Ch 15 Trauma

Front 1

Trauma

Back 1

Interfere w body functions or homeostasis of body. Open trauma, assault, thermal, psychological. Physical trauma leading cause of death in us from age 1-44.

Front 2

Open Trauma

Back 2

Abrasions, Avulsions, Crushing, Puncture, Lacerations

Front 3

Abrasions

Back 3

Outer layers of skin scraped away or roughened up, deeper layers exposed.

Front 4

Abrasions Signs and Symptoms

Back 4

Raw, reddened, painful, small amount of bleeding. Exposure of sensitive nerve endings cause burning. May be embedded w small foreign particles.

Front 5

Abrasions Etiology

Back 5

Caused by friction, scraping or sliding motion (fall or scrape). Friction, floor, or rug burns, road rash.

Front 6

Abrasions Treatment

Back 6

Gentle washing and irrigation of area w germicidal soap to remove bacteria and contamination. Gravel and foreign particles removed w forceps. Germicidal ointment, dressing optional depends on size and location. Prophylaxis w tetanus, diphtheria, pertussis (Tdap) injection if necessary. Prognosis good.

Front 7

Avulsion

Back 7

Portion of the skin and possibly underlying tissue torn away (completely or partially)

Front 8

Avulsion Signs and Symptoms

Back 8

Can involve a limb, appendage, soft tissue. Severe pain, bleeding. Larger avulsed serious, may require split thickness grafting.

Front 9

Degloving

Back 9

Severe avulsion, full thickness of skin peeled away from body such as hand or foot.

Front 10

Avulsion Etiology

Back 10

Body part becomes entangled in machinery, clothing, or other entrapment causing skin, tissue, possibly bone to be pulled away from body. If appendage severed completely called amputation.

Front 11

Avulsion Treatment

Back 11

Control bleeding, clean area, surgically repair tissue. If amputation stump cleaned and surgically repaired. Treat prophylactically w antibiotics. Sterile dressing. Tetanus, diphtheria, pertussis (Tdap) injection if necessary. Pain meds if necessary. Prompt intervention promote healing.

Front 12

Crushing Injuries

Back 12

Part of body is compressed w extreme force bt 2 surfaces. Experience pain, may not be able to move body part, soft tissue, bone, nerve, and vessels may be crushed.

Front 13

Crushing Injuries Treatment

Back 13

Depends on severity. If open wound; cleansed, irrigated, débrided. Immobilization, sterile dressing if open or surgical area. Tetanus, diphtheria, pertussis (Tdap) if necessary. Antibiotics. If at work, workers comp filled w mandatory drug and alcohol screening.

Front 14

Puncture Wounds

Back 14

Pointed or sharp foreign object penetrates soft tissue. Animal bites may be considered puncture wounds.

Front 15

Puncture Wounds Signs and Symptoms

Back 15

Pain, little bleeding, redness, may be no indication besides pain. Meticulous inspection of area and underlying structures should be preformed. Impaled object if foreign object if protruding from wound.

Front 16

Puncture Wounds Etiology

Back 16

Object penetrates skin, skin closes around object or point of entry. Bleeding minimal, or will occur when object removed. If near joint at risk for bacterial infection, and wounds at bottom of foot at risk for cellulitis. Use MRI to inspect under skin.

Front 17

Puncture Wounds Treatment

Back 17

Remove foreign body, copious irrigation w sterile fluid, dressing applied, tetanus, diphtheria, and pertussis (Tdap) if necessary. Antibiotics. Impaled objects stabilized until they can be removed by physician.

Front 18

Lacerations

Back 18

Sharp object cuts skin and possibly underlying tissue. Pain, moderate to severe bleeding, edges may be smooth or jagged. Bleeding proportional to depth and length of laceration.

Front 19

Lacerations Treatment

Back 19

Cleaned gently w germicidal soap and water. If not too deep and bleeding controlled approximate and secure edges w tape, butterfly dressing, or sterile strip, glue. If deep and jagged edges débrided edges trimmed to facilitate approximation. Bleeding controlled by coagulation or suture. If over movable joint immobilization required. Tetanus, diphtheria, pertussis (Tdap) and antibiotics if necessary.

Front 20

Foreign Bodies in Ear

Back 20

Bugs, pebbles, cotton, etc. stuffiness in ear, pain, decreased hearing. May use CT to visualize item. Removed ASAP wo damage to ear canal or tympanic membrane. Use forceps, or removed by physician using controlled suctioning. Bugs removed by placing in dark and pointing flashlight. Bug moves towards light. If dead must be irrigated out w 50/50 h20 and h2o2 or suction.

Front 21

Foreign Bodies in Eye

Back 21

Scratching or irritation in eye, pain, compromised or blurred vision, tearing present. Remove material, gentle irrigation w saline. If embedded remove w surgical instrument or eye spud. Last resort ophthalmologist. Ophthalmic antibacterial drops or ointment and eye covered w patch. Bandage both eyes bc sympathetic movement. Mental can lead to rust rings.

Front 22

Foreign Bodies in Nose

Back 22

Mostly children. Mucus running from one of the nares and congested breathing. Dry material tends to absorb moisture swell and create obstruction. Encouraged to blow nose to expel object, squeeze nose to crush object then blow. May need forceps for removal.

Front 23

Burns

Back 23

Heat (flame,dry, steam, hot substance), chemical, electrical, radiation. Pain (proportional to percentage of body involved). May be blistered, reddened, charred depending on depth. Injury to underlying tissue proportional to duration of exposure and intensity of source.

Front 24

Burns Diagnosis

Back 24

Superficial involve outer layer usually appear reddened painful. Partial thickness burns involve all layers of skin produce blisters painful. Full thickness involve skin and underlying subcutaneous tissue. Destruction of nerve endings result in minimal pain, but surrounding area painful. Rule of 9’s for calculation of body surface involved.

Front 25

Burns Treatment

Back 25

Heat burns cooled w cool water and covered w sterile dressing. Sunburns apply cool water, damaged skin sprayed w antiseptic and analgesics spray. OTC meds, cool compress. Chemical burns flushed w cool water for 15+ minutes and covered. Electrical should be covered and treated by Physician. Large burns have respiratory status, fluid and electrolyte balance, and vital signs monitored. Pain control w narcotic analgesic. Skin grafts. Scarring typical.

Front 26

Electrical Shock

Back 26

Contact w electricity. May be in cardiac or respiratory failure. Visible entrance and exit wound. Pain, charred tissue may be noted. Electric current follows path of least resistance usually along nerve. May be thrown from source causing lacerations, fracture, head trauma. Can cause cardiac dysrhythmia.

Front 27

Electrical Shock Treatment

Back 27

Maintain cardiac and respiratory status. Neurological and vascular status assessed for tissue destruction.

Front 28

Lightning Injuries

Back 28

Clothing burned off, could cause cardiac arrest, burns in moisture areas (axillae, groin) or where metal touching. Motor and sensory disturbances, alter consciousness, hearing or visual difficulties.

Front 29

Lightning Injuries Etiology

Back 29

Direct strike, contact strike (strikes object person was touching), side flash (lightning strikes, travels then jumps through air and strikes person), stride potential (current enters leg travels through lower portion exits other leg), ground current (hits ground travels to person). Tends to travel through surface sparing deep tissue.

Front 30

Lightning Injuries Treatment

Back 30

Maintain respiratory, cardiac monitoring, observation for cerebral edema. May develop cataracts in the year after strike. Could rupture tympanic membrane.

Front 31

Extreme Heat (Hyperthermia)

Back 31

Body temp higher than 98.6 F.

Front 32

Heat Stroke

Back 32

Temp 105 F or greater. Skin hot red dry, dry mouth, headache, nausea, vomiting, dizziness, weakness, shortness of breath. Rapid pulse then weakens, BP decreases, pupils constrict, collapse, seizures, anxiety, alter consciousness.

Front 33

Heat Exhaustion

Back 33

Profuse sweating, fatigue, headache, weakness, nausea, dizziness, muscle cramps, skin pale, cool, moist, pupils dilate.

Front 34

Extreme Heat (Hyperthermia) Etiology

Back 34

Heat stroke: body overheats 105-110. No effective cooling mechanism takes place, damage to brain cells. Heat Exhaustion: salt or water depletion, strenuous activity, prolonged profuse sweating mimics mild state of shock.

Front 35

Extreme Heat (Hyperthermia) Treatment

Back 35

Stroke: Life threatening. Move to cool environment, cool w water. If shiver slow cooling. Bring core temp below 100 F. Exhaustion: move to cool place, cool compress, lie down feet elevated. If conscious 4 ounces of cool water ever 10-15 mins. Bair huggers used in ER to cool.

Front 36

Extreme Cold (Hypothermia)

Back 36

Body drops below 95 F (35 C). Fatigue, loss of coordination, thick speech, disorientation, skin blue puffy, ash colored, pulse slow weak. Breathing slow shallow, pupils dilated. Confusion, stupor, unconscious.

Front 37

Extreme Cold (Hypothermia) Treatment

Back 37

Life threatening. Remove wet clothing, gradual rewarming, warm liquids in small quantities if conscious.

Front 38

Frostbite

Back 38

Frozen or extremely cold tissue (face, ears, toes, fingers, nose) white, ashen. Little to no pain. Usually don’t realize it happened. As freezing deepens tissue becomes firm, skin looks waxy.

Front 39

Frostbite Etiology/Treatment

Back 39

Ice crystals form bt cells of skin. Fluid drawn from cells freezes. Warm, should not be above 105F. Affected skin should never be rubbed. Rewarming should be done by professional, alcohol should never be given. Dehydration may occur give iv.

Front 40

Rocky Mountain Spotted Fever/Tick Bite

Back 40

Most common reported rickettsial disease in US. Usually unaware. Symptoms several days or 2 weeks later. Sudden fever, headache, malaise, macopapular rash over body. Give antibiotics (tetracycline or doxycycline) lifetime immunity

Front 41

Malaria/Mosquito Bite

Back 41

Anopheles mosquito infected w Plasmodium Protozoa (4 species). Feed on hemoglobin reproduce in RBCs. Usually tropical and subtropical areas. Chills, fever, sweat, headache, nausea, fatigue. Last 1-4 weeks. Enlarged liver and spleen, anemia. Recur may be persistent for yrs. Treat w chloroquine. Antipyretic.

Front 42

Snakebites

Back 42

Noticeable bite, slight discoloration, burning pain, swelling, rapid pulse, weakness, visual difficulties, nausea, vomiting. May take 30 mins to several hours. Rattle(most bites), copperhead, water moccasin, Coral snakes extremely poisonous. Usually 1-2 days to develop unless allergic

Front 43

Snakebites Treatment

Back 43

Immobilize, keep below heart. Remove constricting jewelry. Antivenin. Cold should not be applied, would should not be cut, tourniquets not applied, nor electric shock. Treat within 30 mins.

Front 44

Carpal Tunnel

Back 44

Entrapment and compression of median nerve in carpal tunnel cause pain, numbness, in wrist, hands, fingers (fluttering), swelling, shake wrist to relieve pain.

Front 45

Carpal Tunnel Etiology

Back 45

Tendons w/in tunnel become inflamed from overuse resulting in pinching of median nerve. Any condition that exerts pressure on median nerve can cause carpal tunnel. 2 tests: median nerve percussion test and Phalen wrist flexor test.

Front 46

Carpal Tunnel Treatment

Back 46

PT, anti inflammatory, oral corticosteroids or injections, surgery last resort.

Front 47

Thoracic Outlet Syndrome (Brachial Plexus Injury)

Back 47

Compression of brachial plexus nerve. Numbness in fingers. Continuously drop items. Hyperabduction of arm

Front 48

Child Abuse/Neglect

Back 48

Physical, psychological, sexual (complain discomfort in genital region), neglect. Usually discovered by teachers, daycare, healthcare. Child withdrawn, avoid eye contact, does not respond approximately to painful stimuli. Child denies abuse, or acts aggressive

Front 49

Child Abuse/Neglect Etiology

Back 49

Emotional immaturity, stress (economic, social, employment difficulties), poor parenting, drug or alcohol, history of abuser being abused, unrealistic expectations, limitations physically or mentally of challenged kid.

Front 50

Shaken Infant (Baby) Syndrome

Back 50

Altered level of consciousness to complete loss. Irritability, changes in skin color (pale, cyanosis), vomiting, lethargy, convulsions. Fractured or dislocated bones, neck or spinal injury, retinal hemorrhage.

Front 51

Shaken Infant (Baby) Syndrome Diagnosis

Back 51

3 Symptoms not all 3 need to be present. Subdural hematoma, cerebral edema, retinal hemorrhage. Injuries to brain are non reversible or even fatal.

Front 52

Elder Abuse/Neglect

Back 52

Physical, self, verbal, psychological, abandonment, personal rights, financial. Rare for them to complain

Front 53

Psychological or Verbal Abuse

Back 53

Diminishment of self worth or self esteem. No complaints. Transcends age groups. Children frequent victims. Lead to anorexia, bulimia, obesity, alcoholism, self mutilation, drugs, depression, suicide. Often unable to bond.

Front 54

Psychological or Verbal Abuse

Back 54

Etiology unknown, takes place over time, best treatment is prevention.

Front 55

Intimate Partner Violence

Back 55

Most frequent in females. Bruising, avoid eye contact. Could be cultural or societal values. Victimization. Seek counseling. Listening is upmost importance, inappropriate to impose opinion.

Front 56

Sexual Abuse

Back 56

Any form of non consensual sexual contact or activity. Either gender any age. Children often have unusual obsession w genital area and exhibit aggressive behavior.

Front 57

Sexual Abuse Etiology

Back 57

Domination, control, power issues. Often sexually abused as children, sociopathic approach. Remove victim from environment, physical exam w/in 72 hrs. Medical and forensic exam. Law enforcement notified w victims consent or local and state policy. CPS notified if child. Social services involved to remove child.

Front 58

Rape/Sexual Asult

Back 58

Intercourse against will. Bruising, torn clothing, disheveled, withdrawn, avoid eye contact. Crime of domination. Gather samples, urinalysis, blood, AIDS, possible pregnancy, STDs. Sexual assault response team for medical and legal exam. Law enforcement must be notified.