assessing for patency and protection: - can they talk? - what is your name? - are they breathing? (if no, anticipate intubation if not intubated in field) RSI - rapid sequence intubation -involves 3 drugs pushing quickly: sedation (versed), anesthesia (etomidate), paralysis (succinylcholine)

- assess pulses: starting w/ most central pulses and then move forward (femoral and carotid first) - assess capillary refill - control bleeding, infuse products and fluid - access via two large bore IVs (18 gauge is ideal), possible central line - rapid infuser -look for hypotension and shock signs

focused neuro exam: - LOC - GCS - PERRLA - Gross motor function - sensation in 4 extremities

looks at: - eye opening response - verbal response - motor response best score = 15 comatose = 8 unresponsive = 3

completely undress pt and examine entire body - maintain C-spine precautions - assess scalp, axillary folds, skin folds, perineum - prevent hypothermia during work up (warm fluids, blood products, warming blankets) hypothermia can lead to coagulopathy and MODS

- Head CT: for head trauma - Chest X-ray: for chest trauma (can do chest CT, but chest x-ray is portable and faster) - FAST U/S: for abdominal trauma looking for free air/fluid, intestinal damage - X-ray for trauma in limbs - Lab work: CBC, chemistries (electrolytes), coags (clotting factors), abdominal labs (BUN/creatinine/CK), blood type and screen, lactate, urine for presence of blood and pregnancy and/or toxicology, ETOH level, troponin

if pt is stable and not immediately taken to the OR: - assess thoroughly for signs of injury - obtain full set of vitals - detailed history via SAMPLE - head to toe assessment

Trauma Flashcards by Kaitlin Hobbs

Trauma: Pre-arrival to Hospital

EMS in the field reports what is coming in, the ABCs/GCS of pt to charge nurse
Trauma team is notified
CT is made available
Bed made ready
Trauma team dons standard or higher precautions
Equipment is ready: fluids (warm NS), monitoring (BP cuff, SPO2), meds (inotropes, vasopressors), blood products

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Primary Survey

Airway
Breathing
Circulation
Disability
Exposure

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Airway

assessing for patency and protection:

can they talk?
what is your name?
are they breathing? (if no, anticipate intubation if not intubated in field)

RSI - rapid sequence intubation
-involves 3 drugs pushing quickly: sedation (versed), anesthesia (etomidate), paralysis (succinylcholine)

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Breathing

once airway is secured, assess that breathing is adequate (rate and depth)

draw ABGs to look for adequate oxygenations

inspect, palpate, auscultate lungs (looking for bilateral breath sounds and good effort)

in chest trauma, anticipate/prepare for chest tube

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Circulation

assess pulses: starting w/ most central pulses and then move forward (femoral and carotid first)
assess capillary refill
control bleeding, infuse products and fluid
access via two large bore IVs (18 gauge is ideal), possible central line
rapid infuser

-look for hypotension and shock signs

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BPs by Pulse

carotid pulse: systolic must be at least 30-40

femoral pulse: systolic must be at least 50-60

radial pulse: systolic must be at minimum 60-70

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Disability

focused neuro exam:

LOC
GCS
PERRLA
Gross motor function
sensation in 4 extremities

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Glascow Coma Scale

looks at:

eye opening response
verbal response
motor response

best score = 15
comatose = 8
unresponsive = 3

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Exposure

completely undress pt and examine entire body

maintain C-spine precautions
assess scalp, axillary folds, skin folds, perineum
prevent hypothermia during work up (warm fluids, blood products, warming blankets)

*hypothermia can lead to coagulopathy and MODS

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ABC’s rest of alphabet

Facilitate adjuncts/Family - full set of VS, notify familly

Get adjuncts (LMNOP)

Labs
Monitoring
NG to decompress
O2 if needed
Pain (address)

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Trauma: Dx Tools

Head CT: for head trauma
Chest X-ray: for chest trauma (can do chest CT, but chest x-ray is portable and faster)
FAST U/S: for abdominal trauma looking for free air/fluid, intestinal damage
X-ray for trauma in limbs
Lab work: CBC, chemistries (electrolytes), coags (clotting factors), abdominal labs (BUN/creatinine/CK), blood type and screen, lactate, urine for presence of blood and pregnancy and/or toxicology, ETOH level, troponin

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Trauma: Commonly Missed Injuries

blunt abdominal trauma:

hollow viscus injury
diaphragmatic rupture

penetrating abdominal trauma:
-rectal and ureteral injuries

thoracic trauma:

aortic injuries
pericardial tamponade
esophageal perforation

extremity trauma

fractures
vascular injury
compartment syndrome

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Secondary Survey

if pt is stable and not immediately taken to the OR:

assess thoroughly for signs of injury
obtain full set of vitals
detailed history via SAMPLE
head to toe assessment

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Fluid Resuscitation

use hemodynamic parameters such as HR/BP and physical assessment to determine fluid needs

usually start with 2 L NS/LR (NS is usually standard)

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Blood Products

part of fluid resuscitation if needed
-considered when trauma pt remains HD unstable, has signs of tissue hypoxia despite crystalloid infusion

RBCs increase O2 carrying capacity and allow volume expansion

O negative given before type and screen is complete

platelets and fresh frozen plasma can be given as needed

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Trauma: Additional Considerations

tetanus: if pt injury involves dirt, gravel, metal
(need to have had 3 or more tetanus boosters in less than 10 years, then you do not need another booster)

hepatitis: if pt was exposed to used needles

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Head Trauma

priority: Airway
signs: battle’s sign, raccoon eyes, presence of CSF

assess neuro status (if neurologically compromised, can’t protect airway)

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Basilar Skull Fracture

anticipate that head injury is severe

look for CSF leak via halo sign, battle’s sign, raccoon eyes

management: strict bedrest, HOB > 30 degrees, no coughing, no sneezing, no straining, no nasal tubes

herniation and death can occur if undetected or if pt takes a while to get to hospital

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Facial Fractures

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priority: airway

may not be able to use traditional airways b/c of trauma to nose or mouth

nutrition is priority and difficult to address when you can’t use mouth for nutrition

Lefort = nasal bone fractures, can involve orbital area

Facial Fractures: Nursing Care

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assess symmetry
palpate bones and soft tissue
tetanus status
pain
anxiety
remove debris

Chest Trauma: Blunt

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harder to distinguish damage b/c it’s difficult to see what’s effected

could have:

cardiac complication
contusions
aortic dissection
hypoxemia from pneumothorax or disrupted airway

adequate ventilation and circulation is priority

Chest Trauma: Penetrating

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result of sharp objects

tx depends on area affected

adequate ventilation and circulation is priority

Chest Trauma

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typically ribs 4-10 are the ones that are broken

pain worsens w/ cough, deep breathing, movement

crepitus w/ palpation

atelectasis and diminished breath sounds

flail chest: multiple rib fractures, creates free segment of the ribs > paradoxical chest wall movement

Chest Trauma: Dx and Clinical Manifestations

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decreased O2 and ventilation
tachypnea (early)
SOB
subq emphysema
pain
splinting is clinical sign of chest trauma

Dx:

chest x-ray
CT
FAST
ABGs
Lactate
H&H (look at O2 capacity)

Chest Trauma: Tx

- ABCs - small rib fractures can be treated outpatient - pain management - cough/deep breathe (educate pt to splint chest) - pneumonia risk r/t atelectasis - 3-6 wks to heal

Pneumothorax

air in the pleural space results in a lung collapse happens more slowly than a tension pneumothorax

Pneumothorax: Causes

thoracentesis chest trauma ruptured blebs (COPD) infection

Pneumothorax: Sx

- dyspnea - cyanosis - tracheal deviation - asymmetrical chest wall expansion - anxiety - tachycardia - diminished breath sounds

Pneumothorax: Dx

chest x-ray | ABGs

Hemothorax

bleeding into chest cavity blood increases pressure and collapses lung in that area

Tension Penumothorax

happens vey quickly air in chest cavity/pleural space (just like a pneumothorax) ex) knife between ribs, when you breath in knife is dislodged slightly and air leaks into negative pleural space and stays there > tracheal deviation, depresses diaphragm, pressure on other lung

Abdominal Trauma

can also be blunt or penetrating hypovolemia is a big concern with abdominal trauma b/c of major organs in abdomen risk for peritonitis, sepsis, abdominal compartment syndrome dysfunction of liver, spleen, kidneys, bladder

Abdominal Trauma: S/Sx

``` splinting hard, distended abdomen decreased/diminished bowel sounds abrasions/bruising hematuria hematemesis shock ```

Abdominal Trauma: Nursing Care

- anticipate bedside FAST and/or CT scan - NG tube (assess for presence of blood, decompress stomach, slow down bowel function in acute phase) - foley catheter (assess for presence of blood, decompress bladder, bladder pressure) - anticipate need to go to OR for exploratory surgery

Abdominal Compartment Syndrome

- result of increased abdominal pressure - tissue, fluid, blood compress the abdominal wall > bowel death or vital organ death Tx: surgical decompression (fasciotomy), but pt must be stable

Musculoskeletal Injury

dislocations amputations (clean cut, crush, avulsion) soft tissue injury (affects skin, muscle, cartilage, ligaments)

Musculoskeletal Injury: Nursing Care

- CMS checks to affected extremity - sensation, ability to move - Pain management - immobilization - compression - elevate if possible

Pelvic Fractures

high mortality because of bleeding may result in intra-abdominal injury such as paralytic ileus, laceration of colon, bladder, urethra

Pelvic Fractures: Complications

- hypovolemic shock - sepsis - embolus - compartment syndrome (fasciotomies) - DVT (> pulmonary embolus if it moves) - Fat embolus

Pelvic Fractures: Nursing Care

- assess: pelvic stability, pain, hemodynamic stability - stabilize - prepare for intervention (emoblization, OR) - if open, monitor for infection

Fat Embolus

24-72 hours after initial injury of long bone or pelvic fracture s/sx of pulmonary emboli look for petechial rash

Heat Injuries

emergency when person is unable to sweat after a certain amount ``` influenced by: age environment pre-existing conditions medications street drugs ```

Heat Injuries: Tx

``` stabilize ABCs 100% O2 EKG electrolytes cool pt (fan, cooling blankets, spray w/ water) ```

Cold Injuries

frostbite: - gently rewarm - avoid friction hypothermia: - temp less than 95 degrees F - mental status deterioration - cold blood puts pt at risk for clots - severely hypothermic pts appear dead - rewarm!

Triage

Priority 1: Red = Immediate Priority 2: Yellow = Delayed Priority 3: Green = Minimal Priority 4: Black = Expectant Emergent: need immediate care - increased risk of death/threat to limb Urgent: seen w/in 1 hr condition may deteriorate Non-Urgent: can wait at least 2 hrs

Trauma Flashcards

(45 cards)