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Critical Care > Trauma > Flashcards

Trauma Flashcards

1
Q

provider ED safety

A

standard precautions at all times
-TB = negative pressure room

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2
Q

patient ED safety

A

ID bands and two identifiers
-maintain skin integrity –> elderly and spinal cord pt
-avoid medication error –> hx, belonging search, med-alert bracelets

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3
Q

triage

A

sorting of pts into priority levels based on injury or illness severity

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4
Q

emergent

A

life threatening…
1. respiratory distress
2. chest pain w/ diaphoresis
3. acute / active hemorrhage
4. unstable vitals
5. stroke

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5
Q

urgent

A

quick but not life threatening…
1. multiple fractures / displacement
2. severe abd pain
3. complex / multiple soft tissue injuries
4. new onset resp infection (pneuomia)
5. renal colic

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6
Q

nonurgent

A

could wait hours without deterioration….
1. skin rash
2. sprain / strain
3. cold
4. simple fracture

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7
Q

in a mass casualty….

A

triage the minimum / non-urgent but TREAT the red

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8
Q

mental illness ED safety

A
  1. belongings searched
  2. remove nonessential equipment –> tubes, cords, linens
  3. call light cords, oxygen tubes, sharps container
  4. decrease stimulation, reduce noise and harsh light
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9
Q

trauma

A

disease characterized by injury to the body caused by intentional or unintentional acute exposure to mechanical, thermal, electrical or chemical energy

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10
Q

intentional trauma

A

assault, homicides, suicide

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11
Q

unintentional trauma

A

accidents… leading cause of death from those under 35 years

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12
Q

level 1 trauma center

A

UAB…
-provide leadership and total care for every aspect of injury
-prevention through rehabilitation
-professional and community education, conduct research, participate in system planning

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13
Q

level 2 trauma centers

A

-provide to bast majority of injured pts
-may not be able to meet resource needs of pts w/ complex injuries
-role in injury management, education and prevention

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14
Q

level 3 trauma centers

A

-critical link to higher capability trauma centers
-primary focus is injury stabilization and pt transfer

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15
Q

level 4 trauma centers

A

-advanced life support care in rural or remote settings
-pts stabilized to best degree possible before transfer

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16
Q

trauma system critical elements

A
  1. access to care through communication (911)
  2. availability of prehospital emergency medical care
  3. rapid transport
  4. early provision of rehabilitation
  5. injury prevention, research, education
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17
Q

golden hour

A

first one hour of emergent care, rapid assessment / resuscitation / treatment of life threatening injuries

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18
Q

first peak of death

A

seconds to minutes of injury
-only trauma prevention will reduce deaths
ex: high spinal cord injury, exsanguination, apnea from severe head injury

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19
Q

second peak of death

A

minutes to several hours of injury
-subdural / epidural hematoma, hemopneumothorax, significant blood loss

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20
Q

third peak of death

A

days to weeks from initial injury
-result of sepsis, ARDS, and MODS

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21
Q

blunt trauma

A

results from impact forces
-tearing / shearing / compressing anatomic structures

ex: MVC, falls, assault w/ fist, kick, baseball bat, trauma to bones / blood vessel / soft tissue

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22
Q

penetrating trauma

A

caused by sharp objects / projectiles
-knives / ice picks
-bullets / pellets
-fragments of metal
-gunshots –> torso or stab wound to neck = trauma team

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23
Q

blast injury

A

blast effect from explosion causing both blunt and penetrating trauma

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24
Q

primary blast injury

A

shock wave from blast
-tympanic membrane ruptures
-lungs have contusion
-intraocular hemorrhage and intestinal rupture

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25
Q

secondary blast injury

A

shock wave causes debris to strike body causing penetrating injuries

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26
Q

tertiary blast inury

A

body is thrown by explosion, causes blunt tissue trauma including
-head injury
-fractures
-organ injury

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27
Q

quaternary blast injury

A

occurs from chemical, thermal, biological exposure

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28
Q

primary survey

A

most crucial assessment tool…
-identify life threatening injuries
-establish priority
-provide simultaneous interventions

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29
Q

systematic survey

A
  1. airway WITH c-spine
  2. breathing and ventilation
  3. circulation w/ hemorrhage control
  4. disability or neuro status
  5. exposure / environmental considerations

***ABCDE!!!

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30
Q

airway / cervical spine

A
  1. establish a patent survey - clear debris / suction, impaired consciousness = ET tube
  2. c-spine needs protection!!! need neutral in-line position, use jaw thrust maneuver
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31
Q

what us used when assessing the c-spine

A

jaw thrust maneuver!!!

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32
Q

breathing

A

determine if ventilatory efforts are effective
1. auscultate breath sounds
2. evaluate chest expansion and resp effort
3. apneic pts need BVM ventilation until ET tube and ventilator can be used

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33
Q

chest decompression

A

used mainly with clinical evidence of a tension pneumothorax

***use needle or chest tube to vent trapped air

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34
Q

tension pneumothorax s/s

A

-decreased / absent breath sounds over affected side
-resp distress
-hypotension
-JVD
-tracheal deviation!!! (late)

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35
Q

tension pneumothorax causes

A

barotrauma
blunt / penetrating chest trauma
expansion of simple pneumothorax

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36
Q

circulation threats

A
  1. cardiac arrest
  2. hemorrhage –> shock
    -leads to hypovolemic shock , hypotension is late sign
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37
Q

circulation intervention

A
  1. CPR
  2. hemorrhage control = firm direct pressure or tourniquet
  3. IV access = 18 G , central line , warm blood products
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38
Q

disability examination

A

AVPU
1. alert
2. responsive to voice
3. responsive to pain
4. unresponsive

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39
Q

GCS of 8….

A

INTUBATE

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40
Q

exposure

A

remove all clothing for thorough assessment
-CUT CLOTHING
-keep any evidence when necessary
-hypothermia risk for burns

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41
Q

preventing hypothermia

A
  1. remove wet clothing
  2. cover pts with blanket
  3. infuse WARM solutions
  4. increase room temp
  5. use heat lamps / warming blanket
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42
Q

primary survey treatment

A

-maintain airway
-effective ventilation
-control bleeding
-fluids = WARM
-3ml crystalloid solution for 1ml blood loss
-blood products

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43
Q

secondary survey

A

done after immediate threats are addressed
-head to toe assessment
-NG or OG tubes
-foley
-dx studies done

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44
Q

intra abd bleeding studies

A
  1. low H and H are LATE
  2. CT and FAST
  3. peritoneal lavage w/ unreliable exam or high risk for hollow viscus injury
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45
Q

peritoneal lavage

A

lacks organ specificity so not accurate dx test of intra abd bleeding

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46
Q

nose fracture

A
  1. maintain airway
  2. check for CSF leaks!!!
    -can check with dipstick for glucose
    -CSF is clear and will separate on gauze from blood
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47
Q

tension pneumothorax

A

air is forced into chest cavity causing collapse of affected lung

-compresses blood vessels inhibiting venous return… CAN BE FATAL

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48
Q

tension pneumothorax assessment

A
  1. asymmetry of thorax
  2. tracheal movement is towards unaffected side
  3. resp distress
  4. distended neck vein (JVD)
  5. cyanosis
  6. absence of breath sounds on one side
  7. hypertempanic sound over affected side
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49
Q

tension pneumothorax immediate intervention

A

large bore… 14G is inserted to 2nd intercostal space , midclavicular line

***air rush should come out confirming tension pneumothorax

50
Q

pulmonary contusion

A

most common cause of death following chest trauma –> ARDS or pneumonia

51
Q

pulmonary contusion ex….

A
  1. hemorrhage in alveoli
  2. edema reducing air exchange
  3. pt is hypoxic and dyspneic
  4. resp failure develops
52
Q

pulmonary contusion presentation

A

-bloody sputum
-decreased breath sounds
-crackles
-wheezes

53
Q

rib fractures

A

main focus is pain management so pt can maintain adequate ventilation

54
Q

tracheobronchial trauma

A

tears from severe blunt trauma or rapid deceleration

55
Q

tracheobrachial trauma tx

A

cricothyroidotomy or tracheotomy BELOW level of injury

56
Q

cardiac tamponade

A

bleeding into pericardial space , impairs ability of heart to pump

57
Q

cardiac tamponade s/s

A

reduced BP
muffled heart sounds
JVD

**beck’s triad

58
Q

cardiac tamponade tx

A

pericardial sac aspiration- 16 or 18 G needle

**CO will drastically improve

59
Q

aortic disruption

A

LIFE THREATENING
-blunt trauma can result in tearing of two outermost layers of aorta

60
Q

aortic disruption s/s

A

weak pulses
pain
dysphagia
dyspnea
hoarseness

**confirmed by aortogram

61
Q

neck trauma

A
  1. MAINTAIN AIRWAY
  2. assess carotid, esophagus, c-spine
  3. prevent excess neck movement!!!
62
Q

spinal cord injury

A
  1. IMMOBILIZE
  2. x-ray , maybe CT
  3. cervical collar or halo traction
  4. tx for neurogenic shock - vasopressor / atropine
  5. continuous assessment
63
Q

primary head injury

A

occurs from blunt / penetrating trauma
-raccoon eyes to CRIBIFORM PLATE

64
Q

secondary head injury

A

systemic effects of primary head injury…
-edema
-increased ICP
-seizures
-vasospasm
-hypotension
-hypoxia
-infection

65
Q

head injury interventions

A
  1. monitor intracranial pressure
  2. maintain MAP > 50 mmHg
  3. sedatives to reduce agitation
  4. osmotic diuretics / loop
66
Q

hyphema

A

hemorrhage in anterior chamber of eye, blood particles obstruct meshwork –> increased intraocular pressure

67
Q

hyphema tx

A

bedrest - semi fowler’s position

**keep hyphema away from center of cornea!!

68
Q

contusion (black eye)

A

caused by trauma w/ blunt object

69
Q

contusion tx

A

apply ice immediately!!!!
thorough eye exam

70
Q

foreign bodies

A

particles contact conjunctiva / cornea and irritate or abrade surface

71
Q

foreign bodies tx

A
  1. examine with Fluorescein
  2. IRRIGATE with NS (0.9%)
72
Q

eye laceration

A

corneal laceration is an EMERGENCY b/c eye contents can prolapse

**only opthalmologist removes object

73
Q

eye penetrating object

A

poor chance of retaining vision…

MRI IS CONTRAINDICATED, may move any metal particles causing more damage

74
Q

ear trauma

A

blunt and blast trauma damage external / middle / inner ear structure

75
Q

abdominal trauma

A

liver is most commonly injured
pain is a classic sign
dx by exams / CT / FAST

76
Q

abdominal trauma labs

A

-liver fxn
-renal and blood studies
-serial H and H

77
Q

liver trauma

A

-assess abd tenderness : R upper quadrant
-abd distention / rigidity
-increased abd pain with deep breathing

78
Q

abdominal hemorrhage / hypovolemic shock

A

-hypotension
-tachycardia
-tachypnea
-diaphoresis, cool , clammy
-confusion, change in mental status

79
Q

liver trauma interventions

A

close monitoring
bed rest for 5 days!!!
surgery is DANGEROUS just wait if stable

80
Q

spleen trauma

A

-assess abd tenderness : L upper quadrant
-referred pain to L shoulder
-abd distention and rigidity
-guarding the abd

81
Q

spleen trauma interventions

A

same as liver…
-if spleen removed HIGH RISK of infection!!!

82
Q

what does a spleen removal pt get….

A

pneumonia vaccine within first few days postop

83
Q

musculoskeletal trauma

A

rarely a priority in emergent situation EXCEPT…
-unstable PELVIC FRACTURES and FEMUR fractures

84
Q

musculoskeletal trauma tx

A

-closed reduction : setting without surgery
-open reduction : setting with surgery
-traction
-splinting
-wound care

85
Q

musculoskeletal trauma meds

A

-tetanus if open injury and unknown status
-antibiotics especially with open injury

86
Q

compartment syndrome s/s

A
  1. parasthesia
  2. pain out of proportion
  3. paralysis
  4. pallor
  5. pulselessness
  6. pressure

**first 2 are key!!!

87
Q

rhabdomyolysis

A

skeletal muscles are damaged and release myoglobin

-crush injury
-exercise
-dehydration
-overuse of alcohol and drugs

88
Q

rhabdomyolysis s/s

A
  1. dark colored urine
  2. muscle pain
  3. muscle weakness
  4. muscle swelling
  5. back pain–> kidneys
89
Q

rhabdomyolysis management

A
  1. FLUIDS - need 100-200 mL urine / hr
  2. sodium bicarb and osmotic diuretics to protect kidney
90
Q

fat embolism

A

occurs from fracture of long bone and pelvis
**develops 24-48 hrs post injury

91
Q

fat embolism s/s

A

low grade fever
tachycardia
dyspnea
increased RR
hypoxemia
petechial rash

92
Q

fat embolism management

A
  1. PREVENT = stabilize fracture
  2. supplemental O2
93
Q

ARDS

A

occurs 2-48 hrs post injury

94
Q

pediatric trauma

A

-do not take into account risks and have feeling of immortality
-children are more resilient
-bones are more flexible

95
Q

intentional children trauma

A

-majority of fractures in < 3 yrs is abuse
-5 B’s in the bathroom….
1. bumps
2. breaks
3. burns
4. bruises
5. accidents

96
Q

pediatric injury prevention

A

-restraints / car seats
-poison control
-safety latch
-drowning prevention
-helmets
-water safety

97
Q

hypothermia - elderly

A

-have decrease body temperature regulation
-unable to communicate / move to warmer location

98
Q

hypothermia very young

A

-lose heat rapidly
-loose heat through head
-lack of judgement with dress
-unable to generate heat

99
Q

hypothermia - mental illness

A

-diminished judgement (dementia pts will wander out)
-take meds that decrease ability to regulate temp (antidepressants , antipsychotics, sedative)

100
Q

hypothermia - alcohol

A

-false sense of warmth
-vasodilation of vessels = increase heat loss
-lack of judgment

101
Q

mild hypothermia

A

core temp 89.6 - 95

-shivering increases HR, BP, RR
-respiratory alkalosis
-peripheral vasocontriction
-cold diuresis
-mental status change

102
Q

moderate hypothermia

A

core temp 82.4 - 89.6

-aggressive shivering –> eventually stops
-mental status worsens –> coma
-dilated pupil
-cardiac irritability –> dysrhythmias, afib / vfib / vtach
-hypokalemia
-respiratory and lactic acidosis

103
Q

severe hypothermia

A

core temp < 82.4

-hypotension
-worsening cardiac irritability
-death

104
Q

hypothermia labs

A
  1. ABG - metabolic acidosis or resp alkalosis
  2. electrolytes
  3. glucose
  4. CBC - H and H
  5. Coag studies
105
Q

hypothermia assessment

A
  1. CORE TEMP- rectal / bladder temp
  2. pulse –> check for > 45 seconds
  3. neuro status
  4. O2 saturation
  5. BP
106
Q

hypothermia tx

A

-monitor airway and oxygenation
-cardiac monitor = myocardial excitability
-IV access

107
Q

rewarming methods

A
  1. remove from cold
  2. remove wet clothes
  3. dry pt
  4. warm blankets
  5. heat lamps
  6. forces warm air : bair hugger
  7. warmed O2 and IV fluid
  8. thoracic lavage
  9. ECMO
108
Q

hyperthermia

A

body temp > 103

**mortality is greatest for elderly with preexisting conditions

109
Q

hyperthermia risks

A
  1. less than 5 years
  2. greater than 65 years
  3. medications
  4. athletes in hot environments
  5. obese
110
Q

hyperthermia medications / drugs

A

-alcohol
-phenothiazines - affect hypothalamus

111
Q

heat stress

A

body cannot regulate temperature

112
Q

heat edema

A

swelling of feet, ankles, and hands r/t heat

113
Q

heat cramps

A

muscle cramps occurring from loss of fluid

**sodium / magnesium / calcium!!!

114
Q

heat syncope

A

standing still for long period in heat –> vasodilation for skin to cool and blood pools in legs

115
Q

heat exhaustion

A

strenuous activity in heat without replacing lost sodium and fluid

116
Q

heat exhaustion s/s

A

fatigue
weakness
dizziness
profuse sweating
slight confusion but not impairment
body temp > 100

117
Q

heat stroke

A

MEDICAL EMERGENCY - core temp > 104
without intervention organ damage and death occur!!!!

118
Q

heat stroke

A

-red / dry skin / no sweating!!!
-core temp > 104
-CNS change : confusion, irrational behavior, delirium, seizure, coma
-rhabdomylosis
-stroke
-multi-organ failure

119
Q

hyperthermia tx

A
  1. REMOVE FROM HEAT
  2. push fluids
  3. IV fluids if PO is not enough or cannot take
  4. active cooling
120
Q

active cooling

A
  1. sponge bath
  2. ice packs to groin and axilla
  3. cooling blanket / fan
  4. submerge in tepid water
121
Q

hyperthermia eduation

A

avoid exercising in heat of day
drink fluid during exercise
s/s

Critical Care (15 decks)

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