Impending haemodynamic compromise

Cohiba · Jul 18, 2014

What have you done to try figuring this out for yourself? We're not going to just do your homework for you...

Jomaflyhigh · Jul 18, 2014

Actually YES i have but my nurse manager / teacher said that i didn't answer that question FULLY . . .

My answer: Subtle changes or altered Level of Consciousness can result from a variety of factors, including insufficient oxygen or blood flow in the brain and excessive pressure within the skull. Decreased LOC correlates to increased morbidity & mortality .....

Guess ... She's not happy with my answer and that i didn't answer it fully.

thanks in anticipation for any response

Esme12, ASN, BSN, RN · Jul 18, 2014

it is tough knowing what your teacher wants. Do they want a detailed answer with pathophysioloigy?

Start with the ABC's of your assessment.

A quick check for common rapidly reversible causes dovetails nicely with the ABC's approach to all emergency patients.
A- An insecure or incomplete airway can lead to hypoxia and CNS malfunction. Open the airway, check pulse-oxymetry and provide supplemental oxygen.
B- Inadequate ventilation will lead to high levels of CO2 and respiratory acidosis. Bag-valve-mask ventilation should be provided until adequate ventilation can be restored (waking the patient up of putting them on a ventilator)
C- Poor circulation leads to hypoperfusion of the brain. Without blood supplying adequate oxygen and glucose, mental status plummets in seconds. Check pulses, capillary refill and place the patient on a cardiac monitor to assess the rhythm. If there is no organized rhythm, provide immediate continuous CPR and defibrillation (or pacing) as needed. If there is an organized rhythm assess for other causes of circulatory collapse (volume depletion, MI and Cardiogenic shock, sepsis and distributive shock). Circulation must be restored to the brain before any further evaluation can proceed.
D- Gross assessment of disability level. GCS or AVPU for level of consciousness. Note any spontaneous movements: Is there lack of movement on one side of the body (stroke)? Is there lack of movement below a certain level of the body (cord injury)? Is there evidence of seizure activity? Are the pupils equal and reactive?
E- Exposure and rapid head to toe look for signs of trauma, transdermal drug patches, dialysis devices, infectious sources (such as catheters) or petechiae.

CDEM Curriculum