Exam 4 Flashcards
Carry oxygenated blood away from the heart
Arteries
Have thick, muscular walls that enable dilation and constriction
Arteries
Microscopic blood vessels
Capillaries
Carry deoxygenated blood rich in carbon dioxide
back to the heart
Veins
Contain one-way valves to prevent back flow of blood
Veins
Dilation __ blood flow to skin
Increases
Inadequate perfusion of body’s tissues and organs
Hypoperfusion
Four main causes of shock
Volume problems
Pump problems
Blood vessel tone problems
Obstruction of blood flow
A volume shock problem is known as
Hypovolemia
Blood is lost, what kind of shock
Hypovolemia
Relative Hypovolemia
Plasma is removed from circulatory system
Cause of relative Hypovolemia
Dehydration or burns
Hemorrhagic shock is
Loss of blood
Both absolute and relative hypovolemia are called
Hypovolemic shock
Not enough blood volume in the blood vessels, so
pressure falls
Hypovolemia
Pump problems are usually related to a
Mechanical problem of the heart
In pump problems, blood cannot be moved because
Drop in BP
Pump problems are categorized as
Carcinogenic shock
Root cardiac cause of hypoperfusion
Cardiogenic shock
During blood vessel tone problems… all blood vessels
Dilate at same time and blood can’t fill entire circulatory system
Blood vessel tone problem is known as
Distributive shock
Types of distributive shock
Anaphylactic shock
Neurogenic shock
Septic shock
Massive drop in BP because of systemic dilation
Distribute shock
Spinal cord injury, messages to sympathetic nervous system gets interrupted and blood vessels constrict
Neurogenic shock
Body infection causes inflammatory response
Septic shock
What happens in septic shock
BV dilate and cap membrane becomes permeable
Blood flow blocked
Obstructive shock
Obstructive shock causes by
Pulmonary embolism, cardiac tamponade, tension pneumothorax
Constricted blood vessels in GI tract result in
Nausea and vomiting
Baroreceptors are located in
Aorta and carotid arteries and sense decreased pressure
Compensation aims to
Restore blood flow
Ways Compensation aims to restore blood flow.
Regulation of volume Vasoconstriction Cardiopulmonary response
Compensatory actions
Narrow pulse pressure, kidneys retain fluid, increased pulse and respiratory rate
In infants and children, Efficient compensating mechanisms maintain blood
pressure until
Half of volume is depleted
In pediatrics, what is a key indicator of shock
Fast heart rates
Compensated shock requires more
Fuel
When muscles run out of fuel for compensation,
compensated shock becomes
decompensated shock
Indicators of decompensation
Drop in BP
Mental status changed
Slow heart rate and respiratory rate
lead to organ-system
damage and death over time
Prolonged vasoconstriction
As organs fail…
Irreversible shock begins
Irreversible shock and death results in
Apnea and cardiac arrest
What kind of shock?
Wheezing=
Tension pneumothorax=
Anaphylaxis
Obstructive shock
When assessing for shock, if distal pulses they are
Low Bp, narrowed pulse
Distributive shock causes what color skin
Flushing or rash
Identify shock by
Trends in vitals
Signs of shock: order
Pulse increases Blood vessels constrict Respiratory rate increases Nausea Decreasing BP
Deadly triad of trauma
Acidosis, hypothermia, coagulopathy
Decreases body PH, dangerous in hemorrhage shock
Acidosis
Bleeding control, rapid transport: what kind of shock
Hypovolemic
Request ALS, support blood pressure: what shock
Cardiogenic shock
Give epi, what shock
Distributive
Septic shock requires
Rapid transport, time sensitive disorder
Occurs outside of body after force penetrates skin and
lacerates or destroys underlying blood vessels
External bleeding
Bright red color, spurting with heartbeat, oxygen rich : what kind of bleeding
Arterial bleeding
Darker in color, less pressure, volume of blood can create life threatening hemorrhage: What kind of bleeding
Venous bleeding
Occurs where appendages of the body connect to the
trunk.
- Large arteries and veins are not well protected
– Injury is likely to cause massive bleeding
Junctional hemorrhage
Caused by superficial wounds to surface of skin
Capillary bleeding
Identifying type of bleeding is
Irrelevant
Slow and oozing bleed
Capillary bleeding
Affects body’s ability to clot
Hypothermia
Identify and control massive hemorrhage within
first
seconds of primary assessment
Control nonmassive bleeding only after
assessing and treating prior elements
Methods or controlling external bleeding
- Direct pressure
– Hemostatic agents
– Wound packing (don’t take dressings off)
– Tourniquet use on extremities (last)
– Specialized compression devices for junctional
bleeding
Control of bleeding is essential to preventing
Shock
Hold pressure until bleeding is controlled and check after
5-10 minutes
Coughing up blood
Hemoptysis
Once bleeding is controlled…
bandage a dressing firmly
in place to form a pressure dressing
Presents natural cavities that promote profuse bleeding
Junctional areas
Direct pressure should be augmented by
Would packing
In wound packing, fill void spaces with
Hemostatic gauze
Pressure dressing steps
▪ Place several gauze pads on wound. ▪ Hold dressings in place with self-adhering bandage wrapped tightly over dressings and above and below wound site.
Designed to enhance direct pressure’s ability to control
bleeding
Hemostatic agents
Best suited for wound packing
Hemostatic agents
- Use if bleeding is uncontrollable by direct pressure.
– Use only on extremity injuries.
– Always apply between the wound and the heart.
Tourniquet
Designed specifically to control hemorrhage in
junctional areas of axilla and groin
Junctional tourniquets
Elevate injured area how
Above level of heart
Do not elevate if
musculoskeletal injury, impaled
objects in extremity, or spine injury
Minimizes swelling, constricts blood vessels, and
reduces pain
Cold application
From increased intracranial pressure, not direct
trauma to ears or nose
Head injury
Stopping bleeding of head injury increases
Intercranial pressure
Allow head injury to
Drain freely
epistaxis
Nosebleed
Begin hemorrhage control with
Direct pressure
Blood loss commonly not seen in
Internal bleeding
Indication of what with these symptoms…
– Injuries to surface of body
– Bruising, swelling, or tenderness over vital organs
– Painful, swollen, or deformed extremities
– Bleeding from mouth, rectum, or vagina
Internal bleeding
Tender abdomen, coffee grounds are signs of
Internal abdomen
Internal injuries with no pathway from the outside to the injured site
Closed wound
Examples of closed wounds
Contusions, hematomas, closed crush injuries, rupture of hollow organ or solid organ injury, internal puncture
In a confusion what layers are damaged
Epidermis but not dermis
More tissue damage, larger blood vessels affected in a
Hematoma, rather than a contusion
– Force transmitted from exterior to internal structures
– Crush or rupture internal organs
Closed crush injury
If bruise on head and neck, check for
Blood in holes
Bruise on trunk can cause
Coughing up blood, puncture lung, listen to lung sounds
Bruise on abdomen indicates
Injury to organs
What layers damages in abrasion
Epidermis
Perforating puncture wound has
Entrance and exit wound
Open crush injures
Extremity caught between heavy items
Mix of open and closed injures
Blast injuries
Blast injures: primary injuries
Secondary
Tertiary
Quaternary
1: high pressure and winds
2: projectile hitting patient (blast wave)
3: patient throw by blast (fracture, abrasion)
4: exposure to chemicals and burns
With open wounds patient care included
Expose wound, clean wound, control bleeding, care for shock
Always check __ with abrasions and lacerations
CMS
With penetrating search for an
Exit wound
With treating impaled objects…
Don’t remove object, expose area, direct pressure, apply layers of bulky dressing
With impaled objects, place bulky dressing
On opposite sides of object
Keep the cravets wide when treating impaled object, how long?
No less than 4 inches in width once folded
If object impaled in the cheek…
Position patient for drainage, motion airway, dress outside of wound
Apply what kind of protection with impaled eye
Rigid
What gauze used for puncture wound in eye
3 inch gauze or folded 4x4 on vertical axis
What is the only object you can take out if impaled
Cheek, if you see both sides
If avulsed parts of skin are completely torn away…
save in sterile dressing and keep moist with sterile saline.
Wrap an amputation site in
Sterile dressing and secure with self adhesive bandage
Classifying burns
– Agent and source
– Depth
– Severity
Solid organ can result in
Significant blood loss
– Involves only epidermis
– Reddening with minor swelling
Superficial burn (1st degree)
Closed chest and abdominal wounds bear a high risk for
Underlying organ system damage and internal bleeding
– Epidermis burned through, dermis damaged – Deep, intense pain – Noticeable reddening – Blisters and mottling
Partial thickness burn (2nd degree)
– All layers of skin burned – Blackened areas or dry and white patches
Full thickness burn (3rd degree)
JVD and tracheal deviation are key differences in a
Tension pneumothorax vs pneumothorax
The rules of nine is used when
Determining severity of burns
In rules or nine, adult body is divided into __ areas, each representing __ of body surface
11, 9%
With the rule of palm, palm and fingers equal about __ of body surface area
1
What rule is Easier to apply to smaller or localized burns
Rule of palm
Infants and children have a greater…
Relationship of body surface area to total body size, greater fluid and heat loss from burned skin
Ceran wrap can be a type of
Occlusive dressing
With a chemical burn, apply a
Sterile dressing
Most radiation burns will present like
Thermal injures
See patient with a radiological burn only after they have been
decontaminated
After __ mL of blood loss, results in __
1000, hypovolemic shock
Any material applied to wound to control bleeding and prevent contamination
Dressing
Any material used to hold dressing in place
Bandage
Available for profuse bleeding, large wound
Universal dressing
Used to control bleeding
Pressure dressing
Used to form an airtight seal
Occlusive
With bandaging, do not cover
Tips of fingers or toes
To apply a self-adhering roller bandage, secure it with
several overlapping wraps.
Children under __ and adults over __ most severe age for burns
5, 55
Open or closed in reference to a
soft-tissue injury
must be evaluated with consideration to
underlying anatomy and mechanism of injury.
Closed injuries
key concern when treating a patient with
a burn or an electrical injury.
Safety
Adherence of lung tissue to chest wall due to serous fluid and a constant negative pressure, allows…
Lungs to expand and contract with movement of chest wall/diaphragm
Intercostals flex and expand chest outward in
Inhalation
Active process that uses negative pressure to draw air into the lungs
Inhalation
Passive process that uses positive pressure to push air out of the lungs
Exhalation
Superior border of abdomen
Diaphragm
Stomach located in
Gallbladder located in
Spleen located in
Liver located in
LUQ
RUQ
LUQ
RUQ
Solid organs
Spleen, liver, pancreas, kidneys
Hollow organs
Stomach, gallbladder, large and small intestine, bladder, ovaries and uterus
What type of organs tolerate trauma well
Hollow
Abdominal cavity is __ depending on location of .
Dynamic, diaphragm
There’s always __ in abdomen
A large volume of blood
Immediate concern with chest trauma
Disruption of breathing
Largest threat of chest trauma patient
Internal bleeding
What trauma doesn’t penetrate the chest wall
Blunt
Can fracture ribs, sternum, and costal (rib) cartilages
Blunt trauma
MOI that violates the integrity of the chest wall
Penetrating trauma
Bullets, knives, pieces of metal or glass, steel rods, pipes, other objects – Can damage internal organs and impair respiration
Penetrating trauma
Occurs when severe blunt trauma causes the chest to rapidly compress
Compression and shearing injuries
Shearing can damage the
Aorta and vena cava
Chest injuries are classified as
Open or closed
What type of chest injury is caused by a blunt mechanism
Closed
What blunt chest injury is most common in geriatrics and youth sports
Rib fractures
Reduces lung expansion
Hypo ventilation
Fracture of two or more consecutive ribs in two or more places
Flail chest
Flail chest leads to
Inadequate breathing and hypo ventilation.
Movement of flail segment is opposite to movement of the remainder of the chest cavities.
Paradoxical motion
Symptoms of rib fracture
Pain increases when breathing, tender, respiratory distress, self splinting
Flail chest assessment
Difficulty breathing, pain at sure, chest wall muscle contraction, late signs of shock and hypoxia
For flail chest, patient care
Self splint, pillow, request ALS
Hole in chest, negative pressure of breathing can draw air in through the hole
Sucking chest wound
In penetrating chest injuries, it’s difficult to
Tell what’s injured from entrance wound
Assume all wounds are life threatening in
Penetrating chest injuries
What injury listen to lung sounds
Penetrating
Lung damage signs and symptoms
Difficulty breathing, absent of unequal lung sounds, hemoptysis, hypoxia, low BP, tachycardia, tachypnea
For sucking chest wound patient care
Seal wound, apply occlusive dressing (at least two inches wider than wound)
dressing seals wound to stop movement of air
Occlusive
involve taping dressing in place and
leaving a side or corner of dressing unsealed
Flutter valve dressings
In flutter valve dressing, as patient inhales…
Seal wound
Seals all the wound edges and have a valve that allows pressure relief
Asherman chest seal
Patients chest injury needs to be treated during
ABCs in primary assessment
When air accumulates in chest cavity, possibly
causing lung collapse
Pneumothorax
Pressure from air in chest cavity puts pressure on the heart and vena cava
Tension pneumothorax
Patients with pneumothorax or tension pneumothorax typically have
JVD, trachea deviation (opposite side of injury), diminishes lung sounds
Chest cavity fills will blood.
Hemothorax
Chest cavity fills with both blood and air.
Hemopneumothorax
Sudden compression of chest forcing blood out of organs and rupturing blood vessels
Traumatic asphyxia
Neck and face are a darker color than rest of the body are a sign of
Traumatic asphyxia
In traumatic asphyxia, sternum and ribs can exert pressure on heart and lungs which
Forces blood out of right atrium and into jugular veins
Present with MOI of injury that can cause compression of chest
Traumatic asphyxia
Direct injury to heart causing blood to flow into the pericardial sac around the heart
Cardiac tamponade
Increased pressure on heart so chambers cannot fill
Cardiac tamponadeb
Becks triad
Muffled heart sounds, distanced neck veins, narrowing pulse pressure in cardiac tamponade
Systolic and diastolic blood pressure difference gets smaller over time
Narrowed pulse pressure
Cardiac tamponade usually a result of
Penetrating trauma
Largest artery in body, rush from left ventricle to chest
Aorta
Penetrating aortic injury can cause
Blunt trauma aortic injury can
Direct damage
Tear aorta
Inner layer of aorta begins to tear, blood flows between layers of aortas wall
Aortic dissection
Balloon like protrusion of aorta, rupture leads to death
Aneurysm
Aortic injury signs and symptoms
Chest, back pain, shock, differences in pulse or blood pressure between arms or legs
Differences in pulse of BP between right and left arms
Proximal aortic injury
Commotio cordis patient should be treated as a
VF patient
Trauma to chest when heart is vulnerable
Commotio cordis
In commotio cordis, impact occurs just when the heart is
Electrically vulnerable
Uneven chest wall motion is common with
Pneumothorax
Distended neck veins are present in tension pneumothorax unless
Hypovolemic
Coughing up frothy red blood present in
Hemothorax
Bloodshot and buldging eyes present in
Traumatic asphyxia
Cardiac tamponade blood pressure and pulse pressure
Low bp and decreasing pulse pressure
Tearing chest pain radiating to back
Aortic injury or dissection
Allow air to be expelled for
tension pneumothorax
Abdominal evisceration? Treatment?
Organs protruding through wound opening, moist dressing
Most commonly injured organ because of size and vascular, where is it located
Liver, RUQ under lower ribs
Blunt trauma to solid organs can cause
life-threatening
blood loss
Serve irritation and peritonitis can cause involuntary control which leads to
Rigidity of abdominal wall
For patient care of abdominal injures, place patient
On back with legs flexed at knees to reduce tension on abdomen
For adnominal injuries give
Nothing by mouth
Do not touch or replace
Eviscerated organs
For eviscerated organs…
Apply sterile moist dressing then occlusive dressing, with bulky dressing to keep warm
Treatment for impaled object
Stabilize with bulky dressings, leave legs in position to avoid muscular movement
A flail chest is characterized by
Paradoxical motion
Cartilage located…
Outside bone end (epiphysis)
Over relief splint how many times
1
Never tie over a __ in splinting
Joint
Cirrhotic splinting
Pad voids
Patient assessment in pelvic injuries
Pain when pressure to iliac crests, can’t lift legs, lateral rotation of foot, pressure in bladder
Patients entire limb rotated outward, hip flexed
Anterior hip dislocation
▪ Rotation of leg inward and knee is bent.
▪ Foot may hang loose and unable to flex the foot or lift toes.
▪ Lack of sensation in limb
Posterior hip dislocation
With hip dislocation, patient care
Move to long board, immobilize limb with pillows. Care for shock
Hip fracture pain is
Localized
Patient assessment of hip fracture
Sensitive to pressure on greater trochanter, swelling, can’t move limb on back, foot on injured side turns outward, limb looks shorter
Femoral shaft fracture patient assessment
Intense pain, possible open fracture (severe angulation), limb may be shortened
What splints use for tib fib injury
Vacuum, air inflated, immobilize fracture with rigid board splits and apply single splint with ankle hitch.
If patient has multiple trauma or appears to have shock, don’t waste time
Splinting individual fractures
Pelvic fractures and femoral shaft fractures often indicate
More severe internal injuries
Connect bone to bone
Ligaments
Connect muscle to bone
Tendons
Bones made up of
Dense connective tissues
Bones are covered in
Periosteum
Where bones meet
Joints
Break causes soft tissue…
Swelling and a blood clot in fracture
Skeletal muscle
Voluntary
Chief concern in trauma
Skeletal
Smooth muscle is found in the
Walls of organs and digestive structures
__ less rigid than bone
Cartilage
Cartilage acts as an
Articulation surface
Allow for power of movement across joints
Tendons
Connects muscle to bone
Tendons
support joints by attaching bone ends to allow
for stable range of motion
Ligaments
Connects bone to bone
Ligament
Mechanisms of musculoskeletal injury
Direct force, twisting force, and indirect force
MCL, ACL injury are an example of what kind of force
Twisting force
Force that is a sudden stop, falling back
Indirect force
Applies constant pull along length of leg to stabilize fractures and reduce muscle spasms
Traction splint
Early application of traction splint mortality rate from femur drops to
Less than 20%
Greenstick, incomplete breaks are common in
Children
Bone that’s broken in several places
Comminuted
Bent at angle break
Angulated
Coming apart of a joint
Dislocation
Soft tissue of joint capsule and ligaments must be stretched beyond normal range and torn
Dislocation
Stretching and tearing of ligaments (joint injuries)
Sprain
Overstretching or overexertion of muscle
Strain
A traction splint should be applied to a suspected
Femur fracture
Splinting an extremity with a suspected fracture helps
prevent blood loss from bone tissues
Severe swelling in the extremity as a result of fracture
Compartment syndrome
Fracture or crush injury causes
Bleeding and swelling in extremity
Six P’s of assessment
Pain, pallor, paresthesia, pulses diminished, paralysis, and pressure
pins and needles
Parasthesia
Nerve and blood vessel compromise occurs in
Compartment syndrome
During __ assessment, apply cervical collar is spine injury suspected
Secondary
Must immobilize what part in splinting
Adjacent joints and bone ends
Realigning an extremity is limited to
Angulated shafts of long bones
Splint in the position found unless..
distal extremity is cyanotic or lacks pulses
If extremity is cyanotic or lacks pulses, align joint to
Neutral position using gentle traction
Apply manual traction in direction of
Long axis of extremity
Effective splinting may require some
ingenuity
Three types of available splints on EMS units
Rigid, formable, traction splints
Splint that requires the greatest support
Rigid
Require limb to be moved anatomical position
Rigid splints
Immobilize joint injuries in position found
Formable splints
Align long-bone injuries to
anatomical position
Splint __ moving patient to stretcher
Before
Types of traction splints
Bipolar and unipolar
Exert and maintain a firm pull to prevent overriding, firm traction should be applied to align limb
Bipolar traction splint
Traction can be measured in
Unipolar splint
Amount of traction applied should be roughly __ percent of
patient’s body weight
– Not exceeding __ pounds
10, 15
Hair traction splint measured from
Ischial Tuberosity
Secure the patient’s torso and the traction splint to a
long spine board
Use a sling and swathe for what kind of injury
Shoulder girdle
Commercially available devices, can also use a sheet: Applied to patients who have pelvic deformity or instability
whether or not signs of shock are present
Pelvic wrap
To devise a pelvic wrap, lay a sheet, folded flat, approximately __ inches wide onto the backboard.
10
More than one serious injury
Multiple-trauma patient
One or more injuries serious enough to affect more
than one body system
Multisystem-trauma patient
Determining Severity: Physiologic Criteria
Altered mental status, hypotension, abnormal respiratory rates
Altered mental status: GCS <
14
Abnormal respiratory rates below __ or over __
10, 29: <20 in infants
Determining Severity: Anatomic Criteria
Amputation proximal to wrist or ankle, pelvis, skull fracture, paralysis
Chest wall instability or deformity
Flail chest
How many proximal long bone fractures for severity of anatomical criteria
Two or more
Intrusion in high risk auto crash: on occupant side or any side
> 12, >18
Who doesn’t effectively compensate for shock
Older adults after 55
systolic BP below __ may be shock after 65
110
Patients with special conditions when determining severity are
Taking anticoagulants (burns) and pregnancy’s >20 weeks
Assist ventilations at __ if high respiratory rate of __
12, 30
What is the “golden hour” for trauma patients
Need to critical trauma patients to get surgery within 1 hour of injury
Revised trauma score includes
GCS, systolic BP, respiratory rate
Three many ways body loses heat
Conduction, convection, radiation
Direct contact with hot or cold source, water chill
Conduction
Air or water carry away heat, wind chill
Convection
Heat is “picked up” by surrounding air or water.
Radiation
Body’s core temp
98.6
Occurs when the body sweats or gets wet
Exaporation
Loss of body heat through exhaled air
Respiration
The effects of cold temperature on older adults are
Immediate
Infants are unable to __ when cold due to __
Shiver, small muscle mass
Assessment of patients with hypothermia includes
Shivering, stiff posture, drowsy, numbness, rapid breathing and pulse to slow or absent breathing
With patients of hypothermia, perform CPR with
Only 1 shock
Passive vs active rewarming
Passive= cover patient, remove wet clothing Active= apply external heat source
Transport a hypothermic patient unless
Mild case
Patient unconscious, no discernible vital signs
– Heart rate can slow to __ beats/minute.
– Very cold to touch
10, extreme hypothermia
Perform CPR on patient with hypothermia until
Back to normal body range
Treatment for early or superficial frostnip
Remove from cold and cover
Treatment for late deep frostbite
Oxygen, cover frostbite part
Patient with moist, pale, and normal or cool skin known as
Heat exhaustion
As sweating continues, the body loses salts, bringing on
painful muscle
(heat) cramps
Apply __ over cramped muscles from heat
Moist
Temperature-regulating mechanisms fail, The body cannot rid itself of excessive heat (no sweating)
Heat stroke
To care for patient with heat stroke, apply cool packs to
Neck, groin, and armpits
As body temperatures decrease…
Muscles shiver, heart prone to dysthymias, CNS sluggish
As body temperature increases…
Sweating leads to evaporation and cool skin
___ relates to the diseases and ___ relates to death.
morbidity, mortality
During drowning, the reflex spasm of __ is triggered which seals airway
Larynx
Resuscitation should be started __ you immobilize neck and spine.
Before
If an ice shelf water accident, go around to the
Back side and secure from back
Diver holding breath, gas bubbles in bloodstream
Arterial gas embolism
Decompression sickness affects
Joints and muscles
Decompression sickness leads to
Air embolisms
Water rescue order
Reach
Throw and tow
Row
Go
Normal, healthy people who have adjusted to high altitudes have a __ oxygen saturation than do those at sea level because there is less oxygen to breathe.
Lower
What medication reduces inflammation for preparation of high altitudes
Dexamethasone
worse form of
acute mountain sickness
High-altitude cerebral edema (H A C E)
Symptoms of HAPE
Rales , pulmonary edema, dyspnea
Never elevate legs or bite because
Keep it away from heart
most effective technique to slow venom spread
Pressure immobilization bandage
Constricting bands with bites placed
2 inch above and below body
Vitals in snakebite
Labored breathing, rapid pulse
Most common form of anaphylaxis
Insects
Consider using what with insects
Epi pen
Black widow spider releases
Neurotoxin
Brown recluse spider releases
Hematotoxin and dermonecrotic toxin
In brown recluse spider, bite sites become..
Ischemic and necrotic after a few days
Scorpions release
Neurotoxin and cardiotoxin
Lizards and snakes release
Neurotoxin
Tenacious in hanging
onto a victim – Localized pain, edema,
bleeding
Lizards
Always remove stinger from
Jellyfish or stingray
Rely on heat, immobilization
Marine animal injuries
Always treat what first with lighting strikes
ABCs
Who’s more likely to be struck by lighting? Highest incidence in children and adults?
Males 5x, children younger than 16 and adults between. 26-35
Rapid heating/cooling (and
pressure) causes
Blast like trauma inside
Deliver to a level one trauma center if… respiratory rate is below __ and above __.
10, 29
3 things measured in GCS
Verbal, eyes, motor function
Becks triad…
Narrowing pulse pressure, muffled heart sounds, and JVD
Constructing bands avoid toxins going to…
Lymph nodes
Revised trauma score
BP, respiratory rate, Glasgow scale
Following commands, eyes following, but a little confused snd good verbal… what score on GCS
14
What score on GCS do you transport to level 1 trauma center
13
At what score of GCS do you use a bag valve mask
8
Suicide is most common in
Older men
Tylenol overdoses result in
Renal failure
Signs of renal failure and treatment
Jaundice, edema, weight gain, and CPAP
Body % of nitrogen and oxygen
79, 21
If an elderly lady falls on face, the major injury would be the
Proximal part of the femur
The proximal part of the femur break is classified as a… and signs include…
Hip fracture, slight shorter leg and rotates
Distal femur fracture includes the
Patella or knee fracture
Infant respiratory rate
30s
Respiratory rate less than __ and over __ for infants
20, 40
where fertilization
usually occurs.
Fallopian tubes (oviducts
Muscular, hollow organ located along midline in
women’s lower abdominal quadrants
Uterus
Uterus can hold mL normally and mL during pregnancy
5, 500
Muscular ring separating uterus and vagina
Cervix
How many weeks gestation needed for survival
20
Fetal stage begins at week
8
Heart beat forms…
15-18 days after conception
How many weeks of pregnancy
40
Fluid that allows fetus to float, cushions fetus, and maintains constant fetal body temperature
Amniotic sac
During pregnancy, the cardiovascular system makes…
50% more RBCs by 2nd trimester
Pregnant women increased cardiac output more prone to
Pulmonary embolism
Placenta, infant, and amniotic fluid total
20-24 lbs
When supine, Mass compresses inferior vena cava—cardiac output decreases and BP drops
Supine hypotensive syndrome
In shock skin color isn’t an indication with…
Septic shock, neurogenic shock
Irregular, not sustained, and not indicative of impending delivery—false pregnancy pains
Braxton-Hicks contractions
Fetus’s movement from high in the abdomen down toward birth canal
Lightening
When they last __ and are __ apart, delivery of the baby may be imminent
30 sec- 1 minute, 2–3 minutes
Fluid with meconium staining indicates that there may be
fetal distress
Pulse is in the ___ for infants and fetus
160s-170s
Amniotic sac breaks in what stage of labor
First
Third stage of labor lasts 
10-20 minutes
Gravita, pera
G: number of pregnancies
P: number of living children
Newborn=
Neonate=
Within 2 hours
28 days of life
Give narcan to pregnant women at what week
35
What assesses the neonate
APGAR
APGAR stands for
Appearance, pulse (over 100), grimace, activity, respiratory effort: 7-8 is normal
Deep fundus massage role
Release oxytocin for vasoconstriction to stop vaginal hemorrhage
Apply clamps on pulseless umbilical cord at
10 and 7 inches from baby
If shallow, slow, gasping, or absent, provide positive
pressure ventilation on neonate at a rate of
40-60 per minute
In neonate if less than __ bpm, continue positive pressure ventilations.
If less than __ begin chest compressions at __
100
60, 120
Deliver neonate resuscitation at a depth of
One-third to one-half of the chest
Most common abnormal delivery
Breech presentation
Meconium staining common with
Breeching
Position if breeched, limb presentation, and prolapsed cord
Doggy
Stains amniotic fluid greenish or brownish yellow color • Do not stimulate infant before suctioning.
Meconium
Placenta blocks birth canal
Placenta previa
Tearing pain, Placenta prematurely separates from uterine wall, Usually caused by trauma
Abruptio placentae
Ectopic pregnancy vitals
Low BP, Rapid weak pulse, often pain in one side
Seizure in pregnancy vitals
Preeclampsia, weight gain, swelling
Pregnant patient’s pulse ___ beats per minute
faster than nonpregnant women.
Blood loss may be __ percent before
signs/symptoms appear.
10 to 15
30 to 35
Displace uterus in cpr if child is more than
20 weeks
Position hands __ higher on sternum to
make up for shifting of the heart by large uterus
1 to 2 inches
