Chapter 7, 25, 26, and 27 Flashcards
What is trauma?
major cause of death for persons between 1 and 44.
What are the functions of blood?
transportation of gases, nutrition, excretion, protection (blood clots), and regulation (hormones and heat)
What is perfusion?
the supply of oxygen to and removal of wastes from the body’s cells and tissues as a result of the flow of blood through the capillaries
What is hypo perfusion?
the body’s inability to adequately circulate blood to the body’s cells to supply them with oxygen and nutrients
What is shock?
body’s inability to adequately circulate blood to the body’s cells to supply them with oxygen and nutrients, which is a life-threatening condition
What is hemorrhage?
bleeding, especially severe bleeding major cause of shock with only a certain amount of blood to circulate if enough is lost perfusion will not occur in cells with the brain, spinal cord, and kidneys the most sensitive to inadequate perfusions. Can be classified or external or internal, minor or severe
What is external bleeding?
bleeding occurring outside body, typically visible on surface of skin occurring after force penetrates skin and lacerates or destroys underlying tissues. How much someone bleeds is based on size and pressure of blood vessel that has been ruptured and the person’s ability to clot and stop the bleeding.
What is massive hemorrhage?
when extensive wounds open up large blood vessels or many smaller blood vessels.
What is arterial bleeding?
bleeding from an artery, which is characterized by bright red blood that is rapid, profuse, and difficult to control. Spurting with each heartbeat, and as pressure decrease in the system spurting will decrease and may not be noticeable
What is venous bleeding?
bleeding from a vein, which is characterized by dark red or maroon blood and a steady, easy to control flow. Wounds to large veins such as jugular veins can cause massive bleeding because even though has less pressure the sheer volume can cause immediate life thretening hemmorhagging in patients
What is junctional hemmorrhage?
where appendages of body connect to trunk and in these locations large arteries and veins tend ot be less well protected and particularly vulnerable to truamatic forces such as the neck, both armpits, and both sides of groin where it is likely. Control this kind of bleeding before managing airway.
What is capillary bleeding?
bleeding from capillaries, which is characterized by a slow, oozing flow of blood or superficial bleeding ceasing without intervention at all but can occur over large areas meaning there is a high risk of infection with non massive bleeding coming from veins and small arteries. Medications can make this worse and become life threatening
What are blood thinners? and what causes the blood to thin?
Medications such as warfarin (coumadin), clopidogrel (plavix), pradaxa (dabigatran), and xarelto (rivaroxaban) act to prevent stroke or heart attacks but can lead to life threatening bleeding from injuries that might be relatively minor. Hypothermia can can lead to impaired ability to clot.
What is external hemorrhaging?
External hemorrhaging is compressible and can be controlled by compressing the tissue around the wound or vessel that is bleeding
What are the signs and symptoms of blood loss?
pulse will increase in an attempt to pump more blood and as pulse gradually increases becomes weak and thready with patient becoming tachycardic
What is the treatment of bleeding?
Direct pressure, elevation of a limb, hemostatic agent, and tourniquet
What is direct pressure?
compress wound with direct pressure with gloved hand, dress, or pressure dressing and bandage. It compresses the tissue around the wound and diverts blood flow from the affected blood vessels. Firm pressure with palm of hands (finger for smaller wound), may apply body weight to enhance pressure with the amount of pressure based on the severity of the wound. Don’t use dressing if severe dont have time and hold pressure firmly until bleeding stops, once controlled cover with bandage. Don’t remove dressing once placed as it may remove clots or further injury applying additional dressings on top if bandage is soaked using more pressure or hemostatic dressing and tourniquet
What is a pressure dressing?
a bulk dressing held in position with a tightly wrapped bandage, which applies pressure to help control bleeding. And can control most extenal bleeding plazing several gauze pads on wound holding with self-adhering roller bandage wrapped tightly over dressings and above and below wound site make sure pressure isnt to much to be a tounriquet. Checking distal pulses to make sure isnt applied to tightly
What is elevation?
injured extremity has never been proven to decrease bleeding, done quickly and easily at the same time as applying direct pressure gravity helps reduce blood pressure in extremity, slowing bleeding. Dont do this if you suspect musculoskeletal injuries, implaed objects in extremity, or spine injury as movement of borken bone ends or pentrating objects can further damage the tissues.
What are hemostatic agents?
substances applied as powders, dressings, gauze, or bandages to open wounds to stop bleeding if direct pressure isnt working. Applying a material designed to absorb the liquid portion of blood and leave the larger formed elemts to form clot. Absorbent properties aiding direct pressure but not replaceing it and must apply pressure over it and useful for large cavity filling cavity with dressing to absorb filling but not into internal open wound such as penetrating truama to abdomen or chest
What is a tourniquet?
a device used for bleeding control that constricts all blood flow to and from extremity if direct pressure and hemostatic dressing dont work. Severe trauma to an extremity causing multiple lacerations, penetrations, and anatomic destruction leadings to bleeding in more than one area. Protruding broken bone ends and curhs-type amputations can also prevent ability to apply direct pressure leading to direct pressure not being necessary. Rapid solution to massive bleeding in an extremity, can quickly mve to address other pressing concerns like airway and breathing issues. Used only on extremity injuries, dont apply directly over joint, placing tourniquet two inches above bleeding wound. Never use narrow material to cut into skin even blood pressure cuff. Tighten to point where bleeding is controlled, with no distal pulse palpable or tighten till it can’t be tightened further note the time it has been applied visually monitoring it. May have to add a second tourniquet
What is splinting?
can control bleeding control since sharp ends of broken bones may cause tissue and vessel injury, stabilizing it and preventing further movement of bone ends preventing additional damage such as air splints even if no injury produces a form of direct pressure or one wound extending over length and most effective for venous and capillary bleeding not artery unless pressure applied
What is cold application?
controlling bleeding minimizing swelling and reducing bleeding by constricting blood vessels in conjunction with other manual techniques wrapping in cloth and for no longer than 20 minutes
What is head injury?
traumatic injuries resulting in fractured skull cause bleeding or loss of cerebrospinal fluid (CSF) from ears or nose. Head injury results in increased pressure within skull forcing fluid out of the cranial cavity and shouldnt attempt to stop bleeding or fluid loss as it may increase pressure allow pressure to drain slowly and use a pad to collect it
What is nose bleed?
epistazis can be caused by direct trauma to nose or tiny capillaries in nose may burst because of increased blood pressure, sinus infection, or didital trauma (nose picking) is made worse by medications. Have patient sit down and lean forward, apply direct pressure to fleshy portion, keep patient calm and quiet, don’t let patient lean back, allowing blood to flow down esophagus to stomach as patient swallows, if unconscious place on side
What is internal bleeding?
bleeding inside body that is invisible, damage to internal organs and large blood vessels resulting in loss of a large quantity of blood in a short period of time; large bone ends of fractured femur can cause enough tissue and blood vessel damage to cause shock
What is blunt trauma?
Blunt trauma causing internal injury and bleeding from falls, motor-vehicle or motorcycle crashes, auto-pedestrian collisions, and blast injuries. Blunt trauma blow to chest can fracture ribs, sternum, and costal cartilages, with whole sections of chest collapsing. With severe lung and airway can be damaged with the great vessels and heart possible seriously damaged
What is penetrating trauma?
common cause of internal injuries and bleeding often difficult to judge severity of wound even when size and length are unknown assess for exit wounds from things such as gunshot wounds; stab wounds from knife, ice pick, screwdriver, or similar object, and impaled objects. bullets, knives, pieces of metal or glass, steel rods, pipes, and various other objects can penetrate the chest wall, damaging internal organs and impairing respiration
What are signs of internal bleeding?
injuries to surface of body, indicating underlying injuries; bruising, swelling, or tenderness over vital organs in chest and abdomen; painful, swollen or deformed extremities; bleeding from mouth, rectum, vagina or other body orifice; tender rigid or distended abdomen. Vomiting coffee grounds or dark tarry stools like bright red
How does shock develop?
if heart fails to pump, blood volume is lost, blood vessels dilate, creating vascular container capacity too great to be filled by available blood. Body’s reaction to decreased blood circulation to the organ systems as result of inadequate perfusion of tissues with oxygen and nutrients and inadequate removal of metabolic waste products.
What is compensated shock?
when the patient is developing shock but the body is still able to maintain perfusion. For a time the body’s compensatory mechanisms work and patient maintains blood pressure, with the early signs is the body compensating
What is decompensated shock?
when the body can no longer compensate for low blood volume or lack of perfusion. Late signs such as decreasing blood pressure become evident falling blood pressure leading to irreparable damage to vital organs
What is hypovolemic shock?
shock resulting from blood or fluid loss. Bleeding can be internal, external or a combination of both or by burn or crush injuries where plasma is lost or severe dehydration
What is hemorrhagic shock?
shock resulting from blood or fluid loss a kind of hypovolemic shock
What is cardiogenic shock?
shock, or lack of perfusion brought on not by blood loss but by heart’s inadequate pumping action. It is often the result of a heart attack or congestive heart failures. Heart’s contractions decreased because of damage to heart muscle, or heart’s electrical system malfunctioning causing heartbeat that is slow, fast, or irregular. Watch for low blood pressure, edema in feet and ankles, and other signs of heart failure
What is neurogenic shock?
hypoperfusion due to nerve paralysis (sometimes caused by spinal cord injuries) resulting in the dilation of blood vessels that increases the volume of the circulatory system beyond the point where it can be filled. Leading to the dilation of blood vessels and the loss of integrity of the blood vessels, from urinary infection, postsurgical infection or pneumonia. Use intravenous fluid, and early notification of the hospital,. Signs include temperature high or low, tachycardia, tachypnea, and hypertension
What is hypo perfusion?
altered mental status (anxiety, restlessness, and combativeness); nausea and vomiting. Usually pale, cool, and clammy but in neurogenic the skin is typically warm flushed and dry because of the circulatory systems loss of constriction. Nausea and vomiting as diverted away from digestive system, and vital sign changes. Pulse increase then decrease and pulse becomes weak and thready. Respirations become more rapid, labored, shallow, and sometimes irregular. Blood pressure drops because of the decrease in perfusion of blood loss pulse oximetry might not be accurate
What is emergency care?
increasing blood oxygen will improve supply to the tissues, stop external bleeding to maintain perfusion, transportation be as fast as people activating trauma team or surgeon at hospital, with a maximum of 10 minutes. Keep warm preventing hypothermia which depletes the body’s energy and their ability to clot. Giving oxygen means acidosis a condition that occurs when cells receive insufficient oxygen and generate acidic waste products that accumulate in the blood. Splint while transporting splint whole body on long board
What are the soft tissues of the body?
skin, fatty tissues, muscles, blood vessels, connective tissues, membranes (tissues that line or cover organs), glands and nerves
What are hard tissues?
teeth, bone and cartilage
What are the functions of skin/
protection, water balance, temperature regulation, excretion, shock absorption
What does the skin protect?
barrier keeping out microorganisms (germs), debris, and unwanted chemicals), protecting underlying tissues and organs from environmental contact. Germs on surface of skin defends body from unwanted germs
What is water balance?
prevents water loss and stops environmental water from entering body. Helps preserve chemical balance of body fluids and tissues
What is temperature regulation/
blood vessels in skin can dilate (increase in diameter) to carry more blood to the skin, allowing heat to radiate away from body; when body needs to conserve heat, vessels constrict (decrease in diameter) preventing heat loss. Sweat glands perspiration evaporating g and help cooling body
What is excretion/
salts, excess water, and carbon dioxide are released through the skin
What is shock absorption?
skin and its layers of fat help protect underlying organs from minor impacts and pressures
What is epidermis?
the outer layer of skin dead cells rubbed or slouched off and replaced. Cells iof innermost portion are actively dividing replacing dead cells of outer layers. Contains no blood vessels or nerves, only burns and injuries from cold there are few epidermis injuries
What is dermis?
inner (second) layer of skin found beneath epidermis. Rich in blood vessels and nerves. Sweat glands, sebaceous (oil) glands, and hair follicles. Sense of touch cold, heat, and pain. Once opened to outside world, contamination and infection major problems with profuse bleeding and intense pain bad
What are subcutaneous layers?
layers of fat and soft tissues found below dermis. Shock, absorption, and insulation major functions. Problems of tissue and bloodstream contamination, bleeding, and pain
What are soft tissue injuries?
damaged by trauma rips, crushes, stretches, and injuries of delicate cells. Can be injured mechanically, thermally, and even electrically
What are closed wounds?
internal injury with no open pathway from outside. Skin can be damaged but remains intact usually from blunt damage may be crushed tissue beneath. Can be simple bruises, internal lacerations (cuts), and internal punctures caused by fractured bones, crushing forces, or rupture (bursting open of internal organs.) can be major to life threatening. Contusions, hematomas, and crush injuries. Look for nose and ear bleeding, pain swelling or deformity. Blood in eyes, vaginal rectal or urine bleeding. skin is not broken, leading to many people not seeing damage as serious, but can cause trauma nad compression with fractures ribs and contusions and lacerations of heart, lungs and great vessels
What does swelling or deformity of bruise suggest?
posisble underlying fracture
What is a bruise on the head or neck?
possible injury to cervical spine or brain blood in mouth nose or ears
What are the bruises on abdomen?
injury to underlying organs like spleen liver or kidneys
What is contusion?
bruise epidermis remains intact, but cells and blood vessels in dermis are damaged. With variable amount of internal bleeding occurring at time of injury and continue for a few hours with pain swelling and discoloration occurring at wound site. Swelling and discoloration can appear right away or within 48 hours
What is swelling?
caused by collection of blood under skin and inflammation, fluid brought ot site of injury by immune system cushioning injured area and dilutes toxins but can be harmful causing tissues to occupy more space than usual causing possible compression and reduced blood flow
What is hematoma?
swelling caused by collection of blood under skin or in damaged tissues as a result of an injured or broken blood vessel. Involve larger amount of tissue damage, like larger blood vessels with greater internal blood loss
What is a crush injury?
an injury caused when force is transmitted from the body’s exterior to ints internal structures. Bones can be broken; muscles, nerves, and tissues damaged and internal organs ruptured, causing internal bleeding. Liver and spleen when crushed bleed severely causing shock with contents of hollow organs can leak into body cavities
What are blast injuries?
soft-tissue injury including open and closed. Blunt-force trauma from high pressure waves and forces from explosions leading to massive internal damage as well as high pressure flying objects. Can lead to rupture of internal organs like lungs and eardrums from high pressure, can explode hollow organs, break bones, crush organs, and lacerate blood vessels. combination of all injuries blasts causing injury with initial blast (pressure waves affecting air or fluid filled organs), when patient struck by debris (projectiles open and penetrating wounds), when thrown (thrown against objects fractures avulsions and amputations) or from exposure to chemicals.
What are abrasions?
cut or scratch outer layer of skin is damaged but not all layers are penetrated ranging in severity such as skinned elbows and knees, road rash mat burns, rug burns, and brush burns. May be no detectable bleeding or minor ooze. Opportunity of infection great from dirty
What are lacerations?
cut can be smooth or jagged caused by object such as razor blade, broken glass or metal or severe blow from blunt. Rough edges may fall together and obstruct view of wound depth, can’t always tell depth
