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73 Cards in this Set
- Front
- Back
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Trauma makes up what % of call volume and typical code 3 calls
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6%
STEMI Cardiac Arrest Trauma |
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Phases of trauma care
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1) Pre-Incident
-public speaking/prevention (seatbelt campaigns, helmet laws etc) 2) Traumatic incident 3) Post-Incident -airway care, trauma treatment |
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Golden Hour & on scene time documentation
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accident to surgery
document if on scene longer then 10 minutes |
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Trauma rating system and UD/RB/MW/OHSU/Emmanual rating
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1 best
4 worst UD/RB = 2 MW = 3 Emmanual / OHSU = 1 two teams each |
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ATAB
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Area Trauma Adisory Board
board of people who monitor and adjust trauma system depending on local requirements -made up of surgeons, medics, etc |
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STAB
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State Trauma Advisory Board
all ATABs report here |
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Is it ok to stop at a lower level trauma hospital?
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Yes, if specific needs must be met, such as airway securing, continue to appropriate hospital ASAP
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time limits for response
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differ depending on location (urban, rural, frontier etc)
Urban (over 50,000) - 8 min Suburban (1,000 per mile) - 15 min Rural (over 6 per mile) - 45 min Frontier (6 per mile) - 2hrs |
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Full Vs Modified Trauma
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Full = specific complement of hospital staff ready to deal with the patient
Modified = emergency but less urgent, Hospital determines personnel resources |
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Full Vs Modified Criteria
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1) Anatomical
-penetration -flail chest -amputation 2) Physiological -Vitals -GCS 3) Mechanism of Injury -death of same vehicle occupant -ejection from an enclosed vehicle -height of fall (3X pt height) REQUIRE ENTRY INTO TRAUMA SYSTEM |
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Paramedic Discretion
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Most trauma entries
paramedic can opt in, but can not opt out |
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comorbid factors
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-geriatrics (kyphosis, beta blockers)
-pediatrics -certain meds -non english speaking -weather conditions (all calls take longer, hypothermia issues) |
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GCS
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Glascow Coma Scale
Eye 4 Spontaneous 3 Verbal 2 Painful 1 None Verbal 5 Oriented 4 Confused 3 Inappropriate Words 2 Inappropriate Sounds 1 None Movement 6 Spontaneous 5 Localizes pain 4 Withdraws from pain 3 Decortacate 2 Decerebrate 1 None |
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Physical Laws (4)
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1) Newtons 1st Law
-Objects in motion stay in motion until acted upon by an outside force (car crash) 2) Conservation of Energy -energy can not be created or destroyed, only changed 3) Newton's 2nd Law Force = Mass X Acceleration 4) Kinetic Energy Kinetic Energy = 1/2Mass X Velocity [squared] |
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Blunt vs Penetrating Trauma
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Blunt
-we do not work blunt force trauma -Low survivability Penetrating -higher success rates -we will work these |
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5 Different forces during MVAs that contribute to the MOI
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1) Head on
2) Lateral 3) Rear end 4) Rotational 5) Roll over |
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Level I trauma
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-highest level of definitive care, for multi system trauma adult and ped
-total patient care for every aspect of injury from prevention through rehabilitation -emergency physician, general surgeon, anesthesiologist, and nursing personnel who can initiate immediate surgery are in house -nuerosurgeon on call -sub specialists on call -highly specialized care including pediatric trauma burns spinal cord injury eye injury limb reimplantation -resident training/research, regional QI, community education, outreach, injury prevention |
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Level II trauma
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-definitive care for severely injured adults and peds with complex trauma
-physicians, nurses, general surgeon and anesthesiologist on call -neurosurgeon on call and available -specialists available -QA, community education, outreach, injury prevention |
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Level III
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-provides initial evaluation and stabilization including surgical intervention of the severely injured adult or ped patient
-stable or improving condition without specialized care -transfers pt's with req. speciality care to a higher level trauma hospital -general surgeon is on call and available |
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Level IV
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-provides resusitation and stabilization of the severely injured adult or ped patient prior to transferring the patient to a higher level trauma system
-may require surgical intervention -physicians and nurses trained in resusitation |
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How far apart are the two LEVEL 1 trauma centers in portland?
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less then 5 miles
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Concussion signs and symptoms
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no idea what happened
loss of consciousness for an undetermined time period |
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clues found from circling the car
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bent steering wheel
windshield - blood or hair or skin? head rest placement |
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kiss sign
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frontal collision, head hyperflexion
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Rotational forces and injury patterns
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"car spins in a circle really fast"
-C spine precautions rotational and rollovers produce less casualities then would be expected |
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intrusion
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car parts pushed into passenger space (significant amount of intrusion, and varies by patient)
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3 accidents occuring in collisions
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1) collision
2) body to car 3) organs to chest wall (potential for fecal and digestive enzyme release if damaged) |
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closed glottis effect
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lungs explode if severe blunt trauma and patient has a closed glottis (paper bag effect)
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pedestrian injuries adults
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turn away from the car
-bumper hits legs (probable fx), pt goes onto hood and head to windshield - pt rolls off the hood and onto the street |
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pedestrian injuries peds
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kids turn and face the vehicle
-car runs over the top |
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vertical fall patterns
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adults tend to land on their feet, kids on their head because it is heavier
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Blast injury patterns
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Primary - atmospheric overpressurization damages hollow organs
Secondary - shrpanel from the bomb Tertiary - patient is picked up and tossed by blast and into objects |
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Bullet Patterns (hollow point, fragmentation, FMJ)
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HPs = transfer energy instead of shooting thru
FMJ = metal copper point stiffens nose of round |
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High Velocity rounds
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rifle rounds
-push tissue faster then it can move, destroying the tissue in the process |
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Low Velocity rounds
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pistol rounds
-poke holes but do not cause a ton of cavitation |
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Exit wounds
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-huge on arms or legs
-hidden on belly or chest if not enough penetration |
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shooting victim treatment
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C-spine precautions, including headshots
-extremity thru and thru may not require |
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Shotgun damage
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close range wounds have gas damage as well
distance determines amount of pellets on target |
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Compensated Shock
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10-15% blood loss
BP is holding steady due to shunting and compensation systems |
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Uncompensated Shock
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20-30% blood loss
BP drops, compensation no longer effective |
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Irreversible Shock
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40% blood loss
organ damage |
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compensatory shunting
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FIRST
skin muscle bone SECONDARY Liver GI Kidneys |
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PASG
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once you inflate DO NOT deflate unless DIAPHRAGMATIC HERNIA
Relative contraindications -penetrating cx wound Contraindication -crackles in lungs |
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diagragmatic hernia
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firm blow to the belly pushes organs up and through the diaphram usually on L side, as liver protects the right side
sunken wierd shaped amdomen after PASG inflation |
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Normal Saline to Blood ratio
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we replace 1 liter of blood with 2-3 liters of NaCl
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Laceration
Abrasion Contusion Hematoma |
Laceration - deep cut
Abrasion - shallow, breaks skin Contusion - bruise under the skin Hematoma - blood pools under the skin |
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Avulsion
Amputation Bites |
Avulsion - flap of skin, (lose your nose)
Amputation - loss of body part (wrap in sterile dressing, plastic bag, on cold pack) Bite - bacterial issues, advise transport |
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Compartment syndrome
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-pain out of proportion with injury
-hematoma on the inside of the arm, cant see from the outside -moving fingers causes pain tx reduce pressure, via surgery |
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Crush Syndrome
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-large amount of cells destroyed
-potassium leaks out causing hyperkalemia (peaked T wave) Tx -start IV's so when extricated, can control pressure |
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myoglobin
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released from damaged muscles (4-6 hours)
damages kidneys treated with lots of fluids |
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Prednizone
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steroid used for respiratory issues long term
changes skin, looks yellowish transparent |
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Varicose veins
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valves dont work
vein stretches out fragile walls |
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treatment for bleeding
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direct pressure
if not effective TQ |
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Tetanus
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"lockjaw"
worldwide problem, any patient with an open wound should be reminded and encouraged to get transported for a tetanus shot |
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arterial bleeds
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-spray patterns of blood
-bright red blood -5 X 9's can be used or 4X4s -Pain management (amputations) -Ice pack (slows metabolism for salvage, reduces swelling, helps to stop bleeding) |
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penetrating chest or abdominal injury
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leave objects in place
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3 phases of shock physiology
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1) Ischemic Phase
2) Stagnant Phase 3) Washout Phase |
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Ischemic Phase
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Pre and Post capillary sphincters close, shunting blood.
-cells in these capillary areas turn to anerobic respiration and produce lactic acid and other toxic byproducts > diffuse to capillaries cells lining the capillaries become smaller, creating gaps between the cells, allowing larger proteins which would normally stay in the intravascular space to go into the ECF, water follows |
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Stagnant Phase
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precapillary sphincters open, blood from the arterioles flows into the capillaries pushing more blood proteins out of the intravascular space and into the extracellular space
more fluid in ECF, more space between cells, inhibits diffusion of gases to and from the cells thicker blood causes RBC's to stack like a roll of coins "ROLEAUX FORMATION" |
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Washout process
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postcapillary sphincters open, blood is pushed from the arterioles through the capillaries and into the systemic circulation
Lactic acid causes metabolic acidosis. RBC's clumped together reach the capillaries of the lung and lodge as micro emboli, inhibiting gas exchange (ARDS) |
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External Hemorrage
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does not typically pose a life threat
affected by 3 factors 1) anatomical source of the injury (artery, vein, or capillary) 2) degree of vascular disruption 3) amt of blood los that the patient can tolerate |
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Internal Hemorrage
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blunt or penetrating trauma, or acute or chronic illness, higher morbidity rates
4 affected cavities chest abdomen pelvis retroperitoneum S & S -bright red blood from mouth, rectum or orifice -coffee-ground appearance of vomitus -black tarry stools -passage of red blood through the rectum -dizziness or syncope on sitting or standing |
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hemostasis
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cessation of bleeding by chemical means
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3 things needed for oxygenation
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1) heart
2) vasculature 3) lungs |
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fick principle
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quantity of oxygen delivered to an organ is equal to the amount of oxygen consumed by that organ plus the amount of oxygen carried away from that organ
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pulse pressure
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difference between the systolic and diastolic systemic pressure
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percent of total blood flowing through capillaries?
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5% the rest is in the arterioles
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Compensated Shock
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Mild tachy
lethargy, confusion, combativeness delayed cap refill, cool skin normal or slightly hypertensive |
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Uncompensated Shock
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moderate tachy
confusion, unconsciousness delayed cap refill, cold extremeities, cyanosis decreased systolic and diastolic pressure |
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Irreversible Shock
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bradycardia, severe dysrhthmias coma
pale, cool, clammy skin frank hypotension |
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Compensated Shock mechanisms (3)
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Sympathetic Response
-increase cardiac output -increase PVR Hormonal Response -ADH & Aldosterone = water and sodium retention Adrenal Response -release of eppie |
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Uncompensated Shock effects
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systolic and diastolic pressures fall
-PO2 down, cerebral blood flow down -cellular hypoxia -decreased pulse pressure |
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Shock Initial Assessment 5 steps
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1) Aiwray
2) Breathing 3) circulation (pulse rate and character, skin signs, cap refill) 4) disability (mental status) 5) visual inspection of the body surfaces for bleeds |
