Trauma Flashcards
What is the first hour of emergent care called and what does it involve?
Golden hour
focuses on rapid assessment, resuscitation, and treatment of life threatening injuries
Who are part of the trauma team?
EMS
Trauma surgeon
emergency physician
anesthesiologist
trauma nurse leader
trauma resuscitation nurse
scribe
pharmacist
RT
lab
radiology
physician specialist
who is the overall team leader?
Trauma surgeon
What does a primary survey involve?
most crucial assessment tool within 1-2 minutes
used to identify life threatening injuries accurately, establish priorities and provide interventions
uses ABCDEFG mnemonic
What does the mnemonic ABCDEFG stand for?
Airway
Breathing
Circulation
Disability (neuro)
Exposure
Full set of vitals and family
Get resuscitation adjuncts
What does secondary survey involve?
initiated after resuscitation
Head to toe assessment
assess each region of body for any missed injuries
Secondary survey
MIST acronym
Mechanism of injury
Injuries sustained
Signs and symptoms in the field
Treatment in the field
Secondary survey SAMPLE acronym
Symptoms
Allergies
Medications
Past medical history
Last oral intake
Events and environmental factors
what are the three elements that are considered the trauma triad of death?
Hypothermia
hypotension
acidosis
ABCDEFG: Airway assessment
stridor
central cyanosis
nasal flaring
trauma to face or mouth
inability to speak
ABCDEFG: Breathing assessment
asymmetrical chest movement
open chest wounds
dyspnea
low or high resp rate
ABCDEFG: Circulation assessment
presence of pulses
weak, thready
pallor
MAP < 65
obvious hemorrhaging
ABCDEFG: Disability assessment
Neuro status
GCS < 13
posturing
lack of sensations
What is FAST ultrasound?
provides rapid means of diagnosing accumulation of blood or free fluid in peritoneal cavity or pericardial sac
What is E-FAST?
ultrasound that diagnoses accumulation of blood but also extends to chest injuries like hemothorax and pneumothorax
What do you need to monitor during fluid resuscitation?
Urine output (0.5 mL/kg/hr)
LOC
HR
BP
Pulse pressure
Labs
MAP
What can happen with excessive fluid resuscitation?
Dilutional coagulopathy
third spacing
Edema
abdominal compartment syndrome
ARDS
AKI
MODS
What is TEG?
thromboelastography
evaluates whole blood coagulation and identifies coagulopathy
What is the purpose of exposing the patient?
full body visualization
Interventions to prevent prolonged hypothermia?
warmed IV fluids
warm the room
warm blankets
cover patients head
Classic signs of cardiac tamponade?
Beck’s triad: hypotension, muffled or distant heart sounds, elevated venous pressure/distended neck veins
What are some possible ECG presentations for cardiac tamponade?
PVCs, A-fib, bundle branch block, or ST segment changes
What should you anticipate as the treatment for cardiac tamponade and what equipment should you obtain?
pericardiocentesis
obtain equipment for emergency thoracotomy in case arrest occurs
How does the patient with a pneumothorax present?
resp distress
tachypnea
tachycardia
diminished breath sounds
and chest pain
What are the interventions for pneumothorax?
provide oxygen
anticipate chest tube
What is a tension pneumothorax and how does it differ from a normal pneumothorax?
TP is always severe and fatal
air enters the pleural cavity with no escape and air accumulates with each breath
causing mediastinal shift and collapse
What is a pulmonary contusion?
bruising to lung tissue causing inflammation and edema
what is the presentation of a pulmonary contusion?
worsening dyspnea
ineffective cough
hypoxia
chest wall abrasions
chest pain
Nursing interventions for pulmonary contusion?
anticipate mechanical ventilation
supplemental oxygen
pain relief IV narcotics
What are the three levels of triage?
emergent, urgent, and delayed
What is the emergency severity index?
Tool used to categorize patients based on their needs
Explain the tiers of the emergency severity index
1.) Resuscitation, immediately dying
2.) High risk
3.) two or more resources need
4.) one resource needed
5.) no resources needed
What is flail chest?
Occurs when three or more ribs are broken in at least two places
stability of chest wall is disturbed
How does flail chest impact overall health?
Pain
altered gas exchange
permanent chest wall deformity
Expected manifestations of flail chest
severe pain
tachypnea
shallow breaths
splinting
abnormal rise of chest
retractions
Diagnostics for flail chest
chest x ray
lab
hemodynamics
ABGs
What is compartment syndrome?
increased pressure within muscle compressing nerves, blood vessels which can lead to necrosis
What are the Six P’s?
Pain
pressure
pallor
pulses
paresthesia
paralysis
What can you expect in the assessment of a patient with suspected compartment syndrome?
increased pain
no relief from analgesia
pain with extension of first digit
What can you anticipate as the treatment for compartment syndrome?
fasciotomy
what is rhabdomyolysis and what are the interventions?
muscle damage
aggressive fluid resuscitation to flush out myoglobin and prevent aki
What do you do if there is no drainage from a chest tube?
Check for kinks or clots
assess placement
verify suction
check for air leaks
What do you do if there is continuous bubbling in water seal chamber?
check connection from patient to drainage system
could mean an air leak
assess the patient
What do you do if the chest tube gets disloged?
apply a sterile occlusive dressing over insertion site
put tube in sterile water
What do you do if chest tube become clogged?
gently milk the tube
What do you do if the chest tube system is not bubbling at all?
check suction source
assess water seal
assess patient
When should you report to the provider on the drainage amount from chest tube?
more than 200 mL per hour
