Flashcards in Chapter 22 - 30 Trauma Deck (69):
Ensure Scene Safety
MOI / NOI
Take Standard Precautions
Determine Number of Patients
Consider Additional Resources
Form General Impression
Level Of Consciousness - AVPU
Orientation - Person / Place / Time / Event
Pupils - PEARRL
Airway, Breathing, Circulation - Fix Immediate Threats
Priority of Care / Transport Decision
History - SAMPLE
Pain - OPQRST
Physical Assessment - DCAP-BTLS
Assess Vital Signs - BP, Pulse, Resp, O2 Sat
Repeat Primary Assessment
Reassess Vital Signs
Reassess Chief Complaint
Identify and Treat Changes
(Unstable every 5 min; Stable every 15 min)
Awareness and concern for potentially serious underlying and unseen injuries.
Index of Suspiscion
Force acting over distance.
Energy of a moving object.
One half of Mass x Velocity Squared
The energy of falling.
Mass, Force of Gravity, Height
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
Significant mechanisms of vehicular collision injury are suggested by:
Death of vehicle occupant
Severe deformity of vehicle
Altered mental status
Ejection from vehicle
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
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.
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
Glasgow Coma Scale - Eye Opening
3 To Voice
2 To Pain
Glasgow Coma Scale - Verbal Response
3 Inappropriate Words
2 Incomprehensible Words
Glasgow Coma Scale - Motor Response
6 Obeys commands
5 Localizes pain
4 Withdraws from pain
3 Flexes from pain
2 Extends from pain
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
Signs and symptoms of Hypovolemic Shock.
Rapid, weak pulse
Changes in mental status
Cool, clammy skin
Low blood pressure (late)
Location of pressure points.
Injury that causes bleeding beneath the skin, but does not break the skin.
Buildup of fluid and blood beneath the skin.
Ecchymosis (black discoloration)
Buildup of fluid from a large blood vessel.
When a body part is trapped under weight for more than four hours.
can lead to renal failure and death
Pain out of proportion to injury.
swelling compresses blood vessels cutting off blood flow
An injury separates layers of soft tissue so that they either completely detach or hang as a flap.
Treatment for human bites.
Apply dry, sterile dressing
Immobilize area with splint or bandage
Provide transport to ED for surgical cleaning of wound
Depth of burns.
superficial - 1st degree
partial-thickness - 2nd degree
full thickness - 3rd degree
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%
Types of burns
Thermal - caused by heat - flame, scald, contact, steam
Classification of burns.
Full thickness on hands, feet, face, upper airway or
Full thickness more than 10% surface area
Partial thickness more than 30%
Younger than 5 or older than 55
Full thickness 2 - 10% surface area
Partial thickness 15 - 30%
Superficial burns > 50%
Full thickness < 2%
Partial thickness <50%
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
The presence of air in soft tissues.
subcutaneous emphysema - crackling sensation
Layers of tissue that suspend the brain and spinal cord.
Dura mater - tough fibrous outer layer
Arachnoid mater and Pia mater - thin, contain blood vessels that nourish brain
Signs of skull fracture.
Basilar skull fracture
under eyes - raccoon eyes
behind ear over Mastoid Process - Battle's sign
Patient can remember everything up to the injury
Patient unable to remember events after the injury.
Effect of pulling on spine.
Vertebrae out of alignment.
Subluxation of the spine
Loss of sensation with severe spinal injuries.
Quadriplegia - C5 to C6 injury
Paraplegia - L1 injury
Irregular respirations, bradycardia and hypertension.
Cushing's triad is a clinical triad variably defined as having:
Irregular respirations (impaired brainstem function)
Associated with increased intracranial pressure.
When blood or other fluid fills the pericardial sac.
Blunt chest injury caused by sudden, direct blow to the chest at a critical point in the heartbeat.
Causes ventricular fibrillation and possible death
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
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
Common complication of fracture of tibia or forearm in children.
develops within 6 to 12 hours
characterized by pain out of proportion to injury
An object at rest tends to stay at rest.
Newton's First Law
Force equals mass times acceleration.
Newton's Second Law
For every action, there is an equal and opposite reaction.
Newton's Third Law
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)
Bright red blood coughed up by patient.
Management of closed soft tissue injuries (RICES).
Five basic interventions for external bleeding with signs and symptoms of shock.
High flow oxygen
Prevent heat loss
High priority transport
Signs and symptoms of inhalation injury.
Singed facial hair
Soot in mouth or nose
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.
Signs and symptoms of concussion.
Altered LOC that gradually improves
Signs and symptoms of cerebral contusion.
S/S concussion and a least one of:
decreasing mental status
changes in vital signs
obvious behavioral abnormalities
Signs and symptoms of epidural hematoma.
Brief loss of consciousness
Changes in respiration
Signs of increased intracranial pressure.
Altered respiratory pattern
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)
Signs and symptoms of neurogenic shock.
Any sign or symptom of spinal injury
Hypotension without tachycardia
Warm skin, normal color
Signs of cardiac tamponade (Beck's Triad).
Jugular vein distension (JVD)
Muffled heart sounds
Narrowing pulse presssure
What is the most important intervention for a flail chest with respiratory compromise?
Positive pressure ventilation and oxygenation.
Five mechanisms of heat loss.
Signs and symptoms of hypothermia.
Cold skin on torso
Pale skin / cyanotic
Shivering (absent in extreme)
Loss of coordination (stiff muscles, difficult speaking)
Prehospital rewarming is limited to passive measures.
Signs and symptoms of heat exhaustion.
Hx of exertion in a warm climate
Possible muscle and abdominal cramps
Signs and symptoms of heat stroke.
Similar to heat exhaustion
altered or decreased LOC
skin may be hot and dry or wet
Management of systemic heat emergencies
Move to cooler environment
Water for completely alert patient
Rapid and aggressive cooling for heat stroke.
Cool with water, wet towels, ice packs
Ice packs best to groin, neck, arm pits
Be alert for vomiting and/or seizures