HAN 471 Final Exam

How many bones are in the body?

206 bones

What is the best way to treat fractures/musculoskeletal trauma?

- protecting open wounds

- positioning the limb

- immobilizing the injury

- checking neurovascular function; pulse/palpate, motor, and sensation

How do you treat carbon monoxide poisoning?

- oxygen: high flow NRB

- hyperbaric: forces O2 into the cells and displaces CO

What is the affinity of CO to hemoglobin compared to oxygen?

Carbon Monoxide has about 200-250 times greater affinity for hemoglobin than for Oxygen.

this means that CO binds to hemoglobin much more readily and strongly than oxygen does

True or false- CO has a high affinity to hemoglobin.

True

What is the best way to treat joint injuries?

- knees can be reduced in the field

- immobilize above and below the joint

- pain management

- gently move/transport the patient

- ensure neurovascular function is intact

What is a tendon?

Band of tough fibrous tissue connecting muscle to bone

What is a ligament?

Band of tough fibrous tissue connecting bone to bone

What is the axial skeleton?

Head, thorax, and spine

What is the appendicular skeleton?

Upper and lower extremities

What is the key in reassessing patients?

Secondary survey; reassess treatments that were already done earlier.

Best care for pelvic fractures

- pelvic binders

- fluid resuscitation

- pain management

potential for massive hemorrhage

True or false- pelvic injuries are considered critical.

True

What is the most commonly broken bone in the body?

The clavicle (collarbone)

located in a vulnerable spot and absorbs a lot of force during falls or direct impacts

Best care for femur fractures

- traction splints; use with caution in knee/hip injuries

- high force injury high potential for shock

Best care for distal extremity fractures

radius, ulna, tib-fib

- position of comfort

- ensure distal circulation

- splint; rigid/vacuum

- pain management

Best care for clavicle fractures

most frequently fractured bone in the body

- transmitted to 1st and 2nd rib

- be alert for lung injury

- pain management

- splint arm in place to prevent movement

Best care for hip fractures

common in the elderly

- may be able to support weight; ability to walk does NOT rule out fracture

- leg often is externally rotated

- may refer to pain in the knee

- can cause other leg for splint

- pain management

- transport to trauma center

How do you recognize pelvic injuries?

Involves assessing both clinical signs and using diagnostic tools.

- pain

- bruising

- tenderness

- bleeding

- x-ray

- FAST

- CT scan

What is thermolysis?

Heat liberation

- the release (loss) of stored heat and energy of the body

- an increase in CBT causes vasodilation and sweating, which causes increased effective vascular system volume, cardiac output, and pulse/stroke rate

What is thermogenesis?

Heat generation

- production of heat and energy to deal with cold stressors

- hypothalamic center and sympathetic nervous system

- increase muscle tone and initiate shivering, increase thyroid levels

What is the function of the hypothalamus?

Regulates balance and thermoregulation

thermoregulation "set point"

What is radiation in terms of heat loss?

Skin losing heat by coming in contact with cooler temperatures

What is conduction in terms of heat loss?

Skin losing heat by touching a cold surface

What is convection in terms of heat loss?

Skin losing heat to wind chill factor

What is heat syncope?

A form of fainting that occurs when the body overreacts to heat, causing temporary drop in blood pressure and reduced blood flow to the brain.

typically occurs after standing for a long time in hot weather

What is heat stroke?

- least common but most deadly

- caused by severe disturbance in body's thermoregulation

- findings to determine heatstroke: elevated core temperature and altered mental status

- classic heat stroke and/or exertion heatstroke

What are heat cramps?

- acute; involuntary muscle spasms

- occur from: profuse sweating and sodium loss

- most often afflict those in good physical condition

What is heat exhaustion?

- milder form of heat illness with volume depletion and heat stress

- two types: water depleted and sodium depleted

S/S: headache, fatigue, weakness, nausea, tachycardia, hypotension

What is the most reliable way to measure core body temperature?

Through a central temperate taking system, Ex: rectal thermometer

What is a normal human core body temperature?

98.6 degrees F

What body temperature does hypothermia occur at?

95 degrees F

What body temperature does mild hypothermia occur at?

CBT between 95 and 90 degrees F

What body temperature does moderate hypothermia occur at?

CBT between 90 to 82 degrees F

What body temperature does severe hypothermia occur at?

CBT blow 82 degrees F

What temperature does shivering stop at?

when the body becomes too cold to sustain the muscular activity required for it

30-32 degrees C/86-89.6 degrees F

dangerous stage of moderate to severe hypothermia

What are the different classifications of frostbite?

- superficial frostbite

- deep frostbite

Superficial frostbite

- altered sensation of numbness, tingling, and burning

- skin condition: waxy and white, firm to palpation

- thawing causes: cyanotic skin, hot stinging sensation

Deep frostbite

- white, yellow-white, or mottled blue-white skin

- feels hard, cold, without sensation

- major damaged when tissues thaw: area turns purple and is painful

First degree frostbite presentation

- superficial freezing

- edema, skin with waxy appearance

- no blisters or vesicles

Second degree frostbite presentation

- blister formation with clear fluid

- erythema and edema

Third degree frostbite presentation

Blood filled blisters

Fourth degree frostbite presentation

- full thickness injury

- death of dermal tissue

- extension into muscles, tendons, and bones

How do you treat the different classifications of frostbite?

1. Rewarm affected area

2. Pain control

3. Don't pop the blisters

4. Elevate affected limb to reduce swelling

5. Antibodies if infection occurs

What paper changed trauma care in the U.S. and how?

Accidental Death and Disability

A 1966 report by the NAS that highlighted the need for improved emergency medical care in the U.S.

- found that public government were not fully aware of the extent of the problem

- found that ambulance services were often poorly equipped and staffed by untrained personnel.

- Led to the creation of the first federally qualified ambulance services and personnel in the U.S.

highlighted the shortcomings in injury management in the US

What are the prevention methods and examples of them?

- primary prevention: aimed at avoiding the injury before it occurs, Ex: education programs, wearing seatbelts.

- secondary prevention: actions taken to prevent the progression of acute injury once it has occurred, Ex: EMS training and response

- tertiary prevention: directed at minimizing death and long term disability after an injury, Ex: rehab programs

What are the E's of injury prevention?

- education

- enforcement

- engineering

- equity

Passive strategies in injury prevention

- requires little or no action on the part of the individual for additional protection.

Ex: sprinkler system, airbags

Active strategies in injury prevention

- requires an action by the person who wants to be protected.

Ex: wears a seatbelt, puts on a helmet

How do pediatric patients present shock?

show delayed signs of shock

- able to compensate for blood loss secondary to trauma, do not show overt signs of compensation as quickly

- once they can no longer compensate for blood loss, they move very quickly towards irreversible shock.

Why do bariatric patients lack being able to deal with traumatic injuries?

- their physiology has a harder time compensating for the overload placed on their bodies

- the mortality rate is 6x greater than that of a normal-weight patient

True or false- geriatric patients have a different way of dealing with trauma

True

What are the physiological changes in geriatric patients?

1. Physical changes

2. Sensory changes

3. Cognitive changes

4. Cardiovascular changes

5. Respiratory changes

6. Digestive changes

7. Immune system changes

True or false- geriatric patients are less able to tolerate shock and trauma?

True

What is the goal of trauma resuscitation?

-Goal of resuscitation: treat shock so it does not progress to irreversible state

-Determining when tissue perfusion has been restored is a challenge

work quickly to assess and transport

What is the difference between a trauma alert and a code T?

- Code T= highest level; airway obstruction, cardiac arrest, penetration injury, spinal cord injury, amputation, etc

- Trauma Alert= acute level; fall>20 ft, burns>15%, pedestrian struct at >15 mph, etc.

What is the intent of a trauma activation?

- the trauma team should be assembled upon patient arrival

- responsibilities are assigned

- equipment is assembled and ready for use

- threats to life are discovered and treated promptly

- labs are drawn within 5 minutes

- orders should be completed ASAP

When a patent arrives in a trauma bay and there are multiple people there, what is the flow that occurs as soon as EMS arrives? Who is standing where?

in order to keep chaos to a minimum and allow for appropriate examination and treatment of the patient only 5 essential personnel should be around the patient at the time of arrival

- Nurse 1 and Nurse 2 on each side of patient

- airway physician/anesthesia, ED personnel right behind the patient

- primary assessment by PGY2/3 surgery resident on left side of patient

- procedural personnel by PGY3/4 surgery resident on right side of patient

True or false- it is important to expose trauma patients to find their injuries.

True

taking off their shirts and checking under them, etc

avoid hypothermia; keep patients warm after exposing them

What is the FAST exam?

Focused assessment with sonography for trauma

- positive FAST indicates "fluid" in the abdominal cavity; take patient directly to OR

- takes about 1 minute to do right at the patient's bedside.

(POCUS)

What are x-rays?

A type of electromagnetic radiation similar to visible light but of a shorter wavelength; obtain images of bones and fractures, etc.

What are ultrasounds?

Type of medical imaging that uses high-frequency sound waves to create images of structures inside the body.

What are CT scans?

Computed tomography; medical imaging technique that combines multiple x-ray images taken from different angles to create cross-sectional images of the body.

What are MRIs?

Magnetic Resonance Imaging; non invasive medical imaging technique used to create detailed pictures of the inside of the body, especially soft tissues like the brain, muscles, heart and organs.

Level 1 trauma center

the highest designation for a trauma care facility

- provides the most comprehensive and advanced level of care for severely injured patients, with 24/7 access to a full range of surgical staff (and specialists)

Level 2 trauma center

A medical facility capable of providing immediate, comprehensive care and the same 24/7 access to surgical staff however this staff may not be as specialized and may end up requiring the transferring of patients that have highly complex injuries.

Level 3 trauma center

A healthcare facility capable of providing definitive care for patients with mild to moderate injuries and may not have 24/7 access to all trauma specialists, so will most likely require transferring for patients with all life threatening injuries.

Level 4 trauma center

A healthcare facility that provides initial stabilization and evaluation of traumatic injuries, but is primarily focused on preparing the patient for transfer to a higher level trauma center with more advanced capabilities.

What is MTP?

Mass transfusion protocol

Refers to rapid administration of large amounts of blood products (at least 6 units of PRBC) in fixed ratios (usually 1:1:1) for the management of hemorrhagic shock.

Complications of MTP

- hyperkalemia

- hypothermia

- hypomagnesia

- acidosis

a protocol that is based on the most recent evidence based medicine mitigates these risks and provides the best chance of survival

What is code snap?

ABX given within first 15 minutes of patient arrival for open fractures; antibiotics are time critical and needs to be given asap to prevent severe infections which prevent proper healing.

What is REBOA?

Resuscitative Endovascular Balloon Occlusion of the Aorta

- indicated for traumatic life-threatening hemorrhage below the diaphragm in patients with hemorrhagic shock who are unresponsive, or transiently responsive to resuscitation.

- should be used in the very critical patients

- many complications

Who is more exposed than others to hypothermia and what factors affect these patients?

Certain groups of people are more vulnerable due to factors that affect body heat production, retention, or awareness of the cold.

1. Elderly patients; reduced ability to regulate body temperature

2. Infants and young children; cannot shiver

3. People with chronic medical conditions; diabetes, stroke, dementia, etc

4. Alcohol and drug users

5. Homeless individual and outdoor workers

6. People in wet and windy conditions

What is the Haddon's Matrix?

- y axis: pre-event, event, and post event

- x axis: host, agent, and environment

What are the key factors that help determine the severity of burns and the prognosis of the burn patients?

1. Temperature

2. Concentration; amount of heat exposure

3. Duration of exposure

4. Age of patient

5. Approximate TBSA

more severe for trapped patients in enclosed spaces with toxins

What is important to remember about the airways in burn patients?

Burn patients airways go very quickly; be aggressive and early in getting a definitive airway due to the swelling that occurs.

What are the functions of the skin?

1. Provides protection from the environment

2. Regulates temperature and fluid

3. Contains sensory nerves that communicate with the brain

4. Aids in healing by responding to injury with inflammation

What is the dermis?

layer of the skin (2nd)

- contains blood vessels, glands, and nerve endings

- also includes sebaceous glands and sudoriferous glands

What is the epidermis?

layer of the skin

Area of dying and dead cells pushed outward by new cells growing from beneath.

- glands beneath this layer secrete oil which coats outer skin layers; making the epidermis pliable, provides barrier to water and fluids.

What is the temperature that causes burning of the skin?

Temperatures of 118 degrees F or higher (47.8 degrees C)

What are the different degrees of burns?

1. Superficial thickness burns

2. Partial thickness burns

3. Full thickness burns

4. 4th degree burns

Superficial thickness burns

involves only the epidermis

- skin is red and swollen

- usually, blisters are NOT present

- will heal spontaneously in 2-3 weeks

Partial thickness burns

involves the epidermis and the dermis

- subdivided into: superficial partial thickness burns and deep partial thickness burns (it may be difficult to distinguish between the 2).

Full thickness burns

destruction of BOTH layers of the skin

- the skin is incapable of self-regulation

- the skin may appear white and waxy, brown and leathery, or charred

- sensory nerves are destroyed

4th degree burns

subdermal burn

- high mortality

- infection

- loss of fluids

- no way to recover

Risk factor population for burns include:

1. Children

2. Elderly

3. Disabled individuals

4. Low socioeconomic status

5. Individuals with substance abuse issues

Treatment of heat emergencies

- heat cramps: restore lost water and salt, move patient to cool environment

- heat exhaustion: remove excess clothes, place supine with legs elevated

- heat stroke: move patient to a cool environment, cool as rapidly as possible, rehydrate, prepare to treat for seizures