CH 28-35

perfusion

perfusion

the supply of oxygen to and removal of wastes from the body’s cells and tissues as a result of the flow of blood through the capillaries

hypoperfusion

the body’s inability to adequately circulate blood to the body’s cells to supply them with oxygen and nutrients

shock

the body’s inability to circulate blood adequately to the body’s cells to supply them with oxygen and nutrients, life threatening condition

4 problems that can cause shock

volume loss, pump failure, loss of blood vessel tone, obstruction of blood flow

hypovolemic shock

shock resulting from blood or fluid loss; respond with bleeding control and rapid transport

hemorrhagic shock

shock resulting from blood loss

arterial bleeding

bleeding from an artery, characterized by bright red blood that is rapid, profuse, and difficult to control

capillary bleeding

bleeding from capillaries, characterized by a slow, oozing flow of blood

cardiogenic shock

shock, or lack of perfusion, brought on not by blood loss but by the heart’s inadequate pumping action; often the result of heart attack or congestive heart failure; request ALS

compensated shock

patient is developing shock but the body is still able to maintain perfusion

decompensated shock

body can no longer compensate for low blood volume or lack of perfusion, late signs of shock become evident (e.g. decreasing blood pressure)

distributive shock

hypoperfusion due to a lack of blood vessel tone, blood vessel dilation leads to decreased pressure within the circulatory system

hemorrhage

bleeding, especially severe bleeding

hemostatic agents

substances applied as powders, dressings, gauze, or bandages, to open wounds to stop bleeding

neurogenic shock

hypoperfusion caused by a spinal cord injury that results in systemic vasodilation

obstructive shock

describes the different conditions that block the flow of blood and cause hypoperfusion

pressure dressing

bulky dressing held in position with a tightly wrapped bandage, applies pressure to help control bleeding

tourniquet

device used for bleeding control that constricts all blood flow to and from an extremity

venous bleeding

bleeding from a vein, characterized by dark red or maroon blood and steady, easier to control flow

anaphylactic shock

severe allergic reaction causes systemic vasodilation and massive drops in blood pressure; administer epinephrine

septic shock

body infection causes systemic inflammatory response, causes blood vessels to dilate and capillary membranes to become permeable; respond by notifying hospital and rapid transport

conditions that can cause obstructive shock

pulmonary embolism, cardiac tamponade, a tension pneumothorax

compensation

steps the body takes to make up for hypoperfusion; regulation of volume, vasoconstriction, cardiopulmonary response

regulation of volume (compensation)

body takes immediate steps to regulate volume in the circulatory system, kidneys retain fluid

vasoconstriction (compensation)

narrowing of blood vessel diameter activated by epinephrine or norepinephrine, results in pale skin and delayed capillary refill time

cardiopulmonary response (compensation)

heart beats faster and harder, increased respiratory rate

assessing for shock (general)

can be difficult (especially in pediatric patients), look for compensatory signs (decreasing blood pressure, tachycardia, tachypnea, mental status changes) and early signs of shock (anxiety, restlessness, pale skin), scan for massive hemorrhage and mental status, assume shock is present if any signs are present

indicators of decompensated shock

drop in blood pressure, severe mental status changes, bradycardia, irregular and slow respiratory patterns, muscle relaxation

irreversible shock

organ-system damage and death over time caused by shock (dysrhythmias, apnea, cardiac arrest), even if patient survives irreversible damage has been done

Airway and Breathing in assessing for shock

look for voice changes, wheezing and absent lung sounds on one side - keep airway open, low pulse and oximetry and hypoxia should be treated aggressively with supplemental oxygen, any patient with unexplained fast respiratory rate should be assumed to be in shock

Circulation in assessing for shock

look for pale skin, slow capillary refill time (may be inaccurate in adults), changes in heart rate (fast for compensation and slow for decompensation), narrowing of difference between systolic and diastolic blood pressure

signs of shock

altered mental status, pale cool and clammy skin, nausea and vomiting, vital sign changes, cyanosis around the lips and nail beds

deadly triad of trauma (conditions that contribute to mortality)

acidosis, hypothermia, coagulopathy

steps to treat shock

initiate transport to appropriate destination, prevent hypoxia, prevent heat loss, consider shock positioning (supine position), control bleeding, consider advanced life support

precautions with external hemorrhage

wear gloves, wear mask and protective eyewear if there’s a chance of splattered blood, wash hands after

assessing for massive external bleeding

will be easy to notice, look at the junctional areas, “feeling for the wet spots” on clothes, massive bleeding must be controlled immediately before proceeding through assessment, watch for signs of shock

controlling and caring for external bleeding

if bleeding is not massive treat airway and breathing steps first; in the case of massive bleeding apply direct pressure, hemostatic agents, wound packing, tourniquet, specialized compression devices for junctional bleeding (in order when appropriate)

direct pressure for bleeding control

apply firm pressure with the palm (don’t wait for a dressing in severe cases), hold until bleeding is controlled, don’t add layers, pressure dressing once controlled

wound packing for bleeding control

used when there is a cavity in the wound, only for extremities and junctional areas (not chest or abdomen), begin with direct pressure, fill void with hemostatic or traditional gauze and resume direct pressure

abrasion

scratch or scrape

amputation

surgical removal or traumatic severing of a body part, usually an extremity

avulsion

tearing away or tearing off of a piece or flap of skin or other soft tissue; also used for an eye or tooth pulled/dislodged from its socket

bandage

any material used to hold a dressing in place

closed wound

internal injury with no open pathway from the outside

contusion

bruise

crush injury

injury caused by force transmitted from the body’s exterior to its internal structures; bones break, muscles, nerves, and tissues are damaged causing internal bleeding, internal organs may be ruptured causing internal bleeding and food or urine to spread into abdominal cavities

dermis

inner (second) layer of the skin found beneath the epidermis, rich in blood vessels and nerves

dressing

material (preferably sterile) used to cover a wound that will help control bleeding and prevent additional contamination

epidermis

outer layer of the skin

full thickness burn

AKA third degree burn; burn in which all the layers of the skin are damaged, usually has areas that are charred black or dry and white

hematoma

swelling caused by the collection of blood under the skin or in damaged tissues as a result of an injured or broken blood vessel

laceration

a cut

occlusive dressing

any dressing that forms an airtight seal

open wound

injury in which the skin is interrupted, exposing the tissue beneath

partial thickness burn

AKA second degree burn; burn in which the epidermis is burned through and the dermis is damaged, causes reddening, blistering, and mottled appearance

puncture wound

open wound that tears through the skin and destroys underlying tissues; penetrating puncture wound can be shallow or deep; perforating puncture would has both an entrance and exit wound

rule of nines

method for estimating the extent of a burn; in adults, each are represents 9% of body surface: head and neck, each upper extremity, chest, abdomen, upper back, lower back and buttocks, front of each lower extremity, back of each lower extremity, genitals are 1%; in infants or children, 18% is to the head and 14% to each lower extremity

rule of palm

method for estimating the extent of a burn; the palm and fingers of the patients own hand (equal to 1% of body surface) are compared to the burn to estimate its size

superficial burn

AKA first degree burn; burn that involves only the epidermis, characterized by reddening of the skin and some swelling

universal dressing

a bulky dressing

evisceration

an intestine or other internal organ protruding through a wound in the abdomen

flail chest

fracture of two or more adjacent ribs in two or more places that allows for free movement of the fractured segment

paradoxical motion

movement of ribs in a flail segment that is opposite to the direction of movement of the rest of the chest cavity

pneumothorax

air in the chest cavity

sucking chest wound

open chest wound in which air is “sucked” into the chest cavity

tension pneumothorax

type of pneumothorax in which air that enters the chest cavity is prevented from escaping

angulated fracture

fracture in which the broken bone segments are at an angle to each other

bones

hard but flexible living structures that provide support for the body and protection to vital organs

cartilage

tough tissue that covers the joint ends of bones and helps to form certain body parts (e.g. ear)

closed extremity injury

injury to an extremity with no associated opening in the skin

comminuted fracture

fracture in which the bone is broken in several places

compartment syndrome

injury caused when tissues such as blood vessels and nerves are constricted within a space, as from swelling or from a tight dressing or cast

crepitus

grating sensation or sound made when fractured bone ends rub together

dislocation

disruption or “coming apart” of a joint

extremities

portions of the skeleton that include the clavicles, scapulae, arms, wrists, and hands (upper extremities) and the pelvis, thighs, legs, ankles, and feet (lower extremities)

fracture

any break in a bone

greenstick fracture

an incomplete fracture

joints

places where bones articulate or meet

ligaments

tissues that connect bone to bone

manual traction

AKA tension; process of applying tension to straighten and realign a fractured limb before splinting

muscles

tissues or fibers that cause movement of body parts and organs

open extremity injury

extremity injury in which the skin has been broken or torn through from the inside by an injured bone, or from the outside by something that has caused a penetrating wound with associated injury to the bone

sprain

stretching and tearing of ligaments

strain

muscle injury resulting from overstretching or overexertion of the muscle

tendons

tissues that connect muscle to bone

traction splint

splint that applies constant pull along the length of a lower extremity to help stabilize the fractured bone and to reduce muscle spasm in the limb, primarily used on femoral shaft fractures

air embolism

bubble of air in the bloodstream

ataxic respirations

pattern of irregular and unpredictable breathing commonly caused by a brain injury

autonomic nervous system

controls involuntary functions

central nervous system

brain and spinal cord

central neurogenic hyperventilation

pattern of rapid and deep breathing caused by injury to the brain

cerebrospinal fluid (CSF)

fluid that surrounds the brain and spinal cord

Cheyne-Stokes breathing

distinct pattern of breathing characterized by quickening and deepening respirations followed by a period of apnea

concussion

mild closed head injury without detectable damage to the brain, complete recovery is usually expected but effects may linger for weeks to years

contusion (brain injuries)

a bruised brain caused when the force of a blow to the head is great enough to rupture blood vessels

cranium

bony structure making up the forehead, top, back, and upper sides of the skull

dermatome

area of the skin that is innervated by a single spinal nerve

foramen magnum

opening at the base of the skull through which the spinal cord passes from the brain

hematoma (head injuries)

collection of blood within the skull or brain

herniation (brain)

pushing of a portion of the brain downward from the foramen magnum as a result of intracranial pressure