Adult Health Exam 1

D

Stands for disability

Neurologic status, LOC, GCS, pupils.

E

Stands for exposure

Remove clothing to assess; prevent hypothermia; maintain privacy. Do NOT remove impaled objects

F

Stands for full vitals/family

BP, HR, RR, SpO₂, temperature; BP in both arms when indicated; family may be present during resuscitation

G

stands for get monitors/give comfort

LMNOP: Labs, ECG monitor, NG/OG tube, oxygenation/ventilation, pain

hemorrhage

what overides ABCs

MIST

secondary survey

Mechanism of injury • Injuries sustained • Signs/Symptoms before arrival • Treatment before arrival

SAMPLE

Patient history

Symptoms • Allergies + tetanus • Medications • Past history • Last meal/oral intake • Events/Environmental factors

15

glasgow coma scale perfect score

3

glasgow coma scale lowest score

pulseness vtach and vfib

two shockable rhythmns

Targeted temperature management

A medical treatment aimed at maintaining a specific body temperature, usually cold, 24hrs after a cardiac arrest or other critical condition to improve neurological outcomes.

AKA therapeutic hypothermia

goal core temp: 89.6-96.8 F

patients require intubation and mechanical ventilation

return of spontaneous circulation

ROSC

7.35 – 7.45

Normal pH range

35 – 45

Normal PaCO₂ range

80 – 100

Normal PaO₂ range

21-28

Normal HCO₃⁻ range

ROME

Respiratory Opposite (PaCO₂ and pH move in opposite directions) / Metabolic Equal (HCO₃⁻ and pH move in the same direction)

uncompensated

pH is abnormal, one respiratory or metabolic system is abnormal, and the other system is completely normal

partially compensated

pH is still abnormal, but the opposite system has moved outside its normal range to try to correct the pH imbalance

Fully Compensated

pH has returned to the normal range (7.35–7.45), while both PaCO₂ and HCO₃⁻ remain abnormal

Respiratory Acidosis

Caused by hypoventilation leading to CO₂ retention. Key causes include respiratory failure. Compensated by the kidneys conserving HCO₃⁻ and excreting H

Respiratory Alkalosis

Caused by hyperventilation leading to excess CO₂ elimination. Associated with hypoxemia from acute pulmonary disorders

Metabolic Acidosis

Loss of bicarbonate or accumulation of acid. Common causes include DKA, lactic acid from shock, severe diarrhea, and kidney disease

Metabolic Alkalosis

Loss of acid or gain of bicarbonate. Common causes include prolonged vomiting or gastric suction. Often associated with hypokalemia and hypocalcemia

reduction

Procedure to restore bone alignment following a fracture or dislocation.

parkland calculation

A formula used to estimate the total fluid requirements for burn patients in the first 24 hours after injury, based on body weight and percentage of body burned.

4ml x body weight x TBSA

parkland formula:

= total crystalloid fluid for first 24 hours

8 hours

½ of the total volume of fluid should be given to burn patients with in the first

16 hours

the remaining half of the total volume of fluid should be given to burn patients with in the remaining

emergency severity index

A five-level triage system that uses illness severity and predicted resource use to determine who should be treated first

traction

A pulling force applied to an injured extremity to reduce pain/muscle spasms, immobilize a joint, reduce a fracture/dislocation, or treat a pathologic joint

tetanus, diptheria, bone penetrating antibiotics

drugs commonly given to someone with an open fracture

perforating

Object passes completely through, creating both entry and exit wounds

third spacing

Shift of fluid from the intravascular space into a nonfunctional space, leading to decreased circulating blood volume.This can occur in conditions such as burns, trauma, or infections, causing edema and possibly hypovolemia.

heat cramps

Severe, brief muscle spasms after heavy exercise. Treat with rest, oral/IV sodium and water replacement, massage, elevation, and 12 hours of rest

heat exhaustion

Fatigue, extreme thirst, hypotension, tachycardia, temp 99.6°–105.8°F, mild confusion, and profuse sweating. Treat with fluids (oral/IV) and evaporative cooling (moist sheet over patient) SWEATING

heat stroke

Failure of hypothalamic thermoregulation leading to a cessation of sweating (sweat glands stop working). It is a medical emergency that can cause cerebral edema, hemorrhage, and death NO SWEATING

Heatstroke Interventions

ABCs + Rapid cooling (cold-water immersion is most effective), groin/axilla ice packs, control shivering (which raises core temperature), and monitor for rhabdomyolysis (urine color/amount/pH/myoglobin)

Superficial Frostbite

Skin/subcutaneous tissue feels frozen/crunchy, waxy pale yellow/blue/mottled with burning/numbness. Remove constrictive clothing, rewarm in controlled 99°–102°F water (do NOT squeeze/massage/scrub), debride blisters, and apply sterile dressings

deep frostbite

Involves muscle, bone, and tendon; skin is white, hard, and insensitive. Rewarm in 99°–102°F circulating water until flushing occurs distal to the injury; prepare for possible amputation (final necrotic boundaries take ~90 days to determine)

hypothermia

A core body temperature lower than 95°F (35°C)

mild hypothermia

93°F to 95°F (33.9°C to 35°C). Shivering, lethargy, confusion, behavioral changes, and minor heart rate changes

moderate hypothermia

86°F to 93°F (30°C to 33.9°C). Rigidity, bradycardia, bradypnea, Doppler-only BP, acidosis, hypovolemia; shivering stops/disappears at core temps below 86°F

severe hypothermia

< 86°F (< 30°C). Appears dead, absent reflexes, fixed/dilated pupils, profound bradycardia, VF, or PEA. (Must rewarm to at least 86°F/30°C before pronouncing dead).

core, extremities

always rewarm the ___ before ____

snake bite

Monitor ABCs, fluid resuscitation, respiratory support. Consult poison control/venom expert for species-specific antivenom. Measure and mark limb circumference and edema every 30 minutes

human bite

Exceptionally high risk of infection. Staphylococcus aureus (most common), Streptococcus, and hepatitis virus. Infection signs include severe pain, edema, and redness

diabetes insipidus

A condition characterized by excessive thirst and urination due to insufficient production of the hormone ADH, leading to an inability to concentrate urine.

deficient/ineffective ADH

Think: "Dry Inside". Characterized by dehydration, high dilute urine output (2-20 L/day, SG <1.005, urine osmolality <100), hypernatremia (>145), and high serum osmolality (>295)

DI treatment

Fluid replacement (hypotonic saline or D5W) and synthetic ADH replacement via DDAVP (nasal, oral, IV, or SQ)

SIADH

A condition characterized by excessive secretion of antidiuretic hormone (ADH) despite normal or low plasma osmolality, leading to water retention, hyponatremia, and concentrated urine. Patients often present with signs of fluid overload.

Excessive ADH. Think: "Soaked Inside". Characterized by overhydration, scant/concentrated urine output (SG >1.030), weight gain without edema, dilution hyponatremia (<135), and low serum osmolality (<280)

SIADH treatment

Discontinue ADH-stimulating drugs, restrict fluids (800–1000 mL/day), and administer loop diuretics if serum sodium is ≥ 125 mEq/L

3-7

arterial lactate range