Trauma Flashcards
What is the most common type of shock in trauma pateints?
Hypovolemic shock- loss of circulating volume
This stage of hypovolemic shock is very subtle and signs may be very difficult to detect
Initial: Overall aerobic metabolism Baseline MAP decreases 5-10 mm Hg MAP and CO are WNL SNS Activation - may have slight increase in HR / RR Organ function intact S/S shock are difficult to detect
In this stage of shock the compensatory mechanisms are activated and MAP decreased 10-15mmhg. What is occuring with the cells and what are other s/s. Wha is the goal in this phase?
This is the non progressive/ compensatory phase. The cells are in anaerobic metabolism and hypoxic cell injury begins.
S/S include increases in HR / RR, small decrease (2-5%) in O2 Sat, decreased UOP, decreased BP (diastolic pressure rises), narrowing pulse pressure, cool extremities
Lactic acid, and potassium in the intravascular space sodium and h2o enters the cell and causes swelling
Goal= Restore oxygen to the cells and intervene before the cells burst from swelling
In this phase of hypovolemic shock the compensatory mechanisms fail. The patient is showing signs of tachycardia, hypotension, anuria, pale, cool/moist skin, decrease in o2 stat by 5-20%, HIGH LACTATE, and IMPENDING DOOM. What does the MAP decrease by, what is occurring widespread, and what is the goal in this phase?
This is the Progressive phase. MAP decreases by 20 mmhg. Widespread hypoxia/ischemia occur to vital and non vital organs, widespread anaerobic metabolism, and metabolic acidosis.
Goal: Addresss underlying problem and restore oxygen to tissues
In this phase of hypovolemic shock, the shock state is irreversible. what are key s/s
This is the refractory stage. s/s include loss of LOC, non palpable pulse, cold, dusky extremities, slow shallow respirations, and unmeasurable 02 sat
What are the 4 priority nursing interventions for a patient with hypovolemic shock?
1.Airway
2.Oxygen
3.IV fluid replacement
• Isotonic Crystalloids
• Colloids
• Blood products such as PRBC- containg hgb to delivery oxygen while perfusing blood
4. Vasopressors
What is assessed in the primary survey?
ABCDE!
Airways- patency, obstruction, establish airway
Breathing- determine if the patient is breathing and the effectiveness of the ventilatory efforts, open and clear airway does NOT ensure gas exchange
Circulation- BP, CO, HR, LOC, skin, central pulse. STOP THE BLEEDING
Disability- neuro assessment alert, responsive to voice, responsive to pain, unresponsiveness, GCS
Exposure-Remove all clothes and examine all body parts from injury, preserve evidence if necessary, and prevent hypothermia with warm blankets
This is the response from an injury such as hypotension, hypoxia, ICP, hemorrhage, hydrocephalus, brain herniation
Secondary Responses and Insults- Life threatening effects from the source that are responsible for the declines in the patients overall physiological state and account for negative outcomes
What is the number one intervention when caring for a patient with facial trauma, what is a major contraindication.
AIRWAY! The patient may need an laryngeal mask airway, orotacheal intubation, tracheotomy, or criciothyriodotomy.
A major contraindication is NG tube with basal frasctures (risk of going into the brain)
What teaching is importnat when caring for a patient with wired jaw. What is important to keep with at all times
Consume high dense calorie shakes and use straw for nutrition
Water pik for oral care
Antiemetics to prevent vomiting.
KEEP WIRE CUTTERS AT BEDSIDE in case airway becomes compromised.
What are the 3 key s/s for a patient with a recent SCI experiencing neurogenic shock
◊ Bradycardia – Symptomatic bradycardia treated with Atropine (only shock that causes bradycardia
◊ Hypotension – Treated with Vasopressors
◊ Vasodilation – Treated with Fluids & Vasopressors
This occurs in those with an SCI in response to a noxious stimulus and has s/s of bradycardia, severe HA, flushing, visual distrubanced ABOVE the level of injury and sudden increase in BP palllor and vasoconstriction BELOW the level on injury. What is this patient experiencing and what must the nurse do?
This patient is experiencing Autonomic Dysreflexia.
Goal= remove the noxious stimuli
The nurse needs to
Place patient in upright sitting position (PRIORITY)
Assess for origin of noxious stimuli (GU, GI, Integument……)
Loosen any constrictive clothing / Remove compression stockings
Monitor BP every 10 min
Anticipate antihypertensive agents (admin IV)
When caring for a patient with a penetrating trauma to the pelvic region and noticies bleeding at the urethral meatus what must the nurse avoid?
The nurse should NOT insert a foley.
What is the most common skeletal injury that ppl die from? What are common s/s will be seen with this type of injury?
Pelvic injury, this protects the lower urinary tract, major blood vessels, and nerves, and can cause life threatening hemorrhage and neurological impairment.
The key s/s is perianal ecchymosis, pain on palpation, ROCKING LOWER LIMB paresis, and SHORTENING OF LOWER EXTREMITY
What is a patient with a pelvic fracture at greatest risk for 12-72 hrs after a fracture?
Pulmonary fat embolism- assess for sudden onset chest pain and SOB
