Ch 16 and 17: Dealing with Acute Situations

what is the number one cause of death in people under the age of 40

trauma

where should all seriously injured trauma patients go?

a level one trauma center

what films do trauma patients recieve?

• lateral cervical spine

• a/p chest

• pelvic

triage

means by which the most seriously injured patients are treated first

3 levels of trauma care

level 1, 2 and 3

what patients go to triage?

• respiratory injuries

• cardiac injuries

• head injuries

• spinal injuries

when do trauma patients have a greater chance of recovery?

stabilized in the first or golden hour after injury

head injuries

• vary widely from concussion (seeing stars) to injuries that result in patients being totally unresponsive

• any change in level of consciousness should be assessed on all patients with suspected head injury. this is measured by glasgow coma scale

• any patient with decreased LOC must have suction available to clear any oral secretions or vomit may be aspirated

heart attack

Complete disruption of blood flow to a portion of the heart. Characterized by crushing chest pain, pain in the jaw, and pain radiating down left arm

angina

decrease in blood flow to a portion of the heart. occurs with exercise and stressful situations characterized by chest discomfort, nausea, sweating

how is angina relieved?

rest and sublingual nitroglycerine

what kind of intervention does chest pain require?

stat or immediate

cardiac arrest

absence of pulse. patient is clinically dead. required cpr to circulate blood until pulse can be restored. certain rhythms require defibrillation (delivery of electric shock) to restore a pulse

what amount of time does circulation need to be restored to prevent permanent brain injury

3-5 minutes

shock

shock occurs when there is not sufficient perfusion to tissue resulting in tachycardia, hypotension, decreased l.o.c

what is the best indicator of shock?

hypotension

types of shock

• hypovolemic: lack of sufficient circulating volume (blood loss/dehydration)

• septic: severe infections

• cardiogenic: heart failure

syncope

occurs with severe inner ear imbalances or head injuries. characterized by spinning sensation and nausea

seizures

The interruption of normal electrical activity in the brain. There are multiple types tonic/clonic is the most commonly recognized, involves the entire body and is characterized by the thrashing of the extremities. it is important to protect the patient from injury during these episodes. never try to restrain or hold the patient down. this can result from further injuries. instead, place a pillow or something soft under the head to protect from head injuries

green stick fracture

occurs in children d/t flexibility of bones

compound fracture

occurs in long bones, usually displaced, may penetrate skin

comminuted fracture

usually d/t crush injury, bones are splintered into multiple pieces

spiral fracture

Classic sign of abuse. occurs with twisting of the extremity

oxygen delivery

delivered by numerous methods. first thing to do if a patient is having difficulties such as shortness of breath, anxiety attack, chest pain. it is an easy noninvasive treatment that can be done. any patient can recieve 2-3 liters of oxygen

what do delivery systems include

• Nasal cannula: may give up to 6 liters by nasal cannula. Patients with COPD or any chronic obstructive lung disease can receive no more than 3 liters of oxygen

• Mask: multiple types requiring various oxygen flow rates

• mechanical ventilator

• oxygen tent used with infants

how are trauma units identified?

• staffing

• research

• technology

level 1 trauma

around the clock staffing, most advanced technologies

level 2 trauma

specialists on-call, same technology

level 3 trauma

all necessary staff on-call, life-threatening injuries are transferred

trauma unit staff

• ED physicians

• trauma specialists

• anesthesiologist

• trauma nurses

• radiographers

• radiologists

role in trauma assessment

• watch

• work quickly and effectively

• be supportive

• be calm

disaster response

• disaster plans

• triage

• debriefing

disaster plans

one person coordinates, staffing assignments and getting staff

triage

identify victim, complete initial and rapid exam, assign priorities

debriefing

summarize and evaluate performance, helps to avoid prolonged reactions to crisis situations

patient evaluation

• triaged in ed

• sickest patients come first: trauma, life-threatening, acute, non-urgent

• emergency call systems: special codes utilized- voice, numeric, and tone codes

• emergency carts: equipment, supplies and medications