Trauma Flashcards
Exam 3
Mechanism of Injury
include:
Blunt injury
Penetrating injury
Mechanism of Injury
include: Blunt injury: What are examples?
Motor vehicle accidents, falls, assaults, and contact sports
Combination of forces: acceleration, deceleration, shearing, crushing, and compressive resistance
Mechanism of Injury
include: Penetrating injury: What are examples?
Foreign objects penetrating the tissue
Gunshot, stab wound
Initial Assessment and Management
Prehospital management: What should be maintained? What should be ensured?
Maintain the airway
maintain spine immobilization
ensure adequate ventilation
Initial Assessment and Management
Prehospital management: What should be controlled? What should be prevented?
control external bleeding and prevent shock
Initial Assessment and Management
Prehospital management: Where should the patient be transported?
Maintain the airway, ensure adequate ventilation, control external bleeding and prevent shock, maintain spine immobilization,
and transport to the closest appropriate facility.
Initial Assessment and Management
Prehospital management:
Transport to the closest appropriate facility. What does this allow for?
Transporting the patient to a level I facility allows definitive care to be initiated earlier in the process, thereby reducing patient mortality.
In-Hospital Management
What are the three surveys done?
Primary survey
Secondary survey
Tertiary survey
In-Hospital Management
Primary survey: What is included?
Airway, breathing, ventilation, and life-threatening injuries identified
In-Hospital Management
Secondary survey: What is included?
Detailed head-to-toe survey, plan for appropriate diagnostic tests
In-Hospital Management
Tertiary survey: What is included? Where are they admitted?
On admission to the ICU, another head-to-toe examination, assess response to interventions, labs and x-rays reviewed
Fluid Resuscitation:
What fluids are used?
Crystalloids
Colloids
Blood products
Fluid Resuscitation:
Crystalloids: What do they do? What kinds of fluid?
Expand volume status.
Isotonic, hypotonic, and hypertonic, typically at least 2 liters of isotonic (NS, LR)
Fluid Resuscitation:
Colloids: What do they do? What are examples?
Rapid volume expander
(albumin, dextran)
Fluid Resuscitation:
Blood products: Why are they given?
Hemodynamically unstable or are showing signs of tissue hypoxia despite crystalloid infusion
Thoracic trauma:
How do they range?
Minor abrasions to life threatening insults
Thoracic trauma:
How are they managed?
Managed with chest tube insertion, mechanical ventilation, aggressive pain control, and supportive care
Thoracic trauma:
What would result in immediate death?
Great vessel injuries or disruption to the heart usually results in immediate death.
Thoracic trauma:
What would require immediate treatment?
Airway obstruction, tension pneumothorax, cardiac tamponade, open pneumothorax, massive hemothorax, and flail chest require immediate treatment.
Thoracic trauma
What is always the priority? What should there be protection from?
Airway is always the priority
Oxygenation and protection from aspiration
Thoracic trauma
What are common causes of airway obstruction:
tongue,
avulsed teeth,
dentures,
secretions,
and blood.
Thoracic trauma
What other reasons for airway obstruction?
Injuries to the trachea, thyroid cartilage or cricoid process
Abdominal trauma:
What types exist?
Blunt or penetrating
Abdominal trauma:
What areas can be injured here?
Peritoneal area (diaphragm, liver, spleen, stomach, transverse colon and portion covered by bony thorax)
Retroperitoneal area (aorta, vena cava, pancreas, kidney, ureters, parts of duodenum and colon)
Pelvis (rectum, bladder, uterus, iliac vessels)
Abdominal trauma:
Peritoneal area include:
Peritoneal area (diaphragm, liver, spleen, stomach, transverse colon and portion covered by bony thorax)
Abdominal trauma:
Retroperitoneal area
Retroperitoneal area (aorta, vena cava, pancreas, kidney, ureters, parts of duodenum and colon)
Causes of abdominal trauma:
What is the most common cause?
MVAs most common
Assaults, falls, pedestrian-motor vehicle collisions, industrial accidents
Causes of abdominal trauma:
What are symptoms?
Abdominal tenderness or guarding
hemodynamic instability
Lumbar spine injury
Pelvic fracture
Retroperitoneal or intraperitoneal air
Unilateral loss of psoas shadow on radiograph
Causes of abdominal trauma:
When is the abdomen assessed?
During the secondary survey, the abdomen is assessed and reassessed, and laboratory and diagnostic tests are performed.
Priorities for abdominal trauma:
What is inserted?
orogastric or nasogastric tube, and Foley catheter
Priorities for abdominal trauma:
What are ways that assessments are done?
Local wound exploration
Laparoscopy, thoracoscopy, or exploratory laparotomy
Focused abdominal sonography for trauma (FAST), a chest radiograph, and an abdominal CT scan
Focused Assessment with Sonography for Trauma (FAST):
What does this do?
Noninvasive
Determines potential sources of bleeding
Focused Assessment with Sonography for Trauma (FAST):
Determines potential sources of bleeding- where?
Peritoneal cavity
Pericardial sac
Blunt /penetrating abdominal trauma
Blunt: What does this mean?
damage to solid organs
Blunt /penetrating abdominal trauma
Blunt - damage to solid organs
How?
Fractures of solid organ capsules and parenchyma
Blunt /penetrating abdominal trauma
Penetrating trauma: What is it?
– damage to hollow organs
Blunt /penetrating abdominal trauma
Penetrating trauma: – damage to hollow organs
What happens when hollow organs are damaged?
Hollow organs collapse and absorb the force
Blunt /penetrating abdominal trauma
Penetrating trauma: – damage to hollow organs
What is vulnerable to penetrating trauma?
Bowel is vulnerable to penetrating trauma
Blunt /penetrating abdominal trauma
Complications
Intolerance to tube feedings
Peritonitis
Post op bleeding
Hypovolemia
Fistula or obstruction
Musculoskeletal Injuries;
How are they generally?
Generally not life-threatening barring traumatic amputation or pelvic fracture
Musculoskeletal Injuries;
When is assessment for this done?
Assessment is done in secondary survey after hemodynamic stablilization
Musculoskeletal Injuries;
What are causes for this?
Cause: MVA, falls, assaults, industrial, farming, home accidents
Musculoskeletal Injuries;
What is important to understand?
Important to understand the circumstances surrounding the injury and the mechanism of injury.
Priorities-musculoskeletal
What should be obtained?
Obtain films of cervical spine, chest and pelvis, CT, MRI
Priorities-musculoskeletal
What should be monitored?
Cautious monitoring of limb swelling, ecchymosis or deformity is noted, extremity should be immobilized
Monitor for vascular or neurologic compromise
Priorities-musculoskeletal
What should be checked?
Check capillary refill (should be < 2 seconds)
Check pulses, presence of crepitus, muscle spasm, movement, sensation, pain
Complications of musculoskeletal injury
Infection
Compartment syndrome
Deep venous thrombosis
Pulmonary embolus
Fat embolism syndrome
Maxillofacial trauma:
Degree of injury is related to what?
Maxillofacial trauma
Maxillofacial trauma:
What is priority?
Priority- airway, breathing and circulation
Maxillofacial trauma:
What should be assessed?
Assess soft tissues as well as bony structures
Assess cranial nerves
Maxillofacial trauma:
What should be ensured?
Ensure tetanus vaccination for soft tissue injury
Maxillofacial trauma:
What exam should be done?
Neuro exam
Multiple trauma
What are early complications?
Early: severe head injury, hemorrhage
Multiple trauma
What are late complications?
Late: hypovolemic shock, infection, septic shock, ARDS, SIRS, MODS
