Trauma Overview Flashcards
Occur as a result of physical forces applied to the body
Trauma emergencies
Include illnesses or conditions, not caused by an outside force
Medical emergencies
Your awareness and concern for potentially serious underlying and unseen injuries
Index of suspicion
The way in which traumatic injuries occur
MOI
Describes the forces (or energy transmission) acting on the body that cause injury
MOI
Three concepts of energy that are typically associated with injury
- Potential energy
- Kinetic energy
- The energy of work
A force acting over a distance
Work
The energy of a moving object
Kinetic energy
Reflects the relationship between the mass of the object and the velocity at which it is travelling
Kinetic energy
Kinetic energy is expressed as ___
KE = 1/2 m X v^2
The product of mass, force of gravity, and height and is mostly associated with the energy of falling objects
Potential energy
Newton’s Laws of Motion
- Objects at rest tend to stay at rest and objects in motion tend to stay in motion unless acted on by some force
- Force equals mass times acceleration
- For every action, there is an equal and opposite reaction
Change in speed that occurs over time
Acceleration
As the object hits the ground, the kinetic energy is converted into ___
Work
Injury to more than one body system
Multisystem trauma
Examples of significant MOIs
- Multisystem trauma
- Vehicle crashes
- Car vs pedestrian
- Gunshot wounds
- Stabbings
Examples of nonsignificant injuries
- Injury to an isolated body part
- Fall without the loss of consciousness
Whether one or more body systems are involved, maintain a high index of suspicion for ___
Serious unseen injuries
Two categories of traumatic injuries
- Blunt trauma
- Penetrating trauma
The result of force to the body that causes injury without anything penetrating the soft tissues or internal organs and cavities
Blunt trauma
Results in injury by objects that pierce and penetrate the surface of the body and injure the underlying soft tissues, internal organs, and body cavities
Penetrating trauma
These may be the only signs of blunt trauma
- Skin discoloration
- Reports of pain
Motor vehicle crashes are traditionally classified as ___
- Frontal
- Rear-end
- Lateral
- Roll-over
- Rotational
Three collisions in a typical motor vehicle crash
- The car against another object
- The passenger against the interior of the car
- The passenger’s internal organs against the solid structures of the body
A brain injury that occurs when force is applied to the head and energy transmission through the brain tissue causes injury on the opposite side of original impact
Coup-contrecoup brain injury
Significant MOIs are suggested by the following findings in a vehicle crash
- Death on an occupant in the vehicle
- Severe deformity of the vehicle or intrusion into the vehicle
- Ejection from the vehicle
All children shorter than ___ should ride in the rear seat because of the airbag
4’ 9”
Rear-end impacts are known to cause ___
Whiplash injuries
Lateral impacts are known to cause ___
Lateral whiplash injuries
If there is substantial intrusion into the passenger compartment in a lateral crash, suspect your patient to have ___
Lateral chest and abdomen injuries on the side of the impact, as well as possible fractures of the lower extremities, pelvis, and ribs. In addition the organs within the abdomen are at risk because of a possible third collision
The most common life-threatening event in a roll-over
Ejection or partial ejection of the passenger from the vehicle
First steps in evaluating a car versus pedestrian accident
- Estimate the speed of the vehicle that struck the patient
- Determine whether the patient was thrown
- What surface the patient landed on
- What distance the patient was thrown
- Whether the patient was struck and pulled under the vehicle
- Evaluate the vehicle for structural damage that might indicate where the patient was hit
Other things to evaluate if the pedestrian was on a bike when struck by the car
- The position and damage to the bike
- Inspect the helmet for damage
- Assume the patient has a spinal injury
- When practical, roll the patient onto their side to allow an appropriate assessment of the posterior side of the body
Other things to evaluate if the person was on a motorcycle when struck by the car
- Deformity to the motorcycle
- Side of most damage
- Distance of the skid in the road
- Deformity of stationary objects or other vehicles
- Extend and location of deformity in the helmet
Four types of motorcycle impacts
- Head-on crash
- Angular crash
- Ejection
- Controlled crash
Angular crash on a motorcycle usually results in ___
Direct crushing injuries to the lower extremity between the object and the bike. Usually results in severe open and comminuted lower extremity injuries with severe neurovascular compromise, often resulting in traumatic amputation or requiring surgical amputation
A fall from more than ___ is considered significant
20 feet
A fall from more than ___ is considered significant for a child
10 feet (or 2 to 3 times the height of the child)
A vehicle crash faster than ___ is considered significant for a child
> 25 mph
Factors to take into account with a fall
- Height of the fall
- Type of surface struck
- Part of the body that hit first, followed by the path of energy displacement
First evaluation step for a penetrating injury
Determine the number of penetrating injuries and then combine that info with important things you already know about the potential pathway of penetrating projectiles to form an index of suspicion about unseen life-threatening injuries
The path the projectile takes
Trajectory
Results from the rapid changes in tissue and fluid pressure that occur with the passage of the projectile
Cavitation
Results from a stretching of the tissues that occurs with the pressure changes
Temporary cavitation injury
Results along the path where the projectile has passed through the tissue
Permanent cavitation injury
Air resistance is often referred to as ___
Drag
4 mechanisms of injury from explosions
- Primary blast injuries
- Secondary blast injuries
- Tertiary blast injuries
- Quaternary blast injuries
In a gunshot wound, shotgun wadding, bits of clothing, skin and hair driven into the wound can cause ___
Massive contamination
These injuries are due entirely to the blast itself
Primary blast injuries
Damage to the body that is caused by the pressure wave generated by the explosion
Primary blast injuries
___ organs are the most susceptible to the pressure wave
Hollow
Damage to the body resulting from being struck by flying debris, such as shrapnel from the device or from glass or splinters, which have been set in motion by the explosion
Secondary blast injuries
These injuries occur when the patient is hurled by the force of the explosion against a stationary object
Tertiary blast injuries
The physical displacement of the body is referred to as ___ when the body impacts the ground
Ground shock
This category of miscellaneous injuries includes burns from hot gases or fires started by the blast; respiration injury from inhaling toxic gases; suffocation; poisoning; medical emergencies incurred as a result of the explosion; crush injuries from the collapse of buildings; contamination wounds; radiation injuries; and mental health emergencies
Quaternary blast injuries
Evolved to detect minor changes in pressure
Tympanic membrane
The tympanic membrane will rupture at pressures of ___
5 to 7 psi above atmospheric pressure
Tissues most at risk in an explosion
Hollow organs and the junction between tissues of different densities and exposed areas
Organ system that is most sensitive to blast injuries
Ear
Signs and symptoms of blunt or penetrating trauma to the neck
- Noisy or labored breathing
- Increased respiratory rate
- Swelling of the face or neck
- Altered gag reflex
- Decreasing/low GCS score (<9 is severe)
- Decreasing/low Spo2
7.Rapid, weak pulse - Decreasing/low BP
Index of suspicion for blunt or penetrating trauma to the neck
- Significant bleeding or foreign bodies in the upper or lower airway, causing obstruction
- Be alert for airway compromise
Signs and symptoms of significant chest wall blunt trauma from crashes or penetrating trauma to the chest wall
- Significant chest pain
- Shortness of breath
- Increased respiratory rate
- Asymmetric chest wall movement
- Subcutaneous emphysema
- Decreasing GCS score (<9 is severe)
- Decreasing/low Spo2
- Presence of jugular vein distention
- Rapid, weak pulse
- Decreasing/low BP
- Loss of peripheral pulses during inspiration
- Narrowing pulse pressures
Index of suspicion for significant chest wall blunt trauma from crashes or penetrating trauma to the chest wall
- Cardiac or pulmonary contusion
- Pneumothorax or hemothorax
- Broken ribs, causing respiratory compromise
Accumulation of air or gas in the pleural cavity
Pneumothorax
Accumulation of blood in the pleural cavity
Hemothorax
Signs and symptoms of any significant blunt force trauma from vehicle crashes or penetrating injury
- Blunt or penetrating trauma to the neck, chest, abdomen, or groin
- Blows to the head sustained during a crash, fall, or other incident causing loss of consciousness altered mental status, inability to recall events, combativeness, or changes in speech patterns
- Inability to maintain airway
- Difficulty moving extremities; headache, especially with nausea and vomiting
- Decreasing GCS score (<9 is severe)
- Decreasing/low Spo2
- Rapid, weak pulse
- Decreasing/low BP or increasing BP with slow pulse
Index of suspicion for any significant blunt force trauma from vehicle crashes or penetrating injury
- Injuries in these regions may tear and cause damage to the large blood vessels in these areas, causing significant internal and external bleeding
2.
Index of suspicion for any significant blunt force trauma from vehicle crashes or penetrating injury
- Injuries in these regions may tear and cause damage to the large blood vessels in these areas, causing significant internal and external bleeding
- Be alert to the possibility of bruising to the brain and bleeding in and around brain tissue, which may cause the development of pressure inside the skull around the brain
Signs and symptoms of any significant blunt trauma, fall from a significant height, or penetrating trauma
- Severe back and/or neck pain, history of difficulty moving extremities, loss of sensation or tingling in the extremities
- Decreasing GCS score (<9 is severe)
- Rapid, weak pulse or slow pulse
Index of suspicion for any significant blunt trauma, fall from a significant height, or penetrating trauma
Injury to the bones of the spinal column or to the spinal cord
Damage to the ear from a blast injury can be used to assist in triaging patients as they indicate risk of pressure injuries to the ___
Lungs
A patient with pulmonary blast injuries may report ___
- Tightness or pain in the chest
- May cough up blood
- Tachypnea
- Other signs of respiratory distress
If there is any reason to suspect lung injury in a blast victim, administer ___
Oxygen to maintain an Sao2 of 94% to 99%
Avoid giving oxygen under positive pressure to a blast victim with a lung injury because ___
That may simply increase the damage to the lung or increase the size of the pneumothorax
One of the most concerning pulmonary blast injuries is ___
Arterial air embolism
Occurs on alveolar disruption with subsequent air embolization into the pulmonary vasculature
Arterial air embolism
Even small air bubbles can enter a coronary artery and cause ___
Myocardial injury
Air embolisms to the cerebrovascular system can produce ___
Disturbances in vision, changes in behavior, Changes in states of consciousness, and a variety of other neurologic signs
On-scene time with multi-system trauma should be limited to ___
10 minutes or less
Criteria to ID a critically injured patient
- Dangerous MOI
- Decreased level of consciousness
- Any threats to airway, breathing, or circulation
Trauma centers are classified into ___
Levels I to IV
A level ___ facility is a regional resource center and generally serves large cities or heavily populated areas
I
A level I facility must be capable of ____
Providing every aspect of trauma care from prevention through rehabilitation
Able to provide advanced trauma life support before transfer of patients to a higher level trauma center
Level IV trauma center
Able to provide prompt assessment, resuscitation, and stabilization of injured patients and emergency operations
Level III trauma center
Able to initiate definitive care for all injured patients
Level II trauma center
A comprehensive regional resource that is a tertiary care facility, capable of providing total care for every aspect of injury
Level I trauma center
Trauma centers are categorized as either ___ or ___ trauma centers, but not necessarily both
- Adult
- Pediatric
The trauma score calculates a number from ___
1 to 16
Most commonly used for patients with head trauma because it is weighted to compensate for major head injury without multisystem injury or major physiological changes
Revised trauma score
RTS
Revised trauma score
HEMS
Helicopter Emergency Medical Services
RTS score range
0 to 12
Factors to consider when determining if a patient is seriously injured and needs air transport
- Extended period of time required to access or extricate a remote or trapped patient who has evidence of serious injury, and access/extrication depletes the time window to get the patient to care by ground
- Needs medical care and stabilization at the ALS level, and no ALS care is available via ground
- Traffic conditions or hospital availability make transport time too long
- Mass-casualty incident with serious injuries
