Trauma

Question 1

Trauma

Answer 1

Any injury to the body caused by an external force

Question 2

Multiple trauma

Answer 2

Involves at least 2 injuries and/or systems, medical injuries or fractures

Question 3

Golden Hour of ressuscitation

Answer 3

60 minutes

First response may take longer to get pt’s hemostasis, pt warmth, …so that golden hour is lost!

Question 4

Mechanisms of Injury

Answer 4

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)

Question 5

Types of Injury

Answer 5

Blunt Trauma
Penetrating Trauma (gun shoot)
Burns (chemical, electrical and thermal)
Fractures
Bites and stings by humans, animals and insects

Question 6

Risk Factors in Trauma

Answer 6

• 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?

Question 7

“Isms” that impact care?

Answer 7

Ageism
Religion -ism
Racism
Ethnicity
Sexism
...

Question 8

Diagnostic Testing

Answer 8

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)

Question 9

Issues of Major Trauma

Answer 9

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

Question 10

Types of Skull Fractures

Answer 10

• Depressed (risk of infection, increased ICP)
• Linear
• Basilar (battle sign)

Question 11

Increased ICP s+s (think opposite to shock)

Answer 11

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

Question 12

Life-threatening Chest Injuries

Answer 12

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)

Question 13

Abdominal Trauma

Answer 13

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

Question 14

Blunt Abdominal Trauma

Answer 14

Compressive or shearing forces may deform and rupture abdominal organs

Visible signs may not reflect severity of underlying injury

Question 15

Compartment Syndrome: Causes

ischemic myositis

Answer 15

Fractures
Surgery
Vascular injury
Crush Injury
Venomous bites
Electrical Injury

Question 16

Compartment Syndrome

Answer 16

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

Question 17

Compartment Syndrome: s+s (6 Ps)

Answer 17

Pulselessness
Pallor
Paralysis
Paresthesia
Pain
Pressure

Question 18

Spinal Cord Injury: ABCD

Collab management

Answer 18

(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

Question 19

Spinal Cord Injury: Nursing Care

Answer 19

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

Question 20

First response to neuro trauma/Interventions

Answer 20

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

Question 21

Fracture complications

Answer 21

• 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

Question 22

Rhabdomyolysis

Answer 22

Breakdown of muscle and cell contents (myoglobin) into the bloodstream (usually thigh or calf)
Hyperkalemia
Hypercalcemia
Elevated Creatine Kinase

Question 23

Burns complications

Answer 23

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