Module 1-3 dictation ER

Pulmonary Embolism

A PE occurs when a clot or other matter large is in the pulmonary arterial system disrupting the blood flow to region of the lungs Medical management focuses on prevention of the recurrence of PE, initiation of clot dissolution, reversal of the effects of pulmonary hypertension, motion of gas exchange and prevention publication Nursing actions include optimizing oxygenation of ventilation, monitoring for cleaning, providing comfort and emotional support, maintaining surveillance for the complications, and educating the patient and family

Assessment and diagnosis of ARDS

A patient with ARDS is initially may be seen with variety of clinical manifestations depending on the precipitating event as a disorder progresses the patient sign and symptoms can be associated with the face of Arde that he is experiencing. During the x-ray to face the patient presents with tachypnea. Restlessness, apprehension, and moderate increase in accessory muscle use. During the Phibro prolific face the patient signs and symptoms begin to progress to agitation, dyspnea, fatigue, excessive accessory muscle use and fine crackles has respiratory failure develops. ABG analysis shows a low PaO2 despite increases in supplemental oxygen administration or refractory hypoxemia. The PAC out he was initially low as a result of hyperventilation but eventually increases as the patient fatigues. The pH is high initially but increases the respiratory acidosis develops. Initially the chest radio maybe normal because changes in the lungs to not become evident for 24 hours. As the pulmonary edema becomes apparent diffuse patchy interstitial and alveolar infiltrates appear. This progresses to multifocal consolidation of the Longs which appears as a white out on the chest radiograph.

Pulmonary contusion

A pulmonary contusion is a bruise of the lung. Pulmonary contusion is often associated with blunt trauma to the lung and other chest and re-such as rib pressures and flail chest. Pulmonary contusions can occur unilateral or bilateral. Contusion manifests initially as a hemorrhage followed by alveolar and interstitial Adema. The Adema can remain localized and they can twist part or can spread to other areas of the lung. Information negatively affects gas exchange across of evil or cavalier membranes. As inflammation and Adema increase a decrease in respiratory compliance, increased resistance and decreased pulmonary bloodflow may occur. This process is causing ventilation perfusion in balance that results in progressive hypoxemia in poor ventilation. Clinical manifestations of pulmonary contusion may take up to 24 hours after injury to develop. Inspection of the chest wall Maryville echinosis at the side of impact. Diminished breath sounds and course crackles maybe auscultated over the contest long. The patient may have a cough and blood tinged sputum. Abnormal lung function can manifest as arterial hypoxemia. Diagnosis is made primarily by imaging studies consistent with pulmonary infiltrates corresponding to the area of external chest impact and manifest 12 to 24 hours of injury. Pulmonary contusion may worsen over 24 to 72 hours after injury and then slowly resolved and less complications from infection or arts occurs. Aggressive respiratory care is the corner stone for not intubated patients at the pulmonary contusion. Interventions include deep breathing, incentives barometer, early mobilization, or noninvasive positive pressure ventilation. Chest physiotherapy may not be tolerated if there are coexisting rib fractures. Adequate pain control is achieved with nonsteroidal anti-inflammatory drugs, opioids, intercostal nerve blocks, or thoracic epidural analgesia. Removal of airway secretions is important to avoid infection approve ventilation. Patient with unilateral contusions our place with the injured side up and that an injured side down that long down. This position helps correct existing ventilation perfusion mismatch. Patients with severe pulmonary contusion may continue to exhibit signs of decompensation such as respiratory acidosis and increased work of breathing, despite aggressive nursing management. ET tube placement and mechanical ventilation with peep may be required. Complications resulting from pulmonary contusion's include pneumonia, cards, lung abscesses, and pulmonary embolism's.

Acute respiratory distress syndrome

ARDS is characterized by nine cardiac pulmonary Adema and disruption of alveolar capillary membranes as a result of injury to the pulmonary vascular tree or airways. Hallmark of ARDS is re-factory hypoxemia Medical management focuses on treatment of the underlying cause, promotion of gas exchange, support of tissue oxygenation, and prevention of complications. Nursing actions include optimizing oxygenation oxidization and ventilation in providing comfort and emotional support imitating surveillance or complications

Mechanism of injury sci

Acute injuries of the spine are classified according to the mechanism location and stability of the injury. Vertebral fractures can often occur with or without spinal cord injury. The mechanism of spinal injury can be caused by blunt force trauma or penetration. Cervical spinal injuries can be caused by mechanisms like axial loading, flexion, extension, rotation, lateral bending, and distraction. These six types of movements can enter the spine. Special considerations should be focused on older adults osteoporosis which contributes to high rate of spinal cord injuries with minimal trauma. These patients are known to experience ground level or fall from the city position hi index suspicion of spinal injury to see one to C2 fracture should be considered in this population

Acute lung failure description and ideology

Acute lung failure is also known as respiratory failure is a condition in which the pulmonary system fails to maintain adequate gas exchange. It is the most common type of organ failure seen in the critical care unit with approximately 56% of patients experiencing it. 1/3 of patients will require mechanical ventilation and will die in the hospital. ALF results from a deficiency in the performance of the pulmonary system and occur secondary to another disorder. It can be described as a hypoxemic normal Kaepernick respiratory failure type one or a hypoxemic hypercapnic respiratory is the failure failure type two depending on analysis of the ABGs. Type one and the patient presents with low arterial oxygen pressure and a normal arterial carbon dioxide. Take to respiratory failure the patient has a low PaO2 and a high PaCO2. That causes our class causes are classified as extrapulmonary or intrapulmonary depending on the origin of the primary disorder. Extrapulmonary include disorders that affect the brain, spinal cord, neuromuscular system, the thorax, the plural, and the upper airways. Intrapulmonary, causes include disorders that affect the lower air airways in alveoli, the pulmonary circulation, the alveolar to capillary membrane.

Acute respiratory distress syndrome

Acute respiratory distress syndrome is a systemic process that is considered the pulmonary ministration multiple organist function syndrome. It is characterized by non-cardiac culinary demonstration of alveolar cavalier membranes as a result of injury to the trail airways it results in 75,000 patients in anyway. Many different diagnostic criteria have been used identify are used to lead to confusion particularly among researchers. In an attempt to address limitations of the existing definition of our the definition has created a new definition and propose three distinct categories mild moderate and severe The level of acute respiratory distress syndrome is based on the severity of hypoxemia. The Berlin definition of arts is as follows. Timing within one week of non-clinical insult or new worst thing worsening respiratory symptoms Chest imaging bilateral opacities not fully explained by effusion's lobular one collapse or nodulesm Origin of Adema respiratory failure not fully explain my heart failure and fluid overload objective assessment needed to exclude hydrostatic Adema if no risk factor present. Oxygenation mild is 200 mmHg less than the PO to function of inspired oxygen if I heard he was less than or equal to 300 mmHg with positive and expiratory airway pressure or continuous positive every pressure greater than or equal to 5 cm. Moderate is 100 mmHg less than the PO two or less than or equal to 200 mmHg with people greater than or equal to 5 cm. Or severe SPO2 or FiO2 less than or equal to 100 mmHg with people greater than equal to 5 cm. Oh I try to have clinical conditions associated with the development of ours. They are categorized as direct or indirect depending on the primary side of injury. Direct injuries or injuries in which the long epithelium sustained direct insult. The recent coronavirus pandemic is an example of a virus causing a direct injury to the long epithelium. Indirect injuries or injuries in which insult occurs elsewhere in the body and mediators are transmitted by the bloodstream to the lungs. Sepsis aspiration of gastric contents. Diffused pneumonia, and trauma were found a major risk factors for the development of a RDS.

Alveolar hypo ventilation

Alveolar hyperventilation occurs when the amount of action being brought into the Alviola isn't sufficient me the metabolic needs of the body. This can be the result of increasing metabolic auctioneers or decreasing ventilation. Hypoxemia caused by alveolar hypo ventilation is associated with hypercapnia and calling the results from extrapulmonary disorders.

Open pneumothorax

An open pneumothorax or sucking chest wound is caused by penetrating trauma. Large open thoracic wounds greater than 2/3 diameter of the trachea allow communication between the atmosphere and the intrathoracic cavity. Has air moves in and out of the hole in the chest, sucking sound can be hard on inspiration. Respiratory mechanics become impaired. Dyspnea, tachycardia, and hypotension may be observed. Subcutaneous emphysema indicates that air is trapped in the tissue and eat the skin. This may be palpated on the wound as crepitus, a crackling sensation. Initial management is accomplished by probably inserting adjust to. If the chest tube is not immediately available cover the wound at the end of expiration with a sterile gloves addressing taped on three sides and large enough to overlap the edges of the ground. As the patient greets in the dressing it sucked in and include going to prevent her from a tank tank from entering the thoracic cavity. On expiration addressing those outward permitting the patient exhale surgical intervention is often required to close the wound.

Inverse ratio ventilation

Another alternative centaury know that is used in managing patients with ARDS is inverse ratio ventilation either pressure control or volume control. I RV prolongs inspiratory time in shortens the expiratory time. Fast reversing normal inspiratory to expiratory ratio. The goal of IRB is to maintain more constant mean airway pressures to the rental tourist which helps keep all the little pen and gas exchange. It also increases FRC and decreases the work of breathing. In addition as breath is delivered over a longer period of time the peak inspiratory pressure in the lungs is decreased. I made a disadvantage to inverse ratio ventilation is development of auto peep as the excretory phase of ventilation is short and Kurt, Eric become trapped in the lower Airways creating unintentional people or auto people which can cause hemodynamic compromise and worst thing as exchange. Patients on IRV usually require heavy sedation and neuromuscular blackhead to prevent them from fighting the ventilator

Spinal tracks and their functions

Ascending dorsal column functions with proprioception, pressure and vibration. Lateral spinal somatic tractor is sending functions for pain and temperature. Anterior spine with Milla contract is ending functions with light touch, pressure, and it sensation. Spinocerebellar tract functions with prior perception to the cerebellum. Pyramidal tracks descending function for voluntary control of skeletal muscle. Extra per parameter all tracks function for automatic control scuttle muscles descending.t Page 432 Page 432 also has table 37.2 which shows spinal nerve muscle innervation and patient responses such as C4 controls the diaphragm and ventilation.

Aspiration pneumonia

Aspiration pneumonia is the presence of abnormal toxic substances in the areas in LBI resulting in injury to the lungs. Medical management focuses on clearance of the toxic substance from the area support of oxygenation and maintenance of hemodynamics. Nursing actions include optimizing oxygenation and ventilation preventing further aspiration events providing comfort and emotional support and maintain surveillance for complications

Tension pneumothorax

Attention pneumothorax is caused by an injury that perforated the chest wall or plural space. During inspiration, air flows into the plural space and becomes trapped. As inspiration air flows into the plural space as pressure in the plural space increases the long on the injured side classes causing the mediastinum to shift to the opposite side. As pressure continues to build a shift exerts pressure on the heart in the thoracic aorta which decreases the venous return and decreased cardiac output. Tissue perfusion is effective because the collapse alone does not participate in gas exchange. Clinical manifestations of tension new include dyspnea, tachycardia, hypotension, and son chest pain extending to the back, neck, or shoulders. On the injured side rest sounds may be decreased or absent. Percussion of the Chesterfield hyper resident sounds over the affected side. Trickled tracheal deviation is a late sign of attention pneumonia and can be observed as a trachea drifts away from the injured side. Diagnosis is made by immediate clinical assessment. When attention and I suspected any trauma there is no time for a chest x-ray because it is potentially lethal condition must be treated at once. Needle decompression with a large or 14 gauge 5 cm needle is inserted over the second rib midclavicular line on the affected side and it is the immediate treatment of sweet choice. Alternatively all decompression sites include the fourth and fifth intercostal anterior ask Larry or mid axillary line using 5 cm 8 cm needle. This procedure allows release of air from the plural space. Hissing sound will be heard as attention Nemos converted to a simple Nemo. A test he was immediately inserted.

Positive end expiratory pressure

Because hypoxemia that develops with ARDS is often refractory and responsive to action therapy, it is necessary to facilitate oxygenation with PEEP. The purpose of using PEP and a patient with ARDS is to improve oxygenation mortising FiO2 levels. PEEP has several positive effects on lungs including opening class if you like, stabilizing flood it if you like, increasing FRC. Does PEP decreases intrapulmonary shunting and increase compliance. PEEP also has several negative effects including one decreasing CO as a result of decreasing return secondary to increased intrathoracic pressure and to barotrauma as a result of gas escaping into the surrounding states a secondary to a dealer rupture. The amount of PEP a patient requires is determined by evaluatingHemoglobin saturation and CL. In most cases, a PEP of 10 to 15 cm of H2O is adequate. If PEP is too high it can result in over distention pulmonary capillary blood flow, decreased a fact and production, and worsen. If PEP is too low it allows the Alviola to collapse during expiration which can result in more damage to if you like.

Reflexes tested in spinal trauma

Biceps at the level of C-5 to C6 The entire table can be found on page 436 table 37.4

Massive hemothorax

Blunt or penetrating through acid trauma can cause bleeding into the plural space resulting in a hemothorax. Massive hemothorax results from accumulation of more than 1500 ML's of blood in the thoracic cavity. The source of bleeding may be intercostal or internal memory arteries lungs card or gray vessels. Lacerations to the long parenchyma nerve low blood pressure bleeds and typically stop bleeding spontaneously. Arterial bleeding from Hailer vessels are usually requires immediate surgical intervention. Increasing vascular blood loss into the plural space causes a decrease in this return and decreased cardiac output. For patients with massive hemothorax, assessment findings are able to minister I was impressed sounds over the affected him and collect nectarines or hypervolemia or just send it next scenes that coexist with attention Nemo. Massive hemothorax is diagnosed on the basis of paper on the basis of hypotension associated with the absence of breath sounds are dullness to percussion on one side of the chest. Hypovolemic shock may be present. This potentially life-threatening condition must be treated immediately. Resuscitation with IV fluids is initiated to treat hypovolemic shock. HST was placed on the affected side to allow drainage of blood. Emergency thoracotomy may be necessary for patients who require persistent blood transfusions our house and if you can't bleeding greater than 20 ML per kilogram or greater than 200 ML per hour for 2 to 4 hours or more than 1500 ML in an initial tube insertion or when there are more company injuries to major cardiovascular structures.

Sputum studies

Careful analysis of sputum specimen is crucial for rapid identification and treatment of pulmonary infections. The most difficult aspect of sputum examination is proper collection of the specimen. Collection of a good sodium sample requires conscious cooperative and sufficiently hydrated patients. Sputum specimen are best collected in the morning because of nighttime cooling. Brushing teeth is recommended before hand to reduce contamination Many critically ill patients cannot cough effectively and sputum collection by other means is required these methods include tracheobronchial aspiration, transtracheal aspiration, and fiber-optic bronchoscopy on the brush catheter. Mini critical patients have an ET tube or tracheostomy already in place. Collecting speed them from these require special attention to technique. Deep specimens are obtained to avoid collecting specimens that contain upper airway flora who may have migrated down the tube. Colonization of the lower airways with upper airway flora can occur within 48 hours of intubation. After sputum specimen or obtained it is examined for volume properties micro purlins and color. Next to microscopic examination is done a source of the specimen. If a bacterial infection suspected a Gram stain is performed followed by a culture and sensitivity

Spinal protection procedure box 37.1 page 3 page 438

Cervical spine stabilization should be performed as a team. The leader is at the head of the bed manual in-line stabilization is maintained. Assess the patient's motor and sensory level. One assistant applies the cervical collar. I straighten the patient's arms and legs and make sure that they are both the same. On the leaders count and the patient is ruled as a unit. Straps are placed in the patient secured. The patient had to be further immobilized with blocks and towel rolls. Manual in line stabilization is maintained until the head and neck are mobilized. The patient's motor and sensory function should be reassessed after the patient is immobilized.

Pharmacologic management of SCI

Do use of high-dose steroids has been controversial over the years and states of Shawn harmful effects with heart high-dose steroids administration. One study found evidence of significant adverse effects including death. The use of high-dose steroids such as methyl prednisone is no longer recommended. Researchers are currently studying new pharmacological treatments for SCI. Few human studies have been done with stem cells but animals have shown improved outcomes. In one study has shown that intervenous bone marrow can promote recovery and rodents.

Air Leak Disorders

Early disorders consist of conditions that result in extra of Euler era cumulation and are classified into two categories pneumothorax pneumothorax and bear trauma or volume trauma To conditions that require emergency intervention for me to relieve her attention pneumo-intention Nemo pericardium Nursing actions include optimizing oxygenation and ventilation, trusting in system, providing comfort and emotional support and maintaining surveillance for complications

Extra corporeal and intracorporeal gas exchange

Extra corporal and intra-corporal gas exchanges are the last resort techniques used in the treatment of severe ARDS and conventional therapy has failed. These methods allow belongs to rest by facilitating the removal of carbon dioxide and providing oxygen external to the lungs by means of an artificial long or membrane fiber oxygenator. Extracorporeal membrane oxygenation or ECMO extra Courville carbon dioxide removal or two techniques that employ this type of technology. ECMO is similar to Carmen out cardiopulmonary bypass in that blood is removed from the body and pump through a membrane oxygenator CO2 is removed and seals in O2 was out of them returned to the body. The primary focus is removal of CO2

flail chest

Flail chest caused by blunt trauma disrupts the continuity of chest wall structures. Typically a flail segment occurs when two or more rivers are fractured in two or more places in our segment of the chest wall. A flail chest is this is a clinical diagnosis where the so-called foil segment moves paradoxically compared to the rest of the chest wall. During inspiration the intact portion of the test will expands all the injured part of sucked in. During expiration the chest wall moves in the fall segment will move out. Although the flower segment increases the work of breathing, the main cause of hypoxemia is often underlying pulmonary contusion. Physiologic effects of impaired chest wall motion of a flail chest include decrease total volume in vital capacity and impaired cough that leads to hypo ventilation and atelectasis. Inspection of the thorax reveals paradoxical chest movement. Palpation of the chest may indicate crepitus and tenderness near fractured ribs. With a flail chest the x-ray will reveal multiple rib fractures. Evidence of hypoxemia may be demonstrated by ABGs but this does not even diagnosis. Interventions focus on ensuring adequate oxygenation analgesia to improve ventilation. Intubation and mechanical ventilation may be required.

High frequency oscillatory ventilation

High frequency oscillatory ventilation is another alternative and Letory mode that is used in patients who remain severely hypoxemic despite the treatments previously described. This method of ventilation is similar to that if I RV and that it uses a constant airway pressure to promote alveolar recruitment avoiding over to stanchion of the alveoli. High frequency as Letory ventilation use the piston come to deliver very low tire volumes 1 to 3 ML's per breath at very high risk 300 to 900 breast permanent current research has failed to demonstrate this method provide any additional benefit over conventional and it may be even harmful.

Categories of movement that cause spinal cord injuries

Hyper extension - The head is forced back in the vertebrae of the cervical region are placed in an overextended position Hyperflexion the head is forced forward in the cervical vertebrae are placed an over flexed position Axial loading a severe blow to the top of the head causes a blunt downward force on the vertebrae and the spinal column Compression forces from above and below compress the vertebrae Lateral bend the head and neck are bent to one side beyond the normal range of motion Over rotation and distraction the head turns to one side of the cervical vertebrae are forced to be on normal limits

Pathophysiology of acute lung failure

Hypoxemia is the result of impaired gas exchange is the landmark of a cute lung failure. Hypercapnia may be present depending on the underlying cause of the problem the main cause of hypoxemia are all the other hypotension ventilation perfusion mismatch and intrapulmonary shutting. Type one respiratory failure usually results from VQ mismatch and intrapulmonary hunting or has type two results from alveolar hypoventilation which may not be accompanied by Vicky mismatch and intrapulmonary hunting.

Pressure control ventilation

I'm pressure control ventilation mode each breath is delivered or augmented with a preset amount of inspiratory pressure as opposed to tidal volume which is used in value ventilation. That's the actual title volume which is used the patient receives from breath breath. Pressure control ventilation is used to live in control him on a pressure in the lungs and decrease the incidence of volume trauma. The goal is to keep the patients plateau pressure or and inspiratory static pressure lower than 30 cm H2O. I know problem with this ventilation mode is at the patient's lungs will get stiffer. It gets harder and harder to maintain adequate title volume and severe hypercapnia can occur.

Intraparenchymal Micro sensor monitoring device

ICP monitors in silence the brain parenchyma work through the same use a fiber optic strain gauge or pneumatic technologies. Fiber optic devices transmit late fire fiber optic cable toward a displaced from here. Change is an ICP move the mirror differences in time for me to go cited light or translated to SEP value. Another parameters it may be measured within the fiber optic transistor tip catheter is brain temperature. With strain gauge the base technology SEP is a valuated when I see people as the transducer and change it so I love assistance. Pneumatic sensor technology measures ICP by using a small balloon and it still under the catheter to register change in pressure. Pneumatic sensors allow for quantitative measurements of intracranial compliance. The accuracy of the devices depend on their placement relative to the side of injury. The catheter can be easily placed via cranial access device, by ever hole or during a craniotomy. However the device may not be a good gauge of global ICP if pockets of ice if he arrives secondary just woke up saying injuries. The micro transducer system can encounter a draft a fuse for more than five days.

Cervical spine protection

If cervical spine immobilization is required, then the emergency nurse messenger that's final production devices are appropriate we propose propose applied to prevent further neurological injuries. The equipment required to protect the cervical spine includes a rigid cervical collar, lateral head immobilizer, and a full backward with straps.I read it cervical collar is applied to decrease head and neck movement. When applying a cervical collar the emergency nurse and follow the manufacturers instructions for size selection application. The cervical collar she only occur after the patients has been placed in neutral in line position and in line stabilization to be maintained throughout the application. Read it cervical collar should not obstruct the patient's mouth or airway or interfere with the ventilations. Placing the patient on the backboard does not completely protect the spine. The head must be stabilize laterally with a commercial head immobilizer, towel rolls and tape, or by taping the patient's head to the backboard. Taper strap should never obstruct the patient's airway. The patient should be secured to the backboard at the chest abdomen and knees before the head is secured remember the patient should be removed from the backboard within two hours from the time of application to prevent secondary injuries to the skin. If the patient has a helmet in place it should be removed before application of a cervical collar

History sci

In addition to the mechanism of injury, obtaining a thorough history is key. Red flags include complaint of neck or back pain and altered sensation. Back pain with loss of blowout bowel or bladder control. Significant trauma with altered mental status from intoxication or drug impairment, neck tenderness, history of loss of consciousness, and injuries to the head and face. The history of present illness should include an assessment of anybody to cure worn by the patient such as seatbelts, helmets, or riding gear.

Stabilization SCI

Initial stabilization of a patient with spinal trauma begins with treatment of life-threatening injuries like the airway and vascular compromise. The airway is evaluated while maintaining cervical spine control.

Nerve root injuries

Injuries to nerve roots me also occur as a result of spinal cord,., Injuries occur include conus medullaris and cauda equina syndromes both of which result from nerve root compression which is most often secondary to other vertebral fractures or disc herniation. Conus medullaris syndromes occur with compression of the level of T 12 and result in flaccid paralysis of the legs with variable sensory deficits below the level of the injury. Cauda equina syndrome occurs with compression of the nerve roots below L one level of the cord. Patient has caught it Aquinas syndrome percent worth a try it or symptoms including saddle paresthesia, bowel or bladder is function, and lower extremity weakness. And both syndrome the patient loses their anal sphincter town

Airway management SCI

Injuries to the spinal cord at C3 to C5 can result in loss of phrenic nerve function which will result in paralysis of the diaphragm. The patient with cervical spine trauma is at risk for hypoxia, respiratory arrest, and aspiration. As CMA compromise muscles of respiration, and localized Adema can cause area obstruction, particularly in penetrating neck trauma. Andrew said he want a T 11 can result in loss of intercostal muscle function, which can cause hypo ventilation initial clearing of the airway may safely be done with the control chin lift or draw thrust. Advanced airway management such as endotracheal intubation should be considered early on especially in patients with injuries to the level of C5 or above. Any area maneuvers required the cervical spine to remain adequately protected.

Intrapulmonary shunting

Intrapulmonary shunting the extreme form of a VQ mismatch occurs when the blood reaches the arterial system without participating in gas exchange. The mixing of an ox need a chunk of blood and oxygen and blood lowers the average blood level of oxygen present in the blood. Intrapulmonary ocean of a long there's not ventilated. This may be the result of all alveolar clap secondary to atelectasis or two of y'all are flooding with past blood or fluid. If allowed to progress hypoxemia can result in a deficit of oxygen at the cellular level. As a tissue demands her oxygen continue on the supply diminishes an auction supply demand and balance occurs, the tissue hypoxia develops. Decreased oxygen to the cells contributes to impaired tissue perfusion in the development of lactic acidosis and multiple organ dysfunction syndrome.

ABG interpretation step for

Look at the HCO3 or bicarbonate level and answer this question does the HCO3 show metabolic acidosis, alkalosis, or normalcy? Bicarbonate is the acid-based component that reflects kidney function. The HCO3 level is reduced or increase in the plasma by Reno mechanisms. The normal range is 22 to 26 and he keeps per liter. And HCO3 level of less than 22MA cues is metabolic acidosis which can result from keto acidosis, lactic acidosis, renal flat failure, or diarrhea. The cumulative affect is a gain of asses are a loss of base. Bicarb level that is greater than 26MA cues per liter to find metabolic alkalosis which can result from fluid loss from the upper gastrointestinal tract, direct therapy, severe hypokalemia, alkali administration or steroid therapy. Step five of ABG interpretation Look again at the pH level and answer this question does the pH show a compensated or an uncompensated condition? If the pH level is abnormal less than 7.35 or greater than 7.45 the PaCO2 value or the HCO3 level or both will also be abnormal. This is an uncompensated condition because the body has had not enough time to return the patient's normal range. If the pH level is within normal limits the PaCO2 and the HCO3 level or abnormal the condition is compensated because the body has had enough time to restore the pH within its normal range. Differentiating the primary disorder from the common centaury response can be difficult. The primary disorder is the abnormality that caused the page level to shift initially and is determined according to the pH level. The primary disorder is considered the one whichever side of the 7.40 the page level occurs. Partial compensate partial compensation may be present and is evidenced by abnormal pH, PaCO2 and HC03 levels indication that the body is attempting to return the pH to its normal range. In addition that to the parameters other factors must be considered including oxygen saturation auction content-based access and deficit and anion gap analysis

Step two an ABG interpretation

Look at the pH level and answer the question is the page on the acid or alkaline side of 7.40? PH is a hydrogen ion concentration of plasma. Calculation of pH is accomplished by using the arterial pressure of carbon dioxide and the plasma bicarbonate level. The formula uses a Henderson Hasselbeck equation. The normal pH of arterial blood is 7.35 to 7.45 and the main is 7.40. If the pH is less than seven points for zero is on the aesthetic side of the meeting. Level that is less than 7.355 is known as acidemia and the overall condition is called acidosis. If the pH is greater than 7.40 it is on the alkaline side of the mean. A pH level greater than 7.45 is known as alkalemia and the overall condition is called alkalosis. Step three of ABG interpretation Look at the PAC O2 level and answer this question does the PaCO2 to respiratory acidosis, I'll closest, or normalcy? The PaCO2 as a measure of the partial pressure of carbon dioxide dissolved in arterial blood plasma and it is reported in millimeters of mercury. The PaCO2 is the acid base component that reflects the effectiveness of ventilation in relation to the metabolic rate. In other words the PaCO2 value indicates whether the patient conventional it well enough to read the body of carbon dioxide produce as a consequence of metabolism. The normal range for the PaCO2 is 35 to 45 mmHg. This range does not change as a person ages. PaCO2 value greater than 45 is defined as respiratory acidosis which is caused by a V or hypo ventilation. Hyperventilation can result from chronic obstructive pulmonary disease, oversedation, head trauma, anesthesia, drug overdose, neuromuscular disease, or hypo ventilation with mechanical ventilation. Fanta the Tory failure results from the PSP a CO2 levels exceed 50 mmHg. Acute vent Letory failure occurs when the PaCO2 level is greater than 50 mmHg and a pH is less than 7.30. Then territory failure is just referred to as a cute because the pH is not normal allowing enough time for the body to compensate by return the pH to normal range. Chronic mental Tory failure is defined as a PaCO2 failure greater than 50 and a pH level greater than 7.03. A PaCO2 value that is less than 35 mmHg defines respiratory alkalosis which is caused by alveolar hyperventilation. Hyperventilation can result from hypoxia, anxiety, pulmonary embolism, pregnancy, and hyperventilation with with mechanical ventilation or is the conference room magnetism for metabolic acidosis

Low tidal volume ards

Low title volume ventilation use a smaller title volumes to ventilate the patient in an attempt to limit the effects of bear trauma and volume trauma. The goal is to provide maximum title and possible while maintaining and respiratory plateau pressure less than 30 cm of water. To allow for adequate carbon dioxide and elimination the respirators increased to 20 to 30 breaths per minute.

Incomplete spinal cord injury

Many types of incomplete spinal cord injuries are classified according to the effect it's finally tracked. Regardless of the type of injury, patience with incomplete I see I have asymmetric reflexes and flaccid paralysis, with some preserved sensation of all the level of injury. The specific types of incomplete cord syndromes are based on these characteristics and include central cord syndrome, enter your code syndrome, posterior cord syndrome, brown Sicard syndrome, and nerve root injuries. Confirmation of an incomplete lesion is based on evaluation of sensory and motor function as defined by the American spinal injury association

Prone positioning

Numerous studies have shown that prone positioning of a patient with ARDS results and improvements in oxidization. Although many theories propose how propositioning improves oxygenation discovery that with ARDS there is greater damage the dependent areas of the lungs probably provides the best explanation. It was originally thought that ARDS was a diffuse modest disease that affected all areas of the lungs equally. For the dependent long areas are more heavily damaged in the nondependent long areas. Turn the patient crown improves the perfusion to the last damaged parts of a long and improve the dehumidifier and decreases intrapulmonary shunting. Prone positioning of your stay more effective when initiate it during the early phases of ARDS I applied for at least 12 hours a day

SCI outcomes

Patients with complete tetraplegia are at highest risk for secondary complications. These complications are known as pneumonia, pressure ulcers, deep vein thrombosis, pulmonary embolism, and postoperative wound infections. Pressure ulcers are the most frequently observed complication after injury during the first year. The most common location is the sacrum.

Hemodynamic management SCI

Patients with spinal trauma experience hypotension as a result of neurogenic or hypovolemic shock. Injuries to the spinal cord of the level of T6 or above may cause loss of sympathetic diesel motor tone, leading to hypotension and bradycardia. The stroke state and his neurogenic shock prevents a comment Centauri increase in heart rate in response to hypertension. Neurogenic shock assessment findings include bradycardia, hypotension, warm skin with normal color, and core temperature instability. Best loss of sympathetic tone results and compromised perfusion to the spinal cord would result in loss of function. Spinal shock is another condition that could be caused by SCI. Spinal shock occurs when there's disruption in the spinal cord that diseases impulses below the level of the injury. This results in complete loss of reflexes for the ability of the injury. Transient episode of hypertension and inability for thermal regulation can be seen. Spinal shock maker May occur immediately after the injury and can last up to 12 months after the injury. Injuries leading to hypovolemic shock like tension pneumo-, hemothorax, intra-abdominal bleeding should be ruled out these types of injuries can be identified through the use of a bedside ultrasound technique known as the focused assessment sonography for trauma or fast. If hypotension occurs in the trauma patient with suspected SCI, isotonic crystalloids should be used judiciously to prevent pulmonary Adema. If hypertension does not respond with the isotonic fluid administration vasopressor support should be considered.

Penetrating injuries SCI

Penetrating injuries to the spinal cord are usually resulting of gunshot wound and stab loons accounting for at least 1/4 of all new STI's. The emergency nurse should know the presence of any ballistic type of wounds or punctures. If possible the emergency nurse should try to obtain specific caliber of weapons to determine the possible number of fragments. For penetrating objects exact path is not known and visceral injuries must be suspected and ruled out. If the missile passes through the abdominal this run to the spinal cord, the patient is a great risk for central nervous system infection antibiotic prophylaxis is required. If the patient is brought into the ED with a penetrating object in place, the emergency nurse should leave the object in place and stabilize it. Bullets and wounding objects are evidence and should be handled carefully

Permissive hypercapnia ARDS

Permissive hypercapnia uses low title volume ventilation in conjunction with normal respiratory rates in attempt to limit the effects of atelectatic trauma and bio trauma. To maintain normal Near the patient's respiratory rate would have to be increased to compensate for the small tidal volume. In ARDS increasing the respiratory rate can lead to worsening alveolar damage. That's the patient's carbon dioxide level is allowed to increase and the patient becomes hypercapnic. As a general rule the patient's PaCO2 should not rise faster than 10 mmHg per hour and overall should not exceed 80 to 100 and 100 mmHg. Because of the negative comments cardio pulmonary effects of severe acidosis the arterial pH is generally maintained at 7.2 or greater. To maintain the pH the patient may be given intervenous sodium bicarbonate or the respiratoryThe respiratory rate or title volume or both are increased. Permissive hypercapnia isIs contraindicated in patients with increased intercranial pressure, pulmonary hypertension, seizures, and heart failure.

Pneumothorax in trauma

Plural damage is common in trauma. These conditions include pneumothorax, hemothorax, or hemopneumothorax. Pneumothoraces may be managed with chest tubes, algesia, surgical consultation, he note. Hemodynamic stability of the patient and effects on oxidation of ventilation are important. Open Nemo. Tension Nemo, and massive hemothorax, three additional and potentially life-threatening respiratory problems and trauma weren't special can separation

Pneumonia

Pneumonia is an acute inflammation of the lungs parenchyma caused by an infectious agent they going to lead to leave y'all are consolidation and can be classified as a community acquired or hospital acquired Medical management focuses on initiation of anabiotic therapy, nurse ration of oxygen and mechanical ventilation, management of fluids and nutrition support and treatment locations Complications Nursing actions include optimizing oxygenation and ventilation preventing the spread of infection rate and comfort and emotional support and maintaining surveillance for complications

Resolution phase ARDS

Recovery occurs over several weeks of structural and vascular remodeling take place reestablish the alveolar Kaplan membrane. The highly membranes are cleared and intracellular fluid is transported out of the oven you listen to the interstitium. The type to alveolar epithelial cells multiplied some of which differentiated type one popular actually ourselves facilitating the restoration of the alveolus. I'll be able to macrophages remove cellular debris.

Rib fractures

Rib fractures can be minimal and cause minor discomfort or serious and life-threatening particularly when multiple ribs are fractured when pre-existing cardio pulmonary disease is present or when the patient is an old adult. Fracture of the first and second ribs are associated with intrathoracic the six vascular injuries of the brachial plexus or greater vessels. Because arteries and veins are protected by the scapula, clavicle, humerus, and muscles vascular injury signifies a very high degree of force applied to the thorax. Fractures to the Middlerose may be associated with lung injury. Including pulmonary contusion a pneumothorax. Fractures to the lower ribs may be associated with abdominal trauma such a spleen and liver injuries the 7th to 12th. Look less pain than increases with respiration is elicited by rib compression may indicate rib fractures. Pain associated with rib fractures can be aggravated by chest wall movements. The patient often splints fractured ribs, take a shower press, and refused to cough. This can result in atelectasis with pneumonia or a collapsed lung. Definitive diagnosis of the rib fractures can be made with a chest x-ray. Interventions include pain control to improve chest expansion and facilitate gas exchange, chest physiotherapy, and early mobilization. The primary goal of pain management with rib fractures as patient comfort and prevention of pulmonary complications. Pain management and intervention must be tailored to the individual patient in response to therapy. Nonsteroidal anti-inflammatory drugs, intercostal nerve blocks, thoracic epidural analgesia, and opiates may be considered. External splints are not recommended because they may limit just to expansion and add to you atelectasis.

Spinal cord injury without radiographic abnormality

SCIWORA This is a condition in which neurologic deficit are present in the absence of an identified radiographic abnormality. This is most often seen in peds and is not uncommon admitted middle-aged or geriatric patients and it accounts for about 12% of STI's. And children the condition is often attributed to anatomic differences allowing for ligamentous laxity in the cervical spine. In adults, dicks desk prolapse and cervical spondylosis have a noted as causes in addition to ligamentous injuries MRIs are invaluable and diagnosing this condition

Inspection sci

Spinal cord injuries disruptive into Letory pattern of the patient which should be addressed in the primary survey. If the patient has an uncompromised airway then the assessment continues with the inspection of abnormalities. The presence of cerebrospinal fluid from the nose or ears should be noted. Patients with CSF leaks raise even higher suspicion for serious mental trauma The emergency nurse observed the patient for signs of injury including deformity of the vertebral column, cervical edema, and ballistic ones in the neck chest or abdomen. Maintain spinal restrictions until a column injury or spinal cord injury is ruined out. And injury between C3 and C-5 can result in progressive respiratory insufficiency secondary to significant respiratory muscle dysfunction. The respiratory muscle dysfunction is primary to the disruption of the phrenic nerve. Injuries below C-5 can lead to a decreased intercostal and abdominal muscle dysfunction, intern altering mechanics for ventilation and increasing the work of breathing. Another key observation is the patient's ability to move in perceived pain. Diminished pain response and decreased movement of extremities. This type of response can indicate a spinal cord injury especially if they don't notice an IV insertion or urinary catheterization. A continuous erection may also signal a spinal cord injury

Specific types of spinal cord injuries

Spinal cord trauma encompasses both primary and secondary injuries. The initial impact from blend or penetrating forces results in primary injury. Examples of primary injuries include vertebral fractures or dislocations, torn ligaments, and spinal cord transactions. Secondary injuries to the spinal cord may develop within minutes of an initial injury. Microscopic hemorrhage in Adema lead to spinal cord hypo perfusion, hypoxia, and endogenous bio chemical responses. Secondary injuries extend the initial injury, increase morbidity, and limit future recovery. The emergency nurse must be alert to these and provide interventions to minimize their development Injuries of the vertebral column may occur with or without associated SCI. Although they are the most devastating not all SCI's involved transaction or severing of the spinal cord. Contusions, lacerations, vascular damage, hemorrhage, and transaction or all possible injuries to the spinal cord. When they do occur, spinal cord transactions may be complete or incomplete. Complete spinal cord transactions lead to loss of all motor and sensory function below the level of injury an account for 50% of all STI's. Patient with an incomplete spinal cord transaction will have a partial preservation of some motor and sensory tracks or both. Complications related to SCI are based on the location of the injury. An injury of the cervical spine push the patient at risk for pulmonary inventory problems. Hello thoracic spine injury caused his loss of abdominal muscle function, decreased respiratory reserve, and gastric distention. Injury to the lumbosacral area of the spinal cord because lots of temperature regulation of bowel and bladder function. Injuries to the spinal cord at any level may lead to muscle facility and loss of reflex is below the level of entry. Because of the decreased mobility from the spinal injuries all patience with us you are a risk for developing deep vein thrombosis, to keep his ulcers, and pulmonary emboli

Psychosocial care SCI

Spinal trauma and less it's a tremendous amount of anxiety and fear. Many are concerned while they're they will be able to move or walk again. These patients will require a collaborative approach that includes management and spiritual care. The care of SEI includes multidisciplinary approaches. Initial support of care and prevention of further injury are important.

Status asthmaticus

Status asthmaticus is a severe asthma attack that falls fails to respond to conventional therapies with bronchodilators it may result in a LF Medical management focuses on support of oxygenation by bronchodilators, corticosteroids, and oxygen therapy and ventilation. Nursing actions include optimizing oxygenation and ventilation, providing comfort and emotional support, maintaining surveillance for complications, and educating the patient and family

Interpreting ABGs

Step one look at the PO to you and answer this question does the PO to show hypoxemia? The PaO2 is a measure of the partial pressure of oxygen desire solved in blood. Sometimes PO two is shortened to PO two it is reflected in millimeters of mercury. The PaO2 reflects 3% of oxygen in the blood The normal range of PaO2 values breathing room air is 80 to 100 mmHg. However the range is dependent for infants and adults over 60 years old. The normal level for adults over 60 years old decreases with age check due to changes occurring the ventilation for Q fusion matching at the aging of the lung. The correct PA or two for older adults can be ascertained as follows: 80 mmHg minus one for every year of age more than 60 years using this formula a 65-year-old can have a PO 275 and still be within the normal range. And acceptable range for an 80 year old is 60 At any age of PaO2 lower than 40 represents a life-threatening situation that necessitates immediate action. A PO to value less than predicted lowest value indicates hypoxemia which means that lower the normal amount of oxygen is dissolved in plasma The PO to level is analyzed before the levels of other blood gas components. PO to have less than 40 mmHg severely compromised tissue oxygenation and requires immediate administration of supplemental oxygen or mechanical ventilation or both. The test results for the POT level to me analyzed quickly. If the PO two level is more than the lowest value for the patient states the PO two is considered normal

PaO2/FiO2 ratio

The PaO2/FiO2 ratio is clinically the easiest formula to calculate because this formula does not call for the compensation computation of alveolar PO two. Normally the PaO2/FiO2 ratio is greater than 286 the lower value the worse the lung function

PaO2/PaO2 ratio

The PaO2/PaO2 ratio or the arterial/alveolar oxygen ratio is normally greater than 60%. The disadvantage using this formula is that this formula calls for the computation of the alveolar P02 but the advantages that this formula is unaffected by changes in the FiO2 as long as the underlying lung condition is stable

Phibro proliferative phase ARDS

The Phibro proliferative phase begins as a disordered healing and starts in the lungs. Cellular granulation in college and deposition occurs within the alveolar capillary membrane. The Alviola become enlarged and irregularly shaped and the pulmonary capillaries become scarred and obliterated. This leads to further Stephanie of the lungs and crease in pulmonary hypertension and continued hypoxemia.

Alveolar arterial gradient

The a Dash a gradient is normally less than 20 mmHg on room air for patients younger than 61 years. This estimate of intrapulmonary shunting is at least is the least reliable clinically but it is often used in clinical decision-making. A major disadvantage to using his formula is that it is greatly influenced by the amount of oxygen the patient is receiving. Serial determinations of the estimates of intrapulmonary shunting provide the practitioner with objective data on how to base clinical decisions.

Radiographic evaluation SCI

The diagnosis of a spinal column injury is made with use of radiographic imaging in conjunction with clinical assessment. The diagnosis of SCI or vertebrae fracture begins with the use of x-rays. Commonly a three-way film is obtained including 71 junctions to visualize and rule out the cervical spine injuries. If the patient is at a high risk the part writer may directly use a CT scan versus an x-ray at determining specific bone anatomy where a fracture is located. MRI can be used to detect in any blood clots, herniated disc's or other masses that might be compressing the spinal cord

Classic shunt equation and oxygen tension indices

The efficiency of oxygen can be assessed by measuring the degree of intrapulmonary shunting that occurs in a patient at any one time using the classic Shanti Quetion and the oxygen tension in disease. Entered pulmonary shunting or QSQT the portion of the cardiac output not exchanging with the alveolar blood divided by the total cardiac output refers to the venous blood that flows feelings without being oxygenated because of non-functioning Alviola. Other names for this condition inclusion defect, VQ, waisted blood flow, and venous admixture. Direct determination of intrapulmonary shunting requires the use of classic shanty Quetion which is invasive and cumbersome. I shan't greater than 10% is considered abnormal an indicator of a shunt producing disorder. The shunt greater than 30% is serious and potentially life-threatening that requires pulmonary intervention. Often enter pulmonary shunting is estimated by using the tension indices. One invention advantage to these methods is the ease of performance although they've been found unreliable and critically ill patients. An estimate of intrapulmonary shunting can be determined by computing the difference between the alveolar an arterial oxygen concentrations. Normally the alveolar and the arterial values are very equal. And they are not in indicates venous blood is passing malfunctioning elbow leg I'm returning an oxygen into the left side of the heart. The most common oxygen tension used to estimate are the PaO2 FiO2 ratio and the PO to POT ratio and the AA gradient.

Dead space equation

The efficiency of ventilation can be measured by using the clinical dead space or the VD/VT equation. The formula measures a fractional fraction of tidal volume not participating in gas exchange. A dead space value greater than 0.6 indicates a dead space producing disorder and is considered abnormal. The major limitation is to using this formula or that it requires the measurement of exhale carbon dioxide to complete the work of breathing and patients must remain stable during collection

Combination intraventricular fiber optic catheter

The intraventricular fiber optic catheter combines the capability of external ventricular drainage with monitoring of ACP. This hybrid device can be used to monitor SEP intermittently or continuously and drain CSF intermittently or continuously. Third binges and disadvantage is to using this combination catheter. And disadvantage is that the catheter can be shared only before insertion. However because the transducer is in the tip of the fiber optic catheter there is no external strain gauge transducer and no pedals your way and leveling of the transition with the M anatomic reference point for the framing of Monroe. And advantage of the catheter so that allows for CSF drainage. To prevent under drainage or over drainage or CFS attention must be paid the level of reference point of the job changer to the anatomic reference point for the framing of the row and setting pressure at the top of The top of the graduated Brett drip chamber. Consequences of CFS under drainage a good headache, neurologic deterioration, hydrocephalus, increased ICP, secondary neuronal injury, herniation and death. Consequences of CSF over drainage include headache,,, pneumocephalus, ventricular collapse, herniation, and death.

SCI prevention

The most important a big improvement an emergency care and rehabilitation has allowed patients to survive. Although current research studies of decompression surgery nerve cell transplant and nerve regeneration are being conducted there is currently no cure. SCI prevention is crucial to decrease the impact of his injuries on society. Education for prevention to include motor vehicle safety water and support safety and fall prevention and firearm safety

Additional interventions for SCI

The patient should have a urinary catheter to facilitate bladder emptying into monitor output. A gastric tube should be inserted to protect the patient from gaster distention and aspiration. The emergency nurse must recognize the patient has lost the ability to control their body temperature. The patient must be kept warm and protected from a necessary exposure. Increase the room temperature, apply warm blankets, use warmed IV fluids to keep the patient normal thermic. These interventions are even more crucial in geriatric patients with STI because older patients have a lower basal metabolic rate and are more prone to problems maintaining body temperature in the absence of injury. Finally because patients with spinal injuries may lose sensations of pain and pressure, skin care is crucial. Prolonged immobilization leads to ischemic pressure all service. To reduce the occurrence of this the backboard should be removed as soon as possible. Pad all bony prominences and place a clean dry sheet under the patients to protect their skin. Finally patients with unstable fractures may require some type of internal vaccination or cervical tongue support.

Palpation SCI

The patient's hemodynamic status should be assessed by the palpation of central pulses for rate and quality. Patient was SCI is at risk for developing neurogenic shock. Neurogenic shock results from temporary loss of autonomic function which controls cardiovascular function. Martin would only make and systemic effects are seen typically resulting in hypotension, bradycardia and hypothermia. This condition is critical. Next strength and symmetry of movement and all four extremities should be evaluated. Quick motor evaluation should include flexion and extension of the arms, flexion extension of the legs, flexion of the foot, extension of the toes, and sphincter tone. In addition to strength and symmetry, sensation should be assessed. Sensory status may be assessed by evaluation of dermatomes. The patient should be able to distinguish between sharpened all sensations when a safety pin or cotton swab is used. Testing should begin at the level of no reported sensation and proceed upward to identify the level at which feeling will return. The presence of sacral or peroneal sensation should also be assessed. If sacral sensations are present with other deficits this is called sacral sparing and an incomplete SCI should be suspected. Injuries above the level of T4 usually disrupt the sympathetic nervous system, causing vasodilation below the level of the injury. If the patient is diaphoretic, sweat is present above resin below the level of the injury. In addition, a patient with SCI becomes play kilo thermic assuming the temperature of his or her surroundings due to the loss of sympathetic tone can leave the patient at great risk of hypothermia The patient's entire spinal column should be gently palpated for pain, tenderness, crepitus, and step off deformities. Palpation requires the patient to be logroll by at least 40 members to maintain spinal alignment. If cervical collar is removed manual stabilization must be maintained

Patient assessment SCI

The primary focus is the primary survey. Assess the airway, breathing, and circulation or simultaneously maintaining cervical spinal mobilization. Cervical spinal mobilization dragon assessment includes manual stabilization until a rigid cervical collar can be placed. The criteria for cervical and mobilization will be discussed later. The secondary survey consists of conducting a head to toe examination and obtaining a brief history. During the survey assessment will determine whether there any specific injury sustained or specific injuries due to mechanism. Every injury should be every effort should be made to remove the spinal board due to risk of ulcer formation.

ARDS pathophysiology

The progression of ARDS can be described as three phases exudative. Phibro plural affirmative, and resolution. ARDS is initial the simulation of the inflammatory immune system as a result of direct or indirect injury. Inflammatory mediators are released from save injury resulting in the activation and accumulation of neutrophils, macrophages, and platelets and pulmonary capillaries. T cell mediators initiate the release of humeral meditators that caused damage to alveolar cop cowboy membrane

Spinal column

The spinal cord extends from the brain through the foramen magnum and down the vertebral column to the level of L2. This massive nerve tissue regulates body movement and function through transmission of nerve impulses. The diameter of the spinal cord is largest in the cervical and lumbar regions and tapers in the lower thoracic area. An adult determines Nicole cheap structure known as the conus medulla is at the level of L1 or L2. Spinal nerve roots exit below the conus medullaris and I referred to as the codger a coin The primary function of the spinal cord is to regulate bodily function and movement by transmitting nerve impulses between the brain and body. Cross-sectional views of the spinal cord reveal a butterfly shaped core composed of gray matter surrounded on the edges by white matter. The gray matter contains nerve cell bodies and is divided into three regions it was specific characteristics the posterior or dorsal, the inter-medial lateral or lateral, and anterior or ventral horns. The posterior or dorsal Horn contain sensory interneurons and axon to sell bodies are located in the dorsal root ganglion. The entry intermedial or lateral horn contain cell bodies with autonomic nervous system functions. The anterior or ventral Horn contain somatic motor neurons that leave the spinal cord via the spinal nerves. White matter of the descending spinal cord consists of multiple ascending and descending pathways referred to collectively as spinal tracks. Which are individually named based on their origins and terminations. These tracks run parallel to the spinal cord vertical axis and transmit action potentials to and from the brain in other parts of the spinal cord

Spinal nerves

The spinal cord has 31 pairs of nerves which exit the spinal cord bilaterally and provide pathways for involuntary responses to specific stimuli. There are eight cervical nerves, 12 thoracic nerves, five lumber nurse, five sacral nurse, and one coccygeal nerve. The spinal nerves innervate voluntaries try to muscle and responsible for the majority of communication between the spinal cord and the rest of the body. Each of these nerves has a posterior route transmitting sensory impulses from the periphery into the spinal cord and an interior route transmitting water impulses from the spinal cord out to the periphery. The dorsal root of these nerves innervates a distinct region of the body surface known as a journal dermatome. Assessment of the 28 dermatomes provides information about function of the sensory areas of the spinal cord.

Vascular supply

The vascular supply for the spinal cord comes from branches of the vertebral arteries in the aorta. The anterior posterior spinal arteries branch off at the vertebral artery at the cranial base and descend parallel to the spinal cord. Because spinal cord arteries cannot develop collateral but supply got injuries to these arteries can be devastating

Tapes of intercranial pressure monitoring devices

There are several different invasive methods of us to be Madre depending on location type of brain injury and monitoring technique. SEP monitoring to me I'm taking a different intracranial anatomic locations interventricular, intro. Cranky mall, epidural, sub dural, and subarachnoid. The most commonly used I should be monitoring device is the interventricular and the intraparenchymal locations.

Trauma to the spinal cord and spinal column

This can cause devastating life-threatening injuries. A spinal cord injury with or without neurologic deficit must be concerned considered in the trauma patient with multiple injuries. As many as 450,000 people, live with a spinal cord injury. Each year there are approximately 11,000 spinal cord injuries occurring in the US alone. The vast majority of these patients are the ages of 16 to 30 years old males are 80% of these injuries. This percentage represents the number that the healthcare providers are faced with. Trauma to the spinal cord can come from both black forest and penetrating trauma. Patient may sustain injuries from motor vehicle crashes, gunshot wound, falls, higher sports, motorcycle and driving accidents. Motor vehicle crashes have been ranked leading cause of vertebral injuries for those 65 and younger. The mechanism of injury in the MVA is correlated with roll over and objections from unrestrained occupants. And patient 65 years and older, Falls been found to be leading cause of spinal cord injuries. Centers for disease control and prevention of estimated the cost of 9.7 billion each year. Secondary injuries such as pressure else there's also cost an estimated 1.2 billion each year.m Many people with spinal cord injuries were die of respiratory complications like aspiration and pneumonia in the past. Initial care and treatment is stabilization. Stabilization and treatment has improved over the years. Prehospital agencies have been trained to identify potential injuries based on the assessment. Spinal motion restriction guidelines have been developed help determine the needs for spinal protection. Prehospital personnel at fully immobilized trauma patients. The realization of rapid air transport agencies hasn't improved time to definitive care for trauma patients. Recent studies indicate the patients with head injuries or at a higher risk are also having a cervical spine injury. The patient should be evaluated to also rule out a life-threatening injury like attention pneumonia or intro domino bleeding all the spine protection is continued.

Autonomic dysreflexia

This is a complication of STI's above the T6 level occurring anytime after the resolution of spinal shock. This is a life-threatening emergency leading to massive uncontrolled cardiovascular responses. Multiple stimuli below the level of injury can trigger this response. A full bladder is responsible for tracking triggering the response often but stimulation of the skin or cutaneous pain receptors may also cause autonomic dysreflexia crisis. Signs and symptoms include sudden severe headache, hypertension, nausea, bradycardia, and sweating above level of injury with coolness below the level of injury. The patient may also complain of nasal stuffiness and have severe anxiety. Treatment of autonomic dysreflexia begins with identifying the cause of the sympathetic response. Once the cause of the dysreflexia is identified such as a full bladder or constipation, the nurse can rapidly intervene. If the bladder is full insert a catheter. Medication's to relieve constipation or antihypertensive medication to be administered. The patient must be closely monitored to prevent a precipitous drop in blood pressure and quickly identify any serious complications. After the emergency and resolve the emergency nurse should work with the patient and family to develop in for more interventions

Long-term mechanical ventilation dependence

This is a secondary disorder that occurs when a patient requires assistive ventilation for longer than expected given the patient's underlying condition We need to be divided into three stages; pre-weaning, weaning process, and weaning outcome The winning pre-weaning phase consists of resolving the precipitating event the necessitated Vente Letory assistance in preventing the physiologic and psychological factors that can interfere with weaning The weaning process phase consists of initiating the weaning method selected and minimizing the physiological and psychological factors that can interfere with weaning Winning is deemed successful and the patient is able to breathe spontaneously for 24 hours without event Latoria support

Central chord syndrome

This is caused by hyper extension and results and swelling to the central portion of the spinal cord. The syndrome causes a great loss of function in the upper extremities greater than the lower extremities. Black bowel and bladder function are typically maintained

Posterior cord syndrome

This is rare and results from hyper extension injuries that damaged the dorsal column of the spinal cord. Light touch and proprioception are impaired but not completely lost

Intracranial pressure monitoring

This is recommended as part of protocol during Karen patients were at risk of elevated ICP based on clinical imaging features. General indications for ICP monitoring include traumatic brain injury, intracranial hemorrhage, SAH, hydrocephalus, I've had a collection within cephalopathy, cute ischemic stroke with large infection and meningitis. I can try indication for ICP monitoring is coagulopathy. The appropriate threshold for ICP has not been defined. However the more interest if you're not all sister only 5 to 15 mmHg. And the threshold for intercranial hypertension is continued to be greater than 20 million mercury. It is recommended that I should be monitoring be used in conjunction with other intracranial monitoring devices to his clinical decision-making. Both noninvasive and invasive methods of monitoring a spear available. Noninvasive measuring is it Includes TCD, tympanic membrane displacement, optic nerve sheath diameter, CTMRI, and Puype you though Mentry. Non-invasive techniques do not have the complications related to invasive techniques however techniques have got to measure ICP actually.

Intraventricular catheter monitoring device

This is the most common method for placement of an intervention regular catheter is a corona beer whole approach at the Kuchar point our culture point with the two of the catheter placed in the third ventricle. Once CFS flow is visualized the catheter can be transduce to obtain an opening intracranial pressure. The main opening pressure has significant prognostic implications and influences medical management strategies. And the catheters and tunneled through the skin sutured in place and connected to an external drainage system. The combination of ventricular asked me with close drainage is known as external ventricular drain. The underlying condition of the patient and the ICP are considered in determining the prescribed level of EDD drainage point. Drainage can we continue our sunset level to fix volume and a desire time or as needed according to SEP elevations. And even the required repeated zero and leveling so the pressure transducer is in line with the framing of Monroe which falls the level of the external auditory meeting us at the air and the patient in supine. Drawbacks of ICP monitoring by open DVD include undetected increases an ICP above the threshold of less reliable assessments of cerebrovascular auto regulation. Post procedural hemorrhage and ventriculostomy associated infections. The imaging guided system improve the likelihood of optimal placement. The risk of infection may be decreased by using antibiotics or an antibiotic impregnated catheter.

Brown-Sequard Syndrome

This is uncommon resulting from a hemi section of the cord. The most common cause is a penetrating injury like a gunshot, knife, or missile fragment penetration. This syndrome is characterized by ipsilateral or same side paresis or hemi plegia and loss of motor function, touch, pressure, vibratory sense, and proprioception. Contralateral contralateral or opposite opposite side losses include decrease sensation to pain and temperature change

Vertebral column

This provides protection for the spinal cord there are seven cervical vertebrae, 12 thoracic vertebrae, five lumbar vertebrae, one sacral vertebrae that is composed of five fused vertebrae, and one coccygeal vertebrae composed before fused vertebrae. Each is composed of a body, I vertebral arch, and I vertebral freeman. The art of the vertebra is composed of two para seals to laminate for articular processes and to transverse processes, and the spinous process. The cervical vertebrae are the most frequently injured because they are the most mobile part of the spine and are small and delicate. The rib cage provide stability to the vertebra from T1 to 210 and keep that portion of the spine relatively immobile. Because the thoracic vertebrae are so strong fractures or dislocations of these should increase suspicion for a spinal cord injury. The lumber vertebrae are the largest and strongest of the vertebral column Ligaments attached to the transverse spinous process to connect the vertebral bodies and provide support and stability to the vertebral column. They also limit the spinal column from excessive flexion and extension. Between the vertebral bodies are discs acting a shock absorbers an articulating services for the address and or Thibaut bodies.

Anterior cord syndrome

This results from disruption of the anterior spinal artery which supplies the motor and sensory pathways in the anterior portion of the spinal cord. The patient has loss of motor function and pain and temperature sensation for the lower the level of the injury. Vibratory cents, touch pressure and proprioception remain intact because the posterior, column is preserved

Thoracic injuries

Thoracic and reasonable trauma to the chest wall lungs heart great vessels and esophagus. Second only to head injury or spinal cord injury thoracic injuries account for 25% of trauma deaths. Fantastic trauma to the chest is often caused by motor vehicle accident or fall. Various types of blunt trauma associated with specific injury patterns. And penetrating thoracic injury, the object involved determines the degree of damage to underlying structures. Low velocity weapons usually damage only what is in the direct path of the wet weapon. Steroids involve the anterior chest hold in the middle clavicular lives in the angle of Louis and epigastric region are particular concerned because the proximity to the heart and gray vessels. Velocity weapons are capable of causing considerable thoracic injury because of the greater kinetic Andrey.

Ventilation ARDS

Traditionally patient with ARDS were ventilated with a motor volumizer ventilation such as an assist control ventilation or synchronize intermittent mandatory ventilation with title volume suggested to deliver 10 to 15 mL per kilogram. Current research indicates that this approach may have actually lead further lung injury. It is now known the repeated opening and closing of the Alviola cause injury to the lung units resulting in inhibited surfactant production and increased inflammation resulting in the release of mediators and an increase in pulmonary capillary membrane permeability. Excessive pressure on the of your belt, or excessive volume in the alveoli volume, leads to excessive if y'all are well stress and damage to the overall or Cavaleri membrane results and Iris keeping into the surrounding spaces. Does several different approaches have been developed facilitate the mechanical ventilation of patients with ARDS

Ventilation perfusion miss matching

VQ miss matching occurs when ventilation and blood flow or miss matched in various regions of the long and access to it as normal. Blood passes through Alviola that are under ventilated for the given amount of perfusion, do you these areas with a lower than normal amount of oxygen. If you miss matching is the most common cause of hypoxemia is usually the result of alveoli that are partially collapsed or partially filled with fluid

Spinal and neurogenic shock

When complete SCI occurs, all motor and sensory function see split level of injury. Spinal shock is characterized by loss of reflexes and motor and sensory function below the level of injury. The onset is usually immediate and the intensity and duration are determined by the level of injury. Patient with spinal shock exhibit flaccid paralysis, a reflexa, and bowel and bladder dysfunction. In addition spinal shock to stress the patient's ability to thermal regulate the body causing the patient to assume the temperature of the surrounding air. Neurogenic shock, a former distributor shock may also be seen with injuries above the T6 level. Temporary disruption of the sympathetic nervous system causes bradycardia and hypotension. Neurogenic shock leads to further spinal cord hypo fusion it must be recognized and treated early to prevent further damage to the spinal cord

Exudative phase ARDS

Within the first 72 hours after initially saw the x-ray to face or acute phase and she was. Once released the mediators cost and read the pulmonary capillaries resulting in increased capillary membrane permeability leading to leakage of fluid filled with proteins, but cells, fiber, and activated cellular and humeral meditators into pulmonary interstitium. Damage to the pulmonary capillaries also causes development of my growth on by an elevation of pulmonary artery pressure. As fluid enters the pulmonary interstitial in the lymphatics are overwhelmed unable to drain all the accumulating fluid resulting in development of interstitial edema. Where is the force of the interstitial space of the other Larry's I'll take an alley alveolar Adema. Pulmonary interstitial edema also causes compression of the ovary and small airways. I'll be other Adema because the swelling of the type one alveolar epithelial cells and flooding of the ovulate. Protein and fiber in the Adema fluid precipitate the formation of highly membranes over the other life. Eventually the type to alveolar epithelial cells are also damage leading to impaired surfactant production. Injury to the alveolar epithelial cells and losses surfactant lead to further alveolar collapse. Hypoxemia occurs as a result of intrapulmonary shunting in the VQ miss matching secondary to compression, the labs, and flooding of the Alviola and small airways. Increased work of breathing occurs as a result of increased area resistance, decreased functional residual capacity, and decreased lung compliant secondary to atelectasis and compression of the small airways. Hypoxemia and the increase with a breathing lead the patient to fatigue and the development of alveolar hypo ventilation. Pulmonary hypertension occurs as a result of damage the pulmonary capillaries, microphone by, and hypoxic vasoconstriction leading to the development of increased of your dead space and right ventricular outlook. Hypoxemia worsens as result of alveolar hyperventilation and increased alveolar dead space. Right ventricular afterload increases and leads to right unction in an increased cardiac output.