Midterm Flashcards

Question

acute respiratory distress syndrome (ARDS)

Answer 1

- Results from: - Damage to the alveolar cells - Hyper-resuscitation (fluid overload) - Results in: - Leakage of fluid into the interstitial spaces and alveoli

Answer 2

-Impaired clotting cascade -May result from: -Hypothermia -Dilution of clotting factors from fluid administration -Depletion of clotting factors

Answer 3

As you lose more and more blood.... - pulse increases - blood pressure decreases - pulse pressure decreases - RR increases - urinary output decreases - LOC decreases

Answer 4

- inspection - palpation - auscultation- aortic, pulmonary, tricuspid, mitral valves - seal holes - stabilize flail segments- two or more ribs broken in two or more places - oxygen/ventilation

Answer 5

- pupils - equal - and - round - regular in size - react to light

Answer 6

- false - ?? - assessment of cerebral function - primary concern is the patients level of consciousness - glasgow coma scale is a tool use to measure consciousness/mental status - patient can have other causes that can cause decrease neurological function - medical issues can cause trauma - pupillary response is also a good indication of internal head injury - extremity function, sensation will also be good indicators of injury - measures GSC, pupil response, extremity function - factors that can contribute to decreased LOC: - CNS injury - decreased oxygenations - metabolic - drug/alcohol

Answer 7

- rhonci -course bubbling sound indicating sever fluid - rales -fine crackling; indicating fluid build up - wheezing- high pitch sounds, indication bronchi constriction

Answer 8

- bony - subcutaneous emphysema - a grating sound or sensation produced by friction between bone and cartilage or the fractured parts of a bone

Answer 9

- hemodynamic compromise - obstructs blood flow - obstructive shock

Answer 10

- ribs broken and you can see it -> chest moves out during exhalation and inward during inhalation - pneumothorax, hemothorax, pulmonary contusion - positive pressure ventilation to treat

Answer 11

- 25-45 mm Hg | - can be inaccurate with hypotension but can track patterns

Answer 12

- Adult- 10-12; 500-800 ml - Child- 16-20; 100-500 ml - Infant- 25; 6-8 ml/kg - inadvertent hyperventilation may lead to poor outcomes in patients with a traumatic brain injury

Answer 13

- secondary intercostal space, midclavicular line, over the rib (preferred site) - fifth intercostal space, midaxillary line, over the rib (alternate site) - over the rib is always better

Answer 14

chemoreceptors located in the aorta and carotid arteries stimulate the respiratory center

Answer 15

- skin - connective tissue - aponeurotica - layer of alveolar tissue - periosteum of skull

Answer 16

- Maintain SBP 90 mmHg in an adult. - Maintain SBP 80 mmHg in a child. - Maintain SBP 75 mmHg in a young child. - Maintain SBP 65 mmHg in an infant.

Answer 17

-Frontal- Contains emotions, motor function, expression of speech -Parietal- Contains sensory function and spatial orientation -Occipital- Contains vision -Temporal- Reg. memory functions, are of speech reception & integration

Answer 18

- Epidural- -under normal circumstance it does not exist, middle meningeal arteries follow grooves in the temporal bone here - Dura Mater- Made of rough fibrous tissue and Forms Tentorium: divides cerebrum and cerebellum - Subdural space- spanned with veins -> low pressure - Arachnoid- covers brain vasculature - Subarachnoid- vasculature runs - Pia mater- thin covering directly over the brain

Answer 19

- amount of pressure that is needed to push blood through the cerebral circulation - accounts for cerebral pressure - CPP = MAP - ICP (intracranial pressure) - normal intracranial pressure = 7-15 mmHG

Answer 20

- 80% = cerebrum, cerebellum, and brainstem - 12% blood vessels and blood - 8% CSF - increase in size of one component diminishes size of another - inability to adjust = increased ICP - increase in any one of these things will displace CSF and eventually brain and eventually herniation

Answer 21

-Frontal- Contains emotions, motor function, expression of speech -Parietal- Contains sensory function and spatial orientation -Occipital- Contains vision -Temporal- Reg. memory functions, are of speech reception & integration

Answer 22

- Medulla- path way for ascending and descending nerve tracts -> Regulations of heart rate, blood vessel diameter, breathing, swallowing, vomiting, coughing, sneezing - Pons- Contains ascending and descending nerve tracts -> Relays information from the cerebrum to cerebellum, Houses the sleep center and respiratory center, Like medulla helps in the regulation of breathing - Midbrain- Involved in hearing through audio pathways in the CNS, Responsible for visual tracking of moving objects, turning the eyes, Coordinates regulation of the automatic functions that require no conscious thought

Answer 23

- may tear dura - permit CSF to drain through an external passageway - may mediate rise of ICP - evaluate for target or halo sign - clear part of the CSF will be on the outside ring of a blood drop coming from the ear - battle signs- retroauricular ecchymosis (bruising behind ear) -> associated with fracture of auditory canal and lower of skull - racoon eyes- bilateral periorbital ecchymosis -> associated with orbital fractures

Answer 24

``` FOCAL -occur at a specific location in brain -cerebral contusion -intracranial hemorrhage- epidural and subdural hematoma -intracerebral hemorrhage DIFFUSE -concussion -moderate diffusion axonal injury -severe diffusion axonal injury ```

Answer 25

``` CEREBRAL CONTUSION -blunt trauma to local brain tissue -capillary bleeding into brain tissue -confusion -neurologic deficit -personality changes -vision changes -speech changes -result from coup-contrecoup injury EPIDURAL HEMATOMA -bleeding between dura mater and skull -blood is where the brain should be -> herniation -involves arteries - middle meningeal artery most common -rapid bleeding and reduction of oxygen to tissues -patients will have lucid interval- unconscious goes unconscious again SUBDURAL HEMATOMA -bleeding within meninges -slow bleeding- superior sagittal sinus -signs progress over several days -slow deterioration of mentation -blood is displacing the brain INTRACEREBRAL HEMMORHAGE -ruptured blood vessel within the brain -presentation similar to stroke symptoms -Signs and symptoms worsen over time ```

Answer 26

- cerebral vasodilation - encourage blood flow - reduce hypercarbia - reduce hypoxia - contribute to increased ICP - causes classic hyperventilation and hypertension

Answer 27

-cranial insult -> tissue edema -> increased ICP -> compression of arteries -> decrease cerebral blood flow -> decrease O2 with death of brain cells -> edema around necrotic tissue -> increase ICP with compression of brain stem and respiratory center -> CO2 accumulates -> vasodilation -> increase ICP due to increased blood volume -> death

Answer 28

-displacement- vomiting, altered mental state, pupillary dilation

Answer 29

- Due to stretching forces placed on axons - distributed throughout brain - CONCUSSION - Mild to moderate form of diffuse axonal injury (DAI) - Nerve dysfunction without anatomic damage - Confusion, disorientation, event amnesia - momentary loss of consciousness - MODERATE DIFFUSE AXONAL INJURY - Classic Concussion - Additional: minute bruising of brain tissue - Unconsciousness -> confusion - May exist with a basilar skull fracture - Loss of concentration, disorientation - Retrograde and antegrade amnesia - Visual and sensory disturbances - Mood or personality changes - SEVERE DIFFUSE AXONAL INJURY - Brainstem Injury* - Significant mechanical disruption of axons - High mortality rate - Prolonged unconsciousness - Cushing’s reflex - Decorticate (flexion) or decerebrate (extension) posturing

Answer 30

- frontal lobe injury- alterations in personality - occipital lobe injury- visual disturbances - cortical disruption- reduced mental status or amnesia - > retrograde- unable to recall events before injury - > antegrade unable to recall events after trauma -> repetitive questioning - focal deficits- Hemiplegia, weakness, or seizures

Answer 31

``` UPPER BRAINSTEM COMPRESSION -Increasing blood pressure -bradycardia -Vagus nerve stimulation -Cheyne-Stokes respirations -Pupils become small and reactive -Decorticate posturing MIDDLE BRAINSTEM COMPRESSION -Widening pulse pressure -bradycardia -Hyperventilation- Deep and rapid -Bilateral pupil sluggishness or inactivity -Decerebrate posturing LOWER BRAINSTEM COMPRESSION -Pupils dilated and unreactive -Ataxic respirations -Erratic with no pattern -Irregular and erratic pulse rate -ECG changes -Hypotension -Loss of response to painful stimulus ```

Answer 32

Increased pressure due to outside insult causes the base of orbital socket to fracture inward

Answer 33

- Le fort 1: Involves a horizontal detachment of the maxilla from the nasal floor - Le fort 2- Fracture of the right and left maxillae, medial orbital floor and nasal bones. - Le fort 3- Involves the facial bones being fractured off the skull “Craniofacial disjunction”

Answer 34

- 1. eye opening- spontaneous (4), to verbal command (3), to pain (2), no response (1) - 2. verbal response- oriented and converses (5), disoriented conversation (4), speaking but nonsensical (3), moans or makes unintelligible sounds (2), no response (1) - 3. motor response- follows commands (6), localized pain (5), withdraws to pain (4) decorticate flexion (3), decerebrate extension (2), no response (1) - higher GCS (15)- no neurologic disability - 13-14- mild dysfunction - 9-12- moderate to severe dysfunction - 8 or less- severe dysfunction (lowest possible is 3)

Midterm Flashcards

(60 cards)