Block 4 Study Guide

Epidural hematoma

- blood collects between the dura mater and the arachnoid layer of the brain (outer)

rapid onset, lucid interval followed by deterioration

Subdural hematoma

- blood collects between the dura mater and the arachnoid membrane of the brain (inner)

slower onset, often in elderly, may present days after injury

the signs of increased intracranial pressure (ICP)

- Non-reactive pupils

- Changes in level of consciousness

- LATE SIGN Cushing's triad: bradycardia, hypertension, irregular respirations

Know the target end-tidal CO2 ranges for patients with suspected brainstem herniation

30-35 mm Hg

stages of shock

Compensated (adaptive phase): tachycardia, tachypnea, cool/clammy skin, normal BP

Decompensated (failure phase): decreased LOC, thready pulse, hypotension, worsening

symptoms

signs of each type of shock and how to differentiate them

hypovolemic: fluid loss

- rapid weak pulse

- cool clammy skin

- hypotension

- tachypnea

- AMS

- thirst

cardiogenic: pump failure

- MI, CHF

- pulmonary edema

- chest pain

- JVD

- cyanosis

- low BP

- cool clammy

- weak thready pulse

neurogenic: trauma to spinal cord

- warm dry flushed skin

- bradycardia

- hypotension

- paralysis or sensory loss below injury

anaphylactic: allergy

- sudden

- uticaria

- swelling

- wheeing, stridor

- hypotension

- tachycardia

- resp. distress

septic: infection

- hypothermia or fever

- tachycardia

- hypotension

- AMS

- weak pulse

obstructive: obstruction

- sudden collapse

- chest trauma

- JVD

- tracheal deviation

- hypotension

- tension pnemothorax, cardiac tamponade, pulmonary embolism!!

psychogenic: extreme emotion

- sudden stress

- fear, emotional news

- sudden fainting

- pale cool skin

- weak pulse

- dizziness

- rapid recovery after syncope

treatment priorities for shock patients

- control external bleeding

- ROKS

identify the type of bleeding (arterial, venous, capillary)

arterial: bright red, spurting with pulse

venous: dark red, steady flow

capillary: slow, oozing

proper hemorrhage control techniques and their sequence

- Direct pressure

- Pressure dressing

- Tourniquet placement (PROXIMAL to the wound)

Understand how to identify and treat Tension pneumothorax

tachypnea, unequal breath sounds, JVD, subcutaneous emphysema

- High flow O2 via nrb or bvm

- load and go

- seal any open chest wound if present

Understand how to identify and treat Open pneumothorax (sucking chest wound)

occlusive dressing treatment

Understand how to identify and treat Flail chest

- two or more adjacent ribs are fractured in two or more places, creating a free-floating segment of the chest wall

- paradoxical movement

- resp distress

- severe chest pain

- hypoxia

- ABCs

- semi fowlers or position of comfort (if no spinal injury suspected) if there is spinal injury then supine

Understand how to identify and treat pulmonary contusion

pulmonary contusion: bruising of lung tissue caused by blunt chest trauma

- chest pain, SOB, coughing, hypoxia, tachypnea, rales, decreased breath sounds, worsen over time

- ABCs, semi fowlers (if no spinal injury), load n go

Know when to use occlusive dressings (occlusive dressing = airtight seal)

- open chest wound

- neck injury

- evisceration (abdominal organs protruding from wound)

- open pneumothorax

when can you remove the impaled stabbing object?

- if its in the airway then treat as open wound

- if its in the way of cpr (if cpr is initiated)

signs of internal bleeding

- cool pale clammy

- tachycardia

- tachypnea

- low BP

- AMS

- blood vomit or cough

ABDOMEN:

- rigid or distended belly, rebound tenderness, guarding

CHEST:

- SOB, hemoptysis (cough blood), JVD

PELVIS:

- bruising, swelling, deformity

BRAIN:

- unequal pupils, AMS, vomit, cushings reflex (hypertension, bradycardia, irregular respirations)

Understand treatment for evisceration

sterile, moist dressings with occlusive cover

Recognize referred pain patterns

- liver injury: right shoulder

- MI/ Angina: Left arm, jaw, neck, shoulder, upper back

- Pancreatitis: Mid-epigastric pain radiating to the back (worse when lying flat)

- Aortic aneurysm/dissection: chest/back, "tearing" pain to abdomen

- Gallbladder (Cholecystitis): RUQ pain, Right shoulder or scapula

organs in each quadrant of the abdomen

RUQ

- liver

- gallbladder

- duodenum

- right kidney

LUQ

- stomach

- spleen

- pancreas

- left kidney

RLQ

- appendix

- cecum

- right ureter

- part small intestine

LLQ:

- left ureter

- part small intestine

Main complaint from each quadrants pain

- RUQ pain: Suspect liver or gallbladder (e.g. cholecystitis)

- LUQ pain: Think spleen (e.g. splenic rupture) or stomach (e.g. ulcers)

- RLQ pain: Appendicitis is a major concern

- LLQ pain: May point to diverticulitis or ovarian conditions

Know the assessment criteria for splinting

Pulse, Motor function, Sensation (PMS)

Know which fractures are considered high priority

- Pelvic fractures

- Femur fractures

- Multiple fractures

Understand when to use various splinting techniques

vacuum splint:

- Moldable splints that become rigid when air is removed

- use for joint injuries or angulated fractures

sling & swathe:

- Sling supports the arm; swathe holds it against the body

- Shoulder dislocation, upper arm/humerus injury, clavicle fracture

rigid splints:

- Made of firm materials (wood, plastic, metal, cardboard)

- Long bone fractures (arm, forearm, lower leg), dislocations

Be familiar with when traction splinting is appropriate

Designed to apply gentle pulling force on femur fractures

- use for Isolated mid-shaft femur fractures (closed, not involving pelvis, knee, or lower leg)

CONTRAINDICATIONS:

- Hip or pelvic fracture

- Knee injury

- Lower leg/ankle injury

- Open femur fracture with exposed bone

Understand how to assess neurovascular status before and after splinting

PMSCs

- only P and C if unconscious

Know when limb realignment is appropriate

Do NOT try to realign open fractures or angulated fractures unless no pulse is present

5 different types of soft tissue injuries

- Avulsion: tissue flap or complete detachment

- Amputation: Complete removal of a body part

- Laceration: A deep or jagged cut through skin and possibly underlying tissue caused by a sharp object or blunt trauma.

- Puncture: A deep, narrow injury from a pointed object that penetrates the skin and possibly deeper structures.

- Abrasion: A superficial wound caused by rubbing or scraping away of the epidermis.

proper treatment for impaled objects

- remove clothing

- control bleeding around object using direct pressure

- stabilize object with bulky dressing to prevent movement then secure with bandages without pressing on it

how to calculate the percentage of TBSA (Total Body Surface Area)

rule of 9s ADULT

head and neck: 9%

each arm 9%

each leg 18%

front torso 18%

back torso 18%

perineum/genitals 1%

rule of 9s PEDIATRIC

head 18%

each arm 8%

each leg 14%

front torse 18%

back torse 18%

genital 1%

burn degree classifications

- Superficial (1st degree)

- Partial thickness (2nd degree)

- Full thickness (3rd degree)

types of burns & what they are

- Thermal: Burns caused by heat; fire, explosion

- Chemical: Burns caused by caustic substances

- Electrical: Burns caused by electric current passing through the body

Low-voltage (household)

High-voltage (power lines)

Lightning strikes

- Radiation: Burns caused by exposure to ionizing radiation; sunburn, radiation therapy, nuclear accident

proper treatment for each burn type

Thermal:

- stop burning process

- dry sterile non-stick dressing

Chemical:

- brush off extra dry chemicals

- irrigate with copious water (15-20 mins)

Electrical:

- dry sterile dressing to visible burns

Radiation:

- treat like thermal burn (cooling & sterile dressing)

appropriate cooling and covering techniques for burns

COOLING:

- use cool (not cold) water or saline (no more than 10 mins to avoid hypothermia)

- moist cool gauze short term

COVERING:

- dry sterile non stick dressings for most burns

- maintain body temp (blanket)

- Evisceration (abdominal organs exposed): Use moist sterile dressing with occlusive covering

- Facial burns: Leave uncovered if possible but protect from contamination

- Hand/foot burns: Use dry gauze between fingers/toes

Understand hypothermia

- Passive rewarming for mild hypothermia

- Active rewarming for severe

- Importance of preventing further heat loss

how to manage chemical exposures (especially eye injuries)

- brush off excess chemicals

- flush with water & avoid contamination to other eye

Know the proper sequence of trauma XABCDE

Life threating bleeding, Airway, Breathing, Circulation, Disability (GCS), Exposure (trauma naked)

know when to integrate C-spine precautions

- spinal injury suspected (back, neck, head trauma)

- head injury (confusion, AMS)

- loss of motor function

normal vital ranges and concerning values

resp: 12-20

pulse: 60-100

BP: 120/80

O2: 95-100%

skin: pink warm dry

pupils: PERRL

Know how to adapt assessment techniques based on injuries

- take BP on leg when arms are injured (cuff on thigh, listen behind knee)

- facial trauma: opa/npa

- jaw-thrust instead of head-tilt if spinal injury suspected

- burns? use unburned extremeties for vitals

- work AROUND injuries

Understand which patients require rapid transport

RED:

- airway/breathing compromised

- no pulse or cap refill > 2 sec

- severe bleeding

- signs of shock

- AMS (gcs

how to triage multiple patients

START

pedi: jumpSTART

signs that indicate a high-priority patient

- Altered mental status

- Abnormal vital signs (tachypnea, tachycardia)

- Significant mechanism of injury

average blood volume of an adult

6 liters

Know pediatric-specific concerns

higher metabolic rate, different surface area ratios

Epistaxis (nosebleed) positioning

sitting, leaning forward with head tilted forward

Hypothermia management

prevent further heat loss before attempting rewarming

Tourniquet placement

PROXIMAL to the wound

Occlusive dressings are needed for?

open pneumothorax, neck wounds, evisceration

The rule of palm

1% TBSA

Full-thickness burns?

lack pain sensation due to nerve destruction

Jugular vein distention is associated with??

Obstructive shock

The femur can hold ___ liters of blood when fractured

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