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Flashcards in trauma-ppt Deck (88):
1

ppts what is trauma

Trauma is an injury to human tissues and organ s resulting from the transfer of energy from the environment

2

what causes injury

Injuries are caused by some form of energy that is beyond the body’s resilience to tolerate *

3

what does the trimodal distribution of trauma pt deaths look like
% of who dies when

50% in first hr (often on scene)
25% in first 4hrs (often in emerg)
25% in the weeks 1-5 after initial injury (often in ICU)

4

common causes of death in first hr after trauma

hemmorhage
shock
...

5

common causes of death in first 4hrs after trauma

hypovolemia
airway obstruction (generally d/t unconscious pt)

6

common cause of death in 1-5wks after trauma

Die from infection, multiple organ dysfx syndrome (from being ischemic, anaerobic metb)

7

what is the definitive treatment of multiple trauma pts

surgery

8

when are diagnostics a priority of pt care

when they give useful info for Tx

9

how do you calculate the impact force

Impact Force = weight x speed
eg weight of car x speed in km you were going

10

falls > than __ft can be fatal
why?

12 ft
risk of traumatic dissection of thoracic aorta

11

acceleration/deceleration injuries are a form of what type of force

blunt

12

what is a risk if going >50km/h in a vehicle and crashing or stopping abruptly

-when the heart goes forward it creates shearing forces, primarily above the heart, shears on aorta. The heart also bounces back. The aorta has multi layers and they can come apart.
-MVA >50km/h have high risk of shearing aortic dissection

13

what kind of injuries or organs might be caused by sudden accel/decel

-damage to liver, heart, aorta, head injury
-the liver and heart are heavy and htey move in the body cavity more

14

why can blunt force trauma often go without being properly treated

blunt forces often have no visible, outer evidence of injury

15

what are the forms of energy that can cause injury

what is another biomechanism of energy that causes cellular damage

Energy
Mechanical
Thermal
Chemical
Electrical
Radiant

-hypoxia

16

if a pt was in a car accident what kind of injuries from compression might they sustain?
what reaction might the person have in this situation and what organs could it affect?

The lap belt comes up around abdm and can pop bowel up through diaphragm
people tend to hold their breath and clamp their glottis shut, this creates a seal on the lungs and can contribute to a pneumothorax when suddenly compressed

17

what structures do rotational injuries often occur to

limbs generally also head/neck/spine, trunk

18

when a structure is rotated although it might not break or show external signs of damage what might happen and why is this dangerous

the internal strs are damged-->inflm or the damage doesnt allow perfusion-->hypoxia

19

what causes more damage to the structures around it, a sharp or dull penetrating object

dull as it pulls the tissues surrounding it

20

when are penetrating accidents often missed

when the object that entered the person was thin and fine

21

are bullet wounds generally in a straight line

no, theyre designed to spin within the person

22

what basic questions should you ask yourself about your trauma pt and their accident

how much energy, what kind of injury, what organs affected

23

why might some trauma pts not show their injury until many hours after

Sympathetic system will activate. Alpha adrenergic receptors—triage body organs and send blood to most important organs (heart, brain). A lot of your organs dont have blood going to them, youre not hypovolemic although you might present with cold hands etc

24

if your pt has a skull laceration that is barely bleeding should you be worried

yes, this means they had a lot of force to their head and their brain might have been affected or inflm might follow

25

your pt has a compound bone fx and a laceration thats exposed. What do you do?

cover it quickly to prevent infection but dont dress and clean it carefully until pt stable

26

what is a comminuted fx

a bone that has been broken in many places

27

what is a basal skull fx and what kind of pts might present with this

-a fracture to the base of the skull (includes hard palate of the mouth, the middle fossa is around cheeks, posterior fossa is at back of head)
Often assoc w facial trauma or people falling and hitting the back of their head on the sidewalk

28

what is danger with injury to dura mater

WBCs or RBCS or worse entering the arachnoid space

29

if pt had anterior fossa basal skull fx what part of the craniums 3 components might leak and give you a clue as to the location of their injury

the CSF might leak into subcut tissue of the eyes and give them racoon eyes awhile after
CSF might leak out their nose

30

what does CSF do that water wont on a pillow
what might CSF test positive for that water wont

halo
put ina dipstick and it might be positive for glucose
pt might report sweet taste in their mouth if it got in there

31

pt has middle basal fx what sign might you see

mastoid sign (bruising behind ear on mstoid process) i think also called battle sign

32

your pt has a facial injury can you rule out spinal injury

no

33

your pt has a head injury can you rule out spinal injury

no

facial head or c spine injury you must rule out first before taking off spinal precautions

34

which two parts of the spine are most vulnerable to injury or commonly injured

lumbosacral junction and c spine

35

what is an unstable spinal cord injury

torn posterior ligament

36

why do drs inset their fingers into pts rectum in admitting emergent assessment

the final dermatome in the body terminates there. If the pt still has the motor and sensation for rectal tone then they have a chance of recovery from spinal injury

if they have no rectal tone and this persists for >24h the chance of recovery is

37

C_ innervates the diaphragm with the ____ nerve

C5 phrenic nerv

38

what is the only definitive way to rule out spine injury
only real tx for spinal injury

CT scan--could also run hands down spine and next to it and see if pt has pain but this is informal
Sx

39

why are lungs so vulnerable to trauma and how is a pneumothorax corrected

-friable, soft, very elastic and always wanting to reoil. they rely on negative pressure to keep them exanded.
a chest tube re-establishes the vacuum in the pleural space

40

what is a tension pneumothorax and what specific mnfts might you see

Sometimes an alveoli will rupture and it creates a valve. It will tear the visceral pleura which wil alllow air to escape into pleural space with each inhalation. The pressure will inc until it shifts the heart over, shifts trachea, and the other lung will collapse. This is tension pneumothorax.
mnfts:The pt will look worse every breath, inequal chest expansion, may have tracheal shift

41

what other injury to chest can cuase tension pneumo

penetrating

42

what complications can result from broken ribs

pt tends to hypoventilate and is at risk of atelectasis pneumonia

43

flail chest is

ribs broken in multiple places
In this case the ribs arent moving in a concentric form anymore. Paradoxical movement of the chest. Youll feel a segment moving in the opposite direction

44

Normal p02 is ___% on ROOM AIR ONLY

80-100%

45

pts chest tube detaches what do you do

dont clamp it as this can give them a pneumo
put end in a bottle of sterile NS

46

what injuries or risks are assoc w solid organs vs hollow organs

If you perforate solid organs you bleed. If you perforate hollow organs you get sepsis

47

why might abdm bleeding be hard to detect

Under lower ribs are liver and spleen. Organs that are dense and blood filled. Theyre located in a capsule, they can bleed in there. These are very painful injuries as the capsule fills

48

how can you detect a retroperitoneal injury

percuss the costovertebral angle

49

how to treat an orthopedic injury

rest ice compression elevation

50

qualities of first degree burn

1o - Superficial
Dry, red, blanches
Painful

51

qualities of 2nd degree burn

2o – partial thickness
Red, moist, blisters
Painful

52

qualities of 3rd degree burn

3o – full thickness
Dry, no blanching
painless

53

what makes up the volume of the cranium

Volume of intracranium=V of blood (10%)+V CSF (10%) + V brain (80%)

54

what is normal intracranial pressure

10mmHg pressure

55

wht is the first thing in cranium to be reduced in inc ICP

CSF is displaced. the arachnoid villi are always making CSF and it slows down production and inc reabsorption and shunts it down the spinal canal.

56

what component of the cranium is altered second in compensation of IICP

Pt also vasoconstricts...to dec amount of blood in/around cranium

57

inc ICP how are resps affected in early stages

carbon dioxide is very potent cerebral vasodilator. The less C02 you have the more vasoconstriction. IF pt is hyperventilating they will dec the amount of C02

58

pt has inc ICP what symptoms might they report and what else might you see

horrible headache-from mech of injury as well
vomit center is stimulated early--this inc ICP too so dont want this

59

what are terms to describe compensation and not in ICP.
what happens between these places (s/s)

spatial compensation and spatial exhaustion
-inappropriate-->alt consciousness-->sensory changes-->pupil changes

pressure on more advanced outer parts of brain?? PFC? pt becomes inappropriate/behavioural changes

-brain/brainstem gets caught on the foramen magnum the RAS will have circ caught off-->The GCS will change.
Next within the brain stem is the sensory and motor fibres. Youll see unilateral sensory changes (which you cant assess) but you can assess motor functions eg ask them to lift arms, painful stimulus.

-The cranial nerves, 1 &2 cant be assessed. 3 is pupil changes gen one will dilate

60

what part of the brain is affected that leads to VS changes in ICP what ICpressure is this around

circulatory centre, hypothalamus
around 40mmHg

61

what is ___ triad r/t ICP

Irregular respirations (caused by impaired brainstem function) Bradycardia. Systolic hypertension (Widening Pulse Pressure)

62

what do you try to address when treating IICP

what is the ultimate goal

Almost all Tx should focus on dec oxygen demand and inc oxygen supply.
want sx to remove clot (or maybe remove P if another cause??)

63

how to manage ICP with meds. what are they addressing?
what are the names or classes that address the limited amount of space

lasix
mannitol or 20% osmitrol
hypertonic saline sometimes
all of these dec brain water

carbonic anhydrase inhibitor-CSF
and vasoconstricotrs-blood

64

what other meds beyond treating the ICP do you give that prevents symptoms from worseinging the problem

sedatives
anxiolytics
might put in barbituate coma
pain control --i imagine you have to be careful not to cause vasodilation here?
antiemetics

65

beyond meds what do you do for inc ICP

dec stimulation--dark environment
might intubate and hypervntilate them to cause vasoonstriction. dont ant Pc02 below 33 as normal is 35-45

66

pt is victim of multi trauma and has bleeds and inc ICP is lasix a good idea

lasix-->diuresis which helps dec ICP but if theyre having circulation problem the pros and cons must be weighed

67

what is mannitol and when should mannitol not be used

20% osmitrol is a high molecular weight sugar. When pt is hyperglycemic they pee d/t the high osmotic pull. After 5min lg volume. In order for the mannitol to work the cap membranes must be intact. With inflm the pt must not have inc cap permb. Only give mannitol within first 12hr as if after it moves into interstitial space and takes water with it

68

giving which drug interferes with synthesis of CSF

a carbonic anhydrase inhibitor CAI-eg diamox

69

what is the ICpressure during spatial exhaustion

20-40mmHG

70

how do you address chemical burn

flush with copious amounts of water immediately

71

what does a first degree superficial burn look like

1o - Superficial
Dry, red, blanches
Painful

72

what does second degree burn look like
aka

2o – partial thickness
Red, moist, blisters
Painful

73

3rd degree burn characteristics
aka

3o – full thickness
Dry, no blanching
painless

74

how is nervous system affected by burn

pain

75

resp effects of burn

-airway obstruction

CO poisoning

pulmonary edema

hypoventilation

76

cardiovascular complications from burn


hypovolemia

77

Gastrointestinal
complications from burn



paralytic ileus

GI bleed

electrolyte imbalance

78

why is it essential to know amount of body burnt

to det fluid resuscitation parameters

79

what is the best indicator of cardiac output in a burn pt

urine ouput

80

what is the timeframe of % of fluids lost after a burn

50 % in first 8 hours post burn
50% over next 16 hours

81

how do you calculate how much fluids someone will lose from burn

2-4 ml/kg/% of total body surface area burned (>2nd degree)
2 x 60 kg pt x 40% burn = 4800 ml in 24 hours = 2400 in first 8 hours = 400 ml/ hour x 8 hours

82

how might the kidnys be affected by burn

Renal
rhabdomyolysis
shock

83

possible problems from burn to MS system

Musculoskeletal

limb loss

wounds infection

84

what is the problem with circumferential burn

Circumferential deep full thickness burns of an extremity or around the chest or abdomen should be carefully monitored. Oedema and swelling in the tissue deep to the burn cause the unyielding overlying burnt skin ('eschar') to act like a tourniquet. In a limb this will result in interference with distal blood flow.

85

what is silver sulfadiazine

anti-infetive used for burn pts

86

how is coagulation affected for burn pt

hypercoagulable

from loss of fluids?? from SNS and inc coagulabilty there?

87

what are special issues with a burn

Continues to burn
Rapid & excessive inflammation
Very painful
Start volume replacement from time of burn

88

what is curlings ulcer

gastric or duodenal erosion

(Stress Ulcer) or a Curling ulcer is an acute gastritis erosion. complication from severe burns when reduced plasma volume leads to ischemia and cell necrosis (sloughing) of the gastric mucosa.