Trauma and Venipunture Flashcards
Trauma is defined as:
a sudden, unexpected, dramatic, forceful or violent event. It is the leading cause of death in the U.S. for persons 1-44 years of age, excluding suicide and homicide related deaths.
The term “Trauma Center” signifies:
a specific level of emergency medical care as defined by the American College of Surgeons- Commission on Trauma.
Trauma centers are categorized:
into five levels of care: Level I-V. Level I is the most comprehensive. Level V is the most basic.
If you are severely injured, access to care at a Level I trauma center lowers your risk of death by:
25%
The “Golden Hour”:
the idea that trauma patients have significantly better survival rates if they reach a Level I or II Trauma Center within 60 minutes of their injury.
Less than __% of the U.S. population is within one-hour travel distance from a Level I or II Trauma center.
30
Level I Trauma Center:
usually a university based center, research facility, or large medical center. Complete imaging capabilities 24/7. All types of specialty physicians are available on site 24 hours a day.
Level II Trauma Center:
typically has all of the same specialized care available, but is not a research or teaching hospital; some specialty physicians may not be available on site.
Level III Trauma Center:
usually located in rural, smaller communities. Does not have the full availability of specialists, but does have resources for emergency resuscitation, surgery and intensive care of most trauma pts. Has transfer agreements with Level I and/or Level II trauma centers that provide back-up resources for the care of exceptionally severe injuries.
Level IV Trauma Center:
provides the stabilization and treatment of severely injured patients in remote or rural areas where no alternative care is available.
Several types of forces that cause trauma:
blunt, penetrating, explosive and heat.
Blunt trauma:
injury incurred when the human body hits or is hit by a large outside object (as a car); includes MVA’s, which includes motorcycle accidents an collision with pedestrians; falls; and aggravated assaults.
Penetrating trauma:
GSW’s, stab wounds, impalement, foreign body ingestion.
Explosive trauma:
Causes injury by several mechanisms, including pressure shock waves, and high velocity projectiles.
Burn trauma:
Burns may be caused by a number of agents including fire, steam and hot water, chemicals, electricity and frostbite.
Universal guidelines during trauma:
Speed Accuracy Quality Positioning Standard Precautions Immobilization Anticipation Attention to Detail Attention to department protocol and scope of practice. Professionalism
Mobile radiography was first used by:
military for treating battlefield injuries during WWI. Small portable units were carried by soldiers and set up in field locations.
If patients cannot be moved into usual routine positions:
major adaptation of CR angles and image receptor placement is required.
Patients requiring mobile radiography are often:
immobile and among the most sick. Pts may be awake and lying-in bed in traction because of a broken limb, or they may be critically ill and unconscious.
Before entering a pt’s room with the machine, the radiographer should follow several important steps:
Announce your presence to the nursing staff, and ask for assistance if needed.
Determine that the correct pt is in the room.
Introduce yourself to pt and family: explain the exam.
Remove obstacles from the path of the mobile machine.
Assessing the pt’s condition:
Pt’s level of alertness and respiration must be assessed and then determine the extent to which the pt is able to cooperate. Pts may have varying degrees of drowsiness because of their medications or medical conditions.
Keep pt’s mobility in mind:
Never move a pt or part of the pt’s body without assessing the pt’s ability to move, or tolerate movement. Gentleness and caution must prevail! If unsure of pt’s condition, check with nursing staff or physician.
The radiographer should never move a limb that has been operated on or is broken unless:
the nurse, the physician, or sometimes the pt grants permission. Inappropriate movement of the pt by the radiographer during the exam may harm the pt.
If the pt’s trunk or limb must be raised into position for a projection, the radiographer should have:
assistance so the part can be raised safely without causing harm or intense pain.
IR’s must be enclosed in an appropriate, impermeable barrier in any situation in which:
it may come in contact with blood, body fluids, and other potentially infectious material. Approved procedures for disposing of used barrier must be followed.
Principle one of Trauma and Mobile radiography:
Two projections 90º to on another, with true CR-part-IR alignment; may result in two oblique views.
Exceptions with CR-part-IR alignment:
Oblique radiograph of trauma cervical spine, the IR is flat not eh table. Results in some distortion of part.
Principle two of Trauma and Mobile radiography:
Include both joints for all long bones on one IR; include entire trauma area. Make sure divergent beam does not project body part off IR.
Important considerations during trauma exams:
- Time is a critical element.
- Radiographs must be taken with minimal patient movement, requiring more manuvering of the tube and IR.
- Images must b e of high-quality on the first attempt.
- Trauma radiographers must be competent in performing mobile radiography on almost any part of the body.
Exposure factor considerations during trauma/mobile
Use shortest exposure time to minimize motion. Adjust techniques for exposures through immobilization devices and/or pathology.
Positioning considerations during trauma and mobile radiography:
Position stretcher next to upright Bucky.
Enables positioning with minimal pt movement.
Higher ratio grid than portable grids.
Marking radiographs for trauma and mobile radiography:
For penetrating trauma, mark entrance and/or exit wounds with a radiopaque marker. Two exposures at right angles to each other will demonstrate depth, as well as the path, of the projectile.
Sequencing during trauma and mobile radiography:
Perform all laterals first, working top to bottom.
Perform all AP’s next, moving bottom to top.
Types of fractures:
dislocation or luxation subluxation sprain fracture (fx) contusion
Dislocation or Luxation:
Displacement of a bone from a joint.
Clinically identified by abnormal shape or alignment of body parts and any movement can be painful.
Must be imaged in two planes 90º ftp each other to demonstrate degree of displacement.
For a dislocated joint, a minimum of 2 projections is required to assess for damage and/or possible avulsion fractures even if:
a bone has relocated itself following the injury.
Subluxation:
Partial dislocation of a bone from a joint.
Nursemaid’s elbow:
a traumatic partial dislocation of the radial head of a child, caused by a hard pull on the hand and wrist by an adult. Also called “jerked elbow.”
Sprain:
A forced wrenching or twisting of a joint, resting in partial rupture or tearing of supporting ligaments without dislocation.
A sprain can result in:
severe damage to blood vessels, tendons, ligaments or nerves.
Severe swelling and discoloration resulting from hemorrhage of ruptured blood vessels often accompany:
a severe sprain.
Radiographs can aid in differentiating sprains from:
fractures.
Fracture (fx)
a break in the bone
When dealing with a fractured bone, the radiographer must use extreme caution in moving and positioning pt so as not to:
cause further injury or displacement of fracture fragments. NEVER force a limb or body part into position.
Contusion:
Bruising of the bone with a possible avulsion fracture.
And example of a contusion is:
A hip pointer, a football injury involving a contusion of bone at the iliac crest of pelvis.
Apposition:
relationship of the long axes of fracture fragments.
Anatomic apposition:
anatomic alignment of ends of fractured bone fragments, wherein the ends of the bone make end-to-end contact.
Lack of apposition (distraction):
The ends of fragments pulled apart and not making contact (such as may occur from excessive traction.)
Bayonet apposition:
A fracture wherein the fragments overlap and the shafts, but not the fracture ends, make contact.
Angulation:
refers to the loss of alignment
Apex angulation:
describes the direction or angle of the apex of the fracture, such as medial or lateral apex and it is described in degrees.
Varus deformity:
The distal part of the distal fragments angled toward the midline of the body, a lateral apex that points away from the midline.
Valgus deformity:
The apex of the fracture, directed toward the midline (medial apex) and the distal fragment away from the midline.
Simple fracture:
bone does not break through the skin (closed fracture).
Compound fracture:
Bone protrudes through skin (an open fracture).
Incomplete fracture:
Fracture does not traverse through entire bone (examples: torus fx, greenstick fx, plastic fx)
Complete fractures:
(two pieces) transverse fx, oblique fx, spiral fx.
Comminuted fractures:
(two or more fragments) Segmental fx (double type fx), butterfly fx (two fragments) splintered fx (thin, sharp fragments).
Impacted fracture:
One fragment driven into another (ends of bones)
Torus fracture:
incomplete fracture with a buckle of the cortex. Characterized by localized expansion of the cortex. Little or no displacement and no complete break in the cortex. “Soda can” appearance. Most common fx in young children.
Greenstick fracture:
(Hickory or Willow Stick) Fracture is on one side only. Cortex on one side of bone is broken, and other side is bent.
