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Airway/ Ventilation & Shock

Airway/ Ventilation & Shock. Jami Windhorn, RN BSN CPN TNCC ENPC. Objectives. 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

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Airway/ Ventilation & Shock

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  1. Airway/Ventilation&Shock Jami Windhorn, RN BSN CPN TNCC ENPC

  2. Objectives • 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

  3. UpperAirway Anatomy • Mouth • Nose • Pharynx • Oropharynx • Nasopharynx • Epiglottis • Trachea

  4. Lower Respiratory Anatomy • Cricoid Cartilage • Larynx • Bronchi • Lungs • Pleura/Pleural Space • Diaphragm

  5. Ventilation • 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

  6. Airway Assessment • Obstruction * Tongue * Loose Teeth * Blood/Vomit * Foreign Body * Edema

  7. Patient History • Type of Trauma? • Burn? • Pre-Existing Respiratory Disease? • Drugs? Smoking? • Loss of Consciousness?

  8. Nursing Assessment:Airway • Open airway – Head Tilt Chin Lift • Maintain C-Spine • Suction any blood, vomit or objects from airway • Can the patient talk? • Trauma to airway?

  9. Opening the Airway

  10. Airway Management • Oral Airway • Nasopharyngeal Airway

  11. Laryngeal Mask Airway

  12. Combitube

  13. King Airway

  14. Intubation • If unable to maintain an open airway and patient is requiring Bag/Mask Ventilation, endotracheal intubation may be necessary

  15. RSI:Rapid 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

  16. RSI Steps • Preparation: Gather all supplies • Preoxygenation • Pretreatment: Atropine or Fluid Bolus • Paralysis • Protect and Position: Cricoid Pressure • Proof of Placement • Post-Intubation Management

  17. Tube Placement Confirmation • Auscultate breath sounds • Equal chest rise and fall • Exhaled Carbon Dioxide detector “Gold is Good” • Chest X-Ray

  18. Contraindicationsto RSI • Hypotension • Total upper airway obstruction • Total loss of oropharyngeal landmarks • Paralytic can mask seizure activity

  19. Inadequate Ventilation • Due to: * Pain * Loss of Consciousness * Spinal Cord Injury * Trauma to Chest causing flail chest, broken ribs, pneumothorax

  20. All trauma patients should have on 100% Oxygen via a Non-Rebreather mask to allow for adequate oxygenation

  21. Nursing Assessment:Ventilation • Trauma to the chest • Dyspnea • Level of Consciousness • Symmetrical chest rise and fall • Listen for Breath sounds • Tracheal Deviation? • Palpate chest for deformities

  22. Nursing AssessmentContinued • Use of accessory muscles • Agonal respirations • Tachypnea • Bradypnea • Irregular breathing patterns

  23. TensionPneumothorax • Symptoms: * Deviated Trachea * Absent breath sounds on one side * Restlessness * Cyanosis • Prepare for Needle Thoracentesis and chest tube insertion

  24. Ongoing Assessment • Work of Breathing • Pain • Level of Consciousness • Breath Sounds • ABGs • Chest X-Rays • Respiratory Rate • Effectiveness of Interventions

  25. SHOCK

  26. Types of Shock • Cardiogenic • Hypovolemic • Distributive • Obstructive

  27. 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

  28. Cardiogenic Shock • Cardiac tissue is damaged and unable to supple sufficient blood flow • Common Causes: * Acute MI * Dilated Cardiomyopathies * Blunt Cardiac Trauma * Arrhythmias

  29. Cardiogenic ShockSymptoms • Hypotension • Cool, clammy skin • Distended jugular veins • Tachyarrhythmias • Fatigue

  30. Cardiogenic ShockTreatments • Oxygen • Cardiac Meds – Dopamine, Epinephrine, Norepinephrine

  31. Hypovolemic 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

  32. Hypovolemic ShockSymptoms • Anxiety • Hypotension • Rapid, thready pulse • Hypothermia • Thirst and Dry mouth • Cool, mottled skin

  33. Hypovolemic ShockTreatments • Control the bleeding • Fluid boluses • Blood Transfusions • Oxygen

  34. Distributive Shock • Maldistribution of blood volume and flow results from loss of vasomotor tone causing peripheral vasodilation • Three types: * Septic Shock * Neurogenic Shock * Anaphylactic Shock

  35. Septic Shock • Overwhelming Infection • Seen in patients with Disseminated Intravascular Coagulation (DIC) and Multiple Organ Dysfunction Syndrome (MODS)

  36. Septic Shock Symptomsand Treatments • Symptoms: * Fever * Vasodilation • Treatments: * Fluid boluses * Oxygen * Antibiotics

  37. Neurogenic Shock • Caused by a Spinal Cord Injury or any Injury to the central nervous system

  38. Neurogenic Shock Symptoms & Treatments • Symptoms: * Hypotension * Warm, dry skin Treatments: * Fluid Boluses * Vasopressors – Norepinephrine * Atropine

  39. Anaphylactic Shock • Severe whole body allergic reaction • Insect bites/stings, horse serum, food allergies and drug allergies

  40. Anaphylactic Shock Symptoms & Treatments • Symptoms: * Respiratory Distress * Unconsciousness * Hives * Angioedema Treatments: * Remove the antigen * Epinephrine * IV Fluids

  41. Pathophysiology of Shock • 3 stages: 1. Compensated: Compensatory mechanisms are initiated to maintain normal tissue perfusion and organ functions

  42. Pathophysiology of Shock 2. 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 hepatic failure

  43. Lungs • Permeability increases • High oxygen consumption • Respiratory acidosis • Lactate levels increase • Lungs become stiff • Tachypnea

  44. Kidneys • Vasoconstriction causes acute renal failure • Proximal tubules and ascending Loop of Henle are damaged

  45. Heart • Subendocardial hemorrhages are common • Myocardial cells are clumped • Damage resembles shock or drowning injuries • Peripheral Vasoconstriction

  46. Brain • Altered mental status • Infarcts • Laminar necrosis

  47. GI Tract • Infarction of GI Epithelium • Fluid Imbalances • Acidosis • GI tract may appear bloody and swollen

  48. Liver • Liver necrosis/ischemia • Elevated Bilirubin • Pancreas may also have ischemic injury • Glycogen broken down into glucose

  49. Nursing Assessment • Obvious signs of bleeding • Quality of Respirations • Level of consciousness • Auscultate heart, breath and bowel sounds • Skin color and temperature • Pain

  50. Nursing 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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