Anda di halaman 1dari 25

Multisystem Trauma, Shock, Multisystem Organ Dysfunction Syndrome and Systemic Inflammatory Response Syndrome

Introduction to Trauma Unintentional or intentional damage to the body resulting from acute exposure to thermal,

mechanical, electrical or chemical energy Leading cause of critical illness and death in the USA.

Average ICU stay is 5 days

Risk of morbidity and death is increased in older patients and those with comorbidities

Falls are the most common cause of trauma in older adults

Legal Issues in Emergency Care

A highly litigious area (a lot of lawsuits come out of emergency care)

All 50 states have “Good Samaritan Laws” you can give care that is in good faith and

without charge for the good Samaritan law Nurses are accountable to the public for judgment and consequences of judgment

Delegation to unlicensed personnel is our responsibility

Confidentiality and privacy issues are critical

Federal and state laws mandate that EDs have a duty to provide service to those seeking care

 

(no “dumping”) cant send people to other places

Mandated Reporting (Have to be reported to some official organization)

Any death in the ED and deaths within 48 hours of hospital admission

Suspected abuse

Communicable diseases (HIV, hepatitis, TB)CDC

Elopement of psychiatric patients

Extensive burns

Homicide

 

Infectious outbreaks

Rape/sexual assault

Serious injury related to a medical device

STDs

Suicide or attempt

Some states mandate that seizures be reported to DMV

Giving Consent

 

Express consent: oral or written

Implied consent: if patient is unconscious or where immediate decisions must be made to

prevent loss of life or limb Emergent treatment of minors: if necessary to protect life or limb if guardian not available

Involuntary consent: physician or police officer determine the individual is a threat to self or

others Translation services: must be provided to speakers of other languages

Documentation Requirements

Initial assessment date/time

Time when each intervention occurs

Evidence that unstable patients are receiving intensive care

Identified problems and procedures are performed

All interventions

Use of translator

Patient responses to interventions

Nursing observations

 

Communications with other health team members

Communications with family members

Patient teaching/discharge instructions

Any refusal of care

Restraints = False Imprisonment?

Make sure you have an order for restraints

Document reason why you are using restraints

Forensics: Evidence Collection and Preservation

Collection, analysis, and interpretation of medical evidence presented in legal cases

Nurses are involved in evidence collection, preservation, and chain of custody

Blood, urine, photographs, clothing, GSR, weapons/missiles, nail scrapings, fluid collection

Guidelines for Evidence Collection

Never discard clothing

Place wet or bloody clothing in a paper bag

Do NOT wash the hands of a patient with Gun shot wound (cover with paper bags)gun shot

residue will be on the hands of the person who shot the gun Cut around bullet holes, powder marks and knife cuts in clothing

Fold clothing without shaking it (do not cross-contaminate clothing)

Precisely document what the patient says

Describe appearance of wounds and presence of blood

Photograph wounds

Document behavior in objective terms

Unless a procedure is essential, delay cleaning the patient or wounds until police see it

Do not handle bullets or other solid evidence (place in sealed container and label with location found, date, time, initials)

Chain of evidence is critical….must remain with the collector or be locked in a secure area until

released to law enforcement All parties sign the evidence label with date, time, time of exchange

If moisture is needed to collect biological samples (blood, tears), slightly moisten tip of cotton

swab with saline. Dry in separate containers/envelopes Each victim has just one opportunity to have evidence collected properly

Triage (to sort or to choose)

The rapid sorting of patients who present to the ED

Who needs immediate medical attention? Who can safely wait to be seen?

The most experienced nurse on duty should be the triage nurse

Rapid, brief assessment is done by an experienced nurse within 5 minutes of arrival to the ED

Chief complaint, vital signs, focused assessment related to symptoms, brief history

Must be nonjudgmental and empathetic (“I bet that really hurts” or “You don’t look like you feel well” can have a positive impact on the patient’s experience in the ED)

Purpose is to put the right person in the right place at the right time for the right reason

Small hospitals may have a “sick or not sick” system.

Three-level triage is most commonly used.

May be color coded or I, II, III

Emergent Patients

Require immediate care

Presenting problem is a threat to life, limb or organ

Cardiac arrest

 

Major trauma

Respiratory failure

Stroke

Loss of pulse in an extremity

Unconsciousness with inability to maintain airway

Anaphylaxis

Arterial bleeding

Sexual assaultevidence needs to be collected soon

Urgent Patients

 

Require prompt care, but may safely wait several hours if necessary

Abdominal pain

Fractured hip

Kidney stone

Vomiting and diarrhea

Asthma

Blood in urine or stool

Fractured extremity (if pulse is present)

Non-Urgent Patients

Could have been seen in a doctor’s office

Need care, but time is not critical

Patient can wait safely

 

Sore Throats

 

Rash

Conjunctivitis

 

Simple fractures

Lacerations not bleeding profusely but will need stitches

 

Flu

 

N, V & D

Reassess these patients at least every 2 hours

Who would you treat first?

22 year old college soccer player who has an obviously fractured tibia/fibula

36 year old woman who had a syncopal episode two hours ago while standing at her kitchen

sink 40 year old man with history of seizures who is semi-conscious and post-ictal

38 year old man who experienced sudden chest pain during the final minutes of the UGA-GT game and drove himself to the ED1 st

Triage in Multiple Casualty Situations

Treat the most seriously wounded who have the potential to be saved

The Focused Triage Assessment

Chief Complaint (why did you come today?)

 

Allergies

 

Current medications

Past medical history (Including Last Menstrual Period for women)

Events surrounding the illness or injury

 

Vital signs, pulse ox, accucheck if diabetic

Last tetanus shot

If an injury, speed of vehicle, direction of impact, patient position in the vehicle, use of restraints, airbags, ejection, rollover, fatalities, entrapment/prolonged extrication?

Victims of Abuse

 

Separate patient from others.

Victim will not speak honestly if abuser is there

The abuser will normally not step out of the roomlet that be a red flag to you

Document every little thing you see, every word spoken

Be aware of mismatches between physical S&S and what victim says (“tripped and fell down

the steps”) Look for areas that don’t “show” for injuries; Look for perineal trauma

Mechanisms of Traumatic Injuries

Knowledge about the mechanism can help explain type of injury, predict outcome, identify

common injury combinations, and indicate diagnostic testing needed Injury occurs when force deforms tissue

Force = Mass X Acceleration

Blunt Trauma (not penetrating- wont see any blood)

May be MVC, falls, assaults, contact sports

Multiple injuries common…force is distributed over a large area

Acceleration injuries are due to an increase in the velocity (speed) of a moving object

Deceleration injuries are due to a decrease in velocity of a moving object (car hits tree)….body

keeps moving forward when the car has come to an abrupt stop Shearing injuries occur when structures “slip” relative to each other (brain vs skull)like a

carpet burn Crush injuries occur when continuous pressure is applied to a body (pinned between a vehicle and garage wall)

 

Acceleration/Deceleration injuries most often occur in MVC’s and are most common

Injury occurs when soft tissue hits a hard object (such as bone)

Penetrating Injury

 

Produced by foreign objects (bullets, knife blades, debris) entering tissue

External appearance of wound does not reflect extent of internal injury

Low-velocity missiles cause little cavitation and blast effect, essentially only pushing tissue aside

High-velocity missiles (rifles, semi-automatic) produce greater energy and cavitation

The main injury determinants in stab wounds or impalements are length, width, and trajectory of the penetrating object and presence of vital organs in area of wound.

Initial Assessment and Management of Trauma

Pre-Hospital Care

Best chance of survival if advanced care is given within one hour of accident. “The Golden

Hour” Principal factor is transport time to a trauma center

Few interventions will be provided if transport time is short.

Extensive interventions if transport time is longer

Focus on maintaining airway, ventilation, controlling external bleeding and preventing shock, maintaining spine immobilization, quick transport. Neuro assessment after ABCs

Primary Survey (in hospital)****TEST Q’S

Life-threatening injuries identified and managed. ABC first.

C=circulation. Circulation=bleeding. Give fluids

Assessing for hypovolemia (hemorrhagic shock)…compression of artery and area of injury,

elevate, surgery, replacing lost volume. Two large-bore IV lines inserted Monitor, vital signs q 3-5 mins, pulse ox, blood work sent, type and cross match, urinary

catheter inserted, NG placed Assess for hypothermia (will cause clotting)

Primary survey determines diagnostic tests

hypovolemic shockpaleness, poor skin turgor, diaphoresis, tachycardia, oliguria, and

hypotension kidney is the least forgiving organnot uncommon for trauma patients to go through a time of kidney failure b/c of hypoperfusion

Secondary Survey

 

More detailed head-to-toe assessment to detect life or limb-threatening injuries

Patient history is obtained

Information about mechanism of injury (was person on foot or bike? Size of vehicle? Fatality?

 

Length of knife? Was assailant male or female? Caliber of bullet? Distance of GSW? How far was fall?)

Men stab deeper than women do

 

Make an assumption that there is a spinal cord injury until proven otherwise

Fluid Resuscitation in Trauma

Goal is to perfuse vital organs without inducing complications of fluid overload

Aggressive fluid resuscitation puts patient at risk of hypothermia and coagulopathy

Crystaloids (isotonic, hypertonic, or hypotonic)

Isotonics most commonly used in trauma. Closely mimics body’s extracellular fluid. 3 liters

of crystaloids for each liter of blood lost. Most commonly used is Normal Saline Hypertonics remain in vascular space and shift water into plasma. Causes rapid increase in blood volume. Most common is 3% saline

 

More whole particles than blood

 

Hypotonics not often used in trauma. D5W is example

Colloids (albumin, dextran, hetastarch)

Creates oncotic pressure which encourages fluid retention and movement of fluid into vascular

space Colloids have huge protein molecules in them

Fluid pulls from tissue into blood

 

Large molecules stay in intravascular spaces longer

Less volume is needed to achieve hemodynamic stability

Complications: anaphylaxis, coagulopathy

Blood products

 

Packed RBCs increase oxygen-carrying capacity and is the mainstay of treatment for trauma.

 

Provides hgb without a huge amount of fluid

 

If no time for cross-match, O-Negative blood is preferred for women of childbearing

age. O-Positive may be used in men and post-menopausal women

Fresh Frozen Plasma (coagulation factors) and platelets

Massive transfusions put patient at risk for SIRS, ARDS, and DIC

 

systemic inflammatory response syndrome, adult resp distress syndrome

 

Autotransfusion especially for chest trauma victims

Delayed Complications of Trauma

Heme: hemorrhage, coagulopathy, DIC

Cardiac: arrhythmias, heart failure, aneurysm

Resp: atelectasis, pneumonia, emboli, ARDS

GI: peritonitis, paralytic ileus, bowel obstruction, anastomosis leaks, fistulas, bleeding,

compartment syndrome Hepatic: liver abscess, failure

Renal: hypertension, myoglobinuria, ARF

Ortho: compartment syndrome

Skin: wound infections, dehiscence, breakdown

Systemic: sepsis, SIRS

Shock

A state of cellular hypo-perfusion, hypercoagulability, activation of the inflammatory response

system Anaerobic metabolism occurs in hypo-perfused areas and lactic acid is produced (acidosis)

Cell death occurs if oxygen is not adequate

As more cells die, tissues and organs become dysfunctional and end-organ failure occurs

Time is tissue when it comes to saving organs

Stage I of Shock Syndromes

The body activates compensatory mechanisms in an effort to maintain circulatory volume,

blood pressure, and cardiac output.

HR goes up

Relatively normal VS and cerebral perfusion may continue and shock not recognized.

Stage II of Shock Syndromes

Compensatory mechanisms begin to fail and metabolic and circulatory abnormalities become noticeable

Inflammatory and immune responses activate

Signs of dysfunction on one or more organs may become apparent

BUN and Cr begin to rise

Stage III of Shock Syndromes

Final, irreversible damage is done

Cellular and tissue injury are so severe that life may not be sustainable

Multisystem Organ Dysfunction (MODS) occurs

Very first sign of hypoxia=agitation

Decreased urine output

 

Doctor looks at lactic acid to investigate shock

General Principles for Shock Care

Establish adequate organ perfusion and oxygenation ASAP in order to lessen inflammatory

responses Key assessments include neuro, urine output, pulse ox, ABG measurements looking for acidosis and oxygenation, vital signs

Hypovolemic Shock

 

Inadequate circulating volume

Acute loss doesn’t allow normal compensatory mechanisms to occur

Cellular hypoperfusion, anaerobic metabolism, lactic acidosis, electrolyte and acid-base

disturbances occur Existing volume is shunted to heart, lung, brain which makes hypo-perfusion to other organs

worse Renal damage and cerebral anoxia can cause death

H&H, lactic acid levels determine fluid replacement

Large-bore IV needles (16 guage) and warmed fluids

Septic Shock

 

Septic shock, SIRS, and MODS are progressive stages of sepsis

Occurs due to complex interactions among invading microorganisms and the immune system,

inflammatory system, and coagulation Activated WBCs release mediators that cause endothelial cells to lose their tight junctions =

vascular permeability Vasodilation occurs, blood flow is maldistributed, heart muscle is depressed

Dilated veins decrease preload

Get blood cultures before beginning antibiotics!

Remove all potential sources of infection

Maintain MAP greater than 65 mm Hg, CVP 8-12 and blood glucose below 150 mg/dl.

Nutrition must be provided due to the high metabolic rate and need for protein

 

Tube feedings

Cardiogenic Shock

 

Due to loss of contractility of the heart

An extreme form of heart failure

Extensive LV damage from an MI is most common cause

Other causes are papillary muscle rupture, ventricular septal rupture, cardiomyopoathy

More common in advanced age, ejection fraction below 35%, large anterior MI, history of

diabetes. Individuals with preexisting cardiac disease are likely to develop cardiogenic shock after a trauma

Neurogenic Shock

 

Disruption of sympathetic tone, most often due to cervical or upper thoracic cord injury

Parasympathetic symptoms including hypotension, bradycardia, warm dry skin

Fluid resuscitation is most helpful; vasoconstrictions may help a little

External pacemaker

 
Tube feedings  Cardiogenic Shock  Due to loss of contractility of the heart  An

Anaphylactic Shock

 

Allergic reaction to an allergen that evokes a life-threatening hypersensitivity response

Antibody-antigen reaction causes WBCs to secrete mediators that cause vasodilation,

increased capillary permeability, bronchoconstriction, coronary vasoconstriction, urticaria Vasodilation = decreased preload = decreased cardiac output

Multiorgan System Dysfunction Syndrome (MODS)

The end-point of shock

Physiologic failure of several organ systems such that homeostasis cannot be maintained

without intervention No organ is independent of any other

Once one organ fails, others are likely to fail

Age is a big risk factor due to progressive changes in body systems even before a new

illness or injury have occurred. Lungs and kidneys are usually first organs to fail

Assessment and Management of Specific Traumatic Injuries: Thoracic

 Assessment and Management of Specific Traumatic Injuries: Thoracic  Tracheobronchial Trauma  Can be blunt

Tracheobronchial Trauma

Can be blunt or penetrating

Often associated by esophageal and vascular damage

Ruptured bronchi are often present with upper rib fractures and pneumothorax

Symptoms may be subtle: dyspnea, hemoptysis, cough, SQ emphysema, anxiety, hoarseness, stridor, air hunger, hypoventilation, accessory muscle use, retractions, apnea, cyanosis

Nursing: oxygenation!

Bony Thorax Fractures

Ribs and sternal fractures (flail chest)multiple rib fractures

Indicate serious intrathoracic and abdominal injury

Significant pain when breathing or coughing, and quickly cause pulmonary deterioration

Pleural space injuries (see Dr. Streit’s notes)

Injured side down when possiblestabilizes broken bones and inhaling on the good sided

Pulmonary Contusions

Bruising of lung tissue is potentially lethal

Ruptured capillary walls cause hemorrhage and leakage of plasma and protein into alveolar

spaces = Pulm Edema and hypoxia Suspect this in any patient who has a high-energy blunt chest trauma

Presence of scapular fracture, rib fractures, or flail chest raises suspicion

May take 6 hours for contusion to show on X-ray

Dyspnea, crackles, hemoptysis, tachypnea, increasing peak airway pressure, hypoxia, respiratory alkalosis (loosing carbon dioxide), poor response to increasing Fi02

Cardiac Contusion

 

Usually caused by blunt chest trauma (heart impacts sternum or heart is compressed between

sternum and back) EKG abnormalities, ECHO may show myocardial depression

Enzymes may be abnormalbruised heart will release enzymes

Cardiac monitor, hemodynamic monitoring, enzymes, treat pain

 
 Cardiac Contusion  Usually caused by blunt chest trauma (heart impacts sternum or heart is

Cardiac Tamponade

Life-threatening and can be from blunt or penetrating trauma

Problem is with fillingheart cant expand to fill with blood

Blood fills pericardial space and compresses the heart

Decreases cardiac filling which decreases cardiac output, contractility, and leads to shock

Even 50-100 ml of blood can create increased pericardial pressure

“Beck’s Triad”---decreased BP, muffled heart sounds, distended neck veins

Pulsus Paradoxus (inspiratory decrease in systolic BP of 10 mmHg)

Echo makes the diagnosisshows if there is fluid around the heart

Drain blood with long needle

Penetrating Cardiac Injury

Mortality rate 50-80%

If people survive it is because a tamponade saved them

Occasionally a small stab wound to right ventricle will seal itself off because of low pressure in that chamber

Aortic Transection (tearing or rupturing)

Leading cause of death from blunt trauma

Most die at the scene or before reaching hospital

Due to sudden deceleration forces (MVC or fall)

Thoracic aorta is very mobile and tears occur at points of fixation (descending arch)

Aorta continues to travel forward but can just go so far. Vessel wall tears

If outer layer of the aorta remain intact, aneurysm or hematoma may form and prolong live for

a short time Poor perfusion beyond the tear, pulse deficit in lower extremities or left arm, hypotension, upper arm hypertension relative to leg BP, pain, systolic murmur, hoarseness, resp

distress/dyspnea Nursing: hemodynamic monitoring and BP management, preservation of organ function

 

Septic Shock or sepsis is primary concern for penetrating objects into body

The older a person is the more likely the are to develop multi organ system failure

Aortic Transection/Dissection

 Penetrating Cardiac Injury  Mortality rate 50-80%  If people survive it is because a
 Penetrating Cardiac Injury  Mortality rate 50-80%  If people survive it is because a

Abdominal Trauma

 
 Penetrating Cardiac Injury  Mortality rate 50-80%  If people survive it is because a

Facts about Abdominal Trauma

Can be blunt or penetrating

 

Can rapidly lead to death due to hemorrhage, shock, sepsis

Single-organ injuries are rare….usually several are involved

Detection of injuries can be difficult and missed injuries are frequent cause of death

Penetrating injuries are “dirty”

Suspect if there is abdominal tenderness or guarding, hemodynamic instability, lumbar spine

injury, pelvic fracture, or retroperitoneal or intraperitoneal air Blunt trauma compression forces can fracture solid organ capsules and they bleed.

Hollow organs will collapse and absorb force but will leak their fluids

High HR, low BPHypovolemic shock

Diagnostic Tests for Abdominal Trauma

FAST (Focused Abdominal Sonography for Trauma) done in ER

 

First ABC, then if there is any free fluid in abd cavitiy straight to the OR

 

Peritoneal lavage looking for discolored or bloody fluid

CXR to detect organ displacement or free air

Abdominal CT

Regions of the Abdomen

 

Peritoneal Area : diaphragm, liver, spleen, stomach, transverse colon

Retroperitoneal Area : aorta, vena cava, pancreas, kidney, ureters, duodenum and part of colon

Pelvic Area: rectum, bladder, uterus, iliac vessels

Esophageal Trauma

 

Penetrating is the most common cause

Most often it is the cervical esophagus

 

Symptoms are subtle, but hemothorax or pneumothorax without rib fractures raise suspicion

CT of chest, abdomen and pelvis will be done, esophagoscopy, swallow studies

Keep NPO with an NG tube to continuous suction

Aggressive antibiotic therapy

Airway, oxygenation, hemodynamic support

Rupture of Diaphragm

More common in blunt injuries

Allows movement of abdominal organs into thorax, which can cause bowel strangulation

Respiratory compromise due to displacement of lung tissue

CXR, ultrasound, CT

Respiratory distress, dyspnea, decreased breath sounds on affected side, bowel sounds in the chest, abdominal fluid when inserting a chest tube

Stomach Trauma

 

Blunt gastric injuries can present with blood in the NG aspirate or hematemesis

Other signs are often absent and CT findings may be subtle

May not be diagnosed until peritonitis develops

Requires surgery with NG afterwards to keep stomach empty; jejunostomy tube for feedings

Pancreatic Trauma

 

Usually due to penetrating trauma

Acute abdomen, increased serum amylase/lipase levels, epigastric pain radiating to back,

nausea, vomiting Small lacerations may only require drains; larger wounds require surgery

Fistula formation common due to enzymes “eating away”

 

Rest the pancreas: NPO, NG to low suction, patency of drains, monitor fistula development

Colon Trauma

 

Most often due to penetrating trauma

Spillage of contents creates intra-abdominal sepsis and abscess formation

Exploratory lap is done and peritoneal cavity “washed out”

Sometimes colostomy needed

Wound may be left open

Watch for infection, dressing changes, antibiotics

Keep open abdomen moist with saline-soaked dressings, drainage bags, tegaderm

Spleen Injuries

 

The most commonly injured organ, usually from blunt trauma

Minor injuries may be observed with NG to decrease pressure on spleen

Very vascular, so blood loss is rapid

CT to diagnose

Left upper quadrant pain radiating to left shoulder (“Kehr’s sign”), hypovolemic shock,

elevated WBC

Early complications include recurrent bleeding, subphrenic abscess, pancreatitis

Late complications: thrombocytosis and overwhelming sepsis

Liver Trauma

 

Second most common injury

Can be due to blunt or penetrating trauma

May result in hematoma or laceration

 

Signs & Symptoms

 

Right upper quadrant pain

Rebound tenderness

Hypoactive or absent bowel sounds

Hypovolemic shock

 

Can cause huge blood loss into peritoneum

If stable, can observe with serial CT scans, H&H every 6 hours

Unstable patients require surgery to ligate or embolize bleeding vessels, repair lacerations, or resect part of liver

 

May need to give platelets or fresh frozen plasma

 

When hemorrhage is uncontrollable, liver is packed to tamponade the bleedingopen

abdomen. Risk is great for DIC, ARDS, sepsis

Kidney Trauma

 

May lead to “free” hemorrhage, a contained hematoma, intravascular thrombus, laceration or

contusion of renal tissue, or ruptured bladder Signs & Symptoms:

 

Hematuria!

 

Pain, flank hematoma, ecchymosis over flank

 

Treatment:

 

Some injuries can be resolved with bedrest but vascular injury will need surgical repair or

nephrectomy Optimal fluid balance and low-dose dopamine

 

Dilates renal arteries and promotes renal perfusion Complications that may develop:

Acute kidney failure, bleeding, urinary fistula formation, late-onset hypertension may occur

Bladder Trauma

 

Can be lacerated, ruptured, or contused

Usually due to blunt trauma when the bladder is full at the time of impact

Frequently associated with pelvic fractures

Injuries to urethra, scrotal hematoma, or displaced prostate gland must be ruled out before

inserting foley On FAST assessment you will see fluid

 

Urine will enter the intraperitoneal space and cause peritonitis

 

Supra-pubic cystostomy tube may be placed to drain urine out until area can heal

Musculoskeletal Injuries

 

Femur fracture higher priority than tibia or fibula fracture due to muscle/vascular damage

 
 Bladder Trauma  Can be lacerated, ruptured, or contused  Usually due to blunt trauma
 

MVCs, falls, industrial, farming, home injuries, and assaults cause musculoskeletal injuries

Require prompt recognition and stabilization

Fractures are classified according to type, cause, anatomical location.

Open fractures are classified grade I,II, or III depending on the amount of tissue, nerve, and vascular damage has occurred

Amputations

 

“Cut” or guillotine amputation clean lines and well-defined edges

“Crush” amputation ill-defined edges and more soft tissue damage

“Avulsion” amputation occurs when part of the body is stretched and torn away

Assessment

 

This is part of the SECONDARY survey unless there is arterial bleeding

If limb swelling, echymosis, or deformity is noted…

 

Check for capillary refill, pulses, crepitus over bone or joint

Check for muscle spasm, movement, sensation and pain

 

Pelvic fractures often associated with abrasions, lacerations, contusions, asymetry of lower

extremities. “Rock” the pelvis to look for instability

Rectal exams, vaginal exams done to assess for urethral tears. Treatment:

Pelvic binder, external fixator Compartment Syndrome

Pressure within the fascia-enclosed muscle compartment is increased

This compromises blood flow to muscle and nerves Result is tissue ischemia, and prolonged elevation of pressure causes necrosis

Caused By:

 

Decreased compartment size d/t restrictive dressing, splints, casts or excessive traction

Increased compartment contents r/t bleeding, edema, or IV infiltration

Signs:

 

Increased pain in the affected area that is “out of proportion” to injury

Decreased sensation and parasthesia

Firmness of tissue

 

***Paleness and pulselessness are late signs and extremity may be lost Remember 6 P’spallor, parathesia, pain, paralysis and pulselessness

Treatment

 

Fasciotomy surgical decompression of the affected compartment

Maxillofacial Trauma

***Paleness and pulselessness are late signs and extremity may be lost Remember 6 P’s  pallor,

Fractures of facial bones can cause sudden, deadly airway obstruction and death

**Primary concern after facial injury in to establish & maintain a patent airway!!

Only after primary survey, maxillofacial injuries are assessed

Look for facial symmetry then palpate to observe for any movement of bony structures

This coincides with a head injury, so thorough neuro exam is indicated

Careful assessment of ocular muscles & cranial nerve involvement (CN III, IV & VI)

Many injuries require multiple surgeries before patient is definitively treated

Plastic surgical consult for best body image

Continuously assess neuro status, airway, relieve pain and anxiety

Conclusion

 

Please wear your seatbelt

Please stay away from motorcycles

Please be careful when driving an ATV

Lawn mowers can be deadly

Be aware of your environment and don’t travel alone, especially at night

Anticipate what you would do if assaulted (Mace? Raid? Whistle?)

Let’s all teach our young people that their risk-taking behaviors are not cool

29/11/2013 16:36:00

29/11/2013 16:36:00