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NMETC > Trauma Management 1 > Flashcards

Trauma Management 1 Flashcards

Trauma Systems, MOI, Soft Tissue, Burns

1
Q

What is trauma?

A

involves injury to the person by any outside force.

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2
Q

Explain KE and PE

A

KE is energy in motion PE is stored energy

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3
Q

What is the Law of Conservation?

A

energy can neither be created or destroyed

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4
Q

Is Mass or Velocity a bigger contributor to injuries in an accident? AKA who would fair worse: 140lbs woman travelling 50mph or a 210lbs man travelling 25mph.

A

Velocity is a bigger contributor. KE= 1/2mv^2

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5
Q

What are the five types of MVCs?

A

Front End

Rear End

Rollover

Lateral/T Bone

Rotational/Quarter panel

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6
Q

What are the injuries associated with Front End MVC?

A

Pt’s will go down and under (aka knee hits dashboard) or up and over (aka head strikes roof or windshield, chest strikes steering column).

Pt may take deep breath beforehand and rupture lungs.

Also may fx larynx if throat strikes steering wheel.

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7
Q

What are the injuries associated with Rear End MVC?

A

Whiplash injuries

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8
Q

What are the injuries associated with Rollover MVC?

A

Pt most likely to be ejected. Many strike points on body as car rolls.

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9
Q

What are the injuries associated with Lateral MVC?

A

Pt’s on same side of force suffer greatest damage. Head snaps violently downward towards force. Injuries to chest/pelvis/lower extremities. Likely pneumothorax.

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10
Q

What are the injuries associated with rotational MVC?

A

Injuries vary widely and depend upon strike point, seat belt usage, and velocity.

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11
Q

What are the four types of impacts in a motorcycle accident?

A

Head On

Angular impact

Laying the bike down

Ejection

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12
Q

What are the injuries from head on motorcycle MVC?

A

bilateral femur fx possible tib/fib fx

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13
Q

What are the injuries from angular impact on motorcycle MVC?

A

Extensive ortho damage to leg

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14
Q

What are the injuries from laying the bike down MVC?

A

possible abrasions and road rash

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15
Q

What are three predominant MOI in Vehicle vs Ped?

A
  1. Car strikes individual (lower extremity injury) 2. Upper body and head strike car hood 3. Sudden acceleration throws body away from car, pt strikes the ground
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16
Q

What are the five important things to know from fall patients?

A

Height of Fall Position

Upon Impact Area over which impact dissipated

Surface Pt Landed on

Physical condition of Pt before fall (osteoporosis, etc)

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17
Q

What are examples of low/medium/high velocity injuries?

A

Low= stab wounds, penetrations from falls

Medium= shotguns and handguns

High= rifles

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18
Q

Explain the factors to consider when assessing GSW pt’s.

A

Type of firearm

Velocity of bullet physical design- jacketed tend to mushroom and cause more damage size of projectile- larger bullets tend to tumble and cause more damage. smaller bullets tend to ricochet.

distance of pt from muzzle anatomy struck by bullet

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19
Q

What are the stages of blast injuries?

A

Primary Secondary Tertiary Quaternary Quinary

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20
Q

Explain stages of blast injuries.

A

Primary- initial shock wave

Secondary- shrapnel thrown by explosion

Tertiary- injuries due to impact with other object

Quaternary- burns, crush injuries, or inhalation injuries

Quinary- long term damage from contaminants

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21
Q

What affects the speed, duration, pressure of blast shock waves?

A

Size of explosive charge (larger explosions travel faster and stay longer)

Nature of surrounding medium (travel faster through water)

Distance from explosion ( farther away from explosion means slower the shock wave, longer duration, and lower likelihood of injury)

Presence/absence of reflecting surfaces (pressure waves reflected off solid objects, aka walls, tend to amplify damage)

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22
Q

Explain the major components of the trauma pt assessment.

A

Scene safety

Primary survey

  • ABCDE or CABDE
  • AVPU
  • MOI
  • Spinal precautions
  • Rapid exam
  • Txp decisions

Hx -SAMPLE/OPQRST

Secondary Assessment -Isolated or Multisystem

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23
Q

What is the trauma lethal triad?

A

Acidosis Hypothermia Coagulopathy

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24
Q

What is the Waddell Triad?

A

Children turn toward vehicle causing initially injuries to pelvis and femur injuries,

followed by intrathoracic injuries from striking grille,

and finally head injury when head strikes vehicle and pavement after being thrown.

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25
Q

Explain Level I, II, III, IV hospital trauma rankings.

A

l- comprehensive resource. 24 hour surgery coverage. II- able to start definitive care for all injured pt’s. 24 hour immediate surgery coverage. III- able to assess and stabilize injured pt’s. 24 hour immediate care by ER docs and prompt surgery availability. IV- available to provide ATLS before pt transfer. Basic ED functions

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26
Q

When do you utilize air medical services? (6)

A

extended period required to extricate

access pt distance to trauma center is >20-25miles

Pt needs ALS and no ALS ground available

Traffic slows pt transport time

Multiple pt’s that will overwhelm local resources MCI

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27
Q

Trauma Criteria- Physiologic conditions

A

GCS = 13 at any point during pt contact time

SBP <90 at any point (<110 in elderly over 65yo)

RR outside of 10-30

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28
Q

Trauma Criteria- Anatomic Criteria (9)

A

Any penetrating trauma to head/neck/torso/proximal extremities

Chest trauma and fx 2+ proximal long bone fx

Crush injury to any extremity

Degloving injury

Pulseless extremity

Amputation proximal to wrist or ankle

Pelvic instability

Open or depressed skull fx

Paralysis

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29
Q

Trauma Criteria- MOI Criteria

A

Fall > 3x body height in kids or >20ft in adults

Car vs Ped/Bicycle when person is thrown/run over/hit a >20mph

Motorcycle crash speeds >20mph

Car crash involving:

  • intrusion into compartment >12inch
  • ejection from vehicle
  • death of another occupant in same vehicle
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30
Q

Trauma Criteria- Special considerations

A

Pt >55yo

Pt is pregnant

Burns of any kind with other trauma

Pt takes anticoags or has bleeding disorder

EMS provider judgment

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31
Q

What are the layers of skin?

A

Epidermis Dermis Subcutaneous tissue

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32
Q

What are the functions of skin? (5)

A

Protects from injury

Temperature regulation

Fluid regulation

Sensation

Inflammatory response

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33
Q

How does skin function with the immune system?

A

responds to wounds with inflammation, which cause redness, increased warmth, and painful swelling.

Blood vessels dilate and fluids leak to damaged tissues. This allows more nutrients, oxygen, and WBCs to injury site.

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34
Q

Explain closed vs open injuries.

A

closed wounds don’t have a break in skin, open wounds do.

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35
Q

Explain the process of wound healing.

A
  1. Hemostasis: cessation of bleeding through blood vessel constriction and platelet plugs. 2. Inflammation: WBCs migrate to site of injury via capillary leakage/chemotactic factors/mast cells (histamine). 3. Epithelialization: new skin cells are layed down 4, Neovascularization: new capillaries bud from intact capillaries 5. Collagen synthesis: collagen synthesizes to bring stability to wound and close open tissue.
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36
Q

What alters the process of wound healing?

A

certain medications: NSAIDs, corticosteroids, anticoags

skin tension lines can make wounds harder to heal

high risk wounds: bites, imbedded objects

abnormal scar formation- too much collagen produced

pressure injuries: bedridden

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37
Q

What wounds require closure?

A

Lips Face Eyebrows

Gaping wounds over tension lines

Degloving Ring injuries

Skin tears

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38
Q

How do we treat closed wounds?

A

Rest Ice Compression Elevate Splint

39
Q

How do we treat open wounds

A

control bleeding keep wound as clean as possible

40
Q

What are the implications of improperly applied dressings?

A

tissue damage from tight dressing

41
Q

Abrasion tx

A

do not clean cover lightly with sterile dressing

42
Q

Laceration tx

A

control bleeding cover with sterile dressing

43
Q

Puncture wound tx

A

look for entrance and exit wound treat swelling with ice control bleeding stabilize in place

44
Q

Avulsion tx

A

if wound is contaminated, irrigate fold skin back into place dress with sterile gauze control bleeding

45
Q

Amputation tx

A

control bleeding rinse off debris from amputated part wrap loosely in saline moistened gauze seal in plastic bag and keep cool

46
Q

Bite tx

A

control all bleeding apply dry sterile dressing document and txp

47
Q

High pressure injection injury tx (5)

A

irrigate open wounds

dress with sterile bandage

px meds

check cms

check for subcutaneous air

48
Q

Facial and Neck Injuries Tx

A

*Control airway

  • patency and protection
  • 02 as needed
  • Suction secretions

*Control bleeding

  • if only one provider, control airway first
  • use bulky dressing and direct pressure
  • occlusive dressings for neck wounds
  • Realign avulsed skin along face or neck to original position if possible
49
Q

Thoracic Injuries Assessment 4 steps IAPP

A

4 Main steps:

Inspect

Auscultation (at least two sites, diminished sounds=pneumo)

Palpation (abnormalities or subcutaneous emphysema- indicative of tracheobronchial disruption)

Percussion Consider occlusive dressing for thoracic wounds

50
Q

Abdominal lnjuries Tx

A

Be highly vigilant with these injuries Focus on potential injury to underlying organs and vessels –>Cullens Sign, Grey Turner Sign, distended abdomen, etc.

51
Q

What is myositis?

A

inflammation of muscle due to injury or infection s/s: fatigue with exertion, muscle weakness, fever

52
Q

Explain gangrene.

A

Gangrene is dead tissue due to interrupted blood supply to tissue.

It can be dry or wet.

Wet gangrene develops quickly and causes sepsis.

Dry gangrene can develop over months.

Smokers and diabetics the most susceptible.

Many causes.

Basic tx unless sepsis present.

53
Q

Explain tetanus.

A

Tetanus is caused by Clostridium, which produces a potent toxin –> muscle contractions. Rapid transport

54
Q

Explain necrotizing fascitis

A

NF is a complication of Strep, causing tissue death. S/S: warm tissue, redness, fever, night sweats, fever, chills, N/V, diarrhea. Rapid transport and surgical debriedment needed.

55
Q

Explain paronychia

A

Infection of cuticle.

56
Q

Explain flexor tenosunovitis.

A

infection usually caused by penetrating trauma to hand, usually sheath of the tendons that flex the fingers. S/S: inability to extend involved finger, px, swelling along tendon path. Common in pt with RA and overuse injury

57
Q

Explain the anatomy of the surface of the eye

A

Cornea- cover anterior portion of pupil

Pupil- hole in iris that light passes through

Lens- focuses light on retina to form image, behind pupil and iris

Retina- receives light and converts it to electrical signal

Fovea- most light sensitive area of retina

Optic nerve- receives electrical signal

Optic disk- blind spot of eye

Sclera- white of eye

Aqueous Humor- anterior chamber of eye fluid; can be replenished

Vitreous humor- posterior chamber of eye fluid; cannot be replenished

Lacrimal Gland- under upper eyelid on lateral edge, drips tears into eye

Conjunctiva- underside of each eyelid

58
Q

Explain the pathophys of burn injuries

A

Burns are soft tisue injuries resulting from sudden and violent release of energy. Burns can occur from a release of heat in the form of fire, energy from chemical rxns, or radiation released from radioactive substances. Damage to skin in such a profound way also affects body systems other than just the skin:

  1. Airway burns compromising respiratory system
  2. fluid shifts can lead to hypovolemia and cardiovascular compromise
  3. destruction of skin opens pt up to massive infection risk that overtaxes the immune system.
  4. Hypothermia and shock
59
Q

What is the pathophys of burn hypovolemic shock?

A

Hypovolemic shock is the most profound systemic response to a burn.

  • Occurs because of fluid loss across damaged skin and series of volume shifts within the rest of the body
  • capillaries become leaky due to histamine and other mediators released.
  • this allows intravasular volume to ooze out of circulation into interstitial spaces.
  • cells of normal tissues take in increased water and salt from fluid surrounding them
  • as BP falls, HR increases and vasoconstriction occurs, limiting blood flow further, increasing shock.
  • massive fluid shifts and electrolyte imbalances cause N/V
  • adequate fluid replacement NECESSARY
60
Q

What are the S/S of hypovolemic shock?

A

cold or clammy skin

pale skin

rapid, shallow breathing

rapid heart rate

confusion

weakness

weak pulse

blue lips and fingernails

lightheadedness

loss of consciousness

61
Q

What are the five types of thermal burns?

A

1. Flame Burn- open fire burn

2. Scald Burn*- hot liquid caused

3. Contact Burn*- contact with hot object

4. Steam Burn- topical scald burn

  • may cause supraglottic trauma from inhalation
  • or may (rarely) cause subglottic trauma

5. Flash Burn- from explosions or lightning strikes

*common abuse burns in kids and elderly

62
Q

What are the signs of intentional burns?

A

unusual hx patterns

burns with formed shapes

unusual patterns

atypical burn locations

-genitalia, buttocks, and thighs

63
Q

What are the burn zones from worst to furthest?

A

Zone of Coagulation: little or no blood flow to the injured tissue in the area affected.

Zone of Stasis: decreased blood flow and inflammation adjacent to coagulation area; most likely to undergo necrosis within 24-48 hours.

Zone of Hyperemia: least effected

64
Q

Explain the superficial burns.

A

aka 1st degree burn

example: sunburn

only the epidermis is effected and skin will be red/hot to touch, swollen and painful.

when touched skin will blanch and then return to red color

65
Q

Explain partial thickness burns.

A

involves the epidermis

can be further divided into moderate or deep partial thickness

  • Moderate partial thickness involves only superficial dermis with most hair follicles remaining intact. Skin will be red with fluid blisters. Redness will blanch and return to red.
  • Deep partial thickness involves blisters and damage deeper into dermis. It damages hair follicles and sweat glands. May destroy some pain receptors.
66
Q

Explain full thickness burns.

A

involve the entriety of the epidermis and the dermis, burning all the way down to the basement membrane.

Skin will appear white, waxy, charred, or leathery. It is dry, hard and tighter than normal skin.

Can tighten to point of acting as tourniquet, and can hamper breathing if on chest.

Will not feel px except for on outer edges of the burn

67
Q

Explain the pathophys of inhalation burns.

A

Inhalation of superheated air can cuase airway burns. Airway lining swells, sometimes to the point that it closes off the airway completely. Epiglottis, layrnx, and pharynx often take brunt of gas heat and sustain worst trauma. Pt will require aggressive airway managment.

Be cognizant of CO in smoke burns, along with superheated air. Be careful with pt with soot around mouth and nose. Cyanide and HCl are also concerns with smoke, but [] usually not high enough to cause severe damage.

68
Q

What is the primary survey for burn pts?

A

ABCDE

  • burn pt that is combative=hypoxic until proven otherwise
  • unresponsive burn pt= look for other deadly injury
  • Airway is KING
  • Look for S/S of airway involvement:
    1. hoarseness
    2. cough
    3. stridor
    4. singed nasal/facial hair
    5. facial burns
    6. black sputum/lips
    7. hx of burn in enclosed space
  • consider early intubation due to laryngeal edema
  • listen to lung sounds
  • preexisting lung disease may cause bronchospasm, give Beta 2 agonist drugs
  • IV access and fluids
  • after airway and breathing controlled, assess extent of burns
69
Q

Rule of Nines

A
70
Q

Lund Browder Chart

A
71
Q

Explain secondary survey with burn pt’s.

A

Check for other injuries

If pt is in shock, look for other source of shock

Observe for circumfrential burns of chest, neck, extremities

Check CMS in extremities

Vitals which include EtCO2

72
Q

Explain what major burns are.

A

Burns of hands/feet/major joints/gentialia

circumferential burns

full thickness bursn >10% TBSA

Partial burns >25% 10-50yo

Partial burns >20% <10yo or >50yo

inhalation injury

burns with fx or trauma

high voltage electrical burn

chemical burn

73
Q

Explain moderate burn classification

A

Full thickness burns 2-10% TBSA

Partial thickness burns 15-25% TBSA 10-50yo

Partial thickness burns 10-20% TBSA <10yo or >50yo

Superficial burn >50% TBSA

Low voltage electrical burn

Major burn characteristics absent

74
Q

Explain minor burns

A

full thickness covering <2% TBSA

Partial thickness burns <15% TBSA 10-50yo

Partial thickness burns <10% TBSA <10yo or >50yo

Superficial burns <50%

75
Q

What are the burns should be taken to specialty center?

A

Partial thickness >10% TBSA

Burns of face, hands, feet, genital area, major joints

full thickness in any age group

electrical burns

lightning strikes

chemical burns

inhalation burns

burn injuries with preexsisting cdxns that prolong healing

burns and concomitant trauma/fx

76
Q

What are the phases of definitive burn care?

A
  1. Initial eval and resuscitation: 1st 72 hours
  2. Initial wound excision and biolgoic closure: day 1-7
  3. Definitive wound closure: day 7- week 6
  4. Rehab, reconstruction, reintegration: entire hospitalization
77
Q

What are some specific airway management techniques for burn pt’s?

A

Probable field intubation

Potential need for surgical cric

Use smaller tube than normally would

Most experienced medic first pass at intubation

Cool humidified O2

Supplemental O2 for inhaled toxins

78
Q

What are specific fluid resuscitation for burn pt’s?

A

TBSA >20% will need fluid resuscitation

at least 18g IV

can start line in burned extremity

consider IO if IV not possible

check lung sounds to watch for fluid overload

Give LR soln

79
Q

What are px management techniques for burn pt’s?

A

px meds should be given IV due to fluid shifts –> IM not reliable

keep in mind elderly, cirrhosis damage, and respiratory depression should influence narcotic choice

80
Q

What is the Consensus/Parkland Formula?

A

2-4mL x KG x %TBSA

Example: 70kg man with 30% TBSA

2-4mL x 70 x 30= 4200-8400mL in first 24 hours

to determine 1st 8 hours of fluid divide mL by 2

to determine hourly rate for 1st 8 hours divide again by 8

81
Q

Explain how we manage thermal burns.

A

Note skin cdxn

Note any other exsisting trauma

Cool any burns areas

Apply dry non adhesive dressing

Keep warm

Tx shock

Give fluids and px meds if needed

Cool nebulized air for inhalation injury

may need to be aggressive with airway

82
Q

Chemical burn assessment and tx

A

determine TBSA

brush off any remaining dry powder

Flush with copious amounts of water

remove any garments that may have come into contact with agent

keep pt warm

83
Q

Tx of dry lime

A

flush with overwhelming amounts of water after brushing off dry powder

84
Q

Sodium metals tx

A

cover with oil to stop burning

85
Q

Hydrofluoric acid tx

A

very pxful

3-5% TBSA can be fatal

sucks calcium out of body

can make calcium gel- 10mL calcium chloride mixed with water based lube to help with burn px

86
Q

Gas or diesel fuel tx

A

flush with soapy water

may cause pt to be sleepy/coma

87
Q

Hot tar tx

A

immerse in cold water

do not remove tar after cooled

88
Q

Inhalation burn from toxic chemical tx

A

check for stridor/upper airway swelling

check for wheezing/edema/lower airway swelling

maintain spO2

Duo Neb

Aggressive airway management

89
Q

Chemical burns for eye assessment and tx

A

flush with lots of water

remove contact lens

after irrigating, patch eye with light applied dressings

90
Q

Electrical burns assessment and tx

A

when voltage is low it takes path of least resistance

-along blood vessels and nerves

when voltage is high it takes shortest path

initial damage greatest at entrance/exit point

AC more dangerous than DC

AC more likely to cause VF

asphyxia may result from prolonged contact

keep in mind possibility of c spine injury

defib soon if in arrest

look for fx

assess csm in all extremities

be mindful of rigid abdomens

ABCs

EKG

consider fluids for fluid shifts

consider sodium bicarb for acidosis

Supplemental O2

91
Q

Lightning strike injuries assessment and tx

A

start cpr as needed

suspect c spine injury

jaw thrust

EKG

O2

18g IV run LR wide open

Cover burns with dry sterile dressing

Splint fx

if pt falls, immobilize spine

92
Q

Radiation burns assessment and tx

A

scene safety

ABCDE

30% TBSA with radiation likely fatal

Decon before txp

irrigate open wounds

93
Q

Explain special considerations for kids and the elderly when it comes to burns.

A
  • kids have thin skin and delicate respiratory systems
  • fluid resuscitation is challenging with kids- they may need more
  • kids have poor glycogen stores, so may need dextrose; be sure to monitor their BG
  • watch for child abuse
  • elderly sensitive for toxic fumes
  • elderly also have poor glucose stores, monitor!
  • EKG with elderly
  • watch for fluid overload with elderly when giving fluids

NMETC (11 decks)

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