NUR357 EXAM 2024 LATEST UPDATE QUESTIONS WITH COMPLETE VERIFIED SOLUTIONS GRADED A++
HANDS OFF HANDOVER
Ensures that all staff are listening to handover as this provides valuable information on the mechanism of injury, treatment that has occured and vital signs.
IMIST-AMBO- Structured to ens...
HANDS OFF HANDOVER
Ensures that all staff are listening to handover as this provides valuable information on
the mechanism of injury, treatment that has occured and vital signs.
IMIST-AMBO- Structured to ensure focus
I- identification
M- mechanism of injury, time of the event and events that relate to the injury.
I- injuries known or suspected.
S- vital signs
T- treatment provided at the scene.
A- allergies
M- medications
B- background history
O- other pertinent imformation.
BREATHING ASSESSMENT
Look, listen and feel chest.If patient is intubated with ETT check ETc02.
LIFE THREATENING BREATHING PROBLEMS
•Tension pneumothorax
•Pneumothorax
•Haemothorax
•Sucking chest wound
•Flail chest
•Full-thickness circumferential burn of thorax
Intubation/Ventilation
,•Oxygen is required for aerobic cellular metabolism and ultimately for human survival,
with some cells, such as those in the brain, being more sensitive to hypoxia than others.
•Oxygen therapy should be considered for patients with a significant reduction in arterial
oxygen levels, irrespective of diagnosis and especially if the patient is drowsy or
unconscious.
Complications of intubation
Knowledge of emergency procedures, preparation of the patient and eviroment for a
safe and efficent intubation.50% of icu intubation- 1/3 hypoxemia,circulatory collapse,
cardiac arrythmia, aspiration and death.
Rapid Sequence Induction
•Rapid sequence intubation (RSI) is an airway management technique that produces
inducing immediate unresponsiveness (induction agent) and muscular relaxation
(neuromuscular blocking agent) and is the fastest and most effective means of
controlling the emergency airway
Indications for rapid sequence induction
•Lack of airway protection despite patency (swallow, gag, cough, positioning , and
tone)hypoxia
•hypoventilation•need for neuroprotection (e.g. target PaCO2 35-40 mmHg)
•impending obstruction (e.g. airway burn, penetrating neck injury)
•prolonged transfer
•combativeness
•humane reasons (e.g. major trauma requiring multiple interventions)
•cervical spine injury (diaphragmatic paralysis)
02 MARBLES nemonic
O- oxygen
M- masks (NP, non rebreather, BVM) monitoring
A- Airway adjuncts (OPA, NPA, LMA)
R- RSI drugs (resus drugs, propofolol, fentanyl, ketamine)
B- BVM; bougie
, L- Laryngoscope
E- ETTs; ETC02S- Suction; state plan
RSI induction agents
•Are sedatives that provide amnesia, reducing sympathetic responses and improve
intubation.
•Smoothly and quickly render the patient unconscious, unresponsive and amnestic in
one arm/heart/brain circulation time
•provide analgesia
•maintain stable cerebral perfusion pressure and cardiovascular haemodynamic•be
immediately reversible•have few, if any, side effects
•IF a paralytic agent is used without sedation, the patient may be fully aware of his or
her environment, including pain, but unable to respond.
•Sedatives prevents and minimizes these effects.
Paralytic agents
•Suxamethonium
•Rocuronium
•Vecuronium
Powerful muscle relaxantsNeuromuscular blocking agents (NMBAs)Medications effects
the muscles of the diaphram expanding the lungsAllows for decreased resistance for
mechanical ventilation
Patients require both induction agents and paralytic agents when intubation is occurring
Triad of death
hypothermia, acidosis, coagulopathy
Initial stage of shock
Due to decrease in CO and tissue hypoxia the body cells switch from aerobic
metabolism to converse oxygen to anaerobic (without respiration. Anaerobic
metabolism produces a waste product called lactate that is usually metabolised by the
liver, but due inadequate tissue perfusion the liver is not working properly resulting in a
build of lactic acid causing normal lactate is <2mmol and >4mmol
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