trauma all

Patients with CSF leaking from nose or ear are at risk of

Bacterial meningitis

Cushing reflex

Hypertension, Bradycardia, & irregular respirations (cheyne-stokes)

-Sign of increased ICP

Epidural hematoma

Signs & symptoms

Accumulation of blood between skull & dura mater

-Loss of consciousness, followed by brief period of consciousness, then back to unconsciousness

Subdural hematoma

Signs & symptoms

Accumulation of blood beneath dura mater but outside of brain.

-Fluctuating LOC & slurred speech hours or days after injury

Subarachnoid hemorrhage

Signs & symptoms

Bleeding in subarachnoid space where CSF circulates

-Stiff neck, sudden severe headache, & decreased LOC

Anterograde amnesia

Retrograde amneisa

Inability to remember events after injury

-Inability to remember events leading up to injury

How to check motor function

Have patient squeeze your hands & push their foot against your hands

How to perform manual in line stabilization

Place hands around base of skull, Gently lift head till eyes are straight forward, & hold till C-collar is on

When can you remove a helmet

1) If it gets in the way of assess or managing airway

2) Prevents spine immobilization

3) Allows for excess head movement

4) Patient is in cardiac arrest

How to remove helmet

-You need 2 people not moving at the same time

-1 provides constant support

-contact med control before doing so

Signs & symptoms of a concussion

Weakness, visual changes, mood changes, ringing in ears, & slurred speech,

What can you do to help reduce intracranial pressure

elevate head 30 degrees

A ____ pulse is the most suspicious that a patient has a significant head injury

Slow

Decerebrate (extensor) or Decorticate (flexor) posturing is a sign of

Head injury/ increased ICP

Orbital blowout fracture signs

Double vision & inability to move eyes above midline,

How many lobes in each lung

Right: 3 lobes

Left: 2 lobes

Injury at C3 or above can

Injury at C5 or below

- stop pt from breathing completely

- Paralyze intercostal muscle but still breath

Pleuritic pain

Seen in what type of injuries

Sharp/Sticking pain with each breath due to damage to pleural surface.

-chest injuries

How to wrap penetrating chest injury

Tape occlusive dressing on 3 sides leaving 1 open to let air escape

Commotio cordis

Treatment

Blunt chest injury during critical part of heartbeat that causes ventricular fibrillation & cardiac arrest

-Early defibrillation & CPR

Cardiac tamponade

Signs & symptoms

Treatment

Build up of fluid in pericardial sac compresses heart, decreasing CO

-JVD on both sides, Narrow pulse pressure, & muffled heart sounds (Beck triad)

-O2, POC(semi fowler or fowler), Rapid transport

Paradoxical motion

Portion of chest wall moves opposite of normal chest movement (flail chest)

open pneumothorax

An open/penetrating chest wound allowing air to enter, creating a sucking sound ( sucking chest wound)

tension pneumothorax

caused by

signs & symptoms

-Air in thoracic cavity increases pressure inhibiting cardiac function.

-by blunt force trauma

-Hypotension, JVD, Tracheal deviation, Absent or decreased breath sounds, Low SpO2, severe dyspnea

Hemothorax

HemoPneumothorax

-collection of blood in Thoracic cavity

-Collection of blood & air in thoracic cavity

Hemostatic agents is used with

wound packing

Flail chest

Treatment

2 or more adjacent ribs detach from chest wall & causes paradoxical motion

-Provide O2, Rapid transport, & sometimes Positive pressure ventilation via BVM

Traumatic asphyxia

Signs & symptoms

Blood forced from great vessels to back of head & neck due to severe force.

-Hemorrhage into sclera, JVD, & cyanosis in face/neck

Critically injured patient should be on scene for

no more than 10 min

The body cannot tolerate acute blood lose of

20% of total blood or more than 2 pints (1L)

How to treat internal bleeding

Keep them calm, limit movement, Provide O2, & maintain body temp

An organ or tissue might better resist damage from hypoperfusion if

Body temp is considerably less than 98.6 (normal)

Nontraumatic nose bleeds

Traumatic nosebleeds

-Occur from septum & handle via pinching nostrils

-Indicate skull fracture & do not attempt to stop blood flow

If you suspect a skull fracture

Loosely cover bleeding site with gauze wrapping around head

How to treat impaled object

Apply bulky dressing to stabilize object & hold direct pressure for 5 min w/out interruption

Signs of internal bleeding

Pain, Local swelling, Tenderness, Bruising, & rigid/distended abdomen

Rules of nine in Ped

-Head: 12%

-Legs: 16.5%

Rules of nine in infant

-Head: 18%

-Legs: 13.5%

Increased ICP Signs & Symptoms

Treatment

-Cushing triad: (Hypertension, Bradycardia, & irregular respirations) & Dilated or unequal pupils

-Elevate head 15-30 degrees, supportive care, & RT

How to treat penetrating neck injury

Secure airway, maintain C-spine, & Control bleed w/ direct pressure & Occlusive dressing (4 sides)

Types of burns

-Superficial: turns red & no blisters

-Partial-Thickness: Turns Red/white, moist skin, & blisters

-Full-Thickness: Turns White/Charred, dry skin & leathery w/ no pain

Sprain

Strain

-Ligaments are stretched or torn

-Muscle or tendon are stretched or torn

Start Triage

1)Call out to all pts & direct them to landmark away from ambulance (considered green/yellow)

2) Go to nonambulatory pts & assess respiratory status

-If breathing less than 10 or more than 30 breath/min, Triage RED

-If breathing between 10-29 breath/min move on to step 3

-If Apneic, open airway, if still not breathing Triage BLACK & if they begin to breath Triage RED & place in recovery pos.

3) Check for bilateral radial pulses- Absent pulse implies hypotension Triage RED-Present pulse move to step 4

4) Assess pt ability to follow commands-Unconscious or cannot follow commands Triage RED-Follows commands triage YELLOW

Jumpstart Triage

1) Take Infants/children that can't walk are to treatment area

2) Check if pt is breathing

-Apneic but pulse: open airway, if still apneic give 4 rescue breaths, if still apneic triage BLACK

3) Assess RR

-Breathing less than 15 or more than 45 Triage RED & move on to next pt

-Breathing within 15-45 move on to 4

4) Check distal pulse

-Absent pulse, triage RED

-Present pulse, move to 5

5) Neurological status AVPU

-Pt who is Unresponsive, responds to pain by posturing or incomprehensible sounds, or unable to localize pain is triaged RED-Pt who localizes pain, withdraws from pain, or is alert is triaged YELLOW

When & How is rapid extrication performed

When: pt has life-threatening condition

How: Manually stabilize head, slide backboard under pt ass, & remove pt

When & how is emergency move performed

When: you or pt life is in imminent danger

How: Grab pt clothes & drag them out while trying to protect spine as much as possible

Croup

Counter-croup

-injury occurs at the site of impact

- injury occurs at opposite side of impact

Primary blast injury

Secondary blast injury

-Injuries from blast itself

-Injuries from being struck by flying debris

Tertiary blast injury

Quaternary blast injury

-Injuries from being thrown by force of explosion

-Miscellaneous injuries; burns, Respiratory injuries, poisoning

Arterial bleeding

Venous bleeding

Capillary bleeding

-Spurting bright red blood

-Steady flow of dark red blood

- Oozing Dark red blood

How do you treat a patient in the water still

Reach, Throw, Row, & Go

How do you treat External bleeding

Direct pressure then tourniquet

How to treat amputation

Tourniquet, Wrap part in moist sterile dressing, place in plastic bag, & place bag on ice.

When can you remove impaled object

If compromises airway or interferes with chest compressions

How to treat burns

- 1st & 2nd degree: Moist sterile dressing

-3rd degree: dry sterile dressing

What happens If C1-C5 becomes fractured

It causes diaphragm paralysis ( cant breathe)

How much blood is in the average adult

6 liters

After securing a dressing over a stab wound to the stomach, you believe the patient's organs could squeeze out of the injury site. Whats the best way to prevent it from happening

Have pt flex knees slightly (reduces tension on abdomen)

3 types of soft tissue injury

-Closed injuries: Damage to tissue but surface skin remains intact (Bruise)

-Open injuries: Damage to tissue but surface skin breaks (cut)

-Burns: Damage to tissue due to heat, chemicals, electricity, or radiation

types of open soft tissue wounds

Abrasions, Avulsions, Lacerations, Penetrating wounds

Abrasion

Ex

Damage to superficial layer of skin & may ooze blood

Ex: Road rash, Scrap, rug burn

Avulsion

Layers of soft tissue separate becoming fully detached or hanging flap. Often has significant bleeding

How to treat avulsion

-attached

-Complete

If attached: apply direct pressure w/ gauze, clean w/ sterile water, place flap in back, & wrap in dry sterile dressing

If Complete: apply direct pressure w/ gauze, Clean w/ sterile water, wrap it, & Manage separated tissue

-Rinse tissue, Wrap it in moist sterile gauze, place in plastic bag, & place bag on ice

Laceration

Incision

-Deep jagged cut in the skin

- Sharp smooth cut in the skin

When should extremities be splinted

if their painful, swollen, or deformed

What do you need to do every time when splinting

Check pulse, motor, & sensory function distal to injury before and after splinting

How to treat closed soft tissue injuries

RICES

-Rest

-Ice

-Compression

-Elevation: above patient heart

-Splinting

How to treat open soft tissue injuries

1)Direct pressure

2) Pressure Dressing & or splints

3) Tourniquet

Evisceration

How to treat

organs outside of the body

-Wrap in sterile moist gauze & secure it with occlusive dressing

Which has higher risk of infection Human or animal bite

Human bite

How to treat a bite

Apply dry sterile dressing, Immobilize with splint or bandage, & rapid transport

Burns increase the risk of

Infection, shock, Hypothermia & Hypovolemia

Rule of nines

-Head = 9%

-Front & back of Arm = 9%

-Chest + Abdomen = 18%

-Back = 18%

-Front & back of leg = 18%

How to assess potential airway problem in burn patient

check for singed Nasal/facial hair, Soot around mouth/nose, & Clear breath sounds

How long do you flush a liquid chemical off patient

15-20 min after burning sensation stops & never direct stream to burn

Can you use elastic bandages to secure dressings

No bc it can become a tourniquet

How to treat a full-thickness burn

Never

Stop burning, support ABC, Apply dry sterile dressing

-Cool full thickness burns ( increases risk of infection & hypothermia)