trauma chapters Flashcards
Fracture
a break in the continuity of a bone
types of fractures
open- bone sticking out
closed- bone not sticking out
fracture s/s
Pain
Tenderness
Deformity
Discoloration
Paresthesia distal to the fracture site (can indicate nerve injury)
Anesthesia distal to the fracture site (loss of feeling; can indicate nerve injury)
Paresis (weakness; can indicate nerve injury)
Paralysis (loss of muscle control; can indicate nerve injury)
Inability to move the extremity (can indicate muscle or tendon damage)
Decreased pulse amplitude, increased capillary refill time, paresthesia, or pale, cool skin distal to the fracture site (can indicate vessel injury)
osteoperosis
a degenerative bone disorder associated with an accelerated loss of minerals, primarily calcium, from the bone
strain
an injury to a muscle or a muscle and tendon, possibly caused by overextension, or overstretching
sprain
an injury to a joint capsule, with damage to or tearing of the connective tissue, and usually involves ligaments
dislocation
the displacement of a bone from its normal position in a joint
non traumatic/pathologic fracture
results from a disease that causes degeneration and dramatically weakens the bone, making it prone to fracture. These fractures often occur without a significant force being applied
direct force injury
a direct blow, occurs at the point of impact
indirect force injury
force impacts on one end of a limb, causing injury some distance away from the point of impact
twisting force injury
one part of the extremity remains stationary while the rest twists.
Femur Fracture
bone bleeds heavily. A patient can easily lose approximately 1,500 mL, or 1.5 liters, of blood around each femur.
When assessing an extremity for the possibility of a fracture or dislocation, remember to evaluate the six Ps, which are?
Pain. Pain might be on palpation (tenderness) with movement—or without movement.
Pallor. The skin distal to the injury site might be pale and capillary refill delayed if an artery is compressed or torn. If a vein is blocked by the fracture, the distal extremity can appear warm, red (flushed), and swollen.
Paralysis. The patient is unable to move the extremity. This might be from nerve, muscle, tendon, or ligament damage.
Paresthesia. The patient might complain of numbness or a tingling sensation. This can indicate nerve damage.
Pressure. The patient might complain of a pressure sensation within the extremity. This can be associated with swelling from damaged tissue or blood loss within the muscle and surrounding structures.
Pulses. The pulse distal to the injury may be absent or have a decrease in amplitude. This can indicate damage to an artery.
Crepitus
sound or feeling of broken fragments of bone grinding against each other
splinting must dos
PMS before and after splint
Immobilize joint or bone above and below injury
Remove clothing
Cover all wounds, including open fractures, with sterile dressings before applying a splint
If there is a severe deformity or the distal extremity is cyanotic (bluish) or lacks pulses, one chance to align the injured limb with gentle manual traction (pulling) before splinting
Never intentionally replace protruding bones
Pad each splint to prevent pressure and discomfort
If the patient shows signs of shock, align the patient in the normal anatomical position.
types of splints
rigid splints
pressure splints
traction splint
formable splint
vacuum splint
sling and swathe
long spine board/ full body vacuum mattress
rigid splint
commercially manufactured and made of wood, plastic, cardboard, or compressed wood fibers
pressure splints
also called a pneumatic splint. Air splints are soft and pliable before being inflated, but they are rigid after they are applied and filled with air
traction splints
provide a counterpull, alleviating pain, reducing blood loss, and minimizing further injury. Traction splints are not intended to reduce (correct) the fracture, but simply to immobilize the bone ends, reduce the diameter or container size of the thigh, and prevent further injury. Used for midshaft femur fracture
formable splint
a type of rigid splint that is malleable enough to conform to a deformed or angulated extremity
vacuum splint
soft, pliable splints that are easily formed to deformed extremities. The air is then sucked out of the splint, causing it to become rigid in its position of placement
sling and swathe
used to provide stability to a painful and tender shoulder, elbow, or upper humerus injury. A sling is a triangular bandage.
long spine board/full body vacuum
full body splint. In the case of a critical injury when extremity fractures cannot be splinted at the scene, placing the patient on a long spine board or in a full body vacuum mattress will provide some stabilization through the limitation of movement
improper splinting risks
Compress the nerves, tissues, and blood vessels under the splint, aggravating the existing injury and causing new injury
Delay the transport of a patient who has a life-threatening injury
Reduce distal circulation, compromising the viability of the extremity
Aggravate the bone or joint injury by allowing movement of the bone fragments or bone ends or by forcing bone ends beneath the skin surface
Cause or aggravate damage to the tissues, nerves, blood vessels, or muscles from excessive bone or joint movement
Cause damage to the skin from improper padding
traction splint contraindications
The injury is within 1–2 inches of the knee or ankle.
The knee itself has been injured.
The hip has been injured.
The pelvis has been injured.
There is partial amputation or avulsion with bone separation, and the distal limb is connected only by marginal tissue.
compartment syndrome
increased tissue pressure in a confined space causes decreased blood flow leading to hypoxia, and muscle, nerve and vessel impairment
compartment syndrome s/s
Severe pain or burning sensation
Decreased strength in the extremity
Paralysis of the extremity
Pain with movement
Extremity feeling hard to palpation
Compartment syndrome is very unlikely
cranial skull
plates of large, flat bones that are fused together to form a helmet like covering
f
basilar skull
floor of the skull, is made up of many separate pieces of bone and is the weakest part of the skull. has many bony ridges that can cause injury to the brain
Three anatomical components of the brain
cerebrum, cerebellum, brain stem
Cerebrospinal fluid
produced by brain. fluid protects the brain and spinal cord against impact. The cerebrospinal fluid is clear and colorless, circulates throughout the skull and spinal column, and is reabsorbed by the circulatory system
Meninges
layers of tissue, that enclose the brain. The outermost is the dura mater (“hard mother”), composed of a double layer of tough, fibrous tissue. The next layer is the arachnoid. Beneath that, in contact with the brain, is the pia mater (“soft mother”)
cerebrum
largest part of the brain, the cerebrum, comprises three-fourths of the brain’s volume. It is divided into two hemispheres (right and left). Each hemisphere is made up of four distinct lobes: a frontal lobe (anterior), a parietal lobe (middle), an occipital lobe (posterior), and a temporal lobe (side). The cerebrum is responsible for most conscious and sensory functions, the emotions, and the personality
meninges order from brain to skull
Pia mater
Arachnoid mater
Dura Mater
cerebellum
the “little brain,” the cerebellum controls equilibrium and coordinates muscle activity. Tucked underneath the cerebrum
brain stem
funnel-shaped inferior part, the brainstem, is the most primitive and best protected part of the brain. Tethered to the skull by numerous nerves and vessels, it controls most automatic functions of the body, including cardiac, respiratory, vasomotor (blood pressure), and other functions vital to life.
linear skull fracture
most common type, resembles a line. There is no gross deformity in a linear fracture and it can be diagnosed only through a radiograph
depressed skull fracture
when the bone ends are pushed inward toward the brain. Typically, the depression is palpated in the area of the fracture. A depressed skull fracture poses harm if the bone ends damage the brain tissue.
basilar skull fracture
fracture to the floor or bottom of the cranium. This fracture often begins as a linear temporal fracture that extends downward and continues into the base of the skull. Basilar skull fractures often cause leakage of cerebrospinal fluid from the ears, nose, or mouth
primary brain injury
esult of trauma to the brain that occurs at the time of insult from direct impact, acceleration/deceleration, or a penetrating wound
secondary brain injury
occurs from a complex cascade of pathophysiologic processes following the primary brain injury, which can continue for hours to days
Hypotension and hypoxemia are the two conditions most critical to prevent. It has been reported that when hypotension and hypoxemia occur together as secondary injuries in the brain-injured patient, a 75 percent mortality rate occurs
brain herniation s/s
Dilated or sluggish pupil on one side from compression of the third cranial nerve
Weakness or paralysis
Severe alteration in consciousness
Posturing (decorticate, also called flexion; decerebrate, also called extension)—also known as nonpurposeful movement
Abnormal ventilation pattern
Cushing reflex (increased systolic blood pressure and decreased heart rate)
brain herniation
swelling or hematoma continues to develop, pressure inside the skull (called the intracranial pressure, or ICP) rises the brain is eventually compressed and pushed out of its normal position, downward toward and through the foramen magnum,
closed head injury
scalp or skull can be lacerated but the skull remains intact and there is no opening to the brain.
open head injury
a break in the skull and a break in the scalp, such as that caused by impact with a windshield or by an impaled object
concussion
causes some disturbance in brain function, ranging from momentary confusion to complete loss of responsiveness, and it usually causes a headache. If there is a loss of consciousness, it is usually brief (lasting only a few minutes) and does not recur.
contusion
bruising and swelling of the brain tissue, can accompany concussion
coup/contrecoup
can be at the point of a blow to the head and/or damage on the side opposite the blow as the brain is propelled against the opposite side of the skull
acceleration/deceleration injury
typical of a car crash, the head comes to a sudden stop but the brain continues to move back and forth inside the skull, resulting in bruising (possibly severe) to the brain.
diffuse axonal injury DAI
injury to the brain that results from shearing, tearing, and stretching of nerve fibers. This type of injury interferes with the communication and transmission of nerve impulses throughout the brain
subdural hematoma
collection of blood between the dura mater and the arachnoid layer of the brain: typically is due to low-pressure venous bleeding from small bridging veins that are torn during the impact to the head
two types of subdural hematomas
Acute. Signs and symptoms begin almost immediately after the injury.
Occult or chronic. Bleeding continues over time and the signs and symptoms don’t become apparent for days to weeks after the injury.
epidural hematoma
arterial or venous bleeding pools between the skull and the dura (protective covering of the brain). Bleeding is usually rapid, profuse, and severe. The bleeding expands rapidly in a small space, causing a dramatic rise in intracranial pressure
laceration of brain
brain tissue can occur in either an open or a closed head injury. Often it occurs when an object penetrates the skull and lacerates the brain. It is a permanent injury, almost always results in bleeding, and can cause massive disruption of the nervous system.
patients response to pain
purposeful or non purposeful
purposeful response to pain
try to move away from or remove the pain
unpurposeful response to pain
inappropriately moving parts of his body, reacting to the pain but not trying to stop it.
indicates a deeper state of unresponsiveness.
decorticate posturing
indicates an upper-level brainstem injury, flex in towards the core
decerebrate posturing
represents the lowest level of nonpurposeful pain response, indicating a lower-level brainstem injury. extension posturing
raccoon sign
discoloration of tissue around the eye can be an indication of intracranial injury. It is a delayed sign of skull fracture that usually does not appear for up to 4–6 hours after the injury.
battle sign
a purplish discoloration (bruising) of the mastoid area behind the ear, is another delayed and late sign of a basilar skull fracture
cushings triad
hr decrease
systolic bp goes up
abnormal breathing
head injury s/s
-Decreasing mental status
-Irregular breathing pattern (severe)
-Increasing blood pressure and decreasing pulse (Cushing reflex, a late finding) (severe)
-Obvious signs of injury—contusions, lacerations, or hematomas to the scalp or deformity to the skull
-Visible damage to the skull (visible through laceration in the scalp)
-Pain, tenderness, or swelling at the site of injury
-Blood or cerebrospinal fluid from the ears or nose
-Discoloration (bruising) around the eyes in the absence of trauma to the eyes (raccoon sign—very late)
-Discoloration (bruising) behind the ears, the —-mastoid process (Battle sign—very late)
-Absent motor or sensory function (severe or poor response)
-Nausea and/or vomiting; vomiting can be forceful or repeated
-Unequal pupil size with altered mental status (severe)
diplopia
double vision
retrograde amnesia
patient is unable to remember circumstances leading up to the incident
anterograde amnesia
patient is unable to remember circumstances after the incident
compression spinal injuries
When the weight of the body is driven against the head. This is common in falls, diving accidents, motor vehicle crashes, or other accidents in which a person impacts an object head first.
flexion spinal injuries
When there is severe forward movement of the head in which the chin meets the chest, or when the torso is excessively curled forward.
extension spinal injuries
When there is severe backward movement of the head in which the neck is stretched, or when the torso is severely arched backward.
spinal rotation injuries
When there is lateral movement of the head or spine beyond its normal rotation.
spinal lateral bending injuries
When the body or neck is bent severely from the side.
Spinal Distraction Injuries
When the vertebrae and spinal cord are stretched and pulled apart. This is common in hangings
Spinal Penetration Injuries
When there is injury from gunshots, stabbings, or other types of penetrating trauma that involve the cranium or spinal column
spinal column injury
an injury to one or more vertebrae, that is, the portion of the spine composed of bone. Whether it is a fracture or a dislocation, a spinal column injury is a bone injury.
spinal cord injury
involves damage to the nervous tissue that is enclosed inside the hollow center of the bony spinal column: the spinal cord.
complete spinal cord injury
results when an area of the spinal cord has been completely transected (cut crossways) either physically or physiologically.
spinal shock
is a temporary concussion-like insult to the spinal cord that causes effects below the level of the injury
priapism
A male patient might have an involuntary erection of the penis due to spinal injury
neurogenic hypotension
from spinal shock, also called spinal-vascular shock or neurogenic shock, results from an injury to the spinal cord that interrupts nerve impulses to the arteries. When the arteries lose nervous impulses from the brain and spinal cord, they relax and dilate (enlarge)
incomplete spinal cord injury
occurs when the spinal cord is injured—but not completely through all the three major tracts (motor, light touch, and pain tracts). That means that some of the tracts are spared and retain function
central cord syndrome
the medial or middle portion of the spinal cord is injured, causing a dysfunction in the inner tracts that control upper extremity motor and sensory function
anterior cord syndrome
from injury of the sensory and motor tracts located in the anterior portion of the cord The posterior portion of the cord, where the tracts for light touch are located, is not injured. The patient can present with the loss of sensation to pain and loss of motor function below the site of cord injury but can retain the ability to feel light touch.
c3-c5 phrenic nerve
controls the diaphragm, if damaged can cause loss of control of diaphragm
spinal self restriction
the patient himself keeps his head, neck, and spine in alignment and to restrict or prevent his movement.
spine motion restriction indications
An unreliable patient (GCS altered mental status, head injury, can’t communicate effectively, is intoxicated or under the influence of drugs, has a distracting injury)
Has a neurologic deficit (motor or sensory) consistent with a spinal cord injury or complains of numbness or tingling
Complains of pain or tenderness anywhere along the vertebral column
Does not complain of pain to the vertebral column but has a distracting injury
Has an anatomic deformity to the spinal column on assessment
spine motion restriction not necesary for
Normal level of consciousness with a GCS of 15 and is a reliable patient
No spine tenderness on palpation or complaint of pain anywhere along the vertebral column
No abnormal or absent neurologic findings (motor and sensory) to include no abnormal sensations such as numbness or tingling
No distracting injury
Not intoxicated or under the influence of drugs
Can understand and communicate effectively
photophobia
sensitivity to light
chemical burns in the eye treatment
irrigate immediately saline or clean water
pneumothorax
air in the pleural space causing of the lung
flail segment
two or more adjacent ribs broken in two or more places or along the sternum causing movement independent from the rest of the rib cage
pulmonary contusion
bleeding within the lung tissue that causes a disturbance in gas exchange between alveoli and capillaries
sucking chest wound
open wound in the chest area that permits air to enter the thoracic cavity
tension pneumothorax
build up of air in thoracic cavity associated with an injured lung severe to the point that it begins to shift to the uninjured side causing compression of heart, large vessels, and the uninjured lung
cardiac contusion
bruise to the heart wall caused by severe blunt trauma to the chest where the heart is violently compressed between the sternum and the spinal column
commotio cordis
sudden cardiac arrest caused by a projectile like a baseball
pericardial tamponade
blood or fluid filling the fibrous sac around the heart, causing compression of the heart and decreasing the capability of the ventricles to effectively fill and eject blood
open pneumothorax
open wound enabling air into the pleural space adns cause lung collapse
hemothorax
blood in the pleural space causing collapse of the lung
hemopneumothorax
blood and air in the pleural space causing collapse of the lung
traumatic asphyxia
severe sudden compression of the thorax and cause a rapid increase in pressure within the chest that affects blood flow, ventilation, and oxygenation
jugular vein distension JVD
bulging of the exterior jugular vein or veins at the side of the neck
pulsus paradoxus
a decrease in pulse strength during inhalation; a drop in bp of more than 10mmhg during inhalation resulting from increased pressure within the chest that suppresses the filling of ventricles of the heart with blood
tracheal deviation
movement of the trachea towards the side of the uninjured lung in tension pneumothorax
impaled objects
only remove from the cheek, obstructs opening an airway or ability to do compressions, other impaled locations object must be stabilized.
kehr signs
shoulder pain referred from the diaphragm when it is irritated by blood within the abdominal cavity
abdominal evisceration
abdominal organ protruding through an open wound in the abdomen
