Topic 8: Traumatic Injuries

blunt injury

chest trauma that occurs from shearing and compression injuries of chest structures; external appearance may be minor but may have severe internal organ damage (ice berg appearance)

penetrating injury

chest trauma in which a foreign object impales/passes through the body tissues creating an open wound

kehr’s sign

while gently palpating the abdomen while the client is laying down with legs elevated and pain is detected in the left shoulder due to blood in the peritoneal cavit

• decreased breath sounds

• bowel sounds will be heard in the lungs

• kehr’s sign

what are signs of a ruptured diaphragm

• pain with inspiration and coughing

• splinting

• shallow respirations

what are S/S of fractured ribs

reduce pain with NSAIDs, opioids, and nerve blocks to motivate deep breathing

what is the treatment for fractured ribs

flail chest

3 or more consecutive fractured ribs in 2 or more places or fractured sternum and several consecutive ribs

• rapid, shallow respirations

• asymmetric and uncoordinated chest movements → paradoxical breathing

  • THIS IS A MEDICAL EMERGENCY, SEE THIS PATIENT FIRST

• inadequate ventilation and increased WOB

• crepitus (grating sound)

what are the S/S of flail chest

pain management, intubation/mechanical ventilation, surgical fixation

what is treatment for flail chest

pneumothorax

collapsed lung due to build up of air or blood; a medical emergency when traceal deviation is noted due to impaired airway 

tension pneumothorax

a medical emergency that requires needle decompression and a chest tube due to tracheal deviation

• severe dyspnea

• tachycardia

• tracheal deviation

• decreased/absent bowel sounds

• neck vein distention

• cyanosis

• diaphoresis

what are the S/S of a tension pneumothorax

hemothorax

blood in the pleural space that occurs with a pneumothorax and is treated with a chest tube

chylothorax

lymph fluid in the pleural space that is treated with octreotide and refractory surgery

use a nonocclusive dressing on 3 sides to prevent more air from moving in, but still gives air a way out

what should you do for an open/sucking chest wound or chest tube

penetrating trauma

any object that goes into the body and creates an open wound

DO NOT remove as a nurse, stabilize the object

what should a nurse do if a patient has a penetrating trauma

acute aortic dissection

a pocketing in the aorta that usually occurs from HTN as a result of a false lumen through which blood flows between intima and media of the arterial wall which may occlude major branches of the aorta, cutting off blood supply to the brain, abdominal organs, kidneys, spinal cord and extremities

HTN and males

what are the RF for acute aortic dissection

acute type A aortic dissection

aortic dissection that has abrupt onset of severe anterior chest pain or back pain; may feel like it’s tearing and BP and pulses are different on each arm

• severe anterior chest pain or back pain

• tearing pain

• “worse pain ever”

• BP and pulses are different on each arm

what are the S/S of a type A aortic dissection

• surgery ASAP

• life long BB

• keep SBP 100-110 and HR < 60

• once they have it they are at risk for it again

• should get immediate help if pain returns

what is the management for type A acute aortic dissection

ultrasound

what is the quickest way to see abdominal bleeding

• guarding and splinting of the abdomen

• hard, distended abdomen

• decreased bowel sounds

• abdominal sounds heard in the lungs

• cullen’s sign

• grey turner’s sign

• hematemesis or hematuria

• hypovolemic shock

what are the S/S of an abdominal trauma

hard distended abdomen with decreased/absent bowel sounds

what are the signs of peritonitis which may occur with an abdominal trauma

abdominal sounds heard in the lungs

what is the sign of a ruptured diaphragm which may occur with an abdominal trauma

Cullen’s sign

bruising around the umbilicus that indicates bleeding in the peritoneum

Grey Turner’s Sign

bruising at the flanks that indicates retroperitoneal bleeding

• hypotension and tachycardia

• pale/cool extremities

• low urine output

• confused/disoriented

what are the S/S of hypovolemic shock that may be a sign of an abdominal trauma

call a rapid

if a patient with an abdominal trauma deteriorates what should you do

• profuse bleeding

• RUQ pain

• hypoactive/absent bowel sounds

• hypovolemic shock

what are the S/S of a hepatic injury

• hypovolemic shock

• Kehr’s sign

• rigidity

• guarding 

what are the S/S of splenic injury

• neck, shoulder, chest, or abdominal pain

• air in the neck → crepitus

• frank blood from NG or vomit with esophageal varices → aspiration and loss of airway

what are the S/S of an esophageal injury

anaphylactic shock

acute life-threatening hypersensitivity in which massive vasodilation causes release of vasoactive mediators and an increase in capillary permeability (Fluid that leaks into the interstitial space)

• anxiety, confusion, dizziness

• sense of impending doom

• chest pain

• incontinence

• swelling of the lips/tongue and angioedema

• wheezing and stridor

• flushing, pruritus, urticaria

• respiratory distress and circulatory failure

what are the S/S of anaphylactic shock

• epinephrine (gold standard)

• diphenhydramine

• famotodine

• maintain patent airway

• aggressive fluid resuscitation with crystalloids (NS and LR)

• IV corticosteroids if significant hypotension persists after 1-2 hours of aggressive therapy

• 1-2 large bore IVs

• RBC for volume loss due to bleeding

what is the treatment of anaphylactic shock

• electrolyte/fluid imbalances

• infection

• malnutrition

• immobility

• delayed healing

what are concerns about someone who suffers a burn

• high fowler’s

• 100% O2, aerosolized heparin, albuterol

• deep breathing, coughing, and repositioning

• suctioning

• ABCs, tele, capnography, O2 monitoring

• tetanus shot

• intubation

• CO monitoring 

what is the management for inhalation, burns, and fume injuries