Trauma

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Trauma

• JOAN M. PINO-TABLOT
• FALL 2005

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Trauma

• Prevention of Trauma
• CAGE
• Mechanisms of Injury
• Blunt Trauma
• Penetrating Trauma

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Phases of Trauma Care

• Pre-Hospital Resuscitation
• Emergency Department Resuscitation
• Primary Survey (A, B, C, D, E)
• Airway
• Breathing
• Circulation
• Disability
• Exposure

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Phases of Trauma Care

• Resuscitation Phase
• Hypovolemic shock
• Hemorrhage
• 2 large bore peripheral IVs
• Secondary Survey
• A, M, P, L, E

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Phases of Trauma Care

• Definitive Care / Operative Phase
• Critical Care Phase
• ATLS guidelines
• Trauma complications
• ARDS
• Sepsis
• Shock states
• MODS

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Specific Trauma Injuries

• Traumatic Brain Injuries (TBI)
• Mechanism of Injury
• Pathophysiology
• Primary injury
• Secondary injury
• Consequences of increased ICP
• Risks of cerebral hypoperfusion
• Cerebral edema

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Specific Trauma Injuries

• Traumatic Brain Injuries (TBI)
• Skull Fracture
• Concussion
• Contusion
• Hematomas
• Epidural hematoma
• Subdural hematoma
• Intracerebral hematoma

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Specific Trauma Injuries

• Traumatic Brain Injuries (TBI)
• Missile Injuries
• Diffuse Axonal Injury (DAI)
• Neurologic Assessment

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Traumatic Brain Injuries (TBI)

• Degree of Injury
• Mild injury
• Moderate injury
• Severe injury
• Nursing Assessment
• Neurologic Pupils Glasgow Coma Scale
• Diagnostic Procedures
• CT scan

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Specific Trauma Injuries

• Spinal Cord Injuries
• Mechanism of Injury
• Hyperflexion
• Hyperextension
• Rotation
• Axial loading
• Penetrating injuries

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Traumatic Brain Injuries (TBI)

• Nursing Management
• Stabilization of vital signs
• Prevention of secondary injury
• Reduction of elevated ICP
• Hemodynamic management
• Fluid management
• CPP gt 70 mm Hg
• Aggressive pulmonary care
• Reduce environmental stimuli

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• Spinal Cord Injuries
• Functional injury of spinal cord
• Complete injury
• Quadriplegia
• Paraplegia
• Incomplete injury
• Brown-Séquard Syndrome
• Central Cord Syndrome
• Anterior Cord Syndrome
• Posterior Cord Syndrome

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Specific Trauma Injuries

• Spinal Cord Injuries
• Spinal Shock
• Autonomic Dysreflexia
• Assessment
• Airway
• Breathing
• Circulation
• Neurologic
• Diagnostic Procedures

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Spinal Cord Injuries Medical ManagementPharmacolo
gic management MethylprednisoloneSurgical
management Laminectomy Spinal
fusion RoddingNon-Surgical management Cervical
injury Thoracolumbar injury
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Spinal Cord Injuries

• Nursing Management
• Cardiovascular
• Pulmonary
• Musculoskeletal
• Integumentary
• Elimination
• Maximizing psychosocial adaptation

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• Maxillofacial Injuries
• Mechanism of injury
• Maxillofacial skeletal injuries
• Le Fort I
• Le Fort II
• Le Fort III

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Maxillofacial Injuries

• Assessment
• Diagnostic Procedures
• Medical Management
• Nursing Management

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Specific Thoracic Traumatic Injuries

• Pulmonary Injuries
• Pulmonary contusion
• Tension pneumothorax
• Open pneumothorax
• Hemothorax

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Specific Thoracic Traumatic Injuries

• Cardiac Injuries
• Penetrating cardiac injuries
• Cardiac tamponade
• Becks triad
• Blunt cardiac injuries (BCI)
• EAST guidelines

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Abdominal Injuries

• Mechanism of injury
• Blunt trauma
• Penetrating trauma

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Abdominal Injuries

• Physical Assessment
• Distended abdomen
• Rebound tenderness
• Cullens sign
• Grey-Turner sign
• Kehrs sign

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• Genitourinary Injuries
• Mechanism of injury
• Blunt trauma
• Penetrating trauma

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• Genitourinary Injuries
• Assessment
• Urine / hematuria
• Flank pain or colic pain

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• Specific Genitourinary Injuries
• Renal Trauma
• Bladder Trauma

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• Pelvic Fractures
• Mechanism of Injury
• Blunt trauma
• Physical Assessment
• Perianal ecchymosis
• Rocking of iliac crests
• Diagnostic Assessment
• Pelvic x-ray

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• Classification of Pelvic Fractures
• Anterior-Posterior (AP) Compression
• Lateral
• Compression (LC)
• Vertical Shear
• Open Fractures

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• Hypermetabolism
• Infection
• Sepsis
• Pulmonary
• Respiratory failure
• Fat embolism syndrome
• Pain

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• Renal Complications
• Renal Failure
• Myoglobinuria
• Vascular Complications
• Compartment Syndrome
• Deep Venous Thrombosis (DVT)
• Missed Injury
• MODS

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• Meeting needs of family members and significant
  others
• Crisis situation for family and friends
• Trauma in the elderly
• Risk of falls
• Limited physiological reserve
• Age related organ changes