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tissue integrity: trauma Flashcards

1
Q

what does exercise capability depend on and is assessed on?

A

VO2 max (measured in L/min)

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2
Q

what does VO2 max tell us (3)

A
  • circulation capacity (heart and blood)
  • lung capacity
  • oxygen delivery to working muscles and extracted by muscles
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3
Q

neuro involvement with activity and fatigue

A

the CNS command centers and hypothalamus will be triggered. the hypothalamus will then communicate with the brainstem and ultimately the sympathetic nervous system to activate and match the breathing, blood pressure and adrenal glands for hormone secretion. local vasodilatory factors will be stimulated as well in high output organs (due to nitric oxide secretion in coronary circulation, muscles, and the brain) which ultimately cause a cardiac output increase.

*vasoconstriction will take place in the other organs that are not being used at the time

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4
Q

relationship between cardiac output and activity

A

cardiac output increases with activity to match the demand

ex. the skeletal muscle at rest uses 20% of CO, but in exercise 95% of CO is being used

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5
Q

what happens when the cardiac output does not match the demand of the activity

A

we begin to see fatigue

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6
Q

how does cardiac output meet the increased demands in activity

A

cardiac output will naturally be diverted from other organs (ex. GI and GU system) to meet the demands

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7
Q

fast twitch muscle fibers characteristics (4)

A
  • less mitochondria
  • less myoglobin (hemoglobin in the muscles) meaning they have less oxygen reserve
  • utilized in very intense and explosive activities (ex. sprinting)
  • switches to anaerobic activity quickly due to low reserve (low mitochondria and low myoglobin) and decreased capability to form ATP
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8
Q

slow twitch muscle fibers characteristics (3)

A
  • lots of mitochondria
  • lots of myoglobin
  • allows for more energy available for longer durations
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9
Q

where do muscles get energy from

A

from stored ATP and aerobic metabolism using pyruvate (eg. muscle glycogen, fatty acids, creatine phosphate) will yield byproducts of CO2 and water

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10
Q

how are the byproducts CO2 and water secreted

A

CO2 will be exhaled and water will be evaporated via diaphoresis

*evaporation is also a cooling mechanism

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11
Q

with every chemical reaction what occurs

A

heat generation causing a warm/flushed appearance

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12
Q

anaerobic metabolism

A

utilized when the demand for energy is greater than the supply (ex. short bursts of high output, long time exhausts resources). the immediate burning in the muscles is caused by the byproduct lactate

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13
Q

byproduct of anaerobic metabolism

A

lactate

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14
Q

byproduct of aerobic metabolism

A

CO2 and water

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15
Q

difference between lactate and lactic acid

A

to form lactic acid, lactate must combine to hydrogen ion

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16
Q

causes of fatigue (4)

A
  • physiological (inadequate ATP to generate muscle activity)
  • psychologic (inadequate CNS ability to generate activity
  • pathologic (disease, treatment alterations to normal function. ex. heart failure, anemia. renal failure, cancer)
  • unknown (ex. chronic fatigue syndrome)
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17
Q

types of fatigue (2)

A
  • acute (sudden onset, clear cause, rest leads to recovery)
  • chronic (unclear onset and cause, rest does not lead to recovery, accumulates, interferes with ADLs, causes other pathologies ex. depression, anxiety, IBS)
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18
Q

what is fatigue

A

activity intolerance due to exhausted reserves

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19
Q

what else is chronic fatigue syndrome known as (2)

A
  • myalgic encephalomyelitis (ME)

- exertion intolerance disease (SEID)

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20
Q

chronic fatigue syndrome characteristics (3)

A
  • insidious onset (gradual onset, very slow disease manifestations)
  • long duration
  • nonspecific symptomology
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21
Q

etiology of chronic fatigue syndrome

A
  • etiology is unknown
  • hypothesis:an infectious disease postdrome caused by an immune hyperactivity of inflammatory mediators (e.g. cytokines)

*ex. of infections = enteroviruses, coronavirus

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22
Q

signs and symptoms of chronic fatigue syndrome (4)

A
  • chronic fatigue >6months with effect on ADLs
  • post- exercise malaise
  • unrefreshing rest/sleep
  • cognitive or orthostatic effects

*other symptoms may present on health assessment but are not diagnostic due to inability to differentiate from cause and effect (ex. pharyngitis, lymphadenopathy, myalagia, spenomegaly)

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23
Q

treatment for chronic fatigue syndrome (3)

A

Team approach

  • cognitive behavioural therapy (cbt)
  • management of associated pathologies
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24
Q

what does the musculoskeletal system include (3)

A
  • bones
  • cartilage (at articulating surface)
  • soft tissues (in articulations (joints), ligaments (bone-bone connection, attach articulating ends together), tendons (muscle-bone connection; join muscle to bone periosteum), muscle)

*the musculoskeletal system makes up 70% of body mass

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25
Q

causes of fractures at different life stages

A
  • pediatric (sports, falls, bicycle, motor-vehicles) most common fractures are at the clavicle and femur
  • adults (motor-vehicle, motorcycle, sports) most common fractures are at the clavicle, femur, radius and head
  • elderly (falls) most common fractures are hip fractures and spinal disk
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26
Q

acute vs chronic fractures

A
  • acute (sudden force): includes fractures, contusions (soft tissue) and articulation injuries (sprains, strains, dislocations)
  • chronic (caused by overuse): includes stress fractures (no time to heal from acute injury) and tendon strain
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27
Q

fracture signs and symptoms (6)

A
  • severe pain (initial numbness may present due to local shock)
  • inflammation
  • hematoma
  • deformity
  • loss of function
  • injury to surrounding tissues/blood vessels/nerves
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28
Q

types of fractures (3)

A
  • open/compound fracture = skin break
  • compression fracture = 2 bones crushed together
  • impacted fracture = fracture fragments crushed together
  • unstable fractures = oblique, spiral, comminuted (fragmented)
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29
Q

epiphyseal fracture

A
  • seen in children because the epiphyseal plate is present before growth has completed
  • epiphyseal plate is where longitudinal growth occurs and is the weakest part of the bone
  • injury to epiphyseal plate risks no further growth
  • 15% of all childhood fractures involve the epiphyseal plate
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30
Q

types of epiphyseal fractures (5)

A
  • type 1 (through the growth plate)
  • type 2 (through growth plate and metaphysis)
  • type 3 (through growth plate and epiphysis)
  • type 4 (through all three elements)
  • type 5 (crush injury of growth plate)

*types 3-5 impact growth

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31
Q

fracture treatment (6)

A
  • pain management
  • inflammation management
  • immobilization
  • reduction if applicable
  • complications management
  • restoration of function
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32
Q

medications for fractures (3)

A
  • analgesics
  • antiinflammatories
  • anesthesia (local, nerve block, spinal, general)
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33
Q

nerve block used in hip fracture

A

ex. elderly patient does not qualify for general anesthetics, nerve block will be beneficial to the patient

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34
Q

what is reduction

A

restoration of alignment

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35
Q

reduction of a closed fracture (2)

A
  • external traction (pulls into place)
    • two types of external traction:
      manual (pulling)
      skeletal (via inserted
      pins/wires)
  • external fixation (stabilizes)
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36
Q

reduction of an open fracture (2)

A
  • surgical reduction

- internal fixation

37
Q

what is the goal of immobilization

A

maintain alignment

38
Q

methods of immobilization (5)

A
  • fixation
  • traction
  • spint
  • cast
  • brace
39
Q

methods of restoration of function (3)

A
  • rehabilitation exercises
  • physiotherapy
  • occupational therapy
40
Q

how do synovial joints heal

A

synovial joints (movable part of joints) have a good blood and nerve supply, as synovial membranes will be frequently injured, they heal well

41
Q

what is bursitis

A

inflammation of the bursae (synovial fluid sacs)

42
Q

how do bones heal

A

bones heal well as they have an excellent blood and nerve supply

43
Q

how do meniscus heal

A

as the meniscus is made of fibrocartilage, they have a slow healing rate

44
Q

how do tendons (muscle to bone) and ligaments (bone to bone) heal

A
  • tendons and ligaments are made out of collagen
    (fibrous protein structures) with a very low blood supply
  • slow healing due to the fact that they rely on diffusion from surrounding tissues
45
Q

normal healing times (2)

A
  • up to 6 months (long bones, small adhesion surface area = complex)
  • up to 4 weeks (stress fractures)
46
Q

complications with fractures (8)

A
  • vascular damage (bleeding, hypovolemic shock)
  • infection
  • associated injuries (ex. pneumothorax, brain injury)
  • fat embolism syndrome (FES)
  • thromboembolism
  • compartment syndrome
  • complex regional pain syndrome (CRPS)
  • Fracture blisters
47
Q

what is traumatic tension pneumothorax

A

injury to the chest wall which causes air to enter the pleural space but not exit it

=> increase in pressure within the pleural space, compresses the lungs, causes lung collapse => risk of hypoxemia (signs and symptoms can include cyanosis)

=> compresses the myocardium, affecting CO => risk of cardiogenic shock

48
Q

signs and symptoms of traumatic tension pneumothorax (4)

A
  • shortness of breath
  • declining O2 sats
  • tracheal shift
  • signs of cardiogenic shock
49
Q

treatment of traumatic tension pneumothorax (3)

A
  • oxygen
  • one way valve seal
  • chest tube
50
Q

what is pneumothorax

A

air in the pleural space

  • caused by a traumatic event, spontaneous
51
Q

what is hemothorax

A

blood in the pleural space

  • caused by bleeding (hemorrhaging)
  • risk of hypovolemia and hypovolemic shock
  • risk of low CO and cardiogenic shock
52
Q

what is fat embolism syndrome (FES)

A

adipose tissue or bone marrow tissue migration into circulation, with diffuse symptomology of interrupted perfusion

53
Q

etiology of fat embolism syndrome (FES)

A

long bone fractures (3 hours to 3 days post injury)

54
Q

signs and symptoms of fat embolism syndrome (FES) (3)

A
  • Pulmonary embolism signs (chest pain, SOB, decreased O2 sats, cyanosis, pallor)
  • CVA signs (changes in LOC (slight at first such as disorientation), seizure)
  • skin rash (diffuse rash over upper body, oral cavity, conjuctiva)
55
Q

treatment of fat embolism syndrome (FES) (3)

A
  • Prevention is best (early stabilization of fractures with reduction, immobilization)
  • O2
  • glucocorticoids
56
Q

Types of thromboembolisms (2)

A
  • DTSs

- PE

57
Q

Causes of thromboembolism

A
  • low mobility with injuries
58
Q

Risk with thromboembolism

A
  • high risk in hip fractures
  • 60% of patients
  • In the past, mortality rates were high
59
Q

Treatment for thromboembolism (prophylaxis) (3)

A
  • anticoagulants (heparin, enoxaparin)
  • Compression stockings and pnematic compression devices
  • Early ambulation
60
Q

Acute compartment syndrome

A
  • high pressure in body compartment due to injury’s inflammatory sequelae causing increase in volume
61
Q

Etiology of acute compartment syndrome

A
  • post injury, occurred often with immobilization devices

- Can occur within hours to days

62
Q

Signs and symptoms of acute compartment syndrome

A
  • Worsening pain
  • Loss of sensation (nerve compression) causing loss of motor function
  • Swelling
  • Loss of reflexes
63
Q

Treatment of acute compartment syndrome

A
  • relieve pressure immediately

- Elevate

64
Q

Complexe regional pain syndrome (CRPS)

A

High pain than injury warrants

65
Q

Signs and symptoms of complexe regional pain syndrome

A
  • pain more extreme than injury
  • Pain characteristics = severe, burning, aching
  • Pain elicited by very low stimulus
  • Psychologic changes to skin (thin, shiny, eczema) and tissue (muscle wasting)
66
Q

Etiology of complex pain syndrome

A
  • can be associated with poor analgesia in acute pain

- Occurs weeks post injury

67
Q

Treatment of complex regional pain syndrome

A
  • physiotherapy for mobilization

- Chronic pain treatment (non-opioid, NSAIDs)

68
Q

Other soft tissue injuries

A
  • associated with larger trauma
  • Stand alone injuries
  • Assess for other injuries
69
Q

Laceration

A

Integumentary tearing

70
Q

Concerns associated with lacerations

A
  • infection
  • Soft tissue trauma
  • Nerve trauma
  • Bleeding and blood loss (ex. Meds increasing clotting time, heparin anticoagulant)
71
Q

What to assess with laceration

A
  • size, depth, deformity (contusion)*
72
Q

Treatment of laceration (asepsis)

A
  • Cleansing of wound (irrigation)
  • Decontamination as necessary (débridement, antimicrobials)
  • Prévention (vaccinations) ex. Tetanus
    (Closure)
  • Sutures, staples
  • Drugs: local anesthesia, epinephrine, adjunct post (once numbing subsides)
73
Q

contusion (bruising)

A
  • soft tissue injury
  • Skin intact
  • Local hemorrhage causing bruising (ecchymosis) causing reabsorbed*
  • Large hemorrhage = hematoma
  • Accompanying concepts = pain, inflammation
74
Q

treatment of contusions (3)

A
  • control inflammation (compress with cold immediately to decrease bleeding and inflammation) (post 24 hrs use warm and cold compressions alternating, 10-20 min per each)
  • Aspiration with a needle
  • Drugs: NSAIDs
75
Q

strain

A
  • mechanical overload of a muscle or muscle tendon complex (excessive stress or contraction causing tearing in the fascia, muscle, joint structures)
  • Sports have a high risk of strains
76
Q

Signs and symptoms of strain (3)

A
  • inflammation
  • Pain
  • Increased pain with aggravating activity
77
Q

Common strains (4)

A
  • muscles on the lower back
  • C-spine
  • Joints on the elbow and shoulder
  • Feet
78
Q

What to assess with strains

A
  • further injury (tearing)

- X ray not useful as it only rules out #

79
Q

Treatment for strains (6)

A
  • compresses (cold, cold/warm)
  • Compression of affected area (decrease inflammation, support)
  • Immobilization (splint, cast) if support or further damage prevention is required
  • Drugs (NSAIDs)
  • Rest for weeks
  • Rehabilitation to return to function and do strength exercises
80
Q

How to prevent strains (4)

A
  • posture
  • Exercise mechanics
  • Warm up and cool down
  • Limit overuse
81
Q

sprain

A
  • mechanical overload of a joint which can cause a ligament injury leading to a stretch or tear (complete or incomplete), associated bone injury
82
Q

Signs and symptoms of a sprain (4)

A
  • pain
  • Inflammation
  • Contusion
  • Decreased function
83
Q

Common sprains (4)

A
  • ankle (inversion)
  • Knee (ACL
  • Elbow
  • Wrist
84
Q

Treatment for sprains (7)

A
  • compresses (cold, cold/warm)
  • Compression of affected area (decrease inflammation, support)
  • Immobilization (splint, cast) if support or further damage prevention is required
  • Drugs (NSAIDs)
  • Rest for weeks
  • Rehabilitation to return to function and do strength exercises
  • May require surgery
85
Q

dislocation

A
  • complete joint displacement (incomplete joint displacement = subluxation)
86
Q

causes of dislocation

A
  • direct force (traumatic)
  • Congenital (ex. hip dislocation at birth)
  • Pathologic (d/t joint disease ex. Arthritis)

*repeat dislocations are more likely and easier

87
Q

common ball and socket joints

A
  • shoulder (glenohumeral joint)
88
Q

complications associated with dislocations

A
  • nerve/blood vessel injury
89
Q

treatment

A
  • assess level of injury

- Manual closed reduction

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