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
What is a puncture wound?
open wound that tears through skin and destroys underlying tissues. Penetrating puncture wound can be shallow or deep. A perforating puncture wounds has both an entrance and an exit wound. Puncture wounds caused by bullet,s, nails, ice picks, splinters or knives blast injury creating shrapnel can cause. Pushes object through skin and soft tissue may not be external. High infection and serious injury. Exit wound may be more dangerous than entrance with most damage underneath
What is an avulsion?
tearing away or tearing off of a piece or flap of skin or other soft tissue. This term also may be used for an eye pulled from its socket or a tooth dislodged from its socket.
preserve avulsed parts and transport with patient, clean wound surface fold skin back to normal position gentle, control bleeding and dress wound using bulky pressure dressing. Use bulk pressure dressing saving avulsed part and wrap in sterile dressing kept moist with sterile saline labeling patient name date and time and object keep as cool as possible place cool around it not in it
What is amputation?
surgical removal or traumatic severing of a body part, usually an extremity. Jagged skin and bone, massive bleeding or force tears off torn blood vessels limiting bleeding collapsing blood vessels. control hemorrhage and tourniquet if necessary, wrap or bag amputated part in plastic bag and keep cool securing dressing with self-adhesive gauze bandage
What are bite wounds?
infection rates are higher and human bites signs of abuse or assault
What are the bruises on trunk or damage to ribs or sternum?
chest injury coughing up blood may be punctured lung
What are open crush injuries?
extremity caught between heavy items, pieces of machinery. Blood vessels nerves and muscles involved with swelling resulting in blood loss distally. Bones may protrude and soft tissue and internal organs can be crushed producing massive bleeding
What are open wounds?
injury in which skin is interrupted, exposing tissue beneath coming from outside or inside. Kinds of open wounds include: abrasions, lacerations, punctures, avulsions, amputations, crush injuries, blast injuries, and high pressure injection injuries
What are high pressure injection injuries?
patient working with machine that injects something into it and instead into body can’t tell injury but can damage whole extremity because of force killing tissues if toxic and tissue begins to die leading to perhaps amputation of limbs. Elevate and splint limb don’t apply cold leading to more tissue damage
How do you treat open wounds?
remove clothing that covers it cutting it not taking it off the usual way can cause more damage. Clean surface don’t pick embedded particles and debris out removing large pieces of foreign matter from surface using sterile dressing to brush away. Focuss on controlling bleeding with direct pressure and elevation then tourniquet. Provide care for shock for all serious wounds use sterile dressing and bandage after controlling bleeding checking pulse keep them lying still and reassure them.
How do you care for lacerations?
use butterfly when small check pulse, motor and sensory function distal to injury, may need stitches plastic surgery antibiotic or tetronics don’t just leave on scene and don’t pull apart to see injury
What are bullet wounds?
all are serious no idea how it tumbled may have deflected off bone, fragments, or exploded inside body if penetrated must assume considerable internal injury. Close-range have burns around entry, a gunshot to face creates airway problems. Stab wounds dangerous when involve head, neck, chest ,abdomen or groin proximal to knee or elbow . search for additional penetration s such as exit wounds treating both. Care for shock, do not immobilize patient with penetrating trauma to torso unless neurological deficit. Take object ot hospital if not part of crime scene
What is an impaled object?
knife, fence post ,guard rail, shard of glass, wooden stick, or something broke off in the wound piercing part of body. If too long to transport contact emergency description, stabilize object and cut with fine-tooth saw slowly. Don’t remove impaled object, as it might be plugging bleeding of major artery can cause severe bleeding when pressure released and may cause further injury to nerves, muscles and other soft tissues and any movement may magnify damage underneath
how do you treat an impaled object?
expose wound, stabilize object during exposure, bleeding control via pressure positioning on either side of object and exerted pressure downward, and dressing with bulk dressing around injury site surrounding object on all sides starting opposite sides and for large objects folded towels or blankets applying pressure. Place each round perpendicular unstabilized exerting pressure and stabilizing. Tape may not work from blood so use cravats tying one above and below wid and can use splint to immobilize areas
What do you do if a cheek is impaled?
airway obstruction, oral cavity, bleeding can interfere with breathing, or causing vomiting. Inspect both external and inside of cheek, see if passed through wall using dressing pad. Remove object if perforated pulling out in direction that entered cheek if not easily done then leave do not twist. If tip is impaled into deeper structure (palate) stabilize object. Position patient for drainage and stabilize if necessary monitoring airway and suctioning if necessary teeth may be in throat. Dress outside of wound using pressure and applying sterile dressing on iside to control breathing in mouth if patient it alert and cooperative
What do you do if they eye is impaled?
stabilize object placing 3inch gauze bandage or folded 4x4 on either side along vertical axis of head stabilizing. Rigid protection put disposable paper drinking cup or cone over objects not styrofoam. Stabilize dress and secure with self adherent roller bandage or gauze. Dress and bandage uninjured eye reducing sympathetic eye movements
What do you do with genital injury?
bleed heavily and include lacerations, contusions, abrasions, from blunt or penetrating trauma, avulsions penis, blunt trauma from straddle injuries landing heavily on narrow, zipper injuries in uncircumcised boys, blood at meatus (external opening of urine flow from pelvic injury), disruption of urethra may be fracture of pelvis. Control bleeding, preserve avulsed, doe sit suggest another possibly more serious injury. If child or vulnerable inquire non-threatening whether sexual abuse was involved, dress and bandage, consider sexual assault
What are burn injuries?
Burns injuries to skin and below including muscles, bones, nerves, and blood vessels. Injuring beyond repair skin and things like eyes, and respiratory obstructing airway from swelling damaging tissue. Classify by agent and source, by depth, and severity
What is an agent?
source of burn chemicals or electricity such as dry lime or alternating current becoming more specific
What is a thermal burn?
flame, radiation, excessive heat from fire, steam, hot liquids, and hot objects. Stop burning cool burned area by wetting down smothering and removing affected clothing, semi-solid (grease tar wax) cool with water and don’t remove substance. Check Airway for hoarse voice, stridor, soot deposits, burned nasal hair, facial burns. Evaluate by depth extent and severity
How do you treat thermal burns?
Do Not clear debris but remove clothing and jewelry and wrap with sterile dressing and separate toes and fingers if burned. If eyes don’t open patient’s eyelids make sure thermal not chemical apply gauze to both eyes if chemical flush eyes for 20 minutes on route. Moist dressing for partial thickness and dry for more severe. Immersion burns and liquid scald can be indicators of abuse. Do Not apply ointments, sprays or butter (trap heat), don’t break blisters, apply ice (cause damage), keep clean, keep warm. Steam and vapor injuries can cause problems to airway and swelling closing it with burns to mouth nose, soot in sputum or mucus, singed eyebrows or nose hairs, and difficult speaking suggest transport fast and ALS may have carbon monoxide or hydrogen cyanide
What are chemical burns?
various acids, bases and caustics. Cna remain on skin and continue to burn for hours or days entering bloodstream. Wash away chemical with flowing water, if dry chemical brush away as much as possible and flush skin. Continuous flooding area using copious but gently flow not hard sprays cleaning for 20 minutes and continue on route removing contaminated cloths as you wash. Apply sterile dressing or burn sheet and treat for shock. Find out exact chemical in incident
What do you have with mixed or strong acids?
Mixed or strong acids or unidentified substances immediate and severe pain continue washing even after no longer experiencing pain
What is dry lime?
don’t wash burn site it will make it corrosive, brush from skin, hair and clothing away from eyes or airway using water only after brushed off and remove contaminated clothing
What is carbolic acid?
(phenol)- use alcohol for unbroken skin then water not water before
What is sulfuric acid?
heat is produced when water added so continue washing
What is hydrofluoric acid?
etching glass, delayed burns even if not evident flood with water very bad acid damage internally used in glass etching, electronics manufacturing, and rust removers.
What are inhaled vapors?
Inhaled vapors- provide oxygen and transport
What do you do if they are in the eye?
immediately flood eye, from nasal corner of eye to lateral corner holding eyelid open continue washing until patient arrive after washing cover both with moist pads washing for 5 more minutes if more pain and protect yourself
What is electricity?
alternating current, direct current, and lightning. Cause only small areas of skin injury but pose great risk of severe internal injuries. Skin burns where electricity enters body and flows to ground tissue damaged from heat and forceful contraction of muscle tissue and in nerves heart and muscle messing with homeostasis
What are the signs and symptoms of electrical injuries?
Signs and symptoms of electrical injuries: burns where energy enters and exits body, disrupted nerve pathways displayed as paralysis; muscle tenderness, with or without muscular twitching. Respiratory difficulties or respiratory arrest. Irregular heartbeat or cardiac arrest. Elevated blood pressure or low blood pressure with signs and symptoms of shock. Restlessness or irritability if conscious or loss of consciousness, and visual difficulties, possible convulsions, swollen tongue possibly obstructing airway, and fractured bones and seizures
What are the treatment of chemical injuries?
may have to provide positive pressure ventilation if swelling, defibrillation, shock, and oxygen, spine injuries, head injuries, and fractures. Patient should be fully immobilized, look at burns looking for two sites. Cool burn areas and smoldering clothing apply dry sterile dressing and transport immediately
What is light?
intense light sources, ultraviolet light can be considered source of radiation burns
What is radiological?
nuclear sources UV light. Ex. sunburn. From medicine, manufacturing and production of electricity or weapons of mass destruction or dirty bombs. Look like thermal injuries and only deal with after decontaminated having damage to many layers of soft tissue. Cover burns and transport
What are superficial burns?
burn that involves only epidermis, outer layer of skin. Reddening of skin and some swelling. First degree Ex nburn severe pain at site healing of own accord without scarring
What are partial thickness burns?
epidermis (first layer of skin) burned through and dermis (second layer) is damage does not pass through underlying tissue. Burns of this type cause reddening, 48 hours blistering, and a mottled appearance with deep intense pain heal themselves with very little or no scarring. Second degree
What are full thickness burn?
burn in which all the layer of the skin are damaged. There are usually areas that are charred black or areas that are dry and white third-degree. May complain of severe pain or if enough nerves damaged may not feel pain at all except at periphery of burn where adjoining partial thickness burns may be causing pain may require skin grafting can injure muscle bone and underlying organs
What are burns?
determine severity, agent or source of burn, body regions burned, depth of burn, extent of burn, age of patient (children under 5 and over 65 more deadly greater flood and heat loss shock and airway problems elderly moderate burns become severe if over 55) , other injuries and illnesses (may make it worse or life threatening). Bad for face because of airway and eyes, and hands and feet loosing movement of fingers and toes. Groin, genitalia, buttocks, or medial thighs burned potential bacterial contamination high. Circumferential burns (encircle body or body part) constrict skin and interrupt circulation and movement
What are the rule of nines?
a method for estimating the extent of a burn. For an adult, each of the following areas represents 9 percent of the body surface: the head and the neck, each upper extremity, the chest, the abdomen, the upper back, the lower back and buttocks, the front of each lower extremity, and the back of each lower extremity. Used for larger burns. Minor burns- partial thickness less than 10% of body surface. Moderate burns 10-20% of body surface with partial thickness. critical burns- full thickness of any extent or partial burns of 20% or more of body surface
What are the rule of palm?
method for estimating extent of burn. Palm and fingers of patient’s own hand, which equals about 1% of body’s surface area, is compared with the patient’s burn to estimate size. Used for smaller burns
What is dressing?
any material (preferable sterile) used to cover a wound that will help control bleeding and prevent additional contamination. Usually individually wrapped sterile gauze pads, 4 inches square and an sizes. Secured using adhering or non adhering gauze roller bandages, triangular bandages, strips of adhesive tape, or air splint
What is bandage?
any material used to hold a dressing in place needs to be sterile. Self adhering form fitting roller bandage eliminated specialized bandaging techniques
What is a universal dressing?
bulky dressing for profuse bleeding or large wounds or stabilizing impaled object.
What is a pressure dressing?
dressing applied tightly to control bleeding. Gauze pads placed on wound and bulk is placed over pads. Self-adherent roller bandage wrapped tightly over dressing and above and below wound checking pulse
What is an occlusivee dressing?
any dressing that forms an airtight seals. Open wounds to abdomen, for external bleeding from large neck veins and open wounds to chest. Plastic wrap and petroleum gel-impregnated gauze occlusive dressing
What do you do when dressing open wounds?
use sterile or very clean materials, avoid touching dressing in area coming into contact with wound. Grasp b corner from pack and place on wound, cover entire wound and immediate surroundings controlling bleeding do not bandage in place if bleeding isnt controlled except pressure dressing. Don’t remove dressing once applied. If bleeding continues apply pressure and apply more hemostatic agent putting new dressing over old ones. Put gauze before bulk dressing so don’t remove
What do you do when you bandage open wounds?
do not bandage too tightly, held snugly but not restricting blood flow. Not loosely, no loose ends which can get caught. Don’t cover tips of fingers and toes to see skin color changes. Pain pale, cyanotic skin, cold skin, numbness and tingling all suggest too tight. Cover all edges of dressing reducing additional contamination. Except flutter valves. Wrap large area so point pressure does not occur. Bandage across joint but don’t bend limb once in place as could restrict circulation
What is compression?
from severe blunt trauma where chest is rapidly compressed like when driver strikes chest on steering column or person trapped in trench-wall collapse with sternum and ribs possibly fractured and heart severely squeezed, and lungs rupture
What is a flail chest?
fracture of two or more adjacent ribs in two or more places that allows for free movement of the fractured segment leaving a portion of of chest wall unstable affecting breathing and reducing lung expansion leading to inadequate breathing and hypoventilation. When patient’s chest expands to inhale, negative pressure draws air into lungs drawing flail segment inward opposite of the movement of the chest cavity. Difficulty breathing, pain at injury site, and signs of shock and hypoxia. Using noninvasive positive pressure ventilation (NPPV)
What is paradoxical motion?
movement of ribs in a flail segment that is opposite to the direction of of movement of the rest of the chest cavity
What are open chest injuries?
when skin is broken patient has open wound with chest wall penetrated can come from within or out. All chest wounds considered life-threatening with air entering chest cavity possible leading to lung collapse
What is a sucking chest wound?
an open chest wound in which air is “sucked” into the chest cavity and open to the atmosphere with air sucked into opening each time patient breathes developing severe difficulty breathing with wound in chest, sucking in air, gasping. Seal as quickly as possible with hand etc. then occlusive dressing 2 inches wider than wound over both wounds giving high concentration oxygen and caring for shock keeping patient positioned on injured side allowing to expand without restriction
What is an occlusive/flutter valve dressing?
application of dressing allowing air to escape chest cavity and prevent air from entering, one way tape dress in place leaving side or corner unsealed as they inhale will seal the wound and as exhale will flutter air that is trapped in chest cavity getting rid of accumulated material underneath like blood needs to be thick, and skin dry making sure doesn’t always stick to chest. Can use asherman chest seal with tube. Can bleed 3L in chest and never see blood outside bleeding out
What is a pneumothorax?
air in the chest cavity air can enter from external wound or may enter cavity through punctured lung. Respriatory difficulty, uneven chest wall movment, reduction of breath sounds on affected side of chest, indications of shock, distended neck veins, teacheal deviaito to uninjured side, reduced or absent breath sounds on affected signs
What is a tension pneumothorax?
a type of pneumothorax in which air that enters the chest cavity is prevented from escaping when occlusive applied to open chest wound, air that leaks from lung has no avenue of escape building up in chest and pressing the heart blood vessels and unaffected lungs with jugular veins becoming distended and signs of shock and trachea shifting pushing on heart muffled heart tones and increase in heart rate.
What is a hemopneumothorax?
hemo- only blood
hemopneumo- blood and air. Collapsed lung and shockchest cavity fills with blood blood caused when lacerations within chest form peentrating objects or fractured ribs with blood flowing into space around lungs causing lung to collapse leading to loss of blood.
What is traumatic asphyxia?
sudden compression of chest sternum and ribs exert sever pressure on heart and lungs forcing blood out of right atrium and into jugula veins in neck resulting in blood vessels in and near skin rupturing leading to bruising because of pressure seen with crushing of chest and neck and face darker than rest with possible bulging eyes distended neck veins and broken blood vessels in face. Distendedneck veins, head neck and shoulder appearing dark blue or purple, bloodshot and bulging eyes, swollen abd blue tongue an dlips, chest deformity,
What is a cardiac tamponade?
injury to heart causes blood to flow into the surrounding pericardial sac, filling iwth blood and compressing chamber of hear to point where they no longer adequately fill, backing up blood into veins, from penetrating trauma like stab wound. Pericardium tough with limited ability to quickly stretch “self-sealing little or no blood escapes” having distended neck veins, narrowed pulse pressure, and no blood escapes. Distended neck veins, very weak pulse, low blood pressure, steadily decreasing b=pulse pressure. usually knife, gunshot or post surgery events tear into area.
What is an aortic injury?
Aortic injury and dissection-trauma causes injury to aorta, causing massive fatal bleeding with penetrating can damage aorta, and blunt trauma (deceleration in severe motor vehicle collision- head on) leading to severing or tearing of the aorta. Tearing chest pain radiating to back, differences in pulse or blood pressure between right and left extremities or between arms and legs 15mmHg difference indicator, palpable pulsating, cardiac arrest.
What is an aortic dissection?
condition where inner layer of wall of aorta begins to tear with blood from interior of vessel leaking into outer layers causing balloon-like protrusion (aneurysm) with chance of rupturing. Complaining of pain in chest, abdomen, or back exhibiting shock differences in pulse between right and left or arms and legs and may also be palpated don’t probe specifically for aneurysms
What is commotion cordis?
hit in center of chest resulting in bruise or fracture. Occurring when heart is vulnerable several hundredths of second when if stimulated will go into ventricular fibrillation. Don’t treat as trauma do CPR.
What are abdominal injuries?
open or closed with closed by blunt and internal bleeding can be severe if organs and major blood vessels lacerated or ruptured with very serious and painful reactions occurring when hollow organs ruptured and contents leak into abdominal cavity. Penetrating wounds caused by objects like knives, ice picks, arrows, and broken glass and twisted metal of vehicular collisions and structural accidents
What is eviseration/
an intestine or other internal organ protruding through a wound in the abdomen
What is the liver?
most commonly injured because of size and under ribs with very vascular and can bleed profusely
What is the spleen?
located in left upper quadrant and under lowermost ribs on left
What is a diaphragm?
sudden force applied to abdomen pressure posterioly and superiorly transmitted great that diaphragm partially detaches, allowing abdominal contents to enter thoracic cavity
What are hollow organs?
somtach, small and large bowels, gallbladder and urinary bladder spill contents leading to severe irritation and peritonitis causing abdominal muscles to involunatarily contract, leading to riidity of abdominal wall
What are the retroperitoneal organs?
located in posterior abdomen, less commonly injured than organs inside peritoneal cavity such as pancreas and kidney must be hit with center of force in center of abdomen
What are the symptoms of abdominal injury?
pain (mild), cramps, nausea, weakness, thirst, obvious lacerations and puncture wounds, lacerations and puncture wounds to pelvis, indications of blunt trauma large bruised area, developing shock such as restlessness, pale, cooly and clammy skin; rapid, shallow breathing, rapid pulse and low blood pressure; coughing up or vomiting blood, like coffee grouns, rigid and tender abdomen protecting it, distended abdomen, patient laying still with legs drawn up
How do you treat abdominal injury?
place patient on back, legs flexed at knees to reduce pain by relaxing abdominal muscles. Give patient nothing by mouth, dont touch or try to replace eviscerated or exposed organs applying sterile dessing moistened with saline over wound and occlusive keep moist and warm. Dont remove impaled objects
What is neurogenic shock?
neurogenic not going to be cool and moist, going to be dry and pink, relative hypovolemia besides actual loss of volume, low blood pressure going to stay normal for a certain period of time. head or spinal cord trauma affecting dilation of blood vessels. draw line to mark where they have feeling returning to initial line and past illustrates spinal function
What are the symptoms of a person who is dehydrated?
pulse and respiratory rate, headache, dizziness, if eye and mouth is dry with white filmy tongue on mouth
How can you tell if an infant is dehydrated?
no tears no wet diapers, sunken fontanelles
What is the most common type of shock?
hypovolemic loss of plasma from burns, hemorrhagic, number one biggest is through bleeding
What is hemorrhage?
severe bleeding major cause of shock in trauma patients
How long will a person with a pelvic or demure fracture bleed out?
15 minutes
How long will a person with an aorta or demure fracture bleed out?
bleed out in 10 minutes
How do you figure out how much bleeding?
ype of bleeding, rate of beeding, wound size, how much is on the ground, color of patient, where on body
What is exsanginuation?
bleeding out lost volume
When would it be best to use a tourniquet?
when bleeding heavily and far away
What do you do with a cut off part of body?
If hand or part comesoff use snow or ice dont float in fluid and stay moist and not directly on cold source.
How do you add a dressing?
Put dressing on wound and add another layer on top if bleeding through initial. Twist direction of cling with x over injury site causing an increase in pressure than just wrapping singly.
How do you put a tourniquet on?
Tighten tourniquet until bleeding stops and blood pressure cuff is the best. Make sure that every person you turn care over they know put TK on their forehead.
Turning blue, no sensation, no distal pulses it is too tight dont do it for longer than an hour
What are scalp wants?
Head is very vascular, scalp wounds bleed a lot but wont die from that and sit them up, bleeding from ears and nose dont stop that bleeding so put lose dressing to let the drainage come out so dont build up pressure.
what do you do for a nose bleed?
Nose bleed, pressure lean forward dont want it to go back into the stomach which would lead to vomit increase pressure and heart rate which would increase bleeding, dont let them blow their nose, put ice cube wrap tissue and put on top of gums or ice pack on back of head constricting vasculature.
What causes internal bleeding?
Internal bleeding from blunt-force trauma, paina nd discomfort. With falls, motor vehicle or motorcyle crashes, auto-pedestrian injuries, and blast injuries. Bruise injuries might not see a lot yet but will see signs of hypoperfusion.
How do you tell there is internal bleeding?
Internal bleeding cant getto source- by visually inspecting the body, surface of body, bruising swelling or pain over vitals, painful swollen or deformed extremities, bleeding from mouth rectum or vagina. Document bleeding color, where coming form, trauma matching, how is it coming out closer exit brighter gonna be coffee brown is digested.
What do you do for a gunshot?
look for entrance and exit if closer range, shotgun versus rifle bigger exit than entrance and greater source of bleeding, stab wounds try and figure out what it looked like length depthwhere it entered and what angle telling you what internal organs are damage. Unless in cheek going to stay where it is. Stabilize impaled object so dont move and cuase more damage and if in eye stabillize and cover and dont cover other eye.
What is platinum ten?
first ten minutes on trauma patient should be going in ten minutes unless entrapment if not critical and cna do on scene, if unresponsive multiple system trauma or critica injury.
What is golden hour?
time incident happens to definitive care being surgery.
What is hypovolemic shock?
either hemorrhagic- if uncontrolled bleeding, not hemmorhagic- crush injuries burns with fluid shift vomiting and diarhea.
What is cariogenic shock?
something wrong with heart not working as pump, phsyical damage to heart MI, muscle not working, pericarditis blood filling in sac around heart, electrical conduction system
What is traumatic asphyxia?
not a chest injury nipple line and up blue or purple pitecheal hemorrhaging in eyes from crushing, hanging, strangling, or traumatic forcing blood out of top part of aorta forcing everything niplle line up red purple. Majority is fatal
