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GMED5002 > Trauma > Flashcards

Trauma Flashcards

1
Q

Mechanisms of traumatic injury

A

Exchange of forces between environment & person
* Mechanical/kinetic (blunt or penetrating injury)
* Thermal (heat or cold)
* Chemical (acid or alkaline)
* Radiant
* Electrical
* Oxygen deprivation (smoke inhalation, drowning)

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2
Q

Aetiology of fractures

A

Direct force: trauma occurs in the region directly acted on by the force (fall, crush, impact) that leads to multple fractures, open injury, soft tissue damage, tendon contusion

Indirect force: trauma occurs in a region away from the direct force (transmitting or rotational force) e.g. compression fracture on T12 from falling n your hip
* fractures are usually oblique or compressive, tendon injury sprain

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3
Q

Types of skull fractures

A
  • Linear
  • Depressed
  • Diastatic
  • Basillar
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4
Q

Linear skull fracture

A
  • Most common
  • Linear fracture that doesnt involve bone movement
  • Usually no interventions
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5
Q

Depressed skull fractures

A
  • Part of the skull is sunken, with or without scalp damage
  • May require surgery to correct deformity
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6
Q

Diastatic skull fracture

A
  • Fracture along the suture lines - they become widened
  • More common in infants and newborns
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7
Q

Basilar skull fractures

A
  • FRacture of one of the bones of the base of the skull (occipital, temporal etc)
  • Most serious
  • Pt usually have eye bruises (racoon eyes), bruise behind ear, CSF from nose/ears
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8
Q

Le Fort I Maxillary fracture

A
  • Transverse fracture above the teeth (along the ‘mustache’)
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9
Q

Le Fort II maxillary fracture

A
  • Pyramid fracture (apex above the bridge of the nose)
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10
Q

Le Fort III maxillary fracture

A
  • complete craniofacial disruption, that involves fracture up to the infraorbital rims
  • Significant force (e.g. baseball bat)
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11
Q

Sternal fracture

A
  • Usually caused by deceleration injury or blunt chest trauma (MVA)
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12
Q

Rib fractures

A

Fracture to one or multiple ribs that can cause:
* Respiratory splinting (reduced inspiration due to pain, resulting in atelectasis & pneumonia)
* Flail chest
* Penetration (pneumothorax, hemothorax)

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13
Q

Flail chest

A
  • Atleast 2 fractures per rib in atleast 2 ribs, that creates free segments that is unable to control lung expansion
  • This section moves paradoxically to the rest of the chest
  • Lung expansion is compromised, causing SOB & pain, and may require ventilation if segments are large enough
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14
Q

Haemothorax

A
  • Blood in the pleural space from the chest wall, lung parenchyma, heart or great vessels
  • Usually due to blunt or penetrating trauma

On exam: absent breath sounds, dull percussion, haemodynamic instability
Treatment: chest tube/thoracostomy

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15
Q

Pneumothorax

A
  • Air or gas in the pleural cavity that leads to impaired oxygenation, ventillation and/or lung collapse
  • Caused by chest injury (trauma or medical procedures involving needles into the chest), ruptured air blisters that develop on top of the lung, mechanical ventilation (causes an air imbalance)
  • Increased risk in COPD, smoking, males, ventilation, history
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16
Q

Open pneumothorax

A
  • Large open chest wall defect that causes rapid equilibration of atmospheric and intrathoracic pressure that impairs oxygenation & ventilation

Treatment: three sided occlusive dressing (prevents tension pneumothorax), chest tube

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17
Q

Tension pneumothorax

A
  • Severe form of pneumothorax where the injured tissue forms a one-way valve allowing air inflow into pleual space with inhalation
  • The lung collapses, and the increasing pressure causes a mediastinum shift that compresses the other lung and venous return to the heart
  • Leads to hypoxia, reduced venous return & output, CV collapse and respiratory insufficiency

Resp symptoms: absent breath sounds, distended neck veins, tracheal shift
treatment: needle decompression, tube thoracostomy

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18
Q

Pulmonary contusion

A
  • Injury to lung parenchyma that causes oedema and blood collecting in alveolar spaces
  • This impairs gas exchange, decreased lung compliance and increased pulmonary resistance
  • Inflammatory reaction to blood in the lungs causes ARDS
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19
Q

Cardiac tamponade

A
  • When a buildup in the pericardial cavity (pericardial effusion - serous, blood, chylous) compresses on the heart and impairs functioning
  • This is due to trauma, inflammation, infection, autoimmune disorders
  • Reduced ventricular filling & cardiac output, and reduced systemic venous return due to right sided collapse

Becks triad: distended jugular veins, hypotension, muffled heart sounds
Treatment: pericardiocentesis, thoracotomy

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20
Q

Aortic disruption

A
  • Complete or incomplete transection of the aorta, usually due to deceleration, frontal or side impacts, falls
  • The proximal thoracic aorta is at greatest risk due to the highly mobile aortic arch moving against the fixed descening aorta, or due to compression with sternum or spine
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21
Q

Ruptured diaphragm

A
  • Injury by direct blow that increases intra-abnominal pressure or by rib laceration
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22
Q

Hepatic injury

A
  • Very prone to injury due to being large and fixed in position
  • Commonly injured and the most common cause of death in abdominal injury
  • Damage usually by blunt trauma, which can lacerate under pressure (within a capsule) or by hematoma
23
Q

Splenic injury

A
  • Relatively protected by the ribs but can be injured in rapid deceleration, blunt blow, penetration, or during emergency operations
24
Q

Pelvic fractures

A

Are relatively uncommon
* Stable: one break in pelvic ring, bones in place, little bleeding (heals several weeks after surgery)
* Unstable: two or more breaks, mod/sev bleeding (life threatening, organ damage, long rehab)

25
Q

Signs & symptoms

A

NB: dependent on type of injury
* Bleeding
* Pain
* Increased RR, shallow breathing, accessory muscles
* Low sats
* Low UO
* Skin: cool, pale, clammy, low turgor
* Hypotension
* Tachy, thread pulse
* Low GCS, anxious
* arrhythmias
* HTN to pain

26
Q

Trauma assessment steps

A
  • Prep: team assembly, equipment check
  • Triage: sort by acuity
  • Primary survey: quickly identify life threatening injuries & treat
  • Secondary survey: full history & physical exam
  • Monitor & evaluate
  • Transfer (ICU, ward, OT)
27
Q

Airway

A
  • Airway patency (obstructed by injury, oedema, secretions or unable to keep open due to low consciousness)
  • NB noisy respirations, hoarse voice = upper airway injury

Interventions
* Suction
* Chin lift/jaw thrust
* NP airway
* Oxygen (NRBM), bag valve, ETT, emergency cricothyrotomy (immediate airway access, avoid vocal cords & thyroid)

28
Q

C-Spine immobilisation

A

Keep patient in precautions until cleared by radiography
* Rigid spinal collar for neutral head position and/or spinal board for lower spine in-line immobilisation
* Log rolls
* Use blocks, rolled towels, tape

Clearance:
* A&O
* Not intoxicated
* No tenderness at spinous processes
* No focal neurological deficits
* No distracting injuries
* Painless ROM of neck

29
Q

Breathing

A
  • Full respiratory assessment (RR, rhythm, expansion, TD, accessory muscles, paradoxial movements, auscultation - air entry, sounds, palpation)

Injuries to look for
* Tension pneumothorax
* Haemothorax
* Flail chest
* Open pneumothorax

30
Q

Circulation

A

Complete evaluation of HR, BP, CRT, heart auscultation, ECG
Assess for shock
* Haemorrhagic (assume first)
* Obstructive (tamponade, T pneumothorax)
* Neurogenic (SC injury)

Intervention
* 2x large IV to correct hypovolemia
* Stop bleeding (pressure, close lacerations)
* Close fractured with pelvic binder & immobilise fractures
* Cardiac monitoring, BP monitoring

31
Q

Disability

A

Baseline neuro exam (GCS)
* Pupillary exam (dilation = herniation)
* AVPU
* Movement & sensation

BGL

Pupil asymmetry, no reflexes, hemiplegia = increased ICP & herniation risk

32
Q

Exposure

A
  • Remove clothing, examine for other injuries including back (log roll if needed)
  • Avoid hypothermia
33
Q

Supine hypotensive syndrome

A

Condition in pregnancy women > 20 weeks where enlarged uterus with foetus & fluid compress IVC, decreasing venous return & CO
* Keep in left lateral position

34
Q

Diagnostic tests

A
  • XR, CT, US, MRI, cross match bloods, blood alcohol level, drug screen, pregnancy test
  • U&E, FBC including HB, WCC & platelets, coag profile (aPTT & INR) LFT, ABGs
35
Q

Nursing care

A
  • Frequent vitals monitoring including ECG & heat-toe assessment
  • IDC
  • NGT (decompression & aspiration prevention)
  • Ventilation management
  • Pain manegement
  • Blood tranfusions
  • IV therapy
  • Temp management (warmed fluids, blankets, heated lamps)
  • Family & psychpsocial care
  • Liaise with med team, OT, PT, social work, radiology, pastoral care, psych
36
Q

Fluid therapy

A

Use of crystalloids or colloids to restore intravascular volume by increasing oncotic pressure, moving fluid in = increases CVP, CO, SV, BP, UO, perfusion

37
Q

Crystalloids

A

Balances isotonic solution that freely crosses capillary walls (quick plasma expansion but is short lived as they dont stay in the vessels as long as colloids - HL 30-60min)
* NS, CSL

38
Q

Colloids

A
  • Greater capacity to expand circulatory volume as they are larger molecules and stay in the bloodstream longer
  • Gelofusin, albumin
  • Risk of anaphylactic reactions in gelatins, mad cow disease
39
Q

Hypovolemic shock

A

Rapid fluid loss that results in inadequate circulating volume & tissue perfusion
* Usually due to haemorrhaging (trauma, GI bleeds), burns

40
Q

PP - compensatory stage

A
  • SNS responds by increasing HR, contractility, peripheral vasoC, CO & vital organ shunting
  • RAAS causes release of angiotensin & aldosterone = retain water and sodium
    (renin converts angiotensinogen to angiotensin I, lungs convert I to II = vasoC to increase BP & aldosterone secretion)
  • water & sodium retention furthered by ADH production by P pituitary in response to low BP
  • Lactic acidosis = hyperventilation & tachypnoea
  • Bleeding stimulates coag cascade, contracting vessels, activating platelets & fibrin deposition to clot

S&S: hypotension, tachy, cool/pale skin, tachypnoea, oliguria, reduced LOC

41
Q

PP - decompensated/progressive stage

A
  • Na/k pumps start to fail, cells swell & rupture, and enzymes leak causing cell death
  • Decreased CO, SV, venous return = impaired metabolism & perfusion

S&S: severe hypotension, comp tachy, severe peripherla shutdown, comp tachypnoea, sev oliguria, delirium/coma

42
Q

PP - irreversible

A
  • Unresponsive to therapy, irreversible MODS = death
43
Q

Classes of haemorrhagic shock

A

Class I: 0-15% loss, minimal tachy, delayed CRT, no other changes

Class II: 15-30% loss, tachy, tachypnoea, low pulse, cool skin, delayed CRT

Class III: 30-40%, marked tachyp & tachy, low SBP, mental status changes, tranfusion required

Class IV: >40%, severe above, oliguria or no UO, LOC, immeasurable DBP, life threatening

44
Q

Disseminated intravascular coagulation (DIC)

A

Complication of another condition that causes systemic activation of blood coagulation
* Widespread generation & desposition of fibrin = microvascular thrombi throughout the body that can lead to MODS
* At the same time, exhaustion of coag proteins leads to severe bleeding
= simultaneous clotting & bleeding problem

Treatment: original condition, blood transfusion, heparin, supportive treatment

45
Q

Aetiology

A

Conditions that cause DIC are usually those that involve SIRS
* Sepsis & severe infection
* Trauma
* Organ inflammation & failure (pancreatitis, liver failure)
* Cancer
* Obstetric complications
* Transfusion rxs, transplant rejection
* Heat stroke & hyperthermia

46
Q

Acute vs chronic DIC

A

Acute: over hours/days
* clotting first, then bleeding (but bleeding can be noticed first & is often severe)
* Emergency treatment

Chronic: develops slowly over weeks/months
* Lasts longer, not as quickly recognised, mostly clotting & usually no bleeding
* Sometimes no symptoms

47
Q

S&S - clotting

A
  • Chest pain/SOB (clots in lungs & heart)
  • Pain/red/oedema in legs (deep vein)
  • Headache/speech changes/paralysis/dizzy (brain)
  • MI, lung & kidney problems, organ failure
48
Q

S&S - bleeding

A

Internal
* hematuria
* malena
* headache, double vision, seizures (from the brain)

External
* underneath the skin from small wound or IV
* Mucosa (gums from brushing teeth)
* Excessive menstrual bleeding
* Bruising & small purple dots on the skin
* Nosebleeds/epistaxis w/o HTN

49
Q

Rhabdomyolysis

A

Injury to skeletal muscle causes death of muscle fibres and release of toxic intracellular components (myoglobin) into plasma, which is harmful to kidneys

50
Q

Aetiology

A
  • Trauma
  • Alcohol, drugs
  • Heatstroke
  • Infection
  • Metabolic disorders
  • Medications (antipsychotics, statins)
  • Strenuous exercise
51
Q

S&S of rhabdomyolysis

A
  • Myalgias (muscle weakness)
  • Generalised weakness & aching
  • Dark urine
  • Fever, N&V
52
Q

Treatment

A
  • IV fluid therapy to help kidneys & produce urine to prevent AKI
  • Dialysis if severe
  • Treat original cause
  • Manage electrolyte abnormalities
  • Manage complications (protein in urine, compartment syndrome, DIC)
53
Q

Fentanyl

A

Route: IV, IM
Class: opioid analgesic
Mechanism: binds to mu receptors in brain to induce analgesia, euphoria, sedation
Effect: management of severe pain (stronger than morphine)
HL: 3.7
SE: respiratory depression, apnoea, rigitity, muscle twitching, constipation

GMED5002 (9 decks)

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