Test #2 Flashcards

1
Q

what ribs are floating?

A

11 and 12

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what do we want to keep the GCS above? SpO2 above? MAP above?

A

GCS- 9
SpO2- 95%
MAP- 60

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

for a sucking chest wound hole must be greater than what of the trachea for it to effect the air going into the chest?

A

1/3 the size of the trachea.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what is a big function of skin?

A

regulates body temp.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the layers of skin?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is the big function of the Dermis?

A

to help with wound healing.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what do the fascia do?

A

Superficial: connective tissue surrounds subcutaneous fat

Deep fascia: final layer of defense against infection and internal structures; supports underlying anatomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

where does compartment syndrome and crush injuries effect?

A

Deep Fascia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what are tendons?

A

connect muscle to muscle and muscle to bone

what allows the muscle to move the bone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what are some health issues that will effect coagulation?

A
  • Hepatitis (liver helps make clotting factors)
  • ETOH
  • Diabetes
  • Age and Anemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what are high risk wounds?

A

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)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Areas of the body that are high risk of infection from a wound?

A

Areas that have poor circulation.

Biggest one is your feet.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what are the 4 process (4 phases) to wound healing?

A
  • 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)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is a Keloid Scar?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Hypertrophic scar-

A

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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what is a hematoma?

A

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)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is an Abrasion?

A
outer skin layer damage
Little to no bleeding, capillary oozing
Painful
often contaminated
Can be treated like a burn.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what are Lacerations

A

superficial or deep

linear (straight line) or stellate (jagged)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

avulsion

A

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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

injection injury

A

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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Amputation

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what do we do with an amputated limb?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

when a artery is severed what is something you have to keep in mind?

A

They will retract.

Also they can suck in air.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Crush injuries, what are they?

A

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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what are some major concerns with crush injuries metabolically?

A

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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the reperfusion issues with crush injuries?

A

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..

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

what is the treatment for a crush injury?

A

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 well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

how do we fight or treat rhabdo?

A

Fluids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Compartment Syndrome

A

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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What can cause compartment syndrome?

A

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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

what are the 6Ps of compartment syndrome?

A
  • Pain that is out of proportion to the injury
  • Paresthesia- burning/ prickling sensation
  • Paralysis
  • Puffiness
  • Pallor
  • Pulselessness (late or nonexistent sign)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

what is Cellulitis?

A

local infection common in DM or immunosuppressed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Necrotizing faciitis-

A

typically polymicrobial, will spread

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Necrotizing cellulitis-

A

skin and SQ tissue after recent trauma or surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Gangrene-

A

Life threatening condition, chlostridium infection

Initial presentation of heaviness of effected limb, brawny edema, extreme pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Herpes (what two types?)

A

HSV1- mouth

HSV2- genitals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Varicella

A

viral infection of dermatomes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Hand infections

A

commonly caused by Staphylococcus, splint in position found

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

where do you place a tourniquet?

A

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).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

who is more likely to be effected by burns (men or female)

A

female (less surface area)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

what is the frequency in order of burns and most commonly seen.

A

Scald/ flame
Contact
Chemical
Electrical – High voltage > 1000 volts, significant cutaneous injuries and internal injuries. Low voltage < 1000 volts

High Risk – Infant and elderly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

what is considered high voltage?

A

> 1000 volts

<1000 volts (low voltage)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

what are the zones for burns?

A
  • Zone of coagulation
  • zone of stasis (ischemia)
  • zone of hyperemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Zone of Coagulation

A

Skin is dead, necrosis in days
Area of direct contact with source
Devoid of blood flow
If tissue is not removed, leads to sepsis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Zone of Stasis (ischemia)

A

Weak blood supply
Greatest risk for necrosis if perfusion is untimely
>2hrs, full thickness injury
Goal of fluid resuscitation preserving zone of stasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Zone of hyperemia

A

Salvageable
Hyperemia (excess blood)
Blanches when touched, redness, swelling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

how many degrees of burns are there?

A

4

48
Q

1st degree-superficial

A

Sunburn like
Very painful
Dehydrated
Epidermis damage

49
Q

2nd degree-partial thickness

A

Most painful
Will form blisters
Down to dermis-hair follicles, sweat glands, nerves

50
Q

3rd degree-full thickness

A

Burned to the subcutaneous tissue and possibly muscle
Skin is falling off
Open capillary bleeding
Nerve endings have been burned off
Little pain…. area around burned area is painful (lower degree)
Seen in structure fires

(painless, no nerve endings, around the burn is painful)

51
Q

4th degree

A

You be dead homie

Burned down to the bone

52
Q

Partial Thickness in Minor Burn %

A

<15% of total body surface area in adults

<10% in children and elderly

53
Q

Full thickness burn for minor burns

A

<2%

-think ember fall on skin, more then 2% is major burn

54
Q

Moderate Burn %’s

A

Partial- 15%-25% adults
Partial 10-20% in children over 10yrs

Full 2%-10% not involving area of function (eyes, hands, feet, or perineum)

Does not include high voltage (>1000 volts)

No inhalation injury trauma,

Not in high risk individuals (infants and elderly (over 60))

For treatment, best to round up, hard to categorize a moderate burn.

55
Q

Severe Burn %

A

Partial > 25% in adults
>10% TBSA in children < 10 y/o and elderly > 50 y/o

Full >10%

Involves area of function

Caustic chemicals

High voltage electrical injury

Complicated by inhalation injury

Complicated by trauma

56
Q

If a pt automatically have an inhalation burn what severity will they have?

A

Severe!!

57
Q

what is the most common death in burns?

A

Organ failure

58
Q

what are other causes of death with burns?

A
  • pneumonia
  • burn shock
  • pulmonary failure
  • sepsis
  • cardiovascular failure
59
Q

what is our #1 goal with inhalation burn?

A

Airway

60
Q

If you can’t intubate yet with an inhalation burn, what can we give them?

A

O2 with neb saline

61
Q

When do we give a cyanokit?

A
  • when in an enclosed space structure fire

- low BP

62
Q

With burn treatment what do we want to consider?

A
  • hypothermia
  • Coagulopathy
  • acidosis

Keep them warm and keep them from burning

use sterile dressing

63
Q

what is the patients palm in % of total burn?

A

1%

64
Q

what can giving too much fluid to a burn pt do?

A

it can create compartment syndrome. (abdominal)

65
Q

what is burn shock?

A

Its distributive shock

Its comparable to septic shock, difference is that there is a lot of leaking.

we want to give fluid, but be very careful with how much to not create edema.

66
Q

what types of fluids are better?

A

colloids (larger solute) to pull fluid back into the vascular system.

67
Q

What is myocardial depressant factor?

A

an enzyme that says the heart can slow down.

The release of Cytokines also have an effect on the heart. A cytokine called Myocardial Depressant Factor, causes the heart to lose its contractility.

68
Q

what is Parkland Formula

A

4ml x kg x BSA (body surface area)

it is given over the next 24 hrs

1/2 over 1st 8 hrs
1/2 over last 16 hrs

69
Q

what is the mortality rate of a burn inhalation pt?

A

30%

70
Q

what makes up the burn center criteria:

A
  • > 10% TBSA
  • face, hands, feet, genitalia, perineum , major joints
  • 3rd degree
  • electrical burns
  • chemical burns
  • inhalation injury
71
Q

what do ligaments do?

A

connect bone to bone

don’t have good blood supple.

72
Q

what do tendons do?

A

they connect muscle to muscle or bone to muscle.

They have better blood supply

73
Q

what is osteoporosis?

A

porous bone

74
Q

what is an indirect injury (skeletal)?

A

occurs away from the point of impact

impact sends wave of energy though the body

75
Q

what is the definition of a fx?

A

breaks in the cortex of the bone

76
Q

what type of fx can you have?

A

open

closed (bleeding control included)

77
Q

what is a sprains?

A

ligaments

  • stretched beyond normal range of motion
  • tearing
78
Q

what are strains?

A

Tendons

- damage to muscles

79
Q

what is one assessment to do with every orthopedic injury?

A

check for distal pulses and blood supply

80
Q

what does RICE stand for in muscle skeletal injuries?

A

Rest
Ice
Compress
Elevate

81
Q

What is traumatic asphyxia?

A

crush injury to the upper torso or epigastrium.

deep purple color of the head and neck. v

puts pressure on the heart and superior vena cava, causing an increase of pressure to head.

82
Q

What is subcutaneous Emphysema?

A

presence of air in the soft tissue space.

83
Q

what is pulmonary contusion?

A

bruise on the lungs

can cause resp distress and dec. oxygenation due to build up of blood on the lung tissue destroys the capillary bed and blood will go into the alveoli.

major S/S: hemoptysis, dec in pulse ox, capno will most likely go down (shallow and fast breathing), crackles in area of injury

84
Q

who should you not do a needle decompression on?

A

someone that is NOT hypotensive.

85
Q

where do you needle decompress? (what are the land marks)

A

mid clavicular (between the 2nd and 3rd rib)

mid axillary between 4th and 5th rib.

86
Q

what is tracheobronchial injury?

A

when there is blunt or penetrating injuries to the respiratory tree.

SS: could have subq air in the neck.

87
Q

what will have JVD? Tension Pneumothorax or hemothorax?

A

Tension pneumothorax (there is pressure on the major vessels as well as the heart, causing back up of blood)

88
Q

what is pericardial tamponade.

A

fluid that is built up around the heart.

impedes the cardiac filling and CO, dropping the systolic (less force)

89
Q

what is pulses paradoxus?

A

a drop in systolic BP of more than 10 mmHg during inspiration. (good indication of cardiac tamponade)

90
Q

becks triad?

A

hypotension (usually tachycardia), JVD, muffled heart tones

indicative of pericardial tamponade

91
Q

what can happen with a diaphragm rupture?

A

Stomach and intestines can enter the thoracic cavity.

Best to get an advance airway to eliminate air going into the stomach.

92
Q

what are eviscerated organs?

A

when the organ is on the outside of the abdominal cavity.

Pt can become hypothermic

cover in a wet sterol dressing then a dry sterol dressing

93
Q

Exsanguinate

A

To bleed out

94
Q

Vesicants

A

chemicals that destroy tissue through BLISTERING

ex: mustard gas

95
Q

Organic chemical burns

A

primarily carbon atoms

ex: paint strippers, paints, wax

96
Q

when will chemical burn stop?

A

they will continue to burn until they are neutralized.

Alkolotic burns can be some of the worse burns. (need an acid to neutralize them)

97
Q

what is considered low voltage?

A

1000 V or less.

98
Q

word for nerve pain?

A

neuralgia

99
Q

what are the 4 criteria to go to a burn center?

A

1) partial thickness burn >10%
2) Burns to face, hands, feet, genitalia, perineum or major joints
3) Third degree burns
4) Chemical, electrical, or inhalation injuries

100
Q

what is bioburden?

A

If not going to surgery right away need to cover wound w/ antimicrobial agent b/c wound accumulates bacteria

101
Q

epiphyseal plate ?

A

(growth plates)

102
Q

Grade 1 sprain?

A

least serious (most common)

103
Q

Grade 2 sprain?

A

ligament partially torn

104
Q

Grade 3 sprain?

A

complete tear of ligament.

105
Q

Volkmann Contracture

A

permanent shortening of the forearm muscle resulting in deformity of hand, fingers, and wrist

106
Q

what does wound healing require to have proper healing?

A

good blood flow and ability to have proper dilation to allow the immune cells into the cell to heal.

107
Q

health causes that may limit wound healing?-

A
  • diabetes
  • atherosclerosis
  • prolonged compression (cast)
  • infections (other pathogens are competing for O2)
  • swelling
108
Q

folliculitis

A

infection of the hair follicle

109
Q

furuncles

A

boils (zit looking)

110
Q

carbuncles

A

several furuncles

111
Q

burn zone of coagulation?

A

full thickness burn (central area) void of blood flow (not salvageable)

112
Q

burn zone of stasis (ischemia)

A

outside zone of the zone of coagulation. blood supply is weak, greatest risk of necrosis if perfusion not restored.

113
Q

burn zone of hyperemia?

A

outermost layer that will likely remain well perfused.

114
Q

according to the parkland formula, how many mL of fluid should be administered in a burn pt?

A

4ml/kg

115
Q

what % of fluid is administered with in the first 8 hours in the parkland formula?

A

50%

116
Q

What % of fluid is administered in the last 16 hours of the parkland formula?

A

50%