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11th Edition ENA
Cavitation refers to the... - ansSeparation of surrounding tissue resulting from a sound and/or hydraulic wave force. This rapid motion can lead to crushing, tearing, and shearing forces on tissue. The impact of cavitation is dependent on the characterists of the affected tissue. Additional considerations include:
- Air-filled organs such as lungs or stomach, are elastic, so this tissue tolerates high- velocity cavitation relatively well compared to other tissues
- Solid organs such as the liver, have a greater propensity to shear or tear under the same forces
- If those same forces are instead released inside the cranium, bone will resist expansion, augmenting soft tissue crushing, until the tensile strength of the bone is exceeded and an explosive release of pressure results ch. 4, p. 32 Central cord syndrome - ansloss of motor function in upper extremities that is greater than that of lower extremities. often sacral sparing. bladder function may be affected ch. 13, p. 182 Classifications of acute pain are based on the source and origin and include...
- ansSOMATIC pain originates from skin and muscloskeletal structures VISCERAL PAIN originates from organs and may lead to referred pain ch. 8, p. 93 Components of CUS and its purpose - ansC: I am Concerned U: I am Uncomfortable S: This is a Safety issue/ I am Stressed Purpose- used to "stop the line" if a team member senses or discovers an essential safety breach p. 7 Components of DESC and its purpose - ansD: Describe the specific situation or behavior E: Express your concerns or how the situation makes you feel S: Suggest alternatives and seek agreement C: State consequences in terms of impact on performance goals
11th Edition ENA
Purpose- used in conflict management; paraphrasing the other person's comments is an important technique that should be done throughout the DESC script. Following discussion of consequences, team members should work towards consensus. p. 7 Components of SBAR and its purpose - ansS: Situation B: Background A: Assessment R: Recommendation Purpose- to provide framework for communication amount members of the healthcare team p. 7 Compression may occur from the effects of chemical substances and can cause.. - ansEdema, restricting or obstructing the airways, oxygenation, and ventilation. This can result from aspiration of liquids or inhalation of powder or noxious gas. ch. 4, p. 33- 34 Compression strength refers to the tissue's ability to: - ansResist crush force
- Compression injuries to organs occur when the organs are crushed from surrounding internal organs or structures such as a seatbelt worn up across the abdomen causing compression of the small bowel or a fracture to the lumbar spine p. 27 Consider ABGs. A decreased level of consciousness may be an indicator of... - ansDecreased cerebral perfusion, hypoventilation, or acid-base imbalance. ch. 5, p. 46 Define biomechanics - ansThe general study of forces and their effects p. 25 Define kinematics - ansThe study of energy transfer as it applies to identifying actual or intentional injuries p. 25 Define mechanism of injury (MOI) - ansHow external energy forces in the environment are transferred to the body
11th Edition ENA
Ch. 9, p. 113 Describe NEUROGENIC SHOCK - ansOccurs with SCI results in the loss of SNS control of vascular tone, which produces venous and arterial vasodilation. ch. 7, p. 75 Describe SEPTIC SHOCK - ansCaused by systemic release of bacterial endotoxins, resulting in an increased vascular permeability and vasodilation. ch. 7, p. 75 Describe the MOI associated with brain, cranial, and maxillofacial trauma - ansBLUNT injury - falls, MVCs, sports-related injuries, recreation PENETRATING injury - firearms or exploding objects or projectiles Ch. 9, p. 108 Describe the three E's of injury control - ansEngineering: technological interventions such as side impact airbags, automated blind spot alarms, ignition lock devices for those with DUIs. In playgrounds and sports, this involves surface material under playground equipment and athletic safety gear. Another intervention is improved use of smoke alarms in fire prevention Enforcement and legislation: include laws at all jurisdictional levels regarding driving while intoxicated, booster seats, primary seatbelt use, and distracted driving. For sports this includes rules regarding illegal hits, examination after impact, and return-to-play requirements after a head injury Education: these can be community-based initiatives such as public service announcements for improved seatbelt use, education regarding risks of distracted driving, programs to commit to no texting while driving, and promotions for bicycle helmet giveaways with instructions for proper use p. 11 Disadvantages of auto-transfusion include: - ans- Risk of contamination
- RBCs might become hemolyzed during hemorrhage
- Coagulation factors, including platelets and cryoprecipitate may be destroyed, increasing d-dimer in collected blood ch. 7, p. 81
11th Edition ENA
During primary survey... - ansLife-threatening conditions are identified and immediately corrected, beginning immediately upon the patient's arrival to the trauma room. ch. 5, p. 40 During the secondary survey in patient with thoracic or neck trauma, what questions do you want to ask? - ansIf patient is complaining of:
- DYSPNEA
- DYSPHAGIA
- DYSPHONIA Was there a cardiac event prior to injury? If CPR is being performed, when was it started?
- Important information in determining the indications for performing an emergency thoracotomy or when to consider withdrawal of support Ch. 11, p. 143 Early assessment findings of increased ICP include: - ans- HEADACHE
- NAUSEA/VOMITING
- AMNESIA
- BEHAVIOR CHANGES (IMPAIRED JUDGEMENT, RESTLESSNESS, DROWSINESS)
- ALTERED LEVEL OF CONSCIOUSNESS ( HYPO/HYPERAROUSABILITY) Ch. 9, p. 109 Early treatment for septic shock includes... - ansEarly administration of antibiotics and potential need for norepinephrine to vasoconstrict the peripheral vasculature, increase blood volume return to heart, and improve cardiac output. ch. 7, p. 75 Examples of referred pain include... - ans- radiating to left shoulder (Kehr sign)
- referred to testicle may be indicative of duodenal injury
- always begin palpation away from inital site of pain by assessing the painful area last ch. 12, p. 158 Explain 3 phases of injury prevention - ansPrimary: prevention of the occurrence of the injury Secondary: Reduction in the severity of the injury that has occurred
11th Edition ENA
- IRREGULAR or TEARDROP-SHAPED PUPILS or PRESENCE of what looks like a secondary pupil due to a tear in the ciliary body (traumatic iridodialysis)
- PERIORBIAL ECCHYMOSIS
- DECREASED VISUAL ACUITY and EOM
- SEVERE SUBCONJUNCTIVAL HEMORRHAGE
- NAUSEA
- PAIN Treatment includes:
- AVOID ANY TYPE OF PRESSURE TO GLOBE - DO NOT PERFORM TONOMETRY
- APPLICATION OF RIGID SHIELD to protect affected eye
- Administration of antiemetics
- AVOID USE OF OPHTHALMIC DROPS or MEDICATIONS
- CONSULTS
- Pain not always present in globe penetration Ch. 10, p. 131 Ch. Ch. 10, p. 131- 132 Explain how to assess circulation and control of hemorrhage in relation to thoracic trauma - ansAuscultation for:
- MUFFLED HEART SOUNDS or MURMURS Palate for:
- CENTRAL PULSES compare quality between left and right and lower and upper extremities
- EXTERNAL JUGULAR VEIN DISTENTION
- EXTREMITIES FOR MOTOR and SENSORY function Lower extremity paresis or paralysis may indicate an aortic injury Ch. 11, p. 142 Explain HYPHEMA - ansCollection of blood in anterior chamber of eye - classified as spontaneous or traumatic Assessment findings include:
- PAIN, PHOTOPHOBIA
- NOTICEABLE COLLECTION OF BLOOD IN EYE CHAMBER
- BLURRY VISION due to blood in chamber
- INCREASED IOP, NAUSEA, and SEVERE PAIN with grade 4
11th Edition ENA
Treatment includes:
- ELEVATING HOB 30 degrees
- protecting eye with METAL SHIELD
- TOPICAL OPHTHALMIC CYCLOPLEGICS and OPHTHALMIC STEROIDS, OPHTHALMIC BETA-BLOCKERS if IOP is ELEVATED
- Avoid aspirin and NSAIDs as they increase risk of re-bleeding
- Risk of re-bleeding greatest 3-5 days after injury Ch. 10, p. 131 Explain NEUROGENIC SHOCK and what are the assessment findings - ansOccurs with SC damage at T6 or higher, resulting in sympathetic regulation disruption of vagal tone leading to loss of vascular resistance and generalized vasodilation Assessment findings
- BRADYCARDIA
- HYPOTENSION
- WARM, NORMAL COLOR SKIN
- CORE TEMPERATURE INSTABILITY ch. 13, p. 181 Explain OBITAL FRACTURE - ans- NOT CONSIDERED OPHTHALMOLOGIC EMERGENCY unless there is IMPAIRED VISION or GLOBE RUPTURE
- Usually result from DIRECT BLOW TO EYE
- Complication of this type of fracture is ENTRAPMENT OF THE INFERIOR RECTUS or INFERIOR OBLIQUE MUSCLE Assessment findings include:
- PERIORBIAL ECCHYMOSIS
- DIPLOPIA WITH UPWARD GAZE
- ENOPHTHALMOS
- INFRAORBITAL NUMBNESS
- DECREASED EOM Treatment includes:
- ORAL ANTIBIOTICS
- COOL COMPRESSES
- CONSULT with possible surgical repair if pt continues to have DIPLOPIA or ENOPHTHALMOS 1-2 weeks after swelling has decreased
- Discharge instructions include: advise pt to AVOID BLOWING NOSE, SNEEZING, and/or PERFORMING A VASALVA MANEUVER BEARING DOWN
11th Edition ENA
Explain stable and unstable pelvic fractures - ansStable- does not involve pelvic ring or there is minial displacement of pelvic ring Unstable fractures- 2 or more fractures of pelvic ring that have outward rotational displacement ch. 12, p. 166 Explain the AVPU mnemonic - ansUsed to quickly assess patient's level of alertness A- ALERT (If any of the responses below are elicited at this point, the airway may be compromised) V- responds to VERBAL stimuli, airway adjunct may be needed to keep tongue from obstructing airway P - responds to PAIN. U- UNRESPONSIVE. If patient is unresponsive, announce loudly to the team and direct someone to check if the patient has a pulse while assessing if the cause of the problem is the airway. Consider reprioritizing the assessment priority to ABC ch. 5, p. 42 Explain the B2-Transferrin test - ansGold standard for identifying CSF otorrhea or rhinorrhea ch. 5, p. 48 Explain the Cushing response - ansLoss of auto regulation (cerebral blood flow) can result in cerebral and brainstem ischemia, initiating a central nervous system response known as Cushing response. It is characterized by a triad of assessment findings:
- widening pulse pressure
- reflex bradycardia
- diminished respiratory effort Ch. 9, p. 107 Explain the LMNOP mnemonic - ansUsed to remember resuscitation adjuncts L - Lab studies (ABGs, blood type and crossmatch)
- Lactic acid is an excellent reflection of tissue perfusion M - Monitor cardiac rate and rhythm: compare patient's pulse to the monitor's rhythm
- Dysrhythmias (PVCs, a fib, or ST segment changes) may indicate blunt cardiac trauma
- PEA may point to cardiac tamponade, tension pneumothorax, or profound hypovolemia
11th Edition ENA
N - Naso- or orogastric tube consideration: insertion provides stomach content evacuation and relief of gastric distention O - Oxygenation and ventilation assessment
- Pulse ox may only be accurate if there is adequate peripheral perfusion
- ETCO2 monitoring (capnography) provides instantaneous information about the ventilation, perfusion, and metabolism of carbon dioxide (35-45 is normal) ch. 5, p. 47 Explain the MARCH mnemonic - ansM: MASSIVE HEMORRHAGE A: AIRWAY R: RESPIRATION - decompress suspected pneumo, seal open chest wounds, support ventilation and oxygenation as required C: CIRCULATION - vascular access and admin fluids H: HEAD INJURY/HYPOTHERMIA - prevent or treat hypotension and hypoxia to prevent worsening of traumatic brain injury and prevent or treat hypothermia ch. 5, p. 41- 42 Explain TRACHEOBRONCHIAL INJURY and what are the assessment findings and interventions - ansUsually caused by penetrating mechanisms, occurring in proximal trachea. Direct blows to neck or clothesline-type injuries common mechanisms for blunt trauma. Dx based on assessment findings and confirmed with BRONCHOSCOPY or CT. Assessment findings include:
- DYSPNEA, TACHYPNEA
- HOARSENESS
- SUBCUTANEOUS EMPHYSEMA in neck, face, upper thorax
- PNEUMOTHORAX, tension pneumothorax
- HEMOPTYSIS
- DECREASED OR ABSENT BREATH SOUNDS
- SIGNS and SYMPTOMS of AIRWAY OBSTRUCTION Interventions include:
- Attempts at ET placement may cause further damage, anesthesiology if available may reduce risk of intubation injury
- Other approaches include flexible endoscopy, or smaller ET tube Ch. 11, p. 143
11th Edition ENA
Interventions
- prepare for intubation Ch. 11, p. 144 Following the primary survey, FAST examination may be used to rapidly assess for bleeding from damage to the... - ansHeart, liver, kidneys, and spleen. FAST also increasingly used to detect pneumothorax, especially tension pneumothorax. ch. 7, p. 84 For skin, the immediate goal in treating surface trauma is to... and this is accomplished by... - ansOBTAIN AND MAINTAIN HEMOSTASIS, APPLY DIRECT PRESSURE TO SITE ch. 14, p. 208 HEMOTHORAX - anscaused by blood accumulating in the intrapleural space. Results from injury to lung, costal blood vessels, great vessels and from laceration to liver or spleen combined with diaphragm injury. Assessment findings include
- ANXIETY or RESTLESSNESS
- DYSPNEA, TACHYPNEA
- CHEST PAIN
- SIGNS OF SHOCK- tachycardia, cyanosis, diaphoresis, hypotension
- DECREASED BREATH SOUNDS ON INJURED SIDE Interventions
- Prepare for needle thoracentesis and chest tube insertion
- Ensure 2 large IV catheters and blood is available before thoracentesis to treat large volume blood loss if needed ch. 11, p. 146 How can the trauma nurse have an impact when it comes to the legislative process? - ansBy advocating for stronger laws and more consistent enforcement p. 11 How can you check for laxity or instability for possible pelvic fractures? - ansgentle pressure over iliac wings DOWNWARD and MEDIALLY ch. 12, p. 159
Hypothermia combined with and is a potentially lethal combination. - If a penetrating wound is found below the 4th intercostal space, penetration into the is suspected until proven otherwise. - ansABDOMINAL CAVITY
11th Edition ENA
How high should you elevate limb in compartment syndrome? - ansAt level of heart, any higher can reduce circulation and tissue perfusion. Also ice is strongly contraindicated ch. 14, p. 200- 201 How should you wrap an amputated part? - ansWrap it in slightly saline- moistened sterile gauze, placed in sealed plastic bag THEN place in a second bag containing ice water ch. 14, p. 201 hyperEXTENSION - ansetiology/cause- backward thrust beyond anatomic capacity of vertebral column rest of injury- stretching or ligament tears, bony dislocations example- rear-end whiplash ch. 13, p. 179 hyperFLEXION - ansetiology/cause- forceful forward flexion with head striking an immovable object rest of injury- wedge fractures, facet dislocations, subluxation (due to ligament rupture), teardrop, odontoid or transverse process fractures example- head-on MVC with head hitting windshield, creating starburst effect ch. 13, p. 179 ansHYPOTENSION and ACIDOSIS ch. 5, p. 46 Ch. 11, p. 140 If autoregulation fails and MAP is elevated, can result. - ansEDEMA Ch. 9, p. 109
11th Edition ENA
-- compromised or ineffective ventilation -- anticipated of deterioration of neurological status ch. 5, p. 43 Imaging studies for bladder and urethral injuries include - ans- CT cystogram used to dx intraperitoneal or extraperitoneal bladder rupture
- Urethrogram usually performed prior to insertion of urinary catheter when injury is suspected; contrast instilled at meatus. Detection of contrast media within bladder indicates adequate instillation, leakage demonstrates urethral disruption ch. 12, p. 168 Increased or bounding central pulses may indicate increased cardiac output. Peripheral pulses do not demonstrate a similar effect in the presence of hypovolemia due to vasocontriction. Thus, strong central pulses combined with weak peripheral pulses may be... - ansIndicative of Shock ch. 7, p. 82 Initial assessment - approach to trauma patient care that requires a process to identify and treat or stabilize life-threatening injuries in an efficient and timely manner. It is divided into the following process points: - ans- Preparation and triage
- Primary survey (ABCDE) with resuscitation adjuncts (FG)
- Reevaluation (consideration of transfer)
- Secondary survey (HI) with reevaluation adjuncts
- Reevaluation and post resuscitation care
- Definitive care of transfer to an appropriate trauma center ch. 5, p. 39 Interventions for INTRAOCULAR FOREIGN BODY include - ans- Elevating HOB
- CONSULT
- IMMOBILIZE FOREIGN BODY IF LARGE WITH POTENTIAL to become unstable
- PATCH UNAFFECTED EYE to LIMIT concomitant eye movement
- PEFORM GLOBE CLOSURE ASAP
- ADMINISTER SYSTEMIC and TOPICAL ANTIBIOTICS
- SYSTEMIC ANALGESICS Ch. 10, p. 130 Late assessment findings of increased ICP include: - ans- DILATED, NON- REACTIVE PUPILS
- UNRESPONSIVENESS to verbal/painful stimuli
11th Edition ENA
- ABNORMAL POSTURING
- CUSHING RESPONSE
Widening pulse pressure Reflex bradycardia Decreased respiratory effort Ch. 9, p. 109 Lateral impacts (T-bone) are associated with - ansShear injuries to aorta and other organs, fracture of the side clavicle, lateral pelvic and abdominal injuries, and lateral head and neck injury p. 30 Law of Conservation of Energy - ansEnergy can neither be created nor destroyed, but it can change form p. 26 Leading cause of death for ages
- over 65
- 5 to 24
- 25 to 64 - ans1. Falls
- MVCs
- poisoning p. 9 Maintain PaO2 between - ans100-200 mm Hg for ABGs ch. 6, p. 66 Mastoid process ecchymooses - ansBattles sign, indicates middle fossa fracture Ch. 9, p. 113 Newton's First Law of Motion - ansA body at rest will remain at rest, and a body in motion will stay in motion p. 26 Newton's Second Law of Motion - ansForce = Mass X Acceleration p. 26
Penetrating injury to the chest wall and lacerated lung tissue can cause the loss of
. Thus, the collection of air or blood in the pleural space
11th Edition ENA
- Decreased carbon dioxide (hypocapnia)
- Decreased temp (hypothermia)
- Decreased 2,3-diphosphoglycerate levels
- Elevated pH (alkalosis)
- Carbon monoxide and methemoglobinemia ch. 6, p. 65 Pain Theories include... - ansGATE CONTROL THEORY- proposes pain may be modulated by interneurons within spinal cord. Stimulation of the large A-beta cutaneous fibers was thought to close gate pain impulses from A-delta or C fibers. A-beta fibers carry impulses from touch, vibration, rubbing a painful area. Supports non- pharmacologic therapies for pain control such as ice, heat, massage. NEUROMATRIX THEORY- proposes that each person's brain produces a unique pattern of nerve impulses from a complex neural network with multidimensional inputs. This theory explains phantom limb pain and why people with similar injuries report differing levels and responses to pain. NEUROPLASTIC THEORY- suggests that neurons can be permanently affected and reshaped by the experience of pain. This theory attempts to explain chronic pain, pain syndromes, and phantom pain. ch. 8. p. 93 Pathophysiologic concepts that affect the patient with brain, cranial, or maxillofacial injuries include issues related to... - ans- HYPOTENSION and CBF
- HYPOXIA and HYPERCARBIA
- ICP Ch. 9, p. 108 B. LUNG COLLAPSE Ch. 11, p. 141 Pertaining to abdominal trauma, What does non-operative management include? When does operative management occur? - ansNon- serial abdominal exams Op- occurs in patients who exhibit signs of peritonitis or hemodynamic instability
11th Edition ENA
ch. 12, p. 164 Physiologic effects of pain by system: Cardiovascular - ansHYPERCOAGULATION INCREASED CARDIAC WORKLOAD INCREASED OXYGEN DEMAND ch. 8, p. 97 Physiologic effects of pain by system: Endocrine - ansINCREASED RELEASE OF HORMONES AND MEDIATORS ch. 8, p. 97 Physiologic effects of pain by system: Gastrointestinal - ansDECREASED MOTILITY ch. 8, p. 97 Physiologic effects of pain by system: Genitourinary - ansDECREASED URINARY OUTPUT URINARY RETENTION FLUID OVERLOAD ch. 8, p. 97 Physiologic effects of pain by system: Immune - ansDECREASED RESPONSE ch. 8, p. 97 Physiologic effects of pain by system: Metabolic - ansGLUCOGENESIS HYPERFLYCEMIA GLUCOSE INTOLERANCE INSULIN RESISTANCE MUSCLE PROTEIN CATABOLISM INCREASED LIPOLYSIS ch. 8, p. 97 Physiologic effects of pain by system: Musculoskeletal - ansIMPAIRED MUSCLE FUNCTION IMMOBILITY FATIGUE MUSCLE SPASM
