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Critical Care > Module 12 - Trauma and Burns > Flashcards

Module 12 - Trauma and Burns Flashcards

1
Q

Levels of Trauma Care

A

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

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2
Q

Primary prevention

A

Prevent event

  • drive safely, speed limit
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3
Q

Secondary prevention

A

minimize impact

  • seatbelt, airbags
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4
Q

Tertiary prevention

A

Maximize pt outcomes

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5
Q

Blunt Trauma

A

Severity depends on kinetic energy dissipated to the body
 Common vehicular trauma, assault with blunt
objects, falls, and sports
 Acceleration
 Deceleration
 Shearing
 Crushing
 Compression

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6
Q

Penetrating Trauma

A

 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

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7
Q

Blast Trauma

A

 Blunt and penetrating trauma
 Tissue and organ injury
Gas-containing organ injury (e.g., eardrums,
lungs, intestines)

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8
Q

Prehospital Care

A

Emergency stabilization
ABC
Iv access fluid adm
Hemorrhage control
Fracture stabilization

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9
Q

Primary Survey

A

Most crucial assessment tool 1, 2 min
A - airway
B - breathing
C - circulation
D - disability - neuro
E - expose

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10
Q

Secondary Survery

A

Performed after life threatening injuries are identified.
IV started
H2T
C spine , x ray

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11
Q

Emergency/resucitation Care Phase

A

Time from injury to stabilization
Focus: establish circulatory volume
ABCDEs

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12
Q

Maintain airway patency with

A

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

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13
Q

Tension Pneumothorax Tx

A

Needle decompression , Chest tube

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14
Q

Pneumothorax Tx

A

Chest tube

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15
Q

Open chest wound Tx

A

Seak wound with occlusive dressing TAPE THREE SIDES
Chest tube insertion

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16
Q

Pulmonary contusion Tx

A

Mechanical vent

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17
Q

Flail chest Tx

A

mechanical vent and analgesics
can be from rib fx

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18
Q

Spinal cord tx

A

maintain spinal immobilization

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19
Q

DLOC tx

A

Mechanical vent
CT scan

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20
Q

Hemothorax Tx

A

Chest tube insertion on affected side
blood products
thoracotomy

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21
Q

Hypovolemia Caused by hemorrhage Tx

A
  • Pressure on wound- stop bleeding
  • crystalloid fluids - LR
  • blood products
  • large bore IV / central line
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22
Q

SS Shock

A

 Tachycardia, tachypnea
 Narrowing pulse pressure
 Falling PaO2
 Decreasing urine output
 Increased serum lactate levels
 Falling hematocrit

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23
Q

Massive Fluid Resusication

A

1:1:1 packed RBC PLT FFP

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24
Q

Massive fluid resuscitation complications

A

hypocalcemia
hypomag
hypo/hyper kalemia
hypothermia
compartment syndrome
ARDS
AKI
MODS

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25
Q

Hypothermia is associated with

A

coagulation
dysrhythmias
Myocardial dysfunction

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26
Q

TBI

A

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

27
Q

Spinal cord injury

A

Immobilization
X RAY and CT studies
possible neurogenic shock
may need vasopressors

28
Q

Basilar skull fracture

A

Presence of CSF from nose, ears, or both
Ecchymosis over mastoid area or
hemotympanum
Periorbital ecchymosis

NO NG TUBE!

29
Q

Cardiac Tamponade

A

Bleeding in pericardial space
Becks triad - hypotension, muffled ♡, elevated venous BP
decreased co
tx pericadiocentesis

30
Q

Cardiac contusion

A

Blunt chest trauma
S/S dysrhythmia

31
Q

Aortic disruption

A

EMERGENT SURGERY
S/S weak femoral pulse, dyspnea, pain, hoarseness, widened mediastinum

32
Q

Kehrs Sign

A

Pain in shoulder
Spleen injury

33
Q

Musculoskeletal Injury Tx

A

Closed or open reduction
Tx hypovolemia
wound care
tetanus prophylaxis
ABX

34
Q

5 P’s for muskuloskeletal

A

Pain
Pallor
Pulses
Paresthesia
Paralysis

35
Q

Open break

A

Out of skin

36
Q

Comminuted fracture (fragmented)

A

Several pieces

37
Q

Displaced fracture

A

not aligned

38
Q

Oblique fracture

A

angled

39
Q

Spiral fracture

A

twisted

40
Q

Impacted fracture

A

pushed in on itself

41
Q

Greenstick

A

Young soft bone
bends and breaks

42
Q

Traction

A
  • 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
43
Q

Compartment syndrome

A

Increased pressure from internal sources (edema) or external (cast)
tx fasciotomy - if it is caused by muscle

44
Q

Rhabdomylosis

A

Muscle destruction
Increased hemoglobin and K
Tx IV fluids

45
Q

Dermal effects of aging

A

Flattened dermal-epidermal junction
Dermal atrophy
Reduced microcirculation
thinned skin

46
Q

Young and elderly are at increased risk for burns because

A

thinner skin
less stress reserve

47
Q

Superficial - first degree

A

Epidermis - small portion of dermis
heals 3-5 days
erythema
NO FLUID RESUSCITATION

48
Q

Partial thickness - second degree

A

Superficial partial thickness
epidermis and limited dermis
heals 7-10

Deep partial thickness
most of dermis
heals 2-4 weeks may be grafted

49
Q

Full thickness - third degree

A

destruction of all layers down to fat, fascia, muscle, or bone
thick dry leathery
Insensate NO PAIN - nerve damage

50
Q

Burn zones - zone of coagulation

A

central area most contact - irreversible tissue necrosis

51
Q

Burn zones - zone of stasis

A

damaged tissue
decreased blood flow
labile - may or may not survive

52
Q

Burn Zones - Zone of hyperaemia

A

Area of minimal injury
recovers in 7-10 days

53
Q

Physiologic response to burns

A

acute inflammation
intravascular coagulation
activation of complement
altered vascular permeability
fluid goes out of vessels - edema
immunes suppression
hypertension
decreased co
decrease urine

54
Q

prehospital interventions - burn

A

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

55
Q

inhalation injuries

A

pulse ox not accurate - give o2

56
Q

Fluid resuscitation for burns

A

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

57
Q

Fluid guidelines for burns

A

Maintain urine output 30-50
Hold colloids for 8-12 hrs
inhalation injury

58
Q

Burns pain control

A

Opiates - IV
PCA
Nonpharm

59
Q

Wound Care Burns

A

Would cleansed with mild soap
Rinse warm tap
Hydrotherapy
Cover - graft

60
Q

Skin grafts are for

A

Deep partial thickness
full thickness

61
Q

Chest wound taping

A

3 sides

62
Q

Rule of 9’s

A

perineal - 1%
neck up 9%
chest - 9%
abdomen 9%
18% for whole leg

63
Q

Hypovolemia

A

tachycardia
low bp
tachypnea

Tx: Fluids

Critical Care (20 decks)

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