Trauma

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

velocity (instead of mass)

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

3 collisions. Car hits object, body hits inside of car, organ hits ribs

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

up and over (hit head, face, chest, abd), down and under (hit knee, femur, pelvis, spine)

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

Rear: whiplash (hyper-extension with the head back or hyper-flexion with head down)

Lateral: head, neck, chest, pelvis, extremities

Rollover: multiple system injuries, crushing, pt thrown

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

Adults turn away from car so get side impact, hurt leg/back/torso/arms/abd. Children turn towards car so get frontal impact, hurt chest/abd/head/femur

What are some limitations of airbags?

they go off once, don’t protect sides, can cause head/neck injuries

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

distance, surface, body part hit

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

Adult: >20ft. Child: 2-3 times the child’s height

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

Head: face, brain, spine, back. Feet: pelvis, spine

What MOI details are important to gather regarding a knife injury? (5)

blade size, depth/angle of penetration, slice vs stab, organs hit, # wounds

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

temporary cavity around the wound path that can expand beyond the size of the bullet. Entrance wounds are usually smaller and rounder. Exit wounds can be larger and irregular because the cavitation causes more tearing

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

pressure wave (lungs, ears), flying debris (lac, burn, impale), pt thrown (MVC injuries), structural collapse (crush), chemicals/toxins/radiation

What is the “golden period”

time when most likely to survive

"What is “Platinum 10”

first 10 minutes when treatment makes the most impact

How much blood volume does an average size adult have?

70 ml/kg

Arterial bleeds

spurting, bright red, pulsating flow

Venous bleeds

steady slow flow, dark red

Capillary bleed

slow even flow, usually stopped with direct pressure

How do you apply a tourniquet

high and tight until bleeding stops and can’t feel a pulse

Hemostatic agent

helps with clotting. Administered by applying the gauze to the wound

Where can you pack a wound

in the shoulder spaces by chest and by the groin

Occlusive dressing purpose and body part used

creates a seal for abd/chest wounds

s/s of blood loss

increased HR, increased RR, weak/thready pulse, narrow PP and increased DBP, cool/pale

hematoma

damage to larger vessels so blood collects under the skin. Separates tissue

Avulsion and treatment

lose flap of skin. Rise off debris and cover with moist dressing

Laceration types and from what

Linear: regular (usually from sharp obj)

Stellate: irregular (from blunt obj)

Expistaxis

nosebleed

Clamping injury what is, how treat, why want to remove clamping object

When a machine traps a part of the body. Treat with elevation, shock treatment, and splinting. The longer the pt is clamped, the more damage is done.

Evisceration treatment

DONT touch exposed organs. Dress with moist, non-fibrous, occlusive dressing x4. Loose, no pressure. Flex hips/knees

Major risk of open neck wound and treatments

arterial bleed+air embolism+PE. Treat w/ occlusive drsg x4, regular drsg, only enough pressure to control bleed, c-collar. NO circumferential bandage

Treat/transport amputated part

rise part, keep moist, in plastic bag, kept cool but not on ice

When can you remove an impaled object?

obstructs air flow

dressing vs. bandage?

Dressing: sterile part directly on wound, bleed control

Bandage: holds dressing still

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

Epidermis, dermis, subcutaneous layer. Nerves on dermis

What kills most burn patients in the pre-hospital setting? What kills them later?

Acute kills: toxic gas inhalation, airway occlusion, trauma

Long term: fluid shift, infection

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

Skin isn’t there to regulate temperature

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

Non-hemorrhagic hypovolemic shock. Happens a few hours later. From increased cap permeability and swelling

Burn depths and each s/s

Superficial (epidermis pink), partial thickness (blisters on dermis), full thickness (leathery/dark/white, no pain, eschar)

Critical burn (7)

face, eyes, ears, hands, feet, genitals, big joints like hips/shoulders

Why are circumferential burns critical?

constriction of swelling tissue = nerve damage + can stop circulation + limits chest expansion + hurts ventilation

Rule of 9s for adult

For partial/full thickness.

Neck+face+head, anterior chest, abd, back top half, back bottom half, each whole extremity. Each lower extremity = 18%. Genitals = 1%

Rule of 9s for child

For partial/full thickness.

Head = 18%. Each arm = 9%. Front torso = 18%. Back torso = 18%. Each leg = 14%

Rule of palms

size of pt’s palm = 1% BSA

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

pt needs to be cooled down with water/saline for 1-2 minutes. remove jewelry/clothes.

Inhalation injury s/s

singed nasal hair, stridor, wheeze, cyanosis, burned mucosa and upper airway

Compartment syndrome

swelling cuts off blood flow

Severe burn if…

>25% partial or >10% full thickness

Treat dry vs liquid chemical burns

Check haz mat guidebook

Dry: brush off visible stuff

Liquid: if use water to wash away, do it down and away from body

Treat chem burn to eye

continuous flushing. at least 20 min

Considerations for electrical burns

DONT touch pt in contact w/ source. DONT remove pt from source unless trained. Pt might have different HR and cardiac arrest. Pt can have fracture burns + thermal burns. Use O2 or PPV

Ligament vs tendon

Ligament: bone to bone

Tendon: muscle to bone

fracture vs. sprain vs. strain vs. dislocation

Fracture: bone broken/chipped/chipped

Sprain: injury to joint/ligament. Usually in ankle/knee/shoulder

Strain: muscle torn/over stretched

Dislocation: displacement of bone

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

Pelvis (lose 2-3 L), femur (lose 1 L)

Crepitus

sound when broken bone fragments rub together

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

pain, pallor (color), paralysis, paresthesia (numb/tingle), pressure, pulse

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

reduce movement and reduce pain/complications

Compartment syndrome s/s

pt hurts a lot, weaker, feels hard/tough

general rules of splinting

Splint bone: stop joint above/below

Splint joint: stop bone above/below

Check pulse+motor function+sensation

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

1 chance to realign for big deformity/cyanotic/no radial pulse. Stop if hurts too much.

How do you treat an open fracture?

control bleeding, splint

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

fracture is mid shaft and isolated (no additional hip/ankle/etc injuries)

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

use a pelvic binder/sheet wrap/partial pelvic binding device. Move on backboard with padding between the legs

What is a non-traumatic fracture?

fractures from little mvmt. Can be from osteoporosis/cancer. May lack bruise/lac/MOI

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

don’t delay transport. splint after treating for shock.

How should you treat a nontraumatic fracture?

treat like trauma

What are the meninges

3 layers of tissue enclosing the brain

Where is the cerebrum? Cerebellum? Brain stem?

Cerebrum is top part of brain. Cerebellum is small part by the base. Brain stem is the longer tube at the base

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

Can hide skull deformity because is torn and bleeding under skin

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

CSF out of ear/nose/mouth, raccoon eyes, battle signs, temporal skull linear fractures

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

Indicate basilar skull fracture

Raccoon eyes: bruising around eyes from CSF/blood

Battle signs: bruising behind ear

What are the s/s of brain herniation?

Swelling leads to brain displacement.

s/s: posturing, Cushing reflex, dilated/sluggish pupils, weakness/paralysis.

What is Cushing reflex? What does it indicate?

Decreased HR, increased BP, irregular breathing. Indicates herniation and intracranial pressure

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

decorticate: arms stiff at chest

decerebrate: arms flexed at sides w/ wrists out.

Both indicate intracranial pressure

Why should you change your BVM rate for a patient with s/s of brain herniation? What should the EtCO2 level be? If the EtCO2 is higher than this range, should you increase or decrease your rate of ventilations?

change BVM rate to increase O2 to brain and let tissue swell. Keep EtCO2 at 30-35 mmHg. If EtCO2 >35 then ventilate faster. If EtCO2 <30 then ventilate slower.

What is an open vs. closed head injury?

Open: fractured skull w/ open wound to scalp

Closed: fractured skull but no open wound to scalp

Concussion. What are the s/s

Temporary loss of brain function.

s/s: HA, confused/altered, brief LOC, irritable

Brain contusion. What are the s/s

bruising/swelling of brain tissue.

s/s: unresponsive, unequal pupils, seizure, personality change, vomiting

Subdural hematoma. What are the s/s

Blood between brain and dura mater usually from venous bleeding

s/s: AMS, HA, ICP, weakness/paralysis on 1 side, lowered HR, dilate 1 pupil

Epidural hematoma. What are the s/s

Blood between dura mater and skull usually from low velo impacts. Have arterial bleeding + ICP

s/s: LOC, fixed/dilated pupils, increased SBP, decreasedd HR, seizures

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

damage to front and back of brain. Usually causes contusion

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

95%

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

loose dressing

How should you dress/bandage an open/depressed skull fracture?

Dress carefully but NO pressure

What are the 5 parts of the spinal column?

cervical, thoracic, lumbar, sacrum, coccyx

What is the significance of assessing both light touch and pain on the extremities of a patient with possible spinal cord trauma? Which tracts carry impulses to same vs opposite sides?

To see which tracts are injured.

Motor: carry impulses to same side

Pain: carry impulses to opposite side (cross over)

Light touch: same side where touch applied

What are the s/s of spinal cord injury and spinal shock?

Cord: No motor/sensation below injury

Shock: priapism, incontinence, decreased HR, hypotension, warm/dry skin

Spinal column vs spinal cord injury

Bone (hurt) vs nerve (lose motor/sensory function)

Pain vs tenderness

Pain: what pt complains of

Tenderness: pain when you palpate

What is priapism? How might a spinal cord injury cause this?

Involuntary erection from spinal nerve injury

What is neurogenic hypotension? How low do the BP and HR generally go with spinal shock?

Injury to spinal cord that interrupts nerve impulses. Pt has lowered BP (80 SBP) and lowered HR (60-80 bpm)

Where are the tracts for pain vs. motor vs. light touch found in the spinal cord? Which tracts cross over upon entering the spinal cord?

Pain tracts are anterior (right). Motor tracts are anterior/lateral (left). Light touch tracts are posterior (up)

Pain tracts cross.

What are the s/s of anterior cord syndrome?

Can’t feel pain and crude touch below the site of injury and likely experiences the loss of motor function below the injury site. However, the patient retains the ability to feel light touch both above and below the site of injury.

What are the s/s of central cord syndrome?

Weakness and loss of pain sensation to the upper extremities while the lower extremities have good function

What are the s/s of Brown-Séquard syndrome?

loses motor function and light touch sensation on one side but loses pain sensation on the opposite side

What special consideration should you give a patient with injury to C3-C5?

C3-C5 control diaphragm so beware of inadequate breathing

What extremities should be evaluated in order to assess injury to the cervical spine? To the lumbar spine?

Cervical: flex/extend arms + fingers

Lumbar: push/pull feet, toe sensation

C-collar purpose

remind pt no move head

What are some of the hazards of applying a rigid cervical collar?

not fitted properly and worsens injuries, aggravate spinal injury, increase ICP, unnaturally separate the spine, hard to manage airway

What is a KED? Why is it now rarely used to provide SMR?

Kendrick Extrication Device to immobilize spine during extrication. Not used because time consuming + more manipulation (worsens spinal injuries) + lack of evidence that KED is effective

When should you use a c-collar but no LBB for SMR?

Penetrating injuries and pt no have neurological deficits or indications of spinal injury, pt can self restrict.