Sei sulla pagina 1di 24

TRAUMA

SUBMITTED TO
MRS. MEENAL SHARMA
ASSISTANT PROFESSOR
PRESENTED BY A
MS.NISHA KAUSHIK
MSC NURSING Ist YEAR

INTRODUCTION
Trauma is a disease.
Trauma is predictable ,preventable and treatable.
Trauma is a 4
th
leading cause of death in the United
States.
Trauma is the leading cause of death in children and in
adults younger than 44 years of age.
Trauma also known as injury , is a physiological wound
caused by external source.
DEFINITION
An unintentional or intentional wound or injury
inflicted on the body from a mechanism against
which body cannot protect itself.
OR
A body wound or shock produced by sudden
physical injury ,as from violence or accident.
CLASSIFICATION OF TRAUMA
Injury are generally classified by either severity or by the
location of damage.
Classified by the type of force:
Blunt trauma-
Penetrating trauma
Classified by body area :
Injury affecting 40% are polytrauma
Injury affecting 30% are head injuries
20% are chest trauma
10% are abdominal trauma
2% ,extremity trauma

CAUSES
Blunt trauma
Motor vehicle collisions
Falls
Penetrating foreign body such as bullet or knife
enters the body tissue.
Burn injury
Occupational injury
Sports injury
MULTIPLE TRAUMA
Multiple trauma is caused by a single catastrophic
event that causes life-threatening injuries to at least
two distinct organs or organ systems.
Mortality in patients with multiple trauma is related
to the severity of the injuries and number of
systems and organs involved.
Care of the patient with multiple injuries require a
team approach , with one person responsible for
coordinating the treatment.
DEFINITION
Multiple trauma may be defined as physical injuries
occurring simultaneously in several parts of the
body.
MECHANISM OF INJURY
The extent of a patients injuries depends on the
mechanisms of injury .
Mechanisms of injury are the exchange of forces
between environment and person that result in
injury.
There are many different types of energy agents
,including :
1. Mechanical or kinetic energy blunt or penetrating
injury
1. Thermal injury injury due to heat or cold
2. Chemical injury acid or alkaline exposure
3. Radiant injury exposure to radiation
4. Electrical injury-electrocution
5. Oxygen deprivation smoke inhalation or drowning

ASSESSMENT AND DIAGNOSTIC
FINDINGS
Evidence of trauma may be absent.
Patients with multiple trauma should be assumed to
have spinal cord injury until it is proven otherwise.
The injury regarded as the least significant in
appearance may be the most lethal.
MANAGEMENT
Monitoring of the heart rate ,blood pressure ,oxygen
saturation and temperature . This will be seen on a
bedside monitor.
An arterial line may be inserted to monitor blood
pressure and to take blood samples.
Medications and intravenous fluids may be given
via a central venous catheter including sedatives (
to assist in sleep),analgesics (pain killers)and
antibiotics (for infections).These medications will be
given via infusion pumps.
Oxygen may be delivered via a face mask ,and
mechanical ventilation via endotracheal tube or
tracheostomy may be required to assist breathing .The
ventilated patient will require suctioning to remove
secretions from the lungs and airways.
If the patient has a head injury they may have monitoring
of the pressure in their brain(ICP monitoring).
Nutrition may be given via a nasogastric tube. This is a
tube that is placed in the nose and goes down the throat
into the stomach via nasogastric tube.
Insertion of an indweling catheter to drain and measure
urine output.
Drains may be used to drain excess fluids/blood from the
body.
Sequential compression devices may be put on the legs
to prevent the formation of blood clots.
Warming /cooling blankets may be needed to regulate
body temperature.
An air mattress may be used to prevent pressure areas
developing on the skin.

COMPLICATIONS OF MULTI TRAUMA
Pain
Haemorrhage
Infection/sepsis
Multi organ failure

INTRA ABDOMINAL INJURIES
Abdominal trauma is an injury to the abdomen.
Intra abdominal injuries are categorized as penetrating or
blunt trauma.
Penetrating abdominal injuries (ie, gunshot wounds
,stab wounds) are serious .
- Require surgery.
- Penetrating abdominal trauma results in a high incidence
of injury to hollow organs , particularly the small bowel
- The liver is a most frequently injured solid organ.
- All abdominal gunshot wounds that cross the peritoneum
or associated with peritoneal signs require surgical
exploration.
Blunt trauma -To the abdomen may result from motor
vehicle crashes , falls ,blows or explosions.
- It is commonly associated with extra- abdominal injuries
to chest ,head ,or extremities .
- Blunt injuries involving the liver ,kidneys, spleen, or blood
vessels,which can lead to massive blood loss into the
peritoneal cavity

ASSESSMENT AND DIAGNOSTIC FINDINGS
o History of traumatic event is obtained.
o Abdomen is inspected for signs of injury ,including
penetrating injuries , bruises and abrasions.
o Abdominal auscultation for bowel sounds .Absence of
bowel sounds may be an early sign of intra peritoneal
involvement.
o Laboratory studies
Urinalysis to detect hematuria
Serial hemoglobin and hematocrit levels to evaluate
trends reflecting the presence or absence of breathing

Serum amylase analysis to detect increasing levels ,
which suggest pancreatic injury or perforation of the
gastrointestinal tract.
White blood cell (WBC) count to detect
elevation(generally associated with trauma).
MANAGEMENT
Resuscitation procedures (restoration of airway ,
breathing and circulation ) are initiated.
With blunt trauma, the patient is kept on a stretcher to
immobilize the spine.
A backboard may be used for transporting the patient to
the x-ray department , to the operating room or to the
intensive care unit.
Knowing the mechanism of injury (ex- penetrating force
from a gunshot or knife ,blunt force from blow) is
essential to determining the type of management needed

Trauma predisposes the patient to infection by disruption
of mechanical barriers , exposure to exogenous bacteria
from the environment at the time of injury .Tetanus
prophylaxis and broad spectrum antibiotics as
prescribed.
If abdominal viscera is protude ,the area is covered with
sterile,moist saline dressing to keep the viscera from
drying.
Oral fluids are withheld in anticipation of surgery ,and the
stomach contents are aspirated with a nasogastric tube
to reduce the risk of aspiration and to decompress the
stomach in preparation of diagnostic procedures.
CRUSH INJURIES
Crush injuries occurs when a person is caught
between opposing forces.
Ex- run over by moving vehicle ,crushed between
two cars ,crushed under a collapsed building.
ASSESSMENT AND DIAGNOSTIC
FINDINGS
The patient is observed for the following:
Hypovolemic shock resulting from extravasation of
blood and plasma into injured tissues after
compression has been released.
Paralysis of a body part
Erythema and blistering of skin
Damaged body part (usually in extremity) appearing
swollen ,tense , and hard


MANAGEMENT
Maintaining the airway , breathing and circulation.
The patient is observed for acute renal insufficiency
.Injury to the back can cause kidney damage.
Severe muscular damage may cause rhabdomyolysis
,which signifies a release of myoglobin from ischemic
skeletal muscle ,resulting in acute tubular necrosis.
The serum lactic acid level is monitored ;a decrease to
less than 2.5 mmol/L is an indication of successful
resuscitation.


THANK YOU

Potrebbero piacerti anche