(no subject)
So last time I posted it was first day of Trauma. Today was last day of trauma. Techinically. Monday I still need to test for my scenario, but those are pretty easy.
Today was the trauma written exam, which turned out to be harder than I expected. I feel like I kept making stupid mistakes and could have done wayyyy better. I don't know if I passed yet. I'm tired of squeaking by, but I'll take anything with a P.
Here is my study guide for the test.
ET tube size in pediatric pt=over two years old-(age in years/4) + 4
ET tube depth in pediatric pt=3x tube size
Roulaux formations- happen in decompensated shock, coin like rolls of red blood cells.
Decorticate posturing occurs at C6
C1-C5=Neck
T2-T4=Nipple line
T9-T11=Umbilicus
T12-L1=Groin
Treat flail chest segment with positive pressure ventilations, may cause trauma, but should stabilize the bone ends.
Cord injuries-
Concussion-like head injury, temporary and transient disruption of cord function
Contusion- bruising
Compression- secondary to displacement of vertebral bone fragment or from swelling of adjacent tissue
Transection-severing spinal cord (complete or partial)
Do not put pressure on eye injuries
Cardiac Tamponade= caused by penetrating trauma, or rupture of coronary arteries, blood seeps into sac surrounding the heart. The sac does not stretch, causing pressure from added fluid in pericardium to compress the heart, limiting its ability to relax fully, and fill with blood, (or to preload), which then inhibits cardiac output. This is presented in a pt with systemic hypotension, because of the decreased output of the heart, muffled heart tones, because there is not room for the normal amount of fluid hitting the valves in the heart that causes the normal sounding heart tones, and JVD, caused by the back up of blood from the lack of cardiac output. These findings are called Beck’s Triad. The pressure on the heart, which will be made worse on inspiration, may cause lack of radial pulses when the pt inhales. Kussmaul’s sign may also be present, which is absence of JVD when the pt exhales, caused by the decrease of pressure on the heart with exhalation.
Parkland Baxter formula-4ml x % BSA burned, ½ in first 8 hours, 2nd ½ over following 16 hours.
*be able to calculate drops per minute for a given time frame.
Kuhr’s sign-referred left shoulder pain from ruptured spleen.
Rule of nines-
Adult=
Head=9%
Posterior/Anterior trunk-18%
Lower Extremity-18%
Upper Extremity-9%
Child-
Head-18%
Posterior/Anterior Trunk-18%
Lower extremity-13.5%
Upper extremity-9%
*for each year above 1, up to 10 yrs, subtract 1% from head and add 0.5% to each lower extremity.
Hering Breur Reflex-stretch receptors in the lungs signal respiratory center via vagus nerve
Vagus nerve-inhibits inspiration
Phrenic nerve- signals inspiration
Hyphema-anterior chamber of the eye
Subconjunctival Hemorrhage- bleeding occurs between sclera and cornea, stops at corneal margin.
Cushing’s Triad-Low HR, Hypertension, irregular breathing
Cerebrum-Skeletal movement, emotions, senses
Cerebellum-Coordination, balance
Brain stem- Vegetative functions, vital signs.
Damage to sympathetic nervous system will result in vasodilation
Tendons-muscle to bone
Ligaments-bone to bone
LOC most reliable indication of head injury
GCS Qualifications=
Eye-4 (None, opening in response to pain, opening to speech, normal)
Verbal-5 (none, incomprehensible, confused, oriented)
Motor-6 (none, extension to pain, abnormal flexion to pain (decerebate), Flexion/Withdrawal from pain (decorticate), localizes pain, normal)
Spinal cord injury (neurogenic shock) - Above injury site-normal for hypovolemic shock (cool, clammy), below injury site (warm, pink, flushed)
Dosage calcs-
The best way to do it is to break it down by how much
you are going to give per hour. So, if your total
amount of fluid is going to be 22400 and half of that
is given in the first 8 hours, then you get 11,200 in
8 hours which is the same as 1,400 cc per hour
correct? 11,200/8=1400. So you use this to calculate
how many drops...
Brown Sequard syndrome (penetrating)- hemitrasection, s
Ipsilateral-sensory/motor loss
Contralateral- loss of pain/temperature
Anterior cord syndrome (compression)- condition caused by compression of the arteries of the anterior spinal cord, and resulting in loss of motor function and sensation to pain, light touch and temp below injury site.
Central cord syndrome (hyperextension)-condition that usually related to hyperextension of c-spine that results in weakness, usually in the upper extremities and possible bladder dysfunction.
Cauda Equina syndrome (nerve roots compressed)- condition caused when nerve roots at the lower end (below L2) of the spinal cord are compressed, interrupting sensation, movement and function in the lower body.
Tension pneumothorax- can progress from either a simple or an open pneumothorax that maintains a greater pressure than atmospheric pressure within the thorax. May be caused by trauma or by positive pressure ventilation of a pt with chest trauma or congenital defect affecting bronchioles. Occurs because a one way valve is formed from ventilations (air cannot escape chest cavity, so with each breath, air trapped increases in pressure, which eventually collapses the effected lung. Intercostal and suprasternal bulging occurs and begins to exert pressure on the mediastinum. As pressure continues to build, it displaces the mediastinum, compressing the uninjured lung and vena cava as it enters the thorax through the diaphragm, where it attaches to the heart, reducing venous return, resulting in JVD, and narrowing pulse pressure. Tracheal deviation may occur also.
HYPOVOLEMIC SHOCK-
Hypovolemic shock is known as shock caused by fluid loss (hypovolemia), which leads to decreased cardiac output, and tissue ischemia. It can be caused by bleeding, internal or external, seeping wounds, excessive sweating, diarrhea, vomiting, excessive urination and generally dehydration. Each of these causes’ leads to inadequate tissue perfusion, which causes a change from aerobic metabolism to anaerobic metabolism. The body tries to compensate for the lack of homeostasis, by increasing the heart rate, constricting the blood vessels, and retaining water and sodium, to retain fluid bases. Additionally, blood glucose levels will begin to rise and the respiratory rate will increase (hyperventilation) in an attempt to blow off the effects of lactic acidosis which we found when the body switched over from aerobic to anaerobic metabolism. The body will compensate like this for a short time, before depcompensating. Cells are functioning on anaerobic metabolism which causes a buildup of lactic acid and does not produce enough energy to sustain cellular life. The cells experience a failure of the sodium potassium pump. When the pump fails, the cells can receive O2, but are unable to use it, which leads to cell, tissue and organ death.
I have finished my OR clinicals for this semester. I was super super excited to have those OVER. I danced in the OR. I did have one good rotation, in which Jeff, a CRNA, basically held my hand the whole time and helped me find everything I needed. I felt lame, but I got my tubes so that's all that matters. I've had one ER already this semester too. It was decent, I need alot more IVs, and all the pt assessment competency, because I didn't find it until after. And getting all five pt assessments is hard, but I'm getting better at it.
Today was the trauma written exam, which turned out to be harder than I expected. I feel like I kept making stupid mistakes and could have done wayyyy better. I don't know if I passed yet. I'm tired of squeaking by, but I'll take anything with a P.
Here is my study guide for the test.
ET tube size in pediatric pt=over two years old-(age in years/4) + 4
ET tube depth in pediatric pt=3x tube size
Roulaux formations- happen in decompensated shock, coin like rolls of red blood cells.
Decorticate posturing occurs at C6
C1-C5=Neck
T2-T4=Nipple line
T9-T11=Umbilicus
T12-L1=Groin
Treat flail chest segment with positive pressure ventilations, may cause trauma, but should stabilize the bone ends.
Cord injuries-
Concussion-like head injury, temporary and transient disruption of cord function
Contusion- bruising
Compression- secondary to displacement of vertebral bone fragment or from swelling of adjacent tissue
Transection-severing spinal cord (complete or partial)
Do not put pressure on eye injuries
Cardiac Tamponade= caused by penetrating trauma, or rupture of coronary arteries, blood seeps into sac surrounding the heart. The sac does not stretch, causing pressure from added fluid in pericardium to compress the heart, limiting its ability to relax fully, and fill with blood, (or to preload), which then inhibits cardiac output. This is presented in a pt with systemic hypotension, because of the decreased output of the heart, muffled heart tones, because there is not room for the normal amount of fluid hitting the valves in the heart that causes the normal sounding heart tones, and JVD, caused by the back up of blood from the lack of cardiac output. These findings are called Beck’s Triad. The pressure on the heart, which will be made worse on inspiration, may cause lack of radial pulses when the pt inhales. Kussmaul’s sign may also be present, which is absence of JVD when the pt exhales, caused by the decrease of pressure on the heart with exhalation.
Parkland Baxter formula-4ml x % BSA burned, ½ in first 8 hours, 2nd ½ over following 16 hours.
*be able to calculate drops per minute for a given time frame.
Kuhr’s sign-referred left shoulder pain from ruptured spleen.
Rule of nines-
Adult=
Head=9%
Posterior/Anterior trunk-18%
Lower Extremity-18%
Upper Extremity-9%
Child-
Head-18%
Posterior/Anterior Trunk-18%
Lower extremity-13.5%
Upper extremity-9%
*for each year above 1, up to 10 yrs, subtract 1% from head and add 0.5% to each lower extremity.
Hering Breur Reflex-stretch receptors in the lungs signal respiratory center via vagus nerve
Vagus nerve-inhibits inspiration
Phrenic nerve- signals inspiration
Hyphema-anterior chamber of the eye
Subconjunctival Hemorrhage- bleeding occurs between sclera and cornea, stops at corneal margin.
Cushing’s Triad-Low HR, Hypertension, irregular breathing
Cerebrum-Skeletal movement, emotions, senses
Cerebellum-Coordination, balance
Brain stem- Vegetative functions, vital signs.
Damage to sympathetic nervous system will result in vasodilation
Tendons-muscle to bone
Ligaments-bone to bone
LOC most reliable indication of head injury
GCS Qualifications=
Eye-4 (None, opening in response to pain, opening to speech, normal)
Verbal-5 (none, incomprehensible, confused, oriented)
Motor-6 (none, extension to pain, abnormal flexion to pain (decerebate), Flexion/Withdrawal from pain (decorticate), localizes pain, normal)
Spinal cord injury (neurogenic shock) - Above injury site-normal for hypovolemic shock (cool, clammy), below injury site (warm, pink, flushed)
Dosage calcs-
The best way to do it is to break it down by how much
you are going to give per hour. So, if your total
amount of fluid is going to be 22400 and half of that
is given in the first 8 hours, then you get 11,200 in
8 hours which is the same as 1,400 cc per hour
correct? 11,200/8=1400. So you use this to calculate
how many drops...
Brown Sequard syndrome (penetrating)- hemitrasection, s
Ipsilateral-sensory/motor loss
Contralateral- loss of pain/temperature
Anterior cord syndrome (compression)- condition caused by compression of the arteries of the anterior spinal cord, and resulting in loss of motor function and sensation to pain, light touch and temp below injury site.
Central cord syndrome (hyperextension)-condition that usually related to hyperextension of c-spine that results in weakness, usually in the upper extremities and possible bladder dysfunction.
Cauda Equina syndrome (nerve roots compressed)- condition caused when nerve roots at the lower end (below L2) of the spinal cord are compressed, interrupting sensation, movement and function in the lower body.
Tension pneumothorax- can progress from either a simple or an open pneumothorax that maintains a greater pressure than atmospheric pressure within the thorax. May be caused by trauma or by positive pressure ventilation of a pt with chest trauma or congenital defect affecting bronchioles. Occurs because a one way valve is formed from ventilations (air cannot escape chest cavity, so with each breath, air trapped increases in pressure, which eventually collapses the effected lung. Intercostal and suprasternal bulging occurs and begins to exert pressure on the mediastinum. As pressure continues to build, it displaces the mediastinum, compressing the uninjured lung and vena cava as it enters the thorax through the diaphragm, where it attaches to the heart, reducing venous return, resulting in JVD, and narrowing pulse pressure. Tracheal deviation may occur also.
HYPOVOLEMIC SHOCK-
Hypovolemic shock is known as shock caused by fluid loss (hypovolemia), which leads to decreased cardiac output, and tissue ischemia. It can be caused by bleeding, internal or external, seeping wounds, excessive sweating, diarrhea, vomiting, excessive urination and generally dehydration. Each of these causes’ leads to inadequate tissue perfusion, which causes a change from aerobic metabolism to anaerobic metabolism. The body tries to compensate for the lack of homeostasis, by increasing the heart rate, constricting the blood vessels, and retaining water and sodium, to retain fluid bases. Additionally, blood glucose levels will begin to rise and the respiratory rate will increase (hyperventilation) in an attempt to blow off the effects of lactic acidosis which we found when the body switched over from aerobic to anaerobic metabolism. The body will compensate like this for a short time, before depcompensating. Cells are functioning on anaerobic metabolism which causes a buildup of lactic acid and does not produce enough energy to sustain cellular life. The cells experience a failure of the sodium potassium pump. When the pump fails, the cells can receive O2, but are unable to use it, which leads to cell, tissue and organ death.
I have finished my OR clinicals for this semester. I was super super excited to have those OVER. I danced in the OR. I did have one good rotation, in which Jeff, a CRNA, basically held my hand the whole time and helped me find everything I needed. I felt lame, but I got my tubes so that's all that matters. I've had one ER already this semester too. It was decent, I need alot more IVs, and all the pt assessment competency, because I didn't find it until after. And getting all five pt assessments is hard, but I'm getting better at it.