Chapter 7 Flashcards
Primary sites of massive internal hemorrhage include the chest admin in the retroperitoneal space and also long boots
Primary sites
Patient’s overall circulatory status can be determined by
Checking the post and the skin color temperature and moisture
If a radial pulse is not palpable in an uninsured extremity
The patient has likely entered the decompensated phase of shock a late sign of the patients critical condition
The combination of compromised perfusion and impaired breathing should prompt the prehospital care provider to consider
Tension pneumothorax
Changes in color usually appear in
Lips gums and fingertips
Dry skin indicates good perfusion moist skin is associated with shock and decreased perfusion this decrease in perfusion is caused by blood being shunted to the core organs of the body as a result of vasoconstriction of peripheral vessels
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A decreased LOC alerts a prehospital care provider to the following for possibilities
One. Decreased cerebral oxygenation caused by hypoxia or hypo perfusion. Two. Central nervous system injury. Three. Drug or alcohol overdose. For. Metabolic do rangement diabetes seizure cardiac arrest.
If patient is intubated the GCS score contains
Eye and motor scales
A patient who attempts to push away a painful stimulus is considered
Localizing
Abnormal flexion
Decorticate posturing
Abnormal extension
Deceiver it posturing
And title carbon dioxide monitoring
Monitoring the ET CO2 can be useful in confirming into intratracheal placement of an endotracheal tube as well as indirectly measuring the patients arterial carbon dioxide level while ET CO2 may not always correlate well with the patients PaCO2 especially in multiple trauma patients trending of ET CO2 maybe useful and guiding ventilatory rate
Another important step and resuscitation is the restoration of the cardiovascular system to an adequate perfusing volume as quickly as possible
This step does not involve restoring blood pressure to normal but rather providing enough fluid to ensure the vital organs are being perfused
For the critical trauma patient a complete set of vital signs are evaluated and recorded every
3 to 5 minutes, as often as possible, or at the time of any change in condition or a medical problem.
Sample history
Symptoms, allergies, medications, past medical and surgical history, last meal, events,
Crepitus of the Lenix, hoarseness, and subcutaneous emphysema constitute a triad classically indicative of
Laryngeal fracture
Hey line traced from the fourth intercostal space enter early to the sixth intercostal space laterally and to the eighth intercostal space posteriorly defines the
Upward excursion of the diaphragm at full expiration
A penetrating injury that occurs below this line or with a path that may have taken it below this line should be considered to have traversed
Both the thoracic and abdominal cavity’s
Except for the eyes and hands the stethoscope is the most important instrument a prehospital care provider can use for
Chest examination
Crackles heard posteriorly when the patient is live rolled or laterally may indicate
Pulmonary contusion
Cardiac Tampa nod is characterized by
Distant heart sounds
Diminished or absent breath sounds indicate
Possible pneumothorax, tension pneumothorax, or hemothorax
The abdomen should be examined carefully for a tale tale transverse contusion which suggest that in incorrectly worn seatbelt has called underlying injury almost 50% of patients with the sign will have an intestinal injury lumbar spine fractures may also be associated with the seatbelt sign
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If an extremity is immobilized
Pulses movement and sensation should be rechecked after splinting
As with the other regional examinations described the neurologic examination in the secondary assessment is conducted in much greater detail than in the primary assessment.
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Unequal pupils in an unconscious trauma patient may indicate
Increased intracranial pressure or pressure on the third cranial nerve, caused by either cerebral edema or rapidly expanding intracranial hematoma direct eye injury can also cause unequal pupils
The field triage decision scheme
Step one
Physiologic criteria this section includes alteration in mental status hypertension and respiratory abnormalities
The field triage decisions game step to
Anatomic criteria if response times our brief patients may not yet have developed significant alterations and physiology despite the presence of life-threatening injuries the section list and atomic findings that may have associated with severe
The field three hours decision scheme step three
Mechanism of injury criteria these criteria identify additional patients who may have a cult injury not manifested was physiologic the rangement or obvious X ternal injury in general patients to meet one of these criteria I have about 20% chance of having an ISS greater than 16
Field triage decision scheme step for
Special considerations these criteria identify health factors such as age use of anticoagulants or the presence of burns or pregnancy should affect the decision to transport to a trauma center
Resuscitation efforts are not indicated when the patient has sustained an obviously fatal injury decapitation or went evidence exists of dependent lividity rigor mortise or decomposition for victims of blunt trauma resuscitation efforts maybe withheld if the patient is
Pulseless and apneic on arrival of prehospital care providers
For victims of penetrating trauma resuscitation efforts may be withheld if
There are no signs of life no pupillary reflexes and spontaneous movement no organize cardiac rhythm on ECG greater
I Deleigh before deciding to withhold CPR
Hey central pulse carotid or femoral should be palpated for a minimum of 30 to 60 seconds
Pulseless electrical activity PEA
Patient found in PA should be assessed for the presence of hypervolemia, hypothermia, tension pneumothorax, and cardiac tamponade. Fluids, warming, and chest decompression should be performed if indicated. Epinephrine and atropine may be administered
Bradycardia and a systole.
Patient found in this room should be assessed for severe hypoxia and hypovolemia. The location of the airway should be confirmed and volume resuscitation initiated. Epinephrine and atropine may beAdministered
Ventricular fibrillation pulseless ventricular tachycardia
The primary therapy for these dysrhythmias is defibrillation. If you’re available to favor later is biphasic a shot of 120 to 200 J is delivered if they might’ve phasic defibrillator is present a shock of 360 Jules is used
