Comprehensive Trauma and Paramedic Care Review

Vocabulary practice flashcards covering trauma care concepts from the course, including spinal trauma, torso trauma, burns, ballistics, head trauma, fundamentals of shock, and neurovascular anatomy.

Major Trauma

Any trauma patient with an injury as the principal diagnosis who meets specific criteria including death after injury, an Injury Severity Score (ISS) greater than 12 ($\text{ISS} > 12$), intensive care unit admission for $>24\text{ hrs}$ requiring mechanical ventilation, urgent surgery for intracranial, intrathoracic, or intraabdominal injury, or fixation of pelvic/spinal fractures, or injury affecting two or more body systems.

Kinetic Energy Formula (Kinematics)

The mathematical representation of energy associated with motion, expressed as $E_k = \frac{1}{2}mv^2$, reflecting that doubling the mass doubles the impact force, whereas doubling the velocity quadruples the impact force.

Trauma Triad of Death

A lethal clinical syndrome involving the mutually reinforcing pathological states of acidosis ($\text{pH} < 7.35$), hypothermia ($\text{core temp} < 35.5^\circ\text{C}$), and coagulopathy.

Trauma Diamond of Death

An expansion of the lethal trauma triad that incorporates hypocalcaemia alongside acidosis, hypothermia, and coagulopathy, recognizing calcium's vital role in platelet function, haemostasis, and cardiac contractility.

Permissive Hypotension

The controlled administration of intravenous fluids to a trauma patient in hypovolaemic shock without suspected traumatic brain injury, targeted to maintain a palpable radial pulse or a systolic blood pressure of approximately $90\,\text{mmHg}$ while minimizing clot disruption and haemodilution.

COAST Score

A pre-hospital assessment tool scoring entrapment, systolic blood pressure ($>100\,\text{mmHg} = 0$, $90\text{--}100\,\text{mmHg} = 1$, $<90\,\text{mmHg} = 2$), body temperature ($>35^\circ\text{C} = 0$, $32\text{--}35^\circ\text{C} = 1$, $<32^\circ\text{C} = 2$), major chest injury requiring intervention, and likely intra-abdominal or pelvic injury to predict serious bleeding and the need for transfusion.

Primary Brain Injury

Direct damage to the brain parenchyma occurring at the time of initial impact due to mechanical disruption, neuronal shearing, or vascular laceration.

Secondary Brain Injury

Indirect progressive neuronal damage evolving after the initial impact, driven by systemic insults such as hypoxia, hypotension, hypo- or hypercapnia, and raised intracranial pressure.

Coup-Contrecoup Injury

An acceleration-deceleration brain injury pattern wherein the moving brain strikes the inner skull at the initial site of impact (coup) and then rebounds to impact the opposite cranial wall (contrecoup).

Le Fort I Fracture

A transverse maxillary fracture separating the upper dentition and alveolar process from the midface skeleton, passing above the teeth roots and extending posteriorly through the pterygoid plates.

Le Fort II Fracture

A pyramidal fracture pattern separating the central midface from the base of the skull through the nasal bridge, maxillary and ethmoid bones, and infraorbital rims, preserving the lateral orbital rims.

Le Fort III Fracture

Complete craniofacial disjunction characterized by fracture lines extending across the nasal bones, ethmoid, orbits, and zygomatic arches, resulting in total midfacial instability and a characteristic 'donkey-face' deformity.

Basilar Skull Fracture

A fracture involving the base of the cranium, clinically characterized by signs such as periorbital ecchymosis ('raccoon eyes'), post-auricular ecchymosis ('Battle sign'), and cerebrospinal fluid rhinorrhoea or otorrhoea.

Epidural Haematoma

A collection of arterial blood accumulating between the skull and the outer layer of the dura mater, typically caused by a skull fracture lacerating the middle meningeal artery and often presenting with a classic lucid interval prior to rapid deterioration.

Subdural Haematoma

An accumulation of venous blood located in the space between the dura mater and the arachnoid mater, most commonly resulting from the rupture or tearing of bridging cortical veins.

Diffuse Axonal Injury (DAI)

A traumatic brain injury characterized by widespread microscopic shearing and tearing of nerve axons across multiple brain regions due to high-energy angular or rotational acceleration-deceleration forces.

Monro-Kellie Doctrine

The physiological concept that the rigid cranial vault has a fixed non-expandable total volume composed of brain parenchyma ($\approx 80\%\text{ or }1400\,\text{mL}$), blood ($\approx 10\%\text{ or }150\,\text{mL}$), and cerebrospinal fluid ($\approx 10\%\text{ or }150\,\text{mL}$), meaning an increase in any single component requires a compensatory volume reduction in another to prevent intracranial pressure elevation.

Cerebral Perfusion Pressure (CPP)

The net pressure gradient driving blood flow through the cerebral vascular bed, calculated via the formula $\text{CPP} = \text{MAP} - \text{ICP}$, with a normal physiological range of $60\text{--}80\,\text{mmHg}$.

Cushing Triad

A late clinical sign of critically raised intracranial pressure and impending brainstem herniation, characterized by the triad of increased systolic blood pressure with widened pulse pressure, irregular breathing (e.g., Cheyne-Stokes), and bradycardia.

Spinal Shock

The temporary loss of all normal reflex and neurological activity (motor, sensory, and autonomic) at and below the level of an acute spinal cord injury, including the transient loss of bowel and bladder sphincter tone.

Neurogenic Shock

A form of distributive shock resulting from cervical or high-thoracic ($T6\text{ and above}$) spinal cord injuries that interrupt sympathetic outflow, presenting with hypotension due to peripheral vasodilation along with bradycardia and warm, dry skin.

Tetraplegia

The impairment or complete loss of motor and/or sensory function in the cervical spinal cord segments, resulting in functional loss of the arms, trunk, legs, and pelvic organs.

Paraplegia

The loss or impairment of motor and/or sensory function originating from lesions in the thoracic, lumbar, or sacral cord segments or the conus medullaris and cauda equina, sparing upper extremity function.

Dermatome

A specific circumscribed area of cutaneous skin supplied by sensory nerve fibres originating from a single spinal nerve root.

Myotome

A defined group of skeletal muscles innervated by the motor axons originating from a single spinal nerve root.

Flexion Teardrop Fracture

A highly unstable cervical spine fracture caused by combined hyperflexion and axial compression, featuring an anteroinferior triangular bony avulsion fragment, posterior vertebral subluxation, and significant posterior ligament disruption.

Hangman's Fracture

A hyperextension injury of the cervical spine characterized by bilateral fractures through the neural arch or pars interarticularis of the second cervical vertebra ($C2$).

Incomplete Spinal Cord Syndromes

Patterns of partial spinal cord injury categorized into distinct syndromes—including Central Cord Syndrome, Anterior Cord Syndrome, and Brown-Séquard Syndrome—each demonstrating specific tract-dependent sensory and motor deficit patterns.

Central Cord Syndrome

The most frequent incomplete spinal cord injury, typically caused by hyperextension trauma in patients with pre-existing cervical stenosis, producing greater motor impairment in the upper extremities than in the lower extremities.

Anterior Cord Syndrome

An incomplete cord injury caused by infarction in the distribution of the anterior spinal artery or direct anterior bone fragment impingement, characterized by bilateral loss of motor function, pain, and temperature sensation below the lesion, with preserved dorsal column proprioception and vibratory sense.

Brown-Séquard Syndrome

A clinical presentation resulting from hemisection of the spinal cord (frequently from penetrating trauma), characterized by ipsilateral loss of motor function and proprioception alongside contralateral loss of pain and temperature sensation.

SCIWORA

Spinal Cord Injury Without Radiographic Abnormality; a condition occurring primarily in children under 9 years of age due to high ligamentous elasticity and vertebral flexibility allowing severe cord distraction without fractures on standard X-rays.

Poikilothermia

The pathological inability to maintain a constant internal core body temperature independent of the ambient surroundings, occurring in high spinal cord injuries due to the interruption of sympathetic vasoactive and shivering control.

Acinus

The functional respiratory unit of the lung located distal to the terminal bronchioles, composed of respiratory bronchioles, alveolar ducts, and alveoli.

Alveolocapillary Membrane

The ultra-thin structural barrier shared by the alveolar epithelium and the pulmonary capillary endothelium across which gas exchange occurs via passive diffusion.

Myocardial Contusion

Bruising of the heart muscle caused by high-energy blunt anterior chest wall trauma, manifesting with arrhythmias, ECG changes mimicking ischaemia, or cardiogenic shock.

Cardiac Tamponade

An acute accumulation of blood, fluid, or air within the non-compliant pericardial space that restricts ventricular diastolic filling and severely reduces cardiac output.

Beck's Triad

The classic clinical diagnostic triad of cardiac tamponade consisting of systemic arterial hypotension, distended neck veins (elevated JVD), and muffled or distant heart sounds.

Flail Chest

A condition produced by two or more rib fractures in two or more places along each rib, creating a detached chest wall segment that displays paradoxical inward motion during inspiration and outward motion during expiration.

Open Pneumothorax

A pneumothorax with an unsealed chest wall defect communicating with the external environment, generating a 'sucking chest wound' and ventilatory failure when the defect exceeds approximately two-thirds the diameter of the trachea.

Tension Pneumothorax

A life-threatening condition in which air enters the pleural space through a one-way tissue valve during inspiration and cannot escape, progressively building intrapleural pressure that collapses the lung, shifts the mediastinum, and obstructs venous return to the heart.

CRAPPIST Mnemonic

A mnemonic summarizing the clinical signs of a tension pneumothorax: Chest wall injury, Respiratory distress, Absent/decreased breath sounds, Pain, Poor perfusion, Increased JVD, Subcutaneous emphysema, and Tracheal deviation.

Haemothorax

The accumulation of blood within the pleural cavity, commonly arising from torn intercostal vessels, internal mammary arteries, or lacerated lung parenchyma.

Peritonism

Localized or diffuse inflammation of the peritoneum resulting from leakage of visceral contents or blood following hollow or solid organ trauma, typically producing abdominal guarding, rigidity, and rebound tenderness.

Drowning

The process of experiencing primary respiratory impairment from submersion (airway below the liquid surface) or immersion (liquid splashed across the face) in liquid, classified as fatal if death occurs or non-fatal if interrupted with survival.

Impact Brain Apnoea

A transient or prolonged cessation of spontaneous respiration occurring immediately after a concussive or traumatic brain injury due to functional disruption of the brainstem respiratory centres.

Jackson's Burn Zones

The classic pathophysiological model of a thermal burn injury describing concentric rings of tissue alteration: the central Zone of Coagulation, the surrounding Zone of Stasis, and the outer Zone of Hyperaemia.

Zone of Coagulation

The central core area of a burn wound where maximum heat absorption causes non-viable, irreversible cellular necrosis and microvascular thrombosis.

Zone of Stasis

The intermediate zone surrounding the burn core characterized by compromised microvascular perfusion and cellular ischaemia, which can either recover with prompt resuscitation or progress to necrosis with hypoperfusion.

Zone of Hyperaemia

The outermost peripheral margin of a thermal burn injury characterized by prominent inflammatory vasodilation and increased perfusion, which typically heals completely unless compromised by severe infection.

Full Thickness Burn (3rd Degree)

A severe burn involving complete destruction of both the epidermis and the entire dermis including deep adnexal structures, presenting with a white, waxy, leathery, or charred appearance, absent capillary refill, and complete loss of cutaneous sensation.

Terminal Ballistics

The sub-discipline of ballistics that examines the behavior, energy transfer, temporary cavitation, and tissue destruction produced when a projectile strikes and penetrates a target.

Atlas (C1)

The first cervical vertebra, lacking a distinct vertebral body and spinous process, consisting of a ring-like structure with two flattened facets that articulate with the occipital condyles to facilitate head nodding.

Vertebra Prominens (C7)

The seventh cervical vertebra, characterized by a long, non-bifid spinous process that terminates in a prominent tubercle easily palpated at the base of the posterior neck.

Ligamentum Flavum

A series of thick, elastic yellow ligaments connecting the laminae of adjacent vertebrae along the posterior wall of the vertebral canal.

Ventricles of the Brain

A system of four interconnected fluid-filled cavities located within the brain—comprising two lateral ventricles, the third ventricle, and the fourth ventricle—lined with ciliated ependyma and containing cerebrospinal fluid.

Blood-Brain Barrier (BBB)

A selective physiological and structural barrier formed by tightly sealed capillary endothelial cells and astrocytic end-feet that restricts the passage of large molecules, drugs, and pathogens into brain tissue while freely admitting oxygen, carbon dioxide, glucose, and lipophilic compounds.

Broca's Area

The motor speech area located in the frontal lobe of the dominant cerebral hemisphere, responsible for orchestrating the complex muscular movements required for speech production.

Wernicke's Area

The sensory speech association area situated in the superior temporal lobe of the dominant hemisphere, dedicated to the perception, understanding, and comprehension of spoken and written language.

Phrenic Nerve

A key motor nerve arising from cervical nerve roots $C3\text{--}C5$ that innervates the diaphragm, making high cervical injuries at or above this level fatal without mechanical ventilatory support.

Vagus Nerve (Cranial Nerve X)

The tenth cranial nerve, providing predominant parasympathetic motor innervation to the heart, airways, lungs, and gastrointestinal organs, as well as innervating muscles involved in speech and swallowing.

Guillain-Barré Syndrome

An acute, inflammatory, demyelinating polyneuropathy typically developing 1 to 3 weeks after an upper respiratory or gastrointestinal infection, characterized by progressive, symmetrical, ascending muscular weakness and loss of reflexes.

Bell's Palsy

Acute unilateral paralysis of the facial muscles supplied by cranial nerve VII (facial nerve) caused by inflammatory oedema and compression within the temporal bone canal, typically resolving spontaneously within 12 weeks.