TEST 4 Flashcards
Facial/ Head injuries
- Airway compromise
- Watch LOC (changes for worse can mean rise in ICP)
- Nausea/ vomiting
- ALOC
Neck injuries
- Airway compromise
- Breathing compromise (C 3, 4, 5 keep the diaphragm alive)
- Neuro compromise
Chest injuries
- Breathing compromise
- Bleeding compromise
Abdominal injuries
- Bleeding compromise (spleen or liver)
- Sepsis
Pelvic injuries
- Bleeding compromise
Extremities
- Femurs bleeding compromise
- Threat to limb
Back
- Bleeding compromise
- Breathing compromise
- Neuro compromise (priapism)
SXSX of Basilar skull fracture
- Bleeding/ fluid coming from the ears or nose
- Possible ALOC
- Battle signs
- Raccoon eyes
SXSX of Epidural bleed
- Possible loss of consciousness initially then awakens with a lucid interval followed by loss of consciousness
- NO loss of consciousness with a lucid interval followed by loss of consciousness
SXSX of Subdural bleed
- Loss of consciousness or ALOC
- Result of venous bleeding
- Most common type of severe close head injury
SXSX of Intracranial pressure
- ALOC
- Rising blood pressure
- Irregular respirations (Cheyne stokes)
- Bradycardia
- Unequal pupils
- Posturing (decorticate or decerebrate)
Cushing’s triad
- Hypertension with widening pulse pressures
- Bradycardia
- Irregular respirations
Hypovolemic shock
- Fluid issue
- Blood loss (hemorrhagic)
- Burn
Obstructive shock
- Pulmonary embolism
- Tension Pneumothorax
- Pericardial tamponade
Cardiogenic shock
- Pump issue
Distributive shock
- Vessel issue
- Anaphylaxis
- Neurogenic
- Septic
Compensated shock
- Body is trying to correct the cardiac output drop
- Tachycardia
- Tachypnea
- Restless
- Pale, cool, diaphoretic
- GOOD BP
Decompensated shock
-Compensatory mechanisms are no longer able to maintain perfusion and BP
- Tachycardia (120-140)
- Tachypnea
- Altered/ agitated
- Pale, cool, diaphoretic
- POOR BP/ hypotensive
(LAST SIGN TO DROP)
How to control Venous bleeding
- Direct pressure
- Bandage
- Treat for shock
How to control Arterial or any major hemorrhage
- Direct pressure
- Tourniquet
PASG- Pneumatic Antishock Garmet
- Only National Registry
Indications:
Contradictions:
-
Tendon
Attaches muscle to bone
Ligament
Attaches bone to bone
Cartilage
Cushion
Types of fractures
- Greenstick
- Transverse
- Pathological
Greenstick
- Bone bends and cracks, instead of breaking into separate pieces
- Common in children
- “GREEN” like green wood, bends instead of snaps
Transverse
- Breaks straight across the bone
Pathological
Osteoporosis
- Degenerative bone disorder associated with loss of minerals from the bone
- Disease process
- Possible that a bone broke, causing the fall instead instead of the other way around
Sprain
- Injury to MUSCLE or a muscle/ tendon
- Overextension or overstretching
SXSX:
- pain on palpation
- no edema or discoloration
Strain
- Injury to a joint
- Damage or tearing to CONNECTIVE tissue
SXSX:
- immediate pain and swelling
- discoloration after several hours
Dislocation
- Displacement of a bone from it normal position in a joint
Fracture OPEN
- COMPOUND
- break in the skin
Fracture CLOSED
- SIMPLE
- No break in the skin
Impaled objects
Avulsion
- Loose flap of skin
- Partial (still attached) or Complete (unattached)
- If complete, wrap in sterile dressing, put on ice and transport with patient to ER
Abrasion
- Scraping, rubbing, or shearing away of the epidermis
Contusion
- Bruise
- aka Ecchymosis
Laceration
- Regular or irregular break in the skin of varying depth
Hematoma
- Similar to contusion
- Usually involves larger blood vessel
Crepitus
What are the 6 P’s
- Pain
- Pallor
- Pressure
- Pulses
- Paranesthesia
- Paralysis
Tension Pneumothorax
- Compressing heart and other lung
- Shortness of breath
- Absent lung sounds on affected side
- ALOC
- Hypotension
- Tracheal deviation
- Difficult to ventilate (poor ventilatory compliance)
Pulmonary Contusion
- Shortness of breath
- Hypotension
- Altered lung sound
- Clear or diminished lung sounds
- Type of injury is caused by blunt force trauma
Commotio Cordis
- Condition we hear about on TV when a young athlete goes into cardiac arrest after being struck in the chest (Blunt force trauma)
Cardiac Temponade
- Narrowing pulse pressure
- Hypotension
- Pulsus Paradoxus
- Becks triad:
1. Low BP
2. Distension of jugular veins
3. decreased or muffled heart sounds
Cardiac Contusion
- Blunt force trauma to the chest
- Irregular pulse (with no previous history of irregular pulse)
Flail Segment
- Closed chest injur
- 2 or more consecutive ribs broking in 2 or more places
- Paradoxical movement
Penetrating/ Sucking chest wound
- Seal with occlusive dressing
Traumatic Asphyxia
- Result of blunt force trauma to the chest
- See ling of demarcation and petechiae above injury site
GCS- Glasgow coma Scale
- Eye opening (1- 4)
- Verbal response (1-5)
- Motor response (1-6)
GCS rating
- 13-15= MILD
- 9- 12= MODERATE
- 3-8 = SEVERE
How to treat Evisceration
- Control bleeding
-Cover with saline soaked sterile dressing and the cover with occlusive dressings - DO NOT place eviscerated part back into abdomen
General Rules for Splinting
- Check PMS before and after
- Immobilize joint ABOVE and BELOW injury
- Remove/ cut away clothing around injury
- Cover wounds before splinting
- Try to splint before moving patients
- No pulse? try to align the limb (EXCEPT FOR: wrist, elbow, knee, hi, or shoulder)
Causes for shock
- Inadequate blood volume
- Inadequate pump function
- Inadequate vessel tone
Inadequate Volume
- Fluid loss leading to decreased perfusion
- Hemorrhage
- Excessive vomiting/ diarrhea
- Burns
Inadequate Pump Function
- Inability of pump to provide perfusion
- Cardiogenic shock
- Cardiac Tamponade
- Tension Pneumothorax
Inadequate Vessel Tone
- Vasodilation leading to reduced blood pressure
- Anaphylaxis
- Septic shock
- Neurogenic shock
Categories of shock
- Hypovolemic
- Cardiogenic
- Distributive
- Obstructive
Hemorrhagic shock
- Loss of whole blood
- includes not only volume, but oxygen carrying capacities as well
Non- Hemorrhagic shock
- Loss of plasma and water
- Oxygen carrying abilities are still available
-Dehydration/ HX of recent illness - Poor skin turgor
Burn shock
- Non-hemorrhagic
- Damaged capillaries leak plasma into interstitial spaces
- Swelling
- Onset may take hours
Septic shock
- Distributive
- Massive infection leading to wide spread vasodilation
- Skins may be flushed/ hot/ dry
Sepsis SXSX:
- Temp > 100.9 or <96.88
- Heart rate >90 beats pm
- Resp rate >20 breaths pm
- Altered mental status
- Blood sugar <120 mg/dl
Neurogenic shock
- Spinal injury leading to loss of sympathetic vessel tone
- Loss of muscle tone below injury site
- Paralysis
- Priapism
- Hypotension
- Possibly normal skins
- Heart rate may be with in normal limits
Cardiogenic shock
- Pump failure
- Chest pain
- Shortness of breath
- Rales (if CHF)
- Hypotension
- Pale/ cool/ diaphoretic
- Tachycardia
Multiple End Organ Failure
- Aka irreversible shock
- Progressed to where patient outcome is Death
- Unresponsive
- Extreme tachycardia or bradycardia
- Absent peripheral pulses
- May be extremely hypotensive
- Cool, cyanotic skins
Treatments for shock
- Airway/ High flow O2
- Control bleeding
- Maintain body temp/ keep warm
- Supine position
- ALS for non-hemorrhagic types of shock
- Epipen in anaphylaxis
TBI/ ICP SXSX
- Blown pupil on one side
- Weakness or paralysis
- Severe changes in mental status
- Non- purposeful mov’t
- Decorticate
- Decerebrate
- Cheyne- stokes
- Crushing Reflex: high BP, slow pulse, resp pattern
Epidural Hematoma
- Hematoma or bleed between dura mater and skull
- Usually arterial (middle meningeal)
- TBI s/s PLUS lucid intervals of consciousness
Subdural Hematoma
- Intracranial bleed in subdural space (dura and arachnoid)
- Generally venous (bridging veins)
- Mortality rate higher than epidural
