Multiple 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.

• - Immediately: due massive hemorrhage and shock
• - 2hrs: due to internal bleeding, worsening trauma,and change in LOC
• - 3 weeks: due to multisystem failure

• - 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)

• - 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

• 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

• 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

• - 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

• - 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

• - 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

• - 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.

- 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