1. To learn before prac

2. Add haemmorhagic stroke and abruptioplaentaescenario, sinus arrest?
metaclop, 5sec seizure, decerebrategcs 9, naso
Left lat tilt, c-spine, fluids, lots of
3. Adrenalin over 8, what is the issue?
4. Adrenalin over 8, what is the issue?
max dose is 250 mcg, over 8 the dose is only 250mcg but in arrest it is more
5. 3 types of abruptio?
6. 3 types of abruptio?
Marginal one side has come off
7. 3 types of abruptio?
Marginal one side has come off
Concealed no haemorrhage out vagina
8. 3 types of abruptio?
Marginal one side has come off
Concealed no haemorrhage out vagina
Complete complete tear
9. Reasons a newborn may start breathing spontaneously? (4)
10. Reasons a newborn may start breathing spontaneously? (4)
Tactile stimulation
Cold air
11. Reasons a newborn may start breathing spontaneously? (4)
Tactile stimulation
Cold air
Squeeze and release of lungs
Chemoreceptors for CO2 (??? A bit iffy on CO2 or O2.)
12. Define actual time critical?
13. Define actual time critical?
A patient with abnormal vital signs is actually time critical.
What does abnormal vital signs mean for the patient?
14. Define actual time critical?
What does abnormal vital signs mean for the patient?
Abnormal vital signs indicates loss of normal compensatory mechanisms and the patient may deteriorate rapidly
15. Define actual time critical?
What does abnormal vital signs mean for the patient?
Abnormal vital signs indicates loss of normal compensatory mechanisms and the patient may deteriorate rapidly
16. Define emergent time critical?
17. Define emergent time critical?
Emergent time critical patients are those with a pattern of injury or significant illness that has a high probability of deterioration even though vital signs are within normal parameters
18. Traumatic examples of emergent time critical (6)?
19. Traumatic examples of emergent time critical (6)?
penetrating trauma to head, neck, torso, axilla or groin
flail chest
20. Traumatic examples of emergent time critical (6)?
penetrating trauma to head, neck, torso, axilla or groin
flail chest
injuries to more than one body region especially if not adjacent
fractured pelvis or fracture of 2 or more proximal long bones
21. Traumatic examples of emergent time critical (6)?
burns of greater than 10% or involving face or airway
crush injuries with greater than one hour of compression
22. Medical examples of emergent time critical (6)?
23. Medical examples of emergent time critical (6)?
asthmatic unresponsive to treatment
suspected acute myocardial infarction(e.g. chest pain with diaphoresis or unresponsive to GTN)
24. Medical examples of emergent time critical (6)?
asthmatic unresponsive to treatment
suspected acute myocardial infarction(e.g. chest pain with diaphoresis or unresponsive to GTN)
suspected aortic aneurysm
acute decompression sickness
.
25. Medical examples of emergent time critical (6)?
asthmatic unresponsive to treatment
suspected acute myocardial infarction(e.g. chest pain with diaphoresis or unresponsive to GTN)
suspected aortic aneurysm
acute decompression sickness
poisoning
envenomations with stable vital signs.
26. Define potential time critical?
27. Define potential time critical?
Potential time critical patients do not present with significant vital signs alteration or a significant pattern of injury or illness but have a significant mechanism of injury or past history that indicates a high potential for deterioration.
28. Examples of potential trauma time critical (9)?
29. Examples of potential trauma time critical (9)?
falls greater than 5 metres to ground level (body area injured?)
struck by an object falling greater than 5 metres
30. Examples of potential trauma time critical (9)?
falls greater than 5 metres to ground level (body area injured?)
struck by an object falling greater than 5 metres
pedestrian struck at greater than 30 kph
motorcyclists/cyclists with impact speed >30 kph
31. Examples of potential trauma time critical (9)?
falls greater than 5 metres to ground level (body area injured?)
struck by an object falling greater than 5 metres
pedestrian struck at greater than 30 kph
motorcyclists/cyclists with impact speed >30 kph
patient thrown from a moving vehicle
32. Examples of potential trauma time critical (9)?
patient in vehicle rollover
high speed RTC (impact greater than 60 kph or major vehicle damage)
33. Examples of potential trauma time critical (9)?
patient in vehicle rollover
high speed RTC (impact greater than 60 kph or major vehicle damage)
patient in car where death of another occupant has occurred
blast injury
34. Examples of potential medical time critical (2)?
35. Examples of potential medical time critical (2)?
asthmatic responsive to treatment but with previous ICU admission for asthma
undiagnosed severe pain
36. Examples of potential medical time critical (2)?
asthmatic responsive to treatment but with previous ICU admission for asthma
undiagnosed severe pain
37. How does time critical mean you have to act
38. How does time critical mean you have to act
Time Critical implies rapid decision making and treatment
39. time critical does not necessarilly mean?
40. time critical does not necessarilly mean?
rapid transport
41. Modifying factors in time criticallity (3)?
42. Modifying factors in time criticallity (3)?
Age 50 years
43. Modifying factors in time criticallity (3)?
Age 50 years
Current medical condition & treatment
44. Modifying factors in time criticallity (3)?
Age 50 years
Current medical condition & treatment
Distance to hospital / definitive care.
45. What are the respiritory changes in geriatric (7)?
46. What are the respiritory changes in geriatric (7)?
chest wall stiffness
lung elasticity
47. What are the respiritory changes in geriatric (7)?
chest wall stiffness
lung elasticity
air trapping (smaller airway collapse)
strength of respiratory muscles
vital capacity (total exchangeable air)
48. What are the respiritory changes in geriatric (7)?
chest wall stiffness
lung elasticity
air trapping (smaller airway collapse)
strength of respiratory muscles
vital capacity (total exchangeable air)
Decreased cilia in airways increases potential for respiratory infections
Impaired cough and gag reflexes.
49. What are the cardiovascular changes in geriatric (4)?
50. What are the cardiovascular changes in geriatric (4)?
Hypertrophy left ventricle
Fibrosis
51. What are the cardiovascular changes in geriatric (4)?
Hypertrophy left ventricle
Fibrosis
Myocardial conduction system degenerates
Hearts ability to respond to stress diminishes
52. What are the cardiovascular changes in geriatric (4)?
Hypertrophy left ventricle
Fibrosis
Myocardial conduction system degenerates
Hearts ability to respond to stress diminishes
53. Geriatric: Fibrosis occurs where (2)?
54. Geriatric: Fibrosis occurs where (2)?
myocardium
Peripheral vasculature
55. Fibrosis in geriatric causes what to occur (3)?
56. Fibrosis in geriatric causes what to occur (3)?
Hypertension
57. Fibrosis in geriatric causes what to occur (3)?
Hypertension
Arteriosclerosis
58. Fibrosis in geriatric causes what to occur (3)?
Hypertension
Arteriosclerosis
Decreased heart function
59. What changes in hearts ability to respond to stress (3)?
60. What changes in hearts ability to respond to stress (3)?
Stroke volume declines
61. What changes in hearts ability to respond to stress (3)?
Stroke volume declines
Rate decreases
62. What changes in hearts ability to respond to stress (3)?
Stroke volume declines
Rate decreases
Cardiac output decreases
63. What renal changes are there in the geriatric (7)?
64. What renal changes are there in the geriatric (7)?
30-40% in functioning nephrons
Renal blood flow
65. What renal changes are there in the geriatric (7)?
30-40% in functioning nephrons
Renal blood flow
waste in blood
prostate enlarges (prostatic hypertrophy)
66. What renal changes are there in the geriatric (7)?
30-40% in functioning nephrons
Renal blood flow
waste in blood
prostate enlarges (prostatic hypertrophy)
Urinary retention
67. What renal changes are there in the geriatric (7)?
30-40% in functioning nephrons
Renal blood flow
waste in blood
prostate enlarges (prostatic hypertrophy)
Urinary retention
Electrolyte disturbances more likely
Often manifests as apparent confusion, weakness
68. What general changes are there in the geriatric (5)?
69. What general changes are there in the geriatric (5)?
All organ systems decline in function with age
Total body water and fat decreases
70. What general changes are there in the geriatric (5)?
All organ systems decline in function with age
Total body water and fat decreases
Progressive reduction in the efficiency of the bodies homeostatic control systems
71. What general changes are there in the geriatric (5)?
All organ systems decline in function with age
Total body water and fat decreases
Progressive reduction in the efficiency of the bodies homeostatic control systems
Delay in healing
Decrease in recuperation
72. What changes are there in the integumentary system (5)?
73. What changes are there in the integumentary system (5)?
Tearing
Heat retention
74. What changes are there in the integumentary system (5)?
Tearing
Heat retention
Dehydration
75. What changes are there in the integumentary system (5)?
Tearing
Heat retention
Dehydration
Decreased fat tissue
Decreased response to pain
76. Contributing factors of trauma in the geriatric (7)?
77. Contributing factors of trauma in the geriatric (7)?
Decreased hearing and sight
Slower reflexes
78. Contributing factors of trauma in the geriatric (7)?
Decreased hearing and sight
Slower reflexes
Arthritis - Decreased range of movement
Increased fragility of tissue and bone
79. Contributing factors of trauma in the geriatric (7)?
Decreased hearing and sight
Slower reflexes
Arthritis - Decreased range of movement
Increased fragility of tissue and bone
Decreased elasticity of peripheral blood vessels
80. Contributing factors of trauma in the geriatric (7)?
Decreased hearing and sight
Slower reflexes
Arthritis - Decreased range of movement
Increased fragility of tissue and bone
Decreased elasticity of peripheral blood vessels
Susceptible to hypotension (falls)
Vessels more subject to tearing.
81. What is important to remember about geriatric head trauma (3)?
82. What is important to remember about geriatric head trauma (3)?
More prone, even from minor trauma
83. What is important to remember about geriatric head trauma (3)?
More prone, even from minor trauma
Increased ICP signs develop slowly (brain shrinkage larger IC space)
84. What is important to remember about geriatric head injury(3)?
More prone, even from minor trauma
Increased ICP signs develop slowly (brain shrinkage larger IC space)
Patient may have forgotten injury (dementia, etc)
85. What is important to remember about geriatric cervical trauma (2)?
86. What is important to remember about geriatric cervical trauma (2)?
Osteoporosis
Arthritic changes
87. What is important to look for in geriatric abdomen(2)?
88. What is important to look for in geriatric abdomen(2)?
AAA
GI bleed
89. What are symptoms of a GI bleed (2)?
90. What are symptoms of a GI bleed (2)?
Coffee-ground emesis
Black, Tarry or frankly bloody stools
91. What conditions predispose a geriatric to a AAA (2)?
92. What conditions predispose a geriatric to a AAA (2)?
hypertension
atherosclerosis
93. What is the most important thing to do when monitoring GCS in a geriatric?
94. What is the most important thing to do when monitoring GCS in a geriatric?
Essential to compare to baseline
95. What conditions can affect LOC in geriatric?
96. When conditions can affect LOC in geriatric?
Dementia
Alzheimers
97. Cardiovascular changes in pregnancy (4)
98. Cardiovascular changes in pregnancy
Hypervolaemia
Dilutional Anaemia
99. Cardiovascular changes in pregnancy
Hypervolaemia
Dilutional Anaemia
Heart Rate Increases
Blood Pressure Falls
100. How is Hypervolemia caused in pregnancy
101. How is Hypervolemia caused in pregnancy
Maternal blood volume45-50% from 10thweek to the 28thweek
102. Respiritory changes in pregnancy (5)
103. Respiritory changes in pregnancy (5)
Airway at greater risk
Tidal Volume Decreases (40%)
104. Respiritory changes in pregnancy (5)
Airway at greater risk
Tidal Volume Decreases (40%)
Breathing Rate Increases
Residual Volume Decreases (25%)
105. Respiritory changes in pregnancy (5)
Airway at greater risk
Tidal Volume Decreases (40%)
Breathing Rate Increases
Residual Volume Decreases (25%)
The pregnant woman has a higher oxygen demand and lower oxygen reserve.
106. Why does the breathing rate increase?
107. Why does the breathing rate increase?
Arterial Blood Gas reflects compensated respiratory alkalosis due to hypoventilation
PaCO230mmHg
PaO2 101-104mmHg
108. Periabdominal changes in pregnancy (3)?
109. Periabdominal changes in pregnancy (3)?
At 12/40 uterus becomes an intra-abdominal organ
110. Periabdominal changes in pregnancy (3)?
At 12/40 uterus becomes an intra-abdominal organ
Bladder is displaced anteriorly
111. Periabdominal changes in pregnancy(3)?
At 12/40 uterus becomes an intra-abdominal organ
Bladder is displaced anteriorly
Small bowel is displaced upwards
112. Periabdominal changes in pregnancy and how this affects the mother (3)?

At 12/40 uterus becomes an intra-abdominal organ

113. Bladder is displaced anteriorly 114. Small bowel is displaced upwards