Trauma Form/s,Def/s, #s Flashcards
!!!Parkland Burn Form for:
form:
= (BSA >20% only 2 & 3 degree burns)
= 4 mL x BSA x Weight (kg) = ½ 1st 8 Hrs & ½ next 16Hrs
Parkland Burn Form for:
form:
= (BSA >20% only 2 & 3 degree burns)
= 4 mL x BSA x Weight (kg) = ½ 1st 8 Hrs & ½ next 16Hrs
(60%) Fluid compartments % of water:
45% intracellular
15% extracellular (outside cell)
Interstitial 10.5% Intravascular 4.5%
(Blood vol/ loss) Pelvis:
Femur:
Humorous:
= 2-3Liters
= 1.5Liters per femur
= 750ml per humorous
(Burn depth) 2nd degree:
= Partial, EPi & Dermis burned: intense pain, fluid shift comes up thus blisters, RED to WHITE, moist & mottled w/ shifts
(Burn depth) Degrees:
= 1st/Superficial, 2nd/partial, 3rd/full/complete
(Class II Hemorrhage) 1 injuries:
2Compensation for blood:
3Blood Loss: 15 - 30%
4Pulse:
5Blood Pressure:
6Pulse Pressure:
7Capillary Refill:
8Ventilation Rate:
9Urine Output (mL/hr):
10Mental Status:
1= 1/2 Humorous fractures, a femur fracture, 1 full Hemopneumo
2= 1st line comp/ no longer maintain perfusion & 2ndary employed
3= 15 - 30% 750mLs-1.5L
4= > 100BPM
5= Normal
6= Starts to narrow
7= 2-3 secs
8= 20-30RR
9= (mL/hr) 20-30
10= Mildly Anxious
(Class III Hemorrhage)1 injuries/fractures:
2 Compensation to blood:
3 Blood Loss:
4 Pulse:
5 Blood Pressure:
6 Pulse Pressure:
7 Capillary Refill:
8 Ventilation Rate:
9 Urine Output (mL/hr):
10 Mental Status:
1= 2 Humorous, 1-2femur, 1 full Hemopneumo
2= Both 1&2nd comp/ responses failing to maintain perfusion & entering/in Decompensated Shock! (SBP <90)
3= Blood Loss: 30 - 40%, (1500 - 2000 mL’s)
4= >120
5= Starts to decrease
6= Narrows more
7= 3-4secs
8= 30-40
9= 5-10mL/hr
10= Anxious/Confused
(Class IV Hemorrhage) 1 injuries:
2= Compensation to blood:
3= blood loss:
4= Pulse:
5= Blood Pressure:
6= Pulse Pressure:
7= Capillary Refill:
8= Ventilation Rate:
9= Urine Output (mL/hr):
10= Mental Status:
1= GSWs, multiple major fractures, Pelvis
2= Irreversible Shock!
3= > 40% (>2000mLs) of total blood
4= > 140 & barely palpable in central arteries
5= Very low
6= Narrows more
7= > 5 seconds
8= > 40 or agonal
9= Negligible
10= Lethargic or Unconscious
(Critical Criteria) 3rd & 2nd Degree criteria:
Any 2nd or 3rd degree burns involving:
Burn types that’re critical & Rx:
= 3rd>10% & 2nd>30%
= Face, Hands, Genitalia, Circumferential, Feet, (Dipping), Airway
= Chem, high voltage, Burns w/ major trauma go trauma center 1st then burn center
(Non& Hemorrhagic treatment) If hemorrhage can be controlled:
If hemorrhage cannot be controlled:
Med for Sig/hemorrhage, in/external (after external controlled)
= IV/IO therapy (don’t delay transport) can administer 20 mL/kg bolus.
=administer just enough IV fluid to obtain a radial pulse (permissive hypotension therapy!)NO MORE SBP 80-90 (IV fluids Warm)
= Tranexamic Acid (TXA) Adult 1G/10 mins (mix in 50 mL of NS) follwed w/ 1G/8Hrs (500 mL bag) & Pediatric Not recommended
(Thermal burn phases) Hypermetabolic phase:
3rd phase Days or weeks depending on burn severity; increase in body’s demands for nutrients; begins process of repairing damaged tissue (needs Glucose, amino acids, carbohydrates, O2 to support damage)
(Thermal burn phases) Resolution phase:
4th phase Scar tissue laid down and remodeled; rehabilitate and return to normal function (weeks to months) new collagen & usually doesnt remodel to original state & makes escar (burn keloid) bc overgrowth
(Trauma centers) Lvl 1:
Lvl 2:
Lvl 3:
Lvl 4:
= 1 (18tx) med-uni teaching, best care, everything to Neurovascular
= 2 (23 tx) everything BUT neuro, area trauma, surgical care capable all times, typically not teaching
= 3 general hospital w/ some special staff, TIB-FIB, try avoid w/ severe
= 4 basic ER, can stable but bandage, foot ran over
(Wallace Rule of 9s) used only for:
Adult %s:
infants (0-1):
Form:
= burns >10%
= 1 genitals, 9 head thoracic & ABDMN, distal anterior (applies to other areas) arm 4 ½
= head 18, arm 9, legs 13.5, 18 front thoracic & ABDMN
= # of child -1 > take away from head then give to each leg (Applicable up 10y/o) For every year beyond age 1, subtract 1 from head / that # & add it evenly between the 2 legs.
1Lymphatic system:
2Lymph node:
3Spleen relation:
4Lymphatic pathway:
5Sign lymphatic system not working:
1= “body’s garbage system” macrophages eats then system of channels to tissues 1 direction, no pump, dumps into a node
2= were garbage collects
3= Carries “trash” of pathogen destruction to nodes for macrophages
4= >Vessels> nodes> spleen> up to L/R subclavian vein, to kidneys
5= Gray poop
Class 1 hem:
Class 2 hem:
Class 3 hem:
Class 4 hem:
= max15% (750 mL’s) SNS main compensatory
= 15-30% (750-1500 mL’s)RAAS
= 30-40% (1.5-2L’s) comp to decomp SBP90
= >40% (>2Ls) irreversible
1Stages of healing:
1= Hemostasis, Inflam/, Epithelialization, Neovasc/, Collagen synthesis
1Hemostasis:
2Inflammation:
3Epithelialization:
4Neovascular:
5Collagen synthesis:
1= vaso/strict, platelet aggregate, coagulation fibrin (normothermic)
2= Granulocytes, macrophages & Lymphocytes eat, Mast cells released
3= “rebuild” epithelial cells go to wound making scab ~48Hrs after cut
4= new capillaries made (neo new) via previous cap/s +exchanging
5 = fibroblasts go to wound & synthesize collagen creating scar (w/ tension lines quicker/better), Too much synthetization makes Keloid
2 cyanide antidote regimens are available:
Sodium nitrite dose :
Sodium thiosulfate dose:
= Pasadena cyanide kit (amyl nitrite, Na nitrite, & Na thiosulfate) & newer antidote Cyanokit (hydroxocobalamin)
= 300 mg sodium nitrite over 2 to 4 minutes for adults.
= administer 12.5 g of for the adult.
MVC) Phase 1:
Phase 2:
Phase 3:
Phase 4:
Phase 5:
= Vehicle collision (P1) deceleration
= Body collision (P2) decel/ of occupant
= Organ collision (P3) decel of internal
= 2ndary collision (P4) objects in car
= (P5) car rear end, trees,
1 (Burn depth) 3rd degree:
2 feeling & appearance:
1= full thickness burn down to SCT may involve M. bone & organs
2= leather, looks Charred, dark brown or white, hard to touch “painless”
% of all Trauma deaths:
% of GSW account for HT death:
%s of penetrating neck trauma:
%s of penetrating chest trauma are fatal:
% of great vessels injuries & due to:
minimal diameter for sucking chest wound
= 50% of all Trauma deaths is head trauma
= 35% GSW account for Head Trauma deaths
= 5-10% penetrating neck trauma (airway & neuro
= 70-80% penetrating chest fatal
= 90% all great vessels injuries due to a penetrating MOI
= At least ¾inch for penetrating Chest wounds to turn sucking
Adult Men weight from:
Adult Women weight from:
=50 kg + 2.3 kg X (Height (in)- 60)
=45.5 kg + 2.3 kg X (Height (in)-60)
1 Adults for the Rules of Nines, the head is awarded:
2 Adults for the Rules of Nines, the genitalia is awarded:
3 Adults for the Rules of Nines, the posterior trunk is awarded:
4 Adult for the Rules of Nines, each arm is awarded:
5 Adults for the Rules of Nines, each leg is awarded:
6 Adults for the Rules of Nines, the anterior trunk is awarded:
1= 9 % of body surface area.
2= 1 % of body surface area.
3= 9 % of body surface area.
4= 18 % of body surface area.
5= 18 % of body surface area.
6= 18 % of body surface area.
Afferent nerves:
Efferent nerves:
=sensory nerves “ahhh”
=motor “effect”
Any eye trauma PT:
Zofran contra=
= vomiting &/ B/c +ocular pressure
= prolonged QT
AUTOPED) 1st impact:
2nd impact:
3rd impact:
Off-road injuries:
Kids Waddell’s triad:
= auto strikes body
= pedestrian thrown
= body strikes ground or object
= pop increased, usually remote areas, offer less protection,
= turn toward bumper b/c stupid, bumper hits kids pelvis & femur, chest & ABDMN hit grill, head strikes ground b/c buckethead
Shock & perfusion definitions:
= Perfusion: Adequate supply of well oxygenated blood & nutrients to all vital organs
= Shock: body’s lack of perfusion
Beta radiation can travel and can penetrate
6 to 10 feet through air & a few layers of clothing.
blast injuries) Primary:
Secondary:
Tertiary:
Quaternary:
Primary: blast injuring hallow organs
Secondary: shrapnel injuring
Tertiary: thrown against something
Quaternary: damage from other AFTER BLAST
Pulse pressure:
MAP:
CPP Cerebral Perfusion:
= SBP-DBP
= (PP/3) + DBP
= (MAP-ICP) + 10
Blood:
Plasma:
Leukocytes:
Erythrocytes:
= Mixture of water, cells, proteins, & suspended elements.
= makes up 55% of the blood volume
= WBC & platelets make up the “Buffy Coat”
= RBC make up 45%
Blunt T. to head & neck mortality% & w/ MVC:
= 85% mortality (Focus head neck chest abdomen)
Cardiac Output:
Cardiac Output Formula:
Blood Pressure formula:
= amount of blood pumped by the heart in 1 min (70mL)
= SV x HR
= CO x SVR
Shock) Cardiogenic:
Types & defined:
= Pump prob/ not working
= Intrinsic: problem from w/in heart EX MI
& Extrinsic: pob from outside hurting heart EX TPT
Celsius# to degrees Fahrenheit form
Fahrenheit# to Celsius form
C# to F=(C# -32) / 1.8
F# to C= (1.8 x F) + 32
Child burn in water) 120 degrees
125 degrees
140 degrees
150 degrees
= 10 minutes 2 or 3 degree burn
= 2 minutes
= 6 secs
= 2 sec
1 Children for the Rules of Nines, the head is awarded:
2 Children for the Rules of Nines, each leg is awarded:
3 Children for the Rules of Nines, each arm is awarded:
4 Children for the Rules of Nines, the anterior trunk is awarded:
5 Children for the Rules of Nines, the posterior trunk is awarded:
1= 18 % of body surface area.
2= 13.5% of body surface area.
3= 9% of body surface area.
4= 18% of body surface area.
5= 18% of body surface area.
(Class I Hemorrhage) 1 injuries:
2Compensation for blood:
3Blood Loss:
4Pulse:
5Vent rate, BP & Pulse Pressure:
6Cap-Refill:
7Urine Output (mL/hr):
8Mental Status:
1= Broken humorous 750mL
2= Healthy PTs can easily compensate for such blood volume loss
3= Blood Loss: < 15% (<750 mL’s)
4= Pulse: Slightly Tachy
5= all Normal
6= Cap-Refill <2secs
7= 30mL/Hr or more
8= Slightly Anxious
Coagulation Phase of hemostasis:
3rd phase Clotting factors activated and released into bloodstream through a very complex cascade of events Triggers series of chemical reactions; formation of strong protein fibers (fibrin)
Criteria for critical/moderate burn in adult & PT:
Adult:
= Burns associated w/ resp injury aka inhalation burn, Chemical / high voltage, Burns w/ major trauma
Adult: Superficial: BSA >50%, Partial: BSA <30%, Full thickness: BSA <10
CUPS:
C:
U:
P:
S:
= Categories of PT severity
= Critical: ABCs FUCKed
= Unstable: hypotension, comp to decomp
= Potentially unstable: pelvic fracture, stable can unstable
= Stable: stable ex toenail fracture
5 types of shock and treat them appropriately:
Hypovolemic, Cardiogenic, Distributive, Obstructive, Respiratory/Metabolic
Dry dressing for burns:
Wet dressing for burns:
= >10%
= <10%
Dynamic CO:
=1 up other down, L diastole P = L afterload, PVR pulmonary & oil
(Thermal burn phases) Emergent phase:
Vtach, cells anaerobic Body’s initial reaction to burn; pain response (afferent nerves damage> Nor/Epi release > tachycardia ; unless on beta blockers
End-tidal gradient= Difference between partial pressure of arterial CO2(PaCO2) & end-tidal CO2(ETCO2). Formula=
PaCO2 - ETCO2 = End - Formula gradient
Eschar:
Can be severe enough to :
= Burn destroys dermal cells; Skin constricts over wound site, increasing pressure of edema beneath & restricting flow of blood
=occlude all blood flow into distal extremity (compartment syndrome)
Escharotomy =
= release pressure w/ cutting burn to relief fluid pressure
ETT size range~
Adults (6.0-9.0) women~7-8 & man~8-9
Pedi tubes(2.5-5.5)
Evaluation:
= Repeat surveillance “good on paper but what about practice”
Parkland Burn Form) EX: 32yo male found with 10% BSA 1st degree burns, 10% BSA 2nd degree burns, and 10% BSA 3rd degree burns. The patient is 110 pounds.
1. 4 mL x BSA x Weight (kg)
2. Total mL / 2 = (Amount to give for:
3. How many mL’s per hr?
4. How many gtts/min using a 10 gtt/mL IV drip set?
5. Know w/ formula:
- 4mL X 20 (2nd + 3rd degree burns) X 50 (kg) = 4000 mL
- 4000 mL / 2 = 2000 mL (Amount to give 1st 8 hours then next 16Hrs)
- 2000 mL / 8 = 250 mL per/hour for 1st 8 hrs
- 42 gtts/min
- Pick closest option choice for gtts & Vol calculated. Use biggest bores& macro drips
ETCO2 Lvs in head-injured intubated PT shouldn’t drop below:
When vent/ing a adult PT, each breath should have tidal volume of:
= 30 mmHg
= approximately 500mL
Falls:
Examine:
Axial loading:
FOOSH (Fall onto an outstretched hand)
Colles’ fracture:
Smith’s fracture: out
>20ft greater risk of
Aortic anyrusem to tear:
= most common blunt trauma, risk increase w/ age, sig fall 2-3x height
= height, position, surface PT landed on, physical condition of PT
= loading on axial skelton via falling (E starts heel to lumber)
= influxing wrist fractures from fall impact
= efflucing wrist fractures from fall impact “Palm out”
= internal organ damage
= pain tearing to chest shoulders back
= tearing pain from chest goes to back
Fluid accounts for ~% of the body’s weight, Only ~% of the fluid is contained in our vascular system
= 60% of the body’s weight, Only about 7% of the fluid is contained in our vascular system
Fluid resuscitation is an important part of treating serious burns. The formula for the amount of IV fluid needed to be infused includes:
4 mL × patient weight (kg) × BSA burned <Parklands></Parklands>
Thermal burn phases) Fluid-shift phase:
2nd phase; can last up to 24 hours; larger than 15 to 20%(BSA) of total body surface area
vasodilates & capillaries more permeable for phagocytosis
Force:
Force formula:
= force related to a objects mass(weight) and/or achange in velocity
= mass x Acceleration
Frank Starling law/mechanism:
Vascular Resistance:
SVR vs. PVR:
SVR (Systemic Vascular Resistance):
PVR (Pulmonary Vascular Resistance):
= more myocardium is stretched the more force/greater the next contraction will be (increase in preload increases contraction)
= Resistance to overcome to push blood through circulatory system
= Body’s circulation resistance & Lung’s circulation resistance
= resistance blood faces in systemic circulation (arteries size)
= resistance blood faces in pulmonic circulation EX CHF, R ventricle
Frank Starling law/mechanism:
= more myocardium is stretched the more force/greater the next contraction will be (increase in preload increases contraction)
Vascular Resistance:
= Resistance to overcome to push blood through circulatory system
SVR vs. PVR:
= Body’s circulation resistance & Lung’s circulation resistance
SVR (Systemic Vascular Resistance):
= resistance blood faces in systemic circulation (arteries size)
Golden Period “hour”:
Platinum 10:
= incident to surgery time 1 Hr from Crash to EMS to PT to surgery
= no more than 10 mins on scene
Hemostasis:
Hemostasis order:
Factors that effect hemostasis:
= Body’s response to a local hemorrhage w/ 3 phases
= Vascular, Platelet, Coagulation “flow, stick, build”
= Wound type(can pull w/in>cant constrict), M-nt, Temp, Meds( most blood thinners stop/prevent fibrin) Warfrin/Coumadin), IV Fluids
How to estimate PEDI ET tube size: Uncuffed
Cuffed
Uncuffed ET: (Age /4) + 4 OR (Age + 16) /4
Cuffed ET = (Age /4) + 3.5
How to estimate pedi weight
(Age + 4) x 2 = Approximate weight in kg (Old Way)
(Age x 3) + 7 = Approximate weight in kg (New Way
Hyperkalemia) 1st line med:
2) One of two 2nd line meds:
3) One of two 2nd line meds:
4) Hospital only med:
5) Hospital only med to poop:
1= Calcium Chloride IV 0.5-1G/3 mins (Stabilizes doesn’t fix)
2= Albuterol 10-20 mg LVN over 15 mins
3= Sodium Bicarb 50 mEq IV mil equivalent
4= Dextrose (25 grams)w/ Insulin IV (10 units)
5= Kayexalate to poop out hyperK via pull interstitial to GI
Orthostatic hypotension
PT’s BP drops 20 HR+20 when moved from supine to a seated position
Implementation:
= putting effective safety measures EX roads,
Intervention dev:
= dev/mod of programs to reduce both incidence & seriousness of trauma
Jacksons Theory of Thermal Burns 3 burn zones:
1st Zone of Coagulation 2nd Zone of Stasis 3rd Zone of Hyperemia
Kinetic energy:
Kinetic Energy form:
=energy of a object in motion (by objects mass & its velocity
= (Mass x Velocity ^2)/ 2 ½ x mv^2
Kinetic energy:
kinetic energy formula:
Increasing mass vs. velocity directly increases what:
= energy of an object in motion (Fn. of object’s mass & its velocity)
= Kinetic energy=Mass(weight)×Velocity(speed)22
= kinetic energy > +velocity exponentially increases kinetic energy
1 kinetics of penetrating trauma) Study of projectiles in motion & effects on objects
2 Curved path bullet follows after fired from a gun
3 Drag from wind
4 Outward “ballooning” motion of cavity due to projectiles
5 Speed of object in motion
6 Cross-section of bullet along its direction of travel
7 shape of object
1= Ballistics:
2= Trajectory:
3= Drag:
4= Cavitation:
5= Velocity:
6= Profile:
7= Shape:
Lethal blood loss=
40%–> class 4 hemorrhage
Life threatening injuries %:
Most-life threatning trauma occurs to:
Vol per lung & body:
lethal blood loss:
= <10% traumas
= head and/or chest
= 3L per lung & 5L per body
= >40% or ~2L
Lightning can still strike you if proximity up to:
up to 50yrds can strike you
Lightning strikes frequency & strike proximity
~100times a sec around world & up to 50yrds can strike you
mechanism of injury (MOI):
the circumstances and events by which an injury occurs.
Moderate criteria) Superficial:
Partial thickness burns:
Full thickness burns:
= BSA >50%
= BSA <30%
= BSA <10%
MOI:
Energy:
Inertia:
= mech of injury how the injury happened
= Ability to do work
= law of Inertia (Newton’s 1st law) helps explain how objects in motion behave
Morphine & fent drop BP by:
= body releasing Histamines
(Newtons laws) inertia) 2nd law:
force formula is summarized as:
= force is related to object’s mass (weight) & rate of its change in velocity (speed)
= Force=Mass (weight)×Acceleration (or deceleration)2
Normal blood pH range=
7.35 - 7.45 mmHg
Ohm’s law:
relationship between current (I), resistance (R), voltage (V)
Tension pneumo & pulmonary emboli is which type of shock?
Pericardial tamponade presents w/:
= Obstructive
= Becks triad JVD, tachycardia, hypotension, & Muffled heart tones
Pedi intubation ETT location=
ETT Insertion is 2-3 cm below the vocal cords
Penetrating trauma:
Perforating trauma:
(3lvls of Penetrating trauma) 1st Lvl:
2nd Lvl:
3rd Lvl:
Ballistics:
Factors of bullet speed/damage:
Trajectory:
Cavitation:
Profile:
= object pierces the skin and enters the body
= object pierces through & through body
= Low velocity: knifes, swords, ect
= Medium: handguns
= High-velocity: Rifles
= study of projectiles in motion & effects on objects
= Trajectory, Drag, Cavitation, Velocity, Profile, Shape:
= curved path bullet follows after fired from a gun
= Outward motion of cavity due to projectiles speed & vacuums
= cross-section of bullet along its direction of travel
Phrenic nerve location
C-3-5
Platelet Phase of hemostasis:
2nd phase, Platelets aggregate, or collect and adhere. Slows hemorrhage from capillaries and small vessels- splint fractures to decrease of clots being broken down & bleeding again
Preload:
Afterload:
Mean Arterial Pressure (MAP):
= pressure/vol/ w/in ventricles @ end of diastole “End-diastole vol/“
= resistance against which the heart must pump against (increase afterload= increase ventricular workload)
= average pressure in arteries during a single cardiac cycle = pressure that drives blood to tissues (ensuring organ perfusion)
Public health care model:
= Surveillance, Risk identification, intervention dev, implement, Eval/
Respiration ratio=
1 sec inhalation 2 sec exhalation
Risk analysis:
= Examines & determines factors that impact dev
RSI Ideal Body Weight) Men formula
Women formula
Men= 50 kg + (2.3 kg X (Height (in) - 60)
Women= 45.5 kg + (2.3 kg X (Height (in) - 60)
Rule of palm:
use of PT hand = 1% of BSA (burns <10%)
“rule of thumb” for estimating the proper depth of an ETT=
Depth should be ~3x ETT size
Seat belts:
Maternal relation w/ seat belts:
Cullen’s sign:
Most common organ injuries:
SRS:
= vehicle restraints, reduced # of collision related deaths
= US #1 maternal death, hips/pelvis not ABDMN
= internal bleed abdominally
= Spleen adults Liver kids
= supplemental Restraint Systems (SRS) 1st used for front impacts, airbag inflation to cushion energy
Shock) 1 Distributive:
2 Hives:
3 “warm shock/high space”:
4 Sick shock:
5 syncope:
1= uncontrolled vaso-dialation
2= Anaphylactic: release of histamine from Ige & b/c allergen
3= Neurogenic: warm b/c reverse shunting makes warm transient block of SNS
4= Wide spread of infection
5= Physcogenic: Sudden vasodilation physiological means EX hemophobic, arachnophobic
Shock) 1 Obstructive & types:
2 pneumothorax:
3 Pericardium:
3 traveled Embolism to lungs:
1= something obstructing heart} PE, Tension/Pneumo, Pericard/tamp
2= Tension/pneum: plueras so full pushing on hearts atrium
3= Pericardial tamponade: pericardium filled with blood
4= PE: emboli so big obstructs pulmonic vein
Shock) 1 Respiratory/Metabolic:
1= Disruption of O2 transfer into cells/cells unable to utilize O2 from Cyanide, CO poisoning, A change in the blood pH
Shock) Normal S/S of shock:
Compensate shock:
Decompensated shock:
Irreversible shock:
= Tachypnea&cardia, AMS, lower BP
= body is compensating “fighting” to maintain homeostasis
= can no longer maintain homeostasis
= can’t come back to life
Shock) How does hemophilia affect the body and the clotting of blood?
Does not have ability to properly clot due from ½ factors
Shock) S/S of neurogenic shock:
Cushing’s Triad:
= warm/flush, bradyC, HyperBP, AMS, Blown and/or unequal pupils
= HyperBP, BradyC, cheyenne stokes or Biots ventalations
Shock) Hypovolemic:
Types:
= fluid loss
Hemorrhagic: blood loss & Non-hemorrhagic: V/D, Sweating
(Rad) S/S of Exposure:
First sign:
Lethal Dose Exposure:
Organ shutdown:
= SLUDGEM PSNS S/S
= slight nausea & fatigue
= Emesis & malaise, Epistaxis, mouth, gums, & rectum (Vomiting usually lethal exposure
= Death
Site for pneumo decompression:
needs:
Never go under a rib b/c:
Locating decompression site:
Digital thoracostomy:
= Anterior 2nd ICS midclavicular/3rd rib & b/c air is always up/rising
= At least 3in catheter, attach 1way valve: Could use 3way valve, glove,
= vascular; have major thoracic arteries & nerves
= palp/ then slide over 3rd rib
= 1-2in incision between 4th & 5th ICS, ( “cut finger tube” )
Special pop of burns:
PT’s cope less b/c:
= GERI, Pedi, & PTs ill/injured have >dif coping w/ burn injuries
= Fluid retention, <fluid reserves, <able to combat infection, More apt to have underlying diseases
Specialty Centers:
= Neuro, Burn, Pedi trauma, Hand & limb replant microsurgery, Hyperbaric oxygen
1staph:
2Strep:
3Lymphangitis:
4Tetanus (Lockjaw):
5Gangrene:
6Wet Gangrene:
7Dry Gangrene:
1= staphylococcus Anaerobic bacterium infection
2= Streptococcus Anaerobic bacterium infection
3= red lines along lymph lines b/c infection
4= Clostridium tetani>Attacks NS produces toxin >M. contrac/spasms
5= Clostridum perfringen>(diabetes>risk) <peripheral> infection lacks blood supply/flow> less WBC
6= bacteria to tissue & swells then fluids outside of tissue
7= blood supply cut off and dry</peripheral>
Stretch blunt trauma:
Sciwora:
= Tendons & Fibers that (tendons stronger) hold organs & other structures together are pulled & injured or torn
= spinal cord injury with out r a (kids in wreck overstretching neck)
Stridor w/ inhalation burns:
Bad Airway burns might might need:
= AKA “crowing” larynx last defense against heat then swells 2/3s so intubate asap bc only worsens (Press chest & follow bubbles)
= Might need to nasal endotracheal intubation w/ BAAM & Endotrol tube (ET w/ trigger) BAAM> High=inhale &Low=exhale
Stroke volume:
Cardiac Output (CO):
CO form/:
3 factors that affect CO:
Dynamic CO:
= blood amount ejected in 1 contraction> varies 60-100mL 70average
= Amount of blood moved in 1min
= HR X SV -> 5-6 L of blood moved in 1 min
= preload, afterload, contractility
= “1 up & other down”
Suction catheter size w/ ETT~ form:
ETT# x2
Suctioning catheter sizing form/=
Intubation ETT size # X 2
Suctioning time limits:
Adults 15 secs max,
Children= 10 secs max,
Infants=5 secs max,
ET/Trach tube= 5-10 secs max
Surveillance:
= collection of data Epidemiology=study of disease based on med survey
The blood volume of an infant or young child is proportionally:
Population most at risk for trauma & trauma death:
= ~20%> than that of an adult
= Young adult male
The following burn patterns is usually seen with child abuse:
“Stocking burns” to lower legs, Circumferential burns on buttocks, Multiple circular burns of the same size to the arms and legs
The most common & serious trauma associated w/ explosions is:
The most lethal explosions are those: That cause structural collapse
= Pulmonary injury
= That cause structural collapse
Thermal burn phases:
Emergent, Fluid-shift, Hypermetabolic, & Resolution phase
TXA) 1 Dynamics:
2 when do we admin/ it:
3 Correct dose:
4 Followed by:
1= Blocks fibrinolysis by binding to plasminogen, blocking plasminogen fibrin interactions.
2= Significant hemorrhage, either internal or external (after external hemorrhage has been controlled).
3= 1G/10mins (mix in 50 mL bag of NS)
4= 1G/8Hrs (500 mL bag)
Waddells:
= turns to car pevils, thrown, head hits ground
What are the 3 dif types of soft-tissue injuries?
Type: Open
Type: Close: Infection
Type: Burn
What are the 3 different levels of penetrating trauma?
High velocity> sniper
Medium velocity> pistol
Low velocity> knife
What are the three levels of penetrating trauma?
Lvl 1: entrance
Lvl 2: cavation
Lvl 3: exit
Injury which opening occurs in skin & organs protrude through is:
Evisceration
Jacksons Theory) Zone of Coagulation:
Area of burn nearest to the heat source (most damage & tissue necrosis)Most damaged area
Jacksons Theory) Zone of Hyperemia:
surrounding Area of erythema, damage with more RBC coming to area b/c/& cap/s more permeable (increased blood supply) trying to get phagocytes to inside for healing process
Sig burns have sig swelling from shift of fluid
Jacksons Theory) Zone of Stasis / “Ischemia”:
Less damaged area adjacent to the Zone of Coagulation (treatable & posible reversible damage)
“pressure” of electric flow
Voltage
Child Burn form:
(age#-1 from the head) / between 2 legs
Controlled hemo/ fluid dosing
20mL/Kg Warm NS
