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.