Module 20: Trauma Flashcards
What are the four injury pattern factors of trauma?
Mass of object
Acceleration
Force Applied
Duration of time Applied
What is the easiest type of skull fracture to feel? What is the most difficult?
depressed is the easiest. Linear is the hardest
What is a comminuted skull fracture?
Spider-web like fracture
What is a basilar skull fracture?
Fracture at the base of skull that may result in leaking of CSF
What are the telltale signs of a basilar skull fracture?
raccoon eyes and battle’s sign (bruising on back of ear)
What is the area where battle’s sign occurs called?
mastoid process
What are the three injuries that typically occur to eyes?
laceration, chemical, and puncture
Why do we not put pressure on eyes?
They contain a lot of fluid that should not be pushed out of the eyes due to risk of blindness
What is the general process for chemical eye injuries?
flush for twenty minutes, starting at the bridge of the nose
What should be done for puncture wounds in the eye?
Cover both eyes and stabilize the object
How can you assess if an ear injury is internal or external?
Ask pt about MOI.
What is unique about observation of CSF on a gauze pad?
CSF moves toward outside of gauze pad, while blood moves toward center. Think of the target logo.
What is the medical term for a nose bleed? How is it treated?
Epistaxis, pinch where cartilage and bone meet on nose and squeeze nostrils together while pt leans forward.
How long can it take blood to clot?
six to seven minutes
Why shouldn’t pts with epistaxis lean back?
blood may pool in stomach and cause emesis
What is the best process for dental avulsions? What sort of pts should not receive this treatment
Rinse tooth with saline then grab it with crown (not the root). Assess the socket and remove and clots with gauze. Then put tooth back in socket and have pt bite down on gauze
any pt who is not A/Ox3, is immunosuppressed or has cardiac issues that require antibiotics
If reimplantation is not ideal, what should be done with an avulsed tooth?
lowfat milk, pt’s saliva, or saline
What is an underlooked but important aspect of jugular veinous injuries? What sort of dressing should be used for these injuries?
air bubbles, which can create an air embolus. Occlusive (non porous) dressings should be used.
What is subcutaneous emphysema? How should it be treated?
trapped air between tissues due to tracheal laceration/larynx fracture
high flow O2
What is often used to stabilize knives and other puncture objects?
gauze taped to either side of the object
What is flail chest? What does their chest rise look like? What is the treatment for flail chest?
three or more ribs broken in two or more places. Unequal chest rise AKA paradoxical motion. Treated with ventilation
How should a puncture would be treated for puncture wounds in chest?
occlusive dressing taped on all four sides.
What is aortic shearing?
Occurs during a collision. the organs shift during impact, and the aorta may shear from the ligaments that keep it in place.
What is the space between the parietal pleura and the visceral pleura called?
pleural space
What is a hemopneumothorax?
When both blood and air are filling the pleural space
What is paper bag syndrome?
When air fills lung during a collision and causes the lung to pop, creating a pneumothorax
When does traumatic asphyxia occur?
Sudden severe compression someone’s chest producing a rapid increase in pressure. Characterized by distended neck veins, cyanosis in the face and neck, and hemorrhage in sclera.
What is commotio cordis?
Injury caused by a sudden, direct blow to chest during a critical portion of the heartbeat
may result in immediate arrest
v-fib responds to defibrillation within first two minutes of the injury
Should you attempt to put intestines back into abdominal cavity during an abdominal evisceration?
No.
What should be done during an abdominal evisceration?
keep pt warm
cover with moist dressing, then a dry dressing, then an occlusive dressing and seal. keep dressings somewhat loose.
How should pelvic injuries be assessed during physical examination? If unstable, what should be done.
push down on either side. If pelvis feels unstable, secure with a bedsheet.
What should hip fractures be treated with? What sort of stretcher should be used with these sorts of pts?
in order to keep feet apart (abducted), do not use bed sheet. Instead tie using towels or blankets to tie legs together. Use scoop stretcher
What is a common visual indicator of a mid-shaft femur fracture? What sort of splint should be used for this condition?
One leg is shorter than the other, and there is tenderness in the area.
traction splint
When can you use a hare traction splint?
isolated, closed, mid-shaft femur fracture
What is splinting by fixation?
preventing broken bone from jostling.
what is a greenstick fracture? comminuted? pathologic?
greenstick: incomplete fracture that passes only partway through the shaft of bone.
comminuted: fracture in which bone is broken into more than two fragments
pathologic: a fracture of weakened or diseased bone
What is an oblique fracture? transverse? spiral? incomplete?
oblique: bone broken at an angle across the bone
spiral: a type of oblique caused by a twisting force
transverse: a fracture that occurs straight across the bone
incomplete: a fracture that does not run completely through the bone
What is the general management for extremity injuries?
- Manual stabilization
- Assessment of distal neurological function and circulation
- Application of splint
- Reassessment of distal neurovascular function
- apply cold pack
- transport (preferably to trauma facilities with orthopedic element)
When is fixation used vs traction splint?
traction is for isolated mid shaft femur fracture. Fixation is everything else
How should long bone fractures be treated?
- if extremity is either absent of distal pulse OR angulated you may attempt to realign to normal anatomical position 1 time
- if extremity possesses distal pulse and is not angulated, splint in place
GO TO TRAUMA CENTER
How should joint fractures be treated
- if extremity is either absent of distal pulse you may attempt to realign to normal anatomical position 1 time
- if extremity possesses distal pulse, splint in place
GO TO TRAUMA CENTER IF REALIGNMENT DOES NOT WORK
What is the difference between a sprain and a strain?
sprain: ligament (bone to bone)
strain: muscle and tendon (muscle to bone)
What the tendons and ligaments that connect to the patella?
quadriceps tendon and patellar ligament
What should be done with patella dislocation?
put patella back into position, if dislocation is obvious. Check protocols in region to see if OLMC should be contacted first
Describe the process of patellar relocation
gradually extend knee, while at same time, a second provider applies pressure on patella towards midline.
when straight, place entire knee joint in a knee immobilizer or splint
What is compartment syndrome characterized by?
pain that is out of proportion to injury
pain on passive stretching of muscles withing compartment
pallor
swelling
decreased sensation and power
Can anything be done in prehospital syndrome for compartment syndrome?
Besides mentioning suspect CS to ER staff, no
What stretchers should for pts laying supine or prone after a collision?
long board or scoop stretcher due to suspected spinal injury
Can spine immobilization be achieved in seated position?
no, must be in supine position. head of stretcher must be elevated <30 degrees
What are the four techniques for controlling bleeding?
- focused direct pressure
- dressing wound (hemostatic dressing if applicable)
- pressure bandages
- Tourniquet (if extremity wound)
If a wound is not amenable to a tourniquet what should be considered?
packing in the axillary and groin
What are the techniques for treating amputations?
- aggressive bleeding control
- wrap amputated area with moist dressing
- place amputated part in bag
- place into second bag with ice or cold packs
What dressings should be used with partial thickness burns that are less than 10% BSA?
treat w moist dressing
What dressings should be used with full thickness burns that are greater than 10% BSA?
treat with dry dressing
Both __ and __ burns should be irrigated for at least twenty minutes. However, before irrigation, ____ should be brushed off.
liquid and powder
powder
A 33-year-old male sustained an abdominal evisceration to the left lower quadrant of
his abdomen after he was cut with a large knife. After appropriately managing his
ABCs and assessing him for other life-threatening injuries, how you should care for his
wound?
cover with moist, sterile gauze and secure with occlusive dressing
A 17-year-old male was shot in the right anterior chest during an altercation with a
gang member. As your partner is applying 100% oxygen, you perform a rapid
secondary assessment and find an open chest wound with a small amount of blood
bubbling from it. You should:
apply an occlusive dressing to the wound and continue your assessment
Functions of dressings and bandages include all of the following, EXCEPT:
control of external hemorrhage
protection from further injury
immobolization of injury
preventionn of contamination
immobolization of injury
Burns are classified according to:
depth and extent
A 39-year-old male accidentally cut his wrist while sharpening his hunting knife. He is
conscious and alert with adequate breathing but is bleeding significantly, spurting bright red blood from the wound. You should
apply a tourniquet proximal to the wound
You and your partner arrive at the scene of a house fire where firefighters have
rescued a 50-year-old male from his burning house. The patient has superficial and
partial-thickness burns to his face and chest. His nasal hairs are singed and he is
coughing up sooty sputum. You should be MOST concerned with:
potential for airway swelling
treating for hypothermia
estimating the extent of his burns
preventing the risk of infection
potential for airway swelling
Most external bleeding can be controlled by:
applying direct pressure to the wound
applying light dressings to the wound
applying a proximal tourniquet
elevating the injury site
applying direct pressure to the wound
