Trauma 2 Flashcards
Abdominal Cavity Borders
Superior: Diaphragm
Inferior: Pelvis
Posterior: Lumbar spine
Anterior: Muscular Abdominal Wall
Peritoneum
Lines abdominal cavity
Double-walled structure
Separates abdominal cavity into two parts
Peritoneal Cavity
True abdominal cavity
Contents of Peritoneal Cavity
Liver
Spleen
Stomach
Small intestine
Colon
Gallbladder
Female reproductive organs
Solid Organs
Liver
Spleen
Pancreas
Kidneys
Ovaries
Hollow Organs
Stomach
Intestines
Gallbladder and bile ducts
Ureters
Urinary bladder
Uterus and fallopian tubes
Major abdominal blood vessels
Aorta
IVC
SVC
Liver
Largest organ in abdominal cavity
Commonly injured from penetrating trauma
Referred right posterior shoulder pain
Spleen
Upper left quadrant
Injured from blunt trauma
Rich blood supply
Kehr’s Sign
LUQ pain radiates to left shoulder
Sign of splenic injury
Retroperitoneal Cavity
Space behind true abdominal cavity
Risk of concealed exsanguinating hemorrhage with no early symptoms
Contents of retroperitoneal cavity
Abdominal aorta
IVC
Most of duodenum
Pancreas
Kidneys
Ureters
Ascending and descending colon
Cullen Sign
Hemorrhagic discolouration of umbilical area due to intraperitoneal hemorrhage
Grey Turners Sign
Bruising of one or both flanks indicative of retroperitoneal hemorrhage
Pancreatitis
Axial Skeleton
Central axis of the body
Skull, vertebral column, bony thorax
Appendicular skeleton
Limbs
Pectoral girdle
Bones that attach upper limbs to axial skeleton
Pelvic Girdle
Paired bones of the pelvis that attach lower limbs to axial skeleton and sacrum
Critical Factors of Falls
Height
Surface
Follow path of energy through body
S/Sx Pelvic Injury
Tenderness over pubis upon palpation of one plane, SI joint tenderness, hemiparesis, pelvic ecchymosis, hematuria
Risk of Pelvic injury
Internal bleeding, bladder/genital trauma
up to 2000mL blood loss
Diaphysis
Long, narrow shaft
Dense, compact bone
Metaphysis
Head of bone
Between epiphysis and diaphysis
Medullary canal
Contains marrow
Periosteum
Outer fibrous covering
Allows for increase in diameter
Vascular
Nerves
Epiphysis
Articulated, widened end
Allows bone to lengthen, hyaline cartilage
Cancellous bone with red blood marrow
Weakest point in child’s bone
Open Fracture
Wound extends from body surface to fracture site
Produced by bones or object causing fracture
Infection risk
Bone end not necessarily visible
Direct Fracture
Break occurs at point of impact
Indirect fracture
Force transmitted along bone
Injury occurs at some point distant to point of impact
Twisting Fracture
Distal limb remains fixed
Proximal part rotates
Shearing, fracturing occur
Avulsion Fracture
Muscle and tendon unit with attached fragment of bone ripped off bone shaft
Stress Fracture
Feet secondary to prolonged running or walking
Pathological Fracture
Fracture with minimal force
Transverse Fracture
Cuts shaft at right angle to long axis
Often direct injury
Greenstick Fracture
Pliable bone splinters on one side without complete break
In children
Spiral or twisting fracture
Fx coils through bone like spring
Occurs with torsion
Oblique fracture
Angle to long axis of shaft
Comminuted fracture
Bone broken into 3+ pieces
Impacted fracture
Bone ends jammed together
Occurs with compression
No loss of function
Don Juan Syndrome
Fall onto feet
Bilateral heel fractures
Compression fractures of vertebrae
Bilateral Colles’ fractures
Blood Loss Fractures
Tib/fib: 500
Femur: 1000-1200
Pelvis: 2000
Sprains
Stretching, tearing of ligaments surrounding joint
Occur when joint is twisted beyond normal range of motion
No typical deformity
Grades of Sprain
I: Minor + incomplete, stable
II: significant but incomplete, intact but unstable
III: complete tear, unstable
Strains
Tearing, stretching of musculotendonous unit
Spasm, pain on movement
No deformity, swelling
Pain on active movement
6 P’s of MSK assessment
Pain
Pallor
Pulselessness
Paresthesias
Paralysis
Polar/Pressure
MOA Acetaminophen
Activation of descending serotonergic inhibitory pathways in CNS
More antipyretic
Side effects acetaminophen
Very safe
Number one cause of hepatic toxicity
Pts good for acetaminophen
Mild to moderate pain
Severe pain co-administered with stronger analgesic
Pts not good for acetaminophen
Hepatic dysfunction
Drinking alcohol
Taken large doses recently
Ibuprofen MOA
Inhibits free arachidonic acid conversion to prostaglandins and thromboxane A2s
Reduce pain, inflammation and platelet aggregation
Side effects Ibuprofen
Ability to form clots
Bronchoconstriction/worsening asthma
Irritates stomach wall lining
Renal toxicity in high doses
Ibuprofen good pts
Mild to moderate
Severe pain with stronger analgesic
Ibuprofen not good pts
Inability to clot, renal failure, asthma/autoimmune symptoms
Ketorolac MOA
NSAID similar to ibuprofen
Side effects ketorolac
Bronchoconstriction
Impaired clotting
Compounded with NSAID use
Good ketorolac pts
Unable to tolerate oral meds
Mild to moderate pain
Severe pain with stronger analgesic
Precautions Morphine
Resp depression
Hypotension
N/v
Dizziness, mental clouding, sedation
Pruritis fro histamine release
Bradycardia
MoA Morphine
Binds opioid receptors
Inhibits ascending pain pathways
Alters perception of and response to pain
Produces generalized CNS depression
Good morphine pts
Moderate to severe pain
Cardiac ischemia
Going through pre/post reperfusion
Bad morphine pts
High tolerance to morphine
Weak BP
Depressed resp drive
Wooden chest
Rapid administration of large doses of fentanyl cause skeletal and thoracic muscle rigidity
Fentanyl
Synthetic opioid binding to Mu
Works on CNS
Concentration greater than morphine
Less BP effect
1st Degree Burn
Affects epidermis
Redness w/o blistering
2nd Degree Burn
Burn into dermis
May go into glands and hair follicles
Redness + blistering
3rd degree burn
Entire epidermis and dermis, pale and leathery
Minor Burns
2nd degree <15% or <10% ped
3rd degree <2% not involving eyes, ears, face, hands, perineum, feet
Moderate Burns
2nd degree 15-20% or 10-20 child
3rd degree 2-10%
Major Burns
2nd degree >25% or 20% peds
3rd degree >10%
Hands, face, eyes, ears, feet, perineum
Inhalation
electrical
Associated injuries
Poor risk pts
Parkland formula
4ml/kg/%bsa in first 24 hrs
1/2 in first 8
1/2 in next 16
urine output 30-50ml/hr
AC Current
Muscular tetany
Locked on
May paralyze rest muscles
VF arrest
Direct Current
Unidirectional flow of electrons
Pts thrown
aSystole
Rhabdomyolysis
Breakdown of striated muscle tissue
Direct damage
Metabolic Causes
Drugs and Toxin
CK >1000
Complications of rhabdo
myoglobin causes tubular obstruction
HyperK
Phosphate binds to calcium
DIC
