Page 282 - Critical Care Nursing Demystified

Chapter 6 CARE OF THE TRAUMATIZED PATIENT 267

Trauma can be described as an event or incident that severely impairs or
disrupts an individual’s ability to sustain life or to function in a reasonable
manner. Accidents can be caused by numerous factors, incidental or other-
wise, such as falls, MVCs (motor vehicular crashes), contact sports, diving,
drowning, poisonings, overdoses, assaults and attacks, and forces of nature. In
order to understand trauma, one must take a closer look at the mechanisms
of injury, how traumatic injuries are classified, and evaluating reports from
the field.

Mechanisms of Injury (MOI)

Mechanisms of injury means the types of injuries sustained and the amount of
force utilized to create specific injuries. These mechanisms of injury were
explained in Chapter 5 but are mentioned again as blunt, penetrating, and
perforating types.
A blunt injury is a direct blow or impact that causes the greatest injury. The
body surface and the injuring culprit are in direct contact. The most common
causes of blunt, forceful trauma are the acceleration/deceleration injuries of
head and neck trauma. Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
Penetrating injuries are produced by foreign objects such as knives, glass, and
fence stakes that penetrate and impale. They cause internal damage to body
organs and tissues. A bullet can also be included in this category in that it pro-
duces a missile injury that enters but does not exit the body.
Perforating injuries are injuries caused by items that enter and exit the body
causing severe internal damage. Examples are bullets and knives.

Classification of Injuries

1 Injuries can be classified as primary and secondary. Primary injuries are those
that occur at the time of impact and include contusions or bruising, lacerations,
shearing or tearing injuries, hemorrhage, and subluxations. Such injuries can be
mild with minimal or absent neurologic damage, or severe with major organ
(flail chest; cardiac tamponade) and/or neurologic damage.
Secondary injuries occur after the primary injury, such as infection or sepsis
that leads to increased organ and tissue damage and even increases in intracra-
nial pressure. These can be just as lethal as the initial or primary injury and
cause the need for close nursing observation.