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;
98 Cards in this Set
- Front
- Back
|
Trauma is the leading cause of death in Americans under the age of?
|
45
|
|
|
More than 50% of deaths between people ages __ and __ years are the result of traumatic injuries?
|
5 and 34
|
|
|
___ is the leading cause of trauma mortality resulting in 56,000 deaths/year?
|
acute head injury
|
|
|
____ % of injuries result from MVA’s? Falls? Firearms? Sport/recreation
|
MVA's-57%
Falls-21% Firearms-12% Sport/Reaction-10% |
|
|
_____ is the leading cause of death in infants and children
|
trauma
|
|
|
50% of traumatic motor vehicle accidents involve_______.
|
drivers under the influence of alcohol or drugs
|
|
|
Trauma center guidelines were created by
|
The American College of Surgeons
|
|
|
% of patient distribution in a level 1 trauma center? Level II? Level III
|
5%, 10%, 85%
|
|
|
Describe the philosophy, facilities, anesthesia personal, surgery personel, and case load of Level 1 trauma centers.
|
Philosophy:Community hospital committed to excellent care of severe and urgent injuries
Trauma education/training programs Research Facilities: 24 hr/day ER and surgical capabilities Anesthesia Personel: ANESTHESIOLOGIST with Trauma experience in house 24 hours a day Surgery Personel: General/neuro/ ortho/ surgeon, radiology, consultants available 24 hr/day Case Load: 600-1000 cases/year |
|
|
Describe the philosophy, facilities, anesthesia personal, surgery personel, and case load of Level II trauma centers.
|
Philosophy: Provides comprehensive trauma care in collaboration with a level I trauma center. Not required to have ongoing research or residency programs.
Facilities:24 hr/day ER and surgical capabilities Anesthesia Personel:CRNA or ANESTHESIOLOGST with trauma experience in house 24 hours a day Surgery Personal: General/neuro/ ortho/ surgeon, radiology, consultants available 24 hr/day Case Load:300-600 cases/year |
|
|
Describe the philosophy, facilities, anesthesia personal, surgery personel, and case load of Level III trauma centers.
|
Philosophy:Commitment to stabilization and transport of severely injured patients
Facilities:24 hr/day ER services desirable 24 hr OR Anesthesia Personel: CRNA or anesthesiologist on call 24/7 Surgery Personel: General surgeon on call Case Load: No requirement |
|
|
Mechanism of trauma injuries
|
penetrating trauma's from stab wounds
|
|
|
What kind of injuries are caused by narrow pointed instruments like ice picks & nails? microscopic crush injuries confined to the instruments apex.
|
microscopic crush injuries confined to the instruments apex.
|
|
|
What kind of injuries are caused by a flat/tapered instrument (screwdrivers)?
|
fraying and crushing of tissue occurs as they stretch to accommodate the width of the flat edge.
|
|
|
What kind of injuries are caused by a blunt instrument (hammer, walking sticks, axe handles)?
|
a greater area of crushed tissue and the increased force and weight of the penetrating object can cause blunt injury.
|
|
|
The overall mortality from stab wounds is _____ and most fatalities are related to wounds in the _______ region.
|
low; thoracic
|
|
|
Definition of ballistics
|
the science of the travel of an object in flight. This includes it travel down the barrel, it's flight through the air and it's behavior once it strikes a target.
|
|
|
Ballistics experts can determine wound characteristics by studying?
|
velocity of the bullet, composition and behavior of the bullet, what tissue it strikes within the body.
|
|
|
What % is the likelihood of death if a person falls 4 stories?
|
50%
|
|
|
Describe Coupe Countrecoup
|
Head hits an object, brain hits front of cranium and then bounces back, creating suciton between the brain and skull, then the brain hits the back of the skull.
|
|
|
MAC is inversely proportional to
|
potency
|
|
|
What does not increase the delivery of volatile anesthetics?
|
lipid solubility
|
|
|
Most victims of gunshot wounds die where? what is the percentage of victims?
|
At the scene or in the emergency room; 80%
|
|
|
Old bullets were made from _____ and did not travel ____.
|
lead; straight
|
|
|
Newer bullets are encased in a ____ _____ and is filled with _______ in the middle and can do more damage on impact. Newer bullets make ______ inserts and exit really _____.
|
alloid metal; lead
small; big |
|
|
Penetrating wounds occur when the missile?
|
remains in the body
|
|
|
Perforating wounds occur when the missile?
|
enters and then passes out of the body
|
|
|
What is the formula for kinetic energy
|
1/2 (MV2)
|
|
|
What does kinetic energy mean?
|
doubling the mass will double the missiles energy, doubling the velocity will quadruple the energy.
|
|
|
Low velocity missiles cut adn crush its path to form a?
|
drill hole wound (the permanent cavity)
|
|
|
Low velocity missiles produce a small ______ cavity and may _______ or ________ within the body damaging other structures.
|
temporary; fragment or ricochet
|
|
|
High velocity missiles produce a ________ cavity that is surrounded by a large ______ cavity.
|
permanent; temporary
|
|
|
What happens as the temporary cavity collapses?
|
tissues are stretched and torn, and debris can be sucked into the wound
|
|
|
What is cavitation? Why do organs with cavitation have a high mortality rate?
|
bubbles in solid organs caused by bullets; because they bled a lot (liver)
|
|
|
what are the 4 c's to check tissue?
|
color
contractility cap refill consistency |
|
|
do high velocity or small velocity injuries cause more damage
|
high velocity
|
|
|
Is the small or large intestine worse to be shot in? Why?
|
large intestine, due to increased feces and bacteria leading to infection
|
|
|
With gunshot wounds, what factor has influence as to the tissue damage from a gunshot wound?
|
position of extremity
|
|
|
If bone involvement occurs with a gunshot wound, what disease can it lead to?
|
osteomylelitis
|
|
|
MVA's are most often associated with what type of injury?
|
blunt force trauma
|
|
|
Which law is related to MVA's and blunt force trauma?
|
Newton's Law
|
|
|
What is newton's law?
|
an object in motion will stay in motion until acted upon by an outside force.
|
|
|
During abrupt deceleration, _______ gravitational forces are exerted on the body?
|
negative
|
|
|
At 25 mph, the inertial wt. of the body and it's contents is increased _______ fold over resting weight? 65 mph?
|
10, 90
|
|
|
Name 5 types of MVC's.
|
head on, rear impact, side impact, rotational, rollover
|
|
|
Describe down and under collision.
|
driver slumps into floor board of car, then the driver's upper body hits the steering wheel
|
|
|
In a down and under collision, what is the first body part to receive impact? The force of the impact is transmitted where?
|
knees; ankles, femur, acetabulum
|
|
|
In a down and under collision, when the upper body hits the dashboard, what injuries can occur?
|
cervical spine injuries, head injuries, torso injuries
|
|
|
In an up and over collision, what happens to the body? What injuries occur?
|
the body arcs forward and the head hits the windshield; cervical spine and trachael injuries
|
|
|
In rear impact injuries, what happens?
|
whiplash occurs and can stretch, strain, and tear cervical muscles and ligaments
|
|
|
What injuries occur in a lateral collision?
|
lateral whiplash injuries of the head, neck, thorax (ribs), abdomen, upper and lower extremities, femoral head injuries.
|
|
|
What injuries can seatbelts cause?
|
injuries to ribs, sternum, clavicle, and intraabdominal organ damage
|
|
|
Airbags are dangerous for what two populations?
|
pregnant women and small children
|
|
|
What is the terminal velocity during falls?
|
120 m/hr
|
|
|
If a fall occurs from 4 stories, what % is the chance of survival? 7 stories?
|
50%, 90%
|
|
|
How many feet is one story?
|
12
|
|
|
What ist the definition of shock?
|
state of circulatory inadequacy caused by reduced perfusion resulting in inadequate delivery fo oxygen to tissues.
|
|
|
Describe stage I shock.
|
it's a compensatory phase, neuroendocrine response, SNS stimulation and catecholamine surges.
|
|
|
What is the goal of stage I shock?
|
reversal
|
|
|
What happens in stage II shock?
|
loss of effective circulating blod volume
hypoperfusion of peripheral tissues acidosis hypotension |
|
|
What happens in stage III shock?
|
exhaustion of ATP stores leading to death
|
|
|
What happens during shock on a cellular level?
|
In aerobic conditions (without oxygen), the production of lactic acid and process of glycolysis, citric acid cycle, and phosphoralytion produce 38 ATP.
In anaerobic conditions (with oxygen), pyruvic acid is converted to lactic acid and produce 2 ATP. |
|
|
What physiological things occur in the body due to shock?
|
1. decreased active transport of Na and K
2. thrombosis due to sluggish blood flow 3. depressed mitochondrial activity 4. lysosome destruction occurs 5. acidosis occurs due to release of lactic acid from anerobic metabolism and inability of lungs to remove CO2 6. endotoxin release 7. depression of myocardial activity 8. activation of inflammatory mediators |
|
|
What are some s/s of shock?
|
pale
tachycardia hypotension decreased urine output mental status changes normal BP in stage I, hypotension in stage II as they decompensate |
|
|
So you want to keep preolad high or load in the shock state?
|
high
|
|
|
What can you do to maintain high preload in shock state?
|
keep heart full of blood, replace blood as needed to maintain circulation, may want them to remain tachycardic since they may be dependent on it.
|
|
|
When does the golden hour begin and end?
|
time of injury until help arrives
|
|
|
Chances of survival are cut in half how long after incident occurs?
|
30 minutes
|
|
|
What are chances of survival after 90 mins?
|
very low, maybe 5%
|
|
|
What v/s changes occur with < 15% blood loss?
|
HR <120, no BP changes, no cap refill changes, RR 14-20, anxious
|
|
|
What v/s changes occur with 15-30% blood loss?
|
HR >120, no BP changes, delayed cap refill, RR 20-30, very anxious
|
|
|
What v/s changes occur with 30-40% blood loss?
|
HR >120, decreased BP, delayed to absent cap refill, RR 30-40, anxious and confused
|
|
|
What v/s canges occur with > 40% blood loss?
|
HR > 140, decreased BP, absent cap refill, RR > 40, confused and lethargic
|
|
|
Describe the 6 stages of irreversible shock?
|
low blood volume>low venous return (decreased CVP and PA pressures>decreased CO (low BP)>producing a SNS response and catecholamine response (increased SVR)>decreased cellular nutrition (metabolic acidosis, increased lactemia, decreased coagulation (acidotic pts don't clot well)> increased capillary permeability (pulmonary edema, generalized edema)
|
|
|
If a carotid pulse is felt, SBP is at least? femoral? radial?
|
60 bpm, 70, 80
|
|
|
Transfuse blood before stage ____ shock? If you wait until ____ %, it may be too late.
|
II, 40%
|
|
|
At 0-30 min after major trauma, what are the major causes of death?
|
CNS injury, heart or vascular injury
|
|
|
After 1-2 hours of major trauma, what are the major causes of death?
|
CNS injury or hemorrhage
|
|
|
After 3-4 weeks of majuor trauma, what are the major causes of death?
|
CNS injury, sepsis, multi-organ failure
|
|
|
The inflammatory response of trauma is initiated to protect?
|
the person/host
|
|
|
What events can lead to multi system organ failure?
|
tissue ischemia
bacterial translocation tissue disruption |
|
|
Inflammatory responses cause vasoconstriction or vasodilation?
|
vasodilation
|
|
|
What is the first line of defense against infection?
|
macrophages
|
|
|
What are the goals of the imnflammatory response?
|
protect the host
limit extent of injury p[romote rapid healing |
|
|
Name some lymphocytes.
|
B and T cells, cytolytic chemicals
|
|
|
Where are macrophages found?
|
connective tissue
bone marrow lymphatic tissue |
|
|
Do platelets circulate in active or inactive form? What do they form
|
inactive; platelet plugs
|
|
|
What do platelets release?
|
histamine, thromboxane, platelet activating factor
|
|
|
What inhibitor leads to development of DIC?
|
plasminogen activating inhibitor
|
|
|
Prolonged exposure to alpha and beta receptors to catecholamines leads to?
|
receptor desensitization
|
|
|
What do interlukin 1 and TNF do?
|
decrease B adrenergic receptors sensitivity to catecholamines
|
|
|
Decreased responsiveness of the vasomotor center is caused by?
|
hypoxia
|
|
|
Arginine releases?
|
nitrous oxide
|
|
|
What is nitrous oxide?
|
a gas in your body produced in the inner lining of blood vessels. It helps breakdown the arginines and amino acids.
|
|
|
What is the function of nitrous oxide in relation to blood?
|
vasodilates
lowers BP increases blood flow to tissues supposedly has healing effects |
|
|
What is included in the rapid overview of the primary survey?
|
condition of the pt= stable, unstable, or dead
|
|
|
What is done in the primary survey? What steps are included?
|
evaluation and concurrent resuscitation
airway (patency) breathing (ventilation) circulation (perfusion) disability (neuro function, GCS) exposure (examination of pt.......environment) |
|
|
What is done in the secondary survey?
|
interview and history
detailed and systematic evaluation of injury to each anatomic region and resuscitation pen |
