Physiology
Abdominal/head Trauma
Thoracic trauma
Mechanism of Injury
Random
100
How much blood for the average person is considered moderate
1000mls
100
A patient has represented 7 days post initial ED visit. 37 F had a fall, initially complained of L) shoulder pain- Xray completed, Nil injuries identified and DC home.
Today she has come in and is:
Pale, SBP 90, HR 110, Abdominal pain L) upper quadrant.
What suspected injury has been missed?
Ruptured spleen.
Due to the blood being an irritant to the diaphragm, this is referred pain via the vagus nerve - presenting as shoulder tip pain.
100
What is the most important nursing intervention that we can do for a patient with # ribs.
Analgesia.
Multi-modal-
Panadol, NSAIDS,
Oral Morphine,
Tramadol,
Regional blocks
100
Why is understanding of Mechanism of Injury important?
Helpful in predicting the pattern of injuries.
Predict the severity of injury.
Potential seriousness of injuries.
100
You have just recieved a call on the R40 that a 28 M is arriving in 15 mins following T bone at 100k. His vitals are:
SBP 90, HR 105, GCS 13
What preparation will you do?
1. Trauma Call
2. Prepare Team- Assign roles. (Dont forget the scribe role)
3. Heated mattress- Resus 2- onto bed.
4. Prepare Equip- Belmont primed?
200
What are the 3 aspects of the triad of death?
Acidosis
Hypothermia
Coagulopathy
200
These three things are the primary components inside the cranium.
Brain, blood and CSF
200
This often associated with severe rib fractures or misplaced chest tubes...feels like rice crispies under the skin.
Surgical emphysema
If widespread- can compromise airway
200
What injury is associated with the use of lap belts ?
Bowel perforation
Chance # of the spine
200
What is this?
The systematic reassessment of a patient 24-48 hours post admission, including review of radiology, and bloods.
Tertiary survey.
This is important to pick up missed injuries.
300
What are nursing management actions we can do to prevent this triad of death?
Warming- The patient, the room, blood products
Calcium
TXA
300
What are these all a sign of?
Headache, changes in behavior, changes in LOC, nausea, and/or vomiting
Early signs of Increased Cranial pressure.
Late signs are the Cushings reflex:-
Bradycardia
Hypertension
Agonal (erratic) breathing
Indicate brain herniation is pending.
300
This condition may also be referred to as a "lung bruise" and is associated with ineffective ventilation and blood tinged sputum
Lung Contusions.
Are given a higher Injury severity code than rib fractures if more than one lobe affected.
Impairs alvelar function.
300
What is ejection from a vehicle associated with?
Increased risk of injuries.
30% increased risk of significant injuries
300
Used to treat complicated fractures. Includes a series of pins inserted above & below fracture line and connected to a cross bar with clamps.
You may use this to lift extremity
External Fixators
400
Why is calcium important when giving mass blood transfusions?
Calcium is important component in the clotting cascade.
Also in RBC is a preservative called citrate- which binds to the endogenous calcium in the blood- making it unavailable to reduce bleeding.
400
A patient on the ward is 2 days post RTC (Road Traffic Crash) and has the following symptoms-
Distended abdomen, increasing abdo pain, guarding.
What injuries may have been missed?
Small bowel- Duodenal laceration/perforation.
30% patients will have seatbelt sign
400
What is this ?
400
What are these two symptoms indicative of?
400
Subdural Haematoma.
Other intracranial pathologies
500
What would you use a foley catheter for - other than urinary catherterisation?
Heamorrhage at the junctions:
Neck, Groin, axilla.
(Not commonly known but very useful for non-compressable heamorrhage sites and junctional injuries).
500
A 38 Female has represented into ED after having a fall at home. She was assessed 4/7 ago, complained of painful shoulder - xray was normal, and she was discharged.
She has returned and is pale, tachycardic and hypotensive. What is her suspected injury?
Splenic laceration.
Kehr's Sign- Due to the blood causing irritation to the diaphragm, this transfers via the vagus nerve to the diaphragm.
500
What is this?
Ruptured Diaphragm.
-Rare
-More common on Left side due to Right protected via the liver.
Can be subtle- laceration but no herniation of abdominal contents or complete.
Can be missed in initial CT scan.
500
A patient arrives to your department who has jumped from a balcony of a 2 story building landing on his feet
What might his injuries be?
# calcaneous
# vertebrae- compression
# pelvis
500
What is a closed degloving injury called?
A Morel-Lavallée lesion (MLL)
From Blunt Trauma. Often delayed diagnosis. One recently diagnosed after 3 presentations to ED. Can get infected, often have multiple surgeries with VAC dressings.
