Module 5 Flashcards
Acceleration
injuries involve a change in speed of an object. As speed or velocity increases so does the tissue damage.
Deceleration
injuries, in contrast, result from the decrease in speed and causes objects or organ strikes with a stationary object.
Compression
injuries result from the application of a squeezing or inward force. This may occur as a result of a fall or crushing force. Subsequently,
solid organs rupture,
vascular organs bleed, and
hollow organs spill their contents into the peritoneal cavity
The paper bag effect
In a traumatic accident, a person will often instinctively take a deep breath or “gasp” and hold his or her breath. This deep breath fills the lungs with air (paper bag) and closes the glottis (neck of the bag).
On impact, the chest is hit (by the steering wheel, ground, or handle bars), which causes the internal pressures of the lungs to increase.
Hole is created in the lung and pleural covering, creating a pneumothorax.
Major organs in chest
Heart
Lungs
Aorta
Rib fracture complications
Pain
Inability to take deep breaths -atelectasis
Pneumothorax
Flail chest
Flail chest
segment of ribs that moves opposite to the rest
doesn’t allow lung expansion
Pneumothorax signs and symptoms
decreased unilateral breath sounds
SOB
Tracheal deviation- trachea will shift towards the opposing side
pneumothorax interventions
chest tube
Pulmonary contusion
bruised lung
Supportive management
O2
Cardiac contusion
Bruise on heart
Heart can’t beat effectively causes decreased cardiac output
Traumatic aortic injury- transection
aorta is attached to the spine in some places but not all so with acceleration or deceleration it can tear
Wide mediastenium on chest X-ray
TO THE OR
penetrating injuries
stab wounds, impalements, and gunshot wounds
are concentrated in a smaller area, involve less energy, and may have fewer secondary injuries associated with them. (exception is gunshot wounds)
Documenting Gun Shot Wounds
distance from the weapon to the victim during the shooting
wounds and their appearances
suspected number of shots
description of gun powder soot and burns, scorching of wound edges, tearing of the skin and location of palpable bullets
blood loss at the scene and amount of fluid the patient has already received
patient condition at the scene
Gunshot wounds
As the bullet enters tissue, it creates a sonic wave as well as a cavity. The tissue then recoils leaving a permanent wound track or cavity. As the bullet passes through tissue, it creates both temporary and crush injuries, stretching the tissues in its path.
the closer the range of the gun shot, the more potential damage the person may suffer.
Gunshot and Stab Wound Disclosure Act in BC
it is mandatory to report any confirmed cases or suspicious cases involving gunshots or stabbings to the police
What information must be reported to police?
- The injured person’s name, if known;
- The fact that the person is being treated, or has been treated; and
- The name and location of the health care facility or where an emergency medical assistant treated the individual.
Penetrating chest trauma
Pneumothorax Hemothorax cardiac tamponade pericardial/cardiac wound Tracheal/esophagus trauma
how do we prep for trauma
allocates roles to the team
damage control resuscitation
Management begins with damage control resuscitation to minimize blood loss and maximize tissue perfusion and oxygenation to optimize outcome.
The three pillars of management:
permissive hypotension,
hemostatic resuscitation
damage control surgery
ATMIST
Pt handover form EHS
Age Time of injury Mechanism of injury Injuries sustained Signs and symptoms Treatment given so far
Prep for trauma
Assemble team
assign roles
brief team
Get equipment and drugs ready
Horizontal assessment
Components of the ABCD paradigm and initial investigations (such as chest and pelvic X-Ray, and blood tests) are carried out by several people at the same time, coordinated by the trauma team leader. This allows the team to have the required clinical information quickly
