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Introduction
The number of vehicles has grown from a mere306,000 in 1951 to 58,863,000 by 2002 (Ministry of RoadTransport and Highways, Transport Research Wing 200102). An examination of years of potential life lost indicatesthat injuries are the second most common cause of deathafter 5 years of age in India (Mohan and Anderson 2000).As per the report of 2001, 2,710,019 accidental deaths,108,506 suicidal deaths and 44,394 violence-relateddeaths were reported in India. There has been an increasein accidental deaths from 122,221 to 188,003, from 40,245to 78,450 for suicidal deaths and from 22,727 to 39,174 forviolence-related deaths between 1981 and 1991. The
injury mortality rate was 40/100,000 population during2000. The number of deaths due to accidents increased by47% during the period 19902000; 93% were due tounnatural causes and 7% (17,366) due to natural causes.The mortality rate among different age groups was: 8.2%(60 years). Seventythree per cent of total deathsoccurred among men, with a ratio of 3:1 between men andwomen.
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Definition
Trauma
unintentional or intentional damage to the
body resulting from acute exposure to thermal,mechanical, electrical, or chemical energy or from
the absence of such essentials as heat or oxygen.
Unintentional injuries are the leading causes
of death in people between the ages of 1 and 34
years. In the 35- to 44-year age bracket,
unintentional injury is second only to cancer as a
leading cause of death.
Traumatology is the branch of surgery which
deals with trauma patients and their injuries
Polytrauma
Physical injuries or insults occurring simultaneously
in several parts of body
Crush Injuries
Crush injuries occur when a person is caught betweenobjects, run over by a moving vehicle, or compressed bymachinery.
http://www.medterms.com/script/main/art.asp?articlekey=8184http://www.medterms.com/script/main/art.asp?articlekey=5603http://www.medterms.com/script/main/art.asp?articlekey=5603http://www.medterms.com/script/main/art.asp?articlekey=81848/2/2019 Polytrauma Lesson Plan
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Mechanism of injury
The mechanism of injurymay indicate the
need for additional diagnostic workupand
reassessment. The mechanism of injury is related tothe type of injuring force and the subsequent tissue
response. Injury occurs when the force deforms
tissues beyond their failure limits. Wounds vary
depending on the injuring agent. The effect of injury
also depends on personal and environmental
factors, such as the persons age and sex, the
presence or absence of underlying disease process,
and the geographic region. Force may or may not be
penetrating. The injury delivered from force depends
on the energy delivered and the area of contact. In
penetrating injury, the concentration of force is to a
small area. In blunt or nonpenetrating injury, the
energy is distributed over a large area. The
predominant feature affecting the impact is speed,
or acceleration:
FORCE = MASS X ACCELERATION
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Types of trauma
1. Blunt Injury
Mechanisms of blunt injury include MVCs,
falls, assaults, and contact sports. Multiple injuriesare common with blunt trauma, and these injuries
are often more life-threatening than penetrating
injuries because the extent of the injury is less
obvious and the diagnosis can be more difficult.
Blunt injury is caused by a combination of forces.
These forces include acceleration, deceleration,
shearing, crushing, and compressive resistance:
Accelerationis an increase in the velocity (or
speed) of a moving object.
Deceleration, on the other hand, is a decrease
in the velocity of a moving object.
Shearingoccurs across a plane when structures
slip relative to each other.
Crushingoccurs when continuous pressure is
applied to a body part.
Compressiveresistanceis the ability of an
object or structure to resist squeezing forces or
inward pressure.
In blunt trauma it is the direct impact that
causes the greatest injury. Injury occurs when there
is direct contact between the body surface and the
injuring agent. Indirect forces are transmitted
internally with dissipation of energy to the internal
structure. The extent of injury from an indirect force
depends on transference of energy from an object to
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the body. Injury occurs as a result of energy
released and the tendency for the tissues to be
displaced on impact.3 Accelerationdeceleration
injuries are the most common causes of blunt
trauma.
2. Penetrating Injury
Penetrating trauma refers to an injury
produced by foreign objects penetrating the tissue.
The severity of the injury is related to the structures
damaged. The mechanism of injury is caused by the
energy created and dissipated by the penetrating
object into the surrounding areas.3 The amount of
tissue damaged by a bullet is determined by the
amount of energy that transfers into the tissue along
with the amount of time it takes for the transfer tooccur. The surface area over which the transfer is
distributed also contributes to tissue damage.
Velocity determines the extent of cavitation and
tissue damage. Low-velocity missiles localize the
injury to a small radius from the center of the tract
and have little disruptive effect. They cause little
cavitation and blast effect, essentially only pushing
the tissue aside. It is important to obtain a brief
description of the mechanism of gunshot injuries,including the weapon, the ammunition, and
ballistics. This essential information is used to guide
the assessment of patients who sustain injuries from
these weapons. All trauma patients must be
undressed and inspected for entrance and exit
wounds during the assessment process.
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3. Stab Wounds and Impalements
A stab wound or impalement is a low-velocity
injury. The main injury determinants are length,
width, and trajectory of the penetrating object and
the presence of vital organs in the area of the
wound. Although the injuries tend to be localized,
deep organs and multiple body cavities can be
penetrated.
4. Surface trauma
Surface trauma includes any injury that does
not break the skin (closed wound) and any open
wound in which the skin surface is broken. Types of
closed wounds include contusions (bruising) and
hematomas (collection of blood under the skin).
Types of open wounds include abrasions,lacerations, avulsions, amputations, and
punctures.
Abrasions are a scratching of the epidermal
and dermal layers of the skin. They bleed very little
but can be extremely painful because of inflamed
nerve endings..
Puncture wounds result from sharp, narrow
objects such as knives, nails, or high-velocity
bullets. They can often be deceptive because theentrance wound may be small with little or no
bleeding. It is difficult to estimate the extent of
damage to underlying organs as a result. Puncture
wounds usually do not bleed profusely unless they
are located in the chest or abdomen.
Lacerations are open wounds resulting from
snagging or tearing of tissue. Skin tissue may be
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5. Head Trauma
Sharp blows to the head can cause shifting of
intracranial contents and lead to brain tissue
contusion. The pathophysiology of head trauma can
be divided into two phases. The first phase is the
initial injury that occurs at the time of the accident
and cannot be reversed. The second phase involvesintracerebral bleeding and edema from the initial
injury, which causes increased intracranial pressure
(ICP). Management of head trauma is directed at
the second phase and involves decreasing ICP.
Early and late Signs and Symptoms of Increased
Intracranial Pressure.
Early Signs and Symptoms of Increased ICP
Headache
Nausea and vomiting Amnesia
Altered level of consciousness
Changes in speech
Drowsiness
Late Signs and Symptoms of Increased ICP
Dilated nonreactive pupils
Unresponsiveness
Abnormal posturing Widening pulse pressure
Decreased pulse rate
Changes in respiratory pattern
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6. Chest trauma
Chest trauma can damage the heart and
lungs and cause life threatening injuries, including
pericardial tamponade, hemothorax, tension
pneumothorax, and flail chest. Potentially life-
threatening injuries include pulmonary and
myocardial contusion, aortic and tracheobronchialdisruption, and diaphragmatic rupture. Chest trauma
can result in laceration of lung tissue and cause a
change in the negative intrapleural pressure. Air or
blood leaking into the intrapleural space collapses
the lung, resulting in a pneumothorax (air) or
hemothorax (blood) and ineffective ventilation. In a
tension pneumothorax, air is trapped in the pleural
space during exhalation, resulting in increased
pressure on the unaffected lung. The heart, greatvessels, and trachea shift toward the unaffected side
of the chest. As a result, blood flow to and from the
heart is greatly reduced, causing a decrease in
cardiac output. An uncorrected tension
pneumothorax is fatal.
Chest trauma can also injure the heart and
great vessels and reduce the amount of circulating
blood volume. The heart may be bruised
(myocardial contusion) or may sustain direct trauma.
Cardiac tamponade occurs when blood
accumulates in the pericardial sac and increases
pressure around the heart. The increased pericardial
pressure prevents the heart chambers from filling
and contracting effectively. A patient with cardiac
tamponade exhibits hypotension, tachycardia, and
neck vein distention and requires immediate
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intervention to reduce the pressure in the pericardial
sac and restore normal filling and contraction of the
heart chambers.
7. Abdominal Trauma
The organs of the abdomen are vulnerable to
injury because there is limited bony protection. Injuryto organs such as the spleen and liver, which have a
rich blood supply, can result in rapid loss of blood
volume and hypovolemic shock. Abdominal
organs may be injured as a result of severe blunt or
penetrating trauma. If hypotension is present,
intraabdominal hemorrhage may exist. If the urinary
bladder ruptures, urine leaks into the abdomen and
blood may be detected at the urinary meatus or
perineum. Penetrating trauma can cause lacerationsto abdominal organs, resulting in rapid blood loss
and hypovolemic shock.
8. Musculoskeletal Trauma
Fractured bones can result in blood loss,
compromised circulation, infection, and immobility.
Unstable pelvic fractures can cause injury to the
genitourinary system or disrupt the veins in the
pelvis. Fractures of large bones such as the femur
and tibia can cause significant blood loss. For
example, a fractured femur can cause up to 1500
mL of blood loss and a fractured tibia or humerus
can cause up to 750 mL of blood loss. Joint
dislocations can cause neurovascular compromise
by applying pressure to the nerves and blood
vessels.
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PATHOPHYSIOLOGY
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Complications
1. COMPARTMENT SYNDROMECompartment syndrome occurs when
the pressure withinthe fascia-enclosed
muscle compartment is increased, causing
blood flow to the muscles and nerves in the
compartment to become compromised,
thereby resulting in tissue ischemia.37 This
ischemia then leads to tissue damage, which
compromises nerve and muscle function. A
prolonged elevation of compartmental
pressure leads to death of the muscles and
nerves involved. Intracompartmental
pressures that exceed 30 to 40 mm Hg cancause muscle ischemia, and pressures
greater than 55 to 65 mmHg cause
irreversible muscle death.
2. DEEP VENOUS THROMBOSISDVT is a significant risk for all trauma
patients, especiallythose with
musculoskeletal injuries. It is known as a
common, life threatening complication of
major Trauma. The danger of DVT is that it
may progress to pulmonary embolus. The
administration of low-dose heparin or low
molecular-weight heparin and the use of
intermittent pneumatic compression devices
are recommended to prevent DVT.
The pathophysiology of DVT, and later
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pulmonary embolus, is related to Virchows
triad:
Venous stasis from decreased
blood flow, decreased muscular
activity, and external pressure
on the deep veins.
Vascular damage orconcomitant pathological state
Hypercoagulability
3. FAT EMBOLISM SYNDROMEFat emboli are fat globules in the lung tissue and
peripheralcirculation after a long bone fracture or major
trauma. Fat emboli may or may not cause systemic
symptoms. Fat embolism syndrome is a serious (but rare)
manifestation of fat emboli that involves progressive
respiratory insufficiency, thrombocytopenia, and adecrease in mental status. It usually occurs within 72 hours
of injury. Clinical indications of this syndrome include
tachypnea, dyspnea, cyanosis, tachycardia, and fever.
Nurses should be aware of the potential for fat embolism
syndrome to develop and monitor the patient for
hypoxemia with pulse oximetry. The patients neurological
status is also monitored for signs of a decreasing mental
status
4. Shock5. Haemmorrhage6. Stroke7. Disseminated intravascular coagualopathy
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Management
1. Pre-hospital Management
The trauma patient has a greater chance of a
positive outcomeif definitive care is initiated within 1
hour of injury.Care begins in the prehospital arena
and is continued throughout the hospital stay. There
are currently two theories about prehospital
management of patients, the stay and play theory
and the scoop and run theory.5 Proponents of the
stay and play theory believe that time in the field
can be well spent stabilizing the patients physiologic
status, whereas proponents of the scoop and run
theory believe that only life-threatening issues
should be addressed in the field. Several studiesdemonstrated that the time taken to establish
intravenous access was longer than the transport
time to definitive care. This prolongation of transport
was associated with an increase in patient mortality.
Therefore, it was suggested that each emergency
medical system (EMS) evaluate its approach to
prehospital management, taking into account the
transport time to definitive care. For example, in an
urban area, the scoop and run theory may beappropriate because transport time to a definitive
care setting is very short. In a rural area, however,
the extra minutes that it may take to stabilize the
patient may have a positive impact on the overall
outcome because of the long transport time. The
advanced trauma life support (ATLS) guidelines
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state that the emphasis for assessment and
management in the prehospital phase should be
placed on maintaining the airway, ensuring
adequate ventilation, controlling external bleeding
and preventing shock, maintaining spine
immobilization, and transporting the patient
immediately to the closest appropriate facility. Theprehospital priority of maintaining adequate airway,
breathing, and circulation (ABCs) may be difficult to
attain owing to the mechanism of injury. It is
imperative that cervical spine immobilization be
maintained at all times during airway management
and transport to definitive care. After assessing and
managing the ABCs, the trauma patients
neurological status is assessed, including level of
consciousness and pupil size and reaction. Oncethis primary assessment is complete, a secondary
assessment is done to determine any other injuries.
The prehospital providers must consider the
facility that will receive the patient. Transporting the
patient to a level I facility allows definitive care to be
initiated earlier in the process, thereby reducing
patient mortality. Transport of the patient to a lesser
facility for stabilization, followed by transport to the
definitive care setting later on, is associated with
higher patient mortality rates.
2. In-Hospital Management
In-hospital patient management entails a rapid
primaryevaluation and resuscitation of vital
functions, a moredetailed secondary survey, and
initiation of definitive care. According to the ACS,
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adhering to this sequence allows for the efficient
identification of life-threatening conditions.
PRIMARY SURVEY
During the primary survey, each priority of care is
dealtwith in order. The patients assessment does
not continue to the next phase until each precedingpriority is effectively managed. For example, if a
patient does not have a patent airway, breathing and
ventilation cannot be established. Therefore, it is
during this initial phase that life-threatening injuries
are identified and managed. So, if the patient does
not have a patent airway, endotracheal intubation,
chest tube insertion, and central line access may be
initiated and intravenous fluid and blood products
may be administered to maintain life-sustaining vitalsigns before moving on to the next phase of the
evaluation.
Assessing the patient for evidence of hypovolemia is
essential. Blood loss can result from an external
injury, associated with obvious bleeding, or from an
internal injury, where bleeding may not be obvious.
Any of these injuries can lead to inadequate tissue
perfusion, which equals traumatic shock. It is
necessary to first stop the bleeding with
compression or surgery and then replace the lost
intravascular volume. Some signs of hypovolemia
include pallor, poor skin integrity, diaphoresis,
tachycardia, and hypotension. Usually, trauma
patients arrive at the trauma center with a large-bore
intravenous line already in place, with intravenous
fluid running in rapidly.
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During the resuscitation period, an
electrocardiogram (ECG) is done. The patient is
placed on a monitor with pulse-oximetry and end-
tidal carbon dioxide monitoring. A Foley catheter
and a nasogastric or orogastric tube are placed, and
bloodwork is sent to the laboratory for evaluation.
Bloodwork analysis includes evaluation ofelectrolytes, hemoglobin and hematocrit, blood type
and crossmatch, and arterial blood gases (ABGs), if
the patient is expected to have a high level of injury.
The patient is also assessed for hypothermia. The
trauma patient is often subjected to environmental
factors, which, along with his or her altered
physiological state and possible wet clothing,
predispose the patient to hypothermia. Measurestaken by health care professionals, such as the
infusion of room-temperature intravenous fluids or
exposure of the patients body to inspect for injuries,
can exacerbate hypothermia. Warm fluids and
blankets are used whenever possible to increase
body temperature or maintain normothermia.
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SECONDARY SURVEY
Once the primary survey is completed, a moredetailed secondarysurvey is initiated. This survey
begins at the headand works down to the patients
feet. Nonlife-threatening injuries are revealed
during this survey. During this time,a plan is
developed and the appropriate diagnostic tests (e.g.,
x-rays, ultrasound studies, computed tomography
[CT] scans, angiographic studies) are ordered for
the patient. This is also the time when a more
detailed patient history can be obtained, as well asimportant information regarding the mechanism of
injury. The nurse asks the field providers for
information regarding the incident because the
patient may not be able to speak or may not
remember the event. Family and friends might be
helpful in providing additional information about the
patient.
1. FLUID RESUSCITATION
Most trauma patients have a fluid volume deficit
that must be corrected. The goals of fluid
resuscitation are to maintain physiological
support of circulation and oxygen transport while
avoiding physiological and hemostatic
deficiencies. It is essential to have adequate
intravascular volume and oxygen-carrying
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capacity to transport needed nutrients to the
tissues. To guide fluid resuscitation, the nurse
uses the patients physical assessment and
hemodynamic parameters.
Crystalloids
Typically, crystalloids are used in the trauma
patient.Crystalloids contain water and otherelectrolytes that arepremixed into the fluid.
These electrolytes may include sodium,
potassium, and chloride. Crystalloids can be
further broken down by their tonicity. The tonicity
is based on the amount of sodium in the solution.
Crystalloids can be classified as isotonic,
hypotonic, and hypertonic.
Hypertonic saline has been shown to enable a
more rapid restoration of cardiac function with a
smaller volume of fluid. It is supplied either in a
3%, 7.5%, or 23.4% sodium chloride (NaCl)
solution. As little as 4 mL/kg, if given rapidly, may
have the same hemodynamic effect as several
liters of isotonic crystalloid. Hypertonic saline has
the effect of shifting water into the plasma. This
water comes from the red blood cells, interstitial
space, and tissue. The result is a rapid increase
in blood volume, which supports and improves
hemodynamics. Hypertonic saline increases the
mean arterial pressure and cardiac output, which
then leads to peripheral vasodilation. The
peripheral vasodilation allows for an increase in
total splanchnic, renal, coronary, and mesenteric
blood flow. The initial management of trauma
patients often requires the rapid infusion of 2 L of
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isotonic crystalloid as rapidly as possible, while
trying to obtain a normal heart rate and blood
pressure. However, research has shown that the
infusion of crystalloids in patients with
hypotension can cause more harm by displacing
a hemostatic clot, only to cause more bleeding.
The infusion of crystalloid also further dilutes thepatients hemoglobin and can increase
intraperitoneal blood loss.
Colloids
Colloids can also be given to resuscitate a
trauma patient.Colloids, such as albumin,
dextran, and hetastarch, createoncotic pressure,
which encourages fluid retention andmovement
of fluid into the intravascular space. Proponents
for colloid use have argued that less volume of
fluid is necessary to achieve hemodynamic
stability and the fluid is retained in the
intravascular space longer. Despite possible
advantages, there is no clear evidence that
colloids are superior to crystalloids for
resuscitation of the trauma patient. Potential
complications, such as anaphylaxis and
coagulopathy, have been reported with certain
colloids. These potential adverse affects,
together with higher costs, make colloid use less
desirable than crystalloid use for resuscitation of
trauma patients
Blood Products
Blood products are considered an excellent
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resuscitation fluid. Red blood cells increase
oxygen-carrying capacity and allow for volume
expansion. Blood also stays in the intravascular
space for longer periods of time compared with
the other resuscitation fluids. Although there is
some concern about bloodborne pathogens and
transfusion reactions, it is essential tounderstand the advantages offered by blood
transfusion.
Blood should be transfused when patients are
hemo-dynamically unstable or are showing signs
of tissue hypoxia despite crystalloid infusion.
Cross-matched blood is preferred but is not
always possible if emergent transfusion prohibits
type and crossmatching of the patients blood. O-
negative blood is the preferred type of
uncrossmatched blood, especially in women of
childbearing age. O-positive blood may be used
in male and postmenopausal female patients. If
the patient requires large amounts of blood,
transfusion of fresh frozen plasma and platelets
is initiated. It is important to replace coagulation
factors and platelets not contained in blood. In
the event of massive blood transfusions, the risk
of acute respiratory distress syndrome (ARDS)
and disseminated intravascular coagulation(DIC) is heightened. An extended period of
hypotension increases the possibility of renal
failure.
Autotransfusion is another common modality
used in the hemorrhaging trauma patient.
Obviously, the nature of trauma prevents
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patients from donating their own blood, as they
could in an elective surgery. However,
sometimes blood is salvaged from wounds,
drains, and body cavities. Most often blood is
saved from a chest tube underwater seal device.
A cell saver is connected into the system and the
blood from the wound collects there. Once full,the cell saver is disconnected from the
underwater seal device and this blood is then
transfused into the patient using a
macroaggregate filter.
Blood Substitutes
Blood substitutes have been developed but have
not been approved for use in all countries. These
agents do not require crossmatching and do not
carry the risk of bloodborne pathogen
transmission. Blood substitutes have a long shelf
life and are not immunosuppressive. They also
have a lower viscosity then blood, which
promotes flow and peripheral oxygen delivery.
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NURSING MANAGEMENT
1. Ineffective tissue perfusion: cerebral, related to
cerebral edema
EXPECTED OUTCOME: The patient maintains
adequate cerebral homeostasis without cerebral
edema as evidenced by a GCS of 14 or greater.
Give oxygen as ordered to maintain adequate
oxygenation of brain tissues and prevent
cellular damage from hypoxia at the cerebral
level.
If the patient has an altered level of
consciousness or deteriorating respiratory
effort, anticipate and assist with endotrachealintubation as needed to provide respiratory
support to patient.
Elevate the head of the patients bed 15 to 30
degrees, if possible, to reduce ICP.
Maintain the patients head position at midline
to ensure unobstructed venousdrainage to
help reduce ICP.
Maintain intravenous access for fluids to
maintain hemodynamic stability and accessfor medications.
Monitor mannitol IV, an osmotic diuretic, as
ordered to decrease cerebral edema.
If the patient is agitated, calm the patient as
agitation increases ICP.
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2. Ineffective breathing pattern related to neck
injury or unstable chest wall segment or lung
collapse
EXPECTED OUTCOME: The patient maintains
effective respiratory rate and experiences improved
gas exchange in the lungs.
If the cervical spinal cord has beentraumatized, the effectiveness of breathing
may be altered. If signs of respiratory distress
are present, use the jaw thrust or chin lift
maneuver, along with suction and airway
adjuncts as needed to maintain patency of
the airway.
Maintain cervical collar and backboard to
prevent further injury.
Give oxygen as ordered to improve tissueoxygenation. Advanced adjunct airway
equipment, including an endotracheal tube,
must be readily available.
Administer supplemental oxygen as ordered
to promote tissue oxygenation.
Maintain chest tube drainage system if
inserted to help expand lung.
3. Ineffective airway clearance related to neck
injury
EXPECTED OUTCOME: The patient will maintain
clear lung sounds.
Suction the oropharynx and nasopharynx to
clear secretions and prevent aspiration of
secretions into the airway.
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If the patient vomits, log roll the patient onto
side to prevent aspiration of emesis. Use
suction as needed.
4. Impaired physical mobility related to neck injury
EXPECTED OUTCOME: Patient will maintain
normal movement of extremities for patient. Maintain neck immobility during initial
treatment of a patient with head or neck
trauma to prevent serious injury until trauma
damage is identified.
5. Decreased cardiac output related to
compression of heart and great vessels
EXPECTED OUTCOME: The patient will maintain
vital signs within baseline limits.
Report unstable vital signs to physician as
patient may need immediate surgical
intervention in the operating room.
Explain diagnostic testing to patients with
stable vital signs if radiographic studies are
ordered to determine the extent of cardiac or
pulmonary injury.
Monitor patients vital signs and oxygen
saturation continuously to detect signs of
shock.
6. Deficient fluid volume related to hemorrhage or
abdominal organ injury
EXPECTED OUTCOME: Patient will maintain vital
signs within baseline limits.
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Monitor for signs of shock to detect
hypovolemic shock.
Maintain IV fluids as ordered per 18- or 16-
gauge IV cannulas to restore circulating
volume.
Assist with peritoneal lavage if performed to
detect intra-abdominal hemorrhage. Maintain nasogastric tube if ordered to
decompress the stomach.
Cover abdominal wounds with a sterile
dressing to prevent infection.
If abdominal organs are exposed, cover with
sterile saline-soaked dressings to prevent
tissue necrosis.
Assist with blood and blood products
administration as ordered per agency policyto maintain circulating volume and improve
tissue oxygenation.
7. Impaired physical mobility related to bone injury
EXPECTED OUTCOME: Patient will maintain
movement of extremities normal for patient.
Remove all jewelry before applying a splint as
the extremity may swell after injury.
Maintain extremity in splint in the position
found unless the distal circulation is severely
compromised and keep immobilized if there is
severe pain or deformity. Splinting promotes
comfort and prevents further damage to
surrounding tissue by preventing movement
of broken bone ends.
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Immobilize the joints above and below the
affected area using a folded towel or a pillow
until the patient is evaluated by a physician.
Monitor skin color, temperature, distal pulses,
capillary refill, movement, and sensation of
the extremity after splint application to detect
abnormalities.
8. Acute pain related to tissue trauma
EXPECTED OUTCOME: The patient will experience
relief after measures are provided to relieve pain as
evidenced by verbal and nonverbal expressions of
pain relief.
Apply ice, elevate, and immobilize the
affected area to decrease swelling andrelieve pain.
Provide analgesics as ordered to relieve pain.
9. Impaired skin integrity related to trauma
EXPECTED OUTCOME: The patient will
demonstrate healing of impaired tissue.
Apply direct pressure to open wounds to
control bleeding.
Irrigate open wounds with sterile salinesolution to thoroughly remove dirt and debris
and clean exposed tissue to prevent infection.
10. Risk for infection related to tissue trauma
EXPECTED OUTCOME: The patients wounds will
remain free of infection.
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With open wounds, give tetanus
immunization as ordered if it has been more
than 5 years since one was last given to
prevent infection.
Give antibiotics as ordered to prevent
infection.
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Sr.
no
SPECIFIC
OBJECTIVESDURATION CONTENTS
TEACHING
LEARNING
ACTIVITY
A V
AIDS BLACKBOARDACTIVITY EVALUATION
SummaryTill now we have seen about the definition, types,
mechanism of injury, pathophysiology of trauma, diagnosticevaluation and medical and nursing management of patientwith polytrauma.
ConclusionA stitch in time saves nine, and it is better to be
prepared rather than unknown. Trauma can be controlled
but not all, controllable can be prevented by appropriate
human behavior. During trauma help should be implanted
as soon as possible to avoid further casualities.
Assignment
solve the 10 multiple choice questions, 10 marks
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Sr.
no
SPECIFIC
OBJECTIVESDURATION CONTENTS
TEACHING
LEARNING
ACTIVITY
A V
AIDS BLACKBOARDACTIVITY EVALUATION
BIBLIOGRAPHY:-
1. Lewis, Heitkemper & Dirksen (2000) Medical Surgical
Nursing Assessment and Management of Clinical
Problem (7th
ed) Mosby, pg no. 2552-66.
2. Black J.M. Hawk, J.H. (2005) Medical Surgical
Nursing Clinical Management for Positive Outcomes.
(7th ed) Elsevier, pg no. 2441-54.
3. Brunner S. B., Suddarth D.S. The Lippincott Manualof Nursing practice J.B.Lippincott. Philadelphia, pgno. 32051-59
4. Understanding medical surgical nursing, F A Davis 6thedition, elsieiver publication pg. no. 210-224.
5. www.trauma..org/systemtrauma.html
http://www.trauma..org/systemhttp://www.trauma..org/systemhttp://www.trauma..org/systemTop Related