Multiple Trauma

  1. What is head trauma?
    • - any injury to the scalp skull or brain.
    • - with any alterations in consciousness.
    • - most common causes include: MVA, falls, firearms, sports injuries, and recreational activities.
  2. What are the three critical time periods for mortality with head trauma?
    • - Immediately: due massive hemorrhage and shock
    • - 2hrs: due to internal bleeding, worsening trauma,and change in LOC
    • - 3 weeks: due to multisystem failure
  3. What are the types of head injuries?
    • - Scalp Lacerations: external head trauma that bleed profusely.
    • - Skull Fractures: can be linear or depressed; simple, commuted or compound; or closed or open.
    • - Minor Head Trauma: Concussion (a sudden transient mechanical head injury with disruption of neural activity and change in LOC).
    • - Major Head Trauma: Contusion ( the bruising of the brain tissue usually in a focal area, usually associated with a closed head injury), Laceration ( actual tearing of brain tissue usually associated with depressed and open fractures) and Diffuse Axonal Injury ( wide spread axonal damage to the white matter take 12-24hrs to develop)
  4. What are the manifestations of head injuries by location?
    • - Frontal: csf rhinorrhea and pneumocranium
    • - Orbital: periorbital ecchymosis
    • - Temporal: CSF otorrhea, boggy temporal muscle, and battle sign
    • - Parietal: deafness, CSF or Brain otorrhea, bulging of the tympanic membrane, facial paralysis, loss of taste, and battle sign.
    • - Posterior Fossa: occipital bruising, visual defects, ataxia (rare)
    • - Basilar: CSF or brain otorrhea, bulging of Tympanic membrane, battle sign, tinnitus, facial paralysis, gaze deviation and vertigo
  5. what are the complication for head trauma?
    • Hematoma
    • - Epidural: between the dura and the skull
    • - Subdural: between the dura matter and the archnoid layer
    • - Intracerebral: bleeding of brain tissue
    • Signs/Symptoms
    • - headache
    • - nausea/vomitng
    • - decreased LOC
    • -Pupilary changes
  6. What is the nursing management for head trauma?
    • Asses: Glasscow Coma Scale and look for CSF leakage (dextrostix or halo sign)
    • Diagnosis: alterd tissue perfusion, hyperthermia, sensory/perceptual alteration, pain, impaired mobility, risk of infection, anxiety, and self esteem.
    • Planning: reverse the diagnosis given
    • Implementation:
    • - Health Promotion: safety education
    • - Acute Intervention: maintain cerebral perfusion and prevent secondary cerebral ischemia
    • - Ambulatory and Home Care:
    • Evaluation
  7. what is a pneumothorax?
    • - air the pleural space that causes partial or complete collapse of the lung.
    • Types
    • - Closed ( which is caused by injury from mechanical ventilation, insertion of a subclavian catheter, perforation of the esophogaus, broken ribs, or rupture blebs or bullae)
    • - Open ( which occurs when thier is an opening in the chest from a gunshot wound or stab and surgical thorocotomy)
    • - Tension( which is caused by with accumlation air that puts tension on the heart and great vessels)
    • - Hemothorax
    • - Chylothroax
  8. What are the Clinical Manifestation of Pneumothorax?
    • - small pneumothorax ( hemo and chylo) have tachycardia and dyspnea
    • - large pneumothorax have shallow, rapid respiration, dyspnea, air hunger, and oxygen desaturation.
    • - some experience chest pain, absent breath sounds,cough, and mediastinal shift is a medical emergency
  9. What is associated with rib fractures?
    • - most commonly occurs with ribs 5- 10
    • - clinical manifestation include pain ( especially on exspiration)
    • - goal is to decrease the pain to promote good chest expansion
  10. What is associated with flail chest?
    • - Results from multiple rib fractures which causes an unstable chest wall
    • - During inspiration the fractured portion is sucked in and during expiration it bulges out
    • - Patient also may have rapid shallow respiration and tachycardia
    • - Initial therapy consist of airway management, adequate ventilation, oxygen therapy, administration of IV fluids, and pain control.
  11. What is cardiac temponade?
    - Blood rapidly collects in the pericardial sac, compresses the myocardium and prevents heart from pumping effectively

    - S/S-muffled distant heart sounds, hypotension, neck vein distension, increased CVP

    - Treatment- pericardiocetesis with surgical repair
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Multiple Trauma