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Flashcards in Trauma-notes Deck (51):

what do you assume a multi trauma pt has until ruled out



what type of organs might penetrating object cause damage to
what is this pt now at risk of

often damage hollow organs
risk of infect


• For gunshot wound what is the most imp prognostic factor

the velocity of the bullet


priority mgmt in pt with multiple injuries

1. A/W and ventilation
2. Control hemmorhage
3. Prevent and tx hypovolemic shock
4. Assess for head and neck injuries
5. Eval for other injuries eg head and neck, chest, abd, back and extremities
6. Splint fractures
7. Perform more thorough and ongoing exam and assessment


are stab wounds gen explored with surgery

no, can be explored nonoperatively d/t low velocity and less penetration of the implement


when are intra-abdm bullet wounds explored surgically

• All gushot that cross the peritoneum or are assoc w peritoneal signs require sx exploration but stab wounds


when the liver, kidneys, blood vessels are injured are there often more complications from a blunt or penetrating injury



pt with abdm injury has no BS what are two possible causes?

• Absence of bowel sounds may show intraperitoneal involvement but stress can halt or dec BS


what labs do you take for intra-abdm injury
how owuld they help

o Urinalysis (hematuria)
o Serial Hgb and Hct levels to eval trends reflecting the presence or absence of bleeding
o WBC count (gen elevates w trauma)
o Serum amylase analyss to detect inc levels which may show pancreatic injury or perforation fo the GI tract


damage to which abdm organs puts pt at risk of massive bleed

spleen and liver


what outer signs might indicate an abdm bleed

eg front of body, flanks and back for bluish discolouration, abrasion, asymmetry, contusion


which diagnostic (not lab) will give you best info about an internal bleed

CT scan


what diagnostics might be used for intraperitoneal injury

peritoneal lavage, abd ultrasonography, abd CT


what is peritoneal lavage

• peritoneal lavage (an old but quick procedure no longer used so much but more for mass casualty event), instill 1L RL or NS into abd cavity then check for blood, feces etc in the returned fluid


what should be done before inserting catheter into trauma pt
why would a catheter be used

Don’t put catheter in before inspecting rectum and det that urethra has no damage.
-to decompress bladder or to monitor urine outout


what finding in a male might indicate potential urethral injury

For males a high riding prostate during rectal exam suggests potential urethral injury


pt has lg bleeding wound what do?

apply P


your pt is very thirsty and victim of multi trauma with penetrating intra abdm bullet wounds crossing peritoneum do you give water

no. they might need sx
Fluids typically withheld anticipating sx and NG tube w suction used


how are blunt liver or spleen injuries gen medically managed

gen managed without surgery


beyond the directly injured part of the body what organ is at risk from a crush injury and why?

the kidneys from possible rhabdomylosis-->myoglobin and extra proteins...also lactic acid and all the cells contents spill out-->hard on kidneys


what are the 6 ps of assessment that will warn you of compartment syndrome

6 Ps
poikilothermic (or polar) sensation (cold to the touch), parathesia (burning, numb or tingling,
paralysis (lack of purposeful movement.


what do you assess for pt with fracture

when you first receive pt with broken leg o you remove pants or cut htem off

• Ass for pain over or near bone, swelling, circ disturbance. Eccymosis, tenderness, crepitation

cut them off


pt has abdm injury do you treat fx or abdm injury first

also assess for neuro


if you find a pulseless extremity what o you do?
if it doesnt return the pulse what do?

• If pulseless extreme found it must be aligned. May use traction to help w alignment. If pulse doesn’t return must do rapid total body ass then transfer to OR


if you need to move a pt with a fx what do
after you splint an extremity what do you assess

splint it before moving it
-assess vascular and neuro status


how do you classify the amount of body that is burnt

• Total body surface area is used to classify burns.


70+yr old can survive what % of TBSA burn?
how does a 2-5yr old compare?
how about a 20-30yr od

70yr olds can survive up to 30%
2-5yr old can survive 75%
and 20-30yr olds 80%


what kind of treatments is used for burns

• Early debridement and excision are practiced
• Nutritional support v imp


different forms of burns

thermal, electrical, chemical, radiation


what does a burn put the pt at risk of

o Inc fluid loss
o Infection
o Hypothermia
o Scarring
o compromised immunity
o and changes in function, appearance, and body image


what are the burn depths
is it easy to assess the depth

not easy to assess depth
• superficial injuries, superficial partial thickness injuries, deep partial thickness inj, full thickness inj


Dark pink or red in colour. V painful. Cap blanching still present. 10-14 days to heal

what thickness would this be

superficial partial thickness


Wound color can be white, red, brown, black. Painless d/t nerve fiber destr. Skin is leathery. Excision of burn wound and skin grafting nec

what thickness

• full thickness –dermis and epidermis destroyed my involve subcut and fascia as well.


Painful, red, exudes fluid. Hair follicles and other dermal str intact. More likely to result in hypertrophic scars. May need skin graft

what thickness of burn

• deep partial thickness-injury down to deeper part of dermis.


how to classify the total body surface area of a burn

rule of nines
lund browder method
palm method


rule of nines method of classifying burns
benefit of this?

• system that assigns percentages in multiples of nine to major body surfaces eg arms 9% each, head 9% etc
• quick


• For those w scattered burns what is a good way of calculating TBSA burnt?

palm method. Size of pts palm is approx 1% of TBSA


what is a more precise method of measuring TBSA.
how does this work

lunder browder method
• more precise method that incorporates the variation of body proportion caused by growth and age
• divides the body into v small areas and gives estimates of the proportion of TBSA accounted for by such body parts.


what kind of damage does an electrical burn cause

-often the damage is more inside the body than on skin
There will be entrance and exit wound


what kind of tissues does electricity travel along most easily

• Electricity takes path of least resistance-nerves nd blood vessels first bones last


what type of injuries might an electrical burn pt have beond organ damage and external burns from clothes catching fire

• The current contracts muscles as it travels and arrhythmias and spinal inuries often result
make sure to rule out spinal fx


what are a few priorities for assessing and a Tx priority pt with electrical burns

monitor urine output and neurovascular status

give IV fluids


why monitor urine output for electrical burn pt

muscle damage-->myoglobin in blood-->kidney damage (acute tubular necrosis or acute renal failure)

-also kidney damage from low blood volume


burns greater than ___% of TBSA cause more than just a local response



what occurs in pt after burn..why do they have tissue hypoperfusion and organ dyzfx
what is this period followed by

shock. d/t dec cardiac output, followed by hyperdynamic and hypermetb phase


what type of shock is burn pt at risk of



a pt has exposed burns, what should you do and why

over them, the pt can lose up to 3-5litersof fluid a day from the exposed burn


what type of injury is the leading cause of death in fire injury
how long do you need to carefully monitor these pts and for what
what kind of treatment might they need

inhalation injury
if suspected monitor for up to 48hrs
intubation or a/w stabiliztion of some kind is nec


cardinal sign of inhalation injury

expectoration of carbon particles


what kind of labs might be done for someone with inhalation injury

o Bronchoscopy and Xenon 133 ventilation perfusion scans for early Dx
o PulmFxTests good for showing changes
o Pulm complications like ARDS (that may dev in the first 2-5 days after burn injury) and acute resp failure.


what is a leading cause of morbidity and mortality in burn pts

why miht this occur

either skin barrier is broken or

3 parts of the GI tract alt by burn injury
1. First the mucosa is permable
2. This allows overgrowth of GI bact
3. The bact translocate to other organsinfect.