Chapter 24-trauma Overview Flashcards
Trauma emergencies
Occur as a result of force applied to the body
Medical emergencies
Include illnesses or conditions; not caused by an outside force
Index of suspicion
Your awareness and concern for potentially underlying unseen injuries
Mechanism of injury (MOI)
The way in which traumatic injuries occur, it describes the forces acting on the body that causes injury
What are the three concepts of energy typically associated with injury? Not including thermal energy)
Potential energy, kinetic energy, and the energy of work
Work
Force acting over a distance
Kinetic energy
The energy of a moving object
What is the kinetic energy formula
KE = 1/2 mass x velocity
How to find the force of something
F= mass x velocity
Potential energy
The product of mass, force of gravity, and height and is mostly associated with the energy of falling objects
Mustisystem trauma
An injury to more than one body system
Blunt trauma
The result of force to the body that causes injury without any penetrating of the soft tissues or internal organs of cavities
What are the three collisions involved in a car crash
The first collision is a vehicle against another object, the second collision is the passenger against the interior of the car, the third collision is the passengers internal organs against the solid structures of the body
Coup contrecoup brain injury
Compression injury to the anterior and posterior part of the brain
Significant moi’s are suggested by what findings
- death of an occupant in the vehicle
- sever deformity of the vehicle or intrusion in the vehicle
- severe deformities to the frontal part of the vehicle, with or without intrusion
- moderate intrusion in lateral crash
- severe damage from the rear
- crashed in which rotation is involved
- ejecction from the vehicle
What three Likely areas of injury can a significant MOI and condition of vehicle suggest
A. The knees can strike the dashboard, resulting in hip dislocation or fracture
B. Serious chest and abdominal injuries can occur from the steering wheel
C. Head and spinal injuries can occur from collision with the window
What injuries do rear end crashes typically cause?
Whiplash
What injury can happen from a lateral car crash? (T bone)
The passenger can get a lateral whiplash injury in the shoulders and the head moves towards intrusion
Car vs pedestrian
Often results in broken bones, but may also have serious unseen injuries to underlying body systems.
Estimate speed of the vehicle, then whether the patient was ejected, the surface landed on, and what distance or if the patient was pulled under the vehicle
Multi system injuries are common
Car vs bike
Examine position and damage of bicycle.
If Helmet is damaged, expect head/spinal trauma
Car vs motorcycle
Make sure to undergo cervical spine checking
Examine the motorcycle, the distance of skid on the road, the car, and the helmet
What are the four types of motorcycle impacts?
- head on crash
- angular crash; usually results in direct crushing injury between motorcycle and secondary force to the lower extremities
- ejection: can suffer from sever road rash to bone
- controlled crash: the biker lays the bike down to ultimately avoid injury
How many feet of a fall is considered significant
20 feet
What two things are considered a significant moi for a child
- Falls of greater then 10 feet (2 to 3 times the height)
2. Medium to high speed vehicle crash (>25 mph)
When a patient falls, what factor should you account for?
The height of the fall
The type of surface struck
The part of the body that hit first, followed by the path of energy displacement
Trajectory
The path the projectile takes
Cavitation
A phenomenon in which speed causes a bullet to generate pressure waves, which caused damage distance from the bullets path
Drag
Air resistance
What are signs and symptoms of blunt or penetrating trauma to the neck? What would the index of suspicion be?
Noisy or labored breathing Increased respiratory rate Swelling of the face or neck Altered gag reflex Decreasing/low Glasgow, scale Rapid weak pulse Decreasing/low blood pressure
IOS:
- significant bleeding or foreign bodies in the upper or lower airway, causing obstruction
- be alert for airway compromise
What would the signs and symptoms be for significant chest wall blunt trauma from motor vehicle crashes, car versus pedestrian, and other crashes (as well as penetrating trauma)
What would the IOS be?
Significant chest pain Shortness of breath Increased respiratory rate Asymmetric chest wall movement Subcutaneous emphysema Presence of JVD Rapid, weak pulse or decreasing/low blood pressure Loss of peripheral pulses during inspiration Narrowing pulse pressure's IOS: *cardiac or pulmonary contusions * pneumothorax or hemothorax * broken ribs, causing respiratory compromise
Signs and symptoms of any significant blunt force trauma from motor vehicle crashes or penetrating injuries
Along with index of suspicion
Blunt or penetrating trauma to the neck, chest, abdomen, or groin
Blows to the head sustain doing motor vehicle crashes, falls, or other incidents, producing loss of consciousness, altered mental status, inability to recall events, combativeness, or changes in speech patterns
Difficulty moving extremities, headache, especially with nausea and vomiting
Rapid weak pulse, and decreasing/low blood pressure
IOS: injuries in these regions may tear and cause damage to the large blood vessels located in these body areas, resulting in bad bleeding
Be alert to the possibility of bruising to the brain and bleeding in and around the brain tissue
Signs and symptoms and index of suspicion of any significant blunt or penetrating trauma from falls or a significant height
*Severe back and or neck pain, history of difficulty moving extremities, loss of sensation or tingling in extremities
* decreasing GCS
* rapid, weak pulse
IOS: injury to the bones of the spinal column of the spinal cord
Describe primary blast injuries
These injuries are due entirely to the blast itself: damage to the body happens by the pressure wave generated by the explosion
Secondary blast injuries
Damage to the body results from being struck by flying debris such as shrapnel from the device or from glass or splinters which may have been set in motion by the explosion
Tertiary blast injuries
These injuries occur when the patient is hurled by the force of the explosion against a stationary object
Quaternary blast injuries
This category of miscellaneous injuries includes burns from hot gases, respiratory injury from healing toxic gases, suffocation, poisoning, medical emergencies incurred as a result of the explosion, crush injuries, contaminations of wounds
Tim panic membrane
The eardrum, the thin membrane in the middle ear that transmit sound vibrations to the internal ear. This can be damaged in blast injuries and you can use it to help you triage patients
Pulmonary blast injuries
Pulmonary trauma resulting from short range exposure to the destination of explosives
The patient may report tightness or pain in the chest and may cough up blood and have tachapnia or other signs of respiratory distress. Subcutaneous emphysema can be detected over the chest through palpation
Arterial air embolism
Air bubbles in the arterial blood vessels
Level one trauma center
Original resource center in general he serves large cities are heavily populated areas. Level one facilities must be capable of providing every aspect of trauma care from prevention through rehabilitation
Level two trauma facility
Typically located in less populated areas. Level two centers are expected to provide initial definitive care, regardless of injury severity. These facilities can be academic institutions or public/private community facilities.
Level III trauma center
Able to provide prompt assessment, resuscitation, and stabilization of injured patients in emergency operations
Level IV trauma center
Able to provide advanced , Life-support before transportations to a higher level trauma center
Trauma score
Calculator number from 1 to 16. It takes into account the Glasgow coma scale score, respiratory rate, respiratory expansion, systolic blood pressure, and capillary refill
Glasgow, scale: Eyeeye-opening, verbal, motor
Eye opening *spontaneous: 4 * Voice: 3 * pain stimulation: 2 *none: 1 VERBAL * oriented conversation: 5 * confused conversation: 4 * inappropriate words: 3 * incomprehensible sounds: 2 *none: 1 MOTOR: * obeys commands: 6 * localizes pain: 5 * with drawls from pain: 4 * abnormal flexion 3 Abnormal extension 2 None: 1
Revised trauma score
Commonly used for patients with head trauma because it’s a weighted to compensate for major head injury without multi system injury or a major physiological changes
Revised trauma score
GCS: 13-15. SBP. > 80 9MMHG. RR 29 bpm
