quiz

• Injury


  The result of harmful event that arises from the release of specific forms of energy
• Trauma


  Injury of one or more systems, that results in excessive bleeding and may affect the normal body functioning
• Penetrating trauma


  An injury caused by a foreign object piercing the skin, resulting in damage to underlying structures and an open wound
• Penetrating trauma


  • Can cause bleeding, respiratory, neurological problems, or any combination of these
  • Biggest risk for patients is airway compromise and significant hemorrhage
  • Has a high morbidity and mortality rate
  • Estimated that 50% of all trauma deaths are due to traumatic brain injury
• Classifications of penetrating trauma

  • Puncture wound
  • Penetrating wound
  • Perforating wound
• Penetrating wound


  • Common
  • Highly lethal with a fatality rate approaching 70-80%
• Extremity trauma


  • Most extremity injuries are not life threatening
  • Injuries to nerves and tendons can result in lifelong disability
• General body regions affected by penetrating trauma

  • Head
  • Neck
  • Chest
  • Abdomen/Pelvis
  • Extremities
• Solid organs


  Dense and low resilience
• Hollow organs


  • Fluid filled: transmit energy - increased damage
  • Air filled: absorb energy - less damage
• Connective tissues


  • Absorb energy and limit tissue damage
• Low velocity injuries


  • e.g. Stab injuries with knives or sharpened object
  • Injury is localized, less in damage, remains in situ
• High velocity injuries


  • e.g. Gunshot wounds, missiles >1,800 ft/sec
  • Cause cavitation injury, fragmentation, rotation injury
  • Smaller and faster bullets can cause more damage
• Entry wounds


  • Generally smaller and more regular than exit wounds
• Exit wounds


  • Show outward beveling of tissue
• Signs/Symptoms/Complications of penetrating trauma

  • Abdominal compartment syndrome
  • Hemorrhagic shock
  • Trauma to pelvis, diaphragm, or genitourinary system
  • Sepsis
  • Spinal cord injury
• Assessment/Diagnostics for penetrating trauma

  • Ultrasound (FAST)
  • X-ray
  • CT scanning
  • Physical assessment
• Primary survey


  CABCE - assess for entry and exit wounds, signs/symptoms of shock
• The scene should not be entered unless declared safe by the scene commander
• Scene management


  1. Scene time should be kept shorter than 10 minutes

  2. Transport should not be delayed for unnecessary investigations or interventions that can be performed en route or in the hospital
• Treatment/Management


  1. ABCs of trauma - establish airway, place chest tubes, control bleeding, initiate volume resuscitation

  2. Do not touch or remove impaled objects

  3. Use direct pressure, compression bandages, hemostatic agents for bleeding control

  4. Use Abdominal Aortic and Junctional Tourniquet as a bridging device
• Roles of nursing


  • Care provider
  • Educator - providing programs related to promoting wellness and preventing injuries
  • Manager - collaborate to improve emergency health care and provide excellent care
• Pre-hospital phase


  1. Call emergency number

  2. Mobilizes trauma team to ED
• Hospital phase


  1. Advance planning saves time

  2. Agency coordination
• CPR is ineffective for trauma patients due to blood loss, not cardiac arrest
• If a patient has been down for 20 minutes or more, consider whether interventions are an appropriate risk
• Blunt trauma


  • "non-penetrating trauma"
  • Injury to the body by forceful impact, falls, physical attack with a dull object
  • "the energy exchange between an object and the human body, without intrusion through the skin" (McHenry Western Lake County EMS)
• Causes of blunt trauma

  • falls from a high height
  • car collision (MVC)
  • physical assaults
  • contact sports
  • explosion
• Causes of blunt trauma

  • Direct blunt force: object striking the body
  • Acceleration or deceleration: rapid changes in kinetic energy
  • Shear force: forces pushing different parts of the body in opposing directions, often a combination of acceleration and deceleration
  • Compression: crush injury
• Common location of blunt trauma injuries

  • Head
  • Neck
  • Chest
  • Abdomen and pelvis
  • Extremities

  
• Manifestations of blunt trauma

  • pain
  • tenderness
  • bruises
  • internal hemorrhage
  • swelling

  
• Assessment of blunt trauma


  • when the injury occurred
  • mechanism of injury
  • level of responsiveness
  • specific injuries
  • estimated blood loss
  • recent drug or alcohol use
  • prehospital treatment
• How blunt trauma is diagnosed

  • X-ray
  • CT-scan
  • Ultrasound Imaging
  • Physical Examination

  
• Pharmacologic management of blunt trauma

  • Give analgesics
  • Give antibiotics
• Nursing management of blunt trauma

  • Secure and support the airway
  • Encourage deep breathing with strong inspiration; give local support to injured area
  • Regular assessment of vital signs, lungs sounds and oxygen saturation
  • Maintain ongoing surveillance for complications
• Medical management of blunt trauma

  • Surgery (Thoracotomy, Pericardiocentesis)
• Blunt trauma management


  • Immediate scene Assessment
  • Triage and Rapid Treatment
  • Pre-Hospital Care
  • Mobile Medical Units
  • Field Hospital
  • Disaster Interventions
• Injury


  The result of harmful event that arises from the release of specific forms of energy
• Trauma


  Injury of one or more systems, that results in excessive bleeding and may affect the normal body functioning

  
• Penetrating trauma


  Injury caused by a foreign object piercing the skin, resulting in damage to underlying structures and an open wound