N470: trauma (exam 4)

Types of traumatic related injuries (4)

•Blunt

•Penetrating

•Burn

Blast

Types of blunt trauma (6)

1) falls

2) MVAs

3) motorcycles

4) ATV/bikes

5) pedestrian v. vehicle

6) assault

factors that influence severity of injury from fall (3)

Point of impact, surface of the fall, height of fall

factors that influence severity of injury from MVA (2)

Sequence of collision

Rear, rollover, ejection

factors that influence severity of injury from a motorcycle crash (3)

Laying the bike down, head on, lateral

Factors that influence severity of penetrating trauma (3)

•Point of impact

•Velocity and speed of impact

•Proximity

types of burns (5)

•Frostbite

•Thermal

•Chemical

•Electrical

•Radiation

Pressurization can cause barotrauma, ear damage, abdominal perf, globe rupture

primary blast trauma

Projectiles can cause penetrating trauma

secondary blast trauma

Injury from being thrown from the blast: blunt and penetrating trauma

tertiary blast trauma

Anything that happens not related to the others: crush, burns from spills

quaternary blast trauma

Long term exposure to hazardous materials

quinary blast trauma

types of shock

Hypovolemic

Distributive

Cardiogenic

Obstructive

blood loss and burns can result in what type of shock?

hypovolemic

Trauma Triad of Death

hypothermia, acidosis, coagulopathy

impairs thrombin production and platelet function

hypothermia

impairs thrombin production, pH less than 7.4 reduces activity of various coagulation factors

Acidosis

can be caused by whole blood loss and hemodilution of saline, also transfusion without platelets; Hypoperfusion leads to increased levels of thrombomodulin which inhibits thrombin

Coagulopathy

Trauma nursing process (ABCDEF, LMNOP)

1) Airway and alertness- AVPU (alert, voice, pain, unresponsive), assess airway patency

2) Breathing

3) Circulation

4) Disability

5) Exposure (cover them back up!)

6) Full set of vitals

7) Labs

8) Monitor

9) NG tube

10) Oxygen

11) Pain management

Signs of impaired airway patency (4)

•Obstruction

•Teeth

•Gurgling

•stridor

breathing assessment pieces (6)

•Assess for effectiveness

•Spontaneous

•Depth

•Equal Breath Sounds

•Equal rise and fall

•Work of breathing

circulation assessment pieces (6)

Skin Color

Temperature

Moisture

BP/HR

Pulse

Cap refill

disability assessment pieces (3)

•GCS

-Eyes

-Verbal

-Motor

•Pupils

•LOC

When inspecting the posterior surface of a trauma patient, also... (3)

•Turn

•Palpate

•Remove the back board

things to reevaluate frequently in trauma patients (4)

•Vitals

•Identified injuries and effectiveness of interventions

•Primary Survey

•Pain

#1 way for trauma patients to die

hypovolemic shock

goals set for trauma patients (2)

•MAP

•Volume

Which populations are at the highest risk from trauma?

- geriatric

- young peds

Mechanisms of trauma in the geriatric population (5)

•Falls

•MVA

•Firearms

•Cyclists

•Fire

organs frequently damaged by penetrating trauma (4)

small and large bowel, liver, and intra-abdominal vascular systems

Airway changes in geriatric patients (3)

- stiff

- decreased gag

- dentures

c-spine changes in geriatric patients (2)

- less muscle

- more fragile

breathing changes in geriatric patients

- loss of strength (fatigue easier)

- decreased ability to compensate

- decreased cough

circulation changes in geriatric patients (6)

- chronic cardiac diseases common

- HR, not able to compensate 90 can be tachy

- declining cardiac reserve

- decreased contractility

- risk for dehydration

- generally anemic

neuro changes in geriatric patients (2)

- lower BASELINE MENTATION

- always on a thinner

skin and tissue changes in geriatric patients (2)

- thin

- fragile

musculoskeletal changes in geriatric patients (1)

- less muscle mass

renal changes in geriatric patients (1)

reduced renal function

reversal agents for blood thinners

1) vit k (for warfarin)

2) Idarucizumab

3) PCC prothrombin complex concentrate (3 factors: II XIX and X) better immediate reversal

4) KCentra (4 factors: also VII)

5) FFP

The major preventable cause of death in the trauma patient is

•A. airway compromise

•B. Ineffective ventilation

•C. Secondary head injury

•D. uncontrolled hemorrhage

D. uncontrolled hemorrhage