Trauma Flashcards
(33 cards)
Head-on Impact
Motorcycle crashes
- 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
Angular Impact
Motorcycle Crashes
- 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
Laying Motorcycle Down
Motorcycle crashes
- Massive abrasions (road rash) -> treat as you would a burn
- Fractures to the affected side
Vehicle vs. Pedestrian
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
Vehicle vs. Pedestrian
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
Down and Under pathway
Frontal Impact (Head On)
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
Up and Over Pathway
Frontal impact (Head on)
- 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)
Lateral Impact
Car Crash
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
Rotational Impact & Rollover Crashes
Car Crash
Rotational: produces same injuries as commonly found in head-on and lateral crashes
Rollover: ejection, may have several types of injuries
Car Crash Rear End Impact
Vehicle struck from behind - back and neck injuries: hyper extension
Blast Injuries (explosions/bombs)
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
First Degree
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
Parkland Formula
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
Rule of 9s - Adult
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%
Rule of 9s - Pediatric
Head = 18%
Front chest = 18%
Back chest = 18%
Left leg = 14%
Right leg = 14%
Left arm = 9%
Right arm = 9%
Inhalation Injury
Toxic inhalation: synthetic resin combustion -> cyanide and hydrogen sulfide -> systemic poisoning -> more frequent than thermal inhalation burns
Signs and Symptoms of Inhalation Injury Above Glottis
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
Signs and Symptoms of Inhalation Injury Below Glottis
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
Carbon monoxide poisoning
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
Acid vs Akali Burns
Acid -> burning process lasts just 1-2 minutes -> will cause coagulation
Alkalis -> burning process lasts minutes to hours -> will cause liquefaction necrosis
Le Fort fractures
Le Fort 1 - no nose (Horizontal)
Le Fort 2 - nose (Pyramidal injury)
Le Fort 3 - Include eye region (Transverse injury)
Retrograde Amnesia
No recall of events before the injury
Antegrade Amnesia
In ability to create new memories; exists after recovery of consciousness
Subdural Head Bleeds
- 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
