Unit 18 Acute Multiple Injury/Trauma/Emergency Flashcards
Define trauma.
Any bodily injury caused by violence or force
What are the different types of trauma?
Kinetic
Chemical, electrical, radiation burns
Lack of essential agents, i.e oxygen or hear
What are the types of Kinetic Trauma?
What happens in both?
Blunt: Injury occurs without impairing skin integrity, beneath skin
Penetrating: Injury occurs that is obviously impairing skin integrity
Tissue deformity and injury to organs occurs with both
What are the risks factors for kinetic trauma?
Age - young/elderly
Gender - Male
Alcohol/Drug use
Income
Geography
What is the good samaritan act?
What are basic individual rights?
Covers you if you help someone in need
Right to emergency care whether or not they have insurance or are a criminal
What is involved in ACLS (Advanced Cardiac Life Support)?
Beyond BLS w/ AED, usually medications and other interventions
What are the causes of death from trauma that happen within minutes? Within hours? Within days to weeks?
Causes of death from trauma within minutes:
- Brain injury
- Spinal cord injury
- Cardiac Injury
- Arterial Injuries
Within hours:
- Subdural/Epidural hematoma
- Ruptured Spleen and liver
Within days to weeks:
- Sepsis
- MODS
- DIC
What is the definition and goal of triage?
Definition: Process used to determine the severity of illness or injury in a patient
Goal: give priority care to the most critically ill or injured patient
What are the triage classifications?
Emergent - Life threatening, highest priority
ex: cardiac arrest, airway compromise, sudden vision or conscious changes
Urgent - Serious but not life threatening
ex: fracture, abdominal pain, certain wounds
Non-urgent - non life threatening
ex: sprains, strains, simple lacerations
Fast tract: typical do`ctors office problem
What can the nurse use to gather information from a trauma PT?
OPQRST (onset, provocation, quality, radiates, severity, treatments tired before ER)
SAMPLE
What is the primary survey for emergencies?
A: Establish Airway (if c-spine stabilization necessary use jaw thrust instead of head tilt chin lift)
B: Breathing - quality, lung sounds, chest symmetry
C: Circulation - check all peripheral pulses
D: Neurological disability? -LOC, GCS, Pupils
E: Exposure - remove all clothing, put in hosp. gown
What is the secondary survey for emergencies?
F: Full set of VS/ Facilitate family presence
G: Give comfort measures
H: History and head to toe assessment
I: Inspect posterior
J: Jump back and reassess, will help determine how to proceed
What are Emergency Life Threatening Conditions
Airway obstruction:
- Manifestations - hypoxia, hypercapnia
- Management - hemliech meunuver, forceps, endoscopy
Hemorrhage:
- Causes - open wounds, ruptured artery below surface
- Management - 2 large bore IVs, type and screen, O- blood if crossmatch not done yet
What are examples of Traumatic Brain Injuries?
What are secondary issues?
What is the collaborative management?
Sports injury, MVA, Falls.
Secondary issues:
- ICP
- Intracranial bleed
- Impaired auto-regulation
Collaborative management:
- Neuro assessment
- CT/MRI/Spinal tap
- Sx
- Medications
- Nursing interventions to lower ICP
Describe the spinal cord injuries complete spinal cord injury vs incomplete.
Complete:
- Severed completely w/total loss of sensory/motor function
- aka “transection”
Incomplete:
- “partial transection”
- Sensory/motor fibers preserved below injury allowing partial function
What are types of Incomplete Spinal Cord injuries?
Central cord injury:
- Deficit in upper extremities w/loss of motor and sesory function
- Injury or edema to central spinal cord
Anterior cord syndrome:
- Loss of pain, temp, motor below injury
- Maintains touch, vibration, sensation
Brown sequard syndrome:
- spinal cord has vertical cut
- aka “epsilateral paralysis”
- damaged side, loss of motor function (hemiparaplegia)
- non damaged side, loss of sensation (hemianesthesia)
When would you assume a C-spine injury?
MVA’s
Diving accidents
Falls
Trauma
What are the mechanisms of spinal cord injury?
Hyperextension
Hyperflexion
Compression
Penetrating
Describe Neurogenic shock vs Spinal shock.
Neurogenic shock:
- Loss of vasomotor tone
- Impairment of autonomic function below lesion
- Hypotension, bradycardia, warm skin
- Severe vasodilations and decreased cardiac output
- Find cause and eliminate, provide increasing blood flow interventions like passive leg raising, etc
Spinal Shock:
- Loss of spinal reflexes
- Flaccid paralysis
- Occurs within a few minutes of spinal cord injury
- May lose continence during time
- Will resolve on it’s own over time
What is Autonomic Dysreflexia?
What are the signs and symptoms?
Sudden increase in SBP and DBP w/ bradycardia Abnormal exaggerated autoimmune response
Life threatening
Signs and symptoms: -Above T6 initial spinal shock -Above level of injury, profuse diaphoresis, goose bumps, and flushed skin -Below injury pale skin -Severe throbbing headache
What are nursing interventions for Autonomic Dysreflexia?
- Place PT in sitting position
- Notify PCP
-Assess for cause:
Retention
Kinks
Fecal impaction
- Monitor VS
- Give nifedipine or nitrate as prescribed to lower BP
What are the types of eye trauma and what is the management for each?
Chemical: irrigate w/water or normal saline
Foreign body: stabilize until further intervention
Leading cause of blindness among children and young adults
What are types of cardiothoracic trauma?
Myocardial contusion Cardiac tamponade Pulmonary contusion Flail chest Pneumothorax Hemothorax
What organs are mostly affected in abdominal trauma?
What is the collaborative management of abdominal trauma?
Liver and spleen
Assessment, Dx, Sx
Describe pelvic trauma and what to assess/anticipate.
Can be a fracture of the pelvis
Assess for rectal or vaginal bleeding
Assess for hematuria
Anticipate: X-rays, CT scan, IV pyelogram
What can a musculoskeletal trauma cause?
What is more likely to cause a comminuted fracture (bone into fragments)?
Can cause a contusion, laceration, or fracture
A crush injury
When there is injury to the back what should the nurse suspect?
Renal trauma
What is the collaborative management of renal trauma?
Urinalysis
CT
Ultrasound
IV fluids
What are heal related emergencies?
Heat cramps
Heat exhaustion
Heat stroke
What are signs and symptoms of heat cramps and exhaustion?
What’s the treatment?
Fatigue
N and V
Extreme thirst
Hyperthermia
Tx: Rest and fluid replacement, remove clothing
What are signs and symptoms of heat stroke?
What’s the treatment?
> 100.4 temp
Absence of perspiration
ALOA
Decreased BP
Tx: Cover w/ wet sheets, remove clothing, cold fluids,
What are cold related emergencies?
What are signs and symptoms and treatment of hypothermia?
Frostbite:
- superficial
- deep
Hypothermia
- core body temp < 95F (35C)
- medical emergency
Symptoms: shivering, confusion, bradycardia
Tx: Remove from cold, rewarm them, monitor ABC’s
What do you want to do for a snake bite?
Provide first aid, identify what bit you, and go to the ER
During a mass casualty event what’s the goal?
Save the most viable
Greatest amount of ppl saved possible
What should be asked to a PT with a suspected hemorrhagic fever?
Have they recently traveled?
What is the protocol for infectious triage and care?
-Quickly screen, identify, and isolate suspected infectious agent or:
Ebola, Smallpox, anthrax, plague, hemorrhagic viral agents.
- Provide safe environment and minimize exposure to other ppl
- Donning and doffing of appropriate PPE
- Quarantine
What happens regarding death in the ED?
Maintain belongings with PT
Notify next of kin (ask them to come to the hospital, do not give information over the phone)
Suspect autopsy will be performed
Is he/she a possible organ donor?
If a PT develops compartment syndrome what should the nurse be alert for?
Dark, scanty urine
What is the best way method to assess for a DVT in a client with a spinal cord injury?
Leg girth
