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  1. Priority Assessments in the acute phase of trauma:
    ABCDE (Airway, breathing, circulation, disability-neuro, exposure/environment)
  2. AIRWAY:
    If no secure airway, clear any obstructions, intubate, or surgical airway. MAINTAIN neutral c-spine alignment.
    • -Patent airway does not guarantee adequate gas exchange
    • -Assess movement of air, RR, chest rise+fall, skin color, use of accessory muscles, SOB, JVD, change in trachea position
    • -O2! If breathing is effective, administer oxyge via nonbreather mask with flow rate to keep bag inflated (12-15L)-this will deliver 85-90% oxg.
  4. S+S of ineffective breathing:
    • altered mental status
    • cyanosis
    • asymmetrical chest wall expansion
    • use of accessory muscles
    • sucking chest wounds
    • paradoxical chest wall movement
    • trachea shift away from midline

    **Administer 100% O2 via bag-valve mask to assist with intubation or surgical airway and then vent 100% O2
    • -Palpate pulse for rate and quality, palpate central pulses (noticing differences b/t that and periperhal pulses)
    • -Palpate skin for temp and moisture
    • -Inspect skin for color, obvious signs of bleeding
    • -Auscultate BP if staff present
  6. S+S of ineffective circulation:
    • Tachycardia
    • Altered LOC
    • Uncontrolled external bleeding
    • Distended or abnormal flat jugular veins
    • Pale-cool-diaphoretic skin
    • Distant heart sounds
  7. What do you do if circulation is ABSENT?
    • Begin CPR, Initiate advanced life support, administer blood as prescribed, prepare for emergency thoracotomy and op care, & consider end of life issues
    • *Control uncontrolled external bleeding-Cannulate 2 veins with large bore IV's and infuse fluids (NS or LR), blood sample and GIVE BLOOD
    • *PRIORITY GOAL-rapid control of bleeding and restoration of normal tissue perfusion or O2 delivery to prevent shock
    • *Assume hypotensive trauma pt has hemmorhagic shock until proven otherwise
  8. Disability (Neurological Status)
    • Determine LOC using AVPU mnemomic (Alert, responds to Verbal Stimuli, pain, unresponsiveness)
    • Assess pupils for: size, shape, equality, reactivity to light
    • If decrease LOC present, conduct further in secondary assessment, monitor ABC's closely for pt who is not alert and verbal.
    • IF pt demonstrates signs of neuro deterioration, consider hyperventilation
    • *Monitor GCS for changes (eye opening, best verbal response, best motor response)
  9. Hemothorax (Definition, S+S, treatment)
    • Def: blood in pleural space, usually in conjunction with pneumothorax
    • S+S: dyspnea, diminished or absent heart sounds, dullness to percussion, shock
    • Treatment: Chest tube insertion with chest drainage system, auto-transfusion of collected blood, treatment of hypovolemia as necessary
  10. Tension Pneumonthorax (Definition, S+S, treatment)
    • Def: Air in pleural space that does not escape, continued increase in amount of air shifts intrathoracic organs & increases intrathoracic pressure
    • S+S: Cyanosis, air hungar, violent agitation, tracheal deviation away from affected side, subcutaneous emphysema, JVD, hyperresonance to percussion
    • Treatment: MEDICAL EMERGENCY! Needle decompression followed by chest tube insertion with chest drainage system
  11. Flail Chest (Definition, S+S, treatment)
    • Def: fracture in 2 or more adjacent ribs in 2 or more places with loss of chest wall stability
    • S+S: Paradoxic movement of chest wall, resp distress, associated hemothorax, pneumothorax, pulmonary cuntusion
    • Treatment: Stabilize flail segment with intubation in some pts; taping in others; oxygen therapy; treat associated injuries; analgesia
  12. Cardiac Tamponade (Definition, S+S, treatment)
    • Def: Blood rapidly collects in pericardial sac, compresses myocardium bc the pericardium does not stretch, and prevents heart from pumping effectively
    • S+S: Muffled, distant heart sounds, hypotension, JVD, increased CVP
    • Treatment: MEDICAL EMERGENCY! Pericardiocentesis with surgical repair as appropriate
    -Cullen's Sign
    -Grey-Turner's Sign
    ecchymosis around the umbilicus

    Ecchymosis around flanks

    (may indicate retroperitoneal hemorrhage)
  14. Emergency managment of Abdominal Injury
    • *Establish patent airway and adequate breathing, fluid replacement, and prevention of hypovolemic shock
    • *IV lines inserted, and volume expanders or blood given if hypotensive
    • *NG tube inserted to decompress stomach and prevent aspiration.
  15. Lab Values: Hct, Hg, Na, K
    • Hct:
    • *men: 40-55%
    • *women: 38-47%
    • Hgb:
    • *men: 13.5-18
    • *women: 12-16
    • Na:
    • 135-145
    • K:
    • 3.5-5.0
Card Set:
2011-05-09 01:33:42

NRS 440 Final-Major Trauma
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