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Trauma and Surgical Management PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "Trauma and Surgical Management".

This medical PowerPoint presentation talks about trauma which refers to physical injuries caused by an external force, such as an accident, a fall, or an act of violence. Traumatic injuries can range from minor cuts and bruises to life-threatening injuries such as severe bleeding, fractures, and organ damage.

Surgical management of trauma involves the use of surgical procedures to treat traumatic injuries. The goal of surgical management is to repair damaged tissues, control bleeding, prevent infection, and improve overall patient outcomes.

Some common surgical procedures used in the management of trauma include Exploratory Laparotomy, Craniotomy, Thoracotomy, Fracture Fixation, and Soft Tissue Repair etc.

Tags : Trauma and Surgical Management, Traumatic injuries, Exploratory Laparotomy, Craniotomy, Thoracotomy, Fracture Fixation, Soft Tissue Repair, Emergency Medicine, Emergency Medicine PowerPOint presentation

Published on : Apr 12, 2023 | Views : 1626 | Downloads : 2

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Introduction to Trauma Fifth leading cause of death overall Major cause of death and disability ages 16 to 54 years Leading cause of death of teens; 11 teens die in MVCs each day Often associated with drugs and alcohol Financial implications Treatment Rehabilitation Disability Copyright © 2017 Elsevier Inc. All rights reserved. 2
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Quick Quiz! Which hospital description is consistent with a Level I trauma center? Regional resource, state-of-the-science care, education, outreach, and research Provides care for trauma patients and transfer to Level I if needed Community hospital where no Level I or II exists Provides advanced trauma life support (ATLS) and transfer Copyright © 2017 Elsevier Inc. All rights reserved. 4
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Levels of Trauma Care Level I—regional resource, state-of-the-science care, education, outreach, and research Level II—provides care for trauma patients and transfer to Level I if needed Level III—community hospital where no Level I or II exists Level IV—provides advanced trauma life support (ATLS) and transfer Copyright © 2017 Elsevier Inc. All rights reserved. 5
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Prevention Primary prevention—prevent the event Driving safety classes Speed limits Campaigns to not drink and drive Secondary prevention—minimize the impact of the traumatic event Seat belt use Airbags Car seats Helmets Tertiary prevention—maximize patient outcomes after a traumatic event through emergency response systems, medical care, and rehabilitation Copyright © 2017 Elsevier Inc. All rights reserved. 6
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Quick Quiz! What does the “golden hour” in trauma refer to? Hour-long educational programs that focus on prevention strategies for teens First hour of emergent care focusing on rapid assessment, resuscitation, and treatment First hour after stabilization in the emergency department Surgery should occur within a hour of injury for optimal patient survival Copyright © 2017 Elsevier Inc. All rights reserved. 7
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Trauma Team Similar to code team Team members preassigned Trauma surgeons, emergency department physicians, and specialists Nurses Ancillary services: radiologic technologists, laboratory technicians, respiratory therapists, and social workers Copyright © 2017 Elsevier Inc. All rights reserved. 9
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Critical Thinking Challenge What is the role of pastoral services on a trauma team? Why is it important to have security officers as part of the trauma team? Copyright © 2017 Elsevier Inc. All rights reserved. 10
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Trauma Triage Essential for determining if patient needs to be transferred to a Level I trauma center Made by prehospital personnel Criteria in place to guide decision ABCs and lifesaving interventions Ground versus air transport Copyright © 2017 Elsevier Inc. All rights reserved. 11
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Disaster and Mass Casualty Management A sudden event that overwhelms EMS, hospitals, community resources Environmental, man-made, terrorism-related Internal disaster Disaster protocols Disaster debriefing Copyright © 2017 Elsevier Inc. All rights reserved. 12
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Quick Quiz! During a mass casualty, a color is assigned to patients based on severity of injury. Which color indicates the patient needs emergent care? Red Green Yellow Black Copyright © 2017 Elsevier Inc. All rights reserved. 13
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Mechanisms of Injury Knowledge helps to identify potential problems Uncontrolled source of energy Kinetic energy Thermal, chemical, electrical, radiation, blast Copyright © 2017 Elsevier Inc. All rights reserved. 14
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Blunt Trauma Severity depends on kinetic energy dissipated to the body Common vehicular trauma, assault with blunt objects, falls, and sports Acceleration Deceleration Shearing Crushing Compression Copyright © 2017 Elsevier Inc. All rights reserved. 15
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Patterns of Injury with Blunt Trauma Copyright © 2017 Elsevier Inc. All rights reserved. 16 Figure 20-2. Potential sites of blunt trauma injury in unrestrained passenger and driver in a motor vehicle crash. A, Unrestrained passenger in front seat. B, Unrestrained driver. C, Lateral impact collision. (From Herm RL. Biomechanics and mechanism of injury. In Cohen SS, ed. Trauma Nursing Secrets. Philadelphia: Hanley & Belfus. 2003.)
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Penetrating Trauma Impalement of foreign objects into the body Stab wounds are low-velocity injuries Ballistic trauma (e.g., gunshot injuries) Medium velocity: handguns, some rifles High velocity: assault and hunting rifles Velocity and missile (bullet) determine tissue damage Cavitation Copyright © 2017 Elsevier Inc. All rights reserved. 17
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Blast Trauma Blunt and penetrating trauma Tissue and organ injury Gas-containing organ injury (e.g., eardrums, lungs, intestines) Blast injury: Primary Secondary Tertiary Quaternary Copyright © 2017 Elsevier Inc. All rights reserved. 18
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Prehospital Care/Transport Emergency stabilization and quick transport ABCs (with cervical stabilization) IV access and fluid administration Hemorrhage control Fracture stabilization Copyright © 2017 Elsevier Inc. All rights reserved. 19
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Emergency Care Phase Prehospital data obtained Trauma unit in emergency department must always be in a state of readiness Trauma surgeon must be present upon patient arrival, in the operating room, and during critical care interventions Copyright © 2017 Elsevier Inc. All rights reserved. 20
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Primary Survey Done in 1 to 2 minutes Airway patency (with C-spine immobile) Breathing effectiveness Circulation, including hemorrhage and pulses Disability (overview of neurological status) Expose the patient, remove clothing, warm patient and trauma room Identify life-threatening injuries accurately to establish priorities Copyright © 2017 Elsevier Inc. All rights reserved. 21
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Critical Thinking Challenge Patients who present to the emergency department after traumatic injury are at high risk for hypothermia. What factors predispose the patient to hypothermia? What nursing interventions can be done to prevent and/or treat hypothermia? Copyright © 2017 Elsevier Inc. All rights reserved. 22
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Secondary Survey Performed after life-threatening injuries are identified and treated Examination of all body systems: Full set of vital signs; focused interventions, family presence Give comfort measures History and more thorough head-to-toe assessment Inspect posterior surfaces Copyright © 2017 Elsevier Inc. All rights reserved. 23
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Secondary Survey(Cont.) Maintain C-spine immobilization until cleared by x-ray X-ray studies (as determined by injury) Laboratory studies Tetanus toxoid administration Specialty physician consults Copyright © 2017 Elsevier Inc. All rights reserved. 24
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Maintain Airway Patency Many factors affect the airway (e.g., facial fractures, bleeding, vomiting, decreased sensorium) Open airway Jaw thrust or chin lift Nasopharyngeal or oropharyngeal airways Copyright © 2017 Elsevier Inc. All rights reserved. 26
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Maintain Airway Patency (Cont.) Laryngeal mask airways (LMA) Endotracheal intubation Cricothyrotomy Facial fracture Unable to intubate Facial or upper airway burns Oropharyngeal hemorrhage Copyright © 2017 Elsevier Inc. All rights reserved. 27
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Ineffective Breathing Ongoing assessment is essential Respiratory status Arterial blood gases (ABGs) Chest x-rays Computed tomography (CT) imaging Improve ventilation and gas exchange Copyright © 2017 Elsevier Inc. All rights reserved. 29
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Impaired Gas Exchange Supplemental oxygen or mechanical ventilation Ongoing assessment Oxygen saturation Respiratory status (rate, work of breathing, depth of ventilation, breath sounds) Secretion removal Copyright © 2017 Elsevier Inc. All rights reserved. 32
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Circulation: Hypovolemia Hypovolemic shock: Acute blood loss External hemorrhage Internal hemorrhage Ongoing assessment of vital signs, urine output, mental status, and hemodynamic parameters Early rapid identification of cause Copyright © 2017 Elsevier Inc. All rights reserved. 33
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Treatment of Hypovolemia(Cont.) Administration of crystalloids and blood products Lactated Ringer’s is fluid of choice Blood administration is based on response to initial fluid resuscitation and laboratory values Autotransfusion an option Copyright © 2017 Elsevier Inc. All rights reserved. 36
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Response to Treatment Rapid responders Transient responders Patient is still bleeding; surgery needed Minimal or no responders Emergent surgical intervention is needed to stop bleeding Copyright © 2017 Elsevier Inc. All rights reserved. 37
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Ongoing Signs and Symptoms of Shock Tachycardia, tachypnea Narrowing pulse pressure Falling PaO2 Decreasing urine output Increased serum lactate levels Falling hematocrit Copyright © 2017 Elsevier Inc. All rights reserved. 38
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Newer Technologies Technologies that can be used to assess tissue perfusion Sublingual capnometry Near-infrared spectroscopy (NIRS) StO2 ≤ 80% indicates shock Copyright © 2017 Elsevier Inc. All rights reserved. 39
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Massive Fluid Resuscitation Administration greater than 10 units of packed red blood cells (RBCs) in 24 hours Or replacement of patient’s total blood volume in 24 hours Restores oxygen transport to tissues Stops progress of shock Prevents complications Monitor for electrolyte imbalances Copyright © 2017 Elsevier Inc. All rights reserved. 40
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Complications of Massive Fluid Resuscitation Fluid-electrolyte imbalances Hypothermia Coagulopathies Third-spacing and organ dysfunction Abdominal compartment syndrome ARDS Acute kidney injury MODS Copyright © 2017 Elsevier Inc. All rights reserved. 41
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Focused Assessment with Sonography for Trauma (FAST) Noninvasive Determines potential sources of bleeding Peritoneal cavity Pericardial sac Copyright © 2017 Elsevier Inc. All rights reserved. 42
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Quick Quiz! A complication of hypothermia is: Rapid infusion of IV fluids Rapid infusion of blood products Coagulopathies and dysrhythmias Wet linens Copyright © 2017 Elsevier Inc. All rights reserved. 43
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NeurologicalTraumatic Brain Injury (TBI) Primary injury associated with trauma Establish baseline level of consciousness (LOC) Secondary injury associated with: Hypoxemia Hypotension Increased intracranial pressure (ICP) Hypocapnia Hyperthermia Anemia Copyright © 2017 Elsevier Inc. All rights reserved. 45
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NeurologicalTraumatic Brain Injury (TBI)(Cont.) Prehospital phase is crucial Glasgow Coma Scale score less than 8 Monitor and treat ICP Less than 20 mm Hg Cerebral perfusion pressure > 50 mm Hg Ongoing neurological assessment Copyright © 2017 Elsevier Inc. All rights reserved. 46
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Spinal Cord Injury Suspicion: mechanism of injury Immobilization X-rays and possible CT studies Reduction with cervical traction Distributive (neurogenic) shock May need vasopressors Copyright © 2017 Elsevier Inc. All rights reserved. 47
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Basilar Skull Fractures Assess for underlying brain injury Base of the cranium involving five bones Diagnosis based on: Presence of CSF from nose, ears, or both Ecchymosis over mastoid area or hemotympanum Periorbital ecchymosis Copyright © 2017 Elsevier Inc. All rights reserved. 48
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Cardiac Tamponade Bleeding into pericardial space Impairs pumping ability of heart May be difficult to diagnose Pulsus paradoxus Beck’s triad Hypotension Muffled heart sounds Elevated venous pressure Copyright © 2017 Elsevier Inc. All rights reserved. 50
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Cardiac Tamponade(Cont.) Suspect in patient with symptoms of decreased cardiac output who does not respond to treatment Treated by pericardiocentesis Copyright © 2017 Elsevier Inc. All rights reserved. 51
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Aortic Disruption Life-threatening injury requiring emergency surgical intervention Symptoms include weak pulses, pain, and hoarseness Chest x-ray shows widened mediastinum Confirmed by aortogram Emergent surgical intervention Copyright © 2017 Elsevier Inc. All rights reserved. 53
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Quick Quiz! Which traumatic chest injury is most likely to result in patient death? Cardiac contusion Tension pneumothorax Open pneumothorax Pulmonary contusion Copyright © 2017 Elsevier Inc. All rights reserved. 54
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Tension Pneumothorax Life-threatening Increased intrapleural and intrathoracic pressures cause compression of heart and great vessels Cardiovascular collapse Cyanosis: Late manifestation Emergent treatment with needle thoracostomy Chest tube inserted after needle decompression Copyright © 2017 Elsevier Inc. All rights reserved. 55
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Hemothorax Blood (hemo) in pleural space Hypotension and respiratory distress Chest tube insertion needed Monitor blood volume evacuated closely Copyright © 2017 Elsevier Inc. All rights reserved. 56
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Open Pneumothorax Air (pneumo) in pleural space Hypoxia and hemodynamic instability Three-side occlusive dressing Allow small amount of air to escape from occlusive dressing Chest tube insertion needed Copyright © 2017 Elsevier Inc. All rights reserved. 57
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Pulmonary Contusion Bruising of lung tissue Associated with rib fractures and flail chest Often results in pneumonia and acute respiratory distress syndrome (ARDS) May require long-term ventilatory support Pain relief Copyright © 2017 Elsevier Inc. All rights reserved. 58
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Rib Fractures Seriousness varies; treatment also varies Chest x-ray Secondary organ injury: liver, spleen, kidney May result in flail chest Two or more adjacent ribs fracture in more than one location Paradoxical respirations result Treated with intubation, ventilation, and pain management Copyright © 2017 Elsevier Inc. All rights reserved. 59
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Abdominal Injuries Diagnosis facilitated by: FAST Abdominal CT Laboratory tests can also help in identifying organ damage (e.g., liver function studies, renal studies) Ongoing assessment essential Pain Copyright © 2017 Elsevier Inc. All rights reserved. 60
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Abdominal Injuries (Cont.) Trauma can result in damage to any of the organs Liver damage most common Grade I to VI Splenic injury occurs with blunt trauma Kehr’s sign Hypotensive shock Pneumococcal vaccine Copyright © 2017 Elsevier Inc. All rights reserved. 61
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Abdominal Injuries (Cont.) Bowel injury Penetrating and blast injury Postoperative risks of infection and ineffective nutrition Kidney injury Blunt trauma; unilateral injury FAST, pyelogram, cystoscopy Pelvic injury High-speed MVC, falls Hypovolemic/hemorrhagic shock Copyright © 2017 Elsevier Inc. All rights reserved. 62
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Musculoskeletal Injuries Many types of fractures; multiple fractures often present in trauma patient Unstable pelvic fractures and femur fractures can result in a large amount of blood loss Copyright © 2017 Elsevier Inc. All rights reserved. 63
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Musculoskeletal Treatment Closed or open reduction; may need traction Treatment of hypovolemia and blood loss Soft tissue trauma Contusions, abrasions, lacerations, puncture wounds, crush injuries, amputations, avulsions Wound care Tetanus prophylaxis Possible antibiotics Copyright © 2017 Elsevier Inc. All rights reserved. 64
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Copyright © 2017 Elsevier Inc. All rights reserved. 65 Figure 20-4. Common types of fractures. (From Murray CA. Care of patients with musculoskeletal trauma. In Ignatavicius D, Workman ML, eds. Medical-Surgical Nursing: Critical Thinking for Collaborative Care. 6th ed. Philadelphia: Saunders. 2010.)
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Musculoskeletal Injuries(Cont.) Assess for neurological and/or vascular injury Assess the five Ps: Pain Pallor Pulses Paresthesia Paralysis Copyright © 2017 Elsevier Inc. All rights reserved. 66
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Compartment Syndrome Fascia enclosed muscle compartment experiences increased pressure Compression of nerves, blood vessels, muscles Neurovascular assessment (five Ps) Treatment: fasciotomy Copyright © 2017 Elsevier Inc. All rights reserved. 67
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Rhabdomyolysis Muscle destruction Secondary to crush injury Increased myoglobin and potassium Can result in acute kidney injury (AKI) (formerly called acute renal failure [ARF]) IV fluids to achieve urine output ≥ 100 mL/hr Copyright © 2017 Elsevier Inc. All rights reserved. 68
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Venous Thromboembolism High risk in trauma patients Virchow’s triad Vessel damage Venous stasis Hypercoagulability Pulmonary embolism risk Pharmacological and mechanical prophylaxes Copyright © 2017 Elsevier Inc. All rights reserved. 69
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Fat Embolism Long-bone, pelvic, and multiple fractures Symptoms: 24 to 48 hours after injury Symptoms include: Low-grade fever, tachycardia, new onset of respiratory distress, hypoxia, petechial rash, and thrombocytopenia ECG changes, lipuria, decreased LOC Treatment: pulmonary and cardiovascular support Copyright © 2017 Elsevier Inc. All rights reserved. 70
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Disseminated Intravascular Coagulation Diffuse activation of coagulation Microthrombi Consumption of coagulation factors Copyright © 2013, 2009, 2005, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 71
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Critical Care Phase Postoperative management Systemic assessment and monitoring Continued resuscitation Address ongoing patient care priorities Copyright © 2017 Elsevier Inc. All rights reserved. 72
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Damage Control Surgery Patients with multiple injuries Staged surgeries Repair stages: Life-threatening injuries Definitive repair Hemodynamic stabilization Correction of metabolic acidosis and coagulopathies Copyright © 2017 Elsevier Inc. All rights reserved. 73
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Postoperative Management Ready the room Warm room Equipment Zero the bed scale for admission weight Receiving the patient Handoff communication Quick assessment Connect to equipment Detailed assessment Copyright © 2017 Elsevier Inc. All rights reserved. 74
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Postoperative Management(Cont.) Early enteral nutrition should be initiated Consider nutritional consult DVT and stress ulcer prophylaxis Monitor serum electrolytes to include glucose Copyright © 2017 Elsevier Inc. All rights reserved. 75
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Complications Complications may be secondary to: Traumatic injury Severity of shock (poor tissue perfusion/oxygenation) Inflammatory response to injury Complications are more likely in patients with multisystem injuries Copyright © 2017 Elsevier Inc. All rights reserved. 76
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Complications(Cont.) Complications include: Infection/sepsis Venous thromboembolism Acute respiratory failure/acute respiratory distress syndrome (ARDS)/pneumonia Acute kidney injury Multiple organ dysfunction syndrome (MODS) Copyright © 2017 Elsevier Inc. All rights reserved. 77
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Critical Thinking Challenge What strategies can you implement to reduce the risk of the following complications? Infection Venous thromboembolism Pneumonia Copyright © 2017 Elsevier Inc. All rights reserved. 78
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Alcohol and Drug Abuse Up to 40% of traumatic events involve alcohol and/or drugs Increased morbidity and mortality Trauma centers need to have alcohol and drug intervention programs Withdrawal of drugs and alcohol may occur during acute hospitalization Copyright © 2017 Elsevier Inc. All rights reserved. 79
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Critical Thinking Challenge List five special considerations in the care of the geriatric trauma patient. What are unique risk factors associated with aging that increase morbidity and mortality of the older trauma patient? Copyright © 2017 Elsevier Inc. All rights reserved. 80
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Rehabilitation Begins at admission Goal: maximize patient independence Nursing care in acute phase impacts patient’s rehabilitation and recovery Copyright © 2017 Elsevier Inc. All rights reserved. 82