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Critical Care > Trauma > Flashcards

Trauma Flashcards

1
Q

Trauma: Pre-arrival to Hospital

A
  • EMS in the field reports what is coming in, the ABCs/GCS of pt to charge nurse
  • Trauma team is notified
  • CT is made available
  • Bed made ready
  • Trauma team dons standard or higher precautions
  • Equipment is ready: fluids (warm NS), monitoring (BP cuff, SPO2), meds (inotropes, vasopressors), blood products
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2
Q

Primary Survey

A 
Airway
Breathing
Circulation
Disability
Exposure
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3
Q

Airway

A

assessing for patency and protection:

  • can they talk?
  • what is your name?
  • are they breathing? (if no, anticipate intubation if not intubated in field)

RSI - rapid sequence intubation
-involves 3 drugs pushing quickly: sedation (versed), anesthesia (etomidate), paralysis (succinylcholine)

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4
Q

Breathing

A

once airway is secured, assess that breathing is adequate (rate and depth)

draw ABGs to look for adequate oxygenations

inspect, palpate, auscultate lungs (looking for bilateral breath sounds and good effort)

in chest trauma, anticipate/prepare for chest tube

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5
Q

Circulation

A
  • assess pulses: starting w/ most central pulses and then move forward (femoral and carotid first)
  • assess capillary refill
  • control bleeding, infuse products and fluid
  • access via two large bore IVs (18 gauge is ideal), possible central line
  • rapid infuser

-look for hypotension and shock signs

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6
Q

BPs by Pulse

A

carotid pulse: systolic must be at least 30-40

femoral pulse: systolic must be at least 50-60

radial pulse: systolic must be at minimum 60-70

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7
Q

Disability

A

focused neuro exam:

  • LOC
  • GCS
  • PERRLA
  • Gross motor function
  • sensation in 4 extremities
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8
Q

Glascow Coma Scale

A

looks at:

  • eye opening response
  • verbal response
  • motor response

best score = 15
comatose = 8
unresponsive = 3

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9
Q

Exposure

A

completely undress pt and examine entire body

  • maintain C-spine precautions
  • assess scalp, axillary folds, skin folds, perineum
  • prevent hypothermia during work up (warm fluids, blood products, warming blankets)

*hypothermia can lead to coagulopathy and MODS

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10
Q

ABC’s rest of alphabet

A

Facilitate adjuncts/Family - full set of VS, notify familly

Get adjuncts (LMNOP)

  • Labs
  • Monitoring
  • NG to decompress
  • O2 if needed
  • Pain (address)
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11
Q

Trauma: Dx Tools

A
  • Head CT: for head trauma
  • Chest X-ray: for chest trauma (can do chest CT, but chest x-ray is portable and faster)
  • FAST U/S: for abdominal trauma looking for free air/fluid, intestinal damage
  • X-ray for trauma in limbs
  • Lab work: CBC, chemistries (electrolytes), coags (clotting factors), abdominal labs (BUN/creatinine/CK), blood type and screen, lactate, urine for presence of blood and pregnancy and/or toxicology, ETOH level, troponin
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12
Q

Trauma: Commonly Missed Injuries

A

blunt abdominal trauma:

  • hollow viscus injury
  • diaphragmatic rupture

penetrating abdominal trauma:
-rectal and ureteral injuries

thoracic trauma:

  • aortic injuries
  • pericardial tamponade
  • esophageal perforation

extremity trauma

  • fractures
  • vascular injury
  • compartment syndrome
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13
Q

Secondary Survey

A

if pt is stable and not immediately taken to the OR:

  • assess thoroughly for signs of injury
  • obtain full set of vitals
  • detailed history via SAMPLE
  • head to toe assessment
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14
Q

Fluid Resuscitation

A

use hemodynamic parameters such as HR/BP and physical assessment to determine fluid needs

usually start with 2 L NS/LR (NS is usually standard)

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15
Q

Blood Products

A

part of fluid resuscitation if needed
-considered when trauma pt remains HD unstable, has signs of tissue hypoxia despite crystalloid infusion

RBCs increase O2 carrying capacity and allow volume expansion

O negative given before type and screen is complete

platelets and fresh frozen plasma can be given as needed

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16
Q

Trauma: Additional Considerations

A

tetanus: if pt injury involves dirt, gravel, metal
(need to have had 3 or more tetanus boosters in less than 10 years, then you do not need another booster)

hepatitis: if pt was exposed to used needles

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17
Q

Head Trauma

A

priority: Airway
signs: battle’s sign, raccoon eyes, presence of CSF

assess neuro status (if neurologically compromised, can’t protect airway)

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18
Q

Basilar Skull Fracture

A

anticipate that head injury is severe

look for CSF leak via halo sign, battle’s sign, raccoon eyes

management: strict bedrest, HOB > 30 degrees, no coughing, no sneezing, no straining, no nasal tubes

herniation and death can occur if undetected or if pt takes a while to get to hospital

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19
Q

Facial Fractures

A

priority: airway

may not be able to use traditional airways b/c of trauma to nose or mouth

nutrition is priority and difficult to address when you can’t use mouth for nutrition

Lefort = nasal bone fractures, can involve orbital area

20
Q

Facial Fractures: Nursing Care

A
  • assess symmetry
  • palpate bones and soft tissue
  • tetanus status
  • pain
  • anxiety
  • remove debris
21
Q

Chest Trauma: Blunt

A

harder to distinguish damage b/c it’s difficult to see what’s effected

could have:

  • cardiac complication
  • contusions
  • aortic dissection
  • hypoxemia from pneumothorax or disrupted airway

adequate ventilation and circulation is priority

22
Q

Chest Trauma: Penetrating

A

result of sharp objects

tx depends on area affected

adequate ventilation and circulation is priority

23
Q

Chest Trauma

A

typically ribs 4-10 are the ones that are broken

pain worsens w/ cough, deep breathing, movement

crepitus w/ palpation

atelectasis and diminished breath sounds

flail chest: multiple rib fractures, creates free segment of the ribs > paradoxical chest wall movement

24
Q

Chest Trauma: Dx and Clinical Manifestations

A
  • decreased O2 and ventilation
  • tachypnea (early)
  • SOB
  • subq emphysema
  • pain
  • splinting is clinical sign of chest trauma

Dx:

  • chest x-ray
  • CT
  • FAST
  • ABGs
  • Lactate
  • H&H (look at O2 capacity)
25
Q

Chest Trauma: Tx

A
  • ABCs
  • small rib fractures can be treated outpatient
  • pain management
  • cough/deep breathe (educate pt to splint chest)
  • pneumonia risk r/t atelectasis
  • 3-6 wks to heal
26
Q

Pneumothorax

A

air in the pleural space results in a lung collapse

happens more slowly than a tension pneumothorax

27
Q

Pneumothorax: Causes

A

thoracentesis
chest trauma
ruptured blebs (COPD)
infection

28
Q

Pneumothorax: Sx

A
  • dyspnea
  • cyanosis
  • tracheal deviation
  • asymmetrical chest wall expansion
  • anxiety
  • tachycardia
  • diminished breath sounds
29
Q

Pneumothorax: Dx

A

chest x-ray

ABGs

30
Q

Hemothorax

A

bleeding into chest cavity

blood increases pressure and collapses lung in that area

31
Q

Tension Penumothorax

A

happens vey quickly

air in chest cavity/pleural space (just like a pneumothorax)

ex) knife between ribs, when you breath in knife is dislodged slightly and air leaks into negative pleural space and stays there > tracheal deviation, depresses diaphragm, pressure on other lung

32
Q

Abdominal Trauma

A

can also be blunt or penetrating

hypovolemia is a big concern with abdominal trauma b/c of major organs in abdomen

risk for peritonitis, sepsis, abdominal compartment syndrome

dysfunction of liver, spleen, kidneys, bladder

33
Q

Abdominal Trauma: S/Sx

A 
splinting
hard, distended abdomen
decreased/diminished bowel sounds
abrasions/bruising
hematuria
hematemesis
shock
34
Q

Abdominal Trauma: Nursing Care

A
  • anticipate bedside FAST and/or CT scan
  • NG tube (assess for presence of blood, decompress stomach, slow down bowel function in acute phase)
  • foley catheter (assess for presence of blood, decompress bladder, bladder pressure)
  • anticipate need to go to OR for exploratory surgery
35
Q

Abdominal Compartment Syndrome

A
  • result of increased abdominal pressure
  • tissue, fluid, blood compress the abdominal wall > bowel death or vital organ death

Tx: surgical decompression (fasciotomy), but pt must be stable

36
Q

Musculoskeletal Injury

A

dislocations

amputations (clean cut, crush, avulsion)

soft tissue injury (affects skin, muscle, cartilage, ligaments)

37
Q

Musculoskeletal Injury: Nursing Care

A
  • CMS checks to affected extremity
  • sensation, ability to move
  • Pain management
  • immobilization
  • compression
  • elevate if possible
38
Q

Pelvic Fractures

A

high mortality because of bleeding

may result in intra-abdominal injury such as paralytic ileus, laceration of colon, bladder, urethra

39
Q

Pelvic Fractures: Complications

A
  • hypovolemic shock
  • sepsis
  • embolus
  • compartment syndrome (fasciotomies)
  • DVT (> pulmonary embolus if it moves)
  • Fat embolus
40
Q

Pelvic Fractures: Nursing Care

A
  • assess: pelvic stability, pain, hemodynamic stability
  • stabilize
  • prepare for intervention (emoblization, OR)
  • if open, monitor for infection
41
Q

Fat Embolus

A

24-72 hours after initial injury of long bone or pelvic fracture

s/sx of pulmonary emboli

look for petechial rash

42
Q

Heat Injuries

A

emergency when person is unable to sweat after a certain amount

influenced by:
age
environment
pre-existing conditions
medications
street drugs
43
Q

Heat Injuries: Tx

A 
stabilize ABCs
100% O2
EKG
electrolytes
cool pt (fan, cooling blankets, spray w/ water)
44
Q

Cold Injuries

A

frostbite:

  • gently rewarm
  • avoid friction

hypothermia:
- temp less than 95 degrees F
- mental status deterioration
- cold blood puts pt at risk for clots
- severely hypothermic pts appear dead - rewarm!

45
Q

Triage

A

Priority 1: Red = Immediate
Priority 2: Yellow = Delayed
Priority 3: Green = Minimal
Priority 4: Black = Expectant

Emergent: need immediate care - increased risk of death/threat to limb

Urgent: seen w/in 1 hr condition may deteriorate

Non-Urgent: can wait at least 2 hrs

Critical Care (14 decks)

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