|
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
|
|
Radiation
|
Electrical
|
Thermal
|
|
Chemical
|
Mechanical
|
Motion
|
|
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)
|
|
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 |
|
Penetrating or blunt
Children have more pliable chests (cartilage) |
|
Types:
- Myocardial or pulm. contusion - Rib fx - Flail chest - Cardiac tamponade - Pneumothorax - Hemothorax |
|
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)
|
|
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
|
|
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
|
|
Fluid accumulation in pericardium dec. CO
|
|
Assessment - Beck's Triad (muffled heart sounds, JVD, hypotension
|
|
Management - supportive, O
2, pericardiocentesis |
|
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
|
|
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!
|
|
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
|
|
CXR
|
fracture, hemo- or pneumothorax
|
|
ABG's
|
hypoxemic, acid-base imbalance
|
|
EKG
|
hypoxemia arrythmias
|
|
CBC
|
serial CBC's q6h to determine bleeding, something else
|
|
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
|
|
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
|
|
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?
|
|
|
|
GOAL: correct volume deficit, prevent shock & infection
|
|
Prophylactic antibiotics
|
|
IVF - crystalloids, colloids, blood
|
|
NGT, Foley
|
|
All invasive procedures
|
|
Try non-narcotic analgesics no ilieus
|
|
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 |
|
CARDIOVASCULAR
|
NEUROVASCULAR
|
|
Pulseless
|
Paresthesia
|
|
Pallor
|
Paralysis
|
|
Polar
|
|
|
Pain
|
|
|
Blood not circulating
|
|
Hypovolemic shock
|
|
Paralysis
|
|
Erythema - r/t broken blood vessels (= edema) & hard
|
|
Damaged body part
|
|
Renal dysfunction - rhabdomolysis
|
|
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
|
|
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
|
No comments yet.
Cheatography n. The art of mapping complex subjects into clear, instantly navigable reference guides.
