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163 Cards in this Set
- Front
- Back
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What is the Index of suspicion?
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Awareness and concern for potentially serious underlying and unseen injuries
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What are the 3 concepts of energy associated with injury?
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Potential energy
Kinetic energy Work |
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Energy cannot be _______ nor _______, but can only be _________ or ___________
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Created ; destroyed
converted ; transformed |
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What is "work"?
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Force acting over a distance
ex: force needed to bend metal multiplied by the distance over which the metal is bent |
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What is "kinetic energy"?
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The energy of a moving object
kinetic energy = mass/2 x velocity^2 (reflects the relationship between the mass of the object and the velocity at which it is traveling) |
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What is potential energy?
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The product of mass force of gravity, and height and is mostly associated with the energy of falling objects
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What is a multi-system trauma?
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Significant MOIs to more than one body system
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What are significant trauma MOIs?
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Multi-system traumas
Fall from heights MVA Motorcycle crashes Car vs ped. Gunshots Stabbings |
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What are the different types of MVAs?
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Frontal
Rear-end Lateral Rollovers Rotational |
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MVAs typically consist of how many collisions?
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3
Car vs. object You vs. car Organs vs. you |
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What is coup-contrecoup?
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Compression injury (or bruising) to the anterior portion of the brain and stretching (or tearing) of the posterior portion of the brain.
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What are the significant MOIs for a car crash?
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Death of an occupant in the car
Severe deformity of the car or intrusion into the vehicle AMS Ejection |
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What type(s) of MVAs cause whiplash?
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Rear-end collisions
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What type of MVA causes the most deaths?
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Lateral collisions
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25% of all severe injuries to the ______ that occur in MVAs are result of ___________ collisions.
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aorta ; lateral
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What is the first thing you should evaluate in a car vs pedestrian?
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Estimate the speed of the vihicle that struck the pt
-Next, determine whether the pt was thrown through the air/or under the car -Evaluate car that hit the pt's car |
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How many motorcycle impacts are there and what are they?
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4
-Head-on -Angular -Ejection -Controlled |
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What types of falls are considered significant?
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>15 feet or 3x the pt's height
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What types of falls are considered significant for children?
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Falls >10 ft w/o LOC
Falls <10 ft w/ LOC |
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When evaluating a fall what should be taken into account?
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-Height of fall
-Type of surface struck -Body part that hit first, followed by path of energy displacement |
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What is the second leading cause of trauma death in the US?
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Penetrating trauma
(Right after blunt trauma) |
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What is trajectory?
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The path the projectile takes
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What are the 2 types of cavitation?
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Temporary and permanent
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What is temporary cavitation caused by?
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Acceleration of the bullet causes a stretching of tissue.
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What is permanent cavitation caused by?
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Caused by the bullet path but remains once the projectile has passed through the tissue
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What is "drag"?
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Air resistance
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Medium velocity injuried may be caused by what?
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Handguns and some rifles
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High-energy injuries are caused by what?
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Military weapons
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How many blast mechanisms are there, are what are they?
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4
-Primary -Secondary -Tertiary -Miscellaneous |
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What is a primary blast injury?
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Due the the blast itself, blast wave.
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What is a secondary blast injury?
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Damage to the body is from flying debris
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What is tertiary blast injury?
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Occur when the patient is hurdled by the force of the explosion against a stationary object
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What is a miscellaneous blast injury?
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Burns from hot gases or fires caused by blast
Respiratory injury from toxic gases Crush injury from the collapse of buildings |
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The tympanic membrane ruptures at how many pounds per square inch?
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5 - 7
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What is one of the most concerning pulmonary blast injuries?
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Arterial air embolism
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What result from short-range exposure to the detonation of explosives?
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Pulmonary blast injuries (pulmonary trauma - contusions, hemorrhages)
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What is petechiae?
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Pinpoint hemorrhages that show up on the skin
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Multisystem trauma patients have a high level of what?
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Morbidity and mortality
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Organs are classified into 2 categories. What are they?
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Solid and hollow
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What are the solid organs of the body?
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Liver, spleen, pancreas, and kidneys
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What are the hollow organs of the body?
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Stomach, large and small intestines, and bladder
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What can help you identify a critically injured patient?
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Dangerous MOI
Decreased level of consciousness Threats to airway, breathing, or circ. (Also, very young or old, or who have chronic illnesses) |
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In what situations would you use MedEvac?
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Extended period required to access or extricate a remote or trapped patient (snowmobiler, hiker, ect.)
Distance to trauma center is greater than 20-25 miles Pt needs medical care and stabilization at the ALS level, and there are no ALS-level ground ambulance service available within a reasonable time frame Traffic conditions or hospital availability make it unlikely that you can get the pt to trauma via ambo There are multiple pts who will overwhelm resources at the trauma center reachable by ground w/in time window Mass casuality |
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How man trauma levels are there?
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4
Level I-Can provide every aspect of trauma care from prevention to rehabilitation Level II-Provide initial definitive care, regardless of injury Level III-Provide assessment, resuscitation, emergency care, and stabilization (will need to transfer) Level IV-Provide advanced trauma life support prior to transport to higher level trauma center (ex: clinic urgent care facility, w/ or w/o physician) |
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What is the recommended Glasgow Coma Scale score for a Level II pt?
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Less than 14 pts
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When is a patient classified as a Level I trauma patient?
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Glasgow Coma Scale of less than or equal to 8
ER physician discretion BP < 90 mmHg (age specific hypotention in children) Respiratory comprimise Gunshot wound to ab., neck, or chest |
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What are the patient characteristics for a Level II patient?
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GCS < 14 w/ trauma
RR < 10 or > 29 breaths/min (<20 for an infant) Penetrating wounds (other than gunshots) to head, neck, torso, and extremities proximal to the elbow and knee Flail chest Combo of trauma w/ burns 2 or more proximal long bone fractures Pelvic fractures Limb paralysis and/or spinal cord injury Amputation proximal to the wrist and/or ankle |
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What are the Levels on the Glasgow Coma Scale?
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Eye Opening:
-4 spontaneous -3 to speech -2 to pain -1 None Verbal Response -5 Oriented -4 Confused -3 Inappropriate words -2 Incomprehensible words -1 None Motor Response -6 Obeys commands -5 Localizes pain -4 Withdraws (pain) -3 Flexion (pain) -2 Extension (pain) -1 None |
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A patient who has sustained a non-significant MOI should receive what type of assessment?
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Focussed assesment on his/her CC
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Cells in the Lungs and kidneys can survive for how long without O2?
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1 hour
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Skeletal muscle cells may survive for how long without O2?
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2 hours
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What 3 parts are in cardiovascular system?
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1. The heart
2. The blood vessels 3. The fluid |
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What are the 5 types of blood vessels? (In order once the blood flows out of the heart)
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1.Arteries
2.Arterioles 3.Capillaries 4.Venules 5.Veins |
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What is the diameter of a capillary?
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1 RBC
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What are the signs and symptoms of hypovolemic shock?
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Rapid, weak pulse
Low BP (late sign) Changes in mental status Cool, clammy skil Cyanosis |
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What does hemorrhage mean?
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Bleeding
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The body will not tolerate and acute blood loss of more than what?
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20% the blood volume
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Brain and spinal cord can be injured after how long w/o perfusion?
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4-6 mins
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How long can the kidneys sustain inadequate perfusion before being damaged?
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45 mins
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What would the vital signs do when there is a significant blood loss?
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Increase HR
Increase RR Decrease BP |
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In infants how much blood loss is considered "significant"?
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100-200 mL
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What is hypovolemic shock?
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Low blood volume results in inadequate perfusion and even death
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What conditions will cause you to consider bleeding to be serious?
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Bleeding w/ significant MOI
Poor general appearance Assessment reveals signs and symptoms of shock Significant amound of blood loss noticed Blood loss is rapid You cant control bleeding |
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In how many minutes does bleeding tend to stop on its own?
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After about 10 minutes
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Shortly after a persons vessel is cut what happens?
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The vessel will constrict (vasoconstriction)
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What is the process of a clot forming, plugging the hole and sealing the injured portions of the blood vessel?
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Coagulation
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What is hemophilia?
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Lacking one or more of the blood's clotting factors
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What should you always suspect with a patient who has had a penetrating injury or blunt trauma?
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Internal bleeding
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What is the most common symptom of internal bleeding?
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Pain
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What are 2 other names for a bruise?
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Contusion or ecchymosis
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What is hematemesis?
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Vomited blood
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What is melena?
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Black, foul-smelling, tarry stool that contains digested blood
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What is hemoptysis?
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Coughing up bright red blood
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What signs and symptoms may mean that a closed fracture is bleeding?
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Pain, tenderness, bruising, guarding, or swelling
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Broken ribs, bruises over the lower part of the chest, or a rigid, distended abdomen are signs and symptoms of what?
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Lacerated spleen or liver
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What is the first sign of hypovolemic shock?
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Change in mental status
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Later signs of hypoperfusion suggesting internal bleeding would be?
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Tachycardia (goes brady)
Weakness, fainting or dizziness (when resting) Thirst Nausea and vomiting Cold, moist (clammy) skin Shallow rapid breathing Dull eyes Slightly dilated pupils that are slow to respond Weak, rapid, thready pulse Decreasing BP Altered LOC |
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What are the 3 methods to control bleeding? (In order)
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Direct, even pressure
Pressure Dressing Tourniquet |
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What is the name for a nose bleed?
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Epistaxis
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How do you care for patients with possible internal bleeding?
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1. Administer high-flow O2
2. Control any external bleeding 3. Treat suspected internal bleeding in an extremity by applying a splint 4. Reassess vitals every 5 mins 5.NPO 6.Elevate 6" - 12" in nontrauma patients 7. Keep them warm 8. Rapid transport |
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What is the leading form of injury?
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Soft-tissue trauma
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Death as the result of soft-tissue injury is often related to what?
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Hemorrhage or infection
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What are the 3 types of soft-tissue injuries?
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Closed injuries
Open injuries Burns |
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What is a hematoma?
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Blood that has collected within damaged tissue or in a body cavity
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What is a crushing injury?
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When a great amount of force is applied to the body
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What is crush syndrome?
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Develops when an area of the body is trapped for longer than 4 hours and arterial blood flow is compromised
Can lead to renal failure and death |
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What is compartment syndrome?
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For of compression from the swelling that occurs when tissues are injuries.
The cells that are injured leak watery fluid into the spaces between the cells The pressure of the fluid may become great enough to compress the tissue and cause further damage |
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What are the four types of open soft-tissue wound that you must be prepared to manage?
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Abrasions : wound on the superficial layer of the skin (usually does not penetrate the dermis)
Lacerations : jagged cut cause by a sharp object or blunt force that tears the tissue Avulsions : Injury that separate various layers of soft tissue (become completely detached or hang as a flap Penetrating wounds : Injury resulting from a sharp, pointed object, such as a knife, ice pick splinter, or bullet. |
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What is an incision?
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A sharp, smooth cut
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What signs and symptoms will help to guide you in determining types of patients that need immediate transportation?
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Poor initial general impression
ALOC Dyspnea Abnormal vital signs Shock Severe pain |
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What are signs of hypoperfusion?
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Tachycardia
Tachypnea Weak pulse Cool, clammy, pail skin =Rapid Transport |
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How would you assess the neurologic system to gather baseline data?
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LOC - use AVPU
Pupil size and reactivity Motor response Sensory response |
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What does RICES stand for?
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Rest
Ice Compression Elevate Splinting |
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What is a wound in which internal organs are exposed or protruding out of the wound?
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Evisceration
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How do you properly cover an evisceration?
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1. Wet trauma pad with sterile water
2. Gather organs into confined space and cover with trauma pad 3. Cover with sterile plastic 4. Tape on all 4 sides 5. Place more trauma pads on top of wound 6. Slide splint behind back with 2 cravats, and tie cravats lightly to hold dressings in place 7. Place blanket under legs and bend knees (UNLESS: penetrating object ex:knife, no suspected spinal injury, uninjured legs and knees) 8. Treat for shock, transport |
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How do you treat a bite?
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Cover with dry, sterile dressing
If arm or leg was injured, splint that extremity |
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What are the 5 factors to help you determine the severity of a burn?
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1. What is the depth of the burn
2. What is the extent of the burn 3. Are any critical areas (face, airway, hands, genitalia) involved? 4. Does the pt have any preexisting medical conditions or other injuries 5. Is the patient younger than 5 y/o or older than 55 y/o? |
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What are the 3 types of burns?
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Superficial (first-degree) burns
Partial-thickness (2nd degree) burns Full-thickness (3rd-degree) burns |
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Describe a Superficial burn.
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Involves only the top layer of skin
Skin turns red but does not blister or actually burn through Site is painful (ex: sunburn) |
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Describe a Partial-thickness burn.
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Involves the epidermis and some portion of the dermis
Do not destroy the entire thickness of the skin, nor is the subcutaneous tissue injured Skin is moist, mottled, and white to red Blisters are present Cause intense pain |
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Describe a Full-thickness burn.
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Extend through all skin layers and may involve subcutaneous layers, muscle, bone, or internal organs.
Area is dry and leathery and may appear white ,dark brown, or even charred Some are hard to the touch Clotted blood vessels or subcutaneous tissue may be visible under burned skin May have no feeling (area around will be extremely painful) |
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Pertaining to burns; The patients palm is equivalent to what percent of their body?
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1%
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Using the rule of nines, What are the percentages of each body part for an adult?
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Head - 9%
Torso - 18% Arms - 9% each Legs - 18% each Back - 18% Genitalia - 1% |
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Using the rule of nines, What are the percentages of each body part for an child?
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Head - 12%
Torso - 18% Arms - 9% each Legs - 16.5% each Back - 18% Genitalia - 1% |
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Using the rule of nines, What are the percentages of each body part for an infant?
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Head - 18%
Torso - 18% Arms - 9% each Legs - 13.5 or 14% each Back - 18% Genitalia - 1% |
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For chemical burns how long should you flush the area?
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15-20 minutes or until the patient says the burning pain has stopped
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What is the first step in managing a burn?
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Stop the burning source
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Upper airway is associated with inhaling what?
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Superheated gases
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Lower airway is associated with inhaling what?
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Inhalation of chemicals
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What type of radiation burns in the most severe?
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Gamma radiation
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What are the different types of radiation sickness and how many Gy (absorbed radiation dose) for each?
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Mild radiation sickness: 1-2 Gy
Moderate radiation sickness: 2-5 Gy Severe radiation sickness: 4-6 Higher than 8 Gy is immediatly fatal |
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What is the CNS composed of?
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The brain and spinal cord
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What part of the brain is about 75% of the brains total volume?
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Cerebrum
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How many pairs of spinal nerves are there?
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31
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How many cranial nerves are there?
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12
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What part of the nervous system regulates or controls our voluntary activities, including almost all muscular activities?
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The somatic nervous system
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What is the cranium compossed of? (percentages)
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80% brain tissue
10% blood supply 10% CSF |
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What are the 4 major bones that make up the cranium?
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Occiput
Temporal regions Parietal regions Frontal region |
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How many bones are in the face?
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14
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What 2 bones is the orbit (eye socket) made of?
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Maxilla and zygoma
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What are additional signs of skull fractures?
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Raccoon eyes or Battle's sign
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What is amnesia?
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Memory loss
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What is retrograde amnesia?
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Remember everything except the events leading up to the injury
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What is anterograde amnesia?
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Not being able to remember what happened after the injury
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What is distraction?
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When the spine is pulled along it length.
Ex:hangings result in frature of the vertebrae in the upper portion of the cervical spine |
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What is it called when the vertebrae are no longer aligned?
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Subluxation of the spine
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What is Cushing's Triad?
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Increased BP
Decreased HR Irregular resp (Cheyne-stokes) |
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When do you need to preform a rapid extrication?
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You or the patient is in danger
You need to gain immediate access to other patients The patients injuries justify urgent removal |
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Wat is the weakened area of the lung that causes a spontaneous pneumothorax?
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Bleb
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What is a open pneumothorax?
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An open or penetrating wound to the chest wall
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What is a spontaneous pneumothorax?
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A weak area will rupture spontaneously allowing air to leak into the pleural space.
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What is a simple pneumothorax?
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Any pneumothorax that does not result in major changes in the pt's physiology
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What is a tension pneumothorax?
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The complete collapse of the affected lung and then pushing the mediastinum into the opposite pleural cavity.
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What is a hemothorax?
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Blood collect in the pleural space from bledding around the rib cage or from a lung or great vessel.
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What is a hemopneumothorax?
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Air and blood in the pleural space
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What is a cardiac tamponade?
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When the protective membrane around the heart (pericardium) fills with blood or fluid
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What condition is Beck's triad a sign and symptom for?
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Cardiac tamponade
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What is Beck's triad?
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Distended or engorged jugular veins, narrowing pulse pressure (difference between the systolic and dystolic pressure), muffled heart sounds
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What is a flail chest?
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Three or more ribs are fracture in two or more places or if the sternum is fractured along with several ribs
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What is peritonitis?
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Inflammation of the peritoneum (the abdominal cavity)
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What is kehr sign?
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left shoulder pain caused by blood in the peritoneal cavity
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What organs are found in the RUQ?
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Liver, gallbladder, and duodenum, small part of pancreas
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What organs are in the LUQ?
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Stomach and spleen, some pancreas
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What organs are in the LLQ?
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Both large and small, Descending colon and half of transverse colon
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What organs are in the RLQ?
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Portions of the large and small intestines, ascending colon and right half of transverse colon
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Whats a strain?
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Muscle pull
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What is a nondisplaced fracture?
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Hairline fracture
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What is a displaced fracture?
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Actual deformity
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-.-|||
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stupid.
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What is a greenstick fracture?
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Incomplete fracture, only partway in the bone
Occurs to children |
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What is a comminuted?
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When the bone is broken into more than 2 fragments
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What is a pathologic fracture?
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Weakened or diseased bone
Osteoporosis or cancer |
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What is epiphyseal?
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Happens in growth plate
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What is an oblique fracture?
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When the bone is broken at an angle across the bone.
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What is a transverse fracture?
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Fracture straight across the bone.
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What is a spiral fracture?
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Caused by a twisting force; causes oblique fracture around and through the bone
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What is an incomplete fracture?
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Does not run completely through the bone
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What is a sprain?
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When the joint is twisted or stretched beyond normal limits
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What is cardiogenic shock?
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caused by inadequate function of the heart, or pump failure.
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What is obstructive shock?
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Mechanical obstruction of the cardiac muscle.
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What is a distributive shock?
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Widespread dialation of the small arterioles, small venules, or both
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What is septic shock?
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Occurs as a result of a severe infection, usually bacteria
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What is neurogenic shock?
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Damage to the spinal cord; cant control the size and muscular tone of the blood vessels
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