Trauma Patients Flashcards
Bones
Hard, but flexible, living structures that provide support for the body and protection for vital organs
Axial Skeleton
Skull, sternum, ribs, spine
Appendicular Skeleton
Bones in the upper extremities (clavicles, scapula, arms, wrist, hands) & lower extremities (pelvis, thighs, legs, ankles, feet)
Periosteum
Strong, white, fibrous substance that covers bones
Mechanisms of musculoskeletal injury
Direct force, indirect force, or twisting/rotational force
Traction splint
A splint that applies constant pull along a lower extremity to help stabilized the fractured bone and reduce muscle spasm of the limbs
Comminuted fracture
A fracture where the bone is broken in several places
Greenstick fracture
An incomplete fracture
Angulated fracture
Fracture in which the bone segments are at an angle with each other
Dislocation
Disruption or “coming apart” of a joint (ligaments are stretched and torn beyond normal range of motion)
Sprain
Stretching & tearing of ligaments
Strain
Injury caused by overstretching and/or overexertion of the muscle
Closed extremity injury vs. Open extremity injury
Skin is not broken in closed extremity injury, skin is broken in open extremity injury (by injured bone or penetrating object)
Compartment Syndrome
Treatment & Stages
Injury caused when tissues such as blood vessels & nerves are constricted within a space as from swelling or tight dressing or cast. Treatment includes cold application and elevation of extremity after splinting.
Stages:
- Fracture or injury causes bleeding and swelling within extremity
- Pressure and swelling caused by the bleeding within the muscle compartment becomes so great that the body can no longer perfuse against the pressure
- Cellular damage causes additional swelling
- Blood flow to the area is lost. If not relieved, limb may be amputated
Crepitus
A grating sensation or sound when fractured bone ends rub together
The “Six Ps,” Indicating Musculoskeletal Injury
- Pain or tenderness
- Pallor (Pale skin, poor cap refill)
- Paresthesia (Pins & needles sensation)
- Pulses diminished or absent (at injured extremity)
- Paralysis
- Pressure
Emergency Care for Musculoskeletal Injuries
- Standard Precautions
- Primary Assessment (Don’t be distracted by gross injury)
- Secondary Assessment (Trauma), Apply C-spine collar if injury suspected.
- After life threatening conditions have been addressed, injured extremities can be realligned (when necessary) & splinted.
- Stable patient: Splint before transport
- Unstable patient: Immobilize on long spine board & splint specific injuries en route
- If appropriate, cover open wounds with sterile dressing, elevate affected extremity, apply cold pack
Manual traction
The process of applying tension to straighten and realign a fractured limb before splinting. Should only be applied when limb is cyanotic and distal pulse is not present.
Anterior hip dislocation
The patient’s entire limb is rotated outward and the hip is usually flexed
Posterior hip dislocation
Most common type; Patient’s leg is rotated inward, the hip is flexed, and the knee is bent. Foot hangs loose, unable to flex. Often lack of sensation in limb is present, indicates nerve damage.
Hip fracture vs. Pelvic fracture
Hip fracture is a fracture of the proximal femur, pelvic fracture is a fracture of the pelvis
Kinetic Energy=
[Mass * (Velocity)^2]/2
Knee dislocation vs. Patella dislocation
Knee dislocation occurs when the tibia is forced anteriorly or posteriorly in relation to the femur. A patella dislocation occurs when lower leg and knee are dislocated.
Multiple trauma verus Multisystem trauma
Multiple trauma= more than one serious injury
Multisystem trauma= more than one injury that affects more than one body system
Unstable Patients, Anatomic Criteria
Penetrating injuries to head, neck, torso, extremities proximal to elbow/knee, Flail chest, Two or more proximal long bone fractures, Crushed, degloved, mangled extremity, Amputation proximal to wrist or ankle, Pelvic fractures, Open or depressed skull fracture, Paralysis
Criteria for Unstable Patients, Physiologic Criteria
Trauma patient has altered mental status (Glasgow Coma Scale less than 14), hypotension (systolic less than 90 mmHg), abnormally slow or fast RR= high priority (29), difficulty maintaining patient airway
Criteria for Unstable Patients, Mechanism of Injury
Falls greater than 20 feet for adults (two stories), Falls greater than 10 feet for children (2 to 3X height of child), High risk auto crash (>12 in. occupant site, >18 in. any site), Partial or complete ejection from vehicle, Death in same passenger compartment, Vehicle telemetry consistent w/ high risk injury, Auto v. pedestrian where ped. was thrown, run over, or >20 mph impact, Motorcycle crash >20 mph
Outside Presentation of Pneumuenothorax
Diminished or absent lung sounds on one side, Respiratory distress, Elevated pulse, Possible injury on that side of the chest
Presentation of Tension Pnemuenothorax
Absent lung sounds on one side, Distended neck veins, Altered mental status, Narrowing pulse pressure, Increased pulse and respirations, Possible injury penetrating to chest, Tracheal deviation (late sign)
Cardiac tamponade
Distended neck veins, Narrowing pulse pressure, Increased pulse and respirations, penetrating injury to the chest
Solid organ damage
Can bleed profusely and cause shock, Capsules around solid organs can delay bleeding and pain (& therefore diagnosis), Often sharp and in predictable patterns/locations
Hollow organ damage
Spilling contents of organs causes pain and widespread irritation
Special Patient Considerations, Triage guidelines
Older adults (>55), children (should be sent to pediatric trauma centers), Anticoagulation & bleeding disorders, Burns (w/out trauma to burn facility, w/ trauma to trauma center), Time sensitive extremity injury, End-stage renal disease requiring dialysis, Pregnancy >20 weeks, EMS provider judgment
Trauma Score
A system of evaluating patients according to a numerical scale to determine the severity of a patient’s trauma.
Revised Trauma Score components: Glasgow Coma Scale, Systolic Blood Pressure, Respiratory Rate
Newton’s Law
A body at rests tends to stay at rest, and a body in motion will remain in motion unless acted upon by some outside force
Three Impacts of Motor Vehicle Collision
Vehicle collision (w/ object) Body collision (patient w/inside of car) Organ collision (Organs w/ chest or abdomen wall)
Primary phase of blast
Pressure wave of the blast. The injuries associated with this phase are primarily the organs that contain gases, such as the lungs, intestines, stomach, and ears.
Secondary phase of blast
Flying debris is propelled by the force of the blast or blast wind. Patients have lacerations, impaled objects, burns, and/or fractures.
Tertiary phase of blast
Patients are thrown away from the force of the blast, with injuries occurring as the patients strike whatever is behind them. The severity of injury depends on the distance thrown and the point of impact
Level I Trauma Center
Regional trauma center. Can manage all types of trauma 24/7 (24 hours a day, 7 days a week).
Level II Trauma Center
Area trauma center. Can manage most traumas; has surgical capabilities 24/7; is capable of stabilizing specialized trauma patients for transfer to Level I centers.
Level III Trama Center
Community trauma center. Has some surgical capability and specialized trained staff to manage trauma. The main focus of these centers is stabilization and transfer to a higher level center.
Level IV Trauma Center
Trauma facility. Typically a small community hospital in a remote area capable of stabilizing and transferring the trauma patient to a higher level trauma center.
Arterial bleeding
Arterial bleeding is usually bright red because it is still rich in oxygen. Arterial bleeding is often rapid and profuse, spurting and pulsating with each heartbeat because of the high pressure in the arteries. Strength of spurting decreases as the patient’s systolic blood pressure drops. It is the most difficult bleeding to control.
Venous bleeding
Venous bleeding is usually dark red or maroon because oxygen contained in the blood has already been passed to the cells, and cellular waste products have been absorbed into the blood. Bleeding from the veins usually has a steady flow and might be profuse, but it is typically easy to control because veins are under much lower pressure than the arteries.
Venous pressure might actually be lower than atmospheric pressure, which might cause large veins to suck in debris or air bubbles such as puncture wounds to the neck involving the jugular.
Capillary bleeding
Blood from the capillaries is usually somewhere between the bright red of arterial blood and the darker red of venous blood. Capillary bleeding is usually slow and “oozing” as a result of the small size and low pressure of capillary vessels. Most capillary bleeding is considered minor and is easily controlled. It often clots spontaneously or with minimal treatment.
Epistaxis
A nosebleed
Ecchymosis
Black & blue discoloration (bruise)
Central nervous system
Brain and the spinal cord
Cavitation
A cavity formed by a pressure wave resulting from the kinetic
energy of a bullet traveling through body tissue; also called
pathway expansion.
Dissipation of
energy
The way energy is transferred to the human body by the
forces acting upon it.
Drag
Factors that slow a projectile
Fragmentation
The breaking up of an object into smaller pieces on impact.
Profile
The size and shape of a projectile’s point of impact; the
greater the point of impact, the greater the injury.
Mechanism Of Injury (MOI)
The factors and forces that cause traumatic injury.
Vehicle collision
Vehicle strikes an object
Body collision
Patient strikes object/ inside of car
Organ collision
Organs strike abdominal wall/chest wall/skull wall/other organs
Frontal impact injury patterns (MVC)
- Up-and-over: impact to head, neck, abdomen
- Down-and-under: impact to pelvis, thighs, knees, spine
Injuries due to glass
Rear impact injury patterns (MVC)
Injury to the head, neck, chest and spine (more severe in unrestrained patients)
Injuries due to glass
Lateral impact injury patterns (MVC)
Impact to the head, shoulder, lateral chest, lateral abdomen, lateral pelvis, femur, spine.
Injuries due to glass
Rollover collision injury patters (MVC)
Many injuries, especially to the head, neck, chest, abdomen, spine
Injuries due to glass
Adult pedestrian injury patters (Auto v. Pedestrian)
Typically lower extremity injuries/ lateral injuries
If thrown on hood/windshield, experience head, back, chest, shoulder and abdomen injuries
Pediatric pedestrian injury patters (Auto v. Pedestrian)
Femur, pelvis, chest injuries
May be run over by vehicle
If thrown on hood/windshield, experience head, back, chest, shoulder and abdomen injuries
Seat belt injuries
If no shoulder belt: injury to head, neck, chest
If low lap belt: Dislocated hips
If high lap belt: Abdominal injury
Injuries to head, neck, spine (not caused by seatbelt, but occur)
If no lap belt: Neck vascular injury, head injury
abdominal injury, steering wheel impact
Airbag injuries
Injury to head, neck, chest, face
Head-on impact (motorcycle collision)
Rider hits the handle bars at the same speed as the motorcycle (leans forwards when rides).
Angular impact (motorcycle)
- The motorcycle strikes an object at an angle.
- The object impacts whatever body part it comes into contact with, usually breaking or collapsing on the patient.
- Hitting things such as fence posts, telephone poles, and signs are examples.
- Amputations, avulsions, and severe fractures usually result from this type of collision.