Trauma Overview Flashcards
1
Q
- What is shock?
A
Inadequate tissue perfusion
Inadequate amounts of O2 and glucose are delivered to cell
Impairing amount of waste products in body
2
Q
- What is aerobic vs. anaerobic metabolism?
A
Aerobic metabolism is metabolism (production of energy) using oxygen
Anaerobic metabolism is metabolism in the absence of oxygen
Not sustainable as it causes decrease in ATP and increase in acid; induces sodium/potassium pumps to fail which brings sodium and water into the cell causing it swell and burst
3
Q
- What are the 3 basic etiologies of shock?
A
1) Inadequate volume (hypovolemia): decreased blood volume = decrease in preload, which causes stroke volume and cardiac output to fall. Decr. in cardiac output drops systolic blood pressure (which is responsible for transporting the oxygenated blood throughout the systemic circulation). Decr. in systolic BP=inadequate tissue perfusion.
a. Hemorrhage=Loss of blood. Needs increase in blood volume to restore adequate perfusion. Losing whole blood= Needs administration of packed red blood cells and plasma to incr. oxygen-carrying capability of blood and improve pressure and perfusion.
b. Non-hemorrhage or hypovolemic=Loss of plasma/fluids. Resulting from excessive urination/diarrhea/burns/vomiting. Needs to have the fluid or water portion of his blood restored.
2) Inadequate pump function: if the pump fails, regardless of blood volume, delivery of oxygen and glucose to cells will decr.
Pump function failure results from injury to the heart that reduces its ability to generate contractions strong enough to push the blood forward throughout the body. Ex. heart attack. Can also be caused by mechanical obstruction of movement of blood. Pt requires improvement of pump function to eliminate shock state.
3) Inadequate vessel tone: tone is related to the size of the vessel and the resistance created within it and is referred to as systemic vascular resistance/peripheral vascular resistance. As vessel size decr., resistance incr. result is an increase in BP, which is governed by both CO and SVR. Incr. vessel size=reduced pressure and reduced preload and cardiac ouput, decr. in BP and diminished tissue perfusion.
4
Q
- What are the 5 categories of shock? Pathophysiology of each? Examples of each?
A
- Hypovolemic shock=shock caused from a low blood volume. The most common form of shock. Can be due to blood loss or loss of some other body fluid. Basically any condition or injury that results in a reduction in fluid decreases blood content or fluid portion.
a. Most common=hemorrhage=loss of whole blood (ex. laceration, bleeding from gastrointestinal tract)
b. Non-hemorrhagic=hypovolemia associated w/ fluid loss from burns and dehydration - Distributive shock = associated with a decrease in intravascular volume caused by massive systemic vasodilation and an increase in capillary permeability. No fluid loss or blood loss but rather a relative reduction in volume because vessels incr. in size. Decr. in tissue perfusion.
- Cardiogenic shock = ineffective pump function of the heart. Adequate blood volume and vessel tone, but hypoperfusion because the heart cannot contract effectively.
a. Left ventricle fails to generate enough force to eject sufficient blood from the chamber into the system circulation, reduction in stroke volume, cardiac output, and systolic blood pressure; poor tissue perfusion - Obstructive shock = condition that obstructs forward blood flow. Volume is adequate, heart is not damaged, and vessels are of a normal size with adequate resistance. An obstruction is not allowing the blood to move forward. Large clot that will prevent adequate amount of blood from getting to lungs (pulmonary embolism) will prevent an adequate amount of blood from getting to left atrium and left ventricle, reducing preload and stroke volume, cardiac output, systolic BP, and tissue perfusion.
- Metabolic or respiratory shock: dysfunction in ability of oxygen to diffuse into blood, be carried by hemoglobin, off-load at the cell, or be used effectively by the cell for metabolism.
a. Ex. poison like cyanide, CO poisoning, etc.
5
Q
- What is MODS? When does it occur? How might it be related to disseminated intravascular coagulation (DIC)?
A
MODS - Multiple organ dysfunction syndrome
Occurs - When multiple organs begin to fail throughout the body from extreme and prolonged hypoxia, altered metabolism, and evaluated carbon dioxide and acid levels.
Relation between MODS & DIC - MODS is not a single event but a continuous process. One such event that might occur is the production of microemboli that begin to block capillaries throughout the body, leading to lung failure, kidney failure, and multiple organ failures. Clotting factors are used in the formation of the microemboli in the blood. The body responds to the clots by releasing substances to attempt to break them up. Because the clotting factors were used up in the formation of the microemboli, the substances that are released to break down the clots are unopposed in the body and lead to widespread uncontrolled bleeding from any wound that was previously clotted, from intravenous catheter sites, from mucus membranes, and from the skin.
6
Q
- Name three examples of obstructive shock, and explain the etiology of each.
A
Tension Pneumothorax - same as Pericardial tamponade → see below
Pulmonary embolism - A large clot that obstructs blood flow in the lungs will prevent an adequate amount of blood from getting to the left atrium and, subsequently, the left ventricle. This reduces the preload and decreases the stroke volume, cardiac output, systolic bp, and tissue perfusion.
Pericardial tamponade/Tension Pneumothorax - Prevent adequate ventricular filling and compress the heart. This reduces the preload, stroke volume, cardiac output, systolic BP, and tissue perfusion. Once the pressure is relieved, the heart regains its normal function. Although the pump function of the heart is disturbed, once the condition is reversed and the pressure on the heart is relieved, it functions normally.
7
Q
- What are the s/s of the following types of shock: hemorrhagic hypovolemic vs. burn vs. anaphylactic vs. septic vs. neurogenic vs. cardiogenic?
A
Hemorrhagic hypovolemic: low blood pressure, cool/pale/clammy skin, increased HR
Burn: increased HR, cool/pale/clammy skin, (similar to hypovolemic)
Anaphylactic: altered mentation, low blood pressure, airway concerns, swelling, angioedema (lips, tongue, epiglottis, bronchioles swelling)
Septic: low blood pressure
Neurogenic: loss of consciousness, low blood pressure, lowered HR
Cardiogenic: rapid HR, low BP, pale/cool/clammy skin
8
Q
- What are the 2 stages of shock? Signs/symptoms of each?
A
Compensatory: pale/cool/clammy skin, elevated HR and RR, slightly dilated pupils, narrow pulse pressure, anxious/restlessness, normal SBP
Decompensatory: BP dropping, altered mentation/unresponsive
IMPORTANT: the two s/s that indicate a shift from compensatory to decompensatory is altered mentation and decline in SBP
9
Q
- What 2 body systems play the biggest roles in the body’s response to shock? What does each do?
A
The nervous and endocrine system
Nervous: Sympathetic nerve stimulation; vasoconstriction
Endocrine: Releases Hormones; norepinephrine and epinephrine stimulate alpha-1 receptors on arterioles that cause vasoconstriction and regulate blood pressure
10
Q
- What are EMT treatments for shock?
A
- O2
- Stop any external bleeding
- Splint any fractures
- Supine position
- Blanket
6.Rapid Transport
11
Q
- What is the formula for determining the lower limit of the SBP for a child less than 10 yoa?
A
Low SBP = 70 + 2(age in years)
12
Q
- How does IV fluid replacement help hemorrhagic shock? What are its limitations?
A
IV fluid is a volume expander -> it takes the place of missing blood in vessels. The limitations are that it can’t carry oxygen to cells.
13
Q
- How do geriatric patients differ in their response to shock?
A
Geriatric patients have a slower compensatory period, but a faster decompensatory period
14
Q
- How do pediatric patients differ in their response to shock?
A
Pediatric patients have a faster everything (compensatory period, decompensatory period)
15
Q
What is meant by “mechanism of injury” and “index of suspicion”?
A
Mechanism of injury - Is the force or forces that cause injury when applied to the human body.
Index of suspicion - is defined in medicine as the level of suspicion that a disease or condition is the underlying diagnosis based on the available findings in the patient.
16
Q
What is the most significant factor in the transference of kinetic energy?
A
Rapid acceleration and deceleration
17
Q
How many collisions are there in a typical MVC? What occurs with each one?
A
First, the vehicle is suddenly stopped and gets bent out of shape. This is called the vehicle collision.
Next, the patient comes to a quick stop on some part or parts of the inside of the vehicle, such as the steering wheel, causing injury to the chest. This is called the body collision.
Finally, there is the organ collision in which the patient’s internal organs, which are all suspended in their places by tissue, come to a quick stop, sometimes striking an inside surface of the body (e.g., the inner chest wall or the inner skull).
18
Q
What are 2 pathways that might result from a frontal collision? What injuries are associated with each?
A
Abdomen: As abdomen strikes the dashboard or steering wheel, the liver, spleen, and hollow organs of the abdomen are compressed between the front and back abdominal walls and spine. The hollow organs are more easily displaced, leaving the solid liver and spleen to bear the brunt of the compression.
Chest: As the chest hosts the dashboard or the steering wheel, bones and soft tissues are both affected. The ribs and sternum can break, and the cartilage connecting the ribs to the sternum may separate. A torn intercostal artery can bleed 50 mL per minute into the chest cavity with no blood seen externally.
19
Q
What injury patterns might you expect with rear and lateral impact MVCs? With rollover?
A
Rear:
Whiplash (injury to the neck and spine) (Hyperextension: head is pushed back all the way or Hyperflexion: Head is pushed forward, nearly touches your dashboard) which can shift the brain vertebrate and can potentially break the neck and spinal chord (if there is no headrest).
Coup-contrecoup injury (Anterior and posterior bruise on the brain. Happens when head hits headrest so fast; the brain pushes against occipital and then the frontal bone, causing the bruises)
Lateral:
Can be deadly because of the extreme impact on the side of the car (less protection). Spinal injury, broken bones, blunt-force trauma. Neck, head, chest, pelvis injuries
Rollover:
Many injuries, Both head on and lateral injury patterns, Multiple system injuries, Ejection (death 25x more likely), Crushing injuries, injuries to head, neck, spine, face, eye, arms from airbags
20
Q
In a vehicle vs. pedestrian collision, what injury differences might you expect between child vs. adult?
A
Adults turn away from vehicle (side impact, thrown onto hood): leg, back, torso, shoulders, arms, abdomen, head, and neck injuries
Children turn toward vehicle (front impact and are so small they’re thrown forward and ran over) and tend to have Waddell’s Triad: femur, chest/abdomen head injuries
The extent of injury pedestrians experience depends on how fast the car is going, what part of the pedestrian’s body was hit, how far they were thrown, what surface they landed on, and the body part that first hit the ground
21
Q
What is the proper position for a car seat?
A
Secured rear facing in the back seat
Reclined 45 degree angle
22
Q
What injuries might you expect from seatbelts? From airbags?
A
Head, neck, spine, face, eye, arms
23
Q
What are some limitations of airbags?
A
Airbags only work once.
The driver may still hit steering wheel after deflation.
Front airbags don’t protect from side impact.
24
Q
- What are 3 questions you need to ask regarding any fall?
A
Distance, surface, and body part impacted first
25
What constitutes a severe fall for an adult vs. child?
Adult - A fall of 20 feet onto an unyielding surface is considered severe for an adult.
Child - A fall of 10 feet, or 2-3 times the height of the child, can cause severe injuries to a child.
26
What injuries might you suspect with feet-first falls? With head-first falls?
Feet first: fractures of the heels, ankles, tibia/fibula, femur, knee dislocations, hip injury, and spine compressions.
Head first: colle’s or smith’s fracture, elbow injury, shoulder dislocation, clavicle fractures, and damage to the cervical spine.
27
What MOI details are important to gather regarding a knife injury?
How far into the body it penetrates
The angle of penetration
Slice vs. stab
Underlying organs
The cone of damage
28
What is cavitation? How does this relate to the entrance vs. exit wounds of a bullet?
When a bullet travels through tissue, it creates a cavity, but there is also air pressure that is moving perpendicular to the bullet that is about 4x the width of the bullet. This creates a temporary cavity. This cavity then recedes and leaves a cavity that is about twice the size of the bullet.
This means the trauma caused by the bullet will be about 4 widths of the bullet
Because of cavitation, the exit hole of a bullet is larger than the entrance wound. The skin is pushed outwards and oftentimes we see tearing or splitting.
29
15. What are the 5 phases of a blast? What injuries occur in each?
Primary - Due to pressure wave of the blast, it affects gas containing organs such as lungs, stomachs, inner ears, sinuses. Severe damage and death can occur without signs of external injury.
Secondary - Flying debris propelled by force of blast. Obvious injurys like lacerations, impaled objects, fractures, and burns
Tertiary - When a patient is thrown away from a blast. Injuries are similar to ejection from a vehicle. The pattern depends on distance thrown and the point of impact
Quaternary - Result from structural collapse; something landing on top of someone
Quinary - Result of chemicals/toxins/bacteria/radiation; something comes upon one after landing
30
What is the meaning of the “golden period”? “Platinum 10”?
The “golden period” has been established as a parameter for emergency care because severely injured patients have the best chance for survival if intervention takes place as quickly as possible from the time of injury
Some EMS systems refer to the “platinum 10 minutes.” This means that in cases of severe trauma, 10 minutes is the maximum time the EMS team should devote to on-scene activities—with patient assessment, emergency care for life threats, and preparation for transport all being accomplished within 10 minutes of arriving on the scene. The patient should be loaded into the ambulance and transport should begin within 10 minutes after arriving on the scene of a severely injured or multisystem trauma patient.
31
How much blood volume does an average size adult have?
5 liters
32
What difference in bleeding does it make when a vessel is cut at 90 degrees vs. lengthwise?
90 degrees will bleed less because vessels will contract and dilate better
33
. What are the differences between these bleeds: arterial vs. venous vs. capillary? Which are major bleeds?
Arteries: Spurting blood, pulsating flow, bright red color
Oxygen rich
Pulsating - Coincides with force of contraction of the heart
Most difficulty to control from high pressure in arteries
Veins: Steady/slow flow, dark red color
Dark red - Deoxygenation
Steady.slow flow - Veins under less pressure
More profuse, but easier to control
Capillaries: Slow, even flow
Dark red
Slowly comes up
Easily controlled with pressure
Clots spontaneously
34
4. How do you control an arterial bleed? What is the first thing an EMT should do?
This bleeding is identified as bright red, spurting blood from a wound usually indicates a severed or damaged artery. The blood is bright red because it is rich in oxygen. Spurting generally coincides with the pulse or contraction of the heart.
Controlling this can be difficult because of the higher pressure in the arteries; although the muscular walls can assist in hemostasis. Constant, hard, direct pressure of 20 minutes or more can be required to stop the arterial bleeding.
35
When is a tourniquet indicated? How do you apply it?
Indication - When external bleeding to an extremity is not controlled with direct pressure the immediate next step is to apply a tourniquet.
Application - Steps below
1. Wrap the tourniquet around the extremity at a point just proximal to the bleeding.
2.Tighten the tourniquet until the hemorrhage ceases and secure the device in place.
3.Write the time of the tourniquet application on tape and secure it to the tourniquet.
4. If bleeding continues, tighten the tourniquet
5. Notify the receiving medical facility that a tourniquet has been applied.
36
What is a hemostatic agent? How is it administered/applied?
Hemostatic agents are designed to improve clotting and control life-threatening hemorrhage that can’t be controlled with direct pressure. These agents come in two form: (1) a dressing, gauze, or sponge that is impregnated with the hemostatic agent and (2) a powder or substance that is poured directly into the wound.
Powder type hemostatic agents are no longer recommended for prehospital use
After the wound is packed with the hemostatic gauze, sponge, or dressing, it is recommended that a minimum of 3 minutes of direct pressure be applied.
37
Where on the body might a hemostatic dressing be used to pack a wound?
The hemostatic agents are used for bleeding that can’t be controlled with direct pressure in wounds to areas of the body where a tourniquet can’t be applied.
38
When/where do you use an occlusive dressing?
Occlusive dressings create an air tight seal for an open abdominal or chest wound (3 sided dressing) or large neck wound. Petroleum occlusive dressing prevents adhering to open wound. Dressing (should be sterile) covers an open wound to control/aid the bleeding and prevent further damage and contamination
39
How can a splint help with internal bleeding?
Splinting the extremity can assist with control of bleeding associated with a possible fracture because the splint can decrease movement at the site of the bleeding wound
40
What are the s/s of blood loss? What is the earliest sign?
Pale/cool/clammy skin, rapid heart rate (first sign) , weak/thready pulse, narrow pulse pressure, lightheadedness/dizziness/confusion, rapid shallow breathing
Always suspect internal bleeding when penetrating wounds to skull, chest, abdomen, or pelvis; unexplained signs of shock
41
. What is a contusion vs. hematoma vs. abrasion vs. avulsion vs. laceration vs. crush vs. amputation?
Abrasion: scraping of epidermis, usually just capillary bleeding, extremely painful due to exposed nerve endings
Laceration: cut/incision in skin, may be deep
Avulsion: torn flap of skin hanging loose, bleeding may or may not be severe, prolonged healing
Amputation: body part completely removed/body part is “discontinued” (can still be partially attached still, but do not complete amputation)
Crush: usually result of blunt trauma or crushing forces, consider underlying organs and internal bleeding, open or closed
Contusion: bruise (black and blue discoloration is called ecchymosis), injury to tissue/vessels in dermis
Hematoma: similar to bruise but damage to larger vessel and larger amount of tissue, large lump with bluish coloration due to pooling of blood
42
What is a linear vs. stellate laceration? What type of trauma most often causes each?
Linear: smooth and regular, caused by knives, razors, broken glass
Stellate: jagged and irregular, caused by blunt objects. Edges of wound will be jagged. Healing process will be prolonged.
43
What is the treatment for an avulsion?
Rinse off wound to clear surrounding debris
Apply dressing and bandages to keep the avulsed tissue in place.
Splint the extremity to limit movement.
44
What is epistaxis? How do you control it?
Definition - epistaxis is a nosebleed
Treatment - consider the MOI, consider the airway. Make the patient lean forward, and apply pressure, pinch the nostrils, and use a cold pack for the nose. Make sure the patient does not blow their nose during/after the injury for at least 12 hours.
45
What is a clamping injury? How do you treat it? Why is it important to try to remove the clamping object?
Clamping injury - A clamping injury is defined when a body part is caught or strangled by some piece of machinery, a tool, or other object, or equipment.
Treatment - In general, if a body part is trapped in a clamping object and the patient is stable, apply a lubricant and slowly attempt to wiggle the part loose. If possible, evaluate the body part above the level of the patient's head to decrease circulation pressure as you attempt to remove the part.
Importance of removal-
Timing is an important factor because the longer a part remains clamped, the more damage there can be. Also, edema makes removal more difficult over time.
46
How do you treat/bandage an evisceration?
Do NOT touch the organs
Cover the wound with sterile dressing moistened with water or saline. The dressing needs to be large enough to cover all of the organs
Use sterile gauze to cover the moistened dressing with occlusive dressing taped on all four sides
Maintain the temperature with bulky dressing
Use fiber-free abdominal dressing
Flex the patients hips and knees
47
What is the major risk of an open neck wound? What specific condition might this cause?
A major risk of an open neck wound is air embolism which can lead to pulmonary embolism.
48
How should you treat an open neck wound? What is the first thing you should do?
Place a gloved hand over the wound to control bleeding. (First thing you should do)
Apply an occlusive dressing, which should extend beyond all wound edges to avoid air or part of the dressing being sucked into the wound. Tape the dressing on all four sides.
Cover the occlusive dressing with a regular dressing.
Apply only enough pressure to control the bleeding. Compress the carotid artery only if it is severed and it is necessary to control bleeding.
After bleeding is controlled, apply a pressure dressing, taking care not to restrict airflow or compress the major blood vessels in the neck. Such a dressing should not be applied circumferentially around the neck. (Direct pressure is preferred.)
If there is a suspected spinal injury, provide appropriate spine motion restriction. Spinal injury should always be suspected with any significant injury or MOI to the neck.
49
How do you treat/bandage an amputated digit? What do you do with the amputated part?
Remove any gross contamination by flushing with sterile water or saline. Never immerse the part in water or sterile saline because this can damage it.
Apply direct pressure to the stump to control bleeding. Apply sterile dressings and bandages
Wrap the part in a dry sterile gauze dressing. (Check with local medical direction, which can dictate the use of moist dressings instead.)
Wrap or bag the amputated part in plastic. Place it in a watertight plastic bag or plastic wrap in accordance with local protocol. Do not allow the amputated part to be immersed in the water. Label the bag with the patient’s name, date, and time the part was wrapped and bagged.
Keep the amputated part cool. Place the wrapped and bagged part in a cooler or other suitable container with an ice pack or ice on the bottom to keep the part cool. Do not place the part directly on the ice pack or ice to avoid any possibility of freezing the part. The container should also be marked with the patient’s name, date, and body part.
Transport the part with the patient, if possible. In some cases, however, this might not be possible, especially when the part has not been located. In this instance, arrange for immediate transport of the body part, after it is found, to the same facility to which the patient has been transported.
Note: If an amputation is incomplete and the body part is still partially attached, do not complete the amputation. Care for the wound as previously described, but also make sure that the partially amputated part is not twisted or constricted. Immobilize the injured area to prevent further injury.
50
What special considerations should you have for a dog bite?
Infections -> Wash/dress/bandage
Even if not transported, many patients with bites and other open soft tissue injuries should receive tetanus prophylaxis within 72 hours of injury
51
When can you remove an impaled object?
Only if it is obstructing airway
52
What is the difference between dressing vs. bandage?
Dressing is completely sterile, goes on wound for bleeding control/prevention of contamination
Banading; non-sterile (yet clean), holds dressing in place
53
What are some factors that may increase bleeding?
Some of these factors include: movement, coldness, anticoagulant meds, & removal of bandage
54
What are the 3 layers of the skin? What layer contains most nerve receptors?
Layers of skin: Listed below
Epidermis - Outermost layer
Dermis - middle layer
Hypodermis (also called the subcutaneous layer) - the innermost layer of the skin
Most nerve receptors - The dermis
55
What kills most burn patients in the prehospital setting? What kills them later?
Pre-hospital setting - In burns with over 40% of the total body surface area, 75% of all deaths are currently related to sepsis from burn wound infection or other infection complications and/or inhalation injury.
Death at hospital setting - Sepsis infection from the burn.
56
Why is a patient with a significant burn susceptible to hypothermia?
Patients with significant burns are prone to hypothermia due to the loss and degradation of skin–a large component of thermoregulation in the body
57
What is “burn shock”? What is its pathophysiology? When does it occur?
A condition that can occur with moderate to major burns that cover sufficient body surface area (BSA) is called burn shock. Burn shock, which develops only after the first few hours, results from extensive vascular bed damage that allows both fluid and protein molecules in the plasma to leak into surrounding tissues.
The loss of plasma proteins causes the normal fluid balance of the rest of the vascular system to become disturbed and, as a result, blood plasma starts to seep from all capillary beds (even those not involved in the burn itself). The result is a large fluid shift out of the vessels and into the spaces surrounding the cells to a point where the total vascular volume is insufficient to meet the body’s needs. This also explains the extensive swelling seen in the burn patient.
In the first 24 hours after a burn injury, because of the fluid loss from the vessels into the tissues, the edema can cause the body to swell to double its normal size.
58
What are the classifications of burns by depth? What are the s/s of each?
Superficial (1st degree burn): Injury involves only epidermis, skin appears red, pink and dry, some swelling may occur, no blisters, skin is soft and tender to the touch. May be very painful because pain receptors in underlying dermis to the skin is still intact. Examples: sun burn, minor skulled injury
Partial thickness (2nd degree burn): Involves epidermis and portion of the dermis, damage to small blood vessels cause plasma and tissue fluid to collect in between the layers of the skin and form blisters, patient may still complain of burns because pain receptors are still intact. May be further classified as superficial partial thickness and deep partial thickness
Full thickness (3rd degree burn): Involves all of the layers of the skin. Skin becomes dry, hard, tough, and leathery, and may appear white and waxy to even dark brown to black and chard (the tough and leathery dead soft tissue formed in a full thickness burn: called eschar)
59
Why is there no pain at the site of a full-thickness burn?
Because nerve endings have been destroyed. Second degree burn around them, however, can be extremely painful
60
What is a “critical” burn?
A critical burn requires immediate medical attention and are potentially life threatening, disfiguring, and disabling
Burns to face, eyes, ears
Hands and feet
Genital or groin
Major joint function like hips or shoulders
61
Why are circumferential burns critical?
Encircle a body area
Circulatory compromise (decreased or complete lack of consciousness) and nerve damage due to swelling of tissue
62
What is the “rule of nines”? For adults vs. children?
Body part
adult
child
Head and neck
9%
18%
Posterior trunk
18%
18%
Anterior trunk
18%
18%
Each upper extremity
9%
9%
Each lower extremity
18%
14%
External genitalia
1%
n/a
63
What is the “rule of palms”?
Rule of palms - An alternative way to determine the BSA estimate is to compare it to the patient’s palm surface area with the fingers closed, which equals approximately 1% of the BSA. Also known as the rules of ones.
64
What needs to be done for a burn victim during the primary assessment and within 10 minutes of a burn?
Removing the patient from the burn source does not completely stop the burning process. Both injuries need to be “cooled down” within approximately the first 10 minutes of injury. Stop the burning process initially by using water or saline. As you work to stop burning, attempt to remove any smoldering clothing and any constricting jewelry, which produce heat and might constrict swollen extremities. Cure around clothing still adhering to the patient. Do not attempt to remove the adhered portion, b/c can cause further damage to soft tissues.
Afterwards: continue primary assessment and patient’s airway, breathing, oxygenation, and circulation. Look for indication that airway might be compromised (sooty deposits in mouth or nose, singed facial or nose hairs, signs of smoke inhalation, facial burns). SpO2 might give false high reading b/c of CO in blood.
65
How long should you cool a burn before dressing/bandaging it? Should you use water or ice?
Cool a burn for 60-120 seconds only using water
66
What are the s/s of inhalation injury on a burn victim?
Singed nasal hairs, possible colored/swollen tongue, hoarse voice, specks in the sputum, edema/swelling
67
How might a partial or full-thickness burn lead to compartment syndrome?
Partial thickness circumferential burns or full-thickness burns can lead to compartment syndrome from the edema collecting beneath the burn area
68
How do you treat dry vs. liquid chemical burns?
Dry chemical burn:
Remove affected clothing, brush off dry chemical, then irrigate with large amounts of water.
Liquid chemical burn:
Remove affected clothing; irrigate with large amounts of water if the chemical is one that does not react to water.
69
How do you bandage a burn? What is the advantage of bandaging a burn?
Sterile dry fluffy dressing (antimicrobial okay)
Avoid wet dressing—contributes to hypothermia
Burn sheet PRN
Reduces infection risk
Helps reduce pain
70
How do you treat a chemical burn to the eye? How long should you flush this?
Flush the eye with water for 20mins
71
What special consideration should you give to a patient with an electrical burn?
Electrical currents can disrupt the heart’s electrical current, so if a patient has an electrical burn, they may go into cardiac arrest.
Monitor for cardiac arrest
Assess for muscle tenderness
Always assess for a source (entry) and a ground (exit) burn injury
72
What is the difference between ligament vs. tendon?
Ligament: connects bone to bone
Tendon: connects bone to muscle
73
What is the difference between fracture vs. sprain vs. strain vs. dislocation?
Fracture means there is an actual break in the bone
Sprain results in joint capsule injury (meaning ligament tear)
Strain results in a muscle (and possible tendon) tear
Dislocation is the displacement of bone from a normal position within the joint
74
What 2 bones constitute critical fractures? How much blood loss can each cause?
2 bones - The femur and the pelvis
Blood loss - Both listed below:
Femur - A patient can lose approximately 1, 500mL, or 1.5 liters, of blood around each femur.
Pelvis - It has been reported that the patient’s entire blood volume can be lost into a fractured pelvic compartment. The pelvis has a rich blood supply so a large amount of bleeding can occur from the fractured pelvic bone itself. When fractured, the pelvis loses its cylinder-like structure, creating a larger space. The shear force needed to fracture the pelvis also increases the potential for injury to the iliac vessels housed near the pelvis. If these vessels are torn, or ruptured, the predominantly venous bleeding will occur into the retroperitoneal space and into the expanded pelvic compartment. The large amount of blood that can be lost into the unstable and expanded pelvic compartment can easily lead to death.
75
What is crepitus?
Crepitus - The sound or feeling of broken fragments of bone grinding against each other, also known as grating.
76
What are the 6 “Ps” for assessing a fracture/dislocation?
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 extremit may 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.
77
What is compartment syndrome? What are its s/s?
Compartment syndrome can occur when an extremity is fractured or injured. It can also occur in the buttocks and abdomen of the body. When an injury occurs, swelling and bleeding in the space between the tissues are usually present. If the pressure in the space around the capillaries exceeds the pressure needed to perfuse the tissues, the blood flow is cut off and the cells become hypoxic, leading to compartment syndrome. The hypoxic cells release chemicals that cause the capillaries to leak, leading to further swelling. If the pressure continues, the cells eventually die, resulting in the loss of muscle, nerves, and vessels in the affected area.
s/s (HPPS)
Severe pain or burning sensation
Decreased strength in the extremity
Paralysis of the extremity
Pain with movement
Extremity feeling hard to palpation
Distal pulses, motor, and sensory function possibly normal
78
What are the 2 basic reasons for splinting a bone/joint injury?
Bone injury: immobilize joint above/below. Joint injury: immobilize bone above/below.
Splinting prevents movement and reduces the chance of further injury. It reduces pain and minimizes complications (such as conversion of closed fracture to an open fracture; restriction of blood flow as a result of the bone ends compressing the blood vessels, excessive bleeding from the tissue damage, paralysis of extremities resulting from from damaged spine)
79
What are the general rules of splinting?
Check CSM (pulse, motor function, and sensation) before and after. Reassess every 15 minutes after application.
Immobilize joints below and above
Remove clothing/jewelry, especially distally because it can be entrapped by the swelling of the tissues
Cover all wounds including open fractures with sterile dressing
Align with gently manual traction for a limb that has severe deformity or extremity is cyanotic/lack of pulse before splinting. If pain/resistance/crepitus → Stop
Never intentionally replace bones or push them back in
Pad splints
Accomplish goal: immobilize above/below
Open wound→ dress→ bandage→ splint
Signs of shock → SMR→ transport → splint
80
When should you try to realign an extremity before splinting? When should you not do this?
One attempt to realign for extreme deformity or cyanotic extremity
Stop if there is pain/crepitus/resistance
Do not try to put a bone back in to the body
81
What are the indications for a (KTD) traction splint?
Mid shaft
Isolated
82
How do you splint a pelvic fracture? How do you move a person with a pelvic fracture?
Commercial pelvic binder
Can use improvised pelvic wrap, sheet wrap - fold sheet lengthwise to 8 inch width, slide under small of back and around pelvis, then take tails and twist tightly
83
What is a non-traumatic fracture?
Minimal movement. Pathological fracture: osteoporosis, cancer. Pt may lack typical: contusion, abrasion, lac, MOI, treatment: same as trauma
84
When should you splint an extremity fracture on a critical patient?
Immobilize the injured extremity during your primary or secondary assessment if the appropriate resources are available and it does not cause a delay in the transport of the patient, and transport immediately. If life-threatening condition is not directly related to the extremity injury, initiate transport immediately and immobilize the extremity en route if time and critical patient care permit.
85
How should you treat a nontraumatic fracture?
Same as trauma
86
Where are the meninges located?
Located in the skull, layers of tissue that protect the surface of the brain by enclosing it. Outermost is dura mater, composed of 2 layers of tough and fibrous tissue. Next layer is arachnoid. Beneath that is pia mater. Also enclose brainstem and spinal cord.
87
Where is the cerebrum? Cerebellum? Brain stem?
Cerebrum - The largest part of the brain and comprises three-fourths of the brain's volume. It is divided into two hemispheres.
Cerebellum - Is tucked underneath the cerebrum, it controls muscle movement and coordination.
Brain stem - This is tethered to the skull by numerous nerves and vessels, it controls most autonomic functions of the body.
88
How might the fascia found between the skull and scalp compromise your assessment of a head injury?
When palpating the skull, you might identify a depressed skull fracture that doesn't really exist. The reason for this is because the fascia, which lies beneath the scalp but above the skull can rupture/become depressed & feel like a depressed skull fracture. Conversely, blood can fill the area between depressed skull fracture and scalp, making the skull feel normal and not depressed during palpation.
89
What are the s/s of a basilar skull fracture?
Signs and symptoms of a basilar skull fracture - Temporal skull linear fracture (thinnest skull), CSF leaks from the ears/nose, raccoon eyes (late sign), battle scars (late sign/bruising behind ears by the mastoid process)
90
What are raccoon and battle signs? What do they indicate?
Raccoon eyes - A purplish discoloration of the soft tissue around one or both eyes. It usually indicates an intracranial injury. It is a delayed sign of a skull fracture that usually does not appear for up to 4-6 hours after the injury.
Battle signs - A purplish discoloration of the mastrid area behind the ear, and is another late sign of a basilar skull fracture.
91
What are the s/s of brain herniation?
Dilated or sluggish pupil on one side, weakness or paralysis, severe alteration in consciousness, abnormal posturing, abnormal ventilatory patterns, and Cushing reflex (increased systolic blood pressure and decreased heart rate)
92
What is Cushing reflex? What does it indicate?
Definition: your body will decrease heart rate (reflexive bradycardia) and increase SBP
Brain herniation
93
What is decorticate vs. decerebrate posturing? What do these indicate?
Decorticate: Arms are bent towards the body, legs are straight and feet are pointed inwards
Decerebrate: Head and neck arched backwards, the legs are straight and toes are pointed outward
Signs of increased intracranial pressure and that the brain is beginning to herniate
94
Why should you change your BVM rate for a patient with s/s of brain herniation? How do you titrate this rate to EtCO2 30-35 mmHg? If the EtCO2 is higher than this range, should you increase or decrease your rate of ventilations?
Blood pressure increases to increase cerebral perfusion, so it will be beneficial to the patient to hyperventilate (controlled hyperventilation of 20 bpm)
Ventilate to maintain an etCO2 of 30-35 mmhg
etCO2 > 35 mmHg, ventilate faster
etCO2 < 35 mmHg, ventilate slower
95
. What is an open vs. closed head injury?
Closed head - the scalp or skull can be lacerated but the skull remains intact and there is no opening to the brain. Brain damage within the intact skull can, nonetheless, be extensive. The amount of injury depends mainly on the mechanism of injury (MOI) and the force involved.
Open Head Injury - involves 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. It involves direct local damage to the involved tissue, but it can also result in brain damage from infection, laceration of the brain tissue, or punctures of the brain by objects that invade the cranium after penetrating the skull.
96
What is a concussion vs. contusion vs. subdural hematoma vs. epidural hematoma? What are the s/s of each?
Concussion - disturbance in brain function, ranging from momentary confusion to being unresponsive. A concussion is a mild diffuse axonal injury which, as just noted, involves stretching, tearing, and shearing of brain tissue. Generally, a concussion presents with an altered mental status that progressively improves.
s/s - Nausea, Vomiting, Confusion, Restlessness, retrograde/anterograde amnesia.
Contusion - A contusion, or bruising and swelling of the brain tissue, can accompany concussion. A contusion causes bleeding into the surrounding tissues and may or may not cause increased intracranial pressure, even in cases of open head injury. Contusion is usually caused by coup/contrecoup or acceleration/deceleration injury.
s/s -
Decreasing mental status or unresponsiveness
Paralysis
Unequal pupils
Vomiting
Alteration of vital signs
Profound personality changes
Subdural Hematoma - collection of blood between the dura mater and the arachnoid layer of the brain. It typically is due to low-pressure venous bleeding from small bridging veins that are torn during the impact to the head. Subdural hematomas are commonly associated with cerebral contusion.
s/s -
Weakness or paralysis to one side of the body
Deterioration in level of responsiveness
Vomiting
Dilation of one pupil
Abnormal respirations or apnea
Possible increasing systolic blood pressure
Decreasing pulse rate
Headache
Seizures
Confusion
Personality change (chronic subdural hematoma)
Epidural hematoma - In an epidural hematoma, arterial or venous bleeding pools between the skull and the dura. Bleeding usually rapid, profuse, and severe. The bleeding expands rapidly in a small space, causing a dramatic rise in intracranial pressure.
s/s
Loss of responsiveness followed by return of responsiveness (lucid interval) and then rapidly deteriorating responsiveness (a presentation that occurs in only 20 percent of cases)
Severe headache
Fixed and dilated pupil
Seizures
Vomiting
Apnea or abnormal breathing pattern
Systolic hypertension and bradycardia (Cushing reflex)
Posturing (withdrawal or flexion)
97
What is a coup-contrecoup injury? What kind of brain injury does it most often cause?
In coup/contrecoup injury, damage 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. It usually causes contusion
98
What is your target SpO2 for a patient with a head injury?
95% or above
99
How do you treat bleeding/drainage from the ears/nose?
lose dressing
100
How should you dress/bandage an open/depressed skull fracture?
none on a depressed skull
101
What are the 5 parts of the spinal column?
Cervical, Thoracic, Lumbar, Sacral, Coccyx
102
What are the different mechanisms of spinal injuries?
Hyperextension, Hyperflexion
103
What is the significance of assessing both light touch and pain on the extremities of a patient with possible spinal cord trauma?
If there’s an incomplete spinal cord injury, it can tell us what injury we are dealing with (central, anterior cord, brown-sequard)
Basically it can help us determine which tracts (motor, pain, and light touch) have been damaged
104
What is the difference between pain and tenderness?
Tenderness is simply pain upon touching or movement.
105
What are the s/s (signs/symptoms) of spinal cord injury and spinal shock?
Spinal shock: neuro compromise below injury, hypotension, decreased heart rate, warm/flushed skin below injury
Spinal cord injury: neuro-deficit (sensation/movement) below injury
106
What is priapism? How might a spinal cord injury cause this?
Involuntary erection, as spinal cord injury causes loss of sympathetic tone of blood vessels, which leads to vasodilation below injury site
107
What is neurogenic hypotension? How low do the BP and HR generally go with spinal shock?
Neurogenic hypotension - Results from an injury to the spinal cord that interupts nerve impulses to the arteries.
Bp - <90
HR - between 60-80 bpm
108
Where are the tracts for pain vs. motor vs. light touch found in the spinal cord?
Which tracts cross over upon entering the spinal cord?
Pain tracts - Carry impulses from pain receptors up the spinal cord to the brain. These are tested by applying pain to the patient.
Tracts that cross over upon entering the spinal cord- pain tracts
Motor tracts - These carry impulses down the spinal cord and out to muscles. As the name implies these are tested by having the patient move.
Light touch tracts - These tracts carry light touch impulses from sensory receptors up the spinal cord to the brain. These tracts are tested by applying light touch to the patient.
109
What are the s/s of anterior cord syndrome?
Loss of motor function and pain, temperature, and light sensations
110
What are the s/s of central cord syndrome?
Patients may present with weakness or paralysis and loss of pain sensation to upper extremities.
111
What are the s/s of Brown-Séquard syndrome?
The patient experiences motor and sensory losses below the injury site, but the distinctive feature of Brown-Séquard syndrome is that the effects differ on the two sides of the body. The patient loses motor function and light touch sensation on one side but loses pain sensation on the opposite side.
112
What extremities should be evaluated in order to assess injury to the cervical spine? To the lumbar spine?
Upper extremities: Cervical spine
Lower extremities: Lumbar spine
113
What is the primary purpose of a c-collar?
Cervical collar. For the patient with an altered mental status or one who cannot obey your commands, or if the patient complains of pain or tenderness to the vertebral column, following your assessment of the neck, apply the cervical collar. For the patient who is self-restricting, the cervical collar should be applied only after the spinal exam is completed and a positive finding is present
114
What type of SMR should be applied to a patient involved in an MVC who is ambulatory on scene when you arrive?
LBB (long back board) → possible large injury
C-collar → possible spinal/neck injury
115
When should you remove a helmet and shoulder pads? How should you do this?
You should remove the helmet if your assessment reveals the following:
The helmet interferes with your ability to assess or reassess airway and breathing.
The helmet interferes with your ability to adequately manage the airway or breathing.
The helmet does not fit well and allows excessive movement of the head inside the helmet.
The helmet interferes with proper spinal immobilization.
The patient is in cardiac arrest.
Steps
Take the patient’s eyeglasses off before you attempt to remove the helmet.
One rescuer should stabilize the helmet by placing hands on each side of the helmet with fingers on the mandible (lower jaw) to prevent movement.
A second rescuer should loosen the chin strap.
The second rescuer should place one hand anteriorly on the mandible at the angle of the jaw and the other hand at the back of the head.
The rescuer holding the helmet should pull the sides of the helmet apart (to provide clearance for the ears), gently slip the helmet halfway off the patient’s head, and then stop.
The rescuer who maintains stabilization of the neck should reposition, sliding his hand under the patient’s head to keep the head from falling back after the helmet is completely removed.
The first rescuer should remove the helmet completely.
The patient should then be immobilized as described earlier.
116
What are the different parts of the eye?
Globe: eyeball; sclera is the rough outer coat covering it. Cornea is the clear front portion of the eye that covers the pupil and the colored portion, the iris. Pupil lets light into eye through the lens, focusing light on the retina, or the back of the eye. Inner surface of the eyelids and the exposed portion of the sclera are lined w/ a paper-thin covering called the conjunctiva, which does not cover cornea. Interior of eye contains anterior chamber. Bony structures of skull that surrounds the eyes are the orbits, or eye sockets.
117
How do you treat a chemical burn to the eye?
Immediately begin irrigation w/ water or saline. It need not be sterile but should be clean/hold eyelids open so all chemicals can be washed out from behind the lids. Continuously irrigate the eye for at least 20 minutes, or injury allows alkali, for at least an hour or until arrival at hospital. Use running water or continuous pouring from eyeball to outside edge.
118
When should you attempt removal of a foreign body in the eye?
Should attempt removal only of objects in the conjunctiva, not of those on the cornea or lodged in the globe. Generally safer to transport pt for further medical evaluation than to attempt to remove foreign particles from the eye in the field.
119
How do you treat an impaled object in the eye?
Impaled objects to the eye should not be removed. We should stabilize the object to prevent accidental movement or removal until the patient receives further medical attention.
120
When are cold packs indicated for eye injuries? When should they be avoided?
Indication of cold packs- If it is an orbit issue and no eyeball injury is suspected.
Contraindications of cold packs- You can not use an ice pack on a suspected eyeball injury.
121
How do you treat a laceration to the globe of the eye?
Consider contact lens
cover/ transport supine
In the field we can apply patches lightly to both eyes unless a ruptured eyeball is suspected.
We DO NOT use an ice pack for these injuries.
122
How do you treat a laceration to the eyelid?
Control bleeding with light pressure only if there is no suspected eyeball injury
Cover the lid with sterile gauze soaked in saline to prevent drying
Preserve any skin and transport it with the patient if possible to be used for grafting
If there is no eyeball injury then cover the eye with a cold compress
Cover the uninjured eye with a bandage to prevent movement
123
When should you remove contact lenses?
When determining whether to remove a contact lens, seek medical direction and follow local protocol
Generally, remove contact lenses if: there has been a chemical burn to the eye, if the patient is unresponsive, if the patient is wearing hard contact lenses, or if the transport time is delayed/lengthened
Do not remove the lenses if: the eyeball is injured or if transport time will be short
124
How should you handle an avulsed tooth?
Locate/transport the tooth
Rinse the tooth with sterile saline and gently remove debris
Transport the tooth in a cup of saline or wet gauze, do not let it dry out
Do not touch the tooth by the root
Control bleeding from the tooth socket with a gauze pad
125
How should you treat an object impaled in the cheek?
Remove it because it can block airway. Then treat like normal.
126
When should you remove dentures from the mouth of a trauma patient?
If they are loose or fragmented.
127
Aside from blood loss, what special concern should you have for a patient with a lacerated jugular vein? What specific condition might this cause?
A jugular vein laceration can permit development of an air embolism, because venous pressure drops below atmospheric pressure during deep inhalation if the patient is breathing spontaneously. In that circumstance, the negative pressure in the vein may suck in air
128
How do you dress/bandage a neck laceration?
Cover with occlusive dressing to prevent air embolism
129
How can you secure a pressure bandage to the neck?
Secure bandage tightly over dressing but do not restrict blood flow
130
What is the cardiac box?
The area of the chest overlying the heart (bounded by midclavicular lines laterally and from the clavicles to tip of xiphoid).
131
What is the first thing you should do to treat an open chest wound?
What is the first thing you should do to treat an open chest wound?
132
What is a pneumothorax? Open pneumothorax? Tension pneumothorax? What are the s/s of each?
Pneumothorax: air in pleural space, collapses lung (s/s: pleuritic chest pain, respiratory distress, decreased lung sounds on affected side)
Open pneumothorax: same as pneumothorax, but w/ sucking chest wound
Tension pneumothorax: causing mediastinal shift (kinks vena cava) (s/s: respiratory distress, falling BP, decreased LOC, tracheal deviation etc.)
133
What are the s/s that a pneumothorax is progressing to a tension pneumothorax?
Absent breath sounds, tracheal deviation (distended neck veins), and subcutaneous emphysema
134
What defines a flail segment? How do you treat it?
Flail segment - A common life-threatening injury that occurs when two or more adjacent ribs are broken in two or more places. This creates a segment of the chest that is unattached to the rest of the rib cage.
Treatment for a flail segment includes CPAP or positive pressure ventilation using a BVM with supplemental oxygen is the ideal treatment. It expands the alveoli that are collapsed, greatly reducing the amount of hypoxia.
135
What O2 treatment is contraindicated for pneumothorax? Why?
CPAP because it can cause further injury from the machine using air pressure generated during the use of CPAP could force air into the cranial vault.
136
What is pulmonary contusion? How do you treat it?
Pulmonary contusion - Bleeding within the lung tissue is often a serious consequence of a flail segment or other bunt force trauma that can lead to death.
Treatment- Use of CPAP
137
What is a hemothorax? What are its s/s?
A hemothorax can be the result of blunt or penetrating trauma to the chest and can be associated with open or closed injuries. The bleeding usually originates from lacerated blood vessels in the chest wall or chest cav- ity caused by penetrating objects or fractured ribs. The patient can lose a significant amount of blood in the chest, which results in severe shock.
S/S
Early signs and symptoms of hemothorax are usually the same as for shock.
Signs and symptoms of respiratory distress develop late.
Bleeding in and around the lung commonly produce a pink or red frothy sputum when the patient coughs.
138
What causes traumatic asphyxia? What are its s/s?
Traumatic asphyxia occurs when severe and sudden compression of the thorax causes a rapid increase in the pressure in the chest. The heart and lungs are usually severely compressed by the sternum and ribs, causing a backflow of blood of of the right ventricle and into the veins of the head, shoulder, and upper chest.
S/S
Bluish or purple discoloration of the face, head, neck, and shoulders; jugular vein distention; bloodshot eyes that are protruding from the socket; cyanotic and swollen tongue and lips; and bleeding of the conjunctiva (area found under the lower eyelid).
139
What is commotio cordis? What is the best treatment for this?
Sudden cardic arrest from blunt force aplied to the precoridal are of the anterior chest (center of the sternum)
Emergency care is focused on provide effective CPR and early defribrillation
140
What is pericardial tamponade? What are its s/s?
Definition: blood leaks into the pericardial sac. This sac cannot expand outward, so there is an inward pressure on the heart. This causes decreased heart expansion and decreased cardiac output
s/s: JVD, tachycardia, narrow pulse pressure, pulsus paradoxus, decreased BP, clear BS
141
What is pulsus paradoxus? When should the EMT first detect this? Name two conditions that can cause this.
Definition: a weakened pulse when the patient inhales due to decreased blood through the heart so decreased cardiac output
Two conditions: pericardial tamponade and tension pneumothorax
142
What is subcutaneous emphysema? What causes it? Where is it most likely to be found?
Definition: when air gets into the tissues under the skin
143
What is Kussmaul sign? Name two conditions that can cause this.
Paradoxical increase in jugular venous pressure on inspiration or failure of appropriate fall in JVP with inspiration
Happens due to limited right ventricular filling
Constrictive pericarditis
Major pulmonary embolism
144
What kind of dressing should you apply to an open chest wound?
Gloved hand to wound, occlusive dressing taped x3 sides
145
What are the major organs/structures in each of the 4 abdominal quadrants?
Right upper quadrant
Liver → solid organ
Gallbladder → hollow organ
Pancreas → solid organ
Colon
Right kidney
Left upper quadrant
Liver
Spleen → solid organ
Left kidney → solid organ
Stomach
Colon
Pancreas
Right lower quadrant
Right kidney → solid organ
Colon
Small intestines → hollow organ
Ureter → hollow organ
Appendix
Major artery and vein to the right leg
Left lower quadrant
Left kidney
Colon
Small intestines
Major artery and vein to the left leg
Ureter
Also abdominal aorta and inferior vena cava
Hollow organs: stomach, gallbladder, duodenum, large intestine, small intestine, bladder
146
What organs are found in the retroperitoneal cavity?
Peritoneum is lining that surrounds the organs → retroperitoneal organs are those behind this lining
SAD PUCKER
Suprarenal (adrenal) glands
Aorta/inferior vena cava
Duodenum
Pancreas
Ureters
Colon
Kidneys
esophagus
rectum
147
What muscle separates the thorax and abdomen? How high can this muscle go when relaxed?
Diaphragm muscle separates the thoracic and abdominal cavities
Can be injured from penetrating injury or severe blunt force applied to abdomen
It is responsible for 60-70% ventilation
Right at nipple line right around T5 during exhalation
Diaphragmatic rupture → injury to abdomen is so severe that it pushes abdominal organs up into the diaphragm
148
What is Kehr sign?
Blood irritates the diaphragm
Pain in left shoulder indicates ruptured spleen
149
How much blood can be lost into the abdominal cavity before an inch of girth is added to the patient?
1-2 liters of blood loss in abdomen
150
What are Cullen and Grey Turner signs? What do these signs indicate? How long does it take them to develop?
Cullen sign: bruising around the umbilicus
Grey Turner sign: bruising around the flanks
Both indicative of internal bleeding
151
How do you treat an evisceration? What kind of dressing do you use?
Large open wound to abdomen → organs can protrude
Expose wound (cut away clothing if necessary) → position pt on back and flex legs slightly towards the chest if not suspecting spine injury (will reduce pressure of peritoneum) → dressing → administer high flow O2 and be prepared to treat for shock and
Treatment:
Don’t touch or replace
Dressing:
Moist (soak in saline on sterile water) and non-fibrous (not standard trauma dressing because those have lots of fibers)
Occlusive → plastic, taped on four sides
Will retain moisture
Maintain body heat
Prevent infection
Bandage: taped x4
Position:
Supine with knees bent if SMR (spinal injury)
Semi-fowlers with knees bent if no SMR
152
What is the treatment for a GSW to the abdomen?
dress/bandage with a 3 or 4 sided dressing, look for GSW exit
153
How do you treat genital injury to male/female?
Male genital injuries (lacerations, abrasions, avulsions, penetrations, amputations, and contusions) → treat like any other soft tissue injury
Bleeding: direct external pressure and cold pack, high flow O2 with NRB, carefully assess for signs of shock, and transport
Amputation: moist sterile dressing, take part in plastic bag, keep cool but no direct ice, transport part with patient
Female genital injuries (sexual assault, blunt trauma, straddle injury, abortion attempt, lacerations following childbirth, foreign body)
Bleeding: direct external pressure
Never pack vagina
Assess for shock
154
How should you transport an amputated penis?
Direct pressure on bleeding, apply cold pack to area
Wrap penis in moist sterile dressing, plastic bag, cool but not directly on ice
155
At what point should you place dressing inside the vagina to control bleeding?
Never
156
How does a cold compress help with genital injury?
* General diagnosis
Tearing sensation + strong radial pulse + absent pedal pulse → aortic dissection in abdomen
Bowel sounds on auscultation of chest → diaphragmatic rupture (penetration of abdominal organs into the thoracic space)
Intestines protruding through the skin → evisceration
Treat with fiber-free occlusive dressing taped on 4 sides
Abdominal trauma + increased HR + narrow pulse pressure → hemorrhagic shock (esp if diastolic pressure rises)
157
What special consideration should you have when applying SMR to a pregnant trauma patient?
Tilt the patient slightly to the left
158
At how many weeks of gestation should you begin to consider the possibility of supine hypotensive syndrome when a pregnant patient is placed on her back?
Supine Hypotensive Syndrome: when too much pressure is placed on the inferior vena cava, there is decreased preload to the heart
Consider at 20 weeks of gestation
159
What is abruptio placentae? What type of trauma most often causes it?
Definition: separation of the placenta from the uterine wall
Occurs from trauma, especially blunt trauma
160
What is your target SpO2 for a pregnant trauma patient?
100%
161
What are some special considerations that need to be made in assessing a pregnant trauma patient?
Check circulation regularly
Assessing the vaginal opening PRN: check for crowning or bleeding
Absorb the blood with external pads
162
What are some special considerations that need to be made in assessing a pediatric trauma patient?
Greater BSA
Larger heads and less neck stability
Higher metabolism rate could hide shock symptoms and they will fatigue factors
163
What type of injuries might be caused by shaken baby syndrome?
Severe internal brain injury/ swelling
164
What is the PAT? At what point is this done in your assessment?
PAT stands for the pediatric assessment triangle. It includes appearance, work of breathing, and circulation to skin
Tool to form general impression
165
What special considerations should you have when immobilizing a pediatric trauma patient? A geriatric trauma patient?
Pediatric trauma patient: during SMR, if the patient is <8 old, consider padding the shoulders to hips
Geriatric trauma patient: add padding around spaces, be aggressive with padding
166
10. What is the earliest sign of hemorrhagic shock for a pediatric patient?
Fast pulse
167
What is your target SpO2 for a pediatric patient? For a geriatric patient?
Pediatric: as close to 100% as possible
168
What is oftentimes your best source of information for a cognitively impaired patient?
The patient’s caregiver
