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CCM > Trauma > Flashcards

Trauma Flashcards

1
Q

trauma is assoc with these types of shock (spinal cord)

A

hypovolemic and (neurogenic) distributive shock

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2
Q

whats important about trauma

A

prevention and anticipation

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3
Q

what is the golden hour of trauma

A

acute, the first hour, hit car, clock starts, things happen quickly

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4
Q

levels of trauma care

A

1 - regional trauma center, research
2- trauma
3- community hospital
4- life support and transfer

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5
Q

primary prevention

A

education, prevention

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6
Q

secondary prevention

A

minimize impact; helmets, safety belts

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7
Q

tertiary prevention

A

injury has occurred

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8
Q

what does trauma nurse want to know

A

age

mechanism of injury - injuring agent

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9
Q

whats important about the mechanism of injury

A

how event occurred, injuring agent, type/amt of energy exchanged (speed of car crash)

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10
Q

whose on trauma team

A

depends on mechanism of injury

lab techs, radiology, security, pastoral care, social workers

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11
Q

**primary survey

A

done in 1-2 minutes
ABCDE
A - airway patency (c-spine immobile)
B - breathing effectiveness
C - Circulation, including hemorrhages and pulses (BP)
D - Disability (neuro status)
E - Expose pt, remove clothing, warm pt and trauma rm.

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12
Q

secondary survey

A

after life-threatening injuries are identified/trt’d
FGHI
F - full set of vitals, family presence, focused interventions
G - give comfort measures
H - hx and head-to-toe assessment (AMPLE - allergies, medications, past med hx/preg, last meal, event)
I - inspect posterior surfaces (log roll)

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13
Q

life saving interventions

A

ABC’s - airway breathing circulation

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14
Q

what is kinetic energy

A

thermal, chemical, electrical, radiation, blast

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15
Q

what is blunt trauma

A

acceleration, deceleration, shearing, crushing, compression

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16
Q

what is a coup contracoup

A

axonal diffuse injury; shearing and crushing

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17
Q

assessment and trt of blast trauma

A

ABC’s

clean wound, monitor infection, assess for debris

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18
Q

assessment and trt of penetrating trauma

A 
entrance/exit wound
ABC's
Airway 1st
give O2
replace blood loss
take vitals, respond
prepare OR
infection (not primary concern)
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19
Q

assessment and trt of blunt trauma

A 
ABC's airway, breathing, circulation
2 lg bore IV's - fluid administration - labs
vitals/monitors
start fluids 
monitor breathing
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20
Q

pt presenting to ED are at high risk for

A

hypothermia

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21
Q

what 2 organs are effected in respiratory acidosis

A

lungs and kidneys

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22
Q

risk fxrs for hypothermia

A

wet, cold, lost consciousness causing incontinence, age

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23
Q

interventions for hypothermia

A

get wet stuff off, use bear hugger, bahama light (heat lamp)

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24
Q

how long is resuscitation phase

A

from injury to stabilization
include ABCDE’s
focus on effective circulatory volume

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25
Q

ways to maintain airway (non-surgical ways)

A

jaw thrust/chin lift (careful w/spinal cord injuries)

intubate (ET tube)

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26
Q

why do we AVOID nasal tubes in pt w/maxillofacial or basilar skull fractures

A

ng tube can go into brain due to fractures

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27
Q

basic nursing interventions for ineffective breathing

A 
ongoing assessment (resp status, ABGs, chest x-rays, CT imaging)
improve ventilation and gas exchange - maintain proper positioning
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28
Q

what do we for tension pneumothorax

A

needle thoracotomy/decompression

EMERGENCY - REACT FAST

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29
Q

what do we do for pneumothorax

A

chest tube - be prepared

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30
Q

what do we do for open chest wound

A

decreased pulse ox - give O2

3 sided dressing

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31
Q

what do we do for pulmonary contusion

A

insult to lung tissue - bruising - swelling
life threatening Emergency - basis for ARDS
ABC’s
prep for intubation - breathing tubes

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32
Q

what do we do for flail chest

A

worry about pain - comfort measures
is pt ventilating, breathing correctly?
intubate pt. give pain meds

33
Q

what is a flail chest

A

broken ribs, no structure causes flailing

34
Q

interventions for SCI

A

maintain immobilization

monitor for s/s of distributive/neurogenic shock

35
Q

interventions for decreased LOC

A

anticipate intubation - brain center isn’t getting o2

36
Q

interventions for massive hemothorax

A

chest tube to re-inflate lung - get blood out
build up of blood is decreasing ability to oxygenate
may need to replace blood

37
Q

assessment for impaired gas exchange (3)

A

place pt on pulse ox
asses respiratory
secretion removal

38
Q

hypovolemic shock - acute blood loss type of hemorrhaging

A

internal and external

39
Q

most common cause for impaired cardiac output in trauma pt

A

hypovolemia - anticipate*

40
Q

trt for hypovolemia

A

stop bleeding
2 lg bore IV’s
intraosseous IV access - labs (ABG’s, chem 7, hemoglobin, coags/pt/ptt, lactate) - admin lactated ringers
admin. blood

41
Q

s/s of hypovolemic shock

A

increased HR, decreased BP, tachypnea, cool/clammy, decreased urinary output, altered LOC

42
Q

compensatory mechanism of hypovolemic shock

A

vasoconstriction resulting in increased systemic vascular resistance
oliguria/anuria

43
Q

interventions for hypovolemic shock

A

treat the cause

give fluids/blood

44
Q

response to treatment (responders)

A

rapid response
transient response - still bleeding, surgery needed
minimal/no response - emergent surgery to stop bleed

45
Q

technologies to assess tissue perfusion (hypoxia)

A

capnometry (sub-lingual)

spectroscopy (musculature)

46
Q

fluid resuscitation (massive)

A

10 units/replacement of packed blood in 24 hrs

47
Q

goals of fluid resuscitation

A

restore o2 to tissues
stop progression of shock
prevent complications
electrolyte imbalances

48
Q

complications of fluid resuscitation (4)

A 
3rd spacing (2/3 goes from hi to low pressure)
hypothermia
risk for ARDS, kidney dysfunction, MODS, coagulopathies
49
Q

fluid of choice

A

lactated ringers

50
Q

FAST acronym

A

focused assessment with sonography for trauma in peritoneal cavity

51
Q

in traumatic brain injury assess***

A

LOC- protect airway - intubate

1st 72 hours are critical

52
Q

in spinal cord injury assess for

A

s/s of distributive/neurogenic shock

*may need vasopressors - anticipate

53
Q

with skull fractures stay away from

A

nasal tubes

54
Q

trt we should expect for pt with cardiac tamponade/chest injury ***

A

anticipate pericardiocentesis

55
Q

a late sign of chest injury/cardiac tamponade

A

becks triad
hypotension
muffled heart sounds
elevated venous pressures

56
Q

in chest injury we can expect

A 
cardiac tamponade (bld into pericardial space)
cardiac contusion
57
Q

with a cardiac contusion we can expect

A

dysrhythmias
heart-attack
hypotension due to weakened/injured muscle

58
Q

aortic disruption we can expect

A

shearing/tearing of aorta (initma wall) causing dissection
emergent
surgery - if makes it to hospital

59
Q

tension pneumothorax anticipate

A

emergency - life threatening - important to pick-up early

needle decompression then chest tube insertion

60
Q

hemothorax (blood in pleural space) anticipate

A

decreased breath sounds, resp distress
blood in pleural space
chest tube

61
Q

open pneumothorax anticipate

A

3 sided occlusive dressing (allows air to escape)

chest tube

62
Q

pulmonary contusion

A

most common cause of death after chest trauma

63
Q

s/s of pulmonary contusion

A

rib fractures - flail chest - going into ARDS/pneumonia
blood-tinged sputum
hypoxic despite oxygenating the pt. - ABGs are poor
bruised lung tissue causing inflammation throughout

64
Q

intervention for pulmonary contusion

A

intubate

pain mgmt

65
Q

kidney injury(abdominal injury)

A

blunt trauma

bed rest - iv fluids - dialysis

66
Q

what should we note with pelvic/long bone injuries

A

embolisms***

67
Q

closed vs open fractures

A

open breaks skin - closed doesn’t

68
Q

6 P’s of musculoskeletal injuries

A 
pulse
pallor
poikilothermia - temp regulation inability
parasthesia
pain
paralysis
69
Q

compartment syndrome risk for

A

decreased pulses

70
Q

trt for compartment syndrome

A

fasciotomy

71
Q

with a fasciotomy pt is at risk for

A

hypovolemia

72
Q

rhabdomyolysis interventions

A

give fluids

73
Q

what causes rhabdomylosis

A

crush injury

74
Q

telltale sign for rhabdomylosis

A

tea colored urine

75
Q

pt with rhabdomylosis is at risk for

A

compartment syndrome

76
Q

venous thrombo-embolism trt

A

prevention is key
teds - encourage pt to walk
prophylactic meds

77
Q

long bone fractures put you at risk for

A

fat embolisms

78
Q

staged damage control/repair

A

address life threatening injuries
repair
hemodynamic stabilization
correction of metabolic acidosis/coagulopathies

79
Q

post-op mgmt

A 
ready the room - receive the pt. - hand-off/communication
abcde's
put pt on monitor
set alarms
meet nutritional needs

CCM (13 decks)

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