Chapter 25 Trauma

trauma emergencies

emergencies that are the result of physical forces applied to the body

medical emergencies

emergencies not caused by an outside force, illnesses or conditions

index of suspicion

awareness that unseen life-threatening injuries may exist when determining the moi

mechanism of injury

forces, or energy transmission, applied to the body that cause injury

multi system trauma

affects more than one body system

blunt trauma

cause injury without penetrating soft tissues or internal organs and cavities

penetrating trauma

pierce the surface of the body and damage internal tissues and organs, knives and bullets

frontal crashes

lower extremity fractures (knees into dashboard), rib fractures (rib cage into steering wheel), head trauma (head into windshield), internal organs hitting solid structures of the body, watch out for airbags that haven’t deployed

rear-end crashes

whiplash injuries

lateral crashes

lateral whiplash injuries, skull against doorpost or window

rollover crashes and rotational crashes

striking interior of vehicle, ejection or partial ejection (life-threatening injuries)

coup-contrecoup brain injury

compression (or bruising) to anterior portion of the brain and tension (stretching)of the posterior portion

important info

alert medical control and hospital staff to what you see (contusion on patient’s forehead and windshield is starred and pushed out), always take spinal precautions

falls

height, type of surface struck, part of the body that hit first, followed by path of energy displacement, older patients (osteoporosis)

cavitation

speed causes a bullet to generate pressure waves, which cause damage distant from the bullet’s path

problems in trauma patients (1)

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problems in trauma patients (2)

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pulmonary blast injuries

pulmonary trauma resulting from short-range exposure to detonation of high-energy explosives

arterial air embolism

air bubbles in the arterial blood vessels

patient assessment

less than 10 minute on scene, DCAP-BTLS, (head) conduct frequent neurological examinations, (neck and throat) jugular vein distention and tracheal deviation, occlusive dressings, (chest) lung sounds and chest rise and fall, (abdomen) reassess abdominal region

Glasgow Coma Scale (EVM)

eye, verbal, motor

Revised Trauma Score

used for patients with head trauma

critical organs

heart-cardiovascular, brain-central nervous system, lungs-respiratory, kidneys-renal system

hemorrhage

bleeding, body can’t tolerate blood loss greater than 20% of total blood volume (2 pints or 1L)

hypovolemic shock

low blood volume, due to massive internal or external bleeding or extensive loss of body water, results in inadequate perfusion

capillary bleeding

dark red and oozes from a wound steadily but slowly

venous bleeding

darker than arterial bleeding and flows steadily

arterial bleeding

bright red and spurts in time with pulse

coagulation

formation of clots to plug openings in injured blood vessels and stop blood flow

contusion and ecchymosis

local swelling and bruising

internal bleeding

high energy MOI (falls, blast injuries, motor vehicle crashes, penetrating and blunt trauma), bleeding ulcers, bleeding from colon, ruptured ectopic pregnancy, aneurysms, common in head, extremities, and pelvic injuries

internal bleeding signs and symptoms

pain, swelling in the area of bleeding, abdominal distention, dyspnea, tachycardia, hemoptysis (coughing up blood),

care of external bleeding

direct pressure, pressure dressings or splints, tourniquets, junctional tourniquets, hemostatic dressing, wound packing

skills

(976) controlling external bleeding, packing a wound, commercial tourniquet, pelvic binder, bleeding from nose, ear, and mouth, stabilizing impaled objects, occlusive dressing, caring for burns, removing foreign object from under upper eyelid, stabilizing foreign object in eye, controlling bleeding from neck, applying cervical collar, securing a patient to a long board, caring for musculoskeletal injuries, splinting (hand, traction)

bleeding from nose or ears

indicate skull fracture, do not attempt to stop blood flow

epidermis

outer layer of skin that forms a watertight covering for the body

dermis

inner layer of the skin, contains follicles, sweat glands, nerve endings, and blood vessels

mucous membrane

linings of body cavities and passages that communicate directly or indirectly with the environment outside the body, mouth, nose, anus, vagina, moist compared to dry skin

closed injuries

damage occurs beneath the skin or mucous membrane, surface of skin remains intact

open injuries

break in surface of skin or mucous membrane

burn

soft-tissue damage as result of thermal heat, frictional heat, toxic chemicals, electricity, or nuclear radiation

hematoma

blood that has collected within damaged tissue beneath the skin or in a body cavity

abrasion

loss or damage of the superficial layer of the skin as a result of a body part rubbing or scrapping across a rough or hard surface, road rash, road burn, rug burn

laceration

jagged cut in the skin caused by a sharp object or blunt force that tears the tissue

incision

sharp, smooth cut in the skin

avulsion

soft tissue is torn completely loose or is hanging as a flap

amputation

part of the body is completely severed

signs of hypoperfusion

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care of closed soft-tissue injury (RICES)

Rest, Ice, Compression, Elevation, Splinting

occlusive dressing

use in chest, upper abdomen, upper back, taped on three sides leaving one side open

evisceration

displacement of organs outside of the body

treatment for bites

place a dry, sterile dressing over bite wound, splint or bandage, provide transport to ED

burns

keep the patient warm and provide supplemental oxygen for burns, if the patient has altered level of consciousness suspect hypoperfusion, hypoxia, hypoglycemia, or head injury

superficial (first-degree)

involves only the top layer of the skin, epidermis, skin turns red but does not blister or burn through top layer, ex: sunburn

partial-thickness (second-degree)

involve the epidermis and some portion of the dermis but not subcutaneous tissue, blisters and skin that is white to red, moist, and mottled

full-thickness (third-degree)

affect all layers of the skin and may affect subcutaneous layers, muscle, bone, and internal organs, leaving the area dry, leathery, and white, dark brown, or charred

rules of nines (adult)

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rules of nines (child)

12 and 16.5

rule of nines (infants)

18 and 13.5

care for chemical and thermal burn

brush off dry chemicals from the skin and clothing before flushing patient with water, remove patient’s clothing, shoes, stockings, gloves, and jewelry and eyeglasses

CMS

circulatory, motor, sensory

care of injuries to face and neck

face/neck care

care of injuries around the mouth

mouth care

care of injuries of the eye

eye care, normal eye: entire circle of iris is visible, pupils are round, usually equal in size, and react equally when exposed to light, both eyes move in same direction when following moving finger

care of neck injuries

neck care

signs and symptoms of head injury

give supplemental oxygen to patient suspected of head injury

raccoon eyes

bruising under the eyes

battle sign

bruising behind an eye

traumatic brain injury (TBI)

insult to the brain capable of producing physical, intellectual, emotional, social, and vocational changes, primary (direct), secondary (inderect)

cerebral edema

swelling in the brain

central neurogenic hyperventilation

abnormal breathing pattern associated with increased intracranial pressure, characterized by deep, rapid breathing, similar to kussmaul respiration but without acetone breath odor

cushing triad

high blood pressure, decreased heart rate, irregular respirations

concussion

mild TBI, temporary loss or alteration of part or all of the brain’s ability to function without physical damage to the brain

signs and symptoms of head or spinal injury

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paraplegia v. quadraplegia

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signs and symptoms of chest injury

chest injury, tachypnea (rapid respiration), shallow breaths

crepitus

sensation felt when broken bone ends grind together

paradoxical motion

one segment, flail segment, of the chest wall moves opposite the rest of the chest (normal: out with expiration, in with inspiration)

deadly dozen chest injuries

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pneumothorax

accumulation of air or gas in pleural cavity

open pneumothorax or sucking chest wound

open or penetrating chest wall wound through which air passes during inspiration and expiration, creating a sucking sound

simple pneumothorax

any pneumothorax that is free from significant physiologic changes and does not cause drastic changes in the vital signs of the patient

tension pneumothorax

an accumulation of air or gas in the pleural cavity that progressively increases pressure in the chest and interferes with cardiac function

hemothorax

blood in the pleural space

hemopneumothorax

accumulation of blood and air in the pleural space of the chest

cardiac tamponade

compression of the heart as a result of buildup of blood or other fluid in the pericardial sac, leading to decreased cardiac output

rib fractures

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flail chest

condition in which two or more adjacent ribs are fractured in two or more places or in association with fracture of the sternum so that a segment of chest wall is detached from rest of the thoracic cage

pulmonary contusion

injury or bruising of lung tissue that results in hemorrhage

other fractures

sternum (significant force required) and clavicle

tramatic asphyxia

seen after a severe force is applied to the chest, forcing blood from the great vessels back into the head and neck, suggest underlying injury to the heart and a pulmonary contusion

abdominal quadrants

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right upper quadrant

gallbladder, duodenum, liver, small portion of pancreas

right lower quadrant

large portions of large and small intestines, appendix

left upper quadrant

spleen, most of the stomach, larger portion of pancreas

left lower quadrant

portions of large and small intestines

hollow organs

structures through which materials pass, stomach, intestines, urinary bladder

solid organs

solid masses of tissue where much of the chemical work of the body takes place (liver, spleen, pancreas, kidneys), rich blood supply

peritoneum

membrane lining the abdominal cavity

three levels of velocities (trauma)

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