Trauma Surgery Flashcards
When preparing for a trauma patient the perioperative nurse should include what three things in the trauma plan
Equipment, instruments and supplies that are
likely to be used
Decision scheme
An algorithm that guides EMS personnel through the following for decision points:
-Physiologic parameters
-Anatomic parameters
-Mechanism of injury
-Other special considerations
Which diagnostic procedure has the ability to be most specific when identifying a traumatic injury?
Computed tomography (CT) scan 
-can be used diagnostically or as a screening tool 
Trauma triage order- 1st
Cervical spine
C-spine immobilization top priority - immediately above airway
Trauma triage order- 2nd
Airway obstruction
-Anticipate tracheostomy for facial injury, or upper airway edema
-rapid sequence intubation
Pre-oxygenation
Paralysis with induction
Placement with proof
(Skip second pre-oxygenation after paralysis)
Trauma triage order- 3rd
Hemorrhage
-Surgery is not hemodynamically stabilizing to a trauma patient
-Unless the purpose is to stop the bleeding
What two things interrupt the clotting cascade?
Hypothermia
Acidosis
Causes of acidosis
-Hemorrhage
-Vasodilatation
-Myocardial depression
-Hyperkalemia
-Shift of oxyhemoglobin disassociation curve to the right (hemoglobin loses affinity for oxygen molecule)
-Confusion, stupor
Metabolic acidosis treatment options
-Identify cause of bleeding: mechanical versus non-mechanical
-Warm patient to reverse coagulopathies
-Blood, FFP, and platelet replacement
-Bicarb should not be used to treat severe metabolic acidosis unless the ventilation is adequate to remove increased CO2 that is formed
Trauma triage order- 4th
Cardiac tamponade
-Fluid around heart prevents cardiac adequate output
-S/s: Jugular vein distention, narrowing pulse pressure (ex:97/85)
Treatment for cardiac tamponade
-Emergent treatment
-Pericardiocentesis: spinal needle and 60 ML syringe
-Prepare for a chest tube, sternotomy or thoracotomy according to direction
Trauma triage order- 5th
Pneumothorax (tension)
-All mediastinal physiology is shifted
-Closed chest injury to the lung (usually broken rib punctures lung)
-Needle the chest (midclavicular, third intercostal space)
Pneumothorax, sucking chest wound is from
From penetrating wound (stab, bullet)
-Chest tube
Trauma triage order: 6th
Increased ICP
-Cushing’s syndrome or triad (increased BP and drop in HR)
-Hyperventilate
-Evacuate fluid/blood: prepare for burr hole
Neuro assessment tool
Glasgow coma scale
-Evaluates eye-opening, verbal response, motor response
-High score= oriented, awake 15/15
Trauma triage order- 7th
Burns
-Fluid deficit biggest issue
Days 1&2: fluid shifts cause hypovolemia (intravascular to interstitial shift), hyperkalemia
Day 3: fluid shifts back to vascular causing hemodilution (interstitial to intravascular shift), hypokalemia
-Debridement of burnt tissue 72 hours later
Trauma triage order- 8th
Spinal cord injury
-Stabilize the fracture
-loss of vascular tone from injury down
-vasodilation and peripheral pooling
-Neurogenic shock
Treatment for neurogenic shock
-place in Trendelenburg
-Vasopressors
-Fluid replacement
Trauma triage order- 9th
Extremity injury
-Monitor for compartment syndrome (blood flow occluded to part of body)
Check for cap refill, and pulses of injured extremity under drapes
-Fasciotomy of swelling impedes blood flow
Actions upon receiving word of mass casualty
-notify hospital departments
-Call in off duty staff
-Set up command center and triage
Red tag
Immediate status, go to surgery first
-life-threatening illness or injury
-Lifesaving intervention required
Yellow tag
Delayed status
-Serious but not life-threatening illness or injury
-Delaying treatment will not affect outcome
-Second to treat
Green tag
Minimal status
-Minor illness or injury
-Walking wounded
-Third to treat
Black tag
Expectant status
-Not expected to survive
-Will receive comfort care
-May be upgraded to red if new resources permit treatment
Estimated blood loss on 4x4
10 ml
Estimated blood loss on ray-tech
10-20 ml
Estimated blood loss on lap sponges
100 ml
Risk of blood transfusions: transfusion associated immunomodulation (TRIM)
Patient immunosuppressed for about one year
Risk of blood transfusions: transfusion related acute lung injury (TRALI)
Donors blood allergic to patients blood
Who is universal blood donor?
O-
Who is universal blood recipient?
AB+
Why can’t patients who are Rh negative receive Rh positive blood?
Can receive once, then develop antibodies
Women get Rogen within 72 hours of any end of pregnancy
Autologous transfusions
-patient’s own blood
-Preoperative donation
-Eliminates risk blood-borne pathogens
Blood salvage
A.k.a. Cellsaver
Autotransfusion- quickest form of blood replacement in the case of an emergency
Contraindications for autotransfusion
-Dirty bowel
-Clouding agents
-Amniotic fluid
-Bone cement
-Malignancy
Normovolemic hemodilution
- 1-2 units of blood removed preoperatively
-Volume replacement with crystalloids (3 ml for every 1 ml blood)
-Surgical bleeding happens with diluted blood
-Units reinfused with intact clotting factors
-4 hour window from start to finish
Acute hemolytic reaction
-Reaction to antigen or antibody
-Symptoms: lumbar pain, tightness in chest, fever, chills, hemoglobinuria, shock
-Difficult to assess in surgery
-Sudden onset of uncontrolled surgical bleeding that is unexplained
-Bleeding from non-surgical sites
Non-hemolytic transfusion reaction (febrile reaction)
-reaction to antigen, WBCs, or platelets
-No bleeding signs and symptoms
-Fever, chills, headache, back pain
Transfusion associated circulatory overload (TACO)
-non-cardiac pulmonary edema
-Gave too much blood
-Reaction to antigen
-Hives, cough, fever, chills, cyanosis, shock
Massive transfusion
10 units of packed cells or more in 24 hours
Three units in one hour
Massive transfusion adverse effects
-ARDS (acute respiratory distress syndrome): Microaggregates lodge in the pulmonary bed (use a microaggregate filter)
-Coagulopathy: replace clotting factor after four units (FFP and platelets)
-Hypothermia: use a warming device on blood
-Hypocalcemia: citrate from blood bank bags binds patient’s circulating calcium
Platelets
-pooled from 5 to 10 donors
-stored at room temperature
-needs frequent gentle agitation
Platelet pheresis
Single donor
Fresh frozen plasma
Plasma (volume) and clotting factors
-Used to replenish missing coagulating factors
-Reverse the effect of Coumadin in a hurry
What is the reversal for heparin?
Protamine
Cryoprecipitate
Contains clotting factors
-Fibrinogen, factors VIII and XIII
-von Willebrand’s factor (for someone with Von Willebrand’s disease)
-Used to prevent or control bleeding
Blunt trauma
From forces (acceleration, deceleration, shearing, compression)
-no break in skin integrity
-ex: MVA, high contact sports, assault, falls
Penetrating trauma
Foreign object passes through skin tissue
-Resulting injury to tissues/organs
-most often: liver, intestines, vessels
-ex: stabbing, GSW, impaled
-Leave object in place, may be preventing hemorrhage, remove in OR
Primary blast trauma
Shockwave on body
-Lungs, stomach, intestines, tympanic membrane, large blood vessels
Secondary blast trauma
Debris, sharpnel penetration, impact
Tertiary blast trauma
Wind from blast
Moving the injured and debris
Quaternary blast trauma
Complications from original blast injuries
