Trauma Flashcards
S/S of Tension Pneumothorax
Tracheal Shift (Late on external exam, early on radiographic)
Decreased / Absent lung sounds
JVD
Treatment of Tension Pneumothorax
Needle thoracostomy (2nd ICS mid-axillary, 4th-5th Mid-axillary) Tube thoracostomy (5th ICS Anterior Axillary)
S/S of Hemothorax
Midline Trachea
Decreased / Absent breath sounds
Hypovolemic shock
Flat neck veins
Treatment of Hemothorax
Tube thoracostomy (5th ICS Anterior Axillary)
Crystalloid / Blood replacement
Intubate
S/S Open Pneumothorax
Sucking chest wound
Respiratory distress
Tachypnea
Treatment of Open Pneumothorax
Occlusive dressing upon end exhalation
Taped 3 sides until chest tube placement, then 4th
S/S Flail Chest
Paradoxical movement
Respiratory distress
Chest pain
Treatment of Flail Chest
Attempt to stabilize flail chest segment
Injured side down
Limit fluids if available
S/S Early Cardiac Tamponade
Pulsus Paradoxus (Quality of pulse changes with respirations) Sinus Tachycardia
Treatment of Early Cardiac Tamponade
Force Fluids (Increase preload) Anticipate Tamponade progression
S/S Late Cardiac Tamponade
Beck’s Triad (Muffled heart tones, JVD, Narrowed Pulse Pressure)
Treatment of Late Cardiac Tamponade
Pericardiocentesis
S/S Aortic Rupture
Harsh systolic murmur
CXR findings of widened mediastinum
Chest / mid-scapular pain
Treatment of Aortic Rupture
If caval or liver laceration suspected, establish IV access above and below diaphragm
Rapid transport to surgeon
S/S Diaphragmatic Rupture
Bowel sounds in chest
Scaphoid abdomen
Treatment of Diaphragmatic Rupture
NG/OG
NPO
Intubate / PPV
S/S of Tracheobronchial Disruption
Continuous air leak or persistent pneumothorax
Rapidly progressing subcutaneous emphysema
Pneumomediastinum
Treatment of Tracheobronchial Disruption
Supportive
Consider mainstem intubation
S/S of Esophageal Perforation
Hematemesis
Dysphagia
Dyspnea
Shock
Treatment of Esophageal Perforation
NG/OG
Antibiotics
Antiemetics
Newton’s 1st law
Object in motion remains in motion, object at rest stays at rest, unless an outside force acts upon it.
Newton’s 2nd law
F=MA (Force = Mass x Acceleration)
Newton’s 3rd law
Every action has an equal and opposite reaction
Head-on Collison:
Up and Over pattern
Head, neck, chest, pelvis injuries
Head-on Collison:
Down and Under pattern
Knee’s, femur, pelvis, lower back, chest, facial
Rear-end Collision injuries
T12-L1 back injuries
C2 fracture of neck
Evaluate for 2nd impact injury patterns (hitting steering wheel)
T-bone or lateral Collison injuries
Look for injuries secondary to loose objects or other people in vehicle
Motorcycle Head-on injuries
Up and Over
femur, head, neck
Motorcycle Slide / Side injuries
Femur, Pelvic, Tib/Fib
Rollover Collisions
Causes the most lethal injuries of all collisions.
Axial loading, multiple injury patterns
Trauma Management : Airway indications
Conscious ability to swallow
Oxygenation or Ventilation failure (Sao2 <60, Co2 >55, Ph <7.2)
Expected clinical course
Trauma Management : Circulation
Assess cardiac output (HR more important than BP)
Think Tamponade
Assess bleeding
Blood pressure won’t fall until EBL is ___.
> 30-40%
Managing Increasing ICP
Watch for herniation (Posturing, Pupil changes)
Raise HOB 30*
Hyperventilate to 30-35 ETCO2
Sedation, NMBA, Diuretics
Farming accident considerations
Delayed arrival of medical care and extrication
Tractors are heavier than autos
Tractors are prone to rollovers
End-over-end rollovers have a greater potential of entrapment
Higher potential for Hazmat involvement
Falls occur primarily in adults and children ___.
Under 5
Children fall and impact ____.
On their head
Adult’s “lover leap”
Lands on feet then falls backwards on butt and hands.
Feet, leg, hip fx.
Axial loading on lumbar / cervical
Colles fx of wrists
Impalement / stab wound considerations
Area of body
Blade length
Angle of penetration
Firearm wound considerations
Type (caliber, handgun, long gun) Distance from weapon Bullet construction (FMJ, hollow point)
Primary blast injuries
Initial air blast causing damage to hollow organs
Secondary blast injuries
Projectiles / shrapnel from blast force
Tertiary blast injuries
Impacts ground or other object
Parkland burn formula
4ml/kg/BSA%
Give 1/2 over 1st 8 hours, 1/2 over next 16 hours
Don’t calculate 1st degree burns
Always assume Carbon Monoxide poisoning in ____.
Fires in confined spaces
Consider ___ with fires of carpets and plastics.
Cyanide poisoning
Consensus burn formula
2-4ml/kg/BSA%
Burn Mortality percentage
Age + BSA % (add 20% if Resp involvement)
Hydrofluoric acid treatment
Copious water
Infiltrate tissue with 10% Calcium Gluconate
Alkali metal burns (Na, K+) treatment
Reacts with water
Absorb heat with oil
Acid burns
Most cause Coagulative necrosis and can’t penetrate deep into tissues. They denature cellular proteins and cause cellular coagulation.
Alkali burns
Dissolve protein and collagen causing dehydration and Saponification (turns fat into soap). Tend to cause more severe burns.
Two-step Hazmat Decon Process
Usually at a fast break scenario
Remove all clothing or jewelry from body
Wash and rinse patient with soap and water
Reposition out of runoff and rewash and rinse
Myoglobinuria is often a problem due to ____.
Massive muscle damage
Electrical injuries result in ____ and _____.
Acute Tubular Necrosis
Renal failure
Electrical injury treatment
Maintain urine output of a minimum of 100 ml/hr
Osmotic diuretics
Alkalinize urine with Bicarb solution
Start Triage Assessment
Respirations
Perfusion
Mentation
Start Triage Quick Rules
15-30 second assessment per patient
Apneic patients can have airway repositioned once
Check cap refill at core
In START Triage, all penetrating trunk injuries are classified as?
Immediate
In START Triage, all rescuers injured on scene are classified as?
Immediate
Crystalloid to blood replacement ratio
3:1
Initial fluid resuscitation should be with?
Isotonic crystalloid (0.9% NS or LR)
Fluid resuscitation should have a MAP goal of?
80-90 mmHg
Poor urine output in trauma is indicative of ___ failure.
Pre-renal
Humoral blood loss
750 ml
Blood loss femur
1500 ml
Complications of crush injuries
Compartment syndrome
DIC
Renal failure
Hyperkalemia
S/S of Larynx fracture
Subcutaneous emphysema
Flattened cricothyroid prominence
At room temperature, an amputated part is viable for reimplantation for approximately how many hours?
4-6 hours
With proper cooling measures, an amputated part is viable for reimplantation for approximately how many hours?
Up to 18
Spontaneous recurrence is common in what dislocation?
Anterior shoulder
The most common musculoskeletal dislocation is?
Hip
Leading cause of death in trauma victims is?
Head injury
Massive Hemothorax is defined as ___ of blood.
> 1500ml or 1/3 patient’s blood volume