ortho trauma

first survey include

airway with cervical spine stabilization

Brething

Circulation

Disability

airwat assessment

• Assessment of airway for patency

• Assessment for respiratory distress

• Check for loose teeth and foreign objects

• Assessment for bleeding, vomitus, or edema

airway intervention

Open airway.

• Perform jaw-thrust manoeuvre.

• Remove or suction foreign objects.

• Insert oropharyngeal or nasopharyngeal airway, ETT cricothyroidectomy.

• Immobilize cervical spine with collar, backboard, or soft rolls; tape forehead to board.

airway could be

• Inhalation injury

• Obstruction, partial or complete, by foreign bodies

• Penetrating wounds, blunt trauma, or both

-fracture rib

main ss of compromised airway

-SOB

-unable to vocalize

-presence foreigen body

-head/neck trauma

breathing assessment

-CXR

-ventilation

-obeserve paradoxical movement

-cap refill

-RR sat

-mucous memebrane

-use of acessory muscle

breathing intervention

Administer supplemental O2

• Ventilate with bag–valve–mask device

• Prepare to intubate if respiratory distress is severe

• suction

• breath sounds are absent, prepare for needle thoracostomy and chest tube insertion.

breathing d/t

-penumothroax

-allergy

PE

athma

flair chest

circulation assessment

-assess carotid pulse,femoral pulse

-quaility and rate of it

-color, temp,moisture, check cap refill

-external bledding?

-BP

circulation intervention

1.if no pulse:CPR, Shock

2,if shock: RL IV

3.if bledding control with pressure, blood product,TS

circualtion cause

-MI

-tamponade

-shock

-hemorrhage

-hypothermia

disbility assessment

-LOC

-Glasgow

PERRLA

-ALERT

VErbalize to pain

Pain response

Unresponsive

disbility cause

storke

head trauma

secondary survey

Exposure and Environmental Control -remove cloth,temp control

F = Full Set of Vital Signs/Five Interventions/Facilitating Family Presence

G = Giving Comfort Measures

H = History and Head-to-Toe Assessment

I = Inspect the Posterior Surfaces ,spinal precaution

orthopedic trauma

 Falls, car/motorcycle/bicycle crashes, assaults, sport injuries, crush injuries

sprain

ligamentous structures surrounding a joint, usually caused by a wmotion.

wrist ankle

strain

excessive stretching of a muscle, a muscle’s fascial sheath, or a tendon

foot leg

sprain strain ss

pain, edema, decrease in function, and bruising.

sprain strain tx

RICE (Rest, Ice, Compression, Elevation)

NSAID

dislocation

severe injury of the ligamentous structures around a joint that results in the complete displacement of the bone from its normal position,overwhelming force to the joint, disruption of soft tissue

dislocation ss

deformity

local pain, tenderness, loss of function of the injured part, and swelling of the soft tissues in the region of the joint

subluxation

partial /incomplete displacement

dislocation tx

-pain relief

-support protection

-ROM

-restricted movement

-close reduction immediate realignment

open/close fracture

?Open-skin broken and bone and soft tissue exposea

Closed-skin intact

compleete/incomplete fracutre

Complete-break is completely through bone ?

lncomplete-bone is still in one piece but break occurs across the bone shaft

displaced/non displaced

Displaced-two ends separated from one another

Nondisplaced-bone is aligned and periosteum is intact

fracture ss

Deformity

Edema and ecchymoses

Musclespasm

Tenderness and pain ?

Loss of function

Numbness, tingling, loss of distal pulses

Grating (crepitus),shortening

Open wound over injured site, exposure of bone

decrease cap refill

intital tx of fracture

lnitial treatment

Life-threatening injuries first

Ensure airway, breathing, and circulation.

Control external bleeding with direct pressure or sterile pressure dressings and elevation of extremity.

Splint joints above and below fracture sites.

Check neuro-vascular status distal to injury before and after

ice

donot manipulate or striaght

xray

tetenus prophylaxis

l

ongoing assessment

vs

loc

sat

neuro vascular

peripheral vascular assessment (colour, temperature, capillary refill, peripheral pulses, and edema)

and a peripheral neurological assessment (sensation, motor function, and pain)

nurtiion intake for fracture ot

-energy:promote muscle strength,ambulation

diet requirement

protein

mineral

vitamin

fluid 2-3l

rx for fracture

 Moderate to severe pain i.e., opioid analgesics

 Pain r/t muscle spasms i.e., NSAIDs

 Pain r/t nerve injury i.e., pregabalin (Lyrica)

 Central and peripheral muscle relaxants i.e., cyclobenzaprine (Flexeril)

 Tetanus/diphtheria vaccine

 Antibiotics-ancef

clsoed reduction

Nonsurgical, manual realignment of bone fragments to previous anatomical position

Traction and countertraction manually applied to bone fragments to restore position, length, and alignment，maintain immobilized

opemn reduction

through incision internal fixation

but infection,and ansthesai effect

able to early ROM

traction

Application of a pulling force to an injured or diseased part of body or extremity, while countertraction pulls in opposite direction

purpose of traction

Prevent or reduce muscle spasm

plmmobilize joint or part of body p

Reduce a fracture or dislocation

Treat a pathological joint condition

provide immobilization to prevent soft tissue damage.

reduce muscle spasm associated with low back pain or cervical whiplash.

?expand a joint space before major joint reconstruction.

skin traction

Used for short-term treatment until skeletal traction or surgery is possible

Tape, boots, or splints applied directly to skin to maintain alignment, assist in reduction, and help diminish muscle spasms in injured extremity

skeletal traction

ln place for longer periods

Used to align injured bones and joints or to treat joint contractures and congenital hip dysplasia Provides a long-term pull that keeps injured bones and joints aligned

insert wire

countertraction

Countertraction commonly supplied by clients body weight or augmented by elevating end of bed lmperative that nurse maintains traction constantly and does not interrupt weight applied to traction

cast

Temporary circumferential immobilization device

Allows client to perform ADL

]Restricts tendon and ligament movement

Assisting with joint stabilization while fracture heals

externqal fixation

Metallic device

Applies traction or compresses fracture fragments

lmmobilizes decreased fragments when cast or other traction is not appropriate

cast do

Apply ice directly over fracture site for first 24 hours.

Check before getting wet.

Dry cast after exposure to water.

]Elevate extremity above level of heart for first 48 hours.

Move joints above and below cast regularly.

]Keep appointment to have fracture and cast checked.

cast dont

Get plaster cast wet.

Remove any padding

lnsert any objects inside cast.

]Bear weight on new cast for 48 hours.

?]Not all casts are weight bearing.

?]Cover cast with plastic for prolonged periods

pelvic injury sequaleze

1/rhamoyotsis-muscle break down

2.parapltic ileus

3.hemorrhage

4.urethra lacernation,bladder,colon

5.comartmenet syndrome

6.sepsis-shock

7.FES

8.SVT

9.trauma messed upclotting-DIC

infection more in

open fracture(need surgical debridement, driange, grafting), soft tissue injury, massive/blunt soft tissue injury

make osteomyeleits more chronic

compatement syndrome

Elevated intracompartmenta pressure within a confined myofascia compartmemt compromises neuro- vascular function of tissues within that space,reduce cap perfusion

conpartment syndrome early recognition

ischemia 4-8hr

regular neuro vascular

result from restrictive dsg, cast, traction-decrease size

r/t bledding, edema, snake bite, IVF-increase size

6p for compartment syndrome

Paresthesia: numbness and tingling

Pain: distal to injury that is not relieved by opioid analgesics ,on passive stretch of muscle travelling through compartment

Pressure: increase in compartment

Palor: coolness and loss of normal colour of extremity

Paralysis

Pulselessness: diminished/absent peripheral pulses

care for compartment syndrome

not elevate above heart

cold compress no-vasoconstriction

-remove lossen bandage

-reducde traction weight

surgical decompression

VTE risk factor

lncorrectly applied cast or traction

Local pressure on a vein

lmmobility

VTE care

SCD
compression stocking

anticoag

rhmadomylosisb

break down muscle cell into the circulation

muscle wekaness

pain

swelling

d

rhamodolsis led to

1.AKI-/ESRDhigh Oxygen consumption

2.electorlyte imbalance

3.comaprtment syndrome

5. arrthmia

6. DIC

   7INFECTION

FAT EMBOLISM

?Presence of systemic fat globules from fracture that are distributed into tissues and organs atter a traumatic skeletal injury

fat embolism ss

24-48

interstital hemorrhagic ppenuomotnis

impending disaster feeling

pallor-cyanosis

coma

fat embolism care

prevention,immobolization

IVF,correct acidodis, blood transfuision, DB C< oxygen