Ch 27, 28, 29, 30, & 31 Flashcards
The ——— refers to how a person was injured
Mechanism of injury
The science of analyzing MOI’s, sometimes called the ———, helps you to predict the kind and extent of injuries as a basis for your priority decisions regarding continuing assessment care, and transport
Kinetics of trauma
The ——— is used for determining the level of responsiveness, the systolic blood pressure, the respiratory rate, and the anatomical type or location of injury
Glasgow coma scale
— is nearly always the result of two or more bodies colliding with each other
Trauma
— is the branch of mechanics dealing with movements of bodies, so understanding — is helpful in understanding MOI and trauma
Kinetics
The energy contained in a moving body is called ——
Kinetic energy
What is the formula for kinetic energy?
Kinetic energy = body’s mass x body’s velocity/2
The ———, which is one of the laws of motion described by sir Isaac newton, states: a body at rest will remain at rest, and a body in motion will remain in motion unless acted upon by an outside force
Law of inertia
The rate at which a body in motion increases its speed is known as —
Acceleration
The rate at which a body in motion decreases its speed is known as —
Deceleration
Which type of collision happens when the vehicle is suddenly stopped and gets bent out of shape?
Vehicle collision
Which type of collision happens when the patient comes to a quick stop on some part or parts of the inside of the vehicle, such as a steering wheel, causing injury to the chest?
Body collision
Which type of collision happens when the patients internal organs, which are all suspended in their places by tissue, come to a quick stop, sometimes striking and inside surface of the body (the inner chest wall or inner skull)?
Organ collision
Motor vehicle collisions can be classified as:
-frontal
-rear end
-rotational or rollover
-lateral
In the ——, the driver continues to move forward at the same speed the vehicle is traveling
Frontal impact
—— occurs when the heart is caught between the sternum and the spine, which can bruise the heart muscle
Compression force
—— tends to pull the aorta at the ligament, which can tear or transect the aorta
Shear force
Air trapped in the lungs by sudden closure of the epiglottis is compressed between the ribs and spine, this is known as a ———, because it is like blowing up a paper bag and then popping it in your hands
Paper bag injury
In the ———, the patients head and neck are immediately whipped back
Rear end impact
If the vehicle does not have headrests or they are improperly positioned, the neck is hyperextended during a rear end impact and the anterior spinal ligaments are often stretched or torn, this is known as a — injury
Whiplash injury
When a vehicle is struck —, or directly on the side, it can be crushed inward, impinging on the occupants
Laterally
Injuries from — crashes are those in which the vehicle spins around the point of impact, causing the occupants who are not restrained to strike the mirror, posts, and doors, resulting in many injuries
Rotational
During a —, the vehicle hits the ground multiple times and in various places, the occupant changes direction every time the vehicle does
Rollover
— injuries can occur from the use of restraints in motor vehicles, including air bags and seat belts
Hidden injuries
When a —— impact occurs, the motorcycle tends to tip forward because of the location of its center of gravity
Head on
In — motorcycle impacts, the rider strikes an object, usually a protruding object, at an angle
Angular
After a motorcycle collision, — occurs if the rider clears the handlebars
Ejection
This is an evasive action on the part of the rider, designed to prevent ejection and separation of the driver from the bike in an impending collision, this is known as:
“Laying the bike down”
What is the most common MOI?
Falls
A —— landing causes energy to travel up the skeleton
Feet first
In —— falls, the pattern of injury begins with the arms and extends up to the shoulders
Head first
— injuries are caused by any object that can penetrate the surface of the body, such as bullets, nails, darts, and knives
Penetrating
Penetrating injuries can be classified as:
-low velocity
-medium velocity
-high velocity
A low velocity penetrating injury usually occurs with?
A knife or other object impaled in the body
A medium to high velocity penetrating injury usually occur with?
Pellets or bullets
Most handguns or shotguns fire at what velocity?
Medium
High speed rifles such as an M-16 or 30-30 Winchester fire at what velocity?
High
The damage caused by medium and high velocity projectiles depends on what two factors?
-trajectory
-dissipation of energy
— is the path or motion of a projectile during its travel
Trajectory
——— is the way energy is transferred to the human body from the force acting on it
Dissipation of energy
— are the factors that slow a bullet down, such as wind resistance.
Drag
The impact point of the bullet is its —
Profile
Sometimes called pathway expansion, — is the cavity in the body tissues formed by a pressure wave resulting from the kinetic energy of the bullet
Cavitation
— occurs when a bullet breaks up into small pieces or releases small pieces upon impact increasing the body damage
Fragmentation
Of fatal wounds that occur from firearms, —% involve the head, thorax, and abdomen
90%
The — is often secondarily injured when the chest is injured
Abdomen
— injuries can occur because of explosions from, for example, natural gas, gasoline, fireworks, improvised explosive devices, and grain elevators
Blast
Every explosion has what 5 phases?
-primary
-secondary
-tertiary
-quaternary
-quinary
In the — phase of an explosion, air molecules slam into one another, creating a pressure wave moving outward from the blast center, causing pressure injuries
Primary phase
In the — phase of an explosion instantaneous combustion of the explosive agent creates superheated gases. The resulting pressure blows the bomb casing apart. Pieces of the bomb can cause — injuries by striking the patient
Secondary
In the — phase of an explosion, the blast wind may propel the patient to the ground or against objects causing further injuries
Tertiary
In the — and — phases of an explosion, the patient may also be exposed to harmful chemicals or toxins or may be injured by structural collapse
Quaternary and quinary
The —— has been established as a parameter for emergency care because severely injured patients have the best chance for survival if intervention takes place as quickly as possible from the time of injury
Golden period
Some EMS systems refer to the ———, this means that in cases of severe trauma, 10 minutes is the maximum time the EMS team should devote to on scene activities, with patient assessment, emergency care for life threats, and preparation for transport all being accomplished within 10 minutes of arriving on the scene
Platinum 10 minutes
The —— is designed to provide immediate surgical intervention for patients with internal trauma if necessary, extensive intensive care services specific to trauma, and rehabilitation services
Trauma system
What level trauma center can manage the full range of traumatic injuries 24 hours a day, 7 days a week?
Level 1 regional trauma center
What level trauma center can manage the vast majority of trauma with surgical capabilities 24 hours a day, 7 days a week and are capable of stabilizing more specialized trauma patients and then transferring them to a level 1 center?
Level 2 area trauma center
What level trauma center has some surgical capability and specially trained emergency department personnel to manage some traumatic injuries, this type of center focuses on stabilizing the seriously injured trauma patient and then transferring to a higher level center?
Level 3 community trauma center
What level trauma center is typically a small community hospital in a remote area capable of stabilizing seriously injured trauma patients and then transferring them to a higher level trauma center?
Level 4 trauma facility
Blood loss of —% of blood volume or more is considered significant and can lead to shock
15%
The middle layer of a blood vessel consists of smooth muscle (tunica media) that gives it the capability to — when injured
Constrict
A — (across) cut of a vessel causes the vessel to retract, thickening the smooth muscle layer at the cut end of the vessel and reducing the diameter of the vessel, which reduces blood flow and enables clotting to occur more easily
Transverse
What are the three types of bleeding?
-arterial
-venous
-capillary
— bleeding will cause bright red, spurting blood, from a wound usually indicates a severed or damaged artery
Arterial bleeding
A — bleed will cause dark red blood that flows steadily and briskly from a wound usually indicates a severed or damaged vein
Venous
A — bleed will cause slowly oozing blood that is dark or intermediate color of red usually indicates damaged capillaries
Capillary bleed
What are some methods that are used to control major external hemorrhage?
-direct pressure with hand
-compression or pressure dressing
-tourniquet
-wound packing
-hemostatic agent
-junctional tourniquet
Up to — mL of blood can be lost around each femur and — mL around the tibia and fibula
-1,500 mL
-500-750 mL
Possible causes of bleeding from the nose, mouth or ears include:
-skull injury
-facial trauma
-digital trauma (nose picking)
-sinusitis
-clotting disorders
-esophageal disease
—, or nosebleed, is bleeding from the nose, which can result from injury, disease, or the environment
Epistaxis
A — is a contained collection of blood
Hematoma
The two most common sources of internal bleeding are:
-injured or damaged internal organs
-fractured extremities
There can be internal bleeding with no obvious distinction, — L can distend the abdomen only 1 inch
1-2L
What are some factors that can interfere with the clotting process and increase bleeding?
-movement
-low body temp
-medications
-intravenous fluids
-removal of dressings or bandages
— is most often the direct result of inadequate perfusion of tissue from the loss of blood volume
Shock
When the fluid loss results from bleeding or hemorrhage it is known as ——
Hemorrhagic shock
———, also referred to as a wound or wounds, involves injuries to the skin and underlying tissues
Soft tissue trauma
Wounds to the skin can be categorized as :
-closed
-open
-single
-multiple
A wound in which there is no break in the skin is called a ——
Closed injury
What are the 3 specific types of closed injuries?
-contusions
-hematomas
-crush injuries
A —, or bruise, is an injury to the tissue and blood vessels contained within the dermis
Contusion
The patient can have discoloration at the injury site of a contusion caused by blood leaking from damaged vessels and accumulating in the surrounding tissues, the black and blue discoloration is called —
Ecchymosis
A — is similar to a contusion, except it usually involves damage to a larger blood vessel and a larger amount of tissue
Hematoma
A —— is one in which force great enough to cause injury has been applied to the body
Crush injury
When the continuity of the skin is broken, the wound is called an ——
Open injury
What are the six general types of open injuries?
-amputation
-avulsion
-crush injury
-puncture
-abrasion
-laceration
An — generally is caused by scraping, rubbing, or shearing away of the epidermis, the outermost layer of the skin
Abrasion
A break in the skin of varying depth, a — can be linear (regular) or stellate (irregular)
Laceration
— lacerations are usually created by a knife, razor, or broken glass
Linear
— lacerations are commonly caused by a blunt object
Stellate
An — is a loose flap of skin and underlying soft tissue that has been torn loose (partial) or completely pulled off (total or complete)
Avulsion
An — involves a disruption in the continuity of an extremity or other body part
Amputation
A — or — injury generally is the result of a sharp, pointed object being pushed or driven into the soft tissues
Penetration or puncture
Human bites can cause — (inflammation of the liver)
Hepatitis
A — injury occurs when a body part is caught or strangled by some piece of machinery, a tool, or other object or equipment
Clamping injury
An —— is a dressing for a wound that can form an airtight seal
Occlusive dressing
Abdominal wounds sometimes result in an —, meaning that abdominal organs protrude through the wound
Evisceration
An ——, an object that is still embedded in a wound, should never be removed in the field, unless it is impaled in the cheek or in the neck with obvious obstruction of airflow through the trachea
Impaled object
What is an air embolism?
An air bubble under the skin
A — covers an open wound to aid in the control of bleeding and to prevent further damage or contamination
Dressing
The dressing should be —, or free of any organisms (bacteria, virus, or spore) that can cause infection
Sterile
After a dressing is applied, a — is used to secure a dressing in place
Bandage
A — burn is formerly referred to as a first degree burn, involves only the epidermis, is usually caused by a flash, hot liquid, or the sun
Superficial
Formerly known as a second degree burn, a —— burn involves not only the epidermis but also portions of the dermis, can occur from contact with fire, hot liquids or objects, chemical substances, or the sun
Partial thickness
Partial thickness burns can be classified as either:
-superficial partial thickness burns
-deep partial thickness burns
Superficial partial thickness burns typically present with:
-thin walled blisters
-skin is red and weeping
-skin blanches with pressure
-skin is soft and tender to touch
Deep partial thickness burns typically present with:
-thick walled blisters that often rupture
-variable color with patchy areas that are red to cheesy white
-skin is wet or waxy dry
-patient can still feel pressure
-poor capillary refill time
Formerly known as a third degree burn, a —— burn involves all the layers of the skin, usually results from extreme heat sources such as hot liquids or solids, flames, chemicals, or electricity
Full thickness burn
The tough and leathery dead soft tissue formed in the full thickness burn injury is called an —
Eschar
What are the most important factors to consider when determining burn severity?
-depth
-location
-patients age
-preexisting medical conditions
-percentage of body surface area burned
— burns, which encircle a body area such as an arm, a leg, or the chest and especially ones that encircle joint areas are critical because of the circulatory compromise and nerve damage that potentially can occur
Circumferential
The ——— is a standardized way to quickly determine the amount of skin surface, or the body surface area (BSA) percentage of a burn
Rule of nines
The rule of nines is only applied to what type of burns?
Partial thickness and full thickness burns
The head, neck, and both arms represent how much % of the body burned in the rule of nines in an adult?
9% head and neck total
9% each arm
The posterior trunk, anterior trunk, and each leg accounts for how much % of the body burned in regards to the rule of nines in an adult?
18% each
The external genitalia represent how much % of the body burned in regards to the rule of nines in an adult?
1%
The head, neck, posterior trunk, and anterior trunk represent how much % of the body burned in the rule of nines in an infant?
18% each
Each arm of an infant represent how much % of the body burned in the rule of nines?
9% each
Each leg of an infant represent how much % of the body burned in the rule of nines?
14% each
An alternative way to determine the BSA estimate is to compare it to the patients palm surface area with the fingers closed which equals approx 1% of the BSA, this is known as the ———
Rule of ones or rule of palms
— burns are associated with heat applied to the body, caused by flames, hot water, and steam
Thermal burns
— burns are associated with high temp air or steam that is inhaled and causes damage to the mucosa of the upper airway, results in edema that could restrict airflow and lead to airway obstruction
Inhalation burns
Hot water causes thermal burns called —
Scalds
— burns are caused by acids, alkalis, and other heat generating chemicals
Chemical burns
— burns result from resistance to electrical current flow in the body, the burns are primarily internal, the electricity can interfere with the conduction system of the heart and result in cardiac arrest
Electrical burns
— burns occur from the absorption of radiation into the body
Radiation burns
A — burn occurs when the patient comes into contact with an open flame
Flame burn
A — burn normally occurs when a patient comes into contact with a hot object
Contact burn
A — burn is caused when a patient comes into contact with a hot liquid
Scald burn
A — burn is caused by hot steam and is often more severe than flame burns, because of the high heat capacity of the steam
Steam burn
A — burn occurs when a patient comes into contact with hot gases
Gas burn
A — burn is a type of flame burn, but it is the result of a flammable gas or liquid that ignites quickly
Flash burn
When treating a burn patient, you should cover the burned area with a sterile dressing or a disposable, sterile and particle free ——
Burn sheet
What are some substances that can cause chemical burns?
-dry lime
-hydrofluoric acid (delayed burn reaction)
-carbolic acid (phenol)
-sulfuric acid
— connect muscle to bone
Tendons
— connect bone to bone
Ligaments
— is an extension of the bone and is composed of connective tissue, allows for bone to ride over each other and absorb shock
Cartilage
This bending motion moves the extremity towards the body:
Flexion
This bending motion moves the extremity away from the body:
Extension
This is a movement of a body part towards the midline:
Adduction
This is a movement of a body part away from the midline:
Abduction
This movement turns the body along the axis of a bone or joint:
Rotation
This is a movement through an arc of a circle or in a circular motion from a central point:
Circumduction
What are the six basic components of the skeletal system?
-skull
-spinal column
-thorax
-pelvis
-lower and upper extremities
The axial skeleton is made up of:
The head, thorax, and vertebral column
The appendicular skeleton is made up of:
The extremities, to include the shoulder girdle and the pelvis
A — is a break in the continuity of a bone
Fracture
An — fracture is a fracture associated with an open wound
Open fracture
If there is no break in the skin associated with a fracture, it is called a — fracture
Closed
A — fracture is a small crack in the bone that doesnt create instability
Hairline
— is a degenerative bone disorder associated with an accelerated loss of minerals, primarily calcium, from the bone
Osteoporosis
A — is an injury to muscle or tendon, possibly caused by overextension, or overstretching
Strain
A — is an injury to a joint capsule, with damage to or tearing of the connective tissue, and usually involves ligaments
Sprain
A — is the displacement of a bone from its normal position in a joint
Dislocation
The injury from ——, or a direct blow, occurs at the point of impact
Direct force
With ——, the force impacts on one end of a limb, causing injury some distance away from the point of impact
Indirect force
In ——, one part of the extremity remains stationary while the rest twists
Twisting force
Grating, or —, the sound or feeling of broken fragments of bone grinding against each other
Crepitus
The skin distal to the injury site might be pale and capillary refill delayed if an artery is compressed or torn, this is known as:
Pallor
A patient with a fracture may complain of numbness or a tingling sensation in the fractured extremity, can indicate nerve damage, this is known as :
Paresthesia
Suspect a — when deformity and pain are found at joint
Dislocation
Any device used to immobilize a body part is called a —
Splint
— splints are commercially manufactured and made of wood, plastic, cardboard, or compressed wood fibers
Rigid
An — splint is soft and pliable before being inflated, but they are rigid after they are applied and filled with air
Air splint or pressure splint
— splints provide a counter pull, alleviating pain, reducing blood loss, and minimizing further injury
Traction
— splints are a type of rigid splint that is malleable enough to conform to a deformed or angulated extremity
Formable
— splints are soft, pliable, splints that are easily formed to deformed extremities, the air is sucked out of the splint, causing it to become rigid in its position of placement
Vacuum
A — or — is often used to provide stability to a painful and tender shoulder, elbow, or upper numerous injury
Sling or swathe
A ——— or ———— is a full body splint, used in the case of a critical injury when extremity fractures cannot be splinted at the scene
Spine board or full body vacuum mattress
A ———— is sometimes used to splint a suspected pelvic injury when turned upside down
Vest type immobilization device
—— can occur when an extremity is fractured or injured, if the pressure in the space around the capillaries exceeds the pressure needed to perfuse the tissues, the blood flow is cut off and the cells become hypoxic, leading to ——
Compartment syndrome
A ——, or pathological fracture, results from a disease that causes degeneration and dramatically weakens the bone, making it prone to fracture
Nontraumatic fracture
The brain, which occupies 80 to 90% of the space inside the skull, is surrounded by plates of large, flat bones that are fused together to form a helmet like covering called the ——
Cranial skull
The ——, or floor of the skull, is made up of many separate pieces of bone and is the weakest part of the skull
Basilar skull
Within the skull, the brain is cushioned in a dense, serous substance called ——
Cerebrospinal fluid
Inside the skull, the brain is protected by 3 —, or layers of tissue that enclose the brain, what are the 3 layers?
-meninges
-duramater (outermost )
-arachnoid (middle layer)
-pia mater (innermost)
Bleeding that occurs between the arachnoid membrane and the surface of the brain is called a ——
Subarachnoid hemorrhage
The — is the largest part of the brain, compromises three fourths of the brains volume , responsible for most conscious and sensory functions, the emotions, and the personality
Cerebrum
The — also called the little brain, controls equilibrium and coordinates muscle activity
Cerebellum
The — is the brains funnel shaped inferior part, is the best protected part of the brain and controls most automatic functions of the body, including cardiac, respiratory, and vasomotor (blood pressure)
Brain stem
A ———, which is the most common type, resembles a line. There is no gross deformity in a —— fracture and can be diagnosed through a radiograph
Linear skull fracture
A ——— occurs when the bone ends are pushed inward toward the brain, the depression is palpated in the area of the fracture
Depressed skull fracture
A ——— is an injury in which the skull is fractured but there isn’t an open wound to the overlying scalp
Closed skull fracture
An ——— is a fracture of the skull with an associated open wound to the scalp
Open skull fracture
A ——— is a fracture to the floor or bottom of the cranium, these often leak cerebrospinal fluid from the ears, nose or mouth
Basilar skull fracture
The thinnest portion of the skull is the — region
Temporal
A — brain injury is the result of trauma to the brain that occurs at the time of insult from direct impact, acceleration/deceleration, or a penetrating wound
Primary brain injury
A — brain injury occurs from a complex cascade of pathophysiologic processes following the primary brain injury, which can continue for hours to days
Secondary brain injury
Whenever ICP rises, the brain is compressed and pushed out of its normal position, downward and through the foramen magnum (the large opening in the base of the skull) is referred to as:
Brain herniation
What are Cushing reflexes?
Increased systolic blood pressure and decreased heart rate
In cases of ———, the scalp or skull can be lacerated but the skull remains intact and there is no opening to the brain
Closed head injury
Brain damage within the intact skull can, nonetheless, be —
Extensive
An ——— involves a break in the skull and a break in the scalp, such as that caused by impact with a windshield or by an impaled object
Open head injury
Injury to the brain that results from shearing, tearing, and stretching of nerve fibers is called a ———.
Diffuse axonal injury
A — normally causes some disturbance in brain function, ranging from momentary confusion to complete loss of responsiveness, and it usually causes a headache.
Concussion
A —, or bruising and swelling of the brain tissue, can accompany concussion
Contusion
In ———, damage can be at the point of a blow to the head and or damage on the side opposite to the blow as the brain is propelled against the opposite side of the skull.
Coup/contrecoup injury
In ———, typical of a car crash, the head comes to a sudden stop but the brain continues to move back and forth inside the skull, resulting in bruising (possibly severe) to the brain
Acceleration/deceleration injury
—— is a collection of blood between the dura mater and the arachnoid layer of the brain
Subdural hematoma
What are the two types of Subdural hematomas?
-acute
-occult or chronic
—— accounts for only about 2% of all head injuries that require hospitalization, most commonly occurs from low velocity impact to the head or from a deceleration injury
Epidural hematoma
Like a contusion, a — of brain tissue can occur in either an open or closed head injury. It often occurs when an object penetrates the skull and lacerates the brain
Laceration
Nontraumatic injuries to the brain can be caused by:
Clots or hemorrhaging
When a patient tries to move away from or remove the pain it is known as a:
Purposeful response
When the patient responds to pain by inappropriately moving parts of his body, reacting to the pain but not trying to stop it, this is known as an:
Nonpurposeful response
Patients who have an upper level brain stem injury often are found with — posturing in which their arms are flexed across their chest with their legs extended
Flexion or decorticate
patients with a lower level brain stem injury often present with — posturing where they extend both arms down at their sides, extend their legs and often arch their backs
Extension or decerebrate
If a patient has a GCS score of 14-15, how severe would their head injury be?
Mild
If a patient has a GCS score of 9-13, how severe would their head injury be?
Moderate
If a patient has a GCS score of 3-8, how severe would their head injury be?
Severe
Both pupils should constrict the same when a light is shined in only one of the pupils, this reflex in the unstimulated eye is known as a ——
Consensual reflex
A purplish discoloration of the soft tissues around one or both eyes is known as a ——, and can be an indication of intracranial injury
Raccoon sign
——, a purplish discoloration of the mastoid area behind the ear, is another delayed and late sign of a basilar skull fracture
Battle sign
What is diplopia?
Double vision
In —— the patient is unable to remember circumstances leading up to the incident
Retrograde amnesia
In ——, the patient is unable to remember circumstances after the incident
Anterograde amnesia
——— is a brain injury that results from the abuse of an infant or toddler where they are shaken forcefully and repeatedly
Shaken baby syndrome
