trauma Flashcards by Amanda S.

trauma

Injury caused by exposure to mechanical, thermal, electrical, or chemical energy.

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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.

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Three essential components of an injury are: (the pattern of a mechanic is force)

MECHANISM OF INJURY
FORCE OF INJURY
PATTERN OF INJURY

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MECHANISM OF INJURY

What causes the injury?
Mechanical, Thermal, Chemical, Electrical?
MVC
Fall
Fire
Gunshot

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FORCE OF INJURY

What is the force or amount of energy causing the injury?

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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.

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PATTERNS OF INJURY

Possible to anticipate a pattern of injury based on the mechanism and force of injury.

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Example of Pattern of Injury:
PEDESTRIAN VS AUTO (PVA)

Car backs up and hits pedestrian

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EXAMPLES OF INJURIES

MECHANISM
FORCE
PATTERN

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Mechanism (the mechanics of what)

GSW (gun shot wound)
Foreign object
SW (stab wound)

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Forces

Hand gun at close range
Knife Stab
Impaled with nail gun

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Pattern of Injury

Trajectory?

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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

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TRAUMA ASSESSMENT AND RESUSCITATION (the alphabet)

Rapid systematic approach to major trauma:
Primary Assessment (A – F)
Resuscitation
Secondary Assessment (G – H)

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A = AIRWAY

INCLUDES: C-SPINE PRECAUTIONS for Traumas

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AIRWAY PATENCY ?

Check head and neck position
Maintain airway with chin lift or jaw thrust
Consider airways, ET tubes, tracheotomy

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OXYGENATION

Give 100% O2 non-rebreather mask
Check O2 sats, ABG’s

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B = BREATHING -
ASSESS FOR 5 LIFE-THREATENING CHEST INJURIES (5 thoraxes)

Tension Pneumothorax
Open Pneumothorax
Massive Hemothorax
Flail chest
Pericardial Tamponade

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TENSION PNEUMOTHORAX

Air enters pleural space and can’t escape.
Intrathoracic pressure ↑’s and the lung collapses.

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open pneumothorax - where is the air?

Air enters pleural space and can escape Sucking Chest Wound 

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open pneumothorax treatment

3 sided vented dressing to prevent Tension Pneumo
chest tube insertion w/ suction

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open pneumothorax - do NOT

Do Not remove
objects impaled in chest w/o MD

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MASSIVE HEMOTHORAX - what amount?

> 1500 ml blood

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FLAIL CHEST

DX
Fx of 2 or more adjacent ribs

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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

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

trauma Flashcards

(65 cards)