Trauma MidTerm Review

What is surveillance?

collection of data to identify the existence, the significance, and the characteristics of a disease.

What is the Haddon Matrix and what are its components?

A helpful tool to identify risk elements associated with trauma.

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Golden Period

golden period includes response time, time needed to access the patient, for on scene treatment, and for patient transport to a trauma center.

(Incident to injury time = 1HR)

Platinum Ten

10 mins on scene or less

Level One Trauma

Usually a medical university teaching center.Prepared and committed to hand all types of specialty trauma

Regional Trauma Center

Level Two Trauma

High commitment to trauma care but not as great as a Level 1.

Has surgical capability at all times for incoming trauma patients.

Area Trauma Center

Level Three Trauma

General hospital with commitment to special staff training and resourse allocation for trauma patients.Usually located in smaller communities.

Community Trauma Center

Level Four Trauma

Critical access hospital found in rural communities. Offers stabilization and care of trauma patients before shipping them out, most often by helicopter to higher level trauma centers.

Trauma Facility

What is trauma?

Violent transfer of energy open or closed wounds to the skin and possible injuries to structures underneath.

What is kinetics?

The study of energy exchange.

What is Newtons first law of inertia?

A body in motion will stay in motion unless acted upon by an outside force.

A body at rest will remain at rest unless acted upon by an outside force.

What is the kinetics formula?

What makes the biggest difference in that formula?

changes in an objects mass or velocity have different effects on kinetic energy.

KE = (mass x velocity) divided by 2

What is Blunt Trauma?

occurs when impact abruptly stops a portion of of the body while inertia causes remaining structures to continue in motion.

What is Penetrating Trauma?

Injury or injuries that occur when object pierces the skin and enters the body.

Six P's of Penetrating Trauma

- pain

- pallor

- paralysis

- parathesia

- pressure

- pulses (diminished or absent)

Three MOI's of blunt force trauma?

Compression

Stretch

Shear

Phase One (Vehicle Collision)

Vehicle Collision,

deceleration of the vehicle

Phase Two (Vehicle Collision)

Body Collision,

deceleration of the occupant

Phase Three (Vehicle Collision)

Organ Collision,

deceleration of the internal organs.

Phase Four (Vehicle Collision)

Secondary Collision,

other objects in the car hit the person

Phase Five (Vehicle Collision)

Additional Impacts,

additional impacts received by the car.

Frontal Crash Injuries

restrained pathway (seatbelt)

unrestrained pathways:

- up and over

- down and under

- ejection

Lateral Crash Injures

impart energy to the near sided occupant

seatbelts offer little protection

the body is pushed one direction, while the head moves toward the impacting object

Rear End Crash Injures

collision force pushes auto forward

within the vehicle, energy of collision propels occupant forward

may result in sever connective tissue and spinal injures

Oblique Crash Injuries

occurs when lateral crash is off center

the vehicles forward motion stops, but the side continues in rotational motion.

Roll Over Crash Injuries

as vehicle rolls it impacts the ground at various points; occupant experiences collision with each vehicle impact

Especially violent due to:

- limited crumple zones

- lack of supplemental restrain systems (airbags)

- lack of internal padding

What is considered the most common type of vehicle accident?

Frontal

What type of vehicle collision is responsible for the most deaths?

Lateral

What is Waddell's Triad?

Pattern of injures often seen in children.

- child usually turns towards the car

- bumper hits pelvis and femur region

- chest and abdomen hit grill

- head strikes the vehicle and then the ground

Motorcycle Frontal Impact:

motorcycle front dips downward, propelling rider upward and forward.

handlebars can catch riders lower abdomen or pelvis causing abdominal or pelvic injury.

Motorcycle Angular Impact:

motorcycle strikes object at oblique angle

riders lower extremities trapped between object struck and bike

fracture or crush foot, leg, or thigh. often open wounds.

Motorcycle Sliding Impact

occurs when the rider, facing imminent collision "lays the bike down"

reduces changes of ejection

increase in lacerations, abrasions, minor fractures with decrease in more serious injuries

Motorcycle Ejection Impact:

very common, usually results in serious injury of head, spine internal injures and extremity fractures

Results in following impacts:

- initial bike/object collision

- rider/ object impact

- rider/ground impact

What factors should be considered regarding falls?

- fall height

- anatomic point of impact

- nature of impact surface

- transmission pathway of forces along skeleton

What is the difference between penetrating and perforating trauma?

exit wound, or not

What are the three levels of penetrating trauma?

Low Velocity: Knives, swords, ice picks, etc.

Medium Velocity: Handgun bullets

High Velocity: Rifle bullets

What is the difference between the permanent and temporary cavity with penetrating trauma?

the permanent cavity is the actual physical path destroyed by the object, while the temporary cavity is the wider radial stretching of tissue caused by kinetic energy

Ballistics

study of projectiles in motion and their effects on objects they impact

Trajectory

curved path bullet follows after fired from a gun

Drag

as a bullet travels through the air, it meets air resistance

Cavitation

the severe cavity and shockwave created when a high-energy projectile passes through tissue.

Velocity

the speed at which the projectile is moving

Profile

Cross section of bullet along its direction of travel

Shape

bullets shape affects energy change rate and resulting damage

Blast Wave: Primary

Damage is caused by general pressure wave generated by explosion

Close proximity to the origin of the pressure wave carries a high risk of injury or death

Blast Wave: Secondary

Result from being struck by flying debris - a blast wind occurs

Flying debris may cause blunt and penetrating injuries

Blast Wave: Tertiary

occurs when person is hurled against stationary, rigid objects.

ground shock: physical displacement when the body impacts the ground

Blast Wave: Quaternanry

occur from the miscellaneous events that occur during an explosion.

may include:

- burns

- respiratory injury

- crush injury

- entrapment

What organs are most effected by the blast wave?

hollow organs

What is shock?

a life-threatening, critical condition characterized by a sudden drop in blood flow throughout the body. Without enough blood and oxygen reaching vital organs like the brain and heart, cells begin to fail, which can quickly result in permanent damage or death.

What is perfusion?

Adequate supply of well oxygenated blood and nutrients to all vital organs

Oxygen & CO2 exchanged

Nutrients & waste products exchanged

What are baroreceptors and where are they found?

Monitor pressure in the great vessels

Give feedback to the brain

Sympathetic nervous system activation

What part of your body is responsible for compensating shock?

What occurs in the body?

The sympathetic nervous system (SNS) and endocrine (hormone) systems are primarily responsible for compensating shock. Together, they direct vital organs like the brain and heart to receive blood by robbing the skin, gut, and muscles

What three things make up the cardiovascular system?

Heart

Blood Vessels

Blood

What does the systolic and diastolic BP represent?

Systolic: max pressure in arteries when heart contracts

(A & P OPEN)

Diastolic: min pressure in arteries when heart rests

(T & M OPEN)

How do you calculate pulse pressure?

The difference between the systolic and diastolic pressures.

How do you calculate MAP?

SYSTOLIC + (2xDIASTOLIC)

DIVIDED BY 3

What are the differences between arteries, veins, and capillaries?

smoll

bigger

oxygenated vs deoxygenated

What occurs to the body when it attempts to compensate for shock?

SYMPATHETIC RESPONSE

Hypovolemic Shock: Hemorrhagic

Loss of blood.

Hypovolemic Shock: Non-hemorrhagic

Occurs when there is an inadequate amount of fluid in the body, (water and plasma).

Severe Dehydration

Cardiogenic Shock

Pump Failure.

Occurs when the heart is not able to pump efficiently to maintain adequate perfusion.

Distributive: Anaphylactic Shock

Occurs when the body experiences a severe allergic reaction.

Distributive: Neurogenic (Warm) Shock

Occurs when the spinal cord is damaged and unable to control vasomotor tone.

Distributive: Septic Shock

Wide spread infection of the blood.

Distributive: Psychogenic

Results win a sudden, temporary dilation of the blood vessels.

Obstructive: Tension Pneumothorax

Occurs when there is an "obstruction" of a major vessel that causes less blood to be pumped by the heart.

Obstructive: Pericardial Tamponade

Occurs when there is an "obstruction" of a major vessel that causes less blood to be pumped by the heart.

Obstructive: Pulmonary Embolism

Occurs when there is an "obstruction" of a major vessel that causes less blood to be pumped by the heart.

Respiratory/Metabolic Shock

Disruption of O2 into the cell or cells unable to utilize the O2.

Caused by Cyanide, CO poisoning.

A change in the blood pH.

Compensated Shock

Stage in which the body is using specific mechanisms to compensate for lack of adequate perfusion.

Good BP.

Decompensated Shock

Stage in which the body is no longer able to compensate for the lack of perfusion.

Low BP.

Irreversible Shock

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SxS of Compensated Shock?

Restlessness

AMS

Tachycardia

Normal BP

Narrowed Pulse Pressure

Tachypnea

Pale/Cool/Diaphoretic

Sluggish Pupils

N/V

SxS of Deompensated Shock?

Unresponsiveness

Bradycardia

Low BP

Bradypnea

Respiratiory and Cardiac Arrest Imminent

SxS of Irreversible Shock?

Shortly after pt enters decompensated shock, lack of circulation beings to have profound effects on body cells.

Irreversibly damaged: cells die, tissues dysfunction, organ dysfunction, and pt dies.

BLOOD FLOW THROUGH HEART

RIGHT ATRIUM receives deoxygenated blood via Superior Inferior Vena Cava.

Right atrium pumps blood through the TRICUSPID VALVE into the right ventricle.

RIGHT VENTRICLE pumps deoxygenated blood through PULMONIC ARTERY into the LUNGS. After blood circulates lungs and becomes oxygenated it returns to the

LEFT ATRIUM via PULMONARY VEINS.

Left atrium sends blood through the MITRAL VALVE into left ventricle.

LEFT VENTRICLE pumps blood through the AORTIC VALVE into the AORTA, which feeds oxygenated blood to the body.

Red Blood Cells

Robust membrane, a dynamic protein scaffold, and the iron-rich oxygen-carrying protein, hemoglobin.

White Blood Cells

Granulocytes & Agranulocytes,

Platelets

Specialized plasma membrane, and various granules that store active proteins, enzymes, and small molecules

What makes up the Autonomic Nervous System?

Sympathetic

Parasympathetic

Capillary Hemorrhage

Slow oozing of red blood from tissues.

minor scraped and abrasions to skin

Venous Hemorrhage

steady flow of dark red blood.

damages vessels returning blood back to the heart

Arterial Hemorrhage

Bright red blood that is spurting with each heat beat.

Damage to an artery that is carrying oxygen enriched blood away from the heart.

What occurs during hemostasis?

Vascular Phase

Platelet Phase

Coagulation Phase

How does hemophilia affect the body and clotting process?

Prevents blood from clotting properly.

How can you identify a patient has internal bleeding?

Blood can accumulate in interstitial spaces forming visible contusions.

Blood may be forced between layers of tissue creating a hematoma.

How do u control hemorrhage from different types of bleeding?

direct pressure,

hemostatic dressings,

tourniquet

What are the four stages of hemorrhage?

Class 1: 750ml

Class 2: 750-1500ml

Class 3: 1500-2000ml

Class 4: +2000ml

What is TXA used for and what is the dose?

1G over 10mins in 50ml

1G in 500ml over 8hr

How much IV fluid should be given to a pt in differing trauma scenarios?

permissive hypotension

90 systolic

What is the largest organ system in the body?

Skin

Epidermis function?

Protect against environmental hazards, prevent fluid loss and dehydration, produce new skin cells.

Dermis function?

sensation and providing structural and mechanical support, elasticity, and nutritional supply to the skin.

Subcutaneous function?

conserve body temperature

What are the three different types of soft-skin tissue injuries?

Open, Closed, Crush.

Contusion

Blunt, nonpenetrating injuries that crush & damage small blood vessels.

Hematoma

Trapped pocket of blood. Damage to a high pressure vessel. (Artery)

What is crush syndrome?

Systemic effect of large crush injury.

Abrasion

Scraping or abrasive action; removes layers of the epidermis & dermis. Bleeding CAN be persistent.