test 2: trauma Flashcards
4 steps of trauma
eliminate immediate threats to life
rapid initial examination and resuscitation
stabilization, through re-evaluation
definitive repair
3 systems to check for immediate threat to life
central nervous system
respiratory
cardiovascular
sucking chest wound first step
intubate
chest tube, cover hole
return chest to negative pressure
when to put in chest tube
if you tapped more then twice
how to place chest tube
incision into plura
second incision in skin, pull tube under skin to skin cut, close original hole
VQ mismatch
blood into lungs vs air exchange not equal
in fractured rib, blood fills alveoli no gas exchange, deoxygenated into body circulation
massive blood loss triggers
peripheral vasoconstriction
increased cardiac output
conserves blood to heart and brain
CRT >2, pale mucous membranes
oxygen is needed for
ATP synthesis
oxygen delivered = — x —
arterial oxygen content (CaO2)
cardiac output (CO
to increase perfusion
optimize hemoglobin (carries most of the O2 in the body)
stroke volume(how much blood per heart beat)
– will rapidly redistribute to entire interstitial space
crystalloids (LRS)
extracellular fluid will leave vessels and pool in interstitial space
— will pull fluid from interstitial space into the vessels
hypertonic saline
dextran
(effect lasts 45 minutes)
when not to give dextran
dehydration
closed compartment hemorrhage
ongoing hemorrhage
hypertonic saline- pulls fluid into the vessels- positive inotropic effect
colloids are — and cause fluid to —
artificial plasma
pull fluid back into vessels
tension pneumo will cause
lung to collapse
decrease venous return to the heart
wound treatment starts with
Stabilize patient systemically
Pressure bandage to control bleeding- Avoid
torniquets if possible
No ointments or antiseptics
Sterile dressing to minimize further contamination
stages of wound healing
coagulation- platelets and fibrin
inflammation- macrophages
proliferation - fibroblast
remodeling
local factors that affect wound healing
ischemia
infection
foreign body
edema
systemic factors affecting wound healing
DM
steroids
nutrition
sepsis
chemo
how to prep wound
KY jelly
clip
scrub surrounding area
— is ineffective against bacteria and can be damaging to cells
peroxide
wound debridement is most effective —
soon after injury
during debridement you want to retain as much —-
skin as possible
lavage is a combo of —
pressure and high volume
close wound right away
primary closure
when to do primary closure
all infected material removed
minimal dead space
minimal tension on wound edges
when to do delayed primary closure
wound several days old
fresh wound too contused or contaminated
when to do second intention healing
very contaminated
not enough tissue to close
depends on contraction
when to use antibiotics
severe contamination
open joint
fracture
must culture and sensitivity at time of initial debridement
