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Complex care final > Trauma > Flashcards

Trauma Flashcards

1
Q

Triage

A
  • first step when someone comes into the ED
  • process of rapidly determining the patients acuity
  • must promptly recognize who has a threat to life and needs treatment before other patients
  • nurse may be the only one who does this
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2
Q

Emergency severity index (ESI 1)

A
  • requires immediate life saving intervention
  • they have an obvious threat to life from things like: uncontrolled hemorrhage, airway compromise, respiratory arrest/distress
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3
Q

ESI 2

A
  • high risk/ decreased LOC/ severe pain
  • Would you give your last open bed to them?
  • ex: SI, sexual assault, physically agressive, confused, lethargic, disoriented, severe pain
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4
Q

ESI 3

A
  • needs more than 2 resources
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5
Q

ESI 4

A
  • needs one resource
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6
Q

ESI 5

A
  • needs no resources
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7
Q

What stage should you consider if vitals are out of normal range

A
  • up grading to ES2
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8
Q

ESI resources

A
  • labs
  • ECG, X-RAY, CT, MRI, angiography
  • IV fluids
  • IV, IM or nebulized meds
  • special consult
  • Simple procedure = 1 (lac repair, foley cath)
  • complex procedure = 2 (conscious sedation)
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9
Q

NOT ESI resources

A
  • History and physical
  • point of care testing
  • saline or heplock
  • PO meds
  • tetanus immunization
  • prescription refills
  • simple wound care )dressings, recheck)
  • crutches, splints, slings
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10
Q

Emergency Assessment

A
  • most emergency pt are assessed using primary survey followed by focused assessment
  • trauma pt is assessed using primary and secondary survey
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11
Q

Primary survey

A
  • ABC
  • disability
  • Exposure and environmental control
  • full vitals/ family presence
  • get resuscitative agents

*ABC may need to be reprioritized to CABC: catastrophic hemorrhage, airway, breathing, circulation

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12
Q

goal of primary survey

A

identify life threatening conditions

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13
Q

Airway/Alertness. C-spine scale

A
  • AVPU: Alert, verbal, pain, unresponsive
  • important because it assesses if the patient can control their own airway (always want to progress from least invasive to most for airway management)
  • stabilize the cervical spine during airway management
  • always assume pt. with a head, neck, or upper torso injury has a cervical injury
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14
Q

Breathing

A
  • assess breathing (rate, depth, symmetry, effort)
  • admin supplemental o2 (100% via non-rebreather) when there is an injury that could cause deficits to respiratory status like: rib fracture, pneumothorax, penetrating injury
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15
Q

circulation

A
  • check central pulse to assess quality and rate
  • assess skin for temperature, color, and moisture
  • insert 2 large bore IV catheters bilaterally
  • admin blood products to replace lost blood volume (uncross matched is given in emergency- type o negative)
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16
Q

What does a weak/thready pulse mean

A

shock and you should suspect bleeding

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17
Q

What does cap refill and perfusion deficits mean

A

prolonged cap refill is a sign of shock

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18
Q

what is considered a large bore needle

A
  • 16-12 gauge

- put in anticubital or above

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19
Q

why do you need the large bore needle

A
  • in case need rapid blood transfusion
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20
Q

Disability

A
  • assess LOC using GCS scale (less than 8 = intubate)

- assess pupils (size, shape, equality, and reactivity

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21
Q

GCS- eye opening response

A
  1. spontaneous
  2. to speech
  3. to pain
  4. no response
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22
Q

GCS- verbal response

A
  1. oriented to time, person, and place
  2. confused
  3. inappropriate words
  4. incomprehensible sounds
  5. no response
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23
Q

GCS- motor response

A
  1. obeys commands
  2. moves to localized pain
  3. flex to withdrawal from pain
  4. abnormal flexion
  5. abnormal extension
  6. no response
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24
Q

exposure and environment control

A
  • remove clothing (cut off) immediately to assess for injury
  • DO NOT remove impaled objects because that could cause them to bleed out
  • keep the patient warm (blankets, warmed blood and fluids)
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25
Q

Full set of vitals and family presence

A
  • get full set of vitals including temperature

- facilitate family presence (be with the family at all times and answer questions and explain procedures)

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26
Q

Get Resuscitation Adjuncts

A
  • measures taken to monitor the patients condition continuously
  • pneumonic LMNOP
  • L: labs
  • M: cardiac monitoring (continuous and EKG)
  • N: naso or orogastric tube to decompress the stomach (naso may be contraindicated when head or facial trauma)
  • O: pulse ox and end tidal co2 monitoring
  • P: pain assessment and management
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27
Q

Secondary survey

A
  • brief systematic process to identify all injuries
  • Begins after all components of the primary survey have been addressed and the life saving interventions have been started
  • Head to toe
  • inspecting posterior surfaces
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28
Q

History and Head-To-Toe

A
  • Talk to EMS: have them describe the scene and how the patient was injured
  • scene details can provide valuable insight to guide assessment
  • SAMPLE
  • S: symptoms
  • A: allergies
  • M:medication history
  • P:past health history
  • L: last oral intake
  • E: events leading to injury
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29
Q

Head/neck/face exam

A

-gaze, bruising, bleeding, JVD

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30
Q

Bruising behind the ear or under the eyes could mean???

A

-Significant fracture

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31
Q

Chest exam

A

-paradoxical movement, crepitus, breath sounds, symmetry, adventitious breath sounds

32
Q

Abdomen/flanks exam

A
  • bruising, bowl sounds, distention, FAST exam
33
Q

What is the FAST exam for

A
  • assess bleeding in peritoneal cavity

- its a quick bedside ultrasound

34
Q

Pelvis/Perineum exam

A
  • palpate for stability, crepetis, bleeding, priaprism, rectal tone (to assess for spinal injuries), deformities
35
Q

Extremeties exam

A
  • crepitus, deformity, pulses, compartment syndrome (suspected if crush injury)
36
Q

Inspect posterior surfaces

A
  • final step of trauma assessment
  • logroll pt while maintaining c-spine (one person will maintain inline cervical spine, and two will cross arms and roll pt)
  • inspect the back for bruising, abrasions, wounds, and deformities
37
Q

ongoing monitoring and eval

A
  • All interventions must be reevaluated on a continuous basis (ABC then LOC)
  • Assessment must be repeated with any change to evaluate status
  • Diagnostic tests or to the OR for emergency surgery
  • Surgery is often definitive care and treatment for all life threatening trauma= get them to the OR
38
Q

Targeted temperature management

A
  • Indicated for post cardiac arrest patients who achieve ROSC
  • Target temperature is 32 to 34 degrees Celsius for 24 hours post resuscitation which will decrease mortality and increase neuro function
  • Associated with decreased mortality and improved neurological function
39
Q

what is ROSC

A

-return of spontaneous circulation

40
Q

Death in the emergency department

A
  • Common occurrence in critical care
  • RN plays a significant role in providing comfort
  • Organ and tissue donation: contact them
  • prepare the body for viewing and make yourself available for questions
  • allow them to grieve in their own way and make sure you do too
41
Q

geriatric patients

A
  • A growing number of the population > 65
  • Check for advanced directives
  • High risk for injury
  • Most common mechanism of injury = falls causing fractures
42
Q

Heat Cramps signs

A
  • occur during rest
  • n/v
  • tachy
43
Q

heat cramps

A

-large muscle fatigue

44
Q

heat cramps tx

A

-rest 12 hours

45
Q

heat exhaustion

A

-prolonged exposure to heat over hours or days

46
Q

heat exhaustion signs

A
  • fatigue
  • n/v
  • thirst
  • anxiety
  • hypotension
  • tachy
  • mild confusion
  • ashen color
47
Q

Heatstroke

A
  • failure of hypothalamic thermoregulatory process

- medical emergency

48
Q

heat stroke signs

A
  • increased: sweating, vasodilation, RR
  • deplete fluids/electrolytes (ESP NA) from diaphoresis and then body cant cool itself
  • core temp is increased rapidly (104), altered MS, loss of muscle coordination, combative, skin hot, red, dry and ashen
49
Q

Heat stroke Tx

A
  • COOL THEM
  • fan, water bath, cool fluids
  • dont want to shiver
  • stabilize ABG
50
Q

Frostbite

A
  • tissue freezing
  • formation of ice crystals on tissues
  • localized
51
Q

frostbite signs

A
  • peripheral vasoconstriction, decreased blood flow, edema
  • superficial: skin is going to be waxy and pale yellow to blue mottled crunchy and frozen tingling, numbness, or burning
  • deep: involves muscle, bone, tendon mottling to gangrene skin may be white and hard
52
Q

Frostbite tx

A
  • remove wet clothing
  • superficial: never rub, immerse in warm bath. Blisters form within a few hours debride and sterile dressing
  • deep: circulating water bath, after rewarmed elevate extremity to decrease edema, amputation may be necessary if the tissue damage is too severe
53
Q

hypothermia

A
  • body cannot compensate for heat loss

- systmeic

54
Q

hypothermia signs

A
  • Core temperature below 95, may shiver, rigidity, bradycardia, slow RR, hypovolemia
  • if severe: below 89.6
  • if mild: shivering lethargy, confusion and are prone to dysrhythmias
55
Q

hypothermia tx

A

-remove wet clothing
moderate to severe: humidified oxygen, warm fluids, re warm core first
* cannot pronounce dead until warmed at least to 86 degrees
* caught cause of death is usually recurrent ventricular fibrillation

56
Q

Drownings

A
  • Defined as respiratory difficulty after submersion in water
  • Most victims are less than 5 years old
  • If water is aspirated pulmonary edema develops
57
Q

drowning tx

A
  • focuses on correcting hypoxia with agressive airway control (ET tube may be needed)
  • Assume there is a cervical spine injury present
58
Q

stings and bites

A

Severity is based on direct tissue damage or toxins

59
Q

wasp, bee, and hornet stings

A

-can cause localized pain or life-threatening anaphylaxis.-threatening anaphylaxis.
-TX: scraping the stinger away from the body with a fingernail or credit card and removing any restrictive clothing.
`

60
Q

Ticks

A
  • can transmit neurotoxins that cause Lyme disease (which causes ascending paralysis and respiratory arrest)
  • TX: remove the tick using forceps. Muscle function is restored within 42 to 72 hours after tick removal.
61
Q

Animal bites

A
  • cause mechanical destruction to tissue, blood vessels, and bone that can lead to infection
  • TX: Rabies prophylaxis treatment is indicated if the animal was unprovoked or the animal is not found.
62
Q

poisoning

A
  • Any chemical that harms the body is a poison
  • Severity is based on type of chemical and what route it was ingested
  • Goal of treatment is to decrease absorption, enhance elimination, and administer any toxin specific care
63
Q

Gastric Lavage

A
  • one method of decreasing absorption by removing the substance from the stomach. -A large diameter tube is inserted into the stomach.
  • The stomach is irrigated with copious amounts of sterile saline.
  • The contents of the stomach are then drawn out using a large syringe.
  • It is imperative that those with altered LOC or absent gag reflex are intubated prior to gastric lavage to prevent aspiration of substances into the lungs. -Gastric lavage should be performed less than one hour from ingestion.
64
Q

Activated Charcoal

A
  • binds to ingested toxins and prevents absorption.
  • administered orally or via a gastric tube within 1 hour of ingestion of toxic substances.
  • This is the most common and effective method to prevent absorption.
65
Q

hemodialysis for poisoning

A

-may be required if the toxic substance causes the patient to become acidotic.

66
Q

Violence

A
  • All patients are screened for Intimate Partner Violence
  • Sexual Assault Nurse Examiner (SANE)
  • Work place violence in the ED from pt
67
Q

common violence assessment questions

A

“do you feel safe at home?” and “Is anyone hurting you?”

68
Q

SANE nurse

A

specially trained and certified to collect and document evidence in sexual assault cases. They provide emergency care and advocate for the victims.

69
Q

ED assault by pt

A

It is imperative that healthcare workers in the ED remain aware that this environment is high risk for assault by pt and always prioritize the safety of yourself and your fellow healthcare providers. Utilize security and law enforcement resources early and remove yourself from unsafe situations where you have the potential to become a victim.

70
Q

Mass casualty incident (MCI)

A

-Is an emergency that overwhelms a community’s ability to respond with existing resources
-Can be man-made (terrorism) or natural (hurricane)
-Large number of victims
Multiple agencies respond

71
Q

Start triage for MCI

A
  • Triage at an MCI should be completed in 15 seconds for each patient.
  • Colored tags are used to determine the order that patients will be treated and transported to a hospital.
  • This system is designed to do the most good for the most victims.
72
Q

Green tags

A

given to patients who are ambulatory and have minor injuries. This is the “walking wounded” category. All of these patients walk from the scene to a safe location away from the “hot zone”.

73
Q

yellow tags

A

given to patients who are urgent but do not require the next ambulance that is leaving the scene.

74
Q

red tags

A

for those patients who need immediate life-saving intervention and will require the next ambulance to leave the scene.

75
Q

black tags

A

are for those patients who are not breathing or have sustained injuries that will cause them to expire before they reach the hospital. Example (Massive head trauma)

76
Q

how tag system works

A
  • All ambulatory patients are told to walk to a safe area away from the scene. These patients are given a GREEN tag.
  • Next assess patients for spontaneous breathing. If the patient is not breathing open the airway using a jaw thrust maneuver. If the patient starts breathing after airway repositioning the patient is a RED tag. If the patient does not start breathing then they are a BLACK tag.
  • If the patient is breathing then respirations are estimated at either over 30 or under 30 per minute (45 for pediatrics). If respirations are over 30 than the patient is given a RED tag. If respirations are under 30 than the patient’s perfusion is assessed by taking their radial pulse.
  • If capillary refill is under 2 seconds or the patient has a radial pulse then mental status is assessed by determining if the patient can or cannot follow commands. If the patient cannot follow commands they are a RED tag. If the patient can follow commands they are a yellow tag.

Complex care final (8 decks)

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