Exam Notes MDC4 Final study guide
Parkland Formula
a) 4ml x % BSA x weight (kg)= volume of fluid that needs to be infused
b) ½ of the total volume
... [Show More] of fluid in first 8 hours
c) Last half in 16 hours
MAP Calculation
a) MAP= 1/3 * SBP + 2/3 * DBP
Treatment for frostbite
a) Rewarming the skin
a. Rewarm the area using a warm-water bath for 15 to 30 minutes
b. Skin may turn soft and look red or purple
c. You may be encouraged to gently move the affected area as it rewarms.
b) Oral pain medicine
a. The rewarming process can be painful
c) Protecting the injury
a. Once the skin thaws, loosely wrap the area with sterile sheets, towels, or dressing to protect the skin.
b. May have to protect fingers and toes as they thaw by gently separating them from each other
c. You may need to elevate the affected area to reduce swelling
d) Debridement (removal of damaged tissue)
a. To heal properly, frostbitten skin needs to be free of damaged, dead or infected tissue.
e) Whirlpool therapy or physical therapy
a. Hydrotherapy can aid healing by keeping skin clean and naturally removing dead tissue
b. Pt may be encouraged to move the affected area
f) Antibiotics
a. If the skin or blisters appear to be infected, the doctor may prescribe oral antibiotics
g) TPA
a. IV injection of a drug that helps restore blood flow (thrombolytic) such as TPA.
b. TPA lowers the risk of amputation
c. These drugs can cause serious bleeding and are typically used only in the most serious situations and within 24 hours of exposure.
h) Wound care
i) Surgery
a. Severe frostbite patients may need surgery or amputation to remove dead or decaying tissue.
j) Hyperbaric oxygen therapy
a. Some patients show improved symptoms after this therapy, but more study is needed.
Treatment and differences of heat stroke and heat exhaustion
a) Heat exhaustion
a. Symptoms
i. General weakness, increased heavy sweating, a weak but faster HR, N/V, possible fainting, pale/cold/clammy skin
b. Treatment
i. Stop physical activity, transfer to cool space
ii. Cooling measures (ice water bath, mist skin with water, ice packs, special cooling blanket)
iii. Rehydration therapy
b) Heat stroke
a. Symptoms
i. Elevated body temperature above 103 F (39.4 C), rapid and strong HR, loss or change of consciousness, hot, red, dry, or moist skin
b. Treatment
i. Oxygen therapy, IV lines, urinary catheter, continuous cooling (Ice bath, mist skin with water, ice packs, special cooling blanket), benzodiazepine if shivering occurs, monitor for multi system organ dysfunction syndrome and electrolyte imbalances.
Priority assessment in triage
a) ABC’s
Temperature reduction strategies
a) Ice bath, mist skin with water, ice packs, special cooling blanket
Skin injury related to frostbite
a) Frostbite occurs in several stages:
a. Frostnip
i. Mild form of frostbite- does not permanently damage the skin
ii. Continued exposure leads to numbness in the affected area
iii. As the skin warms, the patient may feel pain and tingling.
b. Superficial Frostbite
i. Appears as reddened skin that turns white or pale
ii. The skin may begin to feel warm- a sign of serious skin involvement
iii. If you treat frostbite with rewarming at this stage, the surface of skin may appear mottled and you may notice stinging, burning, and swelling
iv. Fluid-filled blisters may appear 12 to 36 hours after rewarming the skin
c. Deep (Severe) Frostbite
i. Skin turns white or bluish grey, and the patient may experience numbness, losing all sensation of cold, pain, or discomfort in the affected area.
ii. Joints/muscles may no longer work
iii. Large blisters form 24-48 hours after rewarming. Afterwards, the area turns black and hard as the tissue dies.
Rationale for arrythmias in hypothermia
a) The risk of cardiac arrest increases as the core temperature drops below 32°C, and increases substantially if the temperature reaches less than 28°C (Brown et al. 2012). At this level, a severe depression of critical body functions occurs
Blunt chest injury assessment
a) Primary assessment treatments
a. Based on the mechanism of injury, consider manual stabilization of the cervical spine until a more complete spinal exam can be accomplished. Establish and maintain a patent airway while determining the patient's level of consciousness using the AVPU scale. If the patient is not fully awake or alert, manual airway positioning and basic airway adjuncts such as an OPA or NPA may be needed. Suctioning an airway filled with blood or emesis may be necessary.
b) Seal chest wounds
a. Any open chest wound should be sealed as soon as it is found, using the palm of a gloved hand at first, followed by an occlusive dressing.
c) Relieve tension pneumothorax
a. Tachypnea, hypopnea (shallow breathing) and accessory muscle use are key indicators of respiratory distress or failure. Expose the chest and auscultate lung fields immediately. Diminished sounds over one side may indicate a loss of lung capacity, either from a hemothorax, pneumothorax or both.
b. Inspect the neck and chest area. Jugular venous distension may indicate greater than normal pressure within the chest cavity, possibly related to a developing tension pneumothorax. Hyperinflation of the chest over one side is another sign related to a tension pneumothorax. If the patient's mental status worsens and blood pressure falls, a decompression of the tension pneumothorax using a long, large gauge angiocatheter is needed to relieve the excessive pressure in the chest.
d) Control hemorrhage
a. Control any major external bleeding immediately with direct pressure. It will be difficult to create a pressure dressing, as is more commonly seen with extremity injuries. Manual pressure may be needed to stop the bleeding. Recognize that the chance of active bleeding inside the chest is significant and emergent transport to a trauma center is needed.
e) Package for transport
a. Unless there are clear signs of neurological deficit, avoid placing the patient with penetrating chest trauma in spinal precautions. Being supine may worsen respiratory distress and delay transport.
b. In general, on-scene management of chest trauma should be done with BLS interventions, with the intent to begin transport to a trauma center as soon as feasible. With the exception of the needle decompression, other advanced level procedures are best done while en route.
Addressing ventilator alarms
a) Should never be turned off or ignored during mechanical ventilation
b) The major alarms on the ventilator indicate either a high pressure or low exhaled volume
c) If the alarm cannot be determined, ventilate the patient manually with a resuscitation bag until the problem is corrected by another health care professional
Fractured ribs and flail chest
a) Rib fracture
a. Important info
i. The most common cause is blunt trauma from a fall or car accident. Trauma can increase your risk for organ damage when your rib is fractured.
ii. Older age, osteoporosis, or a tumor can increase your risk for rib fractures.
iii. A stress fracture can happen in your upper or middle ribs. Stress fractures can happen when you have a forceful long-term cough. They can also be caused by forceful athletic movements, such as in golf, throwing, or rowing.
iv. A condition called flail chest occurs if 3 or more of your ribs are broken in 2 or more places. This condition may make it hard for you to breathe.
b. Signs and symptoms
i. Chest wall pain that worsens when you breathe, move, or cough
ii. Bruising or swelling near your injury
iii. Shortness of breath or difficulty taking a deep breath
c. Treatment
i. Medications
1. NSAIDs , such as ibuprofen, help decrease swelling, pain, and fever.
2. Prescription pain medicine may be given.
3. Intercostal nerve block may be given to numb the injured area for about 6 hours. It is given as a shot between 2 of your ribs in the fractured area. You may need this if your pain continues or is getting worse even after you take oral pain medicines.
ii. Surgery may be needed if your rib fracture is severe or several ribs are badly broken. Surgery is often needed for a flail chest.
d. Management of symptoms
i. Take deep breaths and cough 10 times each hour. This will decrease your risk for a lung infection. Hug a pillow on your injured side to decrease pain while you take deep breaths. Take a deep breath and hold it for as long as you can. Let the air out and then cough. Deep breaths help open your airway. You may be given an incentive spirometer to help you take deep breaths. Put the plastic piece in your mouth and take a slow, deep breath, then let the air out and cough. Repeat these steps 10 times every hour.
ii. Rest and limit activity as directed. Do not pull, push, or lift objects. Start to do more as your pain decreases.
iii. Apply ice on your chest near your fractured rib for 15 to 20 minutes every hour or as directed. Use an ice pack, or put crushed ice in a plastic bag.
b) Flail chest
Cover it with a towel. Ice helps prevent tissue damage and decreases swelling and pain.
a. an injury that occurs typically following a blunt trauma to the chest. When three or more ribs in a row have multiple fractures within each rib, it can cause a part of your chest wall to become separated and out of sync from the rest of your chest wall.
b. The chest moving unevenly between the separated part and rest of the chest is often the most definitive sign that you have a flail chest. The area of your chest that’s been traumatized will draw in when you breathe in, while the rest of your chest expands outward. When you breathe out, the affected area will expand out while the rest of your chest draws in.
c. Treatment
i. Your doctors will need to protect your lungs while ensuring that you can breathe adequately. They will give you an oxygen mask to assist your breathing and give you medication to help with your pain.
ii. In more serious cases where there is associated underlying lung injury, you may need to be put on a mechanical ventilator in order to keep your chest cavity stable. It’s possible that surgery will be required, depending on the extent of injury and risks versus benefits of surgery.
Chest injury
a) Patients may be asymptomatic at first and can later develop various degrees of respiratory failure and possibly pneumonia
b) These patients often have decreased breath sounds or crackles and wheezes over the affected area
c) Other symptoms include bruising over the injury, dry cough, tachycardia, tachypnea, and dullness to percussion.
d) At first the chest x ray may show no abnormalities but a hazy opacity in the lobes or parenchyma may develop over several days
e) Management includes maintenance of ventilation and gas exchange
Pneumothorax
a) Collapsed lung
b) Signs and symptoms
a. sudden chest pain and shortness of breath.
c) Causes
a. Chest injury.
i. Any blunt or penetrating injury to your chest can cause lung collapse. Some injuries may happen during physical assaults or car crashes, while others may inadvertently occur during medical procedures that involve the insertion of a needle into the chest.
b. Lung disease.
c. Ruptured air blisters. [Show Less]