What is injury and describe some characteristics of it.
Definition- results from acute exposure to energy and occurs because of the body’s inability to tolerate excessive exposure to the energy source.
Do not occur at random
- Risk factors predispose to injury
- Age, gender, alcohol use, race, income, geography
2 major mechanisms
- Blunt
- Penetrating
What are some predisposing clinical conditions for injuries?
- Diabetes
- Heart Disease
- Hypertension
- Psychiatric Illness
- ETOH, Drug Abuse
- COPD or Respiratory illness
- Previous injuries
What determines the extent of damage from an injury?
Injury resulting from force is related to:
- Amount and speed of energy transmission
- Surface area to which energy is applied
- Elasticity of tissues affected
Forces most often applied:
- Acceleration
- Deceleration
- Shearing
- compression
Describe a shearing force
¢: 2 parts slide in opposite directions
Shearing forces often cause of spinal injury, aortic tears, brain injury…etc
What are some characteristics of blunt trauma?
Definition- injury without interruption of skin integrity
- Visual cues not as apparent
- Thorough assessment is critical
- Solid organs more likely to be injured
- Full hollow organs vs. empty hollow organs
- Often mixed with penetrating injuries
What are some characteristics of penetrating trauma?
Definition- result of transmission of energy from a moving object into body tissues with disruption of skin integrity and underlying structures
- Damage related to velocity and mass of object: ex- distance from muzzle, caliber
- Stabbings: Limited tissue involvement, men up and women down, length of blade
- Gunshots: Handgun, Shotgun, Rifle
- Damage from blast wave, cavitation
Describe the Tri-modal distribution of trauma related mortalities?
1st peak
- within minutes of injury
- Usually result of injuries to brain, upper spinal cord, heart, aorta, other major blood vessel
2nd peak-
- Within 2 hours of injury
- Subdural/epidural hematomas, hemopneumothorax, ruptured spleen, lacerated liver, fractured femurs
3rd peak-
- Days to weeks
- Complications of sepsis or MODS
What does the primary survey consist of?
A - Airway with C-spine protection
B - Breathing & ventilation
C - Circulation & hemorrhage control
D - Disability: Neuro status (GCS; AVPU)
E – Exposure
Describe the goal of the A component of the primary survey
- Goal is optimize ventilation and oxygenation
- Injury to C-spine is assumed
What are the causes and symptoms of airway obstruction?
Causes of obstruction:
- Tongue falling into airway
- Blood, vomit, foreign objects
- Fractures of facial bony structures
Symptoms of obstruction:
- Dyspnea
- Diminished breath sounds
- Dysphonia (hoarseness, stridor)
- Dysphagia
- Drooling
Describe the goal of the B component of the primary survey
- Look- Listen- Feel
- All trauma pts should receive high flow oxygen during assessment
- Can evaluate with ABG
- PaO2
- PaCO2
- Positive pressure ventilation
- Bag/mask, BIPAP/CPAP, vent
Describe the goal of the C component of the primary survey
- Assess for pulses, skin temp, LOC
- Inadequate circulation manifests as shock
- Treat causes:
- Control hemorrhage
- Chest- 2.5L of blood can be lost in each hemothorax
- Abdomen- 6L of blood can be lost
- Femur- 500-1000ml can be lost from each
- Pelvis/retroperitoneum/scalp- all can cause sig. bleeding
- Aggressive fluid resuscitation
Describe the goal of the D component of the primary survey
Quick neuro exam:
- A- Alert
- V- Responds to verbal stimulation
- P- responds to painful stimulation
- U- Unresponsive
Describe the goal of the E component of the primary survey
- Get the Pt completely disrobed in preparation for secondary survey
- Factors that predispose pt to hypothermia
- Exposure to cold temp in trauma room
- Large volume of room temp IVF
- Cold blood products infusing
- Wet clothing
What is the secondary survey?
- Completed after all life-threatening injuries have been addressed
- Head-to-toe approach
- If hemodynamic instability occurs return to primary assessment
What do you ask for when taking a patient’s history?
A Allergies
M Medication
P Past medical history
L Last meal
E Events / Environment
Also history from EMS, family, or bystanders if patient is unable to provide information.
What is a tension pneumothorax and what are some signs of having it?
Tension- air trapped in thoracic cavity
- Leads to increased intrathoracic pressure causing decreased venous return and low cardiac output
- Signs- chest pain, air hunger, respiratory distress, tachycardia, neck vein distention, absent breath sounds
- Needle to chest
Open
- Signs- same as tension pneumo
- Create occlusive dressing
What is a Cardiac Tamponade and what are some signs and symptoms of it?
- Pericardium fills with blood
- Inhibits venous return- causes low cardiac output
- Beck’s triad- elevated right atrial pressure with distended neck veins, hypotension, muffled heart sounds
- Pulsus paradoxus-decrease of more than 10mm Hg SBPon inspiration
- Volume resuscitation and pericardiocentesis
What are some characteristics of neurogenic shock?
- Impairment of sympathetic pathways
- Loss of sympathetic innervation to the heart
- Loss of vasomotor tone w/ intravascular pooling (vasodilation of visceral and lower extremity vessels)
- Bradycardia, hypotension, hypothermia
- Interventions: Fluids, vasopressors, atropine
What are some characteristics of spinal shock?
- Transient physiological reflex depression of cord function below the injury
- Loss of sensorimotor functions
- Loss of reflexes
- Flaccid paralysis and loss of rectal tone
- Lasts several hours to days
- Early resolution associated with better outcomes
- Treatment is high dose steroids (30mg/kg bolus then drip over next 23 hours)
Describe an Epidural hematoma
Arterial bleed, usually middle meningeal artery
Describe a subdural hematoma
rupture of bridging veins between cerebral cortex & dura, but also seen with lacerations of brain or cortical arteries
What are the goals of care with brain injuries?
Maintenance of cerebral metabolic needs.
Prevention of secondary injury/increased intracranial pressure
- Hypoxemia
- Hypo/hypercapnia
- Hypotension
