Trauma Flashcards
provider ED safety
standard precautions at all times
-TB = negative pressure room
patient ED safety
ID bands and two identifiers
-maintain skin integrity –> elderly and spinal cord pt
-avoid medication error –> hx, belonging search, med-alert bracelets
triage
sorting of pts into priority levels based on injury or illness severity
emergent
life threatening…
1. respiratory distress
2. chest pain w/ diaphoresis
3. acute / active hemorrhage
4. unstable vitals
5. stroke
urgent
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
nonurgent
could wait hours without deterioration….
1. skin rash
2. sprain / strain
3. cold
4. simple fracture
in a mass casualty….
triage the minimum / non-urgent but TREAT the red
mental illness ED safety
- belongings searched
- remove nonessential equipment –> tubes, cords, linens
- call light cords, oxygen tubes, sharps container
- decrease stimulation, reduce noise and harsh light
trauma
disease characterized by injury to the body caused by intentional or unintentional acute exposure to mechanical, thermal, electrical or chemical energy
intentional trauma
assault, homicides, suicide
unintentional trauma
accidents… leading cause of death from those under 35 years
level 1 trauma center
UAB…
-provide leadership and total care for every aspect of injury
-prevention through rehabilitation
-professional and community education, conduct research, participate in system planning
level 2 trauma centers
-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
level 3 trauma centers
-critical link to higher capability trauma centers
-primary focus is injury stabilization and pt transfer
level 4 trauma centers
-advanced life support care in rural or remote settings
-pts stabilized to best degree possible before transfer
trauma system critical elements
- access to care through communication (911)
- availability of prehospital emergency medical care
- rapid transport
- early provision of rehabilitation
- injury prevention, research, education
golden hour
first one hour of emergent care, rapid assessment / resuscitation / treatment of life threatening injuries
first peak of death
seconds to minutes of injury
-only trauma prevention will reduce deaths
ex: high spinal cord injury, exsanguination, apnea from severe head injury
second peak of death
minutes to several hours of injury
-subdural / epidural hematoma, hemopneumothorax, significant blood loss
third peak of death
days to weeks from initial injury
-result of sepsis, ARDS, and MODS
blunt trauma
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
penetrating trauma
caused by sharp objects / projectiles
-knives / ice picks
-bullets / pellets
-fragments of metal
-gunshots –> torso or stab wound to neck = trauma team
blast injury
blast effect from explosion causing both blunt and penetrating trauma
primary blast injury
shock wave from blast
-tympanic membrane ruptures
-lungs have contusion
-intraocular hemorrhage and intestinal rupture
secondary blast injury
shock wave causes debris to strike body causing penetrating injuries
tertiary blast inury
body is thrown by explosion, causes blunt tissue trauma including
-head injury
-fractures
-organ injury
quaternary blast injury
occurs from chemical, thermal, biological exposure
primary survey
most crucial assessment tool…
-identify life threatening injuries
-establish priority
-provide simultaneous interventions
systematic survey
- airway WITH c-spine
- breathing and ventilation
- circulation w/ hemorrhage control
- disability or neuro status
- exposure / environmental considerations
***ABCDE!!!
airway / cervical spine
- establish a patent survey - clear debris / suction, impaired consciousness = ET tube
- c-spine needs protection!!! need neutral in-line position, use jaw thrust maneuver
what us used when assessing the c-spine
jaw thrust maneuver!!!
breathing
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
chest decompression
used mainly with clinical evidence of a tension pneumothorax
***use needle or chest tube to vent trapped air
tension pneumothorax s/s
-decreased / absent breath sounds over affected side
-resp distress
-hypotension
-JVD
-tracheal deviation!!! (late)
tension pneumothorax causes
barotrauma
blunt / penetrating chest trauma
expansion of simple pneumothorax
circulation threats
- cardiac arrest
- hemorrhage –> shock
-leads to hypovolemic shock , hypotension is late sign
circulation intervention
- CPR
- hemorrhage control = firm direct pressure or tourniquet
- IV access = 18 G , central line , warm blood products
disability examination
AVPU
1. alert
2. responsive to voice
3. responsive to pain
4. unresponsive
GCS of 8….
INTUBATE
exposure
remove all clothing for thorough assessment
-CUT CLOTHING
-keep any evidence when necessary
-hypothermia risk for burns
preventing hypothermia
- remove wet clothing
- cover pts with blanket
- infuse WARM solutions
- increase room temp
- use heat lamps / warming blanket
primary survey treatment
-maintain airway
-effective ventilation
-control bleeding
-fluids = WARM
-3ml crystalloid solution for 1ml blood loss
-blood products
secondary survey
done after immediate threats are addressed
-head to toe assessment
-NG or OG tubes
-foley
-dx studies done
intra abd bleeding studies
- low H and H are LATE
- CT and FAST
- peritoneal lavage w/ unreliable exam or high risk for hollow viscus injury
peritoneal lavage
lacks organ specificity so not accurate dx test of intra abd bleeding
nose fracture
- maintain airway
- check for CSF leaks!!!
-can check with dipstick for glucose
-CSF is clear and will separate on gauze from blood
tension pneumothorax
air is forced into chest cavity causing collapse of affected lung
-compresses blood vessels inhibiting venous return… CAN BE FATAL
tension pneumothorax assessment
- asymmetry of thorax
- tracheal movement is towards unaffected side
- resp distress
- distended neck vein (JVD)
- cyanosis
- absence of breath sounds on one side
- hypertempanic sound over affected side
tension pneumothorax immediate intervention
large bore… 14G is inserted to 2nd intercostal space , midclavicular line
***air rush should come out confirming tension pneumothorax
pulmonary contusion
most common cause of death following chest trauma –> ARDS or pneumonia
pulmonary contusion ex….
- hemorrhage in alveoli
- edema reducing air exchange
- pt is hypoxic and dyspneic
- resp failure develops
pulmonary contusion presentation
-bloody sputum
-decreased breath sounds
-crackles
-wheezes
rib fractures
main focus is pain management so pt can maintain adequate ventilation
tracheobronchial trauma
tears from severe blunt trauma or rapid deceleration
tracheobrachial trauma tx
cricothyroidotomy or tracheotomy BELOW level of injury
cardiac tamponade
bleeding into pericardial space , impairs ability of heart to pump
cardiac tamponade s/s
reduced BP
muffled heart sounds
JVD
**beck’s triad
cardiac tamponade tx
pericardial sac aspiration- 16 or 18 G needle
**CO will drastically improve
aortic disruption
LIFE THREATENING
-blunt trauma can result in tearing of two outermost layers of aorta
aortic disruption s/s
weak pulses
pain
dysphagia
dyspnea
hoarseness
**confirmed by aortogram
neck trauma
- MAINTAIN AIRWAY
- assess carotid, esophagus, c-spine
- prevent excess neck movement!!!
spinal cord injury
- IMMOBILIZE
- x-ray , maybe CT
- cervical collar or halo traction
- tx for neurogenic shock - vasopressor / atropine
- continuous assessment
primary head injury
occurs from blunt / penetrating trauma
-raccoon eyes to CRIBIFORM PLATE
secondary head injury
systemic effects of primary head injury…
-edema
-increased ICP
-seizures
-vasospasm
-hypotension
-hypoxia
-infection
head injury interventions
- monitor intracranial pressure
- maintain MAP > 50 mmHg
- sedatives to reduce agitation
- osmotic diuretics / loop
hyphema
hemorrhage in anterior chamber of eye, blood particles obstruct meshwork –> increased intraocular pressure
hyphema tx
bedrest - semi fowler’s position
**keep hyphema away from center of cornea!!
contusion (black eye)
caused by trauma w/ blunt object
contusion tx
apply ice immediately!!!!
thorough eye exam
foreign bodies
particles contact conjunctiva / cornea and irritate or abrade surface
foreign bodies tx
- examine with Fluorescein
- IRRIGATE with NS (0.9%)
eye laceration
corneal laceration is an EMERGENCY b/c eye contents can prolapse
**only opthalmologist removes object
eye penetrating object
poor chance of retaining vision…
MRI IS CONTRAINDICATED, may move any metal particles causing more damage
ear trauma
blunt and blast trauma damage external / middle / inner ear structure
abdominal trauma
liver is most commonly injured
pain is a classic sign
dx by exams / CT / FAST
abdominal trauma labs
-liver fxn
-renal and blood studies
-serial H and H
liver trauma
-assess abd tenderness : R upper quadrant
-abd distention / rigidity
-increased abd pain with deep breathing
abdominal hemorrhage / hypovolemic shock
-hypotension
-tachycardia
-tachypnea
-diaphoresis, cool , clammy
-confusion, change in mental status
liver trauma interventions
close monitoring
bed rest for 5 days!!!
surgery is DANGEROUS just wait if stable
spleen trauma
-assess abd tenderness : L upper quadrant
-referred pain to L shoulder
-abd distention and rigidity
-guarding the abd
spleen trauma interventions
same as liver…
-if spleen removed HIGH RISK of infection!!!
what does a spleen removal pt get….
pneumonia vaccine within first few days postop
musculoskeletal trauma
rarely a priority in emergent situation EXCEPT…
-unstable PELVIC FRACTURES and FEMUR fractures
musculoskeletal trauma tx
-closed reduction : setting without surgery
-open reduction : setting with surgery
-traction
-splinting
-wound care
musculoskeletal trauma meds
-tetanus if open injury and unknown status
-antibiotics especially with open injury
compartment syndrome s/s
- parasthesia
- pain out of proportion
- paralysis
- pallor
- pulselessness
- pressure
**first 2 are key!!!
rhabdomyolysis
skeletal muscles are damaged and release myoglobin
-crush injury
-exercise
-dehydration
-overuse of alcohol and drugs
rhabdomyolysis s/s
- dark colored urine
- muscle pain
- muscle weakness
- muscle swelling
- back pain–> kidneys
rhabdomyolysis management
- FLUIDS - need 100-200 mL urine / hr
- sodium bicarb and osmotic diuretics to protect kidney
fat embolism
occurs from fracture of long bone and pelvis
**develops 24-48 hrs post injury
fat embolism s/s
low grade fever
tachycardia
dyspnea
increased RR
hypoxemia
petechial rash
fat embolism management
- PREVENT = stabilize fracture
- supplemental O2
ARDS
occurs 2-48 hrs post injury
pediatric trauma
-do not take into account risks and have feeling of immortality
-children are more resilient
-bones are more flexible
intentional children trauma
-majority of fractures in < 3 yrs is abuse
-5 B’s in the bathroom….
1. bumps
2. breaks
3. burns
4. bruises
5. accidents
pediatric injury prevention
-restraints / car seats
-poison control
-safety latch
-drowning prevention
-helmets
-water safety
hypothermia - elderly
-have decrease body temperature regulation
-unable to communicate / move to warmer location
hypothermia very young
-lose heat rapidly
-loose heat through head
-lack of judgement with dress
-unable to generate heat
hypothermia - mental illness
-diminished judgement (dementia pts will wander out)
-take meds that decrease ability to regulate temp (antidepressants , antipsychotics, sedative)
hypothermia - alcohol
-false sense of warmth
-vasodilation of vessels = increase heat loss
-lack of judgment
mild hypothermia
core temp 89.6 - 95
-shivering increases HR, BP, RR
-respiratory alkalosis
-peripheral vasocontriction
-cold diuresis
-mental status change
moderate hypothermia
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
severe hypothermia
core temp < 82.4
-hypotension
-worsening cardiac irritability
-death
hypothermia labs
- ABG - metabolic acidosis or resp alkalosis
- electrolytes
- glucose
- CBC - H and H
- Coag studies
hypothermia assessment
- CORE TEMP- rectal / bladder temp
- pulse –> check for > 45 seconds
- neuro status
- O2 saturation
- BP
hypothermia tx
-monitor airway and oxygenation
-cardiac monitor = myocardial excitability
-IV access
rewarming methods
- remove from cold
- remove wet clothes
- dry pt
- warm blankets
- heat lamps
- forces warm air : bair hugger
- warmed O2 and IV fluid
- thoracic lavage
- ECMO
hyperthermia
body temp > 103
**mortality is greatest for elderly with preexisting conditions
hyperthermia risks
- less than 5 years
- greater than 65 years
- medications
- athletes in hot environments
- obese
hyperthermia medications / drugs
-alcohol
-phenothiazines - affect hypothalamus
heat stress
body cannot regulate temperature
heat edema
swelling of feet, ankles, and hands r/t heat
heat cramps
muscle cramps occurring from loss of fluid
**sodium / magnesium / calcium!!!
heat syncope
standing still for long period in heat –> vasodilation for skin to cool and blood pools in legs
heat exhaustion
strenuous activity in heat without replacing lost sodium and fluid
heat exhaustion s/s
fatigue
weakness
dizziness
profuse sweating
slight confusion but not impairment
body temp > 100
heat stroke
MEDICAL EMERGENCY - core temp > 104
without intervention organ damage and death occur!!!!
heat stroke
-red / dry skin / no sweating!!!
-core temp > 104
-CNS change : confusion, irrational behavior, delirium, seizure, coma
-rhabdomylosis
-stroke
-multi-organ failure
hyperthermia tx
- REMOVE FROM HEAT
- push fluids
- IV fluids if PO is not enough or cannot take
- active cooling
active cooling
- sponge bath
- ice packs to groin and axilla
- cooling blanket / fan
- submerge in tepid water
hyperthermia eduation
avoid exercising in heat of day
drink fluid during exercise
s/s
