trauma-ppt Flashcards
ppts what is trauma
Trauma is an injury to human tissues and organ s resulting from the transfer of energy from the environment
what causes injury
Injuries are caused by some form of energy that is beyond the body’s resilience to tolerate *
what does the trimodal distribution of trauma pt deaths look like
% of who dies when
50% in first hr (often on scene)
25% in first 4hrs (often in emerg)
25% in the weeks 1-5 after initial injury (often in ICU)
common causes of death in first hr after trauma
hemmorhage
shock
…
common causes of death in first 4hrs after trauma
hypovolemia airway obstruction (generally d/t unconscious pt)
common cause of death in 1-5wks after trauma
Die from infection, multiple organ dysfx syndrome (from being ischemic, anaerobic metb)
what is the definitive treatment of multiple trauma pts
surgery
when are diagnostics a priority of pt care
when they give useful info for Tx
how do you calculate the impact force
Impact Force = weight x speed
eg weight of car x speed in km you were going
falls > than __ft can be fatal
why?
12 ft
risk of traumatic dissection of thoracic aorta
acceleration/deceleration injuries are a form of what type of force
blunt
what is a risk if going >50km/h in a vehicle and crashing or stopping abruptly
- when the heart goes forward it creates shearing forces, primarily above the heart, shears on aorta. The heart also bounces back. The aorta has multi layers and they can come apart.
- MVA >50km/h have high risk of shearing aortic dissection
what kind of injuries or organs might be caused by sudden accel/decel
- damage to liver, heart, aorta, head injury
- the liver and heart are heavy and htey move in the body cavity more
why can blunt force trauma often go without being properly treated
blunt forces often have no visible, outer evidence of injury
what are the forms of energy that can cause injury
what is another biomechanism of energy that causes cellular damage
Energy Mechanical Thermal Chemical Electrical Radiant
-hypoxia
if a pt was in a car accident what kind of injuries from compression might they sustain?
what reaction might the person have in this situation and what organs could it affect?
The lap belt comes up around abdm and can pop bowel up through diaphragm
people tend to hold their breath and clamp their glottis shut, this creates a seal on the lungs and can contribute to a pneumothorax when suddenly compressed
what structures do rotational injuries often occur to
limbs generally also head/neck/spine, trunk
when a structure is rotated although it might not break or show external signs of damage what might happen and why is this dangerous
the internal strs are damged–>inflm or the damage doesnt allow perfusion–>hypoxia
what causes more damage to the structures around it, a sharp or dull penetrating object
dull as it pulls the tissues surrounding it
when are penetrating accidents often missed
when the object that entered the person was thin and fine
are bullet wounds generally in a straight line
no, theyre designed to spin within the person
what basic questions should you ask yourself about your trauma pt and their accident
how much energy, what kind of injury, what organs affected
why might some trauma pts not show their injury until many hours after
Sympathetic system will activate. Alpha adrenergic receptors—triage body organs and send blood to most important organs (heart, brain). A lot of your organs dont have blood going to them, youre not hypovolemic although you might present with cold hands etc
if your pt has a skull laceration that is barely bleeding should you be worried
yes, this means they had a lot of force to their head and their brain might have been affected or inflm might follow
your pt has a compound bone fx and a laceration thats exposed. What do you do?
cover it quickly to prevent infection but dont dress and clean it carefully until pt stable
what is a comminuted fx
a bone that has been broken in many places
what is a basal skull fx and what kind of pts might present with this
-a fracture to the base of the skull (includes hard palate of the mouth, the middle fossa is around cheeks, posterior fossa is at back of head)
Often assoc w facial trauma or people falling and hitting the back of their head on the sidewalk
what is danger with injury to dura mater
WBCs or RBCS or worse entering the arachnoid space
if pt had anterior fossa basal skull fx what part of the craniums 3 components might leak and give you a clue as to the location of their injury
the CSF might leak into subcut tissue of the eyes and give them racoon eyes awhile after
CSF might leak out their nose
what does CSF do that water wont on a pillow
what might CSF test positive for that water wont
halo
put ina dipstick and it might be positive for glucose
pt might report sweet taste in their mouth if it got in there
pt has middle basal fx what sign might you see
mastoid sign (bruising behind ear on mstoid process) i think also called battle sign
your pt has a facial injury can you rule out spinal injury
no
your pt has a head injury can you rule out spinal injury
no
facial head or c spine injury you must rule out first before taking off spinal precautions
which two parts of the spine are most vulnerable to injury or commonly injured
lumbosacral junction and c spine
what is an unstable spinal cord injury
torn posterior ligament
