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Pass_with_Pass > Trauma > Flashcards

Trauma Flashcards

1
Q

Head-on Impact

Motorcycle crashes

A
  • Over the handlebars -> head and neck trauma, compression injuries to the chest and abdomen
    -If feet remain on footrest during impact -> mid-shaft femur fracture(s), perineal injuries
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2
Q

Angular Impact

Motorcycle Crashes

A
  • Ride is often caught between motorcycle and second object (vehicle, barrier, etc.)
  • Crush type injuries, open fractures to the femur, tibia, fibula
  • Fracture/dislocation of malleolus
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3
Q

Laying Motorcycle Down

Motorcycle crashes

A
  • Massive abrasions (road rash) -> treat as you would a burn
  • Fractures to the affected side
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4
Q

Vehicle vs. Pedestrian

A

Pediatric Patients

Tend to face oncoming vehicle

Frontal Impact: above knee/pelvis

Initial Impact: femur and pelvic injuries, internal hemorrhage

Secondary impact: thrown backwards, head and neck flexing forward

Third impact: thrown to downward onto ground

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5
Q

Vehicle vs. Pedestrian

A

Adult Patients

Turn away from vehicle

Lateral or posterior impacts

Initial impact: bumper striking lower legs (lower leg fracture)

Secondary Impact: hits hood/windshield, femur, pelvis, thorax, spine fractures

Third impact: thrown to ground, hip and shoulder injuries, deceleration injuries, fractures/hemorrhage

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6
Q

Down and Under pathway

Frontal Impact (Head On)

A

Car Crash: Frontal Impact (Head-on)

  • travels downward into the vehicle seat and forward into the dashboard or steering column
  • Knee becoming leading part of body - upper legs absorb most of impact - knee dislocation, patellar fracture, femoral fracture fracture or posterior dislocation of hips, fracture of acetabulum, vascular injury and hemorrhage
  • Chest wall hits steering column or dashboard, head and torso absorbs energy - tamponade, cardiac contusion, pneumothroax
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7
Q

Up and Over Pathway

Frontal impact (Head on)

A
  • Body strikes the steering wheel - ribs and underlying structures absorb momentum - rib fractures, ruptured diaphragm, hemo/pneumothorax, pulmonary contusion, cardiac contusion, tamponade, myocardial rupture, aortic aneurysm
  • If head strikes windshield first: suspect cervical fracture (axial loading injury)
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8
Q

Lateral Impact

Car Crash

A

Vehicle is struck from the side

“T-bone collison”

Fracture of clavicle, ribs or pelvis

Pulmonary contusion

Ruptured liver or spleen (depending on side involved)

Head and neck injury

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9
Q

Rotational Impact & Rollover Crashes

Car Crash

A

Rotational: produces same injuries as commonly found in head-on and lateral crashes

Rollover: ejection, may have several types of injuries

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10
Q

Car Crash Rear End Impact

A

Vehicle struck from behind - back and neck injuries: hyper extension

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11
Q

Blast Injuries (explosions/bombs)

A

Primary blast: pressure wave - injuries to ears (eustachian tubes),
lungs CNS, eyes, GI tract

Secondary Blast: Flying debris - blunt, penetrating, and lacerating injuries

Tertiary Blast: patient is thrown and injured by impact on ground or other objects

Kinetic energy =
0.5mass x (velocity)2

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12
Q

First Degree

A

First Degree (superficial): Reddened skin, pale at burn site, involves only epidermis, no blistering. Heals in 2-3 days

Second Degree (Partial Thickness): Intense pain, white red skin, blistering, moist-mottled skin, involves epidermis and dermis

Third Degree (Full Thickness): Dry, leathery skin (white, dark brown, or charred), painless, all dermal layers/tissues may be involved.

Fourth Degree: Involvement of muscle and bone, charred appearance, painless

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13
Q

Parkland Formula

A

4mL * kg x TSA burned = 24 hour infusion

1st half over first 8 hours, 2nd half over next 16 hours

> 20% TBSA, 2nd and 3rd degree burns only

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14
Q

Rule of 9s - Adult

A

Front head = 4.5%
Back head = 4.5%
= 9%

Upper chest = 9
Lower chest = 9

Front leg = 9
Back leg = 9

Front arm = 4.5
Back arm = 4.5
= 9%

groin = 1%

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15
Q

Rule of 9s - Pediatric

A

Head = 18%

Front chest = 18%
Back chest = 18%

Left leg = 14%
Right leg = 14%

Left arm = 9%
Right arm = 9%

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16
Q

Inhalation Injury

A

Toxic inhalation: synthetic resin combustion -> cyanide and hydrogen sulfide -> systemic poisoning -> more frequent than thermal inhalation burns

17
Q

Signs and Symptoms of Inhalation Injury Above Glottis

A

The upper airway “normalizes” the temperature of the inspired air (which is great, because it protects our lower airway from these extreme temperatures), however it sustains the impact of the super heated air

Facial Burns, signed nasal or facial hair, “sooty” sputum, hypoxemia, stridor, red mucus membranes, grunting respirations

18
Q

Signs and Symptoms of Inhalation Injury Below Glottis

A

Steam inhalations more likely to reach lower airways - has 4,000 time the heat carrying capacity than dry air

Wheezes, crackles or rhonchi, productive cough, hypoxemia, bronchial spasm

19
Q

Carbon monoxide poisoning

A

Affinity for hemoglobin is 250 times greater than oxygen -> creates carboxyhemoglobin
Odorless, tasteless gas

Cherry red skin only presents at levels > 40% (late sign)

“Multiple people feeling ill in same residence/building” -> nausea/vomiting, headache, decreased LOC, weakness, tachypnea, tachycardia

CO produces false pulse oximetry reading

High flow, high concentration oxygen is best treatment for these patients

20
Q

Acid vs Akali Burns

A

Acid -> burning process lasts just 1-2 minutes -> will cause coagulation

Alkalis -> burning process lasts minutes to hours -> will cause liquefaction necrosis

21
Q

Le Fort fractures

A

Le Fort 1 - no nose (Horizontal)

Le Fort 2 - nose (Pyramidal injury)

Le Fort 3 - Include eye region (Transverse injury)

22
Q

Retrograde Amnesia

A

No recall of events before the injury

23
Q

Antegrade Amnesia

A

In ability to create new memories; exists after recovery of consciousness

24
Q

Subdural Head Bleeds

A
  • Collection of blood between dura and arachnoid matter
  • Venous bleed
  • More common than epidural bleeds
  • Slow onset of symptoms
    • Nausea
    • Headache
    • Decreasing LOC
    • Coma
    • Posturing
25
Q

Subarachnoid Head Bleeds

A
  • Intracranial bleeding into CSF
  • Sudden and severe headache
  • slow onset of symptoms
    • “Worst headache of my life”
    • “Dizziness”
    • “Neck stiffens”
    • ” Unequal pupils
    • Vomiting
    • Seizures
    • Decreasing LOC
26
Q

Epidural Head Bleed

A
  • Collection of blood between cranium and dura in epidural space
  • Arterial bleed (Middle Meningeal Artery)
  • Transient loss of consciousness followed by lucid interval which neurological status returns to normal, then decreasing LOC
  • Slow onset of symptoms
    • Headache
    • Decreasing LOC
    • Increased ICP
      (“Cushing’s Triad”)
27
Q

Increased intracranial pressure

A

“Cushing’s Triad”

Normal ICP range = 10-15mmHGg or less

28
Q

Increased intracranial pressure: Treatment

A

SpO2 >94%

Capnography monitoring of 35-45mmHg

29
Q

Evidence of Herniation

A

Hyperventilation to yield ETCO2 of 30-35mmHg

Crushing’s Triad or Unresponsive

Patient with bilateral, dilated pupils AND decerebrate posturing with no motor response to a painful stimuli

30
Q

Axial Loading

A

Vertical compression of the spine results when direct forces are sent down spinal

31
Q

Central Cord Syndrome

A

Hyper extension cervical injuries -> greater impairment of the upper extremities than of the lower extremities, paralysis of arms, sacral sparing (preservation of sensory or voluntary motor function of the perineum, buttocks, scrotum, or anus)

32
Q

Anterior Cord Syndrome

A

Usually, seen in flexion injuries - decreased sensation of pain and temperature below level of lesion, intact light touch and position sensation, paralysis below the level of the lesion

33
Q

Brown-Sequard Syndrome

A

Hemitransection of the spina

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