Airway/ Ventilation & Shock
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Transcript of Airway/ Ventilation & Shock
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Airway/Airway/VentilationVentilation
&&ShockShock
Jami Windhorn, RN BSN CPN Jami Windhorn, RN BSN CPN TNCC ENPCTNCC ENPC
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ObjectivesObjectives
• Identify Airway and Ventilation Issues in Trauma Patient
• Describe Nursing Assessment and Intervention of the Trauma Patient
• Identify Types of Shock• Describe Signs and Symptoms of
Shock• Discuss Nursing Assessment and
Interventions for Shock
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UpperUpperAirway AnatomyAirway Anatomy
• Mouth • Nose• Pharynx• Oropharynx• Nasopharynx• Epiglottis• Trachea
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Lower Respiratory AnatomyLower Respiratory Anatomy• Cricoid Cartilage• Larynx• Bronchi• Lungs• Pleura/Pleural
Space• Diaphragm
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VentilationVentilation
• Inhalation* Diaphragm moves down, ribs move
up and out, air flows in• Exhalation
* Diaphragm moves up, ribs move down and in, air flows out
• Gas exchange occurs to oxygenate the body
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Airway AssessmentAirway Assessment• Obstruction
* Tongue* Loose Teeth* Blood/Vomit* Foreign Body* Edema
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Patient HistoryPatient History
• Type of Trauma?• Burn?• Pre-Existing Respiratory Disease?• Drugs? Smoking?• Loss of Consciousness?
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Nursing Assessment:Nursing Assessment:AirwayAirway
• Open airway – Head Tilt Chin Lift• Maintain C-Spine • Suction any blood, vomit or objects
from airway• Can the patient talk?• Trauma to airway?
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Opening the AirwayOpening the Airway
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Airway ManagementAirway Management
• Oral Airway
• Nasopharyngeal Airway
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Laryngeal Mask AirwayLaryngeal Mask Airway
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CombitubeCombitube
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King AirwayKing Airway
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IntubationIntubation
• If unable to maintain an open airway and patient is requiring Bag/Mask Ventilation, endotracheal intubation may be necessary
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RSI:RSI:Rapid Sequence IntubationRapid Sequence Intubation
• The process of quickly inducing anesthesia (Sedation and Paralytics) in a patient in order to intubate
• Sedation is used to reduce anxiety• Paralytics are used in a patient who
is awake, has a gag reflex and is agitated or combative
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RSI StepsRSI Steps
• Preparation: Gather all supplies• Preoxygenation• Pretreatment: Atropine or Fluid Bolus• Paralysis• Protect and Position: Cricoid Pressure• Proof of Placement• Post-Intubation Management
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Tube Placement Tube Placement ConfirmationConfirmation
• Auscultate breath sounds
• Equal chest rise and fall
• Exhaled Carbon Dioxide detector
“Gold is Good”
• Chest X-Ray
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ContraindicationsContraindicationsto RSIto RSI
• Hypotension• Total upper airway obstruction• Total loss of oropharyngeal
landmarks• Paralytic can mask seizure activity
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Inadequate VentilationInadequate Ventilation• Due to:
* Pain* Loss of Consciousness* Spinal Cord Injury* Trauma to Chest causing flail
chest, broken ribs, pneumothorax
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• All trauma patients should have on 100% Oxygen via a Non-Rebreather mask to allow for adequate oxygenation
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Nursing Assessment:Nursing Assessment:VentilationVentilation
• Trauma to the chest• Dyspnea• Level of Consciousness• Symmetrical chest rise and fall• Listen for Breath sounds• Tracheal Deviation?• Palpate chest for deformities
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Nursing AssessmentNursing AssessmentContinuedContinued
• Use of accessory muscles• Agonal respirations• Tachypnea• Bradypnea• Irregular breathing patterns
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TensionTensionPneumothoraxPneumothorax
• Symptoms:* Deviated Trachea* Absent breath sounds on one side* Restlessness* Cyanosis
• Prepare for Needle Thoracentesis and chest tube insertion
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Ongoing AssessmentOngoing Assessment• Work of Breathing• Pain• Level of Consciousness• Breath Sounds• ABGs• Chest X-Rays• Respiratory Rate• Effectiveness of Interventions
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SHOCK
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Types of Types of ShockShock
• Cardiogenic
• Hypovolemic
• Distributive
• Obstructive
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• Shock is a medical condition arising from poor tissue perfusion that is insufficient to meet the oxygen and nutrient demands of the body causing metabolic activities to slow or stop
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Cardiogenic ShockCardiogenic Shock• Cardiac tissue is damaged and
unable to supple sufficient blood flow• Common Causes:
* Acute MI* Dilated Cardiomyopathies* Blunt Cardiac Trauma* Arrhythmias
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Cardiogenic ShockCardiogenic ShockSymptomsSymptoms
• Hypotension• Cool, clammy skin• Distended jugular veins• Tachyarrhythmias• Fatigue
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Cardiogenic ShockCardiogenic ShockTreatmentsTreatments
• Oxygen• Cardiac Meds – Dopamine,
Epinephrine, Norepinephrine
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Hypovolemic ShockHypovolemic Shock
• Condition caused by inadequate blood volume which does not allow the heart to pump enough blood to the body
• Most common form of shock
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Hypovolemic ShockHypovolemic ShockSymptomsSymptoms
• Anxiety• Hypotension• Rapid, thready pulse• Hypothermia• Thirst and Dry mouth• Cool, mottled skin
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Hypovolemic ShockHypovolemic ShockTreatmentsTreatments
• Control the bleeding• Fluid boluses• Blood Transfusions• Oxygen
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Distributive ShockDistributive Shock• Maldistribution of blood volume and
flow results from loss of vasomotor tone causing peripheral vasodilation
• Three types:* Septic Shock* Neurogenic Shock* Anaphylactic Shock
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Septic ShockSeptic Shock
• Overwhelming Infection• Seen in patients with Disseminated
Intravascular Coagulation (DIC) and Multiple Organ Dysfunction Syndrome (MODS)
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Septic Shock SymptomsSeptic Shock Symptomsand Treatmentsand Treatments
• Symptoms:* Fever* Vasodilation
• Treatments:* Fluid boluses* Oxygen* Antibiotics
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Neurogenic ShockNeurogenic Shock
• Caused by a Spinal Cord Injury or any Injury to the central nervous system
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Neurogenic Shock Neurogenic Shock Symptoms & TreatmentsSymptoms & Treatments
• Symptoms:* Hypotension* Warm, dry skin
Treatments:* Fluid Boluses* Vasopressors – Norepinephrine* Atropine
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Anaphylactic ShockAnaphylactic Shock
• Severe whole body allergic reaction
• Insect bites/stings, horse serum, food allergies and drug allergies
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Anaphylactic Shock Anaphylactic Shock Symptoms & TreatmentsSymptoms & Treatments
• Symptoms:* Respiratory Distress* Unconsciousness* Hives* Angioedema
Treatments:* Remove the antigen* Epinephrine* IV Fluids
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Pathophysiology of ShockPathophysiology of Shock• 3 stages:
1. Compensated:Compensatory mechanisms are initiated to maintain normal
tissueperfusion and organ functions
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Pathophysiology of ShockPathophysiology of Shock2. Progressive:
Compensation begins to fail leading to tissue damage
3. Irreversible:Untreated shock leads to loss of perfusion to the whole body – Vasomotor, cardiac and hepaticfailure
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LungsLungs
• Permeability increases• High oxygen
consumption• Respiratory acidosis• Lactate levels increase• Lungs become stiff• Tachypnea
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KidneysKidneys
• Vasoconstriction causes acute renalfailure
• Proximal tubules and ascending Loopof Henle are damaged
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HeartHeart• Subendocardial
hemorrhages arecommon
• Myocardial cells are clumped
• Damage resembles shock or drowning injuries
• Peripheral Vasoconstriction
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BrainBrain
• Altered mental status
• Infarcts• Laminar necrosis
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GI TractGI Tract• Infarction of GI Epithelium• Fluid Imbalances• Acidosis• GI tract may appear
bloody and swollen
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LiverLiver• Liver
necrosis/ischemia• Elevated Bilirubin• Pancreas may also
have ischemic injury
• Glycogen brokendown into glucose
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Nursing AssessmentNursing Assessment• Obvious signs of bleeding• Quality of Respirations• Level of consciousness• Auscultate heart, breath and bowel
sounds• Skin color and temperature• Pain
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Nursing CareNursing Care
• Administer oxygen, fluids and pain medicine
• Blood Transfusion• Control external bleeding• Gastric tube? Foley?• Watch for development of
coagulopathies• Collaboration of the team
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Questions???