Trauma
Escharotomy
Incision at bedside through a full thickness burn to reduce constriction caused by tight, nonelastic band of scar tissue
electrical burns
Industrial current, car batteries, lightning, electrosurgical devices
primary injury
Insult directly to the head (blunt and or penetrating trauma). typically occurs in the presence of acceleration, deceleration, or rotational forces. Injury may be focal or diffuse.
Prehospital care/Transport
Interventions include establishing an airway, providing ventilation, applying pressure to control hemorrhage, immobilizing the complete spine, and stabilizing fractures.
Full Thickness Fourth degree
Involves underlying fat, fascia, muscle, tendon, and/or bone - Does not heal; may require amputation or extensive debridement - Black, charred, thick, leathery eschar may be present; bone, tendon, or muscle may be visible
what is seen most with rhabdomyolsis
Myloglobinuria (the excretion of myoglobin through the urine) causes the urine to be a dark tea color.
Depth of burn injury
Superficial (First Degree) Superficial Partial Thickness (Second Degree) Deep Partial Thickness (Second Degree) Full Thickness (Third Degree) Full Thickness (Fourth Degree)
S&S of shock
Tachycardia, tachypnea, narrowing pulse pressure, falling PaO2, decreased urine output, increase serum lactate levels, falling hematocrit
T/F The entrance wound is usually smaller than the exit wound
True
Venous Thromboembolism highest risk to develop
Virchow triad (vessel damage, venous stasis, hypercoagulability)
Secondary Survey
a methodical head-to-toe evaluation of the patient, using the assessment techniques of inspection, palpation, percussion, and auscultation to identify all injuries.
Blunt trauma may be caused by
accelerating, decelerating, shearing, crushing, or compressing forces.
compartment syndrome
an extremity experiences increased pressure from internal and external sources. Internal sources include edema, hemorrhage, or both; external forces include splints, immobilizers, or dressings. swelling in tissue more than the skin can stretch
aortic disruption
blunt trauma to the chest resulting in death on scene. rapid deceleration forces contribute to injury. weak femoral pulses, hoarseness, widened mediastinum, need a CT aortogram.
pulmonary contusions
bruising of lung tissue, associated with rib fractures and flail chest- can lead to ARDs and need for ventilation
pumped a lot of fluids but still has low bp
cardiac tamponade- pericardiocentesis to drain blood out of sac
Fat embolism support
cardiovascular and respiratory, can lead to coma if untreated
When pt has a pneumothorax what will pt need
chest tube
Hemothorax
collection of blood in the pleural space resulting from injuries to the heart, great vessels, or the pulmonary parenchyma.
Fat embolism
complication that accompanies traumatic injury of the long bones and pelvis that results in multiple skeletal fractures. 24-48 hours after injury
FAST is used to
confirm abdominal injury
last sign of tension pneumothorax
cyanosis
SCI causes a loss of sympathetic output, resulting in
distributive shock with hypotension and bradycardia
Compartment syndrome occurs
fascia encloused muscle compartment experiences increased pressure. compressess nerves, blood vessels, muscles.
treatment of compartment syndrome
fasciotomy
FAST means
focused assessment with sonography for trauma (ultrasound) abd!
Blast injuries
forms of blunt and penetrating trauma, including debris impalement. Energy exchanged from the blast causes tissue and organ damage.
most frequently the consequence of penetrating trauma from gunshot wounds
gastric and small bowel injuries
for cerebral perfusion mean arterial pressure needs to be
greater than 50mmHg
CC phase
happens from leaving ER to going to OR until discharge. reassess, encourage active pt care, pt advocacy
neurological traumatic brain injury
has a glaucoma scale score less than 8
most common cause of death after injury
hemorrhage
Mechanism of injury
how a traumatic event occurred, the injuring agent, and information about the type and amount of energy exchanged during the event. Guides assessment and treatment.
mechanism of injuries that result in spinal cord injury
hyperflexion, hyperextension, axial loading, rotation, and penetrating trauma
Penetrating trauma results from
impalement of foreign objects (e.g., knives, bullets, debris) into the body.
Blunt trauma
is the most common mechanism of injury. It most often results from MVCs, but it also occurs from assaults with dull objects, falls from heights, sports-related activities, and pedestrians struck by a motor vehicle.
splenic injury occurs with blunt trauma
kehrs sign, hypotensive shock, and pneumococcal vaccine
patient presents with costovertebral tenderness, microscopic or gross hematuria, bruising or ecchymosis over the 11th and 12th ribs, hemorrhage, and/or shock. Diagnostic studies include FAST, CT scan, angiography, IV pyelogram, and cystoscopy.
kidney injury
what organ is the most commonly injured by blunt or penetrating trauma
liver
specific symptom of a fat embolism
low-grade fever. late sign of EKG changes
most important thing for trauma
maintain pt airway complication example: fractured jaw
Deaths related to trauma are primarily from
motor vehicle crashes (MVCs), homicide, poisoning (e.g., prescription drug overdose), and falls
artificial airways (nurse can do)
nasopharyngeal or oropharyngeal airway
Pulmonary contusion
occurs as a result of blunt or penetrating trauma to the chest; it is one of the most common causes of death after chest trauma, and it predisposes the patient to pneumonia or acute lung injury.
Patients present with hypoxia and hemodynamic instability during
open pneumothorax
nursing considerations for burn pts
pain control, infection prevention, wound management, nutrition
these injuries occur most frequently in high-deceleration MVCs, pedestrian-vehicle impacts, and falls.
pelvic
trauma is defined as
physical injury caused by external forces or violence
With rib fractures nurses should educate on
pillow splinting, incentive spirometry, coughing and deep-breathing exercises, the benefits of early ambulation, and pain management. Effective pain management enables the patient to maximally participate in pulmonary exercises.
Patients undergoing splenectomy are very susceptible to
pneumococcal infections
Basilar Skull Fracture diagnosis
presence of CSG from noes, ears or both. ecchymosis over a mastoid area of hemotympanum, periorbital ecchymosis or raccoon eyes.
most crucial assessment tool in trauma care
primary survey
cardiac tamponade
rapid accumulation of fluid (blood) in the pericardial sac.
The key to neurological assessments is to
recognize subtle changes and notify the physician for prompt intervention
secondary injury
refers to the systemic (hypotension, hypoxia, anemia, hyperthermia) or intracranial changes (edema, intracranial hypertension, seizures) that result in alterations in the nervous system tissue. often results in death
Hemothorax S&S
respiratory distress and hypotension
open pneumothorax
results from penetrating trauma that allows air to pass in and out of the pleural space.
pneumonia is the primary complication of
rib fractures
presentation of abdominal injury
right lower thoracic trauma, fractured lower right ribs, right upper quadrant ecchymosis, right upper quadrant tenderness, and hypotension
Triage
sorting the patients to determine which patients need specialized care for actual or potential injuries
Penetrating trauma to the left upper quadrant of the abdomen or fracture of the anterior left lower ribs also contributes to
splenic injury
Rhabdomyolsysis
syndrome of hypoperfusion and ischemia, followed by reperfusion, in which injured muscle tissue releases myoglobin into the circulation, compromising renal blood flow.
cardiac tamponade does not allow for a lot of blood to come out which means
they have decreased cardiac afterload
physiological responses to burn injury
third spacing- damaged cells release histamines/prostaglandins that cause vasoactive effects and cause the vessel walls to be "leaky"
when treating hypovolemia you should have
two large bore IVs if you cannot then an IO may be needed
tension pneumothorax
•It occurs when an injury to the chest allows air to enter the pleural cavity without a route for escape. •With each inspiration, additional air accumulates in the pleural space, increasing intrathoracic pressure and leading to lung collapse. •The increased pressure causes compression of the heart and great vessels toward the unaffected side, as evidenced by mediastinal shift and distended neck veins.
chemical burns
Contact, Inhalation of fumes, Ingestion or Injection
inhalation burns
Smoke, chemical toxins, products of incomplete combustion
how many mls of crystalloids for each milliliter of blood loss
3 mls (3:1 rule)
Burns: Acute Phase
Begins with onset of diuresis and continues until wound closure occurs (weeks to months) Primary Focus - promotion of wound healing, the prevention of infections and complications, and the provision of psychosocial support.
Deep partial thickness (second degree)
Destruction of epidermis and most of dermis; some skin appendages remain - 2-4 weeks - Pale, mottled, pearly red/white; moist or somewhat dry; typically less painful; blanching decreased and prolonged; difficult to distinguish from full-thickness injury
Full Thickness (third degree)
Destruction of epidermis and most of dermis; some skin appendages remain - 2-4 weeks - Pale, mottled, pearly red/white; moist or somewhat dry; typically less painful; blanching decreased and prolonged; difficult to distinguish from full-thickness injury
Superficial partial thickness (second degree)
Destruction of epidermis and some dermis - 7-10 days - Moist, pink or mottled red, very painful, blisters, blanches briskly with pressure
Superficial- first degree
Destruction of epidermis only - 3-5 days to heal - pink, red, dry, painful
Burns: Resuscitative Phase
Emergency Phase - time of injury until massive fluid shift has stabilized (typically 48 hours) Primary Focus- Assessment and Intervention to maintain ABCs and prevent Burn Shock
Damage control surgery
Emergent surgical management of traumatically injured patients is the gold standard to stop hemorrhage and stabilize life-threatening injuries; definitive surgical interventions may require several surgeries to effectively manage traumatic injuries.
DIC
Presentation is prolonged PT and PTT, decreased fibrinogen, decreased platelets, and elevated fibrin split products, elevated d-dimer. specifically happens with rhabdomyolysis, massive blood transfusions, fat emboli, and prolonged hypothermia.
Burns: Rehabilitative Phase
Primary Focus - Improve function and range of motion to restore the patient's ability to return to normal function
How are blast injuries classified?
•The primary explosive blast generates shock waves that create changes in air pressure, causing tissue damage. •Secondary injuries occur from increased negative pressure from the shock wave, causing debris to impale the body, creating organ and tissue damage. •Tertiary blast injuries are the result of the body being thrown by the force of the explosion, resulting in blunt tissue trauma, including closed head injuries, fractures, and visceral organ injury. •Quaternary blast injuries occur from chemical, thermal, and biological exposure.
Rib Fractures
•are the most common injury associated with chest trauma. •May lead to significant respiratory dysfunction and may indicate a serious injury to organs and structures below and near the rib cage. •Diagnosis is frequently made after a chest x-ray study. •Injury to the liver, spleen, or kidney may accompany fractures of ribs 10 through 12.
A flail chest occurs
•when two or more adjacent ribs are broken in two or more places, creating a free-floating segment of the rib cage. •The flail segment results in paradoxical chest movement; it contracts inward with inhalation and expands outward with exhalation. •Clinical presentation includes paradoxical chest movement, increased work of breathing, tachypnea, and eventually signs and symptoms of hypoxemia.