Chapter 22 - 30 Trauma Flashcards
Scene Size-up
Ensure Scene Safety MOI / NOI Take Standard Precautions Determine Number of Patients Consider Additional Resources
Primary Assessment
Form General Impression
Level Of Consciousness - AVPU
Orientation - Person / Place / Time / Event
Pupils - PEARRL
Airway, Breathing, Circulation - Fix Immediate Threats
Rapid Scan
Priority of Care / Transport Decision
History Taking
Chief Complaint
History - SAMPLE
Pain - OPQRST
Secondary Assessment
Physical Assessment - DCAP-BTLS
Assess Vital Signs - BP, Pulse, Resp, O2 Sat
Reassessment
Repeat Primary Assessment Reassess Vital Signs Reassess Chief Complaint Recheck Interventions Identify and Treat Changes (Unstable every 5 min; Stable every 15 min)
Awareness and concern for potentially serious underlying and unseen injuries.
Index of Suspiscion
Force acting over distance.
Work
Energy of a moving object.
Kinetic Energy
One half of Mass x Velocity Squared
The energy of falling.
Potential Energy
Mass, Force of Gravity, Height
Compression injury to the anterior portion of brain and stretching of the posterior portion.
coup-contracoup brain injury
can also occur when heart hits sternum and shears aorta
Significant mechanisms of vehicular collision injury are suggested by:
Death of vehicle occupant
Severe deformity of vehicle
Altered mental status
Ejection from vehicle
Four types of motorcycle impacts:
Head-on Collision - Drag injury or secondary collision
Angular Collision - Crushing of rider lower extremities
Ejection - Drag injury or secondary collision
Controlled Crash - Rider tries to leave bike, may work
Types of blast injury:
Primary - Damage to body by pressure wave. Hollow organs most susceptible.
Secondary - Struck by flying debris.
Tertiary - Patient hurled by force into stationary object.
Miscellaneous - Burns, toxic gasses, crush from building collapse.
Key elements for Trauma Centers
I - comprehensive regional resource
II - able to initiate definitive care for all injured patients
III - able to provide prompt assessment, stabilization (general surgeons, anesthesiologist can be available)
IV - able to provide advanced life support and has transfer agreement with higher level
Glasgow Coma Scale - Eye Opening
4 Spontaneous
3 To Voice
2 To Pain
1 None
Glasgow Coma Scale - Verbal Response
5 Oriented 4 Confused 3 Inappropriate Words 2 Incomprehensible Words 1 None
Glasgow Coma Scale - Motor Response
6 Obeys commands 5 Localizes pain 4 Withdraws from pain 3 Flexes from pain 2 Extends from pain 1 None
Revised Trauma Score
4 GCS 13-15, SBP>89, RR 10-29 3 GCS 9-12, SBP 76-89, RR>29 2 GCS 6-8, SBP 50-75, RR 6-9 1 GCS 3, SBP 0 RR 0 Sum points on 3 measures to get rating from 0 to 12
Signs and symptoms of Hypovolemic Shock.
Rapid, weak pulse Changes in mental status Cool, clammy skin Cyanosis Low blood pressure (late)
Location of pressure points.
superficial temporal external maxillary carotid brachial ulnar radial femoral dorsalis pedis posterior tibial
Injury that causes bleeding beneath the skin, but does not break the skin.
Contusion
Buildup of fluid and blood beneath the skin.
Ecchymosis (black discoloration)
Buildup of fluid from a large blood vessel.
Hematoma
When a body part is trapped under weight for more than four hours.
Crush Syndrome
can lead to renal failure and death
Pain out of proportion to injury.
Compartment Syndrome
swelling compresses blood vessels cutting off blood flow
An injury separates layers of soft tissue so that they either completely detach or hang as a flap.
Avulsion
Treatment for human bites.
Apply dry, sterile dressing
Immobilize area with splint or bandage
Provide transport to ED for surgical cleaning of wound
Depth of burns.
superficial - 1st degree
partial-thickness - 2nd degree
full thickness - 3rd degree
Rule of nines.
Sections of adult body divided by 9%:
arms 9% each, legs 18% each, head 9%, torso back 18%, torso front 18%, genitalia 1%
Child - legs are 16.5%, head is 12%
Infant - legs are 13.5%, head 18%
Types of burns
Thermal - caused by heat - flame, scald, contact, steam
Inhalation
Radiation
Chemical
Classification of burns.
Severe Full thickness on hands, feet, face, upper airway or genitalia Full thickness more than 10% surface area Partial thickness more than 30% Younger than 5 or older than 55 Moderate Full thickness 2 - 10% surface area Partial thickness 15 - 30% Superficial burns > 50% Minor Full thickness < 2% Partial thickness <50%
Parts of the ear.
Pinna - visible outer
tragus - round fleshy bulge anterior to ear canal
external auditory canal - leads to ear drum
tympanic membrane - ear drum
hammer, anvil, stirrup
cochlea
eustacian tube
The presence of air in soft tissues.
subcutaneous emphysema - crackling sensation
also Crepitus
Layers of tissue that suspend the brain and spinal cord.
Menenges
Dura mater - tough fibrous outer layer
Arachnoid mater and Pia mater - thin, contain blood vessels that nourish brain
Signs of skull fracture.
Basilar skull fracture
ecchymosis:
under eyes - raccoon eyes
behind ear over Mastoid Process - Battle’s sign
Patient can remember everything up to the injury
retrograde amnesia
Patient unable to remember events after the injury.
anterograde amnesia
Effect of pulling on spine.
Distraction
Vertebrae out of alignment.
Subluxation of the spine
Loss of sensation with severe spinal injuries.
Quadriplegia - C5 to C6 injury
Paraplegia - L1 injury
Irregular respirations, bradycardia and hypertension.
Cushing’s triad is a clinical triad variably defined as having:
Irregular respirations (impaired brainstem function)
Bradycardia
Hypertension
Associated with increased intracranial pressure.
When blood or other fluid fills the pericardial sac.
Cardiac tamponade
Blunt chest injury caused by sudden, direct blow to the chest at a critical point in the heartbeat.
Commotio Cordis
Causes ventricular fibrillation and possible death
Signs caused by blood in the peritoneal cavity.
Kehr sign - Left shoulder pain, ruptured spleen
Cullen sign - periumbilical ecchymosis, takes 24-48 hours to appear and can predict acute pancreatitis
Grey Turner’s sign - bruising of the flank, indicative of pancreatic necrosis
Blumberg sign - rebound tenderness, indicative of peritonitis
Types of fractures
Greenstick - incomplete, occurs in children Comminuted - broken into more than 2 fragments Pathologic - weakened or diseased Epiphyseal - occurs in growth plate Oblique - broken at an angle Traverse - straight across Spiral - twisting, child abuse Incomplete - nondisplaced partial crack
Common complication of fracture of tibia or forearm in children.
Compartment syndrome
develops within 6 to 12 hours
characterized by pain out of proportion to injury
An object at rest tends to stay at rest.
Newton’s First Law
Force equals mass times acceleration.
Newton’s Second Law
For every action, there is an equal and opposite reaction.
Newton’s Third Law
Signs and symptoms of hypovolemic shock.
rapid, weak pulse change in mental state cool, clammy skin cyanosis (lips, oral membranes, nail beds) low blood pressure (late sign)
Bright red blood coughed up by patient.
Hemoptysis
Management of closed soft tissue injuries (RICES).
Rest Ice Compression Elevation Splinting
Five basic interventions for external bleeding with signs and symptoms of shock.
Direct pressure High flow oxygen Prevent heat loss Trendelenburg position High priority transport
Signs and symptoms of inhalation injury.
Stridor Dyspnea Coughing Wheezing Facial burns Hoarse voice Airway edema Singed facial hair Soot in mouth or nose
Evaluation of electrical burn.
Possible unseen injury between entrance and exit.
High risk of respiratory and cardiac arrest.
All electrical burns require transport and evaluation by physician.
Signs and symptoms of concussion.
Altered LOC that gradually improves Nausea Vomiting Irritability Repetitive questioning Vision problems Amnesia
Signs and symptoms of cerebral contusion.
S/S concussion and a least one of: decreasing mental status unresponsive pupillary changes changes in vital signs obvious behavioral abnormalities
Signs and symptoms of epidural hematoma.
Brief loss of consciousness Headache Seizures Vomiting Posturing Hypotension Bradycardia Changes in respiration Pupillary changes
Signs of increased intracranial pressure.
Cushing’s response:
Hypertension
Bradycardia
Altered respiratory pattern
Signs and symptoms of spinal injury.
tenderness around injured area
motor and/or sensory deficits
paralysis below injury
possible respiratory arrest in high cervical injury (C5 or above)
Signs and symptoms of neurogenic shock.
Any sign or symptom of spinal injury
Priapism
Hypotension without tachycardia
Warm skin, normal color
Signs of cardiac tamponade (Beck’s Triad).
Jugular vein distension (JVD)
Muffled heart sounds
Narrowing pulse presssure
What is the most important intervention for a flail chest with respiratory compromise?
Positive pressure ventilation and oxygenation.
Five mechanisms of heat loss.
Conduction Convection Evaporation Respiration Radiation
Signs and symptoms of hypothermia.
Cold skin on torso Pale skin / cyanotic Shivering (absent in extreme) Loss of coordination (stiff muscles, difficult speaking) Altered LOC Bradycardia Bradypnea Hypotension
Prehospital rewarming is limited to passive measures.
Signs and symptoms of heat exhaustion.
Hx of exertion in a warm climate Dizziness, weakness Nausea, vomiting Headache Possible muscle and abdominal cramps Thirst Tachycardia
Signs and symptoms of heat stroke.
Similar to heat exhaustion
altered or decreased LOC
skin may be hot and dry or wet
seizures
Management of systemic heat emergencies
Move to cooler environment
Water for completely alert patient
Rapid and aggressive cooling for heat stroke.
Expose patient
Cool with water, wet towels, ice packs
Ice packs best to groin, neck, arm pits
Rapid transport
Be alert for vomiting and/or seizures
Pneumatic antishock garment (PASG).
For the most part, the pneumatic antishock garment (PASG) is no longer routinely used in EMS.
It may be useful to stabilize pelvic fractures, especially if the patient has accompanying signs of shock. In general, the PASG should not be used for patients with blunt or penetrating trauma to the head, chest, or abdomen. Under NO circumstances should the device be used on any patient with pulmonary edema, as evidenced by shortness of breath, crackles in the lungs, or a history of left-side congestive heart failure.
