Trauma

Question 1

Common forces in Blunt trauma

-acceleration or deceleration

Answer 1

-increased velocity or speed of a moving object followed by a sudden decrease

Question 2

common forces in blunt trauma

-shearing injury

Answer 2

when two oppositely directed parallel forces are applied to tissue

Question 3

common blunt traumas

-compression injury

Answer 3

squeezing inward pressure applied to tissue

Question 4

Penetrating Trauma

Answer 4

Injuries penetrate skin and result in damage to internal structures

• misleading because outside injury does not reflect inside injury
• bullets leave cavities 5-30 x greater than bullet hole

Question 5

Triage

Answer 5

screening of trauma patient to determine priority needs

• EMS in community
• Nurse in hospital

Question 6

trimodal distribution of trauma deaths

-FIRST PEAK

Answer 6

dies within minutes

• at scene or within route to hospital
• laceration of brain, spinal cord injury, heart damage

Question 7

Trimodal Distribution of Trauma Deaths

-Second Peak

Answer 7

minutes to hours “GOLDEN HOUR”

• in ER or operating room
• subdural hematoma, pneumothorax, liver laceration

Question 8

Trimodal Distribution of Trauma Deaths

-Third Peak

Answer 8

• days to weeks after injury
• Critical care unit
• Sepsis (infection)
• Multiple Organ Dysfunction Syndrome (MODS)

Question 9

6 phase Care of trauma patient

Answer 9

1- Pre-hospitalization resuscitation
2- Hospital Resuscitation
3- definitive care and operative phase
4-Critical care-SBAR
5- Intermediate care
6- Rehabilitation

Question 10

Hospitalization Resuscitation

-2 phases

Answer 10

1- primary
2- secondary
both can be done within minutes of each other. unless resusc. required

Question 11

Hospitalization Resc.

-PRIMARY ASSESSMENT

Answer 11

A- airway with cervical spine protection
B- Breathing (tension or hemothorax)
C- circulation (hypotensive shock) with bleeding control
D- Diability (neurogenic status)
E- Expose/ environment- remove clothing and keep pt warm

Question 12

Hospital Resc.

-SECONDARY ASSESSMENT

Answer 12

F- Full set of vitals, focused adjuncts, family focus, FAST exam
G- Give comfort measures
H- history and head to toe assessment AMPLE
I- Inspect posterior surfaces

Question 13

what is the most common shock in trauma patients

Answer 13

HYPOvolemic shock

Question 14

How to tx Hypovolemic shock

Answer 14

• 2 large bore IV catheters: 14-16
• draw blood
• IV fluids (NS/LR)
• fluid warmer
• O-negative blood if not responding to LR
• F/C and OGT
• 3 S- stop bleeding, splint fractures, stabalize pelvis

Question 15

Secondary Assessement

AMPLE

Answer 15

A- allergies
M-medications
P- past medical hx/pregnant
L-Last meal
-E-events preceding incident r/t accident

Question 16

Brain Injuries (TBI)

Answer 16

• skull fractures
• macillofacial injuries
• concussion
• contusion
• cerebral hematomas

Question 17

Maxillofacial Injuries

• Le fort 1
• Le fort 2
• Le fort 3

Answer 17

• above maxilla
• above nose
• behind eyes

Question 18

1) coup

2) contrecoup

Answer 18

1- primary impact

2- secondary impact

Question 19

Epidural Hematoma

Answer 19

collection of blood between the inner layer of the skull and the outermost layer of the dura
-associated with skull fractures an middle meningeal artery

Question 20

epidural hematoma s/s

Answer 20

• brief LOC
• period of lucidity then rapid deterioration
• may c/o localized headache

Question 21

Hallmark of Epidural hematoma

Answer 21

-dilated and fixed pupils of same side of impact

Question 22

diagnosis of epidural hematoma

Answer 22

CT, tx with surgery

Question 23

Neurologic Assessment of TBI

Answer 23

• dictates the speed for further assessment and treatment

- ** CORNERSTONE ASSESSMENT = Glascow coma scale- must be early and ongoing

Question 24

Rib Fractures

-interventions

Answer 24

Pain

-treating underlying injuries

Question 25

Rib fractures | -significance of 7th-12th fractures

Answer 25

associated with spleen and liver lacerations

Question 26

Rib Fractures | -Flail Chest

Answer 26

when two or more ribs are fractured in 2+ places

Question 27

Pulmonary Contusion

Answer 27

Bruising of the lung -d/t rib fractures or flail chest use a CXR & aggressive respiratory care such as walking, IS, deep breaths, and suctioning

Question 28

Pulmonary Contusion | -what can it lead to

Answer 28

- ARDS - pneumonia - effusion

Question 29

Tension Pneumothorax

Answer 29

air flows into the pleural space with inspiration and becomes trapped

Question 30

Tension pneumothorax | S/S

Answer 30

-tracheal deviation -decreased lung sounds one side -hypotension -unequal breath sounds -hypoxia JVD

Question 31

Tension Pneumothorax | -tx

Answer 31

Large bore needle (14 gauge) inserted into the lung (2nd ICS MCL) -chest tube in an acute setting

Question 32

Hemothorax | cause

Answer 32

blunt or penetrating throacic trauma causing bleeding into the pleural space

Question 33

Hemothorax | s/s

Answer 33

- hypovolemic shock - diminished breath sounds - **neck veins are collapsed and trachea midline

Question 34

Hemothorax | -tx

Answer 34

CHEST TUBE | -tx hypovolemic shock: IVF, blood transfusions

Question 35

Fluid Resuscitation | -complications

Answer 35

- may lead to hypotension - can cause pulmonary edema - hypothermia- use a warmer to warm fluids

Question 36

Pelvic Fractures | -why is there a high mortality

Answer 36

skeletal fractures have a high mortality d/t hermorrhagic shock

Question 37

Pelvic Fracture Assessment

Answer 37

- perianal ecchymosis - pain - rocking of iliac spine - lower limb paresis - hematuria - low limb rotation or leg shortening - rectal exams and occult bleeding

Question 38

Pelvic Fracture | Dx

Answer 38

CT or AP supine x-ray

Question 39

Pelvic Fracture | -medical management

Answer 39

prevent/control bleeding - temporary pelvic binder - pelvic angiography with contrast and embolization

Question 40

Pelvic Fracture | -Nursing management

Answer 40

- Massive transfusion protocol (MTP) - make sure enough plasma, plt, and blood are cross matched and ready - High risk for abdominal compartment syndrome - stable/unstable fractures - PAIN MEDS

Question 41

Femur fracture | -tractions

Answer 41

early stabilization - reduces risk for fat embolism - relieves pain - restore perfusion

Question 42

Compartment Syndrome

Answer 42

tissue perfusion >35-46

Question 43

5 P's of Compartment Syndrome

Answer 43

``` P- pain P-pallor P-pulse declined P- Pressure increased -Paresthesia ```

Question 44

Trauma complications

Answer 44

- hypermetabolism - infection! - pulmonary - pain - renal failure

Question 45

Renal Failure | -myoglobinuria

Answer 45

seen in crush injuries - dark tea colored urine - increased creatinine-kinase levels - aggressive IV fluids

Question 46

Trauma Prevention

Answer 46

-seatbelts -no drink/drive IPV-initmate partner violence

Question 47

blunt trauma

Answer 47

an injury with no opening in the skin | -can be more life-threatening because injuries difficult to see