Assessment of Trauma Patients PDF

Assessment of patients with trauma Prepared by Yousria Abd El Salam Seloma Assist. Prof. of Critical Care and Emergency Nursing Faculty of Nursing Assessment of patients with trauma  Objectives Upon completion of this lecture, the student...

Assessment of patients with trauma Prepared by Yousria Abd El Salam Seloma Assist. Prof. of Critical Care and Emergency Nursing Faculty of Nursing Assessment of patients with trauma  Objectives Upon completion of this lecture, the student should be able to: Understand what the mechanism of injury is and the information it provides Demonstrate primary and secondary patient assessment  Definition of trauma Damage to the body caused by an exchange of energy beyond the body’s resilience. Injury occurs when an external source of energy affects the body beyond its ability to sustain and dissipate the energy.  Epidemiology of Trauma Leading cause of death in ages 1-44 3rd leading cause of death for all ages 100,000 deaths/year 60 million injuries/year  Overall Approach Anticipate the worst Never make any assumptions History and Exam have to make sense Document frequently TEAMWORK Don’t get distracted with “ugly injuries” Your Initial assessment findings will determine how you will proceed  Trauma System Mortality is decreased when The RIGHT patient Gets to The RIGHT hospital In the RIGHT TIME  Trauma occur as a result of Blunt Penetrating Thermal mechanism mechanism mechanism Motor vehicle crashes Fall Motorcycle crashes Pedestrian Assault Stab wound Gunshot  Minor, major or multiple trauma Blunt, penetrating trauma Other types of trauma occur from inhalation, and thermal changes.  Approach to unstable trauma patient Primary survey/ Assessment – Detect and manage life threatening injuries Examples: Hypoxia, tension pneumo, shock, tamponade, herniation How: ABCD Secondary survey / Assessment – Detect other injuries and formulate treatment plan Examples: All other injuries or fractures How: Expose patient Head-toe exam Investigations A B C’s of Trauma Care A Airway with C-spine B Breathing C Circulation  Primary Survey Patients are assessed and treatment priorities established based on their injuries, vital signs, and injury mechanisms ABCDEs of trauma care –A Airway and c-spine protection –B Breathing and ventilation –C Circulation with hemorrhage control –D Disability/Neurologic status –E Exposure/Environmental control  Airway How do we evaluate the airway?  A- Airway Airway should be assessed for patency – Is the patient able to talk? – Inspect for foreign bodies – Examine for stridor, hoarseness, gurgling, pooled saliva or blood Assume there is a spinal injury in patients with multi-trauma – C-spine clearance can be both clinical(by the doctor) and/or x-ray – Spinal protection should remain in place until patient can cooperate with clinical exam  Airway Interventions Oxygen Suction Chin lift/jaw thrust Oral or nasal airways DiverDave, Wikimedia Commons Establish a secure airway – Rapid intubation for agitated patients with c-spine immobilization  Breathing What can we look for to assess a patient’s ‘breathing’ status?  B- Breathing Airway patency does not ensure adequate ventilation Look, Listen, and Touch – Deviated trachea, crepitus (popcorn chest), flail chest, sucking chest wound, absence of breath sounds Chest X ray if available to evaluate lungs  Breathing Interventions Ventilate with 100% oxygen Needle decompression if tension pneumothorax suspected Chest tubes for pneumothorax / hemothorax Occlusive dressing to sucking chest wound If intubated, evaluate tube position  C- Circulation Rapid assessment of hemodynamic status – Level of consciousness – Skin color – Pulses in arms and legs – Blood pressure  C- Circulation Shock should be considered on every Trauma patient Types of shock: – Hypovolemic – loss of blood or plasma – Cardiogenic – The heart is less able to pump blood – Obstructive – Physical obstruction reduces cardiac output – Distributive – Disruption to vasomotor tone  D- Disability Abbreviated neurological exam – Level of consciousness – Pupil size and reactivity – Motor function – Glasgow Coma Scale Utilized to determine severity of injury  Disability Interventions Spinal cord injury – Keep spine stabalization! – High dose steroids may be used Decreasing Mental Status may be a sign of Elevated Intercranial Pressure – Sit patient up – Hyperventilation – increase breathing and oxygen  E- Exposure Complete disrobing of patient Inspect back Rectal temperature Warm blankets to prevent hypothermia  Secondary Survey AMPLE history – Allergies, medications, Past Medical History, last meal, events Physical exam from head to toe, including rectal exam Frequent reassessment of vitals Diagnostic studies at this time simultaneously – X-rays, lab work – FAST exam (Ultrasound)  Disposition To the OR -Unstable patients with blunt or penetrating abdominal trauma or chest trauma. Hemothorax with >1500 cc of blood out initially. Surgical injuries identified with imaging. Admission -Nonsurgical, high-risk injuries Discharge -Stable patients, minor or no injuries identified.  Summary Trauma is best managed by a team approach (there’s no “I” in trauma) A thorough primary and secondary survey is key to identify life threatening injuries Once a life threatening injury is discovered, intervention should not be delayed Disposition is determined by the patient’s condition as well as available resources. Thank you