370: Trauma Flashcards
What is included in a Primary Assessment?
A = Airway with simultaneous c-spine protection B = Breathing (supplemental oxygen) C = Circulation with D = Disability (neuro status) E = expose/environmental controls (remove clothing + keep warm)
What is included in a Secondary Assessment?
F = Full set of Vitals, Focused adjuncts (cardiac monitoring, urinary catheter, gastric tube), Family presence
G = Give comfort (verbal, pharmacological, and pain management)
H = History + Head-to-toe
I = Inspect posterior surfaces
What is included in a Trauma Panel and Diagnostics?
- CBC
- Electrolytes
- BUN
- Creatinine, Amylase, Lipase
- PT, PTT
- Blood type + crossmatch
- Urinalysis (ethanol + tox screen)
- ABGs
- Lactate
- Imaging (X-ray, CT, US, FAST)
- ECG
Type of compression fracture with multiple pieces of bone
Burst fracture
Type of fracture with fragments out of normal position at fracture site
Displaced fracture
Type of fracture that is intact, caused by minor to moderate force applied directly to bone
Linear fracture
Type of fracture telescoped, one fragment driven into another
Impacted Fracture
Type of fracture results from twisting force
Spiral Fracture
Type of fracture occurs at 90-Degree angle to longitudinal axis of bone
Transverse Fracture
Type of fracture occurs approximately 45-Degree angle across longitudinal axis of bone
Oblique Fracture
Type of fracture where breaks across entire section of bone dividing it into distinct fragments, often displaced
Complete Fracture
Type of fracture where more than 1 fracture line, more than 2 bone fragments, fragments may be splintered or crushed
Comminuted Fracture
Type of fracture where fracture like extends in direction of bone’s longitudinal axis
Longitudinal Fracture
Type of fracture where bone fragments are torn away from the body of the bone at the site of attachment of a ligament or tendon
Avulsion Fracture
Type of fracture where fracture lines radiate from one central point
Stellate Fracture
An incomplete fracture in which one side of the cortex is broken and the other side is flexed but intact
Greenstick Fracture
How much blood is lost in a humerus fracture?
250mL
How much blood is lost for EACH pelvic fracture?
500mL
How much blood is lost for a Hemothorax?
2,000 mL PER LUNG CAVITY
Half of circulating blood
How much blood is lost for a femur fracture?
1000 - 1500 mL
What are primary indications for a Blood Transfusion?
- Blood loss > 20% (1000mL)
- Anemia not benefited from other treatments
- Clotting abilities or platelets are low
What are the 7 Ps of neuro vascular assessments?
- Pain
- Pallor
- Pulselessness
- Parathesia (sensory impairment/pins+needles)
- Paralysis
- Puffiness
- Poikilothermia (temp regulation)
What are complications of a musculoskeletal trauma?
- Nerve injury
- Fat emboli (SOB, Change in LOC, Petechial rash)
- DVT/PE
- Infection
Cast Syndrome
Spica casts (Body casts for hip dysplasia)
Vascular compression of duodenum causing bowel ischemia. Leads to hemorrhage and necrosis of bowel and gastric distension.
Compartment Syndrome
Progressively increased pressure in a confined space compromising circulation.
- Ischemia releases Histamine leading to further edema and further decreased perfusion.
- RHABDOMYOLOSIS = cellular release of myoglobin ➡️ toxic to kidneys ➡️ rise in CK value ➡️ kidney failure
Volkmann’s Contracture
Permanent flexion contracture of the hand at the wrist, resulting in a claw-like deformity of the hand and fingers.
- Not enough innervation to site
- Muscle tissue replaces by fibrous tissue
- Trapsfibres and nerves and results in contracture
Can be due to COMPARTMENT SYNDROME
What is the treatment for Compartment Syndrome?
Fasciotomy = indecision through skin into fascia of muscle
Why do you cycle ice on and off?
Rebound vasodilation can increase swelling
What are possible causes of Compartment Syndrome?
- Soft tissue injuries
- Fractures
- Crush injuries
- Casts
- Prolonged pressure on limb
- Frostbite
- Snakebite
How does a nurse asses pelvic stability?
- Apply gentle pressure to iliac crest towards midline (Don’t do #2 of pain)
- Gently press down on symphysis pubis
What are interventions for a pelvic fracture?
- High flow O2
- Frequent monitoring of vitals
- 2 large bore IV sites, crossmatch
- Fluid bonuses
- Splint pelvis, immobilize spine and legs
- NO FOLEY if blood at urinary meatus
Which type of hip fractures can be missed on plain X-ray films?
- Undisplaced femoral Neck
2. Intertrochanteric
What are the types of hip fractures?
- Subcapital neck fracture
- Transcervical neck fracture
- Intertrochanteric fracture
- Subtrochateric Fracture
- Greater Trochanter Fracture
- Lesser Trochanter Fracture
When is it indicated to intubate?
GCS < 8
“Less than eight, intubate!”
What is important for cervical spine fractures?
Support breathing!!
“C3, 4, 5 = keep diaphragm alive!”
What is important for thoracic spinal fractures?
T2-T8 control intercostals
What is important for sacral spinal fractures?
S4-S5 control rectal tone
When are antibiotics indicated in a trauma setting?
- Compound fractures
- CSF leak
- Penetrating injury
- Prevent secondary osteomyelitis, meningitis, peritonitis
If there is blood at the urinary meatus, should a patient still receive a urinsry catheter?
NO!!
