Download Medical Emergencies: Frostbite, Hypothermia, Chest Injuries, and Collapsed Lungs and more Exams Nursing in PDF only on Docsity!
MDC4 Final EXAM
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Parkland Formula a) 4ml x % BSA x weight (kg)= volume of fluid that needs to be infused b) ½ of the total volume of fluid in first 8 hours c) Last half in 16 hours MAP Calculation a) MAP= 1/3 * SBP + 2/3 * DBP Treatment for frostbite a) Rewarming the skin a. Rewarm the area using a warm-water bath for 15 to 30 minutes b. Skin may turn soft and look red or purple c. You may be encouraged to gently move the affected area as it rewarms. b) Oral pain medicine
a. The rewarming process can be painful c) Protecting the injury a. Once the skin thaws, loosely wrap the area with sterile sheets, towels, or dressing to protect the skin. b. May have to protect fingers and toes as they thaw by gently separating them from each other c. You may need to elevate the affected area to reduce swelling d) Debridement (removal of damaged tissue) a. To heal properly, frostbitten skin needs to be free of damaged, dead or infected tissue. e) Whirlpool therapy or physical therapy a. Hydrotherapy can aid healing by keeping skin clean and naturally removing dead tissue b. Pt may be encouraged to move the affected area f) Antibiotics a. If the skin or blisters appear to be infected, the doctor may prescribe oral antibiotics g) TPA a. IV injection of a drug that helps restore blood flow (thrombolytic) such as TPA. b. TPA lowers the risk of amputation
Treatment and differences of heat stroke and heat exhaustion a) Heat exhaustion a. Symptoms i. General weakness, increased heavy sweating, a weak but faster HR, N/V, possible fainting, pale/cold/clammy skin b. Treatment i. Stop physical activity, transfer to cool space ii. Cooling measures (ice water bath, mist skin with water, ice packs, special cooling blanket) iii. Rehydration therapy b) Heat stroke a. Symptoms i. Elevated body temperature above 103 F (39.4 C), rapid and strong HR, loss or change of consciousness, hot, red, dry, or moist skin b. Treatment i. Oxygen therapy, IV lines, urinary catheter, continuous cooling (Ice bath, mist skin with water, ice packs, special cooling blanket), benzodiazepine if shivering occurs, monitor for multi
system organ dysfunction syndrome and electrolyte imbalances. Priority assessment in triage a) ABC’s Temperature reduction strategies a) Ice bath, mist skin with water, ice packs, special cooling blanket Skin injury related to frostbite a) Frostbite occurs in several stages: a. Frostnip i. Mild form of frostbite- does not permanently damage the skin ii. Continued exposure leads to numbness in the affected area iii. As the skin warms, the patient may feel pain and tingling. b. Superficial Frostbite i. Appears as reddened skin that turns white or pale ii. The skin may begin to feel warm- a sign of serious skin involvement iii. If you treat frostbite with rewarming at
iii. Large blisters form 24-48 hours after rewarming. Afterwards, the area turns black and hard as the tissue dies. Rationale for arrythmias in hypothermia a) The risk of cardiac arrest increases as the core temperature drops below 32°C, and increases substantially if the temperature reaches less than 28°C (Brown et al. 2012). At this level, a severe depression of critical body functions occurs Blunt chest injury assessment a) Primary assessment treatments a. Based on the mechanism of injury, consider manual stabilization of the cervical spine until a more complete spinal exam can be accomplished. Establish and maintain a patent airway while determining the patient's level of consciousness using the AVPU scale. If the patient is not fully awake or alert, manual airway positioning and basic airway adjuncts such as an OPA or NPA may be needed. Suctioning an airway filled with blood or emesis may be necessary. b) Seal chest wounds a. Any open chest wound should be sealed as
soon as it is found, using the palm of a gloved hand at first, followed by an occlusive dressing. c) Relieve tension pneumothorax a. Tachypnea, hypopnea (shallow breathing) and accessory muscle use are key indicators of respiratory distress or failure. Expose the chest and auscultate lung fields immediately. Diminished sounds over one side may indicate a loss of lung capacity, either from a hemothorax, pneumothorax or both. b. Inspect the neck and chest area. Jugular venous distension may indicate greater than normal pressure within the chest cavity, possibly related to a developing tension pneumothorax. Hyperinflation of the chest over one side is another sign related to a tension pneumothorax. If the patient's mental status worsens and blood pressure falls, a decompression of the tension pneumothorax using a long, large gauge angiocatheter is needed to relieve the excessive pressure in the chest. d) Control hemorrhage a. Control any major external bleeding immediately with direct pressure. It will be
Addressing ventilator alarms a) Should never be turned off or ignored during mechanical ventilation b) The major alarms on the ventilator indicate either a high pressure or low exhaled volume c) If the alarm cannot be determined, ventilate the patient manually with a resuscitation bag until the problem is corrected by another health care professional Fractured ribs and flail chest a) Rib fracture a. Important info i. The most common cause is blunt trauma from a fall or car accident. Trauma can increase your risk for organ damage when your rib is fractured. ii. Older age, osteoporosis, or a tumor can increase your risk for rib fractures. iii. A stress fracture can happen in your upper or middle ribs. Stress fractures can happen when you have a forceful long- term cough. They can also be caused by forceful athletic movements, such as in golf, throwing, or rowing. iv. A condition called flail chest occurs if 3
or more of your ribs are broken in 2 or more places. This condition may make it hard for you to breathe. b. Signs and symptoms i. Chest wall pain that worsens when you breathe, move, or cough ii. Bruising or swelling near your injury iii. Shortness of breath or difficulty taking a deep breath c. Treatment i. Medications
- NSAIDs , such as ibuprofen, help decrease swelling, pain, and fever.
- Prescription pain medicine may be given.
- Intercostal nerve block may be given to numb the injured area for about 6 hours. It is given as a shot between 2 of your ribs in the fractured area. You may need this if your pain continues or is getting worse even after you take oral pain medicines. ii. Surgery may be needed if your rib fracture is severe or several ribs are badly broken. Surgery is often needed for a flail chest. d. Management of symptoms
b) Flail chest Cover it with a towel. Ice helps prevent tissue damage and decreases swelling and pain. a. an injury that occurs typically following a blunt trauma to the chest. When three or more ribs in a row have multiple fractures within each rib, it can cause a part of your chest wall to become separated and out of sync from the rest of your chest wall. b. The chest moving unevenly between the separated part and rest of the chest is often the most definitive sign that you have a flail chest. The area of your chest that’s been traumatized will draw in when you breathe in, while the rest of your chest expands outward. When you breathe out, the affected area will expand out while the rest of your chest draws in. c. Treatment i. Your doctors will need to protect your lungs while ensuring that you can breathe adequately. They will give you an oxygen mask to assist your breathing and give you medication to help with your pain. ii. In more serious cases where there is
associated underlying lung injury, you may need to be put on a mechanical ventilator in order to keep your chest cavity stable. It’s possible that surgery will be required, depending on the extent of injury and risks versus benefits of surgery. Chest injury a) Patients may be asymptomatic at first and can later develop various degrees of respiratory failure and possibly pneumonia b) These patients often have decreased breath sounds or crackles and wheezes over the affected area c) Other symptoms include bruising over the injury, dry cough, tachycardia, tachypnea, and dullness to percussion. d) At first the chest x ray may show no abnormalities but a hazy opacity in the lobes or parenchyma may develop over several days e) Management includes maintenance of ventilation and gas exchange Pneumothorax
i. Small air blisters (blebs) can develop on the top of the lungs. These blebs sometimes burst — allowing air to leak into the space that surrounds the lungs. d. Mechanical ventilation. i. A severe type of pneumothorax can occur in people who need mechanical assistance to breathe. The ventilator can create an imbalance of air pressure within the chest. The lung may collapse completely. d) Diagnosis a. chest X-ray. In some cases, a computerized tomography (CT) scan may be needed to provide more-detailed images. Ultrasound imaging also may be used to identify a pneumothorax. e) Treatment a. Observation i. If only a small portion of your lung is collapsed, your doctor may simply monitor your condition with a series of chest X-rays until the excess air is completely absorbed and your lung has re-expanded. This may take several weeks. b. Needle aspiration or chest tube insertion
c. Nonsurgical repair: i. Using a substance to irritate the tissues around the lung so that they'll stick together and seal any leaks. This can be done through the chest tube, but may be done during surgery. ii. Drawing blood from your arm and placing it into the chest tube. The blood creates a fibrinous patch on the lung (autologous blood patch), sealing the air leak. iii. Passing a thin tube (bronchoscope) down your throat and into your lungs to look at your lungs and air passages and place a one-way valve. The valve allows the lung to re-expand and the air leak to heal. d. Surgery: i. Sometimes surgery may be necessary to close the air leak. In most cases, the surgery can be performed through small incisions, using a tiny fiber-optic camera and narrow, long-handled surgical tools. The surgeon will look for the leaking area or ruptured bleb and close it off. ii. Rarely, the surgeon will have to make a larger incision between the ribs to get better access to multiple or larger air
b. Labored and unusually rapid breathing c. Low blood pressure d. Confusion and extreme tiredness c) Treatment a. Oxygen i. Supplemental oxygen. For milder symptoms or as a temporary measure, oxygen may be delivered through a mask that fits tightly over your nose and mouth. ii. Mechanical ventilation. Most people with ARDS will need the help of a machine to breathe. b. Fluids i. Carefully managing the amount of intravenous fluids is crucial. Too much fluid can increase fluid buildup in the lungs. Too little fluid can put a strain on your heart and other organs and lead to shock. c. Medication i. People with ARDS usually are given medication to:
- Prevent and treat infections, Relieve pain and discomfort, Prevent blood clots in the legs and lungs, Minimize gastric reflux, and Sedate
d. pulmonary rehabilitation. i. Many medical centers now offer pulmonary rehabilitation programs, which incorporate exercise training, education and counseling to help you learn how to return to your normal activities and achieve your ideal weight. Pulmonary Embolism a) Overview a. a blockage in one of the pulmonary arteries in your lungs. In most cases, pulmonary embolism is caused by blood clots that travel to the lungs from deep veins in the legs or, rarely, from veins in other parts of the body (deep vein thrombosis). b) Symptoms a. Common signs and symptoms include: i. Shortness of breath. This symptom typically appears suddenly and always gets worse with exertion. ii. Chest pain. You may feel like you're having a heart attack. The pain is often sharp and felt when you breathe in deeply, often stopping you from being able to take a deep breath. It can also be
