first aid

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Author:
nurse&dad
ID:
118736
Filename:
first aid
Updated:
2011-11-23 23:37:39
Tags:
trauma
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Description:
interventions
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  1. What is a major trauma?
    • Energy is applied to body tissues in excess of what the tissues are able to absorb
    • Kinetic energy is the most common cause of trauma and includes mechanisms such as MVCs, falls, gunshot wounds
    • Thermal, electrical, chemical and radiation energy causes burns
    • Lack of O2occurs in events such as drownings and hangings
    • Major trauma pts are at risk for all types of shock - hypovolemic is most common
  2. Assessment
    • Primary
    • Focuses on managing immediate threats
    • "What could kill the pt now"
    • Goal: Evaluate and treat life threatening injuries
    • Secondary
    • Complete head-to-toe assessment to identify other serious injuries
    • Goal: Identify all the injuries the pt has incurred
  3. Primary Assessment
    • A: Airway (includes protection of spine)
    • B: Breathing
    • C: Circulation
    • D: Disability (neurological status)
    • E: Environment/Exposure
  4. Airway and C-spine assessment
    • Is the airway open
    • Can pt maintain airway
    • Is there potential for airway obstruction or compromise - tongue, blood, vomit, secretions, foreign objects, fx, loss of teeth...
    • Inspect face/neck for signs of trauma
    • Palpate neck for crepitus
    • Watch for dyspnea, low breath sounds, stridor, dysphagia, drooling
    • Open and secure airway
    • Suction gently PRN - prevent aspirations
    • Logroll as needed, keeping spine manually stabilized
    • Position pt to allow for max air mvmnt
    • Intubate as needed
  5. Breathing assessment
    • Respiratory rate, depth
    • Chest expansion (symmetry)
    • Accessory muscle use
    • Auscultate breath sounds bi-laterally
    • Palpate for crepitus or sub-q air in chest
    • Inspect for tracheal deviation or jugular vein distention
    • Assess for pain with breathing or palpation
  6. Breathing compromise
    • Injuries that can impair ventilation:
    • Rib fx (flail chest)
    • Pneumothorax
    • Hemothorax
    • Spinal cord injury
    • Head trauma
    • Ruptured diaphragm
    • Aspiration
  7. Circulation assessment
    • Check for obvious bleeding
    • Observe skin color
    • Palpate pulses (rate, rhythm, strength)
    • Check capillary refill
    • Palpate skin for temperature
    • Auscultate heart sounds and BP
    • Risk of shock is high with trauma-observe BP
    • Cardiac arrest, myocardial dysfunction, and hemmorhage can all lead to shock
  8. Rapid assessment of BP
    • Presence of radial pulse: BP at least 80 systolic
    • Presence of femoral pulse: BP at least 70 systolic
    • Presence of carotid pulse: BP at least 60 systolic
  9. Circulation interventions
    • Initiate CPR as needed
    • Control bleeding/hemmorhage
    • Position for shock (supine with feet up)
    • Establish large bore IV access
    • Isotonic fluids - LR or NS and blood
  10. Controlling bleeding
    • Firm, direct pressure on the bleeding site with thick, dry dressing material
    • Tourniquets not to be used unless bleeding so severe that the risk to limb viability is justified to save a life
    • Internal hemmorhage must be suspected in injured pts or those who present with shock
  11. Disability assessment
    • Observe pt responsiveness
    • Determine Glascow Coma Scale score
    • Assess PERRLA
    • Assess gross sensorymotor function - can pt move limbs
  12. Exposure
    • Expose pt to observe for signs of trauma
    • Remove all clothing to allow for thorough assessment
    • Always cut away clothing with scissors :
    • During resusitation when rapid access to pts body is critical
    • When manipulating pts limb to remove clothing could cause further injury
    • When thermal or chemical burns have caused fabrics to melt to pt
  13. Evidence collection
    • Vital in cases involving:
    • Rape
    • Elder abuse
    • Domestic violence
    • Homicide
    • Suicide
    • Drug overdose
    • Assult
  14. Hypothermia
    • Once clothing is removed, hypothermia poses risk to pts (esp those with burns)
    • Complicates management of pt:
    • Vasoconstriction
    • Coagulopathy
    • Difficulty with venous/arterial access or assessment
    • Increased bleeding
    • Slowed drug metabolism
  15. Interventions to prevent hypothermia
    • Remove wet sheets or clothing
    • Cover the pts with blankets
    • Set room temp to 75-80
    • Infuse only warm solutions/blood products
    • Heat lamps and warming blankets
  16. Secondary assessment
    • More comprehensive head-to-toe assessment to identify other injuries or conditions
    • Inspect for contusions, abrasions, lacerations, deformities, discoloration, edema, foreign bodies, other abnormalities
    • Assess all areas to locate areas or pain or tenderness,crepitus, deformity, loss of function
    • Reassess VS, GCS, heart/breath sounds PRN
    • Obtain hx if possible- AMPLE
    • Allergies
    • Medication
    • Past surgeries/Pertinent medical conditions
    • Last meal
    • Events leading up to incident
  17. Secondary interventions
    • Splint any limbs
    • Dress wounds
    • Administer pain meds as ordered
    • Tetanus shot- last date unknown or more than 5 years
    • Prepare for invasive monitoring and definitive treatment
  18. Labwork/Diagnostics
    • Blood typing and screening or cross-matching
    • Blood studies: CBC, Hgb, WBC
    • Coagulation studies: Platelets, PTT, PT, INR
    • ABGs and electrolytes
    • HcG for pregnancy
    • BAC/toxicology
    • Chest/pelvis radiograph
    • CT-head, neck, chest, abd, pelvis
    • Ultrasound
    • FAST- Focused Assessment with Sonography for Trauma
    • Used to assess for fluid around heart, liver, spleen, bladder
  19. Rules in trauma management
    • Every trauma considered C-spine injury until proven otherwise
    • Use nasopharyngeal intubation if C-spine injury
    • Do not give IM narcotics
    • Do not give vasopressors in hemmorhagic shock
    • Do not place NG in pts with neck injuries, facial fx, leakage of CSF
    • No foley if blood at meatus
    • No trendelenberg
    • Use tourniquets only as a last resort
    • Never use MAST suit without volume replacement first
    • Do not clamp chest tubes
    • Head injuries do not usually cause shock
    • Monitor clients with mechanical ventilation
    • No IV in lower extremity if abd injury is suspected
    • Do not apply external heat if blood volume deficits exist
    • Do not remove impaled objects

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