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Nurs332 > emergency part 2 > Flashcards

emergency part 2 Flashcards

1
Q

nearly half of all dramatic injuries involve what?

A

alcohol, drugs or substance abuse

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2
Q

50% of people that are going to die in traumatic incidents is during what time?

where are they?

what are the common causes?

A

first hour
at the scene

brain injury, brainstem in, aortic in, high spinal cord injury, cardiac inju

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3
Q

how long is the second phase of a trauma?

% of people that die in this phase?

where are they?

what is it usually due to?

A

2-4 hour

25-30% of people die

at the hospital.

due to shock, hypovolemia, airway obstr (tongue), inadeq airway management, and flu resuicitation, epidural and subdural bleed, hemopneumothorax, pelvic fractures, long bone fractures, abide injuries

inadeq air

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4
Q

what is the time frame of the 3rd phase of trauma?

where are they?

what are the common causes?

A

1-3 week

ICU

infection, organ failure (ischemic for too long), Sepsis

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5
Q

how do you measure the impact of force?

A

weight x speed

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6
Q

what are the different types of energy that can be transferred during trauma?

A

mechanical, thermal, chemical, electrical, radiant

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7
Q

what are the most common blunt forces? (think in general)

A

Acceleration/deceleration eg) car crash

compression eg) steering wheel hits chest

rotational

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8
Q

why will different organs be affected differently in a MVC or any blunt force injury?

A

Because different organs vary in density and are suspended by different ligaments,etc. for example, the heart is suspended by the aorta and will stretch and twirl

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9
Q

why is it difficult to assess a blunt injury?

A

it is not visible. most crucial damage is internal.

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10
Q

what does injury on the outside of the body indicate?

A

there is injury beneath it (inside)

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11
Q

explain why a pneumothorax could occur if you got into a car crash?

A

in a car crash you might hold your breath and fill your lungs and clamp your glottis and hit your chest on the steering wheel and cause a pneumothorax due to this compression blunt force

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12
Q

what is a big concern regarding rotational blunt injuries?

A

any structure that is rotating cannot be perfused with blood. ischemia could then occur and if it is an organ within a closed space like braiin or spinal column- inflame (occurs 12 hours later)

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13
Q

what is the most common rotational blunt force injury?

A

head injury, then spine

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14
Q

when does inflammation occur?

A

12 hours after incident

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15
Q

what is a basal skull fracture?

when does this usually occur? what incident

A

it is injury to the anterior and posterior and middle fossa of the skull and hard palate of the mouth

usually occurs with facial trauma

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16
Q

what mater will first tear if you fracture your skull? what will then happen?

A

you could tear your dura mater which will allow entry into the arachnoid space and then RBC and WBC could enter this space and CSF could leak out into the subcutaneous area of space

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17
Q

What part of the skull have you fractured if you have racoon eyes? what is occurring?

A

anterior fossa of skull. means that the CSF from the arachnoid space has entered the subcutaneous space.

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18
Q

where can CSF leak out of?

A

nose, ears (if ear drum is ruptured), from arachnoid space into subcut

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19
Q

how is middle fossa basal skull fracture presented?

A

won’t see anything for 12 hours but it will be bruising behind the ears called “battle sign”

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20
Q

what is most superficial to spine?

A

reticular activating system- responsible for consciousness

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21
Q

what is the difference between coup and contra coup brain injuries?

A

coup is 2 parts: bouncing of skull and pulling the brain back with it and contra coup is the opposite side of the head due to brain swinging back and forth (can tear vessels this way) - counter blow.

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22
Q

what causes an epidural bleed?

A

usually the rupture or tear of vessels during a head injury. usually arterial

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23
Q

what is a subarachnoid bleed usually d/t?

A

rupture or congenital barry aneurysm. usually in the circle of willis. not as traumatic but sometimes can be ruptured in trauma

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24
Q

what is a good diagnostic measure to tell you something is wrong in brain following injury?

A

inflm and RBC and WBC found in there

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25
Q

what are some common symptoms of brain injury?

A

headache, nuclear rigidity (touch chin to chest)

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26
Q

where is the subdural space?

A

between pia and dura mater.

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27
Q

why is inflm so serious in brain injuries?

A

because our brain has no more room for external fluid. it is made up of 10% blood, CSF, and brain and there is no more room.

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28
Q

what occurs first as ICP increases?

A

spatial compensation will occur.

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29
Q

what occurs during spatial compensation in a brain injury?

A

the body will diuresis some CSF and try to slow down the production of CSF and shunt some down into the spinal canal.
want to vasoconstrict to make more room- blow off Co2 because it is a cerebral vasodilator

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30
Q

between spatial compensation and spatial exhaustion occurs following a brain injury, what is happening here? what is affected first?

A

pressure in the skull is climbing and the most vulnerable section is affected first- frontal lobe (behavioural changes).

next it is the opening at the base of the skull and the brainstem and it is getting caught in the foramen magnum and reticulating activating system is affected (LOC)

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31
Q

when would the glasgow coma scale show the most changes INITIALLY

A

ICP inc in spatial awareness (RAS is affected) around 10-20mmHg)

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32
Q

what is occurring in the spatial exhaustion phase? what is the pressure here?

A

Unresponsive. 30-40mmHg. most getting sucked down into foramen magnum after RAS, motor and sensory fibres. need to use pain stimulus for motor assessment because LOC

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33
Q

what are the first cranial nerves that are affected during spatial exhaustion of brain injury?

A

first 2 are sensory and 3rd is ocular motor (PERRLA) and will see unilateral puppilary changes.

34
Q

what occurs in 40mmHg ICP and above?

A

vital sign changes. cushings triad. (widening pulse treasure, bradycardia, irregular reps)

35
Q

how can we inc oxygenation to brain cells during inc ICP?

A

dec brain water with diuretics (lasix, mannitol or 20% osmotrol)

36
Q

why is osmotrol a good diuretic to use for brain injury and inc ICP?

A

because it has high molecular weight sugar so polydipsia will occur due to hyperglycaemia and it goes into the vascular space an pulls water out of the IS and takes to kidneys. however capillaries must be intact and this is not usually given after the 12 hours because its probably a leaky capillary and will move into the space and end up inc the pressure. confirm this ?

37
Q

what else might you do to dec metabolic o2 demand?

A

turn off lights, put orogastric tube down, give antiemetics and help nausea, benzos to keep calm and opioids.

38
Q

why is dangerous when neural tissue in the spinal cord is damaged? (in terms of location)

A

inflm will move up and down the spine

39
Q

what is an unstable spinal cord injury?

A

torn posterior ligament. (up on either side of the spine)

40
Q

why is it bad when a patient has no rectal tone?

A

usually means all of their nerves are damaged in their spinal cord. changes are

41
Q

how does a first degree burn present?

how long does it generally take to heal?

A

dry, red, blanches

painful

7 days

42
Q

whats a tension pneumothorax?

A

air gets trapped in the pleura space and with every breath you take the flap will open and close and more and more air will accumulate in that side of the lung and shift the heart

43
Q

what are the 3 abdominal trauma

A

thoracic
pelvic
retroperitoneal

44
Q

how do u treat musculoskelteal trauma?

A

RICE

45
Q

what is a dangerous risk of musculoskeletal trauma?

A

fat embolus

46
Q

what are the different types of burns?

A

thermal, electrical, chemical, and smoke inhalation injury

47
Q

what is the most common type of burn? what does it result from?

A

thermal

flash (explosion), flames, scald, direct contact w hot objects

48
Q

what are electrical burns cause from?

A

intense heat generated by electrical current causing coagulation necrosis as it travels through vessels

there will be entrance and exit wound. electrical current exits to the ground

49
Q

what are chemical burs caused from? what do you do immediately after?

A

contact with corrosive substances

flush with copious amounts to water immediately

50
Q

how do smoke injuries cause burn injury?

A

smoke or superheated air cause inflm of the upper airways which obstruction the airway

also carbon monoxide poisoning

51
Q

whats the % of burns for a young child? (1-4 yr)

head
body
legs
arms

A

head- 19%
arms- 9.5%
body- 35%
legs- 15%

52
Q

whats the % of burns for a child? (5-9 yr)

head
body
legs
arms

A

head- 15
body- 32
arms- 9.5
legs- 17

53
Q

whats the % of burns for an older child (10-14)

head
body
legs
arms

A

head- 13
body- 32
arms- 9.5
legs- 18

54
Q

how does a 2nd degree bur n appear?

A

red, moist, blisters, painful

55
Q

how does a 3rd degree burn present?

A

dry, no blanching
painless

gets to dermis and epidermis

56
Q

what are some possible respiratory problems when it comes to burns?

A

airway obstr
CO poiosniong
pulmonary edema
hypoventilation

57
Q

how is the tissue destroyedin burns?

A

through coagulation, protein denaturation or ionization of cellular contents

58
Q

destruction of skin from a burn can cause____

A 
inc fluid loss
infection
hypothermia
scarring
compromised immunity
changes in function, appearance
59
Q

severity of the burn depends on?

A

temperature of agent and duration of contact with agent

60
Q

what cardiovascular problems can occur from burns?

A

hypovolemia from excessive space fluid losses and circulating burn toxins

61
Q

what GI problems occur from burns?

A

paralytic ileus
GI bleed
E- imbalance

62
Q

what renal problems can occur d/t burns?

A

acute renal failure

rhabdmyolysis

63
Q

what musculoskeltal problems can occur from burns/

A 
limb loss
wounds infection
circumferential burns
hypercoagulability
silver sulfadiazine
64
Q

what is the palm method for burns?

A

size of palm is 1% TBSA

65
Q

where does electricity travel to when you experience an electrical burn

A

travels through least resistance so nerves and blood vessels and bones last

66
Q

what does the current do in your body? (electrical burn)

A

causes the muscles to contract and arrhythmia and spinal injuries often result

67
Q

how much of the body has to be burnt for person to experiences systemic responses?

A

> 25%

68
Q

when does the greatest volume leak following burns?

A

first 24-36 hours after burn and peaks at 6-8 hours

69
Q

when is edema greatest following a burn?

A

18-24 hours. begins to resolve 1-2 days post injury

70
Q

why would compartment syndrome occur from a burn?

A

edema can exert p on vessels and nerves and schema occurs causing compartment syndrome

71
Q

why is hyponatremia present in burns?

A

shifts into the cells

72
Q

why does metb acidosis occur?

A

inc in lactic acid due to anaerobic metb

73
Q

why does anemia occur or Hct dec?

A

RBC destr and plasma loss fror Hct

74
Q

why does bronchoconstriction occur in burns?

A

release of histamine, serotonin thromboxane and chest contraction 2’ to chat ubrns

75
Q

why does hypoxia occur in burns?

A

hypermetb –> inc in tissue o2 use

76
Q

why would atelectasis occur in burns?

A

injury from chemical irritation of alveoli -> l/o surfactant

77
Q

do you initially see pulmonary involvement in burns?

A

no >50% of burn pt don’t show initially.

monitor for 48 hours

78
Q

what are some indicators of pulmonary damage in burns?

A

face or neck burnt, singed nasal hair, hoarse, voice change, sooty sputum, dry cough, stridor, bloody sputum,, laboured breathing or tachypnea. s/s of hypoxemia, erythema and blistering oral or pharyngeal mucosa

79
Q

what diagnostics might you do to check for palm damage in burns?

A

serum carboxyhgb, ABGs
bronchoscopy
pulm fx tests
pulm complications

80
Q

what 3 parts of the GI tract alt by burn injury?

A

first mucosa is permeable

  1. allows overgrowth of GI bacteria
  2. the fact translocate to other organs–> infect

Nurs332 (12 decks)

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