#traumajunkie #traumamama #emergencytraumamama
It’s critical to understand RAAS for critically ill/traumatically injured shock patients. The RAAS regulates blood pressure and fluid balance in the body. When blood volume or sodium levels in the body are low, or potassium is high, cells in the kidney release the enzyme, renin. Renin converts angiotensinogen, which is produced in the liver, to the hormone angiotensin I. An enzyme known as ACE or angiotensin-converting enzyme found in the lungs metabolizes angiotensin I into angiotensin II. Angiotensin II causes blood vessels to constrict and blood pressure to increase. Angiotensin II stimulates the release of the hormone aldosterone in the adrenal glands, which causes the renal tubules to retain sodium and water and excrete potassium. Together, angiotensin II and aldosterone work to raise blood volume, BP and sodium levels in the blood to restore the balance of sodium, potassium, and fluids in an attempt to normalize the BP in an otherwise “shocky” patient.
Hypovolemic shock occurs due to loss of in total volume of blood, available for circulation. Whether the bleeding is caused by blunt or penetrating trauma, the loss of blood stimulated baroreceptors in the carotid bodies and aortic arch to speed up the HR. HR X SV=CO.
When pts are trying to compensate hypovolemic shock, RAAS (Renin angiotensin aldosterone system) is activated.
The activated RAAS system releases angiotensin II. Angiotensin II causes vasoconstriction of arteries and veins, thereby increasing blood pressure. It also promotes adrenal cortex to secrete aldosterone. Aldosterone in turn stimulates sodium and water retention as well as excretion of potassium from kidneys. The resulting high sodium ions in the serum causes secretion of ADH (antidiuretic hormone). ADH intensifies water reabsorption, resulting in increased blood volume, BP (blood pressure) and CO (cardiac output). This is why we frequently see our hypovolemic trauma patients present with tachycardia and hypotension, depending on which stage of shock they present with.
#themoreyouknow #nclex #nclexprep #nclexstudying#nclexreview #nursingschool #nursingstudent#nursingstudentlife
Have you ever taken care of a pediatric patient who was left in a hot car during the summer and suffered from hyperthermia? •
Have you even thought about what kinds of clinical complications you may see w/this type of case? If so, tune in now to my new podcast episode….👂🏼
👶🏼🚁🚑🏩 #newpodcastalert #newpodcastepisode #pals #enpc #ena #emergencynurse #pediatrichyperthermia #rhabdomyolysis #hypoglycemia #electrolyteimbalance #emergencytraumamama
• @theedtraumacist Vancomycin is a tricyclic glycopeptide antibiotic used to cover gram➕bacteria such as methicillin resistant Staphylococcus aureus. 💉
Vancomycin works by inhibiting bacterial cell wall synthesis by binding to D-alanyl-D-alanine cell wall precursors, inhibiting polymerization and preventing linkage to the glycopeptide polymer located within the bacteria’s cell wall.
When dosing vancomycin a couple of factors should be considered including the patient’s weight, renal function, and presenting disease state. It is normally
dosed at 15-20 mg/kg, and even higher for more severe infections (25-30 mg/kg in patients with sepsis, infective endocarditis, meningitis, etc. with a max dose depending on your hospital protocol).
In a study by Fuller and colleagues that reviewed vancomycin management in the ED, they reviewed 4441 doses of vancomycin given to patients with a weight measurement available. Vancomycin was dosed correctly in only 22.1% of patients 😧 with 71 % of patients being dosed below the recommended dose of 15-20 mg/kg 😱. Vancomycin dosing is not one size fits all and patient specific characteristics should be considered when dosing this medication. 💉
#theedtraumacist #trauma #traumaninjas #miamitrauma #traumiami #emergencymedicine #emergencydepartment #pharmacy #pharmacylife #pharmlife #pharmvida #pharmsohard #pharmacystudent #pharmacyresident #pharmer
Have you ever taken care of a pt who had an altered mental status (AMS)? Patients with an altered mental status (or ALOC)are among the toughest to assess since there is no classic, “one size fits all” presentation.
The clinical presentation is often obscure, which makes recognizing changes in mental status a challenging endeavor. There are certain underlying pathophysiological conditions that can cause AMS. This is one of the largest differential diagnoses you may encounter in the ED, EMS or hospital setting.
1-START WITH THE ABCS, IV, O2, ✔️skins & 12 lead 🖤💙🖤
2-ASSESS the pt & extrapolate info from the family (i.e. med list) 💊
3-GET labs: ISTATs, & venous blood gas (VBG) 💉
4-Use AEIOUTIPS mnemonic to help w/DDx
5-Listen to emergency trauma mama’s new podcast to review a super interesting case study 😲💪🏻💯🤗
Let’s talk about a + seatbelt sign and what that could mean when taking care of your trauma patients. Always anticipate the types of injuries that you will see such as:
1. Hemothorax, pneumothorax or hemopneumothorax
2. Clavicular fx’s
3. Blunt abdominal injury with active internal bleeds such as small bowel rupture or mesenteric artery tears. Initial FAST may or may not see so emphasis on pt presentation and repeat FAST exams are key especially in the case of fluctuating patient stability.
4. Traumatic kyphosis with paraparesis
5. Teardrop fx’s L-S spine
6. Chance fx’s-usually related to lap seatbelt use, this mechanism can result in complete ligamentous injury or a combination of bony, ligament, and disk involvement.
Lap belt ecchymosis or “positive seatbelt sign” accounts for approx. 20% of mesenteric, bowel and lumbar spine injuries.
#emergencymedicine #seatbeltsign#emergencytraumamama #emergencynurse #trauma#traumaassessment #fastexam #repeatfastexams#traumamama #traumanurse #traumajunkie#traumainformed #themoreyouknow#nursessupporttheiryoung #nursessupportingnurses#nursesofinstagram #nurseswholift #nurseswhoworkout#nurseswhorock #nurseswithtattoos #nursingstudent#ems #emsstudent #paramedicschool #paramedic