1. 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)

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

3. 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.

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

5. 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

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

7. 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

8. 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.

9. 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

10. 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.

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. Question no.1
A client with trauma to the chest develops a tension pneumothorax. VS as follows:
BP- 100/70 T 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

18. Question no.2
A client with trauma to the chest develops a tension hemothorax.
VS as follows:
BP- 100/70 T 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

19. Curriculum & Course Development Committee
References
Daniel Limmer ,Michael F. O’keefe. Emergency Care .12 th ed, Pearson Education, Inc., ISBN-10: X • ISBN-13:
•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