Module 9- Trauma II Flashcards
What are the common mechanisms of spinal injury?
Motorcycle crashes
Motor vehicle crashes
Pedestrian–vehicle collisions
Falls
Blunt trauma
Penetrating trauma to the head, neck, or torso
Sporting injuries
Hangings
Diving or other water-related accidents
Gunshot wounds to the head, neck, chest, abdomen, back, or pelvis
Unresponsive trauma patient
Electrical injuries
when it is appropriate to use a vest-type short immobilization device
When the PT cannot self-extricate himself from the vehicle
Define the vest-type short immobilization steps:
- Use manual in-line spinal stabilization and apply a cervical collar.
- Position the short spinal device behind the patient.
- Secure the device to the patient’s torso
- Pad behind the patient’s head to ensure neutral alignment of the head and neck with the remainder of the spine
- Secure the patient’s head to the device
- Position a long backboard under or next to the patient’s buttocks and rotate him until his back is in line with the backboard
- Follow the guidelines for securing a patient to a long backboard
When should you leave a helmet in place with a spinal injury?
- Helmet fits well with little to no movement
- no impending airway issues exist
- Removal of helmet would cause further injury to the PT
- You can properly immobilize spine with helmet in place
- helmet doesn’t interfere with your ability to assess and reassess airway and breathing
Explain special handling and immobilization considerations for spinal injury for infants and children with extrication from a car seat.
- cannot use car seat for SMR for transport
- make sure cervical collar fits properly
Extrication:
- apply cervical collar
- lay down car seat
- slide child or infant onto board
Describe the concept of complete spinal cord injury and differentiate between the concepts of spinal shock and neurogenic hypotension.
Spinal shock is temporary concussion-like insult to the spinal cord that causes effects below the level of the injury
- Temporary loss of movement and feeling
neurogenic hypotension (Neurogenic shock) follows the spinal shock
- loss of signal nerve impulses to the arteries which causes arteries to relax and dilate leading to hypovolemia
Describe the anatomy and function of the eye.
- Globe : 1 inch in diameter
- Sclera: White of the eye
- Cornea: Clear portion of the eye that covers dark center
- Pupil: Dark center
- Iris: Colored portion
- lens: behind the pupil
- Conjunctiva: paper thin lining that covers the exposed portion of the sclera
Describe the anatomy and function and structure of the face
- Skull consist of 22 bones
- 8 bones form the cranium
- 14 bones form the face
- immovable face joints (13 bones): orbits, zygomatic (cheekbones), nasal bones, Maxillae (fused upper jawbones)
- only moveable joint: mandible (lower Jaw)
Describe the anatomy and function structures of the neck
- Neck contains the major artery “Carotid” and veins “ Jugular
- Contains the major structures of airway: trachea and larynx
Describe treatment for impaled object in the eye:
- DO not attempt to remove object or force eye back in
- Encircle with eye and object with gauze or soft sterile cloth
- placed metal shield or paper foam cup on top of the eye
- Bandage both eyes to minimize movement
Discuss the steps for face injuries:
- Take precaution SMR
- Control severe bleeding
- Establish and maintain airway
- If SpO2, less then the 95% apply oxygen
- If nerves, tendons, or blood vessels have been exposed, cover them with a moist, sterile dressing
- Treat for shock and transport
What are the treatment steps to treating chemical burns in the eye?
- Flush the eye out for 20 minutes with water or saline
- if injury involves alkali, at least an hour
- Contacts lens must be removed
- place patient on side with towels under the head and continue flushing
Describe treatment of avulsed tooth
- Rinse the tooth with saline to gently remove any debris; never scrub the tooth
- Never handle the tooth by the root
- If tooth cannot be found, assumed it was swallowed
- Control bleeding from the tooth socket with a gauze pad
- recommended time for implantation: 20-60 minutes
Discuss management of injury to the nose:
- Treat as other soft tissue injuries
- Never pack the nose as their could be a skull injury and packing could create dangerous pressure
- apply cold compress and transport
Discuss management of injury to the Ear:
- Assess and treat as for other soft tissue injuries
- Save any avulsed parts; wrap avulsed parts in saline-soaked gauze, and transport with the patient
- Never pack the ear as their could be a skull injury and packing could create dangerous pressure
Discuss management of injury to the Neck:
Laceration to jugular vein:
- due to possible air being sucked in and air embolism
- apply occlusive dressing TAPED on all 4 sides
major blood vessels of the neck is severed:
- Follow care for “Soft tissue injury”
When should you remove a impaled object from the cheek ?
If it has penetrated all the way through the cheek and is loose
- may fall into mouth obstructing airway
What are the steps to removing a impaled object in the cheek?
- Pull or push the object out of the cheek in the opposite direction to which it entered the cheek
- Pack dressing material between the patient’s teeth and the wound.
- Dress and bandage the outside of the wound to control bleeding
- Suction the mouth and throat frequently throughout transport
Describe the anatomy of the Chest
- Diaphragm :
borders the chest (thoracic cavity) - Mediastinum:
middle of the thoracic cavity that contains trachea, venae cavae (two great veins that collect upper and lower body and return it to the heart), Aorta (great artery that carries blood from the heart to the body), esophagus, heart
List the S/S of rib injury and why rib injuries are dangerous
S/S:
- Pain on breathing or movement
- Coughing
- Tenderness over fracture
- Deformity of chest wall
- Inability to breath deeply because of pain
- Broken ribs can cause other damage to other organs
Define and Explain the signs and symptoms of open pneumothorax (Sucking Chest wound)
result of an open wound to the chest created by a penetrating object
S/S:
- chest pain that worsens with deep inspiration
- dyspnea (shortness of breath)
- tachypnea (faster than normal rate of breathing)
- decreased or absent breath sounds on the affected side
Explain the pathophysiology and signs and symptoms of hemothorax.
thoracic cavity is filled with blood rather than air
S/S:
- Same as shock
- Late signs is respiratory distress
- pink or red frothy sputum when the patient coughs when PT coughs
Explain the pathophysiology and signs and symptoms of tension pneumothorax
resulting from a pneumothorax that continues to trap air in the thoracic cavity with no relief or escape
S/S:
- chest pain that worsens with deep inspiration
- dyspnea (shortness of breath)
- tachypnea (faster than normal rate of breathing)
- decreased or absent breath sounds on the affected side
Discuss specific emergency care for an open chest wound.
- Initially seal it with the gloved hand
- Then apply Occlusive dressing taped on 3 sides
List the 8 Hollow organs in the abdominal cavity:
Stomach
Gallbladder
Urinary bladder
Ureters
Internal urethra
Fallopian tubes
Small intestine
Large intestine
What are the 4 Solid organs in the abdominal cavity:
Liver
Spleen
Pancreas
Kidneys
Explain the emergency medical care for an abdominal evisceration.
- Control any massive hemorrhage with direct pressure
2.
S/S of abdominal injury:
Contusions, abrasions, lacerations, punctures, or other signs of blunt or penetrating trauma
Pain that may initially be mild, then worsening
Tenderness on palpation to areas other than the site of injury
Rigid abdominal muscles
Lying with legs drawn up to the chest to reduce the pain
Distended abdomen
Discoloration around the umbilicus or to the flank (late finding)
Rapid, shallow breathing
Signs of hemorrhagic shock
Nausea and vomiting (can contain blood)
Abdominal cramping possibly present
Pain that radiates to either shoulder from irritation of the diaphragm (Kehr sign)
Weakness
Explain the special considerations in the management of trauma to the male and female genitalia
Male genitalia:
- treat as soft tissue injury with direct pressure
- cold compress can be applied to scrotum
- if penis is amputated, wrap in sterile dressing soaked in saline and, place in water right bag and place in ice or water
Female genitalia:
- use direct pressure
- use sanitary napkins for bleeding
- never pack or place dressings inside vagina
Summarize anatomical and physiological changes in both pediatric and geriatric patients that create special considerations in assessing, managing, and transporting trauma patients.
Define SMR
Spine motion restriction
Who is considered a “Reliable person”?
Has a GCS of 15
Does not have a head injury
Is not intoxicated or under the influence of drugs
Does not have a distracting injury (long bone fracture, large laceration, or other injury that causes more pain than the vertebral column, if injured)
Can communicate effectively to understand your questions and provide appropriate response
Who should get SMR in prehospital setting?
An unreliable patient
Has a neurologic deficit (motor or sensory) consistent with a spinal cord injury or complains of numbness or tingling
Complains of pain or tenderness anywhere along the vertebral column
Does not complain of pain to the vertebral column but has a distracting injury
Has an anatomic deformity to the spinal column on assessment
Who does not meet criteria for SMR in prehospital setting?
Normal level of consciousness with a GCS of and is a reliable patient
No spine tenderness on palpation or complaint of pain anywhere along the vertebral column
No abnormal or absent neurologic findings
No distracting injury
Not intoxicated or under the influence of drugs
Can understand and communicate effectively
nervous system has two major functions:
communication and control
What are the 2 divisions of the autonomic Nervous system?
parasympathetic and sympathetic
Describe the dressing used for eyelid injuries:
Sterile gauze soaked in saline to keep fluid from drying
Cover uninjured eye with bandage to decrease movement and transport
What are the 2 functional divisions of the nervous system?
- voluntary nervous system:
which influences the activity of voluntary (skeletal) muscles and movements throughout the body
- The autonomic nervous system:
which is automatic and influences the activities of involuntary muscles and glands
What is the structure of the spinal cord?
- column, or vertebral column:
is the principal support system of the body - vertebrae:
consist of 33 irregularly shaped bones - Disk:
Acts as cushion between the vertebrae - Cervical spine:
The first seven vertebrae that form the neck - Thoracic spine:
12 vertebrae that make up the upper back - Lumbar Spine:
5 vertebrae that make up the lower back - Sacral spine (sacrum):
next 5 vertebrae that are fused together to form the posterior portion of pelvis - Coccyx (tailbone):
4 fused vertebrae that form the lower end of the spine
What is the function of the skeleton system?
Skeletal system gives the body its framework
supports
protects vital organs
and permits motion
What is the function and structure of the spinal cord?
carries messages from the brain to the various parts of the body through nerve bundles
What is the function and structure of the motor tracts, pain tracts , and light touch tracts?
Motor tracts:
carry impulses down the spinal cord and out to muscles
Pain tracts:
carry impulses from pain receptors up the spinal cord to the brain
Light touch:
carry light touch impulses from sensory receptors up the spinal cord to the brain
Describe the “Motor Function Assessment in the Upper Extremities steps”:
“Flex your arms (bend the arms at the elbows) across your chest” (tests motor function at C6 ).
“Extend your arms (straighten the arms to the side of the body)” (tests motor function at C7 ).
“Spread your fingers out on both hands and don’t let me squeeze them together” (tests motor function at T1 ).
“Hold out both arms and don’t let me push your hand down” (done while you support the hand under the wrist) (tests motor function at C7
Describe “Motor Function Assessment in the Lower Extremities”:
“Push down against my hands with your feet” (place your hands under the feet) (tests motor function at S1and S2).
“Pull up against my hands with your feet” (place your hands on the tops of the feet) (tests motor function at the level of L5)
Describe the test for pain and light touch:
Pain :
Take a wooden swap stick and break in half.
Press against hand and ask if it hurts
Light touch:
Lightly touch one hand and the other asking if the PT feels it
What are the S/S of Spinal injury?
- Tenderness at the injury, specifically along the spinal column
- Pain associated with movement from spinal injury
- Pain independent of movement or palpation along the spinal column or in the lower legs
- Obvious deformity of the spine upon palpation
- Soft tissue injuries to head or neck
- Numbness, weakness, tingling, or loss of sensation or motor function in any of the arms or legs
- Loss of sensation or paralysis below the suspected level of injury
- Loss of bowel or bladder control (incontinence)
- Priapism, a persistent erection of the penis resulting from injury to the spinal nerves to the genital
- Impaired breathing
What are the 3 situations you would perform a rapid rollout?
- The scene is not safe
- The patient’s condition is so unstable that you need to move and transport him immediately
- The patient blocks your access to a second, more seriously injured patient
What is the recommended guidance on shoulder pads and sports helmets in regards to removal?
Pads and helmet should be removed prior to transport and should be done by a 3 rescuer team
Define diplopia:
double vision
What are the 2 types of chest wounds?
- Open:
Injury caused by a penetrating knife, gunshot or other object - Closed:
Injury caused by blunt trauma is applied to the chest
Define a flail segment:
two or more adjacent ribs fractured in two more places, causing that section to move independently from rest of the rib
Jugular vein distention (JVD) can be a sign of
Possible cardiac injury or tension pneumothorax
Define Subcutaneous emphysema:
air trapped under the skin giving it a bubbly, inflated appearance and a crackling feel when palpated)
is usually present in the upper chest and neck
S/S of a open/closed chest wound:
Cyanosis to the fingernails or fingertips, lips and around the mouth (circumoral), or face
Dyspnea (shortness of breath)/difficulty in breathing
Breathing rate that is faster (tachypnea) or slower (bradypnea) than normal and usually shallow
Contusions, lacerations, punctures, swelling, or other obvious signs of trauma to the chest
Hemoptysis (coughing up blood or blood-stained sputum)
Signs of shock (decreasing blood pressure, narrowing pulse pressure, increasing heart rate, and pale, cool, and clammy skin)
Tracheal deviation
Paradoxical movement of a segment of the chest wall
Open wound that might produce a sucking sound
Subcutaneous emphysema
Jugular vein distention (JVD), especially during inhalation
Absent or decreased breath sounds upon auscultation
Pain at the injury site, especially pain that increases with inhalation and exhalation
Failure of the chest to expand normally during inhalation
Peripheral pulses that become extremely weak or become absent during inhalation
A drop in systolic blood pressure of or more during inhalation
Define Hemoptysis
coughing up blood or blood-stained sputum
List emergency care for Chest wound
- Maintain open airway
- Administer Oxygen
- Reevaluate breathing status
- Stabilize impaled object in place
- Provide spine motion restriction precautions if spinal injury is suspected
- Treat the patient for shock (hypoperfusion) if signs and symptoms are present
List emergency care for open chest wound:
- Immediately seal the open wound with your gloved hand
- Apply an occlusive dressing to seal the wound
- Tape on all 3 sides
- Continuously assess the patient’s respiratory status
Give examples of both blunt and penetrating mechanisms of abdominal trauma and discuss the potential for severe internal bleeding.
Penetrating trauma:
- Knives
- Gunshot wounds
- ice picks, sharp metal, broken glass, screwdrivers, and other sharp objects
Blunt Trauma:
- MVA
- Crushing injuries from heavy equipment
- motorcycle collisions
- assaults
- blast injuries
- heavy items falling on equipment
For pregnant trauma patients laying in supine , what should be done to protect them from hypotensive supine syndrome?
Elevate PT right hip, elevating back board to the left, or manually displacing the uterus
Compare and contrast hollow organs to solid organs in the abdominal cavity:
Hollow organs are not as vascular but typically contain various substances
Solid organs contain rich blood supply
List the hollow organs in the abdominal cavity:
Stomach
Gallbladder
Urinary bladder
Ureters
Internal urethra
Fallopian tubes
Small intestine
Large intestine
List the Solid organs in the abdominal cavity:
Liver
Spleen
Pancreas
Kidneys
In a PT who has abdominal injury, hemorrhagic shock can be caused due to …
Tearing or laceration of the sold organs
What might be a sign of internal bleeding from a solid organ?
- Signs or hemorrhagic shock
- Kehr Sign
Define Kehr sign:
Shoulder pain referred from the diaphragm when it is irritated by blood within the abdominal cavity
What are the steps for abdominal Trauma?
- Control any massive hemorrhage with direct pressure
- Establish and maintain open airway and SMR precautions if needed
- Adminster Oxygen
- Reassess breathing status
- Treat for hemorrhagic shock
- Dress any open wounds
- position PT
- Stabilize impaled object (if present)
- Transport quickly as possible
What are the steps for abdominal Evisceration?
- Expose the wound
- Position the PT on his back and flex the legs up toward the chest if spinal injury is not suspected
- Prepare a clean sterile dressing by soaking saline or water
- Cover the moist dressing with an occlusive dressing
- Administer oxygen
what is abdominal evisceration?
a life-threatening condition that occurs when abdominal organs protrude through a wound in the abdominal wall:
