- Information
- AI Chat
Cc 7 trauma
Critical Care (408)
Loma Linda University
Students also viewed
Related Studylists
MEDICALPreview text
Trauma Blunt Trauma injury without opening/penetrating the skin diagnosis can be difficult d/t extent of injuries less obvious than penetrating trauma blunt trauma more life threatening Common forces of Blunt Trauma acceleration/deceleration increased velocity/speed of a moving object sudden deceleration shearing two opposite parallel forces applied to tissue compression squeezing inward pressure applied to tissues
Penetrating Trauma injuries penetrate skin damage in internal structure diagnosis can be misleading – condition of outside wound doesn’t reflect extent of internal injury bullets can create holes/cavities 5-30 times larger than diameter of bullet
Trauma Triage screening of trauma pt to determine priority needs EMS - community | RN – hospital Phases of Care – trimodal distribution of trauma deaths First Peak – immediate (50% die) seconds/minutes after injury | at the scene or on the way to medical facility victims die before treatment injuries: brain/brainstem laceration, high SCI, injury to heart/aorta/large vessels Second Peak – early (30% die) golden hour (time from injury to definitive care) for critically injured try to get to ED/OR to get treated ASAP minutes/hours after injury | ED or OR injury: usually hemorrhage related, ruptured spleen, liver laceration, pelvic fracture, hemopneumothorax Third Peak – late (20% die) days/weeks after injury | critical care unit injury: complications - sepsis, multi-organ failure (MODS)
leading cause of death for all age groups < 44 y/o 25% admissions to (ED) r/t trauma most common trauma 1 st: motor vehicle accident (MVA) 2 nd: falls In 2014, 31% of all traffic fatalities in US were linked to alcohol-impairment trauma is a surgical disease Mechanisms of Injury external force of energy impacts the body structural/ physiologic injury understanding mechanism of injury helps nurses/providers to anticipate & predict potential internal injuries Trauma Nursing Management – continuum of 6 phases pre-hospital resuscitation hospital resuscitation definitive care & operative phase (OR) critical care – SBAR (ICU) intermediate care (stepdown) rehabilitation
Hospital Resuscitation Resuscitation Phase hypovolemic shock most common Shock in trauma pts 2 large bore IV catheters 14-16 gauge blood drawn IV fluids administered rapidly normal saline (NS) lactated ringers (LR) fluid warmer if fluid given rapidly O-negative blood or type specific blood if not responsive to LR additional: foley cathether & orogastric tube 3 S stop bleeding splint fractures stabilize pelvis (a lot vessels, prevent bleeding)
Secondary Survey F: Full set of vital signs/focused adjuncts includes cardiac monitor/EKG family presence focused assessment w/ sonography for trauma (FAST exam) G: Give comfort measures verbal reassurance & touch pain management (pharm & non-pharm) H: History & Head-to-toe assessment (AMPLE) A: allergies M: medications P: past medical illness / pregnancy L: last meal (in case of intubation) E: Events immediately
2 phases: primary & secondary assessment both can be done in several mins unless resuscitative measures required
Primary Survey A: airway maintenance w/ cervical spine protection B: breathing (tension or hemothorax) and ventilation C: circulation (hypotensive shock) control hemorrhage D: disability check neurologic status E: expose/environmental controls remove clothing keep the patient warm
preceding incident r/t injury I: Inspect posterior surfaces Traumatic Brain Injury (TBI) Maxillofacial Injury Le Fort I – mustache area horizontal fracture entire maxillary arch moves separately from upper facial skeleton
Le Fort II – above nose, below orbits extension of Le Fort I involves orbit, ethmoid, nasal bones CSF leaks (do NOT put NG tube)
Le Fort III – straight to the orbits associated w/ craniofacial disruption CSF leaks II & III have CSF leaks d/t communication between cranial base and cribriform plate
Concussion vs Contusion | Coup-Contrecoup Injury concussion brief loss of neurological function, loss of consciousness contusion bruising of brain coup injury directly at point of impact contrecoup force within skull from hitting other size of skull common w/ motor vehicle accidents
blunt or penetrating trauma mechanical forces transmitted to brain tissue skull fracture | maxillofacial injury concussion | contusion cerebral hematomas Cerebral Hematoma accumulation of blood space-occupying lesion created increased ICP 2 types epidural (EDH) | subdural (SDH) associated w/ skull fractures & middle meningeal artery
Epidural Hematoma (EDH) | arterial fast bleed collection of blood between dura mater and skull doesn’t cross suture line diagnosis: CT scan treatment: surgery for decompression Signs/Symptoms brief loss of consciousness (knock out) followed by period of lucidity (aware/alert) rapid deterioration may have severe localized headache dilated and fixed pupils on same side of impact hallmark sign of EDH battle’s sign (mastoid process ecchymosis/ bruising) indicates fracture of middle cranial fossa may suggest brain trauma (TBI)
Subdural Hematoma (SDH) | venous slower bleed collection of blood below inner layer of dura mater and above brain & arachnoid membrane between inner dura & arachnoid membrane crosses suture line most common type of intracranial mass lesion harder to find d/t slower loss of consciousness diagnosis: CT scan tx: varies on size, location, extent of mass effect conservative: monitor w/ serial CT surgery: drainage via EVD w/ burr holes 3 Types of Subdural Hematoma acute: faster <4 days subacute: 1-3 weeks chronic: after 3 weeks
TBI - Neurologic Assessment most important tool for evaluating patients w/ TBI indicates severity of injury dictate speed for further evaluation and treatment GCS – cornerstone assessment the lower the GCS, higher the concern for severe injury and need for intubation to protect airway GCS 8 or less consider intubation to protect airway educate family for these signs change in behavior headache nausea & projective vomiting d/t increased ICP pupillary changes
Thoracic Injuries Tension Pneumothorax air flows into pleural space w/ inspiration & air becomes trapped collapsed lung diagnosis: based on clinical assess Signs/Symptoms tracheal deviation away from side of tension
Hemothorax blunt/penetrating thoracic trauma bleeding into pleural space diagnosis: clinical | x- ray & CT scan if stable Signs/Symptoms hypovolemic shock) HOTN hypoxia diminished/absent
Fluid Resuscitation hypotension highest priority treat hypotension first because hypovolemic shock most common type of shock in trauma patients administer about 2L NS or LR then give blood products
Rib Fractures lower rib fractures ( 7 th- 12 th rib) associated w/ spleen or liver laceration flail chest: 2/more ribs fractured in 2/more places (paradoxical movement) Treatment pain control (underlying) treating underlying
compartment syndrome stable (non-displaced) or unstable fracture PAIN MEDS! Spinal cord injuries complete injury C1-T1 tetraplegia T2-L1 paraplegia incomplete injury mixed loss of voluntary motor activity and sensation Brown Sequard syndrome: loss of pain/temp sensation on opposite side, loss of voluntary motor control on same side as cord damage Central cord syndrome: loss of motor and sensory deficit to upper and lower extremities. Bowel/bladder may be involved Anterior cord syndrome: loss of motor power, pain, temp, sensation. Preservation of position, vibration, touch sense Nursing mgmt.: maintain spinal cord stabilization. C collar, log roll. Pulm complications may occur, cough assist, percussion. Cardiac tamponade (blunt chest trauma EKG might be PEA) - BECKS TRIAD (hotn, JVD, muffled heart sounds) DVT development - VIRCHOWS TRIAD (2/3 blood stasis, hypercoagulability, endothelial injury)
Cc 7 trauma
Course: Critical Care (408)
University: Loma Linda University
