Trauma

Question 1

Trauma

Answer 1

An external force of energy tht impacts the body and causes structural or physiologic alterations or injury

Question 2

External Forces of Injury

Answer 2

• Lack of oxygen
  > drowning, smoke
• Electrical
  > lightning, wires, cords, outlets
• Chemical
  > drugs, insects, snakes, poisons
• Thermal (heat)
• Mechanical
  > the most common mechanical injuries: blunt trauma & penetrating trauma
  > crush, cars, guns, knives, humans, machines

Question 3

Types of Mechanical Trauma - Blunt Trauma

Answer 3

• Physical trauma to a body part, either by impact injury or physical attack
  > severity of injury depends on mechanism, not always obvious

Question 4

Types of Mechanical Trauma - Penetrating Trauma

Answer 4

• Injuries tht puncture the body and result in damage to internal structures
  > pierces the dermis
  > size of entry wound does not always reflect the underlying damage to body

Question 5

Types of Mechanical Trauma - Acceleration

Answer 5

• The force tht incrs the velocity of a person or object
  > whatever comes in contact with person IS moving
  > a swinging bat hits head

Question 6

Types of Mechanical Trauma - Deceleration

Answer 6

• The force tht stops or dcrs the velocity of a moving person or object
  > whatever comes in contact w/ person IS NOT moving
  > hitting face on pavement

Question 7

Primary Injury

Answer 7

Occurs at the time of injury

Question 8

Secondary Injury

Answer 8

• The biochemical and cellular response to the initial trauma
  > can present hrs, days, wks later
  > like infection, edema, etc.

Question 9

Prehospital Care

Answer 9

• Airway
  > is pt maintaining airway
• Recognize & control of external bleeding & shock
  > is there a concern for bleeding
• Immobilization
  > did this pt require immobilization
• IV access
• Splinting of fractures
  > does this pt require anything to be splinted
• Pain management

Question 10

Once the pt arrives in the ED…

Answer 10

• Primary survery is completed
• Assess for the presence of environmental hazards
• Stabilize the cervical spine throughout the procedure if injuury is suspected
• Don appropriate personal protective equipment

Question 11

Primary Survery

Answer 11

• Airway
• Breathing
• Circulation
• Disability
• Exposure

Question 12

Primary Survery of Trauma Patient - Airway

Answer 12

• PRIORITY
  > ability to get air in & out
• Immediately assess ability to speak
• Any obvious signs of airway trauma, tachypnea, accessory muscle use
• Can you hear pt breathing
• Feel for air exchange through mouth
• Palpate for tracheal deviation

Question 13

Primary Survery of Trauma Patient - Airway: Immediate Care

Answer 13

• Immobiliza spine
• Oropharyngeal
  > unconscious pt
• Nasopharyngeal
  > conscious pt
• Secure airway
  > endotracheal intubation
  > emergency cricothyrotomy

Question 14

Primary Survery of Trauma Patient - Breathing

Answer 14

• VENTILATION
• Is the pt breathing
• Is pt’s chest rising & falling
• RR, rhythm, symmetry
• Any evidence of thoracic trauma
• Auscultate air entry
• Is there air entry in all lobes
• Chest wall integrity
  > rib fractures

Question 15

Primary Survery of Trauma Patient - Breathing: Immediate Care

Answer 15

• Admin supp oxygen
• For life-threatening condition, immediate needle decompression or chest tube insertion
  > tension pneumo
• Full-support mech vent
  > as required

Question 16

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Primary Survery of Trauma Patient - Circulation

Answer 16

• Assess pulse quality & rate
• Assess for life-threatening conditions
  > uncontrolled bleeding, shock
• Examine & feel pt’s skin
  > warm & dry
  > cool, pale, clammy

Question 17

Primary Survery of Trauma Patient - Circulation: Immediate Care

Answer 17

• S/S of poor tissue perfusion
  > initiate IV access
  > admin 1L of isotonic IV fluid (NS), the reassess hemodynamic status
• If no pulse, begin CPR

Question 18

Primary Survery of Trauma Patient - Disability

Answer 18

• Neuro assessment
  > GCS score
  > Pupils: size & reactivity
  > is pt moving all 4 limbs to command
  > posturing?

Question 19

Primary Survery of Trauma Patient - Disability: Immediate Care

Answer 19

• Consider early neurosurgical consultation
  > consider early CT scan

Question 20

Primary Survery of Trauma Patient - Exposure

Answer 20

• All clothing removed to inspect all body regions
  > any lacerations, abrasions, bruises
  > stab wounds; entrance
  > gunshot wounds; entrance, exit

Question 21

Primary Survery of Trauma Patient - Exposure: Immediate Care

Answer 21

• Prevent hypothermia
  > warm blankets
  > warm IV fluids
  > incr room temp

Question 22

Secondary Survey

Answer 22

• Full set of vitals & focused assessment
• Give comfort measures, get monitoring devices
• History & physical
• Inspect posterior surface

Question 23

What can be delegated

Answer 23

• Full set of vitals
• Transport to other departments
• Comfort measures
• In event of death, transport to morgue
• DO NOT delegate any notifs/consults

Question 24

What types of deaths are required to be reported to coroner

Answer 24

• younger than 18yrs, older than 83yrs
• Unexpected deaths
• MVC/violent deaths
  > DV
• In the care of others
  > disabled

Question 25

Care of deceased who died of a reportable death

DOs

Answer 25

• DOs
  > RN: notify coroner
  > RN, UAP: cover body
  > RN, UAP: transport to morgue

Question 26

Care of deceased who died of a reportable death

DONTs

Answer 26

• DONTs
  > bathe
  > remove lines, tubes, drains (IVs, breathing tubes)
  > throw anything away (evidence)

Question 27

Trauma Summary

Answer 27

• Get whole story
• Know
  > Primary & secondary assessments
  > Injuries based on body system
  > Complications
  > assessment
  > prevention