chapter 33 - trauma

pulmonary contusion

Injury or bruising of lung tissue that results in hemorrhage.

Cardiac Tamponade s/s

JVD, narrow pulse pressure, hypotension (Becks Triad)

rotation

Often occur in conjunction with a flexion or extension injury

complications of trauma (there's quite a few)

Pain Compartment syndrome VTE ARDS Hypermetabolism Acute kidney injury Rhabdomyolysis/myoglobinuria Fat embolism Infection Sepsis Transfusion-related Missed injury MODS

hemothorax

a collection of blood in the pleural cavity

tension pneumothorax

a type of pneumothorax in which air that enters the chest cavity is prevented from escaping

what do you suspect in patients with rapid deceleration or acceleration?

blunt aortic injury

concussion

brain injury accompanied by a brief loss of neuro function

contusion

bruising of the brain

pneumothorax

collapsed lung

second peak

days to weeks after injury death due to complications (infection, MODS)

first peak

first 48 hours after injury death due to hemorrhage or traumatic brain injury

What can flail chest lead to?

hypoventilation and atelectasis

what are patients at high risk for with a facial fracture?

ineffective airway clearance and FVD

permissive hypotension

maintaining a hemorrhagic shock patient's systolic blood pressure between 80 and 90 mmHg to avoid an increase in bleeding that is likely if the blood pressure is above this level.

interventions for rib fractures

pain control, chest expansion, gas exchange, chest physiotherapy, and early mobilization

how do you estimate amount of force sustained in a MVA?

patient's weight X mph

cardiac tamponade

progressive accumulation of blood in the pericardial sac

what is an incomplete spinal cord injury?

results in a mixed loss of voluntary motor activity and sensation below the level of the lesion

what is a complete (spinal) injury?

results in a total loss of sensory and motor function below the level of injury

why do we need wire cutters at the bedside?

to prevent aspiration (??)

What is the term for a brain injury accompanied by a brief loss of neurologic function, especially loss of consciousness? A. Concussion B. Contusion C. Fracture D. Hematoma

A. Concussion

golden hour

"time frame" in which injured patient will die unless he or she receives definitive care.

Central cord syndrome

*>* Associated with cervical hyperextension-hyperflexion injury *>* Hematoma formation in the central areas of the cervical cord *>* More deficit in the upper extremities *>* Bowel and bladder dysfunction may be present

rib fractures

*>* Can be serious and life-threatening *>* Localized pain that increases with respiration or that is elicited by rib compression may indicate rib fractures.

Brown-Séquard syndrome

*>* Damage to only one side of the cord *>* Side of body with best motor control has little or no sensation, the side of the body with sensation has little or no motor control

Abdominal compartment syndrome

*>* Increased peak airway pressure *>* Low urine output, and urinary bladder >25 mmHg *>* Normal pressure: 5 to 7 mm Hg

nursing assessment of the patient w/ TBI

*>* Initial assessment is ABC's *>* Level of consciousness *>* Motor movements *>* Pupillary response *>* Respiratory function *>* Neuro assessment

posterior cord syndrome

*>* Loss of position sense, pressure, and vibration below the level of injury *>* Motor, sensation of pain, and temp remain intact

Examples of blunt trauma

*>* MVAs *>* Falls *>* Contact sports *>* blunt force injuries

examples of penetrating trauma

*>* Stabbings *>* Firearms *>* Impalement

Classification of pelvic fractures

*>* Stable versus unstable *>* Open fractures *>* Anteroposterior (AP) compression pelvic injury *>* Lateral compression (LC) pelvic injury *>* Vertical shear

six phases of trauma care

*>* prehospital resuscitation *>* hospital resuscitation *>* definitive care and operative phase *>* critical care *>* intermediate care *>* rehabilitation

primary survey (its a mnemonic)

*A*irway (maintenance and cervical spine protection) *B*reathing (and ventilation) *C*irculation (with hemorrhage control) *D*isability (neuro status) *E*xposure (or environmental control)

secondary survey (its a mnemonic)

*A*llergies *M*edications currently used *P*ast medical illnesses/pregnancy *L*ast meal *E*vents/environment related to injury

nursing assessment of a patient with SCI

*ABCs* - Ensuring a patent airway is of primary concern *Stabilization* - Mandatory to prevent further injury *Hemodynamic stability* - Ensuring adequate tissue perfusion *Hypovolemic shock* - Occurs in response to FVD often r/t hemorrhage - Tachycardiac *Spinal shock* - May occur 30-60 minutes after injury and may last 3 months - Priapism may be present *Neurogenic shock* - Hallmark S/S: hypotension, bradycardia, and peripheral vasodilation - Duration can persist for 1 month after injury

Le Fort Classification

*Le Fort I* - Most common - Horizontal fractures in which the entire palate moves separately from the lower maxilla *Le Fort II* - Extension of Le Fort I - Resemble a pyramidal fracture *Le Fort III* - Complete craniofacial disruption - "floating face"

mgmt of pelvic fractures

*Medical* - Temporary pelvic binders - Damage control orthopedics *Nursing* - Control of hemorrhage - Administration of IV fluids and blood products - Neurovascular assessment of the lower extremities

degree of TBI *know the difference*

*Mild brain injury* GCS = 13-15 Loss of consciousness that lasts up to 15 minutes *Moderate brain injury* GCS = 9-12 Loss of consciousness for up to 6 hours *Severe brain injury* GCS = 8 or less Loss of consciousness may be 6 hours or longer

nursing mgmt of SCI

*Neurological care* - Monitoring of patient's GCS score - Do not give methylprednisolone! *Cardiovascular complications* - Hemodynamic monitoring - Maintain the MAP at 85-90 - Cardiovascular instability is profound in patients with SCI at the C3-C5 levels - Risk for DVTs *Pulmonary complications* - Avoid succinylcholine - Complications with pulmonary are most common cause of mortality with SCIs - Intubation and mechanical vent are frequently required - Frequent suctioning - Cough assistance *GI and GU care* - Autonomic dysreflexia Caused by full bladder/fecal impaction that results in severe HTN, bradycardia, facial flushing, and pounding headache. *Integumentary and musculoskeletal care* - Poikilothermia - loss of thermoregulation - High risk for pressure ulcers and contractures *Maximizing psychosocial adaptation* - Dedicated emotional support - Promotion of support system

medical mgmt of SCI

*Surgical* - Laminectomy - Spinal fusion - Pedicle screw fixation *Nonsurgical* - Cervical injury = immobilization of the fracture and realignment of any dislocation - Thoracolumbar injury = immobilization with use of plastic or fiberglass jacket, a body cast, or a brace - Halo traction

medical mgmt of TBI's

*Surgical* - May need a craniotomy *Nonsurgical* - ICP monitoring - Maintenance of CPP - Oxygenation - Tx of any complications (pneumonia, infection)

hyperflexion

- C5-C6 - Sudden deceleration motion, as in head-on collisions

penetrating injuries

- Caused by a bullet, knife, or any other object that penetrates the cord - Often cause permanent damage

axial loading

- Compression injury - Seen in a fall from a height

grey-turner sign

- Ecchymosis in the flank area - May indicate retroperitoneal bleeding or a pancreatic injury

tetraplegia

- Injury occurs between the C1-T1 level - "quadriplegia"

paraplegia

- Injury occurs in the T2-L1 region - Still have use of arms

hyperextension

- Involve backward and downward motion of head - Seen in rear-end collisions

cullen sign

- Purplish discoloration of the flanks or umbilicus - May signify blood in the abdominal wall

kehr sign

- Referred pain to the left shoulder - May indicate a ruptured spleen

anterior cord syndrome

- caused by flexion injuries - occurs when 2/3 of the anterior cord is lost - motor function, pain, and temperature sensation lost bilaterally below the lesion (*flaccidity* below the lesion)

open pneumothorax

An open or penetrating chest wall wound through which air passes during inspiration and expiration, creating a sucking sound; also referred to as a sucking chest wound.

Which condition results when bleeding occurs within cerebral tissue? A. Epidural hematoma (EDH) B. Intracerebral hematoma (ICH) C. Subacute subdural hematoma (SDH) D. SDH

B. Intracerebral hematoma (ICH)

A 160-pound man is traveling in a car at 60 miles per hour when he loses control of the vehicle and strikes a telephone pole in a head-on collision. Approximately how many pounds of force was the man subjected to within milliseconds? A. 690 lbs. B. 600 lbs. C. 9600 lbs. D. More than 10,000 lbs.

C. 9600 lbs.firs

flail chest movement

During inspiration = intact expands while injured part is sucked in During expiration = chest wall moves in and fail moves out