Trauma Flashcards
1
Q
What are the top 5 causes of traumatic death?
A
MVC
Falls
Poisonings
Durns
Drownings
2
Q
What is trauma?
A
The acute physiologic and structural change (injury) that occurs in a patient’s body when an external source of energy dissipates faster than the body’s ability to sustain it.
3
Q
What are the 5 types of energy, explain them?
A
Mechanical energy- energy from motion
Chemical energy- may be found in explosive, acid, or drug sources
Electrical energy- high voltage electrocution or lightning strike
Thermal energy- hot or cold injury
Barometric energy- result from sudden and radical changes in pressure
4
Q
Define Velocity, Acceleration, and Gravity?
A
Velocity- distance travelled per unit of time
Acceleration- rate of change of velocity that an object is subjected to
Gravity- the downward acceleration imparted on an object on earth
5
Q
What is the kinetic energy equation?
A
Kinetic Energy = Mass/2 X Velocity(squared)
6
Q
What is Newton’s first law of motion?
A
A body at rest will remain at rest unless acted on by an outside force.
7
Q
What is Newton’s second law of motion?
A
The force that an object can exert is the product of it’s mass times it’s acceleration.
8
Q
What are the 5 phases of progressive deceleration?
A
Deceleration of the vehicle
Deceleration of the occupant
Deceleration of the internal organs
Secondary Impacts
Additional impacts
9
Q
What is the human limit to deceleration?
A
Approximately 30g
10
Q
How do Blunt and penetrating trauma differ?
A
Blunt trauma refers to injuries in which the tissues are not penetrated by an external object
Penetrating trauma results when tissues are penetrated by single or multiple objects
11
Q
What abdominal injury is most likely to be caused by by a seatbelt?
A
Bowel or Bladder rupture
12
Q
What can be assumed when you see a cracked or broken windshield?
A
The front seat occupant has a cervical spine injury until proven otherwise
13
Q
What are the 5 primary impact patterns?
A
Frontal or head on
Lateral or side impact
Rear impact
Rotational
Rollover
14
Q
What are the 2 possible trajectories of unrestrained patients?
A
Down-and-under or up-and-over
15
Q
How many ejection victims sustain major and permanent C-Spine damage?
A
1/13
16
Q
How effective are seat belts?
A
Seat belt use is associated with a 33% reduction in all injuries and more than 50% reduction in major injuries.
17
Q
What are the 4 types of motorcycle impacts?
A
Head on impact
Angular impact
Ejection
Laying the bike down
18
Q
What is the Waddell Triad?
A
Refers to the pattern of vehicle-pedestrian injuries in children and short people
1. Bumper hits pelvis and femurs
2. Chest and abdomen hit grille
3. Head strikes vehicle and then the ground
19
Q
What are the factors affecting the severity of an injury from a fall at heights?
A
Height- determines velocity
Position- helps determine types of injuries
Area- area of force distributed
Surface- onto which the person has fallen
Physical condition- pre-existing medical concerns may effect injuries sustained
20
Q
What are the most common forms of penetrating injuries in Canada?
A
Firearms and stabbings
21
Q
What tissue are most at risk of suffering blast injuries?
A
Middle Ear, Lungs, and GI tract
22
Q
What’s the most common cause of death from blast injuries?
A
Neurologic injuries and head trauma
23
Q
What are the roles of the Levels, 1, 2, and 3 trauma centres?
A
Level 1: leading role in the region, definitive care including subspecialty care, assumes a leadership role in research, teaching, and data collection
Level 2: strategically located, treat single system injuries and some multi systems injuries, some patients will be referred to a level 1 facility
Level 3: smaller hospital, serves as a stabilization and triage facility, refers all but minor injuries to a level 1 or 2 facility
24
Q
When should air transport be considered?
A
- When there is extended transport time by ground
- When transport to a trauma centre is not feasible by ground due to geographic factors
- When extrication is prolonged and the patient is critically injured
- When specific critical procedures may be life saving
25
What is the Trauma Lethal Triad?
Hypothermia, Coagulopathy, and Acidosis are major contributors to death in patients with severe traumatic bleeding.
26
How doe ABCs change in the case of major hemorrhage?
Circulation take priority over airway, CAB
27
What are the 3 components required for adequate circulation?
A functioning pump, the heart
Adequate fluid volume, the blood
Intact system of tubing capable of reflex adjustments, the vessels
28
What is cardiac output?
The amout of blood pumped through the circulatory system in 1 minute.
Cardiac output = Stroke volume X Pulse rate
29
What does the ejection fraction represent?
When the blood volume returned to the heart varies the heart stretches and pumps hard to accommodate allowing the fraction of blood pumped to remain unchanged
30
What are the cells that make up the blood?
Red Blood Cells (erythrocytes)
White Blood cells (leukocytes)
Platelets
31
How long can the brain, kidneys, and skeletal muscles tolerate before sustaining permanent damage due to a lack of perfusion?
Brain/ Spinal cord: 4-6 minutes
Kidneys: 45 minutes
Skeletal muscles: 2 hours
32
How do you manage a patient with internal hemorrhage?
Treatment of shock, minimize movement, and rapid transport
33
How much blood does the human body contain?
Approximately 70 ml/Kg in men or 65 ml/Kg in women
34
How much blood loss can the body tolerate?
The body typically cannot tolerate acute blood loss of greater than 20%, approximately 1L.
Blood loss greater than 20% will cause significant vital signs changes including, increased heart rate and respiratory rate and decreased blood pressure. Also known as hypovolemic shock.
35
What are the steps to control external hemorrhage?
Apply direct pressure
Elevate the injury
Apply a pressure dressing
Tourniquet (last resort)
36
What is epistaxis?
Bleeding from the nose
37
Why is prompt immobilization of a fracture important?
The sharp ends of the bone may lacerate blood vessels or muscle tissues
38
How does the body compensate for decreased perfusion?
Baroreceptors in the aortic arch detect reduced blood flow and simulate the medulla. The sympathetic nervous system is also stimulated to as the body recognizes a potential catastrophic event. The RAAS system is activated to retain water, the adrenal glands produce epinephrine to increase pulse rate and strength, and norepinephrine for vasoconstriction to shunt blood to more important organs.
39
What are the 7 types of shock?
Cardiogenic Shock: occurs when the heart is unable to circulate sufficient blood to maintain adequate peripheral oxygen delivery
Obstructive Shock: occurs when blood flow in the heart or great blood vessels becomes blocked
Hypovolemic shock: occurs when the circulating blood volume is not sufficient to maintain adequate perfusion
Distributive Shock: occurs when there is widespread dilation of the resistance vessels resulting in blood pooling in the vessels, decreasing tissue perfusion
Septic shock: accompanied by sepsis syndrome, fluid leaks out of the vessels often into the respiratory system
Neurogenic shock: blood pools in the vessels because a spinal injury has cut of the nerve impulses to the muscles that cause them to contract
Anaphylactic shock: histamine is released in response to an antigen causing widespread vasodilation
40
What happens as perfusion decreases?
When perfusion decreases cellular ischemia occurs causing the cells to switch from aerobic metabolism to anaerobic metabolism which quickly leads to metabolic acidosis.
41
What is Systemic Inflammatory Response Syndrome (SIRS)?
A systemic inflammatory response to a variety of clinical insults. Manifests with 2 or more of the following conditions,
temp. >38 or <36
heart rate >90 bpm
resp rate >20
Pco2 (partial pressure of carbon dioxide) <32 mmHg
WBC count greater than 12x10(to the 9 power) or less than 4x10(to the 9 power)
42
What are the 3 phases of shock?
Compensated: slight vitals changes and narrowed pulse pressure
Decompensated: BP and cardiac output fall
Irreversible
43
What is important to remember about the effect of shock on blood pressure?
Falling blood pressure is a late sign of shock. Do not wait for blood pressure to fall before starting treatment.
44
Treatment of Shock?
Control airway and ventilatory support
Control external hemorrhage and search for internal hemorrhage
Establish IV and administer fluid to maintain perfusion
Most protocols advise 250ml boluses until radial pulses return (approximately 80-90 systolic)
45
What is permissive hypotension?
The term refers to the controlled use of fluids in adult trauma patients in the prehospital phase when bleeding cannot be controlled.
46
What does soft tissue refer to?
Any group of similar cells that connects, supports, or surrounds the structures and organs of the body.
Ex. Fat, muscle, tendons, ligaments, blood, lymph vessels, nerves
47
How does the skin assist in homeostasis?
Protects underlying tissue from injury
Aids in temperature regulation
Provides a watertight seal between our internals and the environment
Keeps the brain informed about the external environment
48
What are the layers of the skin?
Epidermis
Dermis
Subcutaneous Tissue
49
What are tension lines?
The tautness of the skin varies but occurs in patterns called tension lines. Lacerations parallel to a tension line may remain closed with little intervention, lacerations perpendicular to a tension line result in a wound that remains open and heals slower.
50
How does inflammation occur?
Granulocytes (neutrophils, most cells, basophils, and eosinophils) and macrophages arrive at the site of injury and degranulate to release chemicals in response to infection.
51
What are Epithelializarion, Neovascularization, and Collagen Synthesis?
Epithelialization is the process of new epithelial cells forming
Neovascularization is the process of new blood vessels forming as the body attempts to get nutrients and oxygen to damaged tissues
Collagen synthesis is a vital structural repair unit that forms scar tissue and provides stability to healing mechanisms
52
What are the 2 types of abnormal scars?
Hypertrophic scar: occur in areas of high tissue stress (elbow, knee, etc.) and does not extend past the wound margins, common in light pigmented skin
Keloid scar: grow over the wound margins to be larger than the wound area, common in people with dark pigmented skin. Tend to form on Ears, upper extremities, abdomen, and sternum.
53
What are the visible clues of infection?
Erythema (skin redness), purulent discharge, warmth, edema, and local discomfort.
54
What is Lymphangitis?
Inflammation of lymph channels often appearing as red streaks adjacent to a wound.
55
What is tetanus? How does it present?
Tetanus is a bacterium infection commonly found in animal intestinal tracts, soil, manure, and dust.
Causes muscle contractions that are strong enough to fracture bones. Muscle stiffness may be first noted in the jaw, mortality rate is about 30%.
56
What is Necrotizing fasciitis?
Flesh eating disease involving the rapid death of tissue from infection. Often appears with severe pain and regular infection symptoms. Take droplet protection precautions.
57
What is an Abrasion?
A scrape over a rough surface caused part of the epidermis to be removed
58
What is a Laceration?
A cut inflicted by a sharp instrument that produces a clean or jagged incision through the skin and underlying structures
59
What is a puncture wound?
A stab from a pointed object such as a nail, a knife, or a bullet
Most do not cause significant bleeding
60
What is an avulsion?
Occur when a flap of skin is torn loose partially or completely
61
What is an amputation?
An avulsion involving the complete loss of a body part.
62
What is compartment syndrome?
Develops when edema and hemorrhage result in increased pressure within soft tissues.
63
What are the 6 P’s of classic compartment syndrome presentation?
Pain
Paraethesia (tingling sensation)
Paresis (muscle weakness)
Pressure
Passive pain
Pulselessness
64
What is the in hospital treatment of compartment syndrome?
Fasciotomy: incision of the skin and underlying fascia
65
What is the PRICED mnemonic for minimizing bleeding and swelling?
Protect (splint)
Rest
Ice (cold pack)
Compression
Elevate
Drugs (analgesics if appropriate)
66
What are the 2 principles that govern all open wounds?
Control bleeding with the least invasive method that is effective
Keep the wound as clean as possible
67
When should an occlusive dressing be used?
When it is important to keep air from passing through the material
68
What is the difference between a dressing and a bandage?
A dressing directly covers a wound. A bandage keeps the dressing in place.
69
What is another word for a triangular bandage and what are they typically used for?
Cravats
Ideal shape for making slings and swathes
70
Why does movement of an extremity disrupt the clotting process?
Movement promotes blood flow to that area and may lacerate more blood vessels
71
What are the guidelines for care of an amputated part?
Rinse with saline
Wrap in moist gauze
Seal in plastic bag
Never warm it
Never place it in water
Never place directly on ice
Never use dry ice to cool it
72
What are the 4 basic points of managing an impaled object?
Do not try to remove it
Control hemorrhage with direct pressure
Do not try to shorten the object
Stabilize the object with bulky dressings
73
When might it be the best course of action to remove an impaled object?
If the object obstructs airway management, the object interferes with chest compressions, or the object is immovable. Always contact medical control before removing an impaled object.
74
What is crush syndrome?
When an area of the body is trapped longer than 4 hours crush syndrome may start to develop. When muscles are crushed beyond repair, necrosis develops and leads to the release of harmful chemicals, a process known as rhabdomyolysis.
75
Why is releasing crush syndrome dangerous?
The patient is at risk of going into cardiac arrest very quickly due to hypovelemia or hyperkalemia.
The treatment for crush injuries is aggressive fluid therapy
76
What are the 5 mechanisms by which blast injuries can occur?
Primary: pressure wave from the blast
Secondary: blunt or penetrating wounds from debris
Tertiary: displacement from the blast causes contact with fixed objects or the ground
Quaternary: miscellaneous events during an explosion, Ex. Burns, Entrapment, etc.
Quinary: injuries from biological, chemical, or radioactive contaminants added to the bomb
77
At what temperature can thermal burns occur?
Thermal burns can occur when the skin is exposed to temperatures higher than 44°C
78
What are the signs on non-accidental burns?
Burns in children, old people, or disabled people or Burns in abnormal places or patterns such as genitalia, buttocks, or thighs
79
What is burn shock?
Burn shock occurs because of 2 types of injury. Fluid evaporates into the air causing hypovolemic shock and fluid leaks out of the damaged blood vessels into the interstitial spaces causing disruptive shock.
Typically sets in 6-8 hours after the initial burn.
80
Why is stridor common in burn patients?
Heat can be an irritant to the lungs and airway causing coughing, wheezing, and swelling of the upper airway tissues.
81
What should be considered about a group of people in the same place all experiencing a headache or nausea?
CO intoxication
82
In the case of chemical burns what are the 6 mechanisms of injury?
Reduction (protein denaturation)
Oxidation (chemicals inserts oxygen, sulphur, or halogen into body proteins)
Corrosion
Protoplasmic poisons (chemicals that form esters with proteins)
Desiccation (extract water from tissues)
Vesication (rapid production of blisters, Ex. Mustard gas)
83
What are some electricity related non burn injuries?
Asphyxia
Cardiac arrest
Neurologic complications (seizures, delirium, confusion, coma)
Dysrhythmias (atrial fibrillation and atrial flutter)
Severe titanic muscle spasms
84
What does acute radiation sickness manifestation tell us about mortality?
Unconscious or vomiting within 10 min: will not survive
Vomiting within 1 hour: 30-80% survival rate
Vomiting within 1-2 hours: 95-100% survival rate
85
What is the Galea Aponeurotica?
A tendon expansion that connects the frontal and occipital muscles of the cranium
86
What are the 8 bones that make up the cranial vault?
2 parietal bones
2 temporal bones
Frontal bone
Sphenoid bone
2 Ethmoid bones
87
What is the name of the large opening in the base of the skull?
The brain connects to the spinal cord through the opening called the Foramen Magnum
88
What is the mastoid process?
A cone shaped section at the base of the temporal bone. This is an important site for various muscle attachment.
89
What is the Crista Galli?
A prominent bony ridge in the anterior fossa where the meninges are attached
90
What are the occipital condyles?
The points of articulation between the skull and the vertebral column
91
Which 2 cranial nerves provide sensory and motor control of the face?
Trigeminal nerve (fifth cranial nerve)(branches into ophthalmic, maxillary, and mandibular nerves)
Facial nerve (seventh cranial nerve)
92
What is a blowout fracture?
A blow to the eye may break the this orbital floor causing blood and fat to leak into the maxillary sinus.
93
What are the nerves that control eye movement and vision?
Optic nerve (second cranial nerve) provides sense of vision
Oculomotor nerve (third cranial nerve) innervates the muscle that moves the eyeball
94
How many permanent teeth are in the normal adult mouth?
32 teeth
95
Which cranial nerves provide movement of the tongue, taste sensation, and chewing?
Mandibular branch of trigeminal nerve (fifth cranial nerve) controls chewing
Facial nerve (seventh cranial nerve) in addition to motor activity to the face controls taste in anterior 2/3 of the tongue
Glossopharyngeal nerve (ninth cranial nerve) provides the sense of taste in the posterior tongue
Hypoglossal nerve (twelfth cranial nerve) provides motor function to the tongue
96
How much glucose and oxygen does the brain require?
The brain metabolizes 25% of the body’s glucose (burning approximately 60 mg/min.) and consumes 20% of the total body oxygen.
97
What are the roles of the 4 lobes of the brain?
Frontal- voluntary motor actions and personality
Parietal- somatic or voluntary for the contralateral side of the body as well as memory and emotions
Occipital- processes visual information
Temporal- speech, long term memory, hearing, taste, and smell
98
What are the parts of the Diencephalon and the Brainstem?
Diencephalon: Thalamus, Subthalamus, Hypothalamus
Brainstem: Midbrain, Pons, Medulla (connects the spinal cord to the brain)
99
What are the 3 layers of the meninges?
Dura mater (outermost)
Arachnoid (web of blood vessels)
Pia mater (thin layer attached directly to the brain
100
What are the 3 types of Le Fort fractures?
Le Fort 1: horizontal fracture of the maxilla that involves the hard palate and inferior maxilla
Le Fort 2: pyramidal fracture involving the nasal bone and inferior maxilla
Le Fort 3: fracture of all mid facial bones, separating the mid face from the cranium
101
How might a Zygomatic fracture present?
Affected side of the face may appear flattened, paraesthesia over cheek nose and upper lip, and paralysis of upward gaze.
102
What is cerebrospinal rhinorrhea?
Blood of CSF leakage from the nose, suggestive of a skull fracture.
103
What is Hyphema?
Bleeding into the anterior chamber of the eye that obscures vision partially or completely
104
What is Aniscoria?
A condition in which the pupils are not of equal size.
Significant flinging in ocular injury but occurs normally in 20% of the population
105
What are the guidelines for treatment of an eye injury?
Never exert pressure on or manipulate the injured globe
Gently apply a moist sterile dressing to the globe to prevent drying
Cover the injured eye with sterile dressing
106
What is the prehospital treatment for a chemical eye burn?
Irrigation with saline solution or sterile water
107
Why is the Pinna often complicated by infection?
It heals poorly due to inherently low blood supply.
108
What are the 3 zones that neck injuries may be classified by?
Zone 1: top of chest
Zone 2 neck
Zone 3: base of skull
109
What is mediastinitis?
Inflammation of the mediastinum often caused by leakage of gastric content into the thoracic cavity, may be the result of an esophageal perforation.
110
Why are fractures of the first rib associated with 50% mortality?
It takes significant force to fracture that bone and those forces are usually applied to the head, neck, and face as well.
111
How should you control bleeding of an open neck wound?
Cover the wound with an occlusive dressing to prevent an air embolism
112
What are the 4 types of skull fractures?
Linear (50% occur in temporal-parietal region)
Depressed (most commonly affect frontal and parietal regions)
Basilar (symptoms include CSF leaking from ears, raccoon eyes, and battle signs)
Open (brain tissues may be exposed increasing the likelihood of infection and mortality)
113
What is the difference between primary and secondary brain injury?
Primary: injury to brain and associated structures resulting instantaneously from head impact
Secondary: a consequence of the primary injury, Ex. Cerebral edema, intercranial hemorrhage, cerebral ischemia, hypotension, infection
114
What is a normal ICP range in adults?
Normal intracranial pressure ranges from 5 to 15 mmHg
115
How is Cerebral Perfusion Pressure (CPP) calculated?
CPP = MAP - ICP
Critical minimum threshold (minimum CPP needed for perfusion) = 60 mmHg
MAP (mean arterial pressure)
ICP (intracranial pressure)
116
What may happen if ICP is not treated?
Early symptoms: vomiting, headache, altered LOC, seizures
Late symptoms: herniation through the foramen magnum and Cushing triad (hypertension, bradycardia, and widened pulse pressure)
117
What is a diffuse brain injury?
An injury that affects the entire brain
118
Explain the difference between Retrograde amnesia and anterograde amnesia?
Retrograde: loss of memory of an event before the injury
Anterograde: loss of memory of events after the injury
119
What is diffuse axonal injury (DAI)?
DAI involves stretching, shearing, or tearing of nerve fibres with subsequent axonal damage.
120
What is an Epidural Hematoma and Subdural Hematoma?
Epidural: An accumulation of blood between the skull and dura mater
Subdural: An accumulation of blood beneath the dura mater but outside the brain
121
What is an Intracerebral Hematoma and Subarachnoid Hemorrhage?
Intracerebral Hematoma: bleeding within the brain tissue
Subarachnoid Hemorrhage: bleeding occurs into the subarachnoid space where the CSF circulates
122
What are the 5 major categories of Spinal Cord Injuries?
Motor vehicle collisions (35-40%)
Acts of violence (24.5%)
Falls (21.8%)
Recreational activities (7.2%)
Disease (polio, spina bifida, etc.)
123
What are the 5 sections of vertebrae and how many are there?
Cervical (7)
Thoracic (12)
Lumbar (5)
Sacrum (5)
Coccyx (4)
124
How many spinal nerves are there and what are their roles?
31 pairs of spinal nerves
8 cervical roots control scalp, neck, shoulders, and arms
12 thoracic roots control chest, breathing, abdominal muscles, and sympathetic nervous system
5 lumbar nerve roots supply hip flexors, leg muscles, and anterior leg sensation
Sacral nerves provide bladder control, bowel control, sexual function, and posterior of leg
Coccyx has a single nerve root
125
What may be affected by a SCI at or above the T6 vertebrae?
Flow of sympathetic communication may be disrupted
Disruption of homeostasis
126
How does a stable spinal injury differ from an unstable spinal injury?
Stable injuries usually involve the anterior or middle column
Unstable injuries usually involve the posterior column
127
Describe Flexion, Rotation with flexion, Vertical compression, and Hyperextension injuries?
Flexion: result from forward movement of the head at the cervical level
Rotation with flexion: result from high acceleration forces
Vertical compression: forces transmitted through the vertebral bodies either inferiorly or superiorly
Hyperextension: of the head and neck can result in fractures and ligament injury
128
What is Brown-Séquard syndrome?
Occurs when penetrating trauma is accompanied by hemisection of the cord and complete damage to all spinal traction the involved side
129
How does management of sonorous respirations differ from gurgling respirations?
Snoring indicates a positioning problem whereas gurgling indicates the need for suction
130
Lesions occurring at or above C3-C4 may lead to?
Diaphragmatic paralysis
131
What carbon dioxide level should be maintained in a patient with a head injury?
35-45 mmHg
132
What are myotomes and dermatomes?
Myotomes are regions of the body containing tissues and muscles innervated by spinal nerves
Dermatomes are areas of the body surface innervated by the sensory components of spinal nerves
133
What Babinski Reflex?
Babinski reflex is positive when the toes move upward in response to stimulation of the sole of the foot. Normal response is for toes to move downward.
134
How long should paramedics be on scene at an emergency?
10 minutes or less
135
When should the rapid extraction technique be used?
Vehicle or scene is unsafe
Patient cannot be assessed in the vehicle
Patient needs immediate interventions in supine position
Patient’s condition requires immediate transport
Patient blocks access to another patient
136
Define the dimensions of the Thorax?
Posteriorly by the thoracic vertebrae
Anteriorly and laterally by the ribs
Inferiorly by the diaphragm
Superiorly by the thoracic inlet
137
What are the bony structures of the thorax?
Sternum
Clavicle
Scapula
Thoracic vertebrae
12 pairs of ribs
138
What is the main cause of hypoxemia seen with flail chest injuries?
Pulmonary contusion
139
Explain the difference between a Simple, Open, and Tension, pneumothorax?
Simple: accumulation of air in the pleural cavity
Open: a penetration in the chest wall allows air to enter the thoracic space
Tension: growing accumulation of air in the thoracic space compresses the lung
140
What is a Hemothorax?
Accumulation of blood between the parietal and visceral pleura
Blood accumulation greater than 1500 ml is a massive hemothorax
141
What is pulmonary contusion?
Local tissue injury to the lung that may cause atelectasis (alveolar collapse). A large pulmonary contusion may cause shunting leading to venous blood being returned to the heart, worsening hypoxemia.
142
What is Commotio Cordis?
A direct blow to the chest during the critical portion of the hearts repolarization may cause immediate cardiac arrest
143
What are the 3 phases of diaphragm injury?
Acute: begins at the time of injury, ends at the end of recovery
Latent: intermittent abdominal pain due to herniation or entrapment of abdominal contents
Obstructive: abdominal contents herniate through the defect cutting off blood supply
144
What are the clinical findings indicating traumatic anaphylaxis?
Cyanosis of the head and upper extremities
Ocular hemorrhage
Tongue and lips may be dramatically swollen
145
What type of injury may be made worse by positive pressure ventilations?
A pneumothorax
146
What are the deadly dozen thoracic injuries?
Airway obstruction
Bronchial disruption
Diaphragmatic tear
Esophageal injury
Open pneumothorax
Tension pneumothorax
Massive hemothorax
Flail chest
Cardiac tamponade
Traumatic aortic disruption
Myocardial contusion
Pulmonary contusion
147
What size of dressing should be used on a sucking chest wound?
An occlusive dressing, ideally 3 to 4 times the size of the wound
148
What are the classic signs of a tension pneumothorax?
Absence of breath sounds on the affected side
Tachycardia
JVD
Tracheal deviation
149
What are the classical findings of cardiac tamponade?
Beck’s Triad (Narrowed pulse pressure, JVD, muffled heart sounds)
150
What is a common finding with Myocardial Contusion?
Abnormal Dysrhythmias
151
Which organs are in the retroperitoneal space?
Pancreas
Kidneys
Upper part of ureters
Portions of the duodenum and large intestine
152
Which are the 2 most common organs injured in blunt abdominal trauma?
Spleen (50%)
Liver (30%)
153
What are the possible signs of retroperitoneal bleeding?
Ecchymosis of the flanks (Grey turner sign) or around the umbilicus (Cullen sign)
154
What are the 2 distinct portions of the skeleton?
The 206 bones in the body make up the axial skeleton and appendicular skeleton
Axial: Skull, vertebrae, ribs, sternum
Appendicular everything else
155
When do bones start to lose their strength?
Bones start decreasing in density at age 35
156
What are the 3 general types of joints?
Fibrous
Cartilaginous
Synovial
157
How do tendons and ligaments differ?
Tendons connect muscle to bone
Ligaments connect bone to bone
158
Define atrophy and hypertrophy?
Unused muscles quickly atrophy (shrink or waste away)
Physical training promotes hypertophy (increase in size)
159
What is a dislocation? What is a subluxation?
Dislocation: a bone is totally displaced from the joint and the articulate surfaces are no longer in contact.
Subluxation: partial dislocation of a joint
160
What is a sprain?
An injury in which a ligament is stretched or torn
161
What is a strain?
An injury to a muscle or tendon as a result of violent muscle contraction or excessive stretching
162
When should hot vs cold therapy be used?
Cold therapy for first 48 hours after injury
Heat therapy is used after first 48-72 hours
163
How might you recognize a hip fracture?
The affected leg is almost always externally rotated and shortened
