Page 246 - Critical Care Notes

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MULTISYS
■ Assess for signs of bleeding. Control hemorrhage. Transfuse as needed.
Consider autotransfusion of shed blood, autologous blood, unmatched
type-specific blood, or type O (universal donor) blood.
■ Consider pneumatic antishock garment to control hemorrhage.
■ Replace each milliliter of blood loss with 3 mL of crystalloid (3:1 rule).
■ Monitor vital signs frequently, and assess for signs of hypovolemic shock.
Maintain BP within acceptable parameters.
■ Provide continuous cardiac monitoring.
■ Provide peripheral IV access or insert a central venous catheter for IV fluids.
Use rapid infuser devices as needed.
■ Assess neurological status for confusion and disorientation. Use Glasgow
Coma Scale.
■ Immobilize the spine and cervical area until assessment is made of spinal
cord injury and head and neck injuries. If no injury, elevate HOB or turn
patient to side to prevent aspiration.
■ Prevent hypothermia through the use of blankets, warming blankets, or
warming lights.
■ Insert Foley catheter. Monitor intake and output. Assess fluid and elec-
trolyte balance. Assess urine for bleeding.
■ Assess abdomen. Note bowel sounds, guarding, bruising, tenderness, pain,
rigidity, and rebound tenderness.
■ Obtain focused abdominal sonography for trauma (FAST) followed by
helical CT.
■ Diagnostic peritoneal lavage (DPL) may be done if CT is not available or
detects minimal abdominal fluid, if patient is unstable and needs immedi-
ate diagnosis of possible intra-abdominal hemorrhage, or if peritonitis is
suspected. Most sensitive test for mesenteric and hollow viscus injuries.
If >10 mL blood is aspirated, procedure stops and peritoneal cavity is
lavaged with NS or LR; effluent sample is sent to the laboratory for
analysis.
■ Insert NG tube to prevent gastric distention, decrease risk of aspiration, and
assess for GI bleeding.
■ Provide nutritional support orally, enterally (gastric, duodenal, or jejunal
route), or parenterally (TPN and lipids).
■ Note skin color, pallor, bruising, distended neck veins, and edema.
■ Inspect for soft tissue injury, deformities, wounds, ecchymosis, and tender-
ness. Palpate for crepitus and subcutaneous emphysema.
■ All wounds should be thoroughly cleansed to the degree possible.
■ Administer broad-spectrum antibiotics to prevent and treat infection.
Observe for sepsis. Avoid nosocomial infections.
■ Provide analgesics for pain. Sedate as necessary.
■ Provide DVT and stress ulcer prophylaxis.
■ Administer tetanus prophylaxis.
■ Calculate and monitor a Trauma Score: http://www.mdcalc.com/revised-
trauma-score/
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