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146 Cards in this Set
- Front
- Back
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What is the largest organ in the human body?
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The skin
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What is the leading form of injury?
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Soft-tissue trauma
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Skin is also known as?
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Integument
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What is the crucial role of the skin?
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Homeostasis
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How does the skin maintain homeostasis?
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Protects underlying tissue from injury
Aids in temperature regulation Prevents excessive loss of water Serves as a sensory organ |
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What are the layers of skin?
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Epidermis
Dermis Subcutaneous Tissue Deep Fascia |
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What is the epidermis?
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The outermost layer of tissue
Body's first line of defense Consists of 5 layers [1 nonliving (stratum corneum) and 4 living] Contains melanin granules (known as melanocytes) |
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What is the dermis?
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Tough, highly elastic layer of connective tissue
Composed of collagen fibers, elastic fibers and mucopolysaccharide gel |
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What is collagen?
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Fibrous protein
Gives the skin high resistance to breakage |
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What is elastin?
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Gives elasticity to the skin
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The dermis is split into what 2 layers?
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The papillary layer and the reticular layer
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What is in the papillary layer of the dermis?
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Vasculature
Provides nutrients to the epidermis and aids in thermoregulation |
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What is in the reticular layer of the dermis?
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Dense, irregular connective tissue
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What specialized structures are found in the dermis?
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Nerve endings
Blood vessels Sweat glands Hair follicles Sebaceous gland |
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What is subcutaneous tissue?
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Consists of manly adipose tissue
Below the dermis Insulates tissues |
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What is the deep fascia?
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Dense layer of fibrous tissue
Bands of tissue that ensheath muscles and other structures Protects from injury |
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What are tension lines?
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The way that the skin is arranged over the body structures (provides tension)
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Dynamic tension is found where?
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Areas over muscle
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What is hemostasis?
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The cessation of bleeding
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How does hemostasis occur?
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When soft tissue is damaged, chemicals in the vessel wall are released
These chemicals constrict blood vessels Platelets are also activated when the chemicals are released Platelets adhere to the infected area and begin aggregation and begin blood clot formation |
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What happens in the inflammation stage of wound healing?
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Additional cells move into the area and begin repairing
White blood cells move into the area Chemotactic factors are released Granulocytes and macrophages arrive and engulf bacteria Histamine is realeased |
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What happens when histamine is released?
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When histamine is released the blood vessels dialate causing increased blood flow to the infected area
Results in warm, reddened, or swollen area |
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What stage of healing results in the removal of the foreign material?
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Inflammation stage
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What is epithelialization?
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New epithelial cells quickly multiply and redevelop around the edges of the wound
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What is neovascularization?
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New blood vessels form to bring oxygen and nutrients to the injured tissue
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What is collagen synthesis?
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Synthesized by fibroblasts
Fibroblasts are repair cells that migrate into damaged tissue |
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What are the stages of wound healing?
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Hemostasis
Inflammation Epithelialization Neovascularization Collagen Synthesis |
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What is a hypertrophic scar?
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Develops in area of high stress
Ex: knee and elbow |
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What is a keloid scar?
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Typically develops in people with darker skin, larger than the area injured
Ex: ears, upper extremities, lower ab., sternum |
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What types of wounds require closure?
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Cosmetic areas
Gaping wounds Degloving injuries Ring injuries/skin tear Secondary intention tertiary closure |
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What are clues of an infection?
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Erythema, pus, warmth, edema, and local discomfort
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Red streaks adjacent to the wound indicate what?
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Lymphangitis (inflammation of the lymph channels)
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What is gangrene?
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Clostridium perfringens
Occurs if a wound is not treated, becomes severely infected and necrotic |
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What is tetanus?
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Clostridium tetani
Body produces a potent toxin, that results in painful muscle contractions that are strong enough to fracture bones |
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What is necrotizing fasciitis?
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Involves death of tissue from bacterial infection
Most commonly, Staphylococcus aureus & hemolytic streptococci Morbidity rate: 70-80% |
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What is the characteristic of a closed wound?
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Contusion
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What is an abrasion?
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Superficial wound
Skin is rubbed or scraped |
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What is a laceration?
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Cut inflicted by a sharp instrument
Clean or jagged |
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What is a puncture wound?
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Stab from a pointed object
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What is an avulsion?
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When a flap of skin is town loose, partially or completely
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What is an amputation?
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Avulsion involving the complete loss of a body part
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What is a crush injury?
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When a body part is crushed between two solid objects
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What is crush symdrome?
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Area of body is crushed for >4 hours
Muscle are crushed beyond repair Rhabdomyolysis |
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What is rhabdomyolysis?
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The release of harmful products when tissues become necrotic
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What is the treatment for crush syndrome?
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Large bore IV
Large amount of saline Sodium bicarb (1 mE/kg) |
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What is compartment syndrome?
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When edema and swelling result in increased pressure within soft tissues
Common in extremities |
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Compartment syndrome may cause serious risk for death of local tissues if it is longer than?
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8 hours
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What is a fasciotomy?
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When they slice the skin and underlying tissue to release pressure
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What is Volkmann contracture?
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Deformities of the hand, fingers, or wrists from damage to forearm muscles
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What are the 6 p's of compartment syndrome?
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Pain
Paresthesia Paresis Pressure Passive Stretch pain Pulselessness |
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What is the primary phase of blast injuries?
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Pressure wave
Damages hollow organs |
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What is the secondary phase of blast injuries?
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Projectiles causing penetrating injuries
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What is the tertiary phase of blast injuries?
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Patient being blown against something
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What is the quaternary phase of blast injuries?
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Miscellaneous -- burns
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How do you treat closed wounds?
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1. Apply ice or cold packs to the injured area
2. Apply compression over the injured area to decrease bleeding 3. Elevate the injured part to a level above the heart 4. Apply a splint the prevent motion |
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How do you treat open wounds?
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1. Control the bleeding
2. Keep wound as clean as possible -Determine color of blood, amount lost, and site of origin |
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What are signs of a systemic infection?
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Fever, general malaise, AMS
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What is the difference between sterile and nonsterile dressings?
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Sterile: completely free of microorganisms
-use with high probability of infection Nonsterile: Packaged in a clean manner, but not completely free of microorganisms -Use when there is a low risk of infection |
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What is the difference between occlusive and nonocclusive dressings?
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Occlusive: Used when you don't want air passing through the material
-open wounds to the neck or thorax -Sealed on three sides |
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What is the difference between adherent and nonadherent dressings?
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Adherent: allow exudate from the wound to mesh with dressing material
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What is the dosage for morphine?
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0.5 mg/kg IV every 5 minutes
(max of 10 mg) |
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What is myoglobin?
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Protein found in muscle that is released after a crush injury
May produce kidney damage |
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What is desquamation?
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The continous process of shedding of the skin
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What kind of complications occur with burns?
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Difficulty w/ thermoregulation
Inability to sweat Impared vasoconstriction and dialation Little or no melanin Inability to grow hair |
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What is usually a sign that a person is being abused by burns?
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Burns with formed shaped and unusual patterns in atypical places
ex: genitalia, buttocks, thighs |
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CO binds to ______, _____x more than oxygen.
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Hemoglobin; 250
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What are the 6 mechanisms of injury that may damage the body tissues in the event of a chemical burn?
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Reduction
Oxidation Corrosion Protoplasmic poisons Desecration Vesication |
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What is reduction?
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Protein denaturation by the reduction in amide linkages
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What is oxidation?
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When a chemical inserts oxygen, sulfer, or a halogen atom into the body's protein
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What is corrosion?
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Chemicals corrode the skin and cause massive protein denaturing
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What is protoplasmic poisons?
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Chemicals that form esters with proteins or that bind or inhibit the inorganic ions that the body needs for normal functioning
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What is desecration?
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Desiccants that damage the body by extricating water from tissues
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What is vesication?
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Vesicants rapidly produce cutaneous blisters
Typically reerred to a chemical warfare agents or weapons of mass destructions |
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What chemicals are known to cause burning to the eyes?
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Acids, alkalis, dry chemicals, and phenols
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What are the 3 types of electricity-related burns?
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I- contact burn (most common)
Bull's eye lesion, with a central charred zone of full-thickness burns; middle zone of cold gray, dry tissue; and an outer red zone of necrosis II- Flash burn caused by the arcing of an electric current burns may resemble a find red rash III- Flame burn Occurs when electricity ignites a persons clothing on fire |
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What are the 3 types of ionizing radiation?
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Alpha
Beta Gamma |
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What are alpha particles?
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Have little penetrating energy and are easily stopped by the skin
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What are beta particles?
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Have great penetrating power and can travel much father in air than alpha particles
They can penetrate the skin but can be blocked by simple protective clothing designed for this purpose |
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What are gamma particles?
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Very penetrating and easily passes through the body and solid materials
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How is radiation measured?
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In units of radiation adsorbed dose (rad) or radiation equivalent in man (rem)
100 rad = 1 gray |
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What is acute radiation syndrome?
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It causes hematologic, CNS, and GI changes
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Patients who get acute radiation syndrome will vomit when exposed, what are the time periods showing their chances of survival?
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Vomiting within 10 mins: will not survive
Vomiting in less than an hour: 30%-80% survival rate Vomiting within 1-2 hours: 95%-100% survival rate |
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What is the zone of coagulation?
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The central area that suffers the most damage
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What is the zone of stasis?
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The area around the zone of coagulation
Usually has decreased blood flow and inflammation May under go necrosis 24-48 hrs after injury |
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What is the zone of hyperemia?
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Area least affected by the thermal injury
Cells will usually recover in 7-10 days |
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What is a superficial burn?
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Involves only the epidermis
Skin is usually red and when touched it will blanch and color will return Will heal in about 3-7 days |
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What is a partial-thickness burn?
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Involves the epidermis and varying degrees of the dermis
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What are the differences between a superficial partial-thickness burn and a deep partial-thickness burn?
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Superficial: hair follicles remain intact, heal spontaneously, may scar or have changed appearance
Deep: extends into the dermis, damages hair follicles and sweat and sebaceous glands *may be difficult to determine difference in the field |
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What is a full-thickness burn?
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Involves destruction of both layers of skin
Skin is white and pale, brown and leathery, or charred No cap refill Sensory nerves are destroyed |
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What is eschar?
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Dry and leathery skin
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What are the percentages for the Rule of Nines on a baby?
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Head - 18%
Anterior trunk - 18% Back - 18% Legs - 13.5% each Arms - 9% each Genitals - 1% |
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What are the percentages for the Rule of Nines on an adult?
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Head - 9%
Anterior trunk - 18% Back - 18% Legs - 18% each Arms - 9% each Genitals - 1% |
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What is the most important part of burn management?
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Stop the burning
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What is the Parkland formula?
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Amount of fluid the burned patient will need in the first 24 hours:
4mL x body weight (kg) x % of body surface burned *Half needs to be given in the first 8 hours |
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What burn meet burn center criteria?
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Partial thickness >10% BSA
Burns to face, hands, feet, genitalia, perineum, and major joints Any full thickness burns (3rd) Any electrical burns All chemical burns All inhalation burns Burn complicated by medical conditions Burns complicated by traumatic injuries Burns require special rehab |
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What are symptoms of acute radiation syndrome?
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Nausea, vomiting, diarrhea, fatigue, fever, and headache
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What is the largest cavity in the body?
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The abdominal cavity
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How big is the abdominal cavity?
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It extends from the diaphragm to the pelvis
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The abdomen is divided into what 3 sections?
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Anterior abdomen, the flanks and the posterior abdomen
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Describe the anterior part of the abdomen?
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Extends inferiorly to the inguinal ligaments and symphysis pubis
Extends upwards into the lower thorax at about the level of the nipples or the 4th intercostal space |
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Describe the flank region.
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Between the anterior and posterior axillary lines
From the 6th intercoastal space to the iliac crest |
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Decribe the back of the abdomen region.
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Extends posteriorly between the posterior axillary lines
From the scapula to the iliac crests |
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The abdominal cavity is lined with a membrane called what?
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The peritoneum
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What is mesentery?
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Membranous double fold of tissue in the abdomen that attaches various organs to the body wall
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What structures are contained in the peritoneal cavity?
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Liver, spleen, stomach, small bowel, colon, gallbladder
The female reproductive organs in women |
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What structures are contained in the retroperitoneal cavity?
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Aorta, vena cava, pancreas, kidneys, ureters, and portions of the duodenum and large intestine
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What structures are contained in the pelvis?
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Rectum, ureters, pelvis vascular plexus, major vascular structures, pelvis skeletal structures, reproductive organs
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What is the largest organ in the abdomen?
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The liver
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The diaphragm peaks where?
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At the 4th intercostal space
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What organs are most frequently injured after a blunt trauma?
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1. Spleen (50%)
2. Liver (30%) |
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Which organs are more reilient to blunt trauma?
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Hollow organs
(Unless they are full) |
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What is the inflammation of the stomach lining?
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Peritonitis
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What is Grey Turner's sign?
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Bruising of the flanks
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What is Cullen's sign?
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Bruising of the umbilicus
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What vascular structures are found in the retroperitoneal space?
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Descending aorta, the superior phrenic artery, inferior phrenic artery, the inferior vena cava, and the mesenteric vessels
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Grey Turner's and Cullen's sign are both caused by what?
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Intra-abdominal bleeding found 12-24 hours after the initial injury
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How do you treat abdominal injuries?
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2 large bore IV's
Start replacing fluid Apply cardiac monitor |
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What are pubic rami fractures?
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Fractures of the bones directly under the female and male genitalia
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Who is less likely to have a pelvic fracture? Peds or adults?
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Peds
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What else should you suspect if a patient has a pelvic fracture?
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Multisystem trauma
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What is hematopoiesis?
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The process of generating blood cells
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In adults, where does hematopoiesis most commonly occur?
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Red bone marrow of the sternum, ribs, vertebral bodies, pelvis and the proximal portions of the femur and humerous
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How many bones are in the body?
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206
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What are the 2 portions of a skeleton?
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The axial skeleton and the appendicular skeleton
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What is the skull composed of?
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Cranium, basilar skull, face and inner ear
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How many vertebrae are there?
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33
7 cervical 12 thoracic 5 lumbar 5 sacral 4 coccygeal |
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What is the thorax formed by?
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The sternum and 12 pairs of ribs,
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What is the appendicular skeleton divided into?
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The pectoral girdle, the pelvis girdle, and the bones of the upper and lower extremities
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What does the shoulder girdle consist of?
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2 scapulae and 2 clavicles
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Where does the clavicle attach to the scapula?
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Acromion
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Where does the upper extremity join the shoulder girdle?
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At the glenohumeral joint
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What bones make up the pelvic girdle?
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Ischium, ilium and pubis
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The two iliac bones join together by ligaments to the sacrum where?
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At the sacroiliac joint
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The two pubic bones are connected anteriorly by ligaments where?
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At the symphysis pubis
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The lower extremity consists of what bones?
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Femur, tibia, fibula, and patella
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What is the name of the space that the head of the femur fits into?
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The acetabulum
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What is the most common type of burn?
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Thermal
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What are examples of thermal burns?
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Flames, scalds, contact with hot substances
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What type of burn in a frostbite?
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Thermal injury
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What are chemical burns?
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Burns that produce chemical changes in skin with or without heat protection
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The ability to resist burn injury depends on what?
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Water content of skin tissue
Thickness and pigmentation of skin Insulating substances (skin, oil, hair) Peripheral circulation of skin (affects dissipation of heat) |
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Name the 3 zones of a burn injury.
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Zone of Hyperemia
Zone of Stasis Zone of coagulation |
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What is the local response to a burn injury?
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-Destorys cells or completely disrupts their metabolic funtions
-3 zones |
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What is the systemic response to burn injury?
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-Hypovolemic shock
-decrease in venous return -renal failure may occur -Pulmonary -GI -Musculoskeletal -Neuroendocine |
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The rule of 9's is most accurate for who?
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Adults and children >10 y/o
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What is the American Burn Association Categorization?
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Classifies burns as major, moderate, and minor
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