Penetrating Injuries for Certified Emergency Nursing (CEN)
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Outline
Penetrating Injuries
Definition/Etiology:
- Penetrating injuries from guns, industrial accidents, paint guns, and nail guns
- Appearance of entrance wound does not always reflect the amount of damage beneath
- Do not remove impaling objects
Pathophysiology:
- Firearm injuries can result in extensive damage to underlying tissues and organs
- Fragments from shattered bones can form secondary projectiles
- Passage of the bullet in a gunshot wound (GSW) forms a negative pressure cavity that pulls debris into the wound
- Shock waves travel through tissues, causing shearing and crushing of nerves, vessels, muscles, and organs
- Bullets from rifles have a higher velocity than those from handguns and are associated with greater tissue damage
- High-pressure injuries such as from paint guns or grease guns that are designed to inject these substances into hard-to-reach places
- When forced against the skin, such guns inject paint or grease for several centimeters, typically following tissue plane
- In the volar aspect of the hand, paint or grease can travel down tendon sheaths and along the digits
Collaborative Management:
Interventions:
- ABCs – High-flow supplemental oxygen, bleeding control, frequent vital signs/monitoring
- IV x2
- IVF resuscitation, antibiotics, tetanus
- Projectile path unpredictable, wound evaluation (location, number)
- Preserve forensic evidence
- Surgical vs. nonsurgical
Linchpins: (Key Points)
- Penetrating injuries from guns, industrial accidents, paint guns, and nail guns
- Do not remove impaling objects
- Determine type of projectile, potential for multiple internal injuries, may be more than one projectile (how many shots?)
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Transcript
For more great CEN prep, got to the link below to purchase the “Emergency Nursing Examination Review” book by Dr. Laura Gasparis Vonfrolio RN, PHD
https://greatnurses.com/
References:
- Emergency Nurses Association. (2017) Emergency Nursing Core Curriculum, 7th Edition. PA: Saunders
- Bacidore, V. (2017). Orthopedic and Wound Emergencies. In CEN Online Review. Emergency Nurses Association.
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Certified Emergency Nursing (CEN)
Course Lessons
Cardiovascular Emergencies
Acute Coronary Syndrome for Certified Emergency Nursing (CEN)
Aneurysm and Dissection for Certified Emergency Nursing (CEN)
Cardiopulmonary Arrest for Certified Emergency Nursing (CEN)
Dysrhythmias for Certified Emergency Nursing (CEN)
Endocarditis for Certified Emergency Nursing (CEN)
Heart Failure for Certified Emergency Nursing (CEN)
Hypertension for Certified Emergency Nursing (CEN)
Pericardial Tamponade for Certified Emergency Nursing (CEN)
Thromboembolic Disease- Deep Vein Thrombosis (DVT) for Certified Emergency Nursing (CEN)
Cardiovascular Trauma for Certified Emergency Nursing (CEN)
Cardiogenic Shock and Obstructive Shock for Certified Emergency Nursing (CEN)
Respiratory Emergencies
Aspiration for Certified Emergency Nursing (CEN)
Asthma for Certified Emergency Nursing (CEN)
Chronic Obstructive Pulmonary Disease (COPD) for Certified Emergency Nursing (CEN)
Obstruction for Certified Emergency Nursing (CEN)
Pleural Effusion for Certified Emergency Nursing (CEN)
Pneumothorax for Certified Emergency Nursing (CEN)
Noncardiac Pulmonary Edema for Certified Emergency Nursing (CEN)
Pulmonary Embolus for Certified Emergency Nursing (CEN)
Respiratory Distress Syndrome for Certified Emergency Nursing (CEN)
Respiratory Trauma for Certified Emergency Nursing (CEN)
Pulmonary Hypertension for Certified Emergency Nursing (CEN)
Neurological Emergencies
Neurological Disorders (Multiple Sclerosis, Myasthenia Gravis, Guillain-Barré Syndrome) for Certified Emergency Nursing (CEN)
Increased Intracranial Pressure (ICP) for Certified Emergency Nursing (CEN)
Meningitis for Certified Emergency Nursing (CEN)
Seizure Disorders for Certified Emergency Nursing (CEN)
Stroke for Certified Emergency Nursing (CEN)
Transient Ischemic Attack (TIA) for Certified Emergency Nursing (CEN)
Head and Spinal Cord Trauma for Certified Emergency Nursing (CEN)
Neurogenic Shock for Certified Emergency Nursing (CEN)
Gastrointestinal/Genitourinary/Gynecological/Obstetrical Emergencies
Acute Abdomen for Certified Emergency Nursing (CEN)
Appendicitis for Certified Emergency Nursing (CEN)
Peritonitis for Certified Emergency Nursing (CEN)
Bowel Perforation for Certified Emergency Nursing (CEN)
Bleeding for Certified Emergency Nursing (CEN)
Placenta Previa for Certified Emergency Nursing (CEN)
Cholecystitis for Certified Emergency Nursing (CEN)
Cirrhosis for Certified Emergency Nursing (CEN)
Diverticulitis for Certified Emergency Nursing (CEN)
Esophageal Varices for Certified Emergency Nursing (CEN)
Hepatitis for Certified Emergency Nursing (CEN)
Intussusception for Certified Emergency Nursing (CEN)
Obstructions for Certified Emergency Nursing (CEN)
Pancreatitis for Certified Emergency Nursing (CEN)
Gastrointestinal Trauma for Certified Emergency Nursing (CEN)
Genitourinary Infections for Certified Emergency Nursing (CEN)
Renal Calculi for Certified Emergency Nursing (CEN)
Genitourinary Trauma for Certified Emergency Nursing (CEN)
Urinary Retention for Certified Emergency Nursing (CEN)
Gynecological Infections for Certified Emergency Nursing (CEN)
Ovarian Disorders (Cyst, Torsion, Rupture) for Certified Emergency Nursing (CEN)
Sexual Assault and Battery for Certified Emergency Nursing (CEN)
Gynecological Trauma for Certified Emergency Nursing (CEN)
Abruptio Placenta for Certified Emergency Nursing (CEN)
Emergent Delivery for Certified Emergency Nursing (CEN)
Ectopic Pregnancy for Certified Emergency Nursing (CEN)
Hemorrhage (Postpartum Bleeding) for Certified Emergency Nursing (CEN)
Hyperemesis Gravidarum for Certified Emergency Nursing (CEN)
Preeclampsia, Eclampsia, and HELLP Syndrome for Certified Emergency Nursing (CEN)
Preterm Labor for Certified Emergency Nursing (CEN)
Threatened/Spontaneous Abortion for Certified Emergency Nursing (CEN)
Obstetric Trauma for Certified Emergency Nursing (CEN)
Mental Health Emergencies
Anxiety Disorders (PTSD, Anxiety, Panic Attack) for Certified Emergency Nursing (CEN)
Mood Disorders (Bipolar, Depression) for Certified Emergency Nursing (CEN)
Homicidal and Suicidal Ideation for Certified Emergency Nursing (CEN)
Thought Disorders (Psychosis, Schizophrenia) for Certified Emergency Nursing (CEN)
Medical Emergencies
Allergic Reactions and Anaphylaxis for Certified Emergency Nursing (CEN)
Hematologic Disorders for Certified Emergency Nursing (CEN)
Sodium and Potassium Imbalance for Certified Emergency Nursing (CEN)
Adrenal and Thyroid Disorder Emergencies for Certified Emergency Nursing (CEN)
Immunocompromise (HIV and AIDS, Oncology and Chemotherapy, Transplant Patient) for Certified Emergency Nursing (CEN)
Renal Failure for Certified Emergency Nursing (CEN)
Sepsis for Certified Emergency Nursing (CEN)
Hypovolemic and Distributive Shock for Certified Emergency Nursing (CEN)
Diabetic Emergencies for Certified Emergency Nursing (CEN)
Calcium and Magnesium Imbalance for Certified Emergency Nursing (CEN)
Musculoskeletal/Wound Emergencies
Amputation for Certified Emergency Nursing (CEN)
Compartment Syndrome for Certified Emergency Nursing (CEN)
Fractures (Open, Closed, Fat Embolus) for Certified Emergency Nursing (CEN)
Avulsions and Degloving Injuries for Certified Emergency Nursing (CEN)
Wound Infections for Certified Emergency Nursing (CEN)
Wound Bleeding (Uncontrolled External Hemorrhage) for Certified Emergency Nursing (CEN)
Injection Injuries for Certified Emergency Nursing (CEN)
Lacerations for Certified Emergency Nursing (CEN)
Penetrating Injuries for Certified Emergency Nursing (CEN)
Maxillofacial/Ocular Emergencies
Maxillofacial Trauma for Certified Emergency Nursing (CEN)
Increased Intraocular Pressure for Certified Emergency Nursing (CEN)
Ocular Infections (Conjunctivitis, Iritis) for Certified Emergency Nursing (CEN)
Retinal Artery Occlusion for Certified Emergency Nursing (CEN)
Retinal Detachment for Certified Emergency Nursing (CEN)
Environment/Toxicology Emergencies/Communicable Diseases
Burns for Certified Emergency Nursing (CEN)
Envenomation Emergencies for Certified Emergency Nursing (CEN)
Cold Temperature-related Emergencies for Certified Emergency Nursing (CEN)
C. Difficile for Certified Emergency Nursing (CEN)
Vaccine-Preventable Diseases (Measles, Mumps, Pertussis, Chicken Pox, Diphtheria) for Certified Emergency Nursing (CEN)
Influenza for Certified Emergency Nursing (CEN)
Multi-Drug Resistant Organisms (MRSA, VRE) for Certified Emergency Nursing (CEN)
Tuberculosis for Certified Emergency Nursing (CEN)
Hemorrhagic Fevers for Certified Emergency Nursing (CEN)
Heat Temperature-related Emergencies for Certified Emergency Nursing (CEN)
Professional Issues (Nurse/Patient/System)
Ethical Dilemmas for Certified Emergency Nursing (CEN)
Discharge Planning for Certified Emergency Nursing (CEN)
End-of-Life and Palliative Care (Organ and Tissue Donation, Advance Directives, Care Withholding, Family Presence) for Certified Emergency Nursing (CEN)
Pain Management and Procedural Sedation for Certified Emergency Nursing (CEN)
Patient Satisfaction for Certified Emergency Nursing (CEN)
Abuse and Neglect for Certified Emergency Nursing (CEN)
Delegation of Tasks to Assistive Personnel for Certified Emergency Nursing (CEN)
Patient Safety for Certified Emergency Nursing (CEN)
Transfer and Stabilization for Certified Emergency Nursing (CEN)
Human Trafficking for Certified Emergency Nursing (CEN)
Cultural Considerations (Interpretive Services, Privacy, Decision Making) for Certified Emergency Nursing (CEN)
Gender Equity (Inclusion, Gender Transition) for Certified Emergency Nursing (CEN)
Patient Consent for Treatment for Certified Emergency Nursing (CEN)
Risk Management for Certified Emergency Nursing (CEN)
