Module 8 - Trauma I Flashcards
One of the earliest signs of brain injury is:
altered mental status or unresponsiveness
A brief period of unresponsiveness or disorientation that is followed by a return of alertness can be a sign of:
brain injury
What region of the brain that normally controls blood pressure and heart rate?
Brainstem
IN vehicle collisions,
when should you have a high index of suspicion?
- Death of another occupant in the vehicle
- An unresponsive patient or a patient with an altered mental status (AMS)
- Intrusion of greater than 12 inches for the occupant site including the roof or greater than 18 inches anywhere to the vehicle.
- Ejection from the motor vehicle
- Vehicle telemetry data consistent with a high risk of injury
Motor vehicle collisions can be classified into what 4 categories ?
frontal, rear-end, lateral, and rotational (rollover)
Describe the principles of care for multisystem trauma patients.
- Ensure safety of EMS personnel and people
- Quickly determine need for additional resources
- Determine MOI and kinematics involved in real or potential injuries
- Conduct primary assessment and identify immediate life threats
- Establish and maintain C spine
- Establish and maintain patent airway
- Provide PPV with Supp. O2 if oxygenation is inadequate
- Maintain normal body temp.
- Splint fractures if needed
- Ensure Spine motion restriction precautions are taken
- Transport critically injured with in 10 minutes of on-scene arrival
- Obtain history from family or local bystanders
- Perform secondary assessment
what is Cavitation and Which organ type is particularly susceptible to cavitation?
- cavitation is the cavity in the body tissues formed by a pressure wave resulting from the kinetic energy of the bullet
- Solid organs
What are the S/S of Internal bleeding?
Pain, tenderness, swelling, or discoloration of the suspected site of injury
Bleeding from the mouth, rectum, vagina, or other orifice
Vomiting bright red blood or blood the color of dark coffee grounds
Dark, tarry stools, or stools with bright red blood
Tender, rigid, or distended abdomen
ALSO:
Anxiety, restlessness, combativeness, or altered mental status
Weakness, faintness, or dizziness
Thirst
Shallow, rapid breathing
Rapid, thready pulse ( in an adult)
Pale, cool, clammy skin
Delayed capillary refill
Narrow pulse pressure (difference between systolic and diastolic pressure)
Dropping blood pressure
Dilated pupils that are sluggish in responding to light
Nausea and vomiting
Explain why bleeding from the nose, ears, or mouth is of special concern:
They can indicate a serious condition such as
- Skull injury
- Facial trauma
- Digital trauma (nose picking), Sinusitis and other upper respiratory tract infections
- Hypertension (high blood pressure)
- Clotting disorders
- Esophageal disease
Define hemorrhagic shock :
- Fluid loss from bleeding that results in shock
- AKA “hemorrhagic hypovolemic shock” or “shock”
Explain special considerations and appropriate care for chest injuries, abdominal injuries
Chest injury:
- Use an “occlusive dressing” to prevent air from entering the chest cavity through the wound
- If there is no suspected spinal injury, the patient can assume a position of comfort
Abdominal injury:
- Do not touch the abdominal organs or try to replace the exposed organs
- Cover the exposed organs
- Flex the patient’s hips and knees, if they are uninjured and if spinal injury is not suspected
Explain the classification of burns by depth and by body surface area involved, for both adult and pediatric patients.
- Superficial (1st degree):
Epidermis (outer layer of skin)
“Redness”
- Partial thickness (2nd degree)
Epidermis
Dermis (nerves, connective tissue, hair follicle)
“Blistering”
- Full thickness (3rd degree)
Dermis, epidermis, fat and muscle
“Stiff, waxy, leathery, grey”
Define the “Rule of 9’s”
How burns are calculated in percentages with adults and pediatrics
Describe special considerations with chemical burns?
Dry lime:
- Dry lime mixes with water. Must brush off before flushing with large amounts of water
Hydrofluoric acid:
- Can cause delayed burn and injury. Requires treatment calcium gluconate
- Flush with large amounts of water
Carbolic acid (phenol):
- burns quickly and absorbs into the skin
- MUST BE flushed isopropyl alcohol followed by large quantities of water
Sulfuric Acid:
- can react with water and cause heat
- use large amounts of water to flush
Describe special considerations with electrical burns?
- Never attempt to remove a patient from an electrical source unless trained and equipped to do so
- Never touch a patient still in contact with the electrical source.
- Once the patient has been removed from the electrical source, establish and maintain a patent airway and adequate breathing.
- Administer supplemental oxygen if indicated
- Monitor the patient for cardiac arrest
- Assess the patient for muscle tenderness
- Always assess for a source (entry) and a ground (exit) burn injury
- Transport the patient as soon as possible
Discuss each of the following mechanisms of burn injuries: thermal, inhalation, chemical, electrical, and radiation.
- Thermal:
Burns that come from such things as flame, hot water, steam - Inhalation:
burns from high temperature steam or air - Chemical:
burns from acids, alkalis, and other heat-generating chemicals - Electrical:
burns that come from electricity - Radiation:
burns that occur from the absorption of radiation into the body
Explain the rationale for splinting musculoskeletal injuries.
- prevents movement of any bone fragments, bone ends, or dislocated joints, reducing the chance for further injury
- usually reduce pain and minimize the following common complications from bone and joint injuries such as :
- damage to nerves, muscles or blood vessel
- converting from closed to open fracture
- excessive bleeding from tissue damage
- increased pain from movement of dislocated bones
- paralysis from damage to spine by loose bones
Define cerebral concussion and its S/S?
Is a type of mild diffuse axonal injury (DAI)
S/S:
- Momentary confusion
- Confusion that lasts for several minutes
- Inability to recall the incident and, sometimes, the period just before it (retrograde amnesia) and after it (anterograde amnesia)
- Repeated questioning about what happened
- Mild to moderate irritability or resistance to treatment
- Combativeness
- Inability to answer questions or obey commands appropriately
- Nausea and vomiting
- Restlessness
subdural hematoma
collection of blood between the dura mater and the arachnoid layer of the brain
S/S:
- Weakness or paralysis to one side of the body
- Deterioration in level of responsiveness
- Vomiting
- Dilation of one pupil
- Abnormal respirations or apnea
- Possible increasing systolic blood pressure
- Decreasing pulse rate
- Headache
- Seizures
- Confusion
- Personality change (chronic subdural hematoma)
epidural hematoma
arterial or venous bleeding pools between the skull and the dura (protective covering of the brain
S/S:
- Decreasing mental status (the common presentation)
- Loss of responsiveness followed by return of responsiveness (lucid interval) and then rapidly deteriorating responsiveness
- Severe headache
- Fixed and dilated pupil
- Seizures
- Vomiting
- Apnea or abnormal breathing pattern
- Systolic hypertension and bradycardia (Cushing reflex)
- Posturing (withdrawal or flexion)
define diffuse axonal injury (DAI) and list 4 types:
- a type of traumatic brain injury that occurs when the brain rapidly shifts inside the skull
- Concussion, contusion, hematoma, and laceration
Describe the pathophysiology and key signs of increased intracranial pressure and brain herniation.
What are the 2 patterns of injury associated with frontal collision and the organs they affect?
- Up and over:
head, neck, chest, and abdomen and possible ejection through the windshield - Down and Under:
knees, femurs, hips, pelvis, and spine
Front Impact: What are the 4 types of dashboard injuries?
- Fractured hip or pelvis
- Dislocated hip or knee
- Facial injuries
- Neck injuries
Front Impact (Lungs): The “paper bag” syndrome results from _______
compression of the chest against the steering column.
Rear Impact: what is the pattern of injury and organs involved?
Initially neck is whipped backwards and then the body is thrown forward injuring the Head and Chest
Lateral Impact: Where do the injuries occur too?
head, shoulder, lateral chest, lateral abdomen, lateral pelvis, and femur
The skull is also thinnest in the___________
temporal region
Frontal impact: what should you look for as a sign that a injury to the head has occurred?
“starburst” windshield cracking
Roll over: What are the common characteristic’s for pattern of injury that occur?
- Multisystem injury
- Ejection
- Crushing injuries
What is spinal cord injury without radiologic abnormality (SCIWORA)?
- During a collision a child head is snapped forward causing the neck to stretch against resistance of shoulder restraints
- causing spinal cord injury without injury to the vertebrae,
What are three main types of impact in motorcycle collisions:
head-on, angular, and ejection
At what height is a fall considered severe for an adult?
20 feet
At what height is a fall considered severe for a child?
10 feet or 2-3 x the height of the child
When it comes to injuries and energy what is true_________.
Energy will travel in a straight line until forced to curve
damage caused by medium- and high-velocity projectiles depends on what two factors:
trajectory and dissipation of energy
Trajectory:
is the path or motion of a projectile during its travel
Dissipation of energy:
is the way energy is transferred to the human body from the force acting on it
Cavitation:
is the cavity in the body tissues formed by a pressure wave resulting from the kinetic energy of the bullet
Fragmentation:
bullet that breaks up into small pieces or releases small pieces upon impact increases the body damage.
What are the 4 phases of injuries that occur from explosions ?
- Primary phase/Primary injury : pressure wave
- Blast wave/secondary injury:
Heat wave that includes projectiles - Patient displacement/Tertiary injury:
PT being thrown causing further injuries - Patient being exposed to hazardous material/ Quinary injury:
PT being exposed to harmful toxins
What is a multisystem trauma patient?
a PT that has multiple injuries or involvement of more than one body system.
Define Golden period:
Period of time after a traumatic injury where trauma care must be initiated for best chance of survival for PT
Define Platinum 10 minutes:
On seen activities (initial patient assessment, emergency stabilization, patient packaging and initiation of transport ) should ideally take less than 10 minutes
Indications for On-Scene Time of 10 minutes or Less and Rapid Transport
Airway occlusion or difficulty in maintaining a patent airway
Inadequate tidal volume
Hypoxia
Respiratory distress, failure, or arrest
Suspected skull fracture
Flail chest
Suspected pneumothorax, hemothorax, or tension pneumothorax
Pelvic fracture
Two or more proximal long-bone fractures
Crushed or mangled extremity
Uncontrolled external hemorrhage
Suspected internal hemorrhage
Signs and symptoms of shock
Significant external blood loss with controlled hemorrhage
GCS score 13 or less
Altered mental status
Seizure activity
Sensory or motor deficit
Any penetrating trauma to the head, neck, anterior or posterior chest, abdomen, and above the elbow or knee
Amputation of an extremity proximal to the finger
Trauma in a patient with significant medical history (for example, myocardial infarction, COPD ), > 55 years of age, hypothermia, burns, or pregnancy
Multisystem trauma
Open or depressed skull fracture
Suspected brain injury
Paralysis
What are the 4 levels of trauma care and what do they do?
- Level I (Regional Trauma Center):
can handle all levels of trauma - Level II (Area Trauma center): can manage most traumas
- Level III (Community Trauma Center):
Some surgical capability. Focuses on stabilizing PT - Level IV: (Trauma facility)
Small remote community hospital focusing on stabilizing Seriously injured PT
Label and describe the 3 types of motorcycle injuries:
- Head on impact: Rider hits something head on. Rider strikes handlebars
- Angular impact:
when rider strikes an object at a angle (can cause avulsion and amputee injuries) - Ejection : when rider clears the handlebars and hits the road or pavement causing “roadrash”
Define Blunt force trauma and penetration trauma:
Blunt trauma a force applied to the body in which there is no penetration
penetration trauma involves the skin being penetrated by object
Explain the 3 types of bleeding and their characteristics:
- Arteries: spurting blood, pulsating flow and bright red
- Veins: steady, slow flow , dark red color
- Capillaries: slow, even flow blood dark or immediately red
what are the steps to control major external bleeding?
- Apply direct pressure with hand
- Apply pressure dressing
- If direct or pressure dressing ineffective , apply tourniquet
- if cannot put tourniquet, pack wound and apply dressing
- If direct pressure cannot stop bleeding, apply hemostatic
agent and - if direct pressure in applicable, go straight to tourniquet
what are the wound packing steps?
- stop the bleeding by apply direct pressure
- pack wound tightly with gauze (preferably hemostatic gauze)
- After packed, apply pressure for 3 minutes
- If bleeding continues, pack more gauze ore repack wound
When is wound packing beneficial or needed?
- when direct pressure is impractical or ineffective such as junctional injury or areas (chest, pelvis)
- When Tourniquet cant be used
How often should vitals be done in a critical or unstable patient?
every 5 minutes
Epistaxis:
Nosebleed
what are the steps to handle epistaxis (nosebleed):
- Have PT pinch nose and LEAN forward (do no lean backwards as blood can get into stomach and irritate it)
- Apply cold pack to nose and cheeks to slow blood flow
- continue to pinch for 10 minutes
- Tell PT to not blow nose.
Hematoma:
is a contained collection of blood
What medications can interfere with blood clotting process?
- Coumadin (warfarin), Eliquis, Xarelto
- other anticoagulant drugs, aspirin, ibuprofen, and other nonsteroidal (NSAIDs)
What are the S/S of shock?
Mental status
Restlessness
Anxiety
Altered mental status
Peripheral perfusion and perfusion of the skin:
Pale, cool, clammy skin
Weak, thready, or absent peripheral pulses
Delayed capillary refill
Vital signs:
- Increased pulse rate
- increased breathing rate
- narrow pulse pressure
- decreased blood pressure (late sign)
Other signs:
- Dilated pupils
- marked thirst
- Nausea and vomiting
- pallor with cyanosis
what is the treatment for hemorrhagic shock ?
- Maintain PPE
- Control any external bleeding
- Establish and maintain open airway
- Establish and maintain adequate breathing, and administer supplemental O2 if needed
- Inadequate rate or volume do PPV
- SpO2 low do supplemental O2
- Place the patient in supine
- Use blanket to keep PT warm
- Transport PT immediately
- Splint suspected bone or joint injuries
Label and describe the 3 types of closed injuries:
- Contusions:
(bruise) injury to the blood vessels with in the dermis - Hematomas:
similar to contusions but larger blood vessel and larger amount of tissue
Characterized by large lump with bluish discoloration
- Crush injuries:
occurs from blunt or crushing force severe enough to do damage to body
Define Ecchymosis:
black and blue discoloration that comes with a bruise due to damaged blood vessels leaking
What special care should be taken with bleeding from nose, ears and mouth?
- With Head injury do not stop bleeding as it can create pressure
- Place loose dressing to catch the drainage and limit exposure
- With nose bleeding, do not have PT lean back as blood can flow backwards
- Have PT lean forward and pinch and apply icepack if available
What are the 6 general types of OPEN soft tissue injuries?
abrasions
lacerations
avulsions
amputations
penetrations/punctures
crush injuries
Explain special considerations and appropriate care for impaled objects, amputations, and large neck injuries:
Impaled objects:
-Manually secure object
- expose wound area
- Control bleeding
- Use bulky dressing to help stabilize the object
Amputations:
- Remove any gross contamination by flushing the part with sterile water or saline
- Wrap the part in a dry sterile gauze dressing
- Wrap or bag the amputated part in plastic.
- Keep the amputated part cool
- Transport the part with the patient, if possible
Large neck injury:
- Place a gloved hand over the wound to control bleeding
- Apply an occlusive dressing
- Cover the occlusive dressing with a regular dressing
- Apply only enough pressure to control the bleeding
- After bleeding is controlled, apply a pressure dressing
- If there is a suspected spinal injury, provide appropriate spine motion restriction
Define occlusive dressing and how to apply it :
- Dressing that form a airtight seal
- should be taped on 3 sides leaving the 4th side open for air to escape at PT exhales
Protects against water loss
Provides temperature regulation
Provides a physical barrier against
Protects underlying structures and organs against mechanical shock
Provides insulation and protects the body from extreme environmental temperatures
Protects against ultraviolet light damage
Provides sensory perception (hot, cold, pain, and touch)
Aids in elimination of some of the body’s wastes
Provides biochemical processes such as the production of Vitamin D
What 2 biggest functions are lost when a PT is severely burned that can cause issues like shock and hypothermia?
Fluid loss and temperature regulation
define Burn shock (BSA):
- condition that occurs with moderate to severe burns that develops after a few hours
- comes from from extensive vascular bed damage that allows both fluid and protein molecules in the plasma to leak into surrounding tissues
What are the five types of burns?
Thermal
Inhalation
Chemical
Electrical
Radiation
What are the treatment steps to burn care?
- Stop the burning
- remove wet clothing
- remove jewelry
- leave blisters intact
- Minimize burn wound contamination
- cover with dry dressing or sheets
- do not apply gels or ointments
- Monitor spo2 you
- Administer supplemental O2
- Evaluate respiratory status
- Evaluate distilled circulation in circumferentially burned extremities
- Considered ALS
- Keep patient warm to prevent systemic heat loss
Functions of the musculoskeletal system:
- to give body shape
- protect internal organs
- provide movement
- store salts and other material for metabolism
- produce red blood cells for oxygen transport
What are the three types of muscles ?
Involuntary (smooth), voluntary (skeletal), cardiac
What are the three types of muscles ?
Involuntary (smooth), voluntary (skeletal), cardiac
Define open fracture and closed fracture:
Open fracture : fracture associates with a open wound
Closed fracture: fracture without no break in the skin
Define strain, sprain and dislocation:
Strain:
Injury to muscle or muscle&tendon possibly caused by overstretching or overextension
Sprain:
Injury to joint capsule with damage to or tearing of connective tissue and possibly ligaments
Dislocation:
Displacement of bone from its normal position in a joint
Which two bones qualify as critical fractures?
Femur and pelvis
What are the S/S of bone and joint injury?
- Deformity or angulation
- Pain and tenderness
- Grating/crepitus
- Swelling
- Disfigurement
- Severe weakness and loss of function
- Bruising
- Exposed bone ends
- Joint locked into position
Compartment syndrome:
painful and dangerous condition caused by pressure buildup from internal bleeding or swelling of tissues.
- can lead to hypoxia, possible nerve muscle and vessel impairment, which can be permanent if cells die
What are the contraindications of traction splint?
- If injury is within 1 to 2 in of ankle or knee
- The knee is injured
- the pelvis is injured
- If there is partial amputation or avulsion with bone separation connected only by marginal tissue
What are the contraindications of traction splint?
- If injury is within 1 to 2 in of ankle or knee
- The knee is injured
- the pelvis is injured
- If there is partial amputation or avulsion with bone separation connected only by marginal tissue
List the different parts with rule of 9’s both in pediatric and adults:
Adults
Head/neck: 9%
posterior trunk: 18%
anterior trunk: 18%
Each extremity (arm): 9%
Genitalia: 1%
Each lower extremity (Leg): 18%
Infant
Head: 18%
Each extremity (arm): 9%
posterior trunk: 18%
Anterior Trunk: 18%
Each lower extremity (leg): 14%
Which fractures are pediatrics most subjectable to and why?
Greenstick fractures b/c bones in pediatrics are growing therefore immature and pliable
what are the contraindications of a traction splint?
- The injury is within 1-2 inches of the knee or ankle.
- The knee itself has been injured.
- The hip has been injured.
- The pelvis has been injured.
- There is partial amputation or avulsion with bone separation, and the distal limb is connected only by marginal tissue
what are the 2 types of subdural hematomas?
Acute:
Signs and symptoms begin almost immediately after the injury.
Occult or chronic:
Bleeding continues over time and the signs and symptoms don’t become apparent for days to weeks after the injury.
What are the 3 anatomical parts of the brain?
Cerebrum : Main part of the brain which contains left & right hemispheres
brain stem: stem that connects brain to spinal cord
cerebellum: “little” brain
what are the 5 types of skull fractures and describe them?
- Linear skull fracture:
line fracture - Depressed skull fracture:
Both ends of fracture are pushed inward - Closed skull fracture:
skull is fracture but no open wound present - Open skull fracture:
fracture present with open wound to the scalp - Basilar skull fracture:
fracture to the floor or bottom of the cranium
what are the signs of a basilar skull fracture?
- leakage of cerebrospinal fluid from the ears, nose, or mouth
- Ecchymosis (bruise-type discoloration) around the eyes and behind the ears
List how the steps on primary and secondary?
Primary:
- If PT is unresponsive or AMS, establish airway
Secondary:
- Head:
palpate for deformities, depressions, lacerations, or impaled objects - eyes:
check for consensual reflex (both eyes react equally)
if one eye moves differently
discoloration
- Ears and nose:
check for clear fluid leaking from ears or nose
check for battle sign
Define battle sign:
purplish discoloration (bruising) of the mastoid area behind the ear
- is a delayed and late sign of a basilar skull fracture.
Define Retrograde amnesia and Anterograde amnesia:
Retrograde amnesia—the patient is unable to remember circumstances leading up to the incident
Anterograde amnesia—the patient is unable to remember circumstances after the incident
When a wound is to an area where a tourniquet cannot be applied, what should be done?
use a hemostatic dressing, direct pressure, and a compression bandage.
When should you use a tourniquet?
When bleeding is not controlled with direct pressure
When should you use a second tourniquet?
When the first tourniquet does not stop the bleeding
If a tourniquet is not available what should be used?
wide bandage 4 inches or greater
When should you use wound Packing?
When a tourniquet or direct pressure cant be used such as wounds to :
- groin or axilla
- other areas of the body (chest, abdomen, pelvis, posterior torso)
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