Epc 2 Flashcards by Nooreen Bhanji

Stimulation to breathe occurs via chemoreceptors located in the?And are also key players in monitoring blood pressure and regulating heart rate through the baroreceptor reflex.

Carotid sinus and aortic arch

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When CO2 levels increases, the brain is stimulated to increase …………… and …………… and blow off ……………

Respiratory rate
Respiratory depth
CO2

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( inspiration) The ………… contracts and moves downward while the ……………… contract and move outward

Diaphragm
Intercostals

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( inspiration) ……………. Decreases resulting in air entering the thoracic cavity

Intrathoracic pressure

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(Expiration)
The ………….. relaxes and moves upward while the ………….. relaxes. Intrathoracic pressure increases above ………… . ………… leaves the body

Diaphragm
Chest wall
Atmospheric pressure
Air

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…………….. is the delivery of oxygen from the air to the blood

Oxygenation

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Oxygen binds with …………

Hemoglobin

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…………… is the removal of carbon dioxide from the body to the atmosphere

Ventilation

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………………. Is the volume of blood delivered in 1 minute

Cardiac output

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Cardiac output is equal to …………… X …………………..

Heart rate
Stroke volume

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The ……….. consists of a bony cage overlying some of the most vital organs in the human body

Thorax

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The ………. Is an elongated, S shaped bone that connects to the manubrium medially and overlies rib 1 as it proceeds laterally toward the shoulder

Clavicle

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Laterally, the clavicle connects to the acromian process of the …………, the triangular bone that overlies the posterior aspect of the upper thoracic cage

Scapula

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Between each rib lies an ………….. space

Intercostal

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The heart lies within a tough fibrous sac called the?

Pericardium

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A double-layered serous membrane that surrounds the lungs and lines the chest cavity to reduce friction during breathing.

Pleura

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The diaphragm, the primary muscle of breathing forms a barrier between the ………….. and ………….. cavities

Thoracic
Abdominal

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The primary physiologic functions of the thorax and its contents are to maintain ……………. And …………….and via the heart to maintain …………..

Oxygenation
Ventilation
Circulation

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As the diaphragm contracts downwards, the intercostal and accessory muscles pull the …………..out and away from the center of the body. The resulting …………… pressure within the thoracic cavity draws air in through the ………… and …………… down the ……………, passing through smaller and smaller bronchioles until finally it reaches the …………..

Chest wall
Nose
Mouth
Trachea
Alveolar space

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This includes the delivery of oxygen from the air to the blood, where it is carried to the cells and tissues throughout the body

Oxygenation

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This is the process by which CO2 is removed from the body

Ventilation

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This is the amount of blood pumped out of the heart with each beat

Stroke volume

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This is the total amount of blood pumped in one minute

Cardiac output

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How to calculate cardiac output?

Cardiac output = heart rate X stroke volume

CO=HR X SV

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This is a bruise of the lung tissue caused by blunt chest trauma

Pulmonary contusion

A …………. Is defined as two or more adjacent ribs that are fractured in two or more places

Flail segment

In a …………. Injury, multiple ribs break in two or more places, creating a …………….. rib segment that moves independently from the rest of the chest during breathing

Flail chest Free floating

Presentation of small pneumothirax

May cause only mild dyspnea, pleuritic chest pain and diminished lung sounds

The most common thoracic injury is?

Rib frcatures

When you are examining the chest of a patient who has sustained either blunt or penetratinginjury, palpate for …………. (Air under the skin), which can indicate a potential ……………

Subcutaneous emphysema Pnemothorax

The accumulation of air or gas in the pleural cavity

Pneumothorax

This occurs when a defect in the chest wall allows air to enter the thoracic space. It results from penetrating chest trauma

Open pneumothorax

…………. Occurs when air leaks into the space between the pleural surfaces from an opening in the chest or the surface of the lung. The lung collapses as air fills in the ………

Pneumothorax Pleural cavity

This is a life threatening condition that results from continuous air accumulation within the intrapleural space

Tension pneumothorax ( eg: a rib puncturing the lung, the trapped air builds up crushing the lung and pushing the heart, trachea and major vessels to the opposite side

Symptoms of tension pneumothorax

Tracheal deviation, JVD, shock, tachycardia, absent breath sounds on affected side

This occurs when blood begins to fill the space between the parietal and visceral pleura

Hemothorax

Each lung can hold up to how much blood?

3000ml

A ---------------- is when blood rapidly accumulates in the pleural space, often from chest trauma. It causes lung collapse, hypovolemic shock, and impaired ventilation.

massive hemothorax

Massive hemothorax will reveal signs of both ventilatory insufficiency and and hypovolemic shock what are those?

Ventilatory insufficiency - hypoxia - agitation -anxiety - tachypnea - dyspnea Hypovolemic shock - tachycardia - hypotension - pale and clammy skin

This is a collection of blood in the pleural space produced by bleeding within the chest

Hemothorax

This occurs when both blood and air are present in the pleural space

Hemopneumothorax

-Caused by compression of lung tissue against chest wall -results to alveolar and capillary damage - results in reduced delivery of oxygen across the capillary ( alveolar interface)

Pulmonary contusion

Signs for pulmonary contusion

-Hemoptysis -Signs of overlying injuries such as crepitus, tenderness or contusions

This is defined as excessive fluid in the pericardial sac, causing compression of the heart and decreased cardiac output. May be caused by blunt or penetrating trauma.

Cardiac tamponade

In ------------------ blood or fluid builds up in the pericardial sac (the membrane surrounding the heart), which compresses the heart and prevents it from filling and pumping effectively. It's a life-threatening emergency that requires immediate intervention.

cardiac tamponade

Becks triad ( signs of cardiac tamponade)

-Muffled heart sounds -Narrowed pulse pressures -JVD

-Blunt cardiac injury caused by the heart colliding with the sternum

Myocardial contusion

- may lead to dysrhythmias - patients complains of sharp, retrosternal chest pain - lung sounds may reveal crackles - ECG changes may occur

Myocardial contusion

-Acute perforation of the ventricles, atria, septum, chordae, muscles or valves -caused by severe blunt force

Myocardial rupture

Immediate cardiac arrest caused by blunt trauma during the hearts repolarization period

Commotio cordis

When experiencing commotio cordis a patient appears in …………. Fibrillation, which responds well to …………. If performed quickly

-ventricular -defibrillation

This is a tear in the aorta caused by severe blunt trauma and transaction or dissection. Like a high speed car crash or fall from a height

Traumatic aortic disruption

Body’s largest blood vessel

Aorta

Why is traumatic aortic disruption a life threatening emergency?

Because the aorta carries all the blood from the heart to the body, if it tears completely, massive internal bleeding occurs, often leading to death

The most widely accepted theory of how traumatic aortic disruption occurs is ?

That the aorta is injured in its fixed points due to shearing forces

Signs for traumatic aortic disruption

- patient may complain of pain behind sternum - may also show signs of hypoperfusion

What can cause a tension gastrothorax?

A diaphragmatic herniation, due to blunt or penetrating trauma

This happens when the stomach or intestines move into the chest cavity ( through a tear in the diaphragm) causing a severe pressure on the lungs and heart

Tension gastrothorax

Signs of diaphragmatic injury ( causing tension gastrothorax)

- bowel sounds in the chest cavity - absence of lung sounds in affected side

- caused by the sudden and forceful compression of the thoracic cavity - causes pressure to be translated into the veins of the head, neck and kidneys - pressure in capillary beds results in their rupture

Traumatic asphyxia

Difference between hypoxia and asphyxia

Hypoxia- happens when not enough oxygen reaches the tissues and organs Asphyxia- happens when oxygen can’t get into the body at all because the airway is blocked

Findings on patient with traumatic asphyxia

- cyanosis of head and upper extremities - subconjunctival hematoma (bleeding into the anterior surface of the eye covering the white part) - exophthalmos ( eyes protrude from their normal position) - tongue and lips may be swollen

Signs of airway compromise

Stridor Hoarseness Gurgling Snoring Signs of hypoxia Alterations in mental status Tachypnea Coughing Hemotypsis Accessory muscle usage Retractions

Signs of hyoovolemia

-Cool pale or clammy skin -delayed capillary refill ( > 2 sec) -weak or thready pulse -mild confusion or dizziness -tachycardia ( it is common but not always present ( eg in elderly beta blockers use)

Weak and thready pulse suggests?

Hypovolemia

An ——————— suggests that the heart's electrical activity is abnormal, which can be due to a number of arrhythmias or other cardiac conditions.

Irregular pulse

JVD must be measured at?

-45 degree angle -cannot be determined when the patient is immobilized

Lack of ………. Can indicate that there isn’t enough blood ( hypovolemia) to fill the veins properly, a sign of circulatory compromise or early shock

JVD

Muffled heart sounds may indicate?

Tension pneumothorax or cardiac tamponade

Any patient with chest trauma should be reassessed every?

5 minutes

When ventilating patients with possible lung trauma ventilate gently, if too much force is used a simple pneumothorax maybe converted into?

Tension pneumothorax

The treatment of the trauma patient is best accomplished if the patient can get to the hospital in 1 hour which is the ?

Golden hour

Signs and symptoms of flail chest

-paradoxical motion -dyspnea -chest pain

Signs and symptoms of rib fracture

Hypoxia, hypercapnia and pain

Cover open pneumothorax with occlusive dressing secured on …… sides

Massive hemothorax findings

Lack of JVD Lack of tracheal deviation Hemotypsis Dull to percussion

Largest organ of the human body and serves as the interface between the body and outside world

The skin (integumentary)

Refers to non bony, any group of similar cells that connects, supports or surrounds other structures and organs of the body. Eg: fat, muscles, tendons, ligaments, synovial membranes, blood, lymph vessels and nerves

Soft tissue

Occurs from sudden or extreme changes in air pressure as can occur during scuba diving emergency

Barotrauma

The human integumentary system plays a crucial role in maintaining the constancy of the internal environment, which is called?

Homeostasis

The skin comprises two layers which are?

-epidermis and the dermis

The outermost layer, is the body’s first line of defence. It’s a barrier.

Epidermis

This consists of 5 layers . An outermost layer (stratum corneum) of hardened non living cells, which are continuously shed

Epidermis

Underlying the epidermis is a tough, highly elastic layer of connective tissues called the?

Dermis

This complex material is composed chiefly of collagen fibres, elastic fibres and a mucopolysaccharide gel

Dermis

A fibrous protein with a high tensile strength strength, gives the skin high resistance to breakage under mechanical stress

Collagen

This allows skin to spring back to its usual contours

Elastin

The dermis is subdivided into?

Papillary layer and a reticular layer

Macrophages, lymphocytes and mast cells are also found within the …………… layer

Dermal

These cells are part of the the immune system, once a pathogen enters the dermis, these cells destroy the invading microorganism

Macrophages, lymphocytes and mast cells

These mediate the senses of touch, temperature, pressure and pain

Nerve endings

These carry oxygen and nutrients to the skin and remove carbon dioxide and metabolic waste products

Blood vessels

These are located at the neck of each hair follicle and are a specialized secretory mechanism that produces an oily substance called sebum

Sebaceous glands

What is the layer of tissue beneath the dermis

Subcutaneous layer

The subcutaneous layer consists mainly of?

Adipose tissue (fat)

Blood vessels, lymph vessels and hair roots are found in what layer?

Subcutaneous layer

Below the subcutaneous tissue is a thick dense layer of fibrous connective tissue known as ?

Deep fascia

The skin is arranged over the body structures in a manner that provides tension. This tautness varies by body region but occurs in pattern known as?

Tension lines

This is any injury to the soft tissue, it typically describes an injury in which the integrity of the skin has been disrupted

A wound

This layer of the dermis provides nutrients and aids in thermoregulation

Papillary layer

This layer is part of the dermis its dense, irregular connective tissue. Provides strength and elasticity

Reticular layer

Additional cells move to area to begin repair - granulocytes and macrophages -phagocytes -chemotactic factors -granulocytes degranulate

Inflammation

New epithelial cells move into injured region - stratum germinativum cells multiply and redevelop

Epithelialization

What is this wound healing steps called? -new blood vessels form -new capillaries bud -conduit for oxygen and nutrients -pathway for waste removal -bleeding might result from very minor injury

Neovascularization

- tough fibrous protein found in scar tissue, bones, skin, connective tissues

Collagen synthesis

What kind of wound are these? -human and animal bites - embedded foreign body - injection wounds - devitalized tissue - crush wounds

High risk wounds

What is this? -excessive collagen formation -hypertrophic scar -keloid scar

Abnormal scar formation

What kind of injury is this? - happens to bedridden patient -unconscious or immobilized patient -tissues deprived of oxygen -localized hypoxia -cell deterioration

Pressure injuries

Any break in skin can allow invading pathogens to enter. What is that called?

Infection

Visible clues of infection

Erythema, purulent discharge, warmth, edema, local discomfort, red streaks indicate lymphangitis

Systemic signs for infection?

Fever, rigors, chills, joint pain, hypotension

------------- is the death of body tissue due to loss of blood supply, severe infection, or trauma. It can be life-threatening if left untreated, especially if it leads to sepsis.

Gangrene

This is also called clositridium tetani - anaerobic bacterium produces potent toxin -results in painful muscle contractions ( may be noticed first in jaw/lockjaw) - rare due to vaccination

Tetanus

This is a flesh eating disease, death of tissue from bacterial infection - caused by streptococcus - clinical hallmark is severe pain, you may see central wound necrosis with surrounding severe pain or a subcutaneous emphysema on exam

Necrotizing fasciitis

This type of wound has: - no break in the epidermis -contusion ( bruise) - edema ( swelling) - ecchymosis (black and blue mark) - hematoma (collection of blood beneath skin)

Closed wound

This type of wound has : - disruption of the epidermis -more serious than closed wounds - vulnerable to infection due to contamination

Open wound

This is a clean or jagged incision through skin surface and underlying structure

Laceration

This is a flap of skin torn loose -may be accompanied by profuse bleeding - irrigate with normal saline and place into an atomic position

Avulsion

Complete loss of a body part

Amputation

What are the 2 key causes of increased pressure within a muscle compartment, which can lead to compartment syndrome

Edema (swelling) Hemorrhage ( bleeding)

What is this called? If persists longer than 6 hours - serious risk of death of local tissues - sepsis

Compartment syndrome

Two general principles for open wounds are?

- control bleeding -keep the wound clean

If bleeding is present in an open wound, determine:

- colour of blood - amount lost - site of origin

Directly covers the wound and controls bleeds

Dressing

This keeps the dressing in place

Bandage

This is used to cover wounds - completely free of organisms - used when a high probability of infection is present

Sterile dressing

This is applied on top of a sterile dressing to increase the ability to absorb blood - used when there is lower risk of infection

Nonsterile dressings

This dressing is used when it is important to keep air from passing through the material eg:wounds to neck and thorax

Occlusive dressing

This kind of dressings allow exudate from the wound to mesh with the dressing material -facilitates clotting and aids in bleeding control -removal is painful and may precipitate bleeding

Adherent dressings

This dressing allow the products of wound repair to pass through the material -easy removal but does not aid in clotting - applied after wound closure

Nonadherent dressings

These dressings provide a medium for bacteria and other pathogens to grow, use is limited -can benefit burn care

Wet/moist dressing

This type of bleeding occurs in spurts - blood is usually bright red

Arterial bleeding

This bleeding is characterized by slow, even flow of bright or dark red blood -present in minor injuries

Capillary bleeding

This type of bleeding is more likely to be slow and steady -darker colour blood

Venous bleeding

This type of bleeding is characterized by a slow and steady -dark colour blood

Venous bleeding

Rate of bleeding can be substantially slowed by?

Elevating the extremity above the level of the heart but elevation alone will not control bleeding, it would be helpful in conjunction with pressure

What promotes blood flow, which may disrupt the clotting process and lacerate more blood vessels

Movement

This kind of dressing may be used in conjunction with hemorrhage control techniques -promotes body’s own coagulation process -used in anatomical regions not amendable to tourniquet use - never use on an open cranial wound

Hemostatic dressing

This blood/circulation stopping tool is only used as last resort -used in traumatic amputations -gunshot wounds

Tourniquet

What does cold compress do for pain?

-Reduces pain -diminishes blood flow

When would you do this? - quickly irrigate dirt or debris out of the wound -gently fold the skin flap back onto the wound -hold the flap in place with a dry sterile compression dressing - never remove flap -apply ice packs to surrounding area to decrease pain and swelling

Avulsed flaps

What suggests serious underlying injury with internal bleeding? Medical term for bruise, bleeding underneath.

Ecchymosis

Body parts crushed between two solid objects is called?

Crushed injuries

When an area of the body is trapped for longer than 4 hours what happens?

-arterial blood flow is compromised -muscles are crushed beyond repair

-----------------is the death of cells or tissue within a living organism, typically due to factors like lack of blood supply, infection, toxins, or trauma.

Tissue necrosis

The progression of crush syndrome

1: a body part is trapped for more than 4 hours 2: rhabdomyolysis occurs 3: the trapped body part is freed 4: by products of metabolism and harmful products for tissue destruction are released, possibly resulting in cardiac arrest, dysrhythmias, kidney damage, hyperkalemia and hyperphosphatemia

This refers to a delayed sudden cardiac arrest that can occur after a patient is freed from prolonged crush injury even if they appear stable, fine and smiling at first ( crush syndrome)

Smiling death

In crush syndrome early causes of death are?

Hypovolemia and hyperkalemia

What phase of blast injuries is this? -pressure wave -results from air displacement and heat -damages air filled cavities ( ears, lungs) - high risk of injury or death

Primary phase

What phase of blast injury is this? -blast wind -occurs as combustible gases move across the affected area -less forceful than the pressure wave but longer lasting which involves blunt and penetrating wounds from flying objects

Secondary phase

What phase of blast injury is this? - displacement from high energy explosions -away from the blast site or collapse of the surrounding structure like victims thrown against rigid structures, risk for entrapment

Tertiary phase

What phase of blast Injury is this? - heat generated can cause burns -falling debris can cause crush injuries

Quaternary phase

4 phases of blast injuries

Primary – due to the blast pressure wave (barotrauma) Secondary – due to shrapnel or debris (penetrating trauma) Tertiary – due to body displacement (blunt trauma) Quaternary – everything else (burns, inhalation, crush, etc.)

Largest cavity in the body -contains vital organ systems -extends from the diaphragm to the pelvis

Abdominal cavity

Region from diaphragm to pelvic brim

Abdominal cavity

The abdominal cavity is divided into 3 sections?

Anterior abdomen Flanks Posterior abdomen or back

Membrane that covers the abdominal cavity

Perioneum

————- is a fold of tissue (a double layer of peritoneum) that attaches the intestines to the posterior abdominal wall, helping to anchor them in place while also allowing movement and supplying blood, lymph, and nerves.

The Mesentery

-Peritoneal space -retroperitoneal space -pelvis

The 3 regions of the internal abdomen

Intraperitoneal structures ( encased in peritoneum)

-liver - spleen -stomach - small bowel -colon - gallbladder - female reproductive organs

Retroperitoneal structures

-aorta -venae cava -pancreas -kidneys -upper part of ureters -portions of the duodenum and large intestines

Pelvic structures

-rectum - lower part of ureters - pelvic vascular plexus - infra-aortic and infra vena canal vessels - pelvic skeletal structures - reproductive organs

These are areas of the abdomen where enough blood loss can cause shock

- abdominal cavity - retroperitoneal space - pelvis

The majority of significant abdominal injuries involve blunt trauma and most are due to?

Motor vehicle collisions

These are diffuse soft tissue injuries created by destructive energy transfer -transferred via radiation, thermal or electrical energy

Burns

What temperatures cause burns?

Higher than 44degrees Celsius

What correlates the severity of burns?

Amount of heat energy and duration of exposure

In the abdomen the most commonly injured organs during blunt trauma?

Spleen and liver

Hemorrhage can be?

Internal and external

Bleeding in the abdomen can cause?

Abdominal tenderness or distension ( distension not evident until patient has lost nearly all blood in abdomen)

Examples of solid organs

Liver, kidney, spleen, pancreas, diaphragm

Spleen injury may be indicated by?

Pain in left shoulder ( kehr sign)

Pancreas injury may be indicated by?

Vague upper/midabdominal pain that radiates to back

Diaphragm injury will cause?

Ventilatory compromise

Examples of hollow organs

-Stomach -intestines (small and large) -gallbladder -urinary bladder -appendix -uterus

Spillage of contents from the hollow organs results in?

Peritoneal contamination ( peritonitis)

- This is bruising (ecchymosis) of the flanks -the area between the lower ribs and the top of the hip on the sides of the torso

Greys turner sign

What does greys turners sign suggest?

It suggests retroperitoneal bleeding which can be due to -pancreatitis -AAA ( ruptured aortic aneurysm ) -ectopic pregnancy rupture

This is an indication of intra abdominal bleeding, specifically peri umbilical ecchymosis ( bruising around belly button) it suggests internal bleeding, most commonly associated with 1: abdominal trauma 2: ruptured ectopic pregnancy 3: ruptured AAA 4: retroperitoneal hemorrhage

Cullen sign

In blunt force trauma from motor vehicle collisions, determine?

- the types of vehicles involved - the speed they were travelling - collision patterns - use of seat belt - air bag deployment - the patients position in the vehicle

In penetrating trauma caused by gunshot , determine?

-Type of weapon used - number of shots - distance from victim

In penetrating trauma caused by stabbing, determine?

-type of knife - possible angle of entrance wound - number of wounds

What are signs of a pelvic fracture?

- pain to pelvis, groin or hip - hematomas or contusions to pelvic region - obvious bleeding - hypotension without obvious external bleeding

This is when fluid physically leaves the body ( externally or internally) And what kind of shock occurs?

It’s called absolute fluid loss and hypovolemic shock happens (body loses volume = not enough to circulate = drop in perfusion)

Causes of absolute fluid loss are?

- external bleeding - internal bleeding - severe viniting or diarrhea - burns ( plasma loss through damaged skin) - dehydration

This happens when the fluid is still in the body, but it’s no longer where it needs to be ( eg within the vascular system) - so the volume of fluid is normal but it’s maldistributed due to vessel dilation Which causes what kind of shock?

Relative fluid loss which causes distributive shock (blood volume is distributed improperly not effectively perusing tissues)

What causes relative fluid loss?

- sepsis ( vasodilation + capillary leakage) - anaphylaxis ( massive vasodilation + leakage) - neurogenic shock

- This is present in almost all forms of combustion - should be considered whenever a group of people in the same place all complain of a headache or nausea - it can displace oxygen from the alveolar air and the blood hemoglobin - it binds to receptor sites on hemoglobin at least 250 times more easily than oxygen

Carbon monoxide

The most common type of burn is?

Contact burn

Three types of ionizing radiation

Alpha Beta Gamma

Signs and symptoms of internal hemorrhage (early signs, compensated shock)

Pale, cool clammy Tachycardia Tachypnea Anxiety Delayed cap refill Narrowing pulse pressure Thirst

Late signs of internal hemorrhage ( decompensated shock phase)

Hypotension Altered level of consciousness Cold extremities Cyanosis Weak or threads pulse

Pressure injuries are?

Pressure ulcers or bedsores

What kind of patients are at high risk for pressure injuries

Immobile Elderly Neurologically impaired Malnourished or dehydrated Critically ill Underweight and overweight

Skin helps regulate body temperature through?

-Sweating -Vasodilation -Vasoconstriction -Piloerection (goosebumps) -Radiation, conduction and convection

————— is a serious condition caused by the breakdown of skeletal muscle tissue, releasing a protein called myoglobin into the bloodstream, which can lead to kidney damage

Rhabdomyolysis

Skin helps regulate body temperature through?

-vasoconstriction -vasodilation -sweating -goosebumps

Bright red blood in stool, often from lower GI bleeding

Hematochezia

————- occurs when blood from the stomach or esophagus has been partially digested by stomach acids before being vomited

Coffee ground emesis

Black tarry stool from digested blood, typically from upper GI bleeding

Melena

The ————- is the flat bone in the center of the chest that connects the ribs via costal cartilage. It’s often referred to as breastbone

Sternum

The sternum consistes of 3 parts. What are they and where is each part located?

Manubrium: the uppermost part of the sternum, at the junction between neck and chest Sternal body: the longer middle section of the sternum, it lies below the manubrium and is the main portion of the sternum Xiphoid process: the small cartilaginous tip at the bottom of the sternum. Located just below the sternal body. Landmark for CPR

Phrenic nerve comes from

Cervical plexus