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
Continuing hemodynamic insult to the body in which the compensatory mechanisms break down. The signs and symptoms become very pronounced and the pt moves rapidly toward death
Decompensated shock
The initial shock state
Compensated shock
Begins as the body’s compensatory mechanisms become unable to respond to a continuing blood loss
Decompensated shock
Final stage of shock in which organs and cells are so damaged that recovery is impossible
Irreversible shock
The most practical choice for prehospital fluid resuscitation is
Lactated Ringer’s solution
The ideal catheter for the shock pt is
1 1/2 or shorter
Skin consisting of the epidermis, dermis and subcutaneous layers
Integumentary system
Closed wound in which the skin is unbroken, although damage has occurred to the tissue immediately beneath
Contusion
General reddening of the skin due to dilation of the superficial capillaries
Erythema
Blue-black discoloration of the skin doe to leakage of blood into the tissue
Ecchymosis
Collection of the blood beneath the skin or trapped within a body compartment
Hematoma
Mechanism of injury in which tissue is locally compressed by high pressure forces
Crush injury
Systemic disorder of severe metabolic disturbances resulting from the crush of a limb or other body part
Crush syndrome
Scraping or abrading away of the superficial layers of the skin; an open soft tissue injury
Abrasion
An open wound normally a tear with jagged borders
Laceration
Natural patterns in the surface of the skin revealing tension within
Tension lines
Very smooth or surgical laceration, frequently caused by a knife, scalpel razor blade or piece of glass
Incision
Specific soft tissue injury involving a deep narrow wound to the skin and underlying organs that carries and increased danger of infection
Puncture
Foreign body embedded in a wound
Impaled object
Forceful tearing away or separation of body tissue; may be partial or complete
Avulsion
Avulsion in which the mechanism of injury tears the skin off the underlying muscle, tissue, blood vessels and bone
Devolving injury
Severance, removal, or detachment either partial or complete of a body part
Amputation
The body’s natural ability to stop bleeding ; the ability to clot blood
Hemostasis
New growth of the capillaries in response to healing
Neovascularization
Complex process of local cellular and biochemical changes as a consequence of injury or infection; an early stage of healing
Inflammation
Chemicals released by white blood cells that attracts more white blood cells to an area of inflammation
Chemotactic factors
White blood cells charged with the primary purpose of neutralizing foreign bacteria
Granulocytes
Immune system cell that has the ability to recognize and ingest foreign pathogens
Macrophage
Early stage of wound healing in which epithelial cells migrate over the surface of the wound
Epithelialization
Tough, strong protein that comprises most of the body’s connective tissue
Collagen
Specialized cells that form collagen
Fibroblast
Stage in the wound healing process in which collagen is broken down and relaid in an orderly fashion
Remodeling
Inflammation of the lymph channels, usually as a result of a distal infection
Lymphangitis
Deep space infection usually caused by the anaerobic bacterium Clostridium perfringens
Gangrene
The body’s main structural protein.
Collagen
One of the rarest and most and most feared wound complications is
Gangrene
A cellular component of blood, similar to plasma
Serous fluid
Muscle ischemia that is caused by rising pressures within an anatomical fascial space.
Compartment syndrome
Excessive scar tissue that extends beyond the boundaries of the wound
Keloid
Tissue death usually from ischemia
Necrosis
Acute pathologic process that involves the destruction of skeletal muscle
Rhabdomyolysis
It is important to note that compartment syndrome rarely occurs within the first
4 hrs
Alter the usual substance of something
Denature
Explanation of the physical effects of thermal burns
Jackson’s theory of thermal wounds
Area in a burn nearest the heat source that suffers the most damage and is characterized by clotted blood and thrombosed blood vessels.
Zone of coagulation
Area in a burn surrounding the zone of coagulation that is characterized by decreased blood flow
Zone of stasis
Area peripheral to a burn that is characterized by increased blood flow.
Zone of hyperemia
First stage of the burn process that is characterized by a catecholamine release and pain-mediated reaction
Emergent phase
Stage of the burn process in which there is a massive shift of fluid from the intravascular to the extravascular space
Fluid shift phase
The volume contained by all the arteries, veins,capillaries and other components of the circulatory system
Intravascular space
The volume contained by all the cells (intracellular space) and the spaces between the cells (interstitial space)
Extravascular space
Stage of the burn process in which there is increased body metabolism in an attempt by the body to heal the burn.
Hypermetabolic phase
Final stage of the burn process in which scar tissue is laid down and the healing process is completed.
Resolution phase
The difference of electric potential between two points with different concentrations of electrons
Voltage
The process in which an acid, while destroying tissue forms an insoluble layer that limits further damage
Coagulation necrosis
The process in which an alkali dissolves and liquifies tissue
Liquefaction necrosis
The trauma system is predicted on the principle that serious trauma is a
Surgical disease
Serious trauma is a surgical disease, it’s proper care is immediate surgical intervention to repair
Internal hemorrhage sites
What is the second part of the law of inertia
“A body at rest will remain at rest unless acted on by an outside force”
The liver is suspended in the abdomen by the
Ligamentum teres
Events of a vehicle collision:
- vehicle collision
- body collision
- organ collision
- secondary collision
- additional impacts
Types of vehicle impacts:
- rotational (38%)
- frontal (32%)
- lateral (15%)
- rear-end (9%)
- rollover (6%)
The up and over pathway accounts for __________ of the deaths in vehicular collisions
Over half
The unrestrained occupant slides downward as the vehicle comes to a stop
Down and under pathway
An injury process frequently associated with steering wheel impact is the
Paper bag syndrome
The heart which is not firmly attached in the central thorax moves violently toward the impact as the body
Accelerates
Occupants of a vehicle with a limited crumple zone may experience greater forces in a collision even though damage to the vehicle itself may not appear as severe as damage to a vehicle with a
Greater crumple zone involved in a similar collision
The lethal range for an explosive charge increased threefold with an
Underwater detonation
The extreme pressure damages or ruptures the thin and delicate alveolar walls, resulting in fluid accumulation, hemorrhage and possibly even
The entry of air directly into the blood stream from the alveoli
Coughing up of blood or blood -tinged sputum
Hemoptysis
Pressure of ventilations may induce ____________? By pushing air past blast-induced lung defects and into the pleural space
Pneumothorax
Pressure can disrupt blood flow to and through the limb causing
Anaerobic metabolism and some tissue death
Another consequence of the release of the crushing pressure is severe and difficult to control
Hemorrhage
If you double the mass of an object it will have twice the kinetic energy of the speed of the object
Remains the same
The ______ or _______ of an object has a squared relationship to its kinetic energy
Speed or velocity
Mass(weight) x velocity (speed) /2
Kinetic energy
Factors associated with the damage pathway of a projectile wound:
- direct injury
- pressure shock wave
- cavitation
- temporary cavity
- permanent cavity
- zone of injury
Filling of the pericardial sac with fluid which in turn limits the filling and function of the heart
Pericardial tamponade
Any large penetrating wound may permit air to be drawn into an open external jugular vein and immediately threaten life due to the resulting
Pulmonary emboli
A bullets exit wound often has a ___________ appearance
Blown outward
An exit wound may more accurately reflect the potential damage caused by a bullet’s passage through the body than the
Entrance wound
Types of hemorrhage:
- capillary
- venous
- arterial
Certain categories of pt’s - pregnant women, athletes, children and the elderly react different to
Blood loss
The blood volume of a woman in late pregnancy is _______ greater than normal
50%
The pelvic fracture can acct for blood loss of more than
2000 mL
The femur fracture can acct for up to _______ blood loss
1500 mL
A tibia / fibula or humerus fracture may contribute to a blood loss of
500 to 750 mL
Hematomas and large contusions may acct for a blood loss up to
500 mL
Extreme of Motion:
- hyperextension
- hyperflexion “ kiss the chest “
- excessive rotation
- lateral bending
The sympathetic nervous system and the hormones it releases begin progressive response as hemorrhage causes blood to leave the
Cardio vascular system
Compensated shock:
- pulse rate increases
- pulse strength decreases
- skin becomes cool and clammy
- pt feels progressing anxiety, restlessness, combative
- pt experiences thirst, weakness, eventual air hunger
Decompensated shock:
- pulse becomes impalpable
- BP drops precipitously
- pt becomes unconscious
- respirations slow or cease
Irreversible shock:
Shortly after the pt enters Decompensated shock, the lack of circulation begins to have profound effects on body cells. As they are irreversibly damaged, the cells die, tissue dysfunction, organ dysfunction and the pt dies
Skin consisting of the epidermis , dermis, and subcutaneous layers
Integumentary system
Most common types of trauma injuries are?
Soft- tissue injuries
Closed wound in which the skin is unbroken, although damaged has occurred to the tissue immediately beneath.
Contusion
Blunt, nonpenetrating injuries that crush and damage small blood vessels
Contusions
General reddening of the skin due to dilation of the superficial capillaries
Erythema
Blue-black discoloration of the skin due to leakage of blood into the tissue
Eccymosis
Collection of blood beneath the skin or trapped within a body compartment
Hematoma
Mechanism of injury in which tissue is locally compressed by high pressure forces
Crush injury
Systemic disorder of severe metabolic disturbances resulting from the crush of a limb or other body part
Crush syndrome
Scraping or abrading away of the superficial layers of the skin; an open soft tissue injury
Abrasion
An open wound, normally a tear with jagged borders
Laceration
Natural patterns in the surface of the skin revealing tensions within
Tension lines
Very smooth or surgical laceration, frequently caused by a knife, scalpel, razor blade, or piece of glass
Incision
Specific soft- tissue injury involving a deep narrow wound to the skin and underlying organs that carries an increased danger of infection
Puncture
Foreign body embedded in a wound
Impaled object
Forceful tearing away or separation of body tissue, may be partial or complete
Avulsion
Occurs when a flap of skin, although torn or cut is not torn completely loose from the body
Avulsion
Avulsion in which the MOI tears the skin off the underlying muscle, tissue , blood vessels and bone
Degloving injury
Severance, removal, or detachment either partial or complete of a body part
Amputation
The body’s natural ability to stop bleeding, ability to clot blood
Hemostasis
Early stage in wound healing in which epithelial cells migrate over the surface of the wound
Epithelialization
Complex process of local cellular and biochemical changes as a consequence of injury or infection
Inflammation
Chemicals released by white blood cells that attract more white blood cells to an area of inflammation
Chemotactic factors
White blood cells charged with the primary purpose of neutralizing foreign bacteria
Granulocytes
Immune system cell that has the ability to recognize and ingest foreign pathogens
Macrophage
Process in which a cell surrounds and absorbs a bacterium or other particle
Phagocytosis
Early stage of wound healing in which epithelial cells migrate over the surface of the wound
Epithelialization
The body responds to this increased demand by generating new blood vessels in a process called
Neovascularization
New growth of capillaries in response to healing
Neovascularization
Tough strong protein that comprises most of the body’s connective tissue
Collagen
Specialized cells that form collagen
Fibroblasts
Stage in the wound healing process in which collagen is broken down and relaid in an orderly fashion
Remodeling
Inflammation of the lymph channels usually as a result of a distal infection
Lymphangitis
Deep space infection usually caused by the anaerobic bacterium Clostridium perfringens
Gangrene
Tetanus is caused by
Bacterium Clostridium tetani
A formation resulting from overproduction of scar tissue
Keloid
A cellular component of blood similar to plasma
Serous fluid
Muscle ischemia that is caused by rising pressure within an anatomical fascial space
Compartment syndrome
During the healing process, scar tissue sometimes develops abnormally. A ________ is excessive scar tissue that extends beyond the boundaries of a wound
Keloid
Tissue death usually from ischemia
Necrosis
Acute pathologic process that involves the destruction of skeletal muscle
Rhabdomyolysis
Dressings:
- sterile / nonsterile
- occlusive / nonocclusive
- adherent / nonadherent
- absorbent / nonabsorbent
- wet/ dry
Bandages
- self - adherent roller
- gauze
- adhesive
- elastic
- triangular
In addition to questioning the pt and inspecting the body regions, you should palpate the body’s
Entire surface
The wound should be observed in such a way that it can later be
Described to the attending physician
The three objectives of bandaging are?
Control bleeding
Keep wound clean
Immobilize the wound site
To halt hemorrhage, apply form pressure to the site for at least
10 min
Do not use a tourniquet unless you cannot control bleeding by
Any other means
Once in place a tourniquet should be left in place until the pt arrives at the
Emergency room
Only remove impaired objects that obstruct the
Airway or prevent CPR
Basic types of burns:
- thermal
- electrical
- chemical
- radiation
Explanation of the physical effects of thermal burns
Jackson’s theory of thermal wounds
Area in a burn nearest the heat source that suffers the most damage and is characterized by clotted blood and thrombosed blood vessels
Zone of coagulation
Area in a burn surrounding the zone of coagulation that is characterized by decreased blood flow
Zone of stasis
Area peripheral to a burn that is characterized by increased blood flow
Zone of hyperemia
First stage of the burn process that is characterized by a catecholamine release and pain-mediated reaction
Emergent phase
Stage of the burn process in which there is a massive shift of fluid from the intravascular to the extravascular space
Fluid shift phase
Stage of the burn process in which there is increased body metabolism in an attempt by the body to heal the burn.
Hypermetabolic phase
Final stage of the burn process in which scar tissue is laid down and the healing process is completed
Resolution phase
The process in which an acid, while destroying tissue forms an insoluble layer that limits further damage
Coagulation necrosis
The process in which an alkali dissolves and liquefies tissue.
Liquefaction necrosis
Usually form a thick, insoluble mass where they contact tissue through coagulation necrosis limiting burn damage.
Acids
Usually continue to destroy cell membranes through liquefaction necrosis, allowing them to penetrate underlying tissue and causing deeper burns
Alkalis
Alpha radiation:
Very weak, stopped by paper clothing or epidermis
Beta radiation:
More powerful than alpha; can travel 6-10 ft through air ; can penetrate some clothing and the first few mm of the skin
Gamma radiation:
Most powerful ionizing radiation; great penetrating power; protection requires thick concrete or lead shielding
Great penetrating power but uncommon outside nuclear reactors and bombs
Neutron
Referring to the upper airway
Supraglottic
Suspect __________ in any pt who was in an enclosed space during combustion
Carbon monoxide poisoning
Inhalation injury may be associated with burns, especially if the injury occurred in an
Enclosed space
Factors affecting exposure to radiation:
- Time
- Distance
- Shielding
Referring to the lower airway
Subglottic
Super heated steam is a common cause of
Airway burns
A burn that involves only the epidermis; characterized by reddening of the skin also called a first degree burn
Superficial burn
Burn in which the epidermis is burned through and the dermis is damaged; characterized by redness and blistering also called second degree burn
Partial- thickness burn
Stridor or high pitched “crowing” sounds on inspiration are ominous signs of
Impending airway obstruction
Amount of a pt’s body affected by a burn
Body surface area (BSA)
Method of estimating amount of body surface area burned by a division of the body into regions, each of which represents approx. 9% of total BSA plus 1% genitalia region
Rule of nines
With burns cover 10% of body with a burn sheet soaked in
Normal saline ( Local cooling )
Critical burns
Partial >30% BSA
Full >10% BSA
Any partial or full thickness involving hands, feet, joints, face, or genitalia
Inhalation injury
Hard leathery product of a deep full - thickness burn; it consists of dead and denatured skin.
Eschar
Burns cause several systemic complications. These can affect the overall severity of a burn. Typical complications include
Hypothermia, hypovolemia, Eschar formation, and infection
If any of the clothing adheres to the burn or resists removal,
Cut around it as necessary
Burns to the face, hands, feet, joints, genitalia and circumferential burns are of
Special concern
Serious burns and the associated scar tissue make thermal hand or foot injuries very debilitating. Assess these areas and communicate the precise location of the injury and the degree of the burn to the
Receiving physician
Pay particular attention to burns that completely ring an extremity which includes the
Thorax, the abdomen, or the neck
Carefully assess any burn encircling a part of the body for
Distal circulation or other signs of vascular compromise
Burn severity: Minor
Superficial: BSA
Burn severity: Moderate
Superficial: BSA > 50%
Partial thickness:
Burn severity: Critical
Partial thickness: BSA > 30%
Full thickness: BSA > 10%
Inhalation injury
Any partial - or full- thickness burns involving hands, feet, joints, face or genitalia
4 mL x PT weight in kg x BSA burned = amount of fluids over 24 hrs
Parkland burn formula - used for burn tx in hx
Cool water immersion of minor localized burns may be effective if accomplished in
The first few min after a burn
Cover extensive partial and full thickness burns with
Dry sterile dressing, keep pt warm and initiate fluid resuscitation
Use soft nonadherent dressing between areas of
Full thickness burns, between fingers and toes to prevent adhesion
Twitching of the eyelids
Blepharospasm
Injury resulting from over stretching of muscle fibers
Strain
Tearing of a joint capsules connective tissue
Sprain
Grades of sprains:
Grade 1- minor and incomplete tear.
Grade 2 - significant but incomplete tear.
Grade 3 - complete tear of the ligament
Partial displacement of a bone end from its position I a joint capsule
Subluxation
Complete displacement of a bone end from its position in a joint capsule
Dislocation
This type of injury carries with it the danger of entrapping, compressing or tearing blood vessels and nerves
Dislocations
A pins and needles sensation
Paresthesia
Small crack in a bone that does not disrupt its total structure
Hairline fracture
Break in a bone in which the bone is compressed on itself
Impacted fracture
A break that runs across a bone perpendicular to the bones orientation
Transverse fracture
Break in a bone running across it at an angle other than 90 degrees
Oblique fracture
Fracture in which a bone is broken into several pieces
Comminuted fracture
A curving break in a bone as may be caused by rotational forces
Spiral fractures
Break in a bone associated with prolonged or repeated stress
Fatigue fracture
Partial fracture of a child’s bone
Greenstick fracture
Weakening of bone tissue due to loss of essential minerals especially calcium
Osteoporosis
A gradual progressive decrease in bone mass and collagen structure begins at about age 40 and results in bones that are
Less flexible, more brittle and more easily fractured
Fractures near joints are more likely to compress or s
Sever blood vessels or nerves
Areas around the joints are further endangered because blood vessels supplying the epiphysis enter the long bone through the
Diaphysis
Thickened area that forms at the site of a fracture as part of the repair process
Callus
Acute or chronic inflammation of the small synovial sacs
Bursitis
Inflammation of a tendon and/or its protective sheath
Tendonitis
Inflammation of a joint
Arthritis
Inflammation of a joint resulting from wearing of the articular cartilage
Osteoarthritis
Pelvic fracture may account for hemorrhage of more than
2 liters
A femur fracture may account for as much as
1,500 mL of blood loss
The six P’s
- pain
- pallor
- paralysis
- paresthesia
- pressure
- pulses
Place the limb in a position of ________ whenever possible
Function
Generally you should not attempt alignment of dislocations and serious injuries within _________ of a joint.
3 inches
Only attempt to manipulate such injury sites if the distal circulation is
Compromised
Immobilize the joint ______ and the joint _______the injury regardless of whether the injury occurs at a joint or mid shaft in a long bone.
Above and below
Is a comfortable splint for ankle and foot injuries
Pillow splint
Attempt reduction of a dislocation only when you are sure the injury is a dislocation, when you expect the pt’s arrival at the emergency dept to be delayed or when there is a significant
Neurovascular deficit
Generally a femur fracture presents with the foot turned outward and the injured limb shortened when compared to
The other leg
The anterior dislocation presents with the foot turned outward, the hip and knee flexed and the head of the femur sometimes
Palpable in the inguinal area
Another concern with the knee injury is possible injury to the major blood vessel traversing the area the,
Popliteal artery
