AirwayShock醫(yī)學課件

1、Airway/Ventilation&Shock2021/4/261ObjectivesIdentify Airway and Ventilation Issues in Trauma PatientDescribe Nursing Assessment and Intervention of the Trauma PatientIdentify Types of ShockDescribe Signs and Symptoms of ShockDiscuss Nursing Assessment and Interventions for Shock2021/4/262UpperAirway

2、 AnatomyMouth NosePharynxOropharynxNasopharynxEpiglottisTrachea2021/4/263Lower Respiratory AnatomyCricoid CartilageLarynxBronchiLungsPleura/Pleural SpaceDiaphragm2021/4/264VentilationInhalation* Diaphragm moves down, ribs move up and out, air flows inExhalation* Diaphragm moves up, ribs move down an

3、d in, air flows outGas exchange occurs to oxygenate the body2021/4/265Airway AssessmentObstruction* Tongue* Loose Teeth* Blood/Vomit* Foreign Body* Edema2021/4/266Patient HistoryType of Trauma?Burn?Pre-Existing Respiratory Disease?Drugs? Smoking?Loss of Consciousness?2021/4/267Nursing Assessment:Air

4、wayOpen airway Head Tilt Chin LiftMaintain C-Spine Suction any blood, vomit or objects from airwayCan the patient talk?Trauma to airway?2021/4/268Opening the Airway2021/4/269Airway ManagementOral Airway Nasopharyngeal Airway2021/4/26109、 人的價值，在招收誘惑的一瞬間被決定。2022/7/122022/7/12Tuesday, July 12, 202210、低

5、頭要有勇氣，抬頭要有低氣。2022/7/122022/7/122022/7/127/12/2022 9:29:02 PM11、人總是珍惜為得到。2022/7/122022/7/122022/7/12Jul-2212-Jul-2212、人亂于心，不寬余請。2022/7/122022/7/122022/7/12Tuesday, July 12, 202213、生氣是拿別人做錯的事來懲罰自己。2022/7/122022/7/122022/7/122022/7/127/12/202214、抱最大的希望，作最大的努力。12 七月 20222022/7/122022/7/122022/7/1215、一個人

6、炫耀什么，說明他內心缺少什么。七月 222022/7/122022/7/122022/7/127/12/202216、業(yè)余生活要有意義，不要越軌。2022/7/122022/7/1212 July 202217、一個人即使已登上頂峰，也仍要自強不息。2022/7/122022/7/122022/7/122022/7/12Laryngeal Mask Airway2021/4/26129、 人的價值，在招收誘惑的一瞬間被決定。2022/7/122022/7/12Tuesday, July 12, 202210、低頭要有勇氣，抬頭要有低氣。2022/7/122022/7/122022/7/127/

7、12/2022 9:29:02 PM11、人總是珍惜為得到。2022/7/122022/7/122022/7/12Jul-2212-Jul-2212、人亂于心，不寬余請。2022/7/122022/7/122022/7/12Tuesday, July 12, 202213、生氣是拿別人做錯的事來懲罰自己。2022/7/122022/7/122022/7/122022/7/127/12/202214、抱最大的希望，作最大的努力。12 七月 20222022/7/122022/7/122022/7/1215、一個人炫耀什么，說明他內心缺少什么。七月 222022/7/122022/7/122022

8、/7/127/12/202216、業(yè)余生活要有意義，不要越軌。2022/7/122022/7/1212 July 202217、一個人即使已登上頂峰，也仍要自強不息。2022/7/122022/7/122022/7/122022/7/12Combitube2021/4/2614King Airway2021/4/2615IntubationIf unable to maintain an open airway and patient is requiring Bag/Mask Ventilation, endotracheal intubation may be necessary2021/

9、4/2616RSI:Rapid Sequence IntubationThe process of quickly inducing anesthesia (Sedation and Paralytics) in a patient in order to intubate Sedation is used to reduce anxietyParalytics are used in a patient who is awake, has a gag reflex and is agitated or combative2021/4/2617RSI StepsPreparation: Gat

10、her all suppliesPreoxygenationPretreatment: Atropine or Fluid BolusParalysisProtect and Position: Cricoid PressureProof of PlacementPost-Intubation Management2021/4/2618Tube Placement ConfirmationAuscultate breath soundsEqual chest rise and fallExhaled Carbon Dioxide detector“Gold is Good”Chest X-Ra

11、y2021/4/2619Contraindicationsto RSIHypotensionTotal upper airway obstructionTotal loss of oropharyngeal landmarksParalytic can mask seizure activity2021/4/2620Inadequate VentilationDue to:* Pain* Loss of Consciousness* Spinal Cord Injury* Trauma to Chest causing flail chest, broken ribs, pneumothora

12、x2021/4/2621All trauma patients should have on 100% Oxygen via a Non-Rebreather mask to allow for adequate oxygenation2021/4/2622Nursing Assessment:VentilationTrauma to the chestDyspneaLevel of ConsciousnessSymmetrical chest rise and fallListen for Breath soundsTracheal Deviation?Palpate chest for d

13、eformities2021/4/2623Nursing AssessmentContinuedUse of accessory musclesAgonal respirationsTachypneaBradypneaIrregular breathing patterns2021/4/2624TensionPneumothoraxSymptoms:* Deviated Trachea* Absent breath sounds on one side* Restlessness* CyanosisPrepare for Needle Thoracentesis and chest tube

14、insertion2021/4/2625Ongoing AssessmentWork of BreathingPainLevel of ConsciousnessBreath SoundsABGsChest X-RaysRespiratory RateEffectiveness of Interventions2021/4/2626SHOCK2021/4/2627Types of ShockCardiogenicHypovolemicDistributiveObstructive2021/4/2628Shock is a medical condition arising from poor

15、tissue perfusion that is insufficient to meet the oxygen and nutrient demands of the body causing metabolic activities to slow or stop2021/4/2629Cardiogenic ShockCardiac tissue is damaged and unable to supple sufficient blood flowCommon Causes:* Acute MI* Dilated Cardiomyopathies* Blunt Cardiac Trau

16、ma* Arrhythmias2021/4/2630Cardiogenic ShockSymptomsHypotensionCool, clammy skinDistended jugular veinsTachyarrhythmiasFatigue2021/4/2631Cardiogenic ShockTreatmentsOxygenCardiac Meds Dopamine, Epinephrine, Norepinephrine2021/4/2632Hypovolemic ShockCondition caused by inadequate blood volume which doe

17、s not allow the heart to pump enough blood to the bodyMost common form of shock2021/4/2633Hypovolemic ShockSymptomsAnxietyHypotensionRapid, thready pulseHypothermiaThirst and Dry mouthCool, mottled skin2021/4/2634Hypovolemic ShockTreatmentsControl the bleedingFluid bolusesBlood TransfusionsOxygen202

18、1/4/2635Distributive ShockMaldistribution of blood volume and flow results from loss of vasomotor tone causing peripheral vasodilationThree types:* Septic Shock* Neurogenic Shock* Anaphylactic Shock2021/4/2636Septic ShockOverwhelming InfectionSeen in patients with Disseminated Intravascular Coagulat

19、ion (DIC) and Multiple Organ Dysfunction Syndrome (MODS)2021/4/2637Septic Shock Symptomsand TreatmentsSymptoms:* Fever* VasodilationTreatments:* Fluid boluses* Oxygen* Antibiotics2021/4/2638Neurogenic ShockCaused by a Spinal Cord Injury or any Injury to the central nervous system2021/4/2639Neurogeni

20、c Shock Symptoms & TreatmentsSymptoms:* Hypotension* Warm, dry skinTreatments:* Fluid Boluses* Vasopressors Norepinephrine* Atropine2021/4/2640Anaphylactic ShockSevere whole body allergic reactionInsect bites/stings, horse serum, food allergies and drug allergies2021/4/2641Anaphylactic Shock Symptom

21、s & TreatmentsSymptoms:* Respiratory Distress* Unconsciousness* Hives* AngioedemaTreatments:* Remove the antigen* Epinephrine* IV Fluids2021/4/2642Pathophysiology of Shock3 stages:1. Compensated:Compensatory mechanisms are initiated to maintain normal tissueperfusion and organ functions2021/4/2643Pa

22、thophysiology of Shock2. Progressive:Compensation begins to fail leading to tissue damage3. Irreversible:Untreated shock leads to loss of perfusion to the whole body Vasomotor, cardiac and hepaticfailure2021/4/2644LungsPermeability increasesHigh oxygen consumptionRespiratory acidosisLactate levels i

23、ncreaseLungs become stiffTachypnea2021/4/2645KidneysVasoconstriction causes acute renalfailureProximal tubules and ascending Loopof Henle are damaged2021/4/2646HeartSubendocardial hemorrhages arecommonMyocardial cells are clumpedDamage resembles shock or drowning injuriesPeripheral Vasoconstriction2

24、021/4/2647BrainAltered mental statusInfarctsLaminar necrosis2021/4/2648GI TractInfarction of GI EpitheliumFluid ImbalancesAcidosisGI tract may appear bloody and swollen2021/4/2649LiverLiver necrosis/ischemiaElevated BilirubinPancreas may alsohave ischemic injuryGlycogen brokendown into glucose2021/4/2650Nursing AssessmentObvious signs of bleedingQuality of RespirationsLevel of consciousnessAuscultate heart, breath