Trauma Flashcards
If patient is complaining of pelvic pain, what do you do? What do you not do?
Do not apply pressure or palpate
_____: is a tearing of a joint capsule of connective tissues, specifically ligaments. Injury causes acute pain followed shortly by inflammation and swelling.
Sprain
Grade ___ Sprain: Minor and incomplete tear, painful and swelling is minimal.
Grade 1
Grade ___: Significant but incomplete tear; swelling and pain moderate to severe.
Grade 2
Grade ___ Sprain: Complete ligament tear; severe pain and spasm.
Grade 3
_____: Occurs when muscle fibers are overstretched by forces that exceed the fiber strength. Occurs during extreme muscle stress, heavy lifting or sprints.
Strains
_____: a complicated process that ultimately disrupts the continuity of a bone.
Fracture
_____ fracture: (stable) small crack that doesn’t disrupt the total structure.
Hairline fracture
_____ fracture: (stable) impact on itself resulting in a compressed but aligned bone.
Impacted fracture
_____ fracture: (unstable) a complete break in a bone that runs straight across at about 90 degree angle.
Transverse
_____ fracture: (unstable) runs at an angle across the bone.
Oblique fracture
_____ fracture: (unstable) is several small fragments of bone caused by high velocity bullet or crush injury.
Comminuted fracture
_____ fracture: involving a twisting motion; may result in a curved break around the bone.
Spiral fracture
_____ fracture: (stable) prolonged or repeated stress.
Fatigue Fracture AKA Stress Fracture
_____ fracture: like a bent green twig; only disrupts on the side of the long bone.
Pedi fracture AKA Greenstick fracture
_____: can be caused by excessive walking (plantar fasciitis)
Nontraumatic inflammation
Palpated Carotid Pulse = ___ Systolic
60
Palpated Femoral Pulse = ___ systolic
70
Palpated Radial pulse = ___ systolic
80
In head injuries, how often do you re-assess?
Every 5 minutes
Cushing Triad SS:
Bradycardia
Irregular Respiration
HIGH BP / Hypertension
Cushing’s triad is _____.
Intracranial Pressure
Pneumonic:
CT-Bleeding In Head
Cushing’s Triad-
Bradycardia
Irregular Resps
Hypertension
The number 1 concern in burns is _____ (especially in pedis).
Airway
During burns, _____ burns is the most lethal for pediatrics.
Airway burns
During burns, _____ burns is the most lethal for elderly.
Skin
_____ energy penetrating trauma is knife stab or arrow.
Low energy
_____ energy penetrating trauma is pistol.
Medium energy
_____ energy penetrating trauma is sniper rifle or AR15.
High energy
_____: an open wound that penetrates more deeply into the dermis than an abrasion. Tends to involve a smaller surface area being limited to the tissue around the penetration.
Laceration
_____ is a type of laceration that involves a small entrance wound with damage that extends into the body’s interior. It carries an increased danger of infection.
Puncture wound
_____ is an injury involves a larger blood vessel most commonly an artery blood can separate tissue and pool in pocket.
Hematoma
How often do you ventilate an unconscious person?
Every 6 seconds
Beck’s Triad:
Beck’s Triad is SS for:
Muffled heart sounds
JVD
Narrowing pulse pressure
Cardiac Tamponade
_____ can be a sign of liver failure, right sided heart failure, tension pneumo or Tamponade.
JVD
_____: air will go straight into the abdominal wall and create JVD like a tension pneumo.
Diaphragmatic rupture
Fracture treatment: (4)
Pulse check, immobilize, recheck pulse, and treat pain.
_____: hit someone on top of the head and all force goes to the feet.
Axial loading
Axial loading typically causes compression injuries to the spine between ___ and ___.
T12-L2
In quadriplegics, what nerve controls the diaphragm?
Phrenic Nerve
What is the most common complication in quadriplegics?
Bladder Incontinence
Signs and Symptoms of Neurogenic Shock:
Irregular breathing
Vasodilation
Le Fort Fracture locations: 1, 2, 3
1: Mustache
2: Tip of the Nose
3: Lower eye orbit
The number 1 concern for penetrating trauma to the face or neck is ______.
Airway compromise
_____ is the best treatment for a conscious/talking patient with penetrating trauma. _____ the greatest chance of survival.
Rapid transport
Surgery
1st Degree Burn = _____
2nd Degree Burn = _____
3rd Degree Burn = _____
What do you bandage it with?
Superficial
Partial
Complete
Dry, sterile dressing
If a football player is injured, what do you do with their helmet and/or pads?
If one comes off they both come off.
What to do if you’re going to leave motorcycle helmet on?
Put pad under their shoulders.
If the patient has multiple injuries, _____ is always key.
Surgical intervention
How to treat sucking chest wound:
Occlusive dressing
*not needle decompression
_____, _____ and _____ get treated immediately upon discovery because of their life threats.
Arterial bleeds, sucking chest wounds, tension pneumo’s.
_____ are most common wound with motorcycle injuries.
Abrasions
Electrical burns have a tendency to enter _____ and go out _____ or _____.
Enter right hand, go out left or right foot.
Electrical burns are critical calls because they _____.
Can burn the entire cardiovascular system.
Vertebral Sections:
7 Cervical
12 Thoracic
5 Lumbar
5 Sacral
4 Coccyx
The _____ vertebrae are located at the base of the skull and shoulders and is the sole skeletal support for the head.
Cervical
The _____ vertebrae contain a vertebral body that is heart shaped. Supports more of the human body so it’s larger and stronger than cervical. It is the biggest vertebral section.
Thoracic
The _____ vertebrae carry weight of head, neck, upper extremities and thorax. These vertebral bodies are the largest in the spinal column and they bear the force of lifting and bending above the pelvis.
Lumbar
The _____ vertebrae helps protect urinary and reproductive organs.
Sacral
The _____ vertebrae fused together.
Coccyx
A _____ is caused by blunt trauma to the brain tissue that produces capillary bleeding into the brain substance (focal injury).
Cerebral Contusion
_____ DO NOT save trauma patients; _____ DOES save trauma patients.
IV’s; Rapid Transport to Trauma Centers
How to manage spinal shock:
Manage C spine while intubating if there is no equal rise and fall of chest.
Multiple Injuries:
Always treat _____ first. Even if someone is trapped you have to address _____ first.
Life threats; Bleeding.
Keep blood inside with _____ first, then tourniquet.
Direct Pressure
Transportation of Patient to Trauma Center:
Step 1
Glasgow Coma Scale:
Systolic BP:
Respiratory Rate:
“Go to Highest Level of Care within the Defined Trauma System”
=<13
<90
<10 or >29 /Min; (<20 for infant to <1 year)
Transportation of Patient to Trauma Center:
Step 2
All _____ injuries to head, neck, torso and extremities _____ to elbow or knee.
_____ instability or deformity.
___ or more proximal long-bone fractures.
_____, _____, _____ or _____ extremities.
_____ fractures.
_____ or _____ skull fractures.
_____.
“Go to Highest Level of Care within the Defined Trauma System”
Penetrating; proximal
Chest wall
2
Crushed, degloved, mangled or pulseless
Pelvic
Open or depressed
Paralysis
Transportation of Patient to Trauma Center:
Step 3
Falls:
-Adults: ___ feet.
-Children: ___ feet.
High Risk Auto Crash
-Intrusion (including roof): ___ inches occupant site; ___ inches any site.
-_____ from automobile.
-_____ in same passenger compartment.
-Vehicle telemetry data consistent with a _____.
Auto vs Ped with ___ mph impact.
Motorcycle crash ___ mph.
“Transport to trauma; need not be highest level.”
Adults: >20 ft
Children: >10 feet
>12 inches; >18 inches
Ejection
Death
High risk of injury.
>20 mph
>20 mph
Transportation of Patient to Trauma Center:
Step 4
Older Adults
-Risk of death/injury increases after age ___.
-SBP ___ might represent shock after 65 yo.
Children
-Should be triaged preferentially to _____.
Anticoagulants and Bleeding Disorders
-Patients with _____ are at high risk for rapid deterioration.
Pregnancy ___ weeks.
Transport to trauma center or hospital capable of timely and thorough evaluation.
55
<110
Pediatric capable trauma centers
Head Injuries
>20
Blast Injuries:
_____: Shockwave damage hollow organs; ear drums; tension pneumo etc. “Unique to HE, results form the impact of the over-pressurization wave with he body surfaces.”
Primary
Blast Injuries:
_____: Shrapnel phase (lacerations/bleeding etc).
Secondary
Blast Injuries:
_____: Building collapses fall on top of you causing head and neck injury. “Individuals being thrown by the blast wind.”
Tertiary
Blast Injuries:
_____: radioactive or dirty bomb fall out. “All explosion-related injuries, illnesses or diseases not due to primary, secondary or tertiary. Includes exacerbation or complications of existing conditions.”
Quaternary
_____: Coughing up blood.
Hemoptysis
How to manage non-traumatic back pain:
Position of comfort
How to manage traumatic back pain:
C-Spine then backboard
How to do trauma patient assessment:
Same way every time.
Amputation:
First- _____
Second- Take the part and place in _____.
Stop the bleeding and control life threat.
Plastic baggy in cool water or ice water but NEVER directly on ice.
In blunt trauma, _____ cannot constrict but _____/_____ can constrict or dilate.
Capillaries cannot.
Arteries/veins can.
The biggest thing that kills burn patients is the _____.
Toxic effects of smoke.
Any patient with bilateral tension pneumo needs _____.
Bilateral needle decompression.
Abdominal injuries are mostly caused by _____.
Penetrating injuries (Stabbing/shooting)
2 types of capillary sphincters:
Pre
Post
_____ capillary sphincters open to let trash out.
Post Capillary Sphincter
During _____ shock, the systolic BP falls and diastolic BP remains high then pre capillary sphincter is open and post capillary is closed.
Decompensated
During _____ shock, both pre and post capillary sphincters are closed.
Compensated
Skin burns on _____ have a harder time recovering due to lost collagen, weakened immune system,etc.
Geriatrics
Airway burns on _____ have the highest mortality rate.
Pediatrics
Fluid bolus for trauma patients is _____ ml/kg.
_____ for <1 month.
20 ml/kg
10 ml/kg
Positive Orthostatic (Tilt Test):
Laying flat on bed take BP and HR.
Sit up; after 1 minute retake BP and HR.
If HR GOES UP MORE 10 or BP GOES DOWN MORE THAN 10 systolic.
The goal in hemo shock is to _____.
Maintain preload.
Loss of sensation at:
Diaphragm
Clavicle
Nipples
Umbilicus
Pelvic rim
Diaphragm: C3/C4/C5
Clavicle: C4/C5
Nipples: T4
Umbilicus: T10
Pelvic Rim: T12
In soft tissue injury, _____ is going to have the greatest effect on controlling soft tissue bleeding.
Compression/direct pressure
Hypotension is _____ or less.
Profound hypotension is _____.
90/50
If they can’t profuse to their heart or organs.
If you intubate patient and HR drops, it means you _____.
Spent too long intubating so you need to reoxygenate to get HR up.
Fluid bolus is ___ mL/kg given ___-___ cc at a time.
20 ml/kg given 250-500 cc at a time.
Decompensated shock patient - maintain _____.
Blood Pressure.
Uncontrolled hemorrhage patient; maintain BP of ___/radial pulse.
80.
Controlled hemmorhage patient; maintain BP of ___.
90
_____; blood sits still and forms clot.
Capillary stagnation.
In a multi-system trauma, _____ and _____.
XABCDE and rapid transport
_____: Solid organ pain. Constant or intermittent?
Somatic pain. Constant
_____: Hollow organ pain. Constant or Intermittent?
Visceral pain. Comes and goes with fatty foods
RUQ, _____ is the biggest problem because of blood.
Liver
Gallbladder is hollow and can cause sepsis in ___-___ days.
3-7 days.
LUQ, _____ is the blood organ. If sepsis happens here then it is in the _____.
Spleen. Pancreas
3 types of burns:
Thermal
Chemical
Radiology
_____: most concerning fracture in kids.
Growth plate fracture
In a car wreck, _____ is the greatest cause of death.
Up and over.
_____ helmets are the hardest to remove.
Full Face
4 year olds should have a systolic BP of _____ for compensated shock.
78.
Formula for Compensated shock:
70 + 2xAge = If compensated or not.
_____ (steroid) won’t let the inflammatory response happen.
Prednisone
Peaked T waves means _____.
Patient needs what 2 drugs?
Hyperkalemia; Bicarbonate or Calcium Chloride
What’s the problem with pedis and burns?
They have less surface area.
If patient has compartment syndrome, you must put them on what?
The monitor.
Pedi has small body surface, this means more/less protection from burns?
Less
A nose bleed from high BP is ____. The only way to stop it is _____.
Epistaxis; Get BP lower.
Pericardial tamponade- it takes about ___-___ cc of blood in pericardial sac before it develops. But if you take ___ cc it will dramatically improve patient. In order to do that you have to perform _____.
200-300cc
20cc
Pericardiocentesis
_____ injury is widespread blunt trauma to the head; high chance of death; damages entire nerve axons in the brain.
Diffuse Axonal
How to treat brain injury with cerebrospinal fluid?
Do not pack anything in the ear.
Immediate treatment for sucking chest wound?
Cover with gloved hand.
You discover a patient with a sucking chest wound. Steps to treat.
Cover with gloved hand.
Finish assessment.
Then apply occlusive dressing.
What type of breathing will be present with neurogenic/spinal shock?
Shallow diaphragmatic.
Diaphragmatic breathing occurs in spinal injuries at or above what vertebrae.
C3-C5
How to treat patient with diaphragmatic breathing in neurogenic/spinal shock?
Positive Pressure Vent
12 Cranial Nerves:
On Occasion Our Trusty Truck Acts Funny Very Good Vehicle Any How.
Some Say Merry Money But My Brother Says Big Butts Matter More.
Olfactory
Optic
Occulomotor
Trochlear
Trigeminal
Abducens
Facial
Vestibulocchlea
Glossopharengyeal
Vagus
Accessory
Hypoglossal
CN 1 - Olfactory Nerve:
Smell
CN 2 - Optic Nerve:
Transmits visual information from the retina to the brain.
CN 3 - Occulomotor Nerve:
Controls most of the eye’s movements, pupil constriction and maintains open eyelid.
CN IV - Trochlear:
Controls the superior oblique muscle, allowing the eye to look downward and laterally.
CN V - Trigeminal Nerve:
Provides sensation to the face and controls the muscles involved in chewing.
CN VI - Abducens Nerve
Controls the lateral rectus muscle, which moves the eye outward.
CN VII - Facial Nerve
Controls facial expression, taste sensation from the anterior tongue and glandular secretions.
CN VIII - Acoustic Nerve
Responsible for hearing & balance
CN IX - Glossopharengeal Nerve
Involved in taste, swallowing and monitoring BP
CN X - Vagus Nerve
Controls HR, digestion, and other parasympathetic functions.
CN XI - Spinal Accessory Nerve
Controls muscles used in head movement and some muscles involved in swallowing
CN XII - Hypoglossal Nerve
Controls Tongue Movement
How to position pregnant patients:
On their left side to displace fetus off the Vena Cava.
If doing CPR on pregnant patient:
Have someone push the baby off the vena cava. Push them to the side.
Burns, typically after 12 hours, we get burn shock or fluid shift. The PT goes into _____ shock.
Hypovolemic.
The fluids leak out of the vascular space into the tissue and tend to swell the soft tissue.
If PT is pale, cool, clammy and tachycardic right after the burn happens, it is from _____.
Internal Bleeding.
If PT is warm and dry after burn then several hours later they become pale, cool and clammy then patient is experiencing _____.
Burn Shock
Rapid Trauma Primary Assessment looks for _____.
Life Threats Only
PT complaining of T1 pain, you are probably going to see a change in _____ and the _____ will be affected.
Intercostal Space; little finger
C7-T1 are _____ nerves.
Peripheral nerves
If you are paralyzed at C7/T1, then your _____ aren’t going to move also.
Little Fingers
What is the best treatment for mid-shaft femur fracture?
Traction Splint
Contraindication for traction splint use on femur fracture:
Hip or pelvis injuries
What is the goal (5) for hemorrhagic shock in the prehospital setting?
1 goal is to control the bleeding.
Maintain adequate BP
Minimize prehospital time (Golden 10 Minutes)
Avoid Excessive Fluid Resuscitation
Definitive Care is SURGERY
How to treat any wound that is on the neck to the naval:
Occlusive Dressing.
No Packing
What cranial nerve controls your tongue?
Hypoglossal Nerve (XII)
Le Fort Fractures: I, II, III
I: Lip/Mustache
II: Nose
III: Lower Eye Orbit
Confined Space Explosion:
Primary-
Secondary-
Tertiary-
Quaternary-
Primary- Blast Wave
Secondary- Shrapnel
Tertiary- Thrown against building/collapse
Quaternary- Injuries/Illnesses
When to use occlusive dressing:
Any open wound on the chest, neck or upper chest; Anywhere we could have air introduced into the pleural cavity; can include neck and armpit.
_____: Severe and Final stage of shock where the body’s cells are so extensively damaged that they die in large quantities, leading to organ failure and untimely death.
Irreversible Shock
Irreversible Shock SS:
HR:
BP:
RR:
Down; Down; Down
_____: Stage of the burn process in which there is increased body metabolism in an attempt by the body to heal the burn. Comes after the fluid shift. Characterized by large increase in the body’s demands for nutrients.
Hypermetabolic Phase
What does Secondary Assessment in trauma look for?
Identifies ALL potential injuries.
Any life threats not found during primary.
If someone is stabbed in the left flank, it most likely hit the _____ system.
Urinary system
_____ sign: Bruising on the flanks and can indicate retroperitoneal hemorrhage hemorrhage.
Grey Turner’s Sign
What is the Ligamentum Teres Hepatis? What happens to it during Liver Damage?
It anchors the liver within the abdominal cavity.
It can shear and lead to hemorrhage.
6 P’s of Trauma:
Pain
Pallor
Paralysis
Parasthesia
Poikilothermia
Pulselessness
What to use to identify compartment syndrome?
6 P’s of Trauma
Most Common “P” you see in fractures:
Pain
When intubating a burn patient, how do you choose airway size?
Go down 1/2 size due to swelling.
How many attempts do you get to realign a fracture? *
1 attempt
*if there is no PMS present; if there is PMS present, do not attempt to realign
Can you realign open fractures?
No
Premedication for advanced airway should include _____ to decrease ICP.
Lidocaine
Hypovolemic Shock:
Stage 1:
Blood loss-
HR-
RR-
BP-
Blood loss- Less than 500mL (<15%)
HR- Normal
RR- Normal
BP- Up
Hypovolemic Shock:
Stage 2:
Blood loss-
HR-
RR-
BP-
Blood Loss- 750-1250 mL (15-30%)
HR- Up
RR- Up
BP- Up
Hypovolemic Shock:
Stage 3:
Blood loss-
HR-
RR-
BP-
Blood Loss- 1250-1750 (30-40%)
HR- Up
RR- Up
BP- Below 90
Hypovolemic Shock:
Stage 4:
Blood loss-
HR-
RR-
BP-
Blood Loss- 2000 mL or more (>40%)
HR- Down
RR- Down
BP- Down
Neurogenic Shock SS:
HR-
RR-
BP-
*
HR- Normal
RR- Shallow Diaphragmatic Breathing
BP- Low
* Warm Flushed Skin
*Cap Refill Faster than Normal
Trauma Triad of Death: (HAC)
Hypothermia
Acidosis
Coagulopathy
Glasgow Coma Score:
Eye Opening
-EYES
Verbal Response
-VOICE
Motor Response
OLD BEN
Eye Opening 1-4
-Eyes SHUT, Y pin pricking pain, Ears hears noise, Spontaneous
Verbal Response 1-5
-Voiceless, Obscure, Inappropriate, Confused, Elegant
Motor Response 6-1
-Obey, Localized pain, Draw away, Bend, Extension, None
What is the first drug given in crush injuries, before lifting object off patient? What is second?
Sodium Bicarbonate. Then Albuterol
3 Phases of Burns:
Emergent
Fluid Shift
Hypermetabolic
