TRAUMA a physical injury or wound that is inflicted by an external or violent act occurs when an external force of energy strikes

es the body and causes structural or physiologic alterations or injuries maybe intentional or unintentional Causes: external forces: radiation, electrical, thermal, chemical, or mechanical wound or injuries on human body are from particular mechanism that exceeds the bodys ability to protect itself from injury a. Weapons (multiple stabbing) b. Automobile crashes c. Falls d. Physical confrontation e. Any other unnatural occurrence to the body Classification: 1. BLUNT the body is intact, a sudden compression results to fracture (i.e. ribs) 2. PENETRATING disrupt the body surface due to foreign object penetration. 3. PERFORATING leaves entrance and exit wound as an object passes through the body Head trauma damage of brain, ICP, change in blood flow Multiple trauma may be seen in a situation where there is a vehicular accident, act of violence such of multiple stabbing and gunshot wound it causes a life threatening injuries to at least two (2) distinct organs Abdominal trauma Chest trauma tension pneumothorax, hemothorax EXAMPLES OF MULTIPLE TRAUMA 1. Hit & run result in fracture at the point of impact with the car bumper or hood. 2. Driving without a seatbelt may result in a. Head or facial injury b. Fracture ribs and sternum c. Cardiac compression d. Lacerated solid organ e. Patellar injury, femur fracture 3. Fall from height & lands on heels a. Bilateral calcaneal/heel fracture b. Compression fracture of both wrist Primary Assessment (Pre-hospital Resuscitation) C - circulation (RR, BP, Hemorrhage, capillary refill) A - airway patency B - breathing D - disability E - exposure and environment Secondary Assessment S - signs and symptoms A - allergy M - medications P - past medical history L - last meal E - events leading to injury

REMEMBER!!!!! NOI (nature of incident) TOI (time of incident) POI (place of incident) DOI (date of incident)

PATHO: 1. Abrasion skin is scraped 2. Laceration skin is torn 3. Punctured wound pointed objects 4. Traumatic amputation part of the body is removed CHAMPIONs TRAUMA SCORING Glasgow Coma Scale (GCS) 13-15 9-12 6-8 4-5 3 Assessment: A. Penetrating Chest Trauma Dyspnea Tachypnea Tachycardia Absence of breath sounds Sucking sounds Cyanosis B. Abdominal Trauma Absence of bowel sounds Hypovolemic shock Orthostatic hypotension Pain and tenderness C. Blunt Abdominal Trauma Spleen (LUQ pain) Liver (RUQ pain) Hypovolemic shock signs Diagnosis: X-ray CBC CT Scan Coagulation Studies ABG Analysis Serum Electrolytes Level Nursing Management/Intervention Airway (patency) Jaw-thrust maneuver Neck is at midline and stabilized Breathing Established 100% O2 via bag valve mask Airway tubes (oral/nasal or ET tubes) Suction secretion Remove foreign bodies Treat life threatening conditions Systolic Blood Pressure (SBP) >89 76-89 50-75 1-49 0 Respiratory Rate (RR) 10-29 >29 6-9 1-5 0 Coded Value 4 3 2 1 0

 Circulation CPR, medications, defibrillators, and synchronized cardioversion Control hemorrhage with direct pressure Establish IV access and fluid therapy Treat life threatening conditions Disability Cervical spine immobilization Exposure and Environment Institute appropriate therapy (warming for hypothermia and cooling for hyperthermia) Management Rest Splint the chest during coughing or deep breathing Apply dressing over open wounds Oxygen as ordered High-fowlers position (unless contraindicated) Initiate cardiac monitoring; obtain 12 leads ECG Insert NGT Insert Foley catheter Monitor urine output Monitor vital signs Secondary Assessment and Intervention head to toe assessment prepare for radiograph for cervical spine, chest, CT scan or MRI as indicated administer tetanus booster if wounds are present splint fracture, apply ice, elevate the area clean and dress wound (wounds are repaired only after the client is stabilized or in the OR) provide emotional support to the client and significant others remain with the client, allay anxiety pain medication is commonly not given initially for clients with multiple trauma (may mask the identification of significant injuries and interfere with the accurate neurologic status) Surgical Management Head trauma Craniotomy incision through the cranium to remove accumulated blood or tumor Abdominal trauma Exploratory Laparotomy Chest trauma Chest tube therapy AORTIC ANEURYSM (Aneurysm) a localized outpouching or an abdominal dilation in a weakened arterial wall typically occurs in the aorta between the renal arteries and the iliac branches, but the abdominal, thoracic, or ascending arch of the aorta may be affected Risk Factors: Advanced age History of hypertension Smoking Atherosclerosis Connective tissue disorders Diabetes mellitus trauma

Signs and Symptoms ASYMPTOMATIC Thoracic Aneurysm Substernal pain radiating to the neck, back, abdomen or shoulders (occurs when the patient is in SUPINE) Hoarseness or coughing Dysphagia Dyspnea Hemoptysis Hematemesis Unequal BP when measured in both arms (due to the compression of left subclavian artery) Aortic insufficiency murmurs Expansion of Thoracic Aortic Aneurysm Severe Hypertension Neurologic changes A new murmur of aortic insufficiency Right sternoclavicular lift Jugular vein distension Tracheal deviation Abdominal Aortic Aneurysm Gnawing, generalized, steady abdominal pain Lower back pain unaffected Gastric or abdominal fullness Pulsating mass in the periumbilical area Systolic bruit over the aorta Bruit over the femoral arteries Hypotension (when aneurysm ruptures) Diagnostics Transphenoidal Echocardiography (TEE) and Doppler flow studies Abdominal ultrasonography or echocardiography AP and lateral X-ray of the chest or abdomen CT Scan and MRI Treatment Resection and replacement using a vascular or Dacron graft Serial ultrasonography for small aneurysms Endovascular grafting for abdominal aortic aneurysm Medications to control BP, relieve anxiety and control pain Rupture of Aneurysm: IV fluid and blood replacement (large bore IV catheter) IV propanolol - myocardial contractility Analgesics to relieve pain (Morphine) Arterial line and indwelling urinary catheter Prepare for emergency surgery Nursing Management V/S especially BP every 2-4 hours Assess CV status HR, ECG Blood samples evaluate kidney function I and O hourly

CBC ABG Analysis and cardiac rhythm Administer medications as ordered Monitor for signs of acute blood loss

Post-op Nursing Management Suctioning, CPT, and deep breathing Continuous cardiac monitoring Urine output hourly Maintain NG tube patency Assess for poor arterial perfusion Assist with serial Doppler examination CAROTID ENDARTERECTOMY a surgical procedure removing the intimal lining of an artery to remove atherosclerotic plaques from the aortic arch or common carotid bifurcation may be required before a CABG to alleviate the possibility of plaques dislodging and obstructing coronary artery blood flow Assessment patient history of transient ischemic attack (TIA) physical examination includes: auscultation for presence of a carotid bruit thorough neurologic examination V/S, heart sounds and peripheral pulses Diagnostics Carotid Doppler and CT Scan ECG Angiogram Nursing Management Maintain the head in a straight position Monitor V/S post-op; elevate HOB once V/S are stable Monitor BP frequency ensure cerebral perfusion Assess operative site every 1 hour or PRN for excessive swelling or hematoma Monitor neurologic functions Administer pain medication as prescribed Auscultate for adventitious breath sounds Be aware of complications Complications Hemorrhage Hematoma Embolism CVA TIA ICP