Trauma Flashcards
Trauma
Any injury to the body caused by an external force
Multiple trauma
Involves at least 2 injuries and/or systems, medical injuries or fractures
Golden Hour of ressuscitation
60 minutes
First response may take longer to get pt’s hemostasis, pt warmth, …so that golden hour is lost!
Mechanisms of Injury
1) Object producing the injury (what object)
2) Type of energy released (mechanical, thermal, chemical, …)
3) Force of the energy (intensity, speed)
4) Use or not of protective devices (ex. leather in motorcycle drivers)
Types of Injury
Blunt Trauma Penetrating Trauma (gun shoot) Burns (chemical, electrical and thermal) Fractures Bites and stings by humans, animals and insects
Risk Factors in Trauma
- What was the mechanism of trauma (ask pt, family) to anticipate or predict damage
- Intoxicants (can mask true symptoms)
- Preexisting medical conditions - medications? diabetes? haemophilia? coagulation status? COPD?
- Last meal? (NPO for OR?)
- Tetanus immunizations (q10 years or if any exposure) - need boost?
“Isms” that impact care?
Ageism Religion -ism Racism Ethnicity Sexism ...
Diagnostic Testing
CBC Lytes Urinalysis Lactic Acid D-Dimer C-Reactive Protein ABG O2 sats Type & Cross match (for blood loss) Imaging (XRay, CT scan, MRI, FAST) Toxicology and BAS (Blood alcohol screen)
Issues of Major Trauma
Hypothermia Acidosis Coagulopathy Massive Fluid Shifts Infection Oxygen delivery and consumption Rhabdomyolysis (Fat) Embolism Neuro/endocrine stress response Systemic inflammatory response Multiple Organ Dysfunction syndrome (MODS) Psychologic Response
Types of Skull Fractures
- Depressed (risk of infection, increased ICP)
- Linear
- Basilar (battle sign)
Increased ICP s+s (think opposite to shock)
altered LOC Hypertension Decreased HR Pupil changes - sluggish Change in resp Change in temp Positive Babinski reflex Fixed dilated pupild Abnormal posturing - decerebrate (hemispheres) - decorticate (midbrain & pons)
GCS < 9 intubation is needed
Avoid hypoxia - when body needs greater demand of O2, pressure increases to increase perfusion to vital organs
Life-threatening Chest Injuries
1) Tension Pneumothorax
2) Open Pneumothorax
3) Massive Hemothorax
4) Cardiac Tamponate (Beck’s Triad)
5) Flail Chest with pulmonary contusion
Monitor:
Assymmetry of the lungs
Tracheal deviation
Tx:
Chest tube to remove air (higher 2nd midline intracostal space) or blood (lower)
Abdominal Trauma
Renal
Bladder
Ruptured Spleen **
Liver ** /pancreas
Intestinal tract tears or rupture - Large /small bowel ***
Major vessel - aorta, vena cava, hepatic veins, retroperitoneal vessels
- pelvic fracture
*** - (MOST Common) - these are encapsulated organs
Monitor: Bowel sounds
Keep NPO until system has been cleared for functioning
Blunt Abdominal Trauma
Compressive or shearing forces may deform and rupture abdominal organs
Visible signs may not reflect severity of underlying injury
Compartment Syndrome: Causes
ischemic myositis
Fractures Surgery Vascular injury Crush Injury Venomous bites Electrical Injury
Compartment Syndrome
Medical Emergency
Caused by increased pressure inside a compartment that then affects circulation (leading to ischemia) and nerve innervations (paresthesia, paralysis) - usually caused by a crush injury
Can lead to paralysis, amputation of affected limb or death
Compartment Syndrome: s+s (6 Ps)
Pulselessness Pallor Paralysis Paresthesia Pain Pressure
Spinal Cord Injury: ABCD
Collab management
(A B) Protect and secure airway;
Oxygenation and ventilation;
(C) Fluid management - crystalloids and colloids;
RBCs and blood products; stop bleeding;
Gastric intubation (to keep airway patent)
Urinary drainage- Foley and urometer
Nutrition therapy
Surgery to treat underlying cause
Pharmacology: antibiotics, opiate analgesia, tetanus prophylaxis, proton pump inhibitor for gastric protection, anticoagulation
Rehabilitation
Psychosocial Support
Spinal Cord Injury: Nursing Care
VS Airway management / ABGs Pulse oximetry Fluid and lytes Urinary/gastric catheters EKG Monitor BW Urinary output Pain management Patient and family support Teaching Constant ongoing assessments
First response to neuro trauma/Interventions
Immobilize head Protect airway Swallowing might be compromised Pain management Aspen collar (protect skin around neck)
Nursing interventions:
-Raise HOB
- Keep head straight to increase venous return
Magnesium sulfate, mannitol, hypertonic solutions to pull out fluid and relieve pressure
- Monitor I&O
Fracture complications
- Shock - Hypovolemic
- Fat embolism - fracture of long or pelvic bones or crush injuries
- Compartment syndrome - pressure within a compartment affecting perfusion and nerve innervation - 6Ps
- Venous thromboemboli (DVT)
- Pulmonary embolism
- Rhabdomyolysis
Rhabdomyolysis
Breakdown of muscle and cell contents (myoglobin) into the bloodstream (usually thigh or calf)
Hyperkalemia
Hypercalcemia
Elevated Creatine Kinase
Burns complications
Systemic Capillary Leak Syndrome: proteins and fluid leak from blood vessels into surrounding tissues
- leaking of protein and fluids - dehydration
- Drop in BP, plasma, and albumin & proteins
