Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NMETC > Trauma Management 2 > Flashcards

Trauma Management 2 Flashcards

1
Q

Explain the difference bw head trauma, head injury and TBI.

A

Head trauma- general term inclusive of both head injury and TBI

Head Injury- traumatic insult to head that results in injury of soft tissue of scalp or skull, does not include face.

TBI- impairment of brain fxn caused by external force that causes physical/social/emotional changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the major regions of the brain?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the fxns of the major regions of the brain?

  • cerebrum
  • cerebral cortex
  • cerebellum
  • brainstem
  • diencephalon
  • pons
  • medulla
  • corpus callosum
A

Cerebrum- largest portion of brain, responsible for higher fxn/thought

Cerebral cortex- largest part of cerebrum, regulates voluntary skeletal movement, level of awareness

Cerebellum- maintains posture and equilibrium, skilled motions

Brainstem- crucial for vitals fxns (RAS-awareness)

Diencephalon-relays motor and sensory signals

Pons- regulates breathing and REM

Medulla- controls automatic fxns like HR and RR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the 4 different lobes and their fxns?

A

Frontal lobe: voluntary motions, personality and judgment

Parietal lobe: processes sensory info from skin and joints, responsible for proprioception

Temporal lobe: speech center, hearing, taste, smell, long term memory

Occipital lobe: processes visual information from optic nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the meninges?

A

They are a protective layer around the entire brain and spinal cord.

Dura mater –>Arachnoid –> Pia mater

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Explain epidural hematoma.

A

Occurs bw dura mater and skull

Usually caused by a rupture of middle meningeal artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Explain subdural hematoma

A

Occurs bw dura and arachnoid

Usually caused by rupture of bridging veins in bw these layers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Explain subarachnoid hemorrhage.

A

Occurs below arachnoid membrane.

Bleed directly into brain.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What do we look for in assessing a basilar skull fx?

A
  • Blood and CSF leaking from ears, nose, both
  • Raccoon eyes*
  • Battle Sign*

*late signs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Cervical plexus

A

C1-5

innervates the diaphragm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Brachial plexus

A

C5-T1

Controls upper extremities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Lumbar plexus

A

L1-L4

Supplies skin and muscles of abdominal wall, external genitalia, part of lower limbs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Sacral plexus

A

L4-S4

Supplies buttocks, perineum, most of lower limbs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

SCI at of below ___ may disrupt flow of sympathetic stimulation communication.

A

T6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How do we handle pt assessment for head and spine trauma? Any special considerations?

A

ABCDE

consider C spine

consider aggressive airway

consider neurogenic shock

do neuro exam

assess for ICP/abnormal posturing

consider backboarding

always place hands on pt for assessment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Signs of cerebral herniation

A

Unequal pupils

bilateral fixed dilated pupils

Decerebrate posturing/no motor response to px

GCS <9 that drops by 2+ points

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the S/S of head injury?

A

DCAP

Visible fx

Battle sign

Raccoon eyes

CSF ears/nose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What EtCO2 do we ventilate head injury pt at?

A

30-35mm Hg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

When would you want to start an IV in the case of head or SCI and use lots of fluids?

A
  • establish 18g IV with LR
  • do not give glucose unless known hypoglycemia
  • only administer fluids on needed basis when hypotensive <90
  • neurogenic pt’s may not require fluids so much as vagolytic drugs (atropine) and pressors or TCP
  • watch for pulmonary edema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are some specific assessments we do with SCI?

A

CMS in all extremeties

AVPU/serial GCS

Spinal immobilization

Pupils

check for chest trauma/fx

check for posturing

watch for hypo/hypertension

Stroke neuro exam

ask about sensation/pins and needles/numbness

**if pt unresponsive, but responsive to painful stimuli

–>grimaces, flexes limbs not likely to have SCI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Dermatome map

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Explain skull fx types

A

Basilar- fx to base of skull.

Linear- closed, non displaced fx usually due to blunt trauma

Depressed- multiple fx in one area as result of blunt trauma with depression or dent in skull. can be concurrent with basilar fx. usually profound deficits seen

Open- brain tissue exposed

Closed- brain tissue not exposed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the difference bw primary and secondary injury? Give some MOI examples.

A

Primary- actual injury to brain as direct result of insult. Aka GSW, blunt trauma.

Secondary- damage to brain tissue as result of primary injury that bleeds into brain and swelling. can also include abscess, infection, hypoxia, etc.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Explain ICP

A

Skull is not capable of expanding for swelling brain post injury. The brain swells regardless of skulls capacity to expand, and it begins to take up what available space there is in the cranium. It takes up CSF space, occludes small blood vessels, increasing ICP. As pressure grows, brain recognizes it is hypoxic as a result. To combat this brain sends order to increase BP. In contrast carotid sinuses recognize that BP is increasing they did not call for, and order HR to slow down. This cycle continues, and pressure in skull worsens as the brain tries to maintain CP. As pressure grows, brain has no choice but to herniate out foramen magnum. Breathing centers and HR are sacrificed, ventilation is impaired, acidosis grows. Pupils will change. Pt will vomit out of nowhere with no previous complaint of nausea. Cushings triad is seen.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

How do we determine MAP?

A

MAP= pulse pressure difference/3 + diastolic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Cerebral perfusion formula

A

CPP= MAP-ICP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

ICP numbers

A

0-15

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

minimum CPP

A

60

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Uncal herniation

A

most common brain herniation

part of temporal lobe moves laterally and then down

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Early signs of ICP

A

Seizure

vomit without previous nausea

HA

ALOC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Explain cerebral concussion and what to look for.

A

occurs when teh brain is jarred in the skull.

usually caused by rapid acceleration-deceleration

produces shearing injuries caused by rotational/angular forces

seen with MVCs, falls, sports

S/S: HA, amnesia, confusion, dizzy

if suspected, all pt need eval

check A/O

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Explain diffuse axonal injuries and what to look for

A

diagnosable only in hospital

more extensive damage to brain than concussion

axons can be sheared and torn

often not survivable

causes permanent damage

watch for unresponsiveness, especially >6 hours

watch for airway compromise

probable life flight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

How does an epidural hematoma present?

A

initially lose consciousness

regain consciousness

have period of lucidity

lose consciousness after ICP increases

common to see unequal pupils

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

How does a subdural hematoma present?

A

does not become apparent for a few weeks after initial trauma due to venous bleeding

may present stroke-like

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

How does a intracerebral hematoma present?

A

depends on ICP and size of injury.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

How does a subarachnoid hemorrhage present?

A

sudden severe HA

stiff neck

ALOC

seizure

N/V

posturing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Explain thermal management of brain injuries

A

do not let head injury pt become overheated.

do not cover with blanket if ambient temp >70

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What are some pharmacology treatments to consider for head injury?

A

control seizures

RSI meds

some med control may order lasix or mannitol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Le Forte Fx

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Explain flexion injuries and MOI

A

head whips forward suddenly

can fx atlas and axis or dislocate them

could tear spinal cord

seen with MVC or sports

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Explain rotation with flexion and MOI

A

flexion when combined with rotation of head happens with lateral MVC impact or football tackle or assault.

can cause severe C1/2 injuries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Explain hyperextension and MOI

A

can occur anywhere in spine

most common in cervical area

can cause hangman’s fx- fx of C2 that causes bilateral fx of pedicles. unstable fx that does not usually injure spinal cord.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Explain vertical compression and MOI

A

also known as axial loading

common in cervical and lumbar areas

compression force comes from above

usually hitting head on roof of vehicle, or jumping with locked knees

usually fairly stable injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What is primary SCI?

A

ANY CORD INJURY RESULTING DIRECTLY FROM THE TRAUMATIC EVENT

can be complete or partial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What is secondary SCI?

A

cord swelling as a result of trauma leading to temporary loss of neurological fxn distal to injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Explain complete vs incomplete SCI

A

Complete SCI- complete disruption of all tracts of spinal cord with permanent loss of all cord mediated fxns below level of injury.

Incomplete SCI- pt retains some degree of cord mediated fxn below injury site

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Explain anterior cord syndrome

A

results from disruption of anterior region of cord

usually result of flexion injury

will have motor and sensory loss inferior to injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Explain central cord syndrome

A

associated with hyperextension injuries of cervical spine

loss of upper extremity fxn with intact lower extremity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Explain posterior cord syndrome

A

likely with extension injuries

decreased sensation to light touch and proprioception

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Explain Brown Sequard syndrome

A

also known as lateral cord syndrome

damage to one side of cord via distraction or penetrating trauma

leads to loss of motor/light touch/vibration on side of/inferior to injury

leads to loss of px and temperature sensation on side opposite injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Explain Cuda equina syndrome

A

caued by lesions in L1-2 area

effects lower extremities and bowel

numbness

low back px

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What is neurogenic shock?

A

caused by spinal injuries

causes widespread vasodilation of vessels below site of inury

leads to hypovolemia

pt will be pale and diaphoretic superior to injury and dry warm inferior to it

hypotensive with bradycardia due to loss of sympathetic tone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What is spinal shock?

A

temporary local neuro cdxn that occurs immediately after spinal trauma

swelling on cord produces disruption of nerve conduction

54
Q

What is Autonomic Dysreflexia and how do we tx it?

A

late complication of SCI

occurs at injuries above T4-T6

loss of parasympathetic system

present with huge uncompensated cardiovascular response caused by sympathetic stimulation below injury site

rise of >20mmHg above normal BP and SCI indicate AD

S/S: seizure, HA, blurred vision, anxiety, bradycardia, flushing above injury site, chills with no fever, bronchospasm, constipation, full bladders, kinked foley

Tx: remove restricting clothes, unkink foley, may need to reduce BP with vasodilators or labetalol

55
Q

Explain the mechanics of ventilation in relation to chest trauma

A

The primary fxn of thorax is to maintain oxygenation and ventilation as well as circulation.

the systems require an environment free from disruptions and complications; chest trauma disrupts this and can cause life threatening ventilation problems.

aka broken ribs –> shallow breathing due to px causes decreased ventilation

56
Q

What is the assessment process for pt’s with chest trauma?

A

ABCDE

AVPU

Sick/Not Sick

IAPP for Chest

57
Q

Deadly dozen of Chest injuries

A

airway obstruction

broncial disruption

diaphragmatic tear

esophageal injury

open pneumo

tension pneumo

hemothorax

flail chest

cardiac tamponade

traumatic aortic disruption

myocardial contusion

pulmonary contusion

58
Q

What does lack of JVD in supine position mean?

A

in combination with shock signs, may suggest hypovolemia

59
Q

Chest percussion significance of dull vs hyperresonance

A

dull=blood in chest

hyperresonance= increased air in chest

60
Q

What can muffled heart tones signify?

A

can indicate tension pneumo or cardiac tamponade

61
Q

Tx of chest trauma basics

A

Focus on maitaining airway, oxygenation/ventilation, and supporting circulation.

if facial injuries, don’t nasotrach intubate

if tracheal injuries, don’t intubate

give appropriate ventilation- don’t overinflate!

IV fluids

other than RSI drugs, only other drug to consider is px management

62
Q

How do we manage flail chest?

A

IAPP

pt may splint and make it hard to observe

s/s include shock, hypoxia, shallow breathing

Goal is spO2 >95% with supp O2 or PPV

-if not maintaining consider intubation

consider px management for better ventilation

63
Q

How do we manage rib fx?

A

s/s of pleuritic chest px and mild dyspnea

may see chest tenderness, crepitus, subcut emphysema

ABCDE

give O2 if needed

have pt hold pillow or blanket over affected ribs

px management

64
Q

How do we manage sternal fx?

A

px over anterior part of chest

DCAP on palpation

EKG due to possible myocardial contusion

ABCs

px management

65
Q

How do we manage clavicle fx?

A

skin tents

splint with sling and swathe

cold pack

px management

66
Q

How do we assess and tx simple pneumo?

A

frequent with blunt trauma

S/S: mild dyspnea, pleuritic chest px on one side, diminished/unequal breath sounds

as pneumo grows, s/s get worse –> shock, ALOC, absent breathe sounds

maintain ABCs and provide O2

monitor closely

67
Q

How do we manage and tx open pneumo?

A

“sucking” chest wound

as air is drawn into pleuritic space, lung is unable to fully expand

will find wound or impaled object on exam

pt will be tachycardic/pnea and restless

placed gloved hand over wound

apply occlusive dressing

place on high flow O2

may require intubation if spO2 doesnot improve

usually won’t proceed to tension pneumo

68
Q

Explain pathophys of tension pneumo

A

life threatening

can result from open or closed

lung collapses and mediastinum moves away from injured side

pulmonary shunting occurs

CO decreases as intrathoracic pressure increases

–>compression of heart and vena cava, reduces preload

–> HR increases in attempt to increase CO

69
Q

How do we assess and tx tension pneumo?

A

s/s: absent breath sounds, unequal chest rise, pulsus paradoxus, tachycardia, VT/VF, JVD, narrow pulse pressure, tracheal deviation

supplemental O2

IAPP

occlusive dressings if needed

needle decompression

70
Q

Needle decompression site

A

2nd or 3rd intercostal space midclavicular line on affected side

or fifth intercostal space slight anterior/midaxillary

go above rib 3 (avoids nerve bundles)

71
Q

How do we assess and tx hemothorax?

A

S/S: ventilatory insufficiency (hypoxia, agitation, anxiety, tachypnea, dyspnea) and hypovolemic shock (tachycardia, cool, clammy, hypotension).

there will be a lack of tracheal deviation, hemoptysis, dull chest with percussion, neck veins will be flat

supplemental O2

(2) 18g IV

fluids to limit hypotension

consider intubation as needed

72
Q

How do we assess and tx pulmonary contusion?

A

ventilation can be impaired due to px and injury damage

s/s of impaired respiration

consider O2 or PPV

caution with fluids due to edema–> use small boluses

small amounts of px management to increase ventilation but not cause resp depression

73
Q

Explain assessment/management of cardiac tamponade.

A

Becks triad: muffled heart tones, hypotension, JVD

electrical alternans on EKG

breath sounds will be equal and there will be no tracheal deviation

ABCs

give O2

IV fluds

rapid txp

74
Q

Explain assessment/management of myocardial contusion

A

sharp retrosternal chest px

may hear crackles with lung sounds

EKG

-PAC, Sinus tach, Afib, PVCs, new RBBB, AV block, ST changes

supportive care

-O2, IV fluids, EKG

75
Q

Explain assessment/management of myocardial rupture

A

present with edema or cardiac tamponade

supportive care/ABCs

rapid txp

76
Q

Explain assessment/management of commotio cordis

A

direct blow to heart during repolarization

may be unresponsive and apneic

may have seizure

tx what is present

77
Q

Explain assessment/management of traumatic aortic disruption

A

common result of MVC or falls

most often tearing px behind sternum or scapula

also hypovolemia, dyspnea, ALOC

difference in pulses bw extremities

ABCs

gradual fluids to maintain BP

no pressors

rapid txp

78
Q

Explain assessment/management of penetrating wounds of great vessels

A

common with penetrating injuries

can cause 6 P’s

tx for hypovolemic shock

ABC support

IV fluids

79
Q

Explain assessment/management of diaphragmatic injury

A

most injuries occur on left side

s/s: hypotension, bowel sounds in chest, chest px, absence of breath sounds, possible N/V, abdominal px

ABC support

IV

possible nasogastric decompression

80
Q

Explain assessment/management of esophageal injury

A

rapidly fatal

s/s: pleuritic chest px, px with swallowing or flexion of neck

ABC support

81
Q

Explain assessment/management of tracheobronchial injury

A

seen with severe deceleration injury

rapidly progresses to tension pneumo

can be mild to severe s/s of resp compromise

s/s: hoarseness, dyspnea, tachypnea, hemoptysis, pneumo

ABCs

try to manage with PPV since intubation is discouraged

bag gentle and slow

82
Q

Explain assessment/management of traumatic asphyxiation

A

caused by sudden and forceful compression of thoracic

aka unrestrained driver hitting steering column or ped vs vehicle/wall

ABCs

spine precautions

supp O2 or intubation

IV access (2) 18g

rapid txp

83
Q

Explain the abdominal quadrants and their organs

A
84
Q

What are the solid organs of the abdomen?

A

liver

spleen

pancreas

85
Q

What are the hollow organs of the abdomen?

A

stomach

bladder

gallbladder

intestines

86
Q

What is a complication of a hollow organ bursting?

A

Peritonitis from abdominal irritation and injury

87
Q

What are some MOIs that are likely to cause closed abdomen injuries?

A

compression- direct blow from fixed object (seatbelt/airbag)

crushing- impact from steering column, dash

shearing-rapid deceleration from MVC or fall

88
Q

Assessing abdominal/GU injuries

A

ABCDE

Assessing who is in need of rapid txp

89
Q

Explain the ways a liver can be injured and S/S to expect.

A

most vulnerable organ

suspect injury with right sided trauma

sudden deceleration can cause dissection due to ligamentum teres

look for RUQ ecchymosis/tenderness

abdominal wall spasm

tenderness/guarding

hypotension

shock

90
Q

Explain the ways a spleen can be injured and S/S expected.

A

falls, sports, and MVC

fx of 9th/10th ribs on ULQ

referred px to left shoulder (kehrs sign)

hypotension

shock

91
Q

Explain the ways a pancreas canbe injured and S/S expected

A

most commonly injured by penetrating trauma

guarding/rebound tenderness

92
Q

Explain the ways a diaphragm can be injured and S/S expected

A

injuries are rare

can be due to blunt trauma or penetrating trauma

most likely caused by MVC with lateral impact

bowel sounds in chest

dyspnea

chest px

93
Q

Explain the ways the intestines can be injured and S/S expected

A

commonly injured from penetrating trauma

also severe blunt trauma (lap belt)

may present as back px

generalized abdominal px

94
Q

Explain the ways a stomach can be injured and S/S expected

A

penetrating trauma

generalized abdominal px due to spillage of stomach acid into abdominal cavity

95
Q

Explain the ways a kidney can be injured and S/S expected

A

trauma to back or flanks

MVCs or sports usually

px on inspiration in abdomen and flank area

penetrating renal trauma usually assoc with liver/lung/spleen

96
Q

Management of abdominal injuries

A

ABCDE

spinal immobilization if indicated

IV

EKG

txp- rapid if indicated

97
Q

Care for evisceration

A

wet sterile dressing over intestines

do not put in abdomen

can plastic wrap over dressing

secure intestines best you can

keep pt warm

tx for shock

98
Q

What are abdominal vascular injuries?

A

rapid rates of blood loss

includes vena cava, superior phrenic artery, mesenteric vessels tears

mostly injured due to penetrating trauma

99
Q

S/S of duodenal injury

A

later signs: abdominal px, fever, N/V

*suspect if child is thrown from bike and hits abdomen on handlebars

100
Q

What are age associated changes in bones?

A

fx and dislocations associated with osteoarthritis, atrophy, weaknened proccesses of aging

101
Q

What are injury predictions based on pathologic MOI?

A

fx in hip, spine, and wrist

degradation of joints or disks

102
Q

What are the injury predictions for direct MOI?

A

fx of bone if direct hit

dislocation if near joint

contusion of soft tissues

penetrating trauma can cause fx

103
Q

What are the injury predictions for indirect MOI?

A

knee striking dashboard, fx hip

fall that fx multiple bones up arm

twisting injuries result in fx, sprains, dislocations

104
Q

Explain pathophys of fx.

A

force applied to bone exceeds its strength point, causing it to break.

105
Q

Explain open vs closed fx

A

open fx breaks through skin

closed fx does not break skin barrier

106
Q

What are the S/S of fx?

A

primary s/s is px

hearing snap or pop

deformity

shortening

swelling

ecchymosis

guarding

loss of use

tender to palpation

possible crepitus

exposed bone ends

107
Q

Explain subluxation

A

partial dislocation

108
Q

What is luxation

A

complete dislocation

109
Q

Pathophys of dislocation

A

force of blow exceeds ligament and tendon strength, causing the joint to misalign

110
Q

Explain ligament injuries/sprain

A

usually result from sudden twisting motions beyond ROM

also causes temporary subluxation

s/s: px, swelling, discoloration, reluctant to use

ROM typically limited by px not structural malformation

111
Q

Explain strains

A

injury to muscle and or tendon resulting from violent muscle contarction or from excessive stretching

usually minor swelling

increased px

112
Q

ligament vs tendon

A

ligament = bone to bone

tendon = bone to muscle

113
Q

What are the fx classifications?

A

transverse

oblique

spiral

comminuted

greestick

compression

pathologic

linear

segmental

stress

buckle

complete

depression

114
Q

Explain the process of assessing musculoskeletal injury

A

ABCDE

c spine considerations

cms in extemities

splinting as needed

px management

115
Q

6 P’s of musculoskeletal assessmentq

A

px

paralysis

paresthesias

pulselessness

pallor

pressure

116
Q

Explain inspecting a musculoskeletal injury

A

look at joint above and below injury site

compare injured side to uninjured side

look for:

  • deformity/angulation/shortening/rotation
  • skin changes
  • DCAP BTLS
  • swelling
  • muscle spasm
  • abnormal limb position
  • changed ROM
  • color changes
  • bleeding
117
Q

Explain the relationship bw volume of hemorrhage and open/closed fx.

A

Total blood loss from fx can be significant.

direct pressure, splinting, IV fluids can help stabilize

highest potential blood loss fx- pelvis, femur

118
Q

Explain px control in musculoskeletal injuries

A

assess px level

splinting

resting, elevation

apply ice

consider px management if above not helping

119
Q

Explain general guidelines of splinting

A

visualize injury- remove clothes

assess CMS

cover any open wounds before splinting

do not push exposed bones back in

do not move before splinting done unless hazards exist

splint entire bone lengths if joint dislocated

support limb well while splinting

straighten limb if severely angulated

if pt is resistant to movement or reports severe px, splint in place

recheck cms

ice pack

120
Q

Explain some special considerations with femur fx management

A

fx often causes muscle spasm, by applying traction, it reduces spasm and allows for normal muscle tension which enables bleeding to slow –>potential for lots of blood loss.

121
Q

Basic management of peripheral nerve injury

shoulder girdle fx

midshaft humerus fx

elbow fx

forearm fx

wrist/hand fx

femur fx

knee fx

tib/fib fx

calcaneus fx

A

expose injury

assess cms

consider px management before moving limb

splint injury

ice

rest

elevation

122
Q

Explain assessment and management of compartment syndrome

A

swelling or bleeding within a compartment that causes reduced blood flow to muscle and therefore ischemia

S/S severe px, tenderness, sensory changes

px described as searing or burning

px typically not relieved with narcotics

affected area may feel firm and look pale

look for 6 P’s

elevate limb to heart level

place cold packs

loosen clothes or splint

give IV fluids to flush kidneys

123
Q

Explain the assessment and management of crush syndrome

A

occurs bc of prolonged compression that impairs circulation and metabolism

rhabdo ensues

occurs after 4-6h

release of tissues causes acidosis

renal failure severe complication

hyperK seen

assess ABCDE

give high flow O2

give IV fluids

EKG- watch for hyperK

can give Albuterol

calcium to stabilize heart if changes seen

sodium bicarb

rapid txp if needed

124
Q

S/S of DVT

A

Swelling of extremity

warmth

px

125
Q

S/S of PE

A

sudden dyspnea

pleuritic chest px

tachypnea

tachycardia

low grade fever

right side heart failure

shock

cardiac arrest

hx of recent surgery, prolonged immbolization

tx: ABCs, IV and fluids, rapid txp

126
Q

S/S of fat embolism

A

begins 12-72 h after injury

tachycardia

dyspnea

tachypnea

pulmonary congestion

fever

petechiae

ALOC

organ dysfxn

127
Q

Causes of pelvic fx

A

blunt trauma from MVCs, motorcycle crash, veh v ped

crush injuries

falls from high height

*if have pelvic fx, suspect abdominal and head trauma

128
Q

Types of pelvic fx

A

lateral compression disruption

anterior-posterior compression disruption

vertical shear (falls)

straddle fx (fall and impact to perineum area)

open fx

129
Q

S/S of pelvic ring disruption or fx

A

px can be minimal

difficulty bearing weight

profound shock

gross instability

diffuse pelvic/lower abdominal px

bruising

lacerations

shortening of limb

130
Q

Tx pelvic ring disruption or fx

A

ABCs

spinal stabilization

IV access

IV fluids for open book fx

pelvic binder

131
Q

Hip fx S/S

A

unable to bear weight

externally rotated shortened

can appear normal if not displaced

tenderness on palpation

swelling

deformity

bruising

px

132
Q

How do we reduce ankle/finger/knee dislocation or fx

A

buddy system taping/pad for fingers

splint ankles and knee

NMETC (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions