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
why do drs inset their fingers into pts rectum in admitting emergent assessment
the final dermatome in the body terminates there. If the pt still has the motor and sensation for rectal tone then they have a chance of recovery from spinal injury
if they have no rectal tone and this persists for >24h the chance of recovery is
C_ innervates the diaphragm with the ____ nerve
C5 phrenic nerv
what is the only definitive way to rule out spine injury
only real tx for spinal injury
CT scan–could also run hands down spine and next to it and see if pt has pain but this is informal
Sx
why are lungs so vulnerable to trauma and how is a pneumothorax corrected
-friable, soft, very elastic and always wanting to reoil. they rely on negative pressure to keep them exanded.
a chest tube re-establishes the vacuum in the pleural space
what is a tension pneumothorax and what specific mnfts might you see
Sometimes an alveoli will rupture and it creates a valve. It will tear the visceral pleura which wil alllow air to escape into pleural space with each inhalation. The pressure will inc until it shifts the heart over, shifts trachea, and the other lung will collapse. This is tension pneumothorax.
mnfts:The pt will look worse every breath, inequal chest expansion, may have tracheal shift
what other injury to chest can cuase tension pneumo
penetrating
what complications can result from broken ribs
pt tends to hypoventilate and is at risk of atelectasis pneumonia
flail chest is
ribs broken in multiple places
In this case the ribs arent moving in a concentric form anymore. Paradoxical movement of the chest. Youll feel a segment moving in the opposite direction
Normal p02 is ___% on ROOM AIR ONLY
80-100%
pts chest tube detaches what do you do
dont clamp it as this can give them a pneumo
put end in a bottle of sterile NS
what injuries or risks are assoc w solid organs vs hollow organs
If you perforate solid organs you bleed. If you perforate hollow organs you get sepsis
why might abdm bleeding be hard to detect
Under lower ribs are liver and spleen. Organs that are dense and blood filled. Theyre located in a capsule, they can bleed in there. These are very painful injuries as the capsule fills
how can you detect a retroperitoneal injury
percuss the costovertebral angle
how to treat an orthopedic injury
rest ice compression elevation
qualities of first degree burn
1o - Superficial
Dry, red, blanches
Painful
qualities of 2nd degree burn
2o – partial thickness
Red, moist, blisters
Painful
qualities of 3rd degree burn
3o – full thickness
Dry, no blanching
painless
what makes up the volume of the cranium
Volume of intracranium=V of blood (10%)+V CSF (10%) + V brain (80%)
what is normal intracranial pressure
10mmHg pressure
wht is the first thing in cranium to be reduced in inc ICP
CSF is displaced. the arachnoid villi are always making CSF and it slows down production and inc reabsorption and shunts it down the spinal canal.
what component of the cranium is altered second in compensation of IICP
Pt also vasoconstricts…to dec amount of blood in/around cranium
inc ICP how are resps affected in early stages
carbon dioxide is very potent cerebral vasodilator. The less C02 you have the more vasoconstriction. IF pt is hyperventilating they will dec the amount of C02
pt has inc ICP what symptoms might they report and what else might you see
horrible headache-from mech of injury as well
vomit center is stimulated early–this inc ICP too so dont want this
what are terms to describe compensation and not in ICP.
what happens between these places (s/s)
spatial compensation and spatial exhaustion
-inappropriate–>alt consciousness–>sensory changes–>pupil changes
pressure on more advanced outer parts of brain?? PFC? pt becomes inappropriate/behavioural changes
-brain/brainstem gets caught on the foramen magnum the RAS will have circ caught off–>The GCS will change.
Next within the brain stem is the sensory and motor fibres. Youll see unilateral sensory changes (which you cant assess) but you can assess motor functions eg ask them to lift arms, painful stimulus.
-The cranial nerves, 1 &2 cant be assessed. 3 is pupil changes gen one will dilate
what part of the brain is affected that leads to VS changes in ICP what ICpressure is this around
circulatory centre, hypothalamus
around 40mmHg
what is ___ triad r/t ICP
Irregular respirations (caused by impaired brainstem function) Bradycardia. Systolic hypertension (Widening Pulse Pressure)
what do you try to address when treating IICP
what is the ultimate goal
Almost all Tx should focus on dec oxygen demand and inc oxygen supply.
want sx to remove clot (or maybe remove P if another cause??)
how to manage ICP with meds. what are they addressing?
what are the names or classes that address the limited amount of space
lasix
mannitol or 20% osmitrol
hypertonic saline sometimes
all of these dec brain water
carbonic anhydrase inhibitor-CSF
and vasoconstricotrs-blood
what other meds beyond treating the ICP do you give that prevents symptoms from worseinging the problem
sedatives anxiolytics might put in barbituate coma pain control --i imagine you have to be careful not to cause vasodilation here? antiemetics
beyond meds what do you do for inc ICP
dec stimulation–dark environment
might intubate and hypervntilate them to cause vasoonstriction. dont ant Pc02 below 33 as normal is 35-45
pt is victim of multi trauma and has bleeds and inc ICP is lasix a good idea
lasix–>diuresis which helps dec ICP but if theyre having circulation problem the pros and cons must be weighed
what is mannitol and when should mannitol not be used
20% osmitrol is a high molecular weight sugar. When pt is hyperglycemic they pee d/t the high osmotic pull. After 5min lg volume. In order for the mannitol to work the cap membranes must be intact. With inflm the pt must not have inc cap permb. Only give mannitol within first 12hr as if after it moves into interstitial space and takes water with it
giving which drug interferes with synthesis of CSF
a carbonic anhydrase inhibitor CAI-eg diamox
what is the ICpressure during spatial exhaustion
20-40mmHG
how do you address chemical burn
flush with copious amounts of water immediately
what does a first degree superficial burn look like
1o - Superficial
Dry, red, blanches
Painful
what does second degree burn look like
aka
2o – partial thickness
Red, moist, blisters
Painful
3rd degree burn characteristics
aka
3o – full thickness
Dry, no blanching
painless
how is nervous system affected by burn
pain
resp effects of burn
-airway obstruction
CO poisoning
pulmonary edema
hypoventilation
cardiovascular complications from burn
hypovolemia
Gastrointestinal
complications from burn
paralytic ileus
GI bleed
electrolyte imbalance
why is it essential to know amount of body burnt
to det fluid resuscitation parameters
what is the best indicator of cardiac output in a burn pt
urine ouput
what is the timeframe of % of fluids lost after a burn
50 % in first 8 hours post burn
50% over next 16 hours
how do you calculate how much fluids someone will lose from burn
2-4 ml/kg/% of total body surface area burned (>2nd degree)
2 x 60 kg pt x 40% burn = 4800 ml in 24 hours = 2400 in first 8 hours = 400 ml/ hour x 8 hours
how might the kidnys be affected by burn
Renal
rhabdomyolysis
shock
possible problems from burn to MS system
Musculoskeletal
limb loss
wounds infection
what is the problem with circumferential burn
Circumferential deep full thickness burns of an extremity or around the chest or abdomen should be carefully monitored. Oedema and swelling in the tissue deep to the burn cause the unyielding overlying burnt skin (‘eschar’) to act like a tourniquet. In a limb this will result in interference with distal blood flow.
what is silver sulfadiazine
anti-infetive used for burn pts
how is coagulation affected for burn pt
hypercoagulable
from loss of fluids?? from SNS and inc coagulabilty there?
what are special issues with a burn
Continues to burn
Rapid & excessive inflammation
Very painful
Start volume replacement from time of burn
what is curlings ulcer
gastric or duodenal erosion
(Stress Ulcer) or a Curling ulcer is an acute gastritis erosion. complication from severe burns when reduced plasma volume leads to ischemia and cell necrosis (sloughing) of the gastric mucosa.
