Trauma Flashcards
How much should you ventilate a pt who has signs of cerebral herniation?
20 breaths per min
What nerves originate in the thoracic spine?
sympathetic nerves
Injury of the sympathetic nerves in the thoracic spine inhibit the release of?
epinephrine and norepinphrine
A deep partial thickness burn damages what layer of the dermis?
basal layer of the dermis
What characteristics are associated with partial deep thickness burns?
edema, blisters and decreased sensation
Three types of Distrubutive Shock
Sepsis, Anaphylactis, neurogenc
How do you treat severe oropharyngeal bleed?
suction the airway for 15 seconds and ventilate for 2 minutes, then continue the alternating pattern until clear or until secured with an ET tube
Can you give pt with severe epistaxis, oxymetazoline hydrochloride or phenylephrine hydrochloride to stimulate the alpha adrenergic receptors causing localized vasoconstriction.
yes
What happens if pressure from injury to the face causes the retina out of the eye?
Irreparable damage or blindness
How do you remove rust and metal from an eye?
They require removal from a physcian
What is hyphema?
Bright red bleeding into the anterior chamber of the eye that obscures vision
Symptoms of retinal detachment, separation of the inner layers of the retina from the choroid
flashing lights, specks, “floaters”, cloud or shade over the pt’s vision
What eye injury is common in pt older than 50 years and is usually caused by thrombosis?
central retina vein occlusion which can cause necrosis of the retina and permanent damage to vision
Signs and symptoms to of acid burn to the eyes
cornea will appear white and opaque, loss in vision, facial skin burns
Alkalis is most commonly found in _________?
dry cleaner, lye, concrete
What do alkaline burns to the eyes cause?
liquefactive necrosis, scarring of the cornea leading to permanent vision loss
How do you treat chemical burns to the eye?
flush the eye with water or sterile saline solution
what is conjunctivitis?
Eye becomes red, inflamed and produces tears
What can cause superficial burns to the eyes?
UV rays from welding and sunlamp, snow blindness
Double vision usually points to trauma involved in what?
extraocular muscles and fracture of the orbit
what is dysconjugate gaze?
paralysis of gaze, or discoordination between the movement of the two eyes
Can an abrasion to the eye be more painful when exposed to the air?
yes
What topical anesthetic can relieve symptoms of corneal abrasion?
tetracaine
What is sympathetic eye movement
the movement of both eyes in unison
What should you avoid with injury to the globe of the eye?
Exert pressure or manipulate the globe
What should you do if part of the globe is exposed?
gently apply moist, sterile dressing
If you suspect hypema or rupture of the globe, you should take what kind of precautions?
spinal motion restriction
What is one thing you can do to decrease intraocular pressure?
elevate the pt head 40 Hdegrees and avoid activities that may increase pressure, like coughing
How do you treat an avulsed eye globe?
Cover the eye with moist, sterile dressing and stabalize both eyes, place in supine position to avoid eye fluid loss, transport
For folks who have trouble keeping their eyes open while irrigating, what medication can you administer to anesthetize the eye?
tetracaine hydrochloride
How do you treat for burns of the eye?
cover eyes with sterile, moist pad and eye shield, lay supine
How do you treat chemical burns of the eye?
Irrigate immediately with water or saline only
Should you remove a pt’s eye contacts if you suspect eye injury?
no
What is the only indication for removing contact lenses?
chemical burns to the eye
How long should you irrigate the eye for alkali or strong acid burns?
20 minutes
what should you do if you encounter an eye injury from the use of anhydrous ammonia (used while cooking meth)?
irrigate promptly
The carilaginous pinna is complicated by what due to it’s poor blood supply?
infection
How do you handle an avulsed tooth?
only touch the crown of the tooth, rinse tooth in saline or milk, don’t let the tooth dry
Injuries to what zone of the neck have the highest mortality rate?
Zone 1 ( cricoid and clavicle)
What is a special danger associated with open neck injuries where the jugular veins are exposed and air is sucked in during inhalation?
venous air embolism
Signs of neurogenic shock
hypotension, normal or slow pulse rate, warm and dry
what is mediastinitis?
inflammation of the mediastinum due to leakage of gastric content into the thoracic cavity
A pt may still be able to use their diaphragm but lose control of their intercostal muscles if the spinal cord is damaged ?
below C5
UNequal pupils is a result of pressure against on what structures?
ocular motor nerve
During a refractory period, what happens to the cardiac cell?
It is unable to be stimulated
What are high levels of carbon dioxide in the blood called?
hypercapnia
What are sprains?
stretching or tearing of ligaments
What is a strain?
stretching or tearing of a muscle or tendon
When applying a backboard, scoop stretcher, vaccuum mattress it is essential to do what?
check CSM’s
Open fractures have a high or low risk of compartment syndrome?
high
What do mast cells release as part of the body’s response in the early stages of inflammation?
histamine
What does histamine cause?
Dilation of blood vessels, increasing blood flow, redding, warmth in the area, swelling
What is epithelialization?
a new layer of epithelial cells being built in this region
How do you treat degloving injuries, unraveling of the skin from the hand?
irrigate and
What does occult mean?
hidden
What type of injuries have a high risk of neurovascular compromise bc of the ulnar nerve’s and brachial artery location?
elbow injuries
Order for tourniquet
direct pressure, elevate, tournequet
What is an incision?
a clean linear cut
What is a laceration?
a jagged wound that tears the tissue
What is the most common injury associated with improper lifting techniques?
lumbar
Signs and symptoms of shock
increased HR, increased RR, hypotension
Referred left shoulder pain is caused by?
diaphragmatic irritation
Difficulty seeing with a dark curtain blocking the vision
What is a potential life-threatening complication of a long bone?
pulmonary embolism
-fat embolis
Cushing’s Triad
bradycardia, irregular breath sounds, widening pulses, hypertension
What is the disruption in the balance of procoagulants inhibitors thrombosis formation and lysis following a traumatic injury
disseminated intravascular coauglopathy
Should a pt be taken to a Level 1 Trauma center is the pt has a GCS of 6 or less?
yes
What type of penetrating trauma classifies for trauma level 1?
head, neck, torso, extremities proximal to the elbow or knee
What respiratory rate classifies as level 1 trauma?
respiratory rate of less than 10 or greater than 29 breaths/min
What systolic BP classifies as level 1 trauma?
70mm Hg for pt 0-9
90mm Hg for 10-64
110mm Hg for 65 yrs and older
For high risk MVC, intrusion of what amount qualifies as trauma center?
12 inches for driver
18 inches for passenger/others
What are the contraindications for aeromedical transport?
traumatic cardiac arrest, weather, obese, barotrauma
Compression against the seat belt in an MVC may result in what?
ruptured bowl, bladder rupture, diaphragm tearing, spinal injuries
What are the two major blood vessels in the abdomen?
Inferior vena cava and abdominal aorta
What injuries can happen in a down and under pathway in an MVC?
fractured pelvis, femurs, hip dislocations, tibia fractures, spinal injuries
Assume that pediatrics who follow the down and under pathway in an MCV have what?
pulmonary and cardiovascular injuries
What often kills young patients in pedestrain vs driver?
TBI
Lumbar spine axial loading results in what?
vertebral compression and burst fractures of T12-L1 and L2
The vasomotor center of the medulla onblongata helps regulate what?
BP
An artery that is incised across or transverse will often do what?
recoil
What is the typical blood volume of an adult?
10 pints/5 L
A femur fracture may result in a loss of how much blood?
2 pints/ 1 L
What is a significant amount of blood loss for an infant>
3-6 ounces, 100-200mL
What amount of blood loss in an adults causes signficant changes in vital signs, increase heart rate, decrease BP and increase respirations?
2 pints (1L)
Bleeding tends to stop on it’s in own within how many minutes?
10 minutes
What are the steps of Hemostatis?
vasocrontriction, platlet aggregation, fibrin weaving into the clot
What is hemophilia?
the lack of one or more clotting factors where bleeding may occur spontaneously
What is the trauma triangle of death?
hypothermia, coagulapathy, acidosis
What is coagilopathy?
distruption of the blood’s ability to clot
Hypoperfusion causes the cells to rely on what type of metabolism?
anerobic metabolism which releases acidic compounds
What does acidosis in the blood cause to myocardial performance?
reduces performance, reduces oxygen delivery, increasing hypothermia
What is hypovelemic shock?
inadequate volume -blood or fluids
Crush injuries results in hypovelemic shock due to what?
blood and plasma loss from damaged vessels
What are two examples of obstructive shock?
cardiac tamponade and tension pneumothorax
What are late indications of shock?
hypotension and mental status
How many minutes of direct pressure does an arterial bleeding require to form a clot?
5 or more minutes
How long does TXA need to used within trauma?
Within 3 hours
Do beta bloackers and calcium channel blockers, antidysrhythmic drugs interefere with the body’s ability to compensate for shock?
yes
What is hematuria?
blood in the urine
Coffee ground emesis is a sign of what type of bleed?
upper GI bleed
In the case of an animal bite, what should you do?
dry sterile dressings, rapid transport
What are some key findings of brain injury?
posturing, hypotension or hypertension, abnormal pupils
Ominous signs of cerebral herniation?
hypertension (widening pressures), bradycardia, cushings, posturing
anterior cord syndrome
flexion injuries or fractures that displaces bony fragnents into the anterior portion of the spinal cord; loss of pain, temperature and touch perception
Brown sequard syndrome
penetrating trauma; half dissection of the spinal cord, damage to all spinal tracts involved on that same side
central cord syndrome
hyper extension injuries to cervical area that damage the dorsal column; hemorrage and edema
