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Module 3 > Trauma > Flashcards

Trauma Flashcards

1
Q

Unintentional Injury

Leading cause of death for people ages 1-44
Leading causes of unintentional fatalities:

A

Motor vehicle traffic (MVA, pedestrian, bicyclists)
Poisoning
Falls

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2
Q

Triad of death: a lethal cascade

predictor of poor outcome with severe blood loss in the middle

A

Coagulopathy: excessive fluid dilution, metabolic events, hyperthermia, DIC

Acidosis: build-up of lactic acidosis, build up of Co2 from poor lung functioning, slow breathing

Hypothermia: wet clothing, IV fluids=shivering, decreased tissue perfusion, decreases removal of lactic acid.

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3
Q

Emergency room nurse

Prompt recognition of patients requiring immediate intervention => ___

_______: roles and responsibilities for trauma patient on admission to ER

PPE

Stressful environment

A

triage -
Triage-takes a lot of experience to triage appropriately

Team assembling-
“Code Trauma”: have specific responsibilities/role

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4
Q

Triage “to sort”

Process of sorting or quickly determining victim acuity

Categorizes patients so that ___________ based on illness severity and resource utilization

Emergency Severity Index (ESI): Five levels of triage (1-5)

A

most critical are treated first

ESI-1 & ESI-2 most critical
ESI-3, ESI-4, ESI-5 patients are stable

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5
Q

How sick, how soon need to be seen?
With the ESI, patients are assigned to triage levels based on both their acuity and their anticipated resource needs.
ESI-1 any threats to life (_____)
ESI-2 high risk situation
ESI-3,4,5(nL vs) depends on # of resources(ECG, labs, radiology studies, IV fluids)

A

cardiac arrest

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6
Q

Primary Survey

A

A: airway
B: breathing
C: circulation
D: disability
E: exposure and environmental control

When a trauma patient first comes in. Trauma resuscitation requires immediate treatment, these five things to prevent death. Trauma viewed as multisystem disease. Identify and treat life-threatening conditions first. Primary (ABCDE) & secondary (FGHI) survey for all trauma patients

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7
Q

Secondary Survey

A

F: full set of vital signs & family
G: give comfort measures
H: head to toe assessment & history
I: Inspection of posterior surfaces

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8
Q

A
Airway with simultaneous cervical spine stabilization and/or immobilization

Open airway
Always assume injury to cervical spine
Stabilize/immobilize cervical spine
Remove or sx foreign bodies
Insert airway or prepare for intubation

Nearly all trauma deaths that occur immediately, due to _____ .

S/Sx of compromised airway:
Suspect cervical spine trauma in any patient with ______________________; open airway with modified _________

A

airway obstruction

face, head, or neck trauma and/or significant upper chest injuries

jaw thrust maneuver

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9
Q

Breathing

Assess adequacy of _____
Look, listen, and feel parameters

All trauma patients should receive ______ during initial evaluation/may need BVM

If we must intubate, it is preferred rapid sequence intubation:

If unable to intubate due to injury or edema or a failed intubation: emergency _______ or _______, which is a lifesaving measure.

A

ventilation

high-flow oxygen (NRB)

induce unresponsiveness followed by neuromuscular blockade to cause muscular relaxation(sedate and paralyze).

cricothyrotomy or a tracheostomy

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10
Q

End tidal CO2 monitoring

Increased use of end tidal CO2 monitoring (______) in trauma patients-why?

A

capnography

More accurate than pulse ox.

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11
Q

Circulation

Check central pulse (quality)
Blood pressure, HR, skin color, oxygen saturation, cap refill
If absent pulse, start CPR
STOP THE BLEED!
Determine source of blood loss

Hemorrhage is cause of early post-injury deaths; can occur in several areas:, pelvis, femur, liver, spleen, kidney, head, chest (organs that are vascular or areas that can hold a lot of blood)

Check carotid and brachial

2 large bore IVs (14, 16g)
Type and cross match
Administer fluid/blood products
Aggressive fluid resuscitation: LR or NS

Can give ______ while waiting on type and cross
Type and cross typically takes 45 min.

A

0- or LR

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12
Q

Circulation (fluids)

What would failure to respond to fluids possibly indicate? rapid surgical intervention is required (hypovolemic shock)

A

Warm Lactated Ringer’s solution
Isotonic
The components of LR are the closest to our blood crystalloids
Not usually used as a maintenance fluid because of added electrolytes such as Na+ and K+

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13
Q

Disability:

_____ is common in the early stages of shock, fight or flight response. As shock progresses their _______.

_____ about an event suggests an altered loc

______- indicative of brain injury- ominous sign

A

Brief neuro exam
Determine patient’s level of consciousness:
A –Alert
V – Responsive to voice
P – Responsive to pain
U – Unresponsive
or
Glasgow coma scale
PERRL
posturing

Agitation
LOC decreases

Amnesia

Posturing

Glasgow comma scale scoring can be impaired by drugs and alcohol

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14
Q

Exposure

Patient completely disrobed in preparation for secondary survey

Exposure to:

-
-

A

cold ambient temperatures, large volumes of room temperature IV fluids, cold blood products, and wet clothing  hypothermia

-Heated blankets, overhead warmers, warmed fluids, warmed room, and Bair hugger
-Maintain privacy
-Preservation of evidence

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15
Q

Hypothermia: core temp _____ or less. Hypothermia is the easiest to treat of the trauma triad.

A

35 C or 95 F

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16
Q

Secondary survey

F

G

Finished primary
Labs you would anticipate:?
Blood at meatus-what would you suspect?
Facial fractures - NGT with US guidance

NGT tube- contraindicated with _________

A

Full set VS, focused adjuncts, facilitate family presence: continuous ECG,O2 sat, end-tidal CO2 monitoring; urinary catheter/NGT if indicated; tetanus; labs, X-rays; designate team member to support family

Give comfort measures: assess and reassess pain/anxiety

orbital or brain injuries

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17
Q

H and I

History andHead-to-toe AssessmentInspection

Obtain details of:

Head to toe assessment

AMPLE:

Log roll and inspect back for:

What did happen? ________ is important when obtaining history can help predict the types and combinations of injuries ie. If a fall, how high? if MVA, driver? Seatbelt? Airbag deployed?

May need to remove anterior portion of c-collar to see if any ____ or ____

A

incident/illness, mechanism and pattern of injury, length of time since incident, injuries suspected, treatment provided and pt’s response, LOC

allergies, meds, past health hx, last meal, events/environment preceding injury or illness

deformity, bleeding, lacerations, and bruises

Mechanism of injury

tracheal deviation or JVD

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18
Q

Diphtheria, Tetanus & PertussisVaccinations

DTaP (given to children under age __)
Tdap (_________)
Td (once every ____ after one Tdap)
TIG

When would you give TIG (tetanus immunoglobulin)?

_____, ____ - signs of tetanus

DTaP vs. Tdap – different _____ of vaccine

DTaP- given before (D comes before T)

A

7
one dose age 11-64 years
ten years

Given to someone showing signs of tetanus. They will still need vaccine sat some point

Lockjaw, spastic muscles

concentrations

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19
Q

Tetanus, diphtheria, and acellular pertussis(Tdap)

Only for individuals older than ___ years of age

Now routinely given around _____ years of age

Healthcare professionals should all have this vaccine

Pregnant women should get one dose of Tdap during every pregnancy (CDC, 2022)* “whooping cough”

Td is a derivative of Tdap…but without the ____

Td boosters should be given every ____

*CDC recommends all women receive a Tdap vaccine during the 27th through 36th week ofeachpregnancy, preferably during the earlier part of this time period. Why?

Given with ___, ___, & ____

A

7
11 or 12

pertussis.

10 years

burns, trauma, pregnancy

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20
Q

Trauma Signs

A

Battle’s: post-auricular ecchymosis, behind the ear, over the mastoid bone- basilar skull fx

Raccoon eyes- orbital fractures

Gray turners- internal bleeding retroperitoneal

Cullen’s- umbilicus

Liver laceration

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21
Q

Chest trauma types:
1. Penetrating
2. Blunt
-
-
-

Sternal fx usually by steering wheel, can cause pulmonary contusion. Increases mortality 50%, present like ____________

A

Sternal and rib fractures
Pulmonary contusion (mortality rate >50%)
Flail chest

ARDS presentation. Hypoxemia refractory to oxygen.

Prevent pneumonia with IS or flutter valve

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22
Q

Flail Chest

Fracture of several consecutive ribs in _____ separate places causing ____
causes,
signs and symptoms,
treatment

A

two or more
unstable segment

Causes: severe blunt injury – crushing roll-over injury due to a flipped ATV, MVA or a fall might cause it.

S&S:
Paradoxical breathing-the opposite of what it should be. (lung deflates when it should inflate)

Rapid, shallow respirations and tachycardia

Treatment:
Supportive therapy is key while the ribs heal
Rarely need surgery (external device), supportive therapy-taping, splinting.
If major injury, may be intubated

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23
Q

Thoracic Injuries

______: air enters the pleural space causing a total or partial collapse of the lung
-Loss of _______
-Signs and symptoms depend on ___
Types:
–
-
-

Hemothorax: may require ______

Treatment?

A

Pneumothorax:

negative pressure

size

Types:
-Simple or spontaneous
-Traumatic
-Tension

autotransfusion

Insert CT into pleural space: to drain fluid, blood or air; re-establish the negative pressure, and re-expand the lungs

Sometimes lung issues such as asthma can precipitate the pneumothorax

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24
Q

Spontaneous pneumothorax:

Primary:
Secondary:

Risk factors:

Treatment:

A

Rupture of small blebs

Primary: healthy young individuals
Secondary: as a result of lung disease

VATS procedure: video-assisted thoracic surgery – if it won’t stay inflated with chest tube

Tall and thin adolescent males are typically at greatest risk

Rupture of small blebs, leads to loss of negative pressure, lung collapses.

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25
Q

Traumatic pneumothorax

A

Closed- can occur during invasive thoracic procedures (“drop a lung”) like CVC insertion

Open pneumothorax- “sucking chest wound” (mediastinal shift)
Causes?
Open (flap may act as one-way valve) occurs with a penetrating wound.

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26
Q

Tension pneumothorax
Progressive build-up of air within the ______ and cannot escape

-
-
-

We want to prevent a tension pneumothorax because:

A

pleural space

Increased intrathoracic pressure
compression of lung on affected side
mediastinum shifts to unaffected side
decreased venous return
 decreased cardiac output

(trapped air causes pressure on the heart and lungs)

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27
Q

Tension pneumo s/sx

A

Sudden pleuritic pain
Air hunger, decreased pulse ox
Marked tachycardia, delayed cap refill
Tracheal deviation
Decreased or absent breath sounds on affected side
Neck vein distention
Cyanosis
Profuse diaphoresis

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28
Q

Tension pneumo

Remember tension pneumothorax is one of your “t’s “ in causes of ____

Medical emergency!

Possible:

Not getting blood returning to the heart…what are we gonna do

A

PEA

circulatory collapse w/ hypotension and traumatic arrest

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29
Q

Tension pneumo treatment

A

Act fast!

Prepare patient for needle decompression followed by chest tube insertion to water seal drainage

First action, second action: needle decompression (angiocath inserted to release air, everything goes back into normal place); follow with CT insertion and connect to pleurovac drainage system

30
Q

Cardiac Tamponade

Causes

Tx

Also another one of your “t’s “
in causes of ____!

A

blunt or penetrating trauma (hemorrhage)
diagnostic cardiac procedures
pericardial effusions from metastasis

Pericardiocentesis using echocardiography – immediate relief

PEA

31
Q

Cardiac Tamponade-Beck’s Triad

A

JVD
Muffled of distant heart sounds
low blood pressure

32
Q

Abdominal trauma
Etiology

A
  1. Blunt
    compression & shearing injuries
    may not be obvious - no open wound

Blunt: MVA usually; assoc with: low rib fx, femur fx, pelvic fx, thoracic injuries

Abdominal trauma can cause massive life-threatening blood loss into abdominal cavity.

  1. Penetrating
    0pen wound
33
Q

Abdominal trauma Clinical Manifestations:

MUST lift your patient’s gown to accurately assess abdomen!

Assess for referred pain which may indicate :

What is hematemesis/hematuria?

A

abdominal pain
guarding/splinting of abdominal wall
hard, distended abdomen (“Rigidity”: hard, distended, “board-like”)
decreased or absent bowel sounds
contusions, abrasions, or bruising over abdomen
scapular pain
hematemesis/hematuria
signs of hypovolemic shock

spleen, liver, or intraperitoneal injury. Blood/fluid irritating in the abdominal cavity and phrenic nerve involved

34
Q

Abdominal trauma Complications

A

When solid organs injured (liver, spleen) bleeding can be profuse  hypovolemic shock (requires aggressive fluid resuscitation)

When hollow organs (bladder, stomach) spill into peritoneal cavity  risk for peritonitis and abdominal compartment syndrome

Compartments = can put pressure on diaphragm and lungs causing respiratory compromise

35
Q

Abdominal trauma diagnostic studies

A

labs
urinalysis
CT
diagnostic peritoneal lavage (DPT)
focused assessment with sonography in trauma (FAST) on next slide

Labs: T &CM, BMP, CBC, liver fx tests, UA, CT, US
DPT-accurate, quick bedside assessment: checking for blood and bowel contents
10-15 min.

DPT and FAST can be done at bedside

36
Q

Focused Assessment with Sonography for Trauma

Bedside ultrasound - used to rapidly examine all four abdominal quadrants and the pericardium to identify the presence of ______

Used in high risk injury of mechanism

Unstable and +FAST =

Stable and +FAST =

A

free fluid, usually blood.

goes straight to OR

goes to CT for better localization of the problem

37
Q

Management of the patient with intra-abdominal injuries :

Impaled objects should never be removed except by skilled provider.

Pelvic binder used in suspected:

Who would use an oral gastric tube instead of NGT?

A

Primary survey
Document all wounds
If viscera are protruding, cover with sterile, moist saline dressing
Pelvic binder
Hold oral fluids
NG to aspirate stomach contents
Tetanus and antibiotic prophylaxis
Continuous monitoring and reassessment
Rapid transport to surgery if indicated

pelvic trauma to prevent from further injury. To help stabilize
Ab for open wound or a peritonitis

38
Q

Head injury

Any injury or trauma to the:

___ & ___ most common cause

Factors that predict a poor outcome:

Suspect cervical spine injury with:

TBI more likely in males

A

scalp, skull, or brain

MVA & falls

Factors predicting poor outcome- abnormal neuro check, blood thinners, older age

face, head, neck trauma

39
Q

Glasgow Comma Scale

GCS scores on arrival to hospital strong predictor

the  ---- the GCS score, the less chance of survival

Minor:
Moderate:
Severe:

Comatose=

Totally unresponsive=

A

lower

Minor 13-15 GCS
Moderate 9-12 GCS
Severe 3-8 GCS

comatose = 8 or less
totally unresponsive = 3

40
Q

Scalp lacerations

Profuse bleeding
Tx:

A

staple or suture closed

41
Q

Skull fractures

Can cause _______

Manifestations:

Complications:

Skull fx frequently occur with head trauma. Type and fx depends on:

___ fracture are assoc. with a tear in the dura, leaking of CSF.

May have CSF leak-may have:

A

CSF leaks (basilar fracture)

Battles sign
Periorbital ecchymosis (raccoon eyes)
Halo sign (csf leak)

Intracranial infections, hematoma,
Meningeal and brain tissue damage

velocity, momentum, site of impact.

Basilar
May have CSF leak-may have rhinorrhea (clear fluid from nose or pt c/o of postnasal drip) or can have fluid draining from ear.

rhinorrhea (clear fluid from nose or pt c/o of postnasal drip) or can have fluid draining from ear.

42
Q

Traumatic brain injury(TBI) includes:

A

Concussion
Diffuse axonal injury
Contusion (coup contre coup)
Hematoma

43
Q

Concussion: local injury; sports-soccer, boxing, football.

Repeated concussions are cumulative effect-autopsies show __________

Concussion syndrome:

We do better with post concussion return to game protocol now.

A

chronic encephalopathy.

irritable, difficulty concentrating, reading, math skills.

44
Q

Diffuse axonal injury
DAI-poor prognosis. All over brain injury. 90 % in a ______

A

persistent vegetative state

45
Q

Contusion: minor to severe.

Coup contre coup: two injuries, assoc. with closed head injury,

____ common.

Increased mortality with ______.

A

seizures

anticoagulant

46
Q

Epidural bleed is a medical emergency, usually ____ bleed.

Classic signs: __________, brain compensates at first, but it’s s fixed structure, can only tolerate so much bleeding before they decompensate.

Headache, n/v, unresponsive.

Need:

A

arterial

Disoriented, then have a lucid interval

surgery, craniotomy to evacuate hematoma

47
Q

Subdural bleed is usually a slower bleed, ____ in nature.

Acute and chronic.

Difficult to distinguish from:

A

venous

a mentally declining older person or someone with Alzheimer’s.

48
Q

Subdural bleed is usually a slower bleed, ____ in nature.

Acute and chronic.

Difficult to distinguish from:

A

venous

a mentally declining older person or someone with Alzheimer’s.

49
Q

Epidural hematoma-medical emergency b/c it is arterial
Either case of hematoma- requires a _____

A

craniotomy

50
Q

Nursing Management Head injury

ABC:
-Administer O2 via ______
-Intubate if GCS ___
-Control external bleeding w/ _____
-IV access x 2 large bore
-Stabilize cervical spine

Goals:
Maintain cerebral oxygenation & perfusion
Prevent secondary ____

CT and MRI scans
Cushings triad: worsening head injury; the body’s response to increased ICP:

A

non rebreather mask
<8
sterile pressure dressing

cerebral ischemia

cushings triad:
Widening pulse pressure (Inc SBP and dec. DBP), bradycardia, irregular resp= brain herniation leading to cardiac and resp arrest.

51
Q

Musculoskeletal Trauma
Complications of Crush Injuries:

When a person is caught between opposing forces (for example, you’re standing behind a car that backs up on you, trapping your lower extremities)

A

Hypovolemic shock
Paralysis of body part
Erythema and blistering
Damage to body part
Renal dysfunction

52
Q

Fractures

Disruption or break in continuity or structure of the bone

Some are “pathologic” in nature

2 Types

A
  1. Open (compound)
    Skin is broken and bone is exposed
  2. Closed (simple)
    Skin has not been ruptured and bone is not exposed
53
Q

Emergency Managementof Fractures

A

Treat life threatening injuries first

Ensure ABCs

Control external bleeding with:
–Direct pressure
–Sterile pressure dressing
–Elevation of extremity

Check neurovascular status distal to injury
–Elevate injury if possible

Apply ice packs to affected area

X-rays

Last tetanus?

54
Q

Traction

Skin Traction
Short term (____) treatment
Nothing ___ the skin

Skeletal traction
Longer periods…long term pull
Pin (Steinmann pin) or wire is inserted into the bone to align and immobilize the part

Traction helps prevent or reduce ____, ____, and ____, helps to ___ the fracture (restore a fx bone to its normal anatomical position).____

With skeletal traction: risk for infection at pin site(s) and pulleys must be able to move freely

A

48-72 hrs
penetrates

pain and muscle spasms, and immobilization

reduce

ORIF

55
Q

Complications of fractures

A

compartment syndrome
fat embolism
infection
venous thromboembolism

56
Q

Complications of fractures
Compartment Syndrome

-2 basic causes
-remember 6 P’s

-
-

Compartment syndrome usually involves the leg, but can occur in ___, ___, ___, & ____;

Causes:

If you can’t feel a pulse?

Worried about _____

Tx: if it’s the cast, remove, if no improvement, may need ____, cut through fascia so we can restore circulation, otherwise will lose extremity

UO: with muscle damage in crush injuries, myoglobin released can clog tubules in kidney and get ______

A

Causes: 1.) decreased compartment size (cast too soon, then edema, or drsg, burn around the leg, like a tourniquet)

2.) increased compartment contents(d/t edema, bleeding or both)

remember 6 P’s: pain (disproportionate to injury to passive motion, despite pain med administration), increasing pressure in the compartment, paresthesia (numbness, tingling), pallor, paralysis, pulseless (late sign, check cap refill) or diminished pulses

-emergency fasciotomy
-neurovascular assessments
-urine output

arm, shoulder, abdomen, and buttock

If you can’t feel a pulse?

Worried about rhabdomyolysis

fasciotomy,

acute tubular necrosis (ATN)

57
Q

Complications of fx
2. Fat Embolism Syndrome

Symptoms, if present,
typically occur 24 to 72 hours after the trauma;

Treatment

Esp. with long bone fx or pelvic fx or multiple fx. Fat emboli released from the bone marrow at the fracture site into the venous system
Petechial=_____
Similar to ARDS presentation

A

shortness of breath, confusion, and a transient petechial rash

Treatment
Reduce long bone fractures
Intravascular fluid resuscitation with fluids/albumin, may require intubation

coagulopathy

58
Q

Complications of fx cont.

  1. Infection
    Open fractures->
  2. Venous Thromboembolism
A

aggressive surgical debridement + antibiotic therapy + tetanus & diphtheria prophylaxis

59
Q

Environmental Emergencies

Management of the Patient With Poisoning

Treatment goals:
Remove or inactivate the poison before it is absorbed
Provide supportive care in maintaining vital organs systems
Administer specific antidotes
Hasten the elimination of the poison

Poison Control Center

A
60
Q

Poisons

ABCs
Monitor VS, LOC, ECG, UO
Laboratory specimens
Determine:

Signs and symptoms of poisoning and tissue damage
Health history
Age and weight

A

what, when, and how much substance was ingested

61
Q

Management of the Patient with Ingested Poisons

-
-
-
-

A

Use of emetics* (do not induce vomiting with corrosive agents)
Gastric lavage
Activated charcoal
Administration of specific antagonist as early as possible (i.e what for acetaminophen OD?) Acetylcysteine (NAC)
May include diuresis, dialysis

62
Q

Poisons

*Emetics (induce vomiting)not used as much anymore.

Gastric lavage if done within the ____; activated charcoal to help absorb poison and eliminate it from your body.

Corrosive going down, just as corrosive coming up

Possible psychiatric consultation if suicidal or self-harm attempt; accidental poison ingestion=>education on prevention & poison proofing instructions, esp. with children

A

first hour

63
Q

Snake Bite Treatment

S/sx of envenomation:

May progress without treatment

Tetanus, analgesia, possible fluid or vasopressors

Possible administration of antivenom (between ____)

DO NOT leave patient ____

A

edema, ecchymosis, hemorrhagic bullae–necrosis, lymph node tenderness, n/v, metallic taste in mouth

Lie down, remove constrictive items, clean and cover wound, immobilize the injured body part below the level of the heart; mark the area with pen to monitor progression

4-12 hrs

unattended- they can deteriorate very quickly

What don’t you do? Suck out venum, turnictae, ice

64
Q

Manifestations & treatment for spider bites

Black Widow
Bites feel like pinpricks
Systemic effects within 30 min:

TX:

Brown Recluse
Bites are painless
Systemic effects; within 24 to 72 hours,:

TX:

A

Black widow:
abd. rigidity, N/V, HTN, tachy, paresthesia’s
Severe pain

ice, elevation, last tetanus, analgesic, benzos, antivenom if necessary
Continuous monitoring!

Brown Recluse:
fever, chills, N/V, malaise, joint pain, reddish to purple in color site, necrosis

clean with soap and water, possible hyperbaric O2 or surgical debridement

65
Q

Tick Bites/Lyme disease

Occur in grassy or wooded areas

Pathogen (bacteriumBorrelia burgdorferi) transmitted by tick can cause: Rocky Mountain Spotted Fever, West Nile virus, Lyme disease

Steps to prevent Lyme disease:
using insect repellant, remove ticks promptly, avoid tick-infested areas, check for ticks on self and pets

A
66
Q

Stages of Lyme disease

diagnosis

A

Stage I
S/Sx: flulike, bull’s-eye rash (not always)
TX: antibiotics (10-21 days)

Stage II
S/Sx: facial nerve palsy, joint pain, memory loss, poor motor coordination, adenopathy, cardiac issues

Stage III
S/Sx: arthritis, neuropathy, myalgia and myocarditis

Progresses to stage 2 and 3 if not treated; even with treatment, 10-20% of patients experience long-term
effects (post treatment lyme disease syndrome)

Eliza test

Despite treatment, may progress to further stages

67
Q

If chest tube won’t stay inflated:

A

VATS procedure: video-assisted thoracic surgery

68
Q

Compartments =

A

can put pressure on diaphragm and lungs causing respiratory compromise

69
Q

irritable, difficulty concentrating, reading, math skills.

A

concussion syndrome

70
Q

Disoriented, then have a lucid interval

A

Epidural bleed

Module 3 (6 decks)

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