Review: Section 7 Trauma

Question 1

What is the rule of nines?

Answer 1

The rule of nines divides the body into sections, each of which is approximately 9% of the total surface area. (pg 825)

Question 2

How is the rule of nines for infants and children different from adults?

Answer 2

The head of an infant is relatively smaller than that of an adult and the legs are relatively smaller. (pg 825)

Question 3

What body parts are the same in infants, children & adults?

Answer 3

The arms and front and back torso. (pg 825)

Question 4

What percent of body surface area is the head of an infant (front and back)?

Answer 4

18% (pg 825)

Question 5

What percent of body surface area is the head of an child (front and back)?

Answer 5

12% (pg 825)

Question 6

What percent of body surface area is each leg of an infant (front and back)?

Answer 6

13.5% (pg 825)

Question 7

What percent of body surface area is each leg of a child (front and back)?

Answer 7

16.5% (pg 825)

Question 8

What is the rule of palm?

Answer 8

The size of a patient’s palm is roughly equal to 1% of the patient’s total body surface area. This can be used to estimate burn area. (pg 825)

Question 9

Define sprain.

Answer 9

A joint injury involving damage to supporting ligaments, and sometimes partial or temporary dislocation of bone ends. (pg 1005, 1010)

Question 10

Define strain.

Answer 10

Stretching or tearing of a muscle; also called a muscle pull. (pg 1006, 1011)

Question 11

Define dislocation.

Answer 11

Disruption of a joint in which ligaments are damaged and the bone ends are completely displaced. (pg 1005, 1010)

Question 12

Define fracture.

Answer 12

A break in the continuity of a bone. (pg 1005, 1007)

Question 13

Number one priority in patient care.

Answer 13

The airway. Do what you need to do to maintain it.

Question 14

Can splinting be placed on too tight?

Answer 14

Yes, it can result in compression of nerves, tissues and blood vessels. Also in reduction of distal circulation. (pg 1031)

Question 15

How would you know that splinting is placed on too tight?

Answer 15

Check for reduction in PMS (pulse, motor and sensory)

Question 16

What should you do if you notice that the splint is on too tight?

Answer 16

Loosen and rewrap the splint.

Question 17

What are the signs of decompensated shock?

Answer 17

Falling blood pressure, Labored or Irregular breathing, Ashen, mottled or cyanotic skin, Thready or absent peripheral pulses, Dull eyes, dilated pupils, Poor urinary output. (pg 389)

Question 18

What is the difference between a concussion and a contusion?

Answer 18

A concussion is a mild traumatic brain injury. A contusion is far more serious than a concussion because it involves physical injury to the brain tissue, which may sustain long-lasting and even permanent damage. (pg 896-897)

Question 19

What is a priaprism?

Answer 19

Priapism (prolonged erection of the penis) is indicative of spinal cord injury in a trauma patient.

Question 20

What are the three layers of the meninges?

Answer 20

The Dura Mater, the Arachnoid Mater, and the Pia Mater.

Question 21

Find it, _____ ____, and move on.

Answer 21

Fix it

Question 22

Why are circumferential burns bad?

Answer 22

Circumferential burns of the chest can compromise breathing. Circumferential burns of an extremity can lead to neurovascular compromise and irreversible damage if not appropriately treated.

Question 23

What are the signs of Cushing’s Triad?

Answer 23

Hypertension, Bradycardia, and Irregular respirations as seen in traumatic brain injury.

Question 24

In what situation is it appropriate to skip the C-Spine evaluation?

Answer 24

Never.

Question 25

What should be applied to a penetrating wound on the neck to prevent air from entering a vein or artery?

Answer 25

Occlusive dressing

Question 26

Describe a first-degree burn.

Answer 26

A superficial burn which involves only the top layer of skin, the epidermis. The skin turns red, but does not blister or actually burn through. The burn site is painful. A sunburn is a good example.

Question 27

Describe a second-degree burn.

Answer 27

A partial thickness burn which involves the epidermis and some portion of the dermis. These burns do not destroy the entire thickness of the skin nor is the subcutaneous tissue injured. Typically, the skin is moist, mottled, and white to red. Blisters are present. Partial-thickness burns cause intense pain.

Question 28

Describe a third-degree burn.

Answer 28

A full-thickness burn which extends though all skin layers and may involve subcutaneous layers, muscle, bone, or internal organs. The burned area is dry and leathery and may appear white, dark brown, or even charred. Some full-thickness burns feel hard to the touch. Clotted blood vessels or subcutaneous tissue may be visible under the burned skin. If the nerve endings have been destroyed, a severely burned area may have no feeling. However, the surrounding, less severely burned areas may be extremely painful.

Question 29

What are the priorities in a trauma patient?

Answer 29

Obvious life threats, ABCs.

Question 30

What does electrocution to do the heart?

Answer 30

Electrical current can cross the chest and cause cardiac arrest or arrhythmias.

Question 31

What is the correlation between trauma and pregnancy?

Answer 31

As pregnancy progresses, the uterus enlarges substantially and rises out of the pelvis, becoming vulnerable to both penetrating and blunt injuries. These injuring can be particularly severe because the uterus has a rich blood supply during pregnancy. Look for shock and labor contractions. Note the patient’s due date.

Question 32

Why should lying a pregnant patient in a supine position be avoided and what is the appropriate position to lie the patient in?

Answer 32

The uterus will place pressure on the inferior vena cava, reducing blood returning to the heart. The patient should be placed on her left side.

Question 33

What are the fatal complications of serious burns?

Answer 33

There are several serious complications that can result secondary to a burn injury, all of which can be life threatening? infection, hypothermia, hypovolemia, shock, airway constriction.

Question 34

What are heat cramps?

Answer 34

Painful muscle spasms that occur after vigorous exercise. Heat cramps usually occur in the leg or abdominal muscles.

Question 35

What is heat exhaustion?

Answer 35

Hypovolemia as the result of the loss of water and electrolytes from heavy sweating.

Question 36

What is heat stroke?

Answer 36

Severe hyperthermia caused by exposure to excessive heat, marked by warm, dry skin; severely altered mental status, often irreversible coma.

Question 37

How do you treat heat cramps?

Answer 37

Remove from environment, administer O2, rest, rehydrate, replace electrolytes, actively cool patient.

Question 38

How do you treat heat exhaustion?

Answer 38

Remove from environment, administer O2, splash with cool water, trendelenburg’s position, fan patient, if alert encourage to sit up and slowly drink, transport if symptoms don’t resolve promptly.

Question 39

How do you treat heat stroke?

Answer 39

Remove from environment, remove clothing, 100% O2, ice packs to neck, groin and armpits, cover with wet towels and fan, immediate transport.

Question 40

Why should a patient with moderate or severe hypothermia be warmed slowly?

Answer 40

Rewarming the patient too quickly may cause a fatal cardiac arrhythmia that requires defibrillation. For this reason, passive rewarming (high indoor heat) is also best delivered at an appropriate facility.

Question 41

How should you position a patient to prevent evisceration?

Answer 41

Have the patient flex his knees.

Question 42

What considerations should be taken with a patient that has a brachial shunt?

Answer 42

Central venous catheters are often located in the chest, upper arm, or subclavicular area. Problems associated with these devices may include broken lines, infections around the lines, clotted lines, and bleeding around the line or from the tubing attached to the line. If bleeding occurs, you should apply direct pressure to the tubing and provide immediate transport to the hospital.

Question 43

When backboarding, what should be done with void spaces?

Answer 43

Fill them with padding.

Question 44

Which patients will have the most voids in backboarding?

Answer 44

Children

Question 45

How do you treat a flailed chest?

Answer 45

Positive pressure ventilation with a bag-mask device.