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Gallbladder & ER (audio & narratives)

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cdunbar4's version from 2017-04-20 15:53

ER

Question Answer
ER triage based on stability of vital functions; life threat or organ threat; how soon they should be seen by PCP; how many people will be involved from healthcare team; what diagnostics/studies will be needed
What kind of patients are usually seen first?Trauma, Chest pain, stroke
Primary survey includesID life-threatening conditions=> start interventions asap! Also, c-spine stabilization & airway establishment (use least invasive method first)
Preferred method for someone in respiratory distress or an unprotected airwayrapid sequence intubation, pt. must be paralyzed and sedated.
Approach to intubate someone with a c-spine injury?jaw-thrust maneuver, because you can't move their neck
Assessment before and after intubationComplete respiratory: asymmetric chest movement, dyspnea, decreased or absent breath sounds, tachycardia or hypotension
If you don't hear breath sounds, what should you expect to happen?Pt. will probable crash soon!
After respiratory assessment, what do you do?use appropriate O2 device; two large bore IV catheters (LR or NS); then Disability is assessed: LOC, pupils, Glasgow
When does secondary survey begin? What types of things should start being implemented?After life-saving interventions. This is when to get vital signs on monitor, Foley, get labs/diagnostics, pain/sedation, verbal reassurance (develop trusting relationship with both pt. and family) determine if family is present
Another part of secondary survey includes head to toe, what else should you find out?Any details about injury or story from family, ambulance, patient.
If puncture wounds, what may be ordered for the client?tetanus booster (if pt. hasn't had it within 10 years)
When does secondary survey end?When pt. leaves ER to another unit or facility or home.
If it's a cardiac arrest patient, what type of tx will be started in ER?hypothermic treatment bc research shows reducing pt's temp for 24 after return spontaneous circulation decreases mortality rate and improves neurologic outcomes in most patients. "if you drown in cold water that you aren't dead until you're warm"
Hypothermic treatmentcooled saline, cooling blankets (in ER) will need to be intubated/mechanical ventilation, invasive monitoring/assessment (done in ICU)
Busy ER deals with what, sometimes daily?Death, families will need time with person/family, will need to collect belongings. Call chaplain/priest, nurses may have to call funeral home or medical examiners for autopsy.
If pt. that dies in ER is a donor candidate, someone will need to call donor team, what types of things will nurse tell donor team?If patient is septic, intubated, on any vasopressors, hep c positive, drug users, why is patient brain dead.
If patient is qualified as a donorthere is a person in the hospital who can come talk to family about harvesting/recovering organs
When can they take the lungs?If patient is intubated, if pt. is not intubated then can take cornea, skin
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Mass Casualties

Question Answer
Mass casualty is defined as a disaster that overwhelms communities ability to respond with existing resources. Causes physical/emot'l suffering and permanent changes within community
First responders in mass casualtyfire and police
Triage should only last<15 seconds since resources are all overwhelmed, so you have to triage quickly.
If gas or poison, what must need to happen before transporting to hospital?need to decontaminate them first
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Gallbladder shit

Question Answer
Difference b/t cholelithiasis and 'litisgallstones in gallbladder or inflammation
Symptoms vary from none to severe (SNS response)pain when stones move or obstruct, pain in right shoulder/scapula, n/v, anxiety, diaphoresis
When do symptoms usually occur?3-6 hours after a high-fat meal
If there is a stone obstructing a duct, what will you see? And what other patient will have the same symptoms? How can you tell the difference between the two?jaundice, amber urine, clay colored stools, pruritus, and steatorrhea. Via ultrasounds, ERCP, contrast dye into ducts from liver & pancreas to see if stone is blocking a duct
How will their symptoms change if the gallbladder ruptures? How will you monitor for peritonitis?Lab results will be typical for an infection and ↑ liver enzymes
Treatment varies depending on the symptoms and severity. bile acids, such as the ones listed on your PowerPoint, to dissolve stones.
If they develop cholecystitis, the gallbladder can become gangrenous, they can develop an abscess, then what?pancreatitis, biliary cirrhosis and worst case is if gallbladder ruptures and cause peritonitis.
If n/v persists, patient made needNG tube
Usually patients are out-patient, unless it is an open removal, what will these patients havesurgical wound and t-tube in common bile duct to maintain patency of duct and allow bile to drain
laparoscopic procedure dietthey will need liquids for the rest of that day, and light meals for a few days
open procedure dietstarted on liquids and progressing to a regular diet once their bowel sounds reappear.
Laproscopic is treatment of choice, where is incision made?umbilicus
How long will post op patients need to stay home for?about a week
pain controlNSAIDs and anticholinergics
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