trauma Flashcards
1
Q
shock
A
hypoperfusion
Hypoxia at the cellular level
2
Q
perfusion
A
Adequate delivery of blood through the capillary bed in tissues
3
Q
inotropy
A
strength of the heart’s contractions
4
Q
chronotropy
A
rate of the heart’s contractions
5
Q
preload
A
Amount of venous return available to the ventricle
6
Q
afterload
A
the total resistance against which blood must be pumped.
7
Q
mean arterial pressure (MAP)
A
a function of total cardiac output (CO) and systemic vascular resistance (SVR)
8
Q
MAP forumla
A
MAP = [(DBP × 2) + SBP]/3
9
Q
ejection fraction
A
a measurement of the percentage of blood volume pumped out of the left ventricle with each contraction. Normally, 50% to 70% of the blood is ejected out of the left ventricle. A borderline ejection fraction is 41% to 49%. At this level, a patient may have shortness of breath on exertion. When the ejection fraction is less than 40%, tissue perfusion may be compromised. Echocardiograms are used to estimate ejection fraction.
10
Q
tunicae
A
All vessels larger than capillaries have layers of tissue surrounding the endothelium. These layers provide supporting connective tissue to counter the pressure of blood contained in the vascular system. They also have elastic properties that enable the blood vessels to dampen pressure pulsations and minimize flow variations throughout the cardiac cycle. Finally, the tunicae have muscle fibers that can contract and relax to control the vessel diameter. The vascular system maintains blood flow by changes in pressure and peripheral vascular resistance.
11
Q
muscular arterioles
A
small blood vessels that regulate blood flow to capillaries by constricting or dilating their smooth muscle walls
12
Q
anaerobic metabolism
A
refers to the energy production processes within cells that occur in the absence of oxygen. It’s a vital process, especially for short bursts of intense activity, as it provides a quick source of energy when the body can’t rely on oxygen-dependent metabolism. A key process in anaerobic metabolism is anaerobic glycolysis
13
Q
anaerobic glycolysis
A
glucose is broken down to produce ATP, but also generates lactate, a byproduct that can lead to muscle fatigue.
14
Q
capillary response in shock
A
anaerobic metabolism produces excess lactic acid and leads to metabolic acidosis. The arteriolar and precapillary sphincter control fails. Capillary engorgement and clumping of red blood cells follow, affecting nutritional flow and the removal of metabolic waste products.
15
Q
hypovolemic shock
A
inadequate circulating blood volume. The most common causes are hemorrhage and dehydration. Illnesses and injuries that can lead to hypovolemic shock include trauma, gastrointestinal bleeding, burns, diarrhea, vomiting, endocrine disorders, and internal third-space loss, as in peritonitis.
16
Q
cardiogenic shock
A
Cardiogenic shock is the result of a severe compromise in cardiac output due to dysfunction of the heart itself such that inadequate tissue perfusion occurs despite an adequate amount of circulating blood volume.
17
Q
obstructive shock
A
Obstructive shock is a form of shock associated with the inability to produce adequate cardiac output despite normal intravascular volume and myocardial function. Causes of obstructive shock include:
Pericardial tamponade
Tension pneumothorax
Pulmonary embolism
18
Q
distributive shock
A
Distributive shock occurs when peripheral vasodilation causes a decrease in SVR. Patients tend to have warm extremities, particularly early in the course of disease when the body is able to compensate by significantly increasing the cardiac output.
The most common causes of distributive shock are neurogenic shock, anaphylactic shock, and septic shock
19
Q
signs of compensated shock
A
mild tachycardia
lethargy, confusion, combativeness
delayed cap refill, cool skin
normal or elevated bp
20
Q
signs of decompensated shock
A
moderate tachycardia
confusion, unconsciousness
delayed cap refill, cyanosis, cold
decreased BP
21
Q
signs of irreversible shock
A
bradycardia, severe dysrhythmias
coma
pale, cold, clammy skin
frank hypotension
22
Q
compensated shock
A
homeostasis is maintained and catecholamine production is increased.
23
Q
decompensated shock
A
the body is no longer able to maintain and adequate blood pressure.
24
Q
irreversible shock
A
cells and organelles begin to die due to lack of oxygen and are no longer able to produce energy. necrosis is inevitable even if perfusion is returned.
25
Deceleration injuries
When body organs are put into motion after an impact, they continue to move in opposition to the structures that attach them to the body. Thus, a risk exists of separation of body organs from their attachments.
26
compression injuries
can cause increased pressure of organs in the body leading to ruptures. Compression injuries can lead to fracures, contusions, lacerations, and hemmorrhages inside the body
27
blast injuries
primary
secondary
tertiary
quarternary
quinary
28
primary blast injuries
uncommon and unique to high-order detonations that produce a supersonic blast wave (e.g., nitroglycerin and dynamite). Injuries result from sudden changes in environmental pressure and usually occur in gas-containing organs. Predictable damage includes:
29
secondary blast injuries
usually result when bystanders are struck by flying debris. Obvious injuries are lacerations and fractures, but flying debris also can cause high-velocity missile-type injuries.
30
tertiary blast injuries
occur when people are propelled through space by an explosion or blast wind and strike a stationary object. In most cases, the sudden deceleration from the impact causes more damage than the acceleration. Injuries from these forces include damage to the abdominal viscera, central nervous system, and musculoskeletal system.
31
quaternary blast injuries
are all explosion-related injuries, illnesses, or diseases that are not caused by primary, secondary, or tertiary mechanisms. This classification includes exacerbation or complications of existing conditions.
32
quinary blast injuries
caused by contaminants (eg, chemical, biologic, and radiologic substances [dirty bombs]) released in an explosion. The contaminants are intended to cause damage or injury beyond those produced by the projectiles.
33
cavitation
a temporary or permanent opening produced by a force that pushes body tissues laterally away from the track of a projectile
34
Epidermis
a thin, nonvascular epithelial tissue that derives its nourishment from the capillaries of the dermis.
35
dermis
lies beneath the epidermis. It contains connective tissue, elastic fibers, blood vessels, lymph vessels, and motor and sensory fibers. It also houses other structures of the integumentary system (hair, nails, and sebaceous and sweat glands). The dermis protects the body against bacterial invasion and also helps maintain fluid balance.
36
deep fascia
beneath the dermis. provides for insulation, cushioning, caloric reserve, and body substance and shape. Its primary function is to support and protect the underlying structures.
37
hemostasis of wound healing
vasoconstriction
formation of a platelet plug
coagulation
the growth of fibrous tissue into the blood clot that permanently closes and seals the injured vessel
38
hypertrophic scar
excess accumulation of scar tissue within the original wound borders
39
keloid
excessive accumulation of scar tissue that extends beyond the original wound borders
40
contusions
closed, soft tissue injury characterized by swelling, discoleration, and pain
41
hematoma
closed injury characterized by blood vessel disruption and swelling beneath the epidermis
42
ecchymosis
skin discoleration (bruisin) caused by the escape of blood into the tissues from ruptured blood vessels
43
abrasion
a partial-thickness skin injury that is caused by the scraping or rubbing away of a layer or layers of skin.
44
laceration
results from a tear, a split, or an incision of the skin. Lacerations most often are caused by a knife or other sharp object, resulting in a linear wound or incision.
45
puncture
Contact with a sharp, pointed object such as a wooden splinter, needle, staple, piece of glass, or nail commonly causes a puncture wound. Although the entrance wound generally is small, these injuries often may be associated with deep penetration and injury to underlying tissues. In some penetrating injuries, the object remains embedded or impaled in the wound.
46
high pressure injection injury
The injection of a substance—for example, grease, paint, turpentine, dry-cleaning fluids, and molten plastics—into the body under high pressure also can cause a puncture wound.
47
avulsion
a full-thickness skin loss in which the wound edges cannot be readily approximated, if at all.
48
degloving injury
a type of avulsion in which shearing forces separate the skin from the underlying tissues.
49
amputation
involves a complete or partial loss of a limb by a mechanical force. The digits, lower leg, hand and forearm, and distal portion of the foot are the body parts most often injured in this way. Bleeding is a possibly fatal complication of an amputation injury.
50
mangled extremity
describes a limb injury involving at least three out of four systems (soft tissue, bone, nerves, and vessels). It is the most devastating limb injury and is associated with a high amputation rate.
51
crush injury
one of the three types of injuries that occur when tissue is exposed to a compression force. This force can be sufficient to interfere with the normal structure and metabolic function of the involved cells and tissues. The degree of injury produced by the crushing force depends on the amount of pressure applied to the body, the amount of time the pressure remains in contact with the body, and the specific body region in which the injury occurs.
52
compartment syndrome
usually a result of crush injury and is a surgical emergency and a limb-threatening event. Compartment syndrome in the extremities typically results from compression forces or blunt trauma. Other less common causes include the following:
53
sterile dressing
processed to eliminate bacteria and should be used whenever infection is a concern.
54
nonsterile dressings
are not sterilized and should be used only when infection is not a prime concern.
55
occlusive dressings
do not allow the passage of air through the material. These dressings are useful in treating wounds of the thorax and major vessels.
56
nonocclusive dressings
allow air to pass through the material and are indicated for managing most soft-tissue injuries.
57
adherent dressings
attach to the wound surface by incorporating wound exudate into the dressing mesh. Use of these dressings sometimes can assist in controlling acute bleeding.
58
nonadherent dressings
allow the passage of wound exudate and do not adhere to the wound surface. These dressings do not damage the wound when removed and often are used after wound closure.
59
complications of crush syndrome
Oxygen-rich blood returns to the ischemic extremity, producing a pooling of intravascular volume into crushed tissue and reducing total circulating volume, which often leads to shock.
With the return of oxygen-rich blood, various toxic substances and waste products of anaerobic metabolism are released into the systemic circulation, causing metabolic acidosis. High levels of intracellular solutes and water are released from damaged cells, leading to hyperkalemia, hyperuricemia, and hyperphosphatemia. Hypocalcemia results from the injured muscles’ absorption of water and calcium. This can lead to lethal cardiac dysrhythmias.
Myoglobin is released from the damaged muscle cells (part of rhabdomyolysis) of the injured extremity, potentially clogging the glomerulus and resulting in acute kidney injury.
60
crush syndrome care prior to extrication
Administer IV fluids before releasing the crushed body part. This step is especially important in cases of prolonged crush (more than 4 hours); however, crush syndrome can occur in crush scenarios of less than 1 hour.
Initiate vascular access and infuse 0.9% normal saline 1 L prior to release from entrapment if possible.
Administer IV sodium bicarbonate 1 mEq/kg (maximum 50 mEq) over 5 minutes. This intervention treats acidosis and hyperkalemia, and reduces myoglobin and uric acid deposition in kidneys.
Monitor electrocardiographic (ECG) rhythm and obtain a 12-lead ECG to observe for dysrhythmias and signs of hyperkalemia (before and after release from pressure).
61
crush syndrome care after extrication
Continue normal saline infusion at 500 to 1,000 mL per hour for adults, and at 10 mL/kg per hour for pediatric patients.
If the ECG suggests hyperkalemia, consider administering the following for the adult:
Calcium gluconate 10% 3 g IV or intraosseously over 5 minutes, or calcium chloride 10% 1 g IV over 5 minutes
If not already administered, sodium bicarbonate 1 mEq/kg IV slow push
Albuterol 5 mg by nebulizer
Consider the need for analgesia.
62
how quickly can crush syndrome occur
1 hour
63
rhabdomyloysis
an acute, sometimes fatal, disease charectarized by destruction of skeletal muscle
64
corneal abrasion
occurs when the outer layers of the cornea are avulsed. Patients with corneal abrasion usually report:
65
photophobia
abnormal sensitivity to light
66
traumatic hyphema
globe scleral rupture
67
linear skull fracture
accounts for 80% of all fractures to the skull. Such fractures usually are not depressed. As an isolated injury, these fractures usually have a low rate of complications. However, if the fracture is associated with a scalp laceration, infection is possible. Linear fractures that cross the meningeal groove in the temporal-parietal area, midline, or occipital area may lead to epidural bleeding from the middle cerebral artery.
68
basilar skull fracture
usually associated with major impact trauma. They can cause a dural tear leading to a connection between the subarachnoid space, the paranasal sinuses, and the middle ear.
69
depressed skull fracture
usually results from a relatively small object striking the head at high speed. Thus, they commonly are associated with scalp lacerations causing an open fracture. These patients have a risk of infection and seizures. Depressed skull fractures occur when a portion of the skull is pushed below the level of the adjacent skull.
70
an open vault fracture
results when an opening exists between a scalp laceration and brain tissue. Because of the nature of these injuries and the force required to produce them, they are often associated with trauma to other systems. They have a high mortality rate. Exposure of brain tissue to the external environment may lead to infection (meningitis).
71
cranial nerve 1
oralfactory nerve
loss of smell
impaired taste, dependent of food aroma
hallmark of basilar skull fracture
72
cranial nerve 2
optic nerve
blindness in one or both eyes
visual field defects
73
cranial nerve 3
occulomotor nerve
ipsilateral (same side), dilated, fixed pupil
especially compression by the temporal lobe
mimics direct ocular trauma
74
cranial nerve 7
facial nerve
immediate or delayed facial paralysis
basilar skull fracture
75
cranial nerve 8
vestibulocochlear (auditory) nerve
deafness
basilar skull fracture
76
traumatic brain injury (TBI)
an alteration in brain function, or other evidence of brain pathology, caused by an external force
77
primary brain injury
Primary brain injury refers to direct trauma to the brain and the associated vascular injuries that occurred from the initial injury. It can be further classified as focal or diffuse, though symptoms often coexist.
78
focal brain injury
describes trauma that is localized to specific areas of the brain. These injuries include contusions, hematomas, and penetrating trauma into the brain tissue.
79
diffuse brain injury
caused by blunt acceleration-deceleration or rotational forces that cause stretching, twisting, and tearing of the neurons’ axons throughout the brain.
80
diffuse axonal injury
a clinical spectrum of injury severity caused by increasing amounts of axonal damage in the brain. It is not the result of the blunt trauma itself, but rather the brain’s back-and-forth movement in the skull from acceleration or deceleration forces.
81
secondary brain injury
results from intracellular and extracellular derangements that were initiated at the time of the injury or resulted from a consequence of the initial injury.
82
intracranial pressure (ICP)
As the cranial vault continues to fill, the body tries to compensate for the decline in CPP by an increase in MAP (Cushing reflex). However, this increase further elevates the ICP, causing CSF to be displaced to make up for the expansion. If unresolved, the brain substance may herniate over the edge of the tentorium. Alternatively, it may herniate through the foramen magnum.
83
cushing triad
Signs of ICP
increased systolic blood pressure
bradycardia
irregular respiratory rates
84
decorticate posturing
abnormal flexion posturing
85
decerebrate posturing
abnormal extension posturing
86
epidural hematoma
bleeding between the cranium and the dura in the epidural space
87
subdural hematoma
bleeding between the dura and the arachnoid mater in the subdural space
88
subarachnoid hemorrhage
Intracranial bleeding into the CSF
89
cerebral hematoma
collection of blood withing the substance of the brain
90
mild DAI
concussion. caused by a mild to moderate impact of the skull
91
retrograde amnesia
loss of memory for events that occurred before the event
92
anterograde amnesia
loss of memory for events that occurred immediately after recovery of consciousness
93
axial loading
results when direct forces are sent down the length of the spinal column.
94
distraction
a spinal injury that occurs i spinal motion is stopped suddenly relative to body motion, causing the weight and momentum of the body to shift away from it; a pulling apart
95
transection
a complete or incomplete lesion to the spinal cord
96
central cord syndrome
a spinal cord injury commonly seen with hyperextension cervical injuries; charactereized by greater motor impairment of the upper extremities than of the lower extremities
97
spinal assessment criteria
altered level of consciousness
spinal pain or tenderness
neurologic deficit or complaint
anatomic deformity of the spine
unreliable patient
98
pulmonary contusion
bruising of the lung tissue that results in rupture of the alveoli and interstitial edema
99
simple pneumothorax (closed pneumothorax)
a collection of air or gas in the pleural space that causes the lung to collapse without exposing the pleural space to atmospheric pressure
100
open pneumothorax
a chest wall injury that exposes the pleural space to atmospheric pressure
101
tension pneumothorax
an accumulation of air or gas in the pleural cavity that can lead to an increase in intrathoracic pressure to the point of cardiorespiratory compromise or collapse
102
mediastinal shift
a shift in a patient's mediastinum that moves tissue and organs within the chest cavity to one side
103
hemothorax
the accumulation of blood and other fluids in the pleural space caused by bleeding from the lung parenchyma or damaged vessels
104
traumatic asphyxia
a severe crushing injury to the chest and abdomen that causes an increase in the intrathoracic pressure. the increased pressure forces blood from the right side of the heart into the veins of the upper thorax, neck, and face
105
myocardial contusion
trauma-induced damage to the hear that may range from a localized bruise to a full-thickness injury to the wall of the heart with hemmorrhage and edema
106
pericardial tamponade
compression of the heart produced by the accumulation of fluid or blood in the pericardial sac resulting in hemodynamic instability
107
myocardial rupture
traumatic rupture of the myocardum that occurs when blood-filled chambers of the ventricles are compressed with enough force to rupture the chamber wall, septum, or valve
108
blunt thoracic aortic injury
injury to the thoracic aorta resulting from hearing forces applied during a rapid deceleration. also referred to as traumatic aortic disruption
109
diaphragmatic rupture
traumatic rupture of the diaphragm, which often results from sudden compression of the abdomen
110
open fracture
a break in which a protruding bone or penetrating object causes a soft tissue injury that communicates with the fracture
111
closed fracture
a break in the bone that has not yet penetrated the soft tissue or skin
112
comminuted fracture
a fracture that invovles several breaks in the bone, resulting in multiple bone fragments.
113
greenstick
a break in the bone is bent but only broken on the outside of the bend
114
spiral
a break caused by a ratational force applied to the long axis of a bone where the broken bone resembles a corkscrew on radiography
115
oblique fracture
a break that occurs at a diagonal or slanting angle between the horizontal and perpendicular planes of the bone
116
transverse fracture
a break or fracture line that occurs at right angles to the long axis of the bone
117
stress fracture
a break caused by repeated, long term, or abnormal stress
118
pathalogic
a fracture through abnormal bone from a force that would not be expected break normal bone, such as a break through osteoporotic bone
119
epiphyseal fracture
a break that involves the epiphyseal growh plate of a child's long bone; it may result in permanent angulation or growth arrest or deformity and may cause premature arthritis
120
sprain
injury of a ligament
121
strain
an injury to a muscle or tendon
122
ligament
a short band of tough, flexible, fibrous connective tissue with connects two bones or cartilages or holds together a joint
123
tendon
strong, flexible connective tissues that connect muscles to bones, enabling movement and shock absorption
124
subluxation
incomplete dislocation
125
central thermoreceptors
nerve endings located in or near the anterior hypothalamus that are sensitive to subtle changes in core temperatures
126
peripheral thermoreceptors
nerve endings sensitive to temperature, located in the skin and some mucous membranes. they usually are categorized as cold or warm receptors
127
core body temperature
98.6
128
thermogenesis
production of heat, especially by the cells of the body
129
thermolysis
the dissipation of heat by means of radiation, evaporation, conduction, or convection
130
mechanisms that decrease heat loss
peripheral vasoconstriction
reduction of surface areal by body position or clothing
131
mechanisms that increase heat production
shivering
increased voluntary activity
increased hormone secretion
increased appetite
132
radiation
the direct release of heat to cooler surroundings
133
conduction
the direct movement of heat from a warmer object to a colder one
134
convection
the transfer of heat by mass motion of a fluid such as air or water
135
evaporation
process by which fluid changes from a liquid to a gas and lowers the temperature on the surface where the evaporation occured
136
heat cramps
brief, intermittent, and often severe muscular cramps that frequently occur in muscles fatigued by heavy work or exercise
137
heat exhaustion
a form of heat illness characterized by dizziness, nausea, headache, and a mild to moderate increase in the core body temperature
138
heatstroke
occurs when the body’s temperature-regulating mechanisms break down entirely and mental status becomes affected. As a result of this failure, the body temperature rises to 104°F (40°C) or higher, which destroys protein quickly, leading to cellular destruction, a severe inflammatory response, and disruption of the coagulation cascade.
139
osborn wave
a positive deflection at the j point on a ecg, characteristically seen in hypothermia; also known as a ja wave
140
ecg characteristics of hypothermia
prolonged PR, QRS, and QT intervals and obscure or absent P waves, an osborn wave or j point.
141
barotrauma
a physical injury sustained as a result of expousre to incereased atmospheric or environmental pressure; also known as dysbarism
142
