Trauma Flashcards
1
Q
What are the 3 concepts of energy ?
A
Potential Energy
Kinetic Energy
Energy of work
2
Q
What is Kinetic Energy ?
A
Energy of a moving object . The weight of the object and the velocity at which it is traveling
3
Q
What is the formula for kinetic energy ?
A
KE=1/2 mass x velocity2 (squared)
4
Q
What is potential energy ?
A
The product of mass (weight), force of gravity, and height. Mostly associated with the energy of falling objects
5
Q
What is Energy of work ?
A
Force acting over a distance.
Forces that bend, pull, or compress tissues beyond their limits results in the work that causes injury
6
Q
What are non significant injuries ?
A
Injuries to an isolated body part or fall without loss of consciousness
7
Q
What are significant MOI’s?
A
- Injury to more than one body system (multisystem trauma)
- Falls from heights
- Motor vehicle and motorcycle crashes
- Car versus pedestrian or bicycle
- Gunshot wound
- Standings
8
Q
What is blunt trauma ?
A
The result of force to the body that causes injury without penetrating the soft tissues
9
Q
What is penetrating trauma ?
A
Causes injury by objects that pierce and penetrate the surface of the body
10
Q
What are 3 types of vehicular crash collisions ?
A
- Car against another car, tree, or object
- Passenger against the vehicles interior
- Passengers internal organs against solid structures of the body
11
Q
What are the different types of vehicular crashes
A
Frontal crash
Rear end crash - whiplash
Lateral crashes - very common cause of death
Roll over and rotational crashes
12
Q
What do you assess in Car vs Motorcycle accidents?
A
- Deformity of the motorcycle
- Side of most damage
- Distance of skid in the road
- Extent and location of deformity in helmet
13
Q
What are the different types of Car vs Motorcycle crashes ?
A
- Head on crash
- Angular crash
- Ejection
- Controlled crash
14
Q
What is an angular motorcycle crash ?
A
The motorcycle strikes an object at an angle so that the rider sustains direct crushing injuries to the lower extremity
15
Q
What is a controlled crash?
A
Technique used to separate the rider from the body of the motorcycle
16
Q
What is considered a significant fall ?
A
More than 20 feet
17
Q
What should you take into account when a patient falls from significant heights ?
A
- Height of the fall
- Type of surface struck
- Parts of the body that hit first, followed by the path of energy displacement
18
Q
What is cavitation ?
A
When a high energy projectile travels through the relatively liquid humans body, it forms a cavity along the track of the bullet
19
Q
What are the different types of blast injuries and how are they defined ?
A
- Primary Blast
•Due entirely to the blast itself, damage to the body caused by pressure - Secondary Blast
•Damage to the body results from behind struck by flying debris - Tertiary blast
• The victim is hurled by the force of the explosion against a stationary object
20
Q
What ate Quaternary (miscellaneous) blast injuries ?
A
- Burns from hot gases or fires started by the blast
- Respiratory injury from inhaling toxic gases
- Crush injury from the cal lapse if buildings
- Suffocation, poisoning, other medical emergencies
- Contamination of wounds from Eliot mental, chemical or toxic substances
Most patients who survive an explosion will have some combination of the four types of injury
21
Q
What organs are most susceptible to pressure changes ?
A
- Middle ear
- Lung
- Gastrointestinal tract
The ear is most sensitive to blast injuries
22
Q
What is a pulmonary blast ?
A
Pulmonary trauma that results from short range exposure to the detonation of explosives , characterized by a lack of external visible injuries
23
Q
What are the most concerning pulmonary blast injuries ? And what can they produce ?
A
The most concerning blast injuries is arterial air embolism, which occurs on alveolar disruption with subsequent air embolization into the pulmonary casualties.
Can produce
- Disturbance in vision
- Change in behavior
- Changes in state of consciousness
- Variety of other Neurologic signs
24
Q
What is relatively protected from shock wave injuries ?
A
Solid organs; may be injured by secondary middles or a hurled body
25
What are the most common causes of death in blast injuries ?
Neurologic injuries and head trauma
26
What is multi-system trauma ?
Trauma that involuted more than one body system
27
What are the golden principles of prehospital trauma care ?
1. Your main priority is to ensure
• Your Safety
• Safety of your crew
• Safety of the patient
2.Determine the need for addition personnel or equipment
3. Evaluate the MOI
4. Identify and manage life threats
5. Then focus on patient care
6. Transport immediately to the appropriate facility
7. One scene time should be limited to 10 minutes
8. Obtain SAMPLE history and complete a secondary assessment during transport
9. Consider ALS intercept or air medical transportation
28
What are the different levels of hospital care ?
1. Level 1 facility
• provides every aspect of trauma care
2. Level 2 facility
• provides initial definitive care
3. Level 3 facility
• provides assessment, resuscitation, emergency care, and stabilization
4. Level 4 facility
• provides advanced trauma life support
29
Kinetic energy is a calculation of what ?
Mass and velocity. Energy cannot be destroyed, only converted
30
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35
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37
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39
What does index of suspicion mean ?
Your awareness for potentially serious unseen injuries
40
What is drag ? (Penetrating trauma)
Air resistance slowing a projectile
41
What is the most common cause of shock following a traumatic injury ?
Uncontrolled bleeding
42
What are the 3 parts of the cardiovascular system ?
1. The pump (Heart)
2. Container (blood vessels)
3. Fluid (blood and body fluids)
43
How long can organs last without a constant supply of blood ? (brain & spinal cord lungs, kidneys, skeletal muscles)
1. Brain and spinal - 4 to 6 mins
2. Lungs 15-20 mins
3. Skeletal muscles - up to 2 hours
Times are based on normal body temperatures, colder temperatures will lengthen survival times.
44
How much blood loss can the body tolerate ?
Up to 20%
45
What are the changes in vital signs when significant blood loss occurs ?
1. Increase in heart rate
2. Increase in respiratory rate
3. Decrease in blood pressure
Has the same affect on infants and children
46
How much blood can an adult comfortable donate ?
500mL over 15 to 20 mins
47
What is arterial bleeding ? And what happens ?
1. Pressure causes blood to spurt and makes bleeding difficult to control
2. Bright red (oxygen rich) and spurts in time with the pulse
3. Decreases as the amount of blood circulating in the body drops because blood pressure drops
48
What are the signs of venous bleeding ?
1. Dark red (low in oxygen)
2. Flows slowly or tepidly depending on size of vein
3. Does not spurt and is easier to manage
4. Can be profuse and life threatening
5. More likely to clot spontaneously than arterial blood
49
What are the situations in which clotting would fail ?
1. Movement
2. Disease
3. Medications
4. External environment
5. Body temperature
6. Severe injury
50
What is hemophilia ?
A condition that lacks blood clotting factors
51
What are the possible conditions of internal bleeding ?
1. Stomach ulcer
2. Lacerated liver
3. Ruptured spleen
4. Broken bones
5. Pelvic fracture
52
What pneumonic us used for MOIs involving internal bleeding ?
DCAP-BTLS
53
What are causes for NOI’s involving internal bleeding ?
1. Bleeding ulcers
2. Bleeding from colon
3. Ruptured ectopic pregnancy
4. Aneurysms
54
What are the frequent signs for NOI’s involving internal bleeding ?
1. Abdominal tenderness
2. Guarding
3. Rigidity
4. Pain
5. Distention
55
What is rigidity ?
Stuff or inflexible muscles
56
What can ulcers or other GU problems cause ?
1. Vomiting of blood (hematemesis)
2. Bloody urine (hematuria)
3. Blood diarrhea (dysentery)
57
What are the signs and symptoms of internal bleeding ?
1. Swelling in area of bleeding
2. Distention
3. Dyspnea, tachycardia, hypotension
4. Hematoma
5. Bruising
6. Hematemesis
7. Melena
58
What is a hematoma ?
Blood that is collected within damaged tissue or in a body cavity
•occurs whenever a large blood vessel is damaged and bleeds rapidly
•usually associated with extensive tissue damage
59
What are the early and late signs of hypoperfusion involving internal bleeding ?
Early signs
• Change in mental status
•Weakness, faintness, or dizziness on standing
•changes in skin color (pale skin)
```
Late signs
•tachycardia
•weakness, fainting, or dizziness at rest
•thirst, nausea and vomiting
•Cold, moist, clammy skin
• Cap refill more than 2 seconds
•Shallow, rapid breathing
•slightly dilated pupils
• Weak rapid threads pulse
•decreasing blood pressure
• ALOC
```
60
What are hemostatic agents ? What are the forms ?
Any chemical compound that slows or stops bleeding by assisting with clot formation
There are 2 forms
•granular powder.. can be inserted in a small wound to create a tight seal
•gauze impregnated with a clay substance- used with direct pressure
61
What does bleeding from the nose, ears, and mouth indicate ?
1. Skull fracture
2. Facial injuries
3. Sinusitis, infections, use and abuse of nose drops , dried or cracked nasal mucosa
4. High blood pressure
5. Coagulation disorders
6. Digital trauma
62
What is epistaxis ?
A nose bleed
63
What should you do when a patient is bleeding from the nose, ears and mouth ?
1. Don’t attempt to stop blood flow
2. Loosely cover the bleeding site with a sterile gauze pad
3. Apply light compression with a dressing
64
What will you see if bleeding from the nose ears or mouth containing CSF?
A target or halo shaped stain on the gauze dressing
65
What is the treatment for internal bleeding ?
1. Keep patient calm and quiet
2. Provide high flow oxygen
3. Maintain body temperature (blanket)
4. Splint the injured extremity
66
67
What is a contusion ?
Medical turn for a bruise, also called ecchymosis.
* Causes bleeding beneath the skin but does not break the skin.
* Occurs from blunt force.
* epidermis remains intact but cells within the dermis are damaged
* build up of blood produces blue or black discoloration (ecchymosis)
68
What is a pelvic binder ?
Device used to reduce hemorrhage after a pelvic fracture
69
What are the different types or burns a patient could have ?
1. Electrical
2. Chemical
3. Thermal
4. Radiation
70
What are the different bites or wounds a patient could have ?
1. Avulsions
2. Bite wounds
3. Lacerations
4. Puncture wounds
5. Incisions
71
What are the mechanisms in which soft tissues of the body can be injured ?
1. Blunt injury
2. Penetrating injury
3. Barotrauma
4. Burns
72
What are the areas of the body where skin is most thin ? What types of patients typically have thinner skin ?
1. Eyelids
2. Lips
3. Ears
Very young and very old people typically have thinner skin
73
What are then two layers of the skin and what do they do ?
1. Epidermis
•external later that forms a a water tight covering for the body
2. Dermis
•inner layer of skin
•contains hair follicles, sweat glands, and subcutaneous glands
•blood vessels in the dermis provide the skin with nutrients and oxygen
74
What are the body’s openings line with ? And what is it’s function ?
Mucous membranes
1. Provide a protective barrier against bacterial invasion
2. Secrete a watery substance that lubricates the openings
3. They are moist, whereas skin is generally dry
75
What are the functions of skin ?
1. Keeps pathogens out
2. Keeps fluid in
3. Helps to regulate body temperature
4. Has nerves that report to the brain on the environment and many sensations
5. Nerve pathway connection that allows the body to adapt to the environment through responses in the skin and surrounding tissues
76
What are the types of soft tissue injuries ? And what do they mean ?
1. Closed injuries
•damage beneath skin or mucous membrane
•surface is intact
2. Open injuries
•break in surface of skin or mucous membrane
•exposes deeper tissues to contamination
3. Burns
•damage results from thermal heat, frictional heat, toxic chemicals, electricity, or nuclear radiation
77
What is the Pathophysiology or closed or open injuries ?
1. Cessation if bleeding is the primary concern
2. Healing stage (inflammation)
3. Nerve layer of cells must be moved into the region of damage
78
What is a crushing injury ?
When a significant amount of force is applied to the body
79
What is crush syndrome ?
When an area of the body is trapped for longer than 4 hours and tissues are crushed beyond repair, muscles can die and release harmful substances into the surrounding tissues
80
What is the treatment for crush syndrome ?
1. ALS should administer IV fluid before the crushing object is lifted
81
What is compartment syndrome ?
Develops when edema and swelling result in increased pressure within a closed soft tissue compartment.
1. Pressure increases within the compartment, which interferes with circulation
2. Delivery of nutrients and oxygen is impaired and by products of normal metabolism accumulate
82
What is an abrasion ?
Is a wound of the superficial layer of the skin, caused by friction when a body part rubs or scrapes across a tough or hard surface
```
Examples
•road rash
•road burn
•strawberry
•rug burn
```
83
What is a laceration ?
A jagged cut caused by a sharp object or a blunt force that tears the tissue
84
What is an avulsion ?
Spectated various layers of soft tissue (usually between subcutaneous layer and fascia) so that they become either completely detached or hang as a flap
85
What is the mnemonic RICES stand for and why is it used ?
RICES is a used to treat a closed soft tissue injury
```
Rest
Ice
Compression
Elevate
Splinting
```
86
What are the signs of developing shock ?
1. Anxiety or agitation
2. Changes in mental status
3. Increased heart rate
4. Increased respiratory rate
5. Disaphresis
6. Cool clammy skin
7. Decreased blood pressure
87
How do you treat wounds of the chest ? Upper abdomen, and upper neck ?
With occlusive dressing
88
What is an eviscerstion ?
An open wound in the abdominal cavity that may expose internal organs
89
How do you treat eviscerstions ?
1. Cover wound with sterile gauze moistened with sterile saline solution
2. Secure the gauze with an occlusive dressing
3. Keep the organs moist and warm
4. Immediate transport
90
What are the only times an impaled object can be removed ?
1. If it obstructs the airway
| 2. If the object interferes with CPR
91
What is rabies ?
An cute, potentially fatal viral infection of the CNS. The virus is in the saliva or an animal and is transmitted through biting or licking an open wound.
Treatment is by a series of special vaccine injections
92
Why are human bites worse than animal bites ?
1. The human mouth contains an exceptionally wide range of bacteria and viruses, more so than small animals
2. Can cause a serious infection if teeth penetrate through the skin
93
What is the prehospital treatment for bites?
1. Apply s dry, sterile dressing
2. Promptly immobilize the area with a splint or bandage
3. Provide transport to the ED for surgical cleansing of the wound and antibiotic therapy
94
What are burns ?
Burns are soft tissue injuries that are created by the transfer of radiation, thermal, or electrical energy
95
When does thermal burns occur ?
When the skin is exposed to temperatures higher than 111 degrees Fahrenheit
96
Burns create a high risk for ?
1. Infection
2. Hypothermia
3. Hypovolemia
4. Shock
97
Why are burns to the airway so significant ?
The loose mucosa in the hypopharynx (throat) can swell and completely obstruct the airway
98
What is a circumferential burn ?
A full thickness burn that affects the entire circumference of a digit, extremity, or torso
Circumferential burns to the chest can compromise breathing
Circumferential burns to an extremity can lead to compartment syndrome, resulting in neurovascular compromis and irreversible damage
99
What are the five factors to help determine the severity of a burn ?
1. What is the depth of the burn?
2. What is the extent of the burn
3. Are any critical areas involved ?
•face, upper airway, hands, feet, genetalia
4. Does the patient have any or existing medical conditions or other injuries?
5. Is the patient younger than 5 or older than 55?
100
What are the different depths of burns? And examples
1. Superficial (first degree) burns
•top layer or skin; epidermis
•example - sun burn
2. Partial thickness (second degree) burns
•epidermis and some parts of dermis
•typically do not destroy the entire thickness of skin
•skin is moist, mottled, and white to red
•blisters are present
•intense pain
3. Full thickness (third degree) burns
•extends through all layers of skin, may involve subcutaneous tissue layers, muscle, bone, or internal organs
•burned area is dry and leathery and May appear white, dark brown or charred
•if the nerve endings are destroyed, the burn may have no feeling
•the surround area may be extremely painful
101
What is used to determine the extent of burns ?
1. Rule of palm
| 2. Rule of 9s
102
Rule of 9s
103
What should you ask in SAMPLE history regarding burns ?
1. Are you having difficulty breathing, or swallowing ?
| 2. Are you having any pain ?
104
What are thermal burns caused by ?
Heat
105
What are the 3 types of ionizing radiation ?
1. Alpha
•little penetrating energy
•easily stopped by the skin
2. Beta
• can penetrate the skin but can be blocked by simple protective clothing designed for this purpose
3. Gamma
•vey penetrating and easily passes through the body and solid materials
106
How does burns cause Edema ?
Because of increased capillary permeability, which creates plasma leakage in and around tissue
107
How does the eye keep its shape ?
It keeps its shape as a result of pressure from the jelly like fluid contained within its two chambers.
108
What is the jellylike fluid near the front of the eye and back of the eye?
Front of the eye is called Aqueous Humor
Back of the eye is Vitreous Humor
109
What is the conjunctiva ?
A membrane that covers the eye
110
What are the lacrimal glands ?
Often called tear glands, produce fluid to keep the eye moist. When a person fluid is swept from the lacrimal glands over the surface of the eye, cleaning it .
111
What is the sclera ?
White fibrous tissue that helps maintain the globular shape
112
What is the sclera replaced by in the front of the eye ?
A clear, transparent membrane called the cornea.
113
What is the function of the cornea ?
Allows light to enter the eye
114
What is the iris ?
Circular muscle behind the cornea. Acts like a camera to adjust the size of the opening to regulate the amount of light that enters the eye.
Also is pigmented and gives the eye its color
115
What is the pupil?
The opening in the center of the iris. Also allows light to move to the back of the eye
116
What is anisocoria ?
Condition in which a person is born with different sized pupils
117
What is the lens of the eye ?
Lies behind the iris. Focuses images on the retina at the back of the globe
118
What is the retina ?
Contains never endings which respond to light by transmitting nerve impulses through the optic never behind the brain
119
What causes blindness ?
Retinal detachment; when the retina detached from the underlying choroid and sclera
120
What is the choroid ?
Nourishes the retina by a layer of blood vessels between it and the back of the globe
121
How can face and neck injuries lead to partial or complete airway obstruction ?
1. Blood clots in the upper airway from heavy facial bleeding
2. Direct injuries to the nose or mouth can cause patient to suffocate from choking in blood
3. Injuries may cause teeth or dentures to become dislodged into the throat
122
How do you treat detached avulsed skin?
1. Wrap in a sterile dressing
2. Place in a plastic bag
3. Keep cool but I’d not place directly in ice
4. Label and deliver to emergency department
123
What is the treatment for foreign objects in the eye ?
Use a bulb syringe, nasal airway or cannula to direct saline into the affected eye; never attempt to remove an object that is stuck to the cornea
124
What is hyphema ?
Bleeding in the anterior chamber of the eye
125
What are you suppose to do if you find missing teeth at an accident ?
Place the tooth storage solution , cold milk, or sterile saline
126
What are meninges ?
Protects the CNS. And is composed of 3 layers
* Dura Mater (outside layer)
* Arachnoid & Pia matter (inner two layers that contain the blood vessels)
127
What is the most common MOI ?
Vehicle crashes
128
What is a linear skull fracture ?
1. Non displaced skull fracture
2. Account got 80% of all skull fractures
3. Radio graphs are required to diagnose
4. Usually not life threatening
129
What is a depressed skull fracture ?
1. Results from high energy direct to the head with a blunt object
2. Patients often present with numerologic signs
130
What is a basilar skull fracture?
1. Associated with high energy trauma, but usually occurs following diffused impact to the head (falls, Moro vehicle crashes)
2. Usually result from extension of a linear fracture
3. Signs include CSF drainage from the ears, raccoon eyes, and battle signs
131
What is a traumatic brain injury ?
A traumatic insult to the brain capable of producing physical, intellectual, emotional, social, and vocational changes. Most serious of all head injuries.
132
What categories are traumatic brain injuries classified into ?
1. Primary brain injure results instantaneously from impact to the head
2. Secondary brain injury increases the severity of the primary injury and may be caused by
•cerebral edema
•intracranial hemorrhage
•increased ICP
•cerebral is hex is
•infection
133
What is a coup-countercoup injury ?
When the head slams into an object, causing the brain to move forward until it comes to an abrupt stop by the skull
134
What is ICP and increased ICP?
ICP
•accumulation of blood within the skull or swelling of the brain
Increased ICP
•squeeze the brain against the skull
135
What are the signs of increased ICP ?
1. Cheyne-Stokes respiration’s
2. Ataxic respiration’s
3. Decreasing BP
4. Bradycardia
5. Sluggish; no reactive pupils
6. Decerebrate posturing
7. Increased or widened blood pressure
Cushings triad
•bradycardia
•irregular respiration’s cheyne stokes
•hypotension widening pulse pressure
136
What is an epidural hematoma ?
Accumulation of blood between the skull and dura mater. Causes ICP
137
I get is a subdural hematoma ?
Accumulation of blood beneath the dura mater but outside the brain. Occurs after falls or injuries involving deceleration forces
138
What is a intracerebral hematoma ?
Bleeding within the brain tissue itself
139
What is a subarachnoid hemorrhage ?
Blessing occurs into the subarachnoid space, where the CSF circulates. Common causes include trauma or a rupture of an aneurysm
140
What is a concussion ?
A closed injury with a temporary loss or alteration of part or all of the brains abilities to function without demonstrable physical damage to the brain. Patient may be confused or have amnesia, usually only lasts a short time
141
What is a head contusion ?
A bruise to the brain. More serious than a concussion.
142
What is the Glasgow coma scale?
1. Eye opening
2. Best verbal response
3. Best motor response
143
What is Cushings triad ?
1. Increased blood pressure (hypertension)
2. Decreased heart rate (bradycardia)
3. Irregular respiration’s (Cheyne-stokes respiration’s or Biot respiration’s)
4. Widening pulse pressure
144
When should you remove a helmet for traumatic injuries ?
Never remove helmet unless
1. It is a full face helmet
2. Makes assessing it managing airway problems difficult
3. Prevents you from properly immobilizing the spine
4. Allows excessive head movement
5. The patient is in cardiac arrest
145
What are the different types of Pnuemothorax ?
1. Open
2. Simple
3. Tension
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What are the different type of chest injuries ?
1. Pneumothorax
2. Cardiac tamponade
3. Rib fractures
4. Flail chest
5. Commotio cordis
147
Chest injuries can involve what organs ?
1. Heart
2. Lungs
3. Great vessels
148
What is the thoracic cage ?
The chest, extending from the lower end of the neck to the diaphragm
149
What is the neurovascular bundle ?
Network of nerves, arteries and veins lying closely to the lowest margin of each rib. Can be a source of significant bleeding into the pleural space
150
What is the mediastinum ?
The central part of the chest containing the heart, great vessels, esophagus, and trachea.
151
What contracts during inhalation ?
The diaphragm and intercostal muscles
152
What happens to the intrathoracic Pressure during inhalation ?
The pressure inside the chest decreases, creating a negative pressure differential
153
What happens if a patient that injured their spinal cord below the c5 level ?
May lose the power to move the intercostal muscles
•diaphragm should still contract
• will still be able to breathe because phrenic nerve is still in tact
154
What happens if a patient has a spinal injury at the c3 level and above ?
Can lose the ability to breathe entirely
155
What is minute volume ?
The amount of air moved through the lungs in 1 minute
156
What happens when a patient has decreased tidal volume ?
Patient will have an increased respiratory rate
157
What could happen if you over ventilate a patient with a decreased tidal volume ?
Can increase thoracic pressure, reducing cardiac output and potentially worsening chest injuries such as pneumothorax
158
What is a pneumothorax?
When air enters through a hole in the chest wall or surface of the lung
159
What happened if the lung is collapsed past 30% to 40%?
You may hear diminished lung sounds
160
What does absent lung sounds indicate ?
Tension Pneumothorax
161
What does a sucking sound on inhalation and the sound of rushing air on exhalation indicate ?
That the chest wall has been penetrated (sucking chest wound)
162
What is Hemothorax ?
When blood collects in the pleural space from bleeding around the rib cage or from a lung or great vessel
163
What is cardiac tamponade ?
When the pericardial sac gets filled with blood or fluid. The heart won’t be able to pump an adequate amount of blood because it’s too compressed by the fluid
164
What is becks triad ?
Utilized to determine cardiac tamponade
•JVD
•narrowing pulse pressure
•muffled heart sounds
165
What type of chest injuries can fractures ribs cause ?
1. Pnuemothorax
2. Hemothorax
3. Hemopneumothorax
Fractured rib could lacerate the surface of the lung
166
What is flail chest ?
When a 3 or more ribs are broken in 2 more places causing a paradoxical motion
167
What is a pulmonary contusion ?
When alveoli become filled with blood, leading to hypoxia
168
What is traumatic Asphyxia regarding chest injuries ?
Characterized by
•Distended neck veins
•cyanosis in the face and neck
•hemorrhage into the sclera of eye
169
What is asphyxia ?
A condition arising when the body is deprived of oxygen; the result of hypoxia
170
What is commotio cordis ?
Blunt chest injury caused by a sudden, direct blow to the chest that occurs only during the critical portion of a persons heartbeat
171
How should you treat a patient with commotio cordis ?
CPR and apply AD within first 2 minutes of injury .
| common in softball and baseball games
172
What are the great vessels ?
1. Superior Vena cava
2. Inferior vena cava
3. Pulmonary arteries
4. Four main pulmonary veins
5. Aorta and it’s major branches
173
What is crepitus ?
Cracking sounds in joints or lungs
174
What is subcutaneous emphysema ?
A crackling sensation felt on palpation or the skin
175
What is the abdomen ?
Extends from diaphragm to pelvis. Contains the digestive, urinary, and genitourinary systems, solid and hallow injuries
176
What organs are in each quadrant of the abdomen ?
```
Right upper
•Liver
•Gall bladder
•Duodenum of intestines (small intestine)
•small portion of pancreas
```
Left Upper
•Stomach
•spleen
Left left quadrant
•The descending colon
•the left half of the transverse colon
•(both part of large intestines)
Lower right
•large and small intestines
•ascending colon and the right half of the transverse colon (large intestines)
•Appendix
177
What are the hallow organs of the abdomen ?
Stomach, intestines, uterus, and bladder
178
What happens when a hollow organ is ruptured or eviscerated?
The contents spill into the peritoneal cavity
* Can cause an intense inflammatory reaction and infection
* Peritonitis
179
What is peritonitis ?
Inflammation caused by the rupture of a hollow organ.
Symptoms include
•abdominal pain
•tenderness
•muscular spasms
180
Where does the blood supply for hollow organs come from ?
The mesentery which is a fold of tissue that connects the small intestine to the abdominal wall
181
What are the solid organs of the abdomen and what do they do ?
Liver, spleen, pancreas, and kidneys
They perform the chemical work of the body
* enzyme production
* blood cleansing
* energy production
182
What is deceleration?
Person or the vehicle that he or she is traveling in strikes a large, immovable mass .
183
What is guarding ?
Sign of closed abdominal injury. The stiffening of abdominal muscles
184
What is abdominal distention? And what is it a result off ?
A sign of closed abdominal injury. Often the result of free fluid, blood, or organ contents spilling into peritoneal cavity.
185
What is a low velocity injury ?
Caused by handheld or hand powered objects such as knives and other edged weapons
186
What is a medium velocity injury ?
Caused by a smaller caliber handgun and shotguns
187
What is a high velocity injury.
Cause by a large weapon, such as high powered rifles can and high power handguns
188
What happens in solid organ injuries ?
Caused by blunt or penetrating trauma. Blood slowly oozes into peritoneal cavity
189
What is the largest organ in the abdomen ?
The liver
190
Where is pain referred when there is liver damage ?
To the right shoulder
191
What should you expect if a patient has Hematuria ?
Damage to the kidneys
192
What is the Genitourinary system and where is it located and what are it’s organs?
Controls reproductive functions and waste discharge located in the abdomen. The organs included are kidneys (solid organ), ureters, bladder, and urethra (hollow organs), female and male genitalia
193
How are fractures described ?
By whether the bone is moved from its normal position
194
What is a non displaced fracture ?
A simple crack of the bone
195
What is a displaced fracture ?
Produces actual deformity or distortion of the limb by shortening, rotating, or angulating it.
196
What is a comminuted fracture ?
A fracture in which the bone is broken into more than two fragments
197
What is an epiphyseal fracture ?
A fracture in the growth of a child’s bone
198
What is a green stick fracture ?
An incomplete fracture that passes only partway through the shaft of the bone. Occurs in children
199
What is an incomplete fracture ?
A fracture that does not run completely through the bone
200
What is an oblique fracture ?
A fracture in which the bone is broken at an angle across the bone
201
What is a pathologic fracture ?
A fracture of weakened or diseased bone. Seen inpatients with osteoporosis or cancer
202
What is a spiral fracture ?
A fracture caused by a. Twisting force causing an oblique fracture around and through the bone
203
What is a transverse fracture ?
A fracture that occurs straight across the bone
204
What is a dislocation?
A disruption of a joint in which the bone ends are no longer in contact
205
What is a sprain?
Occurs when a joint is twisted or stretched beyond its normal range if motion; tearing of ligaments
206
What is a strain?
A stretching or tearing of the muscle
207
What are the two situations in which you just splint the limb in position of deformity.
1. When the deformity is sever
| 2. When you encounter resistance or extreme pain when applying gentle traction to the fracture of a shaft of a long bone
208
What is a farmable splint ?
An air splint
209
What is the treatment for statins, sprains , and fractures ?
RICES
```
Rest
ice
Compression
Elevation
Splinting
```
210
What is dysbarism?
Any condition resulting from changes in ambient pressure that occurs before the body can compensate.
211
What are the type of environmental emergencies
1. Heat and cold related emergencies
2. Water emergencies
3. Pressure related injuries
4. Injuries caused by lightning
5. Envenomation
212
What are the conditions that can complicate environmental situations ?
1. Air temperature
2. Humidity level
3. Wind
213
What temperatures cause hypothermia ?
Between 30 & 50 degrees
214
What temperatures do most heat strokes occur in ?
80 degrees and the humidity is 80%
215
What are the 5 ways the body can lost heat ?
Conduction
•heat transfer from an person to object or object to person
Convection
•transfer or heat to circulating air; when cool air moves across the body
Evaporation
•conversion of any liquid to a gas (sweating)
Radiation
•transfer of heat by radiant energy
•heat loss when a person stands in a cold room
Respiration
•loss of body heat during normal breathing
•warm air goes into the atmosphere and cooler air is inhaled
216
What ate the 3 ways the rate and amount of heat gain or loss can be modified ?
1. Increase or decrease in heat production
2. Move to an area where heat loss can be decreased or increased
3. Wear appropriate clothing for the environment
217
What is hypothermia ?
When the core temperature falls below 95 degrees and the body loses the ability to regulate it’s temperature and generate body heat.
218
What is miles hypothermia ?
When core temperature is between 90 degrees and 95 degrees
219
What are the signs of mild hypothermia ?
1. Alert and shivering
2. Pulse rate and respiration’s are rapid
3. Skin May appear red, pale, cyanotic
220
What is sever hypothermia?
When the core temperature is less than 90 degrees
221
What are signs of sever hypothermia?
1. Shivers stop
2. Muscular activity decreases
3 patient becomes lethargic and stops fighting the cold
222
What happens if the body temperature drops below 80 degrees ?
1. Pulse becomes slower and weaker
2. Cardiac dysrythmias may occur
3. Patient May appear dead .
A cold patient isn’t dead until they are warm and dead
223
What is frost nip ?
Prolonged exposure to the cold, skin May freeze while deeper tissues are unaffected
224
What is immersion foot ?
Occurs after prolonged exposure to cold water
225
What is frost bite ?
The most serious local cold injury because the tissues are actually frozen. Can lead to gangrene (permanent tissue damage or cell death)
226
What is the treatment fit mild hypothermia?
1. Place patient in warm environment and remove wet clothing
2. Apply heat packs or hot water to the groin, axillary, and cervical regions . Don’t place directly in skin
3. Give them warm fluids by mouth
227
What is the treatment for patients with moderate or sever hypothermia ?
1. Remove patient from cold environment
2. Remove wet clothing
3. Cover with blanket
4. Do not try to rewarm patient
228
What should the temperature or water be when rewarming a body part that has frost nip ?
Between 102 and 104 degrees
229
How does the body try to rid itself of excess heat ?
1. Sweating
2. Dilation of skin blood vessels
3. Removal of clothing and relocation to a cooler environment
230
What is a hyperthermia ?
Core temperature of 101 degrees or higher
231
What are the 3 heat emergencies ?
1. Heat cramps
2. Heat exhaustion
3. Heat stroke
All 3 forms may present the same
232
What is a heat cramp ?
Painful muscle spasms in the leg or abdominal muscles that occur after vigorous exercise. Does not only occur when it’s hot
233
What ate the most common causes of heat exhaustion ?
1. Heat exposure
2. Stress
3. Fatigue
4. Hypovolemia as the result of the loss of water and electrolytes
234
What is a heat stroke ?
Occurs when the body is subjected to more heat than it can handle and normal mechanisms are overwhelmed. It can lead to death if untreated
235
What are the signs of a heat stroke ?
1. Hot dry flushed skin
2. Patient may be wet from previous sweating
3. Seizures
4. Strong rapid pulse that deteriorates becoming weaker with falling blood pressure
5. Lack of perspiration
236
What are the skin conditions and what do they indicate ?
1. Moist, pale, cool skin
•excessive fluid and salt loss
2. Hot dry skin
•body is unable to regulate core temperature
3. Hot moist skin
•body is unable to regulate for temperature
237
What is the treatment fit heat cramps ?
1. Remove the patient from hit environment and loosen clothing
2. Admistser oxygen if indicated
3. Rest the cramping muscles
4. Replace fluid by mouth
5. Cool patient with water spray or mist
238
What is the treatment for heat strokes ?
1. Move patient out of hit environment to the ambulance
2. Set air conditioning on max cooling
3. Remove clothing
4. Oxygen if indicated
5. Ventilate if indicated
6. Cover patient with wet towels or sheets
239
What is near drowning ?
Refers to a patient who survives at least 24 hours after suffocation in water.
240
When should you assume spinal injury for patients involved in submersion incidents ?
1. Submersion resulted from a diving mishap or fall
2. The patient is unconscious
3. The patient complains of weakness, paralysis, or numbness
241
What are the rules for trying to save someone in water ?
Reach, throw, row and then go
242
What is a ascent emergency ?
Caused by the sudden increase in pressure as the person dives deeper into the water
243
What is an air embolism ?
An ascent emergency where a diver holds there breathe during a rapid ascent into water. The pressure in the lungs remain at a high level while the external pressure on the chest decreases. The air inside the lungs expands rapidly causing the alveoli in the lungs to rupture
244
What are the complications with air embolisms ?
1. Air May enter the pleural space and compress the lungs (Pnuemothorax)
2. Air May enter the mediastinum (pnuemomediastinum)
3. Air May enter the bloodstream and create bubbles of air in the vessels (air emboli)
245
What is decompression sickness ?
Also known as the bends, when bubbles of gas especially nitrogen obstruct the blood vessels.
246
What are the conditions that cause decompression sickness ?
1. Too rapid of an scent from a dive
2. Too ling a dive at too deep a depth
3. Repeated dives within a short period of time
4. Driving a car up a mountain or flying in an unpressurized airplane that climbs too rapidly soon after a dive
5. Nitrogen that is being breathes dissolved in the blood and tissues
247
How do you distinguish an air embolism and decompression sickness ?
1. Air embolism occurs immediately in return to the surface
| 2. Decompression sickness may take several hours
248
What is the treatment for ascent emergencies ?
Decompression in a hyperbaric chamber
249
What is paresthesia?
Numbness and tingling
250
What is breath holding syncope ?
A person swimming in shallow water may experience loss of consciousness caused by a decreased stimulus for breathing. Treat same as a drowning patient
251
What is altitude illness ?
Occurs when an unacclimatized person is exposed to diminished oxygen pressure in the air at high altitudes. The illness affects the CNS and pulmonary system
252
What is acute mountain sickness ?
* above 5000 feet
* caused by ascending too high, too fast, or not being acclimatized to high altitudes
Signs and symptoms include
Headache, lightheadedness and fatigue
253
What is HAPE?
High altitude pulmonary edema when someone goes above 8,000 feet.
254
What is HACE ?
High altitude cerebral edema happens when a person goes above 12,000 feet
255
What mostly gets injured in lightning strikes?
Respiratory and cardiac
256
What are the categories of lighting injuries ?
1. Mild
•loss of consciousness, amnesia, confusion, tingling, superficial burns
2. Moderate
•seizures, respiratory arrest, dysrhythmias , superficial burns
3. Sever
•cardiac arrest
257
What spiders deliver a serious life threatening bite ?
Brown recluse spider and black widow
258
What is a sign and symptom of a black widow bite ?
1. Agonizing Muscle spasms
2. Localized pain
3. Symptoms usually subsided over 48 hours
259
What kind of venom does a black widow have ?
Latrotoxin which overwhelm nerve cells and cause immense pain
260
What kind of venom does a brown recluse spider have ?
Cytotoxic which causes sever tissue damage. The bite isn’t painful at first but it becomes painful within hours. The area becomes swollen and tender developing a pale, mottled, cyanotic center
261
What snakes are venomous?
Rattle snakes, copperheads, cottonmouth, water moccasins and corral snakes
262
What kind of snakes are pit vipers?
Rattlesnakes, copperheads and cottonmouths. They have small outs that contain poison located at each nostril. The pit is a heat sensing organ that allows the snake to strike accurately at any warm target. The fangs are hollow teeth that act much like hypodermic needles connected to a sac containing a reservoir of venom
263
What is the treatment for a pit viper bite ?
1. Supine position
| 2. Locate the bite area and clean it gently with soap and water
264
What is the saying to identify coral snakes ?
Red on yellow will kill a fellow, red in black venom will lack
265
What kind of venom does a coral snake have and what can it do ?
Has a powerful neurotoxin that causes paralysis of the nervous system
266
Scorpion stings
Very painful but not dangerous
267
What is the exception to scorpion stings ?
```
The centruroides sculpturatus . Venom can cause
•circulatory collapse
•sever muscle contractions
•excessive salivation
•hypertension
•convulsions and cardiac failure
```
268
What are some of the complications with tick bites?
Rocky Mountain spotted fever I high occurs within 7 to 10 days after the bite
Lime disease causes a bull eyes rash that may spread to several body parts, painful swelling of joints
269
What is the treatment for a jellyfish sting ?
1. Remove tentacles by scraping them off with the sharpie still edge like a credit card
270
What is the treatment from the spines of stingrays?
Immobilize the affected area and soak in hot water for 30 minutes
271
What are the stages of shock ?
1. Compensated shock
•the body attempts to compensate by maintaining homeostasis
2. Decompensated shock
•as shock progresses blood circulation slows and eventually ceases
3. Irreversibleshock
272
What is pulse pressure ?
The difference between systolic and diastolic blood pressure.
273
What is blood flow through capillary beds regulated by ?
Capillary sphincters which are under control by the autonomic nervous system.
274
What stimuli does capillary sphincters respond to ?
1. Heat
2. Cold
3. Need for oxygen
4. Need for waste removal
275
What does the body need for adequate perfusion ?
1. Working cardiovascular system
2. Adequate diffusion
3. Adequate glucose in the blood
4. Adequate waste removal primarily through the lungs
276
What are the types of shocks and causes ?
1. Cardiogenic shock
•obstructive shock
are Tension Pnuemothorax, cardiac tamponade, and pulmonary embolism which cause pump failure
```
2. Distributive shock
•septic shock
•neurogenic shock
•psychogenic shock
•anaphylactic shock
Caused by poor vessel function
```
3. Hypovolemic shock
•hemorrhagic shock
•non-hemorrhagic shock
Caused by low fluid volume
277
What is Cardiogenic shock caused by ?
Most common is pulmonary embolism
278
What causes obstructive shock?
Cardiac tamponade , tension pneumothorax, pulmonary embolism
279
What is cardiac tamponade and what is the causes ?
Collection of fluid between pericardial sac and the heart which is called pleural effusion. Caused by blunt or penetrating trauma that causes hemorrhage around the heart
280
What triad is used for cardiac tamponade?
Becks triad
•JVD
•muffled heart sounds
•narrowing pulse pressure
281
What happens in distributive shock ?
•widespread dilation if small arterioles, small venules or both
282
What is septic shock?
* occurs as a result of sever infection in which toxins are generated by bacteria or by infected body tissues
* toxins damage vessel walls causing increased cellular permeability
* vessel walls leak and are unable to contract well
283
What is neurogenic shock ?
Usually the result of a high spinal cord injury. Muscles in the blood vessel walls are cut if from the nerve impulses that cause them to contract. Which is why patients will look 2 toned
284
What are the 4 categories of exposure for anaphylactic shock?
Injection, stings, ingestion, inhalation
285
What is a major sign of Hypovolemic shock ?
Dehydration
286
What types of poisoning last may affect the ability of cells to metabolize and carry oxygen ?
Carbon monoxide and cyanide
287
How do you treat shock ?
With oxygen and keeping patient warm with blanket
288
Should patients in Cardiogenic shock take nitroglycerin ?
No because it contraindicates due to hypotension
289
What are signs or Cardiogenic shock ?
1. Low blood pressure
2. Weak, irregular pulse
3. Cyanosis around lips/underneath fingernails
290
What is the treatment for cardiac tamponade ?
* increasing cardiac output is the priority
| * apply high flow oxygen
291
Treatment for tension pneumothorax
Administer high flow oxygen via non rebreather mask and call ALS
292
How to treat septic shock ?
* high flow of oxygen
| * blanket
