Trauma Flashcards
1
Q
How many Bones are in the spine?
A
33
2
Q
What part of the spine can be palpated?
A
The spinous processes
3
Q
What does CSF do
A
Carries nutrients and waste, cushions the brain
4
Q
CSF fills the
A
Sub arachnoid space
5
Q
The spinal cord extends to
A
L1-L2
6
Q
The spinal cord is pulled into the spinal foramen by the
A
Cauda equina
7
Q
What type of brain matter holds the most cell bodies
A
Gray matter
8
Q
What type of brain matter is full of axons and cushions the interior matter
A
White matter
9
Q
Ascending tracts carry
A
Sensory signals to the brain
10
Q
Descending tracts carry
A
Motor signals to the body
11
Q
Where does the 1st pair of spinal nerves exit the spinal cord
A
Between the skull and C1
12
Q
Ventral roots transmit:
A
Motor impulses from cord to body
13
Q
Dorsal roots transmit:
A
Sensory impulses from body to cord
14
Q
The Cervical plexus is
A
5 nerve roots that innervate the neck
15
Q
The phrenic nerve
A
C3-C5. Controls the diaphragm
16
Q
The Brachial plexus
A
C5-T1. Controls upper extremities
17
Q
The Lumbar and Sacral plexus
A
Innervate the lower extremities
Lumbar T12-L4
Sacral L4-S3
18
Q
What’s the most common form of chest trauma
A
Blunt
19
Q
What dermatome innervates the collar region
A
C3
20
Q
What dermatome innervates the little finger
A
C7
21
Q
What dermatome innervates the nipple line
A
T4
22
Q
What dermatome innervates the umbilicus
A
T10
23
Q
What dermatome innervates the small toe
A
S1
24
Q
What myotome is responsible for arm extension
A
C5
25
What myotome is responsible for elbow extension
C7
26
What myotome is responsible for small finger abduction
T1
27
What myotome is responsible for knee extension
L3
28
What myotome is responsible for ankle flexión
S1
29
The parasympathetic nervous system stems from
Sacral and cranial nerves
30
The sympathetic nervous system stems from
Thoracic and lumbar regions
31
The four extremes of motion
Hyperextension, hyper-flexión, excessive rotation, and lateral bending
32
Axial loading most commonly compressed between
T12 and L2
33
Temporary and transient disruption of cord function
Cord Concussion
34
Tissue damage, vascular leakage, and swelling of the cord
Cord contusion
35
Secondary to vertebrae displacement, herniation, swelling
Cord compression
36
Bony fragments driven into vertebral foramen or stretching to a point of tearing in the cord
Cord laceration
37
Paraplegia
Paralysis of the lower half of the body
38
Loss of motor function and sensation below an injury site
Anterior cord syndrome (vascular disruption)
39
Hyperextension of the cervical spine causing motor weakness of the upper extremities
Central cord syndrome
40
Penetrating injury on one side of the cord that causes ipsilateral sensory/motor loss and contralatetal pain and sensation loss
Brown-sequard’s syndrome
41
Priapism
Persistent Erection caused by spinal injury
42
Temporary insult to the cord effecting the body below the injury resulting in flaccid paralysis
Spinal shock
43
Injury to the spinal cord prevents the brain from controlling the body
Spinal shock
44
Neurogenic shock causes sympathetic tone loss which causes
Dilation of blood vessels, reduced cardiac preload, reduction of inotropy.
45
Neurogenic shock causes the ANS to loose control of the adrenal medulla which causes
An inability to control epinephrine and norepinephrine release which prevents positive inotropic and chronotropic effects
46
Symptoms of neurogenic shock
Bradycardia, hypotension, cool/moist/pale skin above injury, warm/dry/pink skin below injury (priapism in males)
47
Consider spinal precautions in patients with
Head injury, intoxication, injuries above the shoulders, distracting injuries, unknown MOI in trauma, suspected spinal insult
48
Babinski’s sign
Indicates upper motor neuron damage. Flaring of big toe when the sole of the foot is stroked with a blunt object
49
Bulbocavernosus reflex
Contraction of the sphincter when the clitoris or penis is squeezed
50
What are you looking for when you palpate the spine
Tenderness, step offs, crepitus, temperature
51
In spinal shock less movement is
Best
52
Gentle manual traction of the C spine should provide
Reduced axial loading and elevate the posterior cervical spine
53
The C-collar is meant to
Limit movement and reduce axial loading
54
Remove a helmet only if
The helmet does not immobilize the head, can’t be secured, prevents airway care, prevents assessment, or will not cause further injury
55
True or false: you should leave helmets at the scene of the accident as they are evidence
False! Being the helmet
56
Spondylosis
Bone overgrowth
57
What are the three main types of chest trauma
Blunt
Penetrating
Compression
58
Blunt trauma can be divided into
Blast
Compression
Acceleration/Deceleration
59
Penetrating trauma can be divided into
High velocity
Low velocity
60
Place in order: Mediastinum shift, C02 decreases, Cardiac arrhythmias, sudden death, compression of large veins, lung collapse, intrapleural space increases, chest injury
Chest injury, intrapleural space increases, lung collapse, mediastinum shift, compression of large veins, C02 decreases, cardiac arrhythmias, sudden death
61
A condition caused by Accumulation of air in the chest without an apparent antecedent event. Caused by blebs. May be spontaneous. May self correct
Simple/Closed pneumothorax
62
An opening in the chest wall that allows air to enter the pleural cavity is called
A sucking chest wound
63
A sucking chest wound becomes the preferential path of air when the hole is
Greater than or equal to 2/3 the diameter of the trachea
64
Air collection in subcutaneous fat from the pressure of air in the pleural cavity is called
Subcutaneous emphysema
65
The five hallmark signs of Tension pneumothorax
Subcutaneous emphysema, hyper resonance, hyper inflation, tracheal deviation, jugular vein distention
(Plus absent lung sounds)
66
A condition where air builds in the pleural space and is unable to escape
Tension pneumothorax
67
What spaces get needle decompressed
1. 2nd intercostal space above the third rib
2. 5th intercostal space above the 6th rib
68
A condition where the pleural space fills with blood
Hemothorax
69
How much blood can each lung hold
1.5 Liters
70
The breaking of 2 or more ribs in 2 or more places is called
Flail chest
71
S/S of flail chest
Paradoxical movement, SOB, bruising, swelling, crepitus, hypertension
72
A condition where blood and other fluids fill the pericardial sac preventing the heart from contracting properly
Pericardial tamponade
73
True or false: Small aortic ruptures have a greater chance of survival
True
74
What’s the most common location for a traumatic aortic disruption
Ligamentum arteriosum
75
During a traumatic aortic rupture, pulses will decrease on the ____ side
Left
76
Sudden compression of the chest cavity leading to rupture of vessels/organs
Traumatic asphyxia
77
Traumatic asphyxia causes
Venous black flow into neck and brain
78
Petechiae, dyspnea, bulging eyes, purple face discoloration, and swollen tongue are all signs of
Traumatic asphyxia
79
A tear in the diaphragm that allows for abdominal organs to enter the chest
Diaphragmatic rupture
80
True or false: you should always needle decompress if you heat bowel sounds in the chest
False. Never dart diaphragmatic rupture
81
The best way to determine if a patient is breathing is to
Listen and feel for breathing at the mouth and nose
82
What is the treatment for a sucking chest wound on the back
Occlusive dressing taped on 4 sides
83
What is the treatment for a sucking chest wound on the front
And occlusive dressing taped on 3 sides
84
If you’re patient has Cheyenne stokes respirations what airway management should be implemented
ET tube
85
After determining a patient is not responsive to verbal stimuli you should check for
Response to painful stimuli
86
A higher than normal ETC02 means a patient is
Acidotic
87
Signs and symptoms of shock include
Increased heart rate, increased respirations, decreased blood pressure
88
General impressions help to
Determine general clinical status and priority
89
Manual stabilization of the spine is meant to
Prevent movement of the neck and lessen axial loading
90
The platinum ten minutes refers to
10 minutes from arrival on scene to en route to the hospital
91
Primary assessment in a trauma assessment begins with
Scene survey
92
Flail chest is managed with
Bulky dressing
93
Golden hour is
60 minutes from arrival on scene to the operating room
94
Gurgling during breathing is associated with
Fluid in the upper airway
95
What injuries are most likely to occur in a rear and collision
Head and neck
96
A patient with a suspected TBI should be transported
At a 15-30 degree angle
97
3 sided occlusive dressings prevent
Tension pneumothorax
98
Coup injuries most often occur at what region of the brain
Frontal
99
A conclusion is
Direct diffuse
100
Direct brain injuries are
The immediate effect of the cranial insult
101
Indirect brain injuries are
The result of the physiological response to the cranial insult
102
Focal injuries
Occur in a specific location. Obvious Anatomical damage
103
Diffuse brain injuries
Are widespread and often caused by small lesions in axons
104
A patient with paradoxical chest movement and a RR of 4 should be
Provided with PPV
105
At what point of low CPP does auto-regulation increase blood pressure
50 mmHg
106
Fractured vertebrae from a lateral twisting motion is likely caused by
Lateral impact
107
The pathway of injury left by a penetrating wound is called
Cavitation
108
Subdural hematomas are likely caused by this blood vessel
Superior sagittal sinus
109
What may cause an indirect brain injury
Systemic hypotension coupled with increased ICP
110
What mechanism will likely result in a tear of the liver at the ligamentum teres
Sudden deceleration
111
What cranial nerve can not be assessed by observing the eyes of a patient
VII
112
Frontal impacts in which a patient takes a “down and under” pathway results in
Hip and femur fractures
113
A stared window shield likely indicates
Compression of the cervical spine and a head injury
114
How can you distinguish and exit wound from an entrance wound?
You can’t. Only trained professionals can
115
The two factors that refer to the rate of change of speed are
Acceleration and deceleration
116
Vehicle supplemental restraint systems are meant to
Absorb the energy exchange of rapid deceleration
117
Shearing/stretching/tearing associated with rapid acceleration/deceleration are what type of brain injury
Direct diffuse
118
What two factors primarily effect the kinetic energy of a bullet
Velocity and mass
119
Concussion is a ____ injury
Diffuse
120
RSI for prehospital management is controversial: true or false
True
121
The cerebrum, Cerebellum, and brain stem are what percentage of cranial volume
80%
122
True or false: pressure waves from blast injuries may be transmitted through blood causing damage a distance from the primary wound
True
123
In head trauma patients, what systolic BP should you aim for in fluid resuscitation
90 mmHg
124
Subdural hematomas are typically caused by
Bridging veins
125
If a patient loses sensation in their little finger, what dermatome is likely damaged
C7
126
Countercoup refers to
Injury on the opposite side of impact
127
Subdural hematomas occur between
The dura mater and arachnoid mater
128
Intracranial hemorrhage is like
Stroke
129
Lucid intervals occur in
Epidural hematomas
130
Nerve dysfunction without anatomical damage
Concussion
131
The cervical plexus innervates
The neck
132
A GCS of 9 is classified as
Moderate
133
Epidural hematomas present as
Rapid unconsciousness followed my a lucid interval and then rapid deterioration
134
Neurogenic shock has bradycardia or tachycardia
Bradycardia
135
Initial management for spinal injury patients is focused on
Spinal alignment
136
Epidural hematomas are often caused by
Arterial bleeds
137
What’s an early complication of acute spinal cord injuries
Respiratory failure
138
The most common site for spinal cord injury is
C1-C2, C7, T12, L1
139
It takes ___ seconds to fall unconscious if blood supply to the brain ceases
10
140
The vertebral bodies are responsible for
Weight baring
141
Complete transection of the spinal cord often results in
Quadriplegia
142
Epidural hematoma is typically caused by bleeding from the
Middle meningeal artery
143
Neurogenic shock should be treated with ____ solution
Isotonic
144
When moving a spinal injury patient you should
Move as a unit
145
Which meninge is the outmost
The dura mater
146
A sudden severe headache is indicative of
Subarachnoid hemorrhage
147
The ___ spine beats the weight of the body
Lumbar
148
The _____ tract is responsible for voluntary motor control of the limbs
Corticospinal
149
Thunderclap headache is indicative of
Subarachnoid hemorrhage
150
What type of medication helps reduce swelling and pressure on the spinal cord
Steroids
151
Which vertebrae have no vertebral body
C1 and C2
152
If your first tourniquet doesn’t work…?
Apply a second bby
153
Flail segments impair
Negative intrathoracic pressure
154
If an airway cannot be secured or maintained you should
CRIC THEM
155
Breathing quality refers to
Depth
156
MOI determination during scene size up permits
Anticipation of injuries
157
Pulse quality refers to
Strength
158
If a patient is hemodynamically unstable and is lacking/ has diminished lung sounds you should
Dart
159
If a patient is hyperkalemic and needs to be RSI’d you should use
A non depolarizing paralytic
160
What sign of shock is easily missed
Tachycardia
161
Rapid heart rate and anxiety are normal in trauma victims and do not indicate early shock, true or false?
False
162
Arterial bleeding does not
Clot quickly on its own
163
Fluids should be administered
As needed to maintain perfusion
164
What medications should be used as pretreatment in RSI with a head injury
Lidocaine and Fentanyl
165
TXA is a
antifibrinolytic
166
A mental summation of suspected injuries based on the event analysis
Index of suspicion
167
The correct treatment of strider depends on
The underlying problem
168
Decreased level of consciousness is a __ sign of shock
Late
169
GCS eye opening
4- spontaneous
3- Speech
2- Pain
1- none
170
GCS verbal response
5- Oriented
4- Confused
3- Inappropriate words
2- sounds
1- None
171
GCS motor ability
6- Obeys commands
5- Localizes to pain
4- Withdraws from pain
3- Decorticate
2- Decerebrate
1- None
172
Time is
Critical
173
CSF is comprised of
Water, protein, and salt
174
CSF is made in the
Brain ventricles
175
A loss of blood flow to the brain results in death by
4-6 minutes
176
CN I
Olfactory, sensory, smell
177
CN II
Optic, sensory, sight
178
CN III
Oculomotor, motor, constriction of pupils, rectus, and obliques
179
CN IV
Trochlear, Motor, superior obliques
180
CN V
Trigeminal, Sensory/Motor, chewing and ophthalmic
181
CN VI
Abducens, Motor, lateral Rectus muscles
182
CN VII
Facial, sensory/motor, tongue, face muscles
183
CN VIII
Acoustic, Sensory, hearing and balance
184
CN IX
Glossopharyngeal, sensory/motor, taste, face muscles, posterior pharynx
185
CN X
Vagus, Sensory/motor, taste, heart rate
186
CN XI
Accessory, motor, trapezius and sternocleidomastoid
187
CN XII
Hypoglossal, motor, tongue
188
Most common bone to break
Temporal due to its thinness
189
Raccoon eyes and battle signs
Late signs of basilar skull fracture
190
Le fort fractures
Facial fractures
191
Retro auricular ecchymosis
Battle signs
192
Bilateral periorbital ecchymosis
Raccoon eyes
193
CSF can be detected by
The halo sign
194
A sudden onset darkness/shadow to vision
Retinal detachment
195
Subdural hematomas have ___ bleeding
Slow
196
Raised ICP is often indicated by
Bradycardia and hypertension
197
C02 in CSF causes
vasodilation which contributes to ICP
198
Reduced C02 in TBI patients causes
Vasoconstriction which causes cerebral anoxia
199
Uneven pupils are a sign of
TBI
200
The _____ in the brain stem controls the respiratory drive
Medulla oblogata
201
S/S of brain injury
Altered LOC, Cushings reflex, vomiting, body temperature changes, changes in pupil reactivity, decorticate posturing
202
Cushings triad
Increased Bp, bradycardia, erratic respirations
203
Retrograde amnesia
Unable to recall events before the injury
204
Antegrade amnesia
Unable to recall events after trauma
205
What kind of respirations occur with head trauma
Cheyne-stokes
206
In pediatrics, swelling within the cranium may be slightly more forgiving due to
Fontanelles
207
Fixed and dilated pupils indicate
Extreme hypoxia
208
Facial tissue is
Highly vascular
209
What should be avoided in the case of patients with nasal trauma
NPAs and nasal tracheal intubation
210
Acute retinal detachment is
An emergency
211
Impaled objects should always be secured, true or false
False. If an object is moving with respiration, ceasing its movement may damage the patient more
212
What populations are most at risk of head trauma
Males 15-24
Infants
Young children
Elderly
213
_____ people experience head trauma annually
4 million
214
Increased ICP leads to
Cerebral hypoxia
215
What’s the largest opening in the skull
Foramen magnum
216
The cribriform plate is
Rough and inferior. Easily causes damage
217
What is the purpose of the meninges
Protects the CNS
218
The dura mater has what above it that provides blood to the surface of the brain
LARGE arteries
219
The brain receives what percentage of cardiac output
15%
220
The brain consumes what percentage of the bodies oxygen
20%
221
How fast does a person fall unconscious without blood supply to the brain
10 seconds
222
The cerebrum does what
Serves as the center of conscious thought, personality, speech, and motor control
223
The main purpose of the frontal lobe is
Personality
224
The main purpose of the parietal lobe
Motor and sensory activity and memory/emotion
225
Occipital
Sight
226
Temporal brain
Hearing, long term memory, speech, taste, smell
227
Dominant side of the brain
Left
228
The cerebellum
Fine tunes motor control and provided balance and muscle tone
229
The brain stem is
The central processing center that serves as a communication junction
230
Structures in the brain stem
Midbrain, pons, medulla oblongata
231
The midbrain contains the
Hypothalamus, thalamus
232
The medulla oblongata controls
Respirations, blood pressure, blood distribution, and heart rate/strength
233
Mean arterial pressure
MAP = DBP +1/3 pulse pressure
234
Cerebral perfusion pressure
CPP = MAP - ICP
235
ICP should be
Less than 10 mmHg
236
Map must be
At least 50 mmHg
237
Pulse pressure
PP = Systolic BP - Diastolic BP
238
Increased ICP Means a ____ in blood pressure
Raise
239
High ICP can cause what to happen to the cerebellum
Herniation or compression
240
The carotid arteries arise from
The brachiocephalic artery (right)
The aorta (left)
241
Carotid bodies monitor
O2 and CO2
242
Carotid sinuses monitor
Blood pressure
243
Jugular veins are either
External or internal
244
A traumatic insult to the brain capable of producing physical, emotional, intellectual, social, and vocational changes
Brain injury
245
Blunt trauma to local brain tissue causing capillary bleeding, confusion, and neurological defect
Cerebral contusion
246
Bleeding between dura mater and skull causing rapid deterioration post lucid interval
Epidural hematoma
247
Most common type of brain bleed
Subdural hematoma
248
Bleeding within the meninges with slow deterioration
Subdural hematoma
249
Ruptured blood vessels within the brain causing stroke like symptoms that get worse over time
Intracranial hemorrhage
250
Nerva damage without an atomic damage
Diffuse axonal injury
251
Hyphema
Bleeding in the eye
252
If a patient has suspected brain herniation what ETCO2 should they be kept at
35-40
253
CSF leakage occurs with
Basilar fracture
254
The halo test
Tests for CSF leakage
255
Less than 8
Intubate
256
Stable pelvic injury mortality rate
9%
257
Unstable pelvic injury mortality rate
30% or more
258
Types of pelvic injury
Anterior posterior compression
Lateral compression
Vertical shear
259
Anterior posterior compression
Caused by frontal impact MV crashes often
260
Vertical shear
Caused by a fall from a height
261
Lateral compression
Caused by side impact in MV or pedestrians vs vehicle
262
Internal hemorrhage is a major cause of death in pelvic injuries within the first
24 hours
263
A pelvic binder should be applied
Early
264
You can and should log roll patients with pelvic injuries, true or false
False. Use a scoop stretcher
265
Physiological Trauma activation criteria
*Systolic BP less than 90mmHg
*GCS <13
*Respiratory rate <10 or >29 (<20 in an infant)
*Need for ventilatory support
266
Anatomical Trauma activation Criteria
*Fracture of 2 or more proximal long bones
*All penetrating injuries to head/neck/torso/and extremities proximal to the elbow and knee
*Chest instability/deformity
*Crushed/degloved/mangled extremity
*Amputation proximal to the wrist or ankles
*Suspected Pelvic fracture
*Depressed or open skull fracture
*Motor/Sensory deficit
*
267
Special Trauma Considerations for activation
*Blood thinners/Bleeding disorders
*Elderly BP < 110 mmHg in an adult >65 years
*Children
*Low impact in the elderly
*Adults >55
Paramedic discretion
*Pregnant patients >20 weeks
*Burns
268
Mechanism of injury trauma activation criteria
*Vehicle vs pedestrian/bike crash >20mph
*Death of another patient in the same vehicle
*Penetration of 12 inches into the drivers compartment or 18 inches anywhere in the vehicle
*MVA >50 mph
*Ejection of an occupant
*Falls >20 ft in and adult or >10 ft in a child (Or 2-3 the height of the child)
*Vehicle telemetry data
*
