4) Soft tissue injuries

Question 1

Injury which opening occurs in skin & organs protrude through is:

Answer 1

Evisceration

Question 2

Most common location for compartment syndrome to occur?
1st “P” of compartment syndrome?
What ECG changes would indicate hyperkalemia?

Answer 2

= Distal leg, anterior compartment
= Pain
= Peaked T Waves

Question 3

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?

Answer 3

= usually for longer than 4 hours
= Closed soft tissue injury
= Sodium Bicarbonate

Question 4

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?

Answer 4

= Integumentary system
= Organ, 16% of total body weight
= Subcutaneous Layer
= Sebaceous glands
= Epidermis
= Epidermis

Question 5

Sodium Bicarbonate is delivered PT’s suspected w/ hyperkalemia at:
Dose of Calcium Chloride for hyperkalemia & line of med?

Answer 5

= 50 mEq as last line
= 500-1000 mg/3mins IV as 1st line med

Question 6

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?

Answer 6

= Puncture

Question 6

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?

Answer 6

= Flap of skin partially/completely torn away from underlying tissue
= Laceration
= Avulsion

Question 7

Thick, fibrous, inflexible membranes surrounding muscle that help bind muscle groups together are called:

Answer 7

Fascia

Question 7

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:

Answer 7

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

Question 8

An injury in which the mechanism of injury tears the skin off the underlying muscle, tissue, blood vessels, and bone is called a(n):

Answer 8

Degloving injury

Question 9

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?

Answer 9

= 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

Question 10

Afferent nerves:
Efferent nerves:

Answer 10

=sensory nerves “ahhh”
=motor “effect”

Question 10

Thickest skin @:
Thinnest skin @:

Answer 10

= Palms & Soles have thickest skin
= eyelids 1st & genitalia 2nd

Question 11

(Soft tissue injuries)

Answer 11

= Risk factors: age (50-70kilos blood) (1yr old ⅓ of gatorade bottle), alcohol/ drug use, Occupation

Question 12

Layers of skin:

Answer 12

Epidermis, Dermis (papillary & Reticular Lvls), Subcutaneous

Question 13

Epidermis:

Answer 13

dead skin cells, no vasculature, astratum corneum, cells are pushed out & are replaced, Sebum (waxy oil lubes (hands), top layer of skin

Question 14

Subcutaneous:

Answer 14

= adipose tissue, most thermal temp/ reg/, (regs cold>heat)

Question 15

Dermis:
2 layers of dermis:
Papillary:
Reticular:
Sebaceous glands:
Sudoriferous Glands:

Answer 15

= 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

Question 16

Blood vessels:
Blood in venous system:
Most of vaso construction by:

Answer 16

= veins low pressure w/ valves, arteries no valves w/ lots tunica media
= ⅔ in venous system,
= Capillaries: most of vaso construction

Question 17

1Lymphatic system:

2Lymph node:
3Spleen relation:
4Lymphatic pathway:
5Sign lymphatic system not working:

Answer 17

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

Question 18

Tendons:
Ligaments:
Fasciae:
Tension lines/Langer lines:

Answer 18

= 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

Question 19

Contusions:
Hematoma:
Severe hematomas to major compartments may contribute to:

Answer 19

= bruise made by ecchymosis: black & blue
= artery bleed, tamponades & helps hemostasis
= hypovolemia

Question 20

1Crush injury:
2Crush syndrome:

3Cellular Lvl:

4 Crush syndrome signs:
5 Crush syndrome Rx:

Answer 20

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

Question 21

Avulsion:

Answer 21

= 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

Question 22

Lacerations:

Answer 22

= Cuts deep into dermis ( Incisions, Punctures, perfuration)

Question 23

Incisions:

Answer 23

= smooth Lac from sharp instrument (knife, razor, glass, ect) gapes open if against tension line, keeps close typically if cut w/ tension lines

Question 24

Punctures:
Impaled:

Answer 24

= type of Lac, small entrance (ABDMN punctures can >evisceration)
= embedded objects

Question 25

1Hemostasis:
2Inflammation:
3Epithelialization:
4Neovascular:
5Collagen synthesis:

Answer 25

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

Question 26

1phagocytosis:

2Granulocytes & macrophages w/ healing:
3Lymphocytes w/ healing:
4Mast cells w/ healing:

Answer 26

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

Question 27

1Stages of healing:

Answer 27

1= Hemostasis, Inflam/, Epithelialization, Neovasc/, Collagen synthesis

Question 28

1Prehospital Infections:
2Infections cause, duration, severities, treatment:

3Risk factors:

Answer 28

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,

Question 29

Internal Hemorrhage being forced between tissue layers (fascia):
Internal Hemorrhage:
Pregnant internal hemorrhage worry:
Internal blood loss may be self limiting:

Answer 29

= 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.

Question 30

Body’s response to a local hemorrhage:
Vascular Phase:

Answer 30

= 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.

Question 31

Hemostasis:
Hemostasis order:
Factors that effect hemostasis:

Answer 31

= 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

Question 32

Fluid accounts for ~% of the body’s weight, Only ~% of the fluid is contained in our vascular system

Answer 32

= 60% of the body’s weight, Only about 7% of the fluid is contained in our vascular system

Question 33

Blood:
Plasma:
Leukocytes:
Erythrocytes:

Answer 33

= 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%

Question 34

Platelet Phase of hemostasis:

Answer 34

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

Question 35

Coagulation Phase of hemostasis:

Answer 35

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)

Question 36

(Non& Hemorrhagic treatment) If hemorrhage can be controlled:
If hemorrhage cannot be controlled:

Med for Sig/hemorrhage, in/external (after external controlled)

Answer 36

= 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

Question 37

1staph:
2Strep:
3Lymphangitis:
4Tetanus (Lockjaw):
5Gangrene:

6Wet Gangrene:
7Dry Gangrene:

Answer 37

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) <peripheral> infection lacks blood supply/flow> less WBC
6= bacteria to tissue & swells then fluids outside of tissue
7= blood supply cut off and dry</peripheral>

Question 38

Compartment syndrome 6 Ps) 1st
2nd
3rd
4th
5th
6th

Answer 38

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)

Question 39

Compartment syndrome:

Answer 39

extrems contain M.s & swelling inside self (usually benign injury but body reacts extreme) (infection)

Question 40

Amputation treatment:

Answer 40

= direct pressure 2in above site , never submerge in ice, keep cool,

Question 41

Site for pneumo decompression:
needs:
Never go under a rib b/c:
Locating decompression site:
Digital thoracostomy:

Answer 41

= 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” )