440 Final-MAJOR TRAUMA

ABCDE (Airway, breathing, circulation, disability-neuro, exposure/environment)

If no secure airway, clear any obstructions, intubate, or surgical airway. MAINTAIN neutral c-spine alignment.

• -Patent airway does not guarantee adequate gas exchange
• -Assess movement of air, RR, chest rise+fall, skin color, use of accessory muscles, SOB, JVD, change in trachea position
• -O₂! If breathing is effective, administer oxyge via nonbreather mask with flow rate to keep bag inflated (12-15L)-this will deliver 85-90% oxg.

• altered mental status
• cyanosis
• asymmetrical chest wall expansion
• use of accessory muscles
• sucking chest wounds
• paradoxical chest wall movement
• trachea shift away from midline

**Administer 100% O₂ via bag-valve mask to assist with intubation or surgical airway and then vent 100% O₂

• -Palpate pulse for rate and quality, palpate central pulses (noticing differences b/t that and periperhal pulses)
• -Palpate skin for temp and moisture
• -Inspect skin for color, obvious signs of bleeding
• -Auscultate BP if staff present

• Tachycardia
• Altered LOC
• Uncontrolled external bleeding
• Distended or abnormal flat jugular veins
• Pale-cool-diaphoretic skin
• Distant heart sounds

• Begin CPR, Initiate advanced life support, administer blood as prescribed, prepare for emergency thoracotomy and op care, & consider end of life issues
• *Control uncontrolled external bleeding-Cannulate 2 veins with large bore IV's and infuse fluids (NS or LR), blood sample and GIVE BLOOD
• *PRIORITY GOAL-rapid control of bleeding and restoration of normal tissue perfusion or O₂ delivery to prevent shock
• *Assume hypotensive trauma pt has hemmorhagic shock until proven otherwise

• Determine LOC using AVPU mnemomic (Alert, responds to Verbal Stimuli, pain, unresponsiveness)
• Assess pupils for: size, shape, equality, reactivity to light
• If decrease LOC present, conduct further in secondary assessment, monitor ABC's closely for pt who is not alert and verbal.
• IF pt demonstrates signs of neuro deterioration, consider hyperventilation
• *Monitor GCS for changes (eye opening, best verbal response, best motor response)

• Def: blood in pleural space, usually in conjunction with pneumothorax
• S+S: dyspnea, diminished or absent heart sounds, dullness to percussion, shock
• Treatment: Chest tube insertion with chest drainage system, auto-transfusion of collected blood, treatment of hypovolemia as necessary

• Def: Air in pleural space that does not escape, continued increase in amount of air shifts intrathoracic organs & increases intrathoracic pressure
• S+S: Cyanosis, air hungar, violent agitation, tracheal deviation away from affected side, subcutaneous emphysema, JVD, hyperresonance to percussion
• Treatment: MEDICAL EMERGENCY! Needle decompression followed by chest tube insertion with chest drainage system

• Def: fracture in 2 or more adjacent ribs in 2 or more places with loss of chest wall stability
• S+S: Paradoxic movement of chest wall, resp distress, associated hemothorax, pneumothorax, pulmonary cuntusion
• Treatment: Stabilize flail segment with intubation in some pts; taping in others; oxygen therapy; treat associated injuries; analgesia

• Def: Blood rapidly collects in pericardial sac, compresses myocardium bc the pericardium does not stretch, and prevents heart from pumping effectively
• S+S: Muffled, distant heart sounds, hypotension, JVD, increased CVP
• Treatment: MEDICAL EMERGENCY! Pericardiocentesis with surgical repair as appropriate

ecchymosis around the umbilicus

Ecchymosis around flanks

(may indicate retroperitoneal hemorrhage)

• *Establish patent airway and adequate breathing, fluid replacement, and prevention of hypovolemic shock
• *IV lines inserted, and volume expanders or blood given if hypotensive
• *NG tube inserted to decompress stomach and prevent aspiration.

• Hct:
• *men: 40-55%
• *women: 38-47%
• Hgb:
• *men: 13.5-18
• *women: 12-16
• Na:
• 135-145
• K:
• 3.5-5.0