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TRAUMA Flashcards

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1
Q

What are the types of le forte fractures?

A

Le forte I
Le forte II
Le forte III

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2
Q

What are the symptoms of le forte fractures?

A

Pain; epistaxis; haemorrhage; numbness in upper teeth, lip and nose; midface mobility; swelling; facial deformity; possible difficulty breathing

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3
Q

What facial anatomy is involved in le forte fracture I?

A

It is a horizontal maxillary fracture, separating the teeth from the upper face.

Fracture line passes through the alveolar Ridge, lateral nose and inferior wall of the maxillary sinus.

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4
Q

What facial anatomy is involved in le forte fracture II?

A

It is a pyramidal fracture where the teeth are the pyramid base and the nasofrontal suture is the apex.

Fracture arch passes through the posterior alveolar Ridge, lateral walls of the maxillary sinuses, the inferior orbital rim and nasal bones.

The uppermost fracture line can pass through the nasofrontal Junction or the frontal process of the maxilla.

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5
Q

What facial anatomy is involved in le forte fracture III?

A

Considered craniofacial disjunction.

Transverse fracture line passes through the nasofrontal suture, the maxillo-frontal suture, the orbital wall, and the zygomatic arch.

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6
Q

What is included in the management of le forte fractures?

A

Pain relief; ice packs to minimise swelling; antiemetic to reduce vomiting.

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7
Q

Why do we want to avoid vomiting in le forte fractures, orbital fractures, eye trauma and nasal trauma?

A

Vomiting can cause air trapping behind the eye.

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8
Q

What is an orbital fracture?

A

A break in one or more of the bones surrounding the eye.

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9
Q

What are the symptoms of an orbital fracture?

A

Pain; swelling; haemorrhage; possible deformity.

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10
Q

What is included in the management of an orbital fracture?

A

Pain relief; ice packs to minimise swelling; antiemetic to reduce vomiting.

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11
Q

What are the categories of eye trauma?

A

Superficial/surface injuries; penetrating injuries

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12
Q

What are the symptoms of superficial eye trauma?

A

Pain; vision impairment; redness; tears; haemorrhage; spasm of eyelid; photophobia

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13
Q

What are the symptoms of penetrating eye trauma?

A

Pain; vision impairment; redness; tears; haemorrhage; abnormally shaped globe; presence of prolapsed tissues; hyphema

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14
Q

What is included in the management of superficial eye trauma?

A

Irrigation with saline or water continuously for >15min or >30 minutes if chemical substances are suspected.

+ pain relief; antiemetic to reduce vomiting.

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15
Q

What is included in the management of penetrating eye trauma?

A

Leave penetrating item in place and use appropriate raised shield (plastic cup, cardboard cone) to protect.

+ pain relief; antiemetic to reduce vomiting.

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16
Q

What are examples of nasal trauma?

A

Nosebleeds; nasal fractures; chemical irritation; obstruction by foreign object.

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17
Q

What are the symptoms of nasal trauma?

A

Pain; epistaxis; possible deformity; swelling.

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18
Q

What is included in the management of nasal trauma?

A

Pain relief; icepacks to reduce swelling; antiemetic to reduce vomiting.

+ (if epistaxis) instruct patient to lean forward for drainage and pinch sides of nose until bleeding stops.

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19
Q

What are the symptoms of jaw fractures?

A

Pain; swelling; reduced jaw mobility; possible deformity.

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20
Q

What is included in the management of jaw fractures?

A

Pain relief; icepacks to minimise swelling; soft collar to aid in splinting the jaw.

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21
Q

What are the symptoms of dental trauma?

A

Avulsion; pain; haemorrhage.

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22
Q

What is included in the management of dental trauma?

A

(if <1 hour), clean the empty socket and tooth with saline and reimplant the tooth; instruct patient to hold tooth in place for reattachment.

+ pain relief.

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23
Q

How long does a tooth have to be held in place for a chance of reattachment?

A

Several hours.

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24
Q

Within what time frame does avulsion in dental trauma require reimplantation?

A

1 hour.

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25
Q

What other injuries or complications do you have to be conscious of with facial trauma?

A

C-spine injuries; airway compromise; haemorrhage.

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26
Q

What potential injuries are involved in facial trauma?

A

Le forte fractures; orbital fractures; eye trauma; nasal trauma; jaw fractures; dental trauma.

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27
Q

What potential injuries are involved in head trauma?

A

Scalp injuries; skull fractures; traumatic brain injuries.

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28
Q

Why is there a risk of severe haemorrhage with scalp injuries?

A

Because the scalp is vascular.

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29
Q

What are the symptoms of scalp injuries?

A

Laceration; haemorrhage; pain; possible swelling.

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30
Q

What is included in the management of scalp injuries?

A

Explore the injury to determine depth and severity.

+ pain relief; apply pressure to reduce haemorrhage; apply pad and dressing.

+ consideration for traumatic brain injury.

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31
Q

What are the types of skull fractures?

A

Linear nondisplaced; depressed; open; impaled object.

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32
Q

What are the key clinical features involved in a basilar skull fracture?

A

Battle’s sign; raccoon eyes.

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33
Q

What is a basilar skull fracture?

A

A break in one or more of the bones that compose the base of the skull.

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34
Q

What are the symptoms of a skull fracture?

A

Haemorrhage; pain; swelling; deformity.

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35
Q

What is included in the management of skull fractures?

A

Explore the injury to determine depth and severity.

+ pain relief; apply pressure to reduce haemorrhage; apply pad and dressing.

+ consideration for traumatic brain injury.

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36
Q

What is a traumatic brain injury?

A

Damage to the brain as a result of trauma.

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37
Q

What is a primary brain injury?

A

The immediate damage caused by traumatic force.

Worsened by secondary injury.

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37
Q

What is a secondary brain injury?

A

Further deterioration caused by primary brain injury.

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37
Q

What are the two ways that bleeding can cause problems in the instance of a traumatic brain injury?

A

Blood is directly irritating to brain tissue and can cause pain and neck stiffness; Monroe-Kellie Doctrine.

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37
Q

What is the Monroe-Kellie Doctrine?

A

Skull is constructed by brain matter, blood and cerebral spinal fluid.

Normally, values are approximately 80% of brain; 10% of blood; 10% of cerebral spinal fluid.

When one component (blood) increases, other components (cerebral spinal fluid and brain matter) have to decrease to compensate.

Cerebral spinal fluid is squashed into spinal column and brain herniates.

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37
Q

What are the symptoms of traumatic brain injury?

A

Internal/external haemorrhage; pain; contusion; concussion; diffuse axonal injury.

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37
Q

What is included in the management of a traumatic brain injury?

A

(if GCS 15) pain relief; apply oxygen therapy; IV access; IV fluids.

+ (if altered GCS) pain relief; apply oxygen therapy; IV access; IV fluids; antiemetic to reduce intracranial pressure; c-spine support; basic airway adjuncts.

+ consideration for seizures (midazolam).

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37
Q

What systolic blood pressure do you want to achieve with IV fluids in the management of a traumatic brain injury in a patient with an altered GCS?

A

100-120 SBP.

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38
Q

What is an epidural haematoma?

A

A collection of blood between your skull and dura matter.

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38
Q

What more commonly causes an epidural haematoma?

A

Temporal fractures with associated rupture of the middle meningeal artery; an arterial bleed which accumulates within the extradural space that causes a rise in intracranial pressure.

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39
Q

What are the symptoms of an epidural haematoma?

A

Initial loss of consciousness with a subsequent lucid interval; progressive deterioration; contralateral paralysis; ipsilateral fixated and dilated pupils.

+ signs of raised intracranial pressure (altered level of consciousness; vomiting; headache).

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40
Q

What is a subdural haematoma?

A

A collection of blood under the dura matter.

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41
Q

What more commonly causes a subdural haematoma?

A

Bleeding into the subdural space from bridging veins; trauma.

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42
Q

What are the symptoms of subdural haematoma?

A

Possible initial loss of consciousness with subsequent extended lucid interval; focal neurological deficits relevant to the underlying brain region; altered level of consciousness; headache.

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43
Q

What is a subarachnoid haemorrhage?

A

A collection of blood between the arachnoid matter and the pia matter.

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44
Q

What are the symptoms of a subarachnoid haemorrhage?

A

“Thunderclap” haemorrhage; photophobia; visual impairment; focal neurological deficits with progressing severity; nausea and vomiting; possible mild hypertension and hyperthermia.

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45
Q

What most commonly causes a subarachnoid haemorrhage?

A

Arterial bleed into the subarachnoid space; trauma.

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46
Q

What is an intracerebral haemorrhage?

A

Bleeding anywhere within the tissues of the brain.

+ CVA/subtype of stroke.

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47
Q

What are the symptoms of an intracerebral haemorrhage?

A

Altered level of consciousness; stroke symptoms; headache; vomiting.

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48
Q

What is a concussion?

A

A mild traumatic brain injury that temporarily impacts brain function.

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49
Q

What are the symptoms of a concussion?

A

Altered level of consciousness; periods of loss of consciousness; retrograde short-term amnesia; dizziness; headache; nausea and vomiting; ringing in ears.

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50
Q

What is a cerebral contusion?

A

Bruising of the brain tissue.

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51
Q

What are the symptoms of cerebral contusions?

A

Prolonged loss of consciousness; profound confusion or amnesia; focal neurological signs.

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52
Q

What is a diffuse axonal injury?

A

Tearing of axons (nerve fibres in the brain).

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53
Q

What are the symptoms of diffuse axonal injuries?

A

Symptoms of a concussion; loss of consciousness; possible seizures.

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54
Q

What most commonly causes diffuse axonal injuries?

A

Acceleration/deceleration of the brain (whiplash - coup and contrecoup actions).

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55
Q

What is a coup action in reference to a diffuse axonal injury?

A

Impact from behind causing the brain to accelerate forward and collide with the skull.

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56
Q

What is a contrecoup action in reference to a diffuse axonal injury?

A

Brain bounces off front of skull and collides with the back of the skull.

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57
Q

What are the meninges?

A

Cover the brain for protection and support.

Dura matter - the fibrous outer layer beneath the skull.
Arachnoid matter - middle layer, beneath the dura matter and the subarachnoid spaces.
Pia matter - innermost layer directly upon the brain.

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58
Q

What is the subarachnoid space?

A

Contains cerebrospinal fluid; provides nutrition and cushioned support.

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59
Q

What area of the brain is more mobile?

A

The top.

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60
Q

What is Cushing reflex?

A

A physiological nervous system response to acute elevations in intracranial pressure.

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61
Q

What is Cushing triad?

A

A development of Cushing reflex that involves a widened pulse pressure (increased systolic and decreased diastolic); bradycardia; irregular respirations.

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62
Q

What does decorticate refer to?

A

Movement of flexion in the extremities.

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63
Q

What does decerebrate refer to?

A

Movement of extension in the extremities.

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64
Q

Out of decorticate or decerebrate, what is more specific to a traumatic brain injury?

A

Decerebrate.

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65
Q

At what GCS score is a severe brain injury suspected?

A

GCS 9 or below.

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66
Q

What is the definition of intracranial pressure?

A

Pressure of the brain and contents of the skull.

Normally 5-15 mmHg.

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67
Q

What is the definition of cerebral perfusion pressure?

A

Pressure required to perfuse the brain.

Normally 50-70 mmHg.

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68
Q

What is the definition of mean arterial pressure?

A

Pressure maintained in the vascular system.

Calculated as diastolic blood pressure + 1/3 systolic blood pressure or pulse pressure.

Normally maintained naturally at a range of 50-150 mmHg.

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69
Q

What is autoregulation?

A

The process of the brain maintaining the same cerebral perfusion pressure within a MAP range of 50-150 mmHg.

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70
Q

What happens to autoregulation during a traumatic brain injury?

A

Function is lost.

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71
Q

What is the formula to calculate cerebral perfusion pressure?

A

Cerebral perfusion pressure = mean arterial pressure - intracranial pressure.

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72
Q

When intracranial pressure begins to rise and autoregulation is lost because of bleeding in the brain, what is important in terms of mean arterial pressure?

A

Mean arterial pressure has to rise by the same amount to maintain cerebral perfusion pressure.

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73
Q

Can we measure intracranial pressure in the pre-hospital setting?

A

No.

*Hospital places transducer into the skull to measure intracranial pressure.

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74
Q

Explain the process of Cushing reflex.

A

As intracranial pressure increases, the body attempts to improve cerebral perfusion pressure by elevating blood pressure.

This increase in systolic blood pressure triggers bradycardia (autonomic response to reduce blood pressure).

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75
Q

What indicates the progression of Cushing reflex into Cushing triad?

A

Bradycardia.

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76
Q

What is cerebral herniation syndrome?

A

Displacement of any part of the brain within the skull due to the raised intracranial pressure.

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77
Q

What condition is the fatal end-stage of extreme intracranial pressure?

A

Tonsillar herniation.

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78
Q

What are the primary goals of management in a traumatic brain injury or head trauma?

A

Avoid hypoxia and hyperoxia; avoid hypotension.

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79
Q

What does hypoxia cause in traumatic brain injuries?

A

An increase in brain damage.

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80
Q

What does hyperoxia cause in traumatic brain injuries?

A

An increase in oxygen-free radical production that further damages injured cells.

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81
Q

What does hypotension cause in traumatic brain injuries?

A

Lack of cerebral perfusion pressure.

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82
Q

What are other considerations involved in the management of a traumatic brain injury or head trauma?

A

C-spine injury; positioning; CCP backup.

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83
Q

Why do we mobilise patients with a traumatic brain injury with a soft collar?

A

Use of rigid collars impedes venous drainage and further raises intracranial pressure.

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84
Q

What position is recommended for patients with a traumatic brain injury? What is it designed to do?

A

Semi recumbent at 30 degrees.

Facilitates venous drainage and lowers intracranial pressure without compromising the C-spine.

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85
Q

What is the best practice airway management for traumatic brain injuries?

A

Rapid sequence intubation.

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86
Q

What does rapid sequence intubation allow for in a traumatic brain injury?

A

Control of ventilation and oxygenation.

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87
Q

What is required alongside rapid sequence intubation in traumatic brain injuries?

A

Use of muscle relaxants.

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88
Q

What does hypertonic saline or mannitol do in a traumatic brain injury?

A

Draw water out of the cells, essentially dehydrating the brain; causes brain to shrink and reduces intracranial pressure.

*Hyperosmolar agents.

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89
Q

What sedatives are used for rapid sequence intubation in traumatic brain injuries?

A

Ketamine and midazolam.

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90
Q

What anatomy is involved in the spinal cord?

A

Cervical vertebrae; thoracic vertebrae; lumbar vertebrae; sacrum; coccyx.

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91
Q

What are the types of spinal cord injuries?

A

Hyperextension; hyperflexion; compression; rotation; lateral stress; distraction.

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92
Q

What is a hyperextension spinal cord injury?

A

Excessive posterior movement of the head or neck.

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93
Q

What are causes of a hyperextension spinal cord injury?

A

Face into the windshield during a car-crash; falling to the floor; football tackle; dive into shallow water.

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94
Q

What is a hyperflexion spinal cord injury?

A

Excessive anterior movement of head onto the chest.

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95
Q

What are causes of a hyperflexion spinal cord injury?

A

Rider thrown off horse or motorcycle; dive into shallow water.

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96
Q

What is a compression spinal cord injury?

A

Weight of the head or pelvis driven into the stationary neck or torso.

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97
Q

What are causes of a compression spinal cord injury?

A

Dive into shallow water; fall of >10-20 feet onto head or legs.

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98
Q

What is a rotation spinal cord injury?

A

Excessive rotation of the torso or head and neck, moving one side of the spinal column against the other.

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99
Q

What are causes of a rotation spinal cord injury?

A

Rollover car-crash; motorcycle crash.

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100
Q

What is a lateral stress spinal cord injury?

A

Direct lateral force on spinal column, typically shearing one level of cord from another.

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101
Q

What are causes of a lateral stress spinal cord injury?

A

“T-bone” car-crash; fall.

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102
Q

What is a distraction spinal cord injury?

A

Excessive stretching of column and cord.

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103
Q

What are causes of a distraction spinal cord injury?

A

Hanging.

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104
Q

What are the key clinical features that differentiate vertebral and spinal cord injuries?

A

Vertebral injuries present with pain.

Spinal cord injuries present with neurological deficits; loss of sensation/altered sensation; loss of motor function/weakness.

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105
Q

Do we treat non-traumatic back pain the same as traumatic back pain?

A

Yes.

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106
Q

What are the types of spinal cord injuries?

A

Complete; incomplete.

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107
Q

What is a complete spinal cord injury?

A

No motor function or sensation below the point of injury.

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108
Q

What is an incomplete spinal cord injury?

A

Some function remaining below the point of injury.

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109
Q

What are the types of incomplete spinal cord injury?

A

Central cord syndrome; anterior cord syndrome; Brown-Sequard’s syndrome.

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110
Q

What is anterior cord syndrome?

A

Blood supply is lost to the anterior section of the spinal cord.

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111
Q

What is preserved in anterior cord syndrome?

A

The ability to feel vibration and proprioception (sense of the body - where limbs are).

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112
Q

What causes anterior cord syndrome?

A

Blood clot which can be a result of trauma.

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113
Q

What is Brown-Sequard’s syndrome?

A

The cord is split in half along its length for a variable distance.

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114
Q

What is preserved in Brown-Sequard’s syndrome?

A

Motor function on one side and sensory function on the other.

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115
Q

What causes Brown-Sequard syndrome?

A

Penetrating trauma.

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116
Q

What is central cord syndrome?

A

Damage to the centre of the cord.

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117
Q

What causes central cord syndrome?

A

Hyperextension.

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118
Q

What is preserved in central cord syndrome?

A

Loss of function in the arms that is more severe than the loss of function in the lower body.

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119
Q

What are the types of vertebral injury?

A

Compression fracture; burst fracture.

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120
Q

What are the symptoms of a vertebral injury?

A

Pain; muscle spasm at site of injury; possible neurological deficits.

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121
Q

What is neurogenic shock?

A

A result of spinal cord injuries above T6.

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122
Q

What is the pathophysiology of neurogenic shock?

A

In severe cord damage, there is disruption of sympathetic tone and an unopposed parasympathetic response.

As a response to the disruption of sympathetic tone, there is venous and arterial vasodilation, resulting in decreased preload and stroke volume.

The unopposed parasympathetic response causes bradycardia and reduced cardiac output and hypotension.

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123
Q

What is the presentation of neurogenic shock?

A

Hypotension with warm and dry skin; possible hypothermia, bradycardia.

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124
Q

What key clinical feature differentiates hypovolaemic shock from neurogenic shock?

A

Hypotension with warm and dry skin (cold and clammy skin alongside hypotension is indicative of hypovolaemic shock).

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125
Q

What is included in the management of cervical spine pain?

A

MILS; soft collar; supine or semi-recumbent positioning.

+ pain relief.

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126
Q

What is included in the management of thoracic, lumber or sacral pain?

A

MILS; soft collar; supine positioning; immobilisation to a longboard.

+ pain relief.

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127
Q

How do you apply MILS in infants or smaller children?

A

Raise shoulders with a pillow or towel.

*Ears in line with clavicle.

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128
Q

How do you apply MILS in adults?

A

Raise heads with a pillow or towel.

*Ears in line with clavicle.

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129
Q

What is important when documenting the loss of sensation or motor function in a spinal cord injury?

A

The level of loss that occurs and the affected area of loss.

*Helps to correlate affected dermatomes.

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130
Q

What are the components of NEXUS?

A

No posterior midline c-spine tenderness; no evidence of intoxication; a normal level of alertness; no focal neurological deficit; no painful distracting injuries.

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131
Q

What is the Canadian C-Spine Rule?

A

A slightly more sensitive assessment of c-spine injuries.

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132
Q

What mechanisms of injury can cause thoracic trauma?

A

Blunt trauma; penetrating trauma.

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133
Q

What is an open pneumothorax?

A

“Sucking chest wound” where air enters the pleural space; ventilation is impaired; hypoxia results.

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134
Q

Does air enter the lung in an open pneumothorax?

A

No.

*It enters the pleural dead space.

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135
Q

What is a tension pneumothorax?

A

Circulatory (obstructive) emergency.

Occurs when a one-way valve is created from trauma. Air can enter but not leave pleural space.

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136
Q

What happens to pressure during a tension pneumothorax?

A

There is an increase in intrathoracic pressure, which will collapse the affected lung and will then exert pressure on the mediastinum.

This pressure will eventually collapse the superior and inferior vena cava, resulting in a loss of venous return to the heart.

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137
Q

What are the symptoms of a tension pneumothorax?

A

Agitation; dyspnoea; anxiety; tachypnoea; distended neck veins; diminished breath sounds; possible tracheal deviation; possible shock with hypotension and cold, clammy skin.

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138
Q

What is the intervention for an open pneumothorax?

A

Chest seal.

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139
Q

What is the intervention for a tension pneumothorax?

A

Needle decompression

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140
Q

What is the anatomical location of needle decompression for a tension pneumothorax?

A

2nd intercostal space on the mid-clavicular line.

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141
Q

When do you use a pneumodart for needle decompression in a tension pneumothorax?

A

If the patient weighs >50kg.

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142
Q

When do you use a 14 gauge cannula for needle decompression in a tension pneumothorax?

A

If the patient weighs 15-50kg; is between 4 and 14 years of age.

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143
Q

When do you use a 16 gauge cannula for needle decompression in a tension pneumothorax?

A

If the patient is <15kg; is less than 4 years of age.

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144
Q

What complications do you see alongside a tension pneumothorax?

A

Respiratory distress; cyanosis; decreasing level of consciousness.

145
Q

What is a haemothorax?

A

Blood in the pleural space.

146
Q

What is a massive haemothorax?

A

At least 1500 mL blood loss into the thoracic cavity.

147
Q

What is the amount of blood that a thoracic cavity can contain?

A

3000 mL

148
Q

What occurs as a result of a haemothorax?

A

Blood accumulates in the pleural space and compresses the lung on the affected side.

The inferior and superior vena cava and contralateral lung are compressed, and ongoing blood loss is complicated by hypoxemia.

If enough blood accumulates, the mediastinum will be shifted away from the haemothorax.

149
Q

What are the symptoms of a massive haemothorax?

A

Anxiety; confusion; flat or distended neck veins; decreased breath sounds; possible shock.

150
Q

What do flat neck veins indicate in a massive haemothorax?

A

Hypovolaemia.

151
Q

What do distended neck veins indicate in a massive haemothorax?

A

Mediastinal compression.

152
Q

What is included in the management of a massive haemothorax?

A

Treatment for shock; IV access; IV fluid administration.

+ close monitoring for tension hemopneumothorax.

153
Q

What are you achieving with fluid administration in a massive haemothorax?

A

Titration to peripheral pulse of 80-90mmHg.

154
Q

What is a flail chest?

A

Where three or more adjacent ribs are fractured in two or more places which causes a segment of the chest wall that is not in continuity with the thorax.

155
Q

What are the types of flail chest?

A

Lateral; anterior (sternal separation).

156
Q

What may be observed in a patient with flail chest that is breathing spontaneously?

A

Flail segment moving with a paradoxical motion relative to the rest of the chest wall.

157
Q

What can multiple rib fractures cause with or without flail chest?

A

Hypoxia from mechanical ventilatory problems; pulmonary contusion; respiratory failure.

158
Q

What two forms of monitoring is especially helpful during a flail chest?

A

Pulse oximetry; capnography.

159
Q

What is included in the management of flail chest?

A

CCP backup.

+ consideration for pulmonary contusion; haemothorax; pneumothorax.

160
Q

Why is CCP backup required in the event of flail chest?

A

Sedation; rapid sequence intubation to provide positive end-expiratory pressure.

*This is considered the best stabilisation but patients are usually awake with an intact gag reflex.

161
Q

What complication can fluid administration cause in patients with massive haemothorax?

A

May increase bleeding.

162
Q

What is cardiac tamponade?

A

Blood in the pericardial sac.

163
Q

What are the symptoms of cardiac tamponade?

A

Beck’s triad; paradoxical pulse; equal breath sounds; narrowed pulse pressures; electrical alternans on an ECG.

164
Q

What is Beck’s triad?

A

Hypotension; distended neck veins; muffled heart sounds.

165
Q

What thoracic trauma is associated with Beck’s triad?

A

Cardiac tamponade.

166
Q

What is the pathophysiology of cardiac tamponade?

A

The pericardial sac is an inelastic membrane that surrounds the heart.

If blood collects rapidly between the heart and the pericardium (like during a cardiac tamponade as a result of cardiac injury), ventricles of the heart will be compressed.

As compression of ventricles increases, the heart is less able to refill and cardiac output falls.

167
Q

What is included in the management of a cardiac tamponade?

A

12-Lead ECG; treatment for shock; IV access; IV fluids.

+ preparation for resuscitation; close monitoring for haemothorax and pneumothorax.

168
Q

What complication can fluid administration cause in patients with cardiac tamponade?

A

May increase bleeding.

169
Q

What is a myocardial contusion?

A

Potentially lethal lesion resulting from blunt chest injury; bruise of the cardiac muscle.

170
Q

What type of cardiac injury most commonly causes a myocardial contusion?

A

Blunt anterior chest injury.

171
Q

What are the symptoms of a myocardial contusion?

A

Chest pain; dysrhythmias; possible cardiogenic shock.

172
Q

What could the chest pain featured in a myocardial contusion also be indicative of?

A

Musculoskeletal discomfort that the patient also suffers as a result of the injury.

173
Q

What will the ECG of a myocardial contusion present with?

A

A similar tracing to a myocardial infarction.

174
Q

How can you distinguish a myocardial contusion from a myocardial infarction?

A

Mechanism of injury; cardiac history of the patient.

175
Q

How do you treat a myocardial contusion?

A

Perform 12-Lead ECG; treat as a cardiac tamponade.

176
Q

What is a traumatic aortic rupture?

A

A near-complete tear through all layers of the aorta due to trauma.

177
Q

What most commonly causes traumatic thoracic aortic tears?

A

Deceleration injuries with the heart where the aortic arch moves suddenly anteriorly, transecting the aorta.

178
Q

Do patients with traumatic thoracic aortic tears always suggest this condition immediately?

A

No.

*20% of patients will rupture within hours unless surgically repaired beforehand.

179
Q

What occurs in patient’s with traumatic thoracic aortic tears that can prevent them from suggesting this condition immediately?

A

The aortic tear can be contained temporarily by surrounding tissues and adventitia.

180
Q

What is a tracheal or bronchial tree injury?

A

A tear in the trachea or bronchi.

181
Q

What types of trauma can result in a tracheal or bronchial tree injury?

A

Blunt trauma; penetrating trauma.

182
Q

What mechanisms of injury can cause a tracheal or bronchial tree injury?

A

Deceleration; compression.

183
Q

What may patients who suffer a tracheal or bronchial tree injury present with?

A

Subcutaneous emphysema relative to their chest, face or neck.

184
Q

What is subcutaneous emphysema and how does it relate to pre-hospital trauma?

A

Air trapping in tissues beneath the skin.

Injuries sustained within trauma can cause or present alongside subcutaneous emphysema.

185
Q

What is included in the management of a tracheal or bronchial tree injury?

A

Adequate airway management; CCP backup.

+ close monitoring for pneumothorax and haemothorax.

186
Q

What can a CCP do for a tracheal or bronchial tree injury?

A

Cuffed ET tube past the site of injury.

187
Q

What is a diaphragmatic tear?

A

Tear in the diaphragm.

188
Q

What type of trauma can result in a diaphragmatic tear?

A

Blunt trauma; penetrating trauma.

*Severe blow to the abdomen.

189
Q

What can a sudden increase in intra-abdominal pressure result in during a diaphragmatic tear?

A

Herniation of abdominal organs.

190
Q

As a result of progression in a diaphragmatic tear, what clinical features does the herniation of abdominal organs present with?

A

Diminished breath sounds; scaphoid appearance of the abdomen; possible bowel sounds auscultated in the chest.

191
Q

What is a pulmonary contusion?

A

A bruise of the lung.

192
Q

What type of trauma can result in a pulmonary contusion?

A

Blunt trauma (more common).

193
Q

What complication can arise with a pulmonary contusion?

A

Hypoxemia.

194
Q

What is the recommended management for an impaled object?

A

Do not remove; stabilise the object.

195
Q

What conditions are you closely monitoring for in patients who present with an impaled object in their chest?

A

Tension pneumothorax; haemothorax; cardiac tamponade.

196
Q

What is traumatic asphyxia?

A

A type of mechanical asphyxia where respiration is prevented by external pressure.

197
Q

What type of trauma can result in traumatic asphyxia?

A

Compression.

198
Q

What can traumatic asphyxia result in?

A

Ruptured capillaries.

199
Q

What are the symptoms of traumatic asphyxia?

A

Cyanosis above site of compression; swelling of the head and neck, tongue and lips; conjunctival haemorrhage.

200
Q

What is a conjunctival haemorrhage?

A

A break in a blood vessel beneath the clear surface of the eye.

201
Q

What is a sternal fracture?

A

A break in the sternum.

202
Q

What type of trauma can cause a sternal fracture?

A

Significant blunt trauma to the anterior chest.

203
Q

What clinical feature presents with a sternal fracture?

A

Pain on palpation.

204
Q

What condition is closely associated with and often presumed in the event of a sternal fracture?

A

Myocardial contusion.

205
Q

What is a simple rib fracture?

A

A break in the ribs.

206
Q

What is included in the management of a simple rib fracture?

A

Pain relief; possible oxygen therapy.

+ closely monitor for pneumothorax and haemothorax.

207
Q

What complications can arise if a patient with a simple rib fracture experiences physiological splinting?

A

Shallow breathing; decrease in ventilation; decrease in perfusion.

208
Q

What two complications are the major causes of preventable death in abdominal trauma?

A

Haemorrhage; infection.

209
Q

When assessing the abdomen, what signs are going to indicate trauma and associated injuries?

A

Deformities; contusions; abrasions; punctures; evisceration; distension; tenderness.

210
Q

What is indicative of a splenic injury?

A

Referred left posterior shoulder pain.

211
Q

What is indicative of a liver injury?

A

Referred right posterior shoulder pain.

212
Q

What mechanisms of injury can cause blunt abdominal injury?

A

Compression; deceleration.

213
Q

What are the symptoms of blunt abdominal injury?

A

Possible pain or tenderness; possible evidence of injury; possible haemodynamic instability.

214
Q

What is a seat-belt sign?

A

Large abrasion over abdomen or upper neck.

215
Q

What is included in the management of blunt abdominal injuries?

A

Pain relief.

+ if required, IV access and IV fluids (80-90mmHg).

216
Q

What are the most common causes of penetrating abdominal trauma?

A

Gun shot wounds; stabbings.

217
Q

What mechanisms of injury can cause penetrating abdominal trauma?

A

Direct trauma to organ and vasculature; projectile and fragments; energy transmitted from mass and velocity.

218
Q

What complication is mostly associated with a penetrating abdominal injury?

A

Uncontrolled haemorrhage.

219
Q

What complication can arise when administering fluids in an abdominal trauma?

A

Fluids can increase the rate of bleeding.

220
Q

What is a pelvic fracture?

A

A break in the pelvis.

221
Q

What types of fractures are included under the umbrella of pelvic fractures?

A

Open; closed; simple; complex; displaced; non-displaced.

222
Q

What is the Young-Burgess classification?

A

Mechanistic system that classifies pelvic ring injuries into anterior-posterior compression, lateral compression, vertical shear injuries and combined mechanism.

223
Q

Where may suffer isolated pelvic fractures?

A

Rami; acetabulum.

224
Q

What are anterior-posterior compression fractures II and III referred to as?

A

Open book fractures.

225
Q

What are complications closely associated with pelvic fractures?

A

Life-threatening haemorrhage; nerve damage; urethral damage.

226
Q

How much blood can the retroperitoneal space accomodate?

A

Entire blood volume.

227
Q

What is ‘springing’ of the pelvis?

A

Application of anterior pressure to either side of the pelvis to assess for movement.

*Outdated.

228
Q

What is included in the management of pelvic fractures?

A

Pain relief; pelvic binder.

+ if required, IV access and IV fluids (80-90mmHg).

229
Q

What additional management may be applied in abdominal trauma to limit coagulopathy?

A

Maintain normothermia.

230
Q

What is included in the management of evisceration?

A

Do not push viscera back into abdomen; gently rinse with sterile water; cover with moistened gauze and cling wrap; apply non-adherent material to prevent drying.

231
Q

What occurs if, during evisceration, the intestines are allowed to dry?

A

They become irreversibly damaged.

232
Q

What are the potential dangers of extremity traumas?

A

Haemorrhagic shock; neurovascular compromise.

233
Q

What is a sprain?

A

Stretching or tearing of ligaments of a joint because of a suddent twist.

234
Q

What are the symptoms of a sprain?

A

Pain; swelling.

235
Q

What is included in the management of a sprain?

A

Pain relief; apply ice pack to minimise swelling; splint.

236
Q

Why splint a sprain and strain?

A

Cannot differentiate between a sprain, strain and a fracture in the pre-hospital setting.

*Splinting may provide comfort in a strain.

237
Q

What is a strain?

A

Stretching or tearing of a muscle or musculotendinous unit.

238
Q

What are the symptoms of a strain?

A

Pain; swelling.

239
Q

What is included in the management of a strain?

A

Pain relief; apply ice pack to minimise swelling; splint.

240
Q

What are the two types of fractures associated with extremities?

A

Compound; simple.

241
Q

What are the symptoms of a fracture?

A

Pain; obvious deformity; swelling; haemorrhage (if open).

242
Q

What is included in the management of a fracture?

A

Pain relief; haemorrhage control (if open); ice pack to minimise swelling.

243
Q

The application of what can assist in arranging fingers in their usual positions when managing a hand injury?

A

A ball of padding within the palm of the hand.

244
Q

What complication can arise when the femur is fractured?

A

Haemorrhage with the fracture.

245
Q

How much blood can be lost per femur fracture?

A

1.5 L

246
Q

What equipment is applied during a femur fracture and why do you apply it?

A

Traction splinting.

Pulls bones back together and reduces bleeding and pain.

247
Q

What is the management for most dislocations?

A

Splint in the position found.

248
Q

Should you apply a sling in shoulder dislocations?

A

No.

*Slings can increase shoulder rotation and pain.

249
Q

What dislocation can we reduce as ACPs?

A

Patella.

250
Q

How do you reduce a patella dislocation?

A

Pain relief; apply firm medial pressure to lateral aspect; extend knee slowly.

251
Q

How do you assess neurovascular compromise?

A

Perfusion status assessment - pulse; skin appearance; cap refill; blood pressure; consciousness.

252
Q

What equipment may you apply in the event of an uncontrollable arterial bleed?

A

Arterial tourniquet.

253
Q

How do you apply arterial tourniquet?

A

Position about 5-7cm above injury; clip buckle; pull tight; twist rod until haemorrhage stops; lock into place and confirm haemorrhage has stopped; make note of time of application.

254
Q

How do you apply a second arterial tourniquet, if it is required?

A

Adjacent and proximal to the first.

255
Q

What is the most common hip fracture subtype?

A

Neck of femur fracture.

256
Q

What clinical features will a neck of femur fracture present with?

A

External rotation; abduction; shortening.

257
Q

What clinical features will a interotrochanter fracture present with?

A

Shortening; swelling.

258
Q

What clinical features will a subtrochanter fracture present with?

A

Internal rotation; flexed knee.

259
Q

What is included in the management of a neck of femur fracture?

A

Pain relief; stabilisation; support of affected leg.

260
Q

What is a neck of femur fracture?

A

An intracapsular hip fracture where the femoral head has essentially disconnected from the rest of the femur.

261
Q

In the pre-hospital setting, how is a hip dislocation and hip fracture distinguished from one another?

A

Mechanism of injury.

Simple falls or minor mechanism will more than likely cause fractures; while, stronger mechanisms will result in dislocations.

262
Q

What is included in the management of a hip dislocation?

A

Pain relief.

263
Q

What must you not apply to hip fractures or dislocations?

A

Pelvic binders.

264
Q

What must you not apply to hip fractures?

A

Traction splint.

265
Q

Why should you not apply a traction splint to hip fractures?

A

May exacerbate injury.

266
Q

Why should you not apply pelvic binders to hip fractures or dislocations?

A

My further displace injury; grind body ends together in fracture.

267
Q

How do you manage an amputation?

A

Control haemorrhage; irrigate; cover with damp sterile dressing; bandage firmly with even pressure; locate amputated part; cover amputated part with saline moistened dressing; place into airtight bag; place bag into 1:3 ice and water mix.

268
Q

What is compartment syndrome?

A

When pressure from injuries compress blood vessels to the extent that circulation is impossible.

269
Q

What is crush syndrome?

A

When pressure from injuries prevents blood flow and, after an extended period of time, the pressure is released alongside toxins that have built up within the injury.

270
Q

What is included in the management of crush syndrome?

A

IV access; IV fluids; CCP backup.

271
Q

How many ml/kg of saline should you aim to administer in crush syndrome?

A

10-20ml/kg.

272
Q

What is a burn?

A

Damage to the skin and underlying tissues after contact with heat, cold, electricity, chemicals, friction or radiation.

273
Q

What are the two layers of skin that are involved in burns?

A

Epidermis (outer); dermis (inner).

274
Q

What are the tree zones relevant to the skin during a burn assessment?

A

Zone of hyperaemia; zone of stasis; zone of coagulation.

275
Q

What is the zone of hyperaemia?

A

Where cell damage is minimal; full recovery is expected.

276
Q

What is the zone of stasis?

A

Where cells are alive but circulation is compromised; can either recover fully or become part of zone of coagulation.

277
Q

What is the zone of coagulation?

A

Cell death occurs immediately; non salvageable.

278
Q

What are the classifications of burns?

A

Superficial; partial; full; full +++

279
Q

What is a superficial burn?

A

Minor epithelial damage to the epidermis.

280
Q

What is a partial burn?

A

Complete damage of epidermis; possible superficial or deep dermal damage.

281
Q

What is a full thickness burn?

A

Destruction of epidermal and dermal layers.

282
Q

What is a full +++ thickness burn?

A

Complete destruction of skin layers; burns have extended to subcutaneous adipose tissues, fascia, muscles, bones, organs.

283
Q

How do supificial burns appear?

A

Redness; pain; hot to touch.

284
Q

How do partial thickness burns appear?

A

Redness; pain; blistering.

285
Q

How do full thickness burns appear?

A

White, dry, leathery; charring; significant pain to surrounding skin.

286
Q

How do full +++ thickness burns appear?

A

Exposure of musculature, bones, organs with evidence of burns.

287
Q

What is the rule of nines?

A

A chart that divides the body’s surface area into areas of percentages to allow for a quick estimation of burn size and severity.

288
Q

What are the types of thermal burns?

A

Heat; cold.

289
Q

What are the types of chemical burns?

A

Acidic; alkali.

290
Q

In addition to thermal and chemical burns, what other types of burns exist?

A

Friction; radiation; electrical; airway.

291
Q

How do burns caused by heat affect the body?

A

Causes coagulation of proteins within tissues; cell death.

292
Q

What are the common causes of cold burns?

A

Liquid nitrogen; dry ice.

293
Q

How do burns caused by acid affect the body?

A

Causes coagulation of proteins within tissues; cell death.

294
Q

What are common acids that cause acidic chemical burns?

A

Hydrochloric acid; sulphuric acid; hydrogen peroxide.

295
Q

How do burns caused by alkali affect the body?

A

Liquefy tissue, expose next level down to become susceptible to further burning.

296
Q

What are common alkali that cause alkali chemical burns?

A

Lime; sodium hypochlorite; sodium hydroxide.

297
Q

What is flash burn?

A

UV damage to the cornea.

*AKA welder’s burn.

298
Q

How do friction burns appear?

A

Abrasion of the skin.

299
Q

What is created during an electrical burn?

A

Entry and exit points.

300
Q

How do airway burns present?

A

Sooty sputum; swollen lips, tongue, throat; difficulty swallowing; stridor; laryngeoedema; progressive obstruction.

301
Q

What is included in the management of burns?

A

Pain relief; burn first-aid; prevention of hypothermia; fluid resuscitation; elevation; prevention of infection; covering of the burn.

302
Q

What is involved in burn first-aid?

A

20 minutes under running cool water; removal of rings and watches; removal of clothing.

303
Q

Why is hypothermia a complication of burns?

A

Burned skin loses thermoregulatory function; cannot vasoconstrict to conserve heat.

304
Q

How do you prevent hypothermia in burns?

A

Apply warming blanket and ambulance.

*Prior to cooling burn.

305
Q

What is PHIFTEEN-B?

A

A guideline for fluid resuscitation during burn management.

306
Q

What is the PHIFTEEN-B volume guideline for an adult?

A

15ml/hr x TBSA, rounded to nearest 10%.

307
Q

When should you delay or not administer fluids in the event of burns and why?

A

When an airway has not been secured.

Fluids can cause rapid airway oedema and obstruction.

308
Q

What will elevating a burnt limb assist with?

A

Reducing of swelling; allowing for increased passive drainage.

309
Q

How are burns covered in the pre-hospital setting and why?

A

Burn is patted dry; cling wrap is applied.

Covering burns prevents infection.

*Cling wrap is used because it is non-stick, close to sterile and translucent.

310
Q

When is BurnAid applied?

A

When <10% of TBSA is affected; burn is minor.

311
Q

When should you not apply cling wrap or BurnAid to burns?

A

Chemical burns.

312
Q

What dressing should be used in a chemical burn?

A

Non-adherent.

313
Q

What are the two options of management for airway in multi-system trauma incidents?

A

Basic management; rapid sequence intubation.

314
Q

What is involved in basic airway management relevant to multi-system trauma incidents?

A

Lateral positioning; simple.

*No protection from aspiration or trismus.

315
Q

What is involved in rapid sequence intubation relevant to multi-system trauma incidents?

A

Supine positioning; complex; additional scene time.

*Protection and control.

316
Q

What are the life-threatening complications of a multi-system trauma incident?

A

Airway compromise; tension pneumothorax; hypovolaemic shock; traumatic brain injuries.

317
Q

In addition to needle decompression, in the event on a tension pneumothorax, what other option of management exists?

A

Finger thoracostomy.

318
Q

What is the complication of performing a finger thoracostomy for a tension pneumothorax?

A

Open chest wound.

319
Q

What medication is administered in the event of internal haemorrhage?

A

Tranexamic acid.

320
Q

How does tranexamic acid work?

A

Inhibits the activation of plasminogen to plasmin which inhibits normal fibrinolysis.

Clots form more readily and are stronger.

321
Q

How much tranexamic acid is administered via IV?

A

1g via slow push over 10 minutes.

322
Q

How much tranexamic acid is administered via IV infusion and how do you prepare it?

A

1g over 10 minutes.

Mix 1g of tranexamic acid in 100mL bag of sodium chloride 0.9%.

323
Q

What is the COAST score?

A

The coagulopathy of severe trauma score which predicts the acute traumatic coagulopathy in adult blunt trauma.

324
Q

What are the components of the COAST score?

A

Entrapment; systolic BP; temperature; major chest injury likely to require intervention; likely intra-abdominal or pelvic injury.

325
Q

What is the Massive Transfusion Protocol?

A

The replacement of total blood volume over 24 hours or 50% of blood volume over 4 hours.

326
Q

What does damage control resuscitation consist of?

A

Minimum volume resuscitation; managing the lethal triad.

327
Q

What does minimum volume resuscitation mean?

A

Give fluids only to maintain a radial pulse; MAP of 65.

328
Q

What are the components of the lethal triad?

A

Hypothermia; coagulopathy; acidosis.

329
Q

How does acidosis become a complication of trauma?

A

Hypoxia from poor perfusion leads to anaerobic metabolism.

Acidaemic blood doesn’t clot well.

330
Q

What is included in the management of acidosis?

A

Maximisation of oxygen delivery; maintain an entitled CO2 of 35-45mmHg; minimisation of fluid administration.

331
Q

What is shock?

A

A systemic condition where blood flow, and the associated oxygen and nutrients, is reduced to cells throughout the body.

332
Q

What are the types of shock?

A

Distributive; obstructive; cardiogenic; hypovolaemic.

333
Q

What happens to the body in distributive shock?

A

Hypotension as a result of expansion.

334
Q

What causes distributive shock?

A

Sepsis; anaphylaxis; neurogenic shock.

335
Q

What happens to the body in obstructive shock?

A

Hypotension as a result of blockage.

336
Q

What causes obstructive shock?

A

Massive pulmonary embolism; tension pneumothorax; tamponade.

337
Q

What happens to the body in cardiogenic shock?

A

Hypotension as a result of cardiac failure.

338
Q

What causes cardiogenic shock?

A

Penetrating injury; myocardial infarction; contusion.

339
Q

What happens to the body in hypovolaemic shock?

A

Hypotension as a result of blood and fluid loss.

340
Q

What are the signs of 15% blood loss?

A

Minimal tachycardic response; minimal blood pressure changes.

341
Q

What are the signs of 15-30% blood loss?

A

Tachycardia; hypotension; peripheral hypoperfusion; ALOC.

342
Q

What are the signs of blood loss >40%?

A

Haemodynamic instability; ALOC.

343
Q

How do you apply an emergency bandage?

A

Place pad on wound; wrap bandage one revolution around limb; insert bandage through pressure applicator; firmly pull bandage in opposite way; secure hooking ends of close bar onto bandage.

344
Q

What are the complications of an arterial tourniquet?

A

Compartment syndrome; reperfusion injury when released; embolism; permanent nerve damage, muscle injury, vascular injury, skin necrosis; ischaemia; fractures; pain.

345
Q

How do you apply QuikClot combat gauze?

A

Pack directly into the wound; apply consistent pressure for at least 3 minutes or until bleeding stops; bandage tightly.

346
Q

What is priority in a traumatic cardiac arrest?

A

External haemorrhage.

347
Q

How to manage airway in traumatic cardiac arrest?

A

DAM or TAM; suction; basic airway adjuncts; advanced airway if direct trauma.

348
Q

What should you do if a patient in cardiac arrest with suspected chest trauma does not respond to airway opening and restoration of blood volume?

A

Needle decompression.

349
Q

What is the approach for a traumatic cardiac arrest in comparison to the normal DRABCs?

A

DERCAB.

Danger; external haemorrhage control; response; circulation; airway; breathing.

350
Q

What is the primary objective of the first crew on scene of a multi-casualty incident?

A

Initiating command and control; ensuring safety; giving initial sit-reps; evaluate further required resources.

351
Q

What are the roles of paramedics on scene during a multi-casualty incident?

A

First crew on scene; forward commander; triage officer.

352
Q

What is the primary objective of the forward commander on scene of a multi-casualty incident?

A

Responsible for ambulance resources at major incidents.

353
Q

What is the primary objective of the triage officer on scene of a multi-casualty incident?

A

Initial triage; resource allocation.

354
Q

What does the first sit-rep involve?

A

Confirmation of arrival and location; snapshot of observations.

355
Q

What does the second sit-rep involve?

A

METHANE.

Major incident confirmation; exact location; type of incident; hazards; access; number of casualties; emergency services required.

356
Q

What is SIEVE in reference to multi-casualty incidents?

A

A triage system used to determine which area of the casualty clearing area to take the patient to.

357
Q

In a multi-casualty incident, what priority would the patient be if they were walking but injured?

A

Priority 3.

358
Q

In a multi-casualty incident, what priority would the patient be if they were laying down and breathing with a respiratory rate of 10-29 breaths per minute but had a pulse of 120 bpm?

A

Priority 1.

359
Q

In a multi-casualty incident, what priority would the patient be if they were laying down and breathing with a respiratory rate of 10-29 breaths per minute but had a pulse of 110 bpm?

A

Priority 2.

360
Q

In a multi-casualty incident, what priority would the patient be if they were laying down and breathing with a respiratory rate of 7 breaths per minute?

A

Priorty 1.

361
Q

In a multi-casualty incident, what priority would the patient be if they were laying down with a closed airway but breathing?

A

Priority 1.

362
Q

What is SORT in reference to a multi-casualty incident?

A

A triaging system used to determine the order of transport to hospital.

363
Q

What are the components of SORT in reference to a multi-casualty incident?

A

GCS score; respiratory rate; systolic BP.

364
Q

What is CBR in reference to multi-casualty trauma incidents?

A

Chemical; biological; radiological.

365
Q

What clinical feature will patients who have been in contact with chemicals that affect their nerves present with?

A

Parasympathetic overstimulation.

366
Q

What clinical features will patients who have been in contact with chemicals that affect their skin present with?

A

Chemical burns; blisters.

367
Q

What clinical features will patients who have been in contact with chemicals that affect their airway present with?

A

Airway damage; choking.

368
Q

What clinical features will patients who have been in contact with chemicals that affect their blood present with?

A

Histotoxic hypoxia and eventual multi-organ failure.

369
Q

What is the management for a multi-casualty incident involving chemicals?

A

Decontamination; airway control; antidotes.

370
Q

What are examples of biological material that could result in a multi-casualty incident?

A

Viruses; bacteria; toxins.

Paramedic (2 decks)

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