Trauma-notes

Question 1

what do you assume a multi trauma pt has until ruled out

Answer 1

spinal

Question 2

what type of organs might penetrating object cause damage to

what is this pt now at risk of

Answer 2

often damage hollow organs

risk of infect

Question 3

• For gunshot wound what is the most imp prognostic factor

Answer 3

the velocity of the bullet

Question 4

priority mgmt in pt with multiple injuries

Answer 4

1. A/W and ventilation
2. Control hemmorhage
3. Prevent and tx hypovolemic shock
4. Assess for head and neck injuries
5. Eval for other injuries eg head and neck, chest, abd, back and extremities
6. Splint fractures
7. Perform more thorough and ongoing exam and assessment

Question 5

are stab wounds gen explored with surgery

Answer 5

no, can be explored nonoperatively d/t low velocity and less penetration of the implement

Question 6

when are intra-abdm bullet wounds explored surgically

Answer 6

• All gushot that cross the peritoneum or are assoc w peritoneal signs require sx exploration but stab wounds

Question 7

when the liver, kidneys, blood vessels are injured are there often more complications from a blunt or penetrating injury

Answer 7

blunt

Question 8

pt with abdm injury has no BS what are two possible causes?

Answer 8

• Absence of bowel sounds may show intraperitoneal involvement but stress can halt or dec BS

Question 9

what labs do you take for intra-abdm injury

how owuld they help

Answer 9

o Urinalysis (hematuria)
o Serial Hgb and Hct levels to eval trends reflecting the presence or absence of bleeding
o WBC count (gen elevates w trauma)
o Serum amylase analyss to detect inc levels which may show pancreatic injury or perforation fo the GI tract

Question 10

damage to which abdm organs puts pt at risk of massive bleed

Answer 10

spleen and liver

Question 11

what outer signs might indicate an abdm bleed

Answer 11

eg front of body, flanks and back for bluish discolouration, abrasion, asymmetry, contusion

Question 12

which diagnostic (not lab) will give you best info about an internal bleed

Answer 12

CT scan

Question 13

what diagnostics might be used for intraperitoneal injury

Answer 13

peritoneal lavage, abd ultrasonography, abd CT

Question 14

what is peritoneal lavage

Answer 14

• peritoneal lavage (an old but quick procedure no longer used so much but more for mass casualty event), instill 1L RL or NS into abd cavity then check for blood, feces etc in the returned fluid

Question 15

what should be done before inserting catheter into trauma pt

why would a catheter be used

Answer 15

Don’t put catheter in before inspecting rectum and det that urethra has no damage.
-to decompress bladder or to monitor urine outout

Question 16

what finding in a male might indicate potential urethral injury

Answer 16

For males a high riding prostate during rectal exam suggests potential urethral injury

Question 17

pt has lg bleeding wound what do?

Answer 17

apply P

Question 18

your pt is very thirsty and victim of multi trauma with penetrating intra abdm bullet wounds crossing peritoneum do you give water

Answer 18

no. they might need sx

Fluids typically withheld anticipating sx and NG tube w suction used

Question 19

how are blunt liver or spleen injuries gen medically managed

Answer 19

gen managed without surgery

Question 20

beyond the directly injured part of the body what organ is at risk from a crush injury and why?

Answer 20

the kidneys from possible rhabdomylosis–>myoglobin and extra proteins…also lactic acid and all the cells contents spill out–>hard on kidneys

Question 21

what are the 6 ps of assessment that will warn you of compartment syndrome

Answer 21

6 Ps 
Pain-severe, 
pallor, 
pulselessness, 
poikilothermic (or polar) sensation (cold to the touch), parathesia (burning, numb or tingling, 
paralysis (lack of purposeful movement.

Question 22

what do you assess for pt with fracture

when you first receive pt with broken leg o you remove pants or cut htem off

Answer 22

• Ass for pain over or near bone, swelling, circ disturbance. Eccymosis, tenderness, crepitation

cut them off

Question 23

pt has abdm injury do you treat fx or abdm injury first

Answer 23

abdm

also assess for neuro

Question 24

if you find a pulseless extremity what o you do?

if it doesnt return the pulse what do?

Answer 24

• If pulseless extreme found it must be aligned. May use traction to help w alignment. If pulse doesn’t return must do rapid total body ass then transfer to OR

Question 25

if you need to move a pt with a fx what do

after you splint an extremity what do you assess

Answer 25

splint it before moving it

-assess vascular and neuro status

Question 26

how do you classify the amount of body that is burnt

Answer 26

• Total body surface area is used to classify burns.

Question 27

70+yr old can survive what % of TBSA burn?
how does a 2-5yr old compare?
how about a 20-30yr od

Answer 27

70yr olds can survive up to 30%
2-5yr old can survive 75%
and 20-30yr olds 80%

Question 28

what kind of treatments is used for burns

Answer 28

• Early debridement and excision are practiced

* Nutritional support v imp

Question 29

different forms of burns

Answer 29

thermal, electrical, chemical, radiation

Question 30

what does a burn put the pt at risk of

Answer 30

o	Inc fluid loss 
o	Infection
o	Hypothermia
o	Scarring
o	compromised immunity
o	and changes in function, appearance, and body image

Question 31

what are the burn depths

is it easy to assess the depth

Answer 31

not easy to assess depth

• superficial injuries, superficial partial thickness injuries, deep partial thickness inj, full thickness inj

Question 32

Dark pink or red in colour. V painful. Cap blanching still present. 10-14 days to heal

what thickness would this be

Answer 32

superficial partial thickness

Question 33

Wound color can be white, red, brown, black. Painless d/t nerve fiber destr. Skin is leathery. Excision of burn wound and skin grafting nec

what thickness

Answer 33

• full thickness –dermis and epidermis destroyed my involve subcut and fascia as well.

Question 34

Painful, red, exudes fluid. Hair follicles and other dermal str intact. More likely to result in hypertrophic scars. May need skin graft

what thickness of burn

Answer 34

• deep partial thickness-injury down to deeper part of dermis.

Question 35

how to classify the total body surface area of a burn

Answer 35

rule of nines
lund browder method
palm method

Question 36

rule of nines method of classifying burns

benefit of this?

Answer 36

• system that assigns percentages in multiples of nine to major body surfaces eg arms 9% each, head 9% etc
• quick

Question 37

• For those w scattered burns what is a good way of calculating TBSA burnt?

Answer 37

palm method. Size of pts palm is approx 1% of TBSA

Question 38

what is a more precise method of measuring TBSA.

how does this work

Answer 38

lunder browder method
• more precise method that incorporates the variation of body proportion caused by growth and age
• divides the body into v small areas and gives estimates of the proportion of TBSA accounted for by such body parts.

Question 39

what kind of damage does an electrical burn cause

Answer 39

-often the damage is more inside the body than on skin

There will be entrance and exit wound

Question 40

what kind of tissues does electricity travel along most easily

Answer 40

• Electricity takes path of least resistance-nerves nd blood vessels first bones last

Question 41

what type of injuries might an electrical burn pt have beond organ damage and external burns from clothes catching fire

Answer 41

• The current contracts muscles as it travels and arrhythmias and spinal inuries often result
make sure to rule out spinal fx

Question 42

what are a few priorities for assessing and a Tx priority pt with electrical burns

Answer 42

monitor urine output and neurovascular status

give IV fluids

Question 43

why monitor urine output for electrical burn pt

Answer 43

muscle damage–>myoglobin in blood–>kidney damage (acute tubular necrosis or acute renal failure)

-also kidney damage from low blood volume

Question 44

burns greater than ___% of TBSA cause more than just a local response

Answer 44

25%

Question 45

what occurs in pt after burn..why do they have tissue hypoperfusion and organ dyzfx
what is this period followed by

Answer 45

shock. d/t dec cardiac output, followed by hyperdynamic and hypermetb phase

Question 46

what type of shock is burn pt at risk of

Answer 46

distributive

Question 47

a pt has exposed burns, what should you do and why

Answer 47

over them, the pt can lose up to 3-5litersof fluid a day from the exposed burn

Question 48

what type of injury is the leading cause of death in fire injury
how long do you need to carefully monitor these pts and for what
what kind of treatment might they need

Answer 48

inhalation injury
if suspected monitor for up to 48hrs
intubation or a/w stabiliztion of some kind is nec

Question 49

cardinal sign of inhalation injury

Answer 49

expectoration of carbon particles

Question 50

what kind of labs might be done for someone with inhalation injury

Answer 50

o Bronchoscopy and Xenon 133 ventilation perfusion scans for early Dx
o PulmFxTests good for showing changes
o Pulm complications like ARDS (that may dev in the first 2-5 days after burn injury) and acute resp failure.

Question 51

what is a leading cause of morbidity and mortality in burn pts

why miht this occur

Answer 51

sepsis
either skin barrier is broken or

3 parts of the GI tract alt by burn injury

1. First the mucosa is permable
2. This allows overgrowth of GI bact
3. The bact translocate to other organsinfect.