Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NSB236 > Trauma > Flashcards

Trauma Flashcards

1
Q

what is Kinematics and mechanisms of injury?

A

Multiple energy forces associated with trauma – acceleration, deceleration, compression and shearing
* Individual responses to trauma and influenced by:
* Multi morbidities – diabetes, epilepsy, substance misuse, cardiovascular disease, peripheral vascular disease
* Pregnancy
* Alcohol and/or drug misuse
* Age – younger and older age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what are Types of trauma?

A

Non-penetrating (blunt force)
* Penetrating
* Low velocity * High velocity
* Thermal – burns
* Other – electrical, poisoning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Thoracic injuries cause?

A

Seatbelt injury
* Crush injury; e.g. farming accidents * Penetrating injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

areas that are impacted during thoracic injury.?

A
  • Heart
  • Lungs
  • Great vessels * airway
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what are Thoracic Assessment ?

A

. Inspection
. Auscultation Percussion
. Palpation (Be Gentle!!!) X-Ray
. Ultrasound
. Computed Tomography (CT)
Magnetic Resonance Imaging (MRI)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is Pneumo/haemothorax

A

Pneumo/haemothorax
* Airand/orbloodinthepleuralspace
* Preventsfullexpansionofthelung,decreasingfunctionalareaforgasexchange
* Tensionpneumothorax=one-wayvalveeffect.Aircanenterthepleuralspacebutcannotescape.This increases thoracic pressure and compresses the heart, lungs and great vessels. A life-threatening emergency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what is Intercostal catheter (ICC) and underwater sealed drainage (UWSD) ?

A

Allows air and fluid to drain ‘escape’ from the pleural space
* The water trap acts as a one-way valve
* Air can escape from the pleural space but is not able to re-enter (opposite principal to a tension pneumothorax)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

ICC and UWSD nursing assessment?

A

Monitor ICC tubing and drainage for the following:
* Swinging – Swinging of fluid in the ICC tubing from side-to-side. Demonstrates a change in intrathoracic pressure; i.e. the lung is expanding and contracting
* Bubbling – Escape of air from the pleural space is still occurring
* Draining – Fluid (normally blood) is draining from the pleural space

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

ICC and UWSD RN responsibilities ?

A
  • Ensure ICC tubing is secure and maintain a dressing that provides an airtight seal at the insertion site
  • Keep UWSD upright and below the level of the chest at all times
  • Monitor UWSD for large or sudden increases in drainage
  • Ensure ‘swing’ does not increase rapidly
  • Maintain patient comfort and education
  • Documentation of ICC drain observations and patient’s response to treatment
    CRICOS No.00213J
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is Intra abdominal trauma ?

A

Aetiology:
* Seatbelt injuries
* Rapid deceleration * Crush injuries
* Penetrating trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Intra abdominal trauma issues

A

Intra abdominal sepsis
* Damage to the great vessels
* Abdominal aorta
* Femoral vessels
* Retroperitoneal haematoma * Pelvic fractures
* Renal, spleen, liver injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Intra abdominal assessment ?

A

INSPECTION
AUSCULTATION
PERCUSSION
COMPUTED TOMOGRAPHY (CT)
PALPATION
MAGNETIC RESONANCE IMAGING (MRI)
X-RAY ULTRASOUND – FAST SCAN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what is Functional assessment sonography in
trauma (FAST) ?

A

Rapid, non-invasive sonograph to detect intra abdominal or pericardial free fluid
* Deemed positive or negative results
* Positive scan would normally proceed to surgery
* Negative scan does NOT exclude intra abdominal injury and further assessment may be required
* Abdominal injury likely to require surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is Orthopaedic trauma ?

A

Varying degrees of severity and type – open fractures, comminuted and greenstick
* Fracture of ‘long bone’ – femur and pelvis can lead to significant blood loss from the bone and surrounding vasculature
* Bone injury can cause further damage to surrounding nerves and musculoskeletal tissue upon movement
* Fat emboli is a potential complication in large orthopaedic injuries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what is a Rib fractures and flail chest ?

A

Rib fractures are dangerous and can penetrate the pleura, lung, myocardium
* VERY painful
* May significantly impair normal respiratory functioning and airway clearance
* Flail chest results from segmental fracture of 2 or more ribs in 2 or more places
* Theseribsnolongermovewiththenormal chest wall expansion; they are ‘free floating’

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what is a Pelvic fractures ?

A

Requires a significant degree of force, particularly in younger people
* Mortality increase associated with pelvic fractures
* Potential for significant blood loss and damage of surrounding tissues and vasculature – hypovolaemic shock
* Close haemodynamic monitoring and staibilisation (ex-fixators) required
* NO movement if pelvic fracture is unstable

17
Q

what is the Stages of bone repair ?

A

Stage1(Haematomaforms)48–72hours
* StageII(Granulation)1–4weeks
* StageIII(Callusformation)2–6weeks
* StageIV(Ossification)3weeks–6months * StageVRemodelling)6weeks–1year

18
Q

Who are the multidisciplinary trauma healthcare team?

A

Emergency department – nurses, doctors, radiography
* Trauma nursing and medical teams
* Radiology
* Pathology
* Physiotherapist
* Social worker
* Mental health team
* Occupational therapist

19
Q

what is Complications post traumatic injury?

A

Traumatic shock – hypovolaemic, obstructive, distributive, neurogenic, cardiogenic, septic
* Multiple organ dysfunction
* Critical bleeding, trauma-induced coagulopathy
* Hypermetabolism, hyperglycaemia
* Compartment syndrome
* Malnutrition
* Infection
* Delayed wound healing
* Pain, anxiety, delirium, sleep disturbance,
PTSD

20
Q

what is Compartment syndrome ?

A

swelling and increased pressure within a limited space press on and compromise the function of blood vessel, nerves and tendon that run through compartment.

21
Q

what is Massive haemorrhage ?

A

Critical bleeding – bleeding that may result in significant morbidity and mortality
* Major haemorrhage – life-threatening, result in massive transfusion
* Smaller volume haemorrhage in critical organ – intracranial, intraspinal, intraocular,
and results in increased morbidity and mortality
* Massive transfusion – the volume of blood lost or volume transfused
* Approx. 7% body weight in adults over 24 hours or 10 units PRBCs
* Replacement of half blood volume within 4 hours or blood loss ≥150 mL/min * Approx. 70 mL/kg blood loss

22
Q

Massive haemorrhage assessment ?

A

Starts with early recognition of blood loss, rapid source control and restoration of circulating blood volume
* Initial assessment includes: * History
* Systolic blood pressure (SBP), heart rate, pulse pressure, peripheral perfusion * Mental status
* Respiratory rate
* Urine output
* Haemoglobin, haematocrit, coagulation status acid-base status * Temperature

23
Q

Massive haemorrhage intervention

A

Consider appropriateness of permissive hypotension (SBP 80-100 mmHg as tolerated) and minimal volume resuscitation
* Product replacement regimen – 4 units PRBC and 2 units FFPà1 adult dose platelets and tranexamic acid (trauma patients)àcryoprecipitate if fibrinogen <1 g/L
* Goals:
* Optimise oxygenation, cardiac output, tissue perfusion, metabolic state
* Monitor every 30-60 minutes full blood count, coagulation screen, ionised calcium, arterial
blood gases
* Aim for temperature >35°C, pH >7.2, base excess <6, lactate <4 mmol/L, Ca2+ >1.1 mmol/L, platelets > 50 x 109/L, PT/APTT <1.5 times normal, INR ≤1.5, fibrinogen >1.0 g/L

24
Q

Psychological care of the trauma patient

A

Lifestyle choices might increase risk, however no one is immune to trauma
* Lives are irreparably change in an instant
* Be prepared for emotional patients and families
* We must tell the truth impartially – never guess, never make promises
* We can only talk about the current clinical situation and our professional recommendations for the patient and their loved ones

25
Q

Trauma management summary

A

Timely assessment of injury and effectiveness of treatment is key to good outcomes
* Remember ABC – implementation is based around this…ALWAYS
* Impaired circulation might impair oxygenation and perfusion – check ABC
* Trauma is TRAUMATIC for all involved – including healthcare staff. Talk to people about what you see if it bothers you
* It is OK to seek professional help
* Be an advocate – drug use, alcohol and violence can be prevented, let people know – it may save a lif

26
Q

what is mono-kelie

A

The Monro-Kellie hypothesis refers to the relationship between the
blood, cerebrospinal fluid and brain tissue. Changes in one volume
need to be offset by changes in the other two volumes to maintain a
stable pressure.

27
Q

what is Cerebral Perfusion Pressure (CPP) ?

A

CPP is the Pressure required for perfusion to take place across the vessels in the brain
Vasoconstriction in cerebral blood vessels allows the brain to maintain consistent perfusion pressure
CPP is dependent upon 2 things Mean Arterial Pressure (MAP) and ICP

28
Q

how to Maintain CPP

A

CPP physiologically needs to be >60 mmHg to maintain cerebral perfusion
* CPP <60 mmHg results in hypoxia and neuronal death
* We can do 2 things to maintain CPP if ICP is increasing:
* Increase the mean arterial pressure(MAP)– temporary fix only
* Decrease the ICP

29
Q

what are Signs and symptoms of elevated ICP

A

Decreased level of consciousness (LOC) * Headache
* Vomiting
* Pupillary abnormalities
* Visual disturbance
* Motor dysfunction
* Speech disturbances * Changes in vital signs

30
Q

what is Traumatic brain injury (TBI)

A

Classical coup-contracoup injuries
* TBI defined as traumatic injury to the brain and presents with a GCS <8
* May be closed (MVA) or penetrating (gunshot wound)
* Skull fracture may or may not be present

31
Q

what is Diffuse axonal injury (DIA)?

A
  • Diffuse axonal injury (DAI) is widespread axonal damage occurring after a mild, moderate or severe TBI. The damage occurs primarily around axons in the subcortical white matter of the cerebral hemispheres, the basal ganglia, the thalamus and the brainstem.
32
Q

what is Cushing’s triad

A

Cluster of symptoms which reveal impending brain herniation
* Herniation occurs when cerebellum is forced through the foramen magnum (top of spinal column) due to increasing ICP
* Cushing’s triad presents as: * Hypertension
* Bradycardia
* Decreasedrespiratoryeffort

33
Q

Controlling ICP

A

Interventions:
* Reduce noise and clinical interactions
* Cluster cares
* Limit bedside conversation
* Educate and support family
* Might involve administration of sedation & analgesia medications if in ICU – consider the haemodynamic effects of this. Changes in sedation & analgesia should be assessed against a validated assessment scale

34
Q

CSF drainage

A

Device used to drain CSF is called an external ventricular drain (EVD)
* Allows us to monitor ICP & drain CSF (remember the Munroe Kellie hypothesis)
* Able to monitor CSF & its contents, e.g. blood
* Allows very precise & simple control of ICP (just turn the tap)
* Needs to be well monitored, no more than 20 mL/hr drainage & a huge potential source for infection
* Accessed only under sterile precautions

35
Q

external fixation of Pelvis and humerus

A

NSB236 (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions