NURS 480 Final Full Set

What is critical care?

• When a patient starts trending downward

• Threats to life

What is RRT?

• Rapid response team

What is a Code Team?

• A team that respond to a code

What are medications like in critical care?

• A lot of IV push meds not really seen in normal floors

• More specialized, stronger, and dangerousused to manage unstable patients, often requiring close monitoring and adjustment.

What is an example of equipment seen in critical care?

• A ventilator is an example of equipment used to assist or control breathing in critically ill patients.

What is a hospitalist?

• A physician primarily focused on the care of hospitalized patients, managing their treatment and coordination of care during their hospital stay.

What is an intensivist?

• A physician specializing in critical care medicine, responsible for managing patients in intensive care units and providing advanced care for severe or life-threatening conditions.

What should be the first step when an ER nurse is dealing with a GSW to the face?

• The primary assessment

What is the primary survey?

• ABCDE

• method used in emergency medicine to quickly assess and treat life-threatening conditions by evaluating Airway, Breathing, Circulation, Disability, and Exposure.

What does a secondary assessment look for?

• Mechanism of injury such as blunt force, penetrating injury, Fall, bee sting

What is a chief complaint?

• “I can’t breathe”

What are some techniques to used if a patient’s airway is not open?

• Head tilt-chin lift

• Jaw thrust

When is head tilt-chin lift not used?

• When there is actual or suspected spinal injury

When are C-spine precautions used?

• When there is a spinal injury or suspected spinal injury

• Spinal immobilization precautions

Why are spinal injury under airway?

• If there is damage to the cervical area, any worsening of the condition can cut off breathing

How do you turn a patient on spinal precautions?

• Logroll them

What are potential problems when placing on C-spin precautions?

• Pressure ulcers

  • Hard to manipulate airway

When does the MD clear the patient for removal of C-Collar?

• After viewing CXR 2-view, or CT Scan of head and neck that shows no significant injury to the neck

What are other ways of keeping airway open if head techniques won’t work?

• Oralpharyngeal airway

• Nasalpharyngeal airway

When is OPA used?

• A patient who is unconscious

• Patient without a gag reflex

When is NPA used?

• Conscious patient

• Gag reflex

When is an NPA contraindicated?

• If the patient has a or suspected skull fracture

What drug can open an airway?

• Epinephrine

Why is epinephrine used for asthma and anaphylaxis?

• Bronchodilates the airway

• Both are an airway problem

• The body vasodilates (arteries open up) which drops blood pressure

What is the concentration for epinephrine to treat anaphylaxis?

• IM 0.5 mg of 1:1000 concentration

What is flail chest?

• 2 or more consecutive rib fracture in 2 or more places producing free floating unstable segment

What is a priority for flail chest?

• Patient will begin to hypoventilate (shallow breaths)

• Manage pain which is one of the few times it is a priority

What is paradoxical breathing?

• You can visually see stomach and chest move in opposite directions during breathing

What is crepitus?

• Grating, crackling sound

What is crepitus caused by?

• Ends of broken bones rubbing against each other, creating a crackling, popping, grating sound

What secondary problem can broken ribs during flail chest cause?

• Sharp ends may puncture lung, creating pneumothorax (air enters pleural cavity)W

What are S/S of pneumothorax?

• Dyspnea, decreased breath sounds on affected side, tachycardia, hypotension, hyperresonance

What should an RN do is pneumothorax is suspected?

• Order stat CXR

• Prep for Chest Tube or Needle Decompression

What is an indication if pneumothorax is seen on a CXR?

• Chest tube insertion

What is tension pneumothorax?

• Medical emergency, life threatening

• not only is air around the lung, but the air is increasing, increasing pressure, pushing stuff from the affected side to the unaffected side

• This adds pressure on the heart, aorta, and other lung

What S/S of tension pneumothorax?

• Tracheal deviation away from affected side (mediastinal shift), tachycardia, hyperresonant, JVD, hypotension, hypoxia

What is treatment for tension pneumothorax?

• Chest tube or needle decompression (Thoracotomy)

What should be done if a sucking chest wound is the cause of tension pneumothorax?

• Place occlusive dressing taped down on 3 sides

What is it called when a wound is sucking in air?

• Sucking chest wound

What is hemothorax?

• Small amount of blood (300 ml) in the pleural space

What is Circulation?

• Assess pulses - 6 Ps

What are the 6 Ps?

• Pain

• Position

• Pulse

• Pallor

• Paresthesia

• Paralysis

What should be inserted if circulation problems are suspected?

• 2 large bore (18 gauge or larger [smaller number])

What type of fluids should be given for circulation problems?

• Isotonic solutions

What is the universal donor?

• O negative

What is the universal recipient?

• AB positive

What kind of pulse indicates weak circulation?

• Weak thready pulse

What is the preferred fluid for trauma?

• Lactated Ringer

Why is D5W not given during circulation problems?

• The sugar is rapidly burned off and leaves water, which is hypotonic

What is cardiac contusion?

• Blunt trauma to the heart

What is a common cause of cardiac contusion?

• Auto accidents

Why is cardiac contusion dangerous?

• Creates arrhythmias or dysrrhytmias which messes up the hearts electrical

What is commotio cordis?

• When the heart is hit at the exact moment that it stops beating

What equipment should be obtained immediately during commotio cordis?

• EKG or AED

What is cardiac tamponade?

• Fluid builds up in sac surrounding heart and strangling it

What are S\S of cardiac tamponade?

• Beck’s Triad

• Chest pain

• SOB

• ST elevation in all leads

What is treatment for cardiac tamponade

• Pericardiocentisis

• A needle is poked into sac and fluid is drained

What is Beck’s Triad?

• Hypotension

• JVD

• Muffled heart sounds

What is disability?

• Assessing level of consciousness

What is AVPU?

• Alert

• Verbal

• Pain

• Unresponsive

  • Gets worse as you go down the acronym

What is GLASGOW Coma scale?

• Assess eyes, verbal, and motor

What is maximum score of GCS?

• 15

What is the lowest GSC score?

• 3

What can’t those with ALOC protect?

• Airway

What should not be given to ALOC patients?

• Anything PO (by mouth)

What emergency equipment should be at hand for ALOC patients?

• Suction

How should ALOC patients be positioned?

• Left lateral recumbant

If a patient is ETOH, what should you anticipate to administer?

• Banana bag/thiamine B1

What should you check to an unconscious ALOC patient?

• Accucheck

What should be given for opioid overdose?

• Naloxone

What should be given for benzodizepine overdose?

• Flumazenil

What does a coma cocktail consist of?

• DONT forget the cocktail

• Dextose - 1 AMP D50W IVP

• Oxygen - Per NC

• Naloxone - 2 mg IVP

• Thiamine - 100 mg IV

• Flumazenil - 0.2 mg IV

What should be done during exposure?

• Cut off clothes

• Rolle to examine their back

• Keep ‘em warm

What is the secondary assessment for Exposure?

• SAMPLET

• S/S

• Allergies

• Medications

• Past Med history

• Last meal

• Events surrounding injury

• Tetanus shot

What kind of trauma should you classify for during head to toe assessment?

• Blunt or penetrating

If there is a basal skull fracture, what should not be done?

• No NG tube

• Do not blow nose

What is anisocoria?

• Unequal pupils

What is Battle’s sign?

• Bruising behind ear

What is Raccoon sign?

• Black eyes

What is Halo sign?

• Drainage coming out of ear where you can see red outline by pink

• indicates basal skull fracture because the pink stuff is CSF

What is hemotympanum?

• Blood in middle of ear cavity

What is subconjunctival hemorrhage?

• Blood trapped in eye

What is otorrhea?

• Drainage from ear

What is Rhinorrhea

• Drainage from nose

What should you check for neuro problems?

• PERRLA

What are Basal skull fracture S/S?

• Pupil changes

• Dizziness/vertigo

• N/V

• Seizures

Where are pupil changes located in relation to brain lesion?

• Ipsalateral (same side)

Fixed and dilated pupils indicates pressure on which CN?

• CN III which is a sign of herniation

What does it mean if both pupils are dilated?

• Herniation

What is fat embolism

• Blood clot from marrow in fracture

What are S/S of fat embolism?

• Sudden chest pain

• Sudden shortness of breath

What is the most common cause of fat embolism?

• DVT/blood clot

Difference from pulmonary embolism and heart attack?

• Pulmonary embolism will cough up blood

Difference between fat embolism and pulmonary embolism?

• Petechiae if chest and upper arms

• Decreased calcium level

When should X-rays be done during trauma diagnostic tests?

• ALWAYS after intubation, chest tube insertion, NG tube placement, Central line insertion

What is pneumothorax?

• Collection of air in the pleural space

What is tension pneumothorax?

• Crazier version of pneumothorax in which the air build up forces a mediastinal shift that puts pressure on heart, decreasing venous return

What is hemothorax?

• Collection of blood in the pleural space

What is chylothorax?

• Collection of lymph fluid in the pleural space

What is Empynema?

• Collection of pus in the pleural space