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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
ways to maintain airway (non-surgical ways)
jaw thrust/chin lift (careful w/spinal cord injuries) | intubate (ET tube)
26
why do we AVOID nasal tubes in pt w/maxillofacial or basilar skull fractures
ng tube can go into brain due to fractures
27
basic nursing interventions for ineffective breathing
``` ongoing assessment (resp status, ABGs, chest x-rays, CT imaging) improve ventilation and gas exchange - maintain proper positioning ```
28
what do we for tension pneumothorax
needle thoracotomy/decompression | EMERGENCY - REACT FAST
29
what do we do for pneumothorax
chest tube - be prepared
30
what do we do for open chest wound
decreased pulse ox - give O2 | 3 sided dressing
31
what do we do for pulmonary contusion
insult to lung tissue - bruising - swelling life threatening Emergency - basis for ARDS ABC's prep for intubation - breathing tubes
32
what do we do for flail chest
worry about pain - comfort measures is pt ventilating, breathing correctly? intubate pt. give pain meds
33
what is a flail chest
broken ribs, no structure causes flailing
34
interventions for SCI
maintain immobilization | monitor for s/s of distributive/neurogenic shock
35
interventions for decreased LOC
anticipate intubation - brain center isn't getting o2
36
interventions for massive hemothorax
chest tube to re-inflate lung - get blood out build up of blood is decreasing ability to oxygenate may need to replace blood
37
assessment for impaired gas exchange (3)
place pt on pulse ox asses respiratory secretion removal
38
hypovolemic shock - acute blood loss type of hemorrhaging
internal and external
39
most common cause for impaired cardiac output in trauma pt
hypovolemia - anticipate*
40
trt for hypovolemia
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
s/s of hypovolemic shock
increased HR, decreased BP, tachypnea, cool/clammy, decreased urinary output, altered LOC
42
compensatory mechanism of hypovolemic shock
vasoconstriction resulting in increased systemic vascular resistance oliguria/anuria
43
interventions for hypovolemic shock
treat the cause | give fluids/blood
44
response to treatment (responders)
rapid response transient response - still bleeding, surgery needed minimal/no response - emergent surgery to stop bleed
45
technologies to assess tissue perfusion (hypoxia)
capnometry (sub-lingual) | spectroscopy (musculature)
46
fluid resuscitation (massive)
10 units/replacement of packed blood in 24 hrs
47
goals of fluid resuscitation
restore o2 to tissues stop progression of shock prevent complications electrolyte imbalances
48
complications of fluid resuscitation (4)
``` 3rd spacing (2/3 goes from hi to low pressure) hypothermia risk for ARDS, kidney dysfunction, MODS, coagulopathies ```
49
fluid of choice
lactated ringers
50
FAST acronym
focused assessment with sonography for trauma in peritoneal cavity
51
in traumatic brain injury assess***
LOC- protect airway - intubate | 1st 72 hours are critical
52
in spinal cord injury assess for
s/s of distributive/neurogenic shock | *may need vasopressors - anticipate
53
with skull fractures stay away from
nasal tubes
54
trt we should expect for pt with cardiac tamponade/chest injury ***
anticipate pericardiocentesis
55
a late sign of chest injury/cardiac tamponade
becks triad hypotension muffled heart sounds elevated venous pressures
56
in chest injury we can expect
``` cardiac tamponade (bld into pericardial space) cardiac contusion ```
57
with a cardiac contusion we can expect
dysrhythmias heart-attack hypotension due to weakened/injured muscle
58
aortic disruption we can expect
shearing/tearing of aorta (initma wall) causing dissection emergent surgery - if makes it to hospital
59
tension pneumothorax anticipate
emergency - life threatening - important to pick-up early | needle decompression then chest tube insertion
60
hemothorax (blood in pleural space) anticipate
decreased breath sounds, resp distress blood in pleural space chest tube
61
open pneumothorax anticipate
3 sided occlusive dressing (allows air to escape) | chest tube
62
***pulmonary contusion***
most common cause of death after chest trauma
63
s/s of pulmonary contusion
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
intervention for pulmonary contusion
intubate | pain mgmt
65
kidney injury(abdominal injury)
blunt trauma | bed rest - iv fluids - dialysis
66
what should we note with pelvic/long bone injuries
embolisms***
67
closed vs open fractures
open breaks skin - closed doesn't
68
6 P's of musculoskeletal injuries
``` pulse pallor poikilothermia - temp regulation inability parasthesia pain paralysis ```
69
compartment syndrome risk for
decreased pulses
70
trt for compartment syndrome
fasciotomy
71
with a fasciotomy pt is at risk for
hypovolemia
72
rhabdomyolysis interventions
give fluids
73
what causes rhabdomylosis
crush injury
74
telltale sign for rhabdomylosis
tea colored urine
75
pt with rhabdomylosis is at risk for
compartment syndrome
76
venous thrombo-embolism trt
prevention is key teds - encourage pt to walk prophylactic meds
77
long bone fractures put you at risk for
fat embolisms
78
staged damage control/repair
address life threatening injuries repair hemodynamic stabilization correction of metabolic acidosis/coagulopathies
79
post-op mgmt
``` 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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