Module 6: Injury Management Flashcards
Jackson’s theory of burns
Zone of coagulation (central)
Zone of stasis (middle)
Zone of hyperemia (outer)
Major burn criteria
Hands, feet, face, major joint, genitals, circumference
Full thickness >10% TBSA
Partial thick >25% (10-50yo) or >20% (<10 or >50yo)
Respiratory injury
Complicated by fx or trauma
High voltage
Chemical burns
Moderate burns criteria
Full thick 2-10% TBSA
Partial thick 15-25% TBSA (10-50yo) or 10-20% (<10 or >50yo)
Superficial >50% TBSA
Low voltage electrical
Major burn characteristics absent
Minor burn criteria
Full thick <2% TBSA
Partial thick <15% (10-50yo) or <10% (<10 or >50yo)
Superficial <50% TBSA
Major burn characteristics absent
Newton’s first law of motion
A body at rest stays at rest until it is acted on by an outside force
A body in motion stays in motion until it is acted on by an outside force.
Newton’s second law of motion
The force an object can exert is the product of its mass x acceleration
Multi-system trauma
Injuries that involve 2 or more body systems.
Blunt trauma
Injuries in which the tissues are not penetrated by an external object
Penetrating trauma
When tissues are penetrated by single or multiple objects
Deceleration injuries
Shearing, avulsing, rupturing of organs and restraining fascia, vasculature, nerves, and other soft tissue.
Flexion or extension of the body.
5 phases of motor vehicle collisions
1) deceleration of vehicle
2) deceleration of the occupant
3) deceleration of internal organs
4) secondary impacts
5) additional impacts.
5 types of impact patterns in MVCs
Frontal or head on
Lateral or side
Rear
Rotational
Rollover
Down-and-under pathway MVC
Occupant slides under the steering column.
Can cause injury to pelvis, hips, femurs, tibia, spine, ribs, cardiac and pulmonary.
Up-and-over pathway MVC
Torso moves upward and forward. Head impacts windshield, roof, mirror, or dash.
Can cause head, C spine, anterior neck trauma, ejection, lower body trauma, pneumothorax.
Revised trauma score
Best score possible is 12
Takes into account GCS, SBP, and RR.
Waddell triad
Vehicle-pedestrian injuries for children and short people.
1) bumper hits pelvis and femurs
2) chest and abdomen hit grille
3) head strikes the vehicle and ground.
Factors for severity of falls
Height
Position or orientation of body
Area which impact is distributed
Surface
Physical condition
Permanent cavity in GSW
Straight or irregular line that the bullet travels along
Pathway expansion in GSW
Tissue displacement that results from shock waves, causing cavitation.
5 causes of blast injury
Primary (due to blast wave itself)
Secondary (propelled fragments)
Tertiary (impact with an object)
Quarternary (burns, crush, toxins)
Quinary (long-term from CBRN additives)
Trauma lethal triad
Hypothermia
Coagulopathy
Acidosis
Approximate amount of blood in the human body
Male: 70ml/kg
Female: 65ml/kg
SAGER traction splint
10% of patients body weight in lbs up to maximum of 15lbs
Hemostatic gauze
Applied when direct pressure and TQ cannot control bleeding, or when bleeding is in an area that a TQ cannot be applied.
Packed inside wound. Provide direct pressure for 2 minutes afterwards
Wound packing
Technique for bleeding in junctional areas.
Apply pressure for 3 minutes if using regular gauze.
Potential blood loss from pelvic fractures
1500-3000ml
Amount of blood loss in femur fracture
1000-1500ml per femur
Wounds requiring closure
Injuries in highly visible areas
Gaping wounds
Wounds over tension lines.
3 types of wound closure
Wound closure should occur within 6-8 hours.
Primary closure
Closure by secondary intent
Tertiary closure.
Primary closure
Wound Margins are brought together as neatly and evenly as possible.
Closure by secondary intent
Dressing high risk wounds and allowing them to heal through normal body process.
Tertiary closure
Wounds with high risk for infection that would have poor cosmetic appearance if closed by secondary intention.
Wounds are irrigated and dressed, then closed 3-4 days later.
Preservation of amputated parts
Rinse free of debris with saline
Wrap in saline moistened sterile gauze
Seal in a bag and keep cool but don’t allow to freeze
Progression of crush syndrome
Body part trapped for more than 4 hours.
Rhabdomyolysis
Trapped part is freed
Potential cardiac arrest, dysthymia, kidney damage, hyperK, hyperphosphatemia
Rule of 9s for burns (adult)
Head: 9
Anterior torso: 18
Posterior torso: 18
Arms: 9 each
Genitalia: 1
Legs: 18 each
Rule of 9s for children
Head: 12
Anterior torso: 18
Posterior torso: 18
Arms: 9 each
Legs: 16.5 each
Genitalia: 1
Rule of 9s for infants
Head: 18
Anterior torso: 18
Posterior torso: 18
Arms: 9 each
Legs: 13.5
Genitalia: 1
Amount of time flushing for chemical burns
Preferable for 30 minutes. 1-2 hours for strong alkalis recommended.
Alternating current vs direct current
Alternating current considered more dangerous due to alternating muscle contractions
Le fort fractures
1: horizontal involving hard palate and inferior maxilla
2: pyramidal involving nasal bone and inferior maxilla
3: all mid facial bones, separating entire mid face from cranium.
Irrigation of eye times
5 minutes
20 minutes if alkali or strong acid
Remove contact lenses or treating patient with chemical burns to the eye.
Types of skull fractures
Linear
Depressed
Basilar
Open
Coup-contrecoup injury
Brain continues to move forward until it impacts the skull, causing compression injury.
Body starts to move backward, brain follows, strikes back of the skull.
Normal ICP
5 to 15mmHg
Critical threshold for cerebral perfusion pressure
60 mmHg
Cushings triad
Hypertension (wide pulse pressure)
Bradycardia
Irregular respirations.
Massive hemothorax blood volume
Accumulation of more than 1500ml of blood in the pleural space.
Each lung can hold up to 3L of fluid.
Fracture classification based on fracture type
Linear (parallel to long axis)
Transverse (right angle)
Oblique (angle)
Spiral (encircling)
Impacted (end wedged into another bone)
Pathologic (erosion or abnormal overgrowth of cortical bone)
Number of fractures on one bone
Comminuted (>2 fragments in one area)
Segmental (>2 fragments int different parts)
Number of cortices injured in bone fracture
Complete (both cortices)
Incomplete (one cortex)
Incomplete includes: greenstick, buckle, plastic deformation, fatigue
Fracture classification based on displacement
Non displaced (bone alignment unchanged)
Displaced
Displaced includes: overriding, distraction, impacted, avulsion, depression
Dislocation
Bone is totally displaced from the joint. Occurs when a body part moves beyond its normal range of motion.
Subluxation
Partial dislocation. Articular surfaces remain partially intact. Part of joint capsule and ligaments may be damaged.
Diastasis
Ligaments are disrupted and the space between them increases.
Sprain
Ligaments are stretched or torn.
Strain
Injury to muscle or tendon resulting from violent muscle contraction or excessive stretching.
Potential blood loss from humerus, Tibia or fibula, ankle, or elbow
250-500ml
Potential blood loss from radius or ulna
150-250ml
Urine output indication for adequate fluid resuscitation
0.5-1ml/kg per hour
