1355 Exam Flashcards
If a patient is complaining of pelvic pain, pelvic injury is suspected, or pelvic injury is present, do not:
Palpate the pelvis and be very careful.
____ is a tearing of a joint capsule of connective tissues, specifically a ligament or ligaments. Injury causes acute pain followed shortly by inflammation and swelling.
Sprain
____: minor and incomplete tear, painful and swelling is minimal.
Grade 1 Sprain
____: significant but incomplete tear. Swelling and pain moderate to severe.
Grade 2 sprain
____: complete ligament tear. Severe pain and spasm.
Grade 3 sprain
____: occur when muscle fibers are overstretched by forces that exceed the fiber strength. Occurs during extreme muscle stress, heavy lifting, or sprints.
Strains
____: is a complicated process that ultimately disrupts the continuity of a bone.
Fracture
Stable fracture. small crack that doesn’t disrupt the total structure
hairline fracture
stable fracture. impact on itself resulting in a compressed but aligned bone
impacted fracture
unstable fracture, a complete break in a bone that runs straight across at about 90 degree angle
Transverse fracture
Unstable fracture. runs at angle across the bone.
Oblique fracture
Unstable fracture. Is several small fragments of bone caused by high velocity bullet or crush injury.
Communicated fracture
Fracture involving a twisting motion that may result in a curved break around the bone.
Spiral fracture
Stable. prolonged or repeated stress.
Fatigue fracture (stress fracture.)
Pediatric fracture. Is like a bent green twig and only disrupts on the side of the long bone.
Greenstick fracture.
Plantar fasciitis, inflammation that can be caused by excessive walking, is called:
Nontraumatic inflammation.
If a patient has a Carotid pulse, the corresponding BP is at least:
60 palp
If a patient has a femoral pulse, the corresponding BP is at least:
70 palp
If a patient has a radial pulse, the corresponding BP is at least:
80 palp
Head injuries require re-evaluation of vital signs every:
5 mintues
What are signs of Cushing’s syndrome for head trauma patients? occurs as a result of increased ICP.
Hypertension, bradycardia, irregular respirations. (also known as Cushing triad)
What is the #1 concern for burn patients?
Airway
Why is the airway the greatest cause of concern for pediatric burn patients?
The airway is the last thing to develop (narrow glottic opening).
What is the most lethal aspect of geriatric burns?
skin
Stabbing, or being shot with an arrow, is an example of _____ penetrating trauma.
low energy
Gun shot (pistol) is an example of ____ penetrating trauma.
medium energy
Gun shot (rifle) is an example of _____ penetrating trauma.
high energy
____: is an open wound that penetrates more deeply into the dermis than an abrasion. Tends to involve smaller surface area being limited to the tissue around the penetration.
Laceration.
______: is a type of laceration that involves a small entrance wound with damage that extends into the body’s interior. It carries an increased danger of infection.
Puncture wound
______: when an injury involves a larger blood vessel, most commonly an artery, blood can separate tissue and pool in a pocket. Blood trapped in a pocket usually caused by blunt force.
Hematoma.
What is a sucking chest wound caused by and how is it managed?
Sucking chest wound is an open pneumothorax. Treat with 3 sided dressing. This allows air to escape and supply O2. Do this when the patient has open PTX and is in respiratory distress. Chest wall may make audible sucking sounds.
How often to ventilate an unconscious person?
every 6 seconds.
What is Beck’s triad?
muffled heart sounds, JVD, and narrowing pulse pressure.
What are the signs and symptoms of pericardial tamponade?
Becks Triad (muffled heart sounds, JVD, and narrowing pulse pressure)
Liver failure, right sided heart failure, tension pneumothorax, diaphragmatic rupture, or cardiac tamponade can all cause:
JVD
What happens as a result of diaphragmatic rupture?
Air will go straight into the abdominal wall and create JVD.
What is the pneumonic for treating basic sprains and strains?
ABC, RICE (rest, immobilization, cold pack, elevation.)
How are fractures treated?
Pulse check, immobilize, re-check pulse, and treat pain.
______: hitting someone on the top of the head and all force goes to the feet.
axial loading
Where does axial loading usually cause injuries?
Compression injuries to the spine between t12 and L2
Quadriplegics have the phrenic nerve controlling the ____ and the ____.
diaphragm and bladder.
What is a common complication with quadriplegics?
Incontinence. (person will most likely have a Foley catheter)
What are the major signs of neurogenic shock?
irregular breathing and vasodilation.
Where is the Le Fort fracture 1 location?
Horizontal; alveolar ridge (mustache)
Where is the Le Fort fracture 2 location?
Pyramidal; nasofrontal suture (Tip of the nose)
Where is the Le Fort Fracture 3 location?
horizontal; craniofacial dislocation (Lower eye orbit.)
What is the #1 concern for penetrating trauma to the face or neck?
airway compromise
____ is the best treatment for a conscious/talking patient with penetrating trauma.
Rapid transport.
Superficial burn is also known as
first degree
partial thickness burn is also known as
second degree
full thickness burn is also known as
third degree
How is a burn treated?
sterile, dry dressing
When dealing with an injured football player, what is the rule for removing helmet and pad?
Either leave it all on or take it all off.
If it is decided to leave the motorcycle helmet on, then pad ______
under the shoulders
For pediatric traumas involving need for immobilization:
pad under the shoulders
What dressing is used to treat a sucking chest wound?
occlusive dressing.
Sucking chest wounds, tension pneumothorax, and arterial bleeding all get:
treated immediately upon discovery during the rapid trauma assessment due to their life threats.
What is the most common wound with motorcycle injuries?
abrasions
Electrical burns have a tendency to enter the ____ and go out of the ____.
right hand; right or left foot.
When evaluating an electrical burn, the entry and exit points must be identified in order that:
everything in-between can be treated.
What are electrical burns considered a critical call?
they can burn the entire cardiovascular system.
How many cervical spine are there?
7
How many thoracic spine are there?
12
How many lumbar spine are there?
5
How many sacral vertebrae are there?
5
How many coccyx vertebrae are there?
4, all fused together.
How much does the head usually weigh?
16-22 lbs.
_____: is caused by blunt trauma to the brain tissue that produces capillary bleeding into the brain. (focal injury)
Cerebral contusion
____: is not the same as a contusion because it is a diffuse axonal injury and represents nerve dysfunction without substantial anatomic damage.
Concussion.
What is the different between concussion and contusion?
Concussion is a diffuse injury and contusion is a focal injury.
What is the most important intervention for trauma patients?
rapid transport to a trauma center
How is spinal shock managed?
Manage the C-spine. Intubate if there is no equal chest rise and fall.
When someone has multiple injuries, always
treat the life threat first
Order or controlling bleeding for limbs:
Direct pressure then tourniquet
____ Blast injuries: shockwave damage hallow organs ear drums tension pneumothorax etc
Primary
_____ blast injuries. Shrapnel phase. (lacerations, bleeding, etc)
secondary
_____ blast injuries. Building collapses fall on top of you causing head and neck injury
tertiary
_____ blast injuries. Radioactive or dirty bomb chemical fall out.
quaternary
What is the medical term for coughing up blood?
Hemoptysis
How is non traumatic back pain treated?
position of comfort
How is traumatic back pain treated?
c-spine and back board
With this injury, first you stop the bleeding and control the life threat.
Amputation
When transporting an amputated limb, place it ____
in cool water or ice water but never directly on ice
What parts of the ear are typically damaged by the blast wave?
inner/middle ear
Blunt trauma can also cause ear
rupture
What is another significant life threat for burn patients?
inhalation of toxic gases
The biggest reason for death of burn patients is:
the inhalation of toxic gases
When would you likely see bilateral tension pneumothorax?
blast injury
Abdominal injuries are mostly caused by ____
penetrating injuries (stabbings and shootings)
What do capillary sphincters do during compensated shock?
Close and do not allow any blood in the capillaries in order to shunt blood to the brain. This delays cap refill and restricts peripheral perfusion.
In decompensated shock, the systolic falls and the diastolic remains high. What does this mean for the capillary sphinters?
Precapillary sphincter is ope and post capillary sphincter is closed.
What is the job of the post capillary sphincters?
Open to let trash/acid out.
What are the status of the capillary sphincters during compensated shock?
both pre and post are shut.
Why do geriatrics have a harder time recovering from burns?
Lost collagen and weakened immune systems
What type of burns have the highest mortality rate in pediatrics?
Airway burns
What is the fluid rate for trauma patients?
20ml/kg
What is the fluid rate for pediatric trauma patients under 1 month?
10ml/kg
What is the orthostatic/tilt test?
Take BP and HR laying flat on bed. Sit up or stand up and retake BP and HR after one minute. If the HR goes up more than 10 or the BP goes down more than 10 systolic that is a positive finding.
What is the treatment for a positive orthostatic/tilt test?
fluid
What is the goal in hemorrhagic shock?
maintain preload
What treatment will have the greatest effect in treating a soft tissue injury?
Direct pressure.
What is considered hypotension?
90/50 or less.
What is the problem with profound hypotension?
unable to perfuse vital organs adequately.
Trauma patients need help conserving ____ or they can become hypothermic.
body heat
If HR drops in a patient who you are prepping for intubation, what does this indicate?
Spent too long intubated. Patient needs to be reoxygenated prior to intubation
What is a fluid bolus for an adult?
20ml/kg given 250-500cc at a time
What is the goal with fluid administration for a patient in decompensated shock?
maintain BP
What is the goal of fluid administration with a patient in uncontrolled hemorrhagic shock?
bp of 80/radial pulse
What is the goal of fluid administration with a patient in controlled hemorrhagic shock?
90
What is it called with blood sits in the capillaries and forms a clot? (pre capillary sphincter closed and bled back into capillaries)
Capillary stagnation
XABCDE and rapid transport is used for:
multi-system trauma
_____ goes on the legs and abdomen used for air spine for pelvic ring fracture only.
Mass pant anti shock pants
What is solid organ somatic pain?
constant pain because of blood
What is an indication of hollow organ/visceral pain
comes and goes after eating fatty, greasy foods.
What is the biggest problem organ in the RUQ?
liver due to blood.
this organ is hallow and can cause sepsis in 3-7 days.
gallbladder
What is the blood organ in the LUQ?
spleen
What organ can cause sepsis in the LUQ?
pancreas
What is the most concerning fracture for kids?
Growth plate/epiphyseal fracture due to leg or arm not growing correctly after the fracture.
What MVC has the greatest incidence of death?
Car wreck up and over because you go up and over the steering wheel, hit the windshield causing head and spine trauma then blunt trauma to the chest on the steering wheel
What type of helmet is the hardest to remove?
full face helmet
What BP should a 4 year old have for compensated shock?
> 78 (70 + 2 x age)
What is the formula for compensated vs decompensated shock?
70 plus 2 x age.
What medication stops the inflammatory process?
prednisone (steroid)
What does peaked T waves with a crush injury signify?
hyperkalemia. patient needs bicarb or calcium chloride
The small body surface for pediatric patients means ___ protection from burns
less
What is the treatment for epistaxis with high blood pressure?
lower the blood pressure. Likely won’t stop until it is lowered.
How much blood in the pericardiac sac does it take to develop pericardial tamponade?
100-300cc. If you are able to take even just 20cc off it will significantly improve the patient but can only be done so with pericardial centesis.
What is a diffuse axonal injury and what is its significance?
widespread blunt trauma to the head. high chance of death. damages entire nerve axons in the brain.
What is worse, bleeding in the brain or nerve damage?
nerve damage. nerves don’t grow back.
If a person has an ear wound, what is a rule to remember when controlling the bleeding?
do not pack an ear wound
What is the number of the facial nerve?
7
what nerve controls vision?
2
what nerve controls smell?
1
what nerve controls swallowing?
12
What nerve controls the tongue?
12
how should a pregnant woman be transported?
left side. gets the baby off of the vena cava
after (8-24) 12 hours of burns, what happens to the patient?
get burn shock or “fluid shift” and the person goes into hypovolemic shock
What signs would you see with internal bleeding vs burn shock/fluid shift?
cool, pale, clammy, tachycardia - internal bleeding
warm and dry then cool, pale, clammy after several hours - fluid shift/burn shock
What does the rapid trauma assessment look for?
immediate life threats
What is an indication of T1 (thoracic 1) pain?
change in intercostal space and little finger
what is the best management for a mid shaft femur fracture?
traction splint
What is the greatest intervention for a trauma patient?
rapid transport to the hospital for blood products and surgical intervention
What is it called when the burn injury requires more nutrients than available?
hypermetabolic phase
What does the secondary assessment/detailed assessment look for after the trauma assessment?
life threats not found with the first assessment.
What systems are usually affected by a stabbing to the left flank?
most likely hit part of urinary system and may have blood present in urine
What is the major cause of traumatic liver damage?
Tear of the ligamentum teres
What is a common liver deceleration injury?
ligamentum teres tear
What are the 6 P’s of trauma?
pain, poikilothermic (inability to regulate core body temperature), paresthesia, paralysis, pulselessness, and pallor.
What is a rule for intubations involving airway burns?
go down .5 in the tube size.
What premedication for RSI should be used in trauma to minimize ICP?
lidocaine
What are the burn percentages for an adult?
rule of 9’s
head - 9
anterior chest - 18
back - 18
arm - 9
leg - 18
groin - 1
what are the burn percentages for an infant?
head - 18
anterior chest - 18
back - 18
arm - 9
leg - 14
groin - 1
Shock classification: Volume loss up to 15% of total blood volume, approximately 750ml. HR is minimally elevated or normal, no change in BP, pulse pressure, or RR.
Class 1
Shock classification: Volume loss from 15-30% to total blood volume from 750-1500ml. HR and RR elevated. pulse pressure begins to narrow but systolic blood pressure may be unchanged to slightly decreased.
Class 2
Shock classification: Volume loss from 30-40 percent of total blood volume from 1500-2000ml. a significant drop in blood pressure and changes in mental status occurs. HR and RR are significantly elevated. Urine output declines. capillary refill is delayed
class 3
shock classification: volume loss over 40% of total blood volume. hypotension with narrow pulse pressure (less than 25 mmHg). tachycardia becomes more pronounced (more than 120 BPM and mental status becomes increasingly altered. Urine output is minimal or absent. capillary refill is delayed
Class 4
What is the Monro-Kellie Doctrine?
intracranial volume = brain volume + CSF volume + blood volume
____: provides cerebral blood flow; mean arterial pressure minus ICP
cerebral perfusion pressure.
Neck zones: below cricoid ring. highest mortality with injury. great vessels and trachea
zone 1
Neck zones: above cricoid ring and below angle of jaw; injuries more common.
zone 2
neck zones: above angle of jaw; cranial nerves and larger vascular structures.
zone 3
What is the simplified motor score?
obeys commands: 2
localizes to pain: 1
withdraws to pain or worse: 0
Score of less than 2, transport to trauma center
Score of 0; endotracheal intubation
