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54 Cards in this Set
- Front
- Back
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What is the first leading cause of death for individuals aged 1-44?
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Trauma
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What is the most prevalent cause of trauma?
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Motor Vehicle Crashes
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What is the "Golden Hour" concept?
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After a crash, you want to be medically seen within an hour.
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What is the study of principles of the action of forces and their effects?
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Biomechanics
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What is a branch of mechanics (energy transfer) referring to motion?
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Kinematics
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What is the mechanism whereby energy is transferred from the environment to the person?
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Mechanism of injury
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What are types of mechanical energy that serve as external forces in mechanical injury?
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Deceleration
-Acceleration -Combination forces -Shearing -Other |
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What are contributors to the amount of energy a moving object has?
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-Mass
-Velocity |
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Patterns of injury are predictable if you know:
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-Type and direction of impact
-Speed of collission & mass of objects -Presence or absence of restraints or safety devices |
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What are the patterns of injury when a pedestrian is hit by a motor vehicle?
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-Knees, tibia, fibula, femur, pelvis (children are different)
-Vertebral column injury -Injuries affected by where positioned in the vehicle |
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Possible injuries for a motorcyclist:
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-Face, chest, lower legs
-Cranial and cervical injuries |
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What is meant by the term axial loading as it applies to falls and jumps?
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The height by which the person falls or jumps will have an effect on the injury or insult.
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Where is most of the energy applied in falls and jumps?
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to the skeleton
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What are factors that affect the pattern of injury in falls or jumps?
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-age
-distance from which victim fell or jumped -energy absorbency of surface -pre-existing condition of victim - pre-existing condition of environment -Anatomic point of impact -Deceleration loaded onto the victim |
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What are common causes of blunt trauma:
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-Vehicle crashes, both with and without motors
-Assaults -Crushing or entrapment in mechanical equipment |
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What are examples of penetrating trauma?
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-Low velocity stabbing
-High velocity bullets -Extent of tissue damage is difficult to predict because entrance and exit pathways are unreliable. |
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What is the difference between how a woman would stab someone and how a man would stab someone?
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Women stab in an upward arching motion.
Men stabin a downward arching motion. |
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What are the phases of trauma?
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-emergency
-critical -rehabilitation -recovery |
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What should be done during the emergent phase of a trauma? Just general, not detail...
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-simultaneous resuscitation and assessment
- "treat in the absence of a diagnosis" -Composed of primary and secondary assessments |
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What are the ABC's of primary survey?
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-Airway with simultaneous cervical spine stabilization and/ or immobilization
-Breathing -Circulation -Disability (neurologic status) -Exposure/ Environment |
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What should be kept in mind regarding airway in a trauma?
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-Airway is always 1st priority & must be constantly reassessed.
-If no secure airway, get one by clearing obstructions from airway, intubate or surgical airway. -Maintain neutral c-spine alignment |
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What should be kept in mind regarding breathing in a trauma?
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-Patent airway does not guarantee adequate gas exchange
-Assess movement of air, respiratory rate, chest rise and fall, skin color, chest wall integrity or soft tissue and body structures, use of accessory muscles, bilateral breath sounds present, shortness of breath -jugular vein distention or flattening, change in trachea position |
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What should be done if breathing is effective?
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Administer oxygen via a nonrebreather mask with a flow rate to keep the reservoir bag inflated (12-15 liters).
This will delivery 85-90% oxygen. |
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What are symptoms of ineffective breathing?
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-altered mental status
-cyanosis -assymetrical chest wall expansion -Use of accessory muscles -Sucking chest wounds -Paradoxical chest wall movement -Tracheal shift away from midline |
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What should be done if breathing is ineffective?
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Administer 100% oxygen via a bag-valve-mask and assist with endotracheal intubation or surgical airway and then ventilate with 100% oxygen.
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What kinds of conditions could effect breathing?
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-pneumothorax
-hemothorax -hemo-pneumothorax -flail chest (4+ rib fx in 2 locations) -Pulmonary contusions -tension pneumothorax |
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How should circulation be assessed for (without any equipment)?
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-palpate for pulse quality and rate.
-palpate central pulses (carotid and femoral) noting differences with peripheral pulses -Palpate skin for temp and moisture -Inspect skin for color -Inspect for any obvious signs of bleeding. |
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How can circulation be assessed with equipment?
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-Auscultate BP if other team members are available
-If not, proceed with primary assessment and auscultate BP at the beginning of the 2ndary assessment. |
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What are S/S of ineffective circulation?
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-Tachycardia
-Altered LOC of mental status changes -Uncontrolled external bleeding -Distended or abnormally flag jugular veins -Pale, cool, diaphoretic skin -Distant heart sounds |
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What should be done if circulation is absent?
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-Begin CPR
-Initiate advanced life support -Administer blood as prescribed -Prepare for and assist with emergency thoracotomy -Prepare for definitive operative care |
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What is a thoracotomy?
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Thoracotomy is an incision into the chest. It is performed by a surgeon, and, rarely, by emergency physicians and paramedics, to gain access to the thoracic organs, most commonly the heart, the lungs, the esophagus or thoracic aorta
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What should be done if circulation is ineffective?
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-Control any uncontrolled external bleeding
-Cannulate 2 veins with large bore IVs (10, 14, 16) and infuse IV fluids (NS or Lactated Ringer's) -Consider use of MAST garment -Obtain blood sample for blood typing -Admin blood as prescribed (especially after 3 liters of warmed IV fluids) |
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What should be assumed if about a patient with hypotensive trauma until proven otherwise?
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It should be assumed that the patient has hemorrhagic shock.
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What are the most common organs injured in an abdominal injury?
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-liver
-spleen |
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How much blood loss can be associated with a femur fx?
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3-4 units!
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S/S of cardiac contusion:
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-pt may have retrosternal pain that mimics anginal pain, tachycardia, or conduction and/or rhythm disturbances.
-May show signs of shock -cyanosis -distant muffled heart sounds -distended neck veins |
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What are S/S of a ruptured aorta or vena cava?
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-Significant chest and/or back pain
-difficulty breathing -these injuries are usually fatal. |
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What mnemonic can be used to determine LOC?
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AVPU
A = alert V = responds to verbal simuli P = responds to painful stimuli U = unresponsive |
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What is done in the brief neuro assessment?
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Assess pupils for:
- size - shape - equality - reactivity to light |
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T/F
If a pt is demonstrating signs of neurologic deterioration, consider hyperventilation. |
True
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What are the main topics addressed in the Glasgow Coma Scale?
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Pt's eyeopening
best verbal response best motor response |
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What are 2ndary factors that may effect neuro status?
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Alcohol
Drugs Hypothermia Shock |
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What are injuries that may affect disability (neuro status)
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-Acute Brain Injury
-Spinal cord injury -respiratory compromise -Pre-existing factors |
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When should the primary assessment be completed and 2ndary survey should be continued?
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Only after ABCDE's are completed
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What is identified during the secondary assessment?
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FGHI
F = full set of VS G = give comfort measures H = History I = Injuries |
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What VS should be taken in a trauma situation?
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Temp
Pulse Oximetry End tidal CO2 (more effective than O2 because instantaneous) Interventions Family Presence |
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What hx is relevant in a trauma situation?
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Prehospital info
- Mechanism of injury - Injuries - Vital Signs - Treatment Pt generated information Past medical hx: - meds - allergies - diseases - surgeries |
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What is included in the head-to-toe assessment:
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- general appearance
- Head and face - Neck - chest - abdomen and flanks - pelvis and perineum - extremities - posterior surfaces |
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What are typical lab tests in trauma?
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- Type and Cross Blood typing and screening
- Hematocrit/ Hemoglobin - Arterial blood gases - electrolytes - coagulation studies - toxicology screen - urinalysis |
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Additional 2ndary assessment:
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Focused survey
Systematic approach Pain Mgmt Tetanus prophylaxis FAST scan Document as you go (protect yourself) |
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Typical Trauma Radiology Tests:
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-chest x-ray
-c-spine x-rays -pelvic x-rays -head CT scan -Abdominal CT scan -Pelvic CT scan - Others determined by pt complaints |
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What are goals of the critical care phase?
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Support healing
Prevent complications Restore functional integrity |
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What are goals of the Rehabilitation phase?
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Prevent 2ndary complications
Rehabilitate pt to return to ADLs |
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What are the goals of recovery phase:
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Pt has returned to ADLs and functioning level that existed before accident - or as near to it as possible.
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