EMT Trauma

What is shock?

o inadequate tissue perfusion

o AKA hypoperfusion

What is aerobic vs. anaerobic metabolism?

o aerobic: cell metabolism with O2

o anaerobic: cell metabolism w/o O2

What are the 3 basic etiologies (origins) of shock?

o Inadequate Volume (hypovolemia) - loss of blood (bleed), loss of plasma (excessive

urination, diarrhea, burns, cap leakage, vomiting)

▪hemorrhagic shock - needs whole blood

▪hypovolemic shock - needs plasma/fluid

o Inadequate Pumping - traumatic injury, heart attack, heart failure, obstruction

o Inadequate Vessel Tone - SVR issues

What are the 5 categories of shock? Pathophysiology of each? Examples of each?

o Hypovolemic: inadequate volume; most common; ex. hemorrhagic shock from major

bleed

o distributive: inadequate vessel tone; relative volume reduction due to vasodilation

and increased capillary permeability; ex. NAPS

▪Neurogenic, anaphylactic, psychogenic, septic

o cardiogenic: inadequate pumping; heart wearing out and isn’t pumping as much; ex.

heart attack (AMI), heart failure (CHF), dysrhythmia, cardiac meds, cardiac contusion

(trauma)

o obstructive: inadequate pumping/blockage of blood flow; ex. pulmonary embolism,

tension pneumothorax, pericardial tamponade

o Metabolic/Respiratory: toxicity; inability to transport/offload/use oxygen; ex.

choking, no O2 in enclosed environment

What is MODS? When does it occur? How might it be related to disseminated intravascular

coagulation (DIC)?

o shock is beyond decompensatory stage and is irreversible

o Multiple Organ Dysfunction Syndrome

o prolonged hypoxia→altered metabolism with more acids/clots→ clots used up→

widespread bleeding as clots break down→ organs fail→ death

o DIC involves widespread activation of the coagulation system, leading to both

excessive clotting and bleeding

Name three examples of obstructive shock, and explain the etiology of each.

o Pulmonary embolism: clot in vasculature of lungs, clots from body’s veins

▪s/s: stabbing CP at site, crackles

▪decreased alveolar respiration, increased back pressure on right ventricle

o tension pneumothorax: air in pleural space, mediastinal shift, vena cava kink

▪s/s: unequal BS, AMS, falling BP

▪decreased preload, CO, and BP

o pericardial tamponade: fluid around heart compressed left ventricle. obstructs heart

pumping

▪s/s: JVD, narrow pulse pressure, pulsus paradoxus (pulse goes away when

deep breath is taken)

▪backup of blood into body, decreased ventricular filling and CO

What are the s/s of the following types of shock: hemorrhagic hypovolemic vs. burn vs.

anaphylactic vs. septic vs. neurogenic vs. cardiogenic?

o Hemorrhagic: loss of whole blood from vasculature; low perfusion, low BP , external

bleeding, low RBC

o Non-hemorrhagic hypovolemic: low BP , low volume, low perfusion, severe diarrhea,

sweating, vomiting

▪Burn: burns, fluid/proteins leak out into interstitial space, hypovolemia, low

perfusion

o Anaphylactic: warm, dry skin, extreme allergic reaction; extreme vasodilation,

increased cap permeability, low perfusion, angioedema (swell airways, lips, etc)

o Septic: vasodilation, cap permeability, hypovolemia, low perfusion; from bacterial

infection

o Neurogenic: spinal cord injury, lose sympathetic NS signals, low HR and vasodilation,

low CO, BP , and perfusion, priapism in males

o Cardiogenic: decreased contractility, stroke volume, SBP, and perfusion

What are the 2 stages of shock? Signs/symptoms of each?

o Compensatory: compensatory mechanisms working, maintaining bp

▪anxious, increased HR and RR, skin pale/cool, narrow pulse pressure,

weal/equal radial pulse, normal SBP

o Decompensatory: compensatory mechanisms failing and BP/mentation decrease

▪altered/unresponsive, increased HR, RR, skin pale/cool, narrow pulse

pressure, weak/absent radial pulse, decreased BP
o Biggest sign of change is altered mentation (this means BP has already started to

drop) and decline in SBP

What 2 body systems play the biggest roles in the body’s response to shock? What does

each do?

o Trying to restore homeostasis by compensating

o Nervous: sympathetic nerve stimulation - higher HR, RR contractility, and

vasoconstriction, release epinephrine and norepinephrine

o Endocrine: hormones - Epi/norepi stimulate alpha 1 receptors to vasoconstriction

and focus blood to core areas (causes pale, cool skin). Epi stimulates beta 1 and 2→

increased HR, contractility, bronchodilation

What are EMT treatments for shock?

o Secure/maintain airway

o O2 via NRB; ventilate PRN: avoid hyperventilation

o dress/bandage: stop external bleeding

o Splint: fractures to reduce internal bleeding, impaled objects in place, pelvis for

suspected abdominal bleed with hypotension, apply SMR PRN

o keep patient supine and warm

o check VS every 5 minutes

o consider ALS

o rapid transport (other treatments en route)

What is the formula for determining the lower limit of the SBP for a child less than 10 yoa?

70 + (2x age in year)

How does IV fluid replacement help hemorrhagic shock? What are its limitations?

o restores circulating blood volume to improve perfusion and maintain bp

o limitations: liquid can leak out of vascular space into tissues causing edema, iv

cannot replace RBC and clotting factors

How do geriatric patients differ in their response to shock?

o meds prevent compensatory responses so crash early

o may not have s/s

How do pediatric patients differ in their response to shock?

compensate well but crash much harder

What is meant by “mechanism of injury” and “index of suspicion”?

o MOI: how a person was hurt

o Kinetics: branch of mechanics dealing with body movement

o Index of suspicion: expected injuries based on kinetics and MOI

What is the most significant factor in the transference of kinetic energy?

Velocity - if u double the velocity then you quadruple the energy

How many collisions are there in a typical MVC? What occurs with each one?

o 3 total collisions

o Vehicle - car hits object at high speed, immediate deceleration

▪energy transfer: damage

o Body - body hits steering wheel, seat belt, or airbag

▪energy transfer: injury

o Organs - organs push forward and hit ribs/sternum

▪energy transfer: injury

What are 2 pathways that might result from a frontal collision? What injuries are associated

with each?

o Up and over - head goes over steering wheel and body slams into steering wheel

▪usually hit with airbag now too

▪face, head, neck, chest, abdomen injury

o Down and under - legs and body slide under steering wheel

▪knee, femur, hip, pelvis, spine injury

o Common overall injuries:

▪rib fracture is common - flail chest (steering wheel crushes ribs and organs)

▪compression - paper bag effect (hold breath before impact so lungs rupture)

▪tearing of liver, kidney, spleen, aortic tear (very severe - 80% mortality on

scene)

What injury patterns might you expect with rear and lateral impact MVCs? With rollover?

o Rear: whiplash (shifts brain violently)

▪hyperextension - head pushed back

▪hyperflexion - head pushed to chest

o Lateral: many are fatal

▪assess passenger compartment intrusion, passenger impact, passenger

movement

▪consider: head, neck, chest, pelvis, extremities, underlying organs

o Roll over: lying on side 90 degrees or more

▪multiple system injury

▪crushing injury

▪ejection→ death 25x more likely

▪airbags only go off once so not helpful for multiple impacts

In a vehicle vs. pedestrian collision what injury differences might you expect between child

vs. adult?

o Adults: turn away from vehicle to get away - side impact

▪thrown onto hood

▪legs, back, torso, shoulders, arms, abd, head, neck

o Children: turn toward vehicle - front impact

▪thrown forward and run over because smaller and freeze

▪Waddell’s Triad: femur, chest/abd, head

What is the proper position for a car seat?

infant: rear facing in backseat and reclined 45 degrees

What injuries might you expect from seatbelts? From airbags?

o Airbags: head, neck, spine, face, eye, arms

o Seatbelts: bruising on torso, abdominal wall contusions, pelvic injury, rib fractures,

neck injury, internal organ damage

What are some limitations of airbags?

o front airbags don’t protect from side impact

o only work once

o drivers may still hit steering wheel after deflation

o Beware if: less than 10 inches from bag, older adult, <5 feet tall, <12 years old

What are 3 questions you need to ask regarding any fall?

o Distance? - higher → greater injury

o surface? harder→greater injury

o body part impacted first?

▪Head: LOC

▪energy transfer along long bones

o also side things: why did they fall? tripped, light-headed, etc

o protective equipment? hard hat, shoulder pads, etc

What constitutes a severe fall for an adult vs. child?

o adult: 20 feet critical

o child: 2-3x height critical

What injuries might you suspect with feet-first falls? With head-first falls?

o feet first: bilateral heel fractures, ankle fractures, distal tibia/fibula fractures, knee

dislocations, femur fractures, hip injuries, spine compression fractures
o hand first: Colle’s (outward) Smith’s (inward) fractures, elbow injury, shoulder

dislocation, clavicle fracture

o head first: face, head, brain, c-spine, spinal cord, back, LOC

▪commonly with alcohol and swimming so leads to drowning too

What MOI details are important to gather regarding a knife injury?

size of blade, depth and angle of penetration, slice vs stab, underlying organs, cone

of damage

What is cavitation? How does this relate to the entrance vs. exit wounds of a bullet?

Cavitation: high speed projectiles cause two types of cavity

▪Temporary: air pressure on sides of bullet (4 times the width of bullet)

▪Permanent: twice diameter of bullet leaves hole as temporary cavity recedes

▪On exit wound, tissue tears and splits so much wider

▪entrance wound has abrasion, burn, tattooing

What are the 5 phases of a blast? What injuries occur in each?

o Primary: pressure blast that affects gas containing organs - intestines, lungs, inner

ears, stomach, sinuses (all internal)

o Secondary: flying debris - lacerations, fractures, impalations, burns (all external)

o Tertiary: victim thrown from blast - same as ejection from vehicle

o Quaternary: what lands on top of you (like in a hurricane or tornado)

o Quinary: chemicals, toxins, bacteria, radiation, thermal waves

What is the meaning of the “golden period”? “Platinum 10”?

o Golden period: time in which survivability is possible; generally within an hour but

varies depending on trauma

o platinum 10: first 10 minutes where most significant treatment can make a big

impact (usually used up in transport but can really help if short transport)

How much blood volume does an average size adult have?

o 4900mL = 5L

o lose 15% → shock

What difference in bleeding does it make when a vessel is cut at 90 degrees vs. lengthwise?

o 90: more bleeding

o lengthwise: vessels natural tension helps reduce bleeding so less bleeding

What are the differences between these bleeds: arterial vs. venous vs. capillary? Which are

major bleeds?

o arterial: spurting blood, pulsating flow, bright red color

o venous: steady, slow flow, dark red color

o capillaries: slow, even flow

How do you control an arterial bleed? What is the first thing an EMT should do?

o direct pressure immediately in general impression

o gloved hand then sterile gauze

When is a tourniquet indicated? How do you apply it?

o extremity bleed

o tighten until bleeding stops and no distal pulse

What is a hemostatic agent? How is it administered/applied?

o facilitates clotting

o directly applied to the site, covered with bandage/dressing. apply pressure to help

with clotting

Where on the body might a hemostatic dressing be used to pack a wound?

pack arterial bleed at junction sites

When/where do you use an occlusive dressing?

prevents air from entering the chest cavity in sucking chest wound

How can a splint help with internal bleeding?

o immobilizes injured area→reduces further movement→minimizes disruption of

blood vessels

o pain management

What are the s/s of blood loss? What is the earliest sign?

tachycardia (hr increased) (earliest), hypotension, weak pulse, pale/cool skin, weakness/dizziness,

tachypnea, excessive thirst

What is a contusion vs. hematoma vs. abrasion vs. avulsion vs. laceration vs. crush vs.

amputation?

o contusion: bruise- ecchymosis; injury to tissue/vessels in dermis; localized

swelling/pain

o hematoma: damage to larger vessel; blood collected beneath skin; separates tissues

and pools in pockets

o abrasion: scraping off epidermis; road rash; painful bc exposes nerve endings;

capillary bleed

o avulsion: torn flap of skin hanging loose; may be severe or not; prolonged healing

▪degloving: avulsion to max; skin torn away; often on the hand

▪treatment: moist sterile dressing, bandage, slide skin back if possible

without any pain

o laceration: cut/incision in skin; linear (knife, broken glass, etc) vs stellate (blunt

trauma); may be deep

o crush: result of blunt trauma; consider underlying organs and internal bleeding; time

and size of crushed part; tamponade by object until released

o amputation: body part completely removed; often little bleeding

What is a linear vs. stellate laceration? What type of trauma most often causes each?

o linear: caused by sharp objects; heal better knife, broken glass, etc

o stellate: blunt trauma, jagged edges; prolonged healing

What is the treatment for an avulsion?

o rinse off surrounding debris

o fold in place PRN

o moist sterile dressing

o bandage

What is epistaxis? How do you control it?

o nosebleed

o control: sit straight up, tilt head forward, pinch nostrils x 10 mins, cold pack to

nose/cheeks, don’t blow nose x 12 hours

What is a clamping injury? How do you treat it? Why is it important to try to remove the

clamping object?

o clamping: clamps part of person

o KY jelly to wriggle part use; elevate above patient’s head

o remove bc compartment syndrome and underlying crush injury

o amputation may be required if can’t get patient free for transport

How do you treat/bandage an evisceration?

o do not replace

o do not touch

o dressing: moist, sterile, non fibrous, occlusive x4

o flex hips/knees bc decreases tension on abdominal muscles

What is the major risk of an open neck wound? What specific condition might this cause?

sucking neck wound; air embolism

How should you treat an open neck wound? What is the first thing you should do?

o gloved hand over wound - first

o occlusive dressing x4 sides

o cover with regular dressing

o apply pressure only to control bleeding

o no circumferential bandage

o consider c collar

How do you treat/bandage an amputated digit? What do you do with the amputated part?

o treatment: provide EM care, care for wound, immobilize injured area, if partly

amputated, don’t complete the amputation

o transport of part: rinse (never immerse), dry/moist sterile gauze, plastic bag, cool

but not directly on ice

o don’t delay transport looking for part

What special considerations should you have for a dog bite?

o infection risk- rabies, tetanus

o location and severity of bite

When can you remove an impaled object?

when causing an airway problem

What is the difference between dressing vs. bandage?

o dressing: goes directly on the wound, covers entire wound, sterile, bleeding control,

occlusive PRN

o bandage: hold dressing in place, cover entire dressing, non sterile, may be used as

dressing if sterile

What are some factors that may increase bleeding?

medications, medical conditions, additional trauma, alcohol use, genetic factors

What are the 3 layers of the skin? What layer contains most nerve receptors?

o Epidermis: water-tight and barrier from external environment

o Dermis: small capillary beds and sensory structures, nerve receptors

o Subcutaneous: larger blood vessels, fatty connective tissue

What kills most burn patients in the prehospital setting? What kills them later?

o Acute: toxic gas inhalation, airway occlusion, associated trauma

o Long-term: fluid shift, infection

Why is a patient with a significant burn suscepmtible to hypothermia?

disrupted thermoregulation leads to excessive heat lost in burned areas

What is “burn shock”? What is its pathophysiology? When does it occur?

o Non hemorrhagic hypovolemic shock

o Occurs a few hours after initial burn

What are the classifications of burns by depth? What are the s/s of each?

o Superficial- first degree burns

▪red skin, pain at site, dry, tenderness, no blisters

▪painful because pain receptors fully intact

▪ex. minor scald, sunburn

o Partial thickness- second degree burns

▪blisters, intense pain, white to red skin, moist and mottled skin

▪AKA superficial partial thickness, deep partial sickness

o Full thickness- third degree burns

▪leathery appearance, charring, dark brown or white, skin hard to touch, no

pain bc pain receptors destroyed, second degree burn pain around the burn

▪eschar formation

Why is there no pain at the site of a full-thickness burn?

dermis layer has been destroyed

What is a “critical” burn?

o injuries to specific areas are more critical - life threatening or altering

o face, eyes, ears - respiratory compromise

o hands, feet - loss of function

o genitals - genitourinary function and infection

o large joints (hips/shoulders) - loss of function/movement

o Circumferential - compartment syndrome, ventilatory compromise

Why are circumferential burns critical?

o These burns can cause eschar (inelastic burned tissue) which constricts blood flow

and swelling

o around the chest it restricts breathing because chest cannot expand

What is the “rule of nines”? For adult vs. child?

o Used to determine amount of skin/body surface area percentage of burn

(classification by body surface area)

o ONLY APPLIES TO PARTIAL AND FULL THICKNESS BURNS

o different percentages because child has bigger head

o trunk includes chest and abdomen (9% each)

o entire torso would be= 36%

o each leg is 18%

o Since head is bigger on children, the percentage is 18%

What is the “rule of palms”?

o Compare to the palm of their hands (not fingers)

o Size of patient’s palm equals 1% BSA

o can be used for any age and typically used for smaller burns

What needs to be done for a burn victim during the primary assessment and within 10

minutes of a burn?

o oxygen (AB)

o Within the first 10 minutes- burn injuries need to be cooled down by pouring

water/saline

o Stop the burning by (D): cooling, remove clothing, jewelry (E). if it adheres then cut

around the area. don’t keep the burn immersed or it will cause hypothermia. cool

for only 1-2 minutes

How long should you cool a burn before dressing/bandaging it? Should you use water or ice?

o all dressings should be dry, fluffy

o use water for 1-2 minutes

What are the s/s of inhalation injury on a burn victim?

singed nasal hairs, facial burns, specs of carbon in the sputum, smoky smell on

breath, respiratory distress - chest tightness, stridor, wheezing, difficulty swallowing,

coughing, cyanosis, bruins of oral mucosa

How might a partial or full-thickness burn lead to compartment syndrome?

o The burned tissue swells creating pressure within the fascial compartments of the

affected area. this restricts blood flow to the muscles and nerves which causes tissue

damage

o especially bad when circumferential

How do you treat dry vs. liquid chemical burns?

o safety first

o make sure water runs away from body

o Dry - brush off visible dry chemical

▪Dry lime: brush then flush

o Wet

▪Carbolic acid: alcohol then water

▪sulfuric acid: water →more heat

How do you bandage a burn? What is the advantage of bandaging a burn?

o Sterile dry fluffy dressing (antimicrobial is okay)

o avoid wet dressing - contributes to hypothermia

o burn sheet PRN

o reduces infection risk and helps with pain

How do you treat a chemical burn to the eye? How long should you flush this?

o flush with water continuously during transport in a medial to lateral direction

o remove contacts and lift eyelids

What special consideration should you give to a patient with an electrical burn?

o severe damage to skin and internal tissues

o safety first - assume source is still active

o causes thermal burns

o can fracture bones

o disrupts body’s electricity - slow onset - be prepared for CPR AED ready for cardiac

arrest

o don’t touch patient touching if they are in contact with electrical source

o administer O2 of PPV

o assess for entry/exit burn injury and seizure

o transport asap

What is the difference between ligament vs. tendon?

o Ligament- connect bone to bone

o Tendon- connects muscle to bone

What is the difference between fracture vs. sprain vs. strain vs. dislocation?

o Fracture: break in continuity of bone - broken, chipped, cracked, splintered

▪open: open wound

▪closed: no break in skin at all

▪s/s: pain, deformity, discoloration, numbness/tingling, anesthesia, paralysis,

inability of movement of extremity, pale/cool skin, less perfusion

o Sprain: injury/tearing to joint capsule or ligament; shoulder, knee, ankle

▪immediate pain to the area. discoloration happens over time

o Strain: muscle/muscle group/tendon overstretched or exerted

▪pain increases with muscle use

o Dislocation: displacement of bone from its joint

▪s/s: swelling, pain, deformity, unable to move extremity

What 2 bones constitute critical fractures? How much blood loss can each cause?

o pelvis and femur - high amounts of blood loss

o a liter and ½ of blood in each femur

o 2-3 liters of blood in pelvic cavity

What is crepitus?

o crackling, grinding, or popping sound that occurs when moving a joint

o caused by rubbing bone on bone or cartilage on cartilage within the joint

What are the 6 “Ps” for assessing a fracture/dislocation?

o Pain

o Pallor- coloration, pale

o Paralysis

o Paresthesia- numbness/tingling

o Pressure

o Pulse- do we have distal pulses

What is compartment syndrome? What are its s/s?

o Compartment syndrome: enclosed swelling→causes ischemia→further

swelling→blocks circulation

o associated with fractures, high-energy trauma, crush injuries

o s/s: severe pain and burning, extremity has decreased strength, paralysis, pain with

movement, hard on palpation. distal pulses/sensory/motor could be normal

o treatment: splint, elevate, cold pack, transport, ED: fasciotomy

What are the 2 basic reasons for splinting a bone/joint injury?

o Prevents movement of bone fragments/dislocated joints

o Reduces chance of further injury- reduce pain and minimize complications

What are the general rules of splinting?

o check CSM before and after

o remove clothing/jewelry

o one attempt to realign→increased pain/resistance/crepitus→stop

o never intentionally replace bones

o pad splints

o accomplish goal: immobilize above/below

o open wound→dress→bandage→splint

o signs of shock→ SMR→transport→splint (if we have time- priority is keeping patient

alive)

When should you try to realign an extremity before splinting? When should you not do this?

o one attempt to gently realign before splinting

o any pain/resistance/crepitus→stop immediately

How do you treat an open fracture?

dress→bandage→splint

What are the indications for a (KTD) traction splint?

o fracture must be mid shaft and isolated

o unilateral or bilateral femur fractures

o can be open or closed injuries

o contraindication: pelvic fracture

How do you splint a pelvic fracture? How do you move a person with a pelvic fracture?

o commercial pelvic binder

o sheet wrap- fold it lengthwise to 8 inch width. slide down the small of the back

underneath the pelvis. centered and equal length on both sides. tie it into square

knot or tuck under

o place patient on backboard or rigid device

What is a non-traumatic fracture?

o pathological fracture such as osteoporosis

o common in geriatrics

o broken bone that occurs without obvious injury

When should you splint an extremity fracture on a critical patient?

immediately after addressing life threatening injuries

How should you treat a nontraumatic fracture?

treat it the same as a trauma fracture

Where are the meninges located?

3 layers over brain

▪dura mater

▪arachnoid

▪pia mater

Where is the cerebrum? Cerebellum? Brain stem?

o cerebrum:top part

o cerebellum: weird part in back/bottom

o brain stem: leading to back

How might the fascia found between the skull and scalp compromise your assessment of a

head injury?

o fascia: layer between scalp and skull

o ruptured fascia mimics depressed skull fracture→bleeding happens under skin→can

be confusing and hide skull deformity

What are the s/s of a basilar skull fracture?

o temporal skull linear fracture (thinnest skull part)

o CSF leaks ears/nose

o raccoon eyes

o battle signs

What are raccoon and battle signs? What do they indicate?

o racoon eyes: bruises around eyes; indicates CSF and blood in the area

o battle signs: bruising behind ear near mastoid process; indicates CSF and blood in

the area

o Seen several hours after basilar skull fracture

What are the s/s of brain herniation?

o swelling→brain displacement into foramen magnum

o s/s: posturing, cushing reflex, severe AMS, dilated/sluggish pupils,

weakness/paralysis

What is the Cushing reflex? What does it indicate?

o Cushing reflex: increased BP , decreased HR (reflexive bradycardia), changes in

respiration

o indicates increased intracranial pressure

What is decorticate vs. decerebrate posturing? What do these indicate?

o decorticate: upper extremities move inward and legs point downward and together

o decerebrate: extending arms and pulling toes down

o indicates increased intracranial pressure→brain herniation

Why should you change your BVM rate for a patient with s/s of brain herniation? How do

you titrate this rate to EtCO2 30-35 mmHg? If the EtCO2 is higher than this range, should you

increase or decrease your rate of ventilations?

o BVM hyperventilation rate

▪adult: 20 bpm

▪child: 25 bpm

▪infant: 30 bpm

o titration of EtCO2 at 30-32 mmHg

o if EtCO2 is higher: increase rate

o if EtCO2 is lower: decrease rate

What is an open vs. closed head injury?

o open: break in both scalp and skull

o closed: scalp lacerated, skull intact

What is a concussion vs. contusion vs. subdural hematoma vs. epidural hematoma? What

are the s/s of each?

o Concussion: AMS that improves; mild DAI; typically self-heals but multiple can have

lasting effects

▪s/s: HA, confusion, amnesia (retro/ante), combative, irritable, N/V, unable to

obey commands

o Contusion: bruising and swelling; possible increased ICP

▪caused: coup-contrecoup; acceleration/deceleration

▪s/s: AMS, paralysis, N/V, unequal pupils, personality change

o Subdural hematoma: blood between dura mater and arachnoid membrane; venous

bleed; most common type of head injury

▪s/s: acute (immediately after injury) and occult (issues seen later on); AMS,

weakness/paralysis to one side of body, HA, N/V, seizures, dilation of one

pupil, personality change

o Epidural hematoma: blood between dura mater and skull; arterial bleed; rapid

bleeding

▪s/s: lucid interval (responsive and then go back to unresponsive), cushing

reflex, AMS, HA, pupil fixed/dilated, seizures, N/V, posturing

What is a coup-contrecoup injury? What kind of brain injury does it most often cause?

o brain rattles so causes injury to point of impact and opposite side of the skull

o causes contusion

What is your target SpO2 for a patient with a head injury?

o target SpO2: 95%

o herniation→hyperventilation

o hyperventilation→don’t hyperventilate more than 20 bpm

How do you treat bleeding/drainage from the ears/nose?

loose dressing on outside of leaking ears/nose