T8: Management of Trauma and Medical Emergencies Flashcards
Level 1 Trauma Center
*Provides comprehensive trauma care
*Regional resource center that provides leadership in education, research, and systems planning
*Providers immediately available, including trauma surgeon, anesthesiologist, physician specialists, and nurses
Level 2 Trauma Center
*Provides comprehensive trauma care as a supplement to a Level I center
*Meets the same provider expectations for care as a Level I center
*Is not required to participate in education and research
Level 3 Trauma Center
*Provides prompt, immediate emergency care and stabilization of patient with transfer to a higher level of care
* Serves a community that does not have immediate access to a Level I or II center
Level 4 Trauma Center
*Provides advanced trauma life support prior to transfer
*Primary goal is to resuscitate and stabilize the patient and arrange for immediate transfer to a higher level of care
Primary prevention
prevent the event (ex: driving safety classes, speed limits, campaigns not to drink and drive)
secondary prevention
minimize the impact of the traumatic event (ex: seat belt, airbags, car sears, helmets)
Tertiary prevention
maximize patient outcomes after a traumatic event through emergency response systems, medical care, and rehabilitation
Trauma team
similar to a code team; preassigned team response for trauma patients that include every specialty
triage
means sorting the patients to determine which patients need specialized care for actual or potential injuries
HINT HINT: primary survey
-identify life threatening conditions
-FOCUS ON ABCs, DISABILITY, EXPOSURE, facilitates the benefits of allowing family to be present when caring for a family member
-appropriate interventions started
HINT HINT: secondary survey
-begins addressing each step of primary survey
-a brief systematic process identifies all injuries
-start life saving interventions
why is famaily helpful in primary survey
family can help tell what happened if the patient cannot
HINT HINT: glasgow coma scale
eyes, verbal, motor
Max- 15 pts, below 8= coma
If uncontrolled external hemorrhage is noted
*the usual ABC assessment format may be reprioritized to <C>ABC for hemorrhage control.
-The <C> stands for catastrophic hemorrhage and, if present, needs to be controlled first</C></C>
intervention for hemorrhage
Apply direct pressure with a sterile dressing followed by a pressure dressing to any obvious bleeding sites
mnemonic to determine level of consciousness
AVPU: A = alert, V = responsive to voice, P = responsive to pain, and U = unresponsive.
Primary Survey (ABCDEFGHI
A-AIRWAY/CERVICAL
SPINE
B-BREATHING
C-CIRCULATION
D-DISABILITY-(LOC,
Glasgow Coma
Scale)
E-EXPOSURE-
(Clothes off)
F-FACILITATE/
FAMILY-(Vital signs,
family to stay)
G - GET RESUSCITATION ADJUNCTS
Secondary Survey (HI)
H-HISTORY/
HEAD TO TOE
ASSESSMENT
I-INSPECT
POSTERIOR
SURFACES
heat exhaustion s/s
-<105
-dizziness, weakness, fatigue
-headache
–moist/sweaty skin
-dry tongue, thirst
-low BP, high HR
-confusion
causes of heat exhaustion
-decreased fluid intake
-increased heat exposure
-increased activity -prolonged/excessive sweating, dehydration
heat stroke vs heat exhaustion
heat exhaustion <105, poor fluid intake,
heat stroke: >105; hypotension
heat stroke s/s
-hot, dry, flushed skin
–kin may be moist or wet at first, but then IMPAIRED SWEATING
->105
–AMS
–may become unresponsive very quickly
-increase HR & RR
-hypotension
-cerebral edema (seizure, delirum, coma)
main goal of heat related injury
get fluids and cool them down
what fluids are given in heat related injuries
normal saline (IV)
interventions for stroke related injury
-normal saline (IV)
-COOL: cooling blanket, wet sheet or towel, fan
why is heat stroke so serious
they can cause seizures (seiz. precautions) or go into a coma and die
frostbite
*true tissue freezing that results in the formation of ice crystals in the tissues and cells.
Where does frostbit occur most frequently?
ears, nose, fingers, and toes
skin appearance in frostbite
ranges from waxy pale yellow to blue to mottled, and the skin feels crunchy and frozen.
what will a person with frostbite complain of
*tingling, numbness, or a burning sensation.
intervention for frostbite
-soak area in 98.6-104 temp water until it flushed pink
-keep water warm and fresh
-warming is extremely painful
what to avoid for frostbite
-do not run or massage area with frostbite
-avoid heavy blankets and clothing
-NO heating pad or electric blanket
-NO fireplace, stove, radiator for warming
-do not walk on feet or toes with frostbite
hypothermia
abnormally low body temperature
mild/moderate hypothermia s/s
-loss of corrdination
-poor judgement
-SHIVERING
-loss of fine motor skills
-lethargy/slurred speech
-increasing complaints
severe hypothermia s/s
-SHIVERING STOPS
-unable to walk, usually lying down
-LOC altered
-disorientation, irrationality, uncooperative attitude, apathy, unconsiousness
intervention for hypothermia
Give WARM IV SOLUTION to warm organs inside
drowning
The process of experiencing respiratory impairment from submersion or immersion in liquid.
submersion
when a person becomes hypoxic as the result of submersion in a liquid, usually water.
Submersion in cold water (below 32° F [0° C]) may…
*slow the progression of hypoxic brain injury.
most drowning victims…
do not aspirate any liquid due to laryngospasm.
Drowning victims who do aspirate water develop…
pulmonary edema
drowning vs near drowning
Near drowning: fell in and you do CPR and get them back
Drowning: patient died
most patients who drown die from
hypoxia and anoxia, not water in the lungs because the larynx constricts
Envenomation (bites)
injection of a poison which results in a hemolytic, neurotoxic, vascular toxic reaction depending upon the type of snake
patients with snake bite die from
bleeding out because snake venom interferes with the coagulation cascade
intervention for snake bite
-Crofab (antivenom)
-possible fasciotomy to relieve pressure if the swelling is bad and circulation is a concern
CroFab
a venom-specific fragment of IgG, which binds and neutralizes venom toxin, helping to remove the toxin from the target tissue and eliminate it from the body.
interventions for animal bites
-wound IRRIGATION and debridement
-RABIES shot prophylaxis
rabies shot schedule
on the day the bite occurred and then again on days 3,7,and 14
initial treatment for human bites
-copious irrigation, debridement, tetanus prophylaxis, and analgesics
-Prophylactic antibiotics for bites at risk for infection
-leave puncutre wounds open
-Don’t suture closed-open or loose sutures due to infection/abcesses
common areas of human bites
Hands, fingers, ears, nose, vagina, and penis
intervention for lice
-put cap on nurse and patient , start treatment
interventions for bug bited
-antihistamines
-calamine
-possible prophylactic abx
intervention for ticks
-PULL THEM OUT, pull upward then clean skin with soap and water
-make sure to get the head out or it will get infected and person can get LYMES DISEASE
first stage of Lyme disease
*begins with flu-like symptoms (e.g., headache, stiff neck, fatigue).
*bull’s eye rash (i.e., a circular area of redness 5 cm or more in diameter). The rash, if it develops, will disappear even if the patient is not treated.
treatment for lyme disease
Doxycycline
concerns about bug stings
-mild discomfort or life-threatening anaphylaxis-number of stings worsens
-Venom may be cytotoxic, hemolytic, allergenic, or vasoactive
-PULL STINGER OUT
Anaphylaxis
Life threatening allergic reaction
Anaphylaxis S/S
-Itching
-Hives
-swelling
-flushing
-warm tingling
-tightness in throat and chest, bronchoconstriction
-cough
-rapid, labored, noisy breathing
-hoarseness
-wheezing
-itchy, watery eyes, runny nose
-sense on impending doom
Anaphylaxis treatment
epinephrine (epimpen or IV), antihistamiens, steroids
(ABCs)
-remove offending agent
-fluid replacement to counteract hypotension
poisonings
-Chemicals that harm body accidentally, occupationally, recreationally, or intentionally
-Severity depends on type, concentration, and route of exposure
intervention for poisoning
-call poison control
-gastic lavage
-activated charcoal
-BRUSH OFF POWDER
-lavage off liquid
-DECONTAMINATION PROTECTIVE EQUIPMENT IS A MUST for all medical personnel
gastric lavage
*involves oral insertion of a gastric tube for irrigation of copious amounts of saline.
*Patients with an altered LOC or diminished gag reflex are intubated before lavage.
when does gastric lavage need to happen to be effective
within 1 hour of ingestion of most poisons
Activated charcoal does not absorb
*ethanol, hydrocarbons, alkali, iron, boric acid, lithium, methanol, or cyanide.
HINT HINT: Tylenol antidote
Acetylcysteine (Mucomyst)
