Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
148 Cards in this Set
- Front
- Back
|
Significant Burns vs Total Burns
|
2nd and 3rd degree burns = significant
all burns = total burn |
|
|
Rule of 9's adults
|
turtle
9's for head, arms, legs, trunk has 18 on front and 18 on back |
|
|
Rule of 9's peds
|
head = 18
Front and Back trunk 18/18 arms 9 legs 14 |
|
|
Parkland Burn Formula
|
Significant Burns (2&3) X Special Number = gtts/min or ML per 10 min
|
|
|
3 kinds of burns
|
1) thermal (& inhalation injury)
2) electrical 3) chemical |
|
|
Inhalation injury 3 factors
|
superglottic - above vocal cords
-caused by heat -> edema and lip edema tracheal mucosal injury -lower respiratory tract carbon monoxide poisoning |
|
|
Signs and Symptoms of inhalation injury
|
-ashes
-hoarse voice -stridor -coughing and soot sputum -singed nasal hair -mouth burns |
|
|
why is smoke inhalation lethal?
|
damage is done by smoke's chemical composition
smoke inhalation and burns have an additive nature |
|
|
Burn treatment
|
-open airway
-O2 -seated position if possible -rapid transport -intubation -recognition is key |
|
|
thermal burns
|
catagorized by depth and surface area
50% = 1/2 of skin surface patient's palm = 1% |
|
|
burn degrees
|
1st = superficial
-outer layer of skin cells -red, dry, painful -ASA 2nd = partial thickness (1st and 2nd) -blisters 3rd = full thickness -entire thickness/dermis -dry, leather like -insensitive to pn |
|
|
Industrial Accident
|
tar or plastic continues to burn skin
-do not remove -cool with saline |
|
|
Electrical Burns
|
limited to point of contact, entry and exit wound
-interior damage -cardiac problems (v-fib possibly or MI) -multiple systems trauma -myoglobin urea (admin fluids) typicaly follows muscle bundles, no damage on the outside, lots of damage within |
|
|
chemical burns
|
continue to burn until material used up or removed
-irrigate with room temperature water -moist dressings for small burns (not for use in large burns due to hypothermia -IV morphine -infection and hypothermia (keep unit warm and use dry sheets and blankets) |
|
|
less then 10% and greater then 10% burn TX
|
less then 10%
-water and burn dressing more then 10% -prevent hypothermia & fluid loss |
|
|
oregon burn center
|
emmanuel
-skin grafts -extremely sterile |
|
|
Burn Center Referral Criteria (10)
|
1) Full thickness 10% total body area
2) burns involving face, hands, feet, genitalia, pernium, or major joints 3) 3 degree burns in any age 4) electrical burns including lightning 5) chemical burns 6) inhalation injury 7) burns in patients with preexisting medical disorders 8) burns and co-concomitant trauma (such as fractures) 9) burned children in hospitals without qualified personnel 10) burn injury in patients who require special social, emotional, or rehab intervention |
|
|
Probability of Upper Airway Obstruction
|
Burns around nose or mouth
soot in mouth or nose: singed nasal hairs intraoral burns: burned tongue intraoral swelling (no stridor) hoarseness of voice visible pharyngeal edema inspiratory stridor |
|
|
AC vs DC
|
AC is lower voltage (110 house line) but more dangerous b/c it mimics nueromuscular physiology
DC = 220 |
|
|
Radiation Exposure Types
|
Alpha - bounce of skin, large particle
Beta - can go through skin, some PPE required Gamma/Xray - tiny particles requires protection -particles hit nucleas and change DNA |
|
|
Radiation protection
|
Shielding (lead)
Distance Time exposed |
|
|
Burn sheets
|
sterile sheets that cover the cot and wrap patient, unwrap to the pt left for IV access
|
|
|
Circumferential Burn
|
any limb or chest (dipping type)
3rd degree = skin becomes leathery, prevents adequate respirations if on chest burns on arms cut off circulation, relief cuts used in both cases |
|
|
Tension Pnuemo S&S (7)
|
Shock - progressively worse
Absent Lung sounds Subcutaneous Emphysema HYPERINFLATED AFFECTED SIDE JVD Tracheal Deviation (away) Hyperresonance = higher pressure equals higher pitch |
|
|
do we wet burn dressings?
|
yes, with room temp water for small percentage burns, we dont want to make hypothermic
|
|
|
Facial Injuries
|
the head is highly vascularized, and superficial injuries may not reflect the true damage below the surface
|
|
|
3 round ring bone break locations
|
1) mandible
2) vertebrae 3) pelvis |
|
|
Mandible Fracture S&S
|
AO = have patient bite down and check for teeth alignment
non AO = associated with basilar skull fracture -battle signs and raccon eyes |
|
|
3 different types of midface fractures
and asessment |
Lafort 1 = Maxilla Moves
Lafort 2 = Nose area Lafort 3 = occular eye and cheek bone check eye movement and tracking for laforts |
|
|
Hemothorax
|
blood in chest cavity collapses lung
-cx sounds may move or diminish based on patient position |
|
|
pnuemothorax
|
air in chest cavity collapses lung
-emphysema & bleb rupture caused TX - increase O2 |
|
|
Tension Pnuemo
|
hole is on the inside or out, and air is drawn into the cavity but is not allowed to escape
-each breathe gets harder to take -HYPERINFLATION AFFECTED SIDE (one side is larger does not breathe) -SUB Q emphysema |
|
|
bubbling chest wounds
|
sucking chest wound
|
|
|
lung sounds absent on on side, no other S & S?
|
hemo thorax or simple pnuemo
|
|
|
Laceration to the head treatment
|
try to control bleeding with pressure but be careful not to push bones or glass into skull
-use larger bandage for diffuse pressure |
|
|
mandible fracture
|
ask patient to bite down and check for teeth alighment
associated basilar skull fracture -batte sign and raccoon eyes |
|
|
blowout fracture
|
ball hits the globe of the eye and pushes the eye into the base of the orbit, sinus cavity, breaking inferior orbit bones
|
|
|
what do all facial fractures require?
|
C-spine precautions
|
|
|
Hyphema
|
blood fills anterior chamber of the eye, caused by a blow to the eye
TX -proparacaine to sooth -occlude both eyes to prevent movement |
|
|
neck trauma treatment and zones
|
use occlusive dressing for neck wounds
Zone 1 - Down Low (WORST) Zone 2 - middle Zone 3 - up high, close line type injury (larynx progressively getting worse, stridor sound indicates RSI required, choose smaller tube) |
|
|
Head Impacts assessment
|
-skin damage not always present
-check for bumps/bruising -check for concussions -coup (initial impact) contre coup (secondary impact) |
|
|
3 Types of bleeds
|
Epidural - Arterial
Subdural - Venous Bleeds Subarachnoid - stroke type |
|
|
Epidural Hematoma characteristics
|
lucid interval, everything is fine after the impact
middle meningeal artery (temple strike) -walk into a baseball |
|
|
Subdural Hematoma
|
pt might be knocked out or have headaches
-decreased LOC |
|
|
Cushing's Triad
|
1) increased BP
2) Decrreased pulse 3) changing respiratory pattern increased pressure tries to push brain through the foramen magnum |
|
|
mean arterial pressure
|
brain tries to remain in an optimal profusing state
HR is slowed by vagus X nerve BP increases from brain cell hypoxia |
|
|
pt with a BP of 90/60 after blow to the head
|
NOT hypovolemic from head injury, consider other bleeds
|
|
|
ventilatory suport for a head injury
|
keep CO2 at 35
|
|
|
Pupillary Reaction during a head injury
|
if the brain pushes on the 3rd cranial nerve the pupil will dilate, the other pupil will dilate shortly
|
|
|
Herniation
|
cartilage fin gets pushed over by venous pressure and squishes the brin causing decerebrate posturing
|
|
|
Pupillary Reaction
|
pupils should be, black, round, equal in size and react to light
abnormal responses -tearing -direct trauma to the pupillary sphincter muscle -optic nerve or globe causes -drug use -cataracts -surgery -strokes -previous injury |
|
|
Extraocular Movements
|
movements of the eyeball 3,4,6
have pt track a penlight abnormalities -orbital content edema -cranial nerve injury -contusions/lacerations of extraocular muscles -muscle entrapent in a fracture -pt CC of double vision |
|
|
Indicators of herniation for hyperventilation
|
an unresponsive patient with
Bilateral, dilated, unresponsive pupils OR asymetric pupils (>1mm) & Abnormal extension (decrebrate) posturing OR no motor response to painful stimuli |
|
|
Basilar Skull Fracture
|
-fracture to te base of the skull
-CSF fluid from nose or ears -no cushings because pressure is relieved -dont block CSF flow (use Halo effect to determine) -Raccoon Eyes -Battle's Signs (late signs) |
|
|
Subarachnoid Bleeds
|
-medical problem -> stokes under 30
-severe head ache -sudden loss of consciousness (worse headache ever, from the rear) -Very Dangerous |
|
|
Linear Skull Fracture
|
crack across the head that is not palpable
-easy to miss -common in falls impacting the side of the head |
|
|
nyastagmus
|
eyes vibrate back and forth
common with nuero injuries |
|
|
Pulmonary Contusion
|
blow from flail chest produces bleeding, hematoma forms and affects O2 diffusion
|
|
|
Traumatic Asphyxia
|
MOI = squeeze to the chest
-blood is forced backwards through the heart and up to the head -eyes red -stroke risk |
|
|
Myocardial Contusion
|
"bruise to the heart"
-steering wheel to chest -cardiac monitor |
|
|
Diaphramatic Rupture
|
Abdominal contents rupture up thru the L chest area
|
|
|
Scafoid abdomen
|
indicative of a diaphragmatic rupture > irregular sunken abdomen
|
|
|
ABD Organs contain...
|
1) digestive enzymes
2) feces 3) blood |
|
|
hypovelemia, no trauma S&S?
|
bleeding into ABD
|
|
|
Seatbelt Restraint injuries
|
punche the pancrease in 2 peices
|
|
|
eviseration
|
bowel comes out of abd
TX -sterile dressing moist, cover with saran warp or foil to prevent hypoterhmia |
|
|
kidney trauma
|
S&S
-blood in the urine (common for marathon runners and truck drivers -kidneys can be fractured like a zuccini |
|
|
Nose bleed
|
hypertension causes posterior nose bleeds
-vblood goes back in throat and is sput up anterior nose bleeds - normal |
|
|
Thermal burn zones
|
1) zone of coagulation (cell death)
2) zone of stasis (ischemic cell death in 24-48) 3) zone of hypermia (cells generally survive) |
|
|
eschar
|
tough non-elastic coagulated collagen of the dermis present in 3rd degree burns
|
|
|
Major burns
|
-partial thickness > 25% BSA in adults or 20% in peds/gers
-full thickness > 10% BSA -burns to face, eyes, ears, hands, feet, perineum -caustic chemical burns -electrical burns -inhalation, major trauma, poor risk |
|
|
Moderate Burns
|
-partial thickness 15-25% BSA adults, 10-20% peds/gers
-less then 10% BSA full thickness -doesnt involve face, ears, hands, feet perineum |
|
|
Minor burns
|
-burns less then 15% BSA adults, 10% BSA in peds/gers
-less then 2% full thickness burns -no functional or cosmetic risk to areas of specialized function |
|
|
burn center referral criteria (10)
|
1) Full thicknes burns reater then 10% BSA
2) Burns involving face, hands, feet, genitals, perineum, joints 3) 3rd degree burns 4) electrical burns 5) chemical burns 6) inhalation injury 7) burn injury with medical disorders 8) burns with concomittant trauma 9) children in hospitals with no burn specialists 10) social, emotional, long term rehab needs |
|
|
greatest loss in IV fluids
|
First 8-12 hrs (50%) next 8 (25%) next 8 (25%)
|
|
|
Parkland Burn Formula
|
%SB X special number = ml/10min
|
|
|
Phases of burn shock (4)
|
1) emergent phase
2) fluid shift 3) resolution 4) hypermetabolic |
|
|
Burns & edema of the face
|
raise bed 30 degrees if possible
|
|
|
Carbon Monoxide Levels
|
< 10% - no symptoms
20% - H/A, N/V, loss of dexterity 30% - confused or lethargic 40 - 60% coma > 60% - fatal |
|
|
upper airway inhalation injury S&S
|
-facial burns
-singed nasal/facial hairs -carbonaceous sputum -edema of the face, oropharynx cavity -hypoxia -grunting respirations -stridor -brassy cough |
|
|
lower airway injuries
|
damaged caused by the inhalation of toxic chemicals
-wheezes -crackles/rhonchi -productive cough -hypoxemia -bronchial spasm |
|
|
6 principles of electricity
|
1) amperage
2) voltage 3) ohm 4) type of current (AC/DC) 5) current pathway 6) duration of flow |
|
|
3 types of electrical injuries
|
1) direct contact burns
2) arc injuries 3) flash burns present similar to compartment and crush injuries, renal failure a problem due to myoglobin release from damaged muscle tissue |
|
|
Radiation levels
|
<100 RAD (radiation absorbed dose) - no acute problems
100-200 RAD - symptoms but not deadly 200 RAD - N/V diarrhea 2-4hrs 450 RAD - 50% mortality if not treated within in 30 days |
|
|
Mandible FX
|
second most common fracture after broken nose
-teeth dont line up, break in 2 places |
|
|
Objects in nose protocol
|
leave unless airway compromised or can remove without tools
|
|
|
Traumatic Hyphema
|
-traumatic dilation
-decrease in visual acuity -blood in anterior chamber TX C-spine precautions elevate spine board 40% |
|
|
Contusion Injury
|
-traumatic dilation/constriction of pupil
-pain -photophobia -blurred vision |
|
|
Globe or sclera rupture
|
-decreased visual acuity
-lowered intraocular pressure -irregular pupil -hyphema |
|
|
Seriousness of head injuries
|
Mild Diffuse - concussion, reversible
Moderate Diffuse - bruised brain, 20^% fatal Diffuse Axonal Injury - most serious |
|
|
cerebral perfusion pressure equation
|
mean arterial pressure - intercranial pressure
|
|
|
cerebral cortex and upper brainstem (increasing ICP patterns)
|
-BP rises
-pulse rate slows -pupils remain inactive -cheyne stokes -patient localizes and removes painful stimuli (flexion occurs) REVERSIBLE |
|
|
middle brainstem
|
-wide pulse pressure and bradycardia
-pupils become non-reactive and sluggish -central neurogenic hyperventilation develops -abnormal posturing (extension) occurs -few patients function normally with injury at this level |
|
|
lower portion of brainstem/medulla
|
-pupil is "blown" (fixed and dilated) on same side of injury
-respiration become ataxic -patient will be flaccid -pulse rate is irregular -QRS, S-T, and T wave changes will be present -blood pressure will fluctuate -patients do not survive |
|
|
cerebral hematoma
|
collection of more then 5 mL of blood somewhere within the substance of the brain, commonly frontal or temporal lobe
|
|
|
cushings triad
|
increased ICP above 15 mmhg, body tries to protect and profuse brain
1) hypertension 2) bradycardia (baroreceptor response to increase pressure) 3) change in breathing pattern |
|
|
systolic blood pressures defining hypotension
|
< 65 in patients from birth to 1 year old
< 75 in patients from 2 - 5 yrs old < 80 in patients 6 - 12 yrs old < 90 in patients 13 years or older |
|
|
nuerogenic shock differentiators
|
-relatively bradycardic response (pulse 80, BP 80)
-skin that is warm and dry (not cool and clammy) -no evidence of significant blood loss or hypovolemia -paralysis and loss of spinal reflexes |
|
|
GCS guidelines
|
reassess every 5 min
a decrease of 2 points with a GCS below 9 |
|
|
pupil assessment
|
asymetric = 1 mm or more in size difference
dilated pupils = 4 mm or more adults fixed pupil - less then 1 mm change in response to bright light |
|
|
GCS scores
|
9-13 = moderate traumatic brain injury
8 or less = severe traumatic brain injury measure after initial assessment |
|
|
myocardial contusion
|
caused by blunt trauma to the chest (steering wheel etc) easily missed
TX -ECG abnormalities -cardiac murmur -pericardial friction rub (late) -persistent tachycardia -palpitations |
|
|
myocardial rupture
|
blood filled chambers of the heart are compresed with enough force to rupture the chamber wall
FATAL |
|
|
Traumatic Aortic Rupture
|
aorta shears under extreme forces
-distal arch damage. transverse arch is not tied down |
|
|
spine bone count
|
C7
T12 L5 S5 Coccxy 4 |
|
|
Dermatomes & Injury effects:
C2-C4 T4 T10 S1 |
C2-C4 = feel above the shoulders only over anterior chest to below clavicles (look for PCC)
T4 = Nipple line and above T10 = umbilicus and above S1 = soles of the feet |
|
|
criteria for C-spine precautions
|
MOI is most important
-neck pain can be masked by other types of pain |
|
|
Indirect spinal cord injury
|
most common
-car into ped, rapid acceleration |
|
|
C1, C2
& C3,C4, C5 & primary vs secondary injury |
C1 sits on the odontoid process of C2
-during hanging, this is broken off. All breathing cut off C3,C4,C5 = keep the diaphram alive primary injury = occurs at the time of impact secondary injury = occur after the injury, swelling, ischemia, movements of bony fragments |
|
|
C5/C6
& C7 |
C5/6 = biceps
C7 = triceps |
|
|
Babinsky's Sign
|
reflex arc can indicate if the cord to the brain has been damaged
-use pen to scrape outside bottom of foot POSITIVE (damage) = toe curls up normal in kids 2 years and younger |
|
|
priapism
|
parasympathetic system controlled so spinal damage does not affect. PT not aware
pelvic fracture can cause |
|
|
6 contraindications to moving the head to a neutral inline position
|
1) Resistance to movement
2) Neck muscle spasm 3) increased pain 4) numbnes, tingling, loss of motor function 5) compromise of airway ventilation 6) severe misalignment of head away from midline |
|
|
Helmets
|
-remove motorcycle helmets, pull base outwards, dont hook nose
football helmets with pads ok to leave on |
|
|
Low back pain
|
cracked bone > causes swelling > pinches nerve, possible deficits
need xray or lowered swelling to fix BACKBOARD |
|
|
compression fracture
|
bones forced together
-considered a more stable fracture |
|
|
open fracture
|
(compound) bone breaks skin
-small hole indicates bone was externally located at one time, cover with dressing look for holes in shoes from lateral malleolus |
|
|
greenstick fracture
|
bone not completely broken
-common in peds, potential for plate disturbances |
|
|
pathological fractures (2 types)
|
fractures caused by disease
1) osteoperosis 2) bone cancer |
|
|
splinting
|
immobilize joint to joint (protects during trip to hospital)
attempts to transfer weight |
|
|
Splinting:
Elbow Humerus Ribs pelvis |
Elbow = tricky, usually stabilize in place
Humerus = sling & swathe Ribs = usually self splinting with arm, watch for pulmonary contusion pelvis = sheet wrap tied |
|
|
shoulder dislocations
|
anterior 99%
-shoulder drops down -muscles start spasming, transport prone with arm hanging down -cartilage cap damaged, and shoulder more prone to dislocation Posterior dislocation -1% -head of humerus in back, back board with space for arm |
|
|
3 Hip problems
|
Hip consists of femur/acetabelum/head and neck
1) Hip FX 2) anterior dislocation 3) posterior dislocation |
|
|
hip anterior dislocation
|
hip dislocates, muscles pull leg anteriorly and laterally
-knee rotates outwardly |
|
|
hip posterior dislocation
|
hip dislocates to the rear
leg gets shorter and pulls medially |
|
|
hip fracture
|
hip rotates and gets shorter
patella is rotated and points outwards |
|
|
long bone fracture splinting
ankle fractures |
long bone = cardboard splint
ankle = pillow splint |
|
|
Femur FX treatment
|
traction splint
1) helps to control bleeding, by tamponade 2) stops bone ends from cutting vessels 3) alleviates pain |
|
|
straightening angulated fractures
|
-less severe angulations
-if no pulse felt, apply traction and reassess |
|
|
patella realignment
|
common in adolescent girls
-patella laterally displaced TX -apply lateral pressure + straighten the leg |
|
|
spiral fx
|
twisted or circular break that affects the length of the bone
|
|
|
oblique fx
|
diagonal or slanting brake that occurs between the horizontal and perpendicular planes of the bone
|
|
|
transverse fx
|
brake or fx that occurs at right angles to the long axis of the bone
|
|
|
comminuted
|
bone is splintered into peices
|
|
|
Epiphyseal fx
|
Type 1 = top broken off
2 = triangular break 3 = joint, top break 4 = vertical slice 5 = crush |
|
|
sprain vs strain
|
sprain = torn ligaments (range in severity)
1st = not joint instability 2nd = joint intact, swelling ecchymosis 3rd = total disruption of ligaments, possible nerve or vascular compromise strain = injury to the muscle or its tendon from overexertion or overextension |
|
|
degenerative conditions 3
|
Bursitis = inflammation of the bursa sacs between joints
tendonitis = inflammtation of the tendon caused by injury (pn, tenderness, restricted movement of the muscle attached to the tendon, NSAIDS) arthritis = inflammation of the joint |
|
|
arthritis types (3)
|
osteoarthritis = normal wear and tear on the joints
rheumatoid arthritis = autoimmune disorder body attacks joints, NSAIDS and immunosuppressive agents Gouty arthritis = joint disease, uric acid builds up in the joints and forms crystals |
|
|
6 p's of musculoskeletal assessment
|
pain
pallor paresthesia pulses paralysis pressure |
|
|
types of spinal cord injuries
|
axial loading
flexion, hyperextension, hyperrotation lateral bending distraction |
|
|
C-spine indications
|
1) significant trauma with intoxicants on board
2) seizure 3) PN/Paresthesia in neck or arms 4) neck tenderness 5) ALOC due to head injury 6) significant injury above clavicles 7) falls 3X height 8) fall and FX of both heels 9) high speed MVA |
|
|
central cord syndrome
|
caused by hypextension or flexion, cervical injuries
-paralysis of arms (legs are ok) -sacral sparing (preservation of sensory/voluntary motor function of the perineum, buttocks, scrotum, anus) |
|
|
anterior cord syndrome
|
caused by flexion, pressure on anterior aspects of cord
-decreased pain & temp below legion -intact light touch and position sensing -paralysis |
|
|
brown-sequard syndrome
|
hemitransection of cord due to knife or missile
-same sided weakness -loss of pain and temp on contralateral side |
|
|
DX tests upper extremity
T1 C7 S1/S2 L5 |
T1 = hold fingers apart while applying squeeze pressure
C7 = hold fingers out, push down S1/S2 = push feet L5 = pull feet back |
|
|
Logrolling
|
4 people, arms at lateral sides
|
|
|
spinal immobilization in diving accidents
|
1) scene safe (only trained rescuers)
2) float supine pt to shallow water 3) prone pt ? sandwitch head between arms and flip assess AB 4) 2nd rescuer slides backboard under, apply collar 5) flat to edge and lift out 6) immobilize pt |
|
|
Autonomic Hyperreflexia Syndrome
|
distended bladder or rectum, with spinal cord injry at T6 or above
massive vasoconstriction, parasympathetic tone cut off -hypertensio -H/A -blurred vision -sweating -nasal congestion -naseau |
