Test #1 Flashcards
With car vs ped, where do adults mostly go? and where do the pediatrics mostly go?
Adults- up and over the vehicle
Pediatrics- under
How many phase of injury are there?
- Pre-incident: reducing the injury through prevention (education)
- Incident: Something happened
- Post Incident: The response to the incident, to help save the life.
What are some key differences about trauma centers?
Level 1- has full range of specialist and equipment available.
Level 2- works in collaboration with level 1 centers, provide essential care, but specialist are not all in house.
Level 3- Able to stabilize and preform most emergent surgery, but most specialist are on-call
Level 1-3 all have pre-incident education.
Level 4/5- All care must get shipped out to a higher level.
How many pt do level 1 hospitals must treat to keep their status?
240
What is Kinematics?
It is the process of predicting the injury patterns. (the transfer of energy from an external source to the human body)
What is Newtons first law?
Object in motion (or not in motion) remains unless acted on by an outside force.
What is conservation of energy law?
energy can not be created or destroyed, it can only change form.
(energy can take on mechanical, thermal, electrical, chemical and nuclear forms.)
what is newtons second law?
Mass x Acceleration (deceleration) = Force
What is Kinetic Energy?
The energy an object posses just by being in motion.
KE=1/2M x V^2
What is the Ligamentum Arteriosum?
The ligament that attatches the aorta to the heart. This can shear in an event where the object stops moving (car) and the heart and aorta continue to move.
What is a pulmonary contusion?
Bruise to the lung.
S/S: Hemoptysis, crackles, decreased pulse ox, decrease capno
What is a tension pneumothorax?
Air leaks in between the lung and chest wall and collapses the lung.
S/S: unilateral diminished lung sounds, JVD (later finding), hypertension, capno down.
What is a hemothorax?
when blood builds up between the lung and chest wall, causing it to collapse.
S/S: unilateral diminished lung sounds, NO JVD, will have hypertension (there is a bleed), and capno is down.
What is a Ruptured Diaphragm?
Puncture or tear in the diaphragm.
S/S: SOB, bowel sounds in the lungs
What is a flail chest?
Fx or break of a rib.
S/S: paradoxical movement, crepitus
what plays a bigger role in Kinetic Energy? Speed or Mass?
Speed
What are the two main things seen with blunt trauma?
Shear (organ or structure moves faster or slower in relation to other object)
Compression (force applied directly to an organ, affected by time, force, and area of compression)
how will “air filled” organs transfer energy?
(Lungs or Intestines) energy moves relatively few particles.
How will “solid or water filled” organs absorb energy?
(Liver, Spleen, Muscle, Vascular Sys.) energy moves a greater proportion
How will “non flexible” material in the body transfer the energy?
Inflexible (Bones) if sustaining impact, will set thick particles in motion
What are 3 phases of motor vehicle collision?
1) vehicle hits object
2) body hits the vehicle
3) organs collide in the body
With front end collision, what are some of the injuries you can expect?
1) down and under: fx femur, dislocated knee, torn ligaments, fx tib/fib.
2) Up and over: head colliding with windshield (spidering), neck injuries, thoracic injury from impact with steering wheel, abdomninal
What is Grey Turner sign?
bruising on the flank
what is a common injury associated with deceleration injuries?
Head (brain contusions, lacs, crush)
** severed aorta at the ligaments arteriosum, causing widespread exsanguination)
What direction do most adults turn for a auto vs ped?
Away
What direction do most kids turn in the event of an Auto vs. Ped?
Toward
What is Waddell’s Triad?
Injuries associated with kids vs vehicle.
1) injury to the legs (lower extremity)
2) impact to torso/ Thoracic cage.
3) striking head on the ground.
What are 4 things to consider with falls?
1) how far did they fall?
2) what did they fall onto?
3) Did they strike any objects while falling?
4) What was the first body part to hit?
What is Don Juan Syndrome?
Its when you fall feet first. Get calcaneus fx with a spinal fx.
Its falling with straight legs, and getting fx all the way up from feet to spine.
Primary Blast injury includes what?
Effected by the blast wave. Most of the organs that have air pockets or gas pockets are affected. The body parts most effected are:
- ears lungs, central nervous system, eyes, and gastrointestinal tract.
High order explosives are what
cause supersonic over-pressurization shock wave (C-4, Semtex, nitroglycerin, dynamite, ammonium nitrate, and trinitrotoluene).
What gives most primary injury.
Secondary Blast Injuries are what?
(shrapnel) – lacerations, fractures, and penetrating injuries, debris
Tertiary blast injuries are what?
(body strikes stationary object) – falls. look at which body part hit first, can have blunt trauma to area and decelerating injuries
Many of the systems that are effected are the abdominal, CNS, and musculoskeletal system.
Quaternary blast injuries are from what?
delayed injuries from chemical, biological, or radiation exposure
These injuries are not always associated with primary, secondary, and tertiary blast injuries. They can be, but these injuries can include radiation injury, burn injuries (inhalation as well), internal brain injury, asthma, COPD. They are injuries that can exacerbation or complication from any existing condition.
what is a low penetrating trauma injury?
Knives, needles, ice picks, falling onto rebar or fence post.
what is a medium penetrating trauma injury?
hand guns
what is a high penetrating trauma injury?
hunting rifles and military rifles.
should you backboard a GSW?
No, it increases mortality
Trauma immediate deaths are what time frame and what injuries?
- minutes to 1 hour
- head, chest, and abdomen
- 50% of trauma deaths
Early trauma deaths are from what time frame?
- w/in first 4 hours
- 30% of trauma deaths
Late trauma deaths are from what time frame, and from what?
- weeks after initial injury.
- Death from: MODS (Multiple Organ Dysfunction Syndrome), respiratory failure, and infection
- 20% of trauma deaths
What is one of the first signs of Hypovolemic Shock?
Tachycardia
what are the two most common causes of hypovolemic shock?
dehydration and hemorrhage
There are how many classes of hypovolemic shock?
4
what is the criteria for hypovolemic shock class 1
Blood loss (up to 15%) Pulse Rate (Normal) Pulse Pressure (Normal) BP (Normal) Mental Status (slightly anxious)
Overall: mild findings and no change in vital signs
what is the criteria for hypovolemic shock class 2
Blood loss (15-30%) Pulse Rate (Tachy: 100-120 bpm) Pulse Pressure (decreased) BP (Normal) Mental Status (slightly anxious)
Overall: See an increase in the heart rate (this should trigger you to think they are going into shock) if their heart is fast you have to think why?
What is the criteria for hypovolemic shock class 3
Blood loss (30-40%) Pulse Rate (tachycardia 120-140 bpm) Pulse Pressure (decrease) BP (decrease) Mental Status (anxious and confused)
Overall: This is where the BP is now dropping, you will see a higher degree of tachycardia to compensate the drop, but if these two are your findings this is where you want to catch and stop it.
What is the criteria for hypovolemic shock stage 4
Blood loss (> 40%) Pulse Rate (>140bpm) Pulse Pressure (decrease) BP (decreased) Mental Status (confused and lethargic)
Overall: This is where the mental status will be your biggest finding to see how far they have compensated. Your BP and HR will both be bad, but if your pt is very altered, they are beginning to decomp and go to irreversible.
What are some signs you will see with cardiogenic shock?
- hypotension
- heart rate can be either normal, Brady, tachy
- narrowed pulse pressure (diastolic falls away, the
what supplies the facial artery?
External Carotid Artery
What is the most common cause of ear canal obstruction?
Cerumen
how many bones in the eye?
7
What is best treatment for chemical in the eye?
Flush (can use the Morgan lens to do continuous flushing)
What is hyphema?
rupture of blood vessels in the iris causing bleeding in anterior chamber.
comes from trauma to the eye (the globe of the eye)
what is the treatment for a pt that has a retinal detachment?
Cover both eyes, and position of comfort.
What are some common injuries that can be seen with Ear Trauma?
- Blunt Trauma
- Penetrating Trauma
- Blast Injuries
- Pressure injuries (diving)
what zone of the neck has the highest mortality rate?
Zone 1
- contains carotid and vertebral arteries, subclavian veins, brachiocephalic vein, jugular veins, aortic arch, lungs, trachea, esophagus.
what sides make up the triad of death?
- Coagulopathy
- Acidosis
- Hypothermia
what is primary brain injury?
refers to direct trauma to the brain.
What is secondary brain injury?
results from intracellular or extracellular derangements that were either initiated at the time of injury or result from consequence of the initial injury.
Diffuse brain injuries are what?
(caused by the acceleration or deceleration forces.)
coup and counter coup, diffuse axonal injury (shearing of the axon).
What is a concussion?
its a mild Diffuse axonal injury.
mild impact of brain to skull.
what is retrograde amnesia?
not remembering event before event
what is antegrade amnesia
not able to create new memories post event.
define perseveration
repetition of verbal or motor. this is commonly seen with people who have brain injury.
cerebral contusion
bruising of the brain. often area of the cortex, frontal, temporal, or occipital lobes.
coup vs contrecoup (define)
coup is the side of impact, contrecoup is the opposing side.
cerebral perfusion pressure (CPP) is a measure of what?
determined by MAP-ICP
amount of pressure needed to get to the brain to perfuse the brain.
when you compress cranial nerve 3, what should be some findings?
blown pupils
non reactive to light
(oculomotor cranial nerve)
what is style of breathing you can see with brain injuries or brain bleeds?
cheyne-stokes breathing
what is decorticate posturing?
arms and hands are flexed toward the body (toward the cor, deCORticate)
what is decerebrate posturing?
arms and hands are straight to the side of the body.
if you have decorticate or decerebrate posturing and abnormal breathing, what is that an indicative sign of?
herniation of the the brainstem.
where is the dura mater?
the lining around the brain.
where is epidural hematoma?
it is a bleed outside the dura mater (epi-outside of)
the bleed is pushing the dura mater, its between dura mater and the skull.
where is a subdural bleed?
Below (inside of) the dura mater and the brain (arachnoid mater)
what is a normal range for CPP
70-80 mmHg
what is the minimum number for the CPP?
60, minimum to perfuse the brain.
what is the normal range for the MAP?
85-95 mmHg
If they are hemorrhagic shock, we want to keep it around 60-65.
what is the normal range for ICP?
10-15 mm Hg
What is subarachnoid Hemorrhage
The bleeding within the brain (the arachnoid material)
Do we want to give fluid to a pt that has a head bleed?
No, in the absence of hypotension, we want to limit the amount of fluid to reduce the amount of cerebral edema.
what does the Glasgow Coma Scale measure?
- eye opening
- verbal
- motor responses
This is a good indication of the pt clinical outcome with brainstem reflex and any neurologic function.
how many points on the GCS scale do you get for EYE.
4
- spontaneous
- verbal
- pain
- none
How many points on the GCS do you get for VERBAL
5
- oriented conversation
- disoriented conversation
- nonsensical speech
- noises (no speech)
- None
How many points for the motor in the GCS?
6
- follows commands
- localizes pain
- withdraw to pain
- abnormal flexion
- abnormal extension
- none
how many cervical sections are there?
7
how many thoracic spinal sections are there?
12
how many lumbar spinal sections are there?
5
how many sacral (fused) sections are there?
5
how many coccygeal (fused) sections are there?
4
what two vertebrae have no vertebral body (to support the weight of the vertebrae)
C1 and C2
what are three things you can do to clear someone with spinal injury?
1) NEED TO BE RELIABLE. (AAO x4) - need to be SOBER, no anxiety, no distracting injury.
2) Clear Hx. No spine pain, no numbness or tingling, no sensation of electrical shooting pain.
3) Clear Physical Exam- No spinal tenderness, intact motor, and sensory skills.
where do spinal nerves end (what vertebrae?)
L2
what vertebrae hold part of the spinal cord that support the diaphragm?
C3,4,5 keep the diaphragm alive.
what vertebrae support the neck?
C1, C2, C3
What vertebrae control shoulder, biceps, tricep, wrist, and hand function?
Between C4-C8
What vertebrae control chest muscles?
T1-T7
what vertebrae control abdominal muscles?
T7-T12
What vertebrae control Leg muscles?
L1-L5
what vertebrae control bladder and bowel control?
S1-S3
what vertebrae control sexual function?
S3-S5
what is the biggest difference with a spinal cord injury vs a musculoskeletal injury?
spinal cord injury will cause loss of motor and sensory skills (keep pulses and good circulation)
Musculoskeletal will have loss of pulses, sensation, and movement. Starting at the site and moving distally.
with a pregnant woman who has a spinal injury, what is better to do?
don’t immobilize supine, tilt to her left side.
what is axial loading?
when there is force going straight down (vertical compression) of the spine. Force is sent down the length of the spine.
Injury can come from striking head on the windshield of the car. Shallow dives.
what is a distraction spinal injury?
occur if the cervical spine is stopped suddenly while the weight and momentum of the body pull away from it.
Opposite of axial, think of a hanging.
why is it so important to protect any spinal injury?
The damage is often irreversible. Neurons do not regenerate the same as other tissue, making preservation #1 goal.
Does hyperventilation increase or decrease your vascular resistance?
increase. Makes you vasoconstrictor.
What type of shock is neurogenic?
distributive
what is the treatment for distributive shock?
fluid
what is the line of demarcation?
its the line that divides where the spinal cord injury is.
what type of shock is sepsis?
distributive
what causes your body to go into shock with sepsis?
its the infection in the blood stream and it not knowing how to handle the systemic infection, it has a histamine response, vasodilation.
how much fluid do you give for sepsis?
30ml/kg
what is more deadly, blunt trauma or penetrating injuries? why?
blunt
- effect more than one system, and they will tend to be a multi systems trauma.
is subdural Venus or arterial bleed?
venus (slow), most common
what are problems with excess fluid administration in a hemorrhagic shock?
- increase in BP will wash out the clots
- dilute the clotting factors
- hypothermia- decrease the clotting cascade and O2 dissociation curve.
- Body is loosing the clotting factors, and the ability to carry O2.
- increase the pressure will trick the body into thinking the pressure is ok. (delay the compensatory mechanisms.)
what makes up the trauma triad of death?
- coagulopathy
- hypothermia
- acidosis
what is a myotome?
its a region of the muscle that is intreated by a spinal nerve innervates.
what is a dermatome?
its the region of the skin that is effected by a spinal nerve innervates.
what dermatome is at nipple line?
T4
what dermatome is at belly button line?
T10
what does acids do to the heart?
it will lower the inotropic effect.
what is associated with a up and over injury?
- head hits the windshield
- C-spine injury
- chest and abdominal injury
fx ribs, pulmonary contusion, heart contusion, - shearing of great vessels
what is a cord concussion?
transient neuro deficit but no structural damage.
what is cord contusion?
soft tissue bruising to the cord.
at what level will a complete cord transection give you quadriplegia (tetraplegia)?
Above T1
at what level will a complete cord transection give you paraplegia?
Below T1
what is autonomic dysreflexia syndrome?
- SNS below injury site
- PNS above injury site.
what is the earliest sign of internal bleeding?
- cold and clammy
- restless
- tachycardia
how does CO2 effect ICP?
- when you hyperventilate, you reduce the CO2, resp alkalosis, cerebral blood vessels constrict, decreasing volume going into brain. (lower ICP)
- however lower ICP (not enough blood), no O2 deliver to fuel the brain.
- not practiced.
Upper Brain Stem Injury?
HR: Brady
BP: increase
RR: Cheyne Stokes
Pupils: small and Reactive
Pos: decorticate
middle brain stem injury?
HR: Brady
BP: widening
RR: CNS hyperventilation
Pupils: Sluggish
Pos: decerebrate
what happens with a lower brain stem injury?
HR: erratic
BP: hypotension
RR: ataxic, boots
Pupils: dilated and unreactive
Pos: no response
