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% Document Info
\author{Maria K (mkravatz)}
\pdfinfo{
  /Title (nursing-management-of-patients-with-trauma.pdf)
  /Creator (Cheatography)
  /Author (Maria K (mkravatz))
  /Subject (Nursing Management of Patients with Trauma Cheat Sheet)
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    {\parbox{\dimexpr\textwidth-2\fboxsep\relax}{\noindent
        \hspace*{-6pt}\includegraphics[width=5.8cm]{/web/www.cheatography.com/public/images/cheatography_logo.pdf}}
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\begin{tabulary}{11cm}{L}
    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{Nursing Management of Patients with Trauma Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{Maria K (mkravatz)} via \textcolor{DarkBackground}{\uline{cheatography.com/71404/cs/18137/}}}
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  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}Maria K (mkravatz) \\
  \uline{cheatography.com/mkravatz} \\
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Published 4th December, 2018.\\
   Updated 4th December, 2018.\\
   Page {\thepage} of \pageref{LastPage}.
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  %\includegraphics[width=48px,height=48px]{dave.jpeg}
  Measure your website readability!\\
  www.readability-score.com
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\begin{document}
\raggedright
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\begin{multicols*}{3}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Trauma Centers}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Level 1}}: {\emph{comprehensive care for any need r/t injury; prevention \& research}}} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Level 2}}: {\emph{can provide care for all injured pts, many of same types of care but often on-call; prevention, no research}}} \tn 
% Row Count 5 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Level 3}}: {\emph{prompt assessment , resuscitation, surgery if needed, stabilize pt; contract w/ another hospital}}} \tn 
% Row Count 8 (+ 3)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Level 4}}: {\emph{(ED) staff have ACLS, stabilize \& transfer; can do mild trauma}}} \tn 
% Row Count 10 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Level 5}}: {\emph{evaluate, stabilize, transfer}}} \tn 
% Row Count 11 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{1.60195 cm} x{1.73926 cm} x{1.23579 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{3}{x{5.377cm}}{\bf\textcolor{white}{Mechanisms of Injury}}  \tn
% Row 0
\SetRowColor{LightBackground}
Radiation & Electrical & Thermal \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
Chemical & Mechanical & Motion \tn 
% Row Count 2 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}---}
\SetRowColor{LightBackground}
\mymulticolumn{3}{x{5.377cm}}{{\bf{Motion: car damage helps w/ body damage}} \newline {\emph{Rapid fwd decel}} - organs on body on tree  \newline {\emph{Head-on collision}} - front impact, windshield, steering wheel, dashboard \newline {\emph{Dashboard}} - knee, long-bone, C-spine, pelvis \newline {\emph{T-bone}} - side of body, rib fx from console \newline {\emph{Rollover}} - depends, thrown if no seat belt  \newline {\emph{Airbags}} - put seat back as far as possible}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}---}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Diagnostic Studies}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Radiological tests} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Diagnostic perineal lavage (now - US)} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Labs - ABGs, CBC, coagulation studies (r/t DIC), serum electrolytes} \tn 
% Row Count 4 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Glucose (r/t stress response)} \tn 
% Row Count 5 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{UA on all trauma pts (tox \& pregnancy)} \tn 
% Row Count 6 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Blood type \& screen (transfusion)} \tn 
% Row Count 7 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Initial Assessment \& Management}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{MAIN GOAL}}: {\emph{minimize time from initial insult to definitive care, optimize pre-hospital care}}} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Want them to be there within 1 hr of injury} \tn 
% Row Count 3 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{\{\{bt\}\} {\bf{Primary Survey}} - often in ER, find injuries} \tn 
% Row Count 5 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{- {\bf{A}} irway \{\{nl\}\} - {\bf{B}} reathing {\emph{(pain, pattern)}} \{\{nl\}\} - {\bf{C}} irculation {\emph{(hypovolemic shock common)}} \{\{nl\}\} - {\bf{D}} isability {\emph{(LOC, \textgreater{}length w/o consciousness = \textgreater{}disability - Glasgow Coma Scale)}} \{\{nl\}\} - {\bf{E}} xposure {\emph{(anything we're missing?)}}} \tn 
% Row Count 11 (+ 6)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{\{\{bt\}\} {\bf{Resuscitation Phase}}} \tn 
% Row Count 12 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Crystalloids}} {\emph{(isotonic)}} \{\{fa-arrow-right\}\} {\bf{Colloids}} {\emph{(large molecules)}} \{\{fa-arrow-right\}\} {\bf{Blood}} {\emph{(O-, T\&C, type)}}} \tn 
% Row Count 15 (+ 3)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{\{\{bt\}\} {\bf{Secondary Survey}} - History, AMPLE} \tn 
% Row Count 16 (+ 1)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{- {\bf{A}} llergies \{\{nl\}\} - {\bf{M}} edications \{\{nl\}\} - {\bf{P}} MH \{\{nl\}\} - {\bf{L}} ast meal - {\emph{(dec. aspiration risk)}} \{\{nl\}\} - {\bf{E}} vents preceeding \{\{nl\}\} {\emph{Also: examine body, indwelling cath (I\&O), NGT (decompress stomach), special prodecures (WKG, XR, CT)}}} \tn 
% Row Count 22 (+ 6)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{\{\{bt\}\} {\bf{Operative Phase}}} \tn 
% Row Count 23 (+ 1)
% Row 9
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{- Must be as stable as possible} \tn 
% Row Count 24 (+ 1)
% Row 10
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{\{\{bt\}\} {\bf{Critical Care Phase}} - ICU} \tn 
% Row Count 25 (+ 1)
% Row 11
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{- Close intensive care, frequent assessments \{\{nl\}\} - IV lines \& fluids \{\{nl\}\} - Ventilator} \tn 
% Row Count 27 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Carotid +}} = SBP \textgreater{}60 / {\bf{Femoral +}} = SBP \textgreater{}70  \newline {\bf{Radial +}} = SBP \textgreater{}80}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Chest Trauma}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Penetrating or blunt \{\{nl\}\} Children have more pliable chests (cartilage)} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Types: \{\{nl\}\} - Myocardial or pulm. contusion \{\{nl\}\} - Rib fx \{\{nl\}\} - Flail chest \{\{nl\}\} - Cardiac tamponade \{\{nl\}\} - Pneumothorax \{\{nl\}\} - Hemothorax} \tn 
% Row Count 6 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Myocardial/Pulmonary Contusion}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Myocardial contusion}}: {\emph{bruising to heart; R side most common}} \{\{nl\}\} - Dec. contractility \{\{fa-arrow-right\}\} dec. CO} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Assessment}} - c/o CP, SOB} \tn 
% Row Count 4 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{\{\{bt\}\} {\bf{Pulmonary contusion}}: {\emph{bruising to lungs}} \{\{nl\}\} - Most common chest injury} \tn 
% Row Count 6 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Assessment}} - erythema, bruising on outside, pain w/ breathing} \tn 
% Row Count 8 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{\{\{bt\}\} {\bf{Management}} - ABC(DE)} \tn 
% Row Count 9 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Pain on breathing \{\{fa-arrow-right\}\} risk for - pneumonia, hypercapnic, hypoxic  \newline May also see rib fx}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Rib Fractures}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Common injury usually due to blunt trauma \{\{nl\}\} - Ribs 4-9 most common, 1-3 take sig. force} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Risk for}} - ARDS} \tn 
% Row Count 3 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Assessment}} - hypoventilating \{\{fa-arrow-right\}\} hypoxia hypercapnia} \tn 
% Row Count 5 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Management}} - treat pain to prevent ARDS, can get up, move, breathe} \tn 
% Row Count 7 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Flail Chest}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Multiple rib fx, part disconnected (3+) \{nl\}\} - Often unilateral, r/t blunt chest trauma} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Paradoxical breathing}}: flail part floats w/ breathing} \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Risk for}} - ARDS} \tn 
% Row Count 5 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Assessment}} - hypoventilating = hypoxia, hypercapnia} \tn 
% Row Count 7 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Management}} - ventillator, PEEP} \tn 
% Row Count 8 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Cardiac Tamponade}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\emph{Fluid accumulation in pericardium \{\{fa-arrow-right\}\} dec. CO}}} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Assessment}} - {\bf{Beck's Triad}} {\emph{(muffled heart sounds, JVD, hypotension}}} \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Management}} - supportive, O`2`, \{\{nl\}\} pericardiocentesis} \tn 
% Row Count 6 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Heart won't move if 200-300 mL!}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Pneumothorax}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\emph{Injury in which air enters pleural space, usually r/t blunt trauma}}} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Open}} (openning in chest cavity) vs. {\bf{closed}}} \tn 
% Row Count 3 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Assessment}}} \tn 
% Row Count 4 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Management}} - chest tube, pain control, O`2`} \tn 
% Row Count 5 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{GOAL}}: {\emph{dec. + pressure \& restore - pressure}}} \tn 
% Row Count 6 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Patho}} - trauma to lung \{\{fa-arrow-right\}\} injury \{\{fa-arrow-right\}\} air enters \{\{fa-arrow-right\}\} lung collapses \{\{fa-arrow-right\}\} alveoli collapse \{\{fa-arrow-right\}\} atelectasis \{\{fa-arrow-right\}\} V/Q mismatch \{\{fa-arrow-right\}\} hypoxia}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Tension Pneumothorax}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\emph{Life-threatening complication usually r/t blunt chest trauma (pneumothorax)}} \{\{nl\}\} - Can quickly be fatal if not detected, treated} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Assessment}} - deviation of everything to unaffected side (trachea); diminished lung sounds, cyanosis, JVD, hypotensive} \tn 
% Row Count 6 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Management}} - Release air!} \tn 
% Row Count 7 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Hemothorax}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\emph{Usually due to blunt chest trauama or penetrating injury}}} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Simple}} (\textasciitilde{}1500 mL) or {\bf{massive}} (\textasciitilde{}3000 mL)} \tn 
% Row Count 3 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Assessment}} - dec. breath sounds, hypoxia; percuss = dull on affected side {\emph{(may have total of 3 L buildup per side)}}} \tn 
% Row Count 6 (+ 3)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Management}} - chest tube or surgery} \tn 
% Row Count 7 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{p{0.54747 cm} x{4.42953 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Diagnostic Findings}}  \tn
% Row 0
\SetRowColor{LightBackground}
CXR & fracture, hemo- or pneumothorax \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
ABG's & hypoxemic, acid-base imbalance \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
EKG & hypoxemia \{\{fa-arrow-right\}\} arrythmias \tn 
% Row Count 5 (+ 2)
% Row 3
\SetRowColor{white}
CBC & serial CBC's q6h to determine bleeding, something else \tn 
% Row Count 7 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Chest Trauama Management}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{\{\{bb\}\} {\bf{GOAL}}: prevent respiratory compromise \& complications} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Airway} \tn 
% Row Count 3 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Hemo - replace blood} \tn 
% Row Count 4 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Chest tube insertion} \tn 
% Row Count 5 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Check dressing around CT for erythema} \tn 
% Row Count 6 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{IVF \& blood replacement} \tn 
% Row Count 7 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{OR depending on severity} \tn 
% Row Count 8 (+ 1)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{No vent \{\{fa-arrow-right\}\} cough, deep breathe (ARDS!), ICS} \tn 
% Row Count 10 (+ 2)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Splint if rib fx} \tn 
% Row Count 11 (+ 1)
% Row 9
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Pain - nerve block} \tn 
% Row Count 12 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Abdominal Trauma}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Injury blunt or penetrating} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Massive blood loss/shock \{\{fa-arrow-right\}\} \& not know until severe retroperitoneal} \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{\{\{bb\}\} {\bf{Assessment}} - s/s may vary greatly, REASSESS!} \tn 
% Row Count 5 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Pain} \tn 
% Row Count 6 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Wounds \& abrasions} \tn 
% Row Count 7 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Bruising} \tn 
% Row Count 8 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Bowel sounds} \tn 
% Row Count 9 (+ 1)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Balance signs} \tn 
% Row Count 10 (+ 1)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Kehr's sign}}: {\emph{acute shoulder pain r/t \{\{nl\}\} blood/other irritants in peritoneum when pt is lying \& legs elevated}} = ruptured spleen} \tn 
% Row Count 13 (+ 3)
% Row 9
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Cullen's sign}}: {\emph{bruising below umbilicus}}} \tn 
% Row Count 14 (+ 1)
% Row 10
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Turner's sign}}: {\emph{flank bruising}}} \tn 
% Row Count 15 (+ 1)
% Row 11
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Diaphragmatic rupture (hear bowel sounds w/ breath sounds)} \tn 
% Row Count 17 (+ 2)
% Row 12
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Hypovolemia w/ large blood loss} \tn 
% Row Count 18 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Spleen most commonly damaged!  \newline - Abd. aorta, liver, \& hepatic vessels  \newline Bladder rupture from blunt trauma  \newline Knife wound w/ evisceration \{\{fa-arrow-right\}\} sterile saline on organs \newline Impalement injury \{\{fa-arrow-right\}\} STABILIZE \& remove in OR}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Diagnostic Studies}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{X-ray} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{CT scan - GOLD STANDARD FOR INJURIES}}} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{CBC (serial H\&H)} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{WBC - inflammation; abd wounds often dirty = prophylactic antibiotics} \tn 
% Row Count 5 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Serum glucose} \tn 
% Row Count 6 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Serum amylase} \tn 
% Row Count 7 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Liver enzymes} \tn 
% Row Count 8 (+ 1)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{US - bleeding?} \tn 
% Row Count 9 (+ 1)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{\textasciitilde{}\textasciitilde{}Peritoneal lavage\textasciitilde{}\textasciitilde{}} \tn 
% Row Count 10 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Abdominal Trauma Management}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{\{\{bb\}\} {\bf{GOAL}}: {\emph{correct volume deficit, prevent shock \& infection}}} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Prophylactic antibiotics} \tn 
% Row Count 3 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{IVF - crystalloids, colloids, blood} \tn 
% Row Count 4 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{NGT, Foley} \tn 
% Row Count 5 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{All invasive procedures} \tn 
% Row Count 6 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Try non-narcotic analgesics \{\{fa-arrow-right\}\} no ilieus} \tn 
% Row Count 8 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Limb Trauma}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Types: \{\{nl\}\} - {\bf{Strains}}: stress injury to muscle at tendon \{\{nl\}\} - {\bf{Sprains}}: ligament injury \{\{nl\}\} - {\bf{Fractures}}: break in the bone} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Assessment}}: \{\{nl\}\} {\emph{Strains \& sprains}} - pain, swelling, tenderness, muscle spasms \{\{nl\}\} {\emph{Fractures}} - same + loss of movement, may actually see bone/deformity} \tn 
% Row Count 7 (+ 4)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Diagnostics}} - XR (broken bones, visualize structures)} \tn 
% Row Count 9 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Management}} - immobilize, RICE \{\{nl\}\} - Compression bandage \{\{nl\}\} - Ice first 24-48 hr, heat to inc. circulation} \tn 
% Row Count 12 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{2.53827 cm} x{2.43873 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{6 P's of Limb Trauma}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{CARDIOVASCULAR}} \{\{bb\}\} & {\bf{NEUROVASCULAR}} \{\{bb\}\} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
Pulseless & Paresthesia \tn 
% Row Count 3 (+ 1)
% Row 2
\SetRowColor{LightBackground}
Pallor & Paralysis \tn 
% Row Count 4 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{Polar} \tn 
% Row Count 5 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{Pain} \tn 
% Row Count 6 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Crush Injuries}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Blood not circulating} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Hypovolemic shock} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Paralysis} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Erythema - r/t broken blood vessels (= edema) \& hard} \tn 
% Row Count 5 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Damaged body part} \tn 
% Row Count 6 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Renal dysfunction - rhabdomolysis} \tn 
% Row Count 7 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Column Break}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{} \tn 
% Row Count 0 (+ 0)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Complications of Trauma}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Hypermetabolism}} - NEED 3,000 cal + regular BMR in first 24-48 hr \{\{nl\}\} - Lose diaphragmatic integrity = won't get off vent, bacteria migrate = VAP \{\{nl\}\} - Promotes healing: inc. permeability of bowel = easier for bacteria to enter blood (infection, sepsis)} \tn 
% Row Count 6 (+ 6)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Infection}} - antobiotics prophylactically; seen in first 3 days, may be septic} \tn 
% Row Count 8 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Sepsis}} - debride often} \tn 
% Row Count 9 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Rhabdomyolysis}} - tissue breakdown \{\{fa-arrow-right\}\} myoglobin released \{\{fa-arrow-right\}\} AKI \{\{fa-arrow-right\}\} renal failure \{\{nl\}\} - Dark, tea-colored urine \{\{nl\}\} - Generalized weakness, muscle stiffness \{\{nl\}\} - Treatment: IVF to clean out kidneys \& lg molecules to dec. kidney damage} \tn 
% Row Count 15 (+ 6)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Multiple organ system dysfunction (MODS)}}} \tn 
% Row Count 16 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{\{\{bt\}\} PULMONARY} \tn 
% Row Count 17 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Respiratory failure}} - risk of ARDS} \tn 
% Row Count 18 (+ 1)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Pulmonary embolism}} - r/t damages, DIC} \tn 
% Row Count 19 (+ 1)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Fat embolism syndrome}} - long bone break = high risk \{\{nl\}\} - Affects clotting system, thrombocytopenia} \tn 
% Row Count 22 (+ 3)
% Row 9
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Pain}} - always an issue} \tn 
% Row Count 23 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Column Break}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{} \tn 
% Row Count 0 (+ 0)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{More Complications of Trauma}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{\{\{bt\}\} GASTROINTESTINAL} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Hemorrhage}}} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Acalculous cholecystitis}}} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{\{\{bt\}\} RENAL} \tn 
% Row Count 4 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Renal failure}}} \tn 
% Row Count 5 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Myoglobinuria}}} \tn 
% Row Count 6 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{\{\{bt\}\} VASCULAR} \tn 
% Row Count 7 (+ 1)
% Row 7
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Compartment syndrome}} - inc. pressure in confined space = restricts blood flow = area tense, swollen, no pulse \{\{fa-arrow-right\}\} fasciotomy \{\{nl\}\} - {\emph{Experienced pain out of proportion with what you would expect}}} \tn 
% Row Count 12 (+ 5)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Venous thromboembolism}}} \tn 
% Row Count 13 (+ 1)
% Row 9
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Hypotension}}} \tn 
% Row Count 14 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Elderly - other comorbidities make recovery difficult}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}


% That's all folks
\end{multicols*}

\end{document}