Common Trauma Injuries

What should you initially assess in a head trauma?

LOC (via GCS), pupils, motor response, + vitals

What is the range of a GCS score?

3-15

What are abnormal pupils a sign of?

increased ICP

What should you look for in motor response?

posturing

What should you look for in vitals for a head trauma?

cushing’s triad (a late sign of increased ICP)

Cushing’s triad

1) HTN w/ widened pulse pressure

2) bradycardia

3) irregular respirations

What are the three main types of skull fractures?

linear, depressed, + basilar

Linear skull fracture

minor + requires no surgical intervention

Depressed skull fracture

fragment of the skull is pushed inward, causing greater concern for brain injury

Basilar skull fx

occurs at the base of the skull

What are three signs associated with a basilar skull fx?

• battle’s sign → bruising behind the ear

• raccoon eyes → periorbital brusing

• CSF leakage (usually from nose or ears)

Is battle’s sign a sign of a posterior or anterior fx?

posterior

Are raccoon eyes a sign of a posterior or anterior fx?

anterior

Characteristics of CSF

clear + high glucose content

TRUE or FALSE: you should never insert an NG tube if a skull fracture is suspected.

true

FAST exam

a quick bedside ultrasound to test for fluid accumulation in the thoracic region

Tension pneumothorax

accumulation of air within the pleural space, causing lung collapse from increased pressure + decreased CO from heart compression

What do vitals look like with tension pneumothorax?

severe tachypnea, tachycardia, low CO + BP

What are some other signs of tension pneumothorax?

• JVD

• hyperresonance + absent breath sounds

• chest pain

• deviated trachea

How is tension pneumothorax managed?

detect quickly! + needle decompression

TRUE or FALSE: tension pneumothorax is treated with a needle decompression.

false; it’s an emergent treatment but requires chest tube placement to actually treat the issue

Nursing care for needle decompression of a tension pneumothorax

• high-flow O2

• continuous VS monitoring

• get IV access

• prep for intubation (if pt isn’t responding to tx)

Open pneumothorax

air passes in and out of the pleural space through an opening in the chest wall; caused by a penetrating injury (“sucking chest wound”)

Signs of an open pneumothorax

• sudden chest pain

• SOB w/ rapid + shallow breathing

• tachycardia

• hypoxia

What would you suspect if a patient with an open pneumothorax is showing worsening signs + symptoms?

the injury might have turned into a tension pneumothorax

How is an open pneumothorax initially treated?

3-sided dressing → acts as a one-way valve to let air out + prevent more air from getting into the pleural cavity

How is an open pneumothorax treated (after a 3-sided dressing)?

chest tube insertion + surgical repair of chest wall

Nursing care for an open pneumothorax

• high-flow O2

• monitor respiratory status

• get IV access

• prep for intubation (if needed)

Hemothorax

blood in the pleural space, causing a compressed lung; usually caused by rib fx

Signs of a hemothorax

• SOB + tachypnea

• dullness on percussion

What complications of a hemothorax should you watch for?

• blood loss → tachycardia, pale/cool/clammy skin

• hypovolemic shock → sudden increase in chest tube output

How can you check for a hemothorax?

FAST exam + CT scan

How is a hemothorax treated?

chest tube insertion

What should you do if there is a sudden increase in chest tube output (or output >100mL/hr) in a hemothorax patient?

call the provider

Nursing care of a hemothorax patient

• O2 + pain management

• monitor for s/s of blood loss or hypovolemic shock

Which type of injury are rib fractures most common in?

blunt-force trauma

What is the main concern with rib fractures?

complications (e.g. hemothorax, liver/splenic injury, lung puncture)

Nursing care for rib fractures

respiratory support, pain control, + monitor for complications

Flail chest

several adjacent ribs that are fractured in two places, causing a “floating segment”; major concern for lung puncture

What are signs of flail chest?

• paradoxical breathing!

• chest pain + SOB

Paradoxical breathing

abdomen + chest move in opposite directions with each breath

Nursing care for flail chest

• ABCs

• respiratory support + monitoring

• pain management

Cardiac tamponade

fluid buildup in the pericardial sac

What is the primary sign of cardiac tamponade?

muffled heart sounds

Beck’s triad

points to cardiac tamponade!

• hypotension

• JVD

• muffled heart sounds

Other s/s of cardiac tamponade

• pulsus paradoxus → systolic drops >10pts during inspiration

• tachycardia

• and beck’s triad! (hypotension, JVD, muffled HB)

How is cardiac tamponade diagnosed?

echocardiogram

Cardiac tamponade - nursing priorities

• fluid resuscitation

• large-bore IV access

• O2

• prep for chest tube insertion

How is cardiac tamponade treated?

pericardiocentesis (needle aspiration)

What should you prioritize after treatment for cardiac tamponade?

early mobilization + q2 turns

Why is nutrition a priority for thoracic trauma management?

trauma creates an increased metabolic demand

Which organs are we most concerned about with blunt trauma to the abdomen?

spleen, liver, + kidneys

What should you prioritize in abdominal trauma?

serial CBCs and frequent assessments → high risk for internal bleeding

What is the main concern with MSK trauma?

risk for hemorrhage, shock, + NV compromise

6 Ps to monitor in a femur fracture

pain, pallor, pulselessness, parasthesias, paralysis, poikilothermia (unable to regulate temp)

What are some complications to watch for in femur fractures?

• bleeding/hypovolemic shock

• fat embolus

• compartment syndrome

When is a fat embolus most likely to occur?

24-72hrs after surgery

Classic triad for fat embolus

• respiratory distress

• neurologic changes

• petechial rash (chest, axilla, + conjunctiva)

Interventions for a suspected fat embolus

• IMMEDIATE oxygen!

• IV fluids

• monitor hemodynamics

• frequent neuro checks

How can you prevent a fat embolus?

early immobilization of fractures

TRUE or FALSE: there is no true cure for a fat embolus.

true

What do labs look like with a fat embolus?

low O2, thrombocytopenia, + anemia

Compartment syndrome

increased pressure in a muscle compartment, causing tissue ischemia + necrosis

What are early and late signs of compartment syndrome?

early: severe pain unrelieved by analgesics

late: 6 P’s

Compartment syndrome interventions

remove the restrictive item immediately + keep the limb at heart level (not above or below)

What is the primary concern with a pelvic fracture?

hemorrhage (“bleeding until proven otherwise!”)

What should you monitor in a pelvic fx?

vitals + UOP

When should you be careful of inserting a foley?

if suspected urethral damage OR if hematuria is present

What labs should you monitor for a pelvic fx?

type + screen, H&H

What is the primary concern with spinal fractures?

spinal cord damage resulting in paralysis

What should you monitor in spine fractures?

neuro checks, urinary/bowel retention, skin integrity

What is the priority nursing intervention for spine fractures?

maintain spinal alignment

Nursing interventions for a traumatic amputation

• control bleeding (direct pressure, pressure dressing, or tourniquet

• wrap amputated limb in sterile, saline-soaked gauze

• place in watertight bag on ice