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Critical Care Test 2 > Trauma > Flashcards

Trauma Flashcards

1
Q

Common forces in Blunt trauma

-acceleration or deceleration

A

-increased velocity or speed of a moving object followed by a sudden decrease

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2
Q

common forces in blunt trauma

-shearing injury

A

when two oppositely directed parallel forces are applied to tissue

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3
Q

common blunt traumas

-compression injury

A

squeezing inward pressure applied to tissue

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4
Q

Penetrating Trauma

A

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
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5
Q

Triage

A

screening of trauma patient to determine priority needs

  • EMS in community
  • Nurse in hospital
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6
Q

trimodal distribution of trauma deaths

-FIRST PEAK

A

dies within minutes

  • at scene or within route to hospital
  • laceration of brain, spinal cord injury, heart damage
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7
Q

Trimodal Distribution of Trauma Deaths

-Second Peak

A

minutes to hours “GOLDEN HOUR”

  • in ER or operating room
  • subdural hematoma, pneumothorax, liver laceration
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8
Q

Trimodal Distribution of Trauma Deaths

-Third Peak

A
  • days to weeks after injury
  • Critical care unit
  • Sepsis (infection)
  • Multiple Organ Dysfunction Syndrome (MODS)
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9
Q

6 phase Care of trauma patient

A 
1- Pre-hospitalization resuscitation
2- Hospital Resuscitation
3- definitive care and operative phase
4-Critical care-SBAR
5- Intermediate care
6- Rehabilitation
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10
Q

Hospitalization Resuscitation

-2 phases

A

1- primary
2- secondary
both can be done within minutes of each other. unless resusc. required

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11
Q

Hospitalization Resc.

-PRIMARY ASSESSMENT

A

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

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12
Q

Hospital Resc.

-SECONDARY ASSESSMENT

A

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

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13
Q

what is the most common shock in trauma patients

A

HYPOvolemic shock

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14
Q

How to tx Hypovolemic shock

A
  • 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
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15
Q

Secondary Assessement

AMPLE

A 
A- allergies
M-medications
P- past medical hx/pregnant
L-Last meal
-E-events preceding incident r/t accident
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16
Q

Brain Injuries (TBI)

A
  • skull fractures
  • macillofacial injuries
  • concussion
  • contusion
  • cerebral hematomas
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17
Q

Maxillofacial Injuries

  • Le fort 1
  • Le fort 2
  • Le fort 3
A
  • above maxilla
  • above nose
  • behind eyes
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18
Q

1) coup

2) contrecoup

A

1- primary impact

2- secondary impact

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19
Q

Epidural Hematoma

A

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

20
Q

epidural hematoma s/s

A
  • brief LOC
  • period of lucidity then rapid deterioration
  • may c/o localized headache
21
Q

Hallmark of Epidural hematoma

A

-dilated and fixed pupils of same side of impact

22
Q

diagnosis of epidural hematoma

A

CT, tx with surgery

23
Q

Neurologic Assessment of TBI

A
  • dictates the speed for further assessment and treatment

- ** CORNERSTONE ASSESSMENT = Glascow coma scale- must be early and ongoing

24
Q

Rib Fractures

-interventions

A

Pain

-treating underlying injuries

25
Q

Rib fractures

-significance of 7th-12th fractures

A

associated with spleen and liver lacerations

26
Q

Rib Fractures

-Flail Chest

A

when two or more ribs are fractured in 2+ places

27
Q

Pulmonary Contusion

A

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

28
Q

Pulmonary Contusion

-what can it lead to

A
  • ARDS
  • pneumonia
  • effusion
29
Q

Tension Pneumothorax

A

air flows into the pleural space with inspiration and becomes trapped

30
Q

Tension pneumothorax

S/S

A

-tracheal deviation
-decreased lung sounds one side
-hypotension
-unequal breath sounds
-hypoxia
JVD

31
Q

Tension Pneumothorax

-tx

A

Large bore needle (14 gauge) inserted into the lung (2nd ICS MCL)
-chest tube in an acute setting

32
Q

Hemothorax

cause

A

blunt or penetrating throacic trauma causing bleeding into the pleural space

33
Q

Hemothorax

s/s

A
  • hypovolemic shock
  • diminished breath sounds
  • **neck veins are collapsed and trachea midline
34
Q

Hemothorax

-tx

A

CHEST TUBE

-tx hypovolemic shock: IVF, blood transfusions

35
Q

Fluid Resuscitation

-complications

A
  • may lead to hypotension
  • can cause pulmonary edema
  • hypothermia- use a warmer to warm fluids
36
Q

Pelvic Fractures

-why is there a high mortality

A

skeletal fractures have a high mortality d/t hermorrhagic shock

37
Q

Pelvic Fracture Assessment

A
  • perianal ecchymosis
  • pain
  • rocking of iliac spine
  • lower limb paresis
  • hematuria
  • low limb rotation or leg shortening
  • rectal exams and occult bleeding
38
Q

Pelvic Fracture

Dx

A

CT or AP supine x-ray

39
Q

Pelvic Fracture

-medical management

A

prevent/control bleeding

  • temporary pelvic binder
  • pelvic angiography with contrast and embolization
40
Q

Pelvic Fracture

-Nursing management

A
  • 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
41
Q

Femur fracture

-tractions

A

early stabilization

  • reduces risk for fat embolism
  • relieves pain
  • restore perfusion
42
Q

Compartment Syndrome

A

tissue perfusion >35-46

43
Q

5 P’s of Compartment Syndrome

A 
P- pain
P-pallor
P-pulse declined
P- Pressure increased
-Paresthesia
44
Q

Trauma complications

A
  • hypermetabolism
  • infection!
  • pulmonary
  • pain
  • renal failure
45
Q

Renal Failure

-myoglobinuria

A

seen in crush injuries

  • dark tea colored urine
  • increased creatinine-kinase levels
  • aggressive IV fluids
46
Q

Trauma Prevention

A

-seatbelts
-no drink/drive
IPV-initmate partner violence

47
Q

blunt trauma

A

an injury with no opening in the skin

-can be more life-threatening because injuries difficult to see

Critical Care Test 2 (6 decks)

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