Trauma Flashcards
You respond to a 28-year-old man who has a gunshot wound to his right arm. Direct pressure and pressure bandage have been administered. Bleeding is not controlled; your next step would be to apply what device?
tourniquet
Identify signs of significant mechanism of injury (MOI).
- ejection from vehicle
- death in same passenger compartment
- falls >20ft (>10 ft for infants and children
- rollover of vehicle
- high-speed vehicle collision (medium speed for infants and children)
- vehicle-pedestrian collision
- motorcycle crash (bicycle collision for infants and children
- unresponsive or altered mental status
- penetrations of head, chest or abdomen
- hidden injuries (seat belts, airbags, etc.)
What does DCAP-BTLS stand for?
Deformities Contusions (deep bruising) Abrasions (scrapes) Puntures, or penetrations Burns Tenderness to palpation Lacerations (cuts) Swelling
Define compensated shock
when the patient is developing shock but the body is still able to maintain perfusion
Define decompensated shock
The second stage of shock begins at the point when the body can no longer compensate for the low blood volume or lack of perfusion. Late signs develop such as falling blood pressure.
Define irreversible shock
When the body has lost the battle to maintain perfusion and irreparable organ and cell damage will inevitably cause death.
Define hypovolemic shock
Shock resulting from fluid or blood loss
Define hemorrhagic shock
Shock resulting from blood loss
Define cardiogenic shock
Shock brought on by inadequate pumping of the heart, often a result of heart attack or congestive heart failure.
Define neurogenic shock
Shock due to nerve paralysis (sometimes caused by spinal cord injuries), resulting in excessive dilation of blood vessels.
What are the 3 principal layers of the skin?
Epidermis (watertight covering)
Dermis (contains structures)
Subcutaneous (insulation)
Name 5 types of soft tissue injuries
Closed injuries Open injuries Burns Impaled objects Amputations
Name 3 types of closed injuries
Contusion
Hematoma
Crushing
Name 4 types of open wounds
Abrasion
Laceration
Avulsion
Penetrating
What treatment should be performed for a penetrating wound?
- Do not attempt to remove any embedded object unless it is in the cheek and is compromising the airway.
- Remove clothing, control bleeding, and immobilize the object
- Apply oxygen
- Protect the impaled object from movement
- Transport patient to the hospital carefully
In an adult burn patient, using the rule of nines, what percentage is associated with the head, each arm, the front torso, the back, each leg, and the groin?
Head=9% Right arm=9% Left arm=9% Front torso=18% Back=18% Right leg=18% Left leg=18% Groin=1%
Define abrasion
is a loss or damage of the superficial layer of skin as a result of a body part rubbing or scraping across a rough or hard surface
Define avulsion
is an injury in which soft tissue either is torn completely loose or is hanging as a flap
Define burn injury
is an injury in which the soft tissue receives more energy than it can absorb without injury, from thermal heat, frictional heat, toxic chemicals, electricity, or nuclear radiation
Define closed injury
is an injury in which damage occurs beneath the skin or mucous membrane but the surface remains intact
Full-thickness burn
a burn that affects all skin layers and may affect the subcutaneous layers, muscle, bone, and internal organs, leaving the area dry, leathery, and white, dark brown, or charred; traditionally called a third-degree burn
Superficial burn
A burn affecting only the epidermis, characterized by skin that is red but not blistered or actually burned through; traditionally called a first-degree burn
Partial-thickness burn
A burn affecting the epidermis and some portion of the dermis but not the subcutaneous tissue, characterized by blisters and skin that it white to red, moist and mottled; traditionally called a second-degree burn
Identify signs and symptoms of an inhalation injury
- singed or absent facial hair
- facial burns
- difficulty speaking, hoarseness, or stridor
- soot in oropharynx
- oropharyngeal edema
- crackles auscultated in lungs
- respiratory failure
What are some complicating factors of burn injuries?
- age/gender
- chronic disease
- circumferential burns
- distracting injury
- fluid loss
- already compromised immune system
What is the proper wound treatment for burn injuries?
- apply dry sterile dressings
- apply wet dressings only when body surface area (BSA) is less than 10%
- keep burns areas covered to reduce pain
- do not remove clothing that has adhered to skin
- do not break blisters
- do not apply ointments, salves, or gels
What are the functions of the skin?
- keep bacteria out and water in
- has nerves that report to the brain about the environment and sensation
- the major organ for controlling temperature
- cools body by sweat evaporation/heat radiation
- Converses heat by decreasing amount of heat radiated (vessels constrict)
Occlusive dressing
a dressing made of petroleum jelly gauze, aluminum foil, or plastic that prevents air and liquids from entering or exiting a wound is called what?
List 5 signs that suggest a closed head injury to assessment of the eye.
- one pupil is larger than the other
- the eyes are not moving together or are pointing in different directions (dysconjugate gaze)
- eyes fail to follow the movement of your finger as instructed
- there is bleeding under the conjunctiva, which obscures the sclera of the eye
- one eye protrudes or bulges
List 3 important guidelines to use when treating eye laceration
- never exert pressure on or manipulate the injured eye (globe) in any way
- If part of the eyeball is exposed, gently apply a moist, sterile dressing to prevent drying
- cover the injured eye with a protective metal eye shield, cup, or sterile dressing. Apply soft dressings to both eyes, and provide prompt transport to the hospital
Describe bleeding-control methods for a laceration to veins or arteries of the neck
- apply direct pressure to the bleeding site using a gloved fingertip if necessary to control the bleeding
- apply a sterile occlusive dressing to ensure that air does not enter a vein or artery
- secure the dressing in place with roller gauze, adding more dressings if needed
- wrap the gauze around and under the patient’s shoulder. To avoid possible airway problems, do not wrap the gauze around the neck
Aniscoria
medical term for unequal pupil size
blowout fracture
a fracture of the orbit or the bones that support the floor of the orbit
conjunctiva
the delicate membrane that line the eyelids and covers the exposed surface of the eye
conjuctivitis
inflammation of the conjunctiva
cornea
the transparent tissue layer in front of the pupil and iris of the eye
eustachian tube
a branch of the internal auditory canal that connects the middle ear to the oropharynx
external auditory canal
the ear canal that leads to the tympanic membrane
globe
the eyeball
What are the management considerations in neck injuries?
- single digital pressure (gloves on) to control bleeding of carotid artery or jugular veins may be necessary
- ALS intercept or air medical transport may be necessary in severe cases of airway compromise
- occlusive dressing for large-vessel wounds (after bleeding is controlled) may be needed to prevent air entry into the circulatory system
How do you treat facial fractures?
remove and save loose teeth or bone fragments from the mouth and transport them with you. Remove any loose dentures or dental bridges to protect against airway obstruction. Maintain an open airway
What are the components of the central nervous system?
the brain and spinal cord, including the nuclei and cell bodies of most nerve cells
cerebellum
the portion of the brain immediately beneath the cerebrum that is responsible for coordinating body movements
brainstem
the most primitive part of the CNS. Its controls virtually all basic life functions, including breathing and respirations. it is the best-protected part of the CNS.
meninges
the 3 distinct layers of tissue that surround and protect the brain and spinal cord in the skull and spinal column
dura mater
the outer layer of the meninges consists of a tough fibrous layer resembling leather
cerebrospinal fluid (CSF)
a shock absorbing fluid in which the brain and spinal cord are suspended. This fluid is produced in the third ventricle of the brain.
cerebral edema
swelling of the brain, one of the most common complications associated with head injuries; this condition is aggravated by low oxygen levels in the blood
cerebrum
the largest part of the brain- 75% by volume; controls voluntary movement and conscious thought
What are motor nerves?
nerves that carry impulses from the CNS to the muscles
Describe the functions of the cerebrum
the cerebrum is the center for conscious perception and response
- frontal lobe
- foresight, planning, judgment
- movement
- parietal lobe
- sensation from lobe surface
- temporal lobe
- hearing
- speech
- occipital lobe
- vision
the left side of the cerebrum controls the sensory and motor functions of the?
right side of the body
the right side of the cerebrum controls the sensory and motor functions of the?
left side of the body
Identify the functions of the cerebellum
- posture
- balance
- equilibrium
- fine motor skills
Identify the functions of the brainstem
- automatic functions below level of consciousness
- heart rate
- respirations
- blood pressure
- body temperature
Identify the functions of the spinal cord
- connects brain with body
- serves as center for reflex action
- surrounded and protected by spinal column
- damage cuts brain off from body structures distal to injury site
sensory nerves
nerves that transmit sensory information from the perceiving only 1 type of information
Describe 4 types of skill fractures
- linear (most common, crack in skull, detected only on x-ray)
- comminuted (multiple cracks radiate from impact point)
- depressed (bone fragments pressed inward, places pressure on brain, brain tissue may be exposed through injury)
- Basilar (fractures in floor of skull, diagnosis made clinically, signs and symptoms, periorbital ecchymosis (raccoon eyes), battle’s sign, CSF drainage from nose, ears)
Define concussion
- temporary disturbance in brain function
- probably due to brain being “rattled” inside the skull by a blow to the head
- patient usually confused or unconscious
- retrograde amnesia- “what happened?”
- no residual effects
define cerebral contusion
- bruising, swelling
- results from the brain striking the inside of the skull, causing a coup-contrecoup pattern injury
- since the brain is in a closed box, pressure increases as the brain swells, and blood flow to the brain decreases
signs and symptoms of cerebral contusion
- personality changes
- loss of consciousness
- paralysis (one-sided or total)
- unequal pupils
- vomiting
define epidural hematoma
- it is associated with skull fracture in temporal area
- fracture damages artery on inside of skull
- blood collects in epidural space between skull and dura mater
- since skull is a closed box, intracranial pressure rises
signs and symptoms of epidural hematoma
- LOC followed by return of consciousness (lucid interval)
- headache
- deterioration of consciousness
- dilated pupil on side of injury
- weakness, paralysis on side of body opposite injury
- seizures
define subdural hematoma
- it is usually results from tearing of veins between dura mater and arachnoid
- blood accumulates more slowly than in epidural hematoma
- signs and symptoms may not develop for days to weeks
signs and symptoms of subdural hematoma
-deterioration of consciousness
-dilated pupil on side of injury
-weakness, paralysis on side of the body opposite injury
-seizures
because of slow or delayed onset, it may be mistaken for stroke
define cerebral laceration
- tearing of brain tissue
- can result from penetrating or blunt injury
- can cause: massive destruction of brain tissue, bleeding into cranial cavity with increased intracranial pressure
define crushing’s triad
- increased blood pressure
- decrease in pulse (bradycardia)
- altered breathing
List 7 common mechanisms for spinal cord injury
- compression
- flexion
- extension
- rotation
- lateral bending
- distraction
- penetration
which nerve(s) innervate(s) the diaphragm?
Phrenic (mainly C4, but also receives input from C3 and C5)
What are the 12 deadly chest injuries?
- airway obstruction
- bronchial disruption
- diaphragmatic tear
- esophageal injury
- open pneumothorax
- tension pneumothorax
- massive hemothorax
- flail chest
- cardiac tamponade
- thoracic aortic dissection
- myocardial contusion
- pulmonary contusion
open chest injury
an injury to the chest in which a fractures rib penetrates the chest wall itself or, more frequently. the chest wall is penetrated by an external object such as a bullet or knife
open pneumothorax
an open or penetrating chest wall wound through which air passes during inspiration and expiration, creating a sucking sound; also referred to as a sucking chest wound
paradoxical motion
the motion of the portion of the chest wall that is detached in a flail chest wound; the motion-in during inhalation, out during exhalation- is exactly the opposite of normal chest wall motion during breathing
pericardium
the fibrous sac that surrounds the heart
pneumothorax
an accumulation of air or gas in the pleural cavity
pulmonary contusion
injury or bruising of lung tissue that results in hemorrhage
simple pneumothorax
any pneumothorax that is free from significant physiologic changes and does not cause drastic changes in the vital signs of the patient
spontaneous pneumothorax
a pneumothorax that occurs when a weak area on the lung ruptures in the absence of major injury, allowing air to leak into the pleural space
sucking chest wound
an open penetrating chest wall wound through which air passes during inspiration and expiration, creating a sucking sound; also referred to as open pneumothorax
what is the management for an open pneumothorax?
this type of injury is a true emergency. Initial care, after clearing and maintaining the airway and providing oxygen is to seal the open wound with a sterile occlusive dressing
define flail segment
- occurs when there are adjacent ribs that are fractured in numerous places
- in effect, the flailed region becomes “detached” from the skeletal framework of the thoracic wall
- as a result, the flailed segment moves opposite of the normal chest excursion during breathing because it is affected by the negative and positive pressure in the thorax created by breathing, rather than the muscular activity of the respiratory effort
- this results in poor air exchange and hypoxemia
What are the indications of a significant chest injury?
- hypotension
- hypoperfusion
- tracheal deviation
- paradoxical motion
- open chest wound
- jugular venous distention (JVD)
- diminished breath sounds
- cyanosis
- dyspnea
- tachypnea
- bradypnea
- hemoptysis
- soft tissue trauma to the chest
- poor chest wall excursion
define pneumothorax
the presence of air between the outside of the lung and the inside of the chest wall, in an area called the pleural cavity
signs and symptoms of pneumothorax
-complaint of mild to severe dyspnea (depending on the amount of collapsed lung tissue) with either a gradual or sudden onset (depending on the size of the hole). Breath sounds will either be diminished or absent over the site of the pneumothorax. For any patient with a suspected pneumothorax, be alert to any change in tracheal position.
define tension pneumothorax
at its most threatening stage is indicated by tracheal shift, as the tension pushes the lungs to one side or the other and the lungs drag the trachea over to the same side.
signs and symptoms of tension pneumothorax
- sudden chest pain
- shortness of breath
- chest tightness
- easy fatigue
- low blood pressure
- decreased mental alertness
- decreased consciousness
- bluish color of the skin due to lack of oxygen
- rapid heart rate
- rapid breathing
- bulging (distended) veins in the neck
closed abdominal injury
is any injury of the abdomen caused by non penetrating instrument or force, in which the skin remains intact; also called blunt abdominal injury
evisceration
is the displacement of organs outside the body
flank
is the region of the lower rib cage
guarding
is contracting the stomach muscles to minimize the pain of abdominal movements; a sign of peritonitis
hematuria
is the presence of blood in urine
holloworgans
are structures through which materials pass, such as the stomach, small intestines, large intestines, ureters, and bladder
peritonealcavity
is the abdominal cavity
peritonitis
is inflammation of the peritoneum
solidorgans
are solid masses of tissue where much of the chemical work of the body takes place (kidneys, liver, spleen, pancreas, etc)
supine hypotensive syndrome
is a drop in blood pressure caused when the heavy uterus of a supine patient in the third trimester of pregnancy obstructs the vena cava, decreasing blood return to the heart
identify indications of a severe abdominal injury
- contusions, abrasions
- lacerations, punctures
- pain (mild or severe)
- tenderness to touch
- tachypnea
- tachycardia
- signs of shock
- weakness
- distended abdomen
- cullen’s sign
- turner’s sign
- knees in flexed position
- nausea and vomiting
- abdominal cramping
- rigid abdominal muscles
- pain that radiates to the shoulder
orthopedic injuries
- frontal bone
- maxilla
- clavicle
- humerus
- ribs
- spinal column
- sternum
- scapula
- mandible
- zygomatic bone
you are dispatched to care for an intoxicated 27-year-old man who jumped from the top of a 3-story home into a pool. He landed directly on his feet just short of the pool. He is now complaining of low back pain and numbness and tingling of his legs
- take all spinal precautions, apply high-flow oxygen, and provide prompt transport to the nearest appropriate facility (trauma center)
- continue to monitor any changes in the pulse, motor function, and sensation, specifically in their lower body
what is the management for amputations?
- ensure the bleeding is controlled at the stump using a tourniquet (if necessary and if protocols allow)
- manage life threats first; do not focus only on trying to save an amputated part
- if life threats are under control and if the amputation is complete, you may wrap the part in a sterile dressing and place it in a plastic bad.
- you should then place the bag containing the amputated part in ice
- do not pack the amputated part in ice
- a frozen part is useless to a surgeon
- transport the amputated part with the patient, but do not delay transport of a seriously injured patient to do so
you are dispatched to an attempted suicide at the local prison. the inmate attempted to kill himself by hanging himself with an electrical cord. when you arrive he is cyanotic and not breathing.
you must take c-spine precautions as you open his airway and determine the presence of breathing. The information provided does not include whether he has a pulse. Assess airway, breathing, and circulation; apply full spinal precautions, high-flow oxygen, positive-pressure ventilations, and cardiopulmonary resuscitation (CPR), as needed. Transport to an appropriate facility immediately. If ALS was not initially dispatched, request them during your scene size-up.
What are 5 ways that the body loses heat?
- conduction
- convection
- radiation
- evaporation
- respiration
What are some signs and symptoms of hypothermia?
- shivering (early stages)
- red skin (early stages)
- rapid breathing and pulse (early stages)
- numbness
- stiff or rigid posture
- drowsiness or inability to do simple activities
- slow breathing and pulse (mid to late stages)
- loss of coordination
- stiffness
- decreased LOC
- cool abdominal skin temperature
What are preexisting conditions can accelerate and intensify effects of heat exposure?
- dehydration
- diabetes
- fever
- fatigue
- high blood pressure
- heart disease
- lung problems
- obesity
- alcoholism
What are some signs and symptoms of an injected poisoning from an insect?
- altered state of awareness
- noticeable stings or bites on skin or puncture marks
- blotchy skin
- localized pain or itching
- numbness in a body part
- burning sensation that spreads
- redness, swelling, or blistering
- weakness
- difficult breathing and abdominal pulse rate
- headache and dizziness
- fever and/or chills
- nausea and vomiting
- muscle cramps, chest tightening, and joint pains
- excessive salivation and sweating
- anaphylaxis
heat cramps
are painful muscle cramps that result from extended sweating and electrolyte loss due to exposure to heat
heat exhaustion
is a form of shock brought about by fluid and salt loss
heatstroke
is a form of hyperthermia, an abnormally elevated body temperature with accompanying physical symptoms including changes in the nervous system function. Unlike heat cramps and heat exhaustion, 2 other forms of hyperthermia that are less severe, this form is a true medical emergency that is often fatal if not properly and promptly treated. Severe hyperthermia is defined as a body temperature of 140F (40C) or higher
In the rare case that you are instructed to actively rewarm a frozen body part, what 12 steps do you take?
- heat water in a container to 100-105F
- remove clothing, jewelry, etc, from the affected area
- fully immerse injured part; do not allow part to touch sides or bottom of container
- continuously stir water
- add fresh warm water when water temperature falls below 100F
- gently dry affected areas and apply sterile dressing once the part no longer feels frozen and is turning red or blue. Separate toes and fingers with sterile dressings. Cover with blankets.
- keep patient at rest
- make sure the patient is kept warm
- continue to monitor the patient
- assist in circulation according to local protocol
- do not allow limb to refreeze
- transport as soon as possible with limb slightly elevated
Define nitrogen (N2) narcosis
- it is also known as “rapture of the deep”
- it is caused by breathing compressed air under pressure
- pressurized N2 is toxic to CNS
- disorientation, confusion result
- problem disappears on surfacing
define air embolism
- patient holds breath and surfaces suddenly
- compressed air in alveoli expands. Lung tissue tears, and air enters pulmonary circulation, resulting in air being pumped to the brain
identify the signs and symptoms of an air embolism
- sudden extremity weakness, numbness
- hemiplegia
- dilated pupil on affected side
- seizures, coma
Define decompression sickness
- it is also known as the “bends”
- diver dives deeply or too long
- diver does not ascend slowly enough to let dissolved nitrogen leak out of blood gradually
- nitrogen bubbles form in tissues, obstructs vessels
- pain only (joint) bends: aching, boring pain in joints
- CNS bends: bubbles affect blood flow to brain or spinal cord
- “Chokes”: bubbles obstruct blood flow through lungs
