Trauma 2 Flashcards
Cardiac output
The volume of blood delivered to the body in one minute.
Cardiac output equation
cardiac output = HR (beats/min) x SV (mL of blood/beat)
atelectasis
Alveolar collapse that prevents the use of that portion of the lung for ventilation and oxygenation.
cardiac tamponade
a condition in which the atria and right ventricle are collapsed by a collection of blood or other fluid within the pericardial sac, resulting in a diminished cardiac output.
commotio cordis
an event in which an often fatal cardiac dysrhythmia is produced by a sudden blow to the thoracic cavity.
Common causes are impacts from hockey pucks, baseballs, footballs, and lacrosse sticks.
crepitus
a grating sensation made when two pieces of broken bone are rubbed together or subcutaneous emphysema is palpated.
coup-contrecoup injury
a coup injury occurs under the site of impact with an object, and a contrecoup injury occurs on the side opposite the area that was hit.
Cheyne-Stokes respirations
an abnormal pattern of breathing characterized by progressively deeper, and sometimes faster, breathing followed by a gradual decrease that results in a temporary stop in breathing.
What is a likely cause of Cheyne-Stokes breathing?
brain stem insult
Beck triad
a collection of three clinical signs associated with pericardial tamponade.
- low BP
- muffled heart sounds
- JVD
parasympathetic nervouse system
rest and digest
sympathetic nervous system
fight or flight
What do you call a group of RBCs stuck together?
rouleaux
Basic principles of kinetics
law of inertia and law of energy conservation
Kinetic energy measures how much _____ an object in motion has.
Energy
What is the vagus nerve responsible for?
regulation of internal organ functions, such as digestion, heart rate, respiratory rate, vasomotor activity, and certain reflex actions (coughing, sneezing, etc.)
What is the Nexus criteria?
- Is there midline tenderness?
- Is there an altered LOC?
- Are there new focal neurological deficits?
- Are they intoxicated?
- Is there a major distracting injury?
Which major organs and blood vessels are located in the retroperitoneal space?
kidneys, pancreas, duodenum, ascending colon, descending colon, middle third of the rectum, proximal ureters, renal vessels ,adrenal glands, abdominal aorta, inferior vena cava, lymph nodes
What are some common signs and symptoms of a tension pneumothorax?
Absence of breath sounds on the affected side
Tachycardia
JVD
Tracheal deviation
What causes JVD?
an increased volume or increased pressure within the central venous system or thoracic cavity.
What is the most common demographic for simple/spontaneous pneumothorax?
Tall and thin adolescent males
Pulsus paradoxus
an exaggerated fall in a patient’s blood pressure during an inspiration by greater than 10mmHg.
What is MAP and why is it important in a traumatic brain injury?
MAP = mean arterial pressure
It is important because controlling the MAP reduces the risk of a secondary brain injury, which is the inflammatory response following the primary brain injury.
What are the classifications of drowning?
Wet drowning-inhaling water
Dry drowning-muscle spasms close the airway (cold water)
What are the indications for TXA?
major trauma pt. after initiation of hypovolemia protocol
physical findings of MOI suggestive of occult or ongoing bleeding.
What are the contraindications of TXA?
known hypersensitivity/allergy to TXA
time > 3hrs after injury
pt. < 16 yrs
What is the dose of TXA?
1g infused in 50ml bag of NS
How can you get fluids into your trauma patient much faster when their BP is rapidly dropping?
two IV lines of 250mls
**auscultate EVERY time you bolus
What should you do for every trauma during RBS?
cut off ALL clothing to expose any and all injuries
What is wet drowning?
the person has inhaled water which interferes with respiration and causes the circulatory system to collapse.
What is dry drowning?
muscle spasms in the area around the voice box blocks the airway. No water enters the lungs.
What is the optimal BP for someone with a TBI?
120 systolic
Will a head injury cause a major drop in BP (ex. 70/40)?
No, this indicates another major bleed.
How long do you check for a pulse on an unconscious hypothermic patient?
at least 60 seconds
What do you need to do for hypothermic drowning? Pediatric?
one shock at least, then transport
check pulse for 60 seconds
try to revive for 60 minutes
*anything with pediatrics, call CliniCall
Why don’t we rewarm someone in severe hypothermia?
The rewarming process causes the frozen blood to move throughout the body, so cold blood goes to the heart and can cause cardiac arrest.
‘rewarming shock’
When do we actively rewarm a patient?
Mild or moderate hypothermia
Explain the Rule of 9’s
head 4.5 chest 9 abdomen 9 groin 1 leg 9 (per side) arm 4.5 (per side) back 18
What are heat cramps?
acute and involuntary muscle pains, usually in the lower extremities and abdomen that occur because of profuse sweating and the loss of sodium in sweat.
How do heat cramps present?
Usually present with severe pain in the extremities and/or abdomen.
Can sometimes present as slight abdominal cramping and tingling in the extremities.
HR increased
pale, moist skin
What is the treatment for heat cramps?
Remove from heat
Give a drink with electrolytes or added salt
If unable to drink, IV NS
What is heat syncope?
a near syncopal episode that typically occurs in people who are not acclimatized or may be under heat stress.
It can occur with prolonged standing, or when standing suddenly from a sitting or laying position.
What is the treatment for heat syncope?
Place the patient in a supine position
Replace fluids
What is heat exhaustion?
A form of heat stress caused by excessive sweating, not enough fluids, and high temperatures. This can lead to heat stroke if not remedied in time.
What are the symptoms of heat exhaustion?
Profuse sweating with pale and clammy skin
Elevated temperature
Tachypnea
Tachycardia
Low BP
Headache, fatigue, dizziness, N/V, abdominal cramping
What is the treatment for heat exhaustion?
Remove from heat Remove excess clothing Place supine with legs elevated Drip water on patient, do not over-cool Rehydration via salty drink or IV NS if N/V
What are the three types of electrical burns?
Direct contact
Arching of current
Electricity ignites clothing
What are the S&S of hypovolemic shock?
increased HR increased RR increased confusion decreased BP decreased LOC decreased urine output PCC fatigue dizzy/headache N/V
What are the S&S of cardiogenic shock?
JVD PCC SOB decreased BP decreased urine output decreased LOC pedal edema increased RR increased HR
What are the S&S of neurogenic shock?
rapid decrease in BP decreased HR priapism warm, flushed skin paralysis cyanosis Cheyne stokes
What are the S&S of septic shock?
Hx of infection fever low BP low urine output increased HR increased RR altered LOC pale skin cyanosis
What is frostnip?
mild form of frostbite that can be treated by warming with body heat and windmilling arms to increase circulation.
What is superficial frostbite?
altered sensation, burning
white, waxy skin
skin is firm on palpation
Tx: rewarm with body heat, don’t massage, cover blisters with dressing
What is deep frostbite?
Skin looks white-yellow or mottled blue-white w/o sensation, firm to palpate.
If still frozen, pad the injury but leave frozen for hospital staff (RTC)
If thawed, CliniCall to discuss rewarming.
What is thermoregulation?
a balance of heat production and loss.
What does the hypothalamus do?
the body’s main regulatory centre
thermostat
What is thermogenesis?
heat production
Internal heat production
the body produces heat from normal metabolic reactions.
ex. physical exertion, burning calories, shivering
peripheral vasoconstriction helps conserve heat, shunting blood to the body’s core.
What are the top 5 causes of trauma death?
MVC falls poisonings burns drownings
Define trauma
an acute physiologic and structural change that occurs in a patient’s body when an external source of energy dissipates faster than the body’s ability to sustain and dissipate it.
What is the most common site of chest injury from deceleration?
the aorta
Head on collision
deformed front end
cracked windshield
bruised/lacerated head or face
brain injury
scalp, facial cuts
cervical spine injury
tracheal injury
Head on collision
deformed steering column
bruised neck
bruised chest
sternal or rib fracture flail chest myocardial contusion pericardial tamponade pneumothorax/hemothorax exsanguination from airtic tering
head on collision
deformed dashboard
bruised abdomen
bruised knee, misplaced kneecap
ruptured spleen, liver, bowel, diaphragm fractured patella dislocated knee femoral fracture dislocated hip
Lateral collision
deformed side of car
bruised shoulder
clavicular fracture
fractured humerus
multiple rib fractures
lateral collision
door smashed in
bruised shoulder or pelvis
fractured hip
fractured iliac wing
fractured clavicle or ribs
lateral collision
“b” pillar deformed
bruised temple
brain injury
cervical spine fracture
lateral collision
broken door or window handles
bruised or deformed arms
contusions
lateral collision
broken window glass
dicing lacerations
multiple lacerations
rear-end collision
posterior deformity of the vehicle or headrest not adjusted
secondary anterior injuries, especially is the patient was unrestrained
whiplash injuries
cervical spine fractures
deceleration injuries of a head on collision
What are the 11 Ring of Chest injuries from impacting the steering wheel or dashboard?
facial injuries soft-tissue neck trauma larynx and tracheal trauma fractured sternum myocardial contusion pericardial tamponade pulmonary contusion hemothorax, rib fractures flail chest ruptured aorta intra-abdominal injuries
What are the signs and symptoms of heat stroke?
temp > 40 ALOC increased HR dehydration hyperventilation tremors, seizures constricted pupils decerebrate/decorticate
What is the treatment for heat stroke?
remove patient from environment rapid cooling (ice packs neck, groin, axillae) O2 remove clothing fan patient IV NS
What is classic heat stroke?
Passive heat stroke; occurs during heat waves and is most likely to strike very old, young, or bedridden people.
Skin appears dry red and hot
What is exertional heat stroke?
typically an illness of young and fit people that are in hot and humid conditions exerting themselves.
Skin appears pale and sweaty.
What is the key feature in heat stroke?
constricted pupils
What are the four modes of diving?
scuba
free-diving
surface-tended diving
saturation diving
What is boyle’s law
a a constant temperature, the volume of gas is inversely proportional to its pressure
What is dalton’s law
each gas in a mixture exerts the same partial pressure that it would exert if it were alone in the same volume and that the total pressure of a mixture of gases is the sum of the partial pressures of all gases in the mixture.
p1 + p2 + p3 = total pressure
What is henry’s law
the amount of gas dissolved in a liquid is directly proportional to the partial pressure of the gas above the liquid.
What is barotrauma?
A major problem encountered during ascent or descent.
Results from a pressure imbalance between gas-filled spaces inside the body and the external atmosphere.
What is the treatment for arterial gas embolism?
manage airway High flow O2 ground transport supine IV NS TKVO transport to hyperbaric chamber
What is nitrogen necrosis
a state of altered mental status caused by breathing compressed air (including nitrogen) at depth.
What are the signs and symptoms of nitrogen necrosis
euphoric feeling
inappropriate behaviour at depth
tingling of lips, gums, and legs
typically occurs at 100ft, and more pronounced at 120fsw.
what is decompression sickness?
nitrogen bubbles causing issues with perfusion and by triggering chemical changes within the body.
If the ascent is quicker that the nitrogen in the body can be removed, the diver’s tissues will begin to bubble.
Type 1 Decompression Sickness
mild forms of DCS that only involve the skin, lymphatic system, MSK system. Skin becomes mottled and pruiritic.
Type 2 Decompression Sickness
more serious
includes all other organs
What is the treatment for DCS?
manage airway high O2 IV NS TKVO ground transport to hyperbaric chamber do not use Entonox
What is shallow water blackout?
most frequently seen among adolescent boys competing to see who can hold their breath the longest.
They will often try to hyperventilate prior to holding their breath.
Hyperventilation causes decreased PaO2 and cerebral vasoconstriction, which in turn causes blackouts upon surfacing.
What is altitude illness?
Caused by the effects of hypobaric hypoxia on the CNS and pulmonary system as a result of unacclimatized people ascending to altitude.
What is secondary drowning?
water gets into the lungs can cause pulmonary edema, and can cause the patient to drown again.
