trauma Flashcards
trauma
Injury caused by exposure to mechanical, thermal, electrical, or chemical energy.
TRAUMA INCIDENCE
Leading cause of death ages 1 to 44 y/o.
Males 2.5X’s more likely to have trauma
> 50% of trauma is related to alcohol use.
Three essential components of an injury are: (the pattern of a mechanic is force)
MECHANISM OF INJURY
FORCE OF INJURY
PATTERN OF INJURY
MECHANISM OF INJURY
What causes the injury?
Mechanical, Thermal, Chemical, Electrical?
MVC
Fall
Fire
Gunshot
FORCE OF INJURY
What is the force or amount of energy causing the injury?
EXAMPLE OF FORCE - don’t need to memorize this or calculate anything
150 pound person hits a brick wall traveling at 60 mph.
Newton’s 2nd Law of Motion
Body wt X mph = psi of impact.
150 lbs X 60 mph = 9000 pounds per square inch of force in a millisecond.
PATTERNS OF INJURY
Possible to anticipate a pattern of injury based on the mechanism and force of injury.
Example of Pattern of Injury:
PEDESTRIAN VS AUTO (PVA)
Car backs up and hits pedestrian
EXAMPLES OF INJURIES
MECHANISM
FORCE
PATTERN
Mechanism (the mechanics of what)
GSW (gun shot wound)
Foreign object
SW (stab wound)
Forces
Hand gun at close range
Knife Stab
Impaled with nail gun
Pattern of Injury
Trajectory?
DEGLOVING INJURY
Driver, Brake pedal injury.
Mech: Degloving injury from brake pedal MVC
Force: High speed MVC
Pattern: Foot with shearing injury from brake pedal
TRAUMA ASSESSMENT AND RESUSCITATION (the alphabet)
Rapid systematic approach to major trauma:
Primary Assessment (A – F)
Resuscitation
Secondary Assessment (G – H)
A = AIRWAY
INCLUDES: C-SPINE PRECAUTIONS for Traumas
AIRWAY PATENCY ?
Check head and neck position
Maintain airway with chin lift or jaw thrust
Consider airways, ET tubes, tracheotomy
OXYGENATION
Give 100% O2 non-rebreather mask
Check O2 sats, ABG’s
B = BREATHING -
ASSESS FOR 5 LIFE-THREATENING CHEST INJURIES (5 thoraxes)
Tension Pneumothorax
Open Pneumothorax
Massive Hemothorax
Flail chest
Pericardial Tamponade
TENSION PNEUMOTHORAX
Air enters pleural space and can’t escape.
Intrathoracic pressure ↑’s and the lung collapses.
open pneumothorax - where is the air?
Air enters pleural space and can escape Sucking Chest Wound
open pneumothorax treatment
3 sided vented dressing to prevent Tension Pneumo
chest tube insertion w/ suction
open pneumothorax - do NOT
Do Not remove
objects impaled in chest w/o MD
MASSIVE HEMOTHORAX - what amount?
> 1500 ml blood
FLAIL CHEST
DX
Fx of 2 or more adjacent ribs
Cardiac Tamponade
Accumulation of blood in the pericardial sac
Compresses heart preventing it from pumping effectively.
C – Assessment of Circulation
BP
Pulse
Cardiac: RRR (Reg Rate and Rhythm)
Skin Color
Cap Refill
Urinary Output
Hct
CVP (Central Venous Pressure Cath)
C = Circulation - For effective circulation you need (volume, rhythm, and tone)
Adequate Volume
Good Cardiac rhythm and function
Good vessel tone and function
C-Circulation Interventions (circulate the blood)
HOW MUCH BLOOD DO WE HAVE?
4-5 Liters (8 – 11 units) 450ml / unit of bld
IS THE PATIENT BLEEDING??
CONTROL BLEEDING:
Direct Pressure? – Surgery? (Internal bleeding)
Trauma pts at risk for hypovolemic shock
Monitor: BP, Pulse, cardiac monitor, Hct, cap refill
IV access: 2 + large-bore IV’s
Anti-arrhythmic meds if needed
Vaso-pressors (make sure pt is on fluids already)
If patient requires emergent blood
Give bolus warmed LR or NS and
Universal donor: Type 0 negative blood until Type and Cross matching blood.
D = DISABILITY: (AVPU)
(Quick Neuro eval)
D can also stand for defibrillate and differential diagnosis
A simple mnemonic is AVPU
A = Alert
V = Responds to verbal stimuli
P = Responds to painful stimuli
U = Unresponsive
GCS: Glascow Coma Scale
GLASCOW COMA SCALE (3 - 15 points) - don’t need to memorize these
BEST MOTOR RESPONSE POINTS
Obeys simple commands 6
Localizes noxious stimulus 5
Flexion withdrawal 4
Abnormal flexion (decorticate) 3
Abnormal extension (decerebrate) 2
No motor response 1
E = EXPOSE
ALL trauma pts…. Completely remove all clothes
SECONDARY ASSESSMENT
Completed only after all immediate life-threatening injuries are stabilized in ABCDE
Secondary Assessment:
FGH
F=Fahrenheit
Completely undress pt.
Keep warm w/ heated blankets, warm IV fluids.
Risk for hypothermia.
F can also mean
Fingers
Foley
Flip
G = Get Vital signs
VS, O2 sat, Cardiac monitor, labs, tests, NG, Xray, CT, FAST
H =
HISTORY AND HEAD TO TOE
HISTORY
MIVT (Mech of injury
suspected Injuries) Usually done by the paramedics
VS
Treatments
SAMPLE
Signs and Symptoms
Allergies
Meds
PMH
Last meal
Events preceding illness or injury.
head to toe
EARS: (ears battle)
Battle’s sign (bruising behind ear = possible basilar skull fx)
runny nose - CSF (Cerebral Spinal Fluid) otorrhea
Racoon eyes (periorbital and cheek ecchymosis
neck
MAINTAIN CERVICAL SPINE IMMOBILIZATION Cleared by Xray or palpation by MD or NP
EXTREMITIES:
Injuries, edema, skin temp…
CSM
Color, sensation, motion
5 P’s
pulses, parasthesias, paralysis, pain, pallor
Compartment Syndrome
ABDOMEN
Distention, pain, guarding, firmness?
Bowel sounds, bruits?
Most common organ injured in blunt trauma
spleen
Cullen’s sign
Ecchymosis around Umbilicus (Intra-Abd & Retroperitoneal Bleeds)
DIAGNOSTIC TESTS FOR ABDOMINAL TRAUMA - (abdominal trauma is FAST)
FAST (Focused Abdominal Sonogram for Trauma)
CT
DPL
BLUNT ABDOMINAL TRAUMA
DIAGNOSTIC TESTS
DPL
Diagnostic Peritoneal Lavage (not used now)
Check for bleeding from blunt trauma
IF SEVERE ABDOMINAL TRAUMA SUSPECTED (lap up the severe abdominal trauma)
Immediate Exploratory Laporatomy
Or
INTERVENTIONAL RADIOLOGY
Stable Abd Trauma
May go to interventional radiology
Or admit for observation
PVA
pedestrian v. auto
any fall greater than 25 ft
is a major trauma
gunshots
Mech: GSW (gunshot wound)
Force: Hi and Lo velocity
Pattern: Trajectory of bullet
Bullet wounds (Yaw’all is long)
Yaw = deviation of bullet on longitudinal axis. Larger trauma
Tumbling = somersaulting rotation of bullet. Larger trauma
B = BREATHING
Breathing? is breathing actually working for the pt?
Respirations effective?
ambu-bag or mechanical vent?
O2 Sat
ABG’s
Assess for 5 life threatening problems
Pneumothorax treatment
(pre-medicate if possible, it’s painful) Needle thoracentesis
Chest tube placement
look at slide
58
eyes
check for injuries, contacts
2nd most common injury
liver
Turner’s sign (Turn the kidney)
Ecchymosis on either flank (Retroperitoneal bleeding)
Seat Belt Sign
Eccyhmosis along seat belt distribution. Associated with blunt abd trauma
symptoms of a tension pneumothorax (tension in my JVD)
Dyspnea, tracheal deviation, ↑ JVD, ↓ BS (breath sounds)
open pneumothorax - s/sx (HR?)
Dyspnea, Tachypnea, Sucking chest wound
massive hemothorax - s/sx (percussion?)
SX: Dyspnea, ↓ breath sounds, dullness to percussion, shock
massive hemothorax - treatment
TX: Chest tube (question if too much blood is coming out, it’s not good)
Treat hypovolemia and control bleeding.
Thoracotomy and surgical intervention.
flail chest - s/sx
Dyspnea, CP (chest pain)
Paradoxical Breathing (chest moves in with inspiration and out with expiration)
flail chest - tx
Intubation
taping/splinting
O2 therapy, analgesics
cardiac tamponade - s/sx (tampon in jugular) and heart sounds?
Sx’s: muffled heart sounds, ↓ BP, ↑ JVD
cardiac tamponade - tx
Pericardiocentesis with surgical repair Stat
