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Nursing and Complex Care > Trauma > Flashcards

Trauma Flashcards

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1
Q

What is the definition of Trauma?

A
  1. Injury to the tissue or organs as a result of energy transferred from the environment.
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2
Q

What is the protocol of trauma for paramedics?

A
  1. MIST
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3
Q

What does MIST stand for?

A

M- Mechanism of Injury
I- Injury received
S- Signs & symptoms
T- Transport

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4
Q

What is the definition of Mechanism of Injury?

A
  1. Source of energy that is transferred to the patient
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5
Q

Why must we know the Mechanism of Injury?

A
  1. In order to anticipate the extent and pattern of the injury.
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6
Q

What are the causes of trauma?

A
  1. Vehicle accidents
  2. Pedestrian Injury
  3. Gunshot wounds
  4. Falls
  5. Burns
  6. Violence
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7
Q

What are the energy sources that could be transferred?

A
  1. Mechanical energy
  2. Gravitational energy
  3. Thermal energy
  4. Chemical energy
  5. Electrical energy
  6. Physical energy
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8
Q

What are the 2 major types of injury?

A
  1. Blunt injury:
    - Road trauma
    - Falls
    - MOI
    - Safety devices: Seatbelts/Steering wheel
  2. Penetrating injury:
    - Gunshot wounds/ Stab wounds
    - Increase incidences with availability of knives/guns
    - Type of weapon
    - Direction of weapon force
    - Distance from assailant
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9
Q

What is the aim of major trauma services?

A
  1. Minimise time to the definitive care
  2. Early transportation of severely injured patient to hospital that provides the most adequate care will increase chances of patient survival
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10
Q

What are the Major Trauma Criteria’s? (1)

A 
1. Haemodynamic instability
Adults
RR: less 10 or more 30 
Cyanosis: Present
Hypotensive: Less 90mmHg
GCS: less 13
Children
RR: less 15 or more 40
Cyanosis: present
Hypotensive (less 75mmHg + age)
GCS: less 15
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11
Q

What are the Major Trauma Criteria’s? (2)

A
  1. ALL penetrating wounds:
    - Head
    - Neck
    - Chest
    - Abdomen
    - Axilla
    - Groin
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12
Q

What are the Major Trauma Criteria’s? (3)

A
  1. Blunt injuries
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13
Q

What are the Major Trauma Criteria? (4)

A
  1. Specific Injuries:
    - Limb amputations/limb threatening
    - Suspected spinal injures
    - Burns >20% to body or resp. tract
    - Major crush injuries
    - Major compound # 2 or more: femur, tibia, humorous, pelvis
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14
Q

What is expected of trauma hospitals?

A
  1. All hospital receiving trauma must have a trauma team.

2. Trauma teams are specialised staff

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15
Q

Who are the staff that are included in trauma team?

A
  1. Trauma team leaders
  2. Airway doctor/nurse
  3. Circulation doctor/nurse
  4. Scrub nurse
  5. Orthopaedic registra
  6. Orderly/porter
  7. Radiography
  8. Social worker
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16
Q

Area’s to consider notifying for collaborative care

A
  1. Radiology
  2. Theatre
  3. Intensive care
  4. Pathology
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17
Q

The Australasian Triage Scale

A
  1. Resuscitative: immediate
  2. Emergency: less then 10mins
  3. Urgent: less than 30mins
  4. Semi- urgent: less then 60mins
  5. Non- urgent: less then 120mins
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18
Q

What are the aims of management with trauma?

A
  1. Assessment/ Resuscitation
  2. Stabilisation
  3. Diagnosis
  4. Maintenance of oxygenation & circulatory volume
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19
Q

What are your predicted clinical problems?

A
  1. Hypovalaemia
    - Blood loss
    - Fluid loss
  2. Respiratory Dysfunction
    - Airway obstruction
    - Mechanical disruption to the thorax: Multiple rib #
  3. Cerebral Dysfunction
    - Intracerebral & Intracranial bleeding
    - Cerebral Oedema
    - Important to exclude underlying pathology that is not associated with trauma eg. BGLs, sedation
20
Q

What does the primary survey consist of?

A

A- Airway & Cervical spinal protection
B- Breathing & Ventilation
C- Circulation & Haemorrhage control
D- Disability & pupils: AVPU & AMPLE
E- Environment & Exposure

21
Q

What are the 6 lethal chest injuries?

A
  1. Airway obstruction
  2. Cardiac Tamponade
  3. Flail chest
  4. Open pneumothorax
  5. Tension pneumothorax
  6. Massive Haemothorax
22
Q

What is Flail chest?

A
  1. Associated with multiple rib #
  2. Segmental # of 2 or more locations on the same rib
  3. Alters normal respiratory patterns: increase WOB = Paradoxial breathing
  4. Associated lung injuries leads to hypoxia
23
Q

Manifestations of Flail chest

A
  1. Hypoxaemia
  2. Increase fatigue
  3. Increase ventilation/muscle effort
  4. Ventilation inefficiency
  5. Untreated Flail chest will result in respiratory distress syndrome & respiratory failure
24
Q

What is the treatment of flail chest?

A
  1. Ventilation & Oxygenation
  2. Pulmonary hygiene: Clearance of secretions & humidified inspired gases
  3. Position: Maximum O2
  4. Caution with fluid replacements
  5. +/- Surgery
  6. Medications:
    - Analgesics
    - Anti- biotics
    - Steroids
    - Inflammatory agents
25
Q

What is Cardiac Contusions?

A
  1. The bruising of the myocardial muscle
  2. R. ventricle most common
  3. Due to blunt trauma
26
Q

What is diaphragmic rupture?

A
  1. Herniation of the abdominal contents into the thoracic cavity
  2. Bowels sounds are audible in the thorax, indication of rupture
27
Q

What is a open pneumothorax?

A
  1. Large defect that remains open
  2. Equilibration between intrathoracic & atmospheric pressure is immediate
  3. Air passes through the chest wall defects 2/3 the diameter of the trachea
  4. Ventilation is impaired causes hypoxia
28
Q

What is the management of open pneumothorax?

A
  1. Seal the chest wall defects with gazes taped on three sides; avoid creation of tension pneumothorax
  2. Chest tube to be inserted distant to the injury
  3. Surgical closure of the wound
29
Q

What is cardiac tamponade?

A
  1. Life threatening condition
  2. Accumulation of intra-pericardial fluid or air
  3. Leads to impaired cardiac filling: decrease CO
  4. Results of penetrating injuries
30
Q

What are the manifestations of cardiac tamponade?

A
  1. Early sign: Dyspnea
  2. Becks Triad:
    a) Hypotension
    b) Distended neck vessels
    c) Distant, muffled heart sounds
  3. Pulse paradox
  4. Tachycardia
  5. Paradoxical increase (JVP)
31
Q

What is the management of cardiac tamponade?

A
  1. Fluid bolus
  2. Pericardiocentesis (needle to aspiration)
  3. Thoracotomy
32
Q

What is a Massive haemothorax?

A
  1. Accumulation of blood in the pleural space
  2. Loss of 1500ml of blood into the chest cavity
  3. 2/3 of available space is occupied by blood
  4. Can hold up to 40-50% of circulatory volume
33
Q

What is the associated injuries of Massive haemothorax?

A

Injury to:

  1. Lung parenchyma
  2. Intercostal artery
  3. Internal mammary
34
Q

What is the 3 mechanisms of life threat associated with massive haemothorax?

A
  1. Hypovalaemia:
    - Preload inadequate to sustain left ventricle
  2. Hypoxia:
    - V/Q (ventilation & perfusion mismatch)
  3. Compression of the vena cava & pulmonary
35
Q

What happens when there is lung parenchyma injury?

A
  1. Further decreases in Preload

2. Increases pulmonary vascular resistance

36
Q

Conditions that support the diagnosis of massive haemothorax?

A
  1. Shock
  2. Absence of unilateral breath sounds
  3. Dullness to percussion
  4. Neck veins may be flat due to hypovalaemia
  5. Distended neck veins due to mechanical effects of intrathoracic blood.
37
Q

What is the treatment of a massive haemothorax?

A
  1. Restoration of volume & decompression of the chest
  2. Usually requires a thoracotomy
  3. Pt with ordinary haemothorax will drain mod. amounts then re-bleed.
  4. Ongoing haemothorax drain 600mls/6hrs
  5. Consider an auto transfusion to re-use their own blood.
38
Q

When would a Resuscitative Thoracotomy be initiated?

A
  1. For blunt injuries (RT) would be done if there are signs of life in the ED.
  2. For penetrating injuries (RT) would be done if there are signs of life @ the scene
  3. Better outcomes for stab wounds then gun wounds
39
Q

Why is a cardiac massage done?

A
  1. Thoracic incision allows for:
  2. Inspection
  3. Control bleeding
  4. Evacuation of pericardial tamponade or haemo-pneumothorax which increases coronary blood flow
40
Q

What are your neuro-trauma injuries?

A
  1. Primary brain injuries
  2. Secondary brain injuries
  3. Post traumatic amnesia
41
Q

What is a primary brain injury?

A
  1. Initial damage to the brain
  2. Severity depends on 2 factors:
    a) Area of the brain that is damaged
    b) Extent of neuronal damage
42
Q

What is a secondary brain injury?

A
  1. After the initial incident & results in:

a) cerebral & oedema

43
Q

What is the result of secondary brain injury?

A
  1. Ischaemia
  2. Haemorrhage
  3. Increased ICP
  4. Neurochemical derangements
44
Q

What are the investigations/monitoring of neurotrauma?

A
  1. Vital signs & GCS
  2. CT scan
  3. ICP monitoring
  4. CSF sampling
  5. Jugular bulb monitoring:
    - Measuring the cerebral metabolic rate (O2 consumption) to the cerebral blood flow
45
Q

Coup? Contrecoup?

A

Coup: forward motion
contrecoup: Backwards motion
hitting the brain matter against the cranium.

46
Q

What are the management principals of Neuro trauma?

A
  1. Reduce the raise of ICP:
    a) Adequate fluid replacement
    b) Raise head of bed to 30 degrees
    c) Prevent shivering & hyperthermia
    d) Avoid stress & anxiety
  2. Control seizures
47
Q

What are the body’s responses to Trauma?

A

Hypofusion:

  1. Hypovalaemia
  2. Cardiac dysfunction
  3. Tension Pneumothorax
  4. Spinal cord injury

Nursing and Complex Care (8 decks)

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