trauma 1 Flashcards
Sudden ecological phenomenon of sufficient magnitude to require external assistance
Disaster
When is the best time for changes in disaster preparedness
After a major disaster
What is the most devastating natural phenomena
Earthquake
local emergency response personnel/organizations able to contain/deal effectively with disaster/aftermath
level I disaster
requires regional efforts/mutual aid from surrounding communities
Level II disaster
magnitude that local and regional overwhelmed, requires state/federal aid
Level III disaster
name natural external events
earthquakes, tornados, fire, storms, flood, hurricaine
name manmade external events
terrorism (WTC)
transportation related (airplan crash)
Nuclear/biological/chemical
Mass gathering (hysteria or unrest
name internal events
electrical power failure water loss fire explosion loss of Rx gases hostage taking elevator emergencies inability of staff to reach hospital
what are the 4 phases of the disaster cycle
mitigation
planning
response
recovery
what reduces devastating effects (evacuations, sprinklers, early warning)
mitigation
what are detailed paper plans (unworkable in the heat of initial response)
planning
activation and implementation (search/rescue, extrication, triage, stabilization, transport)
response
order is restored, this phase is usually underemphasized, Tx of responders vitally important during this phase
recovery
DMAT
disaster medical assitance teams
groups of volunteer MDs, nurses, EMS personnel, that are transported to disaster sites for help
the hospital disaster plan includes protocols/policies that meet the following needs
recognition and notification, assessment of hospital capabilities and personnel recall, est. facility control center, maintenacne of accurate records, public relations
medical triage process at several levels to rapidly identify critical injuries from total number of casualties
disaster triage
Red
emergent
life or death
yellow
urgent
can delay but needs to be handled
green
non urgent
black
dead or severly injuried and not expected to survive
brief clinical assessment
triage
wat does triage do
determines time/sequence pateints are seen in ED, decisions based on short evaluations and assesment of VS
trauma triage
MOI
anatomic criteria
medical criteria
MSE
medical screening examination
federal law requires MSE performed on all who present to ED/request medical care, can not be delayed to collect payer info, or insurance
MD on durty in ED performs MSE in some EDs triage nurse perfomrs MSE
what must be assesed during an MSE
C/O high risk or true emergency
VS
mental status
general apperance
what role does the MSE serve
degree of urgency
to ID if no emergency medical conditions
when does reevaluation of triage have to happen
within 2 hours of initial triage
what are the 3 tiers of the ED triage system
emergent
urgent
non urgent
Category I/Emergent
Red-priority 1
life/limb threat
ex. severe chest pain, cardiac arrest, massive vomit of blood, sudden LOC, major trauma with hypotension
category 2/urgent
yellow-priority 2
needs full eval tx by MD with 20 min-2 hours, reevaluate Q 30-6- minutes
Ex. acute dyspnea, Abd. Pain, ches pain, confusion, severe pain, high temp, diastolic BP over 130
category 3/non urgent
red-priortiy 3
can wait for hours, reevaluate 1-2 hours
ex. lacerations, sprain, rash, cold
category 4 (optional)
appt. with MD, disorders are chronic, minor or self limiting
ex. Rx refill, acne, mild sore troat, BP check
what are pitfalls to triage
failure to recoginize:
c/o severe pain, high risk chief complaints
take VS, adequately document triage and or MSE, failure to retriage pts in waiting room
Level 1 trauma center
tertiary care hospital, 24 hour care of trauma pt, education, research,
level 2 trauma center
24 hour definitive care, may not provide definitive are for more complex injuries (replantation, cardiac surgery)
level 3 trauma center
manage minor trauma independently (resuscitaiton, stabilization rapid transfer to level 1 or 2
level 4 trama center
facility in rural or remote areas no other level of care availble, may not be a hospital, may have limited or no Md coverage, primary function is resuscitation and transfer
major objectives of ED management
perserve life, prevent deterioration after definitive tx given, restore pt to useful living
Primary survey
Airway
breathing
circulation
disability (nuero status)
what do you always assume
c-spine
what are almost all drauma dealth due to
airway obstruction
if you have an airway issue what do you do
suction, jaw thrust, nasal/oral airway, endotracheal tube, cricothyroidotmoy, C-spine, backboard, BVM, rapid sequence intubation (sedation/paralysis)
what are common causes of breathing problems
anaphylazis, astma, flail chest, hemothorax,
what do you do for breathing problems
ventilation, accessory muscles, feel and listen, RR, color, JVD, intubate, O2, needle thoracotomy
Circulation problems
direct cardiac injury (MI, trauma)
pericardial tamponade, shock, uncontrolled external emorrhage
what do yhou do for circulatory problems
check pulses, color, temp, cap refill, bleeding, BP
if absent pulse-CPR, shock-IV, control bleeding with direct pressure, obtain blood sample for cross match for blood products
disability problems
head injury and stroke
secondary survey
follows primary survey, exposure full set of vitals, 5 interventions, facilitate family presence give comfort measures history (AMPLE) and head to toe inspect
Exposure
remove cloting from exam, keep warm blankets, warm IV fluids
Full set of vitals, 5 interventions, facilitate family presence
Obtain BVS
5 inter: heart monitor, O2 sat, foley/NG, blood for labs
determine familys desire to be present during invasive procedures/CPR
give comfort measures
level of pain/anxiety
history & head to toe
Allergery medication Pertant health history lsat oral intake events leading up to
batlle sign
ecchymosis behing ear
acute widespread process of tissue perfusion which results in cellular metabulism & hemodynamic derangements, imbalnce between O2 supply and demand, can result in cellular dysfunction and multiple organ dysfunction syndrome (MODS)
shock
acute widespread process of tissue perfusion which results in cellular metabulism & hemodynamic derangements, imbalnce between O2 supply and demand, can result in cellular dysfunction and multiple organ dysfunction syndrome (MODS)
shock
initial phase of shock
patho: decrease of CO, tissue perfusion impaired
energy source from aerobic to anaerobic
lactic acid is produced
initial phase of shock
patho: decrease of CO, tissue perfusion impaired
energy source from aerobic to anaerobic
lactic acid is produced
compensaroty stage
reversible stage, compensatory mechanisms maintain adequate tissue perfusion to vital organs, most metabolic needs are being met at this stage, they are sick but able to fight it
patho of compensatory stage
decrease arterial pressure, fluid moves from interstitial to vascular space, maintains normal pressure, activation of Symp. NS, release epi & nor epi, causes vasoconstriction, blood flow to heart and brain miantained, but decreases blood flow to kidney, GI, lungs, muscles, skin, stimulates renin into blood, angiotension to angio 1, converts to 2, increases venous return = increase blood pressure
signs and symptoms of shock
LOC*, restelssness, increase HR, RR, decrease UO (due to vasoconstriction)
what is a contraindication of shock
sedation (cant assess LOC)
progressive stage of shock
compensatory mechanisms are becoming ineffective and may be detrimental to pt
patho of progessive stage of shock
profound vasoconstriction occurs, and some vessels become totoally occluded, decrease in CO, leads to tissue hypoxia, cells undergo anaerobic metabolism, increase in lactic acid production worsens, which correlates with severity of shock state
signs and symptoms of progressive stage of shock
listless, apathy, confusion, decrease response to painful stimuli, pupils are dilated with decrease reaction to light, tachycardia, weak thready pulse, hypotension, RR rapid, skin is cold clammy mottles, cyanosis,
irreversible or refractory stage
compensatory mechanisms are either nonfunctioning or totally ineffective, cellular necrosis and MODS may occur, attempts to restore BP have failed, death is imminent
MODS
multi organ dysfunction system
patho of irreversible or refractory stage
sympathetic NS can no longer compenstate to maintain homeostasis, thrombosis of small blood vessels, results in cell death, fluid moves out of vascular space, vicious cycle of hypotension and decompensation
signs and symptoms of irreversible or refractory shock stage
unconsious , unresponsive, BP falls, diastolic falls to 0, HR, slow, pulse weak, cardiac arrhythmias, RR shallow, mechanical ventilations neccessary, skin cool and clammy, BUN and creatinine critical high, cyanosis
hypovolemic shock
most ccommon type of shock, decrease of circulating volume, decrease venous return, decrease stroke volume, decrase CO, Decrease O2, impaired tissue perfusion, impaired cellular metabolism
what asessments need to be done for hypovolemic shock
VS Q5 min, UO Q hour, LOC-orientation, skin (color and temp)
what needs to be done for hypovolemic shock
control bleeding, vitamin K prn, IV fluids, accurate I & O (foley), O2, consider intubation, maintain airway, position supine, legs elevated 45 degrees,
what is the best way to determine effective fluid resuscitation
urine output (30 ml/hour
what shuold be done on scene of a hypovolemic shock pt
NS or LR for SBP greater than 90, avoid aggressive fluid infusion as it may precipitate renewed internal bleeding
what fluid/colume replacement should be done in the ED if not started in the field
2 large bore IVs, warmed fluid replacement, NS or LR (crystalloids) if still hypotensive after 2 liters, transfuse, use packed RBC’s for blood replacement,
universal donor for blood
type O, Rh negative if female pt of childbearing age
blood product replacement
after 7 units of packed RBC’s, give a platelet transfusion and an infusion of cryoprecipitate to replenish lost clotting factors
