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Emergency AssessmentMedical-Surgical Nursing-7th edition

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_______ is the preferred procedure for securing an unprotected airway in the ER to decrease risk of aspiration and airway trauma.
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Rapid Sequence Intubation
What emergency? Hypotension, vascular collapse, severe abdominal pain, n/v, anxiety, clammy/ mottled skin, weak pulses...
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Thoracic aorta disruption (usually MVA/fall).
During F , what vitals are obtained?
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BP (both arms if suspected chest trauma), HR, and rectal temperature.
What are the signs and symptoms of a cardiac contusion, which is life threatening?
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Chest pain, dyspnea, CK-MB increase, ischemia, and troponin increase.
To support circulation, what are the initial interventions?
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Insert 2 large bore (14-16) IVs in upper extremities unless fractured or no circulation. Normal saline or LR. Get blood samples to type/match.
_______ may be used with a pelvic fracture that leads to bleeding/hypotension. It is placed on the legs and belly and inflated with a foot pump.
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Pneumatic Antishock Garment (PASG) *circulation
What are contraindications for catheter insertion during F interventions?
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Urethral tear, pelvis injury, blood at meatus, unable to void, high-riding prostate on DRE.
_______ is used if an intra-abdominal hemorrhage is suspected. It cannot diagnose a retroperitoneal bleed.
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Focused Abdominal Sonography for Trauma (FAST) *CT scan checks for retro bleed.
What is the focus of a primary survey?
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ABDC - Airway, Breathing, Circulation, Disability.
How is an obstructed airway treated?
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Use least invasive method possible. Jaw-thrust maneuver (especially with c-spine); suction to remove foreign body (only if visualized); insert airway; intubate; cricothyroidotomy or tracheostomy.
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How is disability assessed?
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AVPU; Is pt. alert, responds to voice, responds to pain or unresponsive; Glasgow; pupils; know what happened?
What are the components of the secondary survey?
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EFGHI - Exposure and environmental control, Full vitals/5 interventions/ family, Give comfort, History and head to toe assessment, Inspection of posterior surfaces.
When triaging patients, which conditions take priority?
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Those with a threat to life, vision, and/or limbs.
What should be gathered during H of the secondary assessment?
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Preceding event, mechanism of injury, intoxicants, medical conditions, last meal, MVA (seatbelt?).
Why is an OG or NG tube inserted during the F of secondary survey?
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Gastric decompression/emptying to decrease aspiration. Test for blood. No NG for facial or basilar skull fracture! Give OG!
What labs are commonly ordered in the ER?
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CBC, chem 20, cardiac enzymes, ABG's, ETOH, drug screen, urinalysis, type and cross.
_______ can be a sign of laryngotracheal disruption.
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Sub Q emphysema
During F , what are the 5 interventions for patients with significant trauma or who required life-saving measures during primary survey?
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EKG, pulse ox, catheter (need retrograde urethrogram 1st), OG/NG tube, collect blood.
What can cause Pulse less Electrical Activity (PEA)?
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Electrical activity is present with no pulse. C/b: cardiac tamponade, hypovolemia, tension pneumothorax. *CPR
Dysconjugate gaze = _______ Raccoon eyes = _______ Battle's sign = _______
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Dysconjugate = neuro damage, Raccoon = base or frontal skull fracture, Battle's = base fracture *Fluid from ear or nose should NOT be blocked.
What can cause bilateral dilated pupils?
Show Answer
Brain herniation r/t increases ICP, anxiolytics, atropine, belladonna, alkaloids, and hypoxia.
  
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