Trauma Centers
Level 1: comprehensive care for any need r/t injury; prevention & research |
Level 2: can provide care for all injured pts, many of same types of care but often on-call; prevention, no research |
Level 3: prompt assessment , resuscitation, surgery if needed, stabilize pt; contract w/ another hospital |
Level 4: (ED) staff have ACLS, stabilize & transfer; can do mild trauma |
Level 5: evaluate, stabilize, transfer |
Mechanisms of Injury
Radiation |
Electrical |
Thermal |
Chemical |
Mechanical |
Motion |
Motion: car damage helps w/ body damage
Rapid fwd decel - organs on body on tree
Head-on collision - front impact, windshield, steering wheel, dashboard
Dashboard - knee, long-bone, C-spine, pelvis
T-bone - side of body, rib fx from console
Rollover - depends, thrown if no seat belt
Airbags - put seat back as far as possible
Diagnostic Studies
Radiological tests |
Diagnostic perineal lavage (now - US) |
Labs - ABGs, CBC, coagulation studies (r/t DIC), serum electrolytes |
Glucose (r/t stress response) |
UA on all trauma pts (tox & pregnancy) |
Blood type & screen (transfusion) |
Initial Assessment & Management
MAIN GOAL: minimize time from initial insult to definitive care, optimize pre-hospital care |
Want them to be there within 1 hr of injury |
Primary Survey - often in ER, find injuries |
- A irway
- B reathing (pain, pattern)
- C irculation (hypovolemic shock common)
- D isability (LOC, >length w/o consciousness = >disability - Glasgow Coma Scale)
- E xposure (anything we're missing?) |
Resuscitation Phase |
Crystalloids (isotonic) Colloids (large molecules) Blood (O-, T&C, type) |
Secondary Survey - History, AMPLE |
- A llergies
- M edications
- P MH
- L ast meal - (dec. aspiration risk)
- E vents preceeding
Also: examine body, indwelling cath (I&O), NGT (decompress stomach), special prodecures (WKG, XR, CT) |
Operative Phase |
- Must be as stable as possible |
Critical Care Phase - ICU |
- Close intensive care, frequent assessments
- IV lines & fluids
- Ventilator |
Carotid + = SBP >60 / Femoral + = SBP >70
Radial + = SBP >80
Chest Trauma
Penetrating or blunt
Children have more pliable chests (cartilage) |
Types:
- Myocardial or pulm. contusion
- Rib fx
- Flail chest
- Cardiac tamponade
- Pneumothorax
- Hemothorax |
Myocardial/Pulmonary Contusion
Myocardial contusion: bruising to heart; R side most common
- Dec. contractility dec. CO |
Assessment - c/o CP, SOB |
Pulmonary contusion: bruising to lungs
- Most common chest injury |
Assessment - erythema, bruising on outside, pain w/ breathing |
Management - ABC(DE) |
Pain on breathing risk for - pneumonia, hypercapnic, hypoxic
May also see rib fx
Rib Fractures
Common injury usually due to blunt trauma
- Ribs 4-9 most common, 1-3 take sig. force |
Risk for - ARDS |
Assessment - hypoventilating hypoxia hypercapnia |
Management - treat pain to prevent ARDS, can get up, move, breathe |
Flail Chest
Multiple rib fx, part disconnected (3+) {nl}} - Often unilateral, r/t blunt chest trauma |
Paradoxical breathing: flail part floats w/ breathing |
Risk for - ARDS |
Assessment - hypoventilating = hypoxia, hypercapnia |
Management - ventillator, PEEP |
Cardiac Tamponade
Fluid accumulation in pericardium dec. CO |
Assessment - Beck's Triad (muffled heart sounds, JVD, hypotension |
Management - supportive, O 2
, pericardiocentesis |
Heart won't move if 200-300 mL!
Pneumothorax
Injury in which air enters pleural space, usually r/t blunt trauma |
Open (openning in chest cavity) vs. closed |
Assessment |
Management - chest tube, pain control, O 2
|
GOAL: dec. + pressure & restore - pressure |
Patho - trauma to lung injury air enters lung collapses alveoli collapse atelectasis V/Q mismatch hypoxia
Tension Pneumothorax
Life-threatening complication usually r/t blunt chest trauma (pneumothorax)
- Can quickly be fatal if not detected, treated |
Assessment - deviation of everything to unaffected side (trachea); diminished lung sounds, cyanosis, JVD, hypotensive |
Management - Release air! |
Hemothorax
Usually due to blunt chest trauama or penetrating injury |
Simple (1500 mL) or massive (3000 mL) |
Assessment - dec. breath sounds, hypoxia; percuss = dull on affected side (may have total of 3 L buildup per side) |
Management - chest tube or surgery |
|
|
Diagnostic Findings
CXR |
fracture, hemo- or pneumothorax |
ABG's |
hypoxemic, acid-base imbalance |
EKG |
hypoxemia arrythmias |
CBC |
serial CBC's q6h to determine bleeding, something else |
Chest Trauama Management
GOAL: prevent respiratory compromise & complications |
Airway |
Hemo - replace blood |
Chest tube insertion |
Check dressing around CT for erythema |
IVF & blood replacement |
OR depending on severity |
No vent cough, deep breathe (ARDS!), ICS |
Splint if rib fx |
Pain - nerve block |
Abdominal Trauma
Injury blunt or penetrating |
Massive blood loss/shock & not know until severe retroperitoneal |
Assessment - s/s may vary greatly, REASSESS! |
Pain |
Wounds & abrasions |
Bruising |
Bowel sounds |
Balance signs |
Kehr's sign: acute shoulder pain r/t
blood/other irritants in peritoneum when pt is lying & legs elevated = ruptured spleen |
Cullen's sign: bruising below umbilicus |
Turner's sign: flank bruising |
Diaphragmatic rupture (hear bowel sounds w/ breath sounds) |
Hypovolemia w/ large blood loss |
Spleen most commonly damaged!
- Abd. aorta, liver, & hepatic vessels
Bladder rupture from blunt trauma
Knife wound w/ evisceration sterile saline on organs
Impalement injury STABILIZE & remove in OR
Diagnostic Studies
X-ray |
CT scan - GOLD STANDARD FOR INJURIES |
CBC (serial H&H) |
WBC - inflammation; abd wounds often dirty = prophylactic antibiotics |
Serum glucose |
Serum amylase |
Liver enzymes |
US - bleeding? |
Peritoneal lavage
|
Abdominal Trauma Management
GOAL: correct volume deficit, prevent shock & infection |
Prophylactic antibiotics |
IVF - crystalloids, colloids, blood |
NGT, Foley |
All invasive procedures |
Try non-narcotic analgesics no ilieus |
Limb Trauma
Types:
- Strains: stress injury to muscle at tendon
- Sprains: ligament injury
- Fractures: break in the bone |
Assessment:
Strains & sprains - pain, swelling, tenderness, muscle spasms
Fractures - same + loss of movement, may actually see bone/deformity |
Diagnostics - XR (broken bones, visualize structures) |
Management - immobilize, RICE
- Compression bandage
- Ice first 24-48 hr, heat to inc. circulation |
6 P's of Limb Trauma
CARDIOVASCULAR |
NEUROVASCULAR |
Pulseless |
Paresthesia |
Pallor |
Paralysis |
Polar |
Pain |
|
|
Crush Injuries
Blood not circulating |
Hypovolemic shock |
Paralysis |
Erythema - r/t broken blood vessels (= edema) & hard |
Damaged body part |
Renal dysfunction - rhabdomolysis |
Complications of Trauma
Hypermetabolism - NEED 3,000 cal + regular BMR in first 24-48 hr
- Lose diaphragmatic integrity = won't get off vent, bacteria migrate = VAP
- Promotes healing: inc. permeability of bowel = easier for bacteria to enter blood (infection, sepsis) |
Infection - antobiotics prophylactically; seen in first 3 days, may be septic |
Sepsis - debride often |
Rhabdomyolysis - tissue breakdown myoglobin released AKI renal failure
- Dark, tea-colored urine
- Generalized weakness, muscle stiffness
- Treatment: IVF to clean out kidneys & lg molecules to dec. kidney damage |
Multiple organ system dysfunction (MODS) |
PULMONARY |
Respiratory failure - risk of ARDS |
Pulmonary embolism - r/t damages, DIC |
Fat embolism syndrome - long bone break = high risk
- Affects clotting system, thrombocytopenia |
Pain - always an issue |
More Complications of Trauma
GASTROINTESTINAL |
Hemorrhage |
Acalculous cholecystitis |
RENAL |
Renal failure |
Myoglobinuria |
VASCULAR |
Compartment syndrome - inc. pressure in confined space = restricts blood flow = area tense, swollen, no pulse fasciotomy
- Experienced pain out of proportion with what you would expect |
Venous thromboembolism |
Hypotension |
Elderly - other comorbidities make recovery difficult
|
Created By
Metadata
Comments
No comments yet. Add yours below!
Add a Comment
Related Cheat Sheets
More Cheat Sheets by mkravatz