Traumatic Injuries

Question 1

How does inhalation injury occur?

Answer 1

1. Occurs in open or confined spaces.

2. Causes more death from smoke inhalation than burns

Question 2

What causes inhalation injury?

Answer 2

1. Carbon Monoxide Poisoning:
   A. By product of combustion and common chemical in smoke.
   B. Odourless, tasteless and colourless and can be detected by special instrument.
   C. Turn hypoxia in the presence of low concentration of carbon monoxide.
   D. Binds to haemoglobin 257 times stronger than oxygen and unable to transport oxygen.
2. Cyanide Poisoning:
   A. Plastic item bursts to give off cyanide.
   B. Highly toxic causes cellular hypoxia; cells are prevented from using oxygen to generate energy to function.

Question 3

List the classification of inhalation injury:

Answer 3

1. Heated Inhalation Injury:
   A. Inhaled super heated air.
   B. Injured tissue swells causing airway obstruction and even death
   C. Hoarse or stridor voice indicating immediate protection of airway
   D. Aggressive fluid resuscitation hasten swelling
2. Smoke Inhalation Injury:
   A. Confined in a closed space while being burned and exposure to steam
   B. Contain toxic chemical causing structural damage to lung cells.
   C. Toxic products can percipitate bronchospasm and coronary artery spasm
   D. Clinical features includes; burn face and mouth, singed eyebrow and nostril hair and carbonaceous sputum

Question 4

What will burn injury leads to?

Answer 4

Burn injury can cause protein denaturalisation of skin and damage of the normal epithelia barrier

Question 5

List the complications of burns injuries

Answer 5

1. Bacteria invasion
2. External fluid loss
3. Impaired thermoregulation resulting from heat loss from expose wound
4. Edematous further enhancing volume loss
5. Hypovolemic shock correlates with TBSA leading to immediate complications and requiring the need of IV to prevent shock and acute kidney injury
6. Necrosis of red blood cells causing hypoxia and release of HB into circulation causing acute kidney injury
7. Infection; a common complication of burn. The dead tissue promotes the growth of bacteria and fungi and lead to systemic infection such as septica.
8. Eschar formation ; forms a complete round over a body part and can lead to compartmental syndrome due to the accumulation of extracellular and extravascular fluid within confined anatomic spaces of the extremities or digits increase the intra-compartmental pressure.

Further results in the collapse of contained vascular and lymphatic system due to the loss of tissue viability.

Question 6

Goals of burn management

Answer 6

1. Stop burn process and prevent additional injury
2. Access and treat airway obstruction
3. Supportive care for hypovolemic shock
4. Cover all burn injuries with sterile dressing and provide warmth

Question 7

Describe abdominal cavity

Answer 7

1. Lower of the two major body cavities and extends from diaphragm to pelvis
2. Consists of diaphragm, urinary and genitourinary system

Question 8

What does the abdominal cavity houses?

Answer 8

Hollow Organs: material able to pass through and resilient to trauma unless full such as bowel, bile duct, intestinal and stomachs

Solid organs: contain internal organs with firm tissue consistency and injury can cause severe haemorrhage and slow onset of abdominal pain in the liver, spleen, pancreas, kidneys or ovaries.

Question 9

Complications of solid organs

Answer 9

1. Left unrecognised or untreated can cause traumatic death

2. Could lose circulatory blood volume into peritoneal cavity without external bleeding.

Question 10

List the three common abdominal injuries:

Answer 10

1. Haemorrhage either internal or external
2. Peritonitis: spillage of contents of injured organs into the abdominal cavity cause life threatening, inflammatory reaction, severe abdominal pain, tenderness and muscular spasm.
3. Pneuoperitoneum: presence of air or gas in the abdominal cavity resulting from a rupture of a hollow organ, perforated peptic ulcer, recent abdominal surgery and rupture of abscess

Question 11

Causes of closed abdominal injuries

Answer 11

Causes by compression, deceleration and crush injuries

Question 12

Complications of closed abdominal injuries

Answer 12

1. Pain from the lateral part of the hip to midline of groin could be damage of kidney or ureters
2. Voluntary or involuntary guarding, tachycardia, hypotension, pale, cool clammy skin, crepitus in the lower rib area.
3. Bruises on right and left upper quadrant and flank suggest an injury to the liver, spleen, kidney, around the umbilicus indicates significant internal bleeding

Question 13

Examples of close abdominal injuries

Answer 13

1. Gus shot wound involves bowel, colon, liver and vasculature structure
2. Stabbing wound involves small bowel, colon, liver and diaphragm
3. Evisceration goes through the skin and muscle layer through fascia resulting bowel penetration

Question 14

Signs and symptoms of open abdominal injuries

Answer 14

1. Signs and symptoms of bleeding and puncture wounds
2. Tachycardia
3. Evidence of shock
4. Abdominal distention

Question 15

Management of abdominal injuries

Answer 15

1. Assume object is penetrated to peritoneum and into abdominal cavity
2. Stabilise penetrating object
3. Monitor for signs of shock and initiate hypotension protocol

Question 16

Injuries to stomach and intestine

Answer 16

Blunt or penetrating trauma causing burning, rapid, epigastric pain, rigidity and rebound tenderness

Question 17

Injuries to lung

Answer 17

Penetration or rupture to lungs lead to shock especially for patient with right side chest trauma and abdominal trauma

Question 18

Injuries to diaphragm

Answer 18

Abdominal organs pushed upwards to thoracic cavity causing dyspnea (SOB), concave anterior wall, sunken abdomen, ventilatory compression and abnormal respiratory sound

Question 19

Injuries to kidney

Answer 19

Rupture to kidney causing pain on inhalation in the abdomen and flank

Question 20

Injuries to spleen

Answer 20

Rupture if spleen is enlarged by mononucleosis, blood spill into peritoneum, fractured or 9th and 10th rib on left side

Question 21

Injuries to pancreas

Answer 21

Vague pain on upper and mid abdominal pain that radiates to the back and lead to peritoneal irritation

Question 22

Injuries to urinary bladder

Answer 22

Blunt injuries to lower abdomen or pelvis causing urinary bladder rupture and urine spillage to abdominal cavity

Question 23

List the assessment and management of abdominal injuries

Answer 23

1. Determine if blunt trauma or combination injuries
2. SMR
3. Focus on ABC if diaphragm is injured
   4 High flow O2
4. Monitor signs of shock and initiate hypotension protocol
5. Pelvic binder
6. Provide warmth
7. Rapid transportation