Trauma Flashcards
Order of spider straps
- Shoulders
- Feet
- Above Knee
- Pelvis
- Armpits
When two holes in chest, how is oclusive dressing applied?
Vented seal is higher than non-vented
Who gets cel-x (special wound packing)
Hypothermia and blood thinners
i.e., cold and old
Muscle injury from overstretching or overexertion
Strain
Obstructive shock
Due to something that is limiting function - tamponade, tension pneumo, pulmonary embolism
Distributive shock
w/o loss of fluids but with floppy wide blood vessels: neurogenic, septic, anaphylactic - shock
Cardiogenic shock
Due to damage to heart - problematic rhythms, MCI, trauma to heart (contusion)
Hypovolemic shock
Due to the loss of fluid - hemorrhage, loss of plasma, loss of body fluids
Trauma triad
Hypothermia, coagulopathy, acidosis
Coagulopathy happens…
Below 95 degrees, above 1.5 INR
End tidal above ?? means the kidneys are perfused
20
MAP formula and hypoperfusion MAP #
MAP is DBP + 1/3 PP
Hypoperfusion MAP<60
Drugs NR considers for unconscious patient w\o known reason
Thiamine, D50 and Naloxone
Open fracture and shortness of breath
Lead to pulmonary embolism
Especially tib-fib, FAT embolism that can reach lungs. s/s shortness of breath
Compartment syndrome following supracondylar fracture. Distal humorous, close to the elbow; common, especially PED
Volkmann contracture
Blast injuries impact
- Primary - blast wave itself
- Secondary - missiles propelled
- Tertiary - impact w/another object
- Quaternary - collateral: burns, crush injuries, toxic inhalation
- Quinary - long term damage
Related injury - arterial air embolism from alveolar disruption
Bleeding that is life threatening
Exsanguination
Another term for swelling (edema)
Erythema
Term for a bruise w/ black and blue marks
Ecchymosis (e cha mosis)
Collection of blood under the skin. Blue discoloration
Hematoma
The four phases of shock
- Initial - hypoxia, anaerobic cell respiration. Tachypnea
- Compensatory - (MAP above 60 means cells are still perfused)
- Progressive/uncompensated - MAP below 60. Organs are compromised.
- Refractory - Vital organs have failed, imminent death.
The fracture is at an angle to the shaft
Oblique fracture
The fracture is perpendicular to shaft
Transverse fracture
Growth plate in bone - fracture there can cause growth problems
Epiphyseal plate
Shifting of the joint without a full dislocation. Unlike dislocations, allows for normal, albeit painful motion.
Subluxation (sab lak say shen)
Falling on locked knees. Can result in tearing of the ligaments of the pelvis, symphysis pubis, and sacrum.
Vertical shear injury
Alveolar collapse, prevents ventilation
Atelectasis (a te LEK ta ses)
Air under the skin (“snap, crackle, pop”) suggest lung or airway injury
Subcutaneous emphysema
Mid section of the thoracic cavity; contains the heart and main blood vessels. Inflammation of
Mediastinum and mediastinitis
Flail chest is
TWO or more consecutive ribs must also be fractured in TWO or more places
Rib fractures concerns
- Aortic injury
- Tracheobronchial injury
- Pneumothorax (look for subcutaneous emphysema)
9-11 be suspicious of abdominal injuries
Can be auscultated when lung collapses (pneumothorax)
Hyperresonance
s/s of pulsus paradoxes
Drop of 10 mmHg during inspiration; we can feel radial pulse on expiration but not inspiration
Common between tension pneumo and simple pneumo
Shortness of breath, absent/diminished sounds on impacted side
Difference between tension pneumo and simple pneumo
Tachycardia and hypotension due to intrathoracic pressure causing decreased venous return to the heart.
Signs of tension pneumothorax
Absence of breath sounds on affected side, unequal chest rises, pulsus paradoxes, tachycardia and progression to vfib, JVD, narrow pulse pressure and tracheal deviation
Space between the visceral and parietal pleura of the lungs
Pleural cavity. One for each lung. Lubricated. Each space can hold up to 3000ml (exsanguination)
Massive hemothorax defined
More than 1500ml of blood in the pleural space (about 25% of adult blood volume).
When air leaks into the mediastinum
Pneumomediastinum (aka mediastinal emphysema)
s/s = Frequent PVCs in trauma patient. Shortness of breath, chest pain, cardiac dysrhythmias
Myocardial contusion
Beck’s triad (pericardial tamponade)
- Hypotension (bcs pressure limits preload)
- Muffled heart sounds (Fluid makes it harder to hear)
- Jugular venous distension (backup of blood in superior vena cava or heart)
Also, tachycardia and narrowing pulse pressure.
Treatment for pericardial tamponade - Prehospital and in hospital
Prehospital attempt to increase preload through fluids. In hospital - pericardiocentesis
Common between cardiac tamponade in tension pneumo
Right ventricle and vena cava compressed on inspiration - preload leading to lower BP
Different between cardiac tamponade in tension pneumo
w/TP no lung sound on one side; air hunger
Common to pulmonary contusion and pulmonary embolus
V/Q mismatch. i.e., ventilation normal but low pso2 & high end tidal
Aortic dissection, disruption , rupture s/s
Tearing pain behind sternum or in scapula; sign of shock; hematoma can lead to hoarseness or difficulty swallowing; harsh murmur as blood passes the injury site; Blood flow may be interrupted to extremities leading to pulse difference between left/right, upper/lower
Treatment: supportive, fluids
Concussion impact on memory
Transient retrograde amnesia (retrograde means before the event)
TBI Hematoma shapes
Subdural - crescent / banana shape (narrow)
Epidural lemon/round shape and bigger. More severe, only 1-2% of TBI
ETCO2 and head injury
“Targeted Ventilatory Management”
- Maintain 35-40 if NO signs of herniation.
- If herniation, 30-35.
- Never allow the ETCO2 to drop below 25 mmHg (increased mortality)
Signs of ICP
GCS drop of 2 or more, from 9
Pupillary changes
Cushing triad
Hyperpyrexia
Exceptionally high body temp due to ICP or infection
Hyperpyrexia
Cushing triad, (ICP sign)
- Widening pulse pressure;
- Bradycardia;
- Chaine Stokes/abnormal breathing
Medications that decrease cerebral edema and ICP
Mannitol (Osmitrol), furosemide (Lasix)
Epidural hematoma s/s
Often lose consciousness initially; regain consciousness for a while; and then fall unconscious when ICP at critical levels.
Head injury w/rapid onset of s/s: significant headache, mimic meningitis, Cushing reflex.
Subarachnoid hemorrhage
Injury separating facial bones from skull
Le Fort III
This injury disconnects the axons in the spinal cord to the brain.
Diffuse axonal injury
Results from hyperextension of the cervical spine. Loss of function in upper extremities.
Central cord syndrome
Fracture with s/s of battle sign, raccoon eyes, a positive halo test.
Basal skull fracture
Lesion in the spinal cord causing weakness or paralysis on one side and a loss of sensation on the opposite side.
Brown-Sequard syndrome (BSS)
Flexion injury with s/s motor and sensory loss inferior to the injury.
Anterior cord syndrome
Extension injury leading to decreased sensation to light touch and proprioception.
Posterior cord syndrome
Body’s ability to sense its position, movement, and orientation in space.
Proprioception, aka kinesthesia
Double vision
Diplopia
Neurological, ability to move both eyes in the same direction.
Conjugate gaze
4 Layers of skin
- Epidermis - part of it is dead cells that continuously shed
- Dermis - nerve, vessels, sweat, hair
- Subcutaneous tissue - insulates, protects and stores fat
- Deep fascia - thick, dense
Below them tendons connect muscles to the skeleton
Surgical procedure to treat full-thickness circumferential burns.
Escharotomy (es ke RA tami)
Most significant systemic response to burns
Hypovolemic shock due to (a) Fluid loss through damaged skin, (b) Volume shifts of fluids across body.
Injury to skeletal muscle and involves leakage of large quantities of toxic intracellular contents into plasma (potassium).
Rhabdomyolysis (rabdo ma YA la sis)
Emergency procedure to decompress compartment syndrome
Fasciotomy
Collected blood in abdominal cavity
Hemoperitoneum
Referred pain to left shoulder
Kehr sign
Hypothermia temp
Body temperature has decreased to 35°C (95°F) or less
Fragile bones
Osteoporosis
s/s Blood clots, Bruising, mottling of the skin, Drop in blood pressure, Bleeding from many sites in the body
Disseminated intravascular coagulation, or DIC
