Critical Care

Critical Care CPR: CAB – compressions, airway, breathing 1. Determine unconsciousness 2. Check carotid pulse 3. Chest compressions 4. Open airway using head tilt chin lift 5. Check breathing + deliver breaths Foreign Body Airway Obstruction: Avoid blind finger sweeps – risk of pushing object further into airway 1. Stand behind pt 2. Place arms around pt’s waist 3. Make a fist 4. Place thumb side of fist above umbilicus (and below xiphoid) 5. 5 quick in + up thrusts (use chest thrusts for obese or pregnant pts) For infant – place pt over arm or on lap with head lower than trunk; 5 back slaps with heel of hand in between shoulder blades, turn infant and perform 5 chest thrusts, check for foreign object (only remove if visible) Tracheostomy: Inflated cuff = used for pts at risk of aspiration (e.g. unconscious or mechanically ventilated pts); it is uncomfortable for pts who are awake because it’s difficult to swallow/talk Deflated cuff = used when pts improve and are not at risk for aspiration When suctioning: pre-oxygenate with 100% O2, insert suction tube without suction turned on, intermittent suctioning in circular motion during withdrawal, suction no more than 10 seconds, wait 1-2 mins before suctioning again (pts will cough when suction tube is inserted – this is ok – insert until resistance is felt) Tracheostomy Care: Priority: 1. Keep pt in semi-fowlers 2. Wear mask, goggles, and clean gloves 3. Remove soiled dressing 4. Don sterile gloves 5. Remove old cannula + replace with new one 6. Clean around stoma with sterile water, dry, and replace sterile gauze Blood Transfusion Administration: 1. Obtain unit of blood and verify product with type + cross results and at least 2 pt identifiers with another RN (remember to only infuse blood 1 unit at a time; also, blood must be administered within 20 mins) 2. Assess pt, VS, and teach S/S of transfusion reaction 3. Use Y tubing primed with NS; clamp NS side 4. Spike blood product and leave the clamp on the side of the blood open 5. Set infusion pump to deliver blood over 2-4 hours 6. Remain with pt for first 15 mins and observe for signs of transfusion reaction (fever, chills, nausea, vomiting, pruritis, hypotension, decreased urine output, back pain, or dyspnea 7. Take another set of VS after 15 mins. Remember to also take a final set of VS 8. Once the transfusion is done, open the saline clamp to flush all blood in the tubing Post Mortem Care: Wash body, change linens + gown, close eyes, place pillow under head, fold towel under chin to help close mouth, replace dentures, remove lines/tubes/dressings, place pad under perineum, straighten body/limbs, remove soiled linen 46 Impaled Object: To not manipulate/remove! Stabilize the object Triage: Red – life threatening injury that a pt may survive if treated within next hour • E.g.: hemothorax, tension pneumothorax, unstable chest and abdominal wounds, incomplete amputations, open fracture of long bones, and 2nd/3rd degree burn with 15%-40% of total body surface Yellow – pt can wait 1-2 hours without loss of life or limb • E.g.: Stable abdo wounds without evidence of hemorrhage, fracture requiring open reduction, debridement, external fixation, most eye and CNS injuries Green – “walking wounded” • E.g.: upper extremity fracture, minor burns, sprains, small lacerations, behavior disorders Black – unlikely to survive • E.g.: Unresponsive, spinal cord injuries, 2nd/3rd degree burn with 60% of body surface area , seizures, profound shock with multiple injuries, no pulse/BP, pupils fixed or dilated Sepsis: SIRS – inflammatory responses (fever, tachycardia, tachypnea) Sepsis – SIRS + infectious source (e.g. pneumonia, UTI) Septic shock – sepsis + hypotensive despite adequate IV fluids MODS – septic shock + multiple organ damage (e.g. ARDS, AKI, low plt) Angioedema: Rapid swelling of lips, tongue, throat, face, and larynx → can result in airway obstruction and death 47