3- Trauma- Bleeding, Shock, Burns Flashcards
1
Q
What is the largest organ of the body
A
Skin
2
Q
What are the 4 functions of skin
A
- Mechanical barrier
- Protective barrier
- Sensory organ
- Temperature regulation
3
Q
What happens to body temp when skin is burned
A
Hypothermia
4
Q
5 steps of treatment for soft tissue injuries
A
- Stop any significant bleeding
- Maintain the airway
- Assess for life threats
- Prompt transport
- Prevent infections
5
Q
What are tension lines of the body
A
Natural patterns in the surface of the skin revealing tension within
6
Q
What are 3 types of closed wounds
A
- Contusions (bruises)
- Hematomas (blood bump under skin)
- Crush injuries
7
Q
What are 7 types of open wounds
A
- Abrasions
- Lacerations
- Incisions
- Punctures
- Impaled objects
- Avulsions
- Amputations
8
Q
What is an amputation
A
Missing part of body including bone
9
Q
What is an avulsion
A
Flap of full skin still hanging on
10
Q
What is a crush injury
A
Injury where once object is removed an indentation remains
11
Q
What is an abrasion
A
From friction, skin stays in its location
12
Q
What is a laceration
A
A splitting open/division of skin
13
Q
What are 3 types of hemorrhage
A
- Arterial
- Capillary
- Venous
14
Q
How to identify an arterial bleed
A
Spurting/pulsating flow of bright red blood
15
Q
How do identify a venous bleed
A
Steady flow of dark red blood
16
Q
How to identify a capillary hemorrhage
A
Slow even flow of blood
17
Q
About how much blood is lost from a Rib, Radius/Ulna, Humerus, Tib/Fib, Femur, and Pelvis fracture
A
Rib- 125ml Radius/Ulna- 250-500ml Humerus- 500-750ml Tib/Fib- 500-1000ml Femur- 1000-2000ml Pelvis- 1000-3000ml
18
Q
Management for head wounds
A
- Gentle direct pressure
- Do not try to stop drainage from ears and nose
19
Q
Management for neck wounds
A
- Consider direct digital pressure
- Occlusive dressing
20
Q
Management for gaping wounds
A
- Bulky trauma dressing
- Sterile nonadherent dressing
- Compression dressing
- Fill the wound
21
Q
Management for crush injury
A
- Consider and air splint and pressure dressing
- Consider constricting band or tourniquet
22
Q
Sources of burns (4)
A
- Thermal
- Electrical
- Chemical
- Radiation
23
Q
What 2 things does the severity of a burn depend on
A
- Extent
- Depth
24
Q
What 5 things happen to the body when skin is los
A
- Hypovolemia
- Hypothermia
- Hemoconcentration (Excessive RBCs)
- Systemic fluid shift
- Damaged cells release electrolytes
25
What 4 things happen in burn shock
1. Decreased cardia output by 30-50%
2. Increased metabolic acidosis
3. Paralytic ileus (Bowel stops working)
4. Interstitial edema
26
3 burn depth classifications
1. Superficial
2. Partial thickness
3. Full thickness
27
What is Eschar
-Darkened worthless skin, fully dead
28
Main problem of electrical burns
Damage can not be determined by external findings
29
Chemical burns, acid vs base
Acid- Burn and coagulate
| Base- Liquify and burn deep
30
Rule of 9s for an adult
```
9 - Head
18 - Front torso
18 - Back torso
9 - Each arm
18 - Each leg
1 - Groin
```
31
Rule of 9s for Peds
```
18 - Head
18 - Front torso
18 - Back torso
9 - Each arm
14 - Each leg
1 - Groin
```
32
Most important care for for a burn patient
STOP THE BURN
33
Treatment for burns (5)
- Put them out
- Keep them warm
- Transport
- Replace fluid
- Analgesics
34
What is the parkland formula
4mL x BSA% x KG = (X/2) / (8hrs)
35
What do most burn patients die from
HYPOXIA
36
6 inhalation injuries
1. CO poisoning
2. Toxic gas inhalation
3. Smoke inhalation
4. Heat inhalation
5. Steam inhalation
6. Asphyxiation
37
Signs of inhalation injury (6)
1. Burns to face
2. Singed facial hair
3. Soot in sputum
4. HOARSE VOICE OR STRIDOR
5. Cough or dyspnea
6. History of exposure in enclosed space
38
Inhalation injury treatment (3)
1. Airway with high flow O2 (May need size smaller)
2. May need intubation
3. Maintain high pulse ox
39
Treatment for chemical exposure, wet vs dry
Dry- Brush off then flush
Wet- Flush
40
Use of other chemicals to stop chemical burns
HELL NO
41
Extent of electrical burns depends on (4)
- Type of current
- Amount of current
- Path of current
- Duration of contact
42
Most serious immediate injury from electricity
Cardia Arrhythmias
43
3 types of injury patterns from electricity
- Skin burns
- Deep tissue injury
- Fractures
44
What 2 routes does electricity travel through the body
1. Blood vessels
2. Nerves
*Follows the path of least resistance
45
Which current is more dangerous and why DC or AC
AC- Alternating current contracts the muscles to possible stay connected to the source
46
Main interventions for electrical injuries
- Remove source if possible
| - IV, O2, Monitor
47
Types of of injuries from electricity
- True electrical
- TASER effect
- Arc or Flash burn
- Flame burn
48
2 most common causes of death from electrical injury
- Asphyxia
| - Cardiac arrest
49
Can electrical injury cause fluid shifts in the body?
YES
50
Main sign of a lighting strike injury
Feathering pattern on the skin
51
3 types of ionizing radiation in order from weakest to strongest
1. Alpha
2. Beta
3. Gamma
52
What units is radiation measured in
REM- Radiation equivalent in man
RAD- Radiation absorbed dose
53
What’s is Acute Radiation Syndrome (ARS)
Serious illness from high short term exposure
54
Major goals of blast injuries
- Contain the incident
| - Contain the people
55
Where does most force from a blast go
Up
56
Blast injury physiology: Spalling
Shock waves through tissues
57
Blast injury physiology: Implosion
Entrapped gases in hollow organs
58
Blast injury physiology: Shearing
-Tissues moving at different speeds tear form each other
59
Blast injury categories (5)
1. Primary
2. Secondary
3. Tertiary
4. Quaternary
5. Quinary
60
Damages from each blast injury category
Primary: Hollow organ rupture
Secondary: Penetrating injuries
Tertiary: Fractures and soft tissue trauma
Quaternary: Injuries from effects of the blast but not the blast itself
Quinary: Dirty bomb
61
What is a blast front and positive wave pulse
- The leading edge of an explosion
| - Pressure front higher than atmospheric pressure
62
What is Brisance in blasts
Shattering effect of a wave and its ability to cause bodily damage
63
Negative wave pulse in blasts
After initial pos pressure wave, air returns to the negative space left
64
What effects speed, duration and pressure of a shock wave in blasts
- Size of charge
- Surrounding medium
- Distance from explosion
- Reflecting surfaces
65
Blast injury: Lungs s/s, treatment
S/S
- Diff breathing
- Chest pain, shock
Treatment
- O2, CPAP
- Intubate if needed
- Fluids with caution
66
Blast injury: Tympanic membrane s/s, treatment
S/S
- Hearing loss
- Ringing in ears
- Blood in ear canal
Treatment
-Cover bleed, but dont prevent it
67
What are 4 WMD agent types
1. Chemical
2. Blood
3. Choking
4. Radiological
68
Biological warfare is also known as
The poor mans nuclear weapon
69
Key points from 2004 Project Bioshield (3)
- Relax spending procedures for radiation exposure treatment
- Gov guarantee to purchase counter measures
- Permit emergency use of unapproved countermeasures
70
Chemical nerve agents
Examples
S/S
Treatment
Examples
Sarin, Tabun, V agents, Organophosphates
S/S
SLUDGEM
Treatment
Duodote injection
- Atropine and 2-PAM
71
Chemical blister agents
Examples
S/S
Treatment
Examples
Mustard gas, Lewsite
S/S (Take a while to present)
- SOB
- Eye/skin irritation
- Blisters
Treatment
- Level A protection
- Decon
72
Blood agents
Examples
S/S
Treatment
Examples
-Arsenic, Cyanide, CO
S/S
- Hypoxia, convulsions, apnea
- Smell of bitter almonds
Treatment
- Decon
- O2
73
Choking agents
Examples
S/S
Treatment
Examples
- Chlorine
- Ammonia
- Phosgene
S/S
- Varying resp complaints
- Nausea, chest tightness, SOB
Treatment
-O2, BVM, Suction
74
Radiological Agents
Examples
S/S
Treatment
Examples
-Detonated dirty bomb
S/S
- Severe trauma, burns
- Fever, disorientation, vomiting
- Rectal bleeding
Treatment
Unknown
75
Burn Center transport criteria
5% Full thickness burns
10% Partial or Superficial under 10 y/o or over 50 y/o
20% Partial or Superficial at any age
76
Different types of thermal burn injuries (5)
1. Flame
2. Scald
3. Contact
4. Steam
5. Flash
77
Burn zones
1. Zone of coagulation
2. Zone of stasis
3. Zone of hyperemia
78
5 compensatory mechanisms of shock
1. Baroreceptors
2. Renin-Angiotensin-Aldosterone
3. Chemoreceptors
4. ADH
5. Fluid return
79
Explain Baroreceptors location and role in shock
Location
Atria, Vena cava, aortic arch, carotid sinus
Role
Tell SNS to secrete Epi and NorEpi for Alpha and Beta effects
Tell PNS stops signal to vagus nerve, increase HR, vasocon
80
Explain the Renin-Angiotensin-Aldosterone response in shock (6)
1. BP falls
2. Renin released from kidneys to circulation
3. Renin+Blood plasma becomes Angiotensin 1
4. Angiotensin converting enzyme (ACE) turns Angiotensin 1 into Angiotensin 2, a potent vasoconstrictor
5. Aldosterone is released form Adrenal Cortex which stimulates kidney to reabsorption sodium
6. Urine output decreases to maintain fluids
81
Explain the Chemoreceptors role in shock
Find change in pH due to Lactic acid build up from Anaerobic metabolism
Increase rate and depth of respiration’s to blow off CO2
82
Explain the role of Antidiuretic Hormone (ADH) shock
- ADH secreted form pituitary gland
| - Decreases production of urine
83
Explain the role of Fluid return in shock
Splenic squeeze- Veins in spleen constrict releasing 200mL of stored blood into circulation via diffusion
84
```
Capillary sphincters
Normal
Compensated shock
Late compensated shock
Early Decompensated shock
Late Decompensated shock
Irreversible
```
Normal
Pre-Open, Post-Open
Compensated
Pre-Closed, Post-Open
Late Compensated
Pre-Closed, Post-Closed
Early Compensated
Pre-Open, Post-Closed
Late Decompensated
Pre-Open, Post-Open
Irreversible
Pre-Open, Post-Open
85
4 types of shock
1. Hypovolemic
2. Distributive
3. Cardiogenic
4. Obstructive
