Traumatic Disorders and Conditions

Question 1

Abrasion

Answer 1

ETIOLOGY: friction with hard and rough surface scrapes away tissue

S/S: burning pain (nerve ending exposure), small amount of bleeding, foreign particles may be present, red and raw wound

TREATMENT: possible benzocaine, wash with warm germicidal soap, remove foreign particles with forceps, possible germicidal ointment, dress wound, possible prophylactic Tdap injection

PROGNOSIS: good with treatment. Risk of tetanus or other bacterial infections

Question 2

Avulsion

Answer 2

ETIOLOGY: skin, tissue, and possibly the bone is pulled away

S/S: severe pain, bleeding, skin peeled away or completely removed from skin

TREATMENT: control bleeding and clean the wound. Prophylactic antibiotics with possible Tdap injection, wound dressing, basic fibroblast growth factor (bFGF), possible pain medications, possible skin graft

PROGNOSIS: best with prompt treatment.

Question 3

Crushing Injury

Answer 3

ETIOLOGY: mechanical compression of skin, blood vessels, nerves, and/or bone

S/S: immobilization of affected area, pain

TREATMENT: control bleeding, clean wound, debride (remove necrotic tissue). Prophylactic antibiotics with possible Tdap injection, surgical repair

PROGNOSIS: best with prompt treatment

Question 4

Puncture Wounds

Answer 4

ETIOLOGY: sharp object penetrates the skin, extensive bleeding may occur if removed

S/S: impaled object may be observable, minimal bleeding, pain

TREATMENT: cleansing and irrigation of wound, prophylactic antibiotics with possible Tdap injection, removal of foreign object

PROGNOSIS: varies on extent on injury, best with prompt treatment

Question 5

Laceration

Answer 5

ETIOLOGY: sharp object cuts skin and leaves smooth (incision) or jagged opening

S/S: open wound, moderate to severe bleeding, pain

TREATMENT: cleansing and irrigation of wound, adhesive strips/butterfly dressing/taping, possible sutures to control bleeding, prophylactic antibiotics with possible Tdap injection

PROGNOSIS: best with prompt treatment

Question 6

Foreign Bodies in the Ear

Answer 6

ETIOLOGY: (children most affected) small toys, cereal, bugs, pebbles, vegetation, or other small objects become trapped in ear canal

S/S: ear compression, possible pain, muffled hearing, “buzzing” can be heard with bugs

TREATMENT: removal by forceps, gentle irrigation with 50/50% water/H2O2 mixture, light technique with bug

PROGNOSIS: good with prompt treatment. Risk of tympanic damage

Question 7

Foreign Bodies in the Eye

Answer 7

ETIOLOGY: small objects (dust, rust, metal fragments, insects, certain chemicals) can become trapped in eye through workplace accidents, explosions, MVA, sports injuries, or by simply rubbing the eyes

S/S: irritation, pain, and compromised vision

TREATMENT: gentle irrigation with saline solution, removal with eye spud, antibiotic eye drops, bandage both eyes

PROGNOSIS: varies with causative agent and level of involvement. Risks of corneal abrasion, compromised vision, or blindness

Question 8

Foreign Bodies in the Nose

Answer 8

ETIOLOGY: (most common in children) small object becomes trapped in one of the nares

S/S: obstructed airflow, nasal swelling, mucosal secretion

TREATMENT: encourage patient to exhale, crush foreign material if possible, removal with forceps or suction

PROGNOSIS: good with prompt treatment

Question 9

Burns

Answer 9

ETIOLOGY: extreme heat, chemicals, radiation, or electricity damages tissues. Any inhalation of superheated air can lead to respiratory damage

S/S: pain (varies on percent of body affected and degree of burn), red/blistered/charred skin

TREATMENT: rinse with cool water if source isn’t electrical or thermal, analgesics, possible prophylactic antibiotics, possible debriding and skin grafts

PROGNOSIS: varies on severity of burns and organ involvement, but best with immediate treatment

Question 10

Electrical Shock

Answer 10

ETIOLOGY: electrical current makes contact with entry site, flows through path of least resistance, and leaves through exit site.

S/S: possible cardiac dysrhythmia, muscle contractions, pain, charred skin at entry/exit site,

TREATMENT: assess vascular and neurologic status, possible cardiopulmonary resuscitation, debriding and sterile dressing, treat secondary open trauma, possible prophylactic antibiotics and Tdap injection

PROGNOSIS: best with immediate treatment, unfavorable if cardiac dysrhythmia occurs.

Question 11

Lightning Strikes

Answer 11

ETIOLOGY: Lighting may strike directly (direct strike), transfer from an object (contact strike), “jump” from an object (side splash), enter and exit from leg (stride potential), or move through ground (ground current)

S/S: visual and auditory disturbances, possible ruptured tympanic membrane, altered state of consciousness, burns, possible apnea and cardiac dysrhythmia

TREATMENT: possible cardiopulmonary resuscitation, treatment of secondary open wounds, possible prophylactic antibiotics and Tdap injection

PROGNOSIS: varies on type of lighting strike, survival dependent on respiratory function. Possible risk of future cataracts.

Question 12

Hyperthermia

Answer 12

ETIOLOGY: (Heat exhaustion) depletion of salt and water.
(Heat Stroke) Insufficient cooling mechanisms in extreme heat leads to body rising to 105F or above, resulting in cellular damage

S/S: (Heat Exhaustion) sweating, nausea, fatigue, dizziness, headaches, muscle cramps
(Heat Stroke) irritability, hysteria, confusion, altered state of consciousness and possible seizures

TREATMENT: move to cold environment, remove clothing (except for underwear), pour cold water, give 4oz of water if heat exhaustion

PROGNOSIS: varies on duration of heat exposure and underlying conditions

Question 13

Hypothermia

Answer 13

ETIOLOGY: prolonged exposure to cold air, wind, or water leads to body temperature falling below 95F

S/S: shivering, fatigue, confusion, slurred speech, weak pulse with bradycardia, slow and shallow breathing

TREATMENT: dress with warm clothing and blankets, keep body dry, expose to heat source, give small amounts of warm liquids if conscious

PROGNOSIS: varies on cold exposure and underlying conditions

Question 14

Frostbite

Answer 14

ETIOLOGY: prolonged and extreme exposure to cold air, wind, or water leads to formation of ice crystals within and around cells

S/S: necrotic tissue, numbness, possible swelling and blood-filled blisters

TREATMENT: expose to warmth, pain medication, IV fluids to rehydrate debridement or amputation,

PROGNOSIS: varies on duration of exposure, age, and underlying conditions

Question 15

Insect Bites

Answer 15

ETIOLOGY: insect bites skin and may inject venom, leading to possible immune response

S/S: (varies with insect) stinging pain, pruritis, erythema, possible system rash, possible dyspnea, edema, nausea, shock, loss of consciousness

TREATMENT: scrape away stinger, possible antivenin, clean and dress wound

PROGNOSIS: varies on type of insect and underlying pathologies. Possible risks of malaria, lyme disease, encephalitis, and Rocky Mountain spotted fever

Question 16

Rocky Mountain Spotted Fever

Answer 16

ETIOLOGY: Rickettsia rickettsii intracellular bacterium transmitted via tick feces during host feeding and incubates for a few days to a week.

S/S: fever, headache, nausea, malaise, myalgia, systemic maculopapular rash, small vessel or systemic necrotizing vasculitis

TREATMENT: antibiotic course of doxycycline or tetracycline

PROGNOSIS: good with prompt identification and treatment

Question 17

Malaria

Answer 17

ETIOLOGY: Plasmodium protozoa transmitted via mosquito vector then feeds on hemoglobin and reproduces in RBCs

S/S: cycle of chills/fever/sweats, nausea, headache, fatigue, myalgia, enlarged spleen and liver, anemia

TREATMENT: chloroquine (antimalarial drug), possible doxycycline or tetracycline, antipyretics, infusion of packed RBCs

PROGNOSIS: varies, may last 2-14 weeks with year-long lingering symptoms

Question 18

Animal/Human Bites

Answer 18

ETIOLOGY: animal (domestic, farm, wild, or shark) is agitated and bites

S/S: pain, puncture wounds, bleeding, possible avulsion, localized bruising

TREATMENT: clean wound, cauterize or suture wound, rabies immunity injections if animal was rabid or unknown, Tdap, prophylactic antibiotics, possible plastic surgery

PROGNOSIS: varies on tissue damage and possible infections

Question 19

Snakebites

Answer 19

ETIOLOGY: Poisonous (i.e. rattlesnakes, coral snakes) or non-poisonous snakes bites person, venom leads to symptoms within 1-2 days

S/S: bite mark or discoloration, burning pain, swelling, tachycardia, visual difficulties, weakness, nausea

TREATMENT: keep bitten limb below heart level, clean wound with soap and water, possible suctioning, antivenin, no tourniquet

PROGNOSIS: varies on type of snake, underlying pathologies, location of bite, and promptness of treatment

Question 20

Carpal Tunnel Syndrome

Answer 20

ETIOLOGY: repetitive overuse of tendons surrounding median serve leads to tendon inflammation and median nerve entrapment

S/S: numbness of hand and wrist, pain that intensifies at night, wrist and hand swelling

TREATMENT: physical therapy, cease source of overuse, splint, antiinflammatory drugs, corticosteroids, possible carpal ligament division surgery

PROGNOSIS: good with compliance to treatment

Question 21

Tennis Elbow

Answer 21

(Lateral Humeral Condylitis)
ETIOLOGY: Repetitive motion at elbow with wrist flexion leads to inflammation of extensor attachment of distal humerus

S/S: pain in outer elbow and lower arm, weakness

TREATMENT: avoid source of overuse, NSAIDs, possible elastic brace, possible steroid injections

PROGNOSIS: good with compliance to treatment

Question 22

Trigger Finger

Answer 22

(Stenosing Tenosynovitis)
ETIOLOGY: repetitive overuse of digital flexor tendon leads to inflammation and swelling or scarring, thus limiting motion

S/S: lump on flexor tendon, interrupted finger flexion that then “snaps,” pain at base of hand

TREATMENT: ergonomic intervention, ice packs, NSAIDs, possible cortisone injections, possible surgical intervention

PROGNOSIS: good with compliance to treatment

Question 23

Thoracic Outlet Syndrome

Answer 23

(Brachial Plexus Injury)
ETIOLOGY: repetitive hyperabduction of the arm with inflammation, a cervical rib, or continual shoulder girdle dropping leads to inflammation and compression of brachial plexus nerves

S/S: pain in one arm, paresthesia (pins and needles), weakness, possible muscular atrophy

TREATMENT: ergonomic intervention, possible surgical removal of cervical rib

PROGNOSIS: good with appropriate treatment

Question 24

Nonspecific Tendinitis

Answer 24

ETIOLOGY: repetitive overuse, poor ergonomics, calcium deposits, or dysfunctional bursa leads to inflammation of tendon

S/S: acute nonspecific pain along the tendon, possible contractures

TREATMENT: antiinflammatory drugs, possible cortisone injection, possible surgical release of contractures

PROGNOSIS: unpredictable (factors include tendon involved and response to treatment)

Question 25

Child Abuse/Neglect

Answer 25

ETIOLOGY: emotional immaturity of abuser, abuser being abused themselves as child, socioeconomic stress, substance abuse, and limitations of disabled child can contribute

S/S: bruises over soft tissue, finger/ring/belt marks, cigarrete or “dipping scald” burns, greenstick fractures, and social withdrawal are all possible signs and symptoms of child abuse

TREATMENT: legally required to report to appropriate agencies, unconditional emotional support for child, possible removal of child through social services, treat injuries appropriately

PROGNOSIS: VARIES. Depends on duration and extent of abuse, identification of abuser, abuser access to child, emotional attachment of child to abuser…

Question 26

Shaken Infant (Baby) Syndrome

Answer 26

ETIOLOGY: (abuse, tossing baby, or jogging) rapid shaking of infant’s head causes brain to strike against cranial vault, leading to rupturing and hemorrhaging of cerebral blood vessels

S/S: altered state of consciousness, irritability, cyanosis, lethargy, vomiting, retinal hemorrhages

TREATMENT: control bleeding and reduce intracerebral edema

PROGNOSIS: may be fatal, immediate treatment necessary. Possibility of visual deficits, blindness, cerebral palsy, and/or intellectual developmental disorder.

Question 27

Elder Abuse/Neglect

Answer 27

ETIOLOGY: Older adults may experience diminished mental capabilities and dependency. Caretakers may percieve them as physical, emotional, and socioeconomic stressors, leading to abuse, neglect, or financial exploitation.

S/S: Bruises, greenstick fractures, decubital ulcers, malnutrition, unnatural alopecia, elder unlikely to report abuse (emotional attachment, financial dependency, fear of abuser)

TREATMENT: treat injuries appropriately, counseling to all parties involved, possible removal of elder from abusers

PROGNOSIS: Varies. Factors include duration and extent of abuse, profile of abuser, profile of victim

Question 28

Psychological/Verbal Abuse

Answer 28

ETIOLOGY: Partner, caregiver, or other individuals may frequently make negative comments (“you’re useless,” “you’ll never do anything,”) towards victim, leading to poor self-esteem and destructive cognitive-behavioral model

S/S: victim may deny abuse, increased risk of anorexia, bulimia, depression, self-harm, substance abuse, and suicide

TREATMENT: Prevent through public education, psychotherapy recommended (although victim may resist)

PROGNOSIS: varies on duration and management of abuse

Question 29

Intimate Partner Violence (IPV)

Answer 29

ETIOLOGY: (multifactorial) stress, social values, substance abuse, and low-self esteem of victim can contribute to domestic abuse

S/S: bruises in different stages of healing, avoidance of eye contact, denial of abuse (embarassment, emotional attachment to abuser, fear, poor self-efficacy)

TREATMENT: treat injuries appropriately, referral to appropriate agencies (victim allowed to reject referral), listening to victim with unconditional positive regard

PROGNOSIS: varies on duration and extent of abuse, current relationship status, willingness of victim to seek help

Question 30

Sexual Abuse

Answer 30

ETIOLOGY: (multifactorial) certain personality disorders, desire for domination or control, or a history of sexual abuse with the abuser themselves can contribute to sexual abuse

S/S: any form of nonconsensual sexual activity, possible itching in urethra and vagina if victim is young female, unusual obsession with genital region if victim a child

TREATMENT: treat injuries appropriately, possible contraceptins, possible prophylactic STD treatment, referral to law enforcement agencies (with consent of victim, or according to local policies), referral to social services if child, possible removal from environment

PROGNOSIS: varies on form, duration, and extent of abuse,

Question 31

Rape/Sexual Assault

Answer 31

ETIOLOGY: Violent sexual crime in the form of date rape, acquaintance rape, partner rape, or unknown assailant rape

S/S: bruising, tenderness in pelvic or rectal regions, anxiety, lacerations

TREATMENT: unconditional positive regard, notify law enforcement, consider prophylaxis for pregnancy, psychotherapy

PROGNOSIS: varies. Risk of pregnancy or STDs

Question 32

Suicide

Answer 32

ETIOLOGY: (Linked with depression) Multiple biopsychosocial factors including loss of job, poor relationships, inability to meet societal expectations

S/S: decreased motivation, expressions of poor self-esteem, giving certain items away

TREATMENT: possible antidepressent prescription, psychotherapy, call suicide hotline

PROGNOSIS: if patient commits suicide, nothing else can be done. Grief counseling for those in social network may be available