3 Trauma And Surgical Management Flashcards by Brendon Allen

4 major mechanisms for injury

GOAL?

Poisoning (overdose)
MVA
Firearms
Falls

Goal of trauma: PREVENTION

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What is the 4th leading cause of death?

High incidences in what gender?

Disease of the young because what?

Trauma

Males

Younger people are more likely to take risks

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Trauma 1-3 peaks (EXAM)

1st peak : 16-24 y/o
-MVA and homicide (leading cause of death)

2nd peak : 35-54 y/o
-prescription & illegal drugs

3rd peak : 65 & older
-MVA and falls

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Levels of trauma care:
Level 1

-Comprehensive trauma care
-Regional resource
-Required to provide education and research
-Trauma surgeon
-Anesthesia
-Specialist and nurses immediately available

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Levels of trauma care:
Level 2

All criteria of level 1 but:
—not required to participate in education and research

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Levels of trauma care:
Level 3 and 4

3:
ER care
Stabilize patient to transfer to level 1 or 2

4:
ER care
Goal to resuscitate
Stabilize and transfer (may not get to level 1/2)

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Trauma unintentional death peaks:

1st peak of death
-how which it happens
-goal
-examples

Seconds to minutes after injury
(little we can do so prevention is key)

Declared dead at scene or ED
-apnea d/t severe TBI
-high SCI
-massive hemorrhage

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Trauma unintentional death peaks:

2nd peak of death
-how long
-examples
-golden hour?

Minutes to hours
(Golden hour: rapid assessment & intervention)

-liver or spleen laceration
-pelvic fx
-hemopneumothorax

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Trauma unintentional death peaks:

3rd peak of death
-how long
-examples

Several days to weeks
-ARDS
-sepsis
-MODS
-increased ICP

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Injury prevention:
Primary
Secondary
Tertiary

Primary: prevent trauma
-speed limit
-no drink or text and drive

Secondary: minimize impact
-airbags, seat belts
-helmets
-anti bullying
Tertiary: rehab

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EMS focuses on what?

Random things they can do

ABCs

(Stabilize spine/fx, NCD, occlusive dressings)

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IV resuscitation
-type of IV
-guided by?
-type of fluids
-fluid resuscitation goal (exam)

Too much fluid to fast can cause what 3 things?

Large caliber IV and IO access (2 sites)
-guided by VS
-isotonic fluids - crystalloid solution
-goal: SBP above 90 (exam)

Metabolic acidosis/ARDS/MODS

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How to access if fluid resuscitation worked?

What 3 fluids we can give for blood transfusion?

Assess:
-UOP 50ml/hr in adults
-Stable LOC/HR/BP/labs

Blood transfusions:
-PRBCs
-FFP
-Platelets

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Massive transfusions:
-what is it
-3 main complications
-2 others

More than 10 units of PRBCs in 24hrs

Complications:
-citrate toxicity
-hypocalcemia
-hyperkalemia

Other 2:
3rd spacing (diffued into tissue)
Dilutional coagulapathy r/t coagulapathy

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How does massive transfusion cause citrate toxicity and hypocalcemia

-Citrate is in PRBCs so it can build up if we give alot

-Citrate binds to calcium and decreases Ca levels

Tx:
-calcium supplement when getting massive transfusions

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Treatment for dilutional coagulapathy r/t hypocalcemia (due to massive transfusion)

Correct calcium

Admin:
-FFR
-PLTs
-Cryoprecipitate

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Triage is sorting patients
-minor trauma vs major trauma

Minor: single system injury (treated in ED)

Major: multisystem injury

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Disaster and mass cal management:

Causes?
Notification (first responders/hospitals)

Weather/violence/epidemic outbreaks/human error

Notification:
-first responders: level 1 trauam hosp/local hosp
-hospital: activate disaster phone call lists

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Mechanism of injury

Kinetic injury:
-what is it
-the greater the what the greater the injury?
-3 types of kinetic injury

Transfer of injury causes traumatic injury

-greater the mass/speed = greater injury

Types:
-blunt
-penetrating
-blast

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Blunt injury
-examples
-what is happening

MVA
Assault w/ blunt object
Fall

(Accelerating, decelerating, shearing, crushing forces, rupture)

-coup-contrecoup
(Coup = initial impact)
(Contrecoup = on other end of the initial impact gets injured)

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Penetrating injury
3 types
-2 types of nursing/training

Blast injury

Penetrating injury:
Stabbing, GSW, Debris
-forensic nursing
-ballistic training

Blasting injury:
Combination of blunt force and penetration

Primary survey
ABCDEFG

ABC

Airway/breathing

Circulation

Primary survey
ABCDEFG

Disability:
GCS
Pupil size (PERRLA)
Motor activity (sensation in extremities)

Expose patient:
-remove clothes
-warm patient
(Crepitus, deformities, edema, temp)

Primary survey
ABCDEFG

Full vitals/family/ focused intervention:
-vitals
-NGT,FC, blood/urine lab/ABG
-update family

G: give comfort messures
-pain/emotional/physical comfort

Secondary survey Head to toe MIST SAMPLE

Inspect posterior surfaces-log roll MIST: Mechanism of injury injuries s/sx in the field Tx in the field SAMPLE: Symptoms, allergies, meds, PMH, last oral intake, events/environmental factors

Airway and breathing -way we keep airway open -how to not compromise spine -clear debris how? -ETT also helps keep airway open

Jaw thrust chin lift (Neck midline to prevent compromise) Clear debris with yankauer sunction

Circothyrotomy 4 reasons to do one

Facial fx Unable to intubate Facial or upper airway burns Orophayngeal hemorrhage

Thoracic injuries 6 examples

Tension pneumothorax Peumothorax Open chest wound Pulmonary contusion Flail chest Rib fx

WET vs DRY chest tubes

WET: NO bubbling in collecton chamber NO continuous bubbling in water seal chamber -if there is then theres a leak (notify provider) (Intermittent bubbling from water seal chamber means air is able to escape pleural cavity) -want continuous bubbling in water filled suction control chamber DRY: -Dry controlled regulation: can be in negatives (Want to keep its suction to keep lungs expanded) -NO bubbling in water seal chamber

Spinal cord injury: -avoid doing what -monitor what

Avoid hyper extending neck Monitor: -breathing effort/accessory muscle use -neurogenic shock -GCS/pupils -poistion of head and HOB -aspiration precautions

Hypothermia What temp Assess what Tx

T<35C Assess for dysrhythmias Tx: -Remove wet clothing -Warm blanket -IV fluid warmers -Body cavity irrigation (peritoneal) -Bypass cardiopulmonary

Facial truama. Le fort I,II,III Le fort I Le fort II

Le fort I —transverse fx detachment of the entire maxilla above the teeth Le fort II —pyramidal fx involving the triangular segment of the mid-face and nasal bones (Impact or fx above the nasal bone forming a triangular that detaches the segment)

Facial trauma: Le fort III

A separation and detachment of the: -maxilla -nasal -both zygomatic bones

S/s of le forte injury (facial injury)

Pain Periorbital edema/ecchymosis Facial swelling Facial asymmetry CSF rhinoorhea (le fort II/III) Intracranial or spinal injury s/s Epistaxis

What to do if you see CSF rhinorrhea (lefort II/III)

Must get: —head xray —CT scan

Treatment of le forte injury 3 do’s 2 dont’s

Correct positioning to enhance airway HOB elevate Prepare patient for sx NO: -NG tube -Nasal ETT

Cardiac tamponade -s/s -prepare for what?

Becks triad: -muffled heart sounds -JVD -decreased CO Prepare for pericardiocentesis (EXAM)

Cardiac contusion -assess what Aortic rupture -seen with what type of trauma to chest -assess what? -tx

Cardiac contusion: -assess dyrhythmias, cardiac enzymes, HF Aortic rupture: -blunt force trauma to chest -assess: —weak femoral/pedal pulses —tracheal deviation —widened mediastinum —pain/dysphagia Tx: prepare for sx

Abd trauma: -FAST EXAM -assess what -labs

FAST: focused, assessment, stenography Distention, rigidity, refeered pain, rebound tenderness Liver/spleen laceration H&H

Liver and spleen lacerations

Liver: Grade 1-3 = monitor Grade 4 = sx intervention Spleen: Grade 1-3 = monitor Grade 4,5 sx intervention

Kidney injury -assess for what 2 things Bowel injury: -thing we do to check for injury

Kidney: —hematuria, flank pain Bowel: —laproscopy

MSK trauma Primary assessment Secondary

Deformities Dislocations Amputations Closed and open fx Crush injury Secondary: 6P’s Pain, paralysis, parasthesia, pressure, pulselessness, pallor

Tx of msk trauma

Stabilize Abx Clean/dress wound Tetanus vaccine

Comparment syndrome s/s Tx

6 p’s Pain, pallor, paralysis, parathesia, pulselessness, pressure Tx: fasciotomy

Fat embolism High risk from what type of injury Tx

High risk with long bone and pelvic fx -stabilize fx

Rhabdomyolysis Etiology (4 injuries that can cause it) Patho

Crush injuries Compartment syndrome Electrical injury Burns Patho: Injured muscle releases myoglobin Myoglobin toxic to renal tubules (cause AKI) (Hyperkalemia)

Rhabdomyolysis Assess what 3 things Tx

Myoglobin in urine Dark tea colored urine Increased CK total and potassium Tx: Aggressive fluid resuscitation —IVF w/ NaHCO3 UOP goal 100ml/hr Treat hyperkalemia

What really is Rhadbo

Extreme MSK trauma injury that: -damages kidneys -causes hyperkalemia

S/s of alcohol and drug abuse Assessment for withdrawal

Irritabile Confusion Hallucinations (auditory and visual) Tremors N/V/D Tachycardia HTN Fever Sz CIWA: clinical insitute withdrawal assessment

Alcohol and drug abuse -test we do -call posion control fi unsure how to treat -continuous monitoring of what? Methods to reduce drug absorption

Urine and serum toxicology screen Continuous monitoring cardiac and BP Methods: Gastric lavage w/ activated charcoal

Violence: What are is at high risk Signs of family or partner violence? Nurses have a what duty?

ED Story doesnt fit the injury Duty to report