Test #2 Flashcards
what ribs are floating?
11 and 12
what do we want to keep the GCS above? SpO2 above? MAP above?
GCS- 9
SpO2- 95%
MAP- 60
for a sucking chest wound hole must be greater than what of the trachea for it to effect the air going into the chest?
1/3 the size of the trachea.
what is a big function of skin?
regulates body temp.
What are the layers of skin?
Epidermis-mostly dead skin, external layer, cells created in the germinativum
Dermis-important stuff, wound healing (nerves, capillary vessels, hair, sweat glands, mast cells, macrophages, neutrophils, etc.)
Subcutaneous layer-where the fat is
what is the big function of the Dermis?
to help with wound healing.
what do the fascia do?
Superficial: connective tissue surrounds subcutaneous fat
Deep fascia: final layer of defense against infection and internal structures; supports underlying anatomy
where does compartment syndrome and crush injuries effect?
Deep Fascia
what are tendons?
connect muscle to muscle and muscle to bone
what allows the muscle to move the bone
what are some health issues that will effect coagulation?
- Hepatitis (liver helps make clotting factors)
- ETOH
- Diabetes
- Age and Anemia
what are high risk wounds?
Bites
- dogs (bad), humans (worse for infection), cat (the worst)
- Foreign bodies (teeth)
- Farm equipment
- Drag and Crush injuries
- Immunocompromised (cancer, HIV, Diabetics, transplants, autoimmune disorders)
Areas of the body that are high risk of infection from a wound?
Areas that have poor circulation.
Biggest one is your feet.
what are the 4 process (4 phases) to wound healing?
- Bleeding (helps bring clotting factors to site and force out bacteria)
- Inflammatory (macrophages and fibroblast go to work)
- proliferative (fibroblast pull wound together)
- Remodeling (formation of scar tissue (80%) as strong as original tissue, or new skin cells)
what is a Keloid Scar?
Excessive accumulation of scar tissue that extends beyond the original wound borders
More common in- darkly pigmented patients, those who have injuries to the ears, upper extremities, lower abdomen, or sternum
Hypertrophic scar-
excess accumulation of scar tissue confined within original wound borders. Raised appearance.
More common in areas of high tissue stress, suck as the flexion creases across joints.
what is a hematoma?
Bruise
- collection of blood under the skin
- can get very big, and can hold almost a L of blood under the skin (they can cut off blood supply and can cause a pt to be in shock)
What is an Abrasion?
outer skin layer damage Little to no bleeding, capillary oozing Painful often contaminated Can be treated like a burn.
what are Lacerations
superficial or deep
linear (straight line) or stellate (jagged)
avulsion
Fascia stays intact, a full thickness skin loss in which the wound edges cannot be approximated . Frequently involves the ear lobes, nose tip, and fingertips. Distal and proximal avulsions. Bleed profusely. Pull as much debris out that you can, then lay it flat.
injection injury
a type of puncture wound that may result in the injection of a gas, liquid, or solid into the body under pressure- Often have life or limb- threatening potential. Usually associated with minimal bleeding. Maintain a high index of suspicion. Consider the composition of the injected substance.
Amputation
Complete or partial loss of a limb secondary to mechanical force. Bleeding is potentially fatal. Care of patient and parts. Select appropriate hospital. Use tourniquets
what do we do with an amputated limb?
Transport limb, but do not delay transport if you cannot find. Dress and bandage, use moist dressing for stump. Wrap amputated limb in moist sterile dressing and seal in plastic bag, kept cool Not Frozen
when a artery is severed what is something you have to keep in mind?
They will retract.
Also they can suck in air.
Crush injuries, what are they?
occur when tissue is compressed by force that damages structural and metabolic function of underlying vasculature, muscle, and cellular structures. Becomes an ischemic injury to the tissue that was effected.
what are some major concerns with crush injuries metabolically?
They become acidic (we are not refusing that tissue)
Rhabdomyolysis usually results in these injuries. – need lots of fluid!
Releases proteins and the kidneys clog up.
release a lot of electrolytes. Can cause major spirally problems.
What is the reperfusion issues with crush injuries?
injury will cause O2 superoxide, which causes more damage to the tissue with the influx of Ca+ into the Mitochondria. H2O, Na+, Ca+ influx into the cells causing swelling and cellular death. – huge wash of acidosis upon relief creating dysrhythmias, metabolic acidosis, etc..
what is the treatment for a crush injury?
Bicarb, IV bolus 1- 1.5L
LOTS of fluids (to dilute the blood and help the kidneys)
Bicarb is to help make blood alkolitic (reduce the acid build up)
how do we fight or treat rhabdo?
Fluids
Compartment Syndrome
Happens within the fascia, and when that is higher than it can contain, it has no where to go, and builds up pressure.
A continuation in the disease spectrum of crush injury. Usually results from compressive forces or blunt trauma to muscle groups confined in tight fibrous sheaths with minimal ability to stretch.
What can cause compartment syndrome?
Elderly falls, cast swelling, burns, electrical injuries, injections, tissue edema, sprains, snake bites, sepsis, and fractures. Muscle fascia will not stretch, resulting in increased pressure.
what are the 6Ps of compartment syndrome?
- Pain that is out of proportion to the injury
- Paresthesia- burning/ prickling sensation
- Paralysis
- Puffiness
- Pallor
- Pulselessness (late or nonexistent sign)
what is Cellulitis?
local infection common in DM or immunosuppressed
Necrotizing faciitis-
typically polymicrobial, will spread
Necrotizing cellulitis-
skin and SQ tissue after recent trauma or surgery
Gangrene-
Life threatening condition, chlostridium infection
Initial presentation of heaviness of effected limb, brawny edema, extreme pain
Herpes (what two types?)
HSV1- mouth
HSV2- genitals
Varicella
viral infection of dermatomes
Hand infections
commonly caused by Staphylococcus, splint in position found
where do you place a tourniquet?
At least 1.5” wide, reduces trauma to vasculature.
Can be challenging to cut flow completely when there are two long bones involved (tib/fib or rad/ulna) vs. one (humerus, femur).
who is more likely to be effected by burns (men or female)
female (less surface area)
what is the frequency in order of burns and most commonly seen.
Scald/ flame
Contact
Chemical
Electrical – High voltage > 1000 volts, significant cutaneous injuries and internal injuries. Low voltage < 1000 volts
High Risk – Infant and elderly
what is considered high voltage?
> 1000 volts
<1000 volts (low voltage)
what are the zones for burns?
- Zone of coagulation
- zone of stasis (ischemia)
- zone of hyperemia
Zone of Coagulation
Skin is dead, necrosis in days
Area of direct contact with source
Devoid of blood flow
If tissue is not removed, leads to sepsis
Zone of Stasis (ischemia)
Weak blood supply
Greatest risk for necrosis if perfusion is untimely
>2hrs, full thickness injury
Goal of fluid resuscitation preserving zone of stasis
Zone of hyperemia
Salvageable
Hyperemia (excess blood)
Blanches when touched, redness, swelling