EPC Flashcards
oxygen levels should be between?
92-96%
what does the brain need to survive?
oxygen and sugar
what is the major causes of preventable death
not having a clear airway
Why is it that having a clear airway is sometimes ignored and causes death?
1-basic techniques prevented
2-rush to advanced interventions
3-failure to reassess patients (every 5 minutes or whenever you do an intervention
what does our airway do for us?
warm, filter, humidify air
3 structures of airway
nasopharynx, oropharynx, laryngopharynx
if foreign object gets into airway it is called
aspiration pneumonia
bulls eye test meaning?
to check if cerebral spinal fluid is coming out of the nose with blood
what is the most common way of airway obstruction?
the tongue
voice box is called?
larynx
what do we have to make sure we have in order to ventilate a patient?
open airway
intercostal retraction means?
breathing through ribs
lean forward is what position
tripod position
when someones having intercostal retractions, what immediate management is used?
oxygen therpy
/meaning of SAMPLE
S-signs and symptoms
A-allergies
M-medications
P-past medical history
L-last intake
E-Events leading to incident
what’s the pathway of oxygen coming into the lungs list them in order
trachea
main bronchi
smaller bronchi
bronchioles
alveoli
what do we call a collapsed alveoli?
atelactasis
where does most of the gas exchange occur?
alveoli
volume of air inhaled or exhaled in a single respiratory cycle in adults? children?
adults- 5-7ml per kg
children-6-8ml per kg
After the age of 1, how to calculate weight for a child? (till age of 8)
age x 2 +10=____ kg
how to calculate weight for children under 1?
by the month so if 7 months then 7 kg
what is the volume of air inhaled or exhaled in a single respiratory cycle called?
tidal volume
when the respiratory rate is higher, what is the tidal volume higher or lower?
lower
how many breaths a minute is ideal?
12 -20
what is expiratory reserve volume?
the amount of air that you cn exhale following normal exhalation 1200ml
what is residual volume capacity?
The amount of air remaining in the lungs after a forced exhalation 1200 ml. It’s never exhaled, keeps the lungs inflated
what is FiO2
fraction of inspired oxygen, the amount of oxygen in inhaled air, which is usually 21-22%
explain the NRB?
non rebreathing mask
10-15 litres of oxyen coming out of the tank per minute
93%
explain BVM
bag valve mask
15-20 litres of O2/min
100%
explain face mask
6-10 litres of O2/min
60%
explain nasal canula
1-6 litres of oxygen/min
24-44%
what is the condition of when body tissues don’t receive enough oxygen?
hypoxia
what are the causes of decreased oxygen?
-low pressure of atmospheric oxygen
-severe bleeding
-anemia
what are the conditions that reduce the surface air for gas exchange?
-flail chest
-diaphragm injury
-pneumothorax (collapsed lung)
-hemothorax (blood accumulates between lungs and chest)
-hemopnemothorax
what is inspiration?
process of moving air into the lungs
what is expiration?
process of moving air out of the lungs
what are the 2 types of motor nerves that affect breathing
phrenic nerve
inercostal nerve
what are the dorsal cavities?
cranial and spinal cavities
what are the ventral cavities?
mediastinum, plural, abdominal and pelvic cavities
what are the four quadrants?
right upper
right lower
left upper
left lower
what does LUQ (left upper quadrant) consist of?
-stomach
-spleen
-part of small small intestine
-left kidney
-portions of large intestine
-body and tail of pancreas
what does the RUQ (right upper quadrant) consist of?
-liver
-gallbladder
-part of small intestine
-right kidney
-portions of large intestine
-the head of the pancreas
what does the LLQ (left lower quadrant) consist of?
-sigmoid colon(s shaped section of large intestine)
-left ovary and fallopian tube
-left uterer
–left kidney
-left bladder
what does the RLQ (right lower quadrant)consist of?
-appendix
-part of small intestine
-cecum (first part of large intestine)
-right ovary and fallopian tube
-right urether
the total lung capacity in an average adult is?
6 L
what is tidal volume?
its a measure of the depth of breathing, is the volume of air that is inhaled and exhaled during a single respiratory cycle
what is inspiratory reserve volume?
is the amount of air that can be inhaled in addition to the normal tidal volume.
what is dead space?
is any portion of the airway where air lingers but does not participate in gas exchange
what is functional residual capacity
This is the air that is left in your lungs after a normal, relaxed breath out, it includes the
1: residual volume
PLUS
2: exploratory reserves volume ( the extra you could blow out if you tried)
how does each ventilation cycle work?
one ventilation cycle consists of one inspiration which occupies one third of the ventilation cycle and one expiration, which occupies the remaining two thirds.
what do chemoreceptors do?
they monitor the levels of O2 and CO2 in the blood and the PH of the CSF (cerebrospinal fluid) and provide feedback to the respiraoty centres to modify the rate and depth of breathing based on the body’s needs. Maintain homeostasis
how does hypoventilation occur?
if carbon dioxide production exceeds the body’s ability to eliminate it by ventilation, the level of CO2 rises to produce hypoventilation,
PaCO2
partial pressure of carbon dioxide
how does hyperventilation occur?
occurs when carbon dioxide elimination exceeds carbon dioxide production
visual observation of patent airway,things to check
-How is the patient positioned?
-Is the patient experiencing orthopnea?
-is rise and fall of the chest adequate?
-Is the patient gasping for air
-what is the skin colour?
-is there flaring of the nostrils
-is the patient breathing through pursed lips
-do you note any retractions
-is the patient using accessory muscles to breath
-is the patients chest wall moving symmetrically
is a patient taking quick breaths followed by a prolonged exhalation
what is orthopnea?
is shortness of breath that occurs when you lie down, but improves when you sit up or stand
signs of inadequate breathing
slow, <12 breaths/min or fast >20 breaths/min
shallow breathing(reduced tidal volume)
Adventitious (abnormal breath sounds)
altered mental status
cyanosis (blue or purple skin)
auscultation meaning
listening to breath sounds with a stethoscope
what questions to ask for patients history of present illness
-was the onset of the problem sudden or gradual over time
-is there any known cause or trigger of the event
-what is the duration
-does anything alleviate or exacerbate the problem
-are there any other symptoms like a productive cough, chest pain or pressure, or fever
-were any interventions attempted prior to your arrival
-has the patient been evaluated by a physician or been admitted in the hospital in the last year for this condition
-is the patient taking any medication
what are protective reflexes of the airway
-coughing
-sneezing
-gagging
-gag reflex
-aspiration
-sighing
-hiccuping
what are 5 abnormal respiratory patterns
-Apneustic respirations
-Agonal respirations
-Biot respirations
-Cheyne-stokes respirations
-Kussmaul respirations
explain apneustic respirations
prolonged gasping inhalation followed by short exhalation
explain agonal respirations
slow shallow, irregular, gasping,may be seen briefly after the heart has stopped
explain Biot respirations
irregular pattern, rate, and depth, with intermittent periods of apnea
explain cheyne-stokes respiration
is a rhythmic breathing pattern alternating between hyperventilating and period of apnea
explain kussmaul respirations
deep rapid respirations seen in patients with diabetic ketoacidosis
circumstances that might produce errors during pulse oximetry
-bright ambient light
-patient motion
-poor perfusion
-nailpolish
-venous pulsations
-abnormal hemoglobin
normal PH blood gas value is
7.35 - 7.45
what is a capnometer?
provides quantitative information, detects and measures exhaled carbon dioxide levels.
what is capnographer
provides quantitative,graphic representation of exhaled carbon dioxide levels
what is waveform capnography
provides constitutive real time information regarding patients exhaled carbon dioxide levels.
what are causes of airway obstruction
-severe allergic reaction
-tongue
-foreign body
-laryngeal spasm or edema
-laryngeal injury
-aspiration
-
How to recognize a severe airway obstruction
-patient cant breathe, talk or cough
-gasps at his/her throat
-begins to turn cyanotic
intercostal muscles
-hypoxic
meaning of dyspnea
shortness of breath
dyspnea can lead to
hypoxemia
hypoxia
anoxia
ICP
intracranial pressure
explain P1, P2,P3,P4
(refer to the drawing)
P1- Respiratory baseline
P2- Expiratory upstroke
P3- Expiratory plateau (this is where end tidal gets measured)
P4- Inspiratory downstroke
How long do you suction in adults and children?
adults - 15 seconds
children - 10 seconds
how do you insert the catheder suction?
insert iton your way out not on your way in, in circular or zigzag motion
how much mmHg for oral suctioning for adults, children and infants
adults - 500 -550 mmHg
children - 200 -220 mmHg
infants - 80 -100 mmHg
what is a laryngectomy?
is a surgical procedure that removes part or all of the larynx
what is tracheostomy?
its a surgical procedure that an opening in the neck to help a person breath. A tube is usually inserted
what is a stoma suction valve?
its a device that allows air to be released from or added to a stoma pouch. It is used for ballooning or vacuum creation
what is closed suctioning used for?
it is used for patients who have had a laryngectomy or a tracheostomy (any artificial airways)
For closed suctioning how much mmHg is used for adults, children and infants?
infants - 60 -100 mmHg
1-12 years -100-120 mmHg
12 and over-100-150mmHg
what are the 2 types of choking?
-tracheal choking
-esophageal choking
what are airway adjuncts?
are devices and techniques that help maintain an open airway
what are the 2 types of airway adjuncts?
-Oropharyhngeal airway (OPA)
-Nasopharyngeal airway
(NPA)
what is nasopharyngeal airway NPA?
A soft tube that is allows air to flow from the nose to the pharynx. It is used for basic airway management
what is Oropharyngeal airway OPA?
a J-shaped device that fits over the tongue to keep it from blocking the pharynx
make sure oxygen cylinders are labelled?
medical oxygen
what are the 2 cylinders mostly used?
D & M
How much oxygen does the D and the M cylinder contain?
D - 350 L
M -3450 L
what do high pressure regulators do?
used to transfer cylinder gas from tank to tank
pressure of gas in a full oxygen cylinder is approximately?
2000psi
what does a therapy regulator do?
controls gas flow from the oxygen cylinder to the patient reduces the gas flow to a safe amount (about 50psi)
what is a flowmeter?
usually permanently attached to the therapy regulator delivers oxygen with a range of 1-25 L/min
what’s VT, VD, VA
VT: Tidal volume
VD: dead space
VA: alveolar volume
how to calculate alveolar volume?
(VT - VD) x breaths per minute = VA
ideal range of alveolar volume is :
(500 -150) x16 =5600 ml VA
This is not good
(250 -150) x14 =1400 ml VA
Basically dead space always remains at 150
What’s the difference between internal and external respiration?
1: In external respiration oxygen moves from air into the blood, and carbon dioxide moves from the blood into the air (Happens in alveoli)
2: In internal respiration, oxygen moves from the blood into the cells and carbon dioxide moves from the cells into the blood (occurs within the body tissues)
what’s the difference between oxygenation and ventilation?
oxygenation is the process of delivering oxygen to the body tissues, while ventilation is the process of moving air in and out of the lungs
indications and contraindications for an OPA
indications:
indicated for unconscious patients with a depressed gag reflex (absent gag reflex)
contraindications:
conscious patients with an intact gag reflex, significant oral trauma
Indications and contraindications for NPA
Indications: can be used for semi-consious patients with an intact gag reflex, patients with jaw clenching, less invasive
contraindications:
nasal fractured, facial trauma,skull fracture, nasal obstruction
indications and contraindications for I gel
indications:
Used for patients who are unconscious.
patients who 2 unsuccessful endotracheal intubation
contraindications:
patients who are conscious or have an intact gag reflex
Patients with trauma to the trachea
What is an I gel
is a supraglottic airway device used to manage airways in emergency care and anestesia, it is used when endotracheal intubation ius unsuccessful
what does EtCO2 do?
measures the amount of carbon dioxide exhaled at the end of a breath,providing insight into how well the lungs are exchanging gases
what does a rising EtCO2 indicate?
It indicates improved blood flow and can be a key indicator during CPR to monitor the effectiveness of chest compressions and potential return of a spontaneous circulation (ROSC)
where are red blood cells produced
bone marrow
what produces white blood cells called lympocytes
The spleen
What do platelets help with?
Platelets also known as thrombocytes, help prevent and stop bleeding, and are produced in the bone marrow
what do antiplatelet drugs do?
prevent blood clots from forming in your arteries and heart EG: ASA (acetylsalicylic acid)
what muscles are voluntary and involuntary?
Skeletal muscles are voluntary while smooth muscles and cardiac muscles are involuntary
where are smooth muscles found?
digestive, cardiovascular, urinary, respiratory and reproductive systems
what muscles have striations?
cardiac and skeletal
How to measure how long oxygen will last in D tank and tank M?
Lets say the tank has 1200 psi left, always minus 200, that’s what should be left in the tank, the answer you get multiply it by 0.16 (always for D tank)
1200 - 200=1000
1000 x 0.16=160
if using a nasal cannula at 6, then you:
160 divide by 6=26.67
so tank D will last 26.67 minutes
The exact same formula for tank M but you multiply by 1.56
Everytime you go up a Litre in oxygen tank,, you go up by how much percent in oxygen?
4%
CPAP is good to used for patients with?
COPD
What does peep stand for?
Positive end expiratory pressure
(Used in mechanical ventilation, positive pressure maintained in the airways even after exhalation is complete)
what is positive end expiratory pressure?
The positive pressure that remains in the airways at the end of a breath (exhalation) during mechanical ventilation, exceeding atmospheric pressure
Divides the nasopharynx into 2 passages
Nasal septum
Are cavities formed by the cranial bones
Sinuses
Forms the posterior portion of the oral cavity
Oropharynx
Is a large muscle attached to the mandible and hyoid bone
Tongue
This bone is horseshoe shaped
Hyoid bone
These are lymphatic tissues that filter bacteria
Adenoids
This is located in the posterior pharynx and helps trap bacteria
Tonsils
This a a soft tissue structure resembling a punching bag
Uvula
This is the superior border of the glottic opening
Epiglottis
This is a leaf shaped cartilaginous flap
Epiglottis
This is an anatomic space or pocket located between the base of the tongue and the epiglottis
Vallecula
This is formed by many independent cartilaginous structures. Marks where the upper airway ends and the lower airway begins
Larynx
This is a shield shaped structure, it forms the laryngeal prominence known as the Adam’s apple
Thyroid cartilage
This forms the lowest portion of the larynx
Cricoid cartilage
This is the space between the vocal cords
Glottis
This is the narrowest portion of the adults airway
Glottis
The —————cartilages are two pyramid-shaped structures in the larynx that help control the movement of the vocal cords, allowing for sound production and airway protection.
Arytenoid
This forms the posterior attachment of the vocal cords. Valuable guide for tracheal intubation
Artenoid
These are two pockets of tissue on the lateral border of the larynx
Pyriform fossae
This means spasmodic closure of the vocal.cords
Laryngospasm
Where does the lower airway externally extend from
The fourth cervical vertebrae to the xiphoid process
The lower airway internally spans the?
Glottis to the pulmonary capillary membrane
What the windpipe
Trachea
This is the channel for air entry into the lungs
Trachea
What’s is the tracheas structure and how many cm in length
It’s tubular and approximately 10-12cm in length
This is a proteinaceous substance lining the alveoli and decreases surface tension and keeps them expanded
Surfactant
The neural control of ventilation involves brain stem respiratory centers that include
Medulla and pons
Two types of motor nerves that affect breathing are
Phrenic and intercostal
How does increase in the acidity of CSF affect breathing?
Increased rate and depth
Inhalation and exhalation which one is active and which one is passive?
Inhalation ~ active
Exhalation. ~ passive
External respiration also known as?
Pulmonary respiration
Internal respiration also known as ?
Internal respiration
Which one is straighter and shorter the right bronchus or the left one?
Right bronchus is straighter and shorter. A tracheal tube inserted too far comes out of the right bronchus
All the blood vessels and the bronchi enter each lung at the?
Hilum
How many lobes in each lung?
Right has 3 and left has 2
The lungs are covered with a thin slippery outer lining called?
Visceral pleura
What lines the inside of the thoracic cavity
Parietal pleura
These are ballon like clusters of single layer air sacs?
Alveoli
What method of exchange is used between the alveoli and the pulmonary capillaries
Diffusion
This is a process of gas moving from an area of higher concentration to an area of a lower concentration
Diffusion
Dissolved oxygen passes the pulmonary capillary membrane and binds to the?
Hemoglobin molecule of red blood cells
Approximately what percent of the body’s oxygen is bound to the hemoglobin
97%
This measures the percentage of hemoglobin that is saturated with oxygen
Pulse oximetry
Carbon dioxide is transported into the blood in the form of ?
Bicarbonate ions
Decreased mechanical effort due to decreased oxygen to the brain are?
1: severe chest pain
2: traumatic asphyxia ( body deprived of oxygen)
3: hypoventilation
What are the causes of decreased oxygen in the blood from medical conditions?
1: pneumonia, pulmonary edema, COPD
2: non functional alveoli
3: intrapulmonary shunting ( occurs when blood passes through the lungs without participating in gas exchange)
Hypoventilate and hyperventilate what happens to CO2 levels?
Hypoventilate ~ CO2 increases
Hyperventilate ~ CO2 decreases
Hypercapnia
Body has too much CO2 in the blood
Hypocapnia
Condition where the CO2 levels in the blood fall below the normal range of 35 mmHg
This law states that in a mixture of gases , the total pressure is equal tot he sum of the pressures of each gas if they were alone in the same container
Dalton’s law of partial pressure
This is a pulse that occurs when the systolic blood pressure drops more than 10 mmHg during inhalation
Pulses paradoxus
Two types of hemoglobin normally found are
1: oxyhemoglobin (Hbo2)
2: reduced hemoglobin
These detectors, detect the presence of carbon dioxide in exhaled breath
ETCO2
These are also known as French catheters . Are soft plastic non rigid catheters placed in the oropharynx or down a tracheal tube
Whistle tip
What do we use to visualize the airway?
Laryngoscope
Curved forceps
Macgill forceps
If you hear gurgling the patient needs?
Suctioning
Never insert a suctioning catheter past the?
Base of the tongue
This is used primarily to deliver aerosolized medications
Nebulizer
In a nebulizer oxygen enters an aerosol chamber that contains how much fluid?
3-5 ml
This is a large cranial nerve responsible for sensation in the face and motor functions like chewing? And what number cranial nerve is it?
Trigeminal nerve (CN V)
5th cranial nerve
This nerve primarily controls facial muscles for expressions and transmits taste sensations from the anterior two thirds of the tongue? And what number cranial nerve is it?
Facial nerve (CN VII)
7th cranial nerve
Calculate tanks D & M. Explain how?
D - 0.16
m - 1.56
lets measure the pressure for tank D
lets say tank pressure at the moment is 1200
1200 - 200 = 1000
1000 x 0.16 = 160
if using nasal canula at 6 then:
160 divided by 6 = 26.67 minutes
explain P1 to P4 and when end tidal gets measured?
P1 - respiratory baseline
P2 - Expiratory upstroke
P3 - Expiratory plateau (end tidal gets measured)
P4 - inspiratory downstroke
measuring gas exchange per minute
you take the end tidal and minus the dead space which is always 150
so lets say end tidal is 500 then:
500 - 150= 350 ml
then you take 350 and multiply it by bpm (breaths per minute)
350 x 12 = 4200 ml/minute
would be the alveolar minute volume
shocking for ages 8+
1st shock - 120 J
2nd shock - 150 J
3rd shock - 200 J
shocking for children under the age of 8?
eg: shocking for a 4 year old
age x 2 + 10 = kg
4 X 2 + 10 = 18
18 X 2 = 32
therefore you shock at 32 J
This type of pain originates from the internal organs and is felt in the body’s midline
Visceral pain
This type of injury encompass damage to the muscles, tendons, ligaments and other tissues. Includes sprains, strains, contusions and tendinitis
soft tissue injury
stretching or tearing of ligaments which connect bones to each other
sprains
injuries to muscles or tendons which connect muscles to bones caused by overstretching or tearing
strains
contusions
bruising
tendonitis
inflammrion of tendon, a tough band of tissue that connects muscle to bone, often caused by overuse or repetitive movement
What’s the fluid like sac that cushions tendons and muscles and bones near joints
bursa
What do we use to check temperature
tympanic device
What do we use to check arterial oxygen saturation
pulse oximeter
what are 2 forms of stethoscope? and explain how they work?
acoustic - simple mechanically based devices that transmit sound directly to the users ears
electronic - use electronic amplification to enhance sounds for clearer listening
blood pressure cuff is called?
sphygmonometer
this device allows you to look into a patients eyes and view the retina
opthalmoscope
this device evaluates the ears of a patient
otoscope
What are these layers of?
-Skin with hair
-subcutaneous tissue
-galea aponeurotica
-loose connective tissue ( alveolar)
-periosteum
The scalp
How many bones in three anatomic groups ( facial bones)
28 total
6 bones ( auditory ossicles), three on each side)
22 Bones ( cranium and face)
What are the 8 bones of the cranial vault
Parietal ( two each)
Temporal ( two each)
Frontal
Occipital
Sphenoid
Ethmoid
This is a large opening at the base of the skull ( in the occipital bone). It allows the brainstem to connect with the spinal cord and serves as a passage for essential blood vessels and nerves
Foramen magnum
What are the 6 major sutures in the human skull?
-Coronal suture ( runs side to side separating 2 frontal bones from the parietal bones)
-Sagittal suture ( runs along the midline of the skull separating the 2 parietal bones)
-lambdoid suture ( separates the occipital bone from the two parietal bones)
-squamous suture ( right and left) - located on each side of the skull separating the temporal bone from the parietal bone
Maxilla, vomer, inferior nasal concha, zygomatic, palatine, nasal, lacrimal are what bones?
Facial bone
There is 14
Ophthalmic and maxillary nerves are sensory or motor?
Sensory
Mandibular nerve is sensory or motor?
It’s both sensory and motor
Where does the blood supply of the face come from?
Primarily through external carotid artery
These are branches of what artery?
Temporal artery
Mandibular artery
Maxillary artery
External carotid artery
These protect the eye and its structures eg: eyeball and muscles that move it, blood vessels, nerves, fat
The orbits
This on the nose often bulges slightly to one side
Nasal septum
Frontal, maxillary, ethmoid, sphenoid are what sinuses?
Paranasal sinuses
The external nose is mostly made of?
Cartilage
This is a hinge joint that connects the mandible ( lower jaw) to the temporal bone of the skull. It is located in front of each ear and allows for movement of the jaw
Temporomandibular joint ( TMJ)
This joint is responsible for mastication ( chewing) speech, opening and closing the mouth, enables talking, yawning, and swallowing
TMJ
What kind of a joint is TMJ?
It’s a synovial joint with a cartilage disc that’s cushions movements and prevents friction between the bones
This bone is not part of the skull, supports tongue, attachment for neck and tongue muscles
Hyoid bone
How does vision work?
Light through lens to retina
Optic nerve to brain
Brain to visual cortex
What kind of vision is this?
You can see objects directly in front, processed by macula ( central portion of retina)
Central vision
What kind of vision is this?
Let’s you see lateral objects while looking forward, processed by remainder of retina
Peripheral vision
What does this?
Secretes and drains tears from eye
Tears drain into lacrimal ducts
Then into lacrimal sacs
Through nasolacrimal duct into nasal cavity
Lacrimal apparatus
What is cushings triad?
Cushings triad is a set of three signs that indicate ICP.
1: hypertension
2: Bradycardia ( slow heart rate)
3: irregular respirations
How many teeth do adults have?
32
Where are these parts on the ear
1. Pinna
2. External auditory canal
3. Eardrum
External ear
Where are these parts in an ear?
Tympanic membrane, ossicles ( three small bones)
Middle ear
Where are these in an ear?
Cochlea, semicircular canals?
Inner ear
Pulp cavity is what part of the tooth?
The centre of the tooth contains blood vessels, nerves
What surrounds the pulp cavity?
Dentin and enamel
What is the largest mass of tooth?
Dentin
What are the 4 nerves of the mouth?
Hypoglossal (12th cranial nerve)
- it’s the motor function of the tongue
Glossopharyngeal ( 9th cranial nerve)
- salivary gland function
Trigeminal ( 5th cranial nerve)
- motor chewing function
Facial nerve ( 7th cranial nerve)
- facial expression
What are common mechanisms of penetrating injuries?
Gunshot wounds, stabbing and impaled objects
If the mechanism of injury is blunt. What kind of injuries are sustained?
Soft tissue
What occurs when air bubbles enter the blood stream and block blood flow. These bubbles can travel through arteries or veins leading to serious complications by obstructing blood supply to vital organs
Air embolism
What do you do when someone has an open injury?
To prevent air embolism, seal with occlusive dressing immediately
When you apply an occlusive dressing what do you apply directly over it?
Apply manual direct pressure over occlusive dressing with a bulky dressing
These signs and symptoms would be for?
Laboured breathing
Stridor
Hoarseness voice changes
Hemolysis ( coughing up blood)
Subcutaneous emphysema
Swelling edema
Structural irregularity
Laryngeal fracture and tracheal transectiom
These symptoms would be for?
Gross external bleeding
Signs of shock
Hematoma, swelling, edema
Pulse deficits
Vascular injury
These would be symptoms for?
Dysphagia ( difficulty swallowing)
Hematemesis
Hemoptysis ( suggests aspiration of blood)
Esophageal perforation
These would be symptoms of?
Signs of stroke
Paralysis or parenthesis
Cranial nerve deficit
Signs of neurogenic shock
Neurological impairment
What type of head injury is this?
Most common, associated with blunt trauma, dura mater remains intact, brain tissue not exposed, skull fractures, focal or diffuse brain injuries, often complicated my increased ICP
Closed
What type of brain injury is this?
Dura mater and cranial contents penetrated, brain tissue open to environment, gun shot wounds are the most common mechanism of injury
Open
What’s hypovolemic shock?
Significant loss of blood or fluids leading to inadequate circulation and oxygen to the body’s tissues. A shock caused by low blood volume
What are 4 types of skull fractures?
Linear
Depressed
Basilar
Open
What are 2 broad categories of brain injuries?
-Primary ( results instantaneously from impact)
-secondary ( consequences of primary injury eg: cerebral edema, intracranial hemorrhage, increased ICP etc
What is the brains ability to maintain constant cerebral blood flow (CBF) despite changes in mean arterial pressure ( MAP). This ensures that the brain gets enough oxygen and nutrients even when blood pressure fluctuates
Auto regulation in the brain
What is it called when brain is forced from cranial vault through foramen magnum?
Cerebral herniation
What are early signs of brain injury?
Vomiting, headache, altered LOC, seizures
What are later signs of brain injury?
Cushings triad, pupil changes, coma, posturing ( decorticate and decerebrate )
Decorticate ( flexor)
Decerebrate (extensor)
This is a severe form of traumatic brain injury ( TBI) caused by widespread shearing and tearing of axons in the brains white matter it typically results from rapid acceleration or deceleration forces such as motor vehicle accidents, falls, shaken baby syndrome
Diffuse axonal injury (DAI)
This occurs when there is bleeding into where CSF circulates ( bloody CSF). Increased ICP, can cause death. Between arachnoid and pia mater.
Subarachnoid hemorrhage
Brain injury classification based on the GCS
15- no neurological disabilities
13-14 mild traumatic brain injury
9-12 moderate traumatic brain injury
3-8 severe traumatic brain injury
How often to assess patients with brain injury?
Every 5 minutes
Pupil assessment for brain injury, what to look for?
Watch for sluggish reaction to light( that’s a indication of cerebral hypoxia or increased ICP)
Why do we hyperventilate in cerebral herniation? And how does it help?
When the brain is swelling too much ( high ICP) , we need to reduce the swelling quickly to protect the brain. Hyperventilation removes CO2 from the blood, when CO2 levels drop :
1: brain blood vessels shrink ( vasoconstriction)
2: less blood goes to the brain
3:this reduces ICP and swelling
We use this only in emergency when a patient is. Showing signs of brain herniation (blown pupil, irregular breathing, high BP, slow HR)
Hyperventilate at 20 breaths per minute
This type of fracture is a straight crack in the skull like a thin line. The bone doesn’t move out of place
Linear fracture
In the fracture a part of skull is pushed inward like a dent. This can press on the brain
Depressed skull fracture
In this type of skull fracture there is a break at the base of the skull basically near the eyes, ears or nose. It can cause bruising around the eyes ( periorbital ecchymosis) or behind the ears (battle signs)
Basilar fracture
Most common mechanisms of injury for skull fractures are
Motor vehicle collisions
Significant falls
What are signs of shock?
Persistent hypotension, tachycardia, diaphoresis
To manage circulation in a brain injury. what do we do and why?
With a serious braininjury we need to make sure their blood pressure is stable. If the blood pressure drops too low, the brain doesn’t get enough oxygen which can cause more damage.
putting in a large bore IV would help to get fluids in faster. This helps if patient is in shock or bleeding.
DO NOT use dextrose because it can increase brain swelling and may cause blood sugar spikes which may worsen the brain injury
use normal saline or ringers lactate these are fluids that help keep blood pressure stable
what’s the 90 - 90 - 9 rule, for trauma patients?
oxygen < 90
systolic BP < 90
GCS < 9
Chance of death increases if both hypoxemia and hypotension occur
what’s the difference between hypoxia and hypoxemia?
Hypoxemia is low oxygen levels in the blood, specifically a reduced partial pressure of oxygen in arterial blood. It can lead to hypoxia, which is inadequateoxygen supply to the tissues.
what’s the treatment for open fracture with brain exposed?
cover lightly with sterile dressing moistened with sterile saline
This system gives the body its shape,, provides support to the soft tissues, enables erect posture and body movement, provides protection to critical underlying organs and structures
Musculoskeletal system
This occurs in the bone marrow, produced in bone marrow from stem cells, many bones produce new blood cells
Hematopoiesis
Axis
Axial skeleton
Cranium, basilar skull, face, inner ear
Skull
Cervical, thoracic, lumbar, sacral, coccygeal
Vertebral column
Pectoral girdle, pelvic girdle, upper lower extremities
Appendicular skeleton
Two scapulae and two clavicles
Pectoral (shoulder) girdle
This is a flat triangular bone, held to rib cage by powerful muscles
Scapulae ( shoulder blade)
- slender S shaped bone
- articulates with sternum and acrimony
- acts as a strut to keep the shoulder propped up and as scaffolding on which other muscles of the thoracic pull
Clavicle ( collar bone)
What’s the primary joint of the shoulder
Glenohumeral joint
Humerus is the
Upper arm
Distal portion of upper extremity contains?
Radius and ulna ( articulation of these two occurs at the elbow joint
-Larger of two forearm bones
-lies on thumb side of the forearm
Radius
-The narrow forearm bone
- serves as a pivot around which the radius turns
Ulna
Carpals are
Wrist bones
Metacarpals are?
Hand bones
Phalanges are?
Finger bones
This is a large irregularity shaped bone that forms part of the pelvis, it is formed by fusion of three bones ilium, ischium and pubis
Innominate bone
Head of femur articulates proximally with ……… of pelvis to form ball and socket joint
Acetabulum
Neck of femur connects?
Head with shaft
This is a shin bone and it’s superficial
Tibia
This makes up lateral portion of the lower leg
Fibula
This part of the femur is exposed to force when we land on our feet or fall
Femoral neck
Tarsals
Ankle
Metatarsals
Foot
The shaft or central part of the bone, composed mostly of compact bone and containibg
The medullary ( marrow) cavity
Diaphysis
The ends of the bone which contain spongy bone and are covered with particular cartilage where they form joints
Epiphysis
This covers the outer surface of bones except at the joints and it’s a dense, fibrous membrane
Periosteum
This lines the inner surfaces of bones particularly the medullary (bone marrow) cavity, trabeculae ( spongy bone) and the central canals of compact bone
Endosteum
This is the hollow, central space inside long bones such as the femur and humerus
Medullary canal
When bone density decreases there more chances of
- osteoporosis
- risk of injury increases
- loss is accelerated after age of 35 and after menopause
- common injury sites include hip, spine and wrist
Where bones articulate
Joints
Palm facing up ( like holding a bowl of soup)
Supination
Palm facing down
Pronation
3 types of joints
Fibrous
Cartilaginous
Synovial
- synarthroses
- contain dense tissue
- do not allow motion eg: skull, distal tibiofibular joint
Fibrous joints
- amphiarthroses
- allow for minimal motion between bones
- example: pubic symphysis and rib sternum
Cartilaginous joints
Diarthroses
Most mobile joints
Synovial joints
This is a small fluid filled sac that acts as a cushion between bones, tendons, muscles and skin, its main function is to reduce friction and allow smooth movement of structures and joints
They contain synovial fluid which lubricates and cushions the surrounding tissue
Bursa
This is an inflammation of a bursa often caused by repetitive movement , trauma or infection
Bursitis
-Connects muscles to bones
-Flat, cordlike bands of connective tissue
-have a glistening white appearance
Tendons
-connect bone to bone
-help maintain stability of joints
-Determine degree of joint motion
-have similar structure to tendon
Ligaments
-This consists of fibres of collagen embedded in gelatinous substance
-provides smooth surface over bone ends where they articulate
- cushions eg: vertebrae
- provides structure to eg: nose
-serves as model for formation in skeleton of children
-limited nerovascular supply
- does not heal well
Cartilage
Three types of muscles are
- smooth
- cardiac
- skeletal
-This muscle is also called voluntary muscle and striated muscle
-forms the bulk of muscles of arms legs spine and buttocks
Skeletal muscle
Muscle contraction requires energy from?
Glucose metabolism
This refers to the nerve supply to a muscle which allows it to contract and function properly. This involves motor neurons transmitting electrical signals from the nervous system to muscle fibers enabling movement and coordination
Muscle innervation
Two types of innervation
Motor and sensory
Two types of motor innervation
Somatic and autonomic
This motor innervation controls skeletal muscles, voluntary movement
Somatic
This motor innervation controls smooth and cardiac muscles, involuntary functions
Autonomic
This innervation is when nerves carry information from muscles to the brain about stretch, tension and pain
Sensory innervation
-This is a network of nerves that originates from spinal cord at C5-T1 levels
-provides innervation for upper extremities
Brachial plexus
- this is a network of nerves that originates from the spinal cord at L1-S4 levels
- provides innervation for lower extremities
Lumbar and lambosacral plexuses
The upper extremity’s blood supply originates from?
The subclavian artery
The lower extremity’s blood supply originates from?
The external iliac artery
What kind of injury force is this? “Injury happens at the impact site”
Eg: A soccer ball hits a players eye
Direct force
What kind of injury force is this? “Injury happens away from the impact site because the force travels through the body” eg: a player lands awkwardly on their foot, twisting their knee
Indirect force
Musculoskeletal injuries that occur together. Look for rib fracture, pulmonary contusions , pneumothorax if you find?
Scapular fracture
Musculoskeletal injuries that occur together. Look for wrist elbow or shoulder fracture if you find?
Scaphoid fracture
Musculoskeletal injuries that occur together. Look for lumbosacral spine and other long bone fractures, intra abdominal or genitourinary injury if you find?
Pelvic fracture
Musculoskeletal injuries that occur together. Look for fracture of the acetabulum or femoral head if you find?
Hip dislocation
Musculoskeletal injuries that occur together. Look for dislocation of ipsilateral hip if you find?
Patellar fracture
Musculoskeletal injuries that occur together, look for tibial fracture, distal pulse may be absent if you find?
Knee dislocation
Musculoskeletal injuries that occur together. Look for fracture of the ankle leg, hip, pelvis, lumbar spine, and the other calcaneus if you find?
Calcaneal fracture
-This is a break in the continuity of a bone
-it may be classified based on the type of displacement
Fracture
This means that each end of the fracture is not aligned in a straight line and an angle has formed between them
Angulation
-What is it called when a bone is totally displaced from a joint
-articular surfaces are no longer in contact
- joint capsule and supporting ligaments are usually damaged
-severe pain
Dislocation
A partial or incomplete dislocation of a joint, where the bones are still partially in contact
Subluxation ( remember S for slight dislocation)
A significant separation of two bones that are normally close together, often due to ligament damage
Diastasis (remember D for distance between bones)
-This occurs when ligaments are stretched or torn
-results from sudden twisting or overextension at a joint
- causes pain swelling discolouration and unwillingness to use the limb
Sprain
How to treat a sprain
Treat like a fracture including
Protect
Rest
Ice
Compression
Elevation
Drugs
-this occurs when there is an injury to a muscle or a tendon
-results from violent muscle -contraction, excessive stretching, or repeated overuse
-Characterized by minor swelling and pain, increased with movement
Strain
-This is a complete or partial tear of the tendon, which connects the calf muscles to the heel bone
-men over 30 are at higher risk
-sports is a cause too
Achilles tendon rupture
Meaning of PRICED for Achilles tendon rupture management
Protection
Rest
Ice
Compression
Elevation
Diagnosis/drugs
What is inflammation of a joint called?
Arthritis
3 most common types of arthritis
Osteoarthritis
Rheumatoid arthritis
Gout
Blood collects outside a vessel ( false aneurysm)
Pseudo aneurysm
Blood clot inside a vessel ( blocks flow)
Thrombosis
-This occurs when blood vessels are damaged following a musculoskeletal injury
-may result from vascular contusions, lacerations , pseudo aneurysm, thromboses
Devascularization
Potential blood loss from fracture sites most blood loss to least
- pelvis ( 1500-3000 ml)
- femur ( 1000-1500 ml)
- humerus ( 250-500 ml)
- tibia or fibula (250-500ml)
-ankle (250-500 ml)
-elbow (250-500 ml)
-Radius or ulna (150-250 ml)
6 Ps of musculoskeletal injuries
-Pain
-Pallor ( skin becomes pale or bluish)
-Paralysis (loss of function/ movement)
-paresthesia (abnormal sensations like tingling or numbness)
-pulselessness
-pressure ( swelling or tightness )
Cold packs are useful for decreasing pain and swelling during?
The first 48 hours
For this kind of injury immobilize the bone ends and the two adjacent joints
Fractures (eg: for a broken arm like radius or ulna, immobilize the elbow joint and the wrist joint)
For this kind of injury, extend the splint along the entire length of the bone above and the entire length of the bone below the injured joint
For dislocations
For this kind of injury apply longitudinal traction to attempt to realign bone and restore circulation
Severe angulation
How to splint knee
Straight
How to splint elbow
At a right angle
-These injuries occur when both nerves (neuro) and blood vessels (vascular) are damaged often due to trauma such as fractures, dislocations or crush injuries.
- these injuries can lead to serious complications like loss of sensation, weakness, paralysis, tissue death
Neurovascular injuries
-This is a serious condition that occurs when increased pressure within a muscle compartment restricts blood flow and damages nerves and tissues
-if left untreated as it can lead to permanent muscle and nerve damage or even limb loss
Compartment syndrome
What is compartment syndrome caused by
Usually cause by trauma, fractures, crush injuries, burns or vascular injures
Theses are signs and symptoms of:
- feeling of pressure over joint
- pain
- obvious and significant deformity
- decrease in range of motion ( frozen in place)
- possibly compromised distal PMS
Dislocation
Compartment syndrome treatment
-elevate the extremity to the heart level
- place cold packs over the extremity
- open or loosen tight clothing
This refers to conditions caused by blood clots that form in blood vessels and can travel to block blood flow in critical areas
Thromboembolic disease (TED)
This is a condition when a blood clot forms in a deep vein, usually in the legs
Deep vein thrombosis (DVT)
This is when a clot travels to the lungs, blocking blood flow
Pulmonary embolism
How to assess for pulmonary embolism
- sudden onset of dyspnea
- pleuritic chest pain
-tachypnea - right side heart failure
- shock
- cardiac arrest
Explain clavicle fractures
- Common in children
- occur to middle third of bone
- MOI: falling onto outstretched arm or direct contact
Signs and symptoms:
- pain in shoulder
- swelling
- unwillingness to raise arm
- leaning towards injured side
In this fracture the injuries would be in the Glenoid fossa, humeral head and humeral neck
Shoulder injury
-For this fracture splint wrist at 30 degrees of dorsiflexion
-slightly flex fingers
- secure forearm to rigid splint
-elevate hand
Wrist and hand fractures
5 types of pelvic fractures
- lateral compression
- anterior posterior compression
-vertical shear - straddle fracture
- open pelvic fracture
This is a severe pelvic fracture that involves breaks in both public rami (superior and inferior ) on both sides
Straddle fracture
The paired parietal bones join together at the?
sagittal suture
After a blow to the back of his head a person may see stars why does that happen?
The occipital lobe impacts against the back of the skull, which is in charge of vision
The speech center is located in the ……… lobe?
Temporal
The ………. Lobe also controls long term memory, hearing, taste and smell
Temporal
The ……….., which is located between the brainstem and the cerebrum includes thalamus,
subthalamus, hypothalamus and eoithalamis
Diencephalon
This processes most sensory input and influences mood and general body movements especially those associated with fear and rage
Thalamus
This controls motor functions
Subthalamus
This is vital in the control of many body functions including heart rate, digestion, sexual development, temperature regulation emotions hunger thirst vimiting and regulation of sleep cycle
Hypothalamus
This is sometimes called the athletes brain because it is responsible for the maintenance of posture, equilibrium and the coordination of skilled movements
Cerebellum
This consists of the midbrain pons and medulla
Brainstem
This is located at the base of the brain and connects the spinal cord to the remainder of the brain
Brain stem
The mid brain lies immediately below the?
Diencephalon
The inferior portion of the brainstem, the ………….is continuous inferiority with the spinal cord
Medulla
The …………. Also coordinates heart rate, blood vessel diameter, breathing, swallowing, vomiting, coughing and sneezing.
Medulla
The ………… are protective layers that surround and enfold the entire central nervous system, specifically the brain and spinal cord
Meninges
The outermost layer is a strong fibrous wrapping called ………… and it covers the entire brain
Dura mater ( meaning tough mother)
A ………….. is a collection of blood between the dura mater and the brain usually caused by trauma
Epidural hematoma
Is this le fort 1 2 or 3? Horizontal fracture through the maxilla
Le fort 1
Is this le fort 1 2 or 3? Pyramidal fracture extending into the nasal bridge
Le fort 2
Is this le fort 1 2 or 3? Complete craniofacial separation
Le fort 3
This fracture the patient may report double vision and loss of sensation above the eyebrow or over the cheek , it can cause paralysis of the upper gaze so the patients injured eye will not be able to able to follow your finger
Orbital fracture (blow out fracture) or zygomatic fracture
What kind of fracture is this
- massive facial swelling
- dental malocclusion
- palpable deformities
- anterior or posterior epistaxis
Multiple facial bone fractures
What kind of fracture is this?
- crepitus and instability
-swelling tenderness, lateral displacement
- anterior or posterior epistaxis
Nasal fractures
What kind of fracture is this?
- mobility of the midface
- dental malocclusion
- facial swelling
Maxillary le fort fractures
Blood or CSF drainage from the nose (cerebrospinal ) suggests a?
Skull fracture ( do not attempt to control this bleed, it will increase the ICP
Eye lacerations are serious injuries that require prompt transport, although bleeding can be heavy do not?
Do not Put pressure on the eye, pressure may squeeze the vitreous humour, iris, lens or retina out of the eye
When small or moderate objects enter the eye, and when lying on the surface can cause severe irritation. The eye becomes red and inflamed and the eye begins to produce tears to attempt to flush out the object
Conjunctivitis
When one eye is injured still always cover??
Both eyes
Chemical burns in the eye caused by acid or alkaline solutions require ?
Flushing the eye with clean water or sterile saline solution
Symptoms that may indicate serious ocular injury
- visual loss that does not get better when the patient blinks , may indicate damage to the globe
- double vision usually points to trauma, fracture of the orbit
- severe eye pain
- a foreign body sensation usually indicates a superficial injury to the cornea or the presence of a foreign object trapped behind the eyelids
During the physical exam of the eyes evaluate each of the following visible ocular structures
- orbital rim (for ecchymosis swelling , lacerations)
- eyelids ( for ecchymosis, swelling, lacerations)
- corneas ( for foreign bodies)
- conjunctivae ( for redness pus inflammation)
-Globes ( for redness)
- pupils ( for size shape equality)
- eye movement in all direction ( for coordination)
This is a condition in which the pupils are not of equal size, is a significant finding in patients with ocular injuries or closed head trauma
Anisocoria
If hyphema or rupture of the globe is is suspected to what do you do?
- take SMR precautions because such injuries indicate significant amount of force was applied to the face and may include cervical spine injury
- elevate the head of stretcher 30-40 degrees
- discourage them from coughing or vomiting cause it may increase IOP
How long to irrigate the eye if the burn is caused by alkali or a strong acid
20 minutes
The primary threats from
Penetrating neck trauma are?
Massive hemorrhage from major blood vessel disruption and airway compromise
To control bleeding from an open neck wound and prevent air embolism what to do?
Immediately cover the wound with an occlusive dressing
What kind of neck injury has these symptoms?
- laboured breathing or reduced air movement
-stridor
-Hoarseness voice changes
- hemoptysis ( coughing up blood)
-subcutaneous emphysema
- swelling seems
-structural irregularities
Laryngeal fracture, tracheal transection
What neck injury are these symptoms of?
- gross external bleeding
- signs of shock
-hematoma, swelling , edema
-pulse deficits
Vascular injury
What neck injury are these symptoms of?
- dysphagia (difficulty swallowing )
- hematemesis
- hemoptysis
Esophageal perforation
Minimum CPP (cerebral perfusion pressure) required to adequately peruse the brain is?
60 mm Hg
This kind of brain injury is an injury that affects the entire brain
Diffuse brain injury
This brain injury occurs when the brain is jarred around in the skull. This kind of brain injury is caused by rapid acceleration-deceleration forces such as motor vehicle collision, falls
Cerebral concussion
What are signs of a concussion?
- transient confusion and disorientation
-loss of consciousness - retrograde amnesia ( loss of memory of events before injury)
-anterograde amnesia ( loss of memory of events after injury)
In this kind of brain injury the brain tissue is bruised and damaged in a local area. And because of the physical damage there is prolonged confusion and loss of consciousness worse than a concussion
Cerebral contusion
This is an accumulation of blood between the skull and dura mater. It’s nearly always the result of a blow to the head that produces a linear fracture of the thin temporal bone
Epidural hematoma
the parietal bones abut (meet) the frontal bone at the?
coronal suture
the occipital bone attaches to the parietal bones at the?
lambdoid suture
fibrous tissues called …………, which are soft in infants link the sutures
fontanelles
at the base of each temporal bone is a cone shaped section of bone known as the?
mastoid process
the chamber inside the nose that lies between the floor of the cranium and the roof of the mouth is?
the nasal cavity
This is the bone that extends a long the front of the skull below the orbit
zygomatic arch
Blood supply to the face is provided primarily through the
external carotid artery
Blood supply to the face is provided primarily through the external carotid artery which arches into the ……………., ……………, ……………arteries. Because the face is highly vascular is tends to………….. when injured
temporal
madubular
maxillary
bleed heavily
a blow to the eye may result in fracture of the ………… floor because the bone is thin and breaks easily
orbital
A so called ………… fracture results in transmission of forces away from the eyeball itself to the bone, blood and fat then leak into the maxillary sinus
blowout
The ……… bone floats in the superior aspect of the neck just below the mandible
hyoid
This bone supports the tongue and serves as a point of attachment for many important neck and tongue muscles
hyoid bone
The major arteries of the neck the………. and the……….. arteries supply oxygen enacted blood directly to the brain
carotid
vertebral
The largest portion of the brain is the …………, which is responsible for higher functions such as reasoning
cerebrum
The largest part of the cerebrum is the?
cerebral cortex
The cerebral cortex regulates ………….. movement and the level of awareness
skeletal
Injury to the cerebral cortex may result in?
paraesthesia, weakness and paralysis of the extremities
The ……… lobe is responsible for important for voluntary motor action and personality traits
frontal
injury to the frontal lobe may result in?
seizures or placid reactions
The ………. lobe controls the somatic or voluntary sensory and motor functions for the opposite side of the body as well as memory and emotions
parietal
This brain injury is an accumulation of blood beneath the dura matter but outside the brain
Subdural hematoma
This type of brain injury involves bleeding within the brain tissue itself
Intracerebral hematoma
The most important single sign in the evaluation of a patient with a head injury is?
A changing level of consciousness
Signs of cerebral herniation? Unresponsive patient with 2 or more of the following:
1: asymmetric (unequal) pupils or bilaterally fixed and dilated pupils
2: Decerebrate posturing or no motor response to painful stimuli
3: original GCS of 8 or less or that decreases by 2 or more points from the patients best score
Patients with head injury, unlike those with shock can develop a ………………. Body temperature
Very high
Hyperpyrexia
High body temperature
These bones are longer than they are wide
Long bones ( femur humerus radius ulna metacarpals metatarsals and phalanges )
These bones are nearly as wide as they are long
Short bones (carpals and tarsals)
These bones are thin, broad bones
Flat bones (sternum ribs scapulae and skull)
These bones do not fit into one of the other categories but rather have a shape that is designed to perform a specific function
Irregular bones (vertebral column mandible)
These bones are often referred to as Sesamoid bones because of their small size and shape. They are embedded within muscle or tendon
Round bone ( patella which is the largest and most well known Sesamoid bone)
The portion of the bone that is not covered by the articular cartilage is instead covered by the ?
Periosteum
Unused muscles quickly shrink or waste away which is called?
Atrophy
Physical training increases muscle which is called l?
Hypertrophy
Fatigue fractures are caused by repetitive stress when they happen in the metatarsals after prolonged walking marching or dancing they are called?
March fractures
…………. Of a fracture means the ends of the fracture are not aligned in a straight line and that an angle has formed between them
Angulation
What is an open fracture sometimes called?
Compound fracture
……….. occurs in fractures when the broken ends of a bone override one another
Shortening
In a ………….. a bone is totally displaced from the joint and the articular surfaces are no longer in contact
Dislocation
The partial dislocation of a joint is called a ……………
Subluxation
When the ligaments that hold two structures in a fixed position to one another are disrupted and the space between them increases, a situation known as ………… occurs
Diastasis
The scaphoid is also known as
Carpal navicular
This is a fracture of the neck of the fifth metacarpal ( small finger). It commonly occurs after punching a hard object
A boxers fracture
This fracture occurs when a finger is jammed into an object such as a baseball or basketball resulting in an avulsion fracture of the extension tendon
Mallet finger (baseball fracture)
What type of fracture occurs when the bone is broken into multiple fragments
Comminuted
Which of the following is the most common type of dislocation in adults?
Shoulder
What is scaphoid fracture?
A break in the scaphoid bone, one of the eight small carpal bones in the wrist
What is a key sign of compartment syndrome
Pale swollen limb with extreme pain
When should you attempt to realign a deformed extremity
Only if there is no distal pulse
Which type of fracture is most commonly seen I pediatric patients
Greenstick
What is the recommended splinting position for a joint dislocation
In the position found
What is the most critical complication of a femur fracture
Severe hemorrhage
A patient with a femur fracture is at risk of developing
Pulmonary embolism
What can cause a pathological fracture
Osteoporosis
What type of fracture results in the bone being broken at an angle
Oblique
A break in the bony tip of the elbow where the ulna and humerus bones meet
Olecranon fracture
Which fracture type is most concerning for child abise
Spiral
A fracture that results from minimal trauma due to disease
Pathologic fracture
What type of wound occurs when layers of skin are scraped away
Abrasion
Which soft tissue injury involves the tearing away of skin or tissue
Avulsion
When applying tourniquet where should it be placed?
2-3 inches above the wound
What is the greatest concern for a patient with an open chest wound
Pneumothorax
Types of primary brain injury
- concussion
- contusion
- diffuse axonal injury
- hematomas
- penetrating brain injury
Which injury is associated with a lucid interval followed by rapid deterioration
Epidural hematoma can cause a bites period of consciousness (lucid interval) before ICP increases rapidly due to arterial bleeding
What is the typical appearance of a subdural hematoma
Gradual onset of symptoms often over hours or days
What is the primary function of the brainstem
Controls vital functions such as heart rate, blood pressure and breathing
What is a hallmark sign for a basilar skull fracture
CSF leaking from the nose or ears
Epidural and subdural hematoma difference
Epidural = emergency ( fast arterial bleeding)
Subdural = slow ( venous blood)
What is blood in the anterior chamber of the eye called?
Hyphema
A bony cage consisting of:
12 pairs of ribs
Scapula
Clavicle
Sternum
Thoracic vertebrae
Thorax
3 sections of the sternum
Manubrium
Central sternal body
Xyphoid process
Just superior to the manubrium
Suprasternal notch
Junction of the manubrium and sternal body
Angle of louis
Each of the 12 ribs attach posteriorly to the?
12 thoracic vertebrae
Area located between the ribs
Intercostal space
Artery, vein and nerve located in the intercostal space
Neurovascular bundle
Located within the central region Of the thorax , contains heart, great vessels, esophagus, trachea, main stem bronchi and vagus and phrenic nerves
Mediastinum
The ……….. is located within the pericardial sac
Heart
The pericardial sac consists of two layers
Visceral and parietal
The largest artery in the human body
Aorta
The aorta exits the left ventricle and attaches at 3 points what are those?
Anulus
Ligamentum arteriosum
Aortic hiatus
( these points represent sites of potential injury)
What occupies most of the space in the thoracic cavity?
Lungs
These are lined with two pleural membranes and there’s small amount of fluid is found between parietal and visceral membranes
Lungs
This is the primary muscle of respiration
Diaphragm
………. Muscles work in conjunction with the diaphragm
Intercostal
The ………….. increases in size when the muscles contract
Thoracic cavity
The process of breathing includes?
Delivery of oxygen and removal of carbon dioxide
Gas exchange occurs at the ………..
Alveoli
