Trauma Flashcards
Common forces in Blunt trauma
-acceleration or deceleration
-increased velocity or speed of a moving object followed by a sudden decrease
common forces in blunt trauma
-shearing injury
when two oppositely directed parallel forces are applied to tissue
common blunt traumas
-compression injury
squeezing inward pressure applied to tissue
Penetrating Trauma
Injuries penetrate skin and result in damage to internal structures
- misleading because outside injury does not reflect inside injury
- bullets leave cavities 5-30 x greater than bullet hole
Triage
screening of trauma patient to determine priority needs
- EMS in community
- Nurse in hospital
trimodal distribution of trauma deaths
-FIRST PEAK
dies within minutes
- at scene or within route to hospital
- laceration of brain, spinal cord injury, heart damage
Trimodal Distribution of Trauma Deaths
-Second Peak
minutes to hours “GOLDEN HOUR”
- in ER or operating room
- subdural hematoma, pneumothorax, liver laceration
Trimodal Distribution of Trauma Deaths
-Third Peak
- days to weeks after injury
- Critical care unit
- Sepsis (infection)
- Multiple Organ Dysfunction Syndrome (MODS)
6 phase Care of trauma patient
1- Pre-hospitalization resuscitation 2- Hospital Resuscitation 3- definitive care and operative phase 4-Critical care-SBAR 5- Intermediate care 6- Rehabilitation
Hospitalization Resuscitation
-2 phases
1- primary
2- secondary
both can be done within minutes of each other. unless resusc. required
Hospitalization Resc.
-PRIMARY ASSESSMENT
A- airway with cervical spine protection
B- Breathing (tension or hemothorax)
C- circulation (hypotensive shock) with bleeding control
D- Diability (neurogenic status)
E- Expose/ environment- remove clothing and keep pt warm
Hospital Resc.
-SECONDARY ASSESSMENT
F- Full set of vitals, focused adjuncts, family focus, FAST exam
G- Give comfort measures
H- history and head to toe assessment AMPLE
I- Inspect posterior surfaces
what is the most common shock in trauma patients
HYPOvolemic shock
How to tx Hypovolemic shock
- 2 large bore IV catheters: 14-16
- draw blood
- IV fluids (NS/LR)
- fluid warmer
- O-negative blood if not responding to LR
- F/C and OGT
- 3 S- stop bleeding, splint fractures, stabalize pelvis
Secondary Assessement
AMPLE
A- allergies M-medications P- past medical hx/pregnant L-Last meal -E-events preceding incident r/t accident
Brain Injuries (TBI)
- skull fractures
- macillofacial injuries
- concussion
- contusion
- cerebral hematomas
Maxillofacial Injuries
- Le fort 1
- Le fort 2
- Le fort 3
- above maxilla
- above nose
- behind eyes
1) coup
2) contrecoup
1- primary impact
2- secondary impact
Epidural Hematoma
collection of blood between the inner layer of the skull and the outermost layer of the dura
-associated with skull fractures an middle meningeal artery
epidural hematoma s/s
- brief LOC
- period of lucidity then rapid deterioration
- may c/o localized headache
Hallmark of Epidural hematoma
-dilated and fixed pupils of same side of impact
diagnosis of epidural hematoma
CT, tx with surgery
Neurologic Assessment of TBI
- dictates the speed for further assessment and treatment
- ** CORNERSTONE ASSESSMENT = Glascow coma scale- must be early and ongoing
Rib Fractures
-interventions
Pain
-treating underlying injuries
Rib fractures
-significance of 7th-12th fractures
associated with spleen and liver lacerations
Rib Fractures
-Flail Chest
when two or more ribs are fractured in 2+ places
Pulmonary Contusion
Bruising of the lung
-d/t rib fractures or flail chest
use a CXR & aggressive respiratory care such as walking, IS, deep breaths, and suctioning
Pulmonary Contusion
-what can it lead to
- ARDS
- pneumonia
- effusion
Tension Pneumothorax
air flows into the pleural space with inspiration and becomes trapped
Tension pneumothorax
S/S
-tracheal deviation
-decreased lung sounds one side
-hypotension
-unequal breath sounds
-hypoxia
JVD
Tension Pneumothorax
-tx
Large bore needle (14 gauge) inserted into the lung (2nd ICS MCL)
-chest tube in an acute setting
Hemothorax
cause
blunt or penetrating throacic trauma causing bleeding into the pleural space
Hemothorax
s/s
- hypovolemic shock
- diminished breath sounds
- **neck veins are collapsed and trachea midline
Hemothorax
-tx
CHEST TUBE
-tx hypovolemic shock: IVF, blood transfusions
Fluid Resuscitation
-complications
- may lead to hypotension
- can cause pulmonary edema
- hypothermia- use a warmer to warm fluids
Pelvic Fractures
-why is there a high mortality
skeletal fractures have a high mortality d/t hermorrhagic shock
Pelvic Fracture Assessment
- perianal ecchymosis
- pain
- rocking of iliac spine
- lower limb paresis
- hematuria
- low limb rotation or leg shortening
- rectal exams and occult bleeding
Pelvic Fracture
Dx
CT or AP supine x-ray
Pelvic Fracture
-medical management
prevent/control bleeding
- temporary pelvic binder
- pelvic angiography with contrast and embolization
Pelvic Fracture
-Nursing management
- Massive transfusion protocol (MTP)
- make sure enough plasma, plt, and blood are cross matched and ready
- High risk for abdominal compartment syndrome
- stable/unstable fractures
- PAIN MEDS
Femur fracture
-tractions
early stabilization
- reduces risk for fat embolism
- relieves pain
- restore perfusion
Compartment Syndrome
tissue perfusion >35-46
5 P’s of Compartment Syndrome
P- pain P-pallor P-pulse declined P- Pressure increased -Paresthesia
Trauma complications
- hypermetabolism
- infection!
- pulmonary
- pain
- renal failure
Renal Failure
-myoglobinuria
seen in crush injuries
- dark tea colored urine
- increased creatinine-kinase levels
- aggressive IV fluids
Trauma Prevention
-seatbelts
-no drink/drive
IPV-initmate partner violence
blunt trauma
an injury with no opening in the skin
-can be more life-threatening because injuries difficult to see
