanosis, restlessness

• Ill appearance, altered mental status

• Tachycardia

• Tachypenea

• Hypotension

• Weak peripheral pulses, narrowing of the pulse pressure

• Prolonged capillary refill

Emergency Care for Undifferentiated Shock

Recognize the state of shock

• Establish a patent and protected airway

• Maintain adequate oxygen delivery

• Limit blood loss by controlling external hemorrhage

• Restore intravascular volume by initiating fluid resuscitation via IV

• Cover patient to maintain normal body temperature

• Rapidly transport patient to appropriate trauma center

Anaphylaxis

Sudden release of mast cells and basophil-derived mediators that release histamine

Anaphylactic reaction results in an

Exaggerated immune response - Release of immunoglobulin E antibodies

Causes of anaphylactic shock

Food, medication, insect/animal reactions

Risk factors of increased severity of anaphalyxis

• Recent episode of anaphylaxis

• Extremes of age (very young or very old)

• Presence of cardiopulmonary conditions

• Taking medications that may influence timely recognition of symptoms

• Rapid onset of symptoms after exposure

Signs and Symptoms of Anaphylaxis

Skin and/or mucosal tissue: 80-90% present with this

- Hives

- Pruritus- Angioedema

- Flushing or diaphoresis

• Respiratory compromise

- Dyspnea- Wheezing or bronchospasm

- Stridor

- Cough or voice change

Reduced BP or associated end-organ dysfunction involvement from anaphylaxis can result in

- hypotension

- collapse or sudden weakness

- syncope

Gastrointestinal symptoms (nausea, vomiting, diarrhea) are ___________ common in anaphylaxis shock

least

Food-Dependent exericse-induced anaphylaxis

- Usually associated with physical activity

- Reaction within 15-30 minutes of initiating activity

Pharmacological intervention for anaphylactic reaction

Epinephrine

What should be practiced when evaluating anaphylaxis reactions

ABCDE's

- Airway

- Breathing

- Circulation

- Disability

- Exposure

Sudden deaths in NCAA is most common in

mens basketball

Direct fatality

caused by participation in fundamental skill

Indirect fatality

caused by the body system failure as a result of exertion (cardiac failure)

Indirect fatalities is almost ________ as large as the number of direct fatalities in high school fall sports

twice

How to be prepared for a sudden cardiac emergency?

Develop emergency action plans to specify prevention,recognition, treatment, and return-to-play guidelines for each condition.

Sudden Cardiac Arrest (SCA)

Occurs when the heart suddenly develops abnormal heart rhythm- Structural or electrical heart problem

myocardial infarction

occurs due to the loss or dramatic decrease of blood supply to the heart muscle

Sudden cardiac death refers to the death of an individual during or within _______ hour after exercise dueto a cardiovascular disorder

one

SCD is most prevalent in

basketball and football

Electrical signal turns into ___________ ________________ during SCA

ventricular fibrillation

Survival decreases by 7−10% with each minute during

CPR

Hypertrophic Cardiomyopathy

Thickening of the muscle walls of the lower left chamber and in the wall that separates two lower chambers.

Hypertrophic cardiomyopathy causes

1/3 of sudden cardiac deaths in young athletes in the United States.

What happens with Hypertrophic Cardiomyopathy

Muscle fibers become disorganized.- Disrupted electrical signals

Why is hypertrophic cardiomyopathy so hard to detect?

Screening tests are not useful before high school

Coronary Artery Anomalies

Abnormalities in the blood vessels on the surface of the heart that supply the muscle walls.

• Abnormalities can shut off the blood flow to the muscle walls of the heart.

- Changes electrical signals

- SCA

Myocarditis

Non-communicable viral inflammation in the heart muscle.

• Can occur with no prior heart problem.

• Inflammation and scar tissue formation.

- Changes electrical signals

- SCA

• Enlargement of the heart

.- Dilated chamber

Aortic Rupture/ Marfan Syndrome

Marfan syndrome is an inherited problem with connective tissue.

- First part of aorta becomes dilated and weak.- Risk of aortic rupture

Commotio Cordis

Cardiac concussion.

• Occurs as a result of blunt trauma.

- Changes electrical signals

- SCA

Commotio cordis is most common in

adolescent boys (14)

Commotio cordis is most common in sport related being

75% of cases

Mechanism of commotio cordis

Small projectile with a dense core that tends to be propelled at a high velocity

- Baseball, lacrosse, hockey

• Impact over the left side of the heart

• Half of reported victims collapsed instantaneously