Trauma Flashcards
what is Kinematics and mechanisms of injury?
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
what are Types of trauma?
Non-penetrating (blunt force)
* Penetrating
* Low velocity * High velocity
* Thermal – burns
* Other – electrical, poisoning
Thoracic injuries cause?
Seatbelt injury
* Crush injury; e.g. farming accidents * Penetrating injury
areas that are impacted during thoracic injury.?
- Heart
- Lungs
- Great vessels * airway
what are Thoracic Assessment ?
. Inspection
. Auscultation Percussion
. Palpation (Be Gentle!!!) X-Ray
. Ultrasound
. Computed Tomography (CT)
Magnetic Resonance Imaging (MRI)
what is Pneumo/haemothorax
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
what is Intercostal catheter (ICC) and underwater sealed drainage (UWSD) ?
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)
ICC and UWSD nursing assessment?
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
ICC and UWSD RN responsibilities ?
- 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
what is Intra abdominal trauma ?
Aetiology:
* Seatbelt injuries
* Rapid deceleration * Crush injuries
* Penetrating trauma
Intra abdominal trauma issues
Intra abdominal sepsis
* Damage to the great vessels
* Abdominal aorta
* Femoral vessels
* Retroperitoneal haematoma * Pelvic fractures
* Renal, spleen, liver injury
Intra abdominal assessment ?
INSPECTION
AUSCULTATION
PERCUSSION
COMPUTED TOMOGRAPHY (CT)
PALPATION
MAGNETIC RESONANCE IMAGING (MRI)
X-RAY ULTRASOUND – FAST SCAN
what is Functional assessment sonography in
trauma (FAST) ?
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
what is Orthopaedic trauma ?
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
what is a Rib fractures and flail chest ?
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’
what is a Pelvic fractures ?
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
what is the Stages of bone repair ?
Stage1(Haematomaforms)48–72hours
* StageII(Granulation)1–4weeks
* StageIII(Callusformation)2–6weeks
* StageIV(Ossification)3weeks–6months * StageVRemodelling)6weeks–1year
Who are the multidisciplinary trauma healthcare team?
Emergency department – nurses, doctors, radiography
* Trauma nursing and medical teams
* Radiology
* Pathology
* Physiotherapist
* Social worker
* Mental health team
* Occupational therapist
what is Complications post traumatic injury?
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
what is Compartment syndrome ?
swelling and increased pressure within a limited space press on and compromise the function of blood vessel, nerves and tendon that run through compartment.
what is Massive haemorrhage ?
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
Massive haemorrhage assessment ?
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
Massive haemorrhage intervention
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
Psychological care of the trauma patient
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
