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Flashcards in Trauma Patients Deck (171):
1

Bones

Hard, but flexible, living structures that provide support for the body and protection for vital organs

2

Axial Skeleton

Skull, sternum, ribs, spine

3

Appendicular Skeleton

Bones in the upper extremities (clavicles, scapula, arms, wrist, hands) & lower extremities (pelvis, thighs, legs, ankles, feet)

4

Periosteum

Strong, white, fibrous substance that covers bones

5

Mechanisms of musculoskeletal injury

Direct force, indirect force, or twisting/rotational force

6

Traction splint

A splint that applies constant pull along a lower extremity to help stabilized the fractured bone and reduce muscle spasm of the limbs

7

Comminuted fracture

A fracture where the bone is broken in several places

8

Greenstick fracture

An incomplete fracture

9

Angulated fracture

Fracture in which the bone segments are at an angle with each other

10

Dislocation

Disruption or "coming apart" of a joint (ligaments are stretched and torn beyond normal range of motion)

11

Sprain

Stretching & tearing of ligaments

12

Strain

Injury caused by overstretching and/or overexertion of the muscle

13

Closed extremity injury vs. Open extremity injury

Skin is not broken in closed extremity injury, skin is broken in open extremity injury (by injured bone or penetrating object)

14

Compartment Syndrome
(Treatment & Stages)

Injury caused when tissues such as blood vessels & nerves are constricted within a space as from swelling or tight dressing or cast. Treatment includes cold application and elevation of extremity after splinting.

Stages:
1. Fracture or injury causes bleeding and swelling within extremity
2. Pressure and swelling caused by the bleeding within the muscle compartment becomes so great that the body can no longer perfuse against the pressure
3. Cellular damage causes additional swelling
4. Blood flow to the area is lost. If not relieved, limb may be amputated

15

Crepitus

A grating sensation or sound when fractured bone ends rub together

16

The "Six Ps," Indicating Musculoskeletal Injury

1. Pain or tenderness
2. Pallor (Pale skin, poor cap refill)
3. Paresthesia (Pins & needles sensation)
4. Pulses diminished or absent (at injured extremity)
5. Paralysis
6. Pressure

17

Emergency Care for Musculoskeletal Injuries

1. Standard Precautions
2. Primary Assessment (Don't be distracted by gross injury)
3. Secondary Assessment (Trauma), Apply C-spine collar if injury suspected.
4. After life threatening conditions have been addressed, injured extremities can be realligned (when necessary) & splinted.
- Stable patient: Splint before transport
- Unstable patient: Immobilize on long spine board & splint specific injuries en route
5. If appropriate, cover open wounds with sterile dressing, elevate affected extremity, apply cold pack

18

Manual traction

The process of applying tension to straighten and realign a fractured limb before splinting. Should only be applied when limb is cyanotic and distal pulse is not present.

19

Anterior hip dislocation

The patient's entire limb is rotated outward and the hip is usually flexed

20

Posterior hip dislocation

Most common type; Patient's leg is rotated inward, the hip is flexed, and the knee is bent. Foot hangs loose, unable to flex. Often lack of sensation in limb is present, indicates nerve damage.

21

Hip fracture vs. Pelvic fracture

Hip fracture is a fracture of the proximal femur, pelvic fracture is a fracture of the pelvis

22

Kinetic Energy=

[Mass * (Velocity)^2]/2

23

Knee dislocation vs. Patella dislocation

Knee dislocation occurs when the tibia is forced anteriorly or posteriorly in relation to the femur. A patella dislocation occurs when lower leg and knee are dislocated.

24

Multiple trauma verus Multisystem trauma

Multiple trauma= more than one serious injury
Multisystem trauma= more than one injury that affects more than one body system

25

Unstable Patients, Anatomic Criteria

Penetrating injuries to head, neck, torso, extremities proximal to elbow/knee, Flail chest, Two or more proximal long bone fractures, Crushed, degloved, mangled extremity, Amputation proximal to wrist or ankle, Pelvic fractures, Open or depressed skull fracture, Paralysis

26

Criteria for Unstable Patients, Physiologic Criteria

Trauma patient has altered mental status (Glasgow Coma Scale less than 14), hypotension (systolic less than 90 mmHg), abnormally slow or fast RR= high priority (29), difficulty maintaining patient airway

27

Criteria for Unstable Patients, Mechanism of Injury

Falls greater than 20 feet for adults (two stories), Falls greater than 10 feet for children (2 to 3X height of child), High risk auto crash (>12 in. occupant site, >18 in. any site), Partial or complete ejection from vehicle, Death in same passenger compartment, Vehicle telemetry consistent w/ high risk injury, Auto v. pedestrian where ped. was thrown, run over, or >20 mph impact, Motorcycle crash >20 mph

28

Outside Presentation of Pneumuenothorax

Diminished or absent lung sounds on one side, Respiratory distress, Elevated pulse, Possible injury on that side of the chest

29

Presentation of Tension Pnemuenothorax

Absent lung sounds on one side, Distended neck veins, Altered mental status, Narrowing pulse pressure, Increased pulse and respirations, Possible injury penetrating to chest, Tracheal deviation (late sign)

30

Cardiac tamponade

Distended neck veins, Narrowing pulse pressure, Increased pulse and respirations, penetrating injury to the chest

31

Solid organ damage

Can bleed profusely and cause shock, Capsules around solid organs can delay bleeding and pain (& therefore diagnosis), Often sharp and in predictable patterns/locations

32

Hollow organ damage

Spilling contents of organs causes pain and widespread irritation

33

Special Patient Considerations, Triage guidelines

Older adults (>55), children (should be sent to pediatric trauma centers), Anticoagulation & bleeding disorders, Burns (w/out trauma to burn facility, w/ trauma to trauma center), Time sensitive extremity injury, End-stage renal disease requiring dialysis, Pregnancy >20 weeks, EMS provider judgment

34

Trauma Score

A system of evaluating patients according to a numerical scale to determine the severity of a patient's trauma.
Revised Trauma Score components: Glasgow Coma Scale, Systolic Blood Pressure, Respiratory Rate

35

Newton's Law

A body at rests tends to stay at rest, and a body in motion will remain in motion unless acted upon by some outside force

36

Three Impacts of Motor Vehicle Collision

Vehicle collision (w/ object)
Body collision (patient w/inside of car)
Organ collision (Organs w/ chest or abdomen wall)

37

Primary phase of blast

Pressure wave of the blast. The injuries associated with this phase are primarily the organs that contain gases, such as the lungs, intestines, stomach, and ears.

38

Secondary phase of blast

Flying debris is propelled by the force of the blast or blast wind. Patients have lacerations, impaled objects, burns, and/or fractures.

39

Tertiary phase of blast

Patients are thrown away from the force of the blast, with injuries occurring as the patients strike whatever is behind them. The severity of injury depends on the distance thrown and the point of impact

40

Level I Trauma Center

Regional trauma center. Can manage all types of trauma 24/7 (24 hours a day, 7 days a week).

41

Level II Trauma Center

Area trauma center. Can manage most traumas; has surgical capabilities 24/7; is capable of stabilizing specialized trauma patients for transfer to Level I centers.

42

Level III Trama Center

Community trauma center. Has some surgical capability and specialized trained staff to manage trauma. The main focus of these centers is stabilization and transfer to a higher level center.

43

Level IV Trauma Center

Trauma facility. Typically a small community hospital in a remote area capable of stabilizing and transferring the trauma patient to a higher level trauma center.

44

Arterial bleeding

Arterial bleeding is usually bright red because it is still rich in oxygen. Arterial bleeding is often rapid and profuse, spurting and pulsating with each heartbeat because of the high pressure in the arteries. Strength of spurting decreases as the patient's systolic blood pressure drops. It is the most difficult bleeding to control.

45

Venous bleeding

Venous bleeding is usually dark red or maroon because oxygen contained in the blood has already been passed to the cells, and cellular waste products have been absorbed into the blood. Bleeding from the veins usually has a steady flow and might be profuse, but it is typically easy to control because veins are under much lower pressure than the arteries.

Venous pressure might actually be lower than atmospheric pressure, which might cause large veins to suck in debris or air bubbles such as puncture wounds to the neck involving the jugular.

46

Capillary bleeding

Blood from the capillaries is usually somewhere between the bright red of arterial blood and the darker red of venous blood. Capillary bleeding is usually slow and "oozing" as a result of the small size and low pressure of capillary vessels. Most capillary bleeding is considered minor and is easily controlled. It often clots spontaneously or with minimal treatment.

47

Epistaxis

A nosebleed

48

Ecchymosis

Black & blue discoloration (bruise)

49

Central nervous system

Brain and the spinal cord

50

Cavitation

A cavity formed by a pressure wave resulting from the kinetic
energy of a bullet traveling through body tissue; also called
pathway expansion.

51

Dissipation of
energy

The way energy is transferred to the human body by the
forces acting upon it.

52

Drag

Factors that slow a projectile

53

Fragmentation

The breaking up of an object into smaller pieces on impact.

54

Profile

The size and shape of a projectile’s point of impact; the
greater the point of impact, the greater the injury.

55

Mechanism Of Injury (MOI)

The factors and forces that cause traumatic injury.

56

Vehicle collision

Vehicle strikes an object

57

Body collision

Patient strikes object/ inside of car

58

Organ collision

Organs strike abdominal wall/chest wall/skull wall/other organs

59

Frontal impact injury patterns (MVC)

1. Up-and-over: impact to head, neck, abdomen
2. Down-and-under: impact to pelvis, thighs, knees, spine
Injuries due to glass

60

Rear impact injury patterns (MVC)

Injury to the head, neck, chest and spine (more severe in unrestrained patients)
Injuries due to glass

61

Lateral impact injury patterns (MVC)

Impact to the head, shoulder, lateral chest, lateral abdomen, lateral pelvis, femur, spine.
Injuries due to glass

62

Rollover collision injury patters (MVC)

Many injuries, especially to the head, neck, chest, abdomen, spine
Injuries due to glass

63

Adult pedestrian injury patters (Auto v. Pedestrian)

Typically lower extremity injuries/ lateral injuries
If thrown on hood/windshield, experience head, back, chest, shoulder and abdomen injuries

64

Pediatric pedestrian injury patters (Auto v. Pedestrian)

Femur, pelvis, chest injuries
May be run over by vehicle
If thrown on hood/windshield, experience head, back, chest, shoulder and abdomen injuries

65

Seat belt injuries

If no shoulder belt: injury to head, neck, chest
If low lap belt: Dislocated hips
If high lap belt: Abdominal injury
Injuries to head, neck, spine (not caused by seatbelt, but occur)
If no lap belt: Neck vascular injury, head injury
abdominal injury, steering wheel impact

66

Airbag injuries

Injury to head, neck, chest, face

67

Head-on impact (motorcycle collision)

Rider hits the handle bars at the same speed as the motorcycle (leans forwards when rides).

68

Angular impact (motorcycle)

-The motorcycle strikes an object at an angle.
-The object impacts whatever body part it comes into contact with, usually breaking or collapsing on the patient.
-Hitting things such as fence posts, telephone poles, and signs are examples.
-Amputations, avulsions, and severe fractures usually result from this type of collision.

69

Ejection (motorcycle)

-The patient is ejected off the bike and then comes into contact with the ground, another vehicle, or any other objects in his/her path.

70

Indications for on-scene time of less than 10 min & rapid transport

-Difficulty maintaining patient airway
-RR29
-Inadeqaute tidal volume
-Hypoxa (SpO2 less than 95%)
-Respitory distress, failure, arrest
-Suspected skull fracture
-Flail chest
-Suspected pneumothorax, tension pneumothorax, hemothorax
-Pelvic fracture
-Two or more proximal long bone fractures
-Crushed/mangled extremity
-Uncontrollable external hemorrhage
-Suspected internal hemmorhage
-Signs and symptoms of shock
-Controlled external bleeding with severe amount of blood loss
-GCS 55 yrs, pregnant patients,
- Patients w/ hypothermia, burns
-Multisystem trauma
-Open/depressed skull fracture
-Suspected brain injury
-Paralysis

71

Abrasion

An open injury to the epidermis
caused by a scraping away, rubbing, or shearing away of the
tissue.

72

Air embolism

An air bubble that enters the bloodstream and obstructs a
blood vessel.

73

Amputation

An open injury caused by the ripping or tearing away of a limb,
body part, or organ.

74

Avulsion

An open injury characterized by a loose flap of skin and soft
tissue that has been torn loose or pulled off completely

75

Closed injury

Any injury in which there is no break in the continuity of the
skin.

76

Bandage

Any material used to secure a dressing in place.

77

Crush injury

An injury in which tissues are compressed by high-pressure
forces; the injury might be open or closed.

78

Dressing

A sterile covering for an open wound that aids in the control of
bleeding and prevention of further damage and contamination

79

Evisceration

Abdominal organ protrusion through an open wound in the
abdomen

80

Hematoma

A closed injury characterized by a mass of blood beneath the
epidermis.

81

Impaled object

An object embedded in an injury to the body.

82

Laceration

An open injury usually caused by forceful impact with a sharp
object and characterized by a wound with edges that might be linear (smooth and regular) or stellate (jagged and irregular) in
appearance.

83

Occlusive dressing

A dressing that forms an airtight seal over a wound.

84

Open injury

Any injury in which the skin is broken as a result of trauma.

85

Penetration/puncture

An open injury caused by a sharp, pointed object being
pushed into the soft tissues.

86

Controlling external bleeding (methods, order of preference)

1. Direct pressure (DP)
2. Elevation
3. Pressure points
4. Hemostatic agent + DP
5. Cold application + other techniques
6. Tourniquents
7. PASG

87

Care for Bleeding to the mouth

Dressing over the area of injury and applying pressure

88

Care for nosebleed

Ask the patient to lean forward, apply pressure over the nostrils, and place a cold pack (if available) over the bridge of the nose.

89

Bleeding from ears/nose

-Any bleeding noted from the ears or nose in the setting of trauma is considered to be a possible skull fracture until proved otherwise
-Place loose dressings over these areas to limit exposure and infection

90

Factors that increase bleeding

1. Movement
2. Low body temp (slower clotting factors)
3. Medications (Coumadin (warfarin), aspirin, ibuprofen, other NSAIDs)
4. IV fluids
5. Dressing/bandage removal

91

Indications & Contraindications for PASG

Indications:
-Pelvic fracture in patient w/ hypotension
-Controlling bleeding in lower extremities
-Can help control internal bleeding

Contraindications:
-Any patients with difficulty breathing
-Penetrating chest injury
-Eviscerating abdominal injury
-Pregnancy
-Cardiac arrest

92

Things to look for in the physical exam

-Deformities (like crush injuries, amputations, avulsions)
-Contusions
-Abrasions
-Punctures
-Bruises
-Tenderness
-Lacerations
-Swelling

93

Soft Tissue Injuries

-Abrasions
-Lacerations
-Avulsions
-Amputations
-Penetrations
-Crush injuries
-Contusions

94

Occlusive dressings

-Should be applied to any penetrating chest or neck injury to prevent air from entering the chest cavity or the large vessels in the neck
-Ensure that you secure three sides only—to allow air to escape during exhalation—otherwise, a tension pneumothorax might develop.

95

Care for abdominal injuries w/ evisceration

-Cover the organs with a moist dressing and then an occlusive dressing.
-If no spinal injury is suspected, ask the patient to bend and flex the knees to decrease tension in the abdominal muscles

96

Care for impaled objects

Impaled objects should never be removed on scene unless the object is lodged in the cheek and/or neck and is interfering with airway and ventilation

97

Care for amputations

-Flush gross contaminates from the wound using sterile water or saline
-Wrap the amputated part in a dry sterile dressing and then wrap or bag the amputated part in plastic
-Keep the amputated part cool by placing it in a cooler or suitable container
-To prevent freezing and damage to the body part, do not place the amputated part directly on ice

98

Care for large laceration to neck

-Apply nonporous dressing & tape all four sides

99

Care for avulsion

-Rinse wound to clean debris
-Apply dressing/bandage to keep avulsed tissue in place
-Splint extremity to limit movement

100

Care for amputation

Partial: Realign as close to normal as possible, apply sterile dressings
Complete: Clean debris, Control bleeding, apply dry sterile gauze dressing, wrap/bag amputated part in plastic, place on cold pack/ice.

101

Types of closed wounds

-Contusion
-Internal laceration/puncture
-Closed crush injury
-Injury of solid organ
-Injury of hollow organ

102

Fascia

-layer of fibrous membranes loosely attached to the skull
-Area is susceptible to being avulsed
-Collects blood between this fibrous membrane and skull, making it difficult to determine whether the skull is still intact

103

Meninges

Layers of tissue protecting the brain. They include the dura mater (outermost), the arachnoid (middle), and the pia mater (deepest).

104

Epidural hematoma

Bleeding between the dura mater and the skull
-Occurs when middle meningeal artery is torn (usually from linear skull fracture)

S&S:
-Loss of responsiveness followed by a return of responsiveness (lucid interval) and then rapidly deteriorating responsiveness
-decreasing mental status
-severe headache
-seizure
-Cushing reflex
-fixed and dilated pupils
-in some cases, flexion posturing (decorticate posturing) and extension posturing (decerebrate posturing)

105

Subarachnoid hemorrhage

Bleeding that occurs between the arachnoid membrane and the surface of the brain

106

Cerebrum

Largest part of the brain; responsible for most conscious and
sensory functions, the emotions, and personality.

107

Cerebellum

Part of the brain controlling equilibrium and muscle
coordination

108

Brainstem

The funnel-shaped inferior part of the brain that controls most automatic functions of the body; made up of the pons, the midbrain, and the medulla, which is the brain's connection to
the spinal cord
-RAS originates here

109

Battle's signs

Discoloration of the mastoid (skull behind ear) suggesting basilar skull fracture.
-Injury occurred 4-6 hrs earlier

110

Anterograde
amnesia

Inability to remember circumstances after an incident.

111

Concussion

Temporary loss of brain function; symptoms are confusion & headache, amnesia, irrational thinking, resistance to care, combativeness, restlessness, and nausea and vomiting

112

Consensual reflex

Same or similar reaction of the unstimulated pupil when the
other pupil is stimulated, as when a light is shined into one
pupil and both pupils contract.

113

Cushing reflex

A protective reflex by the body to maintain perfusion of the
brain in a head-injured patient with increased intracranial
pressure; systolic blood pressure increases, heart rate
decreases, and respiratory pattern changes.

114

Diplopia

Double vision

115

Extension posturing/Decerebrate posturing

A posture in which the patient arches the back and extends
the arms straight out parallel to the body; a sign of serious
head injury

116

Flexion/Decorticate posturing

A posture in which the patient arches the back and flexes the arms inward toward the chest; a sign of serious head injury

117

Herniation

In head trauma, a protrusion, or pushing, of a portion of the
brain through the cranial wall or tentorium, pushing into brainstem

S&S:
-dilated or sluggish pupil on one side
-weakness
-paralysis
-altered level of consciousness,
-posturing (decorticate or decerebrate)
-Cushing reflex
-abnormal ventilation patterns (Cheyne-Stokes or Biot's respirations)
-Glasgow Coma Scale (GCS) score decrease of 2 points or more from baseline

Treatment: PPV w/ BVM, controlled hyperventilation (20 per minute) --> if patient is not hypotensive

118

Raccoon sign

Discoloration of tissue around the eyes suggestive of basilar
skull injury.

119

Retrograde amnesia

Inability to remember circumstances before an incident.

120

Functions of frontal lobe (cerebrum)

-Controls voluntary muscle movement and contains motor areas such as the one for speech
-Center for personality, behavior, intellect, autonomic functions, and emotional responses.
-One per hemisphere of cerebrum

121

Functions of temporal lobe

-Side lobe
-Center for taste, hearing, smell, and interpretation of spoken language
-One per hemisphere of cerebrum

122

Functions of parietal lobe

-Middle lobe
-Coordinates and interprets sensory information from the opposite side of the body
-One per hemisphere of cerebrum

123

Functions of occipital lobe

-Posterior lobe
-Interprets visual stimuli
-One per hemisphere of cerebrum

124

Diencephalon

Part of brain that contains thalamus & hypothalamus

125

S&S of contusion to brain

Altered mental status ranging to unconsciousness, unequal pupils, paralysis, profound personality changes, and Cushing's reflex.

126

Subdural hematoma

-Bleeding b/w dura mater & arachnoid mater
-Commonly occurs in elderly patients, patients on anticoagulants, and alcoholics
-S&S: Headache, change in personality, confusion, weakness, paralysis, vomiting, unequal pupils, Cushing’s reflex, and seizure

127

Conditions that worsen head injury & treatments

- Hypoxia & Hypercarbia (give O2>95%)
- Hypoglycemia: Administer glucose if awake w/ gag reflex, if not administer O2/PPV & contact ALS
- Hyperglycemia: Recovery position/position of comfort, adminiser O2 or PPV & contact ALS
- Hypotension: Administer 15lpm NRB O2/PPV, maintain body temp, contact ALS

128

Diffuse axonal injury

An acceleration/deceleration injury that causes contusion or concussion to the brain
-Produce rotational forces that affect brain--> axon damage occurs

129

Anterior chamber

The front chamber of the eye containing the aqueous humor (nourishes the lens and cornea, replaced frequently).

130

Conjunctiva

The thin covering of the inner eyelids and exposed portion of the sclera of the eye

131

Cornea

The clear front portion of the eye that covers the pupil and the iris.

132

Globe

Eyeball

133

Iris

The colored portion of the eye that surrounds the pupil.

134

Mandible

The lower movable portion of the jaw.

135

Maxilla

The fixed upper portion of the jaw.

136

Orbits

The bony structures that surround the eyes; the eye sockets.

137

Pupil

The dark center of the eye; the opening that expands or contracts to allow more or less light into the eye.

138

Sclera

The outer coating of the eye; the exposed portion is "the white of the eye"
-Covers the entire eyeball except the cornea, gives the eyeball its shape, and protects its inner parts

139

Posterior chamber

The back chamber of the eye containing the vitreous humor (a jellylike substance helps hold the retina in place so we can see images clearly, produced early in life).

140

Common injuries to the eye

1. Abrasion to the cornea
2. Fracture of the orbit (Can result in diplopia, decrease in vision, loss of sensation above the eyebrow or lip, tenderness to palpation, or paralysis of upper gaze in the involved eye)
3. Injuries to the eyelid (ie contusions, lacerations)
4. Trauma to the globe
5. Chemical burns
6. Conjunctivitis

141

S&S of neck injury

edema, contusions, hematoma, difficulty speaking or a change in voice, subcutaneous emphysema in the neck, crepitation heard during speaking (which indicates air leaking from an injured larynx), and trachea displacement (which can also indicate severe chest injury).

142

Cardiac contusion

A bruise to the heart wall caused by severe blunt trauma to the
chest when the heart is violently compressed between the
sternum and the spinal column.

143

Commotio cordis

Sudden cardiac arrest caused by a projectile, such as a baseball, striking the anterior chest.

144

Flail segment

Two or more adjacent ribs that are fractured in two or more
places and thus move independently from the rest of the rib
cage.

145

Hemoptysis

Coughing up blood or blood-stained sputum.

146

Hemothorax

Blood in the pleural space, causing collapse of the lung.

147

Open pneumothorax

An open wound to the chest that allows air to enter the pleural
space and cause lung collapse.

148

Paradoxical
movement

A section of the chest that moves in the opposite direction to
the rest of the chest during the phases of respiration; typically
seen with a flail segment.

149

Pericardial
tamponade

Blood or fluid filling the fibrous sac around the heart, causing
compression of the heart and decreasing the ability of the
ventricles to fill and eject blood effectively.

150

Pneumothorax

Air in the pleural space causing lung collapse

151

Pulmonary
contusion

Bleeding within the lung tissue that causes a disturbance in
gas exchange between the alveoli and capillaries.

152

Sucking chest wound

An open wound to the chest that permits air to enter the
thoracic cavity.

153

Tension
pneumothorax

A condition in which the buildup of air and pressure in a hemothorax associated with an injured lung is so severe that it begins to shift to the uninjured side, resulting in compression
of the heart, large vessels, and the uninjured lung.

154

Traumatic asphyxia

A severe and sudden compression of the thorax that causes a
rapid increase in pressure in the chest that affects blood flow,
ventilation, and oxygenation.

155

Visceral pleura

Covers the outer surface of the lung (inner pleural layer)

156

Parietal pleura

Covers the internal chest wall (outer pleural layer)

157

Spontaneous pneumothorax

Might occur in patients with respiratory disorders such as emphysema

158

Pulmonary contusion

Contusion (bruise) of the lung, caused by chest trauma. As a result of damage to capillaries, blood and other fluids accumulate in the lung tissue. The excess fluid interferes with gas exchange, potentially leading to inadequate oxygen levels.

159

Signs & Symptoms of Pneumothorax

-anxiety/apprehension
-difficult breathing with increased respiratory distress
-dyspnea
-tachypnea
-decreased or absent breath sounds on the side injured
-cyanosis
-tachycardia
-unequal movement of the chest wall (the injured side is hyperinflated and does not move equally with the uninjured side)
-If positive pressure is being applied, compliance might become poor (increased difficulty in ventilating the patient via BVM)
-pulse that weakens with inspiration
-Late signs of a pneumothorax include jugular vein distention (JVD) and tracheal deviation

160

Signs & Symptoms of Hemothorax

-Coughing up blood or blood-stained sputum (hemoptysis)
-Extensive bleeding
-Shock

161

S&S of Traumatic asphyxia

-bluish or purplish discoloration to the face, neck, head, and shoulders
-JVD
-bloodshot eyes protruding through the socket
-cyanotic tongue and lips
-bleeding in the conjunctiva

162

S&S of cardiac tamponade

-Same as pneumothorax, but lungs sounds are clear and equal
-muffled heart sounds
-JVD
-narrowing pulse pressure
-weak pulse
-hypotension

163

S&S of cardiac contusion

-redness
-swelling
-crepitation
-tachycardia
-irregular pulse
-Sometimes--> Cardiac arrest, which causes ventricular fibrillation and sudden death

164

S&S of aortic injury

-tearing pain in chest radiating down back
-differences in pulses or bp in right and left extremities or b/w arms and legs
-palpable pulsating masses
-cardiac arrest

165

Kehr Sign

Shoulder pain referred from the diaphragm when it is irritated by blood within the abdominal cavity.

166

S&S of internal bleeding

-Injuries to the surface of the body
-Bruising, swelling, or pain over vital organs
-Painful, swollen, or deformed extremities
-Bleeding from the mouth, rectum, vagina, or other orifice
-A tender, rigid, or distended abdomen
-Vomiting a coffee-ground type substance or bright red blood in the vomitus
-Dark, tarry stools, or bright red stools
-Signs & symptoms of shock

167

Rule of Nines (Adults & Children)

Adults:
- Head & neck is 9% BSA
- Anterior trunk is 18%
- Posterior trunk is 18%
- Each upper extremity is 9%
- Each lower extremity is 18%
- External genitalia is 1%

Children:
- Head & neck is 18% BSA
- Anterior trunk is 18%
- Posterior trunk is 18%
- Each upper extremity is 9%
- Each lower extremity is 14%
- External genitalia is 1%

NOTE: 1% BSA = Patient's hand, closed fingers

168

Critical burns in adults

- Any burn complicated by respiratory tract injury or other accompanying major trauma injury
- Full or partial thickness burns on face, eyes, ears, hands, feet, genitalia, respiratory tract, major joints
- Full thickness covering more than 10% BSA
- Partial thickness covering 25% or more in adults 50
- Burn injuries complicated by suspected fracture to extremity
- Any burn that encircles a body part (arm, leg, chest)
- Any burn classified as moderate in adult younger than 55 is considered critical in adult older than 55

169

Moderate burns in adults

- Full thickness burns with 2-10% BSA involvement, excluding hands, feet, genitalia, respiratory tract
-Partial thickness burns with 15-25% BSA involvement
- Partial thickness burns of 20% or more in adults 50


NOTE: Any burn classified as moderate in adult younger than 55 is considered critical in adult older than 55

170

Minor burns

- Full thickness involving less than 2% BSA
- Partial thickness burns less than 15% BSA
- Superficial burns less than 50% BSA

171

Critical burns in children

- Any burn complicated by respiratory tract injury or other accompanying major trauma injury
- Full, partial thickness, or superficial burns on face, eyes, ears, hands, feet, genitalia, respiratory tract
- Full thickness burns with 2% or greater BSA involvement (not including sensitive areas)
- Any partial thickness burn greater than 15-20% BSA
- Burn injuries complicated by suspected fracture to extremity
- Any burn that encircles a body part (arm, leg, chest)