Exam 27: Trauma Surgery

Autotransfusion can present a vital asset in trauma care,when considering the high blood loss associated with many traumatic injuries.This process provides immediate volume replacement,decreases the amount of bank blood used,and reduces the possibility of transfusion reactions or risk of transfusion with bloodborne pathogens.What are the contraindications to using autotransfusion as a blood replacement source?

Mandibular fractures are highly associated with assault as the MOI.The goals of operative intervention are to reduce and immobilize the fracture,prevent infection,and restore facial cosmesis and function.What might be an appropriate nursing action and a nursing outcome statement for a patient with a mandibular fracture caused by assault?

Sherita Noonan,a 9-year-old girl,is admitted to the operating room for elevation of a depressed skull fracture without evidence of a hematoma.She has a history of seizure disorders.The anesthesia provider administers a loading dose of medication to prevent seizure activity under anesthesia.What is the appropriate medication to give and what nursing actions would be indicated?

Mechanism of injury (MOI),or kinematics,involves the action of forces on the human body and their effects.Motor vehicle collisions (MVCs)account for a high degree of blunt trauma.In the case of an adult trauma victim who is the driver in a head-on MVC at high speed,where the head hits the windshield and the chest impacts the steering wheel,what is the MOI and description of the possible injuries?

Focused assessment with sonography in trauma (FAST)may assist with diagnosis in difficult situations.What group of scans is performed and what do they identify?

With injury to the brain,swelling may occur quickly,requiring aggressive decisions to manage increasing intracranial pressure (ICP).What is an appropriate diuretic medication to give and what nursing actions would be indicated for an older adult patient with traumatic brain injury,increased ICP,and a history of congestive heart failure (CHF)?

If cervical spine precautions were not implemented before arrival at the hospital,the emergency department team initiates them before performing any other procedures on the patient.A trauma team member can stabilize the head and neck,if necessary,until a cervical collar is placed.What event needs to take place before the team removes the cervical collar and continues care?

Traumatic deaths may occur in three phases,or time frames.The first phase occurs immediately after the injury,the second phase within the first 1 to 2 hours after the injury,and the third phase occurs days to weeks after the injury.Approximately 30% of total fatalities from trauma could be prevented with definitive trauma care,including appropriate and aggressive resuscitation with rapid transport to an appropriate facility.Which phase,or timeframe,of potential for trauma death,does this group represent?

What statement regarding level I and level II trauma centers best describes the difference between the two types of centers?

Morgan Fairlawn is a 7-year-old female who fell off of the swing at school and landed on her head.She is alert.She does not have a history of seizures and does not take any medications.The ED team would like to keep her awake for further monitoring of level of consciousness,and are not yet considering intracranial pressure monitoring.Morgan is very anxious.What sedative and nursing action would be appropriate for Morgan?

Morbidity and mortality may be greater with penetrating trauma because identification of injuries may be more difficult when injuries are less obvious.In the case of an adult victim with a low-velocity,low-caliber gunshot wound,at far range,of the anterior left quadrant of the lower abdomen,what is the MOI and description of the possible injuries?

The perioperative nurse may not be able to assess the trauma patient until the patient arrives in the OR for surgical intervention.If the patient's condition permits,the perioperative nurse should obtain a brief,precise report from the ED nurse.One component of this report is the AMPLE history.What are the components of the AMPLE mnemonic?

Trauma to the chest area is the primary cause of death in approximately 25% of trauma victims.Involvement of the heart,great vessels,lungs,and diaphragm,attributable to penetrating or blunt injury,can provide multiple unexpected findings when the chest is opened.Because of the nature of the potential findings and expected surgical intervention,what would be an appropriate preparatory nursing action?

Blunt trauma injuries may not fully reveal the degree or depth of injury.What noninvasive diagnostic test is critical to diagnosis in potential traumatic brain injury?

What special consideration should be made when operating on bariatric trauma patients that could negatively impact their surgical outcome?

When the patient arrives in the ED,the trauma team initiates a primary assessment.This is a logical,orderly process of patient assessment for potential life threats.These assessment activities are based on established protocols for advanced trauma life support (ATLS).The mnemonic "ABCDE" is used,representing assessment of the following:Airway,Breathing,Circulation,Disability,and Exposure.The D and E represent what degree of investigation?

A 26-year-old female is rushed to the operating room after a primary and secondary survey in the emergency department.She was hit by a small truck as she was riding her bicycle through a busy intersection.She has sustained rib fractures and several fractured transverse vertebral processes.Renal injury is suspected.As the perioperative nurse prepares to insert a urinary catheter,she notices blood at the urinary meatus.What should the nurse's next action be?

A trauma patient is rushed to the OR after a primary survey is completed in the emergency department.He is a 36-year-old male with multiple penetrating gunshot and knife wounds to the abdomen.He is bleeding profusely.What appropriate nursing actions are critical in the rapid preparation for this procedure?

Blunt force to the larynx can result in a fracture and impose immediate airway obstruction.These patients are at risk for a lost airway and may require immediate tracheotomy followed by repair of the fracture when the fracture is unstable or displaced.It is also important to consider that a trauma patient is assumed to have a full stomach;thus these patients are at high risk for aspiration and resultant pneumonia.What is an appropriate nursing action in the event of a lost airway after anesthesia induction and before intubation?

The emergency medical services system consists of trained prehospital personnel who arrive at the scene and perform definitive interventions designed to reduce morbidity and mortality.What is the primary role of the prehospital personnel? Select all that apply.