Over The Hill Gang , Old Farts with Young Cars

[Xanthos]

Originally Posted by SSE 4 2SS

You have a traumtic head injury patient, lets say for continuity, the same one that hit the windshield above..... the initial vital signs are BP 190/130, HR 48, respirations are 30 and shallow....you do everything in your power to stabilize the patient... and after a few minutes, you check the vitals again, and you get BP 120/70, HR 78, Respirations are 20 and non labored.... are you ready to congratulate yourself on a good job or are you scared to death, and thinking about everything you have learned, seen and done for this particular patient.... ? Why...?

Isn't a change in respiratory rate always bad for a head injury patient? I mean, the baseline vitals sound like cushing's reflex. With the changes in vitals I want to say its a bad thing though. Maybe if the respiratory rate had stayed the same but I'd be worried about any change in respiratory rate with a head injury patient... God, thats a hard one.
- X

P.S. - You beat me to it. I hit the quote button and then sat there staring at the screen. LMFAO.

[Xanthos]

Originally Posted by SSE 4 2SS

Personally I'm scared to death, and the patient is either not injured that bad in the first place, or they are circling he drain...
Simplified explanation.... to get from 190/130 to 0/0 you pass through 120 / 70, and as the blood pressure decreases, the heart rate will increase.... respiration will do whatever... again, this is Cushings Triad....With rising intracranial pressure, BP will increase, consequently HR will decrease, and respirations will do whatever, increase or decrease.... Think of the blood vessels in the brain, if you increase the pressure outside of them, the internal diameter will decrease, and this creates back pressure on the circulatory system... so, with increased resistance, the HR will decrease... it's working harder to pump the blood and any pump that is loaded, will slow in rate....

Yeah, I knew about increasing cranial pressure increasing blood pressure (internal bleeding in the head => hypertension, internal bleeding anywhere else => hypotension) but we've never talked about the BP dropping like that.
- X

[SSE 4 2SS]

Originally Posted by Xanthos

Isn't a change in respiratory rate always bad for a head injury patient? I mean, the baseline vitals sound like cushing's reflex. With the changes in vitals I want to say its a bad thing though. Maybe if the respiratory rate had stayed the same but I'd be worried about any change in respiratory rate with a head injury patient... God, thats a hard one.
- X

P.S. - You beat me to it. I hit the quote button and then sat there staring at the screen. LMFAO.

the respiratory rate is finicky, and yes it's important to monitor it,, but....

Simple response.... you can always affect the respiraory rate...monitor the o2 sats, and determine the effectiveness of your treatment... too slow, oral or nasal airway, and bag them with supplemental oxygen.... to fast or too fast and shallow, again, oral or nasal airway and bag them with supplemental oxygen... you only need to maintain the saturation level...for emergent care....at the basic level, thats about all you can do as far as treatment of a specific head injury...

[Xanthos]

Originally Posted by SSE 4 2SS

the respiratory rate is finicky, and yes it's important to monitor it,, but....

Simple response.... you can always affect the respiraory rate...monitor the o2 sats, and determine the effectiveness of your treatment... too slow, oral or nasal airway, and bag them with supplemental oxygen.... to fast or too fast and shallow, again, oral or nasal airway and bag them with supplemental oxygen... you only need to maintain the saturation level...for emergent care....at the basic level, thats about all you can do as far as treatment of a specific head injury...

Yeah... Get to learn endotracheal tubes next month in my EMT-I class though.

Anyway - I've gotta get to bed (have work in the morning) but I enjoyed the talk. I love the class (and I loved my clinicals) but I still have a lot to learn.

Its quite a change from Engineering (thats what I was studying for the last two years).
- X

[SSE 4 2SS]

Originally Posted by Xanthos

Yeah, I knew about increasing cranial pressure increasing blood pressure (internal bleeding in the head => hypertension, internal bleeding anywhere else => hypotension) but we've never talked about the BP dropping like that.
- X

Think of multiple injuries... or fatigue....

Small internal bleed in addition to the head injury.... the body compensates, for a while.... then, (other injuries) hypovolemia sets in, and the BP decreases, which will most likely lead to HR increase...... so, the vitals normalize to a degree,,,... more normal... and in this maybe there is a temporary decrease in intra-cranial pressure, which could change the respiratory rate... less pressure on the brain stem or whatever.... so things look good, you sit back and start slapping yourself on the back.... five minutes later your chasing problems way outside the box.... reactive....

Fatigue, what is the heart... it's a muscle, it's working hard to overcome the increased back pressure, and it gets tired, so it slows a little, the BP decreases, and the brain, becomes more starved for oxygen, so it can no longer function at peak capacity, and it allows the blood vessels to relax, so you have peripheral fluid loading, and decreased resistance to the heart, so it speeds up.... Bp is down, rate is up, and again respirations do whatever, so it appears the vitals are normalized... but, you and i know better.... so we are proactive... but still, the biggest thing we can do is monitor and control the respiratory QUALITY and consequently the Saturation of 02

[SSE 4 2SS]

Originally Posted by Xanthos

Yeah... Get to learn endotracheal tubes next month in my EMT-I class though.

Anyway - I've gotta get to bed (have work in the morning) but I enjoyed the talk. I love the class (and I loved my clinicals) but I still have a lot to learn.

Its quite a change from Engineering (thats what I was studying for the last two years).
- X

LOL. I went the other way... Medic Firefighter to Engineer, SubSea Engineer...

Good Luck and Good Night...

[BOETIE]

Originally Posted by SSE 4 2SS

LOL. I went the other way... Medic Firefighter to Engineer, SubSea Engineer...

Good Luck and Good Night...

Hey, What up Dude ?

[Walker6]

Hey ya'll! Maybe I'll actually get to check in here when someone is on. Hope all is good with everyone!

[SSE 4 2SS]

Originally Posted by Walker6

Hey ya'll! Maybe I'll actually get to check in here when someone is on. Hope all is good with everyone!

Howdy Libby,

Were you up that early or that late???

[Michael_Js]

Night owl I guess

[BOETIE]

Howdy, anyone home

[Michael_Js]

Nope, no one at home

hi ya!

[SSE 4 2SS]

Originally Posted by Michael_Js

Nope, no one at home

hi ya!

I'm headed to my favorite Mexican food resturant for breakfast, be back later...

Howdy Mj and Boe...

Brandi is in the hospital,,, hoping for an update later today or maybe tomorrow...I'll post up as I find out stuff...

[Xanthos]

Hey old farts. Back to studying.
- X