Emergency Severity Index (ESI) and Trauma Care Management, Exams of Advanced Education

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Final Exam-Trauma Care

Emergency Severity Index (ESI) - a method of classifying patients into five categories based on the severity of their conditions and resource needs. 1—Resuscitation—immediate treatment is necessary 2—Emergent—may deteriorate rapidly, time sensitive 3—urgent---non-life-threatening, needs more than 2 resources 4—non-urgent—non-life-threatening, one resource required 5—minor—non-life-threatening, no resources required Emergency Severity Index (ESI) -1 - Resuscitation—immediate treatment is necessary Emergency Severity Index (ESI) -2 - Emergent—may deteriorate rapidly, time sensitive Emergency Severity Index (ESI) -3 - urgent---non-life-threatening, needs more than 2 resources Emergency Severity Index (ESI) -4 - non-urgent—non-life-threatening, one resource required Emergency Severity Index (ESI) -5 - minor—non-life-threatening, no resources required Initial management - Airway Ventilation Control bleeding

Prevent shock Maintain spinal immobilization Transport to closest facility Triage: Immediate (Red) - stabilization and evaluation/ airway management, breathing, and circulation Triage: Next - history of drug or toxins, time and duration of exposure, first aid treatment received prior to hospitalization Triage - the medical screening of patients to determine their relative priority of need and the proper place of treatment Obtain allergies, underlying disease, processes or related injury Safety for injuries -Contusion - major bruising due to blunt trauma Safety for injuries -Flail chest - segment of the rib cage breaks off due to trauma and becomes detached from the chest wall Safety for injuries -Hemothorax - collapsed lung where pleural cavity fills with blood,prepare for chest tube insertion on affected side, administer blood or blood products as ordered, anticipate and prepare for emergency open thoracotomy Safety for injuries -Spinal Cord Injury - avoid hyperextension or rotation of patient's neck, observe ventilatory effort and use of accessory muscles, maintain complex spinal immobilization, monitor for signs of disruptive (neurogenic) shock

Safety for injuries -Pneumothorax - collapsed lung where pleural cavity is filled with air, prepare for chest tube on affected side Safety for injuries -Compartment syndrome - fascia enclosed muscle compartment experiences increased pressure, neurovascular assessment, 5 p's (pain, pulse, pallor, paresthesia, paralysis), prep for fasciotomy Safety for injuries -Fat embolism - fat globules in lung tissue and peripheral circulation following trauma, causes hypoxemia, neurologic abnormalities, and petechial rash Safety for injuries -Overdose: commonly abused substances - nicotine, alcohol, heroin, marijuana, narcotic analgesic, amphetamine, benzodiazepine, cocaine, household substances Safety for injuries -Overdose: Triage - Immediate—stabilization and evaluation/ airway management, breathing, and circulation Next—history of drug or toxins, time and duration of exposure, first aid treatment received prior to hospitalization Obtain allergies, underlying disease, processes or related injury Is overdose intentional or suspected suicide? Safety for injuries -Overdose: Toxidrome - signs and symptoms associated with specific drugs A syndrome caused by a dangerous concentration of toxins in the body.

Safety for injuries -Overdose: Management - prevent further absorption, administer antidotes or antitoxins, support vital systems, reversative agent if available Emergency Response -Level of response: Level 1 - local emergency personnel/organizations can contain, effectively managed disaster Emergency Response -Level of response: Level 2 - regional efforts/aid from surrounding communities able to manage effects of disaster Emergency Response -Level of response: Level 3 - local/regional systems are overwhelmed, statewide, federal assistance needed Emergency Response -Triage Key elements of patient prioritization: Red - immediate, life-threatening, survivable Emergency Response -Triage Key elements of patient prioritization: Yellow - delayed, significant but can safely wait Emergency Response -Triage Key elements of patient prioritization: Green - minimal, minor, can be moved away from triage area Emergency Response -Triage Key elements of patient prioritization: Black - expectant, survival unlikely, comfort measures

Fluid Resuscitation -Rapid infusion of a crystalloid solution - Lactated Ringer's or normal saline (Isotonic) 250 ml up to 2 Liters Expand Volume Status Fluid Resuscitation -Rapid infusion of a colloid solution - Rapid volume expander (albumin, dextran) Fluid Resuscitation -Blood products - Hemodynamically unstable Showing signs of tissue hypoxia despite crystalloids infusion IV access of a 20 gauge and higher Infuse with only normal saline Transfusion reaction: keep vein open with normal saline solution Fluid Resuscitation -Blood substitutes - Do not require crossmatch Rule of 9's for burns - Head = 9% Arms = 18% (9% each) Back = 18%, Front/chest 18% Legs 36% (18% each) Genitalia = 1 Parkland formula for fluid resuscitation - for first 24 hr to stabilize burn victim 4X (weight kg) X (% body surface burned)=mL Give half in first 8 hour and other half over next 16 hr

Total body surface area % x weight (kg) x 4mL Circumferential burns - Burns on the neck or chest that may compress the airway or on an extremity that might act like a tourniquet. in cases where a full thickness burn affects the entire circumference of a digit, extremity, or even the torso inhalation injury - An injury to the airway as a result of breathing smoke and toxic chemicals into the lungs and airway. acute injuries to your respiratory system and lungs. They can happen if you breathe in toxic substances, such as smoke (from fires), chemicals, particle pollution, and gases. Inhalation injuries can also be caused by extreme heat; these are a type of thermal injuries. TBI - traumatic brain injury generally increase in metabolic rate so at risk for dehydration, falls→ keep body temp normal pt in MVA with closed head trauma→ plan care, think increase ICP...priorities - what was the cause of the injury (concussion, contussion) avoid twisting because causes more edema low stimulus environment monitor BP ABC closed head injury= seizure percautions

keep ICP low= space out interventions, if ICP is high make sure patient is well ventilated pneumothorax: look for mediastinal shift (everything pushed to unaffected side including the trachea) (wouldn't see air on affected side) increase ICP think about bP - keep BP little higher than normal bc CPP (70) MAP-ICP=CPP MAP= 2(diastolic)+systolic/