NREMTP Review-Pedro 🚑 "Trauma & Shock"
Next Session-Airway/Ventilation
ETCO2
COPD
Pneumonia
Asthma
CPAP/BiPap
Tidal volume
Minute volume
V/Q match and mismatch
Trauma Triad of Death
Hypothermia-High Priority!!!!!
Acidosis (Shock)
Coagulopathy
Shock
A rapid degeneration of the body's vital systems/organs, due to an INSUFFICIENT amount of oxygenated blood to the organs and tissues
Hypoperfusion=Low amount of oxygenated blood to the organs/tissues-Shock
Perfusion="To push through oxygenated blood to the organs and tissues
ischemia=lack of oxygen
The biproduct of hypoperfusion/ischemia is Lactic ACID!!!!!
Hypovolemic Shock-"A FLUID Problem
Bleeding-Hemorrhagic Shock
Vomiting
Diarrhea
Sweating
Burns
Urination
Elderly-Poor oral intake
Cardiogenic Shock-"A PUMP Problem"
M.I-Myocardial Infarction-Most common cause
Heart Failure (CHF)-Ventricular failure=Heart Failure=CHF
Dysrhythmias (Blocks, V-tach, V-fib)
Cardiac Arrest
Distributive Shock-"A VESSEL Problem"
The blood vessels become damaged, start to leak (Permeable), massive vasodilation
Septic shock-systemic infection
Anaphylactic shock
Neurogenic Shock-spinal cord injury above T6
Obstructive Shock-"Treat underlying Cause-Something is obstructing or preventing the heart from adequately pumping
Tension PTX
Pulmonary Embolism
Cardiac Tamponade (Pericardial Tamponade)-"Tampon-to press upon
Thrombus/Thrombosis
A static blood clot, does not move
Embolus/Embolism
A blood clot that moves or travels in the body
Blood Clot
Air bubble
Platelets/RBCs sticking together
Piece of fat/Plaque
Infarction-muscle death
Example
62 M pt. c/o CP, dizziness, N/V, and has pale. cool, skins, 12 lead shows ST elevation in leads V1 & V2. Lungs are clear, bilateral. VS as follows-BP-82/40, HR-116, RR-28, Spo2-91% RA. Which of the following is the most appropriate treatment?
A. Administer 250-500 ml of NS
B. NTG 0.4 mg SL
C. Dopamine infusion at 5 mcg/kg
D. Moderate flow oxygen w/ a venturi mask
!!!!!Treat the patient and the Patho, not the numbers & the monitor!!!
Baroreceptors......Baro=Pressure
Receptors found in the aorta and carotids, that detect changes in pressure within the body
120/72---88/42-The baroreceptors will detect this change. and signal the brain
Chemoreceptors......Chemo=Chemical
Receptors in the body that detect changes in chemicals (O2 & CO2)
If the organs are not getting enough oxygen, respiratory distress
Stages of Shock
Compensated Shock
Tachycardia
Normal or slightly elevated BP***
Tachypnea
Anxiety/Agitation/Restlessness=1st s/sx of hypoxia
Pale/cool/clammy (Shunting)
Oliguria-decreased urine output
Decompensated Stage
Hypotension****
Tachycardia
Tachypnea
ALOC/AMS
Anaerobic metabolism (Aerobic-with oxygen/Anaerobic-w/o oxygen
Narrowed pulse pressure
MAP less than 65
Metabolic Acidosis
Aerobic-in the presence of oxygen
Anaerobic-without oxygen, lack of oxygen present
Irreversible Stage ☠️
Bradycardia
Bradypnea
Profound hypotension (60-70s)
Comatose
MODS-multi-organ dysfunction syndrome-2 or more organs have failed
Ashen/Mottled skin
Death
Neurogenic Shock
SCI above the level of T-6
Are unable to compensate
Bradycardia
Hypotensive
Warm/Dry skins
Pulse Pressure
The difference between SBP & DBP
Normal P.P-30-50.......120/80=40
Widened P.P->50......210/100=110 (ICP, Head Injuries, HTN crisis)
Narrowed P.P-<30....80/60=20.... (Shock, Cardiac Tamponade)
Shock Index
Assessment tool to determine the severity of shock
Mild shock-0.6-1.0 (Compensated)
Moderate Shock-1.0-1.4 (Decompensated)
Severe Shock->1.4 (Getting closer to irreversible)
Example
52 M was shot in the abdomen and has signs of internal bleeding. VS as follows-BP-72/40, HR-118, RR-28, Spo2-90%. What is this pts shock index? What shock index is most concerning? What level of shock is your pt. in?
Shock index=118/72=1.6 severe shock
MAP-Mean Arterial Pressure
>65-The organs are being perfused
120/80
1. 120 + 80=200
2. 200 x 2=400
When do we give IV fluids?
Hypotension due to volume loss
DKA-glucose is a dehydrating agent
Dry skins or Dry mucus membranes
Vomiting
Diarrhea
Heat related Sweating
Insensible Water loss-every time we exhale or cough, we are losing water via vapor=dehydration
Asthma, Bronchitis
Fever or infection
Collapsed Lungs
Pneumothorax
Tension Pneumothorax
Hemothorax
Open Pneumothorax=Sucking Chest Wound
Pneumothorax (Closed or Simple)
Caused by blunt trauma, the lung collapses, air escapes from the lung, and accumulates in the pleural space
Chest pain
Absent or diminished L.S
SOB
Dyspnea
Low spo2
Tachycardia
Tachypnea
Tension PTX
JVD
Tracheal Shift
Hypotension
Subcutaneous Emphysema
Hemothorax
Hypo resonant
Flattened neck veins
Onset of hypovolemic shock
Priorities
Primary Exam
Safety
Treat any immediate threats-Active bleeding
Airway (Open/Patent)-stridor, gurgling, snoring, vomit, blood, broken teeth, debris, choking, swelling, Dentures
Breathing
Circulation
Disability (Neuro)
Increased ICP
TBI/Brain bleeds
Meningitis/Encephalitis
Brain swelling/tumor
Do NOT HYPERVENTILATE!!!!!!!
keep ETCO2 levels at the low end-35-40
Elevate the HOB >30 degrees
keep patient cool, monitor for spikes in temp
Secure the airway-Intubate
Watch for seizures
Mannitol (osmotic diuretic)-pulls edema/fluid/blood out of the brain tissue, and allows the kidneys to get rid of it