Trauma Flashcards
What are the criteria for transport to a trauma center step 1
glascow < 13
systolic bp < 90
RR < 10 or > 29
What are the criteria for transport to a trauma center step 2
penetrating injury proximal to elbow or knee Chest wall instability 2 or more proximal long bone fracture crushed, degloved, mangled, pulseless extremity, amputation proximal to wrist or ankle pelvic fracture open or depressed skull fracture paralysis
What are the criteria for transport to a trauma center step 3
falls adults > 20ft children > 10 ft high risk auto crash intrusion ejection death in same passenger compartment vehicle telemetry data consistent with high risk of injury auto vs pedestrian/bicyclist motorcycle crash
What are the criteria for transport to a trauma center step 4
older adults with children anti coagulants and bleeding disorders burns with trauma mechanism pregnancy > 20 wk EMS provider judgment
adult burn area calculation
ful arms or full head = 9
full front chest + abd = 18
full back = 18
full leg = 18
infant burn area calculation
18 for chest and abd, full back, head
9 for full arm
13.5 for full leg
children burn area calculation
18 for chest + abd, full back
12 head
16.5 for full leg
9 for full arm
Major burn severity classification
hands, feet, face, major joints, or genitalia, circumferential
full thickness burns more than 10%
partial thickness on 25% age 10 to 50 or 20% younger than 10 or older than 50
respiratory injury
trauma
high voltage electrical
chemical
burns on pt younger than 5 that would be moderate on young adults
Moderate burns classification
full thickness on 2 to 10% of the TBSA
partial thickness burns on 15 to 25% age 10 to 50
10 to 20% younger than 10 or older than 50
superficial on more than 50%
low voltage electrical
no major burn classification
Superficial burn classification
involves only the epidermis
partial thickness or second degree burn classification
involves some of the dermis but not the entire thickness of the skin. mottled , white to red skin often with blisters
full thickness or third degree burns.
all layers of skin and may involve muscle and subcutaneous tissue. dry leathery and often white or charred skin.
GCS determination
eyes
normal,speech,pain,none
verbal
orientated,confused,inappropriate,sounds,none
motor
obey,localizedpain,flexion,decorticate,decerebrate, none
normal ETCO2
between 35 and 40 mm hg or 30 to 35 in severe cases of herniation. never below 25
What is becks triad?
signs of a pericardial tamponade. Muffled heart sounds, hypotension, JVD.
S/S pericardial tamponade
Becks triad, electrical alternans, almost the same as pnuemothorax except for breath sounds will be equal and trachea will always be midline.
Treatment of abdominal evisceration
Apply a normal saline soaked sterile dressing over the top of the evisceration. cover the injured area to keep it warm.
S/S of neurogenic shock
hypotension, spinal injury, no sweating, loss of body temperature control.
Caused by spinal injury. dilates the blood vessels which ruins hemodynamics and cellular perfusion.
S/S of retinal detachment
seeing stars, floaters, shady area of vision. Usually caused by blunt facial trauma but can be spontaneous. Usually occurs in patients 50 and older.
Treating an eye injury
Cover both eyes to prevent sympathetic eye movement in the injured eye. If the eye is ruptured, possible spinal injury is present so use spinal precautions. elevate the head to decrease intraocular pressure.
Do not exert pressure on the injured eye. Cover both eyes. apply moist dressing if the globe is exposed to prevent drying.
Brown Sequard syndrome
Spinal lesion causing weakness or paralysis on one side of the body and loss of sensation on the other side.
Decorticate posturing
Flexion of elbows, wrists, and fingers. Legs extended and rotated inwards.
Decerebate posturing
extension of the elbows, wrists, and fingers. Back arched, legs extended and rotated inwards.
Traumatic asphyxiation S/S
Cyanosis of the head shoulders and torso above the area of compression. Occular hemorrhage. Possible eye protrusion.
Traumatic asphyxiation treatment
Spinal immobilization, oxygen, 2 large bore IV’s.
S/S epidural hematoma
Loss of consciousness immediately after the injury occurs. regains consciousness and is coherent during a brief period. Lapses back in to unconciousness. Usually occurs due to trauma to the temporal blow.
Le Forte Fracture
Facial fracture that seperates the facial part of the skull from the rest.
Le Forte Fracture classification
I, above upper teeth
II, above nose
III, eyes.
