Chapter 24 trauma notes PDF

Preview

Summary

ch 24 review notes to help study and exam...

Description

Ready for Review    









  









Perfusion is the circulation of blood in adequate amounts to meet each cell’s current needs for oxygen, nutrients, and waste removal. Hypoperfusion, or shock, occurs when the cardiovascular system fails to provide adequate perfusion. Both internal and external bleeding can cause shock. You must know how to recognize and control both. The severity of external bleeding is often a function of the types of blood vessels that have been injured. Bleeding from an open artery is usually bright red and spurts and is difficult to control. Blood from an open vein is much darker and flows steadily. Blood from damaged capillary vessels is dark red and oozes from a wound steadily but slowly. Internal bleeding may occur from trauma to any portion of the body. Bleeding into the thorax, abdomen, or pelvis tends to be severe and uncontrolled. Because internal bleeding is not as obvious, you must rely on signs and symptoms to determine the extent and severity of the bleeding. Signs of internal bleeding include deformity, tenderness, bruised chest, swelling, distended abdomen, guarding, pain, hematemesis, melena, hemoptysis, and broken ribs. During the scene size-up, be sure to follow standard precautions. Depending on the severity of bleeding, this will entail wearing gloves, a mask, eye shield, and possibly a gown. Whether or not you can control bleeding, it is a serious emergency. During your primary assessment, search for life-threatening bleeding and control it immediately. Also determine the patient’s mental status with the AVPU scale and manage ABCs. Assess the patient for signs of shock: rapid, weak pulse; mental status changes; cool, pale, clammy skin; and low blood pressure (a late sign). Additional signs of shock that suggest internal bleeding include weakness and dizziness, tachycardia, thirst, and shallow, rapid breathing. In cases of hemorrhaging, the issue is not whether the patient will be transported, but rather how fast the transport decision should be made and where the patient should be taken. Consider the priority of the patient and the availability of a regional trauma center. You should assess and promptly transport any patient who may have internal bleeding, particularly if the mechanism of injury is severe and has affected the abdomen, chest, or both. Stabilizing a serious fracture has a high priority in the control of bleeding. Splinting the fracture helps control bleeding, and splinting should occur before other bleeding control. Methods for controlling external bleeding include direct, even pressure and elevation; pressure dressings and/or splints; and tourniquets. Most cases of external bleeding can be controlled with direct pressure to the bleeding site. If direct pressure fails to immediately stop the hemorrhaging, and if you are allowed by local protocol and policy, apply a tourniquet above the level





 



of the bleeding. If a commercial tourniquet is not available, a tourniquet can be improvised with a triangular bandage and a stick or rod. Use a pneumatic antishock garment to prevent or minimize hypovolemic shock only when there is massive soft-tissue bleeding of the lower extremities that cannot be otherwise controlled, or bleeding associated with fractures of the pelvis and bilateral femurs. Always follow local protocols and consult medical control for advice regarding use of the pneumatic antishock garment. Bleeding from the nose or ears following a head injury may indicate a skull fracture. Do not attempt to stop the blood flow. Loosely cover the bleeding site with a sterile gauze pad. Apply light compression by wrapping the dressing loosely around the head. If bleeding is present at the nose and a skull fracture is suspected, place a gauze pad loosely under the nose. If bleeding from the nose is present and a skull fracture is not suspected, pinch both nostrils together for 15 minutes. If the patient is awake and has a patent airway, place a gauze pad inside the upper lip against the gum. If you suspect that a patient is bleeding internally, maintain the airway, administer 100% supplemental oxygen and be prepared to assist ventilation, keep the patient still and warm, apply a splint to any affected extremity, and monitor vital signs at least every 5 minutes. Finally, provide rapid transport....