PHTLS and Trauma Review Flashcards
How many people die from trauma annually?
Over 5 million
What is the leading cause of trauma deaths?
MVA
Where do over 90% of trauma deaths occur?
Low-middle income countries
What is the leading cause of death in people aged 1-44?
Trauma
What are the goals of PHTLS?
Reduce morbidity and mortality from trauma, and provide appropriate care to the patient in the field
What is the PHTLS philosophy?
Deliver the patient to the right facility, utilizing the right mode of transportation, in the right amount of time, as safely as possible
What are the components of scene assessment?
Safety, pre-arrival information, arrival on-scene, MOI, and patients
What is paramount for scene assessment?
Personal and Personnel safety
What is the global view?
What you get before you get out of your vehicle
What is the goal of the Primary Survey?
To immediately identify life threatening situations and manage them as they are identified
What are the components of the Primary Survey?
Airway, Breathing, Circulation, Disability, Exposure
When does assessment of the incident begin?
Before arriving at the patient’s side
The findings of the scene assessment and primary survey help to determine what?
If the patient is sick, not yet sick, or not sick
When should the secondary survey be completed?
Only if time and situation permit
What are the components of the secondary survey?
Vital signs, History, Physical Examination, Treatment, Level of Care, Transportation, and Communication
What are the components of a radio report?
Timely, Scene Description, Number of Patients, Current Patient Status, Treatment Provided, ETA
What is a tracheal consideration with pediatric patients in regards to ET intubation?
Potential for right main-stem intubation
What is the most common cause of airway obstruction in the trauma patient?
The tongue
When are basic maneuvers applied in regards to trauma airway management?
First
When are advanced airway maneuvers performed for trauma patients?
After basic, only if needed
What is the goal of managing a patient’s airway?
Maintain an open and patent airway that allows for adequate breathing, ventilation, and oxygenation
What does airway management entail?
Anticipating difficulties and planning for alternate methods of airway control
What is always the first airway maneuver for the trauma patient?
Trauma Jaw Thrust / Chin Lift
What should be considered second for maintaining a patent airway in a trauma patient?
OPA or NPA
What adjunct should be considered third for airway management in the trauma patient?
Supra-Glottic Airways
When should glottic airways be considered?
After jaw thrusts, OPA/NPA, and Supra-Glottic airways have failed
What are some assessment criteria for Endotracheal Intubation?
Decreased LOC (GCS<8), Inability to maintain patent airway, Upper airway burns, Signs of pending airway obstructions
Which type of airway management should be considered last?
Surgical
What types of methods should be used to verify tube placement?
One physiological and mechanical method
When the patient’s breathing draws your attention, you should:
Assume there is a problem until proven otherwise
What are some signs and symptoms you are looking for in a trauma patient’s breathing assessment?
Increased respiratory effort, visible trauma, paradoxical chest wall movement, sucking chest wound
What are some signs and symptoms you are feeling for in a trauma patient’s breathing assessment?
Boney crepitus, subcutaneous emphysema
What is the biggest difference between a simple and a tension pneumothorax?
A tension pneumothorax has a hemodynamic compromise
Which ribs are most at risk for rib fractures?
Ribs 4-8 laterally
What is the most common cause of hemothorax?
Fractures to ribs 4-8
What are common complaints of rib fractures?
Pain and Shortness of Breath
Under what circumstances should you withhold oxygen from a patient?
Never withhold oxygen from a patient in respiratory distress
When should you assist ventilations?
When the respiratory rate is above 28 or less than 10
What is the ventilatory rate for adults?
10-12 bpm for 500-800 cc
What is the ventilatory rate for children?
16-20 bpm for 100-500 cc or good chest rise
What is the ventilatory rate for infants?
25 bpm for 6-8 mL/kg
What end tidal CO2 reading should you maintain?
35-45 mm Hg
Where should a needed decompression be placed?
2nd intercostal space mid clavicular line, over the 3rd rib
What is shock?
A result of inadequate energy production to sustain life
What are the brain, heart and lungs tolerance to hypoxia?
4-6 minutes
What are the kidneys, liver and GI tracts tolerance to hypoxia?
45-90 minutes
What are the muscle, bone, and skin tolerance to hypoxia?
4-6 hours
What is the most common cause of shock in the trauma patient?
Hypovolemia due to hemorrhage until proven otherwise
What is the most common cause of neurogenic shock in the trauma patient?
Spinal Cord Injury
What does adequate perfusion of the body tissues require?
An effective pump, intact blood vessels, adequate blood volume, vascular resistance
What is cardiac output?
Stroke Volume x Heart Rate
What is blood pressure?
Cardiac Output x Systemic Vascular Resistance
Vasoconstriction leads to which phase of shock?
The ischemic phase
What causes an altered LOC in a shock patient?
Decreased cerebral perfusion
What may be the earliest sign of shock?
Increasing respiratory rate caused by hypoxia and acidosis stimulating the respiratory centers of the brain
How much blood loss is required before a drop in BP occurs?
30%
In shock without obvious cause what should you assume?
The patient is bleeding somewhere, internal hemorrhage, fracture
Where is a significant container of blood volumes lost to hemorrhage?
The abdomen
What is the mortality rate of aortic rupture in the prehospital setting?
80-85%
How much blood can each hemithorax hold?
3000-4000 mL of blood
How much blood loss can occur from a single rib fracture?
125 mL
How much blood loss can occur from a fractured radius or ulnar?
250-500 mL
How much blood loss can occur from a fractured humerus?
750 mL
How much blood loss can occur from a fractured tibia or fibula?
500-1000 mL
How much blood loss can occur from a fractured femur?
1000-2000 mL
How much blood loss can occur from a fractured pelvis?
Massive
What is the most common thoracic injury?
Rib fractures
What four questions guide management of shock?
What is the cause of the shock? What is the care for this type of shock? What can and should be done between now and the time the patient reached definitive care? Where is the best place for the patient to get definitive care?
What does proper management of shock achieve?
Improves the oxygenation of RBCs and improves the delivery of RBCs to tissues
How should the shock patients be positioned?
Supine, as the trendelenburg position is no longer recommended
What temperature should the patient compartment be maintained at?
85F
What are the three responses to fluid therapy?
Rapid response, Transient Response, Minimal or No Response
What is the frontal lobe responsible for?
Foresight, personality and judgment
What is the parietal lobe responsible for?
Sensation from the body
What is the temporal lobe responsible for?
Hearing and Speech
What is the occipital lobe responsible for?
Vision
What is primary damage?
Damage that occurs at the moment of impact
What is secondary damage?
Damage that occurs subsequent to the initial impact
What are some systemic causes of secondary brain injury?
Hypoxia, CO2 abnormalities, Anemia, Hypotension, CBG abnormalities
What are some intrinsic causes of secondary brain injury?
Seizures, Edema, Hematomas, Increased ICP
What is typical ICP?
10-15 mm Hg
What does hypercarbia cause?
Cerebral vasodilation
Onto which brain structure does pressure produce vomiting?
The hypothalamus
What are the six components of a complete prehospital neurological exam?
Mental status, Cranial Nerves, Motor Responses, Sensory Response, Coordination. Reflexes
When do you score the GCS?
After the correctable causes a ALOC have been addressed
What is normal pupil size?
3-5 mm. Difference greater than 1 mm is abnormal
What does paralysis of lateral gaze indicate?
Possible rising ICP
What does paralysis of upward gaze indicate?
Possible fracture of orbital floor
Most of the severe TBI symptoms presents in which way?
Headache, Vomiting, Altered Mentation, Neurological Deficits
What is the earliest and best indicator of a patients ICP?
A change in LOC
What are the warning signs of possible increasing ICP and impending herniation?
GCS drop of 2 or more, development of sluggish or no reactive pupils, development of hemiplegia or hemiparesis, Cushing’s phenomenon
What is the ventilatory rate for adults with suspected intercranial herniation?
20 bpm
What is the ventilatory rate for children with suspected intercranial herniation?
25 bpm
What is the ventilatory rate for infants with suspected intercranial herniation?
30 bpm
How much blood must be lost before children show signs of hypotension?
30%
What is fourth degree burn?
A burn to the bone
What is special in the fluid therapy of a child in burn management?
They should receive 5% dextrose in LR solution
acceleration (a)
The rate of change in velocity; speeding up
angle of impact
The angle at which an object hits another; this characterizes the force vectors involved and has a bearing on patterns of energy dissipation
arterial air embolism
Air bubbles in the arterial blood vessels
avulsing
A tearing away or forcing separation
barometric energy
The energy that results from sudden changes in pressure as may occur in a diving accident or sudden decompression in an airplane
biomechanics
The study of the physiology and mechanics of a living organism using the tools of mechanical engineering
blast front
The leading edge of the shock wave
blunt trauma
An impact on the body by objects that cause injury without penetrating soft tissues or internal organs and cavities
brisance
The shattering effect of a shock wave and its ability to cause disruption of tissues and structures
cavitation
Cavity formation; shock waves that push tissues in front of and lateral to the projectile and may not necessarily increase the wound size or cause permanent injury but can result in cavitation
chemical energy
The energy released as a result of a chemical reaction
deceleration
A negative acceleration – that is, slowing down
electrical energy
The energy delivered in the form of high voltage
entry wound
The point at which a penetrating object enters the body
exit wound
The point at which a penetrating object leaves the body; which may or may not be in a straight line from the entry wound
gravity (g)
The acceleration of a body by the attraction of the earth’s gravitational force, normally 32.2 ft/sec2
implosion
A bursting inward
index of suspicion
Anticipating the possibility of specific types of injury
kinetic energy (KE)
The energy associated with bodies in motion, expressed mathematically as half the mass times the square of the velocity
kinetics
The study of the relationship among speed, mass, vector direction, and physical injury
law of conservation of energy
The principle that energy can be neither created nor destroyed; it can only change form
mechanical energy
The energy that results from motion (kinetic energy) or that is stored in an object (potential energy)
mechanism of injury (MOI)
The way in which traumatic injuries occur; the forces that act on the body to cause damage
missile fragmentation
A primary mechanism of tissue disruption from certain rifles in which pieces of the projectile break apart, allowing the pieces to create their own separate paths through tissues
multisystem trauma
Trauma caused by generalized mechanisms which affect numerous body systems
negative wave pulse
The phase of an explosion in which pressure from the blast is less than atmospheric pressure
Newton’s first law of motion
The principle that a body at rest will remain at rest unless acted on by an outside force
Newton’s second law of motion
The principle that the force that an object can exert is the product of its mass times its acceleration
pathway expansion
The tissue displacement that occurs as a result of low-displacement shock waves that travel at the speed of sound in tissue
penetrating trauma
Injury caused by objects that pierce the surface of the body; such as knives and bullets, damage internal tissues and organs
permanent cavity
The path of crushing tissue produced by a missile traversing part of the body
positive wave pulse
The phase of the explosion in which there is a pressure front with a pressure higher that atmospheric pressure
potential energy
The amount of energy stored in an object, the product of mass, gravity, and height, that is converted into kinetic energy and results in injury, such as a fall
pulmonary blast injuries
Pulmonary trauma resulting from short-range exposure to the detonation of high explosives
Revised Trauma Score (RTS)
A scoring system used for patients with head trauma
shearing
An applied force or pressure exerted against the surface and layers of the skin as tissues slide in opposite but parallel planes
spalling
Delaminating or breaking off into chips and pieces
trauma
Acute physiologic and structural change that occurs in a victim as a result of the rapid dissipation of energy delivered by an external force
trauma score
A score that relates to the likelihood of patient survival with the exception of a severe head injury. It is calculated on a scale from 1 to 16, with 16 being the best possible score. It takes into account the Glascow Coma Scale score, respiratory rate, respiratory expansion, systolic blood pressure, and capillary refill
tympanic membrane
The eardrum; a thin, semitransparent membrane in the middle ear that transmits sound vibrations to the internal ear by means of the auditory ossicles
velocity (v)
The distance an object travels per unit time
Waddell triad
A pattern of automobile-pedestrian injuries in children and people short stature in which (1) the bumper hits pelvis and femur, (2) the chest and abdomen hit the grille or low hood, and (3) the head strikes the ground
whiplash
An injury to the cervical vertebrae or their supporting ligaments and muscles, usually resulting from sudden acceleration or deceleration
Seat belts (lap and diagonal) and supplemental restraint systems (air bags) have clearly demonstrated that they reduce serious injury and death in automobile collisions. Tests have shown, however, that the use of one of these devices by itself can result in serious injury or even death. This single restraint device is the: a. diagonal belt b. lap belt c. supplemental restraint system d. lap belt without a diagonal belt
diagonal belt
The mechanics of energy exchange between two objects is relatively simple. When one object strikes another, energy is transferred. In evaluating energy exchange in a patient, the EMT must remember the concept of cavitation. When an object strikes the patient, it displaces particles (tissue). If this displacement of tissue is more forceful than the elasticity of the tissue __________ will result. a. a transdermal cavity b. deformation of the object c. a temporary cavity d. a permanent cavity
a permanent cavity
Lateral or side impact type collisions can often produce more severe energy transfer patterns to an occupant of the vehicle. This is due in large part to the fact that the head is supported in an off-center position by the spine. This off-center positioning places the center of gravity forward and superior to the point of support. This places the neck at the greatest risk from injuries from: a. lateral flexion and rotation b. lateral extension and rotation c. hyperextension and rotation d. hyperflexion and rotation
lateral flexion and rotation
One of the first concepts of energy and trauma injuries that an EMT must understand comes for Newton’s first law of motion. This law states: a. For every force of acceleration a patient experiences, they will experience an equal and opposite deceleration force. b. A body in motion will become a body at rest without any influence of outside forces. c. Energy can be created as easily as it can be destroyed. d. A body in motion or at rest will remain that way until acted upon by some outside force.
A body in motion or at rest will remain that way until acted upon by some outside force.
Injuries to patients from energy transfer can occur in many different ways. One of these is a fall. The EMT would consider as potentially serious to the patient any fall from a height that is at least _______ the height of the patient. a. three times b. four times c. five times d. twice
three times
Motor vehicle collisions take on five (5) different impact types. The type known as “head-on” or “frontal impact” can result in two possible paths for the occupants of the vehicle. The down-and-under path will generally result in the unrestrained driver or occupants of the front seat experiencing the first impact with the vehicle on which part of the body? a. abdomen b. knees c. chest d. head
knees
Blast injuries (explosions) have three phases associated with them. In general, any one of these phases can produce serious or even fatal injuries to victims. The EMT who is knowledgeable in kinematics would be most concerned with injuries occurring in which of the phases? a. the first and second phase b. the first and thrid phase c. the second and third phase d. the first phase only
the second and third phase
Kinetic energy is defined as being a function of an object’s weight and speed. The kinetic energy production rate is influenced to a greater degree by which factor? a. The stopping distance after impact. b. The speed at the time of the collision. c. The angle at which the impact occurs and energy is transferred. d. The patient’s body weight.
The speed at the time of the collision
The most common cause of airway obstruction in unconscious patients is: A. Flaccid tongue blocking the hypopharynx B. Crush injury to the trachea C. Foreign body obstruction D. Edema of the vocal cords
Flaccid tongue blocking the hypopharynx
Which of the following manual airway maneuvers is NOT recommended for use on trauma patients? A. Trauma mandible lift B. Trauma jaw thrust C. Head tilt, chin lift D. Trauma chin lift
Head tilt, chin lift
The first priority of trauma management and resuscitation is: A. Assuring scene safety B. Rapid completion of primary patient survey C. Ensuring a patent airway D. Control of external hemmorrhage
Ensuring a patent airway
_______________ is the most desirable method of achieving maximum control of the airway for trauma patients who are apneic or require assisted ventilation. A. The pharyngeal lumen (PTL) airway B. Endotracheal intubation C. An oral airway D. Percutaneous transtracheal catheter ventilation (PTLV)
Endotracheal intubation
Potential complications of endotracheal intubation include: A. Esophageal intubation B. Hypoxemia from prolonged intubation attempts C. Conversion of cervical injury without neurological deficit to a cervical spine injury with neurologic deficits D. All of the above
All of the above
In a normal adult, the control of respiration by chemoreceptors in the brain is determined by sensing which of the following chemicals? A. Carbon monoxide (CO) B. Carbon dioxide (CO2) C. Oxygen (O2) D. Nitrogen (N)
Carbon dioxide (CO2)
The most important early observation that reveals developing respiratory compromise after trauma is: A. Intercostal nerve decreased blood pressure B. Increased pulse rate C. Increased respiratory rate D. Decreased respiratory rate
Increased respiratory rate
The most important concern about a rib fracture is: A. Intercostal nerve or vessel injury B. Pain with inspiration C. Underlying organ injury D. Associated thoracic spine injury
Underlying organ injury
A patient with a suspected flail chest develops increasing respirations and difficulty breathing. Which of the following interventions would be most likely to help the patient? A. Needle decompression B. Pericardiocentesis C. Administration of an analgesic D. Endotracheal intubation
Endotracheal intubation
Patients with pulmonary contusion should not be given too much intravenous fluid because fluid will: A. Increase blood pressure and intra-abdominal bleeding B. Increase intracerebral edema C. Increase interstitial and intra-alveolar fluid and bleeding D. Cause thoracic compartment syndrome
Increase interstitial and intra-alveolar fluid and bleeding
A patient with a suspected simple pneumothorax will benefit from which of the following interventions? A. Rapid transport B. Needle decompression C. Administration of an analgesic D. Positive pressure ventilation
Rapid transport
Which of the following is a sign and symptom of shock? A. Warm, dry skin temperature in spinal shock B. Falling blood pressure during compensated shock C. Normal pulse during septic shock D. Pink skin color in hypovolemic shock
Warm, dry skin temperature in spinal shock
The organs most commonly injured in the abdomen by blunt trauma are the: A. Stomach and duodenum B. Small intestines and kidneys C. Colon and pancreas D. Liver and spleen
Liver and spleen
Injuries to hollow organs in the abdomen cause peritonitis secondary to hemorrhage into the peritoneal cavity. True False
FALSE
A 35 year old man falls off a 10-foot ladder. Based on this information, which injuries would you attend to first? A. Fractured femur B. Angulated wrist C. C-spine precautions D. Hip fracture
C-spine precautions
What condition would you assess for when dealing with a crushing injury? A. Infection B. Degloving C. Compartment syndrome D. Absence of mobility
Compartment syndrome
The proper way to dress most burn injuries in the pre-hospital setting is to use: A. Moist dressings B. Dry sterile dressings C. Water soluble gels D. Silvadene
Dry sterile dressings
The biggest concern with electrical burns is: A. The wick effect B. Tissue loss C. Entry and exit wounds D. Cardiac arrest
Cardiac arrest
Level 1 Trauma Center
Regional Trauma Center, All types of specialty surgical care 24/7, (Surgical suites, Surgeons, Blood, CT, X-Ray … all in house), Tertiary - all levels of care
Level 2 Trauma Center
Area Trauma Center, Most common trauma emergencies with surgical capabilities 24/7, (can handle most common types of trauma)
Level 3 Trauma Center
Community Trauma Center, Specialized ED and some surgical capability (the speciality staff is on call and has 30 mins to get to hospital)
Level 4 Trauma Center
small community hospitals, (they have to stabilize and transfer) Have ER DR but no surgeon
What are run sheets used for?
QI, Research, Trauma Registry,
What are the 4 E’s?
Engineering -(roads, airbags, pool alarms) Enforcement -(laws) Education -(safety classes) Economics -(government grants)
What is an injury?
being hurt or killed
What is trauma?
inflicted wounds or injury
What is an accident?
an event that is unforeseen or without apparent cause
What is a disease?
an unhealthy condition, illness, or disorder
Why is the Highway Safety Act of 1966 important?
lead to development of EMS “White Paper” - Accidental Death & Disability, The Neglected Disease of a Modern Society
Why is the American College of Surgeons important?
1990: trauma care systems planning and development act (established guidelines, funding and state-level leadership for the development of trauma systems)
What are the leading causes of death in adults & children?
Adults - MVC Children - Falls
In trauma how many die in 1st hr?
50% Fix = Injury Prevention
In trauma how many die days or weeks later?
20% (due to hypoxia, hypotension, end organ failure) Fix = aggressive shock management
What is Precrash?
Age, medical hx, drugs, alcohol
What are the 3 phases of a Crash?
- car into tree 2. person into steering wheel 3. organs into body
What is the main purpose of car restraints?
to slow the occupant down with the vehicle
Platinum 10 mins are used for what?
- identify life-threats 2. perform key interventions 3. rapid extrication were indicated 4. timely transport to an appropriate facility 5. early notification to the receiving facility
Trauma is the leading cause of death in what age group?
1 - 44
What is anatomical trauma criteria?
Specific injuries (bi-lat femur fx)
What is mechanical trauma criteria?
Type of incident / MOI (blunt head, penetrating trauma, PSI)
What is physiological trauma criteria?
vitals signs (ALOC, hypotension GCS < 15)
What is the formula for kinetic energy?
1/2 of mass x velocity(squared)
What is more important velocity of mass?
velocity
If you increase the stopping distance what happens to the potential for injury?
potential for injury is decreased
What is important info in regards to GSWs?
hand guns & rifles - velocity shotguns - what was the distance
What is permanent cavitation?
tissue that is destroyed and not coming back
What is temporary cavitation?
tissue that falls back into place 6x the diameter of permanent cavitation
Concerns with up & over injuries?
Laryngeal fx (may hear stridor) Sub-Q Emphysema Diaphragmatic tear
Concerns with down & under injuries?
Pelvic fx Femur fx Patellar fx
Concerns with lateral impacts?
Less metal to protect people in car Look for injuries to that same side of body
Concerns with rotational forces?
shearing forces to heart, liver, kidneys
What % of ejection victims die?
75%
How much more likely are you to die if you are involved in a rollover?
6x
Concern with rear impacts?
whiplash injuries
Good thing about wearing helmets?
they save lives & decrease injuries
Auto vs. Ped facts?
Child - Freeze “deer in headlights”, get drug under car, multi-system trauma Adult - turn & run, extremity trauma
Important aspects of falls?
15 feet or 3x their height & the surface they land on = (severity of fall) Body part they land on = (type of injury)
what are the 5 phases of blast injuries?
- Primary - pressure wave, effects hollow organs 2. Secondary - Bomb fragments 3. Tertiary - person in thrown, or falling debris 4. Quaternary - heat/thermal burns 5. Quinary - bio/chemical/implanted objects sprayed from the object
What is an intimate injury?
Stabbing. Close proximity. Look for more than one wound, be cautious of “cone of injury, any direction”, length of knife?
In regards to violence what should you do?
- DONT BE THERE!!!! 2. Retreat 3. Defuse the situation (word ninja) 4. Defend yourself
30 - 2, Can Do = what color?
Green
30 - 2, Cant Do = what color?
Yellow
Deficit to 30 - 2, Can Do (ALOC, Respirations, Circulation) = what color?
Red
What is the goal of the primary assessment?
to find & correct life threats
What is the most common threat to life?
inadequate tissue perfusion/shock (a early sign is ALOC)
If you dont know ______ then your already behind the 8 ball?!
the MOI
Injury to solid organs = ?
hemmorage
Injury to hollow organs = ?
Spill which leads to infection/peritonitis)
What is Grey Turners sign?
ecchymosis at the flank due to retroperitoneal bleed
What is Cullens Sign?
ecchymosis at the umbilicus due to retroperitoneal bleed
Mass pants can be used for what?
- belly, retroperitoneal, pelvis bleed w/ BP less than 90 & pelvis fx stabilization 2. wide spread hemorrhage with BP less than 60 (NOT FOR USE ON PENETRATING TRAUMA)
What is the % for Fi02?
at least 85%
What is the % for SP02?
95%
Can you typically remove impaled objects?
Only if it is occluding the airway otherwise No, it maybe stopping the bleeding!!
Abdominal evisceration key points are what?
- moist sterile dressing 2. occlusive dressing 3. keep PT warm 4. keep PT still
What is more important minute volume or tidal volume?
Minute volume
What is the most important mechanism for ventilation?
the plural linings staying intact
In the PHTLS world what are the essential airway skills?
bls skills
What is the PHTLS airway key factor?
Dont do the same thing over & over, try something different
In PHTLS what is the best ET-Tube confirmation in a PT with a pulse?
capography
What is the best ET-Tube confirmation in a PT without a pulse?
lung sounds
If you cant intubate or ventilate then what?
needle / surgical cric
Normal capography value?
35-45
Closed head injury capography range is what?
35 or less
What is the most common type of shock?
hypovolemic / hemorrhagic
What is most sensitive to ischemia?
The brain, heart and lungs (can last about 4-6 mins w/o 02)
What the 2nd most sensitive to ischemia?
The kidneys, liver & GI tract (can last 45-90 mins w/o 02)
What is the least sensitive to ischemia?
Skin and bones (can last 4-6 hrs w/o 02)
What is cell & organ death?
- it starts with aerobic to anaerobic metabolism 2. Na and H20 go into the cell (edema) 3. Potassium and lactic acid leak out of cell and enter blood stream (makes body acidic & hyperkalemic)
What happens during the ischemic phase?
vascular sphincters shut closed
What happens during the stagnant phase?
Sphincters relax and blood pools in the extremities
What happens during the wash out phase?
systemic acidosis
What is Shock Class 1?
1-15% 750 ml compensated> HR normal
What is Shock Class 2?
15-30% 750-1500 ml> HR greater 100
What is Shock Class 3?
30-40% 1500-2000ml (BP goes down here)> HR greater 120
What is Shock Class 4?
greater than 40% 2L or more> HR greater 140
What systolic BP number do you want to see in a trauma and/or traumatic brain injury patient?
Trauma 80-90 TBI 90-100 (just shoot for BP or 90 systolic, & titrate your fluid bolus to meet these values)
How warm should you warm your fluids to if possible?
102 degrees
What is the ratio of fluids given to blood lost during trauma?
3:1 (3 liters of fluid per 1 liter of blood)
Distributive Shock key factors are what?
- vasodilation below the injury site 2. warm skin below the injury site 3. Bradycardia & Hypotension 4. Priapism (Difference between this and hemorrhagic shock is the bradycardia due to parasympathetic system)
What is the TX for rib fx?
- pain management 2. positive pressure ventilation
How do you treat a sucking/open chest wound?
First action is to cover it Make occlusive dressing Diameter of sucking chest wound is about 2/3 size trachea
Signs of hemothorax are?
- Diminished or absent lung sounds 2. Hemodynamic compromise 3. Flat neck veins 4. Dull to chest percussion (3L of blood in each plural cavity, JVD is not a reliable source)
What are signs of Beacks Triad?
(penetrating trauma causes cardiac tamponade) 1. Muffled heart tone 2. JVD 3. Hypotension 4. 50cc of fluid can cause of dysrhythmias 5. 300cc or fluid can causes PEA
What is a pulmonary contusion?
blood filled alveoli, causes a decrease in 02 & C02 exchange
What is traumatic asphyxia?
related to crush injury, blood is unable to drain from head and top half of body
What is an aortic rupture?
a tear in the aorta, bleed out fast
What happens in Tracheobronchial Detachment?
- Detachment usually occurs at the carina 2. Air leaks into the chest cavity 3. pneumothorax / tension
What happens in Commotio Cordis?
- impact to chest 2. heart goes into v-fib 3. is survivable of recognized early, need to do CPR and defibrillate ASAP
If patient is shocky and you suspect a bleed but cant find it, where should you assume it is?
abdominal until proven other wise!! 1. abdominal pain and tenderness are an early sign 2. abdominal distension are late signs
What are the important time frames of protection during pregnancy?
- up to 12 weeks fetus is protected by the pelvis 2. up to 20th week fetus is at the umbilicus 3. up to the xiphoid process by week 38
What are signs of Cushings Tirad?
- hypertension 2. bradycardia 3. Ab. Normal Respirations 4. +1 (ALOC, Blown Pupils ect.) = brain steam herniation
What is autoregulation?
CPP increases due to ICP increase
What is a potent vasodilator?
C02
What is broken in a basilar skull fx?
Cribriform plate (look for blood/fluid from nose and/or ears w/o direct injury to nose or ears)
Important facts of an epidural bleed are what?
- Fast bleeds arterial (medial meningeal artery) 2. Usually die in about 1 hr 3. Lucid intervals (knockd out, wake up & act normal, knock back out)
What are important facts about subdural bleeds?
- slower bleeds- veins (bridging veins) 2. doesnt usually experience lucid intervals
What is a primary brain injury?
the insult to the brain itself (ex. gsw to head)
What is the secondary brain injury?
something we can prevent (ex. hypoxia post primary injury)
What is retrograde amnesia?
forgetting what happened before the accident happened (retro=past)
What is anterograde amnesia?
cant remember the accident or post accident
Where is the atlas?
C1
Where is the axis?
C2
Where is the odontoid process?
is off the axis C2, allows head rotation 180 degrees
What are the biggest vertebra?
Lumbar, they carry the most weight
How many pairs of spinal nerves do we have?
31 pairs
Where do the motor nerves travel?
the ventral root, down the front of the body (efferent)
Where do the sensory nerves travel?
the dorsal root, up the back of the body (afferent)
What are dermatomes?
the bodies sensory boarders T4 - nipple line down T10 - umbilicus down
C 3-5 are what nerves?
the phrenic nerve, control the diaphragm. If severed no intercostal or diaphragmatic movement
What is axial loading?
spinal cord compression (ex. shallow water diving accident, leading on head & pressing down)
What is a distracting injury?
the spinal cord in stretched or disconnected (ex. hanging accident)
Do you need to C-Spine a penetrating injury?
No, unless there is a neuro deficit
What happens during an anterior cord injury?
Loss of motor, pain, and temp. (involves injury to spinal arteries)
What happens during central cord injury?
- hyperextension of spinal cord 2. weakness in the upper extremities, but good lower extremity function 3. loss of bladder control
What happens during Brown Sequard injury?
- loss of function on one side of the body (typically from penetrating injury)
On a stable patient what do you do before moving the patient?
splint fxs and pain meds
Ligaments connect what?
bone to bone
Tendons connect what?
muscle to bone
What is a subluxation injury?
dislocation partially out of the socket
What is compartment syndrome?
The tissues is tight (ex. circumferential burns) 1. after 6 hrs there is lots of damage to tissue 2. Check color of urine
What is crush syndrome?
- release of pressure from compartment syndrome 2. lactic acid rushes into the body
Second degree burns?
- affect the epidermis 2. blisters
Third degree burns?
- affect down to the dermis 2. waxy and leathery looking
Fourth degree burns?
- affect down to the bone and muscle
Nerves are a good conductor for what type of burns?
electrical burns
The hands, feet, face, and genitilia are what kind of burns?
specialty type of burns
What is the fluid formula for fluids in the burn patient?
4cc/kg/BSA = 50% in 1st 24 hr period (divide # by 2 = amount in first 8 hrs) (divide # by 8 = amount in 1st hr)
What 3 things affect the severity of radiation?
- distance 2. shielding 3. time
What is toxic inhalation?
death by delayed respiratory compromise post fire exposure
What is important about acid burns?
coagulate necrosis
What is important about alkaline burns?
liquifaction necrosis
