The trauma patient Flashcards by Jazmine Hawdon

what do patients require when presenting with a traumatic wound

Rapid and accurate triage
Initial stabilisation (ABCD)
Stop any bleeding with direct pressure
Control of contamination

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Is initial assessment the same regardless of the treatment plan?

YES

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What is the correct pressure for wound lavage

8-12psi

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The more fluid used in wound lavage the less risk of what?

infection

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What could a pressure over than 12 cause

infection to go deeper into the cells

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What is wound lavage

a process which removes loose foreign material and necrotic tissue

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What does wound lavage do

Removed impediments to healing and reduced infection

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What is the best gauge needle to use in wound lavage

18-20

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What solution is not recommended for wound lavage

chlorhexidine/ detergents

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What is debridement

The removal of necrotic tissue and foreign material from a wound

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What are the four different types of debridement

Sharp
Mechanical
Autolytic
Larval

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What is an example of sharp debridement

use to a blade to remove tissue (surgical procedure)

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What is an example of mechanical debridement

wet to dry dressing

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What is an example of autolytic debridement

Honey therapy

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When is autolytic debridement not reccomended

in infected or dry wounds

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How many days should debridement be over in

3 days

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What is the concertation of chlorhexidine scrub

50:50

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What is the contact time of chlorhexidine scrub

6 MINS

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What does mechanical debridement rely on

the adherence or friction to remove necrotic tissue

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What does autolytic debridement promote

Promotes the bodies own debridement by activating the phagocytes (WBC) around the wound

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What is the pH of honey

3.5 - 5.5

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What action what would you take if the wound was at a stage of infection/inflammation etc

remove foreign material and debride

absorb exudate

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What would you do if a wound was granulating

dress the wound with a non adherent dressing,
maintain a moist environment.
Do not disturb the process of epithelialisation

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What would you do if a wound showed to have chronic granulation

debride the chronic granulation and kick start the process

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What would you do if a wound was static

Investigate (biopsy)

what are 4 functions of dressings

absorption of exudate protection of the wound promote wound healing prevention of infection

What are 4 characteristics of dressings

non irritant absorptive Sterile maintain a moist environment

What is an example of a perforate polyurethane membrane dressing

Melolin

What is a perforate polyurethane membrane dressing

a dressing that has a thin perforated polyurethane membrane that is coated with an absorbent backing layer

What is an example of a vapour permeable film

Tegaderm or Ioban (iodine)

What do vapour permeable film dressings do

Aid moist wound healing while providing a barrier to protect the wound from environmental contamination and trauma

What is an example of a polyurethane foam dressing

Allyven

What is a polyurethane foam dressing

A foam that has a high absorbent capacity and draws exudate away from the wound

What is a hydrocolloid dressing

Natural or synthetic polymers (e.g gelatin) that allows moist wound healing and provided a gentle debridement and encourages granulation tissue to form

How does a hydrogel function

They function by aiding moisture wound healing providing gentle debridement and encourage growth of granulation tissue

What is an example of a hydrogel

intrasite

What is the function of a alginate dressing

They function by aiding moisture wound healing providing gentle debridement and encourage growth of granulation tissue

What is an example of a alginate dressing

katlostat

When is a polyacrylate (super absorbent) dressing be used for

when a penrose drain is in situ

What are 3 examples of antimicrobial dressings

PHMB impregnated dressing Silver dressings Manuka honey

What is PHMB

a antimicrobial agent exhibiting board spectrum activity against bacteria and fungi

When is PHMB effective

Pseudomonas MRSA

What are some clinical signs of a uroabdomen

``` Acities Azotemia Hyperkalemia Bradycardia Arrhythmias Hypovolemic shock ```

What MUST you do for a patient with a uroabdomen prior to fixing the abdomen

Stabilise the patient

How do you stabilise a patient with a uroabdomen

Manage acid-base and electrolyte imbalance Volume resucitation with isotonic crystalloids treat the hyperkalemia - calcium gluconate

What are the 3 steps to take with a uroabdomen

1. fluids 2. sort electrolytes 3. get urine out

What are the two types of head trauma

primary and secondary

What is a primary head trauma

Direct tissue trauma

What is an example of primary head trauma

skull fracture | cerebral haemorrhage

what are the forces applied in primary head trauma that brain cannot handle

acceleration deceleration rotational

What is secondary trauma

It comes after primary trauma it is the cascade of biomolecular events causing continued and progressive brain pathology

What is an example of secondary head trauma

``` cerebral ischemia (blood flow is restricted) hydrocephalus intracranial pressure ```

What are the main 3 parts of the brain

cerebrum cerebellum brainstem

What is the brain dependant on

sufficient blood flow and energy supply and oxygen

What consumes 20% of the bodies oxygen

brain

how much glucose does the brain require %

more than 25 %

What is cerebral blood flow dependant on?

cerebral perfusion pressure (CCP) and cardiovascular resistance

What is cerebral perfusion pressure (CCP)

the amount of blood that gets to the brain

What is the normal range of CCP

50-150mmhg

Complete the equations CCP= x - x

CCP = MAP - ICP

What are some clinical signs/consequences of a brain injury

``` hypoxia increased ICP Haemorrhage oedema Nystagmus Comatosed ```

What fluids are recommended for ICP

Hypertonic

Why is isotonic fluids not recommended in a case of ICP

Because the fluid will go into the interstitum of the brain causing ICP to worsen.

What is the cushings response

increased BP and decreased HR reflex bradycardia

Why shouldnt you raise the jugular vein on a patient with head trauma

its raises ICP

What is the Seldinger technique

it is a technique using a preplaced guide wire directing a long flexible catheter

When is the Seldinger technique used

Chest drain placement | Central line placement

What are the 5 important sections of CPR/CPA

``` Prepare/prevent Basic life support Advanced life support monitoring post arrest care ```

What is important when preparing people for CPR

``` Train the staff have a designated section Crash trolley (stocked) CPR protocol emergency drug dose and chart Recognition of arrest ```

What does basic life support consist of

Circulation Airway Breathing

What is the 1st thing that should be addressed in CPR and how

Circulation | Compressions

Why should circulation be addressed first in a patient that has CPA

Patients don't have any blood outflow to the heart or o2 delivery

What position should chest compressions be done in

lateral recumbency

in a bull dog what position should chest compressions be done

dorsal recumbency

in a greyhound what position should chest compressions be done?

lateral recumbency on the deepest part of the chest

how deep should you do chest compressions

1/3-1/2 of the width of the chest

how many chest compressions per min should you do regardless of species

100-120 bpm

What should be done first in terms of addressing a patients ventilation if in severe resp distress or comatosed

Intubate the patient with an ET tube

What does the cardiac pump consist of?

The left and right ventricles are directly compressed causing an increasing pressure, causing the ventricles to open the pulmonic and aortic valves, providing blood blow to the lungs and tissues.

What causes a recoil in the chest allowing the ventricles to fill?

Negative pressure

Why is low minute ventilation important in a CPA

Hyperventilated patients lead to a low CO2. Causing a cerebral vasocontriction and decreases oxygen to the brain

What are the main emergency drugs in CPR

``` Adrenaline (epinephrine) Vasopressor Atropine Reversal agents Fluids Calcium Bicarbonate ```

Whats the dose of adrenaline

0.01mg/kg-0.1mg/kg

How often do you administer adrenaline in CPR

every 3-5 mins

How many compressions to breaths should you do in CPR

30 compressions : 2 breaths

What intercoastal space should you place a chest drain or perform thoracentesis

7-8 intercostal space

When placing a chest drain where should you make a skin incision

10th intercostal space

What does ETCO2 (Capno) tell you in a CPR

If the ET tube is in | ETCO2 is proportional of blood flow.

What tracheal ring should you incise when doing a tracheostomy

3-4 or 4-5 ring

what size of trach tube should you place when performing a tracheostomy

no more than 50%

What rib should you measure when placing an o tube

10th rib.