Trauma 3 Flashcards
What are the indications for TXA?
Trauma with signs of shock/hypoperfusion in association with injury suggestive of occult or ongoing bleeding.
>16 years
Systolic BP <90mmHg
HR > 110 bpm
Within 3 hours from time of injury and on route to receiving hospital.
What must you do before administering TXA?
Complete primary
Begin transport
Obtained base set of vitals
Initiated hypovolemia protocol
What is TXA not indicated for?
isolated head trauma
significant external hemorrhage
trauma with a low risk of serious hemorrhage
When should you consider pelvic binding?
Any blunt trauma pt if: pelvic instability hypotensive (<90) tachycardia (>100) GCS <14
How does a concussion present?
mild ALOC (13/14)
N/V
repetitive
MVA, sports, falls
How does an epidural hematoma present?
brain bleed
MVI, assaults, falls
lucid period can be seen (about 50%), followed by progressive deterioration.
Declines as the bleed causes more pressure.
How does a subdural hematoma present?
usually results from ruptured veins between the dura and arachnoid layers.
changes to your mood, concentration or memory problems, fits (seizures), speech problems, and weakness in your limbs.
risk factors: alcohol abuse and old age.
How does a subarachnoid hemorrhage present?
with CVAs, SAH comes from ruptured arteries.
with trauma, can occur in different locations.
at risk for increased ICP
What is an intracerebral hemorrhage?
increased ICP
similar to a stroke
What is a diffuse axonal injury?
primary injury (little can be done to reverse it) the shearing (tearing) of the brain's long connecting nerve fibers (axons) that happens when the brain is injured as it shifts and rotates inside the bony skull.
How do you decrease pressure in a TBI?
head of bed above 30 degrees
ensure hard collars aren’t on too tight
don’t ventilate a TBI patient too quickly or with huge volumes.
What are the TBI VS guidelines?
SpO2 >95%
Systolic BP > 120mmHg
What should trigger your suspicions about the potential for child abuse or neglect when you are responding to a call?
injury doesn’t coincide with the child’s developmental stage.
changing stories
child’s interaction with the parents
What should you try to document and how should you document it when responding to potential child abuse?
bruising and marks location healed injuries claimed injury who says what-direct quotes how the child reacts
Bruising and marks: what is important to know about bruising and marks?
various stages of healing circumferential pattern makrs patchy hair bruises on the upper arms, upper legs, trunk, side of face, ears bruising on both sides of the body any bruising under 6 months
What makes burns suspicious on children?
encircling no splash marks a clear line genital burns pattern burns
How do patients present who may be the victim of Abusive Head Trauma?
there may be no external marks seizures drowsiness apnea accidental falls
How does violent shaking injure babies?
subdural hematoma
irreversible brain damage
What makes fractures suspicious?
young age (< 18 months)
multiple healed fractures
rib fractures
more than one broken bone
How is neglect defined?
A child’s baseline needs are not being met
How does a child with failure to thrive present?
they haven’t grown adequately
medical neglect
starvation
being left alone
What should you report when you call the Ministry Reporting Line?
name of the child
where they live
objective details
What are the 5 major functional areas of the ICS?
Command Operations Planning Logistics Finance/Administration
What are the responsibilities of the Incident Commander?
Develops incident objectives and approved resource orders and demobilization
What are the responsibilities of the operations section?
Identifies, assigns and supervises the resources needed to accomplish the incident objectives.
What are the responsibilities of the planning section?
tracks resources and identifies resource shortages
What are the responsibilities of the logistics section?
orders resources.
What are the responsibilities of the finance/admin section?
produces and pays for the resources.
reports costs.
What are the key actions of the Group Supervisor?
establish report to ICP-stay in ICP
communicate with dispatch:
-identify self and position
-identify MCI level (level 2 requires on-site treatment area)
-ask for hospital notification and capabilities
-provide direction to incoming units (access/egress/staging)
plan response-real estate for EMS
plan ahead
What are the key actions of the Triage Team Leader?
1st pass: initial count, communicate to group supervisor.
Organize walking wounded (bullhorn triage)
Initial taping (start triage process): first count by acuity levels
Initial tagging: monitor patient moving to treatment area
Once all patients are in treatment, recheck black tags.
Close triage tunnel
Report to the Group Supervisor for reassignment.
What are the key actions for the Treatment Team Leader?
Prepare the three areas for treatment.
Stockpile equipment.
Patients all tagged in treatment area.
Communicate with:
-triage: pt. flow
-transport: availability
-group supervisor: update numbers in treatment area
Document acuity, treatment, tag -patient disposition form.
Be positioned at narrow end of triage funnel.
What are the key actions for the Transport Team Leader?
Obtain list of resources and status of hospitals from Group Supervisor.
Report all departing vehicles to group supervisor, include the following information:
-vehicle #
-destination
-content
-ETA
Document patients’ movement
Be positioned at end of treatment area
Communicate with treatment areas and patients.
What are the S/S of multiple facial bone fractures?
massive face swelling
dental malocclusion
palpable deformities
anterior or posterior epistaxis
What are the S/S of zygomatic and orbital fractures?
loss of sensation below the orbit
flattening of the patient’s cheek
loss of upward gaze
What are the S/S of nasal fractures?
crepitus and instability
swelling, tenderness, lateral displacement
anterior or posterior epistaxis
What are the S/S of maxillary (le fort) fractures?
mobility of the facial skeleton
dental malocclusion
facial swelling
What are the S/S of mandibular fractures?
dental malocclusion
mandibular instability
critical minimum threshold required to adequately perfuse the brain
60mmHg in an adult
What are some early signs on increased ICP?
vomiting without nausea
headache
ALOC
seizures
What are the s/s of a mild DAI?
loss of consciousness (brief, if present); confusion, disorientation, amnesia (retrograde and/or anterograde)
most common result of blunt head trauma; for example, concussion
what are the s/s of a moderate DAI?
immediate loss of consciousness
residual effects: persistent confusion and disorientation, cognitive impairment (inability to concentrate), frequent periods of anxiety, uncharacteristic mood swings, sensory/motor deficits
20% of all head injuries, 45% of all DAIs
what are the s/s of a severe DAI?
immediate and prolonged loss of consciousness; posturing and other signs of increased ICP.
16% of all severe head injuries; 36% of all DAIs.
What do unequal or bilaterally fixed and dilated pupils in a a head injured patient indicate?
a significantly increased ICP
What does a mild elevation in ICP present as?
increased BP
decreased HR
reactive pupils
Cheyne-Stokes
patient initially attempts to localize and remove painful stimulus; this is followed by withdrawal and extension.
effects are reversible with prompt treatment
What does a moderate elevation in ICP present as?
widened pulse pressure
bradycardia
pupils are sluggish or nonreactive
central neurogenic hyperventiation (deep, rapid respirations)
decerebrate posturing
survival possible but not without permanent neurological deficit.
What does a marked elevation in ICP present as?
ipsilaterally fixed and dilated (blown) pupil
ataxic respirations (biot resps) characterized by irregular rate, pattern, and volume of breathing with intermittent periods of apnea
flaccid paralysis
irregular pulse rate
changes in QRS complex, ST segment, or T wave
fluctuating blood pressure; hypotension common
most patients do not survive this level
What is the 90-90-9 rule?
- a single drop in the patient’s O2 saturation to less than 90% doubles their chance of death.
- a single drop in the patient’s systolic BP to less than 90mmHg doubles their chance of death.
- a single drop in the patient’s GCS score to less than 9 doubles their chance of death. A drop in the GCS score of two or more points, at any time, also doubles mortality.
At what rate should you ventilate a brain injured patient?
10 breaths per minutes
acute radiation syndrome
the clinical course that usually begins within hours of exposure to a radiation source.
symptoms include N/V, diarrhea, fatigue, fever, and headache.
long term symptoms are dose-related and are hematopoietic and gastrointestinal.
comedo
a noninflammatory acne lesion
dermis
the inner layer of skin containing hair follicle roots, glands, blood vessels, and nerves,
desquemation
the continuous shedding of the dead cells on the surface of the skin
epidermis
the outermost layer of the skin
escharotomy
a surgical cut through the eschat or leathery covering of a burn injury to allow for swelling and minimize the potential for development of compartment syndrome in a circumferentially burned limb on the thorax.
flash burn
an electrothermal injury caused by arcing of an electric current.
full-thickness burn
a burn that extends through the epidermis and dermis into the subcutaneous tissues beneath, also called a third-degree burn
infraglottic
referring to part of the airway including and below the vocal cords
partial-thickness burn
a burn that involves the epidermis and part of the dermis, characterized by pain and blistering.
sebaceous gland
a gland located in the dermis that secretes sebum
superficial burn
a burn involving only the epidermis, producing very red, painful skin.
zone of coagulation
the reddened area surrounding the leathery and sometimes charred tissue that has sustained a full-thickness burn.
zone of hyperemia
in a thermal burn, the area that is least affected by the burn injury.
zone of stasis
the peripheral area surrounding the zone of coagulation that has decreased blood flow and inflammation. This area can undergo necrosis within 24-48 hours after the injury, particularly if perfusion is compromised due to burn shock.
angle of Louis
also called the sternal angle, a prominence on the sternum that lies opposite the second intercostal space
exopthalmus
protrusion of the eyes from the normal position within the socket
manubrium
the superior segment of the sternum, its lower border defines the angle of Louis
mediastinum
space between the chest that contains the heart, major blood vessels, vagus nerve, trachea, and esophagus, located between the two lungs.
myocardial contusion
blunt force injury to the heart that results in capillary damage, interstitial bleeding, and cellular damage in the area
myocardial rupture
an acute traumatic perforation of the ventricles, atria, intraventricular septum, intra-atrial septum, chordae, papillary muscles, or valves.
neurovascular bundle
a closely placed grouping of an artery, vein, and nerve that lies beneath the inferior edge of a rib.
pericardiocentesis
a procedure in which a needle or angiocath is introduced into the pericardial sac to relieve cardiac tamponade.
subconjunctival hematoma
the collection of blood within the sclera of the eye, presenting as a bright red patch of blood over the sclera but not involving the cornea
suprasternal notch
the indentation formed the superior border of the manubrium and the clavicles, often used as a landmark
traumatic asphyxia
a pattern of injuries seen after a severe force is applied to the thorax, forcing blood from the great vessels and back into the head and neck.
xiphoid process
an inferior segment of the sternum often used as a landmark for CPR.
Blunt disruptions of the diaphragm are usually associated with which type of injury?
herniation of all or part of the liver into the right side of the chest and the stomach into the left side of the chest.
Blunt diaphragmatic injuries occur most commonly on the left side.
What are some immediately life-threatening chest injuries that need to be detected and managed during the initial assessment?
airway obstruction bronchial disruption diaphragmatic tear esophageal injury open pneumothorax tension pneumothorax massive hemothorax flail chest cardiac tamponade
What are the classic signs of a tension pneumothorax?
absent breath sonds on affected side
JVD
tracheal deviation
Which organs are located in the RUQ
liver gallbladder duodenum head of pancreas right adrenal gland part of the right kidney hepatic flexure of the colon parts of the ascending and transverse colon
Which organs are located in the RLQ
lower pole of the right kidney cecum and appendix part of the ascending colon bladder (if distended) ovary and salpinx (female) uterus (if enlarged) right spermatic cord (male) right ureter
Which organs are located in the LUQ
left lobe of liver spleen body of pancreas left adrenal gland portion of left kidney splenic flexure of colon parts of the transverse and descending colon
Which organs are located in the LLQ
lower pole of the left kidney sigmoid colon part of the descending colon bladder (if distended) ovary and salpinx (female) uterus (if enlarged) left spermatic cord (male) left ureter
If there are fractures of the lower rib cage, what other injuries should you suspect?
spleen and/or liver injuries
If there are upper abdominal injuries, what other injuries should you suspect?
chest trauma
If there are pelvic fractures, what other injuries should you suspect?
intra-abdominal trauma (bladder laceration)
If there are penetrating thoracic wounds below the nipple line, what other injuries should you suspect?
intra-abdominal injury
linear skull fracture
account for approximately 80% of skull fractures.
approximately 50% of linear fractures occur in the temporal-parietal region.
nondisplaced skull fracture.
depressed skull fracture
results from high energy, direct trauma to a small surface area of the head with a blunt object
the frontal and parietal regions are most susceptible because the bones here are thinner than the rest of the skull.
bone fragments may be driven into the brain.
often present with loss of consciousness
Triage RPM
respirations
pulse
mental status
If anything is off with those, they are red
Triage respirations
Adult: >30 red
Paediatric: <10 or >30 red
Triage pulse
Radial pulse absent, red
Cap refill delayed >2 seconds, red
Triage mental acuity
Unable to comply with simple commands, red
Triage pediatrics
During bullhorn triage, NO patients are to be carried in arms to the green collection area.
All children are to be assessed in primary triage using JumpSTART triage and the methodology used in the ped assessment triangle prior to being assigned a triage colour
Cap refill has environmental limitations. The forehead/chest can be used as an alternate site in cooler weather.
Anything wrong with paediatrics: appearance, work of breathing, circulation= red
Hot (red) zone HAZMAT
- site of contamination
- must have appropriate high level PPE
Warm (yellow) zone HAZMAT
- buffer zone
- decontamination corridor
- life saving emergency care is performed
Cold (green) zone
-safe zone where incident operations take place
Alpha radiation
- very weak
- stopped by paper, clothing, or intact skin
- hazardous if inhaled or ingested
Beta radiation
- more energy than alpha particles
- will penetrate a few mm of skin
Gamma radiation
- high energy (x-rays)
- penetrates most substances
- can damage any cells in the body
- heavy shielding required
Methods of decontamination
Dilution
Absorption
Neutralization
Isolation
Dilution
Application of large quantities of water to the person.
Water is universal decontamination solution.
Water may be aided by soap.
Absorption
Use of pads or towels to blot up the hazardous materials
Usually applied after lavage
More commonly used during environmental clean-up
Neutralization
Almost never used by EMS personnel
A substance reduces or eliminates the toxicity of another substance
Isolation
Separate pt. or equip from haz sub
Zones are established to control decontamination
Field decontamination
Brush off dry chemicals
Apply large quantities of water with green soap if available.
When dealing with unknowns, do not attempt to neutralize.
Level A equipment HAZMAT
Highest respiratory and splash protection
Fully encapsulating
Level B HAZMAT
Full respiratory protection
Non-encapsulating, but chemically resistant.
Level C HAZMAT
Uses an air purifying respirator
Non-permeable suit, boots, and eye and hand protections
Level D HAZMAT
Structural fire-fighting gear
