Trauma New

7/27/2019 Trauma New

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Trauma Lecture 1

Nursing Care of

Clients Experiencing

Trauma

Nursing Care of

Clients Experiencing

Trauma



Trauma Lecture 2

Trauma:

• injury to human tissues and organs resulting

from the abnormal transfer of energy fromthe environment– Associated with ACCIDENT – a result without

intent, a random chance.

• Usually occurs suddenly

• Kills more people between the ages of 1 and44 than any other disease or illness and62% of all deaths from ages 15–24 are dueto trauma

• May alter the client’s previous way of life,potentially affecting independence,mobility, cognitive thinking, andappearance



Trauma Lecture 3

Components and Types of Trauma

• Trauma results from abnormal

exchange of energy between a host,a mechanism, and a predisposingenvironment.

•



Trauma Lecture 4

• FactorsInfluencing

the Host • Age

• Sex

• Race

• Economicstatus

• Preexistingillness

• Abuse

Mechanisms of

Injury

oMechanicaloGravitationalo

ThermaloElectricaloPhysicaloChemicaloEnvironmentaloWeather-relatedoOccupational

•



Trauma Lecture 5

Types of Trauma:

1.Minor – injury to single part or system. Ex.

Fracture, burn.2. Multiple trauma – involves diff. body parts

3. Blunt Trauma – there is nocommunication between the damage

tissues and outside environment.• Various forces include – deceleration,

acceleration, shearing, compression,crushing.

• causes multiple injuries to the head, spine,thorax, and abdomen

• Frequently caused by vehicular crashes, fallsassault, and sports injuries.

•



Trauma Lecture 6

4.Penetrating Trauma – foreign objectsenters the body causing damage to

body structures.• affects the brain, lungs, liver, spleen,

intestines, and vascular system

5.Inhalation – injuries from gases,smoke, steam, fumes.

6. Blast Injuries – can caused damage

in abdominal organs, pulmonaryedema, deafness, burns, etc.

•



Trauma Lecture 7

Effects of Traumatic Injury andImmediate Management

I. Airway Obstruction

• Closed head trauma

• Maxillofacial trauma

• Direct airway trauma

• Cervical spine injury

•

Burns•



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Immediate Management:

1. Establishing patent airway.

•Jaw thrust or chin lift maneuver

• Suctioning, removal of obstruction

2. High flow oxygen administration

3.Placement of an oral endotracheal tube(ETT) for intubation.

• When the ETT is in place, air or oxygencan be blown into the external opening

of the tube and enter the trachea.• Administration of meds such as beta

blockers prior to ETT.



Trauma Lecture 9

Management of TraumaManagement of Trauma



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4. Surgery - tracheostomy



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II. Tension Pneumothorax – resultwhen air enters the pleural cavity.

• On inspiration air enters the pleuralspace does not escape duringexpiration and increases intrapleural

pressure.• Can lead to mediastinal shift

• Can cause collapse of the lungs,

compression of the heart, thetrachea, great vessels resulting

•



Trauma Lecture 25

Manifestations:

• Severe respiratory distress

• Hypotension

• JVD

•

Tracheal deviation toward uninjuredside

• Cyanosis

•



Trauma Lecture 26

Management:

• Needle thoracostomy may be used in

the emergency treatment of atension pneumothorax.

• Large gauge needle is introduced, and

air and fluid are aspirated.• Alternatively, a chest tube may be

inserted and connected to a chest

drainage system.



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III. Hemorrhage

• May result from blunt or penetrating

traumatic injury.

• Can lead to hypovolemia shock

• Immediate Management:

• The major pressure points used for thecontrol of bleeding.

• In severe case blood transfusion isrecommended.

•



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IV. Integument Effects

• Contusions – (superficial tissue injuries)

result from blunt trauma causingmicrobleeding.

• Abrasion – (partial thickness denudation)result from fall or scrapes

• Puncture wound – sharp or blunt objectpenetrate in the skin.

• Lacerations – open wounds resulting from

cutting or tearing.• Full thickness avulsion injuries – result in the

loss of skin surface causing fat and muscleexpose.



Trauma Lecture 34

contusioncontusion



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abrasion.abrasion.



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puncture woundpuncture wound



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Laceration.Laceration.



Trauma Lecture 38

V. Abdominal Effects

• Can lead to rupture of abdominal organs

• Can result to ischemia and infarction• Hemorrhage eventually to peritonitis

VI. Musculoskeletal

• Can cause fracture

• Dislocation of joints•

VII. Neurologic Effects• Head and spinal cord injuries – most

common of sustained injury.

•



Trauma Lecture 39

VIII. MODS (Multiple organ dysfunctionsyndrome)

• Common complication of severe injury• Progressive impairment of 2 or more

organ system

• Common causes- infection, injury,ischemia, intoxication, iatrogenicfactors.

IX. Effects on Family

• Can cause situational crises



Trauma Lecture 40

Collaborative/Interdisciplinary Care for Trauma

• During Pre-Hospital Care at the Scene of Trauma/Accident

I. Injury identification – ex. Head and SC trauma,burns,

• Champion Revise Trauma Scoring System:

• Highest possible score is 12. The higher the ratethe greater the survival.

1.Airway and breathing assessments – if airway ispatent, maintainable, ventilation is impeded.

2.Circulation Assessment – palpation of pulses,assess capillary refill, skin color, temp. etc..

3.LOC and Pupillary function assessmento The use of Glasgow Coma Scale (GCS)



Trauma Lecture 41

Critical Intervention:

• Life support, treating the hemorrhage,

airway (bag valve mask resuscitator)• Immobilizing the cervical spine

• Client is placed on spine board

• cervical collar

• Head immobilizer, head blocks

•

tape•



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II. Rapid Transport

• Use of ambulance/air ambulance

• Any immediate form of transportationEmergency Dept. Care:

• Blood Typing and Cross matching

• Blood Alcohol level/Urine Drug Screen• Pregnancy Test

• FAST (Focused Assessment by Sonography

in Trauma• Diagnostic Peritoneal Lavage

• CT and MRI



Trauma Lecture45

Use of E-Meds:

• Blood Components and Crystalloids (use of IVF –isotonic/hypo ex.NSS, D5LR, Ringer’s solution)

• Inotropic Drugs – ex. Dopamine, Dobutamine,Isopretenolo given only after fluid vol. resuscitation

•

Vasopressors - used to treat neurogenic, septic, or anaphylactic shock. Ex. Dopamine, epinephrine,noreepinephrine, phenyleprine

• O pioids - used to treat pain

• Immunizations - tetanus prophylaxis (in case of open wounds)o Tetanus toxoid

o Anti tetanus serum



Trauma Lecture 46

Blood Transfusions and VolumeResuscitation therapies

• RBCs: replacement of oxygen carryingcapabilities

• Platelets: given for continued

hemorrhage• Whole blood: replaces blood volume

• Albumin: expands blood volume

• FFP – supplies plasma CHON, restoreclotting factors

• Cryoprecipitate – restore fibrinogen



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Note: Before any transfusionremember the ff:

1. Consent and Doctor’s Order2. Blood typing and Crossmatching –

Rh, ABO, expiration date, contains nobubbles and no discolorations.

• 2 Nurses should crossmatch

3. Warm the blood – in case of rapidadministration

4. During infusion:

• Monitor for fever, chills, hives,weakness, fainting, DOB

•



Trauma Lecture 49

• Transfusion Reactions:

1.Febrile reactions – due to leukocyte (mostcommon)

2.Hypersensitivity – results when Ab reacts againstimmunoglobulins.

• Urticaria – severe itchiness and appearance of of

reddened wheals on the skin.3.Hemolytic reactions – result in ABO

incompatibility

• Clumping of RBC’s

• S/sx – flushing of the face, burning sensation in theveins, headache, N/V, hypotension, Urticaria,chills, DOB, fever, lumbar and abdominal pain.

4.Hypervolemia and F and E imbalance



Trauma Lecture 50

•Priority Nursing Diagnosis for TraumaPt. and related individual

• Ineffective breathing pattern• Ineffective airway clearance

•Risk for Infection

•Risk for Injury

•Fluid volume deficit

•Decreased cardiac output

•Spiritual distress, Post-Traumasyndrome



Trauma Lecture 51

Shock

• Clinical syndrome characterized by a

systemic imbalance between O2 supplyand demand.o Life threatening cellular dysfunction

o Loss of tissue perfusion



Trauma Lecture 52

• Hemodynamic Principle and Homeostatic

Regulation:

1.Cardiac Output is sufficient to meet bodilyrequirements

2.Uncompromised vascular system – constrict

and relax3.Sufficient blood volume in the circulatory

system

4.Tissues are able to extract and utilize the O2from the capillaries.



Trauma Lecture 53

o Stroke volume (SV)– amount of blood pumped into

the aorta w/ each contraction of the left ventricle

o

Cardiac Output (CO) - amount of blood pumped per minute into the aorta w/ each contraction of

the left ventricle

• CO = SV x HRo Mean Arterial pressure – product of CO and systemic

vascular resistance (SVR)

o Increase sympathetic stimulation increases

vasoconstriction and SVR.

o Shock is triggered by drop in MAP and decrease in

CO, decrease circulating blood volume



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Stages of Shock

1.Early, Reversible, Compensatory shock

o Early s/sx – normal to slight increase in PR and RR ,bp is within normal,

o MAP falls to 10-15 mmHg below the normal

o Stimulation of Alpha & Beta adrenergic fibers

2. Intermediate or Progressive shock o MAP falls to 20 mmHg below the normal

o Anaerobic metabolism starts leading to acidosis.

3. Refractory or Irreversible Shock o Tissue Anoxia – cellular death

o Lethargic/obtunded



Trauma Lecture 56

Multisystem



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MultisystemEffects of Shock

Pathophysiology



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Types of Shock

1. Hypovolemic Shock – decrease in intravascular volume of

15% or more.

o Most common type of shock, affects all body systems

o Causes

Hemorrhage

Burns Dehydration

Persistent vomiting and diarrhea

Use of diuretics

Shifting of fluids from intravascular to interstitial

Third spacing



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2 Cardiogenic Shock occurs when heart



Trauma Lecture 61

2. Cardiogenic Shock- occurs when heartpumping ability is compromised that cannotmaintain CO and adequate tissue perfusion.

•

Loss of pumping action of the heartCauses:

• M.I – most common cause• Cardiac tamponade

• Pericarditis• Dysrhythmias• Valvular disease• Complications of cardiac surgeries• Electrolyte imbalance• Drugs affecting cardiac contractility• Head injuries

•



Trauma Lecture 62

• S/sx – cyanosis, cold and clammy skin,hypotension, rapid thready pulse,

vein distention, oliguria, increaseCVP



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3. Septic Shock – (Systemic inflammatory

response syndrome)

o Common causes – MRSA, Pseudomonas,E. Coli, strep infection

o Mostly affects pt. who have debilitating

disease and chronically ill.



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4 Ob t ti Sh k



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4. Obstructive Shock

o Cause by obstruction in the heart or great

vessels, impedes venous return or prevents effective cardiac pumping action

o Impaired diastolic filling (pericardial

tamponade, pneumothorax)5. Distributive Shock (Vasogenic shock)

o Result from massive vasodilation and

decreased peripheral resistance.

o Blood volume does not change, hypovolemic

results

6 N i Sh k lt f



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6. Neurogenic Shock – result of animbalance between parasympathetic and sympathetic stimulation of vascular smooth muscle.

o Causes:

Head injury

SCI

Insulin reactions (hypoglycemia)

CNS depressant drugs

Anesthesia (spinal/general)

Severe pain

Heat stroke

S/S



Trauma Lecture 67

S/Sx

• Hypotension

• Slow bounding pulse

• Anxiety, restlessness, lethargic

• Oliguria-anuria

• Decreased body temp.

7 A h l ti Sh k h iti it



Trauma Lecture 68

7. Anaphylactic Shock – severe hypersensitivity

• Cause – allergens (antigen will react to Ig E Ab)

o Ex. Drugs, BT administration, latex, snakevenom, insect bites

o Can result to massive release of histamines

and vasoactive amines.

o S/Sx

Hypotension

Tachycardia

DOB, Stridor, wheezes, laryngospasm,

bronchospasm, pulmonary edema

Restless, lethargic-comatose

Pruritus, cramps, vomiting, diarrhea

C ll b ti C



Trauma Lecture 69

Collaborative Care:

Diagnostic Tests:

• Hemoglobin and Hematocrit

• ABG

• Electrolytes

• BUN, creatinine, urine SG, osmolality

• C/S

•

Cardiac enzymes – LDH, CPK, SGOT• X-ray, CT, MRI

M t f Pt ith Sh k



Trauma Lecture 70

Management of Pt. with Shock

I. Medications

• Diuretics after fluid replacement

• NaHCO3 – to treat acidosis

• Calcium supplements – to treat Ca

imbalance

• Anti arrhythmic agent -

• Broad-spectrum antibiotics – for septic

shock

C di t i l id di it li (f di



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• Cardiotonic glycoside – digitalis (for cardiac

failure)

o Adrenergics drugs – epi/Norepinephrine,dobutamine,

• Corticosteroid – for anaphylactic shock

• Morphine – to dilate veins and decreaseanxiety

II O th i t i P O2 t



Trauma Lecture 72

II. Oxygen therapy – maintain PaO2 greater

than 80 mmHg, use of ventilator if

necessary]III. Fluid Replacement –

• use of crystalloids and colloids solutions

• Blood transfusion

Priority Nursing Diagnosis

• Decreased cardiac output

• Ineffective tissue perfusion

• Anxiety

Nursing Responsibilities



Trauma Lecture 73

Nursing Responsibilities

• Access, establish, and maintain an airway

•Establish a baseline assessment

• Prevent further progression

• Assess and monitor overall tissue perfusion

• Assess and meet psychosocial needs

• Provide comfort measures and reduce stimuli

• The client in shock should be positioned withthe lower extremities elevated approximately

20 degrees (knees straight), trunk horizontal,and the head elevated about 10 degrees.

Interventions for ClientsInterventions for Clients



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Interventions for ClientsInterventions for Clientswith Trauma and Shockwith Trauma and Shock




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• Intravenous Fluids

– Ringer’s lactate: replaces electrolytedeficits, increases circulating

volume– Normal saline compatible with

administration of blood



Trauma Lecture 77

Organ DonationOrgan Donation

• Most people can be organ donors• Organ donation can occur once brain

death established

• Exceptions for organ donation– Currently abuse intravenous drugs

– Preexisting untreated infections

–

Any malignancy other than primarybrain tumor

– Have active TB

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