Exam Prep Flashcards
Define kinematics
The process of looking at the MOI at an accident to determine what injuries are likely to have resulted from the forces and motion and changes in the motions involved; the science of motion.
List the 5 origins of energy.
Motion, Chemical, Electrical, Thermal, Radiation
What are Newtons laws of motion?
- An object at rest or in motion will remain at rest or in motion unless acted upon by an external force
- Every action has an opposite and equal reaction
- Force = mass x acceleration
What is the law energy conservation?
Energy can neither be created nor destroy, it can only change form
What is the law of moving objects?
Kinematic energy (E) = ½ Mass x Velocity2
What populations are more at risk of sustaining trauma injuries?
Those who:
Live remotely
Are in a lower socioeconomic position
Aboriginals & Torres Strait Islander people
are elderly
Men
What are the main causes of injuries resulting in hospitalisation?
Falls (42%)
Inanimate mechanical forces (14%)
MVA (12%)
What is a public health measure that lowers the rate of trauma?
Seat belts
Road safety education
Airbags
Helmets
Drink driving (booze bus)
Speed limits
What components make up the comprehensive trauma system?
Injury prevention
Prehospital care
Acute care facilities (major trauma centres)
Post hospital care (rehabilitation)
What percentage of trauma injuries occur in men?
70%
What 5 actions cause blunt force trauma?
Acceleration
Deceleration
Compression
Shearing
Direct forces
What are the 2 most common forces that result in blunt trauma?
Acceleration and deceleration.
What percentage of all major trauma in Australia is blunt?
95%
What are the 3 common patterns of injury as a result of falls
Don Juan Fracture
Outstretched hands
Head first
What is a Don Juan fracture and when do you see it?
A calcaneus fracture within the foot from landing on the heels after falling from height or direct force through a flexed ankle joint. This is commonly seen in motor vehicle accidents from the body weight being forced down into the flexed foot on the pedal and knees hitting the dash resulting in bone collision.
What are the phases of MVA?
- The vehicle impacts on another object
- The vehicle occupant decelerates, impacting against protective structures and the vehicle
- The internal structures of the occupant move forward until hitting another structure
What are the angles of impact in a MVA?
- Frontal, Rear, Side impact
- Down and under or Up and over
- Rotational impact
- Rollover
- Ejection.
What are the pedestrian vs MV phases for an adult?
- Initial impact of car bumper into pedestrians lower limbs and pelvis.
- Torso hits the hood of the car and possibly windshield.
- Pedestrian falls off vehicle onto the ground, typically striking their head first.
What factors impact the pattern of injury in a pedestrian vs MV?
Nature of the impact
Vehicle size and speed
Height and age of the pedestrian
What is Waddell’s triad?
The injury pattern for pedestrian (child) vs MV.
- Initial impact occurs on the legs (femur) or pelvis
- Second impact when bonnet impacts into the child’s thorax
- The third impact occurs when the child is thrown downward striking head on the ground
What are compression injuries?
Results from an organ or structure (or part of) being directly squeezed between other organs or structures.
What are the first phase blast injuries?
Explosion of air filled organs and cavities
Eardrums & middle ears rupture
Abdominal haemorrhage and perforation
What are the third phase injuries associated to blasts?
Fractures and Traumatic amputations
Closed and open brain injuries
Blunt and crush injuries
What are the fourth phase injuries from blasts?
Burns
Injury or incapacitation from inhaled toxic gases
What are the second phase injuries from blasts?
Penetrating ballistic or blunt injuries
Eye penetration
What non-physical injuries are associated to blasts?
- Psychological trauma
- PTSD
What are the 4 types of shock?
- Hypovolemic
- Cardiogenic
- Obstructive
- Distributive
Define hypovolemic shock
Circulatory failure due to intravascular fluid loss
Define cardiogenic shock
pump failure, due to a problem with myocardial contractility, heart rate or rhythm or valvular apparatus
Define obstructive shock
Shock resulting from any impedance to the flow in any major vessels
Define distributive shock
Shock resulting from a loss of vasomotor tone in the arterioles and the venules resulting in drop of pressure.
Name 3 conditions that may result in obstructive shock
- Tension pneumothorax
- Pericardial tamponade
- Compression of the vena cava
- Thromboembolism in the pulmonary artery
- Aortic dissection
Name 3 conditions that may result in cardiogenic shock
- MI
- Myocardial contusion (impact from steering wheel)
- Acute dysrhythmia compromising cardiac output
Name 3 conditions that may result in distributive shock
- sepsis
- anaphylaxis
- burns
- pancreatitis
- neurogenic shock
Name 3 conditions that may result in hypovolemic shock
- Amputation (hemorrhage)
- Pelvic fracture (hemorrhage)
- Excessive vomiting
- Excessive diarrhea
- Excessive sweating
What are the three haemorrhage classifications?
Capillary:
Slow, even flow
Bright red
Venous:
Steady, slow flow
Dark red
Arterial:
Spurting blood
Pulsating flow
Bright red
What blood pressure are you wanting in a haemorrhagic shock patient?
Systolic of 70-80mmHg
(permissive hypotension)
Name 5 physiological changes you see in pregnant patients
- Expanded blood volume
- Physiological anaemia
- Increased O2 consumption
- Decreased functional residual capacity of lungs
- Supine position causing reduced venous return to the heart
- Increased gastric contents and acidity
- Delayed gastric emptying with increased risk of aspiration into lungs
What are physiological treatment considerations for bariatric patients?
- Metabolic and cardiac demands higher
- High risk for thromboembolism
- Increased cardiac output & stroke volume
- Poor vascular access
- Injuries less obvious injuries due to adipose tissue
What mechanical challenges would you as a paramedic face treating and assessing bariatric trauma patients?
- May be unable to palpate pulses due to excess adipose tissue
- skin folds may mask penetrating injuries
- difficult to auscultate and detect pneumothorax
- difficult to assess for abdominal or bone tenderness
- masses/ deformities difficult to palpate
- use of inappropriate BP cuff size difficulty performing log roll
What are the five functions of the skin that may be impacted by burns
- Thermoregulation
- Fluid and electrolyte imbalance
- Immune response
- Protection from bacterial invasion
- Neurosensory interface
What are the 3 zones of a burn as per Jackson’s model?
Zone of coagulation
- Inner most zone of the wound
- maximum tissue damage
- coagulation, necrosis & absence of blood flow
Zone of stasis
- Middle zone
- Damaged but damage is reversible if treated appropriately
Zone of hyperaemia
- Outer most zone of a burn
- least amount of damage
- intact circulation
Which of the following is a common mechanism of traumatic brain injury?
a) Blunt force
b) Heat exposure
c) Chemical exposure
d) Electrocution
A) Blunt force
What is the primary cause of traumatic brain injuries in motor vehicle accidents?
Blunt force impact
Name three signs and symptoms of a moderate traumatic brain injury.
- Persistent headache
- Altered vision
- Slurred speech
- Vomiting
- Enlargement of pupils
- Unequal pupils
- LOC
- Confusion
- Altered GCS
True or False: A tension pneumothorax occurs when air accumulates in the pleural space, causing lung collapse.
True
Fill in the Blank: Burns caused by hot liquids are classified as ______ burns.
Thermal or scalds
Which of the following is NOT a common sign of a tension pneumothorax?
a) Cyanosis
b) Subcutaneous emphysema
c) Tachypnea
d) Bradycardia
d) Bradycardia
Name four potential causes of chest trauma.
Blunt force trauma,
penetrating trauma,
Compression/crush injuries,
blast injuries
True or False: A full-thickness burn involves damage to both the epidermis and dermis layers of the skin.
True
Fill in the Blank: The presence of crepitus indicates ______ in a chest injury.
Fractures - Flail chest
Explain the concept of the “golden hour” in the context of trauma management.
The golden hour refers to the critical period of one hour following a traumatic injury when prompt medical treatment has the highest chance of saving a person’s life.
Which type of traumatic brain injury involves a rotational force causing tearing of brain tissue?
a) Concussion
b) Contusion
c) Diffuse axonal injury
d) Hemorrhage
C) Diffuse axonal injury
What is the primary cause of tension pneumothorax?
Traumatic chest injuries
Name three potential complications of severe burns.
- Compartment syndrome
- Infection/sepsis
- Respiratory restriction
- Hypovolemia
- Hypothermia
- Loss of movement due to rigidity of scar tissue
True or False: Flail chest is a condition characterized by multiple fractures of any ribs on one side of the chest.
False: It may occur when 3 or more consecutive ribs are broken in at least 2 places causing interference with normal chest rise and fall.
Fill in the Blank: In a motor vehicle accident, a “dashboard deformity” is indicative of significant ______ injury.
Internal
Describe the steps you would take to assess and manage a suspected tension pneumothorax in the prehospital setting.
- Assessment of breathing finds resistance on BMV
- Auscultation finds one sided diminished lung sounds
- Assess for corresponding symptoms: Tracheal deviation, jugular vein distention, subcutaneous emphysema
- Bilateral needle decompression
Which of the following is NOT a common symptom of a traumatic brain injury?
a) Headache
b) Nausea
c) Vision changes
d) Hyperactivity
D) hyperactivity
What is the purpose of the Rule of Nines in burn assessment?
The Rule of Nines is used to estimate the percentage of total body surface area affected by burns, which helps guide fluid resuscitation and treatment decisions.
Name four potential causes of traumatic brain injuries other than motor vehicle accidents.
- Falls
- Sporting injuries
- Assault
- Blast injuries
True or False: In the context of burns, the term “eschar” refers to the dry, leathery dead tissue that forms on the surface.
True
A flail chest can result in impaired ______ and inadequate ventilation.
Oxygenation
Explain the difference between an open pneumothorax and a tension pneumothorax.
An open pneumothorax, also known as a sucking chest wound, is an open communication between the pleural space and the external environment, while a tension pneumothorax involves a one-way valve effect with air accumulation and pressure buildup.
Which of the following is NOT a potential mechanism of injury in a motor vehicle accident?
a) Deceleration
b) Compression
c) Penetration
d) Extension
c) Penetration
What is the primary cause of inhalation injuries in burn patients?
Inhalation injuries in burn patients are primarily caused by the inhalation of toxic substances, such as smoke and chemicals.
Name three signs and symptoms of a tension pneumothorax.
Tracheal deviation,
jugular vein distention,
subcutaneous emphysema,
Poor SpO2
Absent breath sound
Decreased chest expansion
True or False: A hemothorax is a condition where blood accumulates in the pleural space.
True
The primary goal of treating a burn injury is to prevent ______ and promote wound healing.
Further tissue necrosis
In burns, the “Rule of ____” is used to estimate the total body surface area affected.
9s
Which of the following is a common sign of a facial fracture?
a) Severe headache
b) Swelling and bruising
c) Rapid breathing
d) Elevated blood pressure
b) swelling & bruising
List three potential causes of ocular injuries.
Foreign objects
Chemical exposure
Infection
Physical altercations
Blow to the face from sporting equipment
Name three facial bones that are commonly fractured in traumatic injuries.
Mandible, Maxilla, Orbital, Zygomatic
True or False: A spinal cord injury above the C4 level can result in loss of diaphragm function.
True
Thoracic injuries can cause a life-threatening condition called ____________.
Tension Pneumothorax
Describe the primary assessment steps for a patient with a potential neck injury.
Which of the following is NOT a common sign of a spinal cord injury?
a) Loss of sensation and motor function
b) Pain and tenderness at the injury site
c) Difficulty breathing
d) Involuntary muscle spasms
c) Difficulty breathing
Name two potential complications associated with facial fractures.
- Airway compromise/inability to support airway
- Facial paralysis/nerve damage
- Eye injuries
- Facial disfigurement: sunken eyes, flat cheeks
- Reduced jaw movement
- TBI
Name four signs or symptoms of a ocular injury.
Pain,
redness,
swelling, vision changes,
double vision,
foreign body sensation,
abnormal eye movements,
discharge
True or False: In cases of suspected neck injuries, it is important to immobilize the neck and keep it in a neutral position.
True
Fill in the Blank: A tension pneumothorax can cause severe ____________.
respiratory distress
Which of the following is a common mechanism of injury for facial fractures?
a) Direct impact to the face
b) Hyperextension of the neck
c) Severe coughing
d) High-speed motor vehicle collision
a) Direct impact to the face
List three potential signs of a spinal cord injury.
- Altered sensation
- Loss of motor function
- Altered reflexes
- Extreme pain or pressure in head
- Limb weakness
- Loss of bladder or bowel control
- Central line pain or tenderness
True or False: In cases of facial fractures, nasal packing should be performed to control bleeding.
False
Fill in the Blank: The cervical spine consists of ____________ vertebrae.
Seven (C1-C7)
Describe the appropriate management for a patient with a suspected ocular injury.
Which of the following is NOT a common sign of a thoracic injury?
a) Chest pain
b) Rapid breathing
c) Cyanosis
d) Double vision
d) Double vision
Name three common mechanisms of injury for neck fractures.
Hyperextension,
hyperflexion,
direct trauma.
True or False: In cases of suspected spinal cord injuries, it is acceptable to move the patient without immobilization if there is imminent danger.
True
Fill in the Blank: The primary concern in spinal injuries is preventing further ____________.
Spinal cord damage
Explain the steps you would take to assess and manage a patient with a suspected facial fracture.
Which of the following is a common sign of an ocular injury?
a) Blurred vision
b) Decreased urine output
c) Abdominal pain
d) Swollen ankle
a) Blurred vision
List two potential signs of a thoracic injury.
pain in the chest that gets worse when laughing, coughing or sneezing.
pain when breathing in.
difficulty breathing.
tenderness to the chest or back over the ribs.
bruising.
swelling.
a ‘crunchy’ or ‘crackling’ feeling under the skin or in the ribs.
coughing up blood.
Fill in the Blank: A flail chest is characterized by __________
Paradoxical chest wall movement
Describe the steps you would take to immobilize a patient’s
To immobilize a patient’s spine, you would first ensure manual stabilization by placing your hands on both sides of the patient’s head while maintaining inline stabilization. Then, a cervical collar or extrication collar should be applied, and a long spine board with appropriate padding should be used for full-body immobilization.
Which organ is most commonly injured in blunt abdominal trauma?
a) Liver
b) Kidney
c) Spleen
d) Stomach
C) spleen
What is the primary mechanism of injury in a pelvic fracture?
Fracture due to high-energy trauma
Name three signs of intra-abdominal bleeding.
Abdominal pain,
bruising,
distention
nausea & vomiting
pale, clammy, sweaty skin
SOB & WOB
True or False: A ruptured spleen can lead to life-threatening internal bleeding.
True
Fill in the Blank: In genitourinary trauma, blood in the urine is known as ________.
Hematuria
What is the most common type of fracture in the elderly population?
a) Compression fracture
b) Greenstick fracture
c) Displaced fracture
d) Spiral fracture
a) Compression fracture
What is the primary concern in an open fracture?
The primary concern in an open fracture is preventing infection and providing wound care. It is crucial to cover the wound with a sterile dressing and immobilize the injured limb.
Name three common signs of compartment syndrome.
Pain
Feeling of tightness within the affected area
Poor pulse pressure in affected area
Tingling or burning sensation
Numbness or paralysis
True or False: Numbness or tingling beyond the injury site is a symptom of neurovascular compromise.
True
A head injury resulting in temporary loss of brain function is called ________.
Concussion
Describe the steps you would take to immobilize a suspected cervical spine injury.
Which cranial nerve is responsible for controlling eye movements?
a) Cranial nerve I
b) Cranial nerve V
c) Cranial nerve VIII
d) Cranial nerve III
d) Cranial nerve III
Name three signs of an epidural hematoma.
Headache, confusion, unequal pupil size, neurological deficits
True or False: A compression fracture is commonly seen in spinal cord injuries.
False
Describe the prehospital management of an avulsion injury.
The prehospital management of an avulsion injury involves controlling bleeding, gently cleaning the wound, and covering it with a sterile dressing. Preserve any avulsed tissue if possible and transport the patient to a medical facility for further evaluation and management.
Which bone is commonly fractured in a Colles’ fracture?
a) Ulna
b) Radius
c) Scapula
d) Humerus
b) Radius
What is the purpose of applying a traction splint in a femur fracture?
The purpose of applying a traction splint in a femur fracture is to immobilize and align the fractured bone, reduce pain, and minimize the risk of further damage to surrounding tissues and blood vessels.
Name three common signs of a skull fracture.
Headache,
scalp hematoma,
clear fluid drainage from the nose or ears
obvious head or face trauma
racoon eyes
altered GCS
Headache
Dizziness
LOC
True or False: A cerebrovascular accident (CVA) and a stroke are the same thing.
False
The acronym “FAST” is used to remember the signs and symptoms of _________.
The acronym “FAST” is used to remember the signs and symptoms of stroke (Face drooping, Arm weakness, Speech difficulty, Time to call emergency services).
Describe the appropriate treatment for an open fracture in the prehospital setting.
Which of the following is not a symptom of neurogenic shock?
a) Hypotension
b) Bradycardia
c) Hypothermia
d) Tachycardia
b) Bradycardia
Name three potential complications of a traumatic brain injury.
cognitive impairment
difficulty with sensory processing & communication
seizure
hydrocephalus
CSF leakage
Vascular or cranial nerve injuries
True or False: A pelvic fracture is often associated with significant internal bleeding.
True
Fill in the Blank: A sprained ankle occurs due to stretching or tearing of the ________.
ligaments
Is hypo or hyper thermia tolerated better in adults?
Hypothermia
What is a VQ mismatch?
A ventilation/perfusion mismatch refers to an imbalance between the amount of air vs the amount of blood reaching the alveoli of the lung.
What is a high VQ mismatch and when would you see it occur?
High VQ mismatch is when their is adequate ventilation to the lung but inadequate perfusion.
This may occur in;
- Pulmonary embolism
- Pulmonary hypertension
- Right sided heart failure
- Pneumothorax
What is a low VQ mismatch and in what conditions might it occur?
A low VQ mismatch is when there is adequate perfusion to the lungs but inadequate ventilation.
This may occur in;
- Asthma
- Pneumonia
- COPD
- Bronchiolitis
With regards to the oxygen-haemoglobin dissociation curve, in which direction will hyperthermia be hypothermia create a shift?
Hypothermia = left shift
Hyperthermia = right shift
What are 5 risk factors when considering heat related illnesses?
- Age
- BMI
- Medical conditions
- Medications
- Dehydration
What two populations are most at risk of developing heat related illnesses?
- Children
- Elderly
What is hyperthermia?
A core temperature above 38 degrees
What are the signs and symptoms of heat exhaustion?
- Diaphoresis
- Pallor
- Hypotension
- Tachycardia
- Reduced urine output
- Nausea & Vomiting
- Headache
- Thirst
True or False: Heat stroke is always associated with altered mental status
True: this is due to heat-induced encephalopathy and a core temp above 40.5 degrees
Is heart stroke an emergency?
Yes
How do you treat heat stroke?
- Immediately remove from hot environment
- Begin cooling the patient immediately
- Remove clothing
- Apply ice packs to the back of neck, arm pits, groin (this should be done prior to transport)
- Oral and IV a hydration (consider if glucose is required as well)
What are compensatory mechanisms of hypothermia?
- Vasoconstriction
- Shivering
- Maximal metabolic rate
- Increased HR
- Increased RR
- Increased BP
