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AGACNP > Trauma & Burn 1 > Flashcards

Trauma & Burn 1 Flashcards

1
Q

Abdomen (secondary survey)

A
  • Inspect/auscultate
  • palpate/percuss
  • reevaluate
  • special studies
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2
Q

Perineum (secondary survey)

A

Contusions, hematomas, laceration, urethral blood, pelvic fx

*Ppl die from pelvic fx

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3
Q

Pelvis (secondary survey)

A
  • Pain on palpation
  • Leg length unequal
  • Instability
  • Do not rock pelvic. Pelvic blood loss is huge!
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4
Q

Compartment syndrome: what to look for

A
  • Out of proportion pain

- Weak or absent of palpation

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5
Q

Neurologic exam: what to report to neurosurgery

A

The best neurologic exam

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6
Q

How to assess C-spine

A
  • Pt is awake & alert

-

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7
Q

How do you minimize missed injuries?

A
  • High index of suspicion

- Frequent reevaluation and monitoring

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8
Q

How do I know the airway is adequate?

A
  • Patient is alert and oriented.
  • Patient is talking normally.
  • There is no evidence of injury to the head or neck.
  • You have assessed and reassessed for deterioration.
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9
Q

Signs and symptoms of airway compromise

A
  • High index of suspicion
  • Change in voice / sore throat
  • Noisy breathing (snoring and stridor)
  • Dyspnea and agitation
  • Tachypnea
  • Abnormal breathing pattern
  • Low oxygen saturation (late sign)
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10
Q

Protective airway reflexes

A
  • Ability to cough
  • Ability to swallow
  • Oropharyngeal airway
  • Nasopharyngeal airway
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11
Q

How do I manage the airway of a trauma patient?

A
  • Chin lift maneuver/jaw thrust

-

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12
Q

How do I predict a potentially difficult airway?

A
  • Maxillofacial trauma and deformity
  • Mouth opening
  • Anatomy
  • Beard
  • Short, thick neck
  • Receding jaw
  • Protruding upper teeth
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13
Q

Definitive Airway – Easy

A
  1. Oral intubation (medication assisted)
    - suction, back-up *coricoid pressure is no longer needed
    - Maintain c-spine immobilization
  2. Plan for failure:
    - Gum elastic bougie
    - LMA/LTA
    - Needle cricothyroidotomy
    - Surgical airway
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14
Q

Induction agent for rapid sequence intubation

A

Ketamine

- Increase BP (ideal)

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15
Q

Definitive Airway – Difficult

A
  1. Get help
  2. Be prepared
  3. Consider rapid sequence intubation vs. awake intubation
    - Maintain c-spine immobilization
  4. Consider use of:
    - Gum elastic bougie
    - LMA / LTA
    - Surgical airway
    - Other advanced airway techniques, eg, fiberoptic intubation
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16
Q

How do I know the tube is in the right place?

A
  • Visualize it going through the cords
  • Auscultation
  • CO2 detector
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17
Q

What is shock?

A

Inadequate profusion at cellular level

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18
Q

S/Sx of shock

A
  • Alteration in level of consciousness, anxiety
  • Cold, diaphoretic skin
  • Tachycardia
  • Tachypnea, shallow respirations
  • Hypotension
  • Decreased urinary output
  • In ICU always monitor trend. You don’t rely on one point of values
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19
Q

What is the cause of the shock state? (hypovolemic shock)

A
  • Blood loss

- Fluid loss

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20
Q

What is the cause of the shock state? (nonhemorrhagic shock)

A
  • Tension pneumothorax
  • Cardiac tamponade
  • Cardiogenic
  • Septic
  • Neurogenic
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21
Q

Tension pneumothorax

A
  1. Clinical diagnosis, not by x-ray

2. Immediate decompression: Needle, chest tube

22
Q

Frail chest management

A
  • Analgesia
    -Intubate as indicated
    -
23
Q

Cardiac tamponade: S/Sx

A
  • Narrowing systolic & diastolic BP
  • Distended neck veins
  • Muffled heart sounds
  • Pulseless electrical activity
24
Q

Basilar skull fracture: S/Sx

A
  • Racoon eye

- Battle sign

25
Q

Primary survey: ABCDE

A 
Airway w/ spinal protection
Breathing w/ adequate oxygenation
Circulation w/ hemorrhage control
Disability
Exposure/Environment
26
Q

Who needs special consideration when trauma occur?

A

Elderly, pediatric, pregnant women

27
Q

How to assess and ensure adequate oxygenation and ventilation?

A

RR
Chest movement
Air entry
SpO2

28
Q

How to assess for organ perfusion?

A
  • Level of consciousness
  • Skin color and temp.
  • Pulse rate and character
29
Q

Circulatory management methods

A

Control hemorrhage, restore volume, reassess Pt

*Watch out for elderly, children, athletes, meds

30
Q

How do you assess for disability

A

Baseline neuro eval

1. GCS score 2. pupillary response

31
Q

How do you assess for exposure/environment?

A

Completely undress the Pt

32
Q

Resuscitation: 5 points

A
  1. Protect and secure airway
  2. Ventilate and oxygenate
  3. Stop bleeding
  4. Vigorous shock Tx
  5. Prevent hypothermia
33
Q

Dx tools for blunt abdominal trauma (BAT)

A

FAST (focused assessment w/ sonography in trauma)

34
Q

Secondary survey (definition)

A

Complete Hx and physical examination

1. Hx; 2. PE; 3. Neuro exam; 4. Dx tests; 5. reeval

35
Q

When do you start the secondary survey

A

Primary survey is completed
ABCDEs are reassessed
Vital functions are returning to normal

36
Q

How do I minimize missed injuries

A

High index of suspicion
Frequent reeval and monitoring
*Think of what do you do in ICU

37
Q

When should the transfer occur

A

ASAP after stabilizing measures are completed:
Airway and ventilatory control
Hemorrhage control

38
Q

How do I know the airway is adequate

A

Pt is A&O
Pt is talking normally
No evidence of injury to the head or neck
Assessed and reassessed for deterioration

39
Q

S/Sx airway compromise

A
  1. High index of suspicion
  2. Change in voice/sore throat
  3. Noisy breathing (snoring and stridor)
  4. Dyspnea and agitation
  5. Tachypnea
  6. Abnormal breathing pattern
  7. Low SpO2 (late sign)
40
Q

Airway management: Basic techniques

A

Chin-lift maneuver

Jaw-thrust maneuver

41
Q

Airway management: basic adjuncts

A

Oropharyngeal airway

Nasopharyngeal airway

42
Q

How do you know the tube is in the right place (Airway confirmation)

A

Watch the chest
Auscultation; SpO2; CO2 detector
CXR (definitive)

43
Q

What is shock

A

Generalized state of hypoperfusion
Inadequate O2 delivery –> catecholamines and other responses –> anaerobic metabolism –> cell dysfunctinon –> cell death

44
Q

Shock: S/Sx

A

Altered LOC, anxiety; cold, diaphoretic skin; tachycardia; tachypnea, shallow resp.; HoTN; decreased urinary output

45
Q

Two causes of shock state

A

Hypovolemic: blood/fluid loss
*Trauma Pts often 2/2 blood loss
Nonhemorrhagic: tension pneumothorax, cardiac tamponade, cardiogenic, septic

46
Q

How do you locate the bleeding

A

Physical exam

Diagnostic adjuncts: CXR, FAST, pelvic X-ray

47
Q

Technique for stop bleeding

A 
Direct pressure/tourniquet
Angio-embolization
Reduce pelvic volume
Splint fx
Operation
48
Q

Class 1 hemorrhage: Definition, S/Sx, what to give

A

750 mL BVL (15%)
S/Sx: slightly anxious, normal BP, HR < 100 bpm, RR wnl, urinary output 30 mL/hr
Crystalloid

49
Q

Class 2 hemorrhage: Definition, S/Sx, what to give

A

750-1500 mL BVL (15-30%) loss
S/Sx: anxious, BP wnl, HR > 100 bpm, decreased pulse pressure, RR 20-30/min, urinary output 20-30 mL/hr
Crystalloid, ?blood?

50
Q

Immediately life-threatening chest injuries (6)

A
  1. Larygeotracheal injury/airway obstruction; 2. Tension pneumothorax; 3. Open pneumothorax; 4. Flail chest and pulmonary contusion; 5. massive hemothorax; 6. cardiac tamponade

AGACNP (21 decks)

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