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Nursing 304 > Multiple Injuries > Flashcards

Multiple Injuries Flashcards

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1
Q

What are the two different mechanisms of injury?

A

Blunt

Penetrating

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2
Q

What is blunt injury?

A

injury without interruption of skin integrity

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3
Q

What is penetrating injury?

A

injury obtained by transmission of energy with interruption of skin integrity

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4
Q

What are four types of force most often applied?

A

Acceleration
Deceleration
Shearing
Compression

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5
Q

What is acceleration force?

A

Increase in rate of velocity or speed of a moving object

As velocity increases, so does the amount of damage

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6
Q

What is the equation for finding the psi of an acceleration force?

A

Body weight x mph = psi of impact

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7
Q

What is compression force?

A

Being pressed or squeezed together with resulting decrease in volume or size

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8
Q

What is deceleration force?

A

Decrease in velocity of moving object

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9
Q

What is shearing force?

A

Also known as degloving
Injury resulting from 2 structures or 2 parts of same structure sliding in opposite direction (causing tissue separation)

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10
Q

Explain the kinematics of penetrating trauma

A

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 is dependent on surface area of point of impact, density of tissue & velocity of projectile at time of impact

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11
Q

What are the three main pathophysiological mechanisms of shock?

A

Cardiogenic shock
Distributive or vasogenic shock
Hypovolemic shock

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12
Q

What is cardiogenic shock?

A

Dysfunction in pumping effectiveness of the heart

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13
Q

What is distributive or vasogenic shock?

A

Abnormal distribution of vascular volume

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14
Q

What is hypovolemic shock?

A

Reduction in intravascular volume

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15
Q

What are the four stages of shock?

A

Initial stage
Compensatory stage
Progressive stage
Refractory stage

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16
Q

What occurs during the initial stage of shock?

A

Cellular level
Decrease in cardiac output and tissue perfusion
Usually no obvious signs and symptoms of deterioration

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17
Q

What occurs during the compensatory stage of shock?

A

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

18
Q

What occurs during the progressive stage of shock?

A

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

19
Q

What occurs during the refractory stage of shock?

A

Body unable to respond to treatment

Irreversible—Leads to DEATH

20
Q

What are the phases of trauma care?

A 
Prehospital Resuscitation
Emergency Dept. Resuscitation
  - Primary survey/ Resuscitation
  - Secondary survey
Definitive Care/Operative Phase
Critical Care Phase
Rehabilitation Phase
21
Q

What are the steps of the primary survey/resuscitation? (ABCDEF)

A 
A---Airway - stabilization
B---Breathing
C---Circulation
D---Neurological Disability
E—Expose (floats between primary and secondary)
F- Five interventions/ Full Vital signs
22
Q

What are the steps of the secondary survey? (GHI, other)

A 
G- Give Comfort Measures
H- Head to Toe/ History (MIVT/AMPLE)
I – Inspect posterior
Additional Interventions such as:
ECG
Urinary catheter
SPO2
NG tubes
Xrays
Lab work – ABGs
23
Q

What are three ongoing pieces of definitive care?

A

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

24
Q

What are some hematologic complications of trauma?

A

Hemorrhage, blood loss, shock, DIC (disseminated intravascular coagulation)

25
Q

What are some cardiac complications of trauma?

A

Cardiac tamponade, dysrhythmias, aortic dissection

26
Q

What are some pulmonary complications of trauma?

A

Pneumothorax, pulmonary embolism, hemothorax, blood in the pleural space

27
Q

What are some gastrointestinal complications of trauma?

A

Perforation, truamatic hernias, ruptured appendix

28
Q

What is a hepatic complication of trauma?

A

Decreased perfusion

29
Q

What are some renal complications of trauma?

A

Decreased perfusion, acute kidney injury, acute tubular necrosis, altered electrolyte balance, arterial tears (kidneys are stationary, arteries are not as stationary, might have shearing injuries/tears)

30
Q

What are some orthopedic complications of trauma?

A

Fractures, fat embolism (from long bone fractures), compartment syndrome

31
Q

What are some integumentary complications of trauma?

A

Degloving, road rash, rocks/glass embedded in skin

32
Q

When performing primary survey/resuscitation, what is done during the first step, Airway (stabilization)? What are the concerns?

A

can they maintain their own airway? Do they require me to do jaw thrust? Do they need to be intubated? This is directly linked to C-spine stabilization. Until we know for sure what the level of damage is, we need to provide C-spine stabilization.
Ask them to run their tongue along their teeth and tell you if they are missing any teeth. They might choke on broken/lost teeth. If they are unconscious, pull their lower jaw down with your gloved hand and feel it yourself. They also could have foreign objects (eg. rocks, glass, etc) in their mouth.

33
Q

When performing primary survey/resuscitation, what is done during the second step, Breathing? What are the concerns?

A

Do a quick listen to see if they’re breathing. Even if they have a tube in from EMS, you still need to listen to the lungs to make sure they are breathing properly. You don’t want to just assume that the endotracheal tube is working, you need to check.

34
Q

When performing primary survey/resuscitation, what is done during the third step, Circulation? What are the concerns?

A

Check the major pulses (femoral, carotid). If at any point, if there is something that is not correct/needs to be rectified, you need to fix it before moving to the next step. These are in order of priority.

35
Q

When performing primary survey/resuscitation, what is done during the fourth step, Neurological Disability? What are the concerns?

A

Neurologic – check pupils. If they are awake, you can ask them questions. Do a Glasgow coma scale (need a verbal response, eye opening response, etc).

36
Q

When performing a primary survey/resuscitation, what is done during the fifth step, Expose?

A

Expose – Cut their clothes off. If youre in a small town hospital and it’s just you, you don’t get to this until you’ve already done ABCD. If there is someone helping you, they can start cutting the clothes off while youre doing ABCD. They can also start the vital signs.

37
Q

What does MIVT/AMPLE stand for? (Part of the head to toe/history

A

MIVT - Mechamism of trauma, Injuries, Vital signs, Treatment (this can be found on the EMS)
AMPLE – Allergies, Medications, Past medical history, Past hospitalizations, Last meal, Events leading up to the trauma)
Last meal – we want to know what they have in their stomach, how much, etc.

38
Q

Why should blood pressure be taken on both sides of a trauma patient?

A

This can tell us if there is vascular damage affecting only one side.

39
Q

For a male patient, what must be done first before inserting a foley catheter?

A

If this is a male, and we think there is pelvic trauma, we need to get a physician to do a rectal exam first to see if the prostate is intact. We can’t put a catheter in if the prostate is not intact.

40
Q

How should a trauma patient be rolled?

A

Rolling the person:
Person at the head is in charge, and their job is to make sure their head, chin, neck stays in line with the body/spine. The charge person will count 1,2,3 for the roll.
Person at the foot is in charge of making sure their legs stay aligned.
4 People for this minimum if available. More is better (more people to stabilize the patient).
Listen posteriorly, examine for wounds, pull out all the linens they came in with, do a rectal check, quickly and then roll them back safely.

Nursing 304 (12 decks)

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