ER Trauma Terms & Definitions | Medicine Study Set W12

goal of emergency nursing

prioritization! assess for life threatening injuries and stabilize

emergent vs urgent vs nonurgent

- emergent: immediate threat to life or limb (ex. MI, GSW, airway)

- urgent: quick tx but immediate threat to life does not exist (ex. kidney stones, appendicitis, GI)

- nonurgent: can wait for care (ex. labs, med refill, flu like sx, sprain)

describe the emergency severity index (ESI)

categorizes pt into 5 groups based on severity of illness and resource use (1 most acute, 5 least acute)

when should a provider see a pt with an ESI of 1

ASAP

when should a provider see a pt with an ESI of 2

10 mins

when should a provider see. apt with an ESI of 3

1hr

what is a level 1 trauma center

can meet all needs for tx trauma pts, all staff and surgeons are there 24/7

what is a level 2 trauma center

can provide care to mostly all pts

what is a level 3 trauma center

smaller community hospitals that will stabilize and transfer if necessary

what is a level 4 trauma center

stand alone ERs, stabilizes and transfer (does not have IR, caths, surgery)

mechanism of trauma injury

- blunt: internal injury from abuse, MVAs, hitting; can cause bleeding or fractures

- acceleration-deceleration: forwards and back injury from higher velocity; can cause shearing trauma

- penetrating: stabbing, GSW

what do you NOT do in a penetrating injury

don't take object out bc this is tamponading the bleeding!!!

stages of trauma care

first peak (minutes) → second peak (mins to hrs) → third peak (days to weeks)

purpose of the primary survey

rapid initial assessment to detect and treat life threatening conditions in trauma pt (airway, breathing, circulation, disability, exposure, full vitas, get monitoring)

exception to ABCs order

excessive bleeding! use CAB order

assessment/intervention for cervical spine injury

"step off" deformity on palpation, place c-collar

describe the A step in the primary survey

- airway: assess for alertness, airway, and cervical compromise such as altered LOC, stridor, gasping, inability to speak, trauma to face or neck, or foreign object

- stabilize cervical spine w/ c-collar & back board

AVPU pneumonic

assessing LOC: Alert, Verbal, Pain, Unresponsive

describe interventions for a compromised airway in order of lead to most invasive

jaw thrust → suction/removal of foreign body → naso/oralpharyngeal airway → O2 & bag → intubation → tracheotomy

describe the B step in the primary survey

- breathing: assess ventilation ability such as dyspnea, see-saw chest, cyanosis, visible wound, cyanosis, etc

- administer O2, bag, needle decompression, intubation

describe the C step in the primary survey

- circulation: insert 2 large bore IVs for aggressive fluid resuscitation with isotonic fluids (NS or LR) & blood (O-)

- stop the bleed

describe the D step in the primary survey

disability: assess neuro status and LOC, pupils

describe the E step in the primary survey

exposure & environmental control: remove clothing for physical assessment, do not remove impaled objects, keep warm, privacy, VS & BP

describe the F step in the primary survey

full set of vital & family: entire VS, ask if family wants to be present to keep them informed

describe the G step in the primary survey

get monitoring devices & give comfort: labs, ECG, O2, pain management

what is the purpose of the secondary assessment

performed after life threatening injuries are identified and treated, help identify any other injuries; consists of obtaining a head-to-toe, history, inspecting posterior body, and reevaluation

what can make resuscitation efforts uneffective?

- H's: hypovolemia, hypoxia, h+ ion acidosis, hyper/hypokalemia, hypothermia

- T's: toxins, tamponade, tension pneumo, thrombosis

how are defib pads placed on an adult and child

- adult: L anterior chest over heart, R side chest

- child: anterior chest and posterior back

when is defib indicated

pulseless vtach or vfib

goal for sudden cardiac arrest

return of spontaneous circulation (ROSC)

describe targeted temp management (TTM)

therapeutic hypothermia (32-26 C) implemented for 24hrs after ROSC to slow metabolic demands to allow heart and brain to heal

what are the phases of TTM

induction (getting to target temp) → maintenance (staying at the 32-26 C) → rewarming (0.5 C/hr)

management of facial trauma

maintain airway and prep for surgery; NO NG or nasal ETT (b/c we don't know the extent of the damage therefore where the tube would actually be going!)

what does clear dripping fluid indicate

CSF leak

tx for open vs closed pneumothorax

- open: seal wound w/ occlusive dressing

- closed: needle decompression

what complication can be seen with blunt force trauma to the chest

aortic rupture and cardiac tamponade

manifestations of cardiac tamponade

beck's triad (muffled heard sounds, JVD, hypotenion), pulsus paradoxus, (decrease in SBP when breathing in)

manifestations of liver or spleen laceration

ecchymosis, RUQ (liver) or LUQ (spleen) pain, referred pain, hypotension

manifestations of traumatic kidney or bladder injury

hematuria, flank pain & ecchymosis, urge to urinate but can't

when would you NOT insert a foley

bleeding at urethral meatus

what is the concern with fractures to a pelvis

close to large arteries, these bones can lacerate an artery

what needs to be assessed with musculoskeletal trauma

pulses, cap refill, skin color & temp

complications of musculoskeletal trauma

DVT, fat embolism, pulmonary embolism

red flag of fat embolism

petechiae rash on chest

tx for preventing pulmonary embolism

inferior vena cava filter

describe the significant of crush injuries

trauma that damages the tissues effected and damages distant sites r/t the products of tissue death floating in the blood (ex. kidney failure)

patho of compartment syndrome

blood flow to affected area is compromised due to increased venous pressure → leads to decreased arterial inflow → ischemia and edema

s/s of compartment syndrome

pain, paresthesia, pallor, pulselessness, poikilothermia, paralysis

tx for mild and severe compartment syndrome

- mild: elevate

- severe: fasciotomy

patho of rhabomyolysis

injured muscles (ex. crush injuries, burns, excessive exercise, compartment syndrome) releases myoglobin which is toxic to kidneys

manifestations of rhabomyolysis and tx

- hyperkalemia, myoglobin in urine, dark tea colored urine, increased CK

- tx with fluids, dialysis, insulin + dextrose

what is the disposition

where the pt is going from the ER (home, inpatient, transferred death)

in the event of death by suspected foul play, what needs to be done

DO NOT remove anything from the pt or clean them up because an autopsy needs to be done

nursing considerations when telling a family a pt has died

use concrete terms like died and death instead of "passing on" or "passed away"

what 3 forms of ID is needed for a pt post mortem

toe tag, bog bag tag, pt bracelet

triage of pts in a mass casualty must be done in...

15 secs

what are the triage categories in a mass casualty event

- green: nonurgent, can self treat, "walking wounded"

- yellow: urgent illness needing care w/i 1hr, serious & life threatening but status is not expected to deteriorate immediately

- red: life threatening, will deteriorate without immediate help

- black: dead, unconscious, expected to die