Trauma Flashcards
The leading killer of persons under age 44 in the United States is?
Trauma
Injury caused by an object breaking the skin and entering the body
Penetrating trauma
Injury caused by the collision of an object with the body in which the object does not enter the body
Blunt trauma
Occurs when an arrow, bullet, knife or other object enters the body and exchanges energy with human tissue thereby causing injury
Penetrating trauma
Injury that occurs as the energy and forces of collision with an object - not the object itself - enter the body and damage tissue
Blunt trauma
Life treating problems such as _______ and _______ may occur with only subtle signs and symptoms
Internal bleeding and shock
When assessing a trauma patient look beyond obvious injuries for evidence that suggests?
A life threatening condition
Serious trauma is a surgical disease; its proper care is
Immediate surgical intervention to repair internal hemorrhage sites
Commits resources to address all types of specialty trauma 24 hrs a day 7 days a wk
Level 1 - Regional Trauma Center
Commits the resources to address the most common trauma emergencies with surgical capability available 24 hrs a day 7 days a wk; will stabilize and transport specialty cases to the regional trauma center
Level 2 - Area Trauma Center
Commits to special emergency department training and has some surgical capability, but will usually stabilize and transfer seriously injured trauma pt’s to a higher level trauma center as needed
Level 3 - Community trauma center
In remote areas, a small community hospital or medical care facility may be designated a trauma receiving facility, meaning that it will stabilize and prepare trauma patients with moderate to serious injuries for transport to a higher level facility
Level 4 - trauma facility
A physical injury or wound caused by external force or violence
Trauma
Neuro centers, burn centers, pediatric trauma centers and centers specializing in hand and limb re plantation by micro surgery
Specially Centers
To help determine _______ Mentally recreate the accident from evidence available at the scene.
Mechanism of injury
Guidelines to aid prehospital personnel in determining which trauma pt’s require urgent transportation to a trauma center.
Trauma triage criteria
The process and forces that cause trauma
Mechanism of injury
The information you gather during your consideration and reconsideration of the mechanism of injury suggest an
Index of suspicion for possible injuries
Survival from trauma often depends on ?
The time from injury until the pt’s is in surgery
The 60 minute period after a sever injury
The golden hour
Primary pt assessment, emergency stabilization, pt packaging and initiation of transport should ideally take less than ?
10 min
In applying trauma triage criteria, it is best to err on the side of
Precaution
A data retrieval system for trauma pt’s information, used to evaluate and improve the trauma system
Trauma registry
The most common cause of trauma death and disability?
Blunt trauma
Blunt trauma can be deceptive because the true nature of the injury is often hidden and evidence of the serious injury is?
Subtle or even absent
Is a branch of physics dealing with the forces of objects in motion and the energy exchanges that occur as objects collide
Kinetics
The law of inertia, as described by Sir Issac Newton and also known as
Newton’s first law
A body in motion will remain in motion unless acted on by an?
Outside force
Tendency of an object to remain at rest or remain in motion unless acted on by an external force
Inertia
The process of changing place; movement
Motion
The capacity to do work in the strict physical sense
Energy
The energy an object has while it is in motion. It is related to the objects mass and velocity
Kinetic energy
A measure of the matter that an object contains; the property of a physical body that gives the body inertia
Mass
The rate of motion in a particular direction in relation to time
Velocity
The energy of an object in motion. It is a function of the object’s mass and its velocity
Kinetic energy
Occurs when a body area is struck by or strikes an object
Blunt trauma
Events of vehicle collision:
- vehicle collision
- body collision
- organ collision
- secondary collision
- additional impacts
Results as the occupant contacts the vehicle’s interior and slows or stops
Organ collisions
Occurs when a vehicle occupant is impacted by objects traveling within the auto.
Secondary collisions
Additional impacts occur when a vehicle receives a?
Second impact
Seat belt use should be mandatory for all
EMS personnel
Accounts for over half of the deaths in vehicular collisions
Up and over pathway
Application of the forces of trauma along the axis of the spine; this often results in compression fractures of the spine
Axial loading
The region of a vehicle designed to absorb the energy of impact
Crumple zone
Maintain a ________ of serious injury when assessing lateral impact collision because the degree of injury may be greater than the damage alone would indicate
Higher index of suspicion
Having a slanted position or direction
Oblique
Interferes with the pt’s level of consciousness and masks signs and symptoms of injury
Alcohol
______ may be hard to differentiate from the signs of a head injury
Intoxication
Motor vehicle fatalities
By body area:
Head - 47.7%
Internal ( chest/abd/pelvic ) - 37.3%
Spinal and chest fracture - 8.3%
Fractures to the extremities - 2.0%
All other - 4.7%
Helmets reduce the incidence and severity of head injuries in motorcycle collisions but they have no effect on the incidence of
Spinal trauma
In pedestrian -vs- automobile collisions, adults tend to turn away from the on coming vehicle before impact while
Children turn toward it
An agent that enhances combustion of a fuel
Oxidizer
Area of over pressure that radiates outward from an explosion
Pressure wave
Underwater detonation increases the lethal range of an explosion
Threefold
Mechanisms associated with blasts:
- pressure wave
- blast wind
- projectiles
- personal displacement
- confined spaces and structural collapse
- burns
A rapid increase, then decrease in atmospheric pressure created by an explosion
Overpressure
The air movement caused as the heated and pressurized products of an explosion move outward
Blast wind
The most lethal explosions are those causing structural collapse followed by those in
Confined spaces
An agent that combusts easily or creates combustion
Incendiary
Primary blast injuries are caused by the heat of the explosion and the
Overpressure wave
Secondary blast injuries include trauma caused by
Projectiles
If the number of pt’s exceeds the immediate capabilities of your EMS system
Employ disaster triage
The most common and serious trauma associated with explosion
Pulmonary injuries ( lung injuries )
Undissolved solid, liquid or gaseous matter in the blood stream that may cause blockage of blood vessels
Emboli
Labored or difficult breathing
Dyspnea
Expectoration of blood from the respiratory tract
Hemoptysis
Collection of air or gas in the pleural cavity between the chest wall and lung
Pneumothorax
Contact sports may result in the exchange of
Great kinetic force and produce serious injuries
Kinetic energy =
Mass (weight) X Velocity (speed)
_______________________________
2
The study of projectile motion and its interactions with the gun, the air and the object it contacts
Ballistics
The path a projectile follows
Trajectory
The outward motion of tissue due to a projectiles passage, resulting in a temporary cavity and vacuum
Cavitation
The size and shape of a projectile as it contacts a target; it is the energy exchange surface of the contact
Profile
Swing or wobble around the axis of a projectiles travel
Yaw
The portion of the bullet you would see if you looked at it as it traveled toward you
Profile
The anticipated outcome of a disease or injury
Prognosis
The damage done as the projectile strikes tissue, contuses and tears that tissue and pushes the tissue out of its way.
Direct injury
When a high velocity, high energy projectile strikes human flesh it creates a
Pressure shock wave
Is a space created behind the high energy bullet as tissue moves rapidly away from the bullets path
The temporary cavity
The movement that creates the temporary cavity crushes,stretches and tears
The affected tissue
Associated with most projectile wounds is a ______________ that extends beyond the permanent cavity
Zone of injury
Weapons such as knives, Ice picks, arrows or flying objects such as blast debris or wires thrown by a lawn mower can cause
Low velocity penetrating trauma
The tissue’s connective strength and elasticity called__________, also influence how much tissue damage occurs with the kinetic energy transfer.
Resiliency
Solid organs such as the liver, spleen, kidneys, pancreas and brain have the density but not the resiliency of
Muscle and other connective tissue
Hollow organs such as the bowel, stomach, urinary bladder and heart are
Muscular containers holding fluid
Blood filling in the pericardial sac, thus limiting heart function
Pericardial tamponade
Injury to the lung tissue in cases of penetrating trauma is generally less extensive than can be expected with
Any other body tissue
Entrance wounds are usually the size of
The bullets profile
The exit wound is caused by the physical damage from both the passage of the bullet itself and from the
Cavitational wave
Since the pressure wave is moving forward and outward the wound may have a
Blown outward appearance
Make every effort to preserve evidence at a crime scene but remember that
Care of the pt takes priority
A _______ may more accurately reflect the potential damage caused by a bullets passage through the body than the __________?
Exit wound / entrance wound
A surgical incision into the cricothyroid membrane, usually to provide an emergency airway.
Cricothyrotomy
The introduction of a needle or other tube into the cricothyroid membrane, usually to provide an emergency airway
Cricothyrostomy
The loss of the body’s most important medium, blood, is called
Hemorrhage
The transition between normal function ( homeostasis) and death is called
Shock
The paramedic must be able to recognize hemorrhage and shock on trauma pts in order to reduce
Mortality and morbidity
Types of hemorrhage:
- capillary
- venous
- Arterial
Capillary hemorrhage usually ________ from the wound and is normally ______ in coloration
Oozes / bright red - well oxygenated
Venous hemorrhage flows more quickly, though it too generally stops in a few minutes. Bleeding associated with with venous hemorrhage is generally __________ in coloration
Dark red because the blood has already given up its oxygen as it passed through the capillary beds o
Arterial hemorrhage flows rapidly often spurting from the wound. It is ________ and appears _______ in coloration as it escapes the wound
Well oxygenated / bright red
The body’s response to local hemorrhage is a complex three-step process called
Clotting
Step in which smooth blood vessel muscle contracts, reducing the vessel lumen and the flow of blood through it
Vascular phase
To cluster or come together
Aggregate
Second step in the clotting process in which platelets adhere to blood vessel walls and to each other
Platelet phase
The third step in the clotting process which involves the formation of a protein called fibrin that forms a network around a wound to stop bleeding, ward off infection and lay a foundation for healing and repair of the wound
Coagulation
Protein fibers that trap red blood cells as part of the clotting process
Fibrin
Coagulation normally takes from
7-10 min
A clean lateral cut permits the vessel to retract and
Thicken its wall
A longitudinal cut to the vessel causes the wound to
Open
Method of hemorrhage control that relies on the application of pressure to the actual site of the bleeding.
Direct pressure
Use a tourniquet only as a
Last resort
A constrictor used on an extremity to apply circumferential pressure on all arteries to control bleeding
Tourniquet
Compound produced from pyruvic acid during anaerobic glycolyis
Lactic acid
Able to live w/o oxygen
Anaerobic
Employ this device only to halt persistent life threatening hemorrhage
Tourniquet
During the absence of perfusion, what accumulates in the stagnant blood?
Lactic acid, potassium and other anaerobic metabolites
If you must use a tourniquet use a
Wide cravat or belt or BP cuff. (Thin or narrow constricting devices may damage tissue)
Direct pressure on a wound or a combination of direct pressure and _________ work quite well in stopping the bleeding
Elevation
Hemorrhage is either
Internal or external
A fibrous membrane that covers, supports and separates muscles and may also unite the skin with underlying tissue
Fascia
Collection of blood beneath the skin or trapped within a body compartment
Hematoma
Humerus and tibia/fibula may account for ____________ of blood and bodily fluid loss
500-750 ml
Femur fractures may account for up to _______ ml of blood or bodily fluid loss
1500
Bleeding from the nose resulting from injury, disease or environmental factors
Epistaxis
Enlarged and tortuous esophageal veins
Esophageal varices
Black tarlike feces due to gastrointestinal bleeding
Melena
Rectal injury may be caused by
Pelvic fracture or direct trauma
Stage 1 hemorrhage is a blood loss up to
15% of the circulating blood volume
A reduction in the hemoglobin content in the blood to a point below that required to meet the oxygen requirements of the body
Anemia
Difference between the systolic and diastolic blood pressures
Pulse pressure
A hormone such as epinephrine or norepinephrine that strongly affects the nervous and cardiovascular systems, metabolic rate, temperature and smooth muscle
Catecholamine
Stage 2 hemorrhage occurs as
15 to 25% of the blood volume is lost
Blood loss of up to 15%, pt may display some nervousness and marginally cool skin with slight pallor
Stage 1 hemorrhage
Blood loss of 15 to 25%; pt displays thirst, anxiety, restlessness, cool, clammy skin, increased RR
Stage 2 hemorrhage
Blood loss between 25 and 35%; pt experiences air hunger, dyspnea, severe thirst, anxiety, restlessness; survival unlikely w/o rapid intervention
Stage 3 hemorrhage
Blood loss greater than 35% ; pulse barely palpable, respirations ineffective; pt lethargic, confused, moving toward unresponsiveness; survival unlikely
Stage 4 hemorrhage
In infants and young children, blood volumes approx _________ of body weight, volumes that are proportionally about _________ greater than those of adults
8 to 9% / 20%
Suspect hemorrhage early in cases of ______________ and treat aggressively
Child and infant trauma
Passage of stools containing red blood
Hematochezia
A decrease in BP that occurs when a person moves from a supine or sitting to an upright position
Orthostatic hypotension
Drop in the systolic BP of 20 mmHg or an increased or an increase in the pulse rate of 20 BPM when a pt is moved from a supine to a sitting position
Tilt test
Is stool with frank blood in it and reflects active bleeding in the colon or rectum
Hematochezia
A simple medical definition of shock is
A state of inadequate tissue perfusion
The total changes that take place in an organism during physiological process
Metabolism
A blockage in the delivery of oxygenated blood to the cells
Ischemia
The pressure of liquids in equilibrium; the pressure exerted by or within liquids
Hydrostatic pressure
Group of red blood cells that are stuck together
Rouleaux
Release of accumulated lactic acid, carbon dioxide (carbonic acid), potassium and Rouleaux into the venous circulation
Washout
Hemodynamic insult to the body in which the body responds effectively. Signs and symptoms are limited and the human system functions normally
Compensated shock
