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)
