Epc 2 Flashcards
Stimulation to breathe occurs via chemoreceptors located in the?And are also key players in monitoring blood pressure and regulating heart rate through the baroreceptor reflex.
Carotid sinus and aortic arch
When CO2 levels increases, the brain is stimulated to increase …………… and …………… and blow off ……………
Respiratory rate
Respiratory depth
CO2
( inspiration) The ………… contracts and moves downward while the ……………… contract and move outward
Diaphragm
Intercostals
( inspiration) ……………. Decreases resulting in air entering the thoracic cavity
Intrathoracic pressure
(Expiration)
The ………….. relaxes and moves upward while the ………….. relaxes. Intrathoracic pressure increases above ………… . ………… leaves the body
Diaphragm
Chest wall
Atmospheric pressure
Air
…………….. is the delivery of oxygen from the air to the blood
Oxygenation
Oxygen binds with …………
Hemoglobin
…………… is the removal of carbon dioxide from the body to the atmosphere
Ventilation
………………. Is the volume of blood delivered in 1 minute
Cardiac output
Cardiac output is equal to …………… X …………………..
Heart rate
Stroke volume
The ……….. consists of a bony cage overlying some of the most vital organs in the human body
Thorax
The ………. Is an elongated, S shaped bone that connects to the manubrium medially and overlies rib 1 as it proceeds laterally toward the shoulder
Clavicle
Laterally, the clavicle connects to the acromian process of the …………, the triangular bone that overlies the posterior aspect of the upper thoracic cage
Scapula
Between each rib lies an ………….. space
Intercostal
The heart lies within a tough fibrous sac called the?
Pericardium
A double-layered serous membrane that surrounds the lungs and lines the chest cavity to reduce friction during breathing.
Pleura
The diaphragm, the primary muscle of breathing forms a barrier between the ………….. and ………….. cavities
Thoracic
Abdominal
The primary physiologic functions of the thorax and its contents are to maintain ……………. And …………….and via the heart to maintain …………..
Oxygenation
Ventilation
Circulation
As the diaphragm contracts downwards, the intercostal and accessory muscles pull the …………..out and away from the center of the body. The resulting …………… pressure within the thoracic cavity draws air in through the ………… and …………… down the ……………, passing through smaller and smaller bronchioles until finally it reaches the …………..
Chest wall
Nose
Mouth
Trachea
Alveolar space
This includes the delivery of oxygen from the air to the blood, where it is carried to the cells and tissues throughout the body
Oxygenation
This is the process by which CO2 is removed from the body
Ventilation
This is the amount of blood pumped out of the heart with each beat
Stroke volume
This is the total amount of blood pumped in one minute
Cardiac output
How to calculate cardiac output?
Cardiac output = heart rate X stroke volume
CO=HR X SV
This is a bruise of the lung tissue caused by blunt chest trauma
Pulmonary contusion
A …………. Is defined as two or more adjacent ribs that are fractured in two or more places
Flail segment
In a …………. Injury, multiple ribs break in two or more places, creating a …………….. rib segment that moves independently from the rest of the chest during breathing
Flail chest
Free floating
Presentation of small pneumothirax
May cause only mild dyspnea, pleuritic chest pain and diminished lung sounds
The most common thoracic injury is?
Rib frcatures
When you are examining the chest of a patient who has sustained either blunt or penetratinginjury, palpate for …………. (Air under the skin), which can indicate a potential ……………
Subcutaneous emphysema
Pnemothorax
The accumulation of air or gas in the pleural cavity
Pneumothorax
This occurs when a defect in the chest wall allows air to enter the thoracic space. It results from penetrating chest trauma
Open pneumothorax
…………. Occurs when air leaks into the space between the pleural surfaces from an opening in the chest or the surface of the lung. The lung collapses as air fills in the ………
Pneumothorax
Pleural cavity
This is a life threatening condition that results from continuous air accumulation within the intrapleural space
Tension pneumothorax ( eg: a rib puncturing the lung, the trapped air builds up crushing the lung and pushing the heart, trachea and major vessels to the opposite side
Symptoms of tension pneumothorax
Tracheal deviation, JVD, shock, tachycardia, absent breath sounds on affected side
This occurs when blood begins to fill the space between the parietal and visceral pleura
Hemothorax
Each lung can hold up to how much blood?
3000ml
A —————- is when blood rapidly accumulates in the pleural space, often from chest trauma. It causes lung collapse, hypovolemic shock, and impaired ventilation.
massive hemothorax
Massive hemothorax will reveal signs of both ventilatory insufficiency and and hypovolemic shock what are those?
Ventilatory insufficiency
- hypoxia
- agitation
-anxiety
- tachypnea
- dyspnea
Hypovolemic shock
- tachycardia
- hypotension
- pale and clammy skin
This is a collection of blood in the pleural space produced by bleeding within the chest
Hemothorax
This occurs when both blood and air are present in the pleural space
Hemopneumothorax
-Caused by compression of lung tissue against chest wall
-results to alveolar and capillary damage
- results in reduced delivery of oxygen across the capillary ( alveolar interface)
Pulmonary contusion
Signs for pulmonary contusion
-Hemoptysis
-Signs of overlying injuries such as crepitus, tenderness or contusions
This is defined as excessive fluid in the pericardial sac, causing compression of the heart and decreased cardiac output. May be caused by blunt or penetrating trauma.
Cardiac tamponade
In —————— blood or fluid builds up in the pericardial sac (the membrane surrounding the heart), which compresses the heart and prevents it from filling and pumping effectively. It’s a life-threatening emergency that requires immediate intervention.
cardiac tamponade
Becks triad ( signs of cardiac tamponade)
-Muffled heart sounds
-Narrowed pulse pressures
-JVD
-Blunt cardiac injury caused by the heart colliding with the sternum
Myocardial contusion
- may lead to dysrhythmias
- patients complains of sharp, retrosternal chest pain
- lung sounds may reveal crackles
- ECG changes may occur
Myocardial contusion
-Acute perforation of the ventricles, atria, septum, chordae, muscles or valves
-caused by severe blunt force
Myocardial rupture
Immediate cardiac arrest caused by blunt trauma during the hearts repolarization period
Commotio cordis
When experiencing commotio cordis a patient appears in …………. Fibrillation, which responds well to …………. If performed quickly
-ventricular
-defibrillation
This is a tear in the aorta caused by severe blunt trauma and transaction or dissection. Like a high speed car crash or fall from a height
Traumatic aortic disruption
Body’s largest blood vessel
Aorta
Why is traumatic aortic disruption a life threatening emergency?
Because the aorta carries all the blood from the heart to the body, if it tears completely, massive internal bleeding occurs, often leading to death
The most widely accepted theory of how traumatic aortic disruption occurs is ?
That the aorta is injured in its fixed points due to shearing forces
Signs for traumatic aortic disruption
- patient may complain of pain behind sternum
- may also show signs of hypoperfusion
What can cause a tension gastrothorax?
A diaphragmatic herniation, due to blunt or penetrating trauma
This happens when the stomach or intestines move into the chest cavity ( through a tear in the diaphragm) causing a severe pressure on the lungs and heart
Tension gastrothorax
Signs of diaphragmatic injury ( causing tension gastrothorax)
- bowel sounds in the chest cavity
- absence of lung sounds in affected side
- caused by the sudden and forceful compression of the thoracic cavity
- causes pressure to be translated into the veins of the head, neck and kidneys
- pressure in capillary beds results in their rupture
Traumatic asphyxia
Difference between hypoxia and asphyxia
Hypoxia- happens when not enough oxygen reaches the tissues and organs
Asphyxia- happens when oxygen can’t get into the body at all because the airway is blocked
Findings on patient with traumatic asphyxia
- cyanosis of head and upper extremities
- subconjunctival hematoma (bleeding into the anterior surface of the eye covering the white part)
- exophthalmos ( eyes protrude from their normal position)
- tongue and lips may be swollen
Signs of airway compromise
Stridor
Hoarseness
Gurgling
Snoring
Signs of hypoxia
Alterations in mental status
Tachypnea
Coughing
Hemotypsis
Accessory muscle usage
Retractions
Signs of hyoovolemia
-Cool pale or clammy skin
-delayed capillary refill ( > 2 sec)
-weak or thready pulse
-mild confusion or dizziness
-tachycardia ( it is common but not always present ( eg in elderly beta blockers use)
Weak and thready pulse suggests?
Hypovolemia
An ——————— suggests that the heart’s electrical activity is abnormal, which can be due to a number of arrhythmias or other cardiac conditions.
Irregular pulse
JVD must be measured at?
-45 degree angle
-cannot be determined when the patient is immobilized
Lack of ………. Can indicate that there isn’t enough blood ( hypovolemia) to fill the veins properly, a sign of circulatory compromise or early shock
JVD
Muffled heart sounds may indicate?
Tension pneumothorax or cardiac tamponade
Any patient with chest trauma should be reassessed every?
5 minutes
When ventilating patients with possible lung trauma ventilate gently, if too much force is used a simple pneumothorax maybe converted into?
Tension pneumothorax
The treatment of the trauma patient is best accomplished if the patient can get to the hospital in 1 hour which is the ?
Golden hour
Signs and symptoms of flail chest
-paradoxical motion
-dyspnea
-chest pain
Signs and symptoms of rib fracture
Hypoxia, hypercapnia and pain
Cover open pneumothorax with occlusive dressing secured on …… sides
3
Massive hemothorax findings
Lack of JVD
Lack of tracheal deviation
Hemotypsis
Dull to percussion
Largest organ of the human body and serves as the interface between the body and outside world
The skin (integumentary)
Refers to non bony, any group of similar cells that connects, supports or surrounds other structures and organs of the body. Eg: fat, muscles, tendons, ligaments, synovial membranes, blood, lymph vessels and nerves
Soft tissue
Occurs from sudden or extreme changes in air pressure as can occur during scuba diving emergency
Barotrauma
The human integumentary system plays a crucial role in maintaining the constancy of the internal environment, which is called?
Homeostasis
The skin comprises two layers which are?
-epidermis and the dermis
The outermost layer, is the body’s first line of defence. It’s a barrier.
Epidermis
This consists of 5 layers . An outermost layer (stratum corneum) of hardened non living cells, which are continuously shed
Epidermis
Underlying the epidermis is a tough, highly elastic layer of connective tissues called the?
Dermis
This complex material is composed chiefly of collagen fibres, elastic fibres and a mucopolysaccharide gel
Dermis
A fibrous protein with a high tensile strength strength, gives the skin high resistance to breakage under mechanical stress
Collagen
This allows skin to spring back to its usual contours
Elastin
The dermis is subdivided into?
Papillary layer and a reticular layer
Macrophages, lymphocytes and mast cells are also found within the …………… layer
Dermal
These cells are part of the the immune system, once a pathogen enters the dermis, these cells destroy the invading microorganism
Macrophages, lymphocytes and mast cells
These mediate the senses of touch, temperature, pressure and pain
Nerve endings
These carry oxygen and nutrients to the skin and remove carbon dioxide and metabolic waste products
Blood vessels
These are located at the neck of each hair follicle and are a specialized secretory mechanism that produces an oily substance called sebum
Sebaceous glands
What is the layer of tissue beneath the dermis
Subcutaneous layer
The subcutaneous layer consists mainly of?
Adipose tissue (fat)
Blood vessels, lymph vessels and hair roots are found in what layer?
Subcutaneous layer
Below the subcutaneous tissue is a thick dense layer of fibrous connective tissue known as ?
Deep fascia
The skin is arranged over the body structures in a manner that provides tension. This tautness varies by body region but occurs in pattern known as?
Tension lines
This is any injury to the soft tissue, it typically describes an injury in which the integrity of the skin has been disrupted
A wound
This layer of the dermis provides nutrients and aids in thermoregulation
Papillary layer
This layer is part of the dermis its dense, irregular connective tissue. Provides strength and elasticity
Reticular layer
Additional cells move to area to begin repair
- granulocytes and macrophages
-phagocytes
-chemotactic factors
-granulocytes degranulate
Inflammation
New epithelial cells move into injured region
- stratum germinativum cells multiply and redevelop
Epithelialization
What is this wound healing steps called?
-new blood vessels form
-new capillaries bud
-conduit for oxygen and nutrients
-pathway for waste removal
-bleeding might result from very minor injury
Neovascularization
- tough fibrous protein found in scar tissue, bones, skin, connective tissues
Collagen synthesis
What kind of wound are these?
-human and animal bites
- embedded foreign body
- injection wounds
- devitalized tissue
- crush wounds
High risk wounds
What is this?
-excessive collagen formation
-hypertrophic scar
-keloid scar
Abnormal scar formation
What kind of injury is this?
- happens to bedridden patient
-unconscious or immobilized patient
-tissues deprived of oxygen
-localized hypoxia
-cell deterioration
Pressure injuries
Any break in skin can allow invading pathogens to enter. What is that called?
Infection
Visible clues of infection
Erythema, purulent discharge, warmth, edema, local discomfort, red streaks indicate lymphangitis
Systemic signs for infection?
Fever, rigors, chills, joint pain, hypotension
————- is the death of body tissue due to loss of blood supply, severe infection, or trauma. It can be life-threatening if left untreated, especially if it leads to sepsis.
Gangrene
This is also called clositridium tetani
- anaerobic bacterium produces potent toxin
-results in painful muscle contractions ( may be noticed first in jaw/lockjaw)
- rare due to vaccination
Tetanus
This is a flesh eating disease, death of tissue from bacterial infection
- caused by streptococcus
- clinical hallmark is severe pain, you may see central wound necrosis with surrounding severe pain or a subcutaneous emphysema on exam
Necrotizing fasciitis
This type of wound has:
- no break in the epidermis
-contusion ( bruise)
- edema ( swelling)
- ecchymosis (black and blue mark)
- hematoma (collection of blood beneath skin)
Closed wound
This type of wound has :
- disruption of the epidermis
-more serious than closed wounds
- vulnerable to infection due to contamination
Open wound
This is a clean or jagged incision through skin surface and underlying structure
Laceration
This is a flap of skin torn loose
-may be accompanied by profuse bleeding
- irrigate with normal saline and place into an atomic position
Avulsion
Complete loss of a body part
Amputation
What are the 2 key causes of increased pressure within a muscle compartment, which can lead to compartment syndrome
Edema (swelling)
Hemorrhage ( bleeding)
What is this called?
If persists longer than 6 hours
- serious risk of death of local tissues
- sepsis
Compartment syndrome
Two general principles for open wounds are?
- control bleeding
-keep the wound clean
If bleeding is present in an open wound, determine:
- colour of blood
- amount lost
- site of origin
Directly covers the wound and controls bleeds
Dressing
This keeps the dressing in place
Bandage
This is used to cover wounds
- completely free of organisms
- used when a high probability of infection is present
Sterile dressing
This is applied on top of a sterile dressing to increase the ability to absorb blood
- used when there is lower risk of infection
Nonsterile dressings
This dressing is used when it is important to keep air from passing through the material eg:wounds to neck and thorax
Occlusive dressing
This kind of dressings allow exudate from the wound to mesh with the dressing material
-facilitates clotting and aids in bleeding control
-removal is painful and may precipitate bleeding
Adherent dressings
This dressing allow the products of wound repair to pass through the material
-easy removal but does not aid in clotting
- applied after wound closure
Nonadherent dressings
These dressings provide a medium for bacteria and other pathogens to grow, use is limited
-can benefit burn care
Wet/moist dressing
This type of bleeding occurs in spurts
- blood is usually bright red
Arterial bleeding
This bleeding is characterized by slow, even flow of bright or dark red blood
-present in minor injuries
Capillary bleeding
This type of bleeding is more likely to be slow and steady
-darker colour blood
Venous bleeding
This type of bleeding is characterized by a slow and steady
-dark colour blood
Venous bleeding
Rate of bleeding can be substantially slowed by?
Elevating the extremity above the level of the heart but elevation alone will not control bleeding, it would be helpful in conjunction with pressure
What promotes blood flow, which may disrupt the clotting process and lacerate more blood vessels
Movement
This kind of dressing may be used in conjunction with hemorrhage control techniques
-promotes body’s own coagulation process
-used in anatomical regions not amendable to tourniquet use
- never use on an open cranial wound
Hemostatic dressing
This blood/circulation stopping tool is only used as last resort
-used in traumatic amputations
-gunshot wounds
Tourniquet
What does cold compress do for pain?
-Reduces pain
-diminishes blood flow
When would you do this?
- quickly irrigate dirt or debris out of the wound
-gently fold the skin flap back onto the wound
-hold the flap in place with a dry sterile compression dressing
- never remove flap
-apply ice packs to surrounding area to decrease pain and swelling
Avulsed flaps
What suggests serious underlying injury with internal bleeding? Medical term for bruise, bleeding underneath.
Ecchymosis
Body parts crushed between two solid objects is called?
Crushed injuries
When an area of the body is trapped for longer than 4 hours what happens?
-arterial blood flow is compromised
-muscles are crushed beyond repair
—————–is the death of cells or tissue within a living organism, typically due to factors like lack of blood supply, infection, toxins, or trauma.
Tissue necrosis
The progression of crush syndrome
1: a body part is trapped for more than 4 hours
2: rhabdomyolysis occurs
3: the trapped body part is freed
4: by products of metabolism and harmful products for tissue destruction are released, possibly resulting in cardiac arrest, dysrhythmias, kidney damage, hyperkalemia and hyperphosphatemia
This refers to a delayed sudden cardiac arrest that can occur after a patient is freed from prolonged crush injury even if they appear stable, fine and smiling at first ( crush syndrome)
Smiling death
In crush syndrome early causes of death are?
Hypovolemia and hyperkalemia
What phase of blast injuries is this?
-pressure wave
-results from air displacement and heat
-damages air filled cavities ( ears, lungs)
- high risk of injury or death
Primary phase
What phase of blast injury is this?
-blast wind
-occurs as combustible gases move across the affected area
-less forceful than the pressure wave but longer lasting which involves blunt and penetrating wounds from flying objects
Secondary phase
What phase of blast injury is this?
- displacement from high energy explosions
-away from the blast site or collapse of the surrounding structure like victims thrown against rigid structures, risk for entrapment
Tertiary phase
What phase of blast Injury is this?
- heat generated can cause burns
-falling debris can cause crush injuries
Quaternary phase
4 phases of blast injuries
Primary – due to the blast pressure wave (barotrauma)
Secondary – due to shrapnel or debris (penetrating trauma)
Tertiary – due to body displacement (blunt trauma)
Quaternary – everything else (burns, inhalation, crush, etc.)
Largest cavity in the body
-contains vital organ systems
-extends from the diaphragm to the pelvis
Abdominal cavity
Region from diaphragm to pelvic brim
Abdominal cavity
The abdominal cavity is divided into 3 sections?
Anterior abdomen
Flanks
Posterior abdomen or back
Membrane that covers the abdominal cavity
Perioneum
————- is a fold of tissue (a double layer of peritoneum) that attaches the intestines to the posterior abdominal wall, helping to anchor them in place while also allowing movement and supplying blood, lymph, and nerves.
The Mesentery
-Peritoneal space
-retroperitoneal space
-pelvis
The 3 regions of the internal abdomen
Intraperitoneal structures ( encased in peritoneum)
-liver
- spleen
-stomach
- small bowel
-colon
- gallbladder
- female reproductive organs
Retroperitoneal structures
-aorta
-venae cava
-pancreas
-kidneys
-upper part of ureters
-portions of the duodenum and large intestines
Pelvic structures
-rectum
- lower part of ureters
- pelvic vascular plexus
- infra-aortic and infra vena canal vessels
- pelvic skeletal structures
- reproductive organs
These are areas of the abdomen where enough blood loss can cause shock
- abdominal cavity
- retroperitoneal space
- pelvis
The majority of significant abdominal injuries involve blunt trauma and most are due to?
Motor vehicle collisions
These are diffuse soft tissue injuries created by destructive energy transfer
-transferred via radiation, thermal or electrical energy
Burns
What temperatures cause burns?
Higher than 44degrees Celsius
What correlates the severity of burns?
Amount of heat energy and duration of exposure
In the abdomen the most commonly injured organs during blunt trauma?
Spleen and liver
Hemorrhage can be?
Internal and external
Bleeding in the abdomen can cause?
Abdominal tenderness or distension ( distension not evident until patient has lost nearly all blood in abdomen)
Examples of solid organs
Liver, kidney, spleen, pancreas, diaphragm
Spleen injury may be indicated by?
Pain in left shoulder ( kehr sign)
Pancreas injury may be indicated by?
Vague upper/midabdominal pain that radiates to back
Diaphragm injury will cause?
Ventilatory compromise
Examples of hollow organs
-Stomach
-intestines (small and large)
-gallbladder
-urinary bladder
-appendix
-uterus
Spillage of contents from the hollow organs results in?
Peritoneal contamination ( peritonitis)
- This is bruising (ecchymosis) of the flanks
-the area between the lower ribs and the top of the hip on the sides of the torso
Greys turner sign
What does greys turners sign suggest?
It suggests retroperitoneal bleeding which can be due to
-pancreatitis
-AAA ( ruptured aortic aneurysm )
-ectopic pregnancy rupture
This is an indication of intra abdominal bleeding, specifically peri umbilical ecchymosis ( bruising around belly button) it suggests internal bleeding, most commonly associated with
1: abdominal trauma
2: ruptured ectopic pregnancy
3: ruptured AAA
4: retroperitoneal hemorrhage
Cullen sign
In blunt force trauma from motor vehicle collisions, determine?
- the types of vehicles involved
- the speed they were travelling
- collision patterns
- use of seat belt
- air bag deployment
- the patients position in the vehicle
In penetrating trauma caused by gunshot , determine?
-Type of weapon used
- number of shots
- distance from victim
In penetrating trauma caused by stabbing, determine?
-type of knife
- possible angle of entrance wound
- number of wounds
What are signs of a pelvic fracture?
- pain to pelvis, groin or hip
- hematomas or contusions to pelvic region
- obvious bleeding
- hypotension without obvious external bleeding
This is when fluid physically leaves the body ( externally or internally)
And what kind of shock occurs?
It’s called absolute fluid loss and hypovolemic shock happens (body loses volume = not enough to circulate = drop in perfusion)
Causes of absolute fluid loss are?
- external bleeding
- internal bleeding
- severe viniting or diarrhea
- burns ( plasma loss through damaged skin)
- dehydration
This happens when the fluid is still in the body, but it’s no longer where it needs to be ( eg within the vascular system)
- so the volume of fluid is normal but it’s maldistributed due to vessel dilation
Which causes what kind of shock?
Relative fluid loss which causes distributive shock (blood volume is distributed improperly not effectively perusing tissues)
What causes relative fluid loss?
- sepsis ( vasodilation + capillary leakage)
- anaphylaxis ( massive vasodilation + leakage)
- neurogenic shock
- This is present in almost all forms of combustion
- should be considered whenever a group of people in the same place all complain of a headache or nausea
- it can displace oxygen from the alveolar air and the blood hemoglobin
- it binds to receptor sites on hemoglobin at least 250 times more easily than oxygen
Carbon monoxide
The most common type of burn is?
Contact burn
Three types of ionizing radiation
Alpha
Beta
Gamma
Signs and symptoms of internal hemorrhage (early signs, compensated shock)
Pale, cool clammy
Tachycardia
Tachypnea
Anxiety
Delayed cap refill
Narrowing pulse pressure
Thirst
Late signs of internal hemorrhage ( decompensated shock phase)
Hypotension
Altered level of consciousness
Cold extremities
Cyanosis
Weak or threads pulse
Pressure injuries are?
Pressure ulcers or bedsores
What kind of patients are at high risk for pressure injuries
Immobile
Elderly
Neurologically impaired
Malnourished or dehydrated
Critically ill
Underweight and overweight
Skin helps regulate body temperature through?
-Sweating
-Vasodilation
-Vasoconstriction
-Piloerection (goosebumps)
-Radiation, conduction and convection
————— is a serious condition caused by the breakdown of skeletal muscle tissue, releasing a protein called myoglobin into the bloodstream, which can lead to kidney damage
Rhabdomyolysis
Skin helps regulate body temperature through?
-vasoconstriction
-vasodilation
-sweating
-goosebumps
Bright red blood in stool, often from lower GI bleeding
Hematochezia
————- occurs when blood from the stomach or esophagus has been partially digested by stomach acids before being vomited
Coffee ground emesis
Black tarry stool from digested blood, typically from upper GI bleeding
Melena
The ————- is the flat bone in the center of the chest that connects the ribs via costal cartilage. It’s often referred to as breastbone
Sternum
The sternum consistes of 3 parts. What are they and where is each part located?
Manubrium: the uppermost part of the sternum, at the junction between neck and chest
Sternal body: the longer middle section of the sternum, it lies below the manubrium and is the main portion of the sternum
Xiphoid process: the small cartilaginous tip at the bottom of the sternum. Located just below the sternal body. Landmark for CPR
