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The Use of Resuscitative Endovascular Balloon Occlusion of the Aorta in Treating Hemorrhagic Shock from Severe Trauma

Contrada, Emily

AJN The American Journal of Nursing: October 2018 - Volume 118 - Issue 10 - p 29,40
doi: 10.1097/01.NAJ.0000546377.81550.60
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The Use of Resuscitative Endovascular Balloon Occlusion of the Aorta in Treating Hemorrhagic Shock from Severe Trauma

GENERAL PURPOSE:

To provide information about the procedure and device used for resuscitative endovascular balloon occlusion of the aorta.

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LEARNING OBJECTIVES/OUTCOMES:

After completing this continuing education activity, you should be able to

  • outline the evolution of and techniques for this procedure.
  • describe the logistics of deployment for this procedure.
  • recognize the physiologic implications for nursing care.
  1. Zone I of the aorta contains which of the following structures?
    1. descending thoracic aorta
    2. infrarenal abdominal aorta
    3. paravisceral aorta
  2. Occlusion in which of the following aortic zones is optimal for controlling pelvic and lower extremity hemorrhage?
    1. Zone I
    2. Zone II
    3. Zone III
  3. According to data from the American Association for the Surgery of Trauma, as of March 2017, 47 patients had been treated with the Eliason and Rasmussen version of the resuscitative endovascular balloon occlusion of the aorta (ER-REBOA) catheter. In what percentage was aortic occlusion successful?
    1. 77%
    2. 85%
    3. 96%
  4. REBOA requires arterial access via which artery?
    1. femoral
    2. carotid
    3. brachial
  5. After establishing arterial access, the clinician inserts a guide wire to allow introduction of a vascular access sheath. What size sheath is used for introducing an ER-REBOA catheter?
    1. 4 Fr
    2. 7 Fr
    3. 12 Fr
  6. Before use, the catheter's balloon must be
    1. tested via complete inflation.
    2. partially inflated.
    3. completely deflated.
  7. For Zone I deployment, the clinician measures from the
    1. level of the xiphoid to the arterial access point.
    2. sternal notch to the entry point of the sheath.
    3. clavicle to the arterial access point.
  8. When inflating the balloon for Zone III deployment, the clinician should do so gradually, starting with how many cubic centimeters?
    1. 2
    2. 5
    3. 8
  9. Which of the following is an indication that aortic occlusion has been successful?
    1. a gradual decrease in systolic blood pressure
    2. a gradual increase in diastolic blood pressure
    3. a gradual increase in systolic blood pressure
  10. Compared with aortic cross-clamp time, balloon inflation time is
    1. shorter.
    2. equivalent.
    3. longer.
  11. Data from animal studies indicate that the maximum duration of Zone I REBOA should be
    1. 10 minutes.
    2. 20 minutes.
    3. 60 minutes.
  12. After catheter removal, manual pressure should be applied at the puncture site for at least how many minutes before applying a pressure dressing?
    1. 10 minutes
    2. 20 minutes
    3. 30 minutes
  13. According to Pasley and colleagues, mortality is high after which of the following has occurred?
    1. loss of pulses
    2. pulmonary edema
    3. central hypertension
  14. Problems with femoral artery access—a surgical emergency—typically present as a sudden change in
    1. oxygen saturation.
    2. blood pressure.
    3. c pulses.
  15. The sudden increase in afterload produced by aortic occlusion can lead to
    1. worsening myocardial ischemia.
    2. increased right ventricular work.
    3. ventricular constriction.
  16. Central hypertension may exacerbate bleeding in the
    1. lower extremities.
    2. abdomen.
    3. thorax.
  17. Reperfusion injury can manifest as
    1. rhabdomyolysis.
    2. metabolic alkalosis.
    3. profound hypertension.
  18. Throughout the REBOA procedure, nurses should use closed-loop communication, meaning that after a message is spoken or sent,
    1. the sender repeats the message if it hasn't been acknowledged within 3 minutes.
    2. the recipient repeats the message back for confirmation by the sender.
    3. the recipient passes the message along to at least 1 other team member.
  19. Besides the ER-REBOA catheter, a REBOA pack should contain
    1. sterile water.
    2. 2 10-cc syringes.
    3. a pressure bag.
  20. For the first 2 hours after REBOA, nurses should assess vital signs every
    1. 10 minutes.
    2. 15 minutes.
    3. 20 minutes.
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