Trauma/Hemorrhage

by
IMRAN WAHEED
BSN, msn*

Institute of nursing sciences, Khyber medical university

Subject
Critical Care Nursing

1
 Outline
• Trauma
• Types of trauma
• Hemorrhage
• Types of Hemorrhage
• Effects of Hemorrhage
• Classification of hemorrhage
• Nursing and medical management
Injury, Wound and Trauma
• Injury is the more general term. When used literally, wound is specifically the cut or hole in
the skin or organ, they can be used interchangeably.
• Injury is one of the umbrella terms. The wound is a type of injury.
• An injury is anything that causes harm to the body.
• An injury can come from outside or inside the body. For example, a heart attack or a stroke is
caused by something on the inside of the body. They are injuries with an internal cause. These
internal injuries are not trauma.
• A broken leg is caused by an outside force. A broken leg is trauma. Outside forces are external.
Here are some examples of external causes of injury that result in trauma:

• Crashing your car, Falling down the stairs ,Fist fight, Gunshot wounds, Stabbing
• The external forces come from outside of the body and they cause traumatic injuries to the
body. This is what we mean by trauma.
What is Trauma?
• An event that involves
• actual or threatened
death
• serious injury or threat to
physical integrity
• Types of events
• Natural disasters
• Terrorism
• Physical or Sexual Assault
• Motor Vehicle Accidents
• Combat
 Energy and Trauma
• Traumatic injury occurs when the body’s tissues are exposed to
energy levels beyond their tolerance.
• The mechanism of injury (MOI) is the way traumatic injuries occur.
• Describes the forces acting on the body that cause injury
 Mechanism of Injury Profiles
• Different MOIs produce many types of injuries.
• Nonsignificant injuries
• Injury to an isolated body part
• A fall without the loss of consciousness
 Mechanism of Injury Profiles

• Significant injuries:
• Injury to more than one body system (multisystem trauma)
• Falls from heights
• Motor vehicle and motorcycle crashes
• Car versus pedestrian
• Gunshot wounds
• Stabbings
 Blunt Trauma, Penetrating Trauma and
Deceleration trauma
• Either type may occur from a variety of MOIs.
• Blunt trauma is the result of force to the body that causes injury
without penetrating the soft tissues.
• Penetrating trauma causes injury by objects that primarily pierce and
penetrate the surface of the body.
• Deceleration trauma is an injury caused by a sudden stop in motion
 Blunt Trauma
• Blunt trauma is classified as a force striking the body, and its
consequences are dependent on the location of the trauma.
• Results from an object making contact with the body
• Motor vehicle crashes and falls are the most common MOIs.
• Be alert to skin discoloration and pain.
• Maintain a high index of suspicion for hidden injuries.
• The most common cause and location of blunt force trauma in adults
are abdomens after motor vehicle accidents.
• Solid-organ blunt abdominal trauma includes most commonly the liver,
but also the spleen, and kidneys
Penetrating Trauma
• Second leading cause
of trauma death after
blunt trauma
• May be caused
intentionally by a
knife, ice pick, or other
weapon
Penetrating Trauma
• With low-energy penetrations, injuries are caused by the sharp edges
of the object moving through the body.
• Knives may have been deliberately moved around internally, causing
more damage than the external wounds suggest.
• A hypovolemic shock from penetrating trauma is one of the most
feared consequences because it can result in death if not treated
promptly.
• A patient in hypovolemic shock typically presents with hypotension,
tachycardia, tachypnea, and cold skin.
Deceleration Trauma
• Deceleration trauma is an injury caused by a sudden stop in motion.
• Like the two previously discussed categories of trauma, deceleration
trauma also affects different organ systems.
• Acceleration-deceleration injury to the brain resulting from the
motion of the brain hitting one area of the skull and bouncing back,
hitting the direct opposite side of the brain on the other side of the
skull.
• This movement can result from both direct forces like direct head
impact on the steering wheel in a motor vehicle accident or by non-
contact forces like the shaken baby.
 Causes
• There are many causes of bleeding some of them are :
• 1) Wounds
• A break in the continuity of skin is termed as wound. Various types of
wounds are following
a) Incised Wound
b) Laceration
c) Abrasion
d) Contusion
e) Punctured wound
f) Gunshot wound
 Conti…
2. Fractured
3. Intraoperative period
4. Road traffic accident
5. Blunt traumatic injury
6. Invasive diagnostic procedures
7. Anatomical defects
8. Canine bite
9. Crush injury
10. Varicose bleeding
Incised Wound
Abrasion
Puncture wound
///////////////////
Capillary pressure favors filtration of fluid into the interstitial space, so increasing PC leads to
edema and lowering it favors reabsorption of fluid from the interstitial space into the blood.

Glomerular filtration rate (GFR) is the volume of fluid filtered from the renal (kidney)
glomerular capillaries into the Bowman's capsule per unit time.
Osmolality is the concentration of the substance in 1 L of
water divided by its molecular weight.

Osmolality is a test that measures the concentration of all

chemical particles found in the fluid part of blood.
The Reticular Activating System (RAS) is a bundle of
nerves at our brainstem that filters out unnecessary
information so the important stuff gets through.

Reticular Activating System: The RAS is one of the most

critical systems for the proper functioning of sensation,
consciousness, attention, and the sleep-wake cycle.