Trauma Flashcards
What is Level I trauma?
Provides comprehensive trauma care
Regional resource center that provides leadership in education, research, and systems planning
Providers immediately available, including trauma surgeon, anesthesiologist, physician specialists, and nurses
What is Level II trauma?
Provides comprehensive trauma care as a supplement to a Level I center
Meets the same provider expectations for care as a Level I center
Is not required to participate in education and research
What is Level III trauma?
Provides prompt, immediate emergency care and stabilization of patient with transfer to a higher level of care
Serves a community that does not have immediate access to a Level I or II center
What is Level IV trauma?
Provides advanced trauma life support prior to transfer
Primary goal is to resuscitate and stabilize the patient and arrange for immediate transfer to a higher level of care
What are the different levels of prevention?
Primary prevents the event i.e. driving classes, secondary minimizes the impact of the event i.e. seat belt use and tertiary maximizes patient outcomes after the event
What is Triage?
sorting the patients to determine which patients need specialized care for actual or potential injuries
What are the different classifications of disasters?
classified by the number of victims involved: multiple patient incident refers to fewer than 10 victims; multiple casualty incident refers to 10 to 100 victims; mass casualty incident refers to more than 100 victims. Disasters may also be classified as an institutional-based, internal disaster, occurring within a hospital and rendering the facility partially or totally inoperable
What is the most common mechanism of injury?
Blunt trauma
What are we assessing in penetrating injuries?
Examining entrance and exit wounds (if present) and must be monitored closely for subsequent complications, including organ damage, hemorrhage, and infection
What are the different classifications of blast injuries?
The primary explosive blast generates shock waves that create changes in air pressure, causing tissue damage.
Secondary injuries occur from increased negative pressure from the shock wave, causing debris to impale the body, creating organ and tissue damage.
Tertiary blast injuries are the result of the body being thrown by the force of the explosion, resulting in blunt tissue trauma, including closed head injuries, fractures, and visceral organ injury.
Quaternary blast injuries occur from chemical, thermal, and biological exposure.
What kind of care do we expect to provide “at the scene”?
Interventions include establishing an airway, providing ventilation, applying pressure to control hemorrhage, immobilizing the complete spine, and stabilizing fractures.
What is the most crucial tool in trauma care?
Primary survey (ABCDEs)… This rapid, 1- to 2-minute evaluation is designed to identify life-threatening injuries accurately, establish priorities, and provide simultaneous therapeutic interventions.
When does the secondary survey consist of?
initiated after the primary survey has been completed and all actual or potential life-threatening injuries have been identified and addressed. A full set of vital signs is obtained as a baseline for analysis of trends during the resuscitation phase, comfort measures are implemented, patient history is taken, and inspection of posterior surfaces is completed (FGHI). * Maintain C-spine immobilization until cleared by x-ray* X-ray studies (as determined by injury) Laboratory studies Tetanus toxoid administration Specialty physician consults
What is the central component of the primary and secondary survey?
effective resuscitation
When would we require a cricothyrotomy?
maxillofacial trauma, laryngeal fractures, facial or upper airway burns, airway edema, and severe oropharyngeal hemorrhage
What is the definitive nonsurgical airway management technique and allows for complete control of the airway?
Endotracheal intubation
What is important to remember in airway management?
That assessment is ongoing. the nurse must be prepared to assist with intubation and subsequent mechanical ventilation, needle thoracostomy, chest tube insertion, and restoration of circulating blood volume.
Where can we see IO needle placed?
intraosseous (IO) needles may be used for access in the sternum, legs, arms, or pelvis if the patient’s injuries do not interfere with the procedure
What are some markers for tissue perfusion?
The serum arterial lactate level and base deficit. The higher the lactate level and base deficit are, the more severe the tissue under perfusion will be and the higher the morbidity and mortality.
What is considered a massive blood transfusion?
administering 10 or more units of packed red blood cells in 24 hours.
In this situation, it is necessary to administer platelets and fresh frozen plasma in addition to packed RBCs to improve patient outcomes.
Blood products are given in a 1:1:1 ratio when massive blood transfusions are required—1 unit of packed RBCs, 1 unit of platelets, and 1 unit of fresh frozen plasma.
What electrolyte imbalances may develop with massive fluid resuscitation?
hypocalcemia, hypomagnesemia, and hyperkalemia or hypokalemia. These imbalances may lead to changes in myocardial function, laryngeal spasm, and neuromuscular and central nervous system hyper-irritability.
Why can third spacing occur in massive fluid resuscitation?
as more IV fluids are given to support systemic circulation, fluids continue to migrate into the interstitial space, causing excessive edema and predisposing the patient to additional complications such as abdominal compartment syndrome, ARDS, acute kidney injury, and MODS.
What is included in the assessment of neurological disabilities
evaluation of the patient’s level of consciousness, pupillary size and reaction, and spontaneous and reflexive spinal movement, as well as consideration of possible neurological injuries based on the history of the injury (e.g., ejection from motor vehicle, fall, or diving accident).
Evaluate substance abuse (drugs or alcohol use) that may interfere with neurological exam.
What is secondary injury in TBI?
the systemic (hypotension, hypoxia, anemia, hyperthermia) or intracranial changes (edema, intracranial hypertension, seizures) that result in alterations in the nervous system tissue.
What are some nursing interventions needed in the TBI secondary injury stage?
focus on ensuring an adequate blood pressure to meet cerebral perfusion needs (mean arterial pressure greater than 50 mm Hg), maximizing ventilation and oxygenation through effective airway management, maintaining the head in a midline position to enhance cerebral blood flow, administering sedatives to address agitation and increased intracranial pressure, and conducting frequent neurological assessments.
What mechanisms of injury may result in Spinal cord injury?
hyperflexion, hyperextension, axial loading, rotation, and penetrating trauma.
Why is it important to know the level of the SCI?
because higher cervical spine injuries may result in the loss of phrenic nerve innervations, compromising the patient’s ability to breathe spontaneously.
How are Basilar skull fractures diagnosed?
The diagnosis is based on the presence of cerebrospinal fluid in the nose (rhinorrhea), in the ears (otorrhea), or in both; ecchymosis over the mastoid area (Battle’s sign); or hemotympanum (blood in the middle ear). Raccoon eyes or periorbital ecchymoses are present after a cribriform plate fracture
What are the most significant concern with cardiac contusion?
Dysrhythmias
What are signs of an aortic disruption?
weak femoral pulses, dysphagia, dyspnea, hoarseness, and pain.
A chest x-ray study may demonstrate a widened mediastinum, tracheal deviation to the right, depressed left mainstem bronchus, first and second rib fractures, and left hemothorax.
How is an aortic disruption confirmed?
An aortogram
How do we diagnose a tension pneumothorax?
Clinical presentation; never delay treatment as we wait for chest xray
What are some signs and symptoms of a tension pneumothorax?
The increased pressure causes compression of the heart and great vessels toward the unaffected side, as evidenced by mediastinal shift and distended neck veins.
The resulting decreased cardiac output and alterations in gas exchange are manifested by severe respiratory distress, chest pain, hypotension, tachycardia, absence of breath sounds on the affected side, and tracheal deviation.
