Trauma

Question 1

Potential energy

Answer 1

Product of mass, gravity, and height that is converted into kinetic energy

Question 2

Kinetic energy

Answer 2

Energy of a moving object

Question 3

Work

Answer 3

Product of force times distance

Question 4

Mechanical energy

Answer 4

Energy from motion and is subdivided into kinetic energy and potential energy.

Question 5

The energy available to cause injury ____ when an object’s weight doubles, but ____ when its speed doubles.

Answer 5

doubles; quadruples

Question 6

Significant MOI for adults

Answer 6

Multisystem trauma
Ejection from vehicle
Death of passenger in the same vehicle
Fall from a height >20 feet
Unrestrained vehicle rollover
High-speed (>40 mph) vehicle crash
Vehicle-pedestrian collision
Motorcycle crash of >20 mph
AMS
Penetrating trauma to head, chest, or abd

Question 7

Significant MOI for children

Answer 7

Multisystem trauma
Ejection from vehicle
Death of passenger in same vehicle
Fall >10 feet or two-three times child’s height
Fall of <10 feet w/ LOC
Medium-to-high-speed vehicle crash (=>25 mph)
Bicycle crash
AMS
Penetrating trauma to the head, chest, or abd

Question 8

Blunt trauma

Answer 8

Force to the body that causes injury w/o penetrating the soft tissue or internal organs and cavities

Question 9

Penetrating trauma

Answer 9

Injury by objects that pierce and penetrate the surface of the body and injury the soft tissues, internal organs, and body cavities.

Question 10

Top five causes of death from unintentional injury in the US:

Answer 10

Poisonings (OD), MVCs, falls, choking and suffocation, and drowning.

Question 11

MVCs consist of three collisions :

Answer 11

Collision of the car against another car, tree, or some other object.
Collision of the passenger against the interior of the car.
Collisions of the passenger’s internal organs against the solid structures of the body.

Question 12

Coup-countercoup brain injury

Answer 12

Compression injury to the anterior portion of the brain and stretching or tearing of the posterior portion of the brain.

Question 13

What signs of vehicle deformity should you have a high suspicion of significant MOIs?

Answer 13

Severe deformities of the frontal portion, w/ or w/o intrusion into the passenger compartment.
Moderate intrusions of lateral collision.
Severe damage to the rear.
Rotational collision - rollovers and spins.

Question 14

What are body clues would you suspect to see when the front end of a vehicle is deformed and the windshield is cracked? What are the potential injuries?

Answer 14

Body clues : bruises or lacerations to head and/or face

Potential injuries : brain injury; scalp, facial cutes; c-spine injuries; tracheal injuries

Question 15

What are body clues would you suspect to see when the steering column is deformed? What are the potential injuries?

Answer 15

Body clues : Bruised neck and/or chest

Potential injuries : sternal or rib fx, flail chest; myocardial contusion’ pericardial tamponade; pneumothorax or hemothorax; exsanguination from aortic tear

Question 16

What are body clues would you suspect to see when the dashboard is deformed? What are the potential injuries?

Answer 16

Body clues : bruised abdomen; bruised knee, dislocated patella

Potential injuries : ruptured spleen, liver, bowel, diaphragm; patella fx; dislocated knee; femoral fx; dislocated hip

Question 17

What are body clues would you suspect to see when the vehicle is deformed on one side? What are the potential injuries?

Answer 17

Body clues : bruised shoulder

Potential injuries : clavicle fx; humerus fx; multiple rib fx

Question 18

What are body clues would you suspect to see when the door of a vehicle is smashed in? What are the potential injuries?

Answer 18

Body clues : bruised shoulder or pelvic

Potential injuries : hip fx; iliac wing fx; clavicle or ribs fx

Question 19

What are body clues would you suspect to see when the “B” pillar is deformed? What are the potential injuries?

Answer 19

Body clues : Bruised temple

Potential injuries : brain injury; c-spine fx

Question 20

What are body clues would you suspect to see when the door or window handles are broken? What are the potential injuries?

Answer 20

Body clues : bruised or deformed arms

Potential injuries : contusions

Question 21

What are body clues would you suspect to see when the window is broken in a vehicle? What are the potential injuries?

Answer 21

Body clues : dicing lacerations

Potential injuries : multiple lacerations

Question 22

What are body clues would you suspect to see when posterior deformity of the vehicle? What are the potential injuries?

Answer 22

Body clues : secondary anterior injuries, especially if unrestrained

Potential injuries : whiplash; deceleration injuries of a head-on impact

Question 23

What are body clues would you suspect to see when headrest is not adjusted? What are the potential injuries?

Answer 23

Body clues : none

Potential injuries : bleeding, bruising, or tearing inside skull

Question 24

What type of injuries would you suspect from a seatbelt?

Answer 24

Chest injuries
Abdominal injuries, especially in peds
Hip injuries
Lumbar spine fx, especially in elderly

Question 25

What type of injuries would you suspect from an airbag deployment?

Answer 25

Injuries to face, neck, chest, and abdomen including internal organs.

Question 26

Up-and-over pathway injuries from a frontal collision.

Answer 26

Head injuries Spine injuries Chest injuries - rib fx, flailed chest, pneumothorax, hemothorax, contusions, great vessel injury Vena cava Aorta Abdominal injuries - solid organs, hollow organs, diaphragm Pelvis fx

Question 27

Down-and-under pathway injuries from frontal collision.

Answer 27

Posterior knee and hip dislocations Femur fx LE fx Pelvic and acetabular fx

Question 28

Potential injuries and s/s of a blunt or penetrating trauma to the neck?

Answer 28

Potential injuries : Airway obstruction from bleeding, secretions, or FB in upper or lower airway s/s : noisy or labored respirations; swelling of face or neck

Question 29

Potential injuries and s/s of a substantial chest wall blunt or penetrating trauma?

Answer 29

Potential injuries : breathing problems, cardiac or pulmonary contusion, pneumothorax or hemothorax, broken ribs s/s : substantial chest pain, SOB, asymmetrical chest wall movement, penetrating trauma to chest

Question 30

Potential injuries and s/s of a substantial blunt or penetrating trauma to chest, abdomen, or groin?

Answer 30

Potential injuries : hidden blood loss, damage to major vessels s/s : bruising, redness, abrasions, or obvious trauma to the abdomen or pelvis; abdominal distention or rigidity; ttp of pelvis

Question 31

Potential injuries and s/s of a blunt force trauma to the head?

Answer 31

Potential injuries : brain injury s/s : LOC, AMS, amnesia, combative, or changes in speech patterns; difficulty moving extremities; severe HA w/ associated n/v

Question 32

Potential injuries and s/s of a blunt force trauma, penetrating trauma, or fall from a substantial height?

Answer 32

Potential injury : spinal injury s/s : severe neck or back pain, difficulty moving or feeling extremities, loss of sensation or tingling in the extremities

Question 33

Which three factors should you take into account with a fall MOI?

Answer 33

Height of the fall Type of surface struck Part of the body that hit first, followed by the path of energy displacement

Question 34

Penetrating trauma can be classified as :

Answer 34

Low energy Medium energy High energy

Question 35

Primary blast injuries

Answer 35

Injuries from blast wave itself : Flash burns Disruption of major blood vessels Rupture ear drums and major organs Possible amputation of limbs

Question 36

Secondary blast injuries

Answer 36

Injuries due to missiles being propelled by blast force.

Question 37

Tertiary blast injruies

Answer 37

Injuries due to impact with another object.

Question 38

Quaternary blast injuries

Answer 38

Collateral injuries such as : Burns from hot gases or fires Respiratory injury from inhaling toxic gases Suffocation Crush injuries from collapsed building Contamination of wounds from environmental, chemical, or toxic substances Mental health emergencies

Question 39

Pulmonary blast injuries

Answer 39

Pulmonary trauma consisting of contusions and hemorrhages.

Question 40

s/s of pulmonary blast injuries

Answer 40

``` Chest pain Hemoptysis Tachypnea Respiratory distress Subcutaneous emphysema ```

Question 41

Trauma lethal triad

Answer 41

Hypothermia + acidosis + coagulopathy = death

Question 42

What treatments should you administer to prevent death secondary to the trauma lethal triad?

Answer 42

Aggressively control bleeding Keep warm Minimize the volume of acidic IV fluid (nl saline) Warm IV fluids Monitor end-tidal CO and ventilate to prevent respiratory acidosis ALS back up for administration of tranexamic acid (TXA)

Question 43

Criteria for use of emergency air services for trauma patients :

Answer 43

Extended period to access or extricate a remote or trapped patient. Trauma center is greater than 20-25 miles. Needs medical care and stabilization at ALS, and there is no ground ALS unit available. Traffic conditions or hospital availability prevents transportation in an ideal trim. Prevent overwhelming trauma centers w/ multiple patients MCI

Question 44

What is the phenomenon that results from the rapid changes in tissue and fluid pressure that occur with the passage of the projectile resulting in serious injury to internal organs distant to the actual path of the bullet?

Answer 44

Cavitation