HESI Critical Care Review
Acute subdural hematoma= usually with head injury, cut of vessels, symtoms within 24-48
hrs
-see h/a if conscious
-may remain unconscious or have varying LOC
-may see 1 sided findings= pupil dilation/ hemiparesis
Head injury= neuro checks frequently. Goal= oxygenation/perfusion
o See CSF or or dec GCS= tell HCP
o CSF= nothing through nose and no blowing nose
o Monitor hyperthermia
o Last resort= craniotomy and if pt comatose need IC from family
Low TV for flail chest, recent thoracic surgery, pul fibrosis
Want PaCO2> 60, FiO2< 40 and 10-16 bpm
Inc PEEP >5 if resp failure
High pressure alarm= pt is coughing, needs suction, have pneumothorax or ET displaced,
kinked tubing
o Clear secretions, reposition pt, assess breath sounds for placement, unkink tubing,
veryify cm level of ET tube
Low pressure alarm= disconnected from vent or has leak
o Check connections and tighten them
o May need to bag pt
o If pt can talk; cuff not inflated
Change in TV= loose cuff seal
Ventilation
o Assess LOC and HOB 30 degrees
o Assess full resp status, worsening= hypoxia and needs vent or dif settings
o Listen over trachea for airleak
o Tension pneumothorax= remove from vent and bag pt
o Kinked ventilator circuit= check cm level of ET tube
, Inc RR= may be hypoxia, anxiety or hyperthermia/inc HR
ALS= loss of spinal cord function
o Autonomic intact. Dies from resp failure in 3 yrs
o See twitching, weakness, atrophy
o CK increased
o May need vent
o Watch for back ulcers or surgery= log role
o Neuro checks
Aneurysms= occur most often at abdominal aorta.
o Atherosclerosis and HTN most common causes; quit smoking
o Check for hematomas/flank pain
o Usually asymptomatic
o Graft surgery; check BP, CO with a-line and check pulses for occlusion
o Don’t want severe abd pain/distention= perforation
o Rupture= manage airway then circulation; propranolol to dec port HTN and prevent
o Somatostain (octreotide) and vasopressin to
Shock anaphylaxis
o Hypoten, tachy, puritis, lump in throat, wheezing, restless, anxiety, n/v/d, dec CO, flat
JVD
o Give Benadryl/diphenhydramine
o Inc CO/BP= dobutamine and dopamine
o First see= erythema, angioedema, urticarial (hives)
o Have massive vasodilation= hypotension and flat JVD
HHS= BG>600, severe dehydration, dec K+/Phos, Type 2 DM, sloowwww onset
o No ketonuria or acidosis
o Esp over 1500 neuro changes
o Watch change LOC more so in HHS then DKA
o Dec CVP= inc HR and RR but no kussmal
o Convulsions then coma then death
Acute subdural hematoma= usually with head injury, cut of vessels, symtoms within 24-48
hrs
-see h/a if conscious
-may remain unconscious or have varying LOC
-may see 1 sided findings= pupil dilation/ hemiparesis
Head injury= neuro checks frequently. Goal= oxygenation/perfusion
o See CSF or or dec GCS= tell HCP
o CSF= nothing through nose and no blowing nose
o Monitor hyperthermia
o Last resort= craniotomy and if pt comatose need IC from family
Low TV for flail chest, recent thoracic surgery, pul fibrosis
Want PaCO2> 60, FiO2< 40 and 10-16 bpm
Inc PEEP >5 if resp failure
High pressure alarm= pt is coughing, needs suction, have pneumothorax or ET displaced,
kinked tubing
o Clear secretions, reposition pt, assess breath sounds for placement, unkink tubing,
veryify cm level of ET tube
Low pressure alarm= disconnected from vent or has leak
o Check connections and tighten them
o May need to bag pt
o If pt can talk; cuff not inflated
Change in TV= loose cuff seal
Ventilation
o Assess LOC and HOB 30 degrees
o Assess full resp status, worsening= hypoxia and needs vent or dif settings
o Listen over trachea for airleak
o Tension pneumothorax= remove from vent and bag pt
o Kinked ventilator circuit= check cm level of ET tube
, Inc RR= may be hypoxia, anxiety or hyperthermia/inc HR
ALS= loss of spinal cord function
o Autonomic intact. Dies from resp failure in 3 yrs
o See twitching, weakness, atrophy
o CK increased
o May need vent
o Watch for back ulcers or surgery= log role
o Neuro checks
Aneurysms= occur most often at abdominal aorta.
o Atherosclerosis and HTN most common causes; quit smoking
o Check for hematomas/flank pain
o Usually asymptomatic
o Graft surgery; check BP, CO with a-line and check pulses for occlusion
o Don’t want severe abd pain/distention= perforation
o Rupture= manage airway then circulation; propranolol to dec port HTN and prevent
o Somatostain (octreotide) and vasopressin to
Shock anaphylaxis
o Hypoten, tachy, puritis, lump in throat, wheezing, restless, anxiety, n/v/d, dec CO, flat
JVD
o Give Benadryl/diphenhydramine
o Inc CO/BP= dobutamine and dopamine
o First see= erythema, angioedema, urticarial (hives)
o Have massive vasodilation= hypotension and flat JVD
HHS= BG>600, severe dehydration, dec K+/Phos, Type 2 DM, sloowwww onset
o No ketonuria or acidosis
o Esp over 1500 neuro changes
o Watch change LOC more so in HHS then DKA
o Dec CVP= inc HR and RR but no kussmal
o Convulsions then coma then death
