Module 12 - Trauma and Burns Flashcards
Levels of Trauma Care
Level I—regional resource, state-of-the-science
care, education, outreach, and research
Level II—provides care for trauma patients and
transfer to Level I if needed
Level III—community hospital where no Level I or
II exists
Level IV—provides advanced trauma life support
(ATLS) and transfer
Primary prevention
Prevent event
- drive safely, speed limit
Secondary prevention
minimize impact
- seatbelt, airbags
Tertiary prevention
Maximize pt outcomes
Blunt Trauma
Severity depends on kinetic energy dissipated to the body
Common vehicular trauma, assault with blunt
objects, falls, and sports
Acceleration
Deceleration
Shearing
Crushing
Compression
Penetrating Trauma
Impalement of foreign objects into the body
Stab wounds are low-velocity injuries
Ballistic trauma (e.g., gunshot injuries)
Medium velocity: handguns, some rifles
High velocity: assault and hunting rifles
Velocity and missile (bullet) determine tissue
damage
Blast Trauma
Blunt and penetrating trauma
Tissue and organ injury
Gas-containing organ injury (e.g., eardrums,
lungs, intestines)
Prehospital Care
Emergency stabilization
ABC
Iv access fluid adm
Hemorrhage control
Fracture stabilization
Primary Survey
Most crucial assessment tool 1, 2 min
A - airway
B - breathing
C - circulation
D - disability - neuro
E - expose
Secondary Survery
Performed after life threatening injuries are identified.
IV started
H2T
C spine , x ray
Emergency/resucitation Care Phase
Time from injury to stabilization
Focus: establish circulatory volume
ABCDEs
Maintain airway patency with
Open airway
Jaw thrust or chin lift
Nasopharyngeal or oropharyngeal airways
Endotracheal intubation
Cricothyrotomy
Unable to intubate
Facial fracture
Facial or upper airway burns
Oropharyngeal hemorrhage
Tension Pneumothorax Tx
Needle decompression , Chest tube
Pneumothorax Tx
Chest tube
Open chest wound Tx
Seak wound with occlusive dressing TAPE THREE SIDES
Chest tube insertion
Pulmonary contusion Tx
Mechanical vent
Flail chest Tx
mechanical vent and analgesics
can be from rib fx
Spinal cord tx
maintain spinal immobilization
DLOC tx
Mechanical vent
CT scan
Hemothorax Tx
Chest tube insertion on affected side
blood products
thoracotomy
Hypovolemia Caused by hemorrhage Tx
- Pressure on wound- stop bleeding
- crystalloid fluids - LR
- blood products
- large bore IV / central line
SS Shock
Tachycardia, tachypnea
Narrowing pulse pressure
Falling PaO2
Decreasing urine output
Increased serum lactate levels
Falling hematocrit
Massive Fluid Resusication
1:1:1 packed RBC PLT FFP
Massive fluid resuscitation complications
hypocalcemia
hypomag
hypo/hyper kalemia
hypothermia
compartment syndrome
ARDS
AKI
MODS
Hypothermia is associated with
coagulation
dysrhythmias
Myocardial dysfunction
TBI
Primary injury associated with trauma
Establish baseline level of consciousness
(LOC)
Secondary injury associated with:
Hypoxemia
Hypotension
Increased intracranial pressure (ICP)
Hypocapnia
Hyperthermia
Anemia
TREAT ICP, GCS LESS THAN 8
Spinal cord injury
Immobilization
X RAY and CT studies
possible neurogenic shock
may need vasopressors
Basilar skull fracture
Presence of CSF from nose, ears, or both
Ecchymosis over mastoid area or
hemotympanum
Periorbital ecchymosis
NO NG TUBE!
Cardiac Tamponade
Bleeding in pericardial space
Becks triad - hypotension, muffled ♡, elevated venous BP
decreased co
tx pericadiocentesis
Cardiac contusion
Blunt chest trauma
S/S dysrhythmia
Aortic disruption
EMERGENT SURGERY
S/S weak femoral pulse, dyspnea, pain, hoarseness, widened mediastinum
Kehrs Sign
Pain in shoulder
Spleen injury
Musculoskeletal Injury Tx
Closed or open reduction
Tx hypovolemia
wound care
tetanus prophylaxis
ABX
5 P’s for muskuloskeletal
Pain
Pallor
Pulses
Paresthesia
Paralysis
Open break
Out of skin
Comminuted fracture (fragmented)
Several pieces
Displaced fracture
not aligned
Oblique fracture
angled
Spiral fracture
twisted
Impacted fracture
pushed in on itself
Greenstick
Young soft bone
bends and breaks
Traction
- Assess neurovascular status
frequently - Maintain alignment
- Avoid lifting/removing weights
- Ensure that weights hang freely, not
on floor! - Ensure pully system intact Q shift
- Monitor skin integrity
- Notify the provider if severe pain or
muscle spasms are unrelieved with
ordered medication
Compartment syndrome
Increased pressure from internal sources (edema) or external (cast)
tx fasciotomy - if it is caused by muscle
Rhabdomylosis
Muscle destruction
Increased hemoglobin and K
Tx IV fluids
Dermal effects of aging
Flattened dermal-epidermal junction
Dermal atrophy
Reduced microcirculation
thinned skin
Young and elderly are at increased risk for burns because
thinner skin
less stress reserve
Superficial - first degree
Epidermis - small portion of dermis
heals 3-5 days
erythema
NO FLUID RESUSCITATION
Partial thickness - second degree
Superficial partial thickness
epidermis and limited dermis
heals 7-10
Deep partial thickness
most of dermis
heals 2-4 weeks may be grafted
Full thickness - third degree
destruction of all layers down to fat, fascia, muscle, or bone
thick dry leathery
Insensate NO PAIN - nerve damage
Burn zones - zone of coagulation
central area most contact - irreversible tissue necrosis
Burn zones - zone of stasis
damaged tissue
decreased blood flow
labile - may or may not survive
Burn Zones - Zone of hyperaemia
Area of minimal injury
recovers in 7-10 days
Physiologic response to burns
acute inflammation
intravascular coagulation
activation of complement
altered vascular permeability
fluid goes out of vessels - edema
immunes suppression
hypertension
decreased co
decrease urine
prehospital interventions - burn
stop burn
identify life threat
abc’s and cervical spine
oxygen 100%
minimize time on scene
prevent hypothermia
large bore iv -LR
pain management
vs
inhalation injuries
pulse ox not accurate - give o2
Fluid resuscitation for burns
based on % TBSA
IV resuscitation - Lactated Ringers
- 4 mL/kg per % burned
administer half fluids within 8 hrs
administer other half within next 16 hrs
Fluid guidelines for burns
Maintain urine output 30-50
Hold colloids for 8-12 hrs
inhalation injury
Burns pain control
Opiates - IV
PCA
Nonpharm
Wound Care Burns
Would cleansed with mild soap
Rinse warm tap
Hydrotherapy
Cover - graft
Skin grafts are for
Deep partial thickness
full thickness
Chest wound taping
3 sides
Rule of 9’s
perineal - 1%
neck up 9%
chest - 9%
abdomen 9%
18% for whole leg
Hypovolemia
tachycardia
low bp
tachypnea
Tx: Fluids
