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Trauma

  1. Occurs when the heart's ability to contract and pump blood is impaired and the supply of oxygen is inadequate for the heart and tissues
    Cardiogenic Shock
  2. Two types of cardiogenic shock
    • Coronary
    • Non-coronary
  3. Type of cardiogenic shock seen more often, usually from MIs and damage to left ventricular myocardium
    Coronary Cardiogenic Shock
  4. Type of cardiogenic shock seen less frequently from conditions that stress the myocardium (hyoxemia, acidosis, hypoglycemia, hypocalcemia, tension pneumothorax)
    Non-coronary cardiogenic shock
  5. Medical management goals of cardiogenic shock are achieved by:
    increasing oxygen supply while reducing oxygen demands
  6. First-Line treatment for cardiogenic shock:
    • Oxygenation (2-6 L/min... >90%)
    • Pain Control (IV morphine)
    • Hemodynamic Monitoring (arterial line)
    • Labs (BNP, CK-MB, ECG, CRP)
    • Fluid Therapy (**Fluid bolus should never be given rapidly, because pts with cardiac failure may result in acute pulmonary edema)
    • Pharmocologic Therapy (Dobutamin, Nitro, Dopamine, Epi, Vasopressin, Antiarryhthmmics)
  7. Nursing Management of Cardiogenic Shock
    Prevent Cardiogenic Shock (identify pts at risk and collaborate with other HCP)

    Monitoring Hemodynamic Status

    Administering Medications and IV Fluids

    Maintaining Intra-aortic Balloon Counterpulsation

    Enhancing Safety and Comfort (reduce anxiety)
  8. Occurs when intravascular volume pools in peripheral blood vessels causing hypovolemia and resulting in decreased CO and decreased tissue perfusion (called distributive shock)
    Circulatory Shock
  9. Risk Factors of Septic Shock
    • Immunosuppression
    • Extremes of Age (<1, >65)
    • Malnourishment
    • Chronic Illness
    • Invasive procedures
    • Emergent and/or multiple surgeries
  10. Risk factors of Neurogenic Shock
    • Spinal cord injury
    • Spinal anesthesia
    • Depressant action of medications
  11. Risk Factors of Anaphylactic Shock
    • Hx of medication sensitivity
    • Transfusion reaction
    • Hx of reaction to insect bites/stings
    • Food Allergies
    • Latex Sensitivity
  12. Most common type of circulatory shock
    • Septic Shock
    • (caused by widespread infection/sepsis)
  13. Number one cause of death in noncoronary ICU patients
    Septic Shock
  14. Syndrome resulting from severe clinical insult that initiates an overwhelming inflammatory response by the body
    SIRS (Systemic Inflammatory Response Syndrome)
  15. S/S of SIRS
    • Temp >100.4 or <96.8
    • HR >90
    • RR >20
    • WBC >12,000 or <4,000 or >10% immature
  16. Presence of altered function of more than 1 organ in an acutely ill patient requiring intervention and support of the organs to achieve physiologic functioning required for homeostasis
    MODS (multiple organ dysfunction syndrome)
  17. Cardio S/S of MODS
    Hypotension and Hypoperfusion

    • SBP <90
    • MAP <65
  18. Respiratory S/S of MODS
    Hypoxemia

    Hypercarbia 

    Adventitous breath sounds

    • (CO2 <32)
    • (RR >20)
  19. Renal S/S of MODS
    Increased Creatinine

    Decreased Urine Output
  20. Hematologic S/S of MODS
    Thrombocytopenia, Coagulation abnormalities
  21. Metabolic S/S of MODS
    Lactic acidemia, Metabolic Acidosis
  22. Neuro S/S of MODS
    Altered LOC
  23. Hepatic S/S of MODS
    Elevated liver function tests, hyperbilirubinemia
  24. Current goal of patient treatment in someone who is septic
    Identify and Treat patient in early sepsis within 6 hours to optimize patient outcome
  25. Any ____ should be obtained BEFORE administration of antibiotics
    CULTURES!
  26. Antibiotics should be given within the ____ hour(s) of treatment of a patient with sepsis
    The first hour
  27. Reestablishing tissue perfusion through aggressive _____ is key to the management of severe sepsis and septic shock
    fluid resuscitation
  28. Fluid challenges of _____mL of crystaloids or ____mL of colloids over 30 minutes may be required to aggressively treat sepsis-induced tissue hypoperfusion
    • 1000mL crystalloids
    • 300-500mL colloids
  29. If the infecting organism of a patient that has sepsis is unknown, treat with _____ first
    Broad-Spectrum (until culture and sensitivity reports are received)
  30. Pharmacologic Therapy for a patient with severe sepsis or septic shock
    Fluid Therapy (challenges)

    • Vasopressors (norepinephrine and dopamine) -to achieve a MAP >65
    • Inotropic Agents

    Packed Red Blood Cells- support oxygen delivery and transport to the tissues

    Neuromuscular blockade/ Sedation agents- reduce metabolic demands

    DVT prophylaxis with Heparin

    Stress ulcer prophylaxis- (H2 Blocking Agents, PPIs)
  31. Aggressive nutritional supplementation should be initiated within _____ of ICU administration to address the hypermetabolic state present with pts in septic shock
    24-48 hours
  32. Preferred route of feedings in pt with septic shock
    Enteral Feedings

    (more risk of infection with IV catheters, but enteral may not always be possible if there is decreased perfusion to the GI tract)
  33. Shock caused by spinal cord injury, spinal anesthesia, or other nervous system damage, characterized by warm, moist skin, bradycardia and hypotension
    Neurogenic Shock
  34. Nursing Management of Neurogenic Shock
    Elevate HOB >30 degrees 

    Immobilize patient

    Check pt for any lower extremity pain, redness, tenderness, warmth (DVT)

    Passive ROM

    Antithrombotic agents
  35. 3 Defining Characteristics of Anaphylaxis
    Acute onset of symptoms

    • Presence of 2 or more:
    • -Respiratory compromise
    • -Reduced BP
    • -GI distress
    • -Skin or Mucosal tissue irritation

    Cardiovascular Compromise
  36. General treatment of Anaphylactic Shock
    Removing causative agents

    Administering medications to restore vascular tone

    Providing emergency support of basic life functions

    Fluid management

    Intramuscular Epinephrine

    IV Benadryl

    Nebulized meds (Albuterol)

    CPR (if needed)
  37. Organ failure usually beings in the ____ and ____
    Lungs and Cardiovascular instability
  38. Leading cause of critical illness and death in the USA
    Trauma
  39. Average ICU stay for trauma patient
    5 days
  40. Most common cause of trauma in older adults
    Falls
  41. Legal issues in Emergency Care
    Highly Litigous Area

    All 50 states have "Good Samaritan Laws"

    Nurses are accountable to the public for judgment and consequences of judgment

    Delegation to unlicensed personnel is our responsibility

    Confidentiality and privacy issues are critical

    Federal and state laws mandate that EDs have a dute to provide service to those seeking care ("no dumping")
  42. Mandated Reporting:
    Any death in the ED and deaths within 48 hours of hospital admission

    Suspected abuse

    Communicable diseases (HIV, hepatitis, TB)

    Elopement of psychiatric patients 

    Extensive burns

    Homicide

    Infectious outbreaks

    Rape/Sexual assault

    Serious injury related to a medical device

    STDs

    Suicide or Attempted

    (some states mandate that seizures need to be reported to the DMV)
  43. Oral or Written Consent
    Expressing consent
  44. Consent: If pt is unconscious or where immediate decisions must be made to prevent loss of life or limb
    Implied consent
  45. Consent: If necessary to protect life or limb if guardian is not available
    Emergent Treatment of Minors
  46. Consent: Physician or police officer determines the individual is a threat to self or to others
    Involuntary Consent
  47. Consent: Must be provided to speakers of other languages
    Translation services
  48. Documentation Requirements in trauma:
    Initial assessment date/time

    Time when each intervention occurs

    Evidence that unstable patients are receiving intensive care

    Identified problems and procedures are performed

    All interventions

    Use of translator

    Pt responses to interventions

    Nursing Observations

    Communications with other health team members

    Communications with family members

    Patient Teaching/ Discharge Instructions

    Any refusal of care
  49. Evidence collection and preservation...collection, analysis, and interpretation of medical evidence presented in legal cases
    Forensics
  50. What all is a nurse involved with in a forensics case
    evidence collection

    preservation

    chain of custody
  51. Forensics are based off:
    • blood
    • urine
    • photographs
    • clothing
    • GSR
    • weapons/misiles
    • nail scrapings
    • fluid collection
  52. Guidelines for Evidence Collection
    Never discard clothing

    Place wet/bloody clothing in paper bag

    Do NOT wash the hands of a patient with GSW (cover with paper bags)

    Cut around bullet holes, powder marks and knife cuts in clothing

    Fold clothing without shaking it (do not cross-contaminate clothing)

    Precisely document what the patient says

    Describe appearance of wounds and presence of blood

    Photograph

    Document behavior in objective terms

    Unless a procedure is essential, delay cleaning the patient or wounds until police see it

    Do not handle bullets or other solid evidence (placed in sealed container and label with location found, date, time, initials)

    Chain of evidence is critical (must remain with the collector or be locked in a secure area until released to law enforcement)

    All parties sign the evidence label with date, time, time of exchange

    If moisture is needed to collect biological samples, slightly moisten the tip of cotton swab with saline (dry in separate containers/envelopes)
  53. Every "victim" has _____ opportunity to have evidence collected properly
    ONE
  54. Rapid sorting of patients who present to the ED
    Triage

    (who needs immediate medical attention? who can safely wait to be seen?)
  55. Who should be doing the triaging of patients?
    Most experienced nurse on duty
  56. A rapid, brief assessment is done by experienced nurse during triage within ____ of arrival to the ED
    five minutes
  57. What to obtain from focused triage assessment:
    Chief Complaint (why did you come in today)

    Allergies

    Current medications

    Past medical history (LMP for women)

    Events surrounding the illness/injury

    Vital Signs, Pulse ox, Accucheck if DM

    Last tetanus shot

    IF MVA: Speed of vehicle, direction of impact, patient position in the vehicle, use of restraints, airbags, ejection, rollover, fatalities, entrapment/prolonged extrication
  58. It is important to remember to be ____ when triaging a patient in ED
    NonJudgmental and Empathetic

    "I bet that really hurts"
  59. Purpose of Triage
    Right person in the Right Place at the Right Time for the Right Reason
  60. Most common type of triage
    3-level triage (I, II, III)
  61. Emergent patients present with a threat to:
    Life, Limb, Organs
  62. Types of Emergent Patients:
    Threat to Life, Limb, Organs

    Cardiac Arrest

    Major Trauma

    Respiratory Failure

    Stroke

    Loss of pulse in extremity

    Unconsciousness with inability to maintain airway

    Anaphylaxis

    Arterial Bleeding

    Sexual Assault (whether or not they have physical wounds!)
  63. Urgent patients require ___ care:
    Prompt (but may safely wait several hours if necessary)
  64. Type of Urgent Patients:
    • Abdominal Pain
    • Fractured Hip
    • Kidney Stone
    • Vomiting and Diarrhea
    • Asthma (not status asthmaticus)
    • Blood in urine or stool
    • Fractured extremity (if pulse is present)
  65. Non urgent patients:
    (could have been seen in doctor's office)

    Need care, but time is not critical

    Patient can safely wait

    Sore throats

    Rash

    Conjunctivits

    Simple Fractures

    Lacerations not bleeding profusely but will need stitches

    Flu

    N,V,D

    Reassess these patients at least every 1-2 hours
  66. How often should you reassess non-urgent patients in the ED
    1-2 hours (as often as possible)
  67. In a multiple casualty situation, treat:
    The Most seriously wounded who have the potential to be saved
  68. Treating victim of abuse in ED:
    • Separate pt from others
    • (victim will not speak honestly if the abuser is there)

    Document every little thing you see, every word spoken

    Be aware of mismatches between physical S/S and what the victim says

    Look for areas that don't show for injuries (belly, butt, breast, etc)
  69. ___% of rape go unreported
    80%
  70. Rape/sexual assault is an act of ____
    anger or control
  71. Sexual contact against the another person's will
    Rape
  72. Someone needs to be with rape patient:
    AT ALL TIMES (offer to be with pt until family/pt resources are found)
  73. Women ages ____ are most vulnerable for rape/sexual assault
    16-19 years old
  74. Force =
    Mass * Acceleration
  75. Trauma where force is distributed over a large area...may be MVC, falls, assaults, and contact sports
    Blunt Trauma
  76. Injury due to an increase in the velocity (speed) of a moving object
    Acceleration Injuries
  77. Injury due to a decrease in velocity of a moving object (car hits tree)..body keeps moving forward when the car has come to an abrupt stop
    Deceleration Injury
  78. Injury occurs when structures "slip/slide" relative to each other (brain vs skull)...takes forever to heal!!!
    Shearing Injury
  79. Injury occurs when continuous pressure is applied to a body (pinned between a vehicle and garage wall)
    Crush Injury
  80. Acceleration/Deceleration injuries most often occur:
    MVCs
  81. Injury produced by foreign objects (bullets, knife blades, debris) entering tissue
    Penetrating Injury
  82. It is important to remember that the external appearance of a penetrating wound does:
    NOT reflect extent of internal injury
  83. Low- velocity missles cause:
    little cavitation and blast effect, essentially only pushing tissue aside
  84. High velocity missiles (rifles, semi-automatic) produce:
    greater energy and cavitation
  85. What should be done with the object penetrating through the patient?
    LEAVE it!
  86. Main injury determinants in stab wounds:
    • Length
    • Width
    • Trajectory of penetrating object
    • Presence of vital organs in area of wound
  87. PreHospital care for trauma patient:
    Best chance of survival if advanced care is given within 1 hour of accident (THE GOLDEN HOUR)

    Principal factor is transport time to a trauma center

    Few interventions will be provided if transport time is short

    Extensive interventions if transport time is longer
  88. Best chance of survival for trauma patient is if advanced care is given:
    within one hour of the accident (THE GOLDEN HOUR)
  89. Extensive interventions are taken for trauma patient Pre-Hospital if:
    Transport time is longer

    (few interventions will be provided if transport time is short)
  90. Focus of pre-hospital care for trauma patient:
    • Maintaining airway
    • Ventilation
    • Controlling external bleeding
    • Preventing Shock
    • Maintaining spine immobilization
    • Quick Transport
    • Neuro assess after ABCs
  91. Primary survey (IN HOSPITAL) for trauma pt:
    • Life threatening injuries identified/managed
    • (ABCs first, then neuro!)

    Assess for hypovolemia (hemorrhagic shock)

    • Compression, Surgery, Replacing lost volume
    • (2 large bore IV lines 16/14g)

    Monitor vital signs, pulse ox, blood work sent, type and cross match, urinary catheter inserted, NG placed

    Assess for hypothermia (will cause clotting)

    Primary survey determines Dx Tests
  92. Secondary Survey for trauma patient in hospital:
    • More detailed head-to-toe assessment
    • (to detect life or limb-threatening injuries)

    Patient history is obtained

    Information about mechanism of injury (Was person on foot/bike? Size of vehicle? Fatality? Length of Knife? Was assailant male or female? Calliber of bullet? Distance of GSW? How far was fall?)
  93. Aggressive fluid resuscitation puts patient at risk of:
    • Hypothermia and Coagulopathy
    • (can induce DIC)
  94. Most commonly used crystaloids in trauma:
    • Isotonics 
    • (closely mimics body's extracellular fluid...most commonly used Normal Saline)
  95. For each liter of blood lost, give patient:
    3 Liters of Crystaloids
  96. Type of crystaloids that remain in vascular space and shift water into plasma...cause rapid increase in blood volume (most commonly 3% saline)
    Hypertonics
  97. Type of crystaloids not often used in trauma (D5W)
    Hypotonics
  98. Type of Colloids
    • Almbumin
    • Dextran
    • Hetastarch
  99. Creates oncotic pressure which encourages fluid retention and movement of fluid into vascular space...large molecules stay in intravascular spaces longer (less volume is needed to achieve hemodynamic stability)
    Colloids
  100. Complications of giving colloids:
    • Anaphylaxis
    • Coagulopathy
  101. If there is no time for a cross match, give ____ blood to women of childbearing age
    O-Negative
  102. If there is no time for cross match, give ____ blood to men and post-menopausal women
    O-Positive
  103. Massive blood transfusions puts the patient at risk for:
    • SIRS
    • ARDS
    • DIC
  104. Autotransfusion is given especially for:
    Chest Trauma Victims
  105. Delayed Complications of Trauma: HEME
    Hemorrhage, Coagulopathy, DIC
  106. Delayed Complications of Trauma: CARDIAC
    • Arrythmias
    • Heart Failure
    • Aneurysm
  107. Delayed Complications of Trauma:  RESPIRATORY
    • Atelectasis
    • Pneumonia
    • Emboli
    • ARDS
  108. Delayed Complications of Trauma: GI
    • Peritonitis
    • Paralytic Ileus
    • Bowel Obstruction
    • Anastomosis Leaks
    • Fistulas
    • Bleeding
    • Compartment Syndrome
  109. Delayed Complications of Trauma: HEPATIC
    Liver abscess/Failure
  110. Delayed Complications of Trauma: RENAL
    • Hypertension
    • Myoglobinuria
    • ARF
  111. Delayed Complications of Trauma: ORTHO
    Compartment Syndrome
  112. Delayed Complications of Trauma: SKIN
    • Wound Infections
    • Dehiscence
    • Breakdown
  113. Delayed Complications of Trauma: SYSTEMIC
    • Sepsis
    • SIRS
  114. State of cellular hypoperfusion, hypercoagulability, activation of inflammatory response system
    Shock
  115. ____ occurs in hypo-perfused areas and lacatic acid is produced (acidosis)
    Anaerobic Metabolism
  116. "____ is tissue when it comes to saving organs"
    TIME
  117. Stage of Shock Syndromes: the body activates compensatory mechanisms in an effort to maintain circulatory volume, blood pressure and CO
    Stage 1

    Relatively normal VS and cerebral perfusion may continue and shock may not be recognized
  118. Stage of Shock Syndromes: Compensatory mechanisms begin to fail and metabolic and circulatory abnormalities become noticeable...immune and inflammatory responses activate
    Stage 2

    Signs of dysfunction on one or more organs may become apparent
  119. Stage of Shock Syndromes: Final, irreversible damage is done....cellular and tissue injury are so severe that life may not be sustainable
    Stage 3

    (MODS occurs)
  120. General principles for Shock Care:
    Establish adequate organ perfusion and oxygenation ASAP in order to lessen inflammatory responses

    Key Assessments: Neuro, UO, Pulse Ox, ABG, V/S
  121. Maintain MAP > _____ for septic shock
    65
  122. Maintain CVP between ____ for septic shock
    8-10
  123. Maintain BG < ____ for septic shock
    150
  124. Cardiogenic Shock is more common in:
    Advanced age

    EF < 35%

    Large anterior MI

    Hx of DM
  125. End Point of Shock
    MODS (multiorgan system dysfunction syndrome)
  126. First organs to fail in MODS
    Lungs and Kidneys
  127. Tracheobronchial Trauma is usually associated by:
    Esophageal and Vascular Damage
  128. ____ are often present with upper rib fractures and pneumothorax
    Ruptured bronchi
  129. Sx of Tracheobronchial Trauma: (may be subtle)
    • Dyspnea
    • Hemoptysis
    • Cough
    • SQ emphysema
    • Anxiety
    • Hoarseness
    • Stridor
    • Air Hunger
    • Hypoventilation
    • Accessory Muscle Use
    • Retractions
    • Apnea
    • Cyanosis
  130. Main nursing intervention for tracheobronchial trauma:
    OXYGENATION
  131. Bony Thorax Fractures include:
    Ribs and Sternal Fractures (flail chest)
  132. Bony Thorax Fractures indicates:
    serious intrathoracic and abdominal injury
  133. S/S of bony thorax fractures
    Signif. pain when breathing/coughing and quick pulmonary deterioration
  134. Position a patient with bony thorax fractures:
    Injured side down when possible
  135. Bruising of lung tissue (potentially lethal)
    Pulmonary Contusions
  136. Effect of pulmonary contusions:
    Ruptured capillary walls cause hemorrhage and leakage of plasma and protein into alveolar spaces = pulmonary edema and hypoxia
  137. Suspect pulmonary contusions in any patient that has:
    high energy blunt chest trauma
  138. If a patient presents with scapular fracture, rib fractures, or flail chest....also consider that the patient may have:
    Pulmonary Contusions
  139. Pulmonary contusions may take ____ hours to show on Xray
    6 hours
  140. S/S during assessment of pulmonary contusions
    • Dyspnea
    • Crackles
    • Hemoptysis
    • Tachypnea
    • Increasing Peak Airway Pressure
    • Hypoxia
    • Respiratory Alkalosis
    • Poor response to increasing FiO2
  141. Cardiac Contusions are usually caused by:
    Blunt Chest trauma (heart impacts sternum or is compressed between sternum and back)
  142. S/S of cardiac contusion:
    EKG abnormalities, ECHO with myocardial depression, abnormal enzymes
  143. Nursing Interventions of cardiac contusion:
    • Cardiac Monitor
    • Hemodynamic Monitoring
    • Enzymes
    • Treat Pain!!!
  144. Life threatening condition where blood fills the pericardial space and compresses the heart (decreased cardiac filling > decreased CO > decreased contractility > SHOCK)
    Cardiac Tamponade
  145. Even ___ml of blood can create increased pericardial pressure
    50-100
  146. Beck's Triad (present in cardiac tamponade)
    • Decreased BP
    • Muffled Heart Sounds
    • Distended Neck Veins
  147. S/S of cardiac tamponade
    Beck's Triad (decreased BP, muffled heart sounds, distended neck veins)

    Pulsus Paradoxus (inspiratory decreased in SBP of 10mmHg)
  148. Treatment of cardiac tamponade
    • Echo- diagnoses!!!
    • Drain blood with long needle
  149. Mortality rate of penetrating cardiac injury
    • 50-80%
    • (if people survive it is because a tamponade saved them!!!)
  150. Occasionally, a small stab wound to ____ will seal itself off because of low pressure in that chamber of the heart
    Right Ventricle
  151. Leading cause of death from blunt trauma...most die at the scene before reaching hospital
    Aortic Transection (tearing/rupturing)
  152. Aortic Transections are usually due to:
    sudden deceleration forces (MVC or fall)
  153. The thoarcic aorta is very mobile and tears occur at points of _____ (descending arch)
    Fixation
  154. If the outer layer of the aorta remains intact during a aortic transection, ____ may form and prolong life for a short time
    aneurysm or hematoma
  155. S/S of Aortic Transection:
    Poor perfusion beyond the tear

    Pulse Defecit in lower extremities or left arm

    Hypotension

    Upper arm HTN relative to leg BP

    Pain

    Systolic Murmur

    Hoarseness

    Resp Distress/Dyspnea
  156. Nursing interventions of aortic transection:
    Hemodynamic Monitoring

    BP management

    Preservation of Organ Function
  157. Facts about Abdominal Trauma
    Can be Blunt or Penetrating

    Can rapidly lead to death due to hemorrhage, shock, and sepsis

    Single-organ injuries are RARE

    Detection of injuries can be difficult and missed injuries are frequently the cause of death

    Penetrating injuries are "dirty"

    Blunt trauma compression forces can fracture solid organ capsules and they bleed

    Hollow organs will collapse and absorb force but will leak their fluids
  158. Suspect Abdominal Trauma if:
    Abdominal Tenderness/Guarding

    Hemodynamic Instability

    Lumbar Spine Injury

    Pelvic Fracture

    Retroperitoneal or Intraperitoneal air
  159. Diagnostic Tests for Abdominal Trauma
    FAST (Focused Abdominal Sonography for Trauma) in ER

    Peritoneal lavage looking for discolored or bloody fluid

    CXR to detect organ displacement or free air

    Abdominal CT
  160. Region of the Abdomen: diaphragm, liver, spleen, stomach, transverse colon
    Peritoneal Area
  161. Region of the Abdomen: aorta, vena cava, pancreas, kidney, ureters, duodenum and part of colon
    Retroperitoneal Area
  162. Region of the Abdomen: rectum, bladder, uterus, iliac vessels
    Pelvic Area
  163. Most common cause of esophageal trauma
    Penetrating (most often cervical esophagus)
  164. S/S of Esophageal Trauma
    (SUBTLE!)

    Hemothorax or Pneumothorax without rib fractures
  165. Nursing Interventions for Esophageal Trauma
    CT of chest, abdomen, and pelvis

    Esophagoscopy and Swallow studies

    NPO with NG tube to continuous suction

    Aggressive antibiotic therapy

    Airway, Oxygenation, Hemodynamic Support
  166. Rupture of Diaphragm is more common in:
    Blunt injuries
  167. Rupture of Diaphragm allows movement of:
    Abdominal organs into thorax, which can cause bowel strangulation
  168. Rupture of Diaphragm can lead to ____ due to displacement of lung tissue
    Respiratory Compromise
  169. Dx Studies for Rupture of Diaphragm
    CXR, Ultrasound, CT
  170. S/S of Rupture of Diaphragm
    Respiratory Distress

    Dyspnea

    Decreased Breath Sounds on Affected Side

    Bowel sounds in the chest

    Abdominal Fluid when inserting chest tube
  171. Blunt gastric injuries can present with blood in the ______
    NG aspirate or hematemesis
  172. S/S of Stomach (gastric) Trauma
    Blood in the NG aspirate or hematemesis

    Subtle CT findings
  173. A stomach (GI) trauma may not be diagnosed until _____ develops
    Peritonitis
  174. Interventions for stomach trauma
    Surgery with NG afterwards to keep stomach empty

    Jejunostomy tube for feedings
  175. S/S of pancreatic Trauma:
    Acute Abdomen

    Increased Serum amylase levels

    Epigastric pain radiating to back

    Nausea/Vomiting

    May see fistula formation from the enzymes "eating away"
  176. Interventions for Pancreatic Trauma:
    Drains for small lacerations/Surgery for large

    Rest Pancreas! 

    NPO

    NG low to suction

    Patency of drains

    Monitor Fistula Development
  177. Spillage of contents from colon trauma creates:
    intra-abdominal sepsis and abscess formation
  178. Interventions for Colon Trauma
    Exploratory Lap (peritoneal cavity washed out)

    Colostomy (sometimes)

    Wound may be left open

    Watch for infection

    Dressing changes

    Antibiotics

    Keep open abdomen moist with saline-soaked dressings, drainage bags, tegaderm
  179. Most commonly injured organ (usually from blunt trauma)
    Spleen
  180. ___ is rapid in spleen injuries
    Blood Loss
  181. Dx test for Spleen Injury
    CT
  182. S/S of spleen injury
    Left upper quad pain radiating to left shoulder (Kehr's sign)

    Hypovolemic Shock

    Elevated WBC
  183. Early complications of spleen injuries
    Recurrent Bleeding

    Subphrenic Abscess

    Pancreatitis
  184. Late complications of Spleen Injuries
    Thrombocytosis

    Overwhelming Spesis
  185. 2nd most common injury:
    Liver Trauma
  186. Liver trauma may result in:
    Hematoma or Laceration
  187. S/S of Liver Trauma
    RUQ pain

    Rebound Tenderness

    Hypoactive/Absent bowel sounds

    Hypovolemic Shock

    HUGE blood loss into peritoneum
  188. Observe Liver trauma by:
    Serial CT scans

    H&H every 6 hours
  189. When hemorrhage from liver trauma is uncontrollable, the liver is _____
    packed to tamponade the bleeding = open abdomen
  190. Risk from Liver Trauma and packed liver:
    DIC, ARDS, Sepsis
  191. ___ Trauma may lead to "Free Hemorrhage", Contained Hematoma, Intravascular Thrombus, Laceration or Contusion of Organ Tissue, or Ruptured Bladder
    Kidney
  192. S/S of Kidney Trauma
    Hematuria 

    Flank Pain

    Flank Hematoma

    Ecchymosis over flank
  193. Interventions for Kidney Trauma
    Bedrest

    Surgical Repair/Nephrectomy

    Optimal Fluid balance and Low Dose dopamine to promote renal perfusion
  194. Complications of Kidney Trauma
    Acute Kidney Failure

    Bleeding

    Urinary Fistula Formation

    Late-onset HTN
  195. Bladder Trauma is frequently associated with:
    Pelvic Fractures
  196. What must be ruled out before inserting a foley in a bladder trauma patient
    Injuries to Urethra, Scrotal hematoma, Displaced prostate gland
  197. Complication of Bladder Trauma
    Urine entering the intraperitoneal space causing peritonitis
  198. Interventions for bladder trauma
    Supra-pubic cystostomy tube
  199. Fractures are classified according to:
    • Type
    • Cause
    • Anatomical Location
  200. Open Fractures are classified by:
    • Grade
    • (I, II, III)

    *depending on the amount of tissue, nerve, and vascular damage that has occured
  201. Type of Amputation: clean lines, well defined edges
    "Cut" or Guillotine
  202. Type of Amputation: ill-defined edges and more soft tissue
    "Crush"
  203. Type of Amputation: part of the body is stretched and torn away
    "Avulsion"
  204. Assessment of Amputation/Musculoskeletal Trauma is ____ unless there is arterial bleeding
    SECONDARY
  205. If limb is swelling, echymosis, or deformity is noted, check for:
    Capillary refill

    Pulses

    Crepitus

    Muscle Spasm

    Movement

    Sensation and Pain
  206. Associated with abrasions, lacerations, contusions, and asymetry of lower extremities...."Rock" the pelvis to look for instability:
    Pelvic Fractures
  207. What is done during musculoskeletal trauma assessment:
    Rectal Exams

    Vaginal exams

    Pelvic Binder

    External Fixator
  208. When pressure within the fascia-enclosed muscle compartment is increased, compromising blood flow to the muscle and nerves...resulting in tissue ischemia, and prolonged elevation of pressure causing necrosis
    Compartment Syndrome
  209. S/S of Compartment Syndrome
    Increased pain that is "Out Of Proportion" to injury

    Decreased sensation and parasthesia

    Firmness of tissue

    Paleness and Pulselessness (LATE SIGNS)
  210. Late signs of compartment syndrome, indicating the limb may be lost:
    Paleness and pulselessness
  211. Treatment for Compartment Syndrome:
    Fasciotomy
  212. Fractures of facial bones can cause:
    Sudden and Deadly Airway Obstruction and Death
  213. Only _____ primary survey are maxillofacial injuries are assessed
    AFTER
  214. Interventions for Maxillofacial Trauma
    Look for Facial Symmetry

    Palpate to observe for any movement of bony structure

    Thorough Neuro Exam

    Continuously assess neuro, airway, relive pain and anxiety

    Plastic Surgery Consult
Author
NurseFaith
ID
289251
Card Set
Trauma
Description
Trauma
Updated

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