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UNIT 3 Multiple Trauma / Emergency Nursing
CCTC Spring 2013
Terms in this set (141)
What are some internal and external stressors, pathophysiology, manifestations and health care management issues of multiple systems trauma victims
- Mechanical Ventilation
- Disseminated Intravascular Coagulation (DIC)
- Organ Donation
- Sudden Death
How are ER RN's specially trained (have experience with)
- in assessing health care problems in crisis situations
- in identifying health care problems in crisis situations
- in treating health care problems in crisis situations.
What issues might the ER RN have to concern themselves with r/t legal, occupational health and healthcare worker safety issues?
- Patient's right to privacy and consent
- Limiting exposure to health risks
- Threat of violence
What kind of care is Nursing Care?
- Patients & family may be anxious
- Fear of death, permanent disfigurement or disability
What are the Stages of Crisis Reaction
Emergency Nursing and Discharge Planning and Teaching
- May be Verbal and written
- Interpreters are essential
- Community services: Social worker, Transportation, Follow up visits
- social worker can provide referals and vouchers
- cant send homeless back out on the street --> provide transportation to shelter
- follow up visits typically only include suture removal
Gerontologic Considerations for ER
- Pts over 65 y/o account for more than 41% admissions through ED.
- May have One or more presenting conditions --> co-morbidities
- Psychosocial and financial needs --> social worker
- May require Specialized referrals --> social worker
What does triage mean
Taking a History during triage
- Who-what-when-when-how-how much-last time you??????
• Tetanus --> q 5-10 years
• Flu --> always ask if no record in 6-12 months
• Pneumonia --> important r/t elderly r/t respiratory issues
• Pertusis --> important when pt has upper resp issue
How many systems of Triage Sorting are there?
- basically 2
the 1st system of Triage Sorting is:
- Emergent --> must be seen NOW --> next 2 minutes
- Urgent --> must be seen with in 1 hour
- Non-urgent --> must be seen within 24 hours
the 2nd system of Triage Sorting is
- Resuscitation --> need CPR --> immediate tx to prevent death
- Emergent --> chest pain guy --> needs treatment now or may die
- Urgent --> not life threatening but may require 2 or more additional resources (imaging(xray), fluids, tetanus shot, catheter)(cut that needs suture and tetanus shot)
- Non-urgent--> non-life threatening and only one additional resource (cut that needs to be cleaned and given a tetanus)
- Minor--> should have gone to see their doctor.
Triage Disaster Color Coding: Black
- too many resources to care for this patient than can be afforded to give --> expected to die
- 2nd / 3rd degree burns to 60% or more of the body
- Unresponsive patients with penetrating head wounds, high spinal cord injuries, wounds involving multiple anatomical sites and organs
- pupils ﬁxed and dilated
Triage Disaster Color Coding: Red
- life threatening injury but will live (2nd 3rd degree burns of only 15 - 40% of the body, broken long bones), open fracture
- Sucking chest wound, airway obstruction secondary to mechanical cause,
- shock, hemothorax, tension pneumothorax, asphyxia, unstable chest and abdominal wounds, incomplete amputations
Triage Disaster Color Coding: Yellow
- lower extremity fractures that aren't broken (traction), facial wounds without airway compromise, cuts without significant bleeding, broken bone not open to air (closed) non life threatening injuries.
- Stable abdominal wounds without evidence of signiﬁcant hemorrhage; soft tissue injuries;
- genitourinary tract disruption;
- most eye and CNS injuries
Triage Disaster Color Coding: Green
walking wounded --> WALKING!!!
- if they are walking they are GREEN
- Upper extremity fractures, minor burns, sprains, small lacerations without signiﬁcant bleeding,
- behavioral disorders or psychological disturbances.
Primary Emergency Care Interventions
PRIMARY = STABLE
get them stable--> airway, breathing, circulation, disability
Secondary Emergency Care Interventions
- get a history
- do labs
- do wound care
- whatever else is needed (acute care at this point)
ER Nursing and Forensic Issues: Documentation
there has to be a very precise and well documented chain of evidence --> DOCUMENTATION IS KEY
most often will be 2 nurses: 1 to assess and 1 to document --> will take pictures first and then remove their clothing --> if you have to cut clothing off, preserve evidence --> use paper bag not plastic bag --> r/t mold growth
ER Nursing and Forensic Issues: Valuables
inventory pt valuables and put in hospital safe --> if patient cant tell you were to put it --> (after you talk to the police) document whom you give valuables to and what police officer told you it was okay to give it to the person.
ER Nursing and Forensic Issues: Deceased Patient
until the police clear the patient and the patient has died, you leave ALL tubes and lines in place --> put paper bags around their hands and feet to preserve evidence --> any thing the patient says, document as evidence.
Priority Management for (patient with) Multiple Injuries
2. Control Hemorrhage--> hypovolemia
3. Prevent & Treat Hypovolemic Shock --> large bore needles
4. Assess for Head & Neck Injuries --> assume until proven not
5. Evaluate for Other Injuries
6. Splint Fractures
7. Perform a More Thorough & Ongoing Examination & Assessment
S/Sx of Patient with Abdominal Injuries
- Abdominal rigidity
- bruising may be on lower back r/t positioning,
- abd distention
- if pt is alert and oriented --> will be THIRSTY
Complications of Trauma Patient Mnemonic
T -- tissue perfusion
R -- Respiratory problems
A -- anxiety
U -- unstable clotting factors
M -- malnutrition
A -- altered body image
T -- thomboembolism
I -- infection
C -- coping problems
If a patient has injuries to one or more organ systems what complications might you see?
- Mechanical Ventilation
- Disseminated Intravascular Coagulation (DIC)
- Organ Donation
- Sudden Death
Nursing Considerations with Hemorrhage
• Control bleeding,
• IV fluids
- 2 or 3 with large-bore needle
• Central line
• Indwelling bladder catheter
• GI Bleed
When use pressure points for external hemorrhage, which do you use?
- use pressure points proximal to the body in relation to the wound
- always use pressure first before tourniquet
Nursing Considerations for GI Bleed r/t hemorrhage
esophageal varices r/t ETOHism may lead to GI bleed --> watch for signs of etoh withdrawal
What is the primary goal for a patient with hemorrhage
- replace fluid volume
- may need central line
• Most common type of circulatory shock
• often from UTI and ventilator aquired pneumonia
• Pathogenic microorganisms or their toxins (endotoxins) present in the blood
• Gram - (E.coli) & + bacteria (MRSA/VRE)
How does Fluid Deficit occur in sepsis?
- endo-toxins from organism in the blood that causes the release of various vasoactive substances (histamines, prostaglandins, serotonins, endorphins) --> this results in fluid shifts and maldistribution of blood in the body.
S/Sx of cascade early on: (sepsis)
- high Cardiac output
- skin is warm,
- fever (typical infection response),
- HR will increase,
- BP may drop or stay the same,
- RR may be a little high,
- Urine output may increase with fluid intake
- may have NVD
How does Septic Shock progress
- occurs as sepsis continues to progress without treatment --> vasoacitive mediators continue to be released -->constriction prevents blood flow --> acidosis --> body begins to decompensate.
• Low cardiac output with vasoconstriction
• BP drops
• Skin cool and pale
• Temperature normal or below normal
• HR and RR rapid
• Anuria and multiple organ dysfunction progressing to failure
Gerentologic Considerations for Sepsis
- elderly may not show signs of infection until confusion sets in and then they are in sepsis
S/Sx of Septic Shock
- HR rapid
- BP falls
- RR rapid and shallow
- Temp falls.
Nursing Considerations for Septic Shock
- will need to do a blood culture x 2
- tx: broad spectrum antibx, lovenox/heparin
Acute Respiratory Distress Syndrome/ARDS
• Form of pulmonary edema
• Also known as shock lung, stiff lung, white lung, wet lung, DaNang lung
• very severe form of acute lung injury --> can occur very quickly
• generally a complication of critically ill patient (MVA, pneumonia, esp elderly)
Initial Respiratory Labs for ARDS
• PaO2 <50mmHg
• PaCO2 > 50 mmHg
• Arterial pH <7.35
Initial S/Sx of ARDS
- increasing bilateral infiltrates on Xray
- sudden progressing edema
- becomes hypoxic--> nasal canula and mask doesn't work to relieve,
- absense of elevated left arterial pressure can occur over 4-8 hours --> severe dyspnea can occur within 12-48 hours after injury
- fluid is leaking into the alveoli --> because of increased permeability
- large cells like proteins leak into the alveoli --> causing swelling
- surfactant is diminished --> alveoli can't stay inflated --> they collapse
- blood begins to perfuse INTO the alveoli
- blood isnt being filtered for O2 ---> that is why
ventilation = air
perfusion = movement of blood
Progressing ARDS S/Sx
• PaO2 decreased (less than 60 mm Hg)
• PaCO2 decreased
• pH increased (more than 7.45)
• Fine crackles auscultated throughout lungs (as edema worsens)
• VS are beginning to diminish
• very loud lung sounds
• thick secretions
• VERY hypoxic
• dyspnea --> sounds like CHF
• pulmonary capillary wedge pressure will be normal --> 12mmHg or less --> pulmonary edema not cardiac in nature
• will take a BNP to see if it is the heart
Nursing Goals for ARDS
• Goal: maintain tissue oxygenation ( PaO ≥ 60 mm Hg)
• Mechanical ventilation with PEEP
• Early stage fully reversible, if not recognized and treated early, can progress to irreversible state (alveolar fibrosis) --> lifelong ventilation
Positive End Expiratory Pressure (PEEP)
- PEEP will help Alveolar collapse or dysfunction r/t ARDS --> leaves a little air behind --> helps keep the alveoli open
Nursing Interventions for ARDS: Maximize O2
• Respiratory rate --> if it is high, they are compensating!
• Breath sounds
• Skin Color
• Mental status
- Keep head of bed elevated (possibly to 90 degrees)
- Turn q2h
Nursing Interventions for ARDS: Nutrition
35cal/kg/day of calories --> NUTRITION IS IMPORTANT
Nursing Interventions for ARDS: Sedation
if on ventilator --> will prob need sedation --> mechanical breathing feels foreign --> will fight against it.
- versed & propofol
- Norcuron --> muscle relaxant for intubation
- If on ventilator for a week or so --> will be trached
Indications for Mechanical Ventilation
- Altered Pa O2 and CO2 balances
- *Inhalation Injury --> especially smoke inhalation
- *Multiple Trauma
- *Thoracic Surgery
- *Neuromuscular disorder --> Myasthina Gravis/Guillian Barre
- *Multisystem Failure
- persistent acidosis and alkylosis states
- most common --> inflates lungs by exerting positive pressure on the airway --> fills alveoli and causes them to expand --> expiration usually happens passively
- will have trach
- not internal --> does not require intubation
- may have trach
Types Positive Pressure Ventilation
- Pressure Cycled --> fills lungs to certain pressure
- Timed Cycled --> timed
- Volume Cycled --> fills lung to certain volume
- Noninvasive Positive Pressure (NPPV):
C-Pap --> might be useful if patient refuses intubation
Who are good candidates for Noninvasive Positive Pressure (NPPV)
- COPD patients with upper respiratory infection
- CHF patients
- patients who are end of life
- sleep apnea
- highly compliant patient
How do NPPV (C-Pap/Bi-Pap) work
keeps alveoli open with positive pressure
Who are NPPV (C-Pap/Bi-Pap) Contraindicated in?
- patients with sudden respiratory arrest
- serious cardiac arrhythmias,
- facial traumas,
- patients with head and neck cancers,
How many Levels of Air-Pressure do Bi-Paps Use?
2 levels of air pressure
- one for inhalation and one for exhalation
- usually used with severe sleep apnea or COPD
What is C-Pap's often used for?
- Obstructive Sleep Apnea!
- its continuous air flow
Who decides what type of Ventilation/Ventilator is required?
- respiratory therapist
- the hospital
What Settings are on Ventilators?
- Fraction of inspired oxygen (FiO2): Inspired O2 concentration --> 21% on room air
- Rate: Breathing rate/minute
- Tidal Volume: Amount of air received with each breath--> 10-15mg/kg
- Peak (inspiratory) Flow Rate: Speed at which air enters lungs --> 15-20cm H20
- Sigh Rate and Volume: Additional air volume delivered--> 1.5 x TV
- PEEP: • Positive end expiratory pressure--> 5-15 cm H2O
do not need to know normal ranges or volumes for test
Nursing Responsibilities with Ventilator Settings
verify with respiratory tx that ventilator settings are correct --> compare with dr orders
What should you be Assessing on a Ventilator
- type of ventilator
- controlling mode
- the Settings
--> THEY SHOULD BE ON AN ALARM!!!
Bucking the Ventilator refers to
- the patient fighting the ventilator
Why does Bucking the Ventilator occur?
- Patient's thoracic expansion = vent's inspiratory phase
- Bucking patient attempts to breath out of sync with the vent
- most on ventilators will be in a low Glasgow coma scale --> wont be interactive
- Guillian Barre/MG --> patients may not fight the ventilator
Is Bucking the Ventilator always BAD?
- it may mean the patient is trying to breathe on their own --> may be a good thing --> if bucking and not a good thing --> will sedate
What can cause Bucking of the Ventilator
Nursing Assessment for Ventilator Patients
- Monitoring of Laboratory Data:
- Alkylosis, Acidosis???--> is it getting worse or better?
- oral care
- skin care
- pressure sores
Nursing Interventions for Ventilator Patients
• Respiratory Care: Turn Q 2 hrs, Suctioning --> only when needed
• Prevention of Infection
• Communication --> white board/pointing board
What are MAJOR ISSUES with Ventilator patients?
- Risk for infections
Potential Complications of Ventilator Patients
- Nasal/oral injury
- Spontaneous Pneumothorax
- Oxygen toxicity
- Decreased cardiac output
- Gastrointestinal --> will be on PPI
- Skin breakdown
- Psychological distress
most are related to immobility
Nursing Considerations for High Pressure Ventilator Alarm
- increased airway resistance or decreased pulmonary compliance --> mucus plug --> suction
Nursing Considerations for Low Pressure Ventilator Alarm
- leak, disconnection or patient removed the intubation tube
Nursing Considerations for Apnea Ventilator Alarm
- patient may have had apnea period
Nursing Considerations for Ventilator Failure Alarm
- ventilator failed
- get there quickly --> assess --> do intervention
Weaning Phases for the Ventilator
- Gradually removed from the ventilator
- Gradually weaned from the trach
- Oxygen is tapered
Process for Weaning Patients OFF Ventilator
- might change ventilator to on demand setting or turn it off and see if they will breathe on their own.
- there will be O2 going to trach --> then will wean from trach --> cover it with speaking valve to allow patient to talk and allow them to breath without O2 placed.
- O2 is tapered --> trach removed --> stoma covered with occlusive dressing --> nasal canula or mask is used --> O2 is weaned gradually.
Are There Criteria Used for Weaning Patients from a Ventilator
What are S/Sx of Hypoxia
- increased BP
What Should a Nurse Monitoring for During Weaning from a Ventilator
• Increasing Fatigue
• Decreased Neuro Status
• Use of accessory muscles for breathing
• Paradoxical chest movement
What is Disseminated Intravascular Coagulation (DIC)
- the formation of small blood clots inside the blood vessels throughout the body.
- As the small clots consume coagulation proteins and platelets, normal coagulation is disrupted and abnormal bleeding occurs from the skin
How does DIC occur
- inflammatory process generated from disease or trauma begins the clotting cascade -->
- you use up too much of your clotting factors and many tiny clots may form--> fibrolytic systems may become too overtaxed -->
- wont be able to break up the little clots
- clotting factors will continue until they are depleted --> fibrinolytics increase and then they are out of balance
Clotting Factors r/t DIC
DIC is a paradox
labs are drawn often
- platelets will be low
- RBC may be High or Low
- PTT will be elevated --> 60-70 secs
- APTT will be increased --> 30-40 ecs
- fibrinogen levels will be down --> lower than 200 mg/dL
- D-Dimer will be increased (measures fibrinogen degradation) --> more than 250 mcg/L
What is D-Dimer
is a fibrin degradation product (or FDP), a small protein fragment present in the blood after a blood clot is degraded by fibrinolysis
What is the DIC Paradox Caused by:
- Decreased platelets
- Depletion of clotting factors II, V, VIII & fibrinogen
- Production of fibrin degradation products (FDPs) which act as anticoagulants
What might be the ONLY EARLY Indicator of DIC
- LAB FINDINGS!!!
What causes Fragmented RBC's in DIC
RBC are trying to be produced quickly --> may not be formed well before sent out
What is the end result of DIC
- the body may look almost purple black
How is DIC Medically Treated
• Treat primary disease --> stop what is causing it!
• Control bleeding
• Restore normal levels of clotting factors
• Heparin use is controversial
What is a Common cause of DIC
- placental abruption,
- cancer tx with chemo (anything that destroys platelets)
Nurse Monitoring for DIC
- will definitely be replacing fluids, blood and platelets
- electrolytes will be off --> especially K and Na
- may give vasopressors to increase BP and keep it up r/t BP drop in blood loss
Nursing Management for DIC
- Be aware of which patient is at risk --> will have serial D-Dimers --> if they increase then the risk of DIC increases
- Watch for signs of end-organ damage
- Assess amount & nature of bleeding sites
- Give meds orally or IV if possible
- Maintain fluid balance: Hourly urine output, Monitor CVP, LOC, Lung function
- Family support: sudden onset (HUGE)
What are you going to watch for thinking there is a Risk for Bleeding with DIC
no foley catheters --> no shaving --> gentle oral care -->hourly urine outputs --> changes in LOC
Multiple Organ Failure
• Poor prognosis
• Progressive failure of more than one organ
• Primary Immediate consequence of trauma
• Secondary - Sepsis
What may Cause Multiple Organ Failure
- one organ dysfunction can lead to another system starting to fail.
- this is very hard to stop!!
Nursing Interventions for Multiple Organ Failure
- talk about patients end of life choices
- promote O2
The Nurse and Tissue and Organ Procurment
- not a nursing job to discuss organ donor --> just ask if the patient wanted to be an organ donor.
Who does the Nurse Contact regarding Patient Tissue/Organ Donation?
- Lifepoint in SC --> patients who are in imminent death --> notify them
- RN role is to simply notify Lifepoint --> then Lifepoint will contact the patients family
What is Heat Stroke/Heat Exhaustion
- Failure of the heat regulating mechanisms of the body r/t Prolonged exposure to environmental temps > 102.5 ̊
What Patients are at Increased Risk of Heat Stroke/Exhaustion
- Unaccustomed to heat
- Elderly & very young
- Chronic & debilitating illness
- certain medications
- people who live in bad areas r/t fear of environment and locking closing their windows.
What Meds INCREASE a Patients risk of Heat stroke/Exhaustion
- Tranquilizers --> poor sweating
- Anticholinergics --> poor sweating
- diuretics --> water loss
- B blockers --> vasoconstriction --> cant shunt blood away from core
- Damage occurs to cellular level
What Might Heat Stroke Lead to?
- Coagulopathies --> DIC--> Multiple Organ Damage
- Widespread damage to major organs
How Might Heat Stroke Lead to DIC?
hypovolemic --> not enough blood circulating --> over heated --> DIC
What are Assessment Findings for Heat Stroke
- Profound CNS dysfunction
- Elevated body temp
- Hot, dry skin
- Anhidrosis --> NO SWEATING
- Hypotension --> r/t hypovolemia
- Tachycardia --> compensatory
Initial Main Goal of Heat Stroke is:
- Reduce body heat ASAP!!! -->> COOL OFF FAST
- mortality directly related to duration of hyperthermia
Management of Heat Stroke
• Remove clothing
• Cool sheets or towels
• Ice to neck, groin, chest, axilla
• Cooling blankets
• Immersion in cold H2O bath
• Electric fan
• Monitor internal temp --> rectal!
• Stop cooling at 38.8 C (102 F) --> dont want to cause iatrogenic hypothermia
Managing HYPOthermia: Oxygenation
- THINK ABC'S
- Monitor VS & ECG
- Monitor CVP
- Level of responsiveness
- 100% O2
Managing HYPOthermia: Establish IV's
- run NS or LR
- Cautious monitoring for cardiac and renal damage
- Electrolyte replacement
- Fluids may be warm --> WARM SLOWLY
Managing HYPOthermia: Blood Work
- Monitor for DIC
- Serial Enzymes
- Seizure Prevention
Near Drowning is more common in what age group?
#1 cause of death in children under 14 y/o
What are the Most Common Causes in Near Drowning
- Inability to swim
- Diving injuries
Where does Near Drowning Usually Occur
When is someone Considered Dead from Near Drowning
- until they have been warmed to body temperature and are still non responsive --> they are not dead.
- Must be warm to body temp and pronounced dead.
What may Cause Death in Near Drowning Patient?
What Complications may Occur following Near Drowning
- Hypoxia --> ARDS
- Acidosis --> ARDS
What Happens When someone Experiences Near Drowning in FRESH WATER
- loses surfactants --> cant breathe
What Happens When someone Experiences Near Drowning in SALT WATER
- salt water causes --> edema --> pulmonary edema --> cant breathe
- THINK INCREASED INTRACRANIAL PRESSURE
Management for Near Drowning
- Maintain cerebral perfusion --> CPR
- Maintain adequate oxygenation --> mouth to mouth/ventilator
- Manage & correct blood gases
- Mechanical Ventilation with PEEP
- ECG monitoring
- Labs & Diagnostics
- Watch for IICP
- Monitor for ARDS
What does Snake Venom Contain?
What Systems does Snake Venom Affect?
- Neurologic system
- Cardiac System
- Respiratory System
What are the classic signs & symptoms of envenomation?
- Hemorrhagic bullae --> necrosis
- Lymph Node tenderness
- Metallic taste
Most Common Time of Snake Bites
- Early Morning
- early evening
Who is most Commonly Bitten By Snakes
- Children Between 1-9 yo
Where is the Most Common Place for Snake Bite
- Upper Extremity
Snake Bite ED MANAGEMENT
- Fluids for hypotension
- Antivenin (Antitoxin)
How do you Administer Antivenin?
- Two types
- Diluted with NS
- Serum Sickness
- Continued doses until symptoms decrease.
How Many Patients may be Allergic to Antivenin?
33% may be allergic to antivenin --> produced fromhorses --> it is protein too
What are the Treatment Concerns for Ingested Poisons?
- Remove or inactivate the poison prior to absorption
- Provide supportive care in maintaining organ function
- Administer antidote to neutralize
- Implement treatment to hasten elimination of absorbed poison.
What are the Management Concerns for Ingested Poisons?
- what was ingested -->how to treat it
What are Acidic Types of Corrosive Poisons?
- Toilet bowl cleaners
- Pool cleaners
- Metal cleaners
- Rust removers battery acid
What are Alkalytic Types of Corrosive Poisons?
- Drain cleaners
- Toilet bowel cleaners
- Non-phosphate detergents, oven cleaners
- Button batteries
What are the General Treatments for Corrosive Poisons?
- Warm water or milk
- Do not dilute with airway obstruction/edema/burns
- Do not induce vomiting
- Determine material and appropriate antidote
- Gastric Lavage --> stomach pump
- Cathartic --> make them poop
What will the Nurse Monitor for Corrosive Poisonings?
Managing Ingested Non-Corrosive Poisons
• Poison Control Center: Specific antidote
• Induce Vomiting: Ipecac
• Gastric Lavage
- Chart 71-11
• Activated Charcoal
• Cathartic --> makes them poop
Gastric Lavage is Contra-Indicated in:
- after acid or alkali ingestion
- in the presence of seizures
- after ingestion of hydrocarbons
- after ingestion of petroleum distillates.
- It is particularly dangerous after ingestion of strong corrosive agents.
What position is a Patient Placed in During Gastric Lavage
- the patient is positioned on the left side,
- which allows the gastric contents to pool and decreases the passage of fluid into the duodenum.
Gastric Lavage Procedure
- Remove Dentures and Inspect Oral Cavity
- Measure the distance between the bridge of the nose and the xiphoid process (about 50 cm or 20 in)
- left lateral position
- keep head in neutral position while beginning placement --> encourage patient to swallow to help
- Then lower the head of the stretcher or bed.
- if comatose, the patient is intubated with a cuffed nasotracheal or endotracheal tube before placement of the nasogastric tube.
- use syringe or funnel to instill water or antidote
- Elevate the funnel above the patient's head and pour 150 to 200 mL of solution into the funnel
- Lower the funnel and siphon the gastric contents into the container or connect to suction.
- Save samples of the ﬁrst two washings.
- Warn the patient that his stools will turn black from the charcoal.
Carbon Monoxide Poisoning
• Carbon monoxide binds to circulating hemoglobin and reduces the oxygen carrying capacity of the blood.
• Hemoglobin binds to carbon monoxide 200 times more readily than to oxygen.
• Carboxyhemoglobin- does not transport
CNS Symptoms for Carbon Monoxide Poisoning
• May appear intoxicated
• Rapid progression to coma
Skin Symptoms for Carbon Monoxide Poisoning
• Pink --> Cherry red --> Cyanotic --> Pale
• Not to be used as an indicator
How will a Patient's Pulse Ox Present?
should be 100%
What do you Use to Dx Carbon Monoxide Poisoning
ABG's from blood draw
Carbon Monoxide Treatment Goals
- Reverse cerebral & myocardial hypoxia
- Hasten elimination of CO
Medical Management of Carbon Monoxide Poisoning
- Get patient to fresh air
- Loosen tight clothing
- CPR & 100% O2
- Prevent chilling- warm blankets
- Keep patient quiet to preserve O2
- No alcohol! No Smoking!
- Monitor for brain damage
- Hyperbaric Chamber Treatment
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