Trauma Flashcards
What is primary prevention of trauma?
List some examples
Prevent the event
Ex: driving safety classes, speed limits
What is secondary prevention of trauma?
List some examples
Minimize the impact
Ex: seatbelts, helmets, airbags, car seats
What is tertiary prevention of trauma?
List some examples
Maximize outcomes through treatment strategies (take place in facility for trauma)
Ex: emergency response, medical care, rehab
What is major trauma defined as?
Multi-system
Needs immediate intervention to prevent loss of life or limb
Needs to be managed at trauma center
What is minor trauma defined as?
Single system injury
Doesn’t pose a threat to life or limb
Can be managed in local hospital
What are the differences between level I - level IV trauma care?
Level I: comprehensive trauma care, trauma specialists in house
Level II: supportive, receives trauma when level I is full
Level III: only immediate emergency care / stabilization, then transfer
Level IV: free standing ERs, resuscitate and transfer only
What is the purpose of trauma triage?
Determines need for level of hospital by sorting patients by severity of injury
What is the most critical part of disaster prepardeness?
Communication
What are the 4 categories of mass casualty triage during a disaster and what do they each stand for?
Red = emergent, life-threatening
Yellow = urgent, needs care within 1 hour
Green = pt can self treat and should go home
Black = dead/near death, not able to treat
What is the most crucial assessment tool in trauma care?
Primary survey
What is primary survey?
Assessment tool used in trauma care
Done in 1-2 mins
Designed to seek out life-threatening injuries
What are all aspects of the primary survey assessment?
A - airway patency (with c-spine immobile)
B - breathing effectiveness
C - circulation, including hemorrhage and pulses
D - obvious disabilities? Including neurological status
E - exposure / environment (contaminated? Etc.)
F - family present, full set of vitals
G - get equipment/labs
What is a secondary survey?
Head to toe assessment
Performed after life-threatening injuries are identified and treated
What are all aspects of the secondary survey assessment?
added onto head to toe assessment:
F - full set of vitals, foley, NGT, ECG, SpO2, lab, family presence
G - give comfort measures (start comfort care)
H - history, head-to-toe assessment
I - inspect posterior surfaces (look for wounds/exit points)
How should airway be managed?
Check for patency (tongue, facial fix, bleeding, vomiting, decreased sensorium)
Use oral or nasopharyngeal airways if needed (spontaneously breathing pts only)
Endotracheal intubation often needed
If unable to intubate = emergency cricothyrotomy
How can the cervical spine be protected during intubation procedures?
Stabilization
What type of shock do trauma patients need to be monitored for?
*Hypovolemic shock
Type of fluid needed for treatment of hypovolemic shock?
Crystalloids:
- NS is best choice b/c most like blood
- LR
How to monitor for shock in trauma patients
Ongoing assessment of:
Vital signs
Urine output
Mental status
Hemodynamic parameters
Treatment of hypovolemia
Stop bleeding (using pressure, elevate extremity)
Replace circulating blood volume:
- insert 2 large-bore IVs, CVC if possible, OI if needed
- administer crystalloids and blood products
How much fluid should be administered for hypovolemic shock?
1-2 L as rapidly as possible (3 mL per 1 mL loss)
How much blood given could cause complications of massive blood resuscitation?
> 10 units of PRBC in 24 hours
Possible complications of massive blood resuscitation
Volume overload —> third spacing
Organ dysfunction
Coagulopathies - clotting or bleeding
Hypothermia - need to rewarm slowly
Fluid-electrolyte imbalances
Acid-base abnormalities: metabolic acidosis
*What should be monitored to determine patient’s response to treatment?
UOP
LOC
HR
BP
Cap refill
(All s/s of poor perfusion)
Categories for how patients respond to treatment
Rapid responders - respond quickly and remain stable
Transient responders - respond quickly, deteriorate when IVF is low or pt still bleeding or surgery needed
Minimal or no responders - don’t respond or need emergent surgery to stop bleeding
Surgery to look inside of pt to determine where bleeding is coming from
Exploratory laparotomy
Symptoms of deterioration
Aka s/s of decreasing perfusion:
Falling hematocrit
Falling PaO2
Decreasing UOP
*Increased serum lactate levels
Most common damage with abdominal injuries
Liver damage
How are abdominal injuries diagnosed?
Diagnostic peritoneal lavage (DPL)
Ultrasounds
CT of abdomen
What is DPL?
Diagnostic peritoneal lavage
Needle inserted into abdomen, flushed with saline and pulled back out.
If frank bleeding, pt needs emergent laparotomy
What causes cardiac tamponade in trauma patients?
Bleeding into pericardial space as result of blunt or penetrating trauma to chest
S/S of cardiac tamponade
Beck’s triad: decreased BP, JVD, muffled heart sounds
(Impairs pumping ability of heard)
How is cardiac tamponade treated?
*Pericardiocentesis / surgery (pericardial window)
What is aortic disruption?
Life-threatening injury from blunt chest trauma, requiring emergency surgical intervention
What are the symptoms of aortic disruption?
Weak femoral pulses (b/c blood going into abd, not down legs)
Pain
Hoarseness
Dyspnea
Dysphagia
Diagnosis of aortic disruption
Chest x-ray shows widened mediastinum and Trachial deviation
Confirmed by aortogram
What makes a musculoskeletal injury unstable?
Pelvic fractures and femur fracture
Can result in a large amount of blood loss
What is compartment syndrome?
Condition where structure such as nerve or tendon is being confined within a space
First symptom of compartment syndrome
Severe pain unrelieved by narcotics
Treatment for compartment syndrome
Fasciotomy
Symptoms of a fat embolism
Decreased LOC
Fever
Tachycardia
New onset respiratory distress
Decreased BP
PO2 <60
Petechiae
*Treatment for fat embolism
Oxygen
Intubation
Ventilation
PEEP
*Prevention of fat embolism
Stabilization of fracture
Secondary complications of trauma
ARDS
DVT/PE
Infection
AKI
Altered nutrition
What is MODS?
Huge inflammatory response brought on by trauma
(1st thing that occurs is vasodilation from histamine)
Causes Multisystem organ failure
*Risks for MODS
Sepsis
Extensive trauma and tissue damage
Hypotension and hemorrhagic shock
Inadequate fluid resuscitation
Multiple transfusions
Prevention of MODS
Treating infections
Maintaining oxygenation
Nutritional support
What is damage control surgery?
Operative repair of life-threatening injuries
Intra-abdominal within 24-48 hrs
What is DIC?
Life-threatening disorder of coagulation
What occurs with DIC?
*Exaggerated clotting (liver releases too much clothing factors)
Depleted clotting factors (b/c all used up)
*Subsequent bleeding (from every orafice)
Causes of DIC
*Sepsis
Multitrauma
Burns
Infection
ARDS
Anoxia
Acidosis
*Symptoms of DIC
Occult bleeding (stool, emesis, urine)
Petechiae, ecchymoses
Overt oozing to massive hemorrhage
Decreased organ perfusion:
- change in LOC
- aural cyanosis (tips of fingers/toes fall off)
- infarction of digits/nose
- angina
- decreased UOP
*Lab findings that are only seen with DIC
Decreased antithrombin III
Increased FDP/FSP
Increased d-dimer
Treatment for DIC
1st: treat the underlying cause
2nd: control bleeding
3rd: stop abnormal coagulation
How is bleeding controlled with DIC?
1st: give platelets - highest priority
2nd: give FFP - provides all clotting factors
3rd: give cryoprecipitate - factor VIII pulled from donated blood
4th: packed RBCs
5th: vitamin k
How to stop abnormal coagulation
*Heparin (inhibits thrombin) low dose - *Lovenox
