Trauma Flashcards
Fibrous joint
Also called synathroses or fused joints. Contain dense fibrous tissue that does not allow for movement.
Eg skull.
Cartaliginous joint
Also called amphiarthroses. Allow very minimal movement between the bones.
Eg pubis symphysis and joints connecting ribs to the sternum.
Synovial joints
Diarthroses. Most mobile joints of the body. Surrounded by the joint capsule. Contains articular cartilage and the synovial membrane which secretes fluid to lubricate it.
Linear fracture
Parallel to the long axis of the bone. Common cause by low energy stress injuries.
Transverse fracture
Straight across a bone at right angles to each cortex.
Common causes direct low energy blow.
Oblique fracture
At an angle across the bone. Common causes direct or twisting force.
Spiral fracture
Encircles the bone. Common causes twisting injury.
Impacted fracture
End of the bone becomes wedged into another bone.
Common causes fall from a significant height.
Comminuted fracture
More than 2 fracture fragments located in one area of the bone.
Common causes high energy injury (such as crush injury)
Segmental fracture
More than 2 fracture fragments occurring in different parts of the bone. Common causes high energy injury.
Complete fracture
Break through both cortices. Common causes high energy injury.
Incomplete fracture
Break through one cortex. Common causes low energy injury
Types of incomplete fractures
Greenstick
Buckle (torus)
Bowing
Fatigue (stress)
Dislocation
Bone is totally displaced from the joint
Subluxation
The partial dislocation of a joint.
Diastasis
Disruption of ligaments that hold 2 bones together.
Sprain
Injuries in which ligaments are stretched or torn.
Strain
An injury to a muscle and/or tendon due to muscle contraction or excessive stretching.
Compartment syndrome
Localized accumulation of beeding eeding or swelling within the enclosed muscle compartment (fascia) resulting in pain and decreased circulation.
Crush syndrome
Occurs because of prolonged or severe compressive force that impairs muscle metabolism and circulation.
Tertiary trauma centre (level 1)
Highest level of trauma care. Serves as facility for acutely injured patients. Provides education to health professionals. Participates in research.
District trauma centre (level 2)
Urban or rural community hospital. Can fulfill requirements prior to transfer to a tertiary centre. Similar to a level 1 without academic and research programs.
Primary trauma centre (level 3)
Smallest, general practitioner or nursing station and serves as initial clearing station. Refers all but minor injuries to higher care.
Waddell triad
Ped struck with expected pattern of injuries:
Bumper hits pelvis/femur
Chest and abdomen hit grill/hood
Head hits the ground
Blast injuries
Primary: pressure wave damage.
Secondary: blast wind, projectiles
Tertiary: displacement (thrown), structure collapse.
Quarternary: misc events (burns, etc)
Jackson’s theory of burns
Zone of coagulation: little or no blood flow
Zone of stasis: limited blood flow
Zone of hyperemia: increased blood flow
Minor burn classification
Superficial: TBSA less than 50%
Partial thick: TBSA less than 15%
Full thick: TBSA less than 2%
Moderate burn classification
Superficial: TBSA greater than 50%
Partial thick: TBSA less than 30%
Full thick: TBSA less than 10%
Critical burn classification
Partial thick: TBSA more than 30%
Full thick: TBSA more than 10%
Inhalation injury
Partial or full thick: hands, feet, joints, face, genitalia
Le Fort fractures
1: horizontal fracture of maxilla involving the hard palate and inferior maxilla
2: pyramidal fracture involving nasal bone and inferior maxilla
3: fracture of all mid facial bones, separating entire mid face from the cranium.
Flexion spinal injury
Forward movement of the head due to rapid deceleration or a blow to the occiput.
Can result in dislocation or fracture of C1 and C2. Can result in anterior wedge fracture further down spine.
Hyperflexion spinal injury
Can result in teardrop fractures and potentially unstable injuries to ligaments.
Rotation with flexion spinal injuries
Often the result of high acceleration injuries. Usually considered unstable if occurring at C1 and C2.
Can produce a stable dislocation from C3 to C7, or fracture in the thoracolumbar spine.
Vertical compression spinal injuries
Transmitted through spine to either the skull or the pelvis. Result from a blow to the crown or an inferior fall landing. Can result in burst or compression fractures.
Note: sometimes can be associated with retropharyngeal edema
Hyperextension spinal injury
Can result in fractures and ligament injury.
Distraction due to rapid deceleration (hanging) often fractures C2.
Primary spinal cord injury
Injury that occurs at the moment of impact.
Spinal cord concussion
Spinal cord contusion
Cord laceration
Spinal cord concussion
Temporary dysfunction that lasts 24 to 48 hrs. Considered an incomplete injury and May present with simple compression fractures.
Spinal cord contusion
Caused by fracture, dislocation, or direct trauma. Associated with edema, tissue damage, vascular leakage. May cause temporary or permanent loss of function.
Spinal cord laceration
Usually occurs when a projectile or bone enters the spinal canal. Likely to result in disruption of some portion of the cord and its associated pathways.
Secondary spinal cord injury
Occurs when multiple factors permit progression of the primary injury, resulting in further deterioration. Often due to: hypoxemia, hypoglycaemia, hypothermia. Complete SCI Incomplete SCI Anterior Cord Syndrome Central Cord Syndrome Posterior Cord Syndrome Brown Sequard Syndrome Spinal Shock Neurogenic Shock
Complete and incomplete SCI
Depending on degree of function below the injury, SCI is categorized as complete or incomplete.
Complete: permanent loss of function below the injury
Incomplete: retains some degree of function. Initially may have dysfunction due to inflammation and swelling
Anterior cord syndrome
Displacement of bone fragments into anterior portion of spinal cord. Often due to flexion injuries.
Presents with paralysis without loss of sensation of pn, temperature, and touch below the injury.
Central cord syndrome
Common with hyperextension and older patients.
Typically presents with greater loss of function in upper extremities with variable loss of pn and temperature sensation. May also have bladder and bowel dysfunction.
Prognosis is usually positive outcomes.
Posterior cord syndrome
Associated with extension injuries. Relatively rare, resulting in dysfunction of dorsal columns.
Presents as decreased proprioception, light touch sensation, and vibration, while most other motor and sensory function remains.
Brown-sequard syndrome
Occurs due to penetration SCI trauma accompanied by hemisection of the cord and complete damage to all tracts of affected side.
Corticospinal side: ipsilateral motor loss
Dorsal column: ipsilateral loss of light touch, proprioception, and vibration.
Spinothalamic: contralateral loss of pn and temperature sensation
Spinal shock
Temporary local neuro condition occurring immediately after trauma. Presents with variable degrees of acute spinal injury.
Usually subsides in hours to weeks depending on severity.
Massive hemothorax
Defined as the accumulation of 1500ml of blood within the pleural space. Each lung can hold up to 3000ml, meaning a pt can easily bleed out into the thoracic cavity
Deadly dozen thoracic injuries
Immediately life threatening:
Airway obstruction; bronchial disruption; diaphragmatic tear; esophageal injury; open pneumo; tension pneumo; massive hemothorax; flail chest; cardiac tamponade
Potentially lethal:
Thoracic aortic dissection; myocardial contusion; pulmonary contusion
Rule of 9’s for adult burn patient
Head: 9 Anterior torso: 18 Posterior torso: 18 Arm: 9 (9) Leg: 18 (18) Genitalia: 1
Rule of 9’s for a child burn patient
Head: 12 Anterior torso: 18 Posterior torso: 18 Arm: 9 (9) Leg: 16.5 (16.5) Genitalia: 1
Rule of 9’s for an infant burn patient
Head: 18 Anterior torso: 18 Posterior torso: 18 Arm: 9 (9) Leg: 13.5 (13.5) Genitalia: 1
Epidural hematoma
Rapidly progressing arterial bleed between skull and dura mater in a head injury
Subdural hematoma
Slower progressing venous bleed between the dura mater and meninges due to head trauma.
Potential blood loss from fracture sites
Pelvis: 1500-3000ml Femur: 1000-1500ml Humerus: 250-500ml Tib or Fib: 250-500ml Ankle: 250-500ml Elbow: 250-500ml Radius or ulna: 150-250ml
