trauma MidT Flashcards
(271 cards)
1
Q
Parkland Burn Form for:
form:
A
= (BSA >20% only 2 & 3 degree burns)
= 4 mL x BSA x Weight (kg) = ½ 1st 8 Hrs & ½ next 16Hrs
2
Q
Haldon Mix
A
.
3
Q
60%) Fluid compartments % of water:
A
45% intracellular
15% extracellular (outside cell)
Interstitial 10.5% Intravascular 4.5%
4
Q
Blood vol/ loss) Pelvis:
Femur:
Humorous:
A
= 2-3Liters
= 1.5Liters per femur
= 750ml per humorous
5
Q
Burn depth) 2nd degree:
A
= Partial, EPi & Dermis burned: intense pain, fluid shift comes up thus blisters, RED to WHITE, moist & mottled w/ shifts
6
Q
Burn worries) Hypothermia:
A
Burn may disrupt body’s ability to reg/ core temp, If burn is extensive, uncontrolled body heat loss induces rapid, severe hypothermia.
7
Q
Burn worry) late stage Organ failure:
A
= can go into rhabdo from myglobins; Burn process releases material from damaged or dying body cells into bloodstream, May cause kidney failure, liver failure, arrhythmias, possible cardiac arrest.
8
Q
Class II Hemorrhage) 1 injuries:
2Compensation for blood:
3Blood Loss: 15 - 30%
4Pulse:
5Blood Pressure:
6Pulse Pressure:
7Capillary Refill:
8Ventilation Rate:
9Urine Output (mL/hr):
10Mental Status:
A
1= 1/2 Humorous fractures, a femur fracture, 1 full Hemopneumo
2= 1st line comp/ no longer maintain perfusion & 2ndary employed
3= 15 - 30% 750mLs-1.5L
4= > 100BPM
5= Normal
6= Starts to narrow
7= 2-3 secs
8= 20-30RR
9= (mL/hr) 20-30
10= Mildly Anxious
9
Q
Class III Hemorrhage)1 injuries/fractures:
2 Compensation to blood:
3 Blood Loss:
4 Pulse:
5 Blood Pressure:
6 Pulse Pressure:
7 Capillary Refill:
8 Ventilation Rate:
9 Urine Output (mL/hr):
10 Mental Status:
A
1= 2 Humorous, 1-2femur, 1 full Hemopneumo
2= Both 1&2nd comp/ responses failing to maintain perfusion & entering/in Decompensated Shock! (SBP <90)
3= Blood Loss: 30 - 40%, (1500 - 2000 mL’s)
4= >120
5= Starts to decrease
6= Narrows more
7= 3-4secs
8= 30-40
9= 5-10mL/hr
10= Anxious/Confused
10
Q
Class IV Hemorrhage) 1 injuries:
2= Compensation to blood:
3= blood loss:
4= Pulse:
5= Blood Pressure:
6= Pulse Pressure:
7= Capillary Refill:
8= Ventilation Rate:
9= Urine Output (mL/hr):
10= Mental Status:
A
1= GSWs, multiple major fractures, Pelvis
2= Irreversible Shock!
3= > 40% (>2000mLs) of total blood
4= > 140 & barely palpable in central arteries
5= Very low
6= Narrows more
7= > 5 seconds
8= > 40 or agonal
9= Negligible
10= Lethargic or Unconscious
11
Q
Critical Criteria) 3rd & 2nd Degree criteria:
Any 2nd or 3rd degree burns involving:
Burn types that’re critical & Rx:
A
= 3rd>10% & 2nd>30%
= Face, Hands, Genitalia, Circumferential, Feet, (Dipping), Airway
= Chem, high voltage, Burns w/ major trauma go trauma center 1st then burn center
12
Q
Methylene Blue) Dynamics:
Indications:
Contra:
Dose:
A
= Water soluable thiazine dye helps metHb to hemoglobin conversion
= Methemoglobinemia (metHb), Nitrate OD/poisoning
= Hypersensitivity
= 1 mg/kg IV/IO over 5-30 minutes.
13
Q
Newtons laws) inertia) 1st part of 1st law
2nd Part of 1st Law:
The law of energy conservation states:
A
= “body stays in motion unless acted upon by an outside force.”
= “body remains in rest unless acted upon by an outside force.”
= “Energy can neither be created nor destroyed. It can only be changed from 1 form to another.” EX In an auto crash, the changing of energy from one form to another is what deforms the auto and can cause injury to the occupants
14
Q
Non& Hemorrhagic treatment) If hemorrhage can be controlled:
If hemorrhage cannot be controlled:
Med for Sig/hemorrhage, in/external (after external controlled)
A
= IV/IO therapy (don’t delay transport) can administer 20 mL/kg bolus.
=administer just enough IV fluid to obtain a radial pulse (permissive hypotension therapy!)NO MORE SBP 80-90 (IV fluids Warm)
= Tranexamic Acid (TXA) Adult 1G/10 mins (mix in 50 mL of NS) follwed w/ 1G/8Hrs (500 mL bag) & Pediatric Not recommended
15
Q
1phagocytosis:
2Granulocytes & macrophages w/ healing:
3Lymphocytes w/ healing:
4Mast cells w/ healing:
A
1= macrophage eats & grows bacteria flag to show what antibodies to make for cellular response
2= eat dead cells parts & bacteria
3= destroys bacteria & other pathogens
4= release histamine to make capillaries more permeable to bring more RBC
16
Q
Shock’s 5 categories
A
Hypovolemic, Cardiogenic, Distributive, Obstructive, resp/metabolic
17
Q
Sodium Bicarbonate 8.4%) Dynamics:
Indications:
Contra:
Suspected acidosis Dose:
Hyperkalemia Dose:
A
= Alkalinizing Agent. Increases plasma bicarbonate, buffers excess hydrogen ion concertration, raises blood pH & reverses clinical manifestations of acidosis.
= Suspected hyperkalemia, suspected bicarbonateresponsive acidosis (DKA, OD on TCA’s, Aspirin or Cocaine)
= Patients in cardiac arrest
= 1 mEq/kg, Hyperkalemia:
= 50 mEq IV bolus.
18
Q
Thermal burn phases) Hypermetabolic phase:
A
3rd phase Days or weeks depending on burn severity; increase in body’s demands for nutrients; begins process of repairing damaged tissue (needs Glucose, amino acids, carbohydrates, O2 to support damage)
19
Q
Thermal burn phases) Resolution phase:
A
4th phase Scar tissue laid down and remodeled; rehabilitate and return to normal function (weeks to months) new collagen & usually doesnt remodel to original state & makes escar (burn keloid) bc overgrowth
20
Q
(Wallace Rule of 9s) used only for:
Adult %s:
infants (0-1):
Form:
A
= burns >10%
= 1 genitals, 9 head thoracic & ABDMN, distal anterior (applies to other areas) arm 4 ½
= head 18, arm 9, legs 13.5, 18 front thoracic & ABDMN
= # of child -1 > take away from head then give to each leg (Applicable up 10y/o) For every year beyond age 1, subtract 1 from head / that # & add it evenly between the 2 legs.
21
Q
Rocuronium) Dynamics:
Indications:
Contra:
Dose:
A
= Nondepolarizing neuromuscular blocker Binds to ACh receptors
= DSI/RSI
= Hypersensitivity
= 0.6-1.2 mg/kg. TTP: 60-90 seconds. DOP: 45-120 minutes
22
Q
1 (Ketamine) know:
2 Pharmacodynamics:
3 Indications:
4 Contraindications:
5 Adverse Effects:
6 Adult & Pedi Pain Dose:
7 Dissociation dose:
A
1= retrograde amnesia, Raises BP,
2= + sympathetic response, Sedative-hypnotic & analgesic med
3= Moderate to severe pain & SFI/RSI
4= History of hypersensitivity to med, Hypertension
5= Severe hallucinations and/or nightmares
6= 0.2 mg/kg/1-2min IV/IO w/ a max single dose of 20 mg
7= 0.5 mg/kg IN/IM
23
Q
1 (Morphine)
2 Pharmacodynamics:
3 Indications:
4 Contraindications:
5 Adverse Effects:
6 Adult Dose:
7 Pediatric Dose:
8 Keep on standby:
A
1 = not same as Morphine Sulfate
2= Narcotic (opioid) Schedule II Narcotic releases histamine allergy
3= Moderate to severe pain
4= SBP<90 & Known hypersensitivity
5= HypoBP, Syncope Tachy/BradyC, Resp/Depres, Apnea, N/V
6= 2-10 mg or 0.1 mg/kg to max dose (max 20 mg) IV, IO, IM, SQ & PO
7= 0.1 mg/kg IV/IO (slow) or IM up to 10 mg
8= Narcan is an antagonist
24
Q
1 Types of Radiation:
2 Radioactive Particles:
3 Alpha:
4 Beta:
5 Ionizing Rays:
6 Gamma:
7 X-Rays:
8 Atomic:
A
1= Radioactive Particles & Ionizing Rays
2= Alpha &Beta:
3= least worry & deflected w/ newspaper
4= flys further w/o skin penetration
5= Gamma & X-Rays
6= worst, several ft of concrete & lead
7= penetrates skin
8= nuclear reactor
25
1(Fentanyl) know:
2 Pharmacodynamics:
3 Indications:
4 Contraindications:
5 Adverse Effects:
6 Adult & Pediatric Dose same:
7 Antidote:
1= quicker but shorter duration than Morp (100 mcg=10 mg Morp)
2= , Schedule II Narcotic (opioid), sig/ more potent than morphine
3= Moderate to severe pain, Anesthetic
4= Known hypersensitivity to med, SBP <90
5= HypoBP, N/V, Cramps, CHEST WALL RIGIDITY, Resp/depress
6= 1mcg/kg to max of 100 mcg (IV/IO/IM/IN) may repeat PRN in 5-10 minutes w/ Max of 1 mL per nostril if administered IN
7= Narcan is an antagonist
26
1Crush injury:
2Crush syndrome:
3Cellular Lvl:
4 Crush syndrome signs:
5 Crush syndrome Rx:
1= deep injury damage can be massive w/ minimal signs on skin itself
2= body part trapped>4hrs, cells anaerobic>hyperkalemia>TDP torsades de pointes, Aka: traumatic Rhabdomyolysis
3= accumulation of quantities of myoglobin O2, K, lactic acid, toxins, can clog kidneys, can cause severe metabolic acidosis
4= urine is dark red, Shark Peaked T waves
5= 1st Ca-Chloride, 2nd Albuterol, 3rd Sodium Bicarb, Dex w/ Insulin
27
1Lymphatic system:
2Lymph node:
3Spleen relation:
4Lymphatic pathway:
5Sign lymphatic system not working:
1= “body's garbage system” macrophages eats then system of channels to tissues 1 direction, no pump, dumps into a node
2= were garbage collects
3= Carries "trash" of pathogen destruction to nodes for macrophages
4= >Vessels> nodes> spleen> up to L/R subclavian vein, to kidneys
5= Gray poop
28
4 Stages of healing:
= Hemostasis, Inflam/, Epithelialization, Neovasc/, Collagen synthesis (Here I eat naked) “strict, hurt, foundation , remodel”
29
1Hemostasis:
2Inflammation:
3Epithelialization:
4Neovascular:
5Collagen synthesis:
1= vaso/strict, platelet aggregate, coagulation fibrin (normothermic)
2= Granulocytes, macrophages & Lymphocytes eat, Mast cells released
3= “rebuild” epithelial cells go to wound making scab ~48Hrs after cut
4= new capillaries made (neo new) via previous cap/s +exchanging
5 = fibroblasts go to wound & synthesize collagen creating scar (w/ tension lines quicker/better), Too much synthetization makes Keloid
30
2nd line comp response:
Blood loss > RAAS, Catecholamine & Vasopressin released> vasoconstriction, increased Vol, cardiac stim
31
3 parts of circulatory system:
maintain homeostasis via:
Pos feedback:
= “pump fluid pipes” heart, blood, & blood vessels
= negative feedback loop
= childbirth & blood clots
32
3 phases of VC) Phase 1:
Phase 2:
Phase 3:
Phase 4:
Phase 5:
= Vehicle collision (P1) deceleration
= Body collision (P2) decel/ of occupant
= Organ collision (P3) decel of internal
= 2ndary collision (P4) objects in car
= (P5) car rear end, trees,
33
% of all Trauma deaths:
% of GSW account for HT death:
%s of penetrating neck trauma:
%s of penetrating chest trauma are fatal:
% of great vessels injuries & due to:
minimal diameter for sucking chest wound
= 50% of all Trauma deaths is head trauma
= 35% GSW account for Head Trauma deaths
= 5-10% penetrating neck trauma (airway & neuro
= 70-80% penetrating chest fatal
= 90% all great vessels injuries due to a penetrating MOI
= At least ¾inch for penetrating Chest wounds to turn sucking
34
Body maintaining steady, norm/ internal environment:
A condition in which the blood’s ability to clot is impaired:
The body’s response to stop the loss of blood:
Clotting phase when smooth blood vessel M. contracts
= Homeostasis
= Coagulopathy
= Clotting
= Vascular phase
= Medications such as aspirin
= process of coming & sticking together
35
1 Adults for the Rules of Nines, the head is awarded:
2 Adults for the Rules of Nines, the genitalia is awarded:
3 Adults for the Rules of Nines, the posterior trunk is awarded:
4 Adult for the Rules of Nines, each arm is awarded:
5 Adults for the Rules of Nines, each leg is awarded:
6 Adults for the Rules of Nines, the anterior trunk is awarded:
1= 9 % of body surface area.
2= 1 % of body surface area.
3= 9 % of body surface area.
4= 18 % of body surface area.
5= 18 % of body surface area.
6= 18 % of body surface area.
36
Alkalotic vs acidotic burns severity
Alkalotic burns > Acidotic burns
37
AUTOPED) 1st impact:
2nd impact:
3rd impact:
Off-road injuries:
Kids Waddell's triad:
= auto strikes body
= pedestrian thrown
= body strikes ground or object
= pop increased, usually remote areas, offer less protection,
= turn toward bumper b/c stupid, bumper hits kids pelvis & femur, chest & ABDMN hit grill, head strikes ground b/c buckethead
38
Baroreceptors:
Baroreceptors Fn.:
= receptors that monitor blood pressure
= Great vessels recept/ Gives feedback to brain > Sympathetic NS Activation, AArch & carotid arteries> feedback to medulla >SNS
39
Pulse pressure:
MAP:
CPP Cerebral Perfusion:
= SBP-DBP
= (PP/3) + DBP
= (MAP-ICP) + 10
40
Blood:
Plasma:
Leukocytes:
Erythrocytes:
= Mixture of water, cells, proteins, & suspended elements.
= makes up 55% of the blood volume
= WBC & platelets make up the “Buffy Coat"
= RBC make up 45%
41
body's 1st line comp response:
= Blood loss > decreased arterial pressure, altered blood gases > baro&chemoreceptor reflex >cardiac stim/ systemic vasoconstriction, flow&Vol/ retribution
42
Body’s response to a local hemorrhage:
Vascular Phase:
= hemostasis 3 steps: Vascular, Platelet, & Coagulation phase
= Blood vessel is damaged & begins to lose blood , Smooth muscle w/in walls contracts, thus vessel to withdraw into the wound, thicken vascular wall, & reduce lumen.
43
Bohr Effect:
Influences by:
What does it do to hemoglobin:
= Acid> Hemoglobin droping oxy off in body
= + CO2, +temp, -pH+ BPG 2,3 in body
= -oxy affinity
44
Burn worries:
= Hypothermia, Hypovol/, Electrolyte imbalance /HyperK, Infection
45
Caring for chem/ burn, its keen to know if its acid or an alkali b/c:
If carbon monoxide is present should also suspect the presence of:
= Alkalis continue to destroy cell membranes via liquefaction necrosis
= Cyanide
46
Cardiac Output:
Cardiac Output Formula:
Blood Pressure formula:
= amount of blood pumped by the heart in 1 min (70mL)
= SV x HR
= (SV x HR) x SVR
47
1 Children for the Rules of Nines, the head is awarded:
2 Children for the Rules of Nines, each leg is awarded:
3 Children for the Rules of Nines, each arm is awarded:
4 Children for the Rules of Nines, the anterior trunk is awarded:
5 Children for the Rules of Nines, the posterior trunk is awarded:
1= 18 % of body surface area.
2= 13.5% of body surface area.
3= 9% of body surface area.
4= 18% of body surface area.
5= 18% of body surface area.
48
Class I Hemorrhage) 1 injuries:
2Compensation for blood:
3Blood Loss:
4Pulse:
5Vent rate, BP & Pulse Pressure:
6Cap-Refill:
7Urine Output (mL/hr):
8Mental Status:
1= Broken humorous 750mL
2= Healthy PTs can easily compensate for such blood volume loss
3= Blood Loss: < 15% (<750 mL’s)
4= Pulse: Slightly Tachy
5= all Normal
6= Cap-Refill <2secs
7= 30mL/Hr or more
8= Slightly Anxious
49
Coagulation Phase of hemostasis:
3rd phase Clotting factors activated and released into bloodstream through a very complex cascade of events Triggers series of chemical reactions; formation of strong protein fibers (fibrin)
50
Compartment syndrome 6 Ps) 1st
2nd
3rd
4th
5th
6th
1= Pain (always 1st) seems exaggerated from story
2= Pallor (lacking blood flow)
3= Paralysis Efferent N-Fibers damaged
4= Paresthesia afferent N-fibers pushed
5= Pressures (BP < & palpable pressure w/ palpation)
6= Pulses (dim/ gone)
51
Compartment syndrome:
extrems contain M.s & swelling inside self (usually benign injury but body reacts extreme) (infection)
52
Crush injuries w/ compartment syndrome occur IRL & per book:
Hyperkalemia sign:
Crush/Hyperkalemia sign:
Crush injury:
= ~ >3hrs & 4Hrs per book
= (T wave>10boxes/mountain hyperkalemia)
= Calcium-Chloride to “fool cell” then Sodium bi-carb 50mEq or 20mg Albuterol 15LPM
= Major compression of tissue causing them to open up, (releases K & acid)
53
Crush syndrome occurs when trapped/crushed for how long:
Crush injury is what type of wound:
PT has lower L-leg trapped underneath a farm tractor for the last 5hrs. PT presents w/ obvious signs on hyperkalemia. What is 1st line IV med for this patient?
= usually for longer than 4 hours
= Closed soft tissue injury
= Sodium Bicarbonate
54
CUPS:
C:
U:
P:
S:
= Categories of PT severity
= Critical: ABCs FUCKed
= Unstable: hypotension, comp to decomp
= Potentially unstable: pelvic fracture, stable can unstable
= Stable: stable ex toenail fracture
55
Denature:
take away natural state (from chem burns)
56
Direct current (DC):
Alternating current (AC):
= electrons flow in one direction > grab on can’t let go
= reverses flow in short intervals (60 cycles change electrons'' flow) can let go
57
Dry dressing for burns:
Wet dressing for burns:
= >10%
= <10%
58
Electricity follows path of
least resistance w/ entry & exit wound: Nerves & blood vessels
59
Burn worries) Electrolyte imbalance:
Body’s ability to reg Na,K,& electrolytes is overwhelmed, Careful electrocardiogram (ECG) monitoring and fluid resuscitation help prevent hyperkalemic
Succholyine depolarzing makes hyperK worse
60
Thermal burn phases) Emergent phase:
Vtach, cells anaerobic Body's initial reaction to burn; pain response (afferent nerves damage> Nor/Epi release > tachycardia ; unless on beta blockers
61
"energy" or amount of flow in given time
Current; measured in amperes
62
Eschar:
Can be severe enough to :
= Burn destroys dermal cells; Skin constricts over wound site, increasing pressure of edema beneath & restricting flow of blood
=occlude all blood flow into distal extremity (compartment syndrome)
63
Escharotomy =
= release pressure w/ cutting burn to relief fluid pressure
64
Parkland Burn Form) EX: 32yo male found with 10% BSA 1st degree burns, 10% BSA 2nd degree burns, and 10% BSA 3rd degree burns. The patient is 110 pounds.
1. 4 mL x BSA x Weight (kg)
2. Total mL / 2 = (Amount to give for:
3. How many mL’s per hr?
4. How many gtts/min using a 10 gtt/mL IV drip set?
5. Know w/ formula:
1. 4mL X 20 (2nd + 3rd degree burns) X 50 (kg) = 4000 mL
2. 4000 mL / 2 = 2000 mL (Amount to give 1st 8 hours then next 16Hrs)
3. 2000 mL / 8 = 250 mL per/hour for 1st 8 hrs
4. 42 gtts/min
5. Pick closest option choice for gtts & Vol calculated. Use biggest bores& macro drips
65
Falls:
Examine:
Axial loading:
FOOSH (Fall onto an outstretched hand)
Colles’ fracture:
Smith's fracture: out
>20ft greater risk of
Aortic anyrusem to tear:
= most common blunt trauma, risk increase w/ age, sig fall 2-3x height
= height, position, surface PT landed on, physical condition of PT
= loading on axial skelton via falling (E starts heel to lumber)
= influxing wrist fractures from fall impact
= efflucing wrist fractures from fall impact "Palm out"
= internal organ damage
= pain tearing to chest shoulders back
= tearing pain from chest goes to back
66
Fluid accounts for ~% of the body’s weight, Only ~% of the fluid is contained in our vascular system
= 60% of the body’s weight, Only about 7% of the fluid is contained in our vascular system
67
Fluid resuscitation is an important part of treating serious burns. The formula for the amount of IV fluid needed to be infused includes:
4 mL × patient weight (kg) × BSA burned
68
Thermal burn phases) Fluid-shift phase:
2nd phase; can last up to 24 hours; larger than 15 to 20%(BSA) of total body surface area
vasodilates & capillaries more permeable for phagocytosis
69
Force:
Force formula:
= force related to a objects mass(weight) and/or achange in velocity
= mass x Acceleration
70
Frank Starling law/mechanism:
Vascular Resistance:
SVR vs. PVR:
SVR (Systemic Vascular Resistance):
PVR (Pulmonary Vascular Resistance):
= more myocardium is stretched the more force/greater the next contraction will be (increase in preload increases contraction)
= Resistance to overcome to push blood through circulatory system
= Body's circulation resistance & Lung's circulation resistance
= resistance blood faces in systemic circulation (arteries size)
= resistance blood faces in pulmonic circulation EX CHF, R ventricle
71
Frank Starling law/mechanism:
= more myocardium is stretched the more force/greater the next contraction will be (increase in preload increases contraction)
72
Vascular Resistance:
= Resistance to overcome to push blood through circulatory system
73
SVR vs. PVR:
= Body's circulation resistance & Lung's circulation resistance
74
SVR (Systemic Vascular Resistance):
= resistance blood faces in systemic circulation (arteries size)
75
PVR (Pulmonary Vascular Resistance):
= resistance blood faces in pulmonic circulation EX CHF, R ventricle
76
Golden Period “hour”:
Platinum 10:
= incident to surgery time 1 Hr from Crash to EMS to PT to surgery
= no more than 10 mins on scene
77
Haldane Effect:
Influences by:
What does it do to the hemoglobin?
= Alk> Hemoglobin Loves oxy in Lungs
= -CO2, -temp, +pH -BPG 2,3, in Lungs,
= +oxy affinity
78
Hemostasis:
Hemostasis order:
Factors that effect hemostasis:
= Body’s response to a local hemorrhage w/ 3 phases
= Vascular, Platelet, Coagulation "flow, stick, build"
= Wound type(can pull w/in>cant constrict), M-nt, Temp, Meds( most blood thinners stop/prevent fibrin) Warfrin/Coumadin), IV Fluids
79
Burn worries) Hypovolemia:
Tissue destruction reduces/eliminates skin’s ability to contain fluid w/in, Inability of damaged blood vessels to retain plasma causes fluid & electrolyte shift into burned tissue & Takes 4-6hrs to dev/
80
Burn injury in an enclosed space, always consider the possibility of:
Supraglottic structures are useful w/ burns b/c:
= Inhalation Burns
= B/c very moist mucosa lines the airway Supraglottic airways may absorb heat and prevent lower airway burns
81
If you were administering isotonic crystalloid solutions, how much would move out of the intravascular compartment within 1 hour?
2/3s would move out
82
index of suspicion:
Info gathered regarding the scene & MOI for mental summation of suspected injuries based on your event analysis
83
Burn worries) Infection:
natural body bacteria can kill & become opertunicle & Most persistent killer of burn victims & Does not appear for several days following acute injury, Pathogens pose hazard to life when they grow to massive numbers
84
1Prehospital Infections:
2Infections cause, duration, severities, treatment:
3Risk factors:
1= sepsis, staph, strep, Lymphangitis, Tetanus, & Gangrene
2= Anaerobic bacterium, ~10% severe, 2-3 days pain tender warm, fight w/ steroids
3= diabetics, infirm, elderly, chronic diseases, steroids, animal/human bites,
85
Jacksons Theory of Thermal Burns 3 burn zones:
1st Zone of Coagulation 2nd Zone of Stasis 3rd Zone of Hyperemia
86
Kinetic energy:
Kinetic Energy form:
=energy of a object in motion (by objects mass & its velocity
= (Mass x Velocity ^2)/ 2 ½ x mv^2
87
Kinetic energy:
kinetic energy formula:
Increasing mass vs. velocity directly increases what:
= energy of an object in motion (Fn. of object’s mass & its velocity)
= Kinetic energy=Mass(weight)×Velocity(speed)22
= kinetic energy > +velocity exponentially increases kinetic energy
88
mechanism of injury (MOI):
the circumstances and events by which an injury occurs.
89
Moderate criteria) Superficial:
Partial thickness burns:
Full thickness burns:
= BSA >50%
= BSA <30%
= BSA <10%
90
(Newtons laws) inertia) 2nd law:
force formula is summarized as:
= force is related to object’s mass (weight) & rate of its change in velocity (speed)
= Force=Mass (weight)×Acceleration (or deceleration)2
91
Ohm's law:
relationship between current (I), resistance (R), voltage (V)
92
Tension pneumo & pulmonary emboli is which type of shock?
Pericardial tamponade presents w/:
= Obstructive
= Becks triad JVD, tachycardia, hypotension, & Muffled heart tones
93
Oxy Dissociation Curve:
Bohr Effect:
Haldane Effect:
= H-globin “Train” taking & dropping oxy
= Acidotic with R-shift of hemoglobin w/ decrease oxy affinity
= Alkalotic w/ L-shift Loves oxy in Lungs
94
Penetrating trauma:
Perforating trauma:
(3lvls of Penetrating trauma) 1st Lvl:
2nd Lvl:
3rd Lvl:
Ballistics:
Factors of bullet speed/damage:
Trajectory:
Cavitation:
Profile:
= object pierces the skin and enters the body
= object pierces through & through body
= Low velocity: knifes, swords, ect
= Medium: handguns
= High-velocity: Rifles
= study of projectiles in motion & effects on objects
= Trajectory, Drag, Cavitation, Velocity, Profile, Shape:
= curved path bullet follows after fired from a gun
= Outward motion of cavity due to projectiles speed & vacuums
= cross-section of bullet along its direction of travel
95
Platelet Phase of hemostasis:
2nd phase, Platelets aggregate, or collect and adhere. Slows hemorrhage from capillaries and small vessels- splint fractures to decrease of clots being broken down & bleeding again
96
Preload:
Afterload:
Mean Arterial Pressure (MAP):
= pressure/vol/ w/in ventricles @ end of diastole “End-diastole vol/“
= resistance against which the heart must pump against (increase afterload= increase ventricular workload)
= average pressure in arteries during a single cardiac cycle = pressure that drives blood to tissues (ensuring organ perfusion)
97
Pulse pressure:
Pulse pressure signifies:
Pulse pressure <25 mmHg may be seen w/
= dif/ between DBP & SBP pressures (PP= SBP-DBP)
= amount of force the heart generates with each contraction
= PTs w/ sings of shock
98
QA QI should NEVER be
punitive
99
Rocuronium) Dynamics
Indications:
Contra:
Dose:
= Nondepolarizing neuromuscular blocker. Binds to ACh receptors
=DSI/RSI
= Hypersensitivity
= 0.6-1.2 mg/kg. TTP: 60-90 secs. DOP: 45-120 mins
100
Rule of palm:
use of PT hand = 1% of BSA (burns <10%)
101
Seat belts:
Maternal relation w/ seat belts:
Cullen's sign:
Most common organ injuries:
SRS:
= vehicle restraints, reduced # of collision related deaths
= US #1 maternal death, hips/pelvis not ABDMN
= internal bleed abdominally
= Spleen adults Liver kids
= supplemental Restraint Systems (SRS) 1st used for front impacts, airbag inflation to cushion energy
102
Shear blunt trauma:
Axons shearing:
= injury occurs along edges of impacting force or at organ attachments (sudden acceleration) (liver ligament teres cuts liver) (arteriosus ligament shears middle of aorta (ductus oreriosis)
= concussion diffuse axonal injury DAI (changed pep b/c DAI)
103
Site for pneumo decompression:
needs:
Never go under a rib b/c:
Locating decompression site:
Digital thoracostomy:
= Anterior 2nd ICS midclavicular/3rd rib & b/c air is always up/rising
= At least 3in catheter, attach 1way valve: Could use 3way valve, glove,
= vascular; have major thoracic arteries & nerves
= palp/ then slide over 3rd rib
= 1-2in incision between 4th & 5th ICS, ( “cut finger tube” )
104
Special pop of burns:
PT's cope less b/c:
= GERI, Pedi, & PTs ill/injured have >dif coping w/ burn injuries
= Fluid retention,
105
1staph:
2Strep:
3Lymphangitis:
4Tetanus (Lockjaw):
5Gangrene:
6Wet Gangrene:
7Dry Gangrene:
1= staphylococcus Anaerobic bacterium infection
2= Streptococcus Anaerobic bacterium infection
3= red lines along lymph lines b/c infection
4= Clostridium tetani>Attacks NS produces toxin >M. contrac/spasms
5= Clostridum perfringen>(diabetes>risk) infection lacks blood supply/flow> less WBC
6= bacteria to tissue & swells then fluids outside of tissue
7= blood supply cut off and dry
106
Stretch blunt trauma:
Sciwora:
= Tendons & Fibers that (tendons stronger) hold organs & other structures together are pulled & injured or torn
= spinal cord injury with out r a (kids in wreck overstretching neck)
107
Stridor w/ inhalation burns:
Bad Airway burns might might need:
= AKA “crowing” larynx last defense against heat then swells 2/3s so intubate asap bc only worsens (Press chest & follow bubbles)
= Might need to nasal endotracheal intubation w/ BAAM & Endotrol tube (ET w/ trigger) BAAM> High=inhale &Low=exhale
108
Stroke volume is predicated by:
Amount of blood ejected by heart in one cardiac contraction:
Pressure w/in ventricles at the end of diastole:
Blood vol/ moved by heart in 1 min:
Measurement of peripheral vascular resistance is the:
Resistance a heart contraction must overcome in order to eject blood:
= Preload, afterload, and cardiac contractility
= Stroke Volume
= Preload
= Cardiac output
= Mean arterial pressure
= Afterload
109
Stroke volume:
Cardiac Output (CO):
CO form/:
3 factors that affect cardiac output:
Dynamic CO:
= blood amount ejected in 1 contraction> varies 60-100mL 70average
= Amount of blood moved in 1min
= HR X SV -> 5-6 L of blood moved in 1 min
= preload, afterload, contractility
= "1 up & other down"
110
Area nearest the heat source that suffers the most damage is called the zone of:
Coagulation
111
The blood volume of an infant or young child is proportionally:
Population most at risk for trauma & trauma death:
= ~20%> than that of an adult
= Young adult male
112
The following burn patterns is usually seen with child abuse:
"Stocking burns" to lower legs, Circumferential burns on buttocks, Multiple circular burns of the same size to the arms and legs
113
Internal Hemorrhage being forced between tissue layers (fascia):
Internal Hemorrhage:
Pregnant internal hemorrhage worry:
Internal blood loss may be self limiting:
= Hematoma (pocket of blood) usally from arterie)
= Blood accumulation in interstitial spaces, forming visible contusions
= multiple uterine arteries in umbilical cord
= Large body cavities (chest, ABDMN, pelvis) have little resistance & internal blood loss may be severe.
114
Thermal burn phases:
Emergent, Fluid-shift, Hypermetabolic, & Resolution phase
115
tools for external hemorrhage:
Trauma Clamps:
Tourniquets:
Tourniquet use adverse effects:
Hyperkalemia & Sign:
= Hemostatic Agents/Dressings, (combat gauze), trauma clamp, Tourniquets,
= IT clamps "teeth chomper"
= Commercial best at least 1in diameter/width (Willis=turning stick), Improvised (ad hawk), Air inflatable (like BP cuff), Junctional (sam splint=pelvic)
= Due to distal hypo-perfusion, toxins build up>Hyperkalemia:
= tall sharp T waves & treat w/ sodium bicarb bc Acidosis
116
What is hydrostatic pressure in the vascular system & what creates it?
What is oncotic pressure in the vascular system and what creates it?
=Pressure from heart in blood vessels & forces water to cross the capillary membrane into the interstitial space.
=Pulling water back into the blood vessels by the presence of large proteins in the blood (pulling back in)
117
Injury which opening occurs in skin & organs protrude through is:
Evisceration
118
Most common location for compartment syndrome to occur?
1st "P" of compartment syndrome?
What ECG changes would indicate hyperkalemia?
= Distal leg, anterior compartment
= Pain
= Peaked T Waves
119
Sodium Bicarbonate is delivered PT's suspected w/ hyperkalemia at:
Dose of Calcium Chloride for hyperkalemia & line of med?
= 50 mEq as last line
= 500-1000 mg/3mins IV as 1st line med
120
Jacksons Theory) Zone of Coagulation:
Area of burn nearest to the heat source (most damage & tissue necrosis)Most damaged area
121
Jacksons Theory) Zone of Hyperemia:
surrounding Area of erythema, damage with more RBC coming to area b/c/& cap/s more permeable (increased blood supply) trying to get phagocytes to inside for healing process
Sig burns have sig swelling from shift of fluid
122
Jacksons Theory) Zone of Stasis / “Ischemia”:
Less damaged area adjacent to the Zone of Coagulation (treatable & posible reversible damage)
123
“pressure” of electric flow
Voltage
124
Trauma def:
Trauma’s 2 categories:
= Physical injury or wound caused by external force or forces
= Penetrating & Blunt
125
Penetrating:
(under penetrating) Perforating:
= object enters body & exchanges energy directly w/ human tissue causing damage or injury (goes in w/o exit)
= goes in & exits of body
126
Standards established by your system’s medical direction to assist you in determining which PTs require urgent transportation to a trauma center:
Trauma Triage Criteria
127
The health care surveillance process, put in place for trauma systems, is called
the Registry.
128
Any eye trauma PT:
Zofran contra=
= vomiting &/ B/c +ocular pressure
= prolonged QT
129
Subdural venous nature hematoma shows symptoms:
Epidural bleed arterial nature hematoma shows symptoms:
= 2-3 or 3-6hrs for symptoms
= immediately
130
Morphine & fent drop BP by:
= body releasing Histamines
131
Life threatening injuries %:
Most-life threatning trauma occurs to:
Vol per lung & body:
lethal blood loss:
= <10% traumas
= head and/or chest
= 3L per lung & 5L per body
= >40% or ~2L
132
1st doc to classify trauma as a disease was:
1st EMT orange book
= the “white paper 1966”
1st EMT orange book
133
Public health care model:
= Surveillance, Risk identification, intervention dev, implement, Eval/
134
Implementation:
= putting effective safety measures EX roads,
135
Surveillance:
= collection of data Epidemiology=study of disease based on med survey
136
Risk analysis:
= Examines & determines factors that impact dev
137
Intervention dev:
= dev/mod of programs to reduce both incidence & seriousness of trauma
138
Evaluation:
= Repeat surveillance “good on paper but what about practice”
139
(Trauma centers) Lvl 1:
Lvl 2:
Lvl 3:
Lvl 4:
= 1 (18tx) med-uni teaching, best care, everything to Neurovascular
= 2 (23 tx) everything BUT neuro, area trauma, surgical care capable all times, typically not teaching
= 3 general hospital w/ some special staff, TIB-FIB, try avoid w/ severe
= 4 basic ER, can stable but bandage, foot ran over
140
Specialty Centers:
= Neuro, Burn, Pedi trauma, Hand & limb replant microsurgery, Hyperbaric oxygen
141
MOI:
Energy:
Inertia:
= mech of injury how the injury happened
= Ability to do work
= law of Inertia (Newton’s 1st law) helps explain how objects in motion behave
142
Newton' s 1st law:
Newtons 2nd Law:
= (inertia): body in motion will stay in motion unless acted upon an outside force “Body at rest will remain at rest unless acted upon upside force”
= “law forces at work stay in work during collision”
143
Kinetic energy:
Kinetic Energy form:
=energy of a object in motion (by objects mass & its velocity
= (Mass x Velocity ^2)/ 2 ½ x mv^2
144
Force:
Force formula:
= force related to a objects mass(weight) and/or achange in velocity
= mass x Acceleration
145
Biomechanic of trauma:
Occur w/ 2 forms:
= manner in which energy exchange damages human tissue
= blunt or penetrating
146
Faster and/or mass relation to energy:
Cavitation's relation to speed:
Energy exchange Study of:
= more deceleration > more transfer of energy
= Faster object greater cavitation
= “kinetics of energy compact”
147
Compression blunt trauma:
Hematoma:
Contusion:
Ecchymosis:
= impact abruptly stops body part while inertia continues (hit by bat)
= artery bleed under area
= bruise cap bleed
= discoloration ID contusion
148
Stretch blunt trauma:
Sciwora:
= Tendons & Fibers that (tendons stronger) hold organs & other structures together are pulled & injured or torn
= spinal cord injury with out r a (kids in wreck overstretching neck)
149
MVC) Types of impacts:
Most common impact:
Most deadly impact:
commonly most benign impact:
= Frontal, Lateral, Oblique, Roll over, Rear
= Frontal
= Lateral (b/c less crumble zone & Seat belts offer lil protection)
= Rear
150
MVC) Phase 1:
Phase 2:
Phase 3:
Phase 4:
Phase 5:
= Vehicle collision (P1) deceleration
= Body collision (P2) decel/ of occupant
= Organ collision (P3) decel of internal
= 2ndary collision (P4) objects in car
= (P5) car rear end, trees,
151
Seat belts:
Maternal relation w/ seat belts:
Cullen's sign:
Most common organ injuries:
SRS:
= vehicle restraints, reduced # of collision related deaths
= US #1 maternal death, hips/pelvis not ABDMN
= internal bleed abdominally
= Spleen adults Liver kids
= supplemental Restraint Systems (SRS) 1st used for front impacts, airbag inflation to cushion energy
152
Frontal car impact:
(FCI) Restrained pathway:
(FCI) Unrestrained pathway:
= most common, Spider windshield, Pneumo b/c paper bag syndrome
= fold over, chest/ABDMN,
153
Rear Car impact:
(RCI) common injuries:
= read-end, commonly most benign
= Whip lash, common C-Spine injuries
154
Lateral Car Impact:
more deadly impact b/c:
(LCI) body pathway & injurie:
= hit from side aka T-bone(most dealy b/c less crumble zone)
= Seat belts offer lil protection
= Coupe-Countre-Coupe injury > neck/head toward impact & body w/ impact
155
Oblique Car Impact:
= occurs when lateral impact is off center aka "spin/rotating"
156
Roll Over Car Impact:
(ROCI) injuries:
= car is flipping (high critical “drying machine”)
= Multiple impacts from hitting each part of car w/ each 1/4 rotation
157
(Blood vol/ loss) Pelvis:
Femur:
Humorous:
= 2-3Liters
= 1.5Liters per femur
= 750ml per humorous
158
Motorcycles often serious trauma b/c:
Frontal Moto/ pathway & Injuries:
Angular Moto/ pathway & Injuries:
Sliding Moto/ pathway & Injuries:
Ejection Moto/ pathway & Injuries:
= rider tends to absorb much of crash injuries (lots of heads injuries
= most common front dips propelling rider & handlebars catch lower
= "side swipe or lateral" impact w/ guard rails Mostly ortho-injuries
= < chances of ejections) more rashes & "most safe"
= very common, usually more serious injuries Initial Biker then Ground
159
Removing moto helmets:
Paramedic remove that helmet!!! For A&B,
Remove if Helmet isn’t snug &/or bad integrity
Contra: impaled through helmet & skull
160
AUTOPED) 1st impact:
2nd impact:
3rd impact:
Off-road injuries:
Kids Waddell's triad:
= auto strikes body
= pedestrian thrown
= body strikes ground or object
= pop increased, usually remote areas, offer less protection,
= turn toward bumper b/c stupid, bumper hits kids pelvis & femur, chest & ABDMN hit grill, head strikes ground b/c buckethead
161
Falls:
Examine:
Axial loading:
FOOSH (Fall onto an outstretched hand)
Colles’ fracture:
Smith's fracture: out
>20ft greater risk of
Aortic anyrusem to tear:
= most common blunt trauma, risk increase w/ age, sig fall 2-3x height
= height, position, surface PT landed on, physical condition of PT
= loading on axial skelton via falling (E starts heel to lumber)
= influxing wrist fractures from fall impact
= efflucing wrist fractures from fall impact "Palm out"
= internal organ damage
= pain tearing to chest shoulders back
= tearing pain from chest goes to back
162
Blast injuries:
Conventional bomb:
Dirty bomb:
= Effects pulmonary system significantly
= most common >Pipe bombs, fireworks, ect
= Conventional bomb w/ reactive material
163
Blast phases) Primary:
2ndary: flying debris hitting you
Tertiary: thrown off of feet onto something
Quaternary: misc event: tree falls on you, radioactive (dirty bomb)
Isolated blast injury:
Contra blast injury:
Underwater blasts:
= Primary: decompression of lungs
= flying debris hitting you
= thrown off of feet onto something/ground
= misc event: tree falls on you or radioactive injury(dirty bomb)
= injury same side of impact
= opposite side of impact
= enhances injury/death w/ pressure wave
164
“Laying the bike down” results in
the bike absorbing much of the energy
165
Form/ “mass multiplied by velocity squared, divided by two” equals:
Study of processes that bring forces to bear upon human body is:
When sig/ kinetic energy is applied to human anatomy, its called:
Branch of physics w/ objects in motion & E. exchanges w/ collision:
= Kinetic energy
= Kinetics of impact
= Trauma
= Kinetics
166
Frontal impact MVC rarity:
Pathways of travel w/ MVC frontal impact are:
Rear-impact MVC injuries:
= most common type of impact in MVCs
= Down & under or Up & Over
= commonly limited/benign especially w/ Headrest position properly
167
The most common & serious trauma associated w/ explosions is:
The most lethal explosions are those: That cause structural collapse
= Pulmonary injury
= That cause structural collapse
168
What are the 3 different levels of penetrating trauma?
High velocity> sniper
Medium velocity> pistol
Low velocity> knife
169
1 kinetics of penetrating trauma) Ballistics:
2 Trajectory:
3 Drag:
4 Cavitation:
5 Velocity:
6 Profile:
7 Shape:
1= Study of projectiles in motion & effects on objects
2= Curved path bullet follows after fired from a gun
3= Drag from wind
4= Outward/ cavitation motion of cavity due to projectiles
5= Speed of object in motion
6= Cross-section of bullet along its direction of travel
7= Shape of bullet
170
1 kinetics of penetrating trauma) Study of projectiles in motion & effects on objects
2 Curved path bullet follows after fired from a gun
3 Drag from wind
4 Outward "ballooning" motion of cavity due to projectiles
5 Speed of object in motion
6 Cross-section of bullet along its direction of travel
7 shape of object
1= Ballistics:
2= Trajectory:
3= Drag:
4= Cavitation:
5= Velocity:
6= Profile:
7= Shape:
171
What are the three levels of penetrating trauma?
Lvl 1: entrance
Lvl 2: cavation
Lvl 3: exit
172
Shock & perfusion definitions:
= Perfusion: Adequate supply of well oxygenated blood & nutrients to all vital organs
= Shock: body's lack of perfusion
173
Shock) Hypovolemic:
Types:
= fluid loss
Hemorrhagic: blood loss & Non-hemorrhagic: V/D, Sweating
174
5 types of shock and treat them appropriately:
Hypovolemic, Cardiogenic, Distributive, Obstructive, Respiratory/Metabolic
175
blast injuries) Primary:
Secondary:
Tertiary:
Quaternary:
Primary: blast injuring hallow organs
Secondary: shrapnel injuring
Tertiary: thrown against something
Quaternary: damage from other AFTER BLAST
176
Shock) 1 Distributive:
2 Hives:
3 "warm shock/high space”:
4 Sick shock:
5 syncope:
1= uncontrolled vaso-dialation
2= Anaphylactic: release of histamine from Ige & b/c allergen
3= Neurogenic: warm b/c reverse shunting makes warm transient block of SNS
4= Wide spread of infection
5= Physcogenic: Sudden vasodilation physiological means EX hemophobic, arachnophobic
177
Dynamic CO:
=1 up other down, L diastole P = L afterload, PVR pulmonary & oil
178
Shock) 1 Obstructive & types:
2 pneumothorax:
3 Pericardium:
3 traveled Embolism to lungs:
1= something obstructing heart} PE, Tension/Pneumo, Pericard/tamp
2= Tension/pneum: plueras so full pushing on hearts atrium
3= Pericardial tamponade: pericardium filled with blood
4= PE: emboli so big obstructs pulmonic vein
179
Shock) Cardiogenic:
Types & defined:
= Pump prob/ not working
= Intrinsic: problem from w/in heart EX MI
& Extrinsic: pob from outside hurting heart EX TPT
180
Shock) 1 Respiratory/Metabolic:
1= Disruption of O2 transfer into cells/cells unable to utilize O2 from Cyanide, CO poisoning, A change in the blood pH
181
Shock) Normal S/S of shock:
Compensate shock:
Decompensated shock:
Irreversible shock:
= Tachypnea&cardia, AMS, lower BP
= body is compensating “fighting” to maintain homeostasis
= can no longer maintain homeostasis
= can’t come back to life
182
Shock) How does hemophilia affect the body and the clotting of blood?
Does not have ability to properly clot due from ½ factors
183
Shock) S/S of neurogenic shock:
Cushing’s Triad:
= warm/flush, bradyC, HyperBP, AMS, Blown and/or unequal pupils
= HyperBP, BradyC, cheyenne stokes or Biots ventalations
184
TXA) 1 Dynamics:
2 when do we admin/ it:
3 Correct dose:
4 Followed by:
1= Blocks fibrinolysis by binding to plasminogen, blocking plasminogen fibrin interactions.
2= Significant hemorrhage, either internal or external (after external hemorrhage has been controlled).
3= 1G/10mins (mix in 50 mL bag of NS)
4= 1G/8Hrs (500 mL bag)
185
What are the 3 dif types of soft-tissue injuries?
Type: Open
Type: Close: Infection
Type: Burn
186
Hyperkalemia) 1st line med:
2) One of two 2nd line meds:
3) One of two 2nd line meds:
4) Hospital only med:
5) Hospital only med to poop:
1= Calcium Chloride IV 0.5-1G/3 mins (Stabilizes doesn't fix)
2= Albuterol 10-20 mg LVN over 15 mins
3= Sodium Bicarb 50 mEq IV mil equivalent
4= Dextrose (25 grams)w/ Insulin IV (10 units)
5= Kayexalate to poop out hyperK via pull interstitial to GI
187
Avulsions & subtypes:
= separates & creates flap/chunk from skin (“chunk missing)>Degloving, Scalping, Amputations
188
dif types of open soft-tissue injuries:
Abrasions:
= Abrasions, lacerations, avulsions, and penetrating injuries
= scrape across skin skin
189
Lacerations & subtype:
= cut into dermis} Incisions: smooth Lac from sharp (scalpal, glass, ect) open against tension line, close w/ tension lines
190
Penetrating injuries & subtypes:
= puncture: small entrance, Impalement: remove impedes CPR or Airway, Perfurating: through & through
191
Criteria for critical/moderate burn in adult & Pedi PT:
Burns associated with respiratory injury aka inhalation burn
Chemical / high voltage
Burns with major trauma
192
Hydroxocobalamin:
Adult Dose:
Pedi Dose:
= Suspected cyanide poisoning
= 5 grams IV/IO over 15 minutes. May repeat a 2nd 5 gram dose for a max of 10 grams
= 70 mg/kg IV/IO (max 5 grams)
193
Hydroxocobalamin) Dynamics:
Indications:
Contra:
Dose:
= Binds w/ cyanide to form nontoxic cyanacobalamin (Vitamin B12), preventing its toxic effects.
= Suspected cyanide poisoning
= Hypersensitivity
= 5Gs IV/O over 15 mins. May repeat 2nd 5G dose (max 10G)
194
Ketamine) Dynamics:
Indications:
Contra:
Sedation Dose:
Pain dose:
= Dissociative anesthetic. NMDA Receptor Antagonist Anesthetic
= Sedation, SFI/RSI, Analgesic
= Hypersensitivity
= Sedation: 1-2 mg/kg Onset: 30-60 secs, Duration: 10-20 mins
= Pain: 0.2 mg/kg IV/IO (max single dose 20 mg), 0.5 mg/kg IM/IN (if no IV/IO)
195
Methylene Blue) Dynamics:
Indications:
Contra:
Dose:
= Water soluable thiazine dye helps metHb to hemoglobin conversion
= Methemoglobinemia (metHb), Nitrate OD/poisoning
= Hypersensitivity
= 1 mg/kg IV/IO over 5-30 minutes.
196
Rocuronium) Dynamics
Indications:
Contra:
Dose:
= Nondepolarizing neuromuscular blocker. Binds to ACh receptors
=DSI/RSI
= Hypersensitivity
= 0.6-1.2 mg/kg. TTP: 60-90 secs. DOP: 45-120 mins
197
Sodium Bicarbonate 8.4%) Dynamics:
Indications:
Contra:
Suspected acidosis Dose:
Hyperkalemia Dose:
= Alkalinizing Agent. Increases plasma bicarbonate, buffers excess hydrogen ion concertration, raises blood pH & reverses clinical manifestations of acidosis.
= Suspected hyperkalemia, suspected bicarbonateresponsive acidosis (DKA, OD on TCA's, Aspirin or Cocaine)
= Patients in cardiac arrest
= 1 mEq/kg, Hyperkalemia:
= 50 mEq IV bolus.
198
Succinylcholine) Dynamics
Indications:
Contra:
Dose:
= Depolarizing neuromuscular blocker. Binds to Ach recptors
= DSI/RSI
= Hyperkalemia(burns, crush injury), Increased ICP, Severe trauma
= 1-1.5 mg/kg IV/IO. TTP: 45-60 seconds. DOP: 5-10 mins.
199
Fentanyl) Dynamics:
Indications:
Contra:
Dose:
=Synthetic Narcotic (Schedule II Opioid)
= Analgesia & sedation via binding to opiate receptor, sig/ more potent than morphine (100 mcg = 10 mg of Morphine)
= Moderate-Severe pain
= Hypersensitivity, SBP<90
=1mcg/kg to a max dose 100 mcg (IV/IO/IM/) may repeat PRN in 5-10
= 1mcg/kg IN may repeat PRN 5-10mins (Max 1mL PRN if admin/ed IN)
200
Hydroxocobalamin) Dynamics:
Indications:
Contra:
Dose:
Binds with cyanide to form nontoxic
cyanacobalamin (Vitamin B12), preventing its
toxic effects.
Suspected cyanide poisoning Hypersensitivity 5 grams IV/IO over 15 minutes. May repeat a
2nd 5 gram dose for a max of 10 grams
201
Methylene Blue) Dynamics:
Indications:
Contra:
Dose:
= H20 soluable thiazine dye promotes converting metHb>hemoglobin
= Methemoglobinemia (metHb), Nitrate overdose/poisoning = Hypersensitivity
= 1 mg/kg IV/IO over 5-30 mins
202
Succinylcholine) Dynamics:
Indications:
Contra:
Dose:
= Depolarizing neuromuscular blocker. Binds to Ach recptors
= DSI/RSI
= Hyperkalemia(burns, crush injury), +ICP, Severe trauma, Neuromuscular disease.
= 1-1.5 mg/kg IV/IO. TTP: 45-60 seconds. DOP: 5-10 minutes.
203
Tranexamic Acid (TXA) Dynamics:
Indications:
Contra:
Dose:
= Binds to plasminogen, blocking plasminogen fibrin interactions (fibrinolysis)
= Sig/ hemorrhage, either in/external (after external hemorrhage is controlled)
= SP 3 hrs past injury, allergy/Sensitivity, Suspected thromboembolism
1 gram over 10 minutes (mix in 50 mL bag of
NS), Followed by 1 gram over 8 hours (500 mL
bag NS).
204
Injury which opening occurs in skin & organs protrude through is:
Evisceration
205
Most common location for compartment syndrome to occur?
1st "P" of compartment syndrome?
What ECG changes would indicate hyperkalemia?
= Distal leg, anterior compartment
= Pain
= Peaked T Waves
206
Crush syndrome occurs when trapped/crushed for how long:
Crush injury is what type of wound:
PT has lower L-leg trapped underneath a farm tractor for the last 5hrs. PT presents w/ obvious signs on hyperkalemia. What is 1st line IV med for this patient?
= usually for longer than 4 hours
= Closed soft tissue injury
= Sodium Bicarbonate
207
The skin is known collectively as the:
Skin, considered what of body & what % of total body weight:
Which layer of skin primarily insulates the body against heat loss?
Glands w/in the dermis that secrete a lubricant are called the:
Outermost layer of skin is the:
What part of the integumentary system receives no blood supply?
= Integumentary system
= Organ, 16% of total body weight
= Subcutaneous Layer
= Sebaceous glands
= Epidermis
= Epidermis
208
Sodium Bicarbonate is delivered PT's suspected w/ hyperkalemia at:
Dose of Calcium Chloride for hyperkalemia & line of med?
= 50 mEq as last line
= 500-1000 mg/3mins IV as 1st line med
209
Which type of wound has a small opening into the skin, but may be quite deep, and is often caused by instruments such as nails, ice picks, or pencils?
= Puncture
210
Which of the following best describes an avulsion?
Which of the following is considered an open wound?
Which soft tissue injury causes a greater amount of hemorrhage?
= Flap of skin partially/completely torn away from underlying tissue
= Laceration
= Avulsion
211
Thick, fibrous, inflexible membranes surrounding muscle that help bind muscle groups together are called:
Fascia
212
1Blunt non-penetrating injuries that crush/damage lil blood vessels:
2Contusion is considered what type of injury:
3Minor bleeding associated w/ cap/ wounds often continues b/c:
4A hematoma or collection of blood beneath the skin:
5PT sustained a blow to frontal region of his head & now has a large lump present at the point of impact. This lump referred to as:
1= Contusions
2= Closed soft tissue blunt injury
3= Capillaries cannot contract and thus continue to bleed
4= Is most commonly caused by injury to an artery
5= Hematoma
213
An injury in which the mechanism of injury tears the skin off the underlying muscle, tissue, blood vessels, and bone is called a(n):
Degloving injury
214
A rapid trauma assessment should be performed on:
Which of the following is true regarding soft-tissue injuries?
Impaled object may only be removed during what conditions?
= Any patient with a significant MOI
= Most open wounds require only simple care and limited suturing
= CPR is needed and impaled object interferes with chest compressions & The impaled object is causing an obstruction of the patient's airway
215
Afferent nerves:
Efferent nerves:
=sensory nerves “ahhh”
=motor “effect”
216
Thickest skin @:
Thinnest skin @:
= Palms & Soles have thickest skin
= eyelids 1st & genitalia 2nd
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(Soft tissue injuries)
= Risk factors: age (50-70kilos blood) (1yr old ⅓ of gatorade bottle), alcohol/ drug use, Occupation
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Layers of skin:
Epidermis, Dermis (papillary & Reticular Lvls), Subcutaneous
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Epidermis:
dead skin cells, no vasculature, astratum corneum, cells are pushed out & are replaced, Sebum (waxy oil lubes (hands), top layer of skin
220
Subcutaneous:
= adipose tissue, most thermal temp/ reg/, (regs cold>heat)
221
Dermis:
2 layers of dermis:
Papillary:
Reticular:
Sebaceous glands:
Sudoriferous Glands:
= Middle layer of skin
= papillary & Reticular layer
= contains the Glands, blood vessels, nerves "nipple, Nerves"
=contains the venules arterioles, capillaries "Reticular network circul/"
= sebum lubricate palms
= SNS n postsynaptic acetylcholine for response
222
Blood vessels:
Blood in venous system:
Most of vaso construction by:
= veins low pressure w/ valves, arteries no valves w/ lots tunica media
= ⅔ in venous system,
= Capillaries: most of vaso construction
223
1Lymphatic system:
2Lymph node:
3Spleen relation:
4Lymphatic pathway:
5Sign lymphatic system not working:
1= “body's garbage system” macrophages eats then system of channels to tissues 1 direction, no pump, dumps into a node
2= were garbage collects
3= Carries "trash" of pathogen destruction to nodes for macrophages
4= >Vessels> nodes> spleen> up to L/R subclavian vein, to kidneys
5= Gray poop
224
Tendons:
Ligaments:
Fasciae:
Tension lines/Langer lines:
= connects muscle to bone, strong, full of collagen "tend to bone"
= connects bone to bone aligning joints & easily tear
= band sheet of CT stabilizes, encloses, & separates M. compartments
= “way skin is grooved together”, cut against line hard to close & leaves bigger opening, effects healing process
225
Contusions:
Hematoma:
Severe hematomas to major compartments may contribute to:
= bruise made by ecchymosis: black & blue
= artery bleed, tamponades & helps hemostasis
= hypovolemia
226
Avulsion:
= separates & creates flap/chunk from skin (“chunk missing)
Tend to bleeds worst of cuts & more than complete amputation & Very prone to infection & can go to circulatory system > degloving
227
Lacerations:
= “jagged” Cuts deep into dermis ( Incisions, Punctures, perfuration)
228
Incisions:
= smooth Lac from sharp instrument (knife, razor, glass, ect) gapes open if against tension line, keeps close typically if cut w/ tension lines
229
Punctures:
Impaled:
= small entrance (ABDMN punctures can >evisceration)
= embedded objects
230
1Hemostasis:
2Inflammation:
3Epithelialization:
4Neovascular:
5 rebuild/ Collagen synthesis:
1= vaso/strict, platelet aggregate, coagulation fibrin (normothermic)
2= Granulocytes, macrophages & Lymphocytes eat, Mast cells released
3= “rebuild” epithelial cells go to wound making scab ~48Hrs after cut
4= new capillaries made (neo new) via previous cap/s +exchanging
5 = fibroblasts go to wound & synthesize collagen creating scar (w/ tension lines quicker/better), Too much synthetization makes Keloid
231
1phagocytosis:
2Granulocytes & macrophages w/ healing:
3Lymphocytes w/ healing:
4Mast cells w/ healing:
1= macrophage eats & grows bacteria flag to show what antibodies to make for cellular response
2= eat dead cells parts & bacteria
3= destroys bacteria & other pathogens
4= release histamine to make capillaries more permeable to bring more RBC
232
Stages of healing:
1= Hemostasis, Inflam/, Epithelialization, Neovasc/, Remodeling (Collagen synthesis) “Here I Enter New Remodel”
233
1Prehospital Infections:
2Infections cause, duration, severities, treatment:
3Risk factors:
1= sepsis, staph, strep, Lymphangitis, Tetanus, & Gangrene
2= Anaerobic bacterium, ~10% severe, 2-3 days pain tender warm, fight w/ steroids
3= diabetics, infirm, elderly, chronic diseases, steroids, animal/human bites,
234
Internal Hemorrhage being forced between tissue layers (fascia):
Internal Hemorrhage:
Pregnant internal hemorrhage worry:
Internal blood loss may be self limiting:
= Hematoma (pocket of blood) usally from arterie)
= Blood accumulation in interstitial spaces, forming visible contusions
= multiple uterine arteries in umbilical cord
= Large body cavities (chest, ABDMN, pelvis) have little resistance & internal blood loss may be severe.
235
1staph:
2Strep:
3Lymphangitis:
4Tetanus (Lockjaw):
5Gangrene:
6Wet Gangrene:
7Dry Gangrene:
1= staphylococcus Anaerobic bacterium infection
2= Streptococcus Anaerobic bacterium infection
3= red lines along lymph lines b/c infection
4= Clostridium tetani>Attacks NS produces toxin >M. contrac/spasms
5= Clostridum perfringen>(diabetes>risk) infection lacks blood supply/flow> less WBC
6= bacteria to tissue & swells then fluids outside of tissue
7= blood supply cut off and dry
236
Amputation treatment:
= direct pressure 2in above site , never submerge in ice, keep cool,
237
Heat gradient
H → L heat will go
238
Factors of burn severity:
Duration, Exposure, temp, surface
239
agent’s temperature relation to potential damage.
greater the agent’s temp, the greater its potential to cause damage.
240
Electricity follows path of
least resistance w/ entry & exit wound: Nerves & blood vessels
241
Lightning can still strike you if proximity up to:
up to 50yrds can strike you
242
Chemical burns:
biochemical makeup of cell membranes; destroy cells
243
Direct current (DC):
Alternating current (AC):
= electrons flow in one direction > grab on can’t let go
= reverses flow in short intervals (60 cycles change electrons'' flow) can let go
244
Lightning shock pathway to heart can & b/c:
= PSNS & SNS attach heart “defib w/o defibrillator” put in dysrhythmia or arrest
245
Alkalotic vs acidotic burns severity
Alkalotic burns > Acidotic burns
246
Chemical burns effect:
Denature biochemical makeup of cell membranes; destroy cells
247
(Rad) S/S of Exposure:
First sign:
Lethal Dose Exposure:
Organ shutdown:
= SLUDGEM PSNS S/S
= slight nausea & fatigue
= Emesis & malaise, Epistaxis, mouth, gums, & rectum (Vomiting usually lethal exposure
= Death
248
Geiger Counter:
Dosimeter:
= Radiation emission measured w/ Dosimeter
= Cumulative exposure recorded
249
1 Types of Radiation:
2 Radioactive Particles:
3 Alpha:
4 Beta:
5 Ionizing Rays:
6 Gamma:
7 X-Rays:
8 Atomic:
1= Radioactive Particles & Ionizing Rays
2= Alpha &Beta:
3= least worry & deflected w/ newspaper
4= flys further w/o skin penetration
5= Gamma & X-Rays
6= worst, several ft of concrete & lead
7= penetrates skin
8= nuclear reactor
250
(Radiation) Duration:
Distance:
Shielding:
= Radiation exposure accumulative danger
= Rad/ strength lessens quickly as distance from source increases
= More material between you & rad/ source, < exposure experienced
251
Light Burns:
Inhalation Burns:
Toxic inhalation:
Cyanide & carbon monoxide are released via:
= Intense light from arc welder, industrial laser (Ultraviolet keratitis)
= Inhaled gases, heated air, flames, steam; airway & resp/ injury
= Synthetic resins & plastics release toxic gases as they burn
= fake wood & such burning thus Toxic inhalation
252
Stridor w/ inhalation burns:
Bad Airway burns might might need:
= AKA “crowing” larynx last defense against heat then swells 2/3s so intubate asap bc only worsens (Press chest & follow bubbles)
= Might need to nasal endotracheal intubation w/ BAAM & Endotrol tube (ET w/ trigger) BAAM> High=inhale &Low=exhale
253
1 (Burn depth) 3rd degree:
2 feeling & appearance:
1= full thickness burn down to SCT may involve M. bone & organs
2= leather, looks Charred, dark brown or white, hard to touch "painless"
254
(Burn depth) Degrees:
= 1st/Superficial, 2nd/partial, 3rd/full/complete
255
(Burn depth) 1st degree:
= Epidermis only, red skin, pain & tender, NO blister(can lose temp/reg)
256
(Moderate criteria) Superficial:
Partial thickness burns:
Full thickness burns:
= BSA >50%
= BSA <30%
= BSA <10%
257
(Burn depth) 2nd degree:
= Partial, EPi & Dermis burned: intense pain, fluid shift comes up thus blisters, RED to WHITE, moist & mottled w/ shifts
258
(Critical Criteria) 3rd & 2nd Degree criteria:
Any 2nd or 3rd degree burns involving:
Burn types that're critical & Rx:
= 3rd>10% & 2nd>30%
= Face, Hands, Genitalia, Circumferential, Feet, (Dipping), Airway
= Chem, high voltage, Burns w/ major trauma go trauma center 1st then burn center
259
The following burn patterns is usually seen with child abuse:
"Stocking burns" to lower legs, Circumferential burns on buttocks, Multiple circular burns of the same size to the arms and legs
260
1 Resp/ arrest from electrical burn is a result of:
2 The “pressure” of the electric flow is known as:
3 PTs in cardiac arrest b/c electrical current have high survival rate if:
4 human body relation w/ current:
5 Electrical injuries' usually damage:
1= immobilization of M.s from prolong exposure to electrical current
2= Voltage
3= Prehospital intervention is prompt
4= Body offers resistance to the flow of electricity
5= does lots of damage to muscle tissue & other tissues
261
1 One of the chief functions of the skin is:
2 The skin is comprised of 3 layers:
3 Layer that serves as stratum of insulation vs trauma & heat loss is:
4 Layer that contains blood vessels, glands, & nerve endings is:
5 Full-thickness burns can involve injury to:
6 The integumentary system relation to NS:
1= Temp regulation
2= Epidermis, Dermis, & Subcutaneous Tissue
3= Subcutaneous Tissue
4= Dermis
5= blood vessels, nerves, M. T., bone, & sometimes internal organs.
6= is not part of the nervous system
262
Burn injuries should be assigned a higher priority when they affect:
You should increase the severity of a burn patient by 1Lvl w/:
= Pediatric PTs
= pediatric & elderly patients
263
The stage of the burn process characterized by catecholamine and pain-mediated reaction is called the:
Emergent Phase
264
Rad/ only sig/ hazard if inhaled/ingests contaminated material is:
Neutron radiation is:
= Alpha
= uncommon outside of nuclear power reactors & Bombs
265
1 Alkalis are commonly used as:
2 Acids burns:
3 Alkalis burns:
1= oven and drain cleaners, agricultural fertilizers, and in industry
2= form thick, insoluble mass where they contact T. via coagulation necrosis, limiting burn damage
3= continue destroy cell membranes via liquefaction necrosis, allowing them to penetrate underlying tissue & causing deeper burns
266
Beta radiation can travel and can penetrate
6 to 10 feet through air & a few layers of clothing.
267
Alpha rad/ strength, traveling distance, & penetration:
very weak energy source & travels only INs in air, cannot penetrate the epidermis & stopped by paper & clothing
268
Factors Affecting Exposure to Radiation:
Duration of exposure, Distance from source, Shielding from source
269
1 (PTs in severe pain w/ narcotic analgesia) morphine:
2 Fentanyl
3 Ketamine use:
1 = 2-5 mg IV increments every 5mins til' pain is relieved. Use w/ caution b/c it can depress resp/ drive & increase any existing hypovol/
2= start w/ loading dose 25-50mcg IV & repeat doses as needed
3= may be an alternative to fentanyl in selected patients.
270
2 cyanide antidote regimens are available:
Sodium nitrite dose :
Sodium thiosulfate dose:
= Pasadena cyanide kit (amyl nitrite, Na nitrite, & Na thiosulfate) & newer antidote Cyanokit (hydroxocobalamin)
= 300 mg sodium nitrite over 2 to 4 minutes for adults.
= administer 12.5 g of for the adult.
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Child Burn form:
(age#-1 from the head) / between 2 legs
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