Trauma Flashcards
Trauma
Primary cause of death in ages between 1-44 years old
-occurs when external source of energy affects the body beyond its ability to sustain and dissipate it
Mechanical energy
Energy from motion-KINETIC ENERGY
Potential energy
Energy an object can have when stationary
Chemical Energy
Energy released as a result of a chemical reaction and can be found in an explosive or an acid
Electrical Energy
Form of high voltage
Barometric Energy
Sudden radical changes in pressure
Biomechanics
Study of a living organism using tools
Kinetics
Study of speed, mass, direction of force, and physical injury
Organs
Organs that have gas inside can be easily compressed
Types of injury
Depend on force and energy delivered
Blunt Trauma
When skin is not broken and the force and energy is made to dissipate
Duration of force application
Affects trauma because rapidly applied amounts of energy are less tolerated than an identical amount over a longer period of time
Impact resistance of body parts
Determined by what is inside the organs (gas, liquid, solid)
Index of suspicion
Suspecting an injury is present
Velocity
Distance an object travels per unit time
KE
=m/2XV2
Phases of MVC
First: deceleration of vehicle Second: deceleration of occupant Third: deceleration of organs Fourth: secondary collision Fifth: additional impacts
Head on Impact
Brain Injury Scalp Spinal Chest Pneumo Femoral Aortic tear -less survivors
Rear end
Whiplash bleeding inside skull
-more survivors
Abrupt deceleration forces
Sudden stop
- shearing, avulsing, rupturing of organs
- chest vulnerable to aortic injury
- blunt abdominal injuries
Organs commonly affected
Kidneys, small intestine, liver, large intestine, pancreas and spleen
Lateral Impact
Pelvis and chest
Rotational or quarter panel impacts
Forward and diagonal Impact
-three angled seatbelts
Rollovers
May be ejected without seatbelt
- ejection increased death by 25%
- 1 in every 13 people in ejection sustain major cervical spine damage
Airbags
Will not deployed unless hit from the front and won’t if hit lateral quarter
- abrasions to face, arms and hands
- cornstarch used in airbags to load
- pediatrics can be killed with airbag deployment
Motorcycle Crashes
Helmets transmit forces to the spine
4 types of crashes:
Head on- hit and continue forward until stopped by outside force yielding bilateral femur or tibia fractures
Angular Impact- direct crushing injuries to lower extremity between object and motorcycle
Ejected rider- laying down or sliding results in road rash
MOI’s
First: auto strikes body
Second: body hits hood
Third: body hits grund
Waddell Triad
Bumper hits pelvis, chest and abdomen hit grille, head strikes vehicle and ground
Don Juan Syndrome
Jumping down to ground
Energy transferred to heel, legs, pelvis and chest
T12-L1 and L2
-children younger than 3 have fewer injuries from falls greater than three stories than children and adults
Stab Wounds
Low versus high velocity.
Depends on length, blade, and motion of weapon
Cavitation
Cavity formation from a bullet wound
- Entrance: bullet goes in
- Exit: bullet comes out
Obtain information
What caliber was used? What range was fired? What kind of bullet?
Primary Blast Wounds
The wave from a blast and affect hollow membranes
-Can tell severity of ruptured pulmonary tissue by observing the tympanic membrane
Secondary Blast
Debris hitting a person such as shrapnel set in motion by shrapnel
Tertiary Blast
When a person is hurled boy the force and hits ridged objects
Quaternary Blast
Miscellaneous injuries acquired from primary blast
Quinary Blast
Biological, chemical exposure
RTS
Asses injury severity in patients with head trauma Lowest is 0 Max is 12 -GCS, PR & Sbp GCS 13-15 4 9-12. 3 6-8. 2 4-5. 1 3. 0 SBP >89. 4 76-89. 3 50-75. 2 1-49. 1 0. 0 RR 10-29. 4 >29. 3 6-9. 2 1-5. 1 0. 0
Level 1 Trauma
Every injury possible
Level 4 Trauma
Able to provide ATLS
MOI criteria
Adults fall more than 20 feet or three times height Children falls more than 10 feet or <10ft with LOC High risk auto crash Intrusion intompassenger compartment Ejection from automobile High risk injury Pedestrian/bicyclist thrown Burns with other Trauma EMS provider judgment
Special Considerations
Age>55 Systolic <110 in age >65 Using anticoagulants Pregnancy Burns with trauma EMS Judgement
Oxygen Dissisociation Curve
Affinity of oxygen on hemoglobin and oxygen in plasma
Spo2 and PaCo2
-too much fluid can transfer oxygen from hemoglobin to a larger plasma if there is more fluid cause an increase in paco2 and decrease in spo2
-temperature also effects (sweet tea) and how molecules dissolve
-pH also effects trauma by decreasing chance of transporting oxygen
Trauma Triad
Ph, hypothermia, infection
Pain Management
Need to so that there isn’t a massive catecholamines dump
Coagulopathy
Free bleeders because the body uses all clotting ability when bleeding and runs out so bleeding can not clot
Compensated
HR increase, lethargic, skin
Decompensated
Pressure changes signify decompensation
Burns
Hypovolemia, hypothermia, infection, pain
Superficial
Burn to epidermis
- Red color
- Vulnerable to temp regulation
Partial Thickness Burns
Burn to dermis
Glands, Nerves, vessels
-Massive fluid shift ! Fluid forms in bubbles
Full Thickness Burn
Burn to sub
- no ability to thermos regulate
- no sensory
- no fluid containment
Airway Burns
Stridor, burns to pharynx, nasal hairs
-Edema causes loss of airway
Parkland Burn Formula
4xBSAxkg half over first 8 then rest over last 16hours
Easy way = BSAxKg/4 = fluid over first 8 hours
Dry sterile dressing
Dry because the lint does not stick and because bacteria is easier to travel through water than through air. Also, water could cause further hypothermia
Wet sterile dressing
If moderate burns use wet to smooth. If full Thickness burns then use dry
Rule of Nines
Adult head 9 Child head 12 Infant Head 18
Palm Rule
The palm is 1% of TBSA
Chemical Burns Acids Examples
Battery Acid
HCl Acid
HFl Acid
-immediate pain and coagulation necrosis
Chemical Bases and Alkalis examples
Potassium Hydroxide Lime Drain Cleaner Lye -little pain but extensive damage by liquification necrosis. Breakdown of protein, collagen, fats, dehydration of tissues, thrombosis of vessels
Oxidizing Agents
Hydrogen Peroxide
Sodium Chlorate
-can cause systemic poisoning
Phosphrous
Ammunition and fireworks
-burns when exposed to air and can cause systemic posioning
Vesicants
Sulfur mustard
Phosgene oxide
-blister agents. Respiratory compromised if inhaled
Dry Lime
Alkali
-becomes corrosive with water so clean as much off as possible then irrigate with copious amounts of water with hose or shower
Sodium Metals
Produce cosiderable heat when mixed with water and may explode
-cover burn with oil
HFl
Use Calcium Chloride of 10% Solution and make a jelly to apply to site of burn
Eye Solution for ocular anasthetic
Put 100mg of Lidocaine in a 1000ml bag of NaCl to make a analgesic flush solution
Arc Flash Burn
When an arc makes connection with a person.
Flame Burn from electricity
When the electric current ignites someone’s clothing
Radiation Burns
Acute Radiation Exposure is highly seen in industrial sections of work
Alpha Particles
Have little penetrating energy and easily stopped by the skin
Beta Particles
Are stronger than alpha and can penetrate skin but be blocked by very simple clothing
Gamma Particles
Easily passes through the body and solid materials
Radiation
Measured in units of RAD or Radiation Absorbed Dose
Acute Radiation Syndrome
Causes hematologic, CNS and GI chnages
- patients who unresponsive by radiation or manifest vomiting in 10 minutes will die
- patients who manifest vomiting less than an hour have a 30/80% chance of survival
- patients who manifest vomiting within one to two hours have a 95-100% chance of surviving
Radiation Contact Burns
Local soft tissue injury
