KIN 202 Exam 3

define load

define load

external force acting on tissues that causes internal reactions within the tissue (this is basically just the object you are picking up)

define stiffness

ability of a tissue to resist a particular load

define stress

internal resistance of the tissues to an external load

define dislocation

at least 1 bone in a joint is forced completely out of its normal and proper alignment

define subluxation

partial displacement (w/ return to “normal” position)

________________ is a complex physiological process that can be impacted by multiple things including:

• extent of injury

• physical health

• nutrition

• psychological factors

• corticosteroid use

• infection

• adherence to protocols

healing

what are the 3 mechanisms of injury

• compression

• tension (separation)

• Shear (torsion)

what is compression (mechanism of injury)?

force that occurs when the tissue is crushed in between 2 or more objects

what is tension/separation (mechanism of injury)?

force that occurs when a structure is pulled apart from either one of both ends

what is shear/torsion (mechanism of injury)?

when one or more forces move across the tissues

ex: knee ligaments (ACL or PCL tears), low back (disc herniations), blisters, abrasions

what is the degree of injury determined by?

the severity and intensity with which the force is applied and by the size of the area affected

T/F: Most likely a more severe injury if a great amount of force or stress is applied over a small area vs a larger area

true

what are the 3 phases of healing?

1. inflammatory phase

2. fibroblastic repair phase

3. maturation remodeling phase

how long is the inflammatory phase?

begins right when injury occurs and then up to 4 days post injury

how long is the fibroblastic phase?

from 3 days post injury to 6 weeks

how long is the maturation remodeling phase?

from 3 weeks post injury to years later

T/F: the 3 phases of healing do not overlap

false

what happens during the inflammatory phase?

thromboplastin is released from cells which creates events leading to formation of a clot (basic idea is that a “scab” starts forming)

• platelets create a plug that helps limit the size of the inflamed area

• vasoconstriction occurs and then vasodilation begins

• some symptoms are pain, redness, swelling, and increased tissue temperature

• at the end of this phase phagocytes debride the area

what happens during the fibroblastic repair phase?

(basic idea is that the “scab” is being replaced by stronger material but the stronger material is still pretty darn thin and prone to damage)

• decrease in signs and symptoms of inflammation, continuation of phagocytic activity, fibroblastic activity, and formation of collagen tissue and a fragile scar

• capillaries are formed which brings oxygen to the area

• decreased debris, pressure, pain, and swelling (causes increased ROM)

• fibroblasts create a loose meshwork of unorganized collagen at the injury site, which creates a fragile scar

what happens during the maturation remodeling phase?

(basic idea is that your “scab” is gone, and your scar is formed but is now strengthening)

• organization of collagen scar tissue fibers occurs more in the beginning of this phase due to stress applied to the tissue

• scar continues to strengthen and decrease in size

• if too much stress exists, then scar disruption occurs and healing process takes much longer

what is a fracture?

a break or crack in the bone

what are the 2 simple fracture types?

• closed

• open/compond

list the signs and symptoms of a fracture:

• Swelling: caused by bleeding, occurs rapidly

• Deformity: not always obvious, bilateral comparison

• Pain and tenderness: “sharp” acute pain at injury site

• Loss of use: possible guarded motion

• Crepitation: bone ends rubbing together. Do not move to in an attempt to reproduce

hairline fracture

a small crack in the bone that doesn’t go all the way through

oblique displaced fracture

when your bone breaks all the way and then moves out of place

oblique non-displaced fracture

when your bone breaks all the way but stays in place

linear fracture

a fracture that is a line down your bone

comminuted fracture

part of the bone shatters into many pieces (community of little bone dudes)

spiral fracture

a fracture that goes around the bone in a spiral way (spiral staircase)

segmental fracture

the bone breaks into 3 or more separate pieces (not in a tiny shattered way tho)

define luxation

complete bone displacement

what are the 3 skull fracture types?

• linear

• depressed

• compound

linear skull fracture

breaks in the bone that transverse the full thickness of the skull

fairly straight fracture with no bone displacement

what is the common cause of a linear skull fracture?

blunt force trauma (falls/impacts) where the impact energy is transferred over a wide area of the skull

depressed skull fracture

comminuted (fragmented) fractures in which broken bones displace inward

these present a high risk of increased pressure on the brain, or hemorrhaging within the brain

look at this nice picture to help explain skull fractures…

compound skull fracture

a fracture in that puts the outside environment in contact with the brain itself (basically a piece of skull breaks off exposing the brain)

what are the symptoms of a skull fracture?

• deformity

• bleeding

• “battle’s sign” (bruising right behind the ear)

• “racoon eyes”

• clear/pinkish fluid coming from ears or nose (w/ halo sign)

what are the 2 types of hematomas that can happen because of intracranial hemorrhages?

• epidural hematoma

• subdural hematoma

what is an epidural hematoma?

bleeding between the dura mater and the skull that herniates the brain towards the foramen magnum (this causes rapid bleeding and reduction of oxygen within tissues)

what is a subdural hematoma?

bleeding within meninges beneath dura mater and within subarachnoid space (this causes slow bleeding and signs progress over several days w/ slow deterioration of mentation)

what is a cerebral contusion?

a brain bruise where intracerebral bleeding occurs, and blood leaks into the brain tissue

what is a cerebral contusion caused by?

blunt trauma to local brain tissue (linear fractures & concussions)

what are the S/Sx for a cerebral contusion?

• confusion

• neurological deficits (personality changes, vision changes, speech changes)

what is a concussion?

a typically non-life‐threatening injury when the brain is jarred in the skull, resulting in altered consciousness and neurological deficits

• evidence suggests that there is some level of structural damage in all of these injuries

• minor changes may include decreases in blood flow, increases in intracranial pressure, or tissue anoxia

• any brain cells damaged are extremely vulnerable to subsequent trauma

individuals sustaining a concussion have a ___ increased risk of sustaining an additional concussion

3x

what are the S/Sx of a concussion?

• eye signs: pupil reaction to light, visual disturbances (double vision or photophobia)

• balance disturbances: inability to maintain equilibrium

• somatic changes: headache, vomiting, nausea, sleepiness

• memory loss (anterograde amnesia or retrograde amnesia)

• concentration deficits/information processing deficits (slurred speech, unable to follow directions, etc)

• emotional changes

what is anterograde amnesia?

the inability to recall events that have transpired since the time of the injury

what is retrograde amnesia?

the inability to recall events that occurred prior to the injury

what is second impact syndrome (SIS)?

when an individual with a head injury receives another head injury before the symptoms of the initial injury have resolved

this involves rapid, catastrophic brain swelling that can result in death or permanent brain damage

what do you test in QUICK neurological tests?

1. observational testing (eye dilation, photophobia, gait, head tilt)

2. cognitive abilities

3. balance

name 2 types of scalp injuries

• contusions (bruising) and edema (swelling)

• significant hemorrhages

  • lacerations (cut/slit on head)

  • avulsions (whole ass piece ripped off head, like all layers of epidermis)

refer for possible underlying skull and brain injuries

T/F: your face has highly vascular tissue

true

name some common face fractures

• mandibular (jaw) fractures

• maxillary and nasal fractures

• orbit (eye) fractures

what are the S/Sx of jaw dislocation?

• extreme pain and deformity in the region of the TMJ (temporomandibular joint)

• inability to move lower jaw

• jaw is “locked”

T/F: you should immediately relocate jawbone if it dislocates

false (never do this)

what are the S/Sx of a zygomatic bone fracture

• pain and edema at site of injury

• diplopia (double vision)

• edema and ecchymosis (bruising) spreads to the region of the orbit

Tx: have them transported to the ER or call EMS (don’t let them drive themselves)

the nose is a _________ framework wih skin attatched

bone-cartilage

T/F: most nasal injuries are rarely life threatening

true

what is epistaxis?

a nosebleed

what is epistaxis (nosebleed) caused by

• direct trauma

• allergies

• dry nasal passages

• continual inflammation from colds, nose picking, or drugs “snorted” up nose

how do you care for epistaxis?

• wear gloves to avoid contact with blood

• finger pressure applied directly against the nostril that is bleeding

• application of a cold compress against the nasal region

• can pack with gauze or cotton that protrudes from nostril

do NOT lie down or look up (that can cause blood to flow down throat and cause vomiting or choking)

what is a septal hematoma?

bleeding between the septum and the mucous membrane

• swelling is usually visible inside and outside the nose

• can lead to septal erosion

refer to physician for evaluation and treatment

what are the signs of a nasal fracture?

• nosebleed

• deformity

• swelling at bridge of nose

Tx: control bleeding and refer

what is the treatment for a jaw dislocation?

application of ice pack and medical referral

suspect _______ _______ ______ if patient complains of sudden eye pain and sensation of something on the eye

small foreign body

what is a subconjunctival hemorrhage

occurs when a tiny blood vessel breaks just underneath the clear surface of your eye (conjunctiva)

• less serious condition

• may occur after a strong sneeze, severe vomiting, or direct trauma

what is hyphema?

blunt trauma to the anterior chamber of your eye (blood in front of the iris or pupil)

what is the cause of an orbital fracture?

a direct blow to the eye

S/Sx of orbital fractures depend on which bones are fractured, but they generally include what?

• sunken or bulging eye

• inability to look in various directions

• blurred vision

• swelling

• deformity

• racoon eyes

• bleeding from lacerations

what is the treatment for an orbital fracture?

• call 911

• treat for shock

• control bleeding

what are the symptoms for a retinal injury

• floating particles in field of vision

• distorted vision

• changes in amount of light seen

what is a corneal abrasion?

a scratch on the surface of your eye that occurs due to something scraping the cornea or liquids getting into the eye that cause an allergic reaction

what are the S/Sx of a corneal abrasion?

• pain and the sensation of an object in the eye

• teary, red, and bloodshot eyes

• blurred and decreased vision and sensitivity to light

what is the treatment for a corneal abrasion?

eye wash if possible and referring the individual to an ophthalmologist or the ER

what is conjunctivitis?

pink eye

what is the cause of conjunctivitis?

typically caused by a viral infection but can also be caused by bacteria, fungi, allergies, chemicals, and contacts

what are the S/Sx of conjunctivitis?

• redness or pink color in the eye’s sclera (white of the eye)

• itching

• pain

• blurred vision

• sensitivity to light

• significant eye discharge

Also this is highly contagious

what is the treatment for pink eye?

refer to physician and ensure good hygine

explain eye injury care:

corneal irritations

• check for foreign bodies

• rinse with clear water or saline solution

general injury

• cover injured and uninjured eye

  • prevents sympathetic motion

• consider sterile dressing soaked in saline

avulsed or impaled eye

• cover and protect from injury

general care

• calm and reassure patient

what are the 4 question to ask when looking at dental injuries?

• can person open and close their mouth without pain?

• what is the general symmetry of the teeth?

• are there any irregularities in adjacent teeth?

• is there bleeding, especially along gum line?

explain general external ear injuries

pinna frequently injured due to trauma, poor blood supply, or previous poor healing

explain general internal ear injuries

inner ear is well protected from trauma but can be injured due to things like rapid pressure changes (like diving, a blast, or explosion)

• can cause temporary or permanent hearing loss

• tinnitus (ear ringing) may occur

what is an auricular hematoma (cauliflower ear)?

the collection of blood below the skin of the outer ear due to constant friction or direct/blunt trauma

S/Sx for auricular hematoma (cauliflower ear)

• friction induced S/Sx: pain, warmth, and swelling to cauliflower deformation

• blunt trauma induced S/Sx: tinnitus, hearing loss, visual disturbances, pain, warmth, and swelling

Tx for auricular hematoma (cauliflower ear)

• ice application

• manual compression

• referral to a physician if fluid must be drained from ear

injury prevention includes wearing appropriate protective ear wear, headgear, and helmets

what is otitis externa (swimmers ear)?

infection of the outer ear canal

occurs b/c water remains in the outer ear canal after bathing or swimming, sits in canal and bacteria grow

S/Sx of otitis externa/swimmers ear (may not experience significant signs and symptoms at first except for these)

• itching

• mild discomfort

• redness of the outer ear canal

• possible slight discharge

Tx and prevention for otitis externa/swimmers ear

• refer individual to a physician

• prevention includes keeping the outer ear canals dry after swimming or bathing

  • commercial preparations

  • ear plugs

what is otitis media?

a middle ear infection caused by bacteria or viruses trapped in the middle ear

S/Sx of otitis media

• Significant pain

• Sore throat

• Fluid drainage from the ear

• Muffled hearing

• Difficulty sleeping

• Low grade fever

Tx and prevention of otitis media

• Tx: Refer to physician

• Prevention: get flu vaccine annually, quit smoking and avoid secondhand smoke, wash hands regularly

care for fractures and dislocations in spine

• tell the person not to move

• maintain in-line stabilization

• check ABCs

• call 911

• watch for/treat for shock

T/F: the level at which the vertebrate and spinal cord is damaged will result in different levels of dysfunction and possible permanent damage

true

a spinal cord/nerve injury on C1 and C2 results in

usually death

a spinal cord/nerve injury on C3 and C4 results in

complete disability

a spinal cord/nerve injury on C5-C8 results in

quadriplegia

a spinal cord/nerve injury on T1-T5 results in

paraplegia w/ potential thorax issues

a spinal cord/nerve injury on T6-T12 results in

paraplegia w/ less to no trunk issues

a spinal cord/nerve injury on L1-S5 results in

some possible loss of function in hips or legs but not necessarily paraplegia