TRauma Ch 30 Flashcards
(198 cards)
1
Q
1 cause of death for 1-44yos
A
Trauma
2
Q
Leading cause of death for 17-33yos
A
Suicide
3
Q
Law that states a body at rest will remain at rest, unless acted on by an outside force. Similarly, an object in motion, will remain in motion, until acted upon by an outside force.
A
Newton’s 1st law of motion
4
Q
Law that states the force that an object can exert is equal to the product of its mass & acceleration/deceleration. The greater and object mass and/or acceleration, the greater the force that needs to be applied to change the objects course or stop it.
A
Newton’s 2nd law of motion
5
Q
Law that states that energy can be neither created nor destroyed; it can only change form.
A
Law of Conservation of Energy
6
Q
Height of falls that gives you a high index of suspicion
A
Adults: 15ft or 3x’s pts height
Child: 2x’s pt height
Or ground level fall w/LOC
7
Q
Hypotension & lack of JVD in supine pt is an indication of…..
A
Hypovolemia
8
Q
What temp does something have to be to cause damage to the skin?
A
111 degrees Fahrenheit
9
Q
The study of physiology & mechanics of living organisms
A
Biomechanics
10
Q
The study of the relationship among speed, mass, direction, of force, & physical injury caused by these factors.
A
Kinetics
11
Q
Which organs are easily compressed?
A
Organs w/gas in them
12
Q
Which organs are less compressible?
A
Liquid containing organs
13
Q
How much blood can you lose w/pelvic fx?
A
1500ml-2,000ml
Treat w/fluids, titrate to effect
14
Q
The speed at which an object travels in a given unit of time.
A
Velocity
15
Q
The downward acceleration that is imparted to any object moving towards the earth, caused by the effect of earth’s mass.
A
Gravity
16
Q
Energy from motion….
A
Mechanical energy
17
Q
Is found in the force of 2 moving vehicles colliding
A
Kinetic energy
18
Q
Energy stored in an object
A
Potential
Such as a brick sitting on the ledge of a building,
The gravity would be the potential energy source. It is converted to kinetic energy if the object falls.
19
Q
What type of energy is found in explosive’s or reaction from an ingested or medically delivered agent or drug?
A
Chemical Energy
20
Q
What type of energy is transferred from hotter sources than the body?
A
Thermal Energy
(Flames, hot water, steam)
21
Q
What type of energy is transferred from electrocution or lightening strikes?
A
Electrical Energy
22
Q
What type of energy results from sudden changes in pressure, such as flying or scuba diving?
A
Barometric Energy
23
Q
How to determine “Force”
A
Mass X Acceleration/Deceleration
24
Q
Amount of force that is unsurvivable
A
37 G force
25
Injuries from Head-On Impacts
Head Injuries
Cervical Spine Injuries
Torn Aorta
Tearing or Shearing injuries to internal injuries
Crush & compression injuries
26
Injuries from “Down-and-under pathways”
Knees
Femur
Pelvis
Tibia/Fibula
27
Injuries from “Up-and Over Pathway”?
Head Injuries
C-Spine Injury
Laryngeal Fractures
Soft Tissue Injuries
28
How to assess for disability?
GCS
Pupil Size, equality, & reactivity
Evaluate pulse, motor, & sensation in extremities
29
BG will be slightly elevated, pupils will be slightly dilated, following trauma, d/t…
Fight or Flight
30
Closed Head injury w/ICP, what is the 2 most important things you can do for these pts?
Never let systolic BP get below 90
Never let O2 SAT get below 90.
Elevate head at least 30 degrees.
31
Contraindications for Lactated Ringers:
Crush Injury Pts (Potassium, intracellular) crush will send potassium into blood, you don’t want to add more potassium to the blood
Renal Pts
32
Benefits of LR, especially in burns….
Lactate - body detox’s it and turns it into bicarb
33
Trauma Lethal Triad
Acidosis
Coagulopathy
Hypothermia (cold blood doesn’t clot)
34
Criteria for Trauma Center
GCS - 13 or less
SBP of less than 90
RR of less than 10
Penetrating wounds to head/neck/torso/extremities
Chest instability
2 or more long bone fx’s
Crushed/Mangled Extremity
Amputation proximal to wrist/ankle
Pelvic Fx’s
Skull Fx’s
Paralysis
35
Criteria to consider MOI w/high index of suspicion:
Falls: more than 2x height, or what they land on, LOC
High-Risk MVC
Pedestrian/Bicycle vs car
Motorcycle crash at more than 20mph
36
Special Considerations for Trauma Centers:
Older than 55YO
Children to Ped appropriate facility
Anticoagulant use
Pregnancy
Burns
Provider Judgement
37
When making transport decisions, what factors will you take into consideration?
Time
Extent of Injuries
LZ’s
Extended extrication time
Terrain
Distance to trauma center is over 20-25 mins
Pt needs ALS, & no ALS ground level is available
Traffic Conditions
Trauma Center capability
38
Stroke Volume X Heart Rate
Cardiac Output
39
How much blood can you lose before you can no longer compensate?
20%
40
Normal ejection fraction
55-70%
41
Anytime your QRS gets over 170, what will your ejection fraction be?
Below 50%
42
Plasma makes up how much of the blood volume?
55%
43
Plasma is made up of …
Clotting factors
Proteins
Calcium
44
What carries blood away from the heart?
Arteries
45
What transport blood back to the heart?
Veins
46
RAAS - System
Renin
Angiotensin
Aldosterone
Syndrome
47
Endocrine system responds to changes by secreting what?
Aldosterone - Retains sodium in blood
ADH
48
3 steps of hemostasis….
Vasoconstriction
Platelet Aggregations
Fibrin Formation
49
Fibrin/Fibrinolytics
50
Hemophilia 8-9 - Christmas factor - Know about hemophilia
51
Inadequate blood volume is what type of shock?
Hypovolemic Shock
52
Compensated Shock (Class I & II)
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Decompensated Shock
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Irreversible Shock
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Signs of Compensated Shock
56
Signs of of Decompensated Shock
Oliguria - less than 500ml per day
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Estimated blood loss with each bone break…
Radius/Ulna - 250ea
Humerus - 500ml ea
Femur - 1500ml ea
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LEAN - ET tube adm.
Double dosage + Flush
Lidocaine 100mg
Epi
Atropine
Narcan
59
Skins role in maintaining homeostasis in the body…
Protection
Temp & Fluid Regulation
Sensory nerves
Responds to injury w/inflammation
60
Pts with burns may have trouble with…..
Thermoregulation
Inability to sweat
Impaired vasoconstriction & vasodilation
Little or no melanin (at risk for sunburns)
Inability to grow hair
Little or no sensation
61
Which layer of skin contains nerve endings, blood vessels, sweat glands, and hair follicles?
Dermis
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Which layer is the thick layer of connective tissue between the dermis & underlying bone & muscle?
Subcutaneous
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What occurs becuase of fluid loss across damaged skin & series of volume shifts within the body (Intravascular volume oozes into the interstitial spaces?
Hypovolemic shock
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What limits distribution of O2 & glucose & hampers the ability to remove waste products?
Shock
65
What temp can cause thermal burns?
118 degrees F, 47.8 degrees Celsius
66
The severity of the burns directly correlates with what?
Temperature
Concentration
Duration of exposure
(More severe for trapped pts in an enclosed space w/toxins)
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Type of burn that only involves the epidermis; skin is red & swollen, usually no blisters, will heal in 2-3 weeks….
Superficial
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Which type of burn involves dermis & epidermis?
Partial Thickness
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Which type of burn destroys both layers of skin; the skin is unable to self-regenerate, may appear white & waxy, or brown & leathery, or charred; sensory nerves are destroyed?
Full-Thickness Burns
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Which type of burn involves all layers of the skin, along with fat, muscle, bone, or internal organs? Sensory nerves are destroyed & may lead to debilitating/disfiguring injuries.
Subdermal burns
71
Most fire related deaths are caused from….
Smoke/Superheated gas inhalations
72
Exposure to fire smoke causes:
Thermal burns to airway
Hypoxia
Tissue damage
73
What binds to receptors sites 250x’s more easily than O2?
Carbon Monoxide
74
Signs of airway involment from fire/smoke…
Hoarseness
Cough
Stridor
Singed facial/nasal hair
Facial burns
Anyone with suspected burn to airway could benefit from humidified O2.
75
Treatment for burn victims
Listen to stridor, Early Intubation could be life saving!!
Fluid Rescusitation.
Do not delay transport to try multiple IV attempts.
76
Rule of 9’s for adult:
Which parts are 9?
Which parts are 18?
Each arm is 9 (4.5 front, 4.5 back)
Torso & back, each 18
Legs 18 (9 front, 9 back)
77
Rule of 9’s for Peds:
Which parts are 9?
Which parts are 13.5 or 16.5?
Which parts are 18?
Arms: 9 (4.5 front, 4.5 back)
Head 18 (baby) 12 (child)
Legs 13.5 (baby) 16.5 (child)
78
Burns involving hands/feet/face/genitalia
Full thickness for than 10% of TBSA
25% or more TBSA Under 10yo, over 50YO
High voltage Electrical burns
Chemical burns
Are classified as what type burns?
Major
79
Superficial burns covering more than 50% of TBSA
Low voltage electrical burns
Full thickness burns involving 2-10% of TBSA
15-25% TBSA for under 10yo or 55YO & older
Are classified as what type burns?
Moderate
80
Full thickness burns covering less than 2% of TBSA
Superficial burns less than 50% of TBSA
Classified as what type of burn?
Minor
81
Only treat burns, once what is managed?
Airway
82
How to treat burns?
Cold compresses (no ice, ointments, or creams)
Apply dry, sterile, non adherent dressings.
83
Wounds associated with electrical burns….
Entrance & Exit wounds
(400 deaths & 4,400 injuries per year)
84
What type of internal injuries are associated with electrical burns?
Asphyxia
Cardiac Arrest
Nervous System Disruption
85
Which nerve constricts the pupils & is responsible for motion of the eyeball?
Occulomotor
86
Which nerve provides the sense of vision?
Optic
87
How many permanent teeth do we have?
32
88
LeFort fx’s
89
Numbness of the chin, inability to open the mouth, or TMJ dislocations could indicate what type fx?
Mandibular
90
Massive facial swelling, instability of mid facial bones, or elongated appearance of the face could indicate what type fx?
Maxillary
91
Infraorbital hypoesthesia, enophthalmos tramaticus, massive nasal discharge & CSF, impaired vision, & paralysis of upward gaze could indicate what type fx?
Orbital
92
Flattened appearance of face, paralysis of upward gaze, or loss of sensation over cheek, nose & upper lip could indicate what type of fx?
Zygomatic
93
Bleeding into the anterior chamber that obscures vision?
Hyphema
94
If hyphema or rupture of the globe is suspected, you should….
Take spinal precautions
Do not try & manipulate or reposition it
95
How to treat eye burn caused by UV light?
Sterile, moist pad & eye shield
Cool compress
Supine position
96
How long do you irrigate chemical eye burns?
5 mins
97
Ruptured eardrums can be caused from….
Direct blows
Foreign bodies
Pressure-related injuries
98
How to treat ear injuries….
Dressing between ear & scalp
roll gauze
Ice pack
99
Treatment for ear avulsion….
Partially Avulsed:
Realign ear into position
Slightly moistened bandage (normal saline)
Completely Avulsed:
Wrap ear into saline moistened gauze
Place in plastic bag
Place bag on ice
100
To reimplant an Avulsed tooth…..
Place tooth back in its socket
Have the pt bite down to hold it in place.
101
How to care for an Avulsed tooth…
1.) handle by crown only
2.) rinse too w/milk or normal saline
3.) Place tooth in cold milk
4.) wrap in cling film
5.) transport tooth with pt
102
Zones for neck injuries…..
Zone I - lower neck, clavicle area
Zone II - soft tissue, chin area
Zone III - upper neck, mouth area
103
Stretching or tearing of ligaments…
Sprain
104
Stretching or tearing of muscle or tendon…
Strain
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107
●Protects underlying tissue from injury
●Aids in temperature regulation
●Prevents excessive water loss
●Acts as sense organ
●Responds to injuries with inflammation
Skin
108
●Nerve endings
●Blood vessels
●Sweat glands
●Hair follicles
●Sebaceous glands
Dermis
109
Common blood thinner names….
Warfarin
Coumadin
Eliquis
Plavix
110
The bodies naturally blood-clotting mechanism.
Hemostasis
111
Horizontal fx of the maxilla that involves the hard palate & the inferior maxilla, separating it from the rest of the face.
Le Fort I fracture
112
A fracture w/ a pyramidal shape, involves the nasal bone & inferior maxilla.
Le Fort II fracture
113
Fracture of all mid facial bones, separating the entire mid face from the cranium…
Le Fort III Fracture
114
Le Forte III fracture with a concurrent frontal bone fracture
Le Forte IV fracture
115
Excessive collagen formation can occur if healing phases are not balanced, leads to …..
Hypertrophic Scar
Keloid
116
Fluid Resucitation Formula
2-4ml X body weight X Percentage of TBSA
117
Electrical Burn should receive around 4L. Thermal burns should be……
Less
118
The first half of fluid administration should be administered within what time?
8hrs from the time the pt was INJURED
119
What part of the eye is most often injured from thermal burns?
Eyelid
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121
The central area of skin that sustains the most damage.
There is little or no blood flow to the injured tissue in the area, resulting in necrotic tissue in this area.
Zone of Coagulation
122
Peripheral area surrounding the zone of coagulation has decreased blood flow & inflammation. May undergo necrosis within 24/48hrs, if perfusion is compromised by hypovolemic shock. The care you provide will be crucial to whether these cells survive or not.
Zone of Stasis
123
The area least affected by thermal injury. In this area, the cells will typically recover in 7-10 days, so long as perfusion is adequate & infection is controlled.
Zone of Hyperemia
124
Why no moist dressings on burns?
Loss of fluids, decreased thermoregulation, cool blanket will make them shiver
125
4th, 5th, & 6th degree burns, all layers on skin have been damaged, along with layers of fat, muscle, bone, or internal organs.
Subdermal Burns
126
Highly water-soluble gases (ammonia) primarily affect which part of the airway…..
Upper Airway - And are usually immediate
127
Moderately water-soluble gases (chlorine) primarily affect which part of the airway…..
Depends on concentration, effects may be immediate or delayed
128
Slightly water-soluble gases (phosgene, nitrogen dioxide) primarily affect which part of the airway…..
Inflammation & pulmonary edema at the alveolar level, effects may occur hours or days after exposure.
129
How to treat Hydroflouric Acid (used in drain cleaners) burn….
Calcium Gluconate topical gel is the preferred treatment.
Exposure of 6%-8% of TBSA to a concentration of 50% of HF acid will likely cause death.
130
How to prevent lightening related injuries ….
●Don’t be the tallest conductor.
●Don’t stand under or near the tallest conductor.
●Take shelter in a substantial structure.
●Avoid touching good conductors.
131
Skin can protect the body from what type of radiation?
Alpha
132
Protective clothing can protect the body from what type of radiation?
Beta
133
Gamma radiation requires what to be protected from it?
Several inches of lead or concrete
134
How to test or orbit fx?
H tests - have pt follow your finger
135
Occulomotor nerve - Responsible for eye movement is which cranial nerve?
III
136
Optic nerve - Responsible for vision is which cranial nerve?
II
137
Floaters in vision could be….
Broken blood vessel
Or retina detachment
Or strenuous physical exertion
138
Where in the mouth are the Incisors, Canine, Premolars, & molars?
Molars - 12 total - 3 back teeth, 3 on each side, top & back
Premolars - 8 total - 2 teeth just in front of the molars
Incisors - 8 total - 4 up top, 4 on bottom
Canine - 4 total - teeth between the Incisors & Premolars, 2 top, 2 bottom
139
Eyes that don’t track together….
Disconjucate gaze
140
Symptoms of Ocular Injury:
●Visual loss
●Double vision
●Severe eye pain
●A foreign body sensation
141
Size of Spinal Cord
1/2in in diameter, about 18ins long.
33 vertebrae.
142
How many bones in skull?
How many bones in face?
How many bones in ears?
28
14
3
143
Means same side….
Ipsilateral
144
Which part of the brain controls personality & voluntary motor action?
Frontal lobe
145
When is the ONLY time hyperventilation is appropriating?
Cerebral herniation
ICP
Cushing’s
146
The diaphragm attaches to which ribs anteriorly?
The lower 6
147
What are the primary physiologic functions of the thorax?
Maintaining oxygenation/ventilation
Maintain circulation
148
Alveolar collapse that prevents the use of the portion of the lung for ventilation & oxygenation. Reduces the surface area available for gas exchange.
Atelectasis
149
2 or more adjacent ribs that are fractured in 2 or more places
Flail chest
150
Once a flail segment has occurred, inspiration will cause a __________________ pressure within the thoracic cavity, drawing the flail segment toward the center of the chest.
Negative
151
When your pt has a flail segment, when the chest relaxes on expiration, it results in a __________________ pressure, forcing the flail segment away from the thoracic cavity.
Positive
152
An injury to the underlying lung tissue that inhibits the normal diffusion of oxygen and carbon dioxide.
Pulmonary contusion
153
The pressure waves generated by either penetrating or blunt trauma that disrupt the capillary-alveolar membrane, resulting in hemorrhage.
Spalling Effect
154
3 physical mechanisms that contribute to the formation of pulmonary contusion.
Implosion
Inertial effect
Spalling effect
155
Rib fractures can lead to ….
Inadequate ventilations
Self-splinting
Atelectasis
Infection from inadequate ventilations
156
Air under the skin
Subcutaneous emphysema
“Snap, crackle, pop, sensation, under the skin, during palpation”
157
What does subcutaneous emphysema indicate?
Pneumothorax
158
The accumulation of air or gas in the pleural cavity…..
Pneumothorax
159
Diminished breath sounds and what may be found on the affected side of a pneumothorax?
Hyper-resonance
160
A drop in BP upon inhalation
Pulsus paradoxus
161
These signs indicate what?
Unilateral, absent breath sounds
Unequal chest rise & fall
Pulsus paradoxus
Tachycardia
JVD
narrow pulse pressure
Tracheal deviation
Tension Pneumothorax
162
What condition would you need to do a needle decompression for? Where is it performed?
Tension Pneumo
2nd & 3rd rib, midclavicular
5th intercostal space, anterior axillary line
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165
When hyperventilating a pt, what rate do you ventilate at?
Until Capno reads 25-45
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167
How much fluid resuscitation?
20mg/kg up to Systolic of 90
168
What makes glucose necrotic?
It’s severely acidic
PH - 3.2-6.5
169
An area of the body innervated by sensor components of spinal nerves….
Dermatome
170
Which vertebrae (nerve root) controls the diaphragm?
C3-C5
171
Which vertebrae correlates with the nipple nine?
T4
T2-T7 controls intercostal muscles
172
Which vertebrae, nerve roots are responsible for bladder?
Sacral nerves
173
Which skull fx is most common?
Linear, will not be felt upon palpation
174
Tear in the dura mater, CSG drainage from the ears & nose, raccoon eyes and battle signs is what type of fx?
Basilar skull fx
175
Increase in ICP decreases….
MAP-ICP= cerebral perfusion pressure
And blood flow
176
Early warning signs of ICP:
Vomiting
Headache
AMS
Seizures
177
The most commonly broken bone in the body?
Clavicle
178
The umbilicus level is at the same level of which vertebrae?
T10
179
Most commonly broken ribs?
4-9
11-12 are the least commonly broken ribs
180
How many true ribs do we have?
7 set
181
182
Which rib does the diagram connect to?
6th
183
Major respiratory accessory muscles…
See pg 2055
184
Tidal Volume X RR =
Minute Volume
185
What is a physical sign that could be pneumothorax, volume overload, cardiac tamponade, or R-sided heart failure?
JVD
186
How to assess JVD?
Should be seated at least 45 degrees, should be 1/2 to 2/3 up from clavicle
187
188
Potential associated injuries with rib 4-9 fractures….
Aortic injury
Tracheobronchial injury
Pneumothorax
Vascular Injury
189
How large does the hole have to be to create a “sucking chest wound”?
2/3 of the trachea
190
Narrowing pulse pressures
Muffled heart tones
JVD
Hypotention
Are signs of what?
Cardiac Tamponade
(Beck’s Triad)
191
Cardiac Arrest caused by a direct blow to the thorax during repolarization…..
Commotio Cordis
192
What are the 3 layers of blood vessels?
Intima - Internal layer
Media - Middle/Muscle layer
Adventitia - Outside layer
193
194
MOI of diaphragm hernia
Abdominal Pressure
195
What causes traumatic asphyxia?
Sudden, forceful compression of the thoracic cavity
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