Types of Traumas and Treatments Flashcards
This deck should help you to recognize the types of traumas you might encounter and know the most appropriate prehospital treatments.
1
Q
What are the characteristics of an arterial bleed?
A
This bleeding is characteristically bright red and spurts in time with the pulse.
2
Q
What are the characteristics of a venous bleed?
A
This bleeding is darker than arterial bleeding and flows steadily.
3
Q
What are the characteristics of capillary bleeds?
A
This bleeding is dark red and oozes from the wound slowly and steadily.
4
Q
What are the different types of external bleeds?
A
Capillary, Venous, and Arterial
5
Q
Which types of bleeding are most likely to clot spontaneously?
A
Venous and capillary bleeding.
6
Q
What are the causes of internal bleeding?
A
High-energy mechanisms of injury
(blast injuries, falls, motor vehicle crashes, etc)
or nature of illness
(ulcers, ruptured ectopic pregnancy, aneurysms, etc.)
7
Q
What are some methods used to control external bleeding?
A
Direct pressure, tourniquets, hemostatic dressings, wound packing.
8
Q
What are some methods used to control internal bleeding?
A
We can’t control internal bleeds, but we can treat for shock and transport rapidly.
9
Q
What are two types of closed injuries?
A
Contusion and Crushing injury
10
Q
What is compartment syndrome?
A
An increase of pressure within a closed soft-tissue compartment. This can result in impairment of circulation of nutrients and oxygen, resulting in tissue death.
11
Q
What is crushing syndrome?
A
When the patient’s tissues are crushed beyond repair and release harmful substances into the surrounding tissue (caused when the body is trapped for longer than 4 hours with the arterial blood flow being compromised).
12
Q
What are the four types of open injuries?
A
Abrasions, Lacerations, Avulsions, and Penetrating wounds.
13
Q
What primary part of the body does an abrasion affect?
A
The superficial layer of the skin, usually does not penetrate completely through the dermis.
14
Q
What is the difference between a laceration and an incision?
A
A laceration is a jagged cut in the skin caused by a sharp object or a blunt force that tear the tissue. An incision is a sharp, smooth cut.
15
Q
Describe an avulsion.
A
An injury that separates various layers of soft tissue so they become either completely detached or hang as a flap.
16
Q
What type of shock would most likely result from an amputation?
A
Hypovolemic shock.
17
Q
What should be a main consideration when treating a penetrating wound?
A
No matter how small the entrance hole, consider that the internal damage may be extensive.
18
Q
What is a primary blast injury?
A
Injury to the body caused by the blast wave itself (sudden pressure changes).
19
Q
What is a secondary blast injury?
A
Injuries caused to the body by being struck by flying debris propelled by the force of the blast.
20
Q
What is a tertiary blast injury?
A
Injuries to the body from being thrown by the force of the explosion into an object or onto the ground.
21
Q
How would you care for a penetrating wound with an impaled object?
A
Stabilize the object. If bleeding, apply pressure around the area. Only remove if hindering CPR.
22
Q
RICES
What is R?
A
Rest. Keep the patient quiet and comfortable
23
Q
RICES
What is I?
A
Ice. Use ice or cold packs to slow bleeding and reduce pain.
24
Q
RICES
What is C?
A
Compression. Apply pressure over the injury site to slow bleeding
25
RICES
What is E?
Elevation. Raise the injured part just above the level of the patient's heart to decrease swelling.
26
RICES
What is S?
Splinting. Immobilize to decrease bleeding and reduce pain.
27
What is an air embolism?
How can you reduce the risk of one developing?
This occurs when air gets sucked into a blood vessel and blocks the flow of blood into the lungs and cause cardiac arrest.
Cover the wound in an occlusive dressing.
28
True or False. You should consider all small animal bites as contaminated.
True.
29
True or False. Human bites are not serious injuries because humans clean their mouths more frequently than animals, resulting in a lower risk of infection.
False.
30
What are the types of ways that burns occur?
The transfer or radiation, thermal, or electrical energy.
31
What are the five factors to determine burn severity?
1) Depth
2) Extent
3) Critical areas
4) Age
5) Preexisting medical conditions
Mnemonic I use for this: Don't Eat Crusty Ass Pasta
32
What burn type and percentage would require transfer to a burn center for a patient 10-50 years old?
Partial-thickness burns of 20% or greater.
33
What burn type and percentage would require transfer to a burn center for a patient younger than 10 years old or older than 50?
Partial-thickness burn of 10% or greater
34
What burn type and percentage would require transfer to a burn center regardless of age?
Full-thickness burns of 5% or greater
35
What are some examples of burns which would require transfer to a burn center regardless of age and percentage and thickness?
High-voltage electrical injuries, significant chemical burns, concomitant (burn related) traumatic injury or significant ongoing medical, inhalation injury
35
What area of the body would require transfer to a burn center regardless of type and percentage?
Any burn to the hands, face, feet, genitalia, or major joints.
36
How would you treat a chemical burn of the eye?
Flushing the eye with water or a sterile saline solution for 20 minutes.
37
How would you treat a thermal burn of the eyelids?
provide prompt transport and cover both eyes with a sterile dressing moistened with sterile saline. Transport to a designated burn center.
38
How would you treat a light burn of the eye? (infrared and ultraviolet rays)
Cover each eye with a sterile, moist pad and an eye shield. Have the patient lie down during transport to prevent exposure from bright light.
39
How would you treat a laceration to the globe of the eye?
Apply no pressure (pressure can result in loss of vision from damage to the retina). If part of the globe is exposed, gently apply a moist, sterile dressing. Cover the injured eye with a protective eye shield, cup, or sterile dressing to prevent drying.
40
How should you treat an eyeball displaced from out of its socket?
Do not attempt to reposition it. Cover the eye and stabilize it with a moist, sterile dressing. Remember to cover both eyes to prevent further injury. Place the patient supine during transport to prevent further fluid loss.
41
What would variation of pupil size be an indication of?
A brain injury.
42
If the patient does not move his or her eyes together, what are they likely suffering from?
Muscle entrapment caused by a blow-out fracture.
43
What are some traumas to consider in environmental emergencies?
44
What is a full-thickness (third-degree) burn?
Extends through all skin layers and may involve muscle, bone, or internal organs. Area is dry and leather and may appear white, dark brown, or even charred.
45
What is a superficial (first-degree) burn?
Involves only the top layer of skin, the epidermis. ex: a sunburn.
46
At what point would you apply sterile water or saline solution to a burn?
If the skin or clothing is still hot or smoldering. (Remember to remove all jewelry in an affected area)
47
Under which circumstances would you need to remove contact lenses from a patient's eye?
In the case of a chemical burn, because, the lens can trap the chemical and make irrigation difficult.
48
How should the patient be positioned for nontrauma epistaxis (nosebleed).
Forward with nostrils pinched together.
49
What fluid is coming out when there is a dot of blood on the gauze haloed by a lighter ring of fluid?
Cerebrospinal fluid
50
How should the patient be placed for a traumatic epistaxis (nosebleed)?
Maintaining manual cervical spine position while taking the necessary steps to maintain a clear airway.
51
When bandaging the ear, what is an extra step necessary to ensure patient comfort?
Placing a soft, padded dressing between the back of the ear and the scalp.
52
True or False. A child has place a crayon in his left ear. It is visible and seems like it would be easy to pull out. You should grip the crayon with tweezers and pull gently to ensure no further damage to the canal.
False. You should never try to manipulate a foreign body because you may press it further into the auditory canal and cause further damage.
53
What should you do when a patient has very loose teeth or bone fragments in the mouth?
Remove and save them, along with any loose dentures or dental bridges.
54
True or False. Any injury to the neck should be considered life threatening until proven otherwise in the emergency department.
True
55
Describe subcutaneous emphysema.
A leakage of air into the soft tissues of the neck, producing a crackling sensation.
56
What should you be most alert for with subcutaneous emphysema in the throat?
Progressive airway obstruction due to rapid swelling or bleeding.
57
What should be applied to bleeding in the neck, to ensure air does not enter a vein?
An occlusive dressing
58
What are some signs of a larynx injury?
Respiratory distress, hoarseness, pain, difficulty swallowing (dysphagia), cyanosis, pale skin, sputum in the wound, subcutaneous emphysema, bruising on the neck, hematoma, or bleeding.
59
What is the function of the meninges?
Three distinct layers of tissue that suspend the brain and the spinal cord within the skull and the spinal canal.
60
Describe the dura mater.
The dura mater is the outer layer of the meninges and is tough and fibrous. It forms a sac to contain the central nervous system, with small openings through which the peripheral nerves exit.
61
Describe the arachnoid and the pia mater.
Thinner than the dura mater. They contain the blood vessels that nourish the brain and spinal cord.
62
What is the primary function of cerebrospinal fluid?
Acts as a shock absorber for the brain and the spinal cord.
63
What is another name for the voluntary nervous system?
The somatic nervous system.
64
What is another name for the involuntary nervous system?
The autonomic nervous system.
65
What are the two sections of the autonomic nervous system?
The sympathetic nervous system and the parasympathetic nervous system.
66
What effect does the sympathetic nervous system have on the body?
Reacts to stress with the fight-or-flight response. Pupils dilate, smooth muscle in the lungs dilate, heart rate increases, blood pressure rises. Body shunts blood to vital organs and skeletal muscle.
67
What effect does the parasympathetic nervous system have on the body?
Relaxation state. Blood vessels dilate, slowing the heart rate, muscle sphincters relax. Body shunts blood to digestive organs.
68
What is the opening at the base of the skull which allows for the brain to the spinal cord?
The foramen magnum.
69
What are the two types of head injuries?
Closed head injury (no opening to the brain) and Open head injury (opening exists from the outside world to the brain).
70
What are the most common MOIs for head and brain injuries?
Falls and motor vehicle collisions, also occur in cases of assault.
71
Because of the rich blood supply of the face and scalp, what could result from even small lacerations, especially in children.
Hypovolemic shock.
72
Irregular breathing pattern, widening pulse pressure, slow heart rate, and failure of the pupils to react to light are all signs and symptoms of what?
A head injury and damage to the brain.
73
Raccoon eyes (echymosis that develops under the eyes) or battle sign (echymosis that develops behind one ear over the mastoid process) are both indicative of what?
A skull fracture.
74
What are the types of skull fractures?
Linear (nondisplaced), Depressed, Basilar, and Open.
75
What are the characteristics of a linear skull fracture?
No physical signs such as deformity. Would have traditional signs and symptoms of a head injury (i.e. altered behavior, unequal pupil size, etc.)
76
What are the characteristics of a depressed skull fracture?
from high-energy direct trauma to the head with a blunt object. Bony fragments may be driven into the brain, resulting in injury. Often present with signs of neurologic injury (such as loss of consciousness).
77
What are the characteristics of a basilar skull fracture?
from high-energy trauma, but usually occur following diffuse (or spread out) impact to the head. Generally result from an extension of a linear fracture. CSF drainage from the nose or ears. Raccoon eyes or battle sign may appear within 24 hours.
78
What are the characteristics of open skull fractures?
Associated with trauma to multiple body systems. Brain tissue may be exposed to the environment, which increases risk of bacterial infection.
79
What are the two categories of traumatic brain injuries?
Primary (direct) injury and Secondary (indirect) injury.
80
What is a coup-contrecoup injury?
The brain strikes the front of the skull, as the body begins its path of moving backward. May also occur on opposite sides of the brain in a lateral collision.
81
What is cerebral edema?
Swelling of the brain.
82
What is Central neurogenic hyperventilation?
An abnormal breathing pattern associated with increased intracranial pressure that is characterized by deep, rapid breathing
(pattern is similar to Kussmaul respirations, but without an acetone breath odor).
83
Where does an epidural hematoma occur?
Between the skull and the dura mater.
84
Where does a subdural hematoma occur?
Beneath the dura mater but outside the brain.
85
Where does an intracerebral hematoma occur?
Within the brain tissue itself.
86
Where does a subarachnoid hemorrhage occur?
Into the subarachnoid space, where the CSF circulates.
87
What might be have occurred in a patient who has delayed motor functions, lack of coordination, displays inappropriate emotional responses, and says they are feeling "in a fog" or "just not right"?
These are indicators of a concussion.
88
What would be a cause for a compression injury to the spine?
A fall, a direct blow to the crown of the skull, coccyx, or top of the head.
89
What would be a cause for a hyperextension spinal injury?
Hanging
90
What are some common causes of head and spinal injury?
Motor vehicle crashes, direct blows, falls from heights, assault, and sports injuries.
91
Because of the potential for increasing ICP (intracranial pressure), what is there an increased risk for during transport?
vomiting and seizures. Suctioning should be readily available.
92
Because the level of consciousness may fluctuate, what should be used to determine a baseline neurologic score?
The Glasgow Coma Scale or the Revised Trauma Score.
93
What are the elements of the Cushing Triad?
Increased blood pressure (hypertension), decreased heart rate (bradycardia), and irregular respirations.
94
What are some things the patient might report which would cause you to stop moving their head to a neutral position?
Muscle spasms in the neck, substantial increased pain, numbness, tingling, or weakness in the arms or legs, compromised airway or ventilations.
95
How many people are necessary for a helmet removal?
At least two people.
96
What are the types of chest injuries?
A closed chest injury and an open chest injury.
97
What are some signs and symptoms of chest injury?
Pain at the site of injury, pain aggravated by or increased with breathing, bruising to the chest wall, crepitus, penetrating injury, dyspnea, hemoptysis, abnormal chest expansion, signs of hypoxia.
98
What would hemoptysis indicate?
The lung itself or the air passages have been damaged.
99
For quick initial care of an open chest wound, what should you use?
Your gloved hand until further dressings can be applied.
100
What is an indicator for an impending tension pneumothorax?
Difficulty delivering breaths to the patient.
101
If a tension pneumothorax has developed, what should be done?
You should briefly remove the occlusive dressing to allow air to escape and then place it back over the wound.
102
List 1-4 of the deadly dozen chest injuries?
1) Airway obstruction
2) Bronchial disruption
3) Diaphragmatic tear
4) Esophageal injury
103
List 5-8 of the deadly dozen chest injuries?
5) Open pneumothorax
6) Tension pneumothorax
7) Massive hemothorax
8) Flail chest
104
List 9-12 of the deadly dozen chest injuries?
9) Cardiac tamponade
10) Thoracic aortic dissection
11) Myocardial contusion
12) Pulmonary contusion
105
What are the differences between and open pneumothorax, a tension pneumothorax, and a massive hemothorax?
An open pneumothorax is an open or penetrating wound to the chest wall and is often called a sucking chest wound.
A tension pneumothorax is when there is significant ongoing air accumulation in the pleural space (increases pressure on the chest).
A massive hemothorax is when the lung is being compressed by blood in the cavity.
106
What is cardiac tamponade?
Occurs when the space between the protective membrane around the heart (pericardium) and the heart, fills with blood or fluid.
107
What is a flail chest?
When a segment of the chest wall may be detached from the rest of the thoracic cage.
108
What would cause a pulmonary contusion?
The alveoli fill with blood and fluid accumulates in the injured area, leaving the patient hypoxic. Often caused by a flail chest, hours after the injury.
109
What is peritonitis?
inflammation and pain of the peritoneum, caused by leaked substances into the abdominal cavity.
110
Abdominal distention and rigidity in the peritoneal cavity may be indicative of what?
Internal bleeding or leaking of hollow organs.
111
What are the three levels of velocity commonly used in the discussion of traumatic injuries?
Low velocity (handheld or hand-powered object)
Medium velocity (small-caliber handguns and shotguns)
High velocity (More powerful weapons such as high-powered rifles and handguns or higher caliber)
112
How do you take care of clothing around an evisceration?
If there is clothing close to the wound, carefully cut the clothing around the wound, leaving a border of intact cloth outside the injured area. Never pull, even gently, on any clothing stuck to or inside the wound.
113
How should you treat an evisceration?
stabilize in place and cover with a warm, moist, sterile dressing. Treat for shock and keep the patient in a position of comfort.
114
What is a common finding with an injured kidney?
Hematuria (blood in the urine)
115
What would be a sign that the patient has been digesting blood?
Coffee-ground emesis (poop).
116
What is another word for black, tarry stools?
Melena
117
When a patient complains of abdominal pain, why is it sometimes deceiving?
Injured organs tend to irritate the surround tissues, causing the pain to diffuse. They may report having pain "all over"
118
Where should palpation of the abdomen start if the patient already states they have pain in the upper right quadrant of the abdomen?
The opposite spot, the lower left quadrant.
119
Why would a patient with a ruptured diaphragm have a sunken anterior wall?
The abdominal contents have shifted up into the chest cavity.
120
When should you suspect kidney damage?
An injury to the flank, a penetrating wound to the upper abdomen, fractures on either side of the lower rib cage or of the lower thoracic or upper lumbar vertebrae.
121
In cases of external bleeding and trauma to the female genitalia, how should you treat?
Apply a sterile absorbent sanitary napkin to the labia. Do not insert any instruments, gloved fingers, or a tampon into the vagina.
122
When checking for abdominal trauma in a woman, what might be a pertinent question?
Is there any possibility that you may be pregnant? When was your last period?
123
How should you treat a male patient's injured genitalia?
The same as other soft-tissue injuries. Direct pressure, stabilization of impaled objects, wrapping or retrieving of avulsed skin.
124
True or False. When dealing with an amputation of the penile shaft, you should apply a tourniquet proximal to the bleeding point.
False. Constricting devices are not appropriate for the control of penile bleeding.
125
True or False. Moist, sterile compresses are most appropriate when treating lacerations, abrasions, and avulsions of the female genitalia.
True.
126
What are some causes of rectal bleeding?
Sexual assault, rectal foreign bodies, hemorrhoids, colitis, or ulcers of the digestive tract.
127
When is it appropriate to examine the genitalia of a victim of sexual assault?
If there is obvious bleeding in the area.
128
Why would you want to ask the patient who was a victim of sexual assault if they would be willing to be wrapped in a sterile burn sheet?
It can help investigators find any hair, fluid, or fiber from the alleged offender.
129
If a female patient who was a victim of sexual assault insists on urinating, how would you have her do so?
Into a sterile urine container (if available), also, have her deposit the toilet paper into a paper bag. Seal and label.
130
What is the difference between a nondisplaced fracture and a displaced fracture?
A nondisplaced fracture is a simple crack in the bone that may be difficult to distinguish from a sprain or simple contusion. A displace fracture produces an actual deformity, or distortion, of the limb.
131
What are the specific types of fractures?
Comminuted, epiphyseal, greenstick, incomplete, oblique, pathologic, spiral, and transverse.
132
Describe a comminuted fracture.
A fracture in which the bone is broken into more than two fragments.
133
Describe an epiphyseal fracture.
A fracture that occurs in a growth section of a child's bone and may result in growth abnormalities.
134
Describe a greenstick fracture.
An incomplete fracture that passes only partway through the shaft of a bone but may still cause substantial angulation; occurs in children.
135
Describe an incomplete fracture.
A fracture that does not run completely through the bone; a nondisplaced partial crack.
136
Describe an oblique fracture.
A fracture in which the bone is broken at an angle across the bone. This is usually the result of a sharp, angled blow to the bone.
137
Describe a pathologic fracture.
A fracture of weakened or diseased bone, seen in patients with osteoporosis, infection, or cancer; often produced by minimal force.
138
Describe a spiral fracture.
A fracture caused by a twisting or spinning force, causing a long, spiral-shaped break in the bone, this is sometimes the result of abuse in young children.
139
Describe a transverse fracture.
A fracture that occurs straight across the bone, this is usually the result of a direct and relatively high-energy blow.
140
What is false motion?
Any motion at a point in the limb where there is no joint and therefore motion is not expected to occur.
141
What is a dislocation?
A disruption of a joint in which the bone ends are no longer in contact.
142
What is a sprain?
When a joint is twisted or stretched beyond its normal range of motion.
143
What is a strain?
A stretching or tearing of the muscle and/or tendon, causing pain, swelling, and bruising of the soft tissues in the area.
144
What is an amputation?
An injury in which an extremity is completely severed form the body.
145
What are considered Critical Injuries on the musculoskeletal injury grading system?
Multiple open fractures of the limbs and suspected pelvic fractures with hemodynamic instability.
146
What should you note before and after splinting?
the patient's neurovascular status.
pulse, sensation, and movement.
147
What are the types of splints?
Rigid splints, Formable splints, Pelvic binders.
148
When are some times you would sling and swathe?
Any clavicular break, shoulder injury or dislocation. A humeral shaft fracture.
149
How would you treat a dislocated hip?
Splint the dislocation in the position of the deformity. Place the patient supine on the backboard. Support the affected limb with pillows and rolled blankets.
150
How is a femoral shaft fracture best stabilized?
With a traction splint.
