Exam 3: Chest Trauma And Thoracic Injuries & Abdominal And GU Trauma Flashcards
Thoracic Injuries: Mechanisms of Injury include
- Blunt thoracic trauma
- Penetrating thoracic injuries
Chest wall injuries include
- Rib fractures
- Flail chest
- Ruptured diaphragm
What is flail chest?
2-3 or more consecutive ribs on one side; unstable chest wall d/t fractured ribs and paradoxical movements which prevents adequate perfusion of the lungs.
Pulmonary injuries include
- Pulmonary contusion
- Tension pneumothorax
- Open pneumothorax
- Hemothorax
What is a tension pneumothorax?
- Occurs when air enters the pleural space but cannot escape.
- The continued accumulation of air in the pleural space causes increasingly elevated intrapleural pressures.
- This result in compression of the lung on the affected side and pressure on the heart and Great Vessels, pushing them away from the affected side.
- The mediastinum shifts to the unaffected side, compressing the “good” lung which further compromises oxygenation.
What is a hemothorax?
accumulation of blood in the pleural space resulting from injury to the chest wall, diaphragm, lung, blood vessels or mediastinum
Abdominal Injuries: Mechanism of Injury includes
- Blunt trauma
- Penetrating Trauma
Assessment of Abdominal Injuries: Physical Assessment
- Location of entry and exit sites associated with penetrating trauma assessed and documented
- Cullen’s sign
- Grey Turner’s sign
- Distended abdomen
- Rebound tenderness
- Kehr’s sign
Cullen’s Sign
Ecchymosis around umbilicus
Grey Turner’s Sign
ecchymosis of flank area; indicates retroperitoneal hemorrhage
Kehr’s Sign
pain in the shoulder d/t presence of blood in Peritoneal cavity
Assessment of Abdominal Injuries: Diagnostic Assessment
- Diagnostic peritoneal lavage (DPL)
- Bedside ultrasound
- Chest x-ray
- CT scan of abdomen
Diagnostic Peritoneal Lavage
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Combined Organ Injuries
- Multivisceral Injuries
- Abdominal compartment sydnrome
Combined Abdominal Organ Injuries: Damage control surgery
- Initial operation
- Intensive care unit resuscitation
- Definitive reoperation
Abdominal Compartment Syndrome
End-organ dysfunction caused by intraabdominal hypertension
Specific Organ Injuries: Liver Injuries
- Life-threatening hemorrhaging
- Hemodynamic instability
- Coagulopathies, acidosis, and hyperthermia
Specific Organ Injuries: Spleen Injuries
- Life-threatening hemorrhaging
- Sepsis
Specific Organ Injuries: Intestinal Injuries include
Sepsis and abscess or fistula formation
Genitourinary Injuries: Mechanism of Injury
- Blunt trauma
- Penetrating trauma
Genitourinary Injuries: Assessment will show
- Flank pain or colic pain
- Bluish discoloration of the flanks
- Perineal discoloration
- Urine/hematuria
Specific Genitourinary Injuries: Renal Trauma
- Flank ecchymosis
- Fracture of inferior ribs or spinous processes
- Gross hematuria
- CT scan
Specific Genitourinary Injuries: Bladder Trauma
- Caused by pelvic fractures
- Lower abdominal bruising, distention, and pain
- Difficulty in voiding
- Retrograde urethrogram
Complications of Trauma include
- Hypermetabolism
- Infection
- Sepsis
- Pulmonary: Respiratory Failure And Fat Embolism Syndrome
- Pain
- Renal Complications: Renal failure and myoglobinuria
- Vascular Complications
Hypermetabolism: Enteral Feedings
Initiate enteral feedings within 72 hours for patients with blunt and penetrating abdominal injuries and those with head injuries
Complications of Trauma: Vascular Complications include
- Compartment syndrome
- Venous thromboembolism
- Missed injury: Commonly discovered in first 24 to 48 hours after presentation
- MODS
Special Considerations in Trauma Patients: Meeting needs of family members and significant others
Crisis situation for family and friends
Special Considerations in Trauma Patients: Trauma in older patients
- Risk of falls
- Risk of motor vehicle collisions
- Limited physiological reserve
- Age-related organ changes
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