- TRAUMA - Flashcards
Demonstrate an understanding of the epidemiology of trauma in the Australian context
Injury contributes extensively to mortality, morbidity and permanent disability from road injury, self harm, assaults, burns, accidents and falls.
Death from trauma occurs:
Peak 1: Seconds to minutes
Peak 2: 1 -2 hours after injury. ‘The golden hour’
Peak 3: Days to weeks after injury
Identify the major trauma criteria
– Life or limb threatening
– Requires immediate interventions
– May be multiple injuries
Disscuss the ‘Airway’ component of the primary survey of the trauma pt
Look, Listen Feel:
– Assess for airway stability
– Assess for soiled airway
– Attempt simple airway manoeuvres if required (no head tilt, no NPA for head injury)
Secure airway if required. If patient intubated document:
– Size, position, ETCO2, cuff pressure and mallampati
- Cx spine protection if indicated
- Full spinal precaution until
documented otherwise
Discuss the secondary survey a the trauma pt
• Performed once the patient is resuscitated and stabilised • History (AMPLE) • Head to toe examination – Head and face – Neck – Chest – Abdomen – Limbs – Back – Buttocks and perineum – Genitalia – Psychosocial
Discuss the interventions for a traumatic brain injury
Airway, Breathing, Circulation, Disability, Exposure CT scan Fluid and Electrolyte Balance Appropriate Pharmacology ICP management Body position Wound Management Psychosocial considerations Documentation and communication Behavioural manifestations Appropriate preoperative and postoperative nursing interventions Calm and gentle approach Reassessment
Discuss the epidemiology of spinal cord injuries in the Australian context.
- 70% are traumatic
- 80% male
- 35% sport
- 60% injury to cerical spine
- 49% incomplete tetraplegia
- > 10,000 people living with a SCI
- costs $2 billion annually
Identify the mechanisms of injury that can cause a spinal cord injury
Compression:
- any condition that puts pressure on the spinal cord
Direct:
- caused by direct blow to vertebral column
Flexion:
- sudden forcible flexion (falls, unstable fractures)
Hyperextension:
- tearing of invertebral discs and stretching of the spinal cord
Rotation:
- usually in combination with a fleaxion injury from falls or passengers in MVAs
Describe the pathophysiology of a spinal cord injury
- After a traumatic injury the spinal cord becomes oedematous
- There is limited space to cope with the swelling
- Neurological function deteriorates rapidly
- Can effect two nerve exit points above the level of SCI
- As swelling goes down, there may be recovery above the level of
injury - Patients may have a combination of motor and sensory deficits that
may be unilateral or bilateral and affecting their upper and/or lower
regions
Outline the implications of trauma in the elderly
Resuscitation conducted in same manner – Airway, Breathing, Circulation, Disability, Exposure Medications may mask symptoms ECG for all elderly trauma patients Ethical considerations
Outline the implications of trauma in paediatrics
- Paediatric scoring criteria Management principles are the same o Airway, Breathing, Circulation, Disability, Exposure Consider anatomical and physiological differences Insert orogastric early Deliver high percentage oxygen IV or IO access Cross match for paediatric trauma patients – Infants 2 units – Small child 4 units – Large child 6 units Cervical collars Care of the Family Awareness of mandatory reporting
Outline the implications of trauma in pregnant pts
Complications associated with trauma and pregnancy – Placental abruption – Cardiorespiratory arrest – Labour and birth – Preterm labour – Spontaneous abortion – Uterine rupture – Pelvic fractures – Haemorrhage and shock
Discuss the clearance of the cervical spine following trauma
NEXUS CRITERIA
- midline cervical spine tenderness
- focal neurological deficit
- intoxication
- painful distracting injury
- Altered mental status
Discuss the pathophysiology of autonomic dysreflexia
- After a traumatic injury the spinal cord becomes oedematous
- There is limited space to cope with the swelling
- Neurological function deteriorates rapidly
- Can effect two nerve exit points above the level of SCI
- As swelling goes down, there may be recovery above the level of
injury - Patients may have a combination of motor and sensory deficits that
may be unilateral or bilateral and affecting their upper and/or lower
regions
Discuss the management of autonomic dysreflexia
- remove possible cause
- nitrates or captopril if cause not
identified
Outline the markers for serious injury in the trauma pt
ISS 25-49 Factors: - region of body affected - injury description - AIS - Square of top 3
