EXAM 1 STUDY GUIDE
EMERGENCY/TRAUMA
TRIAGE:
EMERGENT- MI, stroke, hemorrhage, DKA, oncology, SCA.
URGENT- Abd pain, compound fracture, kidney stones
NON-EMERGENT- UTI,flu/cold, etc.
LEVELS & FUNCTIONS OF TRAUMA:
LEVEL 1- usually within large teaching hospitals in densely populated areas. Provides
FULL continuum of trauma services for adults & pediatrics. (total collaborative care for
every aspect of injury).
LEVEL 2- community hospital, provides care to most injured patients. Transfers patient’s
if needed. (May not have resources for very complex pts).
LEVEL 3- Stabilizes pts with major injuries. Transfers pt if excess resources are needed.
(DO NOT have ready access to level 1 & 2).
LEVEL 4- located in rural or remote areas. Provides basic trauma pt stabilization &
advanced life support within resource capabilities. Arrange transfer to higher trauma
levels as necessary. (establish close relationships with level 1 & 2).
Disaster Triage= limited resources (mass casualty)
TAGS:
RED- critical (prevent black), pediatric 2nd degree burns, TBI
YELLOW- open fracture wound
GREEN- walking wounded, concussion
BLACK- Death, severe head injury, dilatated pupil’s/fixed, non-reactive, non-verbal.
PRIMARY SURVEY: (ABCDE)
A- AIRWAY/cervical spine (jaw alignment), obstruction, O2, stridor.
B- BREATHING, breath sounds, chest expansion/rise & fall.
C- CIRCULATION, HR/pulse, color, capillary refill, BP.
D- DISABILITY, LOC/neuro, AVPU (GCS) orientation.
E- EXPOSURE, evidence/assessment (remove clothing).
*Stridor- airway closing (priority)
*Agonal breaths- CPR or intubate
SECONDARY SURVEY: (identify/comprehensive)
F- Full set of vitals & family present
G- Get monitoring devices/gastric tube.
Allergies, monitor on ECG, pain assessment, lab testing, events.
A- ALERT
V- VERBAL
P- PAIN
U- UNRESPONSIVE
HEAT STROKE:
RISK- Body temp exceeds 104 F.
PREVENTION- stay hydrated, A/C, open windows
TX- (HOME)- splash cool water, sports drink, remove excess clothing.
(HOSPITAL)- cooling blanket, ice pack on groin, IV, oxygen, CBC, rectal temp.
Exertional- wearing heavy clothing.
Classic heat stroke- chronic exposure to heat like home w/out A/C.
UNTREATED- organ dysfunction, death, seizures, thermal regulation fail, muscle breakdown
(rhabdomyolysis).
HYPOTHERMIA:
RISK- body temp 95 F or lower.
S/S:
Mild (home)- shivering, decrease muscle coordination, impaired cognition, diuresis.
Moderate (hospital)- muscle weakness, increased loss of coordination, acutely confused,
apathy, decrease clothing.
Severe (hospital)- bradycardia, severe hypotension, decreased respiratory rate, acid base
imbalance, decreased pain response.
TX- (Home)-apply warm clothing, heating blanket, air heater (monitor pts skin for burns),
drink warm carbohydrate liquids. (NO alcohol/coffee).
(Hospital)- heating blanket, position pt supine to prevent orthostatic, administer warm IV
fluids.
IMMUNITY: (Antibodies)
Humoral/B cells
IgG- chronic, secondary, long term immunity
IgA- Respirator/GI, secretory
IgM- largest, 1st response to infection, acute
IgE- allergic response up, hypersensitivity
Active artificial- vaccine immunizations, body can’t create on it’s own.
Active natural- body creates response w/out vaccine after getting sick.
Passive natural- breastfeeding, (mother to baby), placenta.
Passive artificial- give something to someone that doesn’t stay. (plasma, IVIG).
INFECTION:
Neutrophils
Segs- mature/more cells (55-70%)
Bands- immature (0-5%)
-Bands up= shift to the left- Bacteria (can’t fight infection).
Basophils 0.5-1 inflammation
Europhiles 1-4% allergic reaction, parasitic infection, cancer cells?
Monocytes 2-8%
Lymphocytes 20-40% elevated, viral infection
HIV/AIDS: (Retrovirus)
Tests:
Viral load (antigen)- when test is positive, you’re positive; if negative, retest.
(swab/blood) quickest/rapid, (therapeutic testing every 4-6 months)- amount of HIV
virus in system, determine medication effectivness.
ELISA (antigen)
Western blot (antibody)
High risks: incarcerated (jail), IV drug users/needle, prostitutes/sex workers, homosexual men,
pregnant & breastfeeding/placenta.
PRIORITY: INFECTION, NUTRITION, FLUID & ELECTROLYTES
HIV 1/CLASS 1- Night sweats, flu-like symptoms, rash, sore throat, muscle aches. (T-cell greater
than 500)
HIV 2/CLASS 2- Undetected w/drugs. (T-cell between 200-499)
AIDS/CLASS 3- (T-cell count less than 200) OPPORTUNISTIC INFECTIONS- cmv, retinitis, fungal,
encephalitis, meningitis, Kaposi sarcoma, pjv pneumonia.
Angioedema (priority is airway) Epi
Anaphylaxis- circulatory + airway (epi) for swelling/decreases swelling. (immediate, helps
circulatory).
LYME DISEASE: (systemic)
1. Flu-like symptoms, raised rash/bulls eye, pain in joints/stiffness. s/s- 7-14
2. Carditis, dizziness, dyspnea, dysrhythmia, palpitation, CNS/peripheral neuritis. 2-12
(IV antibiotics 30 days) ceftriaxone, cefotaxime.
3. Chronic, months to years. Arthritis/joint pain.
LUPUS (SLE) Autoimmune:
Butterfly rash on face
Swollen joints
Alopecia, lesions on scalps
Oral/nasal sores
Muscle aches
Chronic fatigue
Sensitivity to sun
TX: plasma, corticosteroids
ANEMIA:
B-12/PERNICIOUS(Nutrition)- Lacking intrinsic factor (stomach).
Gastric bypass/small bowel resection, vegans, chronic diarrhea/chron’s, tapeworm, overgrowth
in intestinal bacteria.
S/S: CNS, peripheral nerve damage, paresthesia, glossitis, orthostatic hypotension, foggy brain.
TX: IM B-12 injections
IRON DEFICIENCY(Nutrition)- RBC’s don’t carry enough oxygen, Hbg,Hct.
S/S: dizziness, fatigue, pallor, fissure, PICA cravings.
TX: iron pills, iron rich foods, blood transfusion if under 7.
FOLIC ACID(Nutrition)- Alcoholism, malnutrition. NO neuro s/s.
TX: folic acid replacement therapy.
APLASTIC- Pancytopenia- low RBC, WBC, Platelets. Bone marrow failure.
SICKLE CELL ANEMIA (SCD)- Abnormally shaped RBC structure.
Risk factors: African American/genetics
s/s: jaundice, weakness, SOB.
Triggers: stress, anxiety, infection, cold/sick, cold temperatures.
Meds: Hydroxyurea (everyday)
PVK/prophylactic antibiotic
Spleen crisis/infection to spleen; pain crisis
Crisis: O2, PAIN, IV.
PCA PUMP FOR PAIN MED ADMINISTARTION FOR PT USE ONLY.
Increased pain & decreased O2= more sickle cell crisis
Life threatening: priapism acute chest
Bedrest (non-exert) b/c decreases O2.
BLOOD ADMINISTRATION/TRANSFUSION:
Order
Consent
Type & screen
Pick up blood at lab and inspect
Start verification with another nurse
Baseline vitals
Administer at slow rate 2mL/min, stay with patient first 15 mins.
Infuse blood over duration of 4 hours.
REACTIONS:
-Acute hemolytic- within the first 15 mins, when blood crossmatch/wrong blood, FLANK PAIN,
BACK, CHEST PAIN.
-Anaphylactic- within the first 24 hrs, URITICA/ITCHING, BRONCHOSPASMS.
GIVE Epi, steroids, antihistamine.
-Circulatory overload- hypertension, tachycardia, dyspnea, signs of shock (urine outout).
-Febrile Non-hemolytic- immunosuppress, headache, chills, hypotension. Seen in patients with
past/multiple transfusions.
CANCERS:
LEUKEMIA- Overproduction of WBCs
Blast cells (immature cells)
s/s: Bone & joint pain because of overproduction causes pressure in the bone marrow.
Pathological fractures due to weakened bones.
Pancytopenia- low neutrophils (neutropenic) low platelets (thrombocytopenia), low RBC
(erythrocytes).
Enlarged spleen and liver lymph nodes. CNS-Lumbar puncture test.
TX: chemo or bone marrow transplant
LYMPHOMA (Hodgkin’s/Non-Hodgkin’s)
S/S: swollen/painless lymph nodes
Bone marrow biopsy
HL: Reed Sternberg cells (organized spread of CA)
NHL: NO Reed Sternberg cells (NOT organized)
TX: chemo, radiation
MULTIPLE MYELOMA- WBC Cancer (excessive plasma & antibodies, high total protein).
Affects: Kidneys (hematuria/kidney function).
Bone (hypercalcemia) spleen
TX: Chemo helps control it (life long).
