Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
63 Cards in this Set
- Front
- Back
|
how do levels 1, 2, 3, & 4 trauma centers differ in their provider requirements, and what sorts of agreements do level 3 & 4 hospitals have to keep in place with other hospitals? |
level one: 24 hour in-house trauma surgeons, staff, equipment; also conducts training/research level two: 24 hour immediate coverage by trauma surgeonsand other main specialties (orthopedics,neurosurgery etc) Level three: 24 hour emergency medicine physician coverage level 4: 24 hour doctor/advanced practice coverage w/trauma trained nurses agreements: both have agreements with level 1 or 2 for transfer |
|
|
what does mechanism of injury mean, what role does it play in initial assessment, and can the outcome be predicted by MOI? |
what it is: how they were hurt role: still plays a role in predicting injuries outcome: not an absolute predictor |
|
|
what are examples of blunt force injuries, what organs are associated with blunt force injuries, and what specific areas/organ injuries should we look out for with driver and passenger seat belt sign? |
example: explosion, crushing, MVC organs: spleen, liver, intestines, vascular structures passenger: chest & spleen driver: chest & liver |
|
|
how does injury relate to velocity and structure density with GSW, and what are the two classifications of GSW? |
greater structure density = greater damage greater velocity = greater damage type: low velocity & high velocity |
|
|
what is the 3 collision pattern of an MVC? |
car ==> object occupant ==> inside of vehicle organs ==> internal framework of body |
|
|
describe primary, secondary, and tertiary blast injuries. |
primary: exposed to direct pressure waves of blast secondary: injury from flying debris tertiary: results from person striking another object |
|
|
what are standard PPE precautions for trauma? |
cap gown gloves (double, per lecture) mask show covers goggle/face shield |
|
|
what are things we are looking for when doing primary assessment of the airway? |
vocalization obstructions = tongue, loose teeth, foreign bodies abnormal sounds bleeds vomit/secretions edema burns |
|
|
how should you position the peds airway? |
towel under shoulders |
|
|
what piece of equipment is crucial for trauma? |
suction |
|
|
name 5 indications for intubation |
apnea airway obstruction airway protection respiratory insufficiency/failure hemodynamic instability |
|
|
which is preferred, ED or nasal intubation, and what are the benefits/risks of both? |
preferred: endotracheal oral: can't have gag reflex (paralysis?), provides good airway control & prevents aspiration nasal: can have gag & be partially conscious, can provide good airway & prevent aspiration, increase risk of nasal trauma/infection |
|
|
what needs to be done/seen to confirm placement? |
chest rise and fall bliat lung sounds pt improves SaO2 monitor fogging of tube (although he said this isn't as reliable) secondary confirmation = ETCO2 detector, esophageal detector, continuous capnography |
|
|
what are the 2 types of surgical airways? |
needle & surgical crocothyroidotomy |
|
|
what are interventions for bleeds? |
direct pressure elevation dressings tourniquets |
|
|
what are the types of IV access we'll use in trauma? |
PIV = 2 sites, large bore IO central |
|
|
what must be done with fluids prior to infusion, what kind of crystalloids might we infuse, what kind of tubing might we consider using, and what is the rate for peds? |
done: warm them crystalloids: NS or LR tubing: blood tubing peds rate: 20 mL/kg |
|
|
what PTs will receive O+ & O- blood if uncrossed matched and when is it done? |
O+ : males & females > 55 yo O- : females < 55 and peds when done: not enough time to do match testing |
|
|
how do we assess disability? |
LOC AVPU scale = alert, voice, pain, unresponsive glasgow coma pupils peripheral movement & sensation |
|
|
what are methods of preventing heat loss in trauma pts? |
warm environment warm blankets convection blankets aggressive warming = body cavity lavage, ECMO (extracorporeal membrane oxygenation = oxygenating blood externally and putting it back into the body), dialysis |
|
|
what does SAMPLE mean with respect to trauma assessment? |
S – S&S A – Allergies M – Medications P – Past Illnesses L – Last Oral Intake E – Events Leading Up To Present Illness / Injury |
|
|
what are labs that will need to be done in trauma? |
CBC electrolyte type & cross coag panels pregnancy test |
|
|
what does FAST mean, what is the purpose, and what are the 4 areas of evaluation? |
What it is: Focused Assessment with Sonography in Trauma why: rapid assessment of abdominals injury/bleed 4 locations: pericardial morison's pouch = space between liver & right kidney spleno-renal recess = left kidney pouch of Douglas = rectum and posterior wall of uterus |
|
|
what are the 5 areas we bleed into internally? |
chest abdomen retroperitoneum pelvis long bones/soft tissue |
|
|
what amount of crystalloid will cover 1 mL or fluid loss, and how much fluid infused is going to stay in vascular space or be excreted? |
3 mL crystalloid fluid = 1 mL fluid loss 2/3 infused fluid will leave vasculature, and 1/3 of that will be excreted |
|
|
how much will Hgb and hematocrit change per unit of blood, how often should we consider calcium supplementation, and what are other fluids (and amounts) we should consider infusing? |
1 unit blood ≈ 1 g Hgb & 3% hematocrit calcium supplementation = every 4th unit other colloids: hespan (plasma expander), dextran (polysaccharide), albumin amounts: 1 mL for every 1 mL lost |
|
|
what are the benefits & downsides of hypertonic saline infusion, and what combination w/hypertonic saline has been shown to help which pts? |
benefits: as effective as large amounts of isotonic sol'n, increases perfusion to microvasculature downside: may increase bleed combo/patients: hypertonic saline + dextran good for isolated head injury pt |
|
|
what is the SBP threshold for permissive hypotension? |
~ 90 mmHg |
|
|
name and describe 4 potential complications of infusing fluids |
hypothermia = cold blood/IVF reduces body temp, decreased O2 delivery to cells electrolyte imbalances = hyperkalemia from cell lysing, hypocalcemia from citrate in banked blood acid-base imbalance: banked blood pH ≈ 7.1, liver converts citrate to bicarbonate clotting issues: PRBCs ≠ clotting factors |
|
|
how often should FFP and platelets be given with PRBC? |
FFP: q4-6 units of PRBC platelets: q5-10 units PRBC |
|
|
what are mechanical & pharm management methods and goals for cardiogenic shock? |
goals: reduce preload & afterload pharm: inotropes mechanical: IABP = intra-aortic balloon pump LVAD = battery-operated pump, which helps the left ventricle pump blood ECMO = extracorporeal membrane oxygenation |
|
|
what are the causes of obstructive shock, pump? |
tension pneumothorax cardiac tamponade pulmonary embolism aortic aneurysm |
|
|
what is Beck's triad and what is it indicative of? |
what it is: low arterial blood pressure distended neck veins distant, muffled heart sounds what it means: cardiac tamponade = compression of the heart due to fluid in the pericardial sac |
|
|
what are some clinical presentations for obstructive shock? |
chest and/or back pain distended neck veins dyspnea tachycardia hypotension cyanosis muffled heart sounds |
|
|
what are methods or tx the underlying cause of obstructive shock? |
chest decompression pericardiocentesis = aspiration of fluid from the pericardial space that surrounds the heart embolectomy surgical repair |
|
|
describe neurogenic distributive shock and what spinal injury it is associated with. |
what it is: loss of vasomotor tone r/t loss of vasomotor sympathetic regulation & increased parasympathetic response injuries: at or above T6 |
|
|
what is poikilothermia and which shock is it associated with? |
what it is: inability to maintain constant core temp associate: neurogenic |
|
|
what range of changes in BP indicates shock? |
+/- 20 mmHg preshock levels |
|
|
how does lactate relate to RBCs and O2 perfusion? |
RBC: unable to clear lactate, but only an issue when lactate formation > lactate clearance excess: indirect measure of O2 debt |
|
|
is a concussion reversible, does it cause amnesia/loss of consciousness, how is is caused, what are sx, and what is secondary impact syndrome? |
reversible: yes amnesia: yes, minutes to hours loss of consciousness: sometimes cause: sudden deceleration or sudden blow to skull sx: N&V, dizziness, HA, amnesia, asking the same question repeatedly secondary impact syndrome: risk in concussion, receiving another shock before 1st is healed |
|
|
what is an epidural hematoma, how does it happen, and what are sx w/respect to consciousness, pupil size, paralysis, and Cushing's response? |
what it is: collection of blood between skull and dura how: laceration to Middle Menigeal Artery w/temporal skull fracture (skull fracture + arterial bleed) consciousness sx: initial unconsciousness followed by lucid interval and then decline into RAPID unconsciousness pupils: unilateral, fixed, or dilated paralysis: contralateral cushing's response: late sign of increased ICP, triad of sx = increased blood pressure, irregular breathing, and a reduction of the heart rate |
|
|
what is a subdural hematoma, how does it happen, and what time frame constitutes acute, subacute, and chronic? |
what: blood between dura mater and subarachnoid later of meninges how: veins in subdural space are torn acute: < 48 hr subacute: 2-14 days chronic: > 14 days |
|
|
what are mgmt methods for hematomas? |
monitor neuro status BP monitoring elevate HOB sedation, analgesis, anticonvulsant decompression to decrease ICP emergency surgery for clot evac or coiling |
|
|
what is a spinal cord injury, what are mechanisms of injury, what are complete and incomplete injuries, and what are nursing interventions |
what: bruise or tear or cord MOI: axial loading, hyperflexion, hyperextension, penetrating, rotational complete v incomplete: total transection of spine (total loss below injury) vs. partial damage (partial loss below injury) interventions: head and neck stabilization, G tube/urinary cath, support perfusion, monitor for neuro change, prepare for relaignment, remove backboard ASAP |
|
|
what are sx of orbital fractures? |
edema deformity ecchymosis enophthalmos = posterior displacement of eyeball diplopia entrapment of rectus muscles |
|
|
what is the halo sign for CSF during a facial injury? |
yellow ring around clear fluid on a white sheet |
|
|
what is a le forte injury, what does it indicate, and what is the method of tx? |
what it is: 3 stages of facial fracture (rare in peds) indicate: large amount of energy transfer tx: surgical fixation |
|
|
what should be done with penetrating objects in neck injuries? |
stabilized, not removed |
|
|
which rib fractures indicate significant force, which ribs are associated with liver/spinal injury, and what might be seen & felt over injury? |
force: 1st rib liver/spleen: 10-12 seen: ecchymosis felt: crepitus |
|
|
what issue should we be looking for in a sternal fracture, how significant are clavicle fractures, and what usually causes a scapula fracture? |
sternal: cardiac contusion clavicle: not significant, but very painful scapula: lots of force, blunt trauma |
|
|
what is a tension pneumothorax, what happens to the lung, what are sx, and how is it tx? |
what it is: tear in visceral pleura allowing air to enter pleural space what happens: lung collapse, thoracic structures pushed to opposite side of chest presents: absent lung sounds on affected side, hypotension, JVD, hyperresonance on percussion, tracheal deviation (late sign) tx: needle decompression, chest tube *don't delay tx for chest Xray, tx on clinical assessment* |
|
|
what is a pericardial tamponade, is it cause by penetrating or blunt trauma, and what is the tx? |
what: tear in pericardial sac so that blood collects in pericardial space and impairs pumping of heart; may be as small as 20 mL sx: beck's triad, radial pulses disappear on inspiration, ST change on ECG PEA, widened mediastenum on CXR penetrating or blunt: penetrating tx: pericardiocentesis, open thoracotomy |
|
|
what is an open pneumothorax and how does it present? |
what: sucking chest wound, opening of pleural space to atmospheric pressure so lung collapses presents: penetrating wound w/bubbling, decrease breath sounds on affected side, hemodynamic changes |
|
|
what is a hemothorax, how does it present, & what's the tx? |
what it is: blood in pleural space from blunt or penetrating trauma present: hypovolemia, dyspnea, dull percussion, decrease/absent breath sounds on affected side tx: fluids, autotransfusion, thoracotomy, chest tube thoracotomy |
|
|
what is a flail chest, presentation, how does it happen, & how is it tx? |
what: rib fractures in two or more places resulting in floating section of rib present: moves paradoxically w/chest wall movement happens: blunt force trauma tx: intubation, stabilization, pulmonary toilet |
|
|
what is a thoracic aortic disruption, how fatal is it, what is the most common site on injury, what are sx, and what is the tx? |
what: disruption of aortic flow of blood fatal: 85-90% common site: ligamentum ateriosum sx: diminished distal pulse, assymetry in BP of upper extremities, obvious chest wall trauma, harsh systolic murmur, chest/back pain tx: volume replacement, airway mgmt, prevent HTN (SBP goal = 90-100), surgical repair |
|
|
what is a pulmonary contusion, how does it present, and what is the tx? |
what it is: blunt trauma to chest leading to tissue damage/hemorrhage/edema presents: increased CO2 retention, whiting out in CXR, hemoptysis, crackles on auscultation, respiratory acidosis tx: O2, ECMO, PEEP (positive end expiratory pressure), prone position, avoid overhydration |
|
|
what is a tracheobronchial injury, how does it present, and how is it managed? |
what: tear/injury to large airways in bronchial tree from decel or compression injury presentation: subcutaneous air in chest and neck, dyspnea, hemoptysis mgmt: bronchoscopy to ID damage, surgery, may be difficult to intubate |
|
|
what is myocardial contusion, how does it present, and how is it managed? |
what it is: blunt trauma to heart muscle inparing pumping and resulting in cell necrosis/scar formation presents: EKG changes, elevated cardiac enzymes, hypotension, chest pain, tachyarrhythmias, PVC mgmt: O2, no thrombolytics, pain control |
|
|
how does a diaphragmatic tear present, and how is it tx? |
presents: decreased breath sounds, chest pain, bowel sounds in chest mgmt: gastric decompression, surgical repair, use caution if chest tube needed |
|
|
what is an esophageal injury, how does it present, how is it identified, how is it managed, and what is the outcome with respect to time of tx? |
what: tear in espophagus presents: subQ air, mediastinal air, dysphagia, chest pain ID: EGD = esophagogastroduodenoscopy, esophagogram managed: airway mgmt, NPO, surgery outcome: poor if not IDed & corrected |
|
|
what is the most common intrabdominal injury, what is it associated with, and what is the clinical presentation? |
type: spleen associated: blunt trauma clinical presentation: LUQ w/guarding, referred pain to left shoulder, sx hypovolemia |
|
|
what are liver injuries associated with, how do they occur, and what is the presentation? |
associated: rib fractures occur: blunt trauma presentation: RUQ pain, referred pain to shoulder, sx of hypovolemia, external sx of trauma |
