Chapter 22 - 30 Trauma Flashcards Preview

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Flashcards in Chapter 22 - 30 Trauma Deck (69):
1

Scene Size-up

Ensure Scene Safety
MOI / NOI
Take Standard Precautions
Determine Number of Patients
Consider Additional Resources

2

Primary Assessment

Form General Impression
Level Of Consciousness - AVPU
Orientation - Person / Place / Time / Event
Pupils - PEARRL
Airway, Breathing, Circulation - Fix Immediate Threats
Rapid Scan
Priority of Care / Transport Decision

3

History Taking

Chief Complaint
History - SAMPLE
Pain - OPQRST

4

Secondary Assessment

Physical Assessment - DCAP-BTLS
Assess Vital Signs - BP, Pulse, Resp, O2 Sat

5

Reassessment

Repeat Primary Assessment
Reassess Vital Signs
Reassess Chief Complaint
Recheck Interventions
Identify and Treat Changes
(Unstable every 5 min; Stable every 15 min)

6

Awareness and concern for potentially serious underlying and unseen injuries.

Index of Suspiscion

7

Force acting over distance.

Work

8

Energy of a moving object.

Kinetic Energy
One half of Mass x Velocity Squared

9

The energy of falling.

Potential Energy
Mass, Force of Gravity, Height

10

Compression injury to the anterior portion of brain and stretching of the posterior portion.

coup-contracoup brain injury
can also occur when heart hits sternum and shears aorta

11

Significant mechanisms of vehicular collision injury are suggested by:

Death of vehicle occupant
Severe deformity of vehicle
Altered mental status
Ejection from vehicle

12

Four types of motorcycle impacts:

Head-on Collision - Drag injury or secondary collision
Angular Collision - Crushing of rider lower extremities
Ejection - Drag injury or secondary collision
Controlled Crash - Rider tries to leave bike, may work

13

Types of blast injury:

Primary - Damage to body by pressure wave. Hollow organs most susceptible.
Secondary - Struck by flying debris.
Tertiary - Patient hurled by force into stationary object.
Miscellaneous - Burns, toxic gasses, crush from building collapse.

14

Key elements for Trauma Centers

I - comprehensive regional resource
II - able to initiate definitive care for all injured patients
III - able to provide prompt assessment, stabilization (general surgeons, anesthesiologist can be available)
IV - able to provide advanced life support and has transfer agreement with higher level

15

Glasgow Coma Scale - Eye Opening

4 Spontaneous
3 To Voice
2 To Pain
1 None

16

Glasgow Coma Scale - Verbal Response

5 Oriented
4 Confused
3 Inappropriate Words
2 Incomprehensible Words
1 None

17

Glasgow Coma Scale - Motor Response

6 Obeys commands
5 Localizes pain
4 Withdraws from pain
3 Flexes from pain
2 Extends from pain
1 None

18

Revised Trauma Score

4 GCS 13-15, SBP>89, RR 10-29
3 GCS 9-12, SBP 76-89, RR>29
2 GCS 6-8, SBP 50-75, RR 6-9
1 GCS 3, SBP 0 RR 0
Sum points on 3 measures to get rating from 0 to 12

19

Signs and symptoms of Hypovolemic Shock.

Rapid, weak pulse
Changes in mental status
Cool, clammy skin
Cyanosis
Low blood pressure (late)

20

Location of pressure points.

superficial temporal
external maxillary
carotid
brachial
ulnar
radial
femoral
dorsalis pedis
posterior tibial

21

Injury that causes bleeding beneath the skin, but does not break the skin.

Contusion

22

Buildup of fluid and blood beneath the skin.

Ecchymosis (black discoloration)

23

Buildup of fluid from a large blood vessel.

Hematoma

24

When a body part is trapped under weight for more than four hours.

Crush Syndrome
can lead to renal failure and death

25

Pain out of proportion to injury.

Compartment Syndrome
swelling compresses blood vessels cutting off blood flow

26

An injury separates layers of soft tissue so that they either completely detach or hang as a flap.

Avulsion

27

Treatment for human bites.

Apply dry, sterile dressing
Immobilize area with splint or bandage
Provide transport to ED for surgical cleaning of wound

28

Depth of burns.

superficial - 1st degree
partial-thickness - 2nd degree
full thickness - 3rd degree

29

Rule of nines.

Sections of adult body divided by 9%:
arms 9% each, legs 18% each, head 9%, torso back 18%, torso front 18%, genitalia 1%

Child - legs are 16.5%, head is 12%
Infant - legs are 13.5%, head 18%

30

Types of burns

Thermal - caused by heat - flame, scald, contact, steam
Inhalation
Radiation
Chemical

31

Classification of burns.

Severe
Full thickness on hands, feet, face, upper airway or
genitalia
Full thickness more than 10% surface area
Partial thickness more than 30%
Younger than 5 or older than 55
Moderate
Full thickness 2 - 10% surface area
Partial thickness 15 - 30%
Superficial burns > 50%
Minor
Full thickness < 2%
Partial thickness <50%

32

Parts of the ear.

Pinna - visible outer
tragus - round fleshy bulge anterior to ear canal
external auditory canal - leads to ear drum
tympanic membrane - ear drum
hammer, anvil, stirrup
cochlea
eustacian tube

33

The presence of air in soft tissues.

subcutaneous emphysema - crackling sensation
also Crepitus

34

Layers of tissue that suspend the brain and spinal cord.

Menenges
Dura mater - tough fibrous outer layer
Arachnoid mater and Pia mater - thin, contain blood vessels that nourish brain

35

Signs of skull fracture.

Basilar skull fracture

ecchymosis:
under eyes - raccoon eyes
behind ear over Mastoid Process - Battle's sign

36

Patient can remember everything up to the injury

retrograde amnesia

37

Patient unable to remember events after the injury.

anterograde amnesia

38

Effect of pulling on spine.

Distraction

39

Vertebrae out of alignment.

Subluxation of the spine

40

Loss of sensation with severe spinal injuries.

Quadriplegia - C5 to C6 injury
Paraplegia - L1 injury

41

Irregular respirations, bradycardia and hypertension.

Cushing's triad is a clinical triad variably defined as having:
Irregular respirations (impaired brainstem function)
Bradycardia
Hypertension

Associated with increased intracranial pressure.

42

When blood or other fluid fills the pericardial sac.

Cardiac tamponade

43

Blunt chest injury caused by sudden, direct blow to the chest at a critical point in the heartbeat.

Commotio Cordis
Causes ventricular fibrillation and possible death

44

Signs caused by blood in the peritoneal cavity.

Kehr sign - Left shoulder pain, ruptured spleen
Cullen sign - periumbilical ecchymosis, takes 24-48 hours to appear and can predict acute pancreatitis
Grey Turner's sign - bruising of the flank, indicative of pancreatic necrosis
Blumberg sign - rebound tenderness, indicative of peritonitis

45

Types of fractures

Greenstick - incomplete, occurs in children
Comminuted - broken into more than 2 fragments
Pathologic - weakened or diseased
Epiphyseal - occurs in growth plate
Oblique - broken at an angle
Traverse - straight across
Spiral - twisting, child abuse
Incomplete - nondisplaced partial crack

46

Common complication of fracture of tibia or forearm in children.

Compartment syndrome
develops within 6 to 12 hours
characterized by pain out of proportion to injury

47

An object at rest tends to stay at rest.

Newton's First Law

48

Force equals mass times acceleration.

Newton's Second Law

49

For every action, there is an equal and opposite reaction.

Newton's Third Law

50

Signs and symptoms of hypovolemic shock.

rapid, weak pulse
change in mental state
cool, clammy skin
cyanosis (lips, oral membranes, nail beds)
low blood pressure (late sign)

51

Bright red blood coughed up by patient.

Hemoptysis

52

Management of closed soft tissue injuries (RICES).

Rest
Ice
Compression
Elevation
Splinting

53

Five basic interventions for external bleeding with signs and symptoms of shock.

Direct pressure
High flow oxygen
Prevent heat loss
Trendelenburg position
High priority transport

54

Signs and symptoms of inhalation injury.

Stridor
Dyspnea
Coughing
Wheezing
Facial burns
Hoarse voice
Airway edema
Singed facial hair
Soot in mouth or nose

55

Evaluation of electrical burn.

Possible unseen injury between entrance and exit.
High risk of respiratory and cardiac arrest.
All electrical burns require transport and evaluation by physician.

56

Signs and symptoms of concussion.

Altered LOC that gradually improves
Nausea
Vomiting
Irritability
Repetitive questioning
Vision problems
Amnesia

57

Signs and symptoms of cerebral contusion.

S/S concussion and a least one of:
decreasing mental status
unresponsive
pupillary changes
changes in vital signs
obvious behavioral abnormalities

58

Signs and symptoms of epidural hematoma.

Brief loss of consciousness
Headache
Seizures
Vomiting
Posturing
Hypotension
Bradycardia
Changes in respiration
Pupillary changes

59

Signs of increased intracranial pressure.

Cushing's response:
Hypertension
Bradycardia
Altered respiratory pattern

60

Signs and symptoms of spinal injury.

tenderness around injured area
motor and/or sensory deficits
paralysis below injury
possible respiratory arrest in high cervical injury (C5 or above)

61

Signs and symptoms of neurogenic shock.

Any sign or symptom of spinal injury
Priapism
Hypotension without tachycardia
Warm skin, normal color

62

Signs of cardiac tamponade (Beck's Triad).

Jugular vein distension (JVD)
Muffled heart sounds
Narrowing pulse presssure

63

What is the most important intervention for a flail chest with respiratory compromise?

Positive pressure ventilation and oxygenation.

64

Five mechanisms of heat loss.

Conduction
Convection
Evaporation
Respiration
Radiation

65

Signs and symptoms of hypothermia.

Cold skin on torso
Pale skin / cyanotic
Shivering (absent in extreme)
Loss of coordination (stiff muscles, difficult speaking)
Altered LOC
Bradycardia
Bradypnea
Hypotension

Prehospital rewarming is limited to passive measures.

66

Signs and symptoms of heat exhaustion.

Hx of exertion in a warm climate
Dizziness, weakness
Nausea, vomiting
Headache
Possible muscle and abdominal cramps
Thirst
Tachycardia

67

Signs and symptoms of heat stroke.

Similar to heat exhaustion
altered or decreased LOC
skin may be hot and dry or wet
seizures

68

Management of systemic heat emergencies

Move to cooler environment
Water for completely alert patient
Rapid and aggressive cooling for heat stroke.
Expose patient
Cool with water, wet towels, ice packs
Ice packs best to groin, neck, arm pits
Rapid transport
Be alert for vomiting and/or seizures

69

Pneumatic antishock garment (PASG).

For the most part, the pneumatic antishock garment (PASG) is no longer routinely used in EMS.

It may be useful to stabilize pelvic fractures, especially if the patient has accompanying signs of shock. In general, the PASG should not be used for patients with blunt or penetrating trauma to the head, chest, or abdomen. Under NO circumstances should the device be used on any patient with pulmonary edema, as evidenced by shortness of breath, crackles in the lungs, or a history of left-side congestive heart failure.