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Airway/ Ventilation & Shock PowerPoint Presentation
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Airway/ Ventilation & Shock

Airway/ Ventilation & 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