Trauma Flashcards
Biomechanics
Study of physiology and mechanics of living organisms.
Kinetics
Study of the relationship among speed, mass, direction of force, and physical injury caused by these factors:
Ability of the body to disperse energy delivered.
Force and energy.
Duration and direction.
Position of victim.
Describe the impact resistance of hollow vs. solid organs.
Organs with gas inside are easily compressed.
Liquid containing organs are less compressible.
Velocity
(V) distance per unit of time.
Accelerations
(a) rate of change in velocity.
Gravity
(g) downward acceleration imparted to any object moving toward earth.
Kinetic energy (KE)
(mass/2) x V^2
Law of conservation of energy
Energy can neither be created nor destroyed.
Energy dissipation
Process by which KE is transformed into mechanical energy.
Newton’s first law of motion
A body at rest will remain at rest unless acted on by an outside force.
Newton’s second law of motion
The force an object can exert is the product of its mass times its acceleration.
Force
mass (weight) x acceleration (or deceleration)
Deceleration and acceleration can be measured in numbers of
G force
Blunt trauma
Injuries in which tissues are not penetrated by an external object.
What are the five phases of motor vehicle crashes?
1: Deceleration of the vehicle.
2: Deceleration of the passenger.
3: Deceleration of internal organs.
4: Secondary collisions.
5: Additional impacts received by the vehicle.
What are the two trajectories of frontal/head-on impact?
Down and under pathway
Up and over pathway
What are three common injuries caused by the down and under pathway?
Knee/hip dislocations
Femur fractures
Lower extremities fractures
What is the most common injury caused by rear impacts?
Whiplash
What is the function of the cervical plexus (C1-C5)?
Innervates the diaphragm
What are rotational or quarter panel impacts?
Occurs when a lateral crash is off centre.
The vehicle’s forward motion stops, but the side continues in rotational motion.
Rollovers
Patients may be ejected.
Patients may be struck hard against the interior of the vehicle.
What is a common injury caused by seat belts during a crash?
Cervical fractures.
Airbags
Reportedly reduced deaths in direct frontal crashes by 30%.
Can also result in secondary injuries:
-direct contact
-chemicals
Airbags
Reportedly reduced deaths in direct frontal crashes by 30%.
Can also result in secondary injuries:
-direct contact
-chemicals
What are people protected by during motorcycle crashes?
Any protection is derived from protective devices worn by the rider.
What are the 5 motorcycle crash factors to take note of on scene?
Deformity of motorcycle Side damaged Distance of skid Deformity of objects or vehicles Helmet deformity
What are the 4 types of motorcycle impact?
Head on impact
Angular impact
Ejected
Able to lay the bike down
Pedestrian MOIs
First impact: auto strikes body with its bumpers.
Second impact: adult is thrown on hood and/or grille of vehicle.
Third impact: body strikes ground or some other object.
What is the Waddell Triad?
Pattern of injuries in children and people of short stature.
- bumper hits pelvis and femur.
- chest and abdomen hit grille.
- head strikes vehicle and ground.
Severity of fall injuries are impacted by which four factors?
Height
Position
Surface
Physical condition
What is Don Juan syndrome or lover’s leap?
Feet first jump
What is penetrating trauma?
Disruption of skin and tissues in a focused area.
- low velocity: caused by sharp edges
- medium and high velocity: object might flatten out, tumble, or ricochet.
What are the 4 stab wound severity factors?
Anatomic area involved
Depth of penetration
Blade length
Angle of penetration
What are 5 gunshot wound severity factors?
Type of firearm Velocity of projectile Physical design/size of projectile Distance of victim from muzzle Type of tissue struck
*GSW in thorax, good idea to put a collar on them.
GSW deformation/tissue destruction is based on
Density
Compressibility
Missile velocity
Missile fragmentation
Which factors of a GSW do you need to take note of?
Weapon used
Range fired
Bullet used
Look for:
Powder residue around the wound (close range)
Entrance and exit wounds
Primary blast injuries
Damage is caused by the pressure wave generated from the explosions.
Close proximity to the origin of pressure wave carries high risk.
Secondary blast injuries
Result from being struck by flying debris.
A blast wind occurs.
Flying debris may cause blunt and penetrating injuries.
Tertiary blast injuries
Occur when a person is hurled against stationary, rigid objects.
Ground shock-physical displacement when the body impacts the ground.
Quaternary (misc.) blast injuries
Occur from the miscellaneous events that occur during an explosion. May include: Burns Respiratory injury Crush injury Entrapment
Quinary blast injury
Caused by biological, chemical, or radioactive contaminants added to an explosive.
Associated with “dirty bombs”.
Propellants
Explosives designed to release energy relatively slowly.
Blast front
Leading edge of a blast wave.
Positive wave pulse
Pressure front is higher than atmospheric pressure.
Shock wave
High-explosive blast waves.
Negative wave pulse
Pressure is less than atmospheric.
The speed, duration, and pressure of the shock wave are affected by
Size of the explosive charge
Nature of surrounding medium
Distance from explosion
Presence or absence of ___
Blast tissues at risk
Air-containing organs are more susceptible to pressure changes.
Junctions between tissues of different densities and exposed tissues are prone.
The ear is most sensitive.
Blast injuries
Primary pulmonary blast injuries occur as contusions and hemorrhages.
If there is any reason to suspect lung injuries in a blast victim, administer O2.
Multi-system trauma
Injures that involve several body systems.
Assess the entire body.
Prioritize treatment of the injuries.
Transport without delay.
Trauma score
Used to determine the likelihood of survival. Takes into account: -GCS -RR -Respiratory expansion -Systolic BP -Cap refill
Physical Findings- RTC
Evisceration (disembowelment) No distal pulse (limb threatening) Hypovolemia (<90mmHg) Priapism Pelvic instability Flail chest Open chest/abdomen Tension hemo/pneumothorax Increased/decreased HR/RR Pupils fixed/dilated >1 long bone fracture Open skull fracture GCS < 13 Amputation (other than digits) Airway compromise
MOI RTC
Rollover MVA Penetrating injury Amputation (wrist up) Electrocution Fall > 6m Burns > 30% (encircling burns, face/genitals/airway, full thickness > 10%) Crush injuries GSW Ejection from vehicle Blunt injury Pedestrian struck > 30km/hr
General Impression RTC
Severe hemorrhage Posturing Decreased LOC Visible multi-system trauma Seizures SOB Spinal fluid Elderly patient Hypothermic
Trauma primary assessment: A
Assess the thorax and neck for: Deviated trachea Tension pneumothorax Neck and chest crepitation Broken ribs Fractured Sternum Other problems that may inhibit breathing
Trauma Primary Assessment: C
Check radial and carotid
Trauma Primary Assessment: Transport
Immediate transport: altered mental status airway or breathing problems multi-system trauma significantly compromised circulation
*on-scene time should be limited to 10 minutes (platinum 10 minutes) if RTC.
Trauma SAMPLE
Make sure to get full SAMPLE and OPQRST before VS because they could crash quickly.
Trauma HTT
only press in on the hips.
palpate all the way down the legs.
don’t forget to do the back assessment.
Physical Criteria for referral to a trauma centre
GCS < 13
SBP < 90mmHg
RR < 10 / > 29 breaths/min or need for ventilator support
Anatomical criteria for referral to a trauma centre
Penetrating tauma to head, neck, torso, and extremities Chest wall instability or deformity two or more proqimal long bone fractures crushed, mangled, or pulseless extremity amputation proximal to wrist or ankle pelvic fractures open or depressed skull fractures paralysis
MOI criteria for referral to a trauma centre
adults: falls > 20 ft Children: falls > 10 ft high risk auto crash intrusion into passenger compartment ejection from automobile consistent with high risk of injury pedestrian/bicyclist thrown or run over motorcycle crash > 20mph
Trauma centre 1
capable of providing total care for every aspect of injury – from prevention through rehabilitation.
VGH/Royal Columbian/BC Children’s
Trauma centre 2
able to initiate definitive care for all injured patients.
Kelowna/Kamloops
Trauma centre 3
an ability to provide prompt assessment, resuscitation, surgery, intensive care and stabilization of injured patients and emergency operations.
Trail/Penticton/Vernon
Trauma centre 4
an ability to provide advanced trauma life support (ATLS) prior to transfer of patients to a higher level trauma center.
Nelson
When making the transport decision, consider:
If the patient can be transported by ground within a reasonable amount of time
Time for aircraft to lift off, travel, and land
Terrain
Cardiogenic shock
when the heart suddenly can’t pump enough blood to meet the body’s needs.
Neurogenic shock
injury to the spinal cord with associated autonomic dysregulation.
- loss of sympathetic tone (fight or flight)
- unopposed parasympathetic response (rest and digest)
Hypovolemic shock
sudden drop in total body blood/fluid volume.
Anaphylactic shock
a severe, potentially life threatening allergic reaction. It causes your immune system to release a flood of chemicals that can cause you to go into shock.
Septic shock
a severe potentially fatal condition that occur when sepsis leads to life threateningly low BP.
Septic shock
a severe potentially fatal condition that occur when sepsis leads to life threateningly low BP.
trismus
clenched jaw
epistaxis
bleeding nose
cavitation
The formation of a cavity, such as from a high-velocity projectile striking the body.
Coup/contrecoup
Injury to tissue occurring on the side of the impact (coup) and the opposite side of the impact (contrecoup).
Coup/contrecoup
Injury to tissue occurring on the side of the impact (coup) and the opposite side of the impact (contrecoup).
Le Fort Fracture
transfacial fracture of the midface, involving the maxillary bone and surrounding structures. Broken into 3 categories.
Cushings reflex
nervous system response to acute increase in ICP causing increased systolic, decreased diastolic, bradycardia and irregular respirations.
Golden hour
1 hr from initial trauma until time in the OR for good outcome.
Brown-Sequard’s Syndrome
neurological condition characterized by a lesion in the spinal cord which results in weakness or paralysis on one side of body and a loss of sensation on the other side.
GCS (eyes)
4-spontaneous
3-verbal
2-pain
1- unresponsive
GCS (verbal)
5-comprehensible 4-mumbles 3-inappropriate 2-incomprehensible 1-unresponsive
GCS (movement)
6- follows direction 5- localizes 4-withdraws 3- flexion 2-extension 1-unresponsive
4 ways to clear out a wound prior to packing it
- clapping
- dabbing
- flushing
- sweeping
5 Nexus criteria
- no new focal neurological deficits
- altered LOC
- intoxicated
- major distracting injuries
- midline tenderness
3 Ps of bleeding
pressure
position of wound
position of patient
Nexus high risk
over 65
ankylosing spondylitis
osteoporosis
Stage 1 hemorrhage
less than 15% TBV
Stage 2 hemorrhage
15-30% TBV
Stage 3 hemorrhage
30-40% TBV
Stage 4 hemorrhage
40% + TBV
Potential blood loss in pelvis
2.0 L
Potential blood loss in femur
1.5L
Potential blood loss in humerus
750mL
Potential blood loss in tibia
750mL
What are the deadly H’s
hypoxia
hypovolemia
hypothermia
Trauma centre 5
provides initial evaluation, stabilization and diagnostic capabilities and prepares patients for transfer to higher levels of care.
Castlegar
A group of RBCs stuck together
Rouleaux
Stage 3 shock is defined as a blood loss of
25-35%
Basic principles of kinetics
law of inertia and law of energy conservation
How many vertebrae does the human body have?
33
What are the five sections of the spinal column?
Cervical Thoracic Lumbar Sacral Coccyx
What are the three membranes (aka meninges) enclosing the CNS?
Dura mater
Arachnoid
Pia mater
What is the function of the brachial plexus (C5-T1)?
Controls the upper extremities
What is the function of the lumbar plexus (L1-L4)?
Supplies the skin and muscles of the abdominal wall, external genitalia, and part of the power limbs.
What is the function of the sacral plexus (L4-S4)?
Supplies the buttocks, perineum, and most of the lower limbs.
What causes flexion injuries?
Forward movement of the head, typically as a result of rapid deceleration or from a direct blow to the occiput.
What causes rotation-flexion injuries?
High acceleration forces
What causes vertical compression injuries?
A direct blow to the crown (parietal region) or rapid deceleration from a fall through the feet, legs, and pelvis.
Primary spinal cord injury
Injury that occurs at the moment of impact.
Secondary spinal cord injury
Injury that occurs when multiple factors permit a progression of the primary SCI; the ensuing cascade of inflammatory responses may result in further deterioration.
Complete spinal cord injury
results in permanent loss of all spinal cord-mediated functions below the level of injury.
Incomplete spinal cord injury
The patient retains some degree of cord-mediated function.
Anterior cord syndrome
results from the displacement of bony fragments into the anterior portion of the spinal cord, often due to flexion injuries or fractures.
Central cord syndrome
hyperextension injuries to the cervical area present with hemorrhage or edema to the central cervical segments.
-frequently seen in older patients.
Propioception
the ability to perceive the position and movement of one’s body.
Posterior cord syndrome
associated with extension injuries.
produces dysfunction with the dorsal columns, presenting as decreased sensation to light touch, propioception ,and vibration.
Spinal shock
the temporary local neurological condition that occurs immediately after spinal trauma.
Swelling and edema of the cord begins withing 30 minutes of the initial insult.
Usually subsides in hours-weeks depending on severity..
What are the three types of vertebral fractures commonly associated with older patients?
Compression fractures
Burst fractures
Seat-belt type fractures (chance fractures)
Babinski reflex
When the toe(s) moves upward in response to stimulation to the sole of the foot. Under normal circumstances, the toe(s) moves downward.
Hyperesthesia
hyperacute pain to touch
Define kinetics
Study of the relationship among speed, mass, direction of force, and physical injury.
Which law (developed by Sir Isaac Newton) helps explain what happens during blunt trauma?
Newton’s first law of motion
What are the two categories of trauma?
Blunt and penetrating
What is the down and under pathway that a patient could travel in an MVA?
Knees and hip dislocation, femur fracture, lower extremity fracture
What is the up and over pathway a patient could have traveled in an MVA?
Abdomen collides with the steering column, head and thorax absorb most of the impact, head impacts windshield
What causes a primary blast injury?
Damage is caused by the pressure wave generated by explosion.
What causes a secondary blast injury?
Results from being struck by flying debris.
What is the most common injury associated with explosions?
Lung injury - hollow organs (especially ears)
Blast injuries usually hemorrhage which organs?
Hollow organs
What is Newton’s second law?
The force an object can exert is the product of its mass times acceleration.
What is ballistics?
The Science of projectiles and firearms and the interaction with objects.
Define the vascular stage of clotting.
Vascular spasm-the smooth muscle in the vessel wall contracts near the injury point, reducing blood loss.
Define the platelet phase of clotting.
Platelet plug formation-platelets are activated by chemicals released from the injury site.
Define the coagulation phase of clotting.
Fibrinogen is converted to fibrin which forms a mesh that traps more platelets and erythrocytes, producing a clot.
What is compensated shock?
The body is experiencing a state of low blood volume but is still able to maintain BP and organ perfusion by increasing HR and constricting the blood vessels.
Able to respond to hemodynamic shortfall.
What is decompensated shock?
The body is unable to keep up and perfusion of vital organs is no longer maintained.
Define irreversible shock.
The last stage of which. A progressive decrease in BP and perfusion leads to organ failure and death.
What is neurogenic shock?
Distributive shock.
A disruption of the autonomic pathways within spinal cord.
What is multiple organ dysfunction (MOD) syndrome?
The development of potentially reversible physiologic derangement involving two or more organ systems.
What is the MOI of paper bag syndrome?
If the patient takes a deep breath, such as a gasp, right before impact, hyperinflation of the lungs closes the glottis and can pop the alveoli in the lungs at impact causing a pneumothorax.
Define axial loading.
Force directed through the top of the head and through the spine.
What is a temporary cavity?
The hole that a bullet makes passing through the tissue.
