Multiple Injuries

Question 1

What are the two different mechanisms of injury?

Answer 1

Blunt

Penetrating

Question 2

What is blunt injury?

Answer 2

injury without interruption of skin integrity

Question 3

What is penetrating injury?

Answer 3

injury obtained by transmission of energy with interruption of skin integrity

Question 4

What are four types of force most often applied?

Answer 4

Acceleration
Deceleration
Shearing
Compression

Question 5

What is acceleration force?

Answer 5

Increase in rate of velocity or speed of a moving object

As velocity increases, so does the amount of damage

Question 6

What is the equation for finding the psi of an acceleration force?

Answer 6

Body weight x mph = psi of impact

Question 7

What is compression force?

Answer 7

Being pressed or squeezed together with resulting decrease in volume or size

Question 8

What is deceleration force?

Answer 8

Decrease in velocity of moving object

Question 9

What is shearing force?

Answer 9

Also known as degloving
Injury resulting from 2 structures or 2 parts of same structure sliding in opposite direction (causing tissue separation)

Question 10

Explain the kinematics of penetrating trauma

Answer 10

Transmission of energy from moving object into body tissues as object disrupts integrity of skin and underlying structures
Amount of energy transmitted = amount of damage
Amount of energy is dependent on surface area of point of impact, density of tissue & velocity of projectile at time of impact

Question 11

What are the three main pathophysiological mechanisms of shock?

Answer 11

Cardiogenic shock
Distributive or vasogenic shock
Hypovolemic shock

Question 12

What is cardiogenic shock?

Answer 12

Dysfunction in pumping effectiveness of the heart

Question 13

What is distributive or vasogenic shock?

Answer 13

Abnormal distribution of vascular volume

Question 14

What is hypovolemic shock?

Answer 14

Reduction in intravascular volume

Question 15

What are the four stages of shock?

Answer 15

Initial stage
Compensatory stage
Progressive stage
Refractory stage

Question 16

What occurs during the initial stage of shock?

Answer 16

Cellular level
Decrease in cardiac output and tissue perfusion
Usually no obvious signs and symptoms of deterioration

Question 17

What occurs during the compensatory stage of shock?

Answer 17

Body attempts to maintain adequate function (i.e. cardiac output & arterial pressure via mediation of nervous, chemical and hormonal mechanisms)
Effects of mechanisms are responsible for clinical signs and symptoms
Compensatory mechanisms only effective for limited time

Question 18

What occurs during the progressive stage of shock?

Answer 18

Compensatory mechanisms no longer able to maintain adequate tissue perfusion
Loss of auto regulatory control and increased capillary membrane permeability = decreased cardiac output and decreased tissue perfusion

Question 19

What occurs during the refractory stage of shock?

Answer 19

Body unable to respond to treatment

Irreversible—Leads to DEATH

Question 20

What are the phases of trauma care?

Answer 20

Prehospital Resuscitation
Emergency Dept. Resuscitation
  - Primary survey/ Resuscitation
  - Secondary survey
Definitive Care/Operative Phase
Critical Care Phase
Rehabilitation Phase

Question 21

What are the steps of the primary survey/resuscitation? (ABCDEF)

Answer 21

A---Airway - stabilization
B---Breathing
C---Circulation
D---Neurological Disability
E—Expose (floats between primary and secondary)
F- Five interventions/ Full Vital signs

Question 22

What are the steps of the secondary survey? (GHI, other)

Answer 22

G- Give Comfort Measures
H- Head to Toe/ History (MIVT/AMPLE)
I – Inspect posterior
Additional Interventions such as:
ECG
Urinary catheter
SPO2
NG tubes
Xrays
Lab work – ABGs

Question 23

What are three ongoing pieces of definitive care?

Answer 23

Ongoing assessment and recognition of potential injuries and associated signs and symptoms
Ongoing management of pre-existing health conditions
Ongoing monitoring of the development of possible complications

Question 24

What are some hematologic complications of trauma?

Answer 24

Hemorrhage, blood loss, shock, DIC (disseminated intravascular coagulation)

Question 25

What are some cardiac complications of trauma?

Answer 25

Cardiac tamponade, dysrhythmias, aortic dissection

Question 26

What are some pulmonary complications of trauma?

Answer 26

Pneumothorax, pulmonary embolism, hemothorax, blood in the pleural space

Question 27

What are some gastrointestinal complications of trauma?

Answer 27

Perforation, truamatic hernias, ruptured appendix

Question 28

What is a hepatic complication of trauma?

Answer 28

Decreased perfusion

Question 29

What are some renal complications of trauma?

Answer 29

Decreased perfusion, acute kidney injury, acute tubular necrosis, altered electrolyte balance, arterial tears (kidneys are stationary, arteries are not as stationary, might have shearing injuries/tears)

Question 30

What are some orthopedic complications of trauma?

Answer 30

Fractures, fat embolism (from long bone fractures), compartment syndrome

Question 31

What are some integumentary complications of trauma?

Answer 31

Degloving, road rash, rocks/glass embedded in skin

Question 32

When performing primary survey/resuscitation, what is done during the first step, Airway (stabilization)? What are the concerns?

Answer 32

can they maintain their own airway? Do they require me to do jaw thrust? Do they need to be intubated? This is directly linked to C-spine stabilization. Until we know for sure what the level of damage is, we need to provide C-spine stabilization. Ask them to run their tongue along their teeth and tell you if they are missing any teeth. They might choke on broken/lost teeth. If they are unconscious, pull their lower jaw down with your gloved hand and feel it yourself. They also could have foreign objects (eg. rocks, glass, etc) in their mouth.

Question 33

When performing primary survey/resuscitation, what is done during the second step, Breathing? What are the concerns?

Answer 33

Do a quick listen to see if they’re breathing. Even if they have a tube in from EMS, you still need to listen to the lungs to make sure they are breathing properly. You don’t want to just assume that the endotracheal tube is working, you need to check.

Question 34

When performing primary survey/resuscitation, what is done during the third step, Circulation? What are the concerns?

Answer 34

Check the major pulses (femoral, carotid). If at any point, if there is something that is not correct/needs to be rectified, you need to fix it before moving to the next step. These are in order of priority.

Question 35

When performing primary survey/resuscitation, what is done during the fourth step, Neurological Disability? What are the concerns?

Answer 35

Neurologic – check pupils. If they are awake, you can ask them questions. Do a Glasgow coma scale (need a verbal response, eye opening response, etc).

Question 36

When performing a primary survey/resuscitation, what is done during the fifth step, Expose?

Answer 36

Expose – Cut their clothes off. If youre in a small town hospital and it’s just you, you don’t get to this until you’ve already done ABCD. If there is someone helping you, they can start cutting the clothes off while youre doing ABCD. They can also start the vital signs.

Question 37

What does MIVT/AMPLE stand for? (Part of the head to toe/history

Answer 37

MIVT - Mechamism of trauma, Injuries, Vital signs, Treatment (this can be found on the EMS) AMPLE – Allergies, Medications, Past medical history, Past hospitalizations, Last meal, Events leading up to the trauma) Last meal – we want to know what they have in their stomach, how much, etc.

Question 38

Why should blood pressure be taken on both sides of a trauma patient?

Answer 38

This can tell us if there is vascular damage affecting only one side.

Question 39

For a male patient, what must be done first before inserting a foley catheter?

Answer 39

If this is a male, and we think there is pelvic trauma, we need to get a physician to do a rectal exam first to see if the prostate is intact. We can’t put a catheter in if the prostate is not intact.

Question 40

How should a trauma patient be rolled?

Answer 40

Rolling the person: Person at the head is in charge, and their job is to make sure their head, chin, neck stays in line with the body/spine. The charge person will count 1,2,3 for the roll. Person at the foot is in charge of making sure their legs stay aligned. 4 People for this minimum if available. More is better (more people to stabilize the patient). Listen posteriorly, examine for wounds, pull out all the linens they came in with, do a rectal check, quickly and then roll them back safely.