Trauma Flashcards
Trauma
The unintentional or intentional wound or injury inflicted on the body against which the body cannot defend itself.
What is the leading cause of death of people between the ages of 1-44?
Trauma
T or F. The bulk of MVCs are minor?
True, 230k of people who people who sustain a MVC are hospitalized, but 1.1M are treated and released from an ED
By 2020, what is predicted to be the 3rd largest contributor to the global burden of disease?
Traffic collusions, they disable 20 to 50M people a year globally.
T or F. Approx. 475,000 TBIs occur among children ages 0-14 years, and ED visits account for more than 90% of the TBis in this age group?
TRUE
What is the leading cause of TBIs?
Falls; rates are highest for children 0-4 and adults 75 yrs and older.
T or F. Trauma is responsible for 80% of all teenage deaths and 60% of all childhood deaths?
TRUE
Trauma is responsible for approx. 20% of all healthcare costs in the US?
False, 40%
T or F. Anytime anyone is critically ill or injured, they become hyperglcemic?
TRUE
The metabolic response to trauma occurs in 3 phases, what are they?
Ebb, Catabolic, Anabolic
What is the duration of the Ebb phase?
<24 hrs
What is the duration of the catabolic phase?
3-10 days
What is the duration during the anabolic phase?
10-60 days
What is the role of the Ebb phase?
Maintain blood volume, release catecholamines
What is the role of the catabolic phase?
Maintain energy
What is the role of the anabolic phase?
Replace lost tissue
Abdominal trauma
Hard to detect. When unrecognized, it is one of the major causes of death in trauma patients
T or F. Abdominal trauma is the 2nd leading cause of preventable trauma deaths?
TRUE
T or F. Increased incidences of death are due to increased hemorrhage and delay in receiving surgical intervention?
True, signs of bleeding that aren’t detected contribute to increased cause of death.
T or F. Injury of abdominal structures causes death primarily as a result of hemorrhage?
TRUE
Damage to solid and vascular organs vs. damage to hollow organs?
Damage to solid and vascular organs can result in hemorrhage and stroke; damage to hollow organs can result in spillage of contents, peritonitis, and stroke.
T or F. Hemorrhage in the true abdomen may lead to abd. distension?
True. However, extensive bleeding in the retroperitoneal space may go undetected.
What are common S/S of Abdominal Trauma?
Pain, External signs of injury (abrasions, bruising, open wounds, bleeding), Shock
What are common S/S of Shock?
Distended or rigid abdomen, pain on palpitation, rebound tenderness
What is the most reliable indicator of Intra-abdominal hemorrhage?
The presence of Shock w/o an identifiable source.
What should you always worry about in regards to Chest Trauma?
Tension pneumothorax.
There are 4 types of Chest Trauma, what are they?
Pleural disruption, Aortic rupture, Flail Chest, Pulmonary Contusion.
Pleural Disruption
Air enters as the result of perforation via the lung or chest wall. The injury may be the result of penetrating trauma, spontaneous rupture of an emphysematous bleb, or spontaneous without any apparent cause.
Pleural disruption can cause:
Pneumothorax or Tension Pnemothorax
Aortic Rupture
Dissection or rupture of the Aorta; a condition in which there is bleeding either into or around (or both) the wall of the aorta.
T or F. Survivial rates for Aortic Rupture are high?
False, most PTs with traumatic aortic rupture will expire at the site of the accident, up to 20% survive in the hospital.
Identify 5 S/S of Aortic Rupture
Chest Pain (sudden, sharp, stabbing, radiating to shoulder, neck, and jaw), Decreased Sensation, Anxiety, Pallor, Dry Skin (dry mouth/thirst), N/V, Dizziness, SOB
Flail Chest
Occurs when a segment of the thoracic wall becomes unattached from the rest of the chest wall. Most typically occurs when there are 2 or more ribs fractured, allowing that segment of the thoracic wall to FLOAT independently of the rest of the chest wall
T or F. The flail segment is pushed out during inspiration and drawn in during expiration?
False, the flail segment is drawn in during inspiration and pushed out during expiration.
S/S of Flail Chest include:
Paradoxical motion, hypoventilation, dyspnea, guarding, self-splinting, bony crepitus, tachycardia, excruciating pain upon movement.
T or F. Flail Chest is the most common life-threatening thoracic injury in America?
False, Pulmonary contusion. 30-70% of all victims of blunt force trauma experience it. It is the result of a portion of the lung forcefully impacting onto the chest wall. This condition is commonly assoc. w/ flail chest victims of blunt force trauma, however.
What are common S/S of Pulmonary Contusion?
Pulmonary edema, Interstitial hemorrhage, Atelectasis, Airway obstruction, Increased pulmonary vasculary resistance (PVR), Intra-alveolar hemorrhage
What does increased PVR mean for the heart?
It has to work harder
Intra-alveolar hemorrhage would indicate:
Bleeding in the alveoli; couging will occur
In regards to Nursing Management, what interventions can be performed for MINOR flail chest injuries?
Supplemental O2, Postural drainage (pulmonary toilet), Bronchoscopy (if PT is unable to remove excessive secretions), Pain Rx, Local anesthetic block, Firm chest wrap.
When giving meds to patients with minor flail chest injuries, what’s most important to keep in mind?
They should be given to enhance the ability to breathe, but they suppress the respiratory system so continue to mointor PT.
In regards to MAJOR flail chest injuries, intubation and ventilation should be considered when:
Greater than 3 ribs are fractures or there’s a free floating sternum and/ or when serious compression injury has occured.
What are 4 common causes for Head and Spinal Trauma?
MVAs, Falls, Stabbings, Firearms.
In regards to MVAs, what are 3 types of Collusion impact?
Vehicle impact (>40mph), Body impact, Organ impact
Frontal injuries caused by MVCs include:
Head and neck, back, brain, spine, ribs and clavicle, arms and legs, concussions, soft tissue, internal, dislocations, abrasions, cuts, and bruises.
Delayed injuries resulting from Frontal injuries include:
HA, blurred vision, dizziness and loss of taste, smell, or hearing. Also, difficulty breathing, blood in urine or stool, swelling, loss of motion and visualized bruising.
T or F. When completing a Head-to-Toe assessment on a PT that was involved in a MVC, it’s important to keep in mind that some symptoms may surface slowly?
TRUE
Head and C-spine injury
The combination of the flexion and rotation of the spine that occurs with lateral impact (side impact). Produces more frequent and severe cervicle injuries
T or F. Fractures of the spine are more common in frontal injuries?
False, fractures of the spine are more common with lateral/ side impact injuries than frontal or rear- end collusions
T or F. Chest and abdominal injuries to the side of impact are the same as in head on collusions?
TRUE
Nursing assessment for Lateral/ Side Impact injuries include:
Complete head-to-toe, but special focus needs to be placed on C-spine immobility and potential for cervical and spine injuries.
Injuries from Rear impact collusions usually occur:
As the torso and seat shoot forward. If the headrest is too low, the neck will end up hyper-extended over the top of the headrest. This is how strains, torn ligaments, and more serious cervical injuries occur.
T or F. The nursing assessment after Rear Impact collusions should be focused on the neck and potential cervical injuries?
TRUE
The severity of Stab wounds depends on:
Location penetrated, Blade length, and Angle of Penetration.
When assessing a PT with a penetrating wound, what is most important to keep in mind?
Don’t underestimate the internal damage of simple entrance wounds; the attacker may have moved the blade around inside the PT.
T or F. A gunshot only causes 2 wounds- an entrance and exit wound?
False, a gunshot causes 3 wounds. Entrance wound, Exit wound, and Internal wound.
Entrance wounds
May be round or oval; shots from close range may have burns or smoke marks on the skin
Exit wounds
If present, it will be larger and may be linear or stellate in appearance; not all entrance wounds have an exit.
Internal wounds
Damage to the tissue in the direct path of the bullet will cause a permanent cavity; tissue on either side of the bullet’s path will also be injured d/t pressure from energy exerted outward from the path of the bullet which results in a temporary cavity.
The temporary cavity resulting from a gunshout wound is usually 3 to 6 times the size of the front surface?
TRUE
T or F. Wounds caused by stabbings are most often explored more than gunshot wounds?
False, 85-95% of wounds caused by firearms will require surgical intervention; only 30% of knife wounds will need to be explored.
Who are most at risk for Fall injuries?
Children, Adults >55, Elders
What is the most common cause of TBI, hip fractures, and other fractures?
Falls
Injuries that require Forensic include:
Anything that involves criminal activity and has legal requirements. Sexual assault, Physical assault and battery.
In regards to Trauma, what assessment criteria is best to follow?
Assess ABCs, Circulatory status, Head-to-Toe, Neurovascular, Neck and Spine immobility
Glascow Coma Scale (GCS)
Ranges from 3-15. It’s a widely used assessment tool used to measure the LOC in the trauma populations. Its components include Eye opening, Verbal response, and Motor response.
Acute Concussion Evaluation (ACE)
an assessment tool created for assessing concussion in primary care and emergency medicine settings.
ACE components include:
Characteristics of the injury including mechanism LOC, and post-traumatic amnesia; Signs and Symptoms, and Risk factors for prolonged recovery.
SAC
Test used to document the presence and severity of neurocognitive impairment associated with concussion. It tests for impairment in orientation, immediate memory, concentration, and delayed recall.
Rivermead Post-Concussion Symptom Questionaire
A measure to assess symptoms following MTBI. It includes somatic, cognitive, and emotional symptoms as well as a severity rating for each of the 16 items.
Grey- Turner Sign
Subcutaneous bruising around the flanks and umbilicus, suggestive of a RETROperitoneal hematoma
Hamman Crunch
A crunching sound synchronous w/ the heartbeat and heard on auscultation of the precardium. Suggestive of a hemothorax, pneumothorax and possibly fluid build up that could l/t resp. failure. Not the same as subcutaneous air.
Raccoon Eyes
Eccymotic discoloration and swelling behind either or both eyes. Associated with head trauma and suggestive of basilar skull fracture or facial bone fracture
Battle Sign
Eccymotic discoloration and swelling behind either or both EARS. Associated with head trauma and suggestive of basilar skull fracture
Cullen Sign
A bluish HALO surrounding the umbilicus, indicating bleeding into the tissues. Associated with intra-abdominal bleeding and trauma. Could also be a sign of ectopic pregnancy or pancreatitis.
Kehr’s Sign
Pain in the sub-scapular region of the shoulder, usually on the LEFT side, referred from an irritated phrenic nerve. Associated with a ruptured SPLEEN, but can also be a sign of ectopic pregnancy.
