Final (Trauma) Flashcards
“pressure” of electric flow
Voltage
Jacksons Theory) Zone of Stasis / “Ischemia”:
” Sits in mid” Less damaged area adjacent to the Zone of Coagulation (treatable & posible reversible damage)
Jacksons Theory) Zone of Hyperemia:
“Highest” surrounding Area of erythema, damage with more RBC coming to area b/c/& cap/s more permeable (increased blood supply) trying to get phagocytes to inside for healing process
Sig burns have sig swelling from shift of fluid
Jacksons Theory) Zone of Coagulation:
Area of burn nearest to the heat source (most damage & tissue necrosis)Most damaged area
Which type of wound has a small opening into the skin, but may be quite deep, and is often caused by instruments such as nails, ice picks, or pencils?
= Puncture
The skin is known collectively as the:
Skin, considered what of body & what % of total body weight:
Which layer of skin primarily insulates the body against heat loss?
Glands w/in the dermis that secrete a lubricant are called the:
Outermost layer of skin is the:
What part of the integumentary system receives no blood supply?
= Integumentary system
= Organ, 16% of total body weight
= Subcutaneous Layer
= Sebaceous glands
= Epidermis
= Epidermis
“Laying the bike down” results in
the bike absorbing much of the energy
Sodium Bicarbonate is delivered PT’s suspected w/ hyperkalemia at:
Dose of Calcium Chloride for hyperkalemia & line of med?
= 50 mEq as last line
= 500-1000 mg/3mins IV as 1st line med
Which of the following best describes an avulsion?
Which of the following is considered an open wound?
Which soft tissue injury causes a greater amount of hemorrhage?
= Flap of skin partially/completely torn away from underlying tissue
= Laceration
= Avulsion
Injury which opening occurs in skin & organs protrude through is:
Evisceration
Most common location for compartment syndrome to occur?
1st “P” of compartment syndrome?
What ECG changes would indicate hyperkalemia?
= Distal leg, anterior compartment
= Pain
= Peaked T Waves
What is hydrostatic pressure in the vascular system & what creates it?
What is oncotic pressure in the vascular system and what creates it?
=Pressure from heart in blood vessels & forces water to cross the capillary membrane into the interstitial space.
=Pulling water back into the blood vessels by the presence of large proteins in the blood (pulling back in)
What are the three levels of penetrating trauma?
Lvl 1: entrance
Lvl 2: cavation
Lvl 3: exit
What are the 3 different levels of penetrating trauma?
High velocity> sniper
Medium velocity> pistol
Low velocity> knife
What are the 3 dif types of soft-tissue injuries?
Type: Open
Type: Close: Infection
Type: Burn
TXA) 1 Dynamics:
2 when do we admin/ it:
3 Correct dose:
4 Followed by:
1= Blocks fibrinolysis by binding to plasminogen, blocking plasminogen fibrin interactions.
2= Significant hemorrhage, either internal or external (after external hemorrhage has been controlled).
3= 1G/10mins (mix in 50 mL bag of NS)
4= 1G/8Hrs (500 mL bag)
Trauma def:
Trauma’s 2 categories:
= Physical injury or wound caused by external force or forces
= Penetrating & Blunt
tools for external hemorrhage:
Trauma Clamps:
Tourniquets:
Tourniquet use adverse effects:
Hyperkalemia & Sign:
= Hemostatic Agents/Dressings, (combat gauze), trauma clamp, Tourniquets,
= IT clamps “teeth chomper”
= Commercial best at least 1in diameter/width (Willis=turning stick), Improvised (ad hawk), Air inflatable (like BP cuff), Junctional (sam splint=pelvic)
= Due to distal hypo-perfusion, toxins build up>Hyperkalemia:
= tall sharp T waves & treat w/ sodium bicarb bc Acidosis
Thickest skin @:
Thinnest skin @:
= Palms & Soles have thickest skin
= eyelids 1st & genitalia 2nd
Thick, fibrous, inflexible membranes surrounding muscle that help bind muscle groups together are called:
Fascia
Thermal burn phases:
Emergent, Fluid-shift, Hypermetabolic, & Resolution phase
Internal Hemorrhage being forced between tissue layers (fascia):
Internal Hemorrhage:
Pregnant internal hemorrhage worry:
Internal blood loss may be self limiting:
= Hematoma (pocket of blood) usally from arterie)
= Blood accumulation in interstitial spaces, forming visible contusions
= multiple uterine arteries in umbilical cord
= Large body cavities (chest, ABDMN, pelvis) have little resistance & internal blood loss may be severe.
The stage of the burn process characterized by catecholamine and pain-mediated reaction is called the:
Emergent Phase
The most common & serious trauma associated w/ explosions is:
The most lethal explosions are those:
= Pulmonary injury
= That cause structural collapse
The health care surveillance process, put in place for trauma systems, is called
the Registry.
Frontal impact MVC rarity:
Pathways of travel w/ MVC frontal impact are:
Rear-impact MVC injuries:
= most common type of impact in MVCs
= Down & under or Up & Over
= commonly limited/benign especially w/ Headrest position properly
Form/ “mass multiplied by velocity squared, divided by two” equals:
Study of processes that bring forces to bear upon human body is:
When sig/ kinetic energy is applied to human anatomy, its called:
Branch of physics w/ objects in motion & E. exchanges w/ collision:
= Kinetic energy
= Kinetics of impact
= Trauma
= Kinetics
The following burn patterns is usually seen with child abuse:
“Stocking burns” to lower legs, Circumferential burns on buttocks, Multiple circular burns of the same size to the arms and legs
The blood volume of an infant or young child is proportionally:
Population most at risk for trauma & trauma death:
= ~20%> than that of an adult
= Young adult male
Area nearest the heat source that suffers the most damage is called the zone of:
Coagulation
Tendons:
Ligaments:
Fasciae:
Tension lines/Langer lines:
= connects muscle to bone, strong, full of collagen “tend to bone”
= connects bone to bone aligning joints & easily tear
= band sheet of CT stabilizes, encloses, & separates M. compartments
= “way skin is grooved together”, cut against line hard to close & leaves bigger opening, effects healing process
Surveillance:
= collection of data Epidemiology=study of disease based on med survey
Subdural venous nature hematoma shows symptoms:
Epidural bleed arterial nature hematoma shows symptoms:
= 2-3 or 3-6hrs for symptoms
= immediately
Subcutaneous:
= adipose tissue, most thermal temp/ reg/, (regs cold>heat)
Stroke volume:
Cardiac Output (CO):
CO form/:
3 factors that affect cardiac output:
Dynamic CO:
= blood amount ejected in 1 contraction> varies 60-100mL 70average
= Amount of blood moved in 1min
= HR X SV -> 5-6 L of blood moved in 1 min
= preload, afterload, contractility
= “1 up & other down”
Stroke volume is predicated by:
Amount of blood ejected by heart in one cardiac contraction:
Pressure w/in ventricles at the end of diastole:
Blood vol/ moved by heart in 1 min:
Measurement of peripheral vascular resistance is the:
Resistance a heart contraction must overcome in order to eject blood:
= Preload, afterload, and cardiac contractility
= Stroke Volume
= Preload
= Cardiac output
= Mean arterial pressure
= Afterload
Stridor w/ inhalation burns:
Bad Airway burns might might need:
= AKA “crowing” larynx last defense against heat then swells 2/3s so intubate asap bc only worsens (Press chest & follow bubbles)
= Might need to nasal endotracheal intubation w/ BAAM & Endotrol tube (ET w/ trigger) BAAM> High=inhale &Low=exhale
Stretch blunt trauma:
Sciwora:
= Tendons & Fibers that (tendons stronger) hold organs & other structures together are pulled & injured or torn
= spinal cord injury with out r a (kids in wreck overstretching neck)
Gangrene:
Wet Gangrene:
Dry Gangrene:
= Clostridum perfringen>(diabetes>risk) <peripheral> infection lacks blood supply/flow> less WBC
= bacteria to tissue & swells then fluids outside of tissue
= blood supply cut off and dry</peripheral>
Standards established by your system’s medical direction to assist you in determining which PTs require urgent transportation to a trauma center:
Trauma Triage Criteria
Specialty Centers:
= Neuro, Burn, Pedi trauma, Hand & limb replant microsurgery, Hyperbaric oxygen
Special pop of burns:
PT’s cope less b/c:
= GERI, Pedi, & PTs ill/injured have >dif coping w/ burn injuries
= Fluid retention, <fluid reserves, <able to combat infection, More apt to have underlying diseases
Site for pneumo decompression:
needs:
Never go under a rib b/c:
Locating decompression site:
Digital thoracostomy:
= Anterior 2nd ICS midclavicular/3rd rib & b/c air is always up/rising
= At least 3in catheter, attach 1way valve: Could use 3way valve, glove,
= vascular; have major thoracic arteries & nerves
= palp/ then slide over 3rd rib
= 1-2in incision between 4th & 5th ICS, ( “cut finger tube” )
(Rad) S/S of Exposure:
First sign:
Lethal Dose Exposure:
Organ shutdown:
= SLUDGEM PSNS S/S
= slight nausea & fatigue
= Emesis & malaise, Epistaxis, mouth, gums, & rectum (Vomiting usually lethal exposure
= Death
Shock) Hypovolemic:
Types:
= fluid loss
Hemorrhagic: blood loss & Non-hemorrhagic: V/D, Sweating
Shock) 1 Distributive:
2 Hives:
3 “warm shock/high space”:
4 Sick shock:
5 syncope:
1= uncontrolled vaso-dialation
2= Anaphylactic: release of histamine from Ige & b/c allergen
3= Neurogenic: warm b/c reverse shunting makes warm transient block of SNS
4= Wide spread of infection
5= Physcogenic: Sudden vasodilation physiological means EX hemophobic, arachnophobic
Shock) 1 Obstructive & types:
2 pneumothorax:
3 Pericardium:
3 traveled Embolism to lungs:
1= something obstructing heart} PE, Tension/Pneumo, Pericard/tamp
2= Tension/pneum: plueras so full pushing on hearts atrium
3= Pericardial tamponade: pericardium filled with blood
4= PE: emboli so big obstructs pulmonic vein
Shock) 1 Respiratory/Metabolic:
1= Disruption of O2 transfer into cells/cells unable to utilize O2 from Cyanide, CO poisoning, A change in the blood pH
Shock) Normal S/S of shock:
Compensate shock:
Decompensated shock:
Irreversible shock:
= Tachypnea&cardia, AMS, lower BP
= body is compensating “fighting” to maintain homeostasis
= can no longer maintain homeostasis
= can’t come back to life
Shock) How does hemophilia affect the body and the clotting of blood?
Does not have ability to properly clot due from ½ factors
Shock) S/S of neurogenic shock:
Cushing’s Triad:
= warm/flush, bradyC, HyperBP, AMS, Blown and/or unequal pupils
= HyperBP, BradyC, cheyenne stokes or Biots ventalations
Shear blunt trauma:
Axons shearing:
= injury occurs along edges of impacting force or at organ attachments (sudden acceleration) (liver ligament teres cuts liver) (arteriosus ligament shears middle of aorta (ductus oreriosis)
= concussion diffuse axonal injury DAI (changed pep b/c DAI)
Seat belts:
Maternal relation w/ seat belts:
Cullen’s sign:
Most common organ injuries:
SRS:
= vehicle restraints, reduced # of collision related deaths
= US #1 maternal death, hips/pelvis not ABDMN
= internal bleed abdominally
= Spleen adults Liver kids
= supplemental Restraint Systems (SRS) 1st used for front impacts, airbag inflation to cushion energy
Rule of palm:
use of PT hand = 1% of BSA (burns <10%)
Roll Over Car Impact:
(ROCI) injuries:
= car is flipping (high critical “drying machine”)
= Multiple impacts from hitting each part of car w/ each 1/4 rotation
Risk analysis:
= Examines & determines factors that impact dev
1 Resp/ arrest from electrical burn is a result of:
2 The “pressure” of the electric flow is known as:
3 PTs in cardiac arrest b/c electrical current have high survival rate if:
4 human body relation w/ current:
5 Electrical injuries’ usually damage:
1= immobilization of M.s from prolong exposure to electrical current
2= Voltage
3= Prehospital intervention is prompt
4= Body offers resistance to the flow of electricity
5= does lots of damage to muscle tissue & other tissues
Removing moto helmets:
Paramedic remove that helmet!!! For A&B,
Remove if Helmet isn’t snug &/or bad integrity
Contra: impaled through helmet & skull
Rear Car impact:
(RCI) common injuries:
= read-end, commonly most benign
= Whip lash, common C-Spine injuries
QA QI should NEVER be
punitive
Punctures:
Impaled:
= small entrance (ABDMN punctures can >evisceration)
= embedded objects
Pulse pressure:
Pulse pressure signifies:
Pulse pressure <25 mmHg may be seen w/
= dif/ between DBP & SBP pressures (PP= SBP-DBP)
= amount of force the heart generates with each contraction
= PTs w/ sings of shock
Public health care model:
= Surveillance, Risk identification, intervention dev, implement, Eval/
Lightning shock pathway to heart can & b/c:
= PSNS & SNS attach heart “defib w/o defibrillator” put in dysrhythmia or arrest
1 (PTs in severe pain w/ narcotic analgesia) morphine:
2 Fentanyl
3 Ketamine use:
1 = 2-5 mg IV increments every 5mins til’ pain is relieved. Use w/ caution b/c it can depress resp/ drive & increase any existing hypovol/
2= start w/ loading dose 25-50mcg IV & repeat doses as needed
3= may be an alternative to fentanyl in selected patients.
Preload:
Afterload:
Mean Arterial Pressure (MAP):
= pressure/vol/ w/in ventricles @ end of diastole “End-diastole vol/“
= resistance against which the heart must pump against (increase afterload= increase ventricular workload)
= average pressure in arteries during a single cardiac cycle = pressure that drives blood to tissues (ensuring organ perfusion)
Platelet Phase of hemostasis:
2nd phase, Platelets aggregate, or collect and adhere. Slows hemorrhage from capillaries and small vessels- splint fractures to decrease of clots being broken down & bleeding again
Penetrating:
(under penetrating) Perforating:
= object enters body & exchanges energy directly w/ human tissue causing damage or injury (goes in w/o exit)
= goes in & exits of body
Penetrating trauma:
Perforating trauma:
(3lvls of Penetrating trauma) 1st Lvl:
2nd Lvl:
3rd Lvl:
Ballistics:
Factors of bullet speed/damage:
Trajectory:
Cavitation:
Profile:
= object pierces the skin and enters the body
= object pierces through & through body
= Low velocity: knifes, swords, ect
= Medium: handguns
= High-velocity: Rifles
= study of projectiles in motion & effects on objects
= Trajectory, Drag, Cavitation, Velocity, Profile, Shape:
= curved path bullet follows after fired from a gun
= Outward motion of cavity due to projectiles speed & vacuums
= cross-section of bullet along its direction of travel
Penetrating injuries & subtypes:
= puncture: small entrance, Impalement: remove impedes CPR or Airway, Perfurating: through & through
Oxy Dissociation Curve:
Bohr Effect:
Haldane Effect:
= H-globin “Train” taking & dropping oxy
= Acidotic with R-shift of hemoglobin w/ decrease oxy affinity
= Alkalotic w/ L-shift Loves oxy in Lungs
Rad/ only sig/ hazard if inhaled/ingests contaminated material is:
Neutron radiation is:
= Alpha
= uncommon outside of nuclear power reactors & Bombs
1 One of the chief functions of the skin is:
2 The skin is comprised of 3 layers:
3 Layer that serves as stratum of insulation vs trauma & heat loss is:
4 Layer that contains blood vessels, glands, & nerve endings is:
5 Full-thickness burns can involve injury to:
6 The integumentary system relation to NS:
1= Temp regulation
2= Epidermis, Dermis, & Subcutaneous Tissue
3= Subcutaneous Tissue
4= Dermis
5= blood vessels, nerves, M. T., bone, & sometimes internal organs.
6= is not part of the nervous system
Tension pneumo & pulmonary emboli is which type of shock?
Pericardial tamponade presents w/:
= Obstructive
= Becks triad JVD, tachycardia, hypotension, & Muffled heart tones
Ohm’s law:
relationship between current (I), resistance (R), voltage (V)
Oblique Car Impact:
= occurs when lateral impact is off center aka “spin/rotating”
(Newtons laws) inertia) 2nd law:
force formula is summarized as:
= force is related to object’s mass (weight) & rate of its change in velocity (speed)
= Force=Mass (weight)×Acceleration (or deceleration)2
Newton’ s 1st law:
Newtons 2nd Law:
= (inertia): body in motion will stay in motion unless acted upon an outside force “Body at rest will remain at rest unless acted upon upside force”
= “law forces at work stay in work during collision”
Motorcycles often serious trauma b/c:
Frontal Moto/ pathway & Injuries:
Angular Moto/ pathway & Injuries:
Sliding Moto/ pathway & Injuries:
Ejection Moto/ pathway & Injuries:
= rider tends to absorb much of crash injuries (lots of heads injuries
= most common front dips propelling rider & handlebars catch lower
= “side swipe or lateral” impact w/ guard rails Mostly ortho-injuries
= < chances of ejections) more rashes & “most safe”
= very common, usually more serious injuries Initial Biker then Ground
MVC) Types of impacts:
Most common impact:
Most deadly impact:
commonly most benign impact:
= Frontal, Lateral, Oblique, Roll over, Rear
= Frontal
= Lateral (b/c less crumble zone & Seat belts offer lil protection)
= Rear
Morphine & fent drop BP by:
= body releasing Histamines
MOI:
Energy:
Inertia:
= mech of injury how the injury happened
= Ability to do work
= law of Inertia (Newton’s 1st law) helps explain how objects in motion behave
Moderate criteria) Superficial:
Partial thickness burns:
Full thickness burns:
= BSA >50%
= BSA <30%
= BSA <10%
(Moderate criteria) Superficial:
Partial thickness burns:
Full thickness burns:
= BSA >50%
= BSA <30%
= BSA <10%
mechanism of injury (MOI):
the circumstances and events by which an injury occurs.
Lightning can still strike you if proximity up to:
up to 50yrds can strike you
Light Burns:
Inhalation Burns:
Toxic inhalation:
Cyanide & carbon monoxide are released via:
= Intense light from arc welder, industrial laser (Ultraviolet keratitis)
= Inhaled gases, heated air, flames, steam; airway & resp/ injury
= Synthetic resins & plastics release toxic gases as they burn
= fake wood & such burning thus Toxic inhalation
Life threatening injuries %:
Most-life threatning trauma occurs to:
Vol per lung & body:
lethal blood loss:
= <10% traumas
= head and/or chest
= 3L per lung & 5L per body
= >40% or ~2L
Layers of skin:
Epidermis, Dermis (papillary & Reticular Lvls), Subcutaneous
Epidermis:
dead skin cells, no vasculature, astratum corneum, cells are pushed out & are replaced, Sebum (waxy oil lubes (hands), top layer of skin
Lateral Car Impact:
more deadly impact b/c:
(LCI) body pathway & injurie:
= hit from side aka T-bone(most dealy b/c less crumble zone)
= Seat belts offer lil protection
= Coupe-Countre-Coupe injury > neck/head toward impact & body w/ impact
Lacerations:
= “jagged” Cuts deep into dermis ( Incisions, Punctures, perfuration)
Lacerations & subtype:
= cut into dermis} Incisions: smooth Lac from sharp (scalpal, glass, ect) open against tension line, close w/ tension lines
1 kinetics of penetrating trauma) Ballistics:
2 Trajectory:
3 Drag:
4 Cavitation:
5 Velocity:
6 Profile:
7 Shape:
1= Study of projectiles in motion & effects on objects
2= Curved path bullet follows after fired from a gun
3= Drag from wind
4= Outward/ cavitation motion of cavity due to projectiles
5= Speed of object in motion
6= Cross-section of bullet along its direction of travel
7= Shape of bullet
1 kinetics of penetrating trauma) Study of projectiles in motion & effects on objects
2 Curved path bullet follows after fired from a gun
3 Drag from wind
4 Outward “ballooning” motion of cavity due to projectiles
5 Speed of object in motion
6 Cross-section of bullet along its direction of travel
7 shape of object
1= Ballistics:
2= Trajectory:
3= Drag:
4= Cavitation:
5= Velocity:
6= Profile:
7= Shape:
Kinetic energy:
kinetic energy formula:
Increasing mass vs. velocity directly increases what:
= energy of an object in motion (Fn. of object’s mass & its velocity)
= Kinetic energy=Mass(weight)×Velocity(speed)22
= kinetic energy > +velocity exponentially increases kinetic energy
Kinetic energy:
Kinetic Energy form:
=energy of a object in motion (by objects mass & its velocity
= (Mass x Velocity ^2)/ 2 ½ x mv^2
Jacksons Theory of Thermal Burns 3 burn zones:
1st Zone of Coagulation 2nd Zone of Stasis 3rd Zone of Hyperemia
Intervention dev:
= dev/mod of programs to reduce both incidence & seriousness of trauma
1Prehospital Infections:
2Infections cause, duration, severities, treatment:
3Risk factors:
1= sepsis, staph, strep, Lymphangitis, Tetanus, & Gangrene
2= Anaerobic bacterium, ~10% severe, 2-3 days pain tender warm, fight w/ steroids
3= diabetics, infirm, elderly, chronic diseases, steroids, animal/human bites,
Burn worries) Infection:
natural body bacteria can kill & become opertunicle & Most persistent killer of burn victims & Does not appear for several days following acute injury, Pathogens pose hazard to life when they grow to massive numbers
index of suspicion:
Info gathered regarding the scene & MOI for mental summation of suspected injuries based on your event analysis
Incisions:
= smooth Lac from sharp instrument (knife, razor, glass, ect) gapes open if against tension line, keeps close typically if cut w/ tension lines
Implementation:
= putting effective safety measures EX roads,
If you were administering isotonic crystalloid solutions, how much would move out of the intravascular compartment within 1 hour?
2/3s would move out
Burn injury in an enclosed space, always consider the possibility of:
Supraglottic structures are useful w/ burns b/c:
= Inhalation Burns
= B/c very moist mucosa lines the airway Supraglottic airways may absorb heat and prevent lower airway burns
Burn worries) Hypovolemia:
Tissue destruction reduces/eliminates skin’s ability to contain fluid w/in, Inability of damaged blood vessels to retain plasma causes fluid & electrolyte shift into burned tissue & Takes 4-6hrs to dev/
Hyperkalemia) 1st line med:
2) One of two 2nd line meds:
3) One of two 2nd line meds:
4) Hospital only med:
5) Hospital only med to poop:
1= Calcium Chloride IV 0.5-1G/3 mins (Stabilizes doesn’t fix)
2= Albuterol 10-20 mg LVN over 15 mins
3= Sodium Bicarb 50 mEq IV mil equivalent
4= Dextrose (25 grams)w/ Insulin IV (10 units)
5= Kayexalate to poop out hyperK via pull interstitial to GI
Hydroxocobalamin:
Adult Dose:
Pedi Dose:
= Suspected cyanide poisoning
= 5 grams IV/IO over 15 minutes. May repeat a 2nd 5 gram dose for a max of 10 grams
= 70 mg/kg IV/IO (max 5 grams)
Hemostasis:
Hemostasis order:
Factors that effect hemostasis:
= Body’s response to a local hemorrhage w/ 3 phases
= Vascular, Platelet, Coagulation “flow, stick, build”
= Wound type(can pull w/in>cant constrict), M-nt, Temp, Meds( most blood thinners stop/prevent fibrin) Warfrin/Coumadin), IV Fluids
Heat gradient
H → L heat will go
Haldane Effect:
Influences by:
What does it do to the hemoglobin?
= Alk> Hemoglobin Loves oxy in Lungs
= -CO2, -temp, +pH -BPG 2,3, in Lungs,
= +oxy affinity
Golden Period “hour”:
Platinum 10:
= incident to surgery time 1 Hr from Crash to EMS to PT to surgery
= no more than 10 mins on scene
Geiger Counter:
Dosimeter:
= Radiation emission measured w/ Dosimeter
= Cumulative exposure recorded
Frontal car impact:
(FCI) Restrained pathway:
(FCI) Unrestrained pathway:
= most common, Spider windshield, Pneumo b/c paper bag syndrome
= fold over, chest/ABDMN, <injuries
= Up & Over, down & under, ejection (most injuries)
Frank Starling law/mechanism:
Vascular Resistance:
SVR vs. PVR:
SVR (Systemic Vascular Resistance):
PVR (Pulmonary Vascular Resistance):
= more myocardium is stretched the more force/greater the next contraction will be (increase in preload increases contraction)
= Resistance to overcome to push blood through circulatory system
= Body’s circulation resistance & Lung’s circulation resistance
= resistance blood faces in systemic circulation (arteries size)
= resistance blood faces in pulmonic circulation EX CHF, R ventricle
Frank Starling law/mechanism:
= more myocardium is stretched the more force/greater the next contraction will be (increase in preload increases contraction)
Vascular Resistance:
= Resistance to overcome to push blood through circulatory system
SVR vs. PVR:
= Body’s circulation resistance & Lung’s circulation resistance
SVR (Systemic Vascular Resistance):
= resistance blood faces in systemic circulation (arteries size)
PVR (Pulmonary Vascular Resistance):
= resistance blood faces in pulmonic circulation EX CHF, R ventricle
Force:
Force formula:
= force related to a objects mass(weight) and/or achange in velocity
= mass x Acceleration
Thermal burn phases) Fluid-shift phase:
2nd phase; can last up to 24 hours; larger than 15 to 20%(BSA) of total body surface area
vasodilates & capillaries more permeable for phagocytosis
Fluid resuscitation is an important part of treating serious burns. The formula for the amount of IV fluid needed to be infused includes:
4 mL × patient weight (kg) × BSA burned <Parklands></Parklands>
Fluid accounts for ~% of the body’s weight, Only ~% of the fluid is contained in our vascular system
= 60% of the body’s weight, Only about 7% of the fluid is contained in our vascular system
Faster and/or mass relation to energy:
Cavitation’s relation to speed:
Energy exchange Study of:
= more deceleration > more transfer of energy
= Faster object greater cavitation
= “kinetics of energy compact”
Falls:
Examine:
Axial loading:
FOOSH (Fall onto an outstretched hand)
Colles’ fracture:
Smith’s fracture:
>20ft greater risk of
Aortic anyrusem to tear:
= most common blunt trauma, risk increase w/ age, sig fall 2-3x height
= height, position, surface PT landed on, physical condition of PT
= loading on axial skelton via falling (E starts heel to lumber)
= influxing wrist fractures from fall impact
= efflucing wrist fractures from fall impact “Palm out”
= internal organ damage
= pain tearing to chest shoulders back
= tearing pain from chest goes to back
Factors of burn severity:
Duration, Exposure, temp, surface
Factors Affecting Exposure to Radiation:
Duration of exposure, Distance from source, Shielding from source
Parkland Burn Form) EX: 32yo male found with 10% BSA 1st degree burns, 10% BSA 2nd degree burns, and 10% BSA 3rd degree burns. The patient is 110 pounds.
1. 4 mL x BSA x Weight (kg)
2. Total mL / 2 = (Amount to give for:
3. How many mL’s per hr?
4. How many gtts/min using a 10 gtt/mL IV drip set?
5. Know w/ formula:
- 4mL X 20 (2nd + 3rd degree burns) X 50 (kg) = 4000 mL
- 4000 mL / 2 = 2000 mL (Amount to give 1st 8 hours then next 16Hrs)
- 2000 mL / 8 = 250 mL per/hour for 1st 8 hrs
- 42 gtts/min
- Pick closest option choice for gtts & Vol calculated. Use biggest bores& macro drips
Evaluation:
= Repeat surveillance “good on paper but what about practice”
Escharotomy =
= release pressure w/ cutting burn to relief fluid pressure
Eschar:
Can be severe enough to :
= Burn destroys dermal cells; Skin constricts over wound site, increasing pressure of edema beneath & restricting flow of blood
=occlude all blood flow into distal extremity (compartment syndrome)
“energy” or amount of flow in given time
Current; measured in amperes
Thermal burn phases) Emergent phase:
Vtach, cells anaerobic Body’s initial reaction to burn; pain response (afferent nerves damage> Nor/Epi release > tachycardia ; unless on beta blockers
Burn worries) Electrolyte imbalance:
Body’s ability to reg Na,K,& electrolytes is overwhelmed, Careful electrocardiogram (ECG) monitoring and fluid resuscitation help prevent hyperkalemic
Succholyine depolarzing makes hyperK worse
Electricity follows path of
least resistance w/ entry & exit wound: Nerves & blood vessels
Dynamic CO:
=1 up other down, L diastole P = L afterload, PVR pulmonary & oil
Dry dressing for burns:
Wet dressing for burns:
= >10%
= <10%
Direct current (DC):
Alternating current (AC):
= electrons flow in one direction > grab on can’t let go
= reverses flow in short intervals (60 cycles change electrons’’ flow) can let go
5 types of shock and treat them appropriately:
Hypovolemic, Cardiogenic, Distributive, Obstructive, Respiratory/Metabolic
dif types of open soft-tissue injuries:
Abrasions:
= Abrasions, lacerations, avulsions, and penetrating injuries
= scrape across skin skin
Dermis:
2 layers of dermis:
Papillary:
Reticular:
Sebaceous glands:
Sudoriferous Glands:
= Middle layer of skin
= papillary & Reticular layer
= contains the Glands, blood vessels, nerves “nipple, Nerves”
=contains the venules arterioles, capillaries “Reticular network circul/”
= sebum lubricate palms
= SNS n postsynaptic acetylcholine for response
Denature:
take away natural state (from chem burns)
CUPS:
C:
U:
P:
S:
= Categories of PT severity
= Critical: ABCs FUCKed
= Unstable: hypotension, comp to decomp
= Potentially unstable: pelvic fracture, stable can unstable
= Stable: stable ex toenail fracture
Crush syndrome occurs when trapped/crushed for how long:
Crush injury is what type of wound:
PT has lower L-leg trapped underneath a farm tractor for the last 5hrs. PT presents w/ obvious signs on hyperkalemia. What is 1st line IV med for this patient?
= usually for longer than 4 hours
= Closed soft tissue injury
= Sodium Bicarbonate
Crush injuries w/ compartment syndrome occur IRL & per book:
Hyperkalemia sign:
Crush/Hyperkalemia sign:
Crush injury:
= ~ >3hrs & 4Hrs per book
= (T wave>10boxes/mountain hyperkalemia)
= Calcium-Chloride to “fool cell” then Sodium bi-carb 50mEq or 20mg Albuterol 15LPM
= Major compression of tissue causing them to open up, (releases K & acid)
Criteria for critical/moderate burn in adult & Pedi PT:
Burns associated with respiratory injury aka inhalation burn
Chemical / high voltage
Burns with major trauma
Contusions:
Hematoma:
Severe hematomas to major compartments may contribute to:
= bruise made by ecchymosis: black & blue
= artery bleed, tamponades & helps hemostasis
= hypovolemia
Compression blunt trauma:
Hematoma:
Contusion:
Ecchymosis:
= impact abruptly stops body part while inertia continues (hit by bat)
= artery bleed under area
= bruise cap bleed
= discoloration ID contusion
Compartment syndrome:
extrems contain M.s & swelling inside self (usually benign injury but body reacts extreme) (infection)
Compartment syndrome 6 Ps) 1st
2nd
3rd
4th
5th
6th
1= Pain (always 1st) seems exaggerated from story
2= Pallor (lacking blood flow)
3= Paralysis Efferent N-Fibers damaged
4= Paresthesia afferent N-fibers pushed
5= Pressures (BP < & palpable pressure w/ palpation)
6= Pulses (dim/ gone)
Coagulation Phase of hemostasis:
3rd phase Clotting factors activated and released into bloodstream through a very complex cascade of events Triggers series of chemical reactions; formation of strong protein fibers (fibrin)
Class I Hemorrhage) 1 injuries:
2Compensation for blood:
3Blood Loss:
4Pulse:
5Vent rate, BP & Pulse Pressure:
6Cap-Refill:
7Urine Output (mL/hr):
8Mental Status:
1= Broken humorous 750mL
2= Healthy PTs can easily compensate for such blood volume loss
3= Blood Loss: < 15% (<750 mL’s)
4= Pulse: Slightly Tachy
5= all Normal
6= Cap-Refill <2secs
7= 30mL/Hr or more
8= Slightly Anxious
1 Children for the Rules of Nines, the head is awarded:
2 Children for the Rules of Nines, each leg is awarded:
3 Children for the Rules of Nines, each arm is awarded:
4 Children for the Rules of Nines, the anterior trunk is awarded:
5 Children for the Rules of Nines, the posterior trunk is awarded:
1= 18 % of body surface area.
2= 13.5% of body surface area.
3= 9% of body surface area.
4= 18% of body surface area.
5= 18% of body surface area.
Child Burn form:
(age#-1 from the head) / between 2 legs
Chemical burns:
biochemical makeup of cell membranes; destroy cells
Chemical burns effect:
Denature biochemical makeup of cell membranes; destroy cells
Shock) Cardiogenic:
Types & defined:
= Pump prob/ not working
= Intrinsic: problem from w/in heart EX MI
& Extrinsic: pob from outside hurting heart EX TPT
Cardiac Output:
Cardiac Output Formula:
Blood Pressure formula:
= amount of blood pumped by the heart in 1 min (70mL)
= SV x HR
= (SV x HR) x SVR
Caring for chem/ burn, its keen to know if its acid or an alkali b/c:
If carbon monoxide is present should also suspect the presence of:
= Alkalis continue to destroy cell membranes via liquefaction necrosis
= Cyanide
Burn worries:
= Hypothermia, Hypovol/, Electrolyte imbalance /HyperK, Infection
Burn injuries should be assigned a higher priority when they affect:
You should increase the severity of a burn patient by 1Lvl w/:
= Pediatric PTs
= pediatric & elderly patients
Bohr Effect:
Influences by:
What does it do to hemoglobin:
= Acid> Hemoglobin droping oxy off in body
= + CO2, +temp, -pH+ BPG 2,3 in body
= -oxy affinity
Body’s response to a local hemorrhage:
Vascular Phase:
= hemostasis 3 steps: Vascular, Platelet, & Coagulation phase
= Blood vessel is damaged & begins to lose blood , Smooth muscle w/in walls contracts, thus vessel to withdraw into the wound, thicken vascular wall, & reduce lumen.
body’s 1st line comp response:
= Blood loss > decreased arterial pressure, altered blood gases > baro&chemoreceptor reflex >cardiac stim/ systemic vasoconstriction, flow&Vol/ retribution
1Blunt non-penetrating injuries that crush/damage lil blood vessels:
2Contusion is considered what type of injury:
3Minor bleeding associated w/ cap/ wounds often continues b/c:
4A hematoma or collection of blood beneath the skin:
5PT sustained a blow to frontal region of his head & now has a large lump present at the point of impact. This lump referred to as:
1= Contusions
2= Closed soft tissue blunt injury
3= Capillaries cannot contract and thus continue to bleed
4= Is most commonly caused by injury to an artery
5= Hematoma
Blood:
Plasma:
Leukocytes:
Erythrocytes:
= Mixture of water, cells, proteins, & suspended elements.
= makes up 55% of the blood volume
= WBC & platelets make up the “Buffy Coat”
= RBC make up 45%
Blood vessels:
Blood in venous system:
Most of vaso construction by:
= veins low pressure w/ valves, arteries no valves w/ lots tunica media
= ⅔ in venous system,
= Capillaries: most of vaso construction
Pulse pressure:
MAP:
CPP Cerebral Perfusion:
= SBP-DBP
= (PP/3) + DBP
= (MAP-ICP) + 10
Blast phases) Primary:
2ndary:
Tertiary:
Quaternary:
misc event:
Isolated blast injury:
Contra blast injury:
Underwater blasts:
1= Primary: decompression of lungs
2= flying debris hitting you
3= thrown off of feet onto something/ground
4= misc event: tree falls on you or radioactive injury(dirty bomb)
5= injury same side of impact
6= opposite side of impact
7= enhances injury/death w/ pressure wave
Blast injuries:
Conventional bomb:
Dirty bomb:
= Effects pulmonary system significantly
= most common >Pipe bombs, fireworks, ect
= Conventional bomb w/ reactive material
blast injuries) Primary:
Secondary:
Tertiary:
Quaternary:
Primary: blast injuring hallow organs
Secondary: shrapnel injuring
Tertiary: thrown against something
Quaternary: damage from other AFTER BLAST
Biomechanic of trauma:
Occur w/ 2 forms:
= manner in which energy exchange damages human tissue
= blunt or penetrating
Beta radiation can travel and can penetrate
6 to 10 feet through air & a few layers of clothing.
Shock & perfusion definitions:
= Perfusion: Adequate supply of well oxygenated blood & nutrients to all vital organs
= Shock: body’s lack of perfusion
Baroreceptors:
Baroreceptors Fn.:
= receptors that monitor blood pressure
= Great vessels recept/ Gives feedback to brain > Sympathetic NS Activation, AArch & carotid arteries> feedback to medulla >SNS
Avulsions & subtypes:
= separates & creates flap/chunk from skin (“chunk missing)>Degloving, Scalping, Amputations
AUTOPED) 1st impact:
2nd impact:
3rd impact:
Off-road injuries:
Kids Waddell’s triad:
= auto strikes body
= pedestrian thrown
= body strikes ground or object
= pop increased, usually remote areas, offer less protection,
= turn toward bumper b/c stupid, bumper hits kids pelvis & femur, chest & ABDMN hit grill, head strikes ground b/c buckethead
Any eye trauma PT:
Zofran contra=
= vomiting &/ B/c +ocular pressure
= prolonged QT
An injury in which the mechanism of injury tears the skin off the underlying muscle, tissue, blood vessels, and bone is called a(n):
Degloving injury
Amputation treatment:
= direct pressure 2in above site , never submerge in ice, keep cool,
Alpha rad/ strength, traveling distance, & penetration:
very weak energy source & travels only INs in air, cannot penetrate the epidermis & stopped by paper & clothing
Alkalotic vs acidotic burns severity
Alkalotic burns > Acidotic burns
agent’s temperature relation to potential damage.
greater the agent’s temp, the greater its potential to cause damage.
Afferent nerves:
Efferent nerves:
=sensory nerves “ahhh”
=motor “effect”
1 Adults for the Rules of Nines, the head is awarded:
2 Adults for the Rules of Nines, the genitalia is awarded:
3 Adults for the Rules of Nines, the posterior trunk is awarded:
4 Adult for the Rules of Nines, each arm is awarded:
5 Adults for the Rules of Nines, each leg is awarded:
6 Adults for the Rules of Nines, the anterior trunk is awarded:
1= 9 % of body surface area.
2= 1 % of body surface area.
3= 9 % of body surface area.
4= 18 % of body surface area.
5= 18 % of body surface area.
6= 18 % of body surface area.
A rapid trauma assessment should be performed on:
Which of the following is true regarding soft-tissue injuries?
Impaled object may only be removed during what conditions?
= Any patient with a significant MOI
= Most open wounds require only simple care and limited suturing
= CPR is needed and impaled object interferes with chest compressions & The impaled object is causing an obstruction of the patient’s airway
Body maintaining steady, norm/ internal environment:
A condition in which the blood’s ability to clot is impaired:
The body’s response to stop the loss of blood:
Clotting phase when smooth blood vessel M. contracts <lumen size:
1 common factor hindering clotting process is:
aggregation:
= Homeostasis
= Coagulopathy
= Clotting
= Vascular phase
= Medications such as aspirin
= process of coming & sticking together
% of all Trauma deaths:
% of GSW account for HT death:
%s of penetrating neck trauma:
%s of penetrating chest trauma are fatal:
% of great vessels injuries & due to:
minimal diameter for sucking chest wound
= 50% of all Trauma deaths is head trauma
= 35% GSW account for Head Trauma deaths
= 5-10% penetrating neck trauma (airway & neuro
= 70-80% penetrating chest fatal
= 90% all great vessels injuries due to a penetrating MOI
= At least ¾inch for penetrating Chest wounds to turn sucking
1 (Burn depth) 3rd degree:
2 feeling & appearance:
1= full thickness burn down to SCT may involve M. bone & organs
2= leather, looks Charred, dark brown or white, hard to touch “painless”
MVC) Phase 1:
Phase 2:
Phase 3:
Phase 4:
Phase 5:
= Vehicle collision (P1) deceleration
= Body collision (P2) decel/ of occupant
= Organ collision (P3) decel of internal
= 2ndary collision (P4) objects in car
= (P5) car rear end, trees,
3 parts of circulatory system:
maintain homeostasis via:
Pos feedback:
= “pump fluid pipes” heart, blood, & blood vessels
= negative feedback loop
= childbirth & blood clots
2nd line comp response:
Blood loss > RAAS, Catecholamine & Vasopressin released> vasoconstriction, increased Vol, cardiac stim
2 cyanide antidote regimens are available:
Sodium nitrite dose :
Sodium thiosulfate dose:
= Pasadena cyanide kit (amyl nitrite, Na nitrite, & Na thiosulfate) & newer antidote Cyanokit (hydroxocobalamin)
= 300 mg sodium nitrite over 2 to 4 minutes for adults.
= administer 12.5 g of for the adult.
1Hemostasis:
2Inflammation:
3Epithelialization:
4Neovascular:
5 rebuild/ Collagen synthesis:
1= vaso/strict, platelet aggregate, coagulation fibrin (normothermic)
2= Granulocytes, macrophages & Lymphocytes eat, Mast cells released
3= “rebuild” epithelial cells go to wound making scab ~48Hrs after cut
4= new capillaries made (neo new) via previous cap/s +exchanging
5 = fibroblasts go to wound & synthesize collagen creating scar (w/ tension lines quicker/better), Too much synthetization makes Keloid
4 Stages of healing:
= Hemostasis, Inflam/, Epithelialization, Neovasc/, Collagen synthesis (Here I eat naked) “strict, hurt, foundation , remodel”
Stages of healing:
1= Hemostasis, Inflam/, Epithelialization, Neovasc/, Remodeling (Collagen synthesis) “Here I Enter New Remodel”
1st doc to classify trauma as a disease was:
1st EMT orange book
= the “white paper 1966”
1st EMT orange book
1Lymphatic system:
2Lymph node:
3Spleen relation:
4Lymphatic pathway:
5Sign lymphatic system not working:
1= “body’s garbage system” macrophages eats then system of channels to tissues 1 direction, no pump, dumps into a node
2= were garbage collects
3= Carries “trash” of pathogen destruction to nodes for macrophages
4= >Vessels> nodes> spleen> up to L/R subclavian vein, to kidneys
5= Gray poop
1Crush injury:
2Crush syndrome:
3Cellular Lvl:
4 Crush syndrome signs:
5 Crush syndrome Rx:
1= deep injury damage can be massive w/ minimal signs on skin itself
2= body part trapped>4hrs, cells anaerobic>hyperkalemia>TDP torsades de pointes, Aka: traumatic Rhabdomyolysis
3= accumulation of quantities of myoglobin O2, K, lactic acid, toxins, can clog kidneys, can cause severe metabolic acidosis
4= urine is dark red, Shark Peaked T waves
5= 1st Ca-Chloride, 2nd Albuterol, 3rd Sodium Bicarb, Dex w/ Insulin
1 Types of Radiation:
2 Radioactive Particles:
3 Alpha:
4 Beta:
5 Ionizing Rays:
6 Gamma:
7 X-Rays:
8 Atomic:
1= Radioactive Particles & Ionizing Rays
2= Alpha &Beta:
3= least worry & deflected w/ newspaper
4= flys further w/o skin penetration
5= Gamma & X-Rays
6= worst, several ft of concrete & lead
7= penetrates skin
8= nuclear reactor
1 Alkalis are commonly used as:
2 Acids burns:
3 Alkalis burns:
1= oven and drain cleaners, agricultural fertilizers, and in industry
2= form thick, insoluble mass where they contact T. via coagulation necrosis, limiting burn damage
3= continue destroy cell membranes via liquefaction necrosis, allowing them to penetrate underlying tissue & causing deeper burns
(Wallace Rule of 9s) used only for:
Adult %s:
infants (0-1):
Form:
= burns >10%
= 1 genitals, 9 head thoracic & ABDMN, distal anterior (applies to other areas) arm 4 ½
= head 18, arm 9, legs 13.5, 18 front thoracic & ABDMN
= # of child -1 > take away from head then give to each leg (Applicable up 10y/o) For every year beyond age 1, subtract 1 from head / that # & add it evenly between the 2 legs.
(Trauma centers) Lvl 1:
Lvl 2:
Lvl 3:
Lvl 4:
= 1 (18tx) med-uni teaching, best care, everything to Neurovascular
= 2 (23 tx) everything BUT neuro, area trauma, surgical care capable all times, typically not teaching
= 3 general hospital w/ some special staff, TIB-FIB, try avoid w/ severe
= 4 basic ER, can stable but bandage, foot ran over
Thermal burn phases) Hypermetabolic phase:
3rd phase Days or weeks depending on burn severity; increase in body’s demands for nutrients; begins process of repairing damaged tissue (needs Glucose, amino acids, carbohydrates, O2 to support damage)
Thermal burn phases) Resolution phase:
4th phase Scar tissue laid down and remodeled; rehabilitate and return to normal function (weeks to months) new collagen & usually doesnt remodel to original state & makes escar (burn keloid) bc overgrowth
(Soft tissue injuries)
= Risk factors: age (50-70kilos blood) (1yr old ⅓ of gatorade bottle), alcohol/ drug use, Occupation
Sodium Bicarbonate 8.4%) Dynamics:
Indications:
Contra:
Suspected acidosis Dose:
Hyperkalemia Dose:
= Alkalinizing Agent. Increases plasma bicarbonate, buffers excess hydrogen ion concertration, raises blood pH & reverses clinical manifestations of acidosis.
= Suspected hyperkalemia, suspected bicarbonateresponsive acidosis (DKA, OD on TCA’s, Aspirin or Cocaine)
= Patients in cardiac arrest
= 1 mEq/kg, Hyperkalemia:
= 50 mEq IV bolus.
Shock’s 5 categories
Hypovolemic, Cardiogenic, Distributive, Obstructive, resp/metabolic
(Radiation) Duration:
Distance:
Shielding:
= Radiation exposure accumulative danger
= Rad/ strength lessens quickly as distance from source increases
= More material between you & rad/ source, < exposure experienced
1phagocytosis:
2Granulocytes & macrophages w/ healing:
3Lymphocytes w/ healing:
4Mast cells w/ healing:
1= macrophage eats & grows bacteria flag to show what antibodies to make for cellular response
2= eat dead cells parts & bacteria
3= destroys bacteria & other pathogens
4= release histamine to make capillaries more permeable to bring more RBC
Non& Hemorrhagic treatment) If hemorrhage can be controlled:
If hemorrhage cannot be controlled:
Med for Sig/hemorrhage, in/external (after external controlled)
= IV/IO therapy (don’t delay transport) can administer 20 mL/kg bolus.
=administer just enough IV fluid to obtain a radial pulse (permissive hypotension therapy!)NO MORE SBP 80-90 (IV fluids Warm)
= Tranexamic Acid (TXA) Adult 1G/10 mins (mix in 50 mL of NS) follwed w/ 1G/8Hrs (500 mL bag) & Pediatric Not recommended
Newtons laws) inertia) 1st part of 1st law
2nd Part of 1st Law:
The law of energy conservation states:
= “body stays in motion unless acted upon by an outside force.”
= “body remains in rest unless acted upon by an outside force.”
= “Energy can neither be created nor destroyed. It can only be changed from 1 form to another.” EX In an auto crash, the changing of energy from one form to another is what deforms the auto and can cause injury to the occupants
(Critical Criteria) 3rd & 2nd Degree criteria:
Any 2nd or 3rd degree burns involving:
Burn types that’re critical & Rx:
= 3rd>10% & 2nd>30%
= Face, Hands, Genitalia, Circumferential, Feet, (Dipping), Airway
= Chem, high voltage, Burns w/ major trauma go trauma center 1st then burn center
Class IV Hemorrhage) 1 injuries:
2= Compensation to blood:
3= blood loss:
4= Pulse:
5= Blood Pressure:
6= Pulse Pressure:
7= Capillary Refill:
8= Ventilation Rate:
9= Urine Output (mL/hr):
10= Mental Status:
1= GSWs, multiple major fractures, Pelvis
2= Irreversible Shock!
3= > 40% (>2000mLs) of total blood
4= > 140 & barely palpable in central arteries
5= Very low
6= Narrows more
7= > 5 seconds
8= > 40 or agonal
9= Negligible
10= Lethargic or Unconscious
Class III Hemorrhage)1 injuries/fractures:
2 Compensation to blood:
3 Blood Loss:
4 Pulse:
5 Blood Pressure:
6 Pulse Pressure:
7 Capillary Refill:
8 Ventilation Rate:
9 Urine Output (mL/hr):
10 Mental Status:
1= 2 Humorous, 1-2femur, 1 full Hemopneumo
2= Both 1&2nd comp/ responses failing to maintain perfusion & entering/in Decompensated Shock! (SBP <90)
3= Blood Loss: 30 - 40%, (1500 - 2000 mL’s)
4= >120
5= Starts to decrease
6= Narrows more
7= 3-4secs
8= 30-40
9= 5-10mL/hr
10= Anxious/Confused
Class II Hemorrhage) 1 injuries:
2Compensation for blood:
3Blood Loss: 15 - 30%
4Pulse:
5Blood Pressure:
6Pulse Pressure:
7Capillary Refill:
8Ventilation Rate:
9Urine Output (mL/hr):
10Mental Status:
1= 1/2 Humorous fractures, a femur fracture, 1 full Hemopneumo
2= 1st line comp/ no longer maintain perfusion & 2ndary employed
3= 15 - 30% 750mLs-1.5L
4= > 100BPM
5= Normal
6= Starts to narrow
7= 2-3 secs
8= 20-30RR
9= (mL/hr) 20-30
10= Mildly Anxious
Burn worry) late stage Organ failure:
= can go into rhabdo from myglobins; Burn process releases material from damaged or dying body cells into bloodstream, May cause kidney failure, liver failure, arrhythmias, possible cardiac arrest.
Burn worries) Hypothermia:
Burn may disrupt body’s ability to reg/ core temp, If burn is extensive, uncontrolled body heat loss induces rapid, severe hypothermia.
(Burn depth) Degrees:
= 1st/Superficial, 2nd/partial, 3rd/full/complete
Burn depth) 2nd degree:
= Partial, EPi & Dermis burned: intense pain, fluid shift comes up thus blisters, RED to WHITE, moist & mottled w/ shifts
(Burn depth) 1st degree:
= Epidermis only, red skin, pain & tender, NO blister(can lose temp/reg)
(Blood vol/ loss) Pelvis:
Femur:
Humorous:
= 2-3Liters
= 1.5Liters per femur
= 750ml per humorous
60%) Fluid compartments % of water:
45% intracellular
15% extracellular (outside cell)
Interstitial 10.5% Intravascular 4.5%
Haldon Mix
.
Parkland Burn Form for:
form:
= (BSA >20% only 2 & 3 degree burns)
= 4 mL x BSA x Weight (kg) = ½ 1st 8 Hrs & ½ next 16Hrs
What organs are contained in the thoracic cavity?
Heart, lungs, Liver, spleen, gallbladder
Thoracic Skeleton:
# false ribs vs true ribs
1st rib
Angle lewie is hump @:
= Forms thoracic cage 12 pairs ribs
= 7-12 false ribs 1-7 true ribs
= is usually under clavicle
= directly 1-1 connects to manubrium
Sternal Fracture
Sternal Dislocation:
= severe impact thus +Mortality due to underlying blunt cardiac injury, cardiac rupture, pericardial tamponade, pulmonary contusion.
= Severe imact
2 dif/ pleura linings in the chest cavity:
Pleura Fn:
Viscera vs Parietal pleura:
= reduce friction 5-10mL w/ surface tension w/ pleura fluid
= Major reason for negative pressure
Viscera outer lung tissue w/o nerves
Parietal has nerves outer pleura
Flail chest can only ventilate not respirate (Usually when vent a conscious PT)
Paradoxical only w/ flail segments
Flail chest:
reason for inability to perfuse:
Paradoxical breathing:
S/S:
Rx:
= 3 or more adjacent ribs fracture in 2 or more places (can be more) Severe underlying pulmonary injury
= Chest segment becomes free to move with respiratory pressure changes ( No longer able to create negative P)
= Tachypnea, crepitis, paradoxical m-nt
= Assist ventilations if needed, Consider CPAP (monitor), Load-and-go, Monitor for: Pulmonary contusion, Hemothorax, Pneumothorax (bad compliance: = bagging is easy w/o back force/ resistance)
Best Rx Positive pressure
Pneumothorax’s
Simple, Open, Tension, Hemo, TensionHemo
Simple Pneumothorax:
S/S:
= marfan syndrome + chance & w/ bleps
Also known as closed pneumothorax 20% & 50% usually symptomatic
Lung tissue injured, air leaks into pleural space.
= Trauma to chest, Chest pain on inspiration, Dyspnea, Diminished breath sounds on the affected sidetho
Open Pneumothorax:
Sucking chest wound:
S/S:
Treatment:
= Penetrating chest injury Leads to free air passage between atmosphere and pleural space, Air compresses lung tissue
Air Mnt into & out of hole causes a “sucking chest wound”
= Exit wound bigger 4 sided in back 3 anterior& Hole ¾ inch minimal to suck into chest cavity “sucking sound”
= Trauma to chest, Chest pain on inspiration, Dyspnea, Diminished breath sounds on the affected side, Sucking chest wound, Frothy blood sputum at wound site
= GLOVE 1st, Oxygen therapy, 3-Sided Occlusive Dressing, Standard ALS care
Tension Pneumothorax:
S/S:
Treatment:
= Open or simple pneumothorax that makes & maintains pressure > than atmospheric pressure, Pushes pressure against unaffected side, compressing the right atria. Decreases preload
= Severe dyspnea (gauge by words speaking “1-2word tachypneia”), Absent lung sounds on ipsilateral side, Cyanosis, +JVD at 45degree angle, Hypotension, Tachycardia, Subcutaneous emphysema, Hyperresonance on affected side (percussion indirect ICS bounding sound) hyporesonance dull= blood) tracheal deviation
= PT needs an immediate needle decompression or digital thoracostomy, Assist vent/s as needed with a BVM
Hemothorax:
Only decompress:
S/S:
Treatment:
= Accumulation of blood in pleural space from internal hemorrhage, Blood loss problem Associated w/ rib fractures; blunt or penetrating mechanisms, Often accompanies pneumothorax (hemopneumothorax )
blood go down & can dispurse
= BSOLUTE needed or blood is hanging
= Dyspnea, Diminished lungs sounds on ipsilateral side, S/Sx of shock, No JVD!!!!!, Dull “thud” percussive sounds over site of collecting blood
= Treat for shock, permissive Fluid administration, Titrate to peripheral pulse (80-90 mmHg), Monitor for: Tension Hemopneumothorax, Standard ALS care
What is a pneumomediastinum:
S/S:
= Abnormal presence of air in the mediastinum, air escaping & surrounding pericardium, Obstructive shock pushing R-Atrium
= Chest pain, dyspnea, subcutaneous emphysema
What sound could you hear with it? “BLOOP BLOOP BLOOP”
!Electrical alternans:
!Pulsus alternans:
Beck’s Triad:
Pulsus Paradoxus:
= amplitude alternating goes w/ Pulsus alternans
= pulse alternates betweens mirrored side
= JVD muffled or narrowing BP(SBP &DBP coming together),
Kussmaul’s Sign (inhale +inthoracic P. pushes & JVD on inhale,
= drop SBP 10 or more in inhale (Manual BP Heart beat sounds inhale goes away)
Where & how do you perform a chest decompression?
Anterior 2nd ICS best, 5th ICS lateral mid axillary
3 way stop cock, finger of glove, hamleick valve, Needle decompression anterior
How can a pulmonary contusion interfere with gas exchange?
How can a cardiac contusion decrease the amount of blood that is ejected from the ventricles?
Spalding Effect:
= Hurts to breath normal, < inspatory vol, less O2, ect
= Soft tissue contusion or bruise to the lung
= Small, flame-shaped disruption areas throughout membrane leading to microhemorrhage & edema.
Commotio cordis & where in the ECG complex does this affect?
Acute interruption during weakest point of cardiac cycle: Relative refractory period- TP seg
aortic dissection is:
Fixation points:
S/S:
= Tearing or arterial fixation points
= Ligamentum Arteriosum Aorta &
= Pulsus deficit R-hand pink left cold blue, Severe tearing chest pain w/ ripping pain radiating into back, Hypotension, Tachycardia
What occurs with traumatic asphyxia?
S/Sx :
1= Severe compressive force applied to chest * Reverse blood flow from right heart into superior vena cava into venous vessels of upper extremities
2= Petechiae, Subconjunctival hemorrhages, Stagnating blood above compression point, purplish color face, eye exothalomus/protusion or blood rupture anterioer chamber,
Pericardial tamponade:
S/S:
Sign’s & triads associated:
Treatment:
Monitor for:
= Restriction to cardiac filling caused by blood within pericardial sac, Related to penetrating injury 90%(120/5-150mL for major impediment)
= Dyspnea & cyanosis, Hypotension, muffeled heart sounds
= Kussmaul’s Sign, Pulsus & Electrical alternans, Pulsus Paradoxus
= Treat for shock, Permissive Fluid admin Titrate to peripheral pulse (80–90 mmHg), Monitor & treat dysrhythmias,
= Hemothorax, Pneumothorax, Transport ASAP for a pericardiocentesis (sub xiphoid)
Where in the diaphragm is considered the weakest point and what occurs during a traumatic rupture of the diaphragm?
S/S similar to tension pneumothorax:
Diaphragmatic Rupture Rx:
= Perforation and herniation most frequently on left side weakest point BOCHDELCK
= dyspnea, hypoxia, hypotension, J V D, Scaphoid abdomen
= Rapid detection, Place the patient’s torso in an elevated position, Try to decrease the use of a BVM, Early ET intubation! Put incline position
Tracheobronchial Injury:
S/S:
Rx:
= Blunt or penetrating injury treach going into bronchois gap, drop ET right there! (50% die w/in hour or so of injury)
= Respiratory distress w/ cyanosis, hemoptysis, massive subcutaneous emphysema.
= Pneumothorax & possible tension pneumothorax
If trouble be fine w/ R-bronchi
ABDMN cavity 3 spaces:
the peritoneal space, retroperitoneal space, and pelvic space
peritoneal space:
Retroperitoneal space:
pelvic space contains:
= contains the stomach, spleen, gall bladder, liver, pancreas, & intestines
= contains the kidneys, proximal ureters, and adrenal glands & most major vascular structures w/in ABDMN
= urinary bladder, distal ureters, proximal urethra, terminal sigmoid colon, rectum, & anal canal
Females: uterus, Fallopian tubes, ovaries, and upper vagina.
males: prostate
Anatomic landmarks of the ABDMN & pelvic anatomy:
RLQ contains:
LLQ contains:
RUQ contains:
LUQ contains:
= umbilicus, the xiphoid process, the iliac crests, & pubic prominence.
= gallbladder, right kidney, most of the liver, some small bowel, a portion of the ascending & transverse colon, small portion of pancreas.
= stomach, spleen, left kidney, most of pancreas, portions of the liver, small bowel, transverse & descending colon
= Appendix, Portions of urinary bladder, small bowel, ascending colon, rectum, (right ovary).
= sigmoid colon, portions of the urinary bladder, small bowel, descending colon, rectum, (left ovary)
Hollow organs:
Solid organs:
= Stomach, Intestines (small & large), Gallbladder, Bladder.
= Liver, Spleen, Pancreas, Kidneys.
Blunt Trauma 3 most common mechanisms associated w/ blunt trauma: 1
2
3
1 Deceleration: Shear Injuries} AAA, ligament of teres (around liver shearing it)
2 Crushing: Solid organs} vascular & bleed a lott (Liver & Spleen most rich)
3 Compression: Hollow organs
3 dif/ types of abdominal pain:
Visceral (dull), somatic (sharp), &referred
What makes up the upper versus lower GI system and what is the separation between the two?
Lower GI System?
mL required to overcome & cause what is know as acid reflex/GERD
= The Ligament of Treitz @ duodnium Jujinuim junction
= the duodenjejunal junction, to include the rest of the small intestine, all the large intestine, and the rectum/anus.
= 20ml to overcome Lower esophageal Sphincer & bottom stomach pallor shoincter
What is Kehr’s sign?
pain into the left shoulder classic of ruptured spleen
What is the mesentery: The
injury:
= mesentery is a fold of tissue that attaches the intestines to the abdominal wall, providing support & allowing blood vessels, nerves, & lymphatics to supply the intestines. It plays a role in nutrient absorption & stabilizing the position of abdominal organs. mesentery provides circulation, innervation, and attachment for the bowel.
= Blunt injury occurs as the mesentery stretches or is compressed during impact. This injury occurs most frequently at points of relative immobility such as the duodenal/jejunal juncture (where the small bowel is affixed by the ligament of Treitz
Cullen’s Sign:
Grey Turns
= aka Periumbilical bruising: contusion/eechymossis, (found w/ ectopic peg/s & #1 cause preg deaths), anything Center up fucked
= (same finding) pancretitics, , } R/L-Flank bruising from some type of organ
Evisceration & what is the appropriate treatment of it?
Intestines perforate through abdomen wall Rx with wet gloves & dressing
How do you take care of a patient with a suspected pelvic fracture?
Pelvic imbolization, pain management, TXA, permisive fluid,
What muscle separates the thoracic and abdominal cavities:
The diaphragm. It’s a dome-shaped muscle essential for respiration, contracting to expand the thoracic cavity during inhalation & relaxing during exhalation.
What is supine hypotensive syndrome in a pregnant female?
Baby compresses inferior vena cava & descending aorta
Placenta Previa:
placenta dev/ before uterus so cervix dilates & tears placenta after dropping mucus plug (treat interal hemmorage for shock & pad vagina)
Abruptio Placentae:
VERY PAINFUL trauma (can be fall onto but or car crash) placenta rips away from uterine way, bright red hem rips away cervix, concealed no leaking,
The largest organ in the abdominal cavity is the:
Liver
Uterine Inversion: pulling umbilicus prolapse uteris, RX:
slowly work back into w/ glove CUPPED so dont puncture through, More kids more likely
Uterine trauma/ Rupture:
= “baby shoots through” usually seatbelts used wrong, Actual tearing, or rupture, of uterus; occurs w/ onset of labor or blunt abdominal trauma. Most common cause 3rd tri SB
Rare occurrence; extremely high maternal and fetal mortality rate
Can see all of kid, major hemmorage,
The number one killer of pregnant females is:
Trauma
Bright red hemorrhage without pain in a female that is in her third trimester most likely describes:
Placenta Previa
The division of the abdominal cavity containing organs or portions of organs covered by the peritoneum is called the:
Peritoneal space
Which of the following structures separates the upper and lower GI system?
Ligament of Treitz
Detachment of the placenta from the uterine wall during pregnancy is called:
Abruptio placentae
Peritoneum:
parietal peritoneum:
visceral peritoneum:
= membrane that lines ABDMN cavity & covers the ABDMN organs.
This tissue resembles the lung’s pleura & Fns in a similar manner.
= The portion that lines the cavity
= the portion that covers ABDMN organs
most common fracture
Most common cause of orthos injuries
Bones heal/work by:
older women commonly break bones b/c:
= Clavicle most common fracture
MVA most common cause of orthos
Bone living & constantly braking down & building up
= Older become calcified Estrogen, big role on building
Menopause w/ reduction of estrogen can osteoporosis
What make up the axial and appendicular skeleton?
Axial:
Appen:
= “axe in the trunk” trunk of bones so skull spine pevlis
= “Ape arms” extremities
Haversian canals
Volkmann’s canals
= Blood vessels travel lengthwise along bone through small tubes
= Perforating canals that distribute blood to bone tissue & structures located w/in the medullary canal
Osteocytes (bone cells):
Osteoblasts:
Osteoclasts:
= Maintain collagen and calcium, phosphate, carbonate, salt crystals.
= Lay down new bone in areas of stress during growth and bone repair cycle “build Ca+”
= Dissolve bone structures not carrying pressures of articulation and support “Crash Ca+”
What would occur if a patient was to break a long bone through the very end of the bone?
Complications with growing normally
What are the parts of a long bone?
Cancellous bone:
Cortical bone:
= Diaphysis, Epiphysis, Metaphysis, Medullary Canal, Epiphyseal plate, Articular Surface, Periosteum
= “spongy” responsible for making RBC)
= “hard bone” Central portion or shaft of long bone
What are the different bone classifications?
Flat bones:
Short bones:
Sesamoid Bones:
Long bones:
Irregular bones:
= Cranium, sternum, ribs, shoulder, pelvis.
= (wider than long) Wrists, ankles, carpals, tarsals.
= (knee cap) Grows within tendinous tissue (kneecap)
= Humerus, radius, ulna, tibia, fibula, metacarpals, metatarsals,
= (most of the blood cells)
= Vertebral column, facial bones.
What are the different bone classifications?
= Flat, Short bones, Sesamoid, Long, & Irregular bones
Diaphysis:
Epiphysis:
Cancellous bone:
Articular Surface:
Metaphysis:
Periosteum:
Epiphyseal plate:
Medullary Canal:
Medullary canal fn:
Red bone marrow fn:
= Central portion or shaft of long bone
= Widened, articular longbone end. (most common “hip fracture”)
= “Spongy” Tissue within epiphysis; spongy (responsible for making RBC)
= Thin layer of compact bone supporting surface that meets and moves against another bone
= Intermediate region between epiphysis and diaphysis
= Tough fibrous membrane covers exterior of diaphysis
= Growth plate (where the growing originates)
= Chamber in hollow diaphysis and cancellous bone of epiphysis
= filled with yellow bone marrow Stores fat in semiliquid form Marrow fatty makes WBC cartilage, If hypoxic can make YBM to RBM,
= (hematopoietic tissue) fills cancellous bone chambers of long bones, pelvis, & sternum. (Makes RBCs and other blood cells)
Flat bone:
Short bone:
Sesamoid bone:
Long bone:
Irregular bone:
= Cranium, sternum, ribs, shoulder, pelvis.
= –(wider than long) Wrists, ankles, carpals, tarsals.
= (knee cap) Grows within tendinous tissue (kneecap)
= Humerus, radius, ulna, tibia, fibula, metacarpals, metatarsals, phalanges. (most of the blood cells)
= Vertebral column, facial bones.
What are the three basic types of joints?
Synarthrosis:
Fontenells Post 3 months, anterior 9-16 months, helps m-nt & ICP
Amphiarthrosis:
Diarthrosis:
= Also known as a fibrous joint Immovable joints (skull)
(gumphosis for gums) grab a tooth by crown but never ever ever root best is hanks solution & save a tooth
= Fontenells Post 3 months, anterior 9-16 months, helps m-nt & ICP
= Also known as a cartilaginous joint, Joints that allow very limited movement (vertebra, pubic symphsis
= Also known as a synovial joint, Permit free movement
Ligaments
What is the function of synovial fluid and bursae?
Joint capsule (synovial): –
Synovial fluid:
Bursae: *
= (B-B) make synovial capsule
= Ligaments surrounding joint form – Chamber holds fluid to lubricate articular surfaces
= Oily, viscous substance that helps facilitates joint motion by reducing friction.
= Small sacs filled with synovial fluid that help reduce friction and absorb shock (bursitis lil sacks get filled)
Sprain:
Grade I:
Grade II:
Grade III:
= Tearing of joint capsule’s connective tissues (ligament(s)). – Acute pain, inflammation and swelling.
= Minor, small tears. (MRI microtears)
= Larger than a grade I but still an incomplete tear (tear but still attach)
= Complete ligament tear/transection
Subluxation:
=(c1&2 most common)Partial bone end displacement from position within joint capsule
Painful, swells quickly, range of motion limited, joint unstable.
Separates & comes back wrong
Dens c1 rotates around c2 dens
1Closed Fracture:
2Open Fracture:
3 hairline:
4Impacted Fracture:
5Transverse Fracture:
5Comminuted Fracture:
6 oblique
7 ?
8Spiral Fracture:
9Fatigue Fracture:
10Greenstick Fracture:
11Fat Embolism:
12Epiphyseal Fracture:
1= Bone not significantly displaced, Fracture does not penetrate through skin
2= Sharp bone ends exit skin – Increase risk for infection
3= Bone has small crack but doesn’t disrupt total structure
4= Compression MOI, bone impacts on itself; compressed but aligned bone (usually peri incomplete)
5= Complete break in bone; runs straight across at 90-degree angle (no shards 1 of most common)
6= Runs at angle across bone (common femur)
7= Bone splintered into several smaller fragments (more bone
8= Twisting motion; results in curved break around bone shaft. (sports & up periosteum)
9= Prolonged or repeated stress
10= Flexible nature of pediatric bones; type of partial fracture; disrupts only one side of long bone. (lots of E. to break kids femur)
11= Infrequent but serious fracture complication (long bone fractures & end up in lungs) 4 Fs of PE
12= Growth plate disrupted Could cause a reduction or halt in bone growth (ibibrofrien impedes osteoblasts) Fracture repair and remodeling rapid in children
How does a bone repair itself after a fracture?
Osteoclasts & blasts “break down to remodel stronger”
Types of Synovial Joints:
Ball & Socket, Joint Condyloid Joint, Gliding Joint, Hinge Joint, Pivot Joint, Saddle Joint
Ball & Socket joint
Joint Condyloid Joint,
Gliding Joint
Hinge Joint
Pivot Joint,
Saddle Joint
= shoulder
= femur/pelvis
= horzontal m-nt
= door m-nt
= C1atlis C2axis
= metacarpals
3 types of muscles found in your bod:
Skeletal (voluntary), Smooth (involuntary), Cardiac (involuntary)
muscles fn:
Make heat by:
Muscle and bone protect:
= Uses contraction and relaxation to move and manipulate your environment
= where most heat comes from b/c ATP byproduct) product of moving (shivering)
= the structures underneath them
Fascicle:
Origin:
Insertion:
Opposition:
Tendons:
= * Muscle cells layer together to form muscle fiber
= Attachment point that remains stationary as muscle contracts
= Attachment point to moving bone (Muscles are usually paired, one on each side of joint.)
= Limb straightening (extension) Limb bending (flexion)
= Connective tissue that attach of muscle to bone – Extremely strong and do not stretch
Compartment Syndrome:
Rx
6 Ps:
= When injured, soft tissues within the compartment swell. Reduces blood flow to muscles and nerve tissues Deep, burning pain out of proportion to apparent injury. Leg most common location
= make pain tollerable/take edge off
= Pain – Pallor (loss of collor/ pale)– Paralysis (lack m-nt) – Paresthesia (lack of sense) – Pressure (feeling of tension) – Pulses (diminished or absent)
Muscle Cramps:
Really not a direct injury but more of a painful continuous muscle contraction (spasm)
Exercise consumes oxygen and energy sources; circulatory system fails to remove metabolic waste products.
Also caused by electrolyte imbalances ; preg females cramp in legs,
Muscle Spasm:
Affected muscle goes into intermittent (clonic) or continuous (tonic) contraction
May be firm enough to feel like deformity associated with fracture and can confound assessment
Usually subsides uneventfully with rest (benzo, pain control, cortical steroid, fluid replacement)
Luxation/dislocation
= stay out of origin, Complete displacement of bone ends from normal joint position (luxation)
Joint fixes in abnormal position with noticeable deformity
HIGHEST CHANCE on impeachment of nerves, & ALS,
Strain:
Muscle fibers overstretched by forces that exceed fiber’s strength “strain muscle” vs “sprain joint”
Stretch and tear, causing pain.
Fibers damaged without significant internal bleeding, edema, discoloration
Thermolysis)Resp:
Evaporation: sweating & babys white soot
Convection: radiation plus moving air (window defroster) moving heat
Radiation: loosing heat via vasodialation (noncontact)
Conduction: transferring heat gradient via direct physical contact
= exhale heat
= sweating & babys white soot
= radiation plus moving air (window defroster) moving heat
= loosing heat via vasodialation (noncontact)
= transferring heat gradient via direct physical contact
Thermolysis: What are the 5 different ways of thermolysis?
= Respiration, Evaporation, Convection, Radiation, Conduction
Thermogenesis:
Types:
= Heat created by molecules in motion
= work induced, thermoregulatory, Metabolic or diet-induced thermogenesis (eating hog)
What is a thermal gradient?
M-nt of temperature of body away
What in our body is responsible for thermoregulation?
Hypothalamus
Heat cramps:
S/S:
Emergency Rx:
= Painful muscle spasms, seen in fingers, arms, legs and/or abdomen. (Intermittent cramping of skeletal muscles may occur)
Result of excessive sweating: leads to electrolyte imbalances (Na, K, Ca)
= Painful muscle spasms Usually involves the fingers, arms, legsmost common , abdominal muscles. Mentally alert, weakness, dizzy, faint.
Vital signs stable Temperature normal; slightly elevated Skin moist and warm
= Remove patient from hot environment* Administer water or sports drink, If patient unable to take fluids orally, IV of normal saline may be needed. Antiemetic medications (Risk for heat exhaustion/stroke)
Do not administer salt tablets! Hypertonic dehydrates cells (Hypotonic saline best)
heat exhaustion: Acute reaction to heat exposure core temp (over 100°F / 37.8°C)
Signs:
Symptoms:
Treatment:
= Acute reaction to heat exposure core temp (over 100°F / 37.8°C)
= Working in warm/hot environment can result in a 1-2 L loss of water, Loss of water and sodium with vasodilation, Decreased circulating blood volume, venous pooling, reduced cardiac output
= Elevated core temp (over 100°F / 37.8°C), Weak & tired, Tachypnea & weak pulse, Skin: Cool, clammy & diaphoretic, Diarrhea, muscle cramps, very weak.
= Remove PT from environment Remove outer clothing (external cooler) and fan patient Administer water or sports drink IV therapy compensating hypovolemia
heat stroke:
SIGNS:
S/S:
Emergency Treatment:
Avoid
= Life or death, hypothalus can no longer help, decompensating 105˚F (40.6˚C) or high“you gone die”
True environmental emergency, Hypothalamic temperature regulation lost; uncompensated hyperthermia, Cell death, kidney damage
= Temperature of at least 105˚F (40.6˚C) or high“you gone die”, C N S disturbances (headache, anxiety, paresthesia, impaired judgment, psychosis), Cessation of sweating * Hot & dry skin, Very high core temperature
= Deep respirations; shallow, rapid at first, may later slow, Rapid, full pulse, may slow later, Hypotension <90SBP, Confusion, disorientation, or unconsciousness, AMS, Phycosis, Possible seizures, if shivering RSI
= Remove patient from environment, Initiate active cooling, Remove clothing, AC/Fan on high, Soak sheets in tepid water and cover, IV extensions coil & put ice packs on, Refrain from overcooling; watch for shivering, Administer cool O2 if the patient is hypoxic, 1-2 large bore IV’s wide open Monitor ECG (watch for signs of hyperkalemia)
= Avoid vasopressors and anticholinergic (atropine) drugs, Vaso pressing presses heat back in
Classic Heat stroke:
Predisposing factors:
Exertional heat stroke:
Emergency Treatment:
old people getting hot from outside, Patients with chronic illnesses
Increased core temp caused by deficient thermoregulatory functions
= Increase age, Diabetes, Sedentary lifestyle, Medications that inhibit temp regulation
= marathon Result of activity, exercise. Hot environment for long periods * May create metabolic acidosis or hyperkalemia from lactic acid accumulation and injury to muscle cells, Rhabdo
= Remove patient from environment, Initiate active cooling, Remove clothing, AC/Fan on high, Soak sheets in tepid water and cover, IV extensions coil & put ice packs on, Refrain from overcooling; watch for shivering, Administer cool O2 if the patient is hypoxic
Administer IV fluid therapy
= Avoid vasopressors and anticholinergic (atropine) drugs
Vaso pressing presses heat back in
Frostbite:
(ITH) Therapeutic hypothermia for:
= below 95˚F (35˚C) Inadequate thermogenesis, excessive cold stress, combination of both. Important to differentiate induced therapeutic hypothermia (I T H) from accidental hypothermia
= for neuron protection “hibernation”
Mild hypothermia definer:
Moderate Hypothermia definers:
Severe Hypothermia definers:
= Core temp 90–95˚F (32–35˚C) Tachycardia&pnea, Shivering, Fatigue; impaired judgment UNALTERED
= Core temperature 82– 90˚F (28–32˚C) Cold-induced rhythms & arrhythmias, AMS,
= Core temp< 82˚F (28˚C) finna die: Bradycardia most common cold induced & Severe, Coma, Apnea, Ventricular arrhythmias or asystole
Only defib cold induced V-arythmia until core temp 86F
Pyrexia:
Pyrogens:
= virus, Elevation of body temp above normal temp, Pathogens enter and cause infection
= substances that cause fever (viruses, bacteria, substances in body) in response to infection or inflammation.
Increased temperature fights infection by making body less hospitable environment for invading organism
Deep Frostbite:
happens commonly too:
Treatment:
Do nots:
= All layers Epidermal and subcutaneous layers; white appearance, Severe Hypothermia: Core temp< 82˚F (28˚C) finna die: hard (frozen) to palpation, loss of sensation.
= Extremities, head, face.
= Cover thawed part w/ loosely applied dry, sterile dressings.
Separate toes to prevent growing back together, If transport delayed, thaw frozen part by immersion in 102 to 104˚F (39 to 40˚C) water bath
= Wrap tightly, pop bubbles
Febrile seizure:
when pyrogen production stops:
Fever hard to differentiate from heatstroke; neuro symptoms may present w/ either Treat:
= fever seizure with kid & cool down
= Hypothalamic thermostat will reset to normal
= for heatstroke if you are unsure which it is * If child history of febrile seizures, treat for fever.
As temperature falls, so does
Major mechanisms:
which temp condition kills quicker:
= the metabolic rate and cardiac output.
= conduction, convection, radiation, evaporation, respiration.
= Hyperthermia stroke kills quicker than hypo
Mammalian Diving Reflex:
Water in lungs from & cause:
ARDS) Acute Respiratory Distress Syndrome:
Emergency Treatment:
= contact w/ cold water (<70˚F) Bradycardia, Blood shunts to core, , Breathing slows (Jump in cold water then reflex inhale) Larynx shuts down
= wet drowning from warm water (hypertonic in lungs so flash pulmonary edema)
= Fluid invades the alveoli Atelectasis, Immune system responds and increases inflammation to area, Major V/Q mismatch!
Can shock on Ice, wet surface but not puddles
= Remove PT from water ASAP, Primary assessment, if no pulse, begin immediate CPR, IV/IO & ALS airway (ET), Follow ACLS protocols, Protect from heat loss
Boyle’s Law:
The volume of gas is inversely proportional to the pressure of it The more pressure, the less volume.
The less pressure, the more volume.
At sea level 1 atmosphere of pressure on your body
Every 33 feet under water adds another atmosphere
14.7PSI
Down 33ft 1000 vol, 66ft 500
Ascent pops lung
Henry’s Law:
The amount of a dissolved gas in a given amount of fluid is directly proportional to the amount of pressure on top of that gas
Diving down puts more pressure on nitrogen to dissolve & into bloodstream
Usually compresses brain
Descent injurie w/ diving w/ ear infection or dental work
Gay-Lussac’s Law:
As you heat a volume of gas, the pressure is going to go up.
If you cool a volume of gas, the pressure will decrease. – This would affect your oxygen tanks
Charles’s Law:
If the temperature increases:
If the temperature decreases,
(temp vol) At a constant temperature, the volume of a gas is directly proportional to the absolute temperature of the gas.
= the volume increases.
= the volume will decrease.
Acute Mountain Sickness:
S/S:
6 to 24 hours after ascent;
Treatment:
= Unacclimated PT ascends rapidly to 2,000 m (6,600 ft) or greater
= Lightheadedness, Breathlessness, Weakness, H/A, N/V
= more severe symptoms: –Weakness –Severe vomiting – Decreased urine output –Shortness of breath – Altered level of consciousness
= Halting ascent, lowering altitude, acetazolamide and Antinauseants., Immediate descent, definitive treatment In very severe cases, hyperbaric oxygen Necessary
High Altitude Pulmonary Edema (HAPE)
S/S:
Early stages:
Rx
= Increased pulmonary pressure and hypertension caused by changes in blood flow at high altitude:
= Dry cough, shortness of breath on exertion, crackles in lungs. – Dyspnea: quite severe; causes cyanosis –
= completely reversible with descent and oxygen – Supplemental oxygen can completely reverse HAPE; 36 to 72 hours – Portable hyperbaric bag very useful – Acetazolamide used to decrease symptoms
High-Altitude Cerebral Edema (HACE)
Treatment:
If coma develops:
= AMS, Ataxia (poor coordination), Decreased LOC, Coma
= Descent to lower altitude, Oxygen and steroids may help to improve recovery
= may persist for days after descent to sea level; usually resolves
Accidents generally occur at one of the following four stages of a dive:
= On the surface, During descent, On the bottom, During ascent
Dives below ? ft may require staged ascent to prevent decompression sickness,
also called: the bends or dysbarism.
This condition develops in divers subjected:
= Dives below 33 feet may require staged ascent to prevent
= bends or dysbarism
= to rapid reduction of air pressure while ascending to the surface following exposure to compressed air, w/ formation of expanding nitrogen bubbles causing severe pain, especially in ABDMN & joints.
Pressure Disorders:
= Decompression sickness, Pulmonary overpressure, Arterial gas embolism, Pneumomediastinum, Nitrogen narcosis
(AGE)
Injury occurs from:
Usually from divers thatL
Can occur w/ a deep dive, or as little as:
= an air bubble or air embolism that enters the circulatory system from the damaged lung.
= barotrauma that occurs during ascent is injury to the lung from pulmonary overpressure
= holding his breath during ascent. As diver ascends, the air in the lung, which has been compressed, expands. If it is not exhaled, the alveoli may rupture.
= 3 feet below the surface
2 meds will limit or prevent dev/ of medical conditions related to high altitude are:
Acetazolamide (Diamox) & Nifedipine (Procardia, Adalat)
Acetazolamide (Diamox):
Nifedipine (Procardia, Adalat):
= acts as diuretic, forces bicarbonate out body, enhances acclimatization, hypoxic vent/ response reaches new set point
= causes vasodilation preventing increase in pulmonary pressure that often causes pulmonary edema (for hyperBP)
Body gains & loses heat in two ways:
Thermal gradient:
= From w/in body itself & By contact w/ external environment
= Difference in temp between environment (ambient temp) & body (H→ L Hot→cold)
Meds predispose to dehydration worsening hyperthermia:
Meds that interfere with central thermoregulation:
= Diuretics
= Antipsychotics & Antihistamines, & phenothiazines
Exertional Heat Stroke (EHS):
= Results from strenuous physical activity in a hot/humid environment EX: athletes or workers overexerting themselves, leading to an inability to dissipate heat efficiently.
2 ways in which a patient can develop heat stroke?
Exertional Heat Stroke (EHS) & Non-Exertional/Classic Heat Stroke (Pyrexia)
Non-Exertional/Classic Heat Stroke:
Occurs in individuals exposed to prolonged high temps w/o adequate cooling. Common in elderly, PEDIS, or those w/ chronic illnesses, who may have impaired thermoregulation.
PEDI trauma assessment) Primary:
A:
B:
C:
D:
E:
= “Find & Fix”
= Airway with C-spine
= Breathing & Oxygenation & Ventilation
= Circulation (perfusion status, life threatening hemorrhage) cap refill (can do on nose)
= Disability (AVPU - Mental Status)
= Expose, exam, emotional support (adults) Cover after
PEDI/PT Assessment Triangle (PAT):
A
B:
C:
= across the room assessment, Sick or not sick
= Appearance, Mentation, M. tone/body position (Activity, response)
= Breathing Visible m-nt (chest/abdomen) effort (normal /increased)
= Circulation Skin color
Where do most spinal injuries occur at for pediatric patients?
C2 (phrenic nerve)
pediatric spine w/ head/neack trauma)
Positive:
Negative:
= no hard aduld discs
Positive: no intervertebral discs so more room for m-nt
Negative: More prone to invisible disc injuries (SCIWORA)
Functional vs SCIWORA spinal injury?
Functional injury:
SCIWORA:
= visible w/ xray & no visible damage
= Involves physical damage to the vertebrae and spinal cord, visible on imaging.
= Spinal Cord Injury Without Radiographic Abnormality, where the spinal cord is injured w/o bony or ligamentous damage on imaging, more common in children due to immature spine.
How do you properly immobilize a pediatric trauma patient?
Place a folded towel or padding under the shoulders to align the head with the body due to larger occiput.
hypervent/ for Child w/ brainstem herniation
hypervent/ for Infant w/ brainstem herniation
ETCO2 target:
= 30 breathes a min (>1yr)
= 35 breathes a min (1mth to 1yr)
= ETCO2 target should be 35 mmHg
dif/ from a PEDI vs adult airway) PEDI:
Adult:
= Large tongue, Floppy omega epiglottis, cricoid narrowest point
= glottis narrowest point, firm epiglottis
Pedi Uncuffed ETT form:
Pedi Cuffed ETT form:
= (Age in years ÷ 4) + 4.
= (Age in years ÷ 4) + 3.5
Suction form:
How to estimate weight:
= 2 x ETT
= (Age x 3) + 7 = Approximate weight in kg
fluid replacement for PEDI trauma PT form:
Best way to rapidly admin fluids:
hypoglycemic with PEDIs trick:
hypoglycemia Rx for neonate:
hypoglycemia Rx for infant:
= give 20 cc/kg NS/LR even if BP norm, repeat bolus if HR, LOC, CR & other signs of systemic perfusion fail to improve.
= 20mL/kG push pull push pull 3way stop cock
fluid replacement after perfusion rule:
4 2 1rule/ formula :
=back to normovolemia Used for every hr after to maintain
= [A] 4ml/kg 1st 10 [B]2m/Kg 2nd 10kg [C]1ml/kG after per hour Used for every hour after to maintain
hypoglycemic with PEDIs trick:
hypoglycemia Rx for neonate:
hypoglycemia Rx for infant:
= Lots of sick kids hypoglycemic so use bone marrow for BGL
= <45BGL neonate
= <60BGL infant
PEDI Ventilation may be impaired by:
Chest Injuries-most 3 prevalent:
Chest Injuries- least 3 prevalent:
Most likely to impede initial stabilization
= Tension pneumothorax, Open pneumothorax, Hemothorax, Flail chest
= Open/closed pneumo, Tension & hemo/ pneumo/
= hemothorax, Flail chest, Cardiac Tamponade (ra
= Open & tension pneumo
PEDI tension pneumo decompression
2nd ICS above 3rd rib midclavicular to decompress
Might have to decompress again
Major thoracic injuries may be present in the absence of
bruising
What is supine hypotensive syndrome in a pregnant female?
= Drop in SBP of at least 15-30 mmHg
Usually occurs with 20-week or larger uterus
Decreases cardiac output by 30-40%
JumpSTART made for:
At what age do we use JumpSTART vs. START:
= Pedi injuries hit dif physchologically
= 8Yrs 45kG 100lbs
What is the goal of Triage?
time should be spent w/ each PT during initial triage?
= quickly assessing & sorting PT’s from likelihood of survival.
= 30 secs or less
Primary Triage:
Secondary Triage:
= Performed at the scene to quickly categorize PTs. Focuses on life threats and immediate transport decisions
= More detailed evaluation performed after PTs have been moved to a treatment area or during transport.
Be familiar w/ how to triage using the START & JumpSTART system.
triage categories) Red:
Yellow =
Green =
Black =
= Immediate: Life-threatening injuries that require immediate intervention. EX: Severe bleeding, airway compromise, shock.
= Delayed: Serious injuries but not immediately life-threatening. EX: Stable fractures, controlled bleeding.
= Minor: Minor injuries; walking wounded. EX: Bruises, small lacerations.
= Deceased: No pulse or breathing after airway adjustments or rescue breaths (JumpSTART)
JUMPstart Mods) For non-breathing children:
Respirations:
= Check a pulse. If present, give 5 rescue breaths before categorizing as Black
= <15 or >45
START triage Assess RPM
Respirations:
Perfusion:
Mental Status:
= (Respirations, Perfusion, Mental status)
= >30/min = Red. If no breathing after airway opened = Black
= Check cap refill >2 seconds or no radial pulse = Red
= Fails to follow commands = Red.
Triage Age Guidelines: START
JUMPSTART
= “Grown” PTs aged 8y/o & >
= <8 y/o or weighing less <100 lbs
most common killer in 1st tri
Ectopic pregnancy
Treatment of a pregnant female that presents with signs/symptoms of supine hypotension should be placed in the:
Left lateral position at a 15-30° angle or Displace baby (on moms right push baby &mom’s L-side pull baby)
Incident Commander (IC):
“Boss man” Individual who runs entire incident
If someone is hurt on watch you in truck
Full legal authority and associated liabilities of dealing with incident
Ultimate authority for decision making
Span of Control:
Optimal span of control for most operations:
Transferring Control & Info should be:
= # of people or tasks a single individual can monitor
= 5 (more risky task / op is, =more tightly span of control)
=Face to face to transfer
Multiple casualties:
Multiple agencies involved in response to incident
Who should establish command
when to Establish command & implement the IMS?
= First-arriving public safety unit
= 2 or > units respond to emergency
3 main priorities of all emergency services operations?
Life safety, Incident stabilization, Property conservation “People, scene, ground”
Command staff:
General staff “on floor”:
= Public Information Officer, Safety Officer, Liaison Officer
= “on floor”: Ops, planning, logistics, finance/admin
Singular command:
Unified command:
= Smaller scope than an MCI and usually does not involve outside agencies (small house fires
Incident Command Post (ICP):
who should on talk to IC
Representatives and officers from agencies meet and make decisions
In-charges ex Captains, Sheiriffs, ect
Act of sorting patients based on severity of their injuries:
Use ribbons during triage of patients in which phase:
Use triage tags during y triage of patients in whixh pahse:
= Triaging
=Primary Triage:
= Secondary Triage:
START triage made by & @
newport Cali firefighter
Staging) Primary site:
Secondary site:
= Organization of resources in one place
=Located in different area from primary staging area
Unified command:
= Managers from several agencies coordinate activities and share command responsibilities for incident while maintaining control of respective agencies (astroworld, boston marathon)
Logistics:
(tractor for barn fire, porta-pots for long scenes)
EMS Incident Command Structure: Command staff over operations section’s general staff
32-year-old male, breathing 24 times per minute, absent radial pulse, and obeys command.
Red
24-year-old male, breathing 20 times per minute, radial pulse is present, and he obeys simple commands.
Yellow
51-year-old male, breathing 5 times per minute, radial pulse is absent, and he is unconscious.
Red
You are at a scene of an MCI, and you are assigned to triage. You approach an adult male, who is up walking around, breathing 18 times per minute, radial pulse is present, and he obeys simple commands. Using START Triage guidelines, you would classify this patient into what category?
Green
71-year-old female, breathing 36 times per minute, radial pulse is absent, and she doesn’t obey simple commands.
Red
3-year-old male, breathing 40 times per minute, radial pulse is present, and he obeys simple commands.
Yellow
7-year-old female, breathing 50 times per minute, radial pulse is weak, and her eyes open with verbal stimulus.
Red
18-year-old male, apneic, radial pulse is absent, and he unconscious/unresponsive.
Black
11-year-old female, breathing 20 times per minute, radial pulse is present, and she obeys simple commands.
yellwo
6-year-old female, breathing 4 times per minute, radial pulse is absent, and she obeys simple commands.
Red
Major blood vessels are:
Jugular vein joins what & where:
Carotid bodies & sinus are located at & responsible for:
Internal jugular runs in:
= Carotid, Jugular, Aortas (both have 1 on the right and left)
= brachiocephalic veins beneath the clavicles
= the bifurcation & monitoring carbon dioxide and oxygen lvs in the blood and BP
= sheath w/ carotid & vagus nerve; external runs superficially just lateral to the trachea
Treatment for brain herniation) Maintain ETCO2 between what w/ providing what:
Adults ventilations range:
Children ventilations range:
Infants ventilations range:
= 30 & 40 mmHg w/ hyperventilation/ ventalating at the upper end of the range
= 20 per minute
= 30 per min
= 35 per minute
Le Fort 1 fracture
Le Fort 2 fracture
Le Fort 3 fracture
= Below the nose maxillary break
= Breaks the nasal and maxilla
= Breaks the entire facial region zygoma, nasal and maxilla
Neck Zone 1:
Neck Zone 2:
Neck Zone 3:
= Below the cricoid ring HIGHEST MOTILITY RATEW/INJURY GREAT VESSELS AND TRACHEA
= Between cricoid ring and the angle of jaw
Injuries more common
= Above the angle of jaw Cranial nerves and larger vascular structures
Neurogenic shock:
Injury to spinal cord or brain that disrupts brain’s ability to control body (autonomic functions), This is a “pipe” problem, Unable to maintain blood pressure, Severe reduction in cardiac output
Spinal cord MOI:
= Flexion, Hyperextension, Compression Flexion-rotation, Distraction, Penetration
S&S of spinal injury:
= Paralysis of extremities, Pain w/ & w/o m-nt, Tenderness along spine, Impaired breathing, Priapism, Posturing, Loss of bowel or bladder control, Nerve impairment to extremities
Brown-sequard (half of it):
= Caused by penetrating injury (hemitransection), Motor & sensory loss to ipsilateral side, Pain and temperature loss to contralateral side
Anterior cord injury Results from:
S/S:
= bony fragments or pressure compressing arteries that profuse anterior SC, Usually w/ severe extension-flexion injury
= Loss of motor function, sensation to pain, light touch & temperature below the injury site
Central cord (center of spine):
More commonly seen w/:
S/S:
= Consider an incomplete cord injury, Usually w/ hyperextension of cervical spine,
= in pt older than 50 yo/o,
= Usual presents w/ a loss of motor (or weakness) to the upper extremities & loss of bladder control
Cauda equina:
Reversible roots at the lower end of nerve roots are compressed, Usual caused by herniated disc, tumor, or infection, Loss of bowel and bladder control, Saddle anesthesia
Spinal shock:
= Temp insult to SC affecting body below Lvl of injury, Area becomes flaccid & loses feeling, Paralysis below Lvl of injury, Loss of bladder &/ or bowel, Loss of temp/ control below injury site
Abruptio placenta) 3 classes) Partial separation:
Partial separation:
Complete separation:
= concealed hemorrhage
= apparent hemorrhage
= Complete separation heavy hemorrhage
Which gas law) Dissolves gas in given amount of fluid is directly proportional to amount of pressure on top of gas
Henry’s gas law:
Which gas law) Pressure goes up atmosphere goes down and same if (P) goes up then (A) goes down
Boyle’s gas law (Every 33 ft adds another atmosphere
Which gas law) If temp increases, volume increases
If temp decreases the volume decreases
Charles’s gas law:
what is the cut off for using adult vs pediatric colormetric ETCO2 device
= PT’s weight is: 15 kg or below
Which gas law) Pressure of mixture of gases is equal to the sum of partial pressure of individual gases
= Dalton’s gas Laws
Which gas law) Heat a volume of gas, the pressure increases
Cool a volume of gas, the pressure decreases
Gay-Lussac’s gas law
The most accurate core temp will be obtained by the
Rectal measurement.
definite Sign of high altitude pulmonary edema is:
Coughing, producing frothy sputum.
a PT has been snow skiing all day & has developed frostbite to both of his feet. Your treatment should include:
Provide an analgesic before thawing
Collin’s Fracture:
Smith’s Fracture:
= influxing wrist fractures from fall impact
= efflucing wrist fractures from fall impact “Palm out”
