First Aid and Emergency Nursing (Theory) University of Tabuk Faculty of Applied Medical Sciences Department of Nursing First Aid and Emergency Nursing (Theory) (NUR 410)

Curriculum & Course Development Committee Topics Outline Definition HEAD TRAUMA CHEST TRAUMA DEPARTMENT OF NURSING Curriculum & Course Development Committee Department of Nursing

TRAUMA The unintentional or intentional wound or injury inflicted on the body from a mechanism against which the body cannot protect itself, is the third leading cause of the deaths in children and adults younger than 44 years old in other countries.

Types of Trauma: HEAD TRAUMA Is a trauma to the head, that may or may not include injury to the brain.

Signs and symptoms Severe head or facial bleeding Change in level of consciousness for more than a few seconds Black-and-blue discoloration below the eyes or behind the ears Cessation of breathing Confusion

Signs and symptoms Loss of balance Weakness or an inability to use an arm or leg Unequal pupil size Repeated vomiting Slurred speech

If severe head trauma occurs: Keep the person still. Until medical help arrives, keep the person who sustained the injury lying down and quiet in a darkened room, with the head and shoulders slightly elevated. Don't move the person unless necessary and avoid moving the person's neck. Stop any bleeding. Apply firm pressure to the wound with sterile gauze or a clean cloth. But don't apply direct pressure to the wound if you suspect a skull fracture. Watch out for breathing changes and alertness. If the person shows no sign of circulation (breathing, coughing, or movement) begin CPR

Management Immobilize the patient to insure no further damage to the spine or nervous system Insert an airway to insure uninterrupted breathing, and perform endotracheal intubation if indicated. One or more IVs will be inserted to maintain perfusion status. In some cases medications may be administered to sedate or the patient to prevent additional movement which may worsen the brain injury.

Management Primary treatment involves controlling elevated intracranial pressure. This can include sedation, paralytics, cerebrospinal fluid diversion. Second line alternatives include decompressive craniectomy (Jagannathan et al. found a net 65% favorable outcomes rate in pediatric patients), barbiturate coma, hypertonic saline and hypothermia

II.CHEST TRAUMA (or thoracic trauma) Is a serious injury of the chest. Thoracic trauma is a common cause of significant disability and mortality. Thoracic injuries account for approximately 25% of all trauma-related deaths.

TYPES OF CHEST TRAUMA Rib Fracture Cause: Blow to chest S/Sx: Pain on Inspiration, Local Tenderness First Aid: Immobilize and Transport to the nearest hospital

TYPES OF CHEST TRAUMA Flail Chest Cause: Rib Fracture in more than one place, Chest wall becomes unstable S/Sx: Paradoxical respiration, Respiratory distress, Chest Pain First Aid: Apply external pressure, Sand bed pillow, Give O2, transport with flail side down

TYPES OF CHEST TRAUMA Open Pneumothorax Cause: penetrating trauma to chest, loss of negative intra-thoracic pressure as air moves in and out of wound S/Sx: sucking sound on chest wall during inspiration, tracheal deviation First Aid: Cover wound with occlusive dressing exhalation, Give O2

TYPES OF CHEST TRAUMA Single Pneumothorax Cause: Lacerations of lungs, hyperinflation (Blast injuries, driving accident) loss of negative intra-thoracic pressure S/Sx: Sudden onset of chest pain, decreased breath sound of affected area, dyspnea, tachypnes First Aid: Semi-fowler’s or fowler’s position, Give o2

TYPES OF CHEST TRAUMA Tension Pneumothorax Cause: Complication of another type of pneumonia, air enters the pleural cavity but cant escape S/Sx: Respiratory distress, paradoxical chest movement, neck vein distention, tracheal deviation to unaffected side First Aid: Maintain airway breathing, give oxygen

TYPES OF CHEST TRAUMA Hemothorax Cause: Blunt and penetrating injuries, injuries to major blood vessels and heart, blood collects to the pleural cavity S/Sx: Decreased breath sounds and dyspnea First Aid: Treat shock, give oxygen

Question no.1 A client with trauma to the chest develops a tension pneumothorax. VS as follows: BP- 100/70 T- 37.3 RR- 33 PR-118 As an ER nurse what is the priority Nsg. Intervention. Assess the patient Give patient water Maintain airway breathing and give oxygen as per Doctor’s order Let patient rest Ans C Department of Nursing Department of Nursing

Question no.2 A client with trauma to the chest develops a tension hemothorax. VS as follows: BP- 100/70 T- 37.3 RR- 33 PR-118 The family ask you about this condition. As an ER nurse what is the correct explanation of this condition? It when blood accumulates in the chest cavity of the patient secondary to impact to the chest wall. When air is trapped inside the chest cavity of the patient It is due to increase glucose level in the blood It when the patient coughs blood and has fever. It is bacterial in origin and communicable Ans A Department of Nursing Department of Nursing

Curriculum & Course Development Committee References Daniel Limmer ,Michael F. O’keefe. Emergency Care .12 th ed, Pearson Education, Inc., 2011. ISBN-10: 013254380X • ISBN-13: 9780132543804 •Kathleen Sanders Jordan, Emergency Nursing Core Curriculum,5 th ed, Philadelphia, W.B. Saunders company :A division of Harcourt Brace & company,2000. DEPARTMENT OF NURSING Curriculum & Course Development Committee Department of Nursing