Prevent event - drive safely, speed limit

minimize impact - seatbelt, airbags

Module 12 - Trauma and Burns Flashcards by Julia Mohler

Levels of Trauma Care

Level I—regional resource, state-of-the-science
care, education, outreach, and research
 Level II—provides care for trauma patients and
transfer to Level I if needed
 Level III—community hospital where no Level I or
II exists
 Level IV—provides advanced trauma life support
(ATLS) and transfer

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Primary prevention

Prevent event

drive safely, speed limit

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Secondary prevention

minimize impact

seatbelt, airbags

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Tertiary prevention

Maximize pt outcomes

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Blunt Trauma

Severity depends on kinetic energy dissipated to the body
 Common vehicular trauma, assault with blunt
objects, falls, and sports
 Acceleration
 Deceleration
 Shearing
 Crushing
 Compression

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Penetrating Trauma

 Impalement of foreign objects into the body
 Stab wounds are low-velocity injuries
 Ballistic trauma (e.g., gunshot injuries)
Medium velocity: handguns, some rifles
High velocity: assault and hunting rifles
Velocity and missile (bullet) determine tissue
damage

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Blast Trauma

 Blunt and penetrating trauma
 Tissue and organ injury
Gas-containing organ injury (e.g., eardrums,
lungs, intestines)

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Prehospital Care

Emergency stabilization
ABC
Iv access fluid adm
Hemorrhage control
Fracture stabilization

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Primary Survey

Most crucial assessment tool 1, 2 min
A - airway
B - breathing
C - circulation
D - disability - neuro
E - expose

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Secondary Survery

Performed after life threatening injuries are identified.
IV started
H2T
C spine , x ray

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Emergency/resucitation Care Phase

Time from injury to stabilization
Focus: establish circulatory volume
ABCDEs

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Maintain airway patency with

Open airway
 Jaw thrust or chin lift
 Nasopharyngeal or oropharyngeal airways
 Endotracheal intubation

Cricothyrotomy
 Unable to intubate
 Facial fracture
 Facial or upper airway burns
 Oropharyngeal hemorrhage

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Tension Pneumothorax Tx

Needle decompression , Chest tube

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Pneumothorax Tx

Chest tube

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Open chest wound Tx

Seak wound with occlusive dressing TAPE THREE SIDES
Chest tube insertion

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Pulmonary contusion Tx

Mechanical vent

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Flail chest Tx

mechanical vent and analgesics
can be from rib fx

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Spinal cord tx

maintain spinal immobilization

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DLOC tx

Mechanical vent
CT scan

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Hemothorax Tx

Chest tube insertion on affected side
blood products
thoracotomy

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Hypovolemia Caused by hemorrhage Tx

Pressure on wound- stop bleeding
crystalloid fluids - LR
blood products
large bore IV / central line

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SS Shock

 Tachycardia, tachypnea
 Narrowing pulse pressure
 Falling PaO2
 Decreasing urine output
 Increased serum lactate levels
 Falling hematocrit

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Massive Fluid Resusication

1:1:1 packed RBC PLT FFP

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Massive fluid resuscitation complications

hypocalcemia
hypomag
hypo/hyper kalemia
hypothermia
compartment syndrome
ARDS
AKI
MODS

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Hypothermia is associated with

coagulation dysrhythmias Myocardial dysfunction

TBI

Primary injury associated with trauma Establish baseline level of consciousness (LOC) Secondary injury associated with: Hypoxemia Hypotension Increased intracranial pressure (ICP) Hypocapnia Hyperthermia Anemia TREAT ICP, GCS LESS THAN 8

Spinal cord injury

Immobilization X RAY and CT studies possible neurogenic shock may need vasopressors

Basilar skull fracture

Presence of CSF from nose, ears, or both Ecchymosis over mastoid area or hemotympanum Periorbital ecchymosis NO NG TUBE!

Cardiac Tamponade

Bleeding in pericardial space Becks triad - hypotension, muffled ♡, elevated venous BP decreased co tx pericadiocentesis

Cardiac contusion

Blunt chest trauma S/S dysrhythmia

Aortic disruption

EMERGENT SURGERY S/S weak femoral pulse, dyspnea, pain, hoarseness, widened mediastinum

Kehrs Sign

Pain in shoulder Spleen injury

Musculoskeletal Injury Tx

Closed or open reduction Tx hypovolemia wound care tetanus prophylaxis ABX

5 P's for muskuloskeletal

Pain Pallor Pulses Paresthesia Paralysis

Open break

Out of skin

Comminuted fracture (fragmented)

Several pieces

Displaced fracture

not aligned

Oblique fracture

angled

Spiral fracture

twisted

Impacted fracture

pushed in on itself

Greenstick

Young soft bone bends and breaks

Traction

* Assess neurovascular status frequently * Maintain alignment * Avoid lifting/removing weights * Ensure that weights hang freely, not on floor! * Ensure pully system intact Q shift * Monitor skin integrity * Notify the provider if severe pain or muscle spasms are unrelieved with ordered medication

Compartment syndrome

Increased pressure from internal sources (edema) or external (cast) tx fasciotomy - if it is caused by muscle

Rhabdomylosis

Muscle destruction Increased hemoglobin and K Tx IV fluids

Dermal effects of aging

Flattened dermal-epidermal junction Dermal atrophy Reduced microcirculation thinned skin

Young and elderly are at increased risk for burns because

thinner skin less stress reserve

Superficial - first degree

Epidermis - small portion of dermis heals 3-5 days erythema NO FLUID RESUSCITATION

Partial thickness - second degree

Superficial partial thickness epidermis and limited dermis heals 7-10 Deep partial thickness most of dermis heals 2-4 weeks may be grafted

Full thickness - third degree

destruction of all layers down to fat, fascia, muscle, or bone thick dry leathery Insensate NO PAIN - nerve damage

Burn zones - zone of coagulation

central area most contact - irreversible tissue necrosis

Burn zones - zone of stasis

damaged tissue decreased blood flow labile - may or may not survive

Burn Zones - Zone of hyperaemia

Area of minimal injury recovers in 7-10 days

Physiologic response to burns

acute inflammation intravascular coagulation activation of complement altered vascular permeability fluid goes out of vessels - edema immunes suppression hypertension decreased co decrease urine

prehospital interventions - burn

stop burn identify life threat abc's and cervical spine oxygen 100% minimize time on scene prevent hypothermia large bore iv -LR pain management vs

inhalation injuries

pulse ox not accurate - give o2

Fluid resuscitation for burns

based on % TBSA IV resuscitation - Lactated Ringers - 4 mL/kg per % burned administer half fluids within 8 hrs administer other half within next 16 hrs

Fluid guidelines for burns

Maintain urine output 30-50 Hold colloids for 8-12 hrs inhalation injury

Burns pain control

Opiates - IV PCA Nonpharm

Wound Care Burns

Would cleansed with mild soap Rinse warm tap Hydrotherapy Cover - graft

Skin grafts are for

Deep partial thickness full thickness

Chest wound taping

3 sides

Rule of 9's

perineal - 1% neck up 9% chest - 9% abdomen 9% 18% for whole leg

Hypovolemia

tachycardia low bp tachypnea Tx: Fluids