Unit 18 Acute Multiple Injury/Trauma/Emergency Flashcards Preview

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Flashcards in Unit 18 Acute Multiple Injury/Trauma/Emergency Deck (39):
1

Define trauma.

Any bodily injury caused by violence or force

2

What are the different types of trauma?

Kinetic

Chemical, electrical, radiation burns

Lack of essential agents, i.e oxygen or hear

3

What are the types of Kinetic Trauma?
What happens in both?

Blunt: Injury occurs without impairing skin integrity, beneath skin

Penetrating: Injury occurs that is obviously impairing skin integrity

Tissue deformity and injury to organs occurs with both

4

What are the risks factors for kinetic trauma?

Age - young/elderly

Gender - Male

Alcohol/Drug use

Income

Geography

5

What is the good samaritan act?

What are basic individual rights?

Covers you if you help someone in need

Right to emergency care whether or not they have insurance or are a criminal

6

What is involved in ACLS (Advanced Cardiac Life Support)?

Beyond BLS w/ AED, usually medications and other interventions

7

What are the causes of death from trauma that happen within minutes? Within hours? Within days to weeks?

Causes of death from trauma within minutes:
-Brain injury
-Spinal cord injury
-Cardiac Injury
-Arterial Injuries

Within hours:
-Subdural/Epidural hematoma
-Ruptured Spleen and liver

Within days to weeks:
-Sepsis
-MODS
-DIC

8

What is the definition and goal of triage?

Definition: Process used to determine the severity of illness or injury in a patient

Goal: give priority care to the most critically ill or injured patient

9

What are the triage classifications?

Emergent - Life threatening, highest priority
ex: cardiac arrest, airway compromise, sudden vision or conscious changes

Urgent - Serious but not life threatening
ex: fracture, abdominal pain, certain wounds

Non-urgent - non life threatening
ex: sprains, strains, simple lacerations

Fast tract: typical do`ctors office problem

10

What can the nurse use to gather information from a trauma PT?

OPQRST (onset, provocation, quality, radiates, severity, treatments tired before ER)

SAMPLE

11

What is the primary survey for emergencies?

A: Establish Airway (if c-spine stabilization necessary use jaw thrust instead of head tilt chin lift)

B: Breathing - quality, lung sounds, chest symmetry

C: Circulation - check all peripheral pulses

D: Neurological disability? -LOC, GCS, Pupils

E: Exposure - remove all clothing, put in hosp. gown

12

What is the secondary survey for emergencies?

F: Full set of VS/ Facilitate family presence

G: Give comfort measures

H: History and head to toe assessment

I: Inspect posterior

J: Jump back and reassess, will help determine how to proceed

13

What are Emergency Life Threatening Conditions

Airway obstruction:
-Manifestations - hypoxia, hypercapnia
-Management - hemliech meunuver, forceps, endoscopy

Hemorrhage:
-Causes - open wounds, ruptured artery below surface
-Management - 2 large bore IVs, type and screen, O- blood if crossmatch not done yet

14

What are examples of Traumatic Brain Injuries?
What are secondary issues?
What is the collaborative management?

Sports injury, MVA, Falls.

Secondary issues:
-ICP
-Intracranial bleed
-Impaired auto-regulation

Collaborative management:
-Neuro assessment
-CT/MRI/Spinal tap
-Sx
-Medications
-Nursing interventions to lower ICP

15

Describe the spinal cord injuries complete spinal cord injury vs incomplete.

Complete:
-Severed completely w/total loss of sensory/motor function
-aka "transection"

Incomplete:
-"partial transection"
-Sensory/motor fibers preserved below injury allowing partial function

16

What are types of Incomplete Spinal Cord injuries?

Central cord injury:
-Deficit in upper extremities w/loss of motor and sesory function
-Injury or edema to central spinal cord

Anterior cord syndrome:
-Loss of pain, temp, motor below injury
-Maintains touch, vibration, sensation

Brown sequard syndrome:
-spinal cord has vertical cut
-aka "epsilateral paralysis"
-damaged side, loss of motor function (hemiparaplegia)
-non damaged side, loss of sensation (hemianesthesia)

17

When would you assume a C-spine injury?

MVA's

Diving accidents

Falls

Trauma

18

What are the mechanisms of spinal cord injury?

Hyperextension

Hyperflexion

Compression

Penetrating

19

Describe Neurogenic shock vs Spinal shock.

Neurogenic shock:
-Loss of vasomotor tone
-Impairment of autonomic function below lesion
-Hypotension, bradycardia, warm skin
-Severe vasodilations and decreased cardiac output
-Find cause and eliminate, provide increasing blood flow interventions like passive leg raising, etc

Spinal Shock:
-Loss of spinal reflexes
-Flaccid paralysis
-Occurs within a few minutes of spinal cord injury
-May lose continence during time
-Will resolve on it's own over time

20

What is Autonomic Dysreflexia?
What are the signs and symptoms?

Sudden increase in SBP and DBP w/ bradycardia Abnormal exaggerated autoimmune response
Life threatening


Signs and symptoms:
-Above T6 initial spinal shock
-Above level of injury,
profuse diaphoresis, goose bumps, and flushed skin
-Below injury pale skin
-Severe throbbing headache

21

What are nursing interventions for Autonomic Dysreflexia?

-Place PT in sitting position

-Notify PCP

-Assess for cause:
Retention
Kinks
Fecal impaction

-Monitor VS

-Give nifedipine or nitrate as prescribed to lower BP

22

What are the types of eye trauma and what is the management for each?

Chemical: irrigate w/water or normal saline

Foreign body: stabilize until further intervention


Leading cause of blindness among children and young adults

23

What are types of cardiothoracic trauma?

Myocardial contusion
Cardiac tamponade
Pulmonary contusion
Flail chest
Pneumothorax
Hemothorax

24

What organs are mostly affected in abdominal trauma?

What is the collaborative management of abdominal trauma?

Liver and spleen


Assessment, Dx, Sx

25

Describe pelvic trauma and what to assess/anticipate.

Can be a fracture of the pelvis

Assess for rectal or vaginal bleeding

Assess for hematuria

Anticipate: X-rays, CT scan, IV pyelogram

26

What can a musculoskeletal trauma cause?
What is more likely to cause a comminuted fracture (bone into fragments)?

Can cause a contusion, laceration, or fracture

A crush injury

27

When there is injury to the back what should the nurse suspect?

Renal trauma

28

What is the collaborative management of renal trauma?

Urinalysis

CT

Ultrasound

IV fluids

29

What are heal related emergencies?

Heat cramps

Heat exhaustion

Heat stroke

30

What are signs and symptoms of heat cramps and exhaustion?
What's the treatment?

Fatigue
N and V
Extreme thirst
Hyperthermia

Tx: Rest and fluid replacement, remove clothing

31

What are signs and symptoms of heat stroke?
What's the treatment?

> 100.4 temp
Absence of perspiration
ALOA
Decreased BP

Tx: Cover w/ wet sheets, remove clothing, cold fluids,

32

What are cold related emergencies?

What are signs and symptoms and treatment of hypothermia?

Frostbite:
-superficial
-deep

Hypothermia
-core body temp < 95F (35C)
-medical emergency

Symptoms: shivering, confusion, bradycardia

Tx: Remove from cold, rewarm them, monitor ABC's

33

What do you want to do for a snake bite?

Provide first aid, identify what bit you, and go to the ER

34

During a mass casualty event what's the goal?

Save the most viable

Greatest amount of ppl saved possible

35

What should be asked to a PT with a suspected hemorrhagic fever?

Have they recently traveled?

36

What is the protocol for infectious triage and care?

-Quickly screen, identify, and isolate suspected infectious agent or:
Ebola, Smallpox, anthrax, plague, hemorrhagic viral agents.

-Provide safe environment and minimize exposure to other ppl

-Donning and doffing of appropriate PPE

-Quarantine

37

What happens regarding death in the ED?

Maintain belongings with PT

Notify next of kin (ask them to come to the hospital, do not give information over the phone)

Suspect autopsy will be performed

Is he/she a possible organ donor?

38

If a PT develops compartment syndrome what should the nurse be alert for?

Dark, scanty urine

39

What is the best way method to assess for a DVT in a client with a spinal cord injury?

Leg girth