Trauma Assessment and Management, Exams of Nursing

Download Trauma Assessment and Management and more Exams Nursing in PDF only on Docsity! TNCC Final Exam Questions and Correct Answers 2024 A 22 yr. old was struck by a vehicle while crossing the street, sustaining multiple fx sheis alert and answering questions and crying what is the best method for initial painassessment for this pt – ANS self-report scale A pt sustained a penetrating injury of his upper leg. The pre hospital personnel states alarge amount of blood loss before hemostasiswas achieved. He presents to the ERresponding to painful stimuli with moaning. He is tachy 142 b/p 104/96 and RR 24 –ANS decompensated An unrestrained driver was involved in a frontal collision without airbag deployment. heis hypotensive and tachycardic with shallow respirations, distended JVD and muffledheart ton s the nurse prepare for what – ANS pericardiocentesis A during assessment of an extremity with suspected pulses are – ANS can be normal A for a ptwho has undergone recent bariatric surgery, flouroscopy is recommended to place - ANSNG tube A identification of vulnerabilities is an example of what phase of disaster management – ANS mitigation A in mass casualty "doing the greatest good for the greatest number of people refers to a situation where – ANS there may be more patients than resources A in neurogenic shock, alterations in vital signs include hypotension and which other abnormal VS – ANS bradycardia A In the primary survey AVPU is performed to determine if the patient can: - ANS Protect their airway A prego trauma pt develops tachy, hypotension, a rigide board like uterus, and dark, redvagin l ble ing. she reports constant back pain which is increasing. the most likelycause of s/s is - ANSplacental abruption A several groups of people are at higher risk for maltreatment including children, elderly, prego, and ... - ANSpt's with disability A the nurse is preparing to cleanse an extensive abrasion contaminated with dirt and gravel. which of the following intervention is indicated - ANSus copious amounts of NS A The systemic inflammatory response is a normal part of the body's response to shockfrom traumatic injury. what best describes this response - ANSit is activated by tissuehypoxia and sends neutrophils to injury site 1 A what is an early assessment finding to increased ICP in pt with a brain injury - ANSvomiting A when providing care for the pedicatric pt with burns the post resuscitation care, how are fluids delivered - ANSparkland formula with maintainence fluidss A which of hte following nursing interventions would be best for traumitc - ANSHOB 30 degrees A which of the following structures would be hte most affected by teh concept of caviation - ANSLiver A which of the following values is within the acceptable limits for trauma pt - ANSend tidal CO2 of 40 B a pt father arrives in teh ER and needs to be told his son was severely injured in a MVC and is in surgery, the father si agitated, yelling, and smells of alcohol. in planningto talk with the father the trauma nurse will - ANSdeliver information regarding the son;scare in a calm voice B a pt involved in an MVC develops asymmetric pupillary reactivity, bilateral pupillaryd ion and abnormal motor posturing. what does the nurse suspect as the most likelycause - ANSherniation syndrome B a pt with injury to the middle meningeal artery is at risk for which of the following - ANSepidural hematoma B an occlusive dressing has been applied to a pt with a penetrating injury to the chest.upon ass sment the nurse notes that the patient is in respiratory distress nad hasabsn t breat sounds on hte affected side. what is the priroruty intervention -ANSremove the dressing to the wound B an unrestrained driver inlvolved in a MVC in which alcohol was involed. he denies anypain and numbness and tinlging. according to NEXUS critera which factors indicateneed for radiological - ANSsuspected alcohol abuse B pt to ER after being pinned to brick retaining wall. knwoing crushing injuries can resultto significant damage to muslces the priority asessment for trauma nruse is for -ANSmyoglobinemia nd renal failure B the most common cause of shock in the trauma pt is - ANSloss of circ volume B the unrestrained fron seat passenger in a MVC develops echymosis aroundumbillicus. this assessment finding is most commonly associated with: - ANSbleeding inthe perito eal cavity 2 A during assessment of an extremety with suspected pulses are - ANScan be normal A for a ptwho has undergone recent bariatric surgery, flouroscopy is recommended toplace - ANSNG tube A identification of vulnerabilities is an example of what phase of disaster management -ANSmitigati on A in mass casualty "doing the greatest good for the greatest number of people refers toa situation where - ANSthere may be more patients than resources A in neurogenic shock, alterations in vital signs include hypotension and which otherabnormal VS - ANSbradycardia A In the primary survey AVPU is performed to determine if the patient can: - ANSProtecttheir aiway A prego trauma pt develops tachy, hypotension, a rigide board like uterus, and dark, redvagin l ble ing. she reports constant back pain which is increasing. the most likelycause of s/s is - ANSplacental abruption A several groups of people are at higher risk for maltreatment including children, elderly,prego, and ... - ANSpt's with disability A the nurse is preparing to cleanse an extensive abrasion contaminated with dirt andgravel. which of the following intervention is indicated - ANSus copious amounts of NS A The systemic inflammatory response is a normal part of the body's response to shockfrom traumatic injury. what best describes this response - ANSit is activated by tissuehypoxia and sends neutrophils to injury site A what is an early assessment finding to increased ICP in pt with a brain injury -ANSvomitin g A when providing care for the pedicatric pt with burns the post resuscitation care, howare flu ds delive d - ANSparkland formula with maintainence fluidss A which of hte following nursing interventions would be best for traumitc - ANSHOB 30 degrees A which of the following structures would be hte most affected by teh concept ofaviation - ANSLiver A which of the following values is within the acceptable limits for trauma pt - ANSendtidal CO2 of 40 5 B a pt father arrives in teh ER and needs to be told his son was severely injured in aMVC and is in surgery, the father si agitated, yelling, and smells of alcohol. in planningto talk with the father the trauma nurse will - ANSdeliver information regarding the son;scare in a calm voice B a pt involved in an MVC develops asymmetric pupillary reactivity, bilateral pupillaryd ion and abnormal motor posturing. what does the nurse suspect as the most likelycause - ANSherniation syndrome B a pt with injury to the middle meningeal artery is at risk for which of the following - ANSepidural hematoma B an occlusive dressing has been applied to a pt with a penetrating injury to the chest.upon ass sment the nurse notes that the patient is in respiratory distress nad hasabsn t breat sounds on hte affected side. what is the priroruty intervention -ANSremove the dressing to the wound B an unrestrained driver inlvolved in a MVC in which alcohol was involed. he denies anypain and numbness and tinlging. according to NEXUS critera which factors indicateneed for radiological - ANSsuspected alcohol abuse B pt to ER after being pinned to brick retaining wall. knwoing crushing injuries can resultto significant damage to muslces the priority asessment for trauma nruse is for -ANSmyoglobinemia nd renal failure B the most common cause of shock in the trauma pt is - ANSloss of circ volume B the unrestrained fron seat passenger in a MVC develops echymosis aroundumbillicus. this assessment finding is most commonly associated with: - ANSbleeding inthe perito eal cavity B thinning skin and diminished autonomic response in older adult can have what effect on primary assessment - ANScompromised thermoregulation B when assessing a pt following a MVC the nurses asks how fsat the car was going - ANSwhen volocity is doubled speed is quadroupled B WHich may lead to unreliable pulse ox reading - ANScarboxyhemoglobin B which of hte following significant assessment findigns is frequently found in a patientwith complete cransiofacial separation involving the maxilla, zygoma, orbits, and bonesof the cranial base. - ANSdiplopia B which of the following hemodynamic support strategies is the prioririty intervention for a pt with traumatic pulmonary contusion - ANSjudicios use of IV fluids 6 Bduring the primary survery which of the following has the greatest priority - ANScervical spine injury C 32 wk pregnant lady arrives in er after trapped in a car that flipped. the initialassessment reveals s/s of shock, vaginal bleeding, a palpable asymmetrical uterus, andslowing fetal heart tones what is the most likely cause - ANSuterine rupture C a college student presents to the er stating afterarriving at a party , she awoke in adorm rom. she didnt recognize with no memory of the previous evening the traumanurse prepare for what exam. - ANSsexual assult C an adult pt involved in a brush fire arrives to the er. upon initial assessment in the erthe most concerning finding is - ANShoarse voice and repeatedly decides to clearthroa t. C an older adult pt fell in the bathtub 3 days ago. now she is exihibiting decreasd LOCand difficulty with speaking and walking. which of the following injuries is most effective- ANSsubdural hematoma C effective pain management in hte pt iwth rib fxwill promote what - ANScough with ability to clear secretions C properly restrained 6 wk old kid was involved in a MVC. after the assessment andstabilization the pt becomes more difficult to rouse. responding with a weak cry topainful stimuli. the pupils remain brisk and reactive. the anterior fontanel is soft and flat.what is the most likely cause and pririty interventions - ANShypoglycemia C What are the primary benefits of a team approach to trauma care - ANSit provides a systemic approach to care and organizes care C what organ might be injured in left lower rib fx - ANSspleen C which of the following would be priority intervention for a pt with multiple rib fracturesand chest wall instability follwoing a mvc collision - ANSassist with endotrachealintubatio n C which of the follwoing is a risk factor for DVT in the trauma pt. - ANSpelvic fx Cthe term worried well when refering to disaster preparedness planning refers to: - ANSindividuals hwo think they have been affected by the event but are asymptomatic Cthe trauma nurse would prepare for a definitive airwya for which of the following condition. - ANSGCS of 8 or ls 7 A passenger is brought to the emergency department of a rural hospital following ahigh-speed MVC. When significant abdominal and pelvic injuries are noted in theprimary survey, which of the following is the priority interventions? A) initiate transfer to a trauma centerB) provide report to the operating room nurseC) Obtained imaging studiesD) Place a gastric tube - ANSA) initiate transfer to a trauma center A patient arrives with a large open chest wound after being assaulted with a machete,Prehospi al providers placed a nonporous dressing over the chest wound and tapes ito 3 sid . He is now showing signs of anxiety, restlessness, severe respiratorydi tress, cyanosis, and decreasing blood pressure. Which of the following is the MOSTappropriate interventions? A) needle decompression B tube thoracostomyC) dressing removalD) surgical repair - ANSC) dressing removal A patient has been in the ED for several hours waiting to be admitted. He sustainedmultipl rib fractures and a femur fracture after a fall. He has been awake, alert, and c/oleg pai . His wife reported suddenly becoming anxious and confused. Uponreassessment, the patient is restless, with respiratory distress and petechiae to hisn ck. the patient is exhibiting signs of symptoms commonly associated with which of thefollowing conditions? A) acute lung injury B fat embolismC) PTXD) pulmonary contusion - ANSB) fat embolism A patient is found lying on the floor after falling 13 hours ago. Which of the following labva ues is expected with a musculoskeletal complication associated with thispresentatio n? A) elevated creatine kinaseB) decreased potassium levelC) decreased WBCD) elevated GFR - ANSA) elevated creatine kinase A patient is thrown against a car during a tornado and presents with obvious bilateralfem ral frac u es. The patient is pale, alert, disoriented, and has delayed cap refill.Which of the following interventions would be most appropriate for this patient based onthe disaster triage principle? 10 A) initiate two large bore intravenous lines for Ringers lactate solution administrationB) Adminis er Dilaudid for pain control and provide comfort careC) Place the patient in an observation area for care within the next few hoursD) Contact the command center for the personnel to notify next of kin. - ANSA) initiatetwo large bore intravenous lines for Ringers lactate solution administration A patient with a complete spinal cord injury in neurogenic shock will demonstrate hypotension and which other clinical signs? A) Bradycardia and ipsilateral absences of motor functionB) Tach i re piratory depressionC) Tachycardia and absent motor function below the level of injuryD) Bradycardia and absent motor function below the level of the injury - ANSD)Brad cardia and absent motor function below the level of the injury A patient with lower extremity fracture complains of severe pain and tightness in his calf,minimally relieved by pain medications. Which of the following is the priority nursinginte ventio n? A) elevating the extremity above the level of the heartB) repositioning and apply iceC) Elevating the extremity to the level of the heartD) Pr paring the patient for ultrasound - ANSC) Elevating the extremity to the level ofheart A trauma patient is en route to a rural ED. Radiology notifies the charge nurse that theCT canner will be out of service for several of hours. The team gathers to planaccordingly. Which of the following terms best describes this trauma teamscom unicatio n? A) Brief) loopC) debriefD) huddle - ANSD) huddle A trauma patient is restless and repeatedly asking "where am I?" vital signs upon arrivalwere BP 100/60 mm Hg, HR 96 beats/min, and RR 24 breaths/min. Her skin is cool anddry. Current vital signs are BP 104/84mm Hg, HR 108, RR 28 breaths/min. The patientis demonstrating signs and symptoms of which stage of shock? A) compensatedB ProgressiveC) irreversibleD) d compensated - ANSA) compensated 11 An elderly patient with a history of anticoagulant use presents after a fall at home thatday. sh denies any loss of consciousness. She has a hematoma to her forehead andc mpl ins of headache, dizziness, and nausea. Which is a most likely cause of hersympt ms? A) epidural hematomaB) diffuse axonal injuryC) post-concussive syndromeD) subdural hematoma - ANSD) subdural hematoma An intubated trauma patient is being transferred to a tertiary care center. After movingthe patient to the stretcher for transport, a drop in pulse oximetry to 85% is noted. Whichof he following is the priority interventions? A) call for a portable CXR statB) chest to make sure the ventilator is plugged inC) suction the ET tubeD) confirm ET tube placement - ANSD) confirm ET tube placement An unresponsive trauma patient has an oropharyngeal airway in place, shallow andlabored respiratory, and dusky skin. the trauma team has administered medications fordrug assisted intubation and attempted intubation but was unsuccessful. What is themos appropriate immediate next step? A) Ventilate with a BVMB Prepare for cricothyroidotomyC) administer reversal medicationsD) contact anesthesia for assistance - ANSA) Ventilate with a BVM Caregivers carry a 2-year old into the ED who fell out of 2nd story window. The patientis awake and crying with increased work of breathing and pale skin. which of thefollowing interventions has the highest priority? A) padding the upper back while stabilizing the cervical spine ***B) applying a tight-fitting NRB mask with an attached reseviorC) stablishing intravenous access and administering a 20mL/kg bolusD) preparing for drug assisted intubation - ANSA) padding the upper back whilestabilizing the cervical spine During the primary survey of an unconscious patient with multi-system trauma, thenurse no es snoring respirations. Which priority nursing interventions should beperformed next? A) open the airway with the head-tilt/chin lift maneuverB) auscultate bilateral breath sounds to assess ventilatory statusC) assist re pirations using a BVM 12 B) respiratory rate and capnographyC) pulse oximetry and respiratory rateD) capnography and capnometry - ANSA) pulse oximetry and capnogaphy What factor contributes most the kinetic energy of a body in motion? A) accelerationB) massC) velocityD) inertia - ANSC) velocity What finding raises suspicion of complete spinal cord injury? A) Weakness in the lower extremitiesB) PriapismC) voluntary anal sphincter toneD) intact reflexes distal to the injury - ANSB) Priapism Which is the effect of hypothermia on the oxyhemoglobin dissociation curve? A) Hemoglobin does not readily release oxygen for use by the tissuesB) The amount of oxygen available to the tissues increasesC) Tissue oxygenation (PaO2) increasesD) Hemoglobin molecule saturation (SaO2) decreases - ANSA) Hemoglobin does notreadily release oxygen for use by the tissues Which of the following assessment findings differentiates a tension pneumothorax from a simple pneumothorax? A) increased work of breathing B) unilaterally diminished breath soundsC) pleuritic chest painD) hypotension that worsens with inspiration - ANSD) hypotension that worsens withinspiration. Assessment findings associated with tension pneumothorax include anxiety, severerestl ssness, severe respiratory distress, and absent breath sounds on the injured side.Hypotension due to compression of the heart and great vessels is consistent withobstructive shock. Hypotension worsens with inspiration due to increased intrathoracicpressure. Late signs include distended neck veins, tracheal deviation, and cyanosis. Which of the following considerations is most important when caring for a geriatric trauma patient?A) h ad to to examB) medical historyC) incontinence 15 D) falls - ANSB) medical history Which of the following injuries is LEAST likely to be promptly identified? A) spleenB) lungC) bowelD) brain - ANSC) bowel Which of the following is a component of the trauma triad of death? A) AcidosisB) hyperthermiaC) hemorrhageD) sepsis - ANSA) Acidosis hypothermia, metabolic acidosis, coagulopathy Which of the following is a late sign of increased intracranial pressure? A) Restlessness or drowsinessB) Naus a and vomitingC) Decreased respiratory effortD) Amnesia and anxiety - ANSC) Decreased respiratory effort Which of the following is an expected finding in a patient with a thoracostomy connectedo a chest drainage system? A) output of 200 mL/hrB) tubing clamp closed for transportC) de endent loops in the tubing to promote drainageD) fluctuations in the water serial chamber - ANSD) fluctuations in the water serialchambe r Which of the following is NOT considered goal-directed therapy of cardiogenic shock? A) controlled fluid bolusesB) antidysrhythmic administrationC) pericardiocentesisD) cardiac cath - ANSC) pericardiocentesis Which of the following is possible complication of positive-pressure ventilation? A) worsening pneumothorax B) worsening flail chest C) reabsorption of pleural air 16 D) negative intrapleural pressure - ANSA) worsening pneumothorax Which of the following is true about the log roll maneuver? A) it causes less spinal motion than the lift and slide maneuverB) it is r commended for patients with unstable pelvic fracturesC) it can worsen cord damage from an unstable spinal injury ***D) it does not increases the risk of life threatening hemorrhage from unstable injuries -ANSC) it can worsen cord damage from an unstable spinal injury Which of the following mnemonics can help the nurse prioritize care for a trauma patientwith massiv uncontrolled hemorrhage? A) ABCB) MARCH C) AVPU D) VIPP - ANSB) MARCH Which of the following occurs during the third impact of a motor vehicle crash? A) The driver of the vehicle collides with the steering wheelB) the vehicl collides with a treeC) the aorta is torn at its attachment with the ligamentum arteriosumD) the airbag deploys and strikes the front seat passenger - ANSC) the aorta is torn atits attachmen with the ligamentum arteriosum Which of the following patients warrants referral to a burn center? A) a 21- year old female with a partial thickness burn to the right forearmB) a 40-year old hypertensive male with a superficial burn to the backC) a 52-year old diabetic male with partial thickness burn to the left lower legD) a 35-year old hyperlipidemic female with superficial burns to the anterior thorax. -ANSC) a 52-year old diabetic male with partial thickness burn to the left lower leg Which of the following values indicates the need for alcohol withdrawal interventions? A) CIWA-Ar of 36 ***B) GCS 13C) ETCo2 of 48 mm HgD) heart rate of 45 beats/min - ANSA) CIWA-Ar of 36 Which pulse pressure description is an indication of early hypovolemic shock? A) widenedB) narrowedC) bounding 17 Circulation and Control of Hemorrhage Assessment - ANSInspect: Uncontrolled external bleeding, skin color Auscultate: Muffled heart sounds - may indicate pericardial tamponade Palpate: carotid and/or femoral pulses for rate, rhythm, strength Circulation and Control of Hemorrhage Interventions - ANSControl and treat externalbl eding: apply direct pressure, elevate bleeding extremity, apply pressure over arterialsit s, consider use of a tourniquet. 2 large bore IVs, if unable consider IO, obtain labs and crossmatch. Initiate IVF of warmed isotonic crystalloid solution. Consider blood products after 2L. **Large volumes of fluid lead to dilution coagulopathy which worsens metabolic acidosisand may c use hypothermia. Component therapy, including administering RBC, plasmaand platelets is a balanced approach so that O2 delivery is optimized, acidosiscorrect and c agulopathy prevented. Classifications of Shock - ANSHypovolemic - decrease in the amount of circulating blood volume Obstructive - obstruction in either the vasculature or heart Cardiogenic - pump failure in the presence of adequate intravascular volume Distributive - maldistribution of an adequate circulating blood volume (septic, anaphylactic, neurogenic) Corneal Abrasion - ANSDamage to the corneal epithelium. Easy to evaluate with fluorescein. Findings: photophobia, tearing, pain, injected conjunctiva (redness), lid swelling, irritation Treatment: Ophthalmic ABX, Cycloplegic agent to decrease spasms and pain,ophth lmic NSAIDS to decrease swelling, oral analgesics, Ophthalmic f/u in 24 hours.(Do NOT patch - increases infection) Corneal Foreign Body - ANSRoutinely metal, plastic or wood. Findings: photophobia, pain, injected conjunctiva (redness), lid swelling 20 Treatment: topical anesthetic, removal of foreign body, ophthalmic ABX, cycloplegics, oral analgesia Corneal Laceration - ANSInvolves one or more layers of the cornea. Visualized with a slit lamp. Findings: similar to abrasion, pain out of proportion to findings, decreased vision Treatment: treat small lacerations similar to an abrasion, larger lacerations need ophthalmology referral and possible surgery Cycloplegic agent - ANSCycloplegia is paralysis of the ciliary muscle of the eye,resulting in a loss of accommodation. Because of the paralysis of the ciliary muscle, thecurvature of the lens can no longer be adjusted to focus on nearby objects. D (Primary Survey) - ANSDisability (Neurologic Status) Disability Assessment - ANSAssess GCS on arrival and repeat per policy. Assess pupils for equality, shape and reactivity (PERRL) Disability interventions - ANSEvaluate for need for CT. Assume AMS to be the result of CNS injury until proven otherwise. Consider ABGs - AMS may be indicator of decreased cerebral perfusion, hypoventilation or acid-base imbalance. Consider bedside glucose. Distributive Shock - ANSOccurs as a result of maldistribution of an adequate circulating volume with a loss of vascular tone or increased permeability. Diffuse vasodilation lowers the systemic pressure, creating a relative hypovolemia orreduction of the mean systemic volume and venous return to the heart or drop inp eload, resulting in distributive shock. Anaphylactic: release of inflammatory mediators, such as histamine, which contracts bronchial smooth muscle and increases vascular permeability and vasodilation. Septic Shock: systemic release of bacterial endotoxins, resulting in an increasedvascular permeability and vasodilation Neurogenic shock: loss of sympathetic nervous system control of vascular tone, whichproduces venous and arterial vasodilation. With the loss of sympathetic nervous systeminput in spinal cord injury, unopposed vagal activity may result in decreased cardiacoutput through bradycardia. 21 TREATMENT: increase systemic resistance, controlled volume replacement. Vasoconstriction and in some cases (neurogenic) Atropine to counteract bradycardia. E (Primary Survey) - ANSExposure and Environmental Control Exposure and Environmental Control - ANSCarefully and completely undress the patient. Inspect for uncontrolled bleeding and note any obvious injuries. Prevent heat loss. Hypothermia combined with hypotension and acidosis is a potentiallylethal combination in the injured patient. Consider: warm blankets, keep ambientt m erature warm, warm IVF, forced air warmers, radiant warming lights. F (Primary Survey) - ANSFull Set of VS & Family Presence G (Primary Survey) - ANSGet Resuscitation Adjuncts:(LMNOP )L: LabsM: Monitor cardiac rate and rhythmN: Naso or orogastric tube considerationO: Oxygenation - SpO2 and/or etCO2 monitorP: Pain assessment and management GCS - ANSGCS EYES 1: Does not open eyes2: Opens eyes in response to pain3: Opens eyes in response to voice4: Opens eyes spontaneously VERBAL1. Makes no sounds2. Makes sounds3. Words4. Confused, disoriented5. O , converses normally MOTOR1. Makes no movements2. Extension to painful stimuli (decerebrate)3. Abnormal flexion to painful stimuli (decorticate)4. Withdr wal to painful stimuli5. Localizes painful stimuli6. Obeys commands 22 Functions: Store and metabolize lipids, transport nutrients, produce glucose andbilirubin, convert ammonia to urea, secrete electrolytes, lipids, lecithin, cholesterol andbile. Metabolizes vitamin K and produces thrombin and fibrinogen (all necessary forclotting). Obstructive Shock - ANSResults from hypo perfusion of the tissue due to an obstruction in either the vasculature or heart. Tension pneumothorax - increased thoracic pressure leads to displacement of the vena cava, obstruction to atrial filling, decreased preload and decreased cardiac output. Cardiac tamponade - impedes diastolic expansion and filling leads to decreasedpreload, strokes volume and cardiac output and ultimately end organ perfusion. P (AVPU) - ANSPainful. Responds only to painful stimuli. (Airway adjunct may be needed while determining need for intubation) Reevaluation - ANSPortable radiograph - AP chest, pelvis. Can quickly identify potentially life-threatening injuries such as pneumothorax or pelvic fracture withun ontrolled internal hemorrhage. Can also confirm placement of ET tubes, chest tubesand gastric tubes. Consider need for transfer. shock - ANSInadequate tissue perfusion. Spleen - ANSEncapsulated organ LUQ level of 9th-11th ribs and curves around aportion of the stomach. Minimal elasticity and flexibility - most frequent injured organ inblunt trauma. Secondary lymph organ that filters and cleanses the blood. Removes old RBCs andhold reserve of blood. It recycles iron. It removes antibody-coated bacteria. Supplieslymphocytes to stimulate an immune response to blood borne microorganisms. Stores200-300ml of blood and leads to hemodynamic instability quickly if damaged. Splenic Injuries - ANSIn blunt trauma the spleen may lacerate from increased abdominal pressure. Graded I-V, I = minor trauma Assessment findings: signs of trauma LUQ, abdominal distention, asymmetry, abnormal contour, tenderness, guarding, rigidity, pain left shoulder when supine. CT: Hemoperitoneum. Hypodensity - represents parenchymal disruption, intraparenchymal hematoma or subcapsular hematoma. Contrast blush or extravasation 25 - hyperdense area that represent traumatic disruption. Active extravasation implies ongoing bleeding. Nonoperative management is preferred if hemodynamically stable, stable H/H x 12-24hours, minimal transfusion requirements (<2units), grade I or II without blush, age <55,a ert able to assist in assessment of abdomen. Surgical options: total splenectomy for severe injury, for less severe - direct pressure packing, embolization, splenorrhaphy (suturing spleen), partial removal. Asplenic patients have difficulty destroying encapsulated bacteria - Streptococcus pneumoni , Neisseria meningitides and Haemophil s influenza. A risk forpn umoco cal sepsis. Need annual flu shot and q5yr meningococcal andpneumococcal vaccines. U (AVPU) - ANSUnresponsive. Does not respond to any stimuli. V (AVPU) - ANSVerbal. Needs verbal stimuli to respond.(Airway adjunct may be needed to prevent tongue obstruction)- ANSPrehospital shock index pg. 85 Injury: shearing or tearing. Diagnosed with MRI.Widespread microsc pic hemorrhage. - ANSDiffuse Axonal Injury (Cannot recover fromthis; shearing/tearing portion DOES NOT heal) Injury: shearing or tearing. Diagnosed with MRI.Widespread microsc pic hemorrhage. - ANSDiffuse Axonal Injury (Cannot recover fromthis; shearing/tearing portion DOES NOT heal) Shock: Spinal cord injury at any level. Transient loss of reflex belowthe level of injury. Variab e duration. S & S: flaccidity, loss of reflexes, bowel/bladderdysfunction. - ANSSpinal Shock: Spinal cord injury at any level. Transient loss of reflex belowthe level of injury. Variab e duration. S & S: flaccidity, loss of reflexes, bowel/bladderdysfunction. - ANSSpinal Shock: Spinal cord injury at T6 or above. Temporary loss ofvasomotor tone and sympathetic innervation. Temporary duration usually <72 hours. S& S: ypotension, bradycardia, loss of ability to sweat below level of injury. -ANSNeurogenic Shock: Spinal cord injury at T6 or above. Temporary loss ofvasomotor tone and sympathetic innervation. Temporary duration usually <72 hours. S& S: ypotension, bradycardia, loss of ability to sweat below level of injury. -ANSNeurogeni c 26 : Impairs thrombin production and platelet function : Impairs thrombin production: Results in depletion of clotting factors throughhemodilution and the impai ed ability to produce clotting factors. - ANSTrauma Triad ofDeat h1. Hypothermia2. Metabolic Acidosis3. C agulopathy : Impairs thrombin production and platelet function : Impairs thrombin production: Results in depletion of clotting factors throughhemodilution and the impai ed ability to produce clotting factors. - ANSTrauma Triad ofDeat h1. Hypothermia2. Metabolic Acidosis3. Coagulopathy ???;.][''''''''''''''''''' - ANSthis card was created by a cat. enjoy. .. activation: .... are found in the carotid sinus and along the aortic arch, are sensitive tothe degree of stretch in the arterial wall. When the receptors sense a decrease instretch, they stimulate the sympathetic nervous system to release Epi, norepi, causingstimulation of cardiac activity and constriction of blood vessels, which causes a rise inheart rate and diastolic blood pressure - ANSBaroreceptors: ... describes the concept of under treatment of pain. - ANSOligoanalgesia ... describes the concept of under treatment of pain. - ANSOligoanalgesia ... describes the concept of under treatment of pain. - ANSOligoanalgesia ... is a principle that confuses on prevention rather than intervention. - ANSDamage control resuscitation ... is a principle that confuses on prevention rather than intervention. - ANSDamage control resuscitation ... is a principle that confuses on prevention rather than intervention. - ANSDamage control resuscitation ... is a test that requires fluid to be sent to the lab and is considered the gold standard for identifying CSF - ANSBeta2-Transferrin 27 ... results from a collection of blood forming between the dura Mater and the skull. Thisis frequently associated with fractures of the temporal or parietal skull that lacerated the.... - ANSEpidural hematoma ; middle meninges artery ... shock is from hemorrhage and is the leading cause of preventable deaths in trauma patients. Can also be caused by plasma loss in ... - ANSHypovolemic; burns ... shock is from hemorrhage and is the leading cause of preventable deaths in trauma patients. Can also be caused by plasma loss in ... - ANSHypovolemic; burns ... shock is from hemorrhage and is the leading cause of preventable deaths in trauma patients. Can also be caused by plasma loss in ... - ANSHypovolemic; burns ... shock occurs as a result of maldistribution of an adequate circulation blood volumwith the loss of vascular tone or increased permeability. 3 examples. - ANSDistributive;anaphylactic, septic and neurogenic ... shock occurs as a result of maldistribution of an adequate circulation blood volumewith the loss of vascular tone or increased permeability. 3 examples. - ANSDistributive;anaphylactic, septic and neurogenic ... shock occurs as a result of maldistribution of an adequate circulation blood volumewith the loss of vascular tone or increased permeability. 3 examples. - ANSDistributive;anaphylactic, septic and neurogenic ... shock results from hypoperfusion of the tissue due to an obstruction in either thevasculature or heart. Two examples include.... - ANSObstructive;tension pneumothorax,cardiac tamponade. (With tension pneumo the increase in intrathoracic pressure leadsto di plac ment of the vena cava, obstruction to arrival filling leading to decreasedpreload and decreased cardiac output) ( with cardiac tamponade there is anaccumul tion of fluid in the pericardial sac impeding diastolic expansion and fillingleading to decreased preload, stroke volume,CO and end organ perfusion) ... shock results from hypoperfusion of the tissue due to an obstruction in either the va culature or heart. Two examples include.... - ANSObstructive;tension pneumothorax,cardiac tamponade. (With tension pneumo the increase in intrathoracic pressure leadsto di plac ment of the vena cava, obstruction to arrival filling leading to decreasedpreload and decreased cardiac output) ( with cardiac tamponade there is anaccumul tion of fluid in the pericardial sac impeding diastolic expansion and fillingleading to decreased preload, stroke volume,CO and end organ perfusion) ... shock results from hypoperfusion of the tissue due to an obstruction in either the va culature or heart. Two examples include.... - ANSObstructive;tension pneumothorax,cardiac tamponade. (With tension pneumo the increase in intrathoracic pressure leadsto di plac ment of the vena cava, obstruction to arrival filling leading to decreasedpreload and decreased cardiac output) ( with cardiac tamponade there is an 30 accumulation of fluid in the pericardial sac impeding diastolic expansion and filling leading to decreased preload, stroke volume,CO and end organ perfusion) .... activation: .... are found in the carotid sinus and along the aortic arch, are sensitive to the degree of stretch in the ar erial wall. When the receptors sense a decre s instretch, th y imulate the sympathetic nervous system to release Epi, norepi, causingstimulation of cardiac activity and constriction of blood vessels, which causes a rise inheart rate and diastolic blood pressure - ANSBaroreceptor activation; baroreceptors .... activation: .... are found in the carotid sinus and along the aortic arch, are sensitive to the degree of stretch in the ar erial wall. When the receptors sense d creas intretch, they stimulate the sympathetic nervous system to release Epi, norepi, causingstimulation of cardiac activity and constriction of blood vessels, which causes a rise inheart rate and diastolic blood pressure - ANSBaroreceptor activation; baroreceptors .... activation: .... are found in the carotid sinus and along the aortic arch, are sensitive to the degree of stretch in the ar erial wall. When the receptors sense d creas intretch, they stimulate the sympathetic nervous system to release Epi, norepi, causingstimulation of cardiac activity and constriction of blood vessels, which causes a rise inheart rate and diastolic blood pressure - ANSBaroreceptor activation; baroreceptors .... are frequently associated with minor injury in older adults, patients taking anticoagulation medications and patients with chronic lcohol abuse. - ANSChronicsubdur alHematoma .... are frequently associated with minor injury in older adults, patients takingan coagulation medications and patients with chronic alcohol abuse. - ANSChronicsubdur alHematoma .... are frequently associated with minor injury in older adults, patients takingan coagulation medications and patients with chronic alcohol abuse. - ANSChronicsubdur alHematoma .... can produce bleeding that may not be evident until several hours after injury - ANSBasilar skull fractures .... can produce bleeding that may not be evident until several hours after injury - ANSBasilar skull fractures .... can produce bleeding that may not be evident until several hours after injury - ANSBasilar skull fractures .... is suspected in any patient with multi system trauma. - ANSCervical spine injury 31 .... is suspected in any patient with multi system trauma. - ANSCervical spine injury .... is suspected in any patient with multi system trauma. - ANSCervical spine injury .... is the major cause of preventable death after injury - ANSUncontrolled hemorrhage .... is the major cause of preventable death after injury - ANSUncontrolled hemorrhage .... is the major cause of preventable death after injury - ANSUncontrolled hemorrhage .... is the study of energy transfer as it applies to identifying actual or potential injuries -ANSKinematic s .... is the study of energy transfer as it applies to identifying actual or potential injuries -ANSKinematic s .... is the study of energy transfer as it applies to identifying actual or potential injuries -ANSKinematic s ...activation: consist of carotid and aortic bodies. ... detect changes in blood oxygen and Co2 and pH. When Co2 rises or oxygen level of pH falls these receptors are activated and information is relayed to the CNS and the cardiorespiratory centers in the medulla , which increases respiratory rage and depth and BP - ANSChemoreceptors ...activation: consist of carotid and aortic bodies. ... detect changes in blood oxygen and Co2 and pH. When Co2 rises or oxygen level of pH falls these receptors are activated and information is relayed to the CNS and the cardiorespiratory centers in the medulla , which increases respiratory rage and depth and BP - ANSChemoreceptors ...activation: consist of carotid and aortic bodies. ... detect changes in blood oxygen and Co2 and pH. When Co2 rises or oxygen level of pH falls these receptors are activated and information is relayed to the CNS and the cardiorespiratory centers in the medulla , which increases respiratory rage and depth and BP - ANSChemoreceptors #1 Early Killer - ANSHemorrhage #1 Late Killer - ANSInfection & MODS `CPP - ANSMAP-ICP + gurgling over epigastrium - ANS-in stomach, pull out, preoxygenate, try again 1 Liter of O2 = % FiO2 - ANS4% 1 Liter of O2 = % FiO2 - ANS4% 32 Auscultiate or listen for:1. Obstructive airway sounds such as snoring or gurgling2. Possible occlusive maxillofacial bony deformity3. Subcutaneous emphysema - ANSInspect the mouth for: 8 year old child with longitudinal thigh lacerations - ANSSign of child abuse 8 year old child with longitudinal thigh lacerations - ANSSign of child abuse 24 Hour Burn Fluid Calculation - ANSDosage x Kg x % - ml in first 24 hours-More than 20% of their TBSA burned require : *Ad lts: 2-4 ml of crystalloid solution x kg x %*Peds: 3-4 ml of crystalloid solution x kg x %*Infants: fluid with 5% dextrose at a maintenance rate in addition to the Peds rateprotoc ol (1/2 the amount should be infused in first 8 hours) 24 Hour Burn Fluid Calculation - ANSDosage x Kg x % - ml in first 24 hours-More than 20% of their TBSA burned require:*Ad lts 2-4 ml of crystalloid solution x kg x %*Peds: 3-4 ml of crystalloid solution x kg x %*Infants: fluid with 5% dextrose at a maintenance rate in addition to the Peds rateprotoc ol (1/2 the amount should be infused in first 8 hours) 24 Hour Burn Fluid Calculation - ANSDosage x Kg x % - ml in first 24 hours-More than 20% of their TBSA burned require:*Ad lts 2-4 ml of crystalloid solution x kg x %*Peds: 3-4 ml of crystalloid solution x kg x %*Infants: fluid with 5% dextrose at a maintenance rate in addition to the Peds rateprotoc ol (1/2 the amount should be infused in first 8 hours) 24 Hour Burn Fluid Calculation - ANSDosage x Kg x % - ml in first 24 hours-More than 20% of their TBSA burned require:*Ad lts 2-4 ml of crystalloid solution x kg x %*Peds: 3-4 ml of crystalloid solution x kg x %*Infants: fluid with 5% dextrose at a maintenance rate in addition to the Peds rateprotoc ol (1/2 the amount should be infused in first 8 hours) 35 50 to 150 - ANSMAP Range A and approach is used by all members of the trauma team to provide optimalcare for the tr uma pt. - ANSSystematic , Organized A and approach is used by all members of the trauma team to provide optimalcare for the tr uma pt. - ANSSystematic , Organized A and approach is used by all members of the trauma team to provide optimalcare for the tr uma pt. - ANSSystematic , Organized A - ANS-AVPU -Cervical spine (2nd person and jaw-thrust maneuver- inspect palate ausvultate + 4 issues- tate need for OPA-or definitive airway-reassess airway after insertion of opa (no snoring heard) A ... fracture is a complete craniofacial separation - ANSLefort III A ... fracture is a complete craniofacial separation - ANSLefort III A ... fracture is a complete craniofacial separation - ANSLefort III A 14 gauge needle that is inserted into the 2nd intercostal space in the midclavicularline on the ffected side over the top of the rib to avoid neuromuscular bundle that runsunder the rib. Prepare for chest tube placement. - ANSTension pneumo intervention A a 22 yr old was struck by a vehicle while crossing the street, sustaining multiple fx sheis alert and answering qestions and crying what is the best method for initial painassessment for this pt - ANSself report scale A a pt sustrained a penetrating injury of his upper leg. the pre hospital personnel statesa large amount of blood loss before hemostasiswas achieved. he presents to the ERresponding to painful stimuli with moaning. he is tachy 142 b/p 104/96 and RR 24 -ANSdecompensat ed A an unrestrained driver was involved in a frontal collision without airbag deployment.h is hypotensive and tachycardic with shallow respirations, distended JVD and muffledheart ton s the nurse prepare for what - ANSpericardiocentesis A body at rest will remain at rest, a body in motion will stay in motion - ANSNewton'sfirst law 36 A body at rest will remain at rest, a body in motion will stay in motion - ANSNewton'sfirst law A body at rest will remain at rest, a body in motion will stay in motion - ANSNewton'sfirst law A breath every 5 to 6 seconds: 10-12 ventilations per minute - ANSBag mask ventilation A during assessment of an extremety with suspected pulses are - ANScan be normal A for a ptwho has undergone recent bariatric surgery, flouroscopy is recommended to place - ANSNG tube A identification of vulnerabilities is an example of what phase of disaster management - ANSmitigation A in mass casualty "doing the greatest good for the greatest number of people refers to a situation where - ANSthere may be more patients than resources A in neurogenic shock, alterations in vital signs include hypotension and which other abnormal VS - ANSbradycardia A In the primary survey AVPU is performed to determine if the patient can: - ANSProtect their aiway A moderately dilated pupil with sluggish response may be an early sign of what? - ANSherniation syndrome from increased ICP A prego trauma pt develops tachy, hypotension, a rigide board like uterus, and dark, redvagin l ble ing. she reports constant back pain which is increasing. the most likelycause of s/s is - ANSplacental abruption A several groups of people are at higher risk for maltreatment including children, elderly, prego, and ... - ANSpt's with disability A the nurse is preparing to cleanse an extensive abrasion contaminated with dirt and gravel. which of the following intervention is indicated - ANSus copious amounts of NS A The systemic inflammatory response is a normal part of the body's response to shockfrom traumatic injury. what best describes this response - ANSit is activated by tissuehypoxia and sends neutrophils to injury site A traumatic incident may be classified as ....(assault or suicide) or ... (falls or collisions) - ANSIntentional;unintentional 37 Amylase level looks at - ANSPancreas An external force applied time of impact, ex. Steering wheels or dashboards that collidewith or push up into a person. - ANSCompression force An external force applied time of impact, ex. Steering wheels or dashboards that collidewith or push up into a person. - ANSCompression force An external force applied time of impact, ex. Steering wheels or dashboards that collidewith or push up into a person. - ANSCompression force Anaphylactic - ANSVasodilation due to allergens, IM epi anaphylactic shock - ANSDistributive shockA severe reaction that occurs when an allergen is introduced to the bloodstream of ana lergic individu l. Histamines are released which cause bronchoconstriction, laboredeat ing, widespread vaso ilation, increased vascular permeability, circulatory shock,and sometimes sudden death. any deformities? bleeding? contusions, lacs? skin temp?? place splints on deformities,pulses - ANSHead to toe assessment: Extremities any lacs? deformities? blood at the urtheral meatus palpate pelvis with high pressure over the iliac wings downward and medially -ANSHead to toe assessment: pelvis and perineum Aortic Dissection - ANSUnequal extremity pulse strength possibility of.. Aortic injuries - ANSmay not have pulses in LE or one arm apply direct pressure to bleeding elevate extremity apply pressure over arterial sites Consider a pelvic binder for pelvic fractures consider a tourniquet cannulate two veins with large caliber IV - if unable to gain assess consider IOa. obtain labs, type and crossb. infuse warm isotonic fluidsc. consider balanced resuscitation 40 d. use rapid infusion device - ANSC Interventions: As ICP increases CPP decreases resulting in ... - ANSCerebral ischemia, hypoxemiaand lethal secondary insult As ICP increases CPP decreases resulting in ... - ANSCerebral ischemia, hypoxemiaand lethal secondary insult As ICP increases CPP decreases resulting in ... - ANSCerebral ischemia, hypoxemiaand lethal secondary insult ask pt to pen his or her mouth - ANSWhile assessing airway the patient is alert andresponds to verbal stimuli you should.. Assessment findings with maxillary fractures include - ANSFacial edema, ecchymosesand dipl poa (lefort III) Assessment findings with maxillary fractures include - ANSFacial edema, ecchymosesand dipl poa (lefort III) Assessment findings with maxillary fractures include - ANSFacial edema, ecchymosesand dipl poa (lefort III) Avoid when administering oxygen/ventilation - ANShyperoxia Avoid when administering oxygen/ventilation - ANShyperoxia AVPU - ANSAlert, Verbal, Pain, Unresponsive AVPU - ANSID ptNeed intubation B - ANS-Determine breathing effectiveness-state n ed for assisted ventilation with bag-valve mask device-as ess ET placement-Et s cure, number at teeth documented-need for manuel ventilation B a pt father arrives in teh ER and needs to be told his son was severely injured in aMVC and is in surgery, the father si agitated, yelling, and smells of alcohol. in planningto talk with the father the trauma nurse will - ANSdeliver information regarding the son;scare in a calm voice B a pt involved in an MVC develops asymmetric pupillary reactivity, bilateral pupillaryd ion and abnormal motor posturing. what does the nurse suspect as the most likelycause - ANSherniation syndrome 41 B a pt with injury to the middle meningeal artery is at risk for which of the following - ANSepidural hematoma B an occlusive dressing has been applied to a pt with a penetrating injury to the chest.upon ass sment the nurse notes that the patient is in respiratory distress nad hasabsn t breat sounds on hte affected side. what is the priroruty intervention -ANSremove the dressing to the wound B an unrestrained driver inlvolved in a MVC in which alcohol was involed. he denies anypain and numbness and tinlging. according to NEXUS critera which factors indicateneed for radiological - ANSsuspected alcohol abuse B Demonstrates and describes techniques for determining breathing effectiveness usingcomponent of inspection, auscultation, and palpation. identifies at least FOUR - ANS-isthere spontaneous breathing-is there symmetrical chest rise-what are the depth, pattern and rate of respirations-is there i creased work of breathing-skin color- pen wounds or deformities, subcutaneous emphysema-trac eal deviation or jugular venous distention-great s unds present and equal B pt to ER after being pinned to brick retaining wall. knwoing crushing injuries can resultto significant damage to muslces the priority asessment for trauma nruse is for -ANSmyoglobinemia nd renal failure B the most common cause of shock in the trauma pt is - ANSloss of circ volume B the unrestrained fron seat passenger in a MVC develops echymosis aroundumbillicus. this assessment finding is most commonly associated with: - ANSbleeding inthe perito eal cavity B thinning skin and diminished autonomic response in older adult can have what effect on primary assessment - ANScompromised thermoregulation B when assessing a pt following a MVC the nurses asks how fsat the car was going - ANSwhen volocity is doubled speed is quadroupled B WHich may lead to unreliable pulse ox reading - ANScarboxyhemoglobin B which of hte following significant assessment findigns is frequently found in a patientwith complete cransiofacial separation involving the maxilla, zygoma, orbits, and bonesof the cranial base. - ANSdiplopia 42 C an adult pt involved in a brush fire arrives to the er. upon initial assessment in the erthe most concerning finding is - ANShoarse voice and repeatedly decides to clearthroa t. C an older adult pt fell in the bathtub 3 days ago. now she is exihibiting decreasd LOCand difficulty with speaking and walking. which of the following injuries is most effective- ANSsubdural hematoma C effective pain management in hte pt iwth rib fxwill promote what - ANScough with ability to clear secretions C properly restrained 6 wk old kid was involved in a MVC. after the assessment andstabilization the pt becomes more difficult to rouse. responding with a weak cry topainful stimuli. the pupils remain brisk and reactive. the anterior fontanel is soft and flat.what is the most likely cause and pririty interventions - ANShypoglycemia C What are the primary benefits of a team approach to trauma care - ANSit provides a systemic approach to care and organizes care C what organ might be injured in left lower rib fx - ANSspleen C which of the following would be priority intervention for a pt with multiple rib fracturesand chest wall instability follwoing a mvc collision - ANSassist with endotrachealintubatio n C which of the follwoing is a risk factor for DVT in the trauma pt. - ANSpelvic fx C-circulation and hemorrhage - ANS-*determine adequacy of circulation usinginspec , auscultation, palpation-assess medic line-*2nd large bore IV, warm crystalloid infusing at controlled rate if not shocky can be caused by blunt trauma. air escapes from injured lung to pleural space andnegative intrapleural pressure is lost causing partial or collapsed lung - ANSSimplePneumothor ax Can be caused by blunt trauma. Air escapes from the injured lung into the pleuralspace, and negative intrapleural pressure is lost resulting in partial or complete collapse of the lung. S & S: dyspnea, tachypnea, decreased/absent breath sounds on injured side, chest pain. Treatment: based on size, symptoms, and stability. Chest tube may be placed to evacuate pleural air and maintain lung expansion - ANSPneumothorax Can be caused by blunt trauma. Air escapes from the injured lung into the pleuralspace, and negative intrapleural pressure is lost resulting in partial or complete collapseof the lung. S & S: dyspnea, tachypnea, decreased/absent breath sounds on injured 45 side, chest pain. Treatment: based on size, symptoms, and stability. Chest tube may be placed to evacuate pleural air and maintain lung expansion - ANSPneumothorax can result from penetrating wound through chest wall causing air to be trapped in to the intrapleural place. Might hear "sucking" Tx: nonporous dressing tapes on 3 sided, then Chest tube and would closure surgical repair. - ANSOpen Pneumo: Capnography monitors numeric value, as well as continuous waveform, indicating real- time measurement and trending over time. - ANSQuantitative: Cardiac Tamponade - ANScompression of heart due to fluid accumulation within pericardiumCardiac tamponade - ANSPericardial window Cardiogenic - ANS-ineffective perfusion caused by inadequate contractility of heart-blunt ardiac injury-pressors, dop, epi, NO FLUIDS Cardiogenic shock - ANSAntiarrythmics Care of Amputations - ANS-Remember ABCDs-Focu on Life-Threatening Injuries-Circulation: control bleeding, elevate & apply pressure on artery-Vasoconstriction reflex: decreases bleeding Save life over limb! Cause of Spleen & Liver Injuries - ANSMVC/T- bone Caused by a sudden stop of the body's motion - ANSDeceleration forces Caused by a sudden stop of the body's motion - ANSDeceleration forces Caused by a sudden stop of the body's motion - ANSDeceleration forces Caused by blood in the intrapleural space/ May also occur from lac to live or spleen combined with injury to the diaphragm. Ensure two large bore IVS are placed. Prepare for thoracentesis and chest tube insertion. If open thoracotomy is done chest tube is deferred. - ANSHemothorax: 46 Caused from a sudden and rapid onset of motion ( a Parker car being hit by another vehicle) - ANSAcceleration forces Caused from a sudden and rapid onset of motion ( a Parker car being hit by another vehicle) - ANSAcceleration forces Caused from a sudden and rapid onset of motion ( a Parker car being hit by another vehicle) - ANSAcceleration forces Causes of Hemothorax - ANS-Rib Fx -Heart or Great Vessel Injury Causes of oligoanalgesia include... - ANSFailure to assess initial pain; failure toimplement guidelines and protocols; failure to document pain; failure to meet patientsexpect tio ns Causes of oligoanalgesia include... - ANSFailure to assess initial pain; failure toimplement guidelines and protocols; failure to document pain; failure to meet patientsexpect tio ns Causes of oligoanalgesia include... - ANSFailure to assess initial pain; failure toimplement guidelines and protocols; failure to document pain; failure to meet patientsexpect tio ns Causes of Thoracic Injuries - ANS1. Blunt Thoracic Injuries: front or side impact withMVCs 2. Penetrating Thoracic Injuries: assaults, firearms, stabbings Cavitation - ANSLiver Cerebral contusion - ANS-damage to capillary vasculature, 18-36 hours after time of injury Cerebral Perfusion Pressure (CPP) - ANSCPP = MAP - ICP Cerebral response - ANS-brain autoregulates so blood is shunted from other organs tob ai n-SBP >50 cerebral ischemia occurs and the increase in CO2 in the brain stimulates theCNS response Chest tube insertion site - ANS5th intracostal space Church fever/malaise - ANSBiologic Circulation and Control of Hemorrhage 47 Collaborative Management of Spleen & Liver Injuries - ANS-Medical: monitor, SerialH/ H-Surgical: repair vs remove organ (better not to remove)-Supportive Treatment: O2, blood, fluids, vasopressors Collection of blood in pericardial sac. Mechanism of injury is typically penetratingtrauma. Compresses the heart and decreases ability of the ventricles to fill causingdecrea ed SV and CO. S & S: hypotension, muffled heart sounds, distended neckveins, tachycardia or PEA, dyspnea, cyanosis, chest pain. Surgical evacuation will beneeded. - ANSCardiac Tamponade Collection of blood in pericardial sac. Mechanism of injury is typically penetratingtrauma. Compresses the heart and decreases ability of the ventricles to fill causingdecrea ed SV and CO. S & S: hypotension, muffled heart sounds, distended neckveins, tachycardia or PEA, dyspnea, cyanosis, chest pain. Surgical evacuation will beneeded. - ANSCardiac Tamponade Colorimetric CO2 detectors provide info about the presence or absence of CO2. Achemically treated indicator strip changes color revealing the presence or absence ofexhaled CO2 - ANSQualitative Compartment syndrome - ANSPainPuls ePallo rPressur eParalysi sParasthesi a Compensated stage - ANS-SBP is normal, rising DBP, tachy bounding, lactate builds up Complete craniofacial separation involving maxilla, zygoma, orbits, and bones of thecranial bas . Assessment findings include: massive facial edema, mobility anddepressio of zygomatic bones, ecchymoses, diplopia, and open bite or malocclusion. -ANSLeFort III Complete craniofacial separation involving maxilla, zygoma, orbits, and bones of thecranial bas . Assessment findings include: massive facial edema, mobility anddepressio of zygomatic bones, ecchymoses, diplopia, and open bite or malocclusion. -ANSLeFort III Complications of Abdominal Compartment Syndrome - ANS-Decreased Venous Returnb/c g t pushi g on vena cava-Falsely elevates CVP-Pushes on Diaphragm 50 Control bleeding with direct pressure, elevate, apply tourniquets. - ANSAmputation Control bleeding with direct pressure, elevate, apply tourniquets. - ANSAmputation CPP range - ANS50- 70 Crush Injuries - ANS-Skeletal muscle damage causes Myoglobin release=Rhabdomyolysis --> Myoglobinuria-Soft Tissue swelling- Pain-Compartment Syndrome-Loss f Neurovascular Integrity distal to injury-Possible Bone injury-Life-threatening if involves legs or pelvis Crush injury - ANSMyoglobinuriaRenal failure CT Scan - ANS-more expensive-Diag os s Retroperitoneal & Intraperitoneal Bleeding-n to stabilize patient first Cthe term worried well when refering to disaster preparedness planning refers to: -ANSindividuals hwo think they have been affected by the event but are asymptomatic Cthe trauma nurse would prepare for a definitive airwya for which of the followingconditi n. - ANSGCS of 8 or ls Cullen sign - ANSbruising around umbilicus Cullen's Sign - ANSEcchymosis in Umbilical Area, Associated with IntraperitonealBleedin g Cushing - ANSpressure on brain stem causes wide pulse pressure, brady, decreasedRR Cushing response - ANSTraid of widening pulse pressure, reflex brady, diminished respeffec t.Attempt to incrased MAP against an elevated ICP causing a rise in CPP Cushing's triad/response - ANSr/t loss of auto regulation due to ICPSigns of increased intracranial pressure:1. hypertension2. bradycardia3. irregular respirations 51 D - ANSdisability (neurologic status)-GCS (best eye opening, best verbal response, best motor reaponse)-assess pupils-states need for CT of head and cervical spine D An unrestrained driver is brought into the emergency department following a frontalimpact MVC. she is pale, anxious, and c/o SOB. what is the potential injury -ANSLumbar fx D displaced tubeO obstructed or kinkedP pneumothoraxE equipment failure , such as becoming detached from the equipment or loss ofcapnopgrahy - ANSDOPE D elevated comaprtment pressure can be the result of - ANShemorrhage from within the muscle D pt with amputation of an index finger with a knife. amputaiton is brought in with pt. it israp ed in sterile gauze with saline and sealed in a plastic bag. the next stepamputation care is - ANSplace the bag on ice D restrained driver is involved in a severe head on MVC and presnts with a seatbeltmark along the neck and upper chest area. bilateral decreased breath sounds,hemoptysis and diffuse sub q emphysemato the neck and upper chest area -ANStr cheobronchial injury D which of the following diagnostic intervention is most appropriate for the unstable ptwith a suspectedinternal hemorrhage - ANSfocused assessment with sonography fortraum a D which physiological change in airway of an odler adult pt places the pt at risk for difficult intubation - ANScervical arthritis D- disability - ANS-*GCS- eye opening, verbal response, motor- *pupil s -*need for head CT, cspine Decrease cranial calcification - ANSCT normal without radio graphic abnormality Define central or transtentorial herniation. - ANSA downward movement of the cerebralhemisphe es with herniation of the diencephalon and midbrain through the elongatedgap of he tentorium. 52 Define tension pneumothorax. - ANSLife-threatening injury. Air enters pleural space oninspir tion, but air cannot escape on expiration. Rising intrathoracic pressure collapseslung on side of injury causing a mediastinal shift that compresses the heart, greatv ssels, tr chea and uninjured lung. Venous return impeded, cardiac output falls,hypotension results. Immediate decompression should be performed. Treatment should not be delayed. Define tension pneumothorax. - ANSLife-threatening injury. Air enters pleural space oninspir tion, but air cannot escape on expiration. Rising intrathoracic pressure collapseslung on side of injury causing a mediastinal shift that compresses the heart, greatv ssels, tr chea and uninjured lung. Venous return impeded, cardiac output falls,hypotension results. Immediate decompression should be performed. Treatment should not be delayed. Define tension pneumothorax. - ANSLife-threatening injury. Air enters pleural space oninspir tion, but air cannot escape on expiration. Rising intrathoracic pressure collapseslung on side of injury causing a mediastinal shift that compresses the heart, greatv ssels, tr chea and uninjured lung. Venous return impeded, cardiac output falls,hypotension results. Immediate decompression should be performed. Treatment should not be delayed. Define tension pneumothorax. - ANSLife-threatening injury. Air enters pleural space oninspir tion, but air cannot escape on expiration. Rising intrathoracic pressure collapseslung on side of injury causing a mediastinal shift that compresses the heart, greatv ssels, tr chea and uninjured lung. Venous return impeded, cardiac output falls,hypotension results. Immediate decompression should be performed. Treatment should not be delayed. Define tension pneumothorax. - ANSLife-threatening injury. Air enters pleural space oninspir tion, but air cannot escape on expiration. Rising intrathoracic pressure collapseslung on side of injury causing a mediastinal shift that compresses the heart, greatv ssels, tr chea and uninjured lung. Venous return impeded, cardiac output falls,hypotension results. Immediate decompression should be performed. Treatment should not be delayed. Define uncal herniation. - ANSThe uncus (medial aspect of the temporal lobe) isdisplaced v r the tentorium into the posterior fossa. This herniation is the morecommon of the two types of herniation syndromes. 55 Define uncal herniation. - ANSThe uncus (medial aspect of the temporal lobe) isdisplaced v r the tentorium into the posterior fossa. This herniation is the morecommon of the two types of herniation syndromes. Define uncal herniation. - ANSThe uncus (medial aspect of the temporal lobe) isdisplaced v r the tentorium into the posterior fossa. This herniation is the morecommon of the two types of herniation syndromes. Define uncal herniation. - ANSThe uncus (medial aspect of the temporal lobe) isdisplaced v r the tentorium into the posterior fossa. This herniation is the morecommon of the two types of herniation syndromes. Define uncal herniation. - ANSThe uncus (medial aspect of the temporal lobe) isdisplaced v r the tentorium into the posterior fossa. This herniation is the morecommon of the two types of herniation syndromes. Definitive treatment of a Tension Pneumothorax - ANSChest Tube demonstrates and describes techniques for determining latency of airway usinginspection, ausculataton, and palpation. Identifies at least FOUR - ANS- is tongueobstructing airway-a e there any lose or missing teeth-are there any foreign bodiesis th re any blood, vomitus or other secretions-is there any edema-is there any snoring, gurgling, or stridor Depressed - ANSextends below surface of head Describe a Grade I Hyphema. - ANSBlood occupying less than one third of the anteriorey chamber. Describe a Grade II Hyphema. - ANSBlood occupying one third to half of the anteriorey chamber. Describe a Grade III Hyphema. - ANSBlood occupying half but less than total filling ofhe anterior eye chamber. Describe a Grade IV Hyphema. - ANSBlood occupying the entire anterior eye chamber. Diagnostic Peritoneal Lavage (DPL) - ANS-Rapid test for Intraperitoneal Bleeding- Invasiv e -Peritoneal catheter inserted into abdomen (right below umbilicus) & warm NS or LRinstilled then drained-Drop bag below level of bed-If bag filled with blood, yellow, green, food, particles, stool= Positive DPL & go to OR 56 Diaphragmatic Rupture - ANS-Stomach in Thoracic Cavity -Bowel Sounds heard in chest Difficult intubation elderly - ANSCervical arthritis Diffuse anoxal - ANSsweating, posturing, sym storm, HTN, hyperthermiashea ing and tearingimmediate unconciousness Diffuse Axinal vs. Herniation Syndrome - ANSDAUnconsciousne ssIncreased ICPPosturin gHT NHyper- thermiaSweat n g HSAsymmetric pupilsUnilateral or bilateral pupil dilationPos urin gCushing sLoss of reflexes Diplopia - ANSLefort III Disability - Neurologic Status 1. Assess pupils for equality, shape, and reactivity (PERRL) 2. Assess GCS (eye opening, verbal response, and motor response) - ANSD Disaster management - Vulnerable - ANSMitigation Disruptions of the bony structures of the skull can result in what? - ANSDisplaced ornondisplaced fx's causing CSF leakage b/c of lac to the dura mater, creating a passagefor CSF. CSF leaks through the nose (rhinorrhea) or the ears (otorrhea). A potential entrance forinvading bacteria.Also: meningitis or encephalitis or brain abscess Disruptions of the bony structures of the skull can result in what? - ANSDisplaced ornondisplaced fx's causing CSF leakage b/c of lac to the dura mater, creating a passagefor CSF. 57 Energy can neither be created nor destroyed but rather I can change form - ANSLaw of conservation of energy Epidural hematoma - ANStemporal or parietal skull that lacerate the meningeal arteryyounger population, with skull fx, rapid accumulation of arterial blood in spacetransie t LOC, rapid deterioation ETT - ANS-tube in trachea with cuff inflated- GCS<8-inhalation injury, unable to breath due to pain, apnea, high risk foraspiration/decompensation Examples that can cause distributive shock - ANSAnaphylactic shock, septic shock, neurogenic shock Examples that can cause distributive shock - ANSAnaphylactic shock, septic shock, neurogenic shock Explain adrenal gland response. - ANSWhen adrenal glands are stimulated by SNS,release of catecholamines (epinephrine and norepinephrine) from adrenal medulla willincreas e. Epi stimulates receptors in heart to increase force of cardiac contraction (positiveinotropy) and increase HR (positive chronotropy) to improve cardiac output, BP andtissue perfusion. Shock stimulates hypothalamus to release corticotropin-releasing hormone that stimulates pituitary to release ACTH that stimulates adrenal gland to release cortisol. Effect of cortisol release is elevation in blood sugar and increased insulin resistance and gluconeogenesis, hepatic process to produce more sugar. Cortisol also causes renal retention of water and sodium, a compensatory mechanism to conserve body water. Explain adrenal gland response. - ANSWhen adrenal glands are stimulated by SNS,release of catecholamines (epinephrine and norepinephrine) from adrenal medulla willincreas e. Epi stimulates receptors in heart to increase force of cardiac contraction (positiveinotropy) and increase HR (positive chronotropy) to improve cardiac output, BP andtissue perfusion. Shock stimulates hypothalamus to release corticotropin-releasing hormone that stimulates pituitary to release ACTH that stimulates adrenal gland to release cortisol. 60 Effect of cortisol release is elevation in blood sugar and increased insulin resistance and gluconeogenesis, hepatic process to produce more sugar. Cortisol also causes renal retention of water and sodium, a compensatory mechanism to conserve body water. Explain adrenal gland response. - ANSWhen adrenal glands are stimulated by SNS,release of catecholamines (epinephrine and norepinephrine) from adrenal medulla willincreas e. Epi stimulates receptors in heart to increase force of cardiac contraction (positiveinotropy) and increase HR (positive chronotropy) to improve cardiac output, BP andtissue perfusion. Shock stimulates hypothalamus to release corticotropin-releasing hormone that stimulates pituitary to release ACTH that stimulates adrenal gland to release cortisol. Effect of cortisol release is elevation in blood sugar and increased insulin resistance and gluconeogenesis, hepatic process to produce more sugar. Cortisol also causes renal retention of water and sodium, a compensatory mechanism to conserve body water. Explain adrenal gland response. - ANSWhen adrenal glands are stimulated by SNS,release of catecholamines (epinephrine and norepinephrine) from adrenal medulla willincreas e. Epi stimulates receptors in heart to increase force of cardiac contraction (positiveinotropy) and increase HR (positive chronotropy) to improve cardiac output, BP andtissue perfusion. Shock stimulates hypothalamus to release corticotropin-releasing hormone that stimulates pituitary to release ACTH that stimulates adrenal gland to release cortisol. Effect of cortisol release is elevation in blood sugar and increased insulin resistance and gluconeogenesis, hepatic process to produce more sugar. Cortisol also causes renal retention of water and sodium, a compensatory mechanism to conserve body water. Explain adrenal gland response. - ANSWhen adrenal glands are stimulated by SNS,release of catecholamines (epinephrine and norepinephrine) from adrenal medulla willincreas e. 61 Epi stimulates receptors in heart to increase force of cardiac contraction (positiveinotropy) and increase HR (positive chronotropy) to improve cardiac output, BP andtissue perfusion. Shock stimulates hypothalamus to release corticotropin-releasing hormone that stimulates pituitary to release ACTH that stimulates adrenal gland to release cortisol. Effect of cortisol release is elevation in blood sugar and increased insulin resistance and gluconeogenesis, hepatic process to produce more sugar. Cortisol also causes renal retention of water and sodium, a compensatory mechanism to conserve body water. Explain Cardiogenic Shock. - ANSSyndrome that results from ineffective perfusioncaused by inadequate contractility of cardiac muscle. Some causes: MI, Blunt cardiacinjury, Mitr l valve insufficiency, dysrhythmias, Cardiac Failure Explain Cardiogenic Shock. - ANSSyndrome that results from ineffective perfusioncaused by inadequate contractility of cardiac muscle. Some causes: MI, Blunt cardiacinjury, Mitr l valve insufficiency, dysrhythmias, Cardiac Failure Explain Cardiogenic Shock. - ANSSyndrome that results from ineffective perfusioncaused by inadequate contractility of cardiac muscle. Some causes: MI, Blunt cardiacinjury, Mitr l valve insufficiency, dysrhythmias, Cardiac Failure Explain Cardiogenic Shock. - ANSSyndrome that results from ineffective perfusioncaused by inadequate contractility of cardiac muscle. Some causes: MI, Blunt cardiacinjury, Mitr l valve insufficiency, dysrhythmias, Cardiac Failure Explain Cardiogenic Shock. - ANSSyndrome that results from ineffective perfusioncaused by ineffective perfusion caused by inadequate contractility of cardiac muscle. Some causes:- MI- Blunt cardiac injury- Mitral valve insufficiency- dysrhythmia s - Cardiac Failure Explain Distributive Shock. - ANSResults from disruption in SNS control of the tone ofblood v ssels, which leads to vasodilation and maldistribution of blood volume and flow.(Neuroge ic and Septic Shock). Neurogenic shock may result from injury to spinal cordin cervical or upper thoracic region. Spinal shock = areflexia and flaccidity associated with lower motor neuron involvement in complete cord injuries; reflexes return with resolution of spinal shock. 62 Explain Hypovolemic Shock. - ANSMost common to affect a trauma pt cause byhypovolemia.. Hypovolemia, a decrease in amount of circulating blood volume, mayres lt fro significant loss of whole blood because of hemorrhage or from loss ofse ipermeable integrity of cellular membrane leading to leakage of plasma and proteinfrom intravascular space to the interstitial space (as in a burn). Some causes:- Blood loss- Burns, etc. Explain Hypovolemic Shock. - ANSMost common to affect a trauma pt cause byhypovolemia.. Hypovolemia, a decrease in amount of circulating blood volume, mayres lt fro significant loss of whole blood because of hemorrhage or from loss ofse ipermeable integrity of cellular membrane leading to leakage of plasma and proteinfrom intravascular space to the interstitial space (as in a burn). Some causes:- Blood loss- Burns, etc. Explain Hypovolemic Shock. - ANSMost common to affect a trauma pt cause byhypovolemia.. Hypovolemia, a decrease in amount of circulating blood volume, mayres lt fro significant loss of whole blood because of hemorrhage or from loss ofse ipermeable integrity of cellular membrane leading to leakage of plasma and proteinfrom intravascular space to the interstitial space (as in a burn). Some causes:- Blood loss- Burns, etc. Explain Hypovolemic Shock. - ANSMost common to affect a trauma pt cause byhypovolemia.. Hypovolemia, a decrease in amount of circulating blood volume, mayres lt fro significant loss of whole blood because of hemorrhage or from loss ofse ipermeable integrity of cellular membrane leading to leakage of plasma and proteinfrom intravascular space to the interstitial space (as in a burn). Some causes:- Blood loss- Burns, etc. Explain Hypovolemic Shock. - ANSMost common to affect a trauma pt cause byhypovolemia.. Hypovolemia, a decrease in amount of circulating blood volume, mayres lt fro significant loss of whole blood because of hemorrhage or from loss ofse ipermeable integrity of cellular membrane leading to leakage of plasma and proteinfrom intravascular space to the interstitial space (as in a burn). 65 Some causes:- Blood loss- Burns, etc. Explain Irreversible Shock. - ANSShock uncompensated or irreversible stages willcaus compromises to most body systems.- Inadequate venous return- inadequate cardiac filling- decreased coronary artery perfusion- Membranes of lysosomes breakdown within cells and release digestive enzymes thatcause intracellular damage. Explain Irreversible Shock. - ANSShock uncompensated or irreversible stages willcaus compromises to most body systems.- Inadequate venous return- inadequate cardiac filling- decreased coronary artery perfusion- Membranes of lysosomes breakdown within cells and release digestive enzymes thatcause intracellular damage. Explain Irreversible Shock. - ANSShock uncompensated or irreversible stages willcaus compromises to most body systems.- Inadequate venous return- inadequate cardiac filling- decreased coronary artery perfusion- Membranes of lysosomes breakdown within cells and release digestive enzymes thatcause intracellular damage. Explain Irreversible Shock. - ANSShock uncompensated or irreversible stages willcaus compromises to most body systems.- Inadequate venous return- inadequate cardiac filling- decreased coronary artery perfusion- Membranes of lysosomes breakdown within cells and release digestive enzymes thatcause intracellular damage. Explain Irreversible Shock. - ANSShock uncompensated or irreversible stages willcaus compromises to most body systems.- Inadequate venous return- inadequate cardiac filling- decreased coronary artery perfusion- Membranes of lysosomes breakdown within cells and release digestive enzymes thatcause intracellular damage. 66 Explain Obstructive Shock. - ANSResults from inadequate circulating blood volumeecause of an obstruction or compression of great veins, aorta, pulmonary arteries, orheart itself. Some causes:- Cardiac tamponade (may compress the heart during diastole to such and extent thatatria cannot adequately fill, leading to decreased stroke volume).- Tension pneumothorax may lead to inadequate stroke volume by displacing inferiorvena cava a d obstructing venous return to right atrium.- Air embolus may lead to obstruction of pulmonary artery and subsequent obstructiont right ve tricular outflow during systole, with resulting obstructive shock Explain Obstructive Shock. - ANSResults from inadequate circulating blood volumeecause of an obstruction or compression of great veins, aorta, pulmonary arteries, orheart itself. Some causes:- Cardiac tamponade (may compress the heart during diastole to such and extent thatatria cannot adequately fill, leading to decreased stroke volume).- Tension pneumothorax may lead to inadequate stroke volume by displacing inferiorvena cava a d obstructing venous return to right atrium.- Air embolus may lead to obstruction of pulmonary artery and subsequent obstructiont right ve tricular outflow during systole, with resulting obstructive shock Explain Obstructive Shock. - ANSResults from inadequate circulating blood volumeecause of an obstruction or compression of great veins, aorta, pulmonary arteries, orheart itself. Some causes:- Cardiac tamponade (may compress the heart during diastole to such and extent thatatria cannot adequately fill, leading to decreased stroke volume).- Tension pneumothorax may lead to inadequate stroke volume by displacing inferiorvena cava a d obstructing venous return to right atrium.- Air embolus may lead to obstruction of pulmonary artery and subsequent obstructiont right ve tricular outflow during systole, with resulting obstructive shock Explain Obstructive Shock. - ANSResults from inadequate circulating blood volumeecause of an obstruction or compression of great veins, aorta, pulmonary arteries, orheart itself. Some causes:- Cardiac tamponade (may compress the heart during diastole to such and extent thatatria cannot adequately fill, leading to decreased stroke volume).- Tension pneumothorax may lead to inadequate stroke volume by displacing inferiorvena cava a d obstructing venous return to right atrium. 67 For every action there is an equal and opposite reaction - ANSNewton's third law Force = mass x acceleration - ANSNewton's second law Force = mass x acceleration - ANSNewton's second law Force = mass x acceleration - ANSNewton's second law from hemorrhage is leading cause. Hypovolemia is caused by decrease in the amountof circulating volume. Goal is to replace volume. - ANSHypovolemic Shock Full set of vitals and family presence - ANSF G - ANSGET resuscitation adjuncts LMNOP G- LMNOP - ANS- labs- lactate, ABG, type and cross, glucose-m- monito r -n-NG/ OG-o-pulse o x -p-pain- pharma and nonpharm GCS breakdown - ANS GCS scores :I. Mild TBIII. Moderate TBIIII. Severe TBI - ANS13-15; 9-12; 8 or less GCS scores :I. Mild TBIII. Moderate TBIIII. Severe TBI - ANS13-15; 9-12; 8 or less GCS scores :I. Mild TBIII. Moderate TBIIII. Severe TBI - ANS13-15; 9-12; 8 or less General study of forces and their effects on living tissue and the human body -ANSBiomechani cs General study of forces and their effects on living tissue and the human body -ANSBiomechani cs Get Resuscitation Adjuncts 70 L - Labs (maybe a lactic acid), a b g 's, blood typeM - monitorsN - aso or oro gastric tubesO Oxygen and ETC02 monitorsP - pain assessment and management - ANSG Glascow Coma Scale (GCS) - ANSNeurologic assessment of a patient's BEST verbalr sponse, eye opening, and motor function. Lowest score is a 3, highest is 15, Intubateat 8. Goal of Primary Survey - ANSidentify life-threatening injuries Goal of Secondary Survey - ANSidentify all injuries Goals of Early Surgical Tx of Abdominal Trauma - ANS-Control Hemorrhage-Re ove dead tissue-Lavage the abdominal cavity-Control contamination-Close the abdomen without tension Gray Turner Sign - ANSEcchymosis in flank area associated with Retroperitoneal Bleeding Grey turner sign - ANSBruising of the flanks. Between last rib and top of hip GSW chest - ANSThoracic injury GSW to Abdomen Risk - ANS1. Hemorrhage 2. Hollow Viscus Perforation with Peritonitis H - ANSHistory MIST Mechanism of injuryI ies sustainedSigns an symptoms in fieldTreatment in field H- hx and head to toe - ANS-hx: MIST, past medical hx -head to toe H,I - ANSSecondary Survery Head to toe - ANS- face-neck- c- spine-chest- lung and heart-abdomen and flanks 71 -pelvis and perineum- gentle pressure over iliac crest, pubic symphysis, foley-extremities- neurovascular-posterior- spinal board Head to toe assessment - ANS1) Inspects AND palpates face/neck2) inspects AND palpates neck for injuries, demonstrate removal AND replacement ofc rvi al collar or assessment3) In pects AND palpates chest4) auscultate heart and lung sounds5) i spects abdomen and flanks6) au cultate and palpates abdomen7)inspects pelvis and perineum8) applies gentle pressure over iliac crests downward and medially9)gentle pressure to symphysis pubis10)urinary catheter unless contraindicated11) Inspects AND palpates 4 extremities Hemopneumothorax - ANSair & blood (need 2 chest tubes) Hemorrhage is the leading cause. Can result from vomiting, diarrhea, and burn trauma.Decreased circulating volume --> decreased preload. Therapy includes replacing thety e of volume that was lost. - ANSHypovolemic Shock Hemorrhage is the leading cause. Can result from vomiting, diarrhea, and burn trauma.Decreased circulating volume --> decreased preload. Therapy includes replacing thety e of volume that was lost. - ANSHypovolemic Shock Hemothorax - ANSblood in the pleural space Herniation syndrome - ANSuncontrolled increases in ICP, uncal and central (shift down) or transtentorial, midline shift is seen with uncal herniation History and Head to toe MIST - prehospital reportMO Injuries sustainedS s/s the fieldT treatment in the fieldif patients family present get a better hx on them - ANSH How do you assess Mnemonic "D"? - ANSDISABILITY A = lertV = VerbalP = PainU = Unresponsive- GCS 72 How external forces in the environment are transferred to the body - ANSMechanism of injury How should you dress a severed limb? - ANSSterile gauze with normal saline THEN putice on it How should you dress a severed limb? - ANSSterile gauze with normal saline THEN putice on it How to maintain ICP < 20mmHg - ANSElevated HOB 30 DegreesProvid sedationLoosen cervical collarDrain CSFAdminister mannitol prninitiate insulin therapypromote normothemia How would you assess a patient with ocular, maxillofacial and neck trauma? - ANS(Initial assessment) HISTORY - MOI? - Acceleration/Deceleration? - What was it caused by? - Pt restrained? Airbags deployed? Etc. - What are the pt's complaints? - Pt normally wear glasses or contacts? - Pt have hx of eye problems? - Pt ever have eye surgery? -Pt have visual or ocular changes associated with chronic illness? PHYSICAL INSPECTION: - Inspect eye, orbits, face and neck - Check for symmetry, edema, ecchymosis, ptosis, lacerations and hematomas -Inspect globe for lacerations, large corneal abrasions, hyphema, and extrusion or prolapse of intraocular contents - Determine whether lid lac's - Assess pupil's (PERRL) -Unilateral fixed and dilated pupil may indicate oculomotor nerve compression as a result of ICP + herniation syndrome - Bilateral fixed and pinpoint pupils = pontine lesion or drugs - Mildly dilated pupil w/sluggish response may early sign of herniation syndrome - Widely dilated pupil occasionally occurs w/direct trauma to globe of eye - Assess for consensual response - Assess redness, eye watering, blepharospasm -Assess extraocular movement, except when an open globe injury is known or suspected. 75 - Limitation range of ocular motion may indicate orbital rim fx w/entrapment or paralysisof cr nial nerve or ocular muscle- Perform visual acuity exam- Use Snellen or handheld chart. Check uninjured eye first- Asse s for blurred or double vision with injured eye and then with both eyes open- Inspect for rhinorrhea or otorrhea- If drng present, may indicate CSF leak- Observe for impaled objects- Asse s occlusion of mandible and maxilla- Malocclusion or inability to open + close mouth is highly indicative of maxillary orandibular fx- Observe for uncontrolled bleedingPALPATION - Palpate periorbital area, face and neck for:- Tenderness- Edema- Step-off de How would you assess a patient with ocular, maxillofacial and neck trauma? - ANS(Initial assessment) HISTORY - MOI? - Acceleration/Deceleration? - What was it caused by? - Pt restrained? Airbags deployed? Etc. - What are the pt's complaints? - Pt normally wear glasses or contacts? - Pt have hx of eye problems? - Pt ever have eye surgery? -Pt have visual or ocular changes associated with chronic illness? PHYSICAL INSPECTION: - Inspect eye, orbits, face and neck - Check for symmetry, edema, ecchymosis, ptosis, lacerations and hematomas -Inspect globe for lacerations, large corneal abrasions, hyphema, and extrusion or prolapse of intraocular contents - Determine whether lid lac's - Assess pupil's (PERRL) -Unilateral fixed and dilated pupil may indicate oculomotor nerve compression as a result of ICP + herniation syndrome - Bilateral fixed and pinpoint pupils = pontine lesion or drugs - Mildly dilated pupil w/sluggish response may early sign of herniation syndrome - Widely dilated pupil occasionally occurs w/direct trauma to globe of eye - Assess for consensual response - Assess redness, eye watering, blepharospasm 76 - Assess extraocular movement, except when an open globe injury is known orsuspecte d.- Limitation range of ocular motion may indicate orbital rim fx w/entrapment or paralysisof cr nial nerve or ocular muscle- Perform visual acuity exam- Use Snellen or handheld chart. Check uninjured eye first- Asse s for blurred or double vision with injured eye and then with both eyes open- Inspect for rhinorrhea or otorrhea- If drng present, may indicate CSF leak- Observe for impaled objects- Asse s occlusion of mandible and maxilla- Malocclusion or inability to open + close mouth is highly indicative of maxillary orandibular fx- Observe for uncontrolled bleedingPALPATION - Palpate periorbital area, face and neck for:- Tenderness- Edema- Step-off de How would you assess a patient with ocular, maxillofacial and neck trauma? - ANS(Initial assessment) HISTORY - MOI? - Acceleration/Deceleration? - What was it caused by? - Pt restrained? Airbags deployed? Etc. - What are the pt's complaints? - Pt normally wear glasses or contacts? - Pt have hx of eye problems? - Pt ever have eye surgery? -Pt have visual or ocular changes associated with chronic illness? PHYSICAL INSPECTION: - Inspect eye, orbits, face and neck - Check for symmetry, edema, ecchymosis, ptosis, lacerations and hematomas -Inspect globe for lacerations, large corneal abrasions, hyphema, and extrusion or prolapse of intraocular contents - Determine whether lid lac's - Assess pupil's (PERRL) -Unilateral fixed and dilated pupil may indicate oculomotor nerve compression as a result of ICP + herniation syndrome - Bilateral fixed and pinpoint pupils = pontine lesion or drugs - Mildly dilated pupil w/sluggish response may early sign of herniation syndrome - Widely dilated pupil occasionally occurs w/direct trauma to globe of eye - Assess for consensual response 77 - LabsPl nning and Implementation- Oxygen- IV's with warmed replacement fluids- Control external bleeding with direct pressure- Elevat LE's- NGT - Foley- Monitor and pulse oximeter- Moni o for development of coagulopathies- Surgery? How would you assess a pt in hypovolemic shock? - ANS(Use Initial Assessment) and then: Inspect: - LOC - Rate and quality of respirations - External bleeding? - Skin color and moisture -Assess jugular veins and peripheral veins Auscultate: - BP - Pulse pressure - Breath sounds - Heart sounds -Bowel sounds Percuss: -Chest and abdomen Palpate: - Central pulse (carotid or femoral) -Positive inotropic effect (force of contraction) may be evidence by a bounding central pulse - Palpate peripheral pulses -Palpate skin temp and moisture Diagnostic Procedures: - Xrays and other studies - Labs Planning and Implementation - Oxygen - IV's with warmed replacement fluids - Control external bleeding with direct pressure - Elevate LE's - NGT - Foley - Monitor and pulse oximeter - Monitor for development of coagulopathies 80 - Surgery? How would you assess a pt in hypovolemic shock? - ANS(Use Initial Assessment) and then: Inspect: - LOC - Rate and quality of respirations - External bleeding? - Skin color and moisture -Assess jugular veins and peripheral veins Auscultate: - BP - Pulse pressure - Breath sounds - Heart sounds -Bowel sounds Percuss: -Chest and abdomen Palpate: - Central pulse (carotid or femoral) -Positive inotropic effect (force of contraction) may be evidence by a bounding central pulse - Palpate peripheral pulses -Palpate skin temp and moisture Diagnostic Procedures: - Xrays and other studies - Labs Planning and Implementation - Oxygen - IV's with warmed replacement fluids - Control external bleeding with direct pressure - Elevate LE's - NGT - Foley - Monitor and pulse oximeter - Monitor for development of coagulopathies - Surgery? How would you assess a pt in hypovolemic shock? - ANS(Use Initial Assessment) andthe n:Inspec t:- LOC - Rate and quality of respirations- External bleeding?- Skin color and moisture- As ess jugular veins and peripheral veins 81 Auscultate: - BP - Pulse pressure - Breath sounds - Heart sounds -Bowel sounds Percuss: -Chest and abdomen Palpate: - Central pulse (carotid or femoral) -Positive inotropic effect (force of contraction) may be evidence by a bounding central pulse - Palpate peripheral pulses -Palpate skin temp and moisture Diagnostic Procedures: - Xrays and other studies - Labs Planning and Implementation - Oxygen - IV's with warmed replacement fluids - Control external bleeding with direct pressure - Elevate LE's - NGT - Foley - Monitor and pulse oximeter - Monitor for development of coagulopathies - Surgery? How would you assess a pt with a cranial injury? - ANS(Initial assessment) INSPECTION: - Assess airway- RR, pattern and eff rt- Assess upil size and response to light- Unilateral fixed and dilated pupil = oculomotor nerve compression from increased ICP+ herniation syndrome- Bilateral fixed and pinpoint pupils indicate a pontine lesion or effects of opiates- Mildly dilated pupil w/sluggish response may be early sign of herniation syndrome- Wi ely dilated pupil occasionally occurs w/direct trauma to globe of eye- Determine if pt uses eye meds- Abnormal posturing?- Inspect craniofacial area for ecchymosis/contusions- Periorbital ecchymosis- Mastoid's process ecchymosis- Blood behind tympanic membrane- Inspect nose and ears for drainage 82 -Drng present w/out blood, test drng w/chemical reagant strip. Presence of glucose indicated drng of CSF -If drng present and mixed with blood, test by placing drop of fluid on linen or gauze. If a light outer ring forms around dark inner ring, drng contains CSF - Assess extraocular eye movement (Tests cranial nerves, III, IV, VI) - Performing extraocular eye movements indicates functioning brainstem -Limitation indicates orbital rim fx w/entrapment or paralysis of either a cranial nerve or ocular muscle -Determine LOC with GCS PALPATION - Palpate cranial area for: - Point tenderness - Depressions or deformities - Hematomas - Assess all 4 extremities for: - Motor function, muscle strength and abnormal motor posturing -Sensory function DIAGNOSTIC PROCEDURES - Lab Studies PLANNING AND IMPLEMENTATION - (Initial assessment) -Clear airway (stimulation of gag reflex can produce transient increase in ICP or vomiting with subsequent aspiration. - Administer O2 via NRB - Assist with early ET intubation - Administer sedative/neuromuscular blocking agent - Consider hyperventilation - PaCO2 above 45 How would you assess a pt with a cranial injury? - ANS(Initial assessment) INSPECTION: - ess airway- RR, pattern and eff rt- Assess pupil size and response to light- Unilateral fixed and dilated pupil = oculomotor nerve compression from increased ICP+ herniation syndrome- Bilateral fixed and pinpoint pupils indicate a pontine lesion or effects of opiat s- Mildly dilated pupil w/sluggish response may be early sign of herniation syndrome- Wi ely dilated pupil occasionally occurs w/direct trauma to globe of eye- Determine if pt uses eye meds- Abnormal posturing?- Inspect craniofacial area for ecchymosis/contusions- Periorbital ecchymosis- Mastoid's process ecchymosis- Blood behind tympanic membrane- Inspect nose and ears for drainage 85 -Drng present w/out blood, test drng w/chemical reagant strip. Presence of glucose indicated drng of CSF -If drng present and mixed with blood, test by placing drop of fluid on linen or gauze. If a light outer ring forms around dark inner ring, drng contains CSF - Assess extraocular eye movement (Tests cranial nerves, III, IV, VI) - Performing extraocular eye movements indicates functioning brainstem -Limitation indicates orbital rim fx w/entrapment or paralysis of either a cranial nerve or ocular muscle -Determine LOC with GCS PALPATION - Palpate cranial area for: - Point tenderness - Depressions or deformities - Hematomas - Assess all 4 extremities for: - Motor function, muscle strength and abnormal motor posturing -Sensory function DIAGNOSTIC PROCEDURES - Lab Studies PLANNING AND IMPLEMENTATION - (Initial assessment) -Clear airway (stimulation of gag reflex can produce transient increase in ICP or vomiting with subsequent aspiration. - Administer O2 via NRB - Assist with early ET intubation - Administer sedative/neuromuscular blocking agent - Consider hyperventilation - PaCO2 above 45 How would you assess a pt with a thoracic injury? - ANS(Initial assessment) Obtain Hx.PHYSICAL: Inspectio n : - Observe chest wall- Assess breathing effort and RR- Symmetr y - Inspec jugular vein (Distended = increased intrathorac c pressure as re ult oftension pneumothorax or pericardial tamponade. Flat = external jugular veins mayr flect hypovolemia)- Inspect upper abdominal region for injuryPercussion :- Percuss the chest (Dullness = hemothorax, Hyperresonance = pneumothorax)Palpation :- Palpate chest wall, clavicles and neck for:- Tenderness- Sw lling or hematoma 86 - Subcutaneous emphysema- Note presence of bony crepitus- Palpate central and peripheral pulses and compare quality between:- Right and left extremities- Upper and lower extremities- Palpate the trachea (above suprasternal notch. Trach shift may indicate late sign oftension pneumothorax or massive hemothorax)- Palpate e tremities for motor and sensory function (lower extremitiy paresis orparalysis may indicate aortic injury).Auscultatio n:- Auscultate compare BP in both UE's and LE's- Auscultate breath sounds (decreased or absent breath = pneumo or hemothorax.Dimins ed BS = splinting. Shallow = b/c of pain).- Auscultate chest for presence of BS (diaphragmatic rupture)- Auscultate Heart sounds (muffled = pericardial tamponade)- Auscultate neck vessels for bruits (vascular injury)Diagnostic Procedures:- Xrays- Arteriograph y - Bronchoscopy and laryngoscopy- CT's- FAST - Labs (cardiac enzymes)- ECG, CVP How would you assess a pt with a thoracic injury? - ANS(Initial assessment)Obtain Hx.PHYSICAL: Inspectio n : - Observe chest wall- Assess breathing effort and RR- Symmetr y - Inspec jugular veins (Distended = increased intrathoracic pressure as result oftension pneumothorax or pericardial tamponade. Flat = external jugular veins mayr flect hypovolemia)- Inspect upper abdominal region for injuryPercussion :- Percuss the chest (Dullness = hemothorax, Hyperresonance = pneumothorax)Palpation :- Palpate chest wall, clavicles and neck for:- Tenderness- Sw lling or hematoma- Subcutaneous emphysema- Note presence of bony crepitus- Palpate central and peripheral pulses and compare quality between:- Right and left extremities 87 - Auscultate breath sounds (decreased or absent breath = pneumo or hemothorax.Dimins ed BS = splinting. Shallow = b/c of pain).- Auscultate chest for presence of BS (diaphragmatic rupture)- Auscultate Heart sounds (muffled = pericardial tamponade)- Auscultate neck vessels for bruits (vascular injury)Diagnostic Procedures:- Xrays- Arteriograph y - Bronchoscopy and laryngoscopy- CT's- FAST - Labs (cardiac enzymes)- ECG, CVP How would you care for a pt with an Abdominal Injury? - ANS(Initial assessment) Obtain Hx. PHYSICAL: Inspection: - Observe the lower chest for asymmetric chest wall movement. -Observe the contour of the abdomen. Distention may indicate bleeding -Inspect lower chest, abdomen, flanks, and back for seat belt abrasions or soft tissue injuries -Inspect pelvic area for soft tissue bruising Percussion: -Percuss for hyperresonance or dullness. Hyperresonance indicates air, dullness indicates fluid. Palpation: -Palpate all four quadrants. Press and quickly release to determine presence of rebound tenderness. -Palpate pelvis for bony instability, asymmetry, or pain. -Palpate flanks for tenderness -Palpate anal sphincter for presence or absence of tone Auscultation: -Auscultate the chest. If bowel sounds heard in chest may have diaphragmatic rupture with herniation of the stomach or small bowel -Auscultate bowel sounds. Absence indicative of visceral injury. Diagnostic Procedures: - Xrays - MRI - IVP and DPL - CT's - FAST - Labs (cardiac enzymes) -Cystogram or urethrogram -Angiography 90 How would you care for a pt with an Abdominal Injury? - ANS(Initial assessment) Obtain Hx. PHYSICAL: Inspection: - Observe the lower chest for asymmetric chest wall movement. -Observe the contour of the abdomen. Distention may indicate bleeding -Inspect lower chest, abdomen, flanks, and back for seat belt abrasions or soft tissue injuries -Inspect pelvic area for soft tissue bruising Percussion: -Percuss for hyperresonance or dullness. Hyperresonance indicates air, dullness indicates fluid. Palpation: -Palpate all four quadrants. Press and quickly release to determine presence of rebound tenderness. -Palpate pelvis for bony instability, asymmetry, or pain. -Palpate flanks for tenderness -Palpate anal sphincter for presence or absence of tone Auscultation: -Auscultate the chest. If bowel sounds heard in chest may have diaphragmatic rupture with herniation of the stomach or small bowel -Auscultate bowel sounds. Absence indicative of visceral injury. Diagnostic Procedures: - Xrays - MRI - IVP and DPL - CT's - FAST - Labs (cardiac enzymes) -Cystogram or urethrogram -Angiography How would you care for a pt with an Abdominal Injury? - ANS(Initial assessment) Obtain Hx.PHYSICAL: Inspectio n:- Observe the lower chest for asymmetric chest wall movement.-Obs rv the contour of the abdomen. Distention may indicate bleeding-Inspect lower chest, abdomen, flanks, and back for seat belt abrasions or soft tissueinjurie s-Inspect pelvic area for soft tissue bruisingPercussion :- Percuss for hyperresonance or dullness. Hyperresonance indicates air, dullnessindicate fluid.Palpatio n: 91 - Palpate all four quadrants. Press and quickly release to determine presence ofrebou d tenderness.-Palpate pelvis for bony instability, asymmetry, or pain.-Palpate flanks for tenderness-Palpate anal sphincter for presence or absence of toneAuscultatio n:-Auscultate the chest. If bowel sounds heard in chest may have diaphragmatic rupturewith erniation of the stomach or small bowel-Auscultate bowel sounds. Absence indicative of visceral injury.Diagnostic Procedures:- Xrays- MRI- IVP and DPL- CT's- FAST - Labs (cardiac enzymes)-Cystogram or urethrogram-Angiography How would you care for a pt with an Abdominal Injury? - ANS(Initial assessment) Obtain Hx. PHYSICAL: Inspection: - Observe the lower chest for asymmetric chest wall movement. -Observe the contour of the abdomen. Distention may indicate bleeding -Inspect lower chest, abdomen, flanks, and back for seat belt abrasions or soft tissue injuries -Inspect pelvic area for soft tissue bruising Percussion: -Percuss for hyperresonance or dullness. Hyperresonance indicates air, dullness indicates fluid. Palpation: -Palpate all four quadrants. Press and quickly release to determine presence of rebound tenderness. -Palpate pelvis for bony instability, asymmetry, or pain. -Palpate flanks for tenderness -Palpate anal sphincter for presence or absence of tone Auscultation: -Auscultate the chest. If bowel sounds heard in chest may have diaphragmatic rupture with herniation of the stomach or small bowel -Auscultate bowel sounds. Absence indicative of visceral injury. Diagnostic Procedures: - Xrays - MRI - IVP and DPL - CT's 92 Slightly elevated BP could protect against brain ischemia in a pt with high ICP. Cerebralischemia c n lead to increased concentration of CO2 and decreased concentration ofO2 in cerebral vessels. CO2 dilates cerebral blood vessels = increase blood volume andICP. IF clothing is needed for evidence preserve in paper bag. Maintain body temp - cover the pt, turn up heat in room, administer warm fluids - ANSE Interventions: If injury causes the CPP to fall outside the range of 50 - 160, the brain loses its ability to ... and CBF is directly dependent on ... for perfusion - ANSAuto regulate ; MAP If injury causes the CPP to fall outside the range of 50 - 160, the brain loses its ability to ... and CBF is directly dependent on ... for perfusion - ANSAuto regulate ; MAP If injury causes the CPP to fall outside the range of 50 - 160, the brain loses its ability to ... and CBF is directly dependent on ... for perfusion - ANSAuto regulate ; MAP immobilize cervical spine, tenderness, tracheal deviation - ANSHead to toe assessment: Neck and cervical spine Impalements - ANS-DO NOT remove the object -Stabilize/Support the Object-Tape in Place if possible, prepare for OR-Object removed in OR in massive transfusion protocol... responsible for dissolving clots - ANSTXA In the ... ... response two catecholamines are released ... and ... . - ANSAdrenal gland response; epinephrine and norepinephrine In the ... ... response two catecholamines are released ... and ... . - ANSAdrenal gland response; epinephrine and norepinephrine In the ... ... response two catecholamines are released ... and ... . - ANSAdrenal gland response; epinephrine and norepinephrine In the adrenal gland response ... is released to raise blood glucose and promote renal retention of water and sodium. - ANSCortisol In the adrenal gland response ... is released to raise blood glucose and promote renal retention of water and sodium. - ANSCortisol In the adrenal gland response ... is released to raise blood glucose and promote renal retention of water and sodium. - ANSCortisol 95 In those with traumatic brain injury where should you maintain the systolic pressure? - ANSgreater than 90 mmHG Inflammatory response - ANSactivated by hypoxia, neutrophils travel to injury site Initial fluid management for patient in shock - ANS1L -2L warmed fluid bolus (NS or LR -crystolloids - pref towards LR as to not cause hyperchloremic metabolic acidosis fromlarge amount of NS) if no evidence of CHF inspect for lacs, abrasions, asymmetry of facial expressions palate for depressions and tenderness look at ears for drainage - ANSHead to toe assessment: Head and face inspect posterior surfaces blogroll with at least 3 people. maintain c spine take out backboard Rectal tone per MD - ANSI inspect, auscultate, palpate any spontaneous breathing, rate, depth, and degree of effort, use of accessory muscles lacs, contusions, auscilate lung sounds and heart sounds - ANSHead to toe assessment: Chest Internal Abdominal Injuries - ANS-Most common "Missed Injury"-Vulnerable Organs: spleen, liver, bladder, bowel, kidneys, aorta-Ongoing assessment needed Intracerebral hematoma - ANSdeep in brain tissue, HA, increased ICP, LOC, pupil changes, frontal lobe more risk for sig herniation Intracranial pressure - ANSNormal ranges 0-15 mm Hg. Intubation with RSI-assess 5 - ANS-assess placement with CO2 detector, bilateral chestrise and fall, auscultation of breath sounds and epigastrium, 5-6 breaths CO2, skin color Intubation- post assessment - ANS- secure at the lip, number at the teeth 96 -state need for a vent Irreversible damage - ANSobtunded comatose, sbp 50-60, brady, shallow resp death Ischemia develops -- Pressure Fasical Development -- Impaired Blood Flow. 6 P's: Pressure, pallor, pulses, paresthesia, paralysis. Extremity goes to level of the !!! NO !! - ANSCompartment Syndrome: Level of heart; NO ice!!Ischemia develops -- Pressure Fasical Development -- Impaired Blood Flow. 6 P's: Pressure, pallor, pulses, paresthesia, paralysis. Extremity goes to level of the !!! NO !! - ANSCompartment Syndrome: Level of heart; NO ice!!jaw thrust maneuver to open airway and assess for obstruction. If pt has a suspectedcsi, the jaw thrust procedure should be done by two providers. One provider canmaintain c-spine and the other can perform the jaw thrust maneuver. - ANSWhileassessing airway pt is unable to open mouth, responds only to pain, or is unresponsiveyou should.. Kehr sign - ANSshoulder pain referred from the diaphragm when it is irritated by bloodwithin the a d minal cavity Kinect is energy is equal to ... - ANS1/2 the mass x by the velocity squared (v^2) Kinect is energy is equal to ... - ANS1/2 the mass x by the velocity squared (v^2) Kinect is energy is equal to ... - ANS1/2 the mass x by the velocity squared (v^2) Lab evidence of cellular perfusion - ANSBase Excess (Less than -6 is BAD) Lab evidence of cellular perfusion - ANSBase Excess (Less than -6 is BAD) Lab studies for shock pt - ANSINR/PT/Ptt - ongoingABG with lactate - ongoingCalcium Leve l Toxicology screenType+Scree nCBC w/Diff H+H BUN +CreBMP Liver profile labs, wound care, tetanus, administer meds, prepare for transfer - ANSSecondary Revaldjunct s Late assessment findings of increased ICP include: - ANS- DILATED, NON- REACTIVEPUPILS - UNRESPONSIVENESS to verbal/painful stimuli 97