Multiple Injuries Flashcards
What are the two major categories of injury?
1) Blunt - injury without interruption of skin integrity
2) Penetrating - injury obtained by transmission of energy with interruption of skin integrity
Describe force as it relates to the kinetics of blunt trauma:
- Physical factor-push or pull that changes the state of an object that is at rest or in motion
- Amount and speed (velocity) of energy transmitted and surface area to which energy is applied + elasticity of the tissue = degree of injury
What are the four types of forces most often applied in multiple injuries?
1) Acceleration
2) Deceleration
3) Shearing
4) Compression
Describe acceleration:
- Increase in rate of velocity or speed of a moving object
- As velocity increases, so does the amount of damage
- Body weight x MPH = psi of impact
Decrease deceleration:
Decrease in velocity of a moving object
Describe shearing:
- Aka. degloving
- Injury resulting from 2 structures or 2 parts of same structure sliding in opposite direction
Describe compression:
- Being pressed or squeezed together with resulting decrease in volume or size
- E.g. sudden acceleration/deceleration of MVA can cause compression of heart and lung between post and anterior chest wall
Describe the kinematics of penetrating trauma:
- Transmission of energy from moving object into body tissues as object disrupts integrity of skin and underlying structures
- Amount of energy transmitted = amount of damage
- Amount of energy dependent on surface area of point of impact, density of tissue and velocity of projectile at time of impact
What are the three types of shock?
Classified according to 3 main pathophysiological mechanisms:
1) Cardiogenic shock (dysfunction in pumping effectiveness of heart)
2) Distributive or vasogenic shock (abnormal distribution of vascular volume)
3) Hypovolemic shock (reduction in intravascular volume)
What are the four stages of shock?
1) Initial stage
2) Compensatory stage
3) Progressive stage
4) Refractory stage
Describe the initial stage of shock:
- Cellular level
- Decrease in cardiac output and tissue perfusion
- Usually no obvious signs and symptoms of deterioration
Describe the compensatory stage of shock:
- Body attempts to maintain adequate function (i.e. cardiac output & arterial pressure via mediation of nervous, chemical and hormonal mechanisms)
- Effects of mechanisms are responsible for clinical signs and symptoms
- Compensatory mechanisms only effective for limited time
Describe the progressive stage of shock:
- Compensatory mechanisms no longer able to maintain adequate tissue perfusion
- Loss of auto regulatory control and increased capillary membrane permeability = decreased cardiac output and decreased tissue perfusion (third spacing)
Describe the refractory stage of shock:
- Body unable to respond to treatment
- Irreversible, leads to death
What are the phases of trauma care?
- Pre-hospital Resuscitation (typically by paramedics)
- Emergency Dept. Resuscitation (Primary survey/ Resuscitation, Secondary survey)
- Definitive Care/Operative Phase
- Critical Care Phase
- Rehabilitation Phase
Describe the primary survey/resuscitation:
A - Airway stabilization
B - Breathing
C - Circulation (e.g. blood, NS bolus)
D - Neurological disability (e.g. coma scale, pupils)
E - Expose (floats between primary and secondary)
F - Five interventions/Full VS
Describe secondary survey:
G - Give comfort measures
H - Head to toe assessment, history
I - Inspect posterior
Additional interventions such as:
- ECG
- Urinary catheter
- SPo2
- NG tubes
- Xrays
- Lab work, ABG’s
What is definitive care?
- Ongoing assessment and recognition of potential injuries and associated signs and symptoms
- Ongoing management of pre-existing health conditions
- Ongoing monitoring of the development of possible complications
What are complications of multiple injuries?
- Hematologic (alterations in clotting, hemorrhage)
- Cardiac (arrhythmia, HF)
- Pulmonary (atelectasis, PE, distress)
- GI (perforations, obstructions)
- Hepatic (liver failure, abscesses)
- Renal (AKI, lost hormonal regulation for BP)
- Orthopedic (compartment syndrome)
- Skin (loss of integrity)
- Systemic (sepsis, SIRS)
What is pulse pressure?
- the difference between the systolic and diastolic pressure readings, measured in mmHg
- represents the force that the heart generates each time it contracts
- E.g. 40 is the PP if BP is 120/80
What is an arterial line?
- Goes into an artery instead of a vein
- Measures real time blood pressure, and can gather ABG’s
- Nurses responsible to help set up individual obtaining ABG’s, monitor and document BP, change drsg’s, monitor for infection
At what point is a patient considered hypothermic? What is the main complication?
- 32-35 degrees
- Can clot the blood and lead to additional hemorrhaging
What is phenylephrine?
- Constricts blood vessels by affecting SNS
- Requires full monitoring (e.g. bedside ECG, regular BP’s), more of a critical care drug
What is the significance of Calcium as it relates to blood loss?
Ca+ a co-factor for coagulation, necessary if we want to prevent blood loss
For every 5 units of blood, what does there need to be?
2 units of plasma and 2 units of platelets
How is hyperkalemia related to metabolic acidosis?
- Kidneys excreting excess hydrogen, which leads to re-absorption of potassium in the extracellular space
- Dextrose and insulin can help balance these against
What is lactate a result of?
Byproduct of anaerobic metabolism
