Trauma part 2

pressure injuries aka

pressure ulcers

decubitus ulcers

bedsores

pressure injuries

injuries to skin and underlying tissue from prolonged pressure

location of pressure injuries

bony areas: heels, ankles, hips, coccyx

pressure injury timing

hours to days

patients at risk of pressure injuries

patients with conditions that limit ability to change position

chornic conditions that decrease perfusion, wound healing and increase inflammation

limit ability to change positions

surgery

fractures

trauma

burns

chronic conditions that decrease perfusion, wound healing and increase inflammation

diabetes mellitus

cardiac issues

obesity

imporance of prevention of pressure injuries

once occur some never heal completely

stage 1 pressure ulcer

non-balancing

erythema

with intact epidermis

stage 2 pressure injuries

partial thickness involving dermis and epidermis

stage 3

full thickness extending through dermis into subcutaneous tissue

stage 4 pressure injury

deep tissue destruction extending through fascia and amy involve muscle, bone and tendon

treatment of pressure injury

keep clean

analgesia

prophylactic antibiotics

assess signs and symptoms

deep wound care

wound packing

wound irritation

follow unit protocol and patient orders

wound packing for wounds

deep draining

purpose of packing wounds

promotes healing and prevents superifical closure with an enclosed abscess

wound irritation

normal saline and antibiotics

antibiotic use with wounds

decrease evidence for use due to resistance

how to measure exercise capability

VO2 max measured in L/min

VO2 max measures

circulaiton capacity to heart and blood

lung capacity

oxygen delivery to working muscles and is extracted by muscles

CN commond center and hypothalmus in acitivity

brainstem and SNS

adrenal gland hormone secretion

local vasodilatory factors stimulated in high-output organs

CO increase

vasodilation location

coronary circulation

muscle

brain

CO increase to

match demans

Skeletal muscle co at rest

20%

skeletal muscle co in exerise

95%

Co increase other mechanism

diverted from other organs

energy stored form

ATP

energy is used from

stored ATP

aerobic metabolism of pyruvate

other sources of energy

muscle glycogen

fatty acids

creatinine phosphate

CO2 excretition

exhaled and evaporated via diaphoresis

evaporation causes

cooling

high water losses cause

dehydration

extreme dehydration

fluid shifts and hypovolemic shock

heat

a product of chemical reactions = warm/flushed appearance

anaerobic metabolism

When demand exceeds supply (short bursts of high output: long time

by product of aerobic metabolism

carbon monoxide and water

by product of anaerobic metabolism

lactate

fatigue

activity intolerance due to exhausted reserves

causes of fatigue

physiologic

psychologic

pathologic

unknown

physiologic

inadequate ATP to generate muscle activity

physiological fatigue has depleted

glucose and electrolytes

psychologic fatigue

inadequate CNS ability to generate activity

deleted in psychologic fatigue

neurotransmitters, enhanced inhibitory neurotransmitters

pathologic fatigue

disease treatment alterations to normal function

disease that alter noraml function

heart failure

anemia

renal failure

cancer

unknown causes of fatigue

chronic fatigue syndrome

types of fatigue

acute and chronic

acute

sudden onset, clear cause, rest leads to recovery

chronic

unclear onset and causality, rest does not lead to recovery, accumulates and interferes with ADLs causes other pathologies

other pathologies caused by chronic fatigue

depression

anxiety

IBS

chronic fatigue syndrome aka

myalgia encephalomyelitis

systemic exertion intolerance disease

ME

myalgia encephalomyelitis

SEID

systemic exertion intolerance disease

etiology hypothesis chronic fatigue syndrome

an infectious disease postdrome caused by an immune hyperactivity of inflammatory mediators (cytokines)

infection

infections that chronic fatigue syndrome

enteroviruses, coronaviruses

diagnosis of chronic fatigue syndrome

signs and symptoms

signs and symptoms of chronic fatigue syndrome

chronic fatigue longer than 6 months with effect on ADLs

post exercise malaise

unrefreshing rest/sleep

congnitive and orthostatic effects

other symtpoms might be present on health assessment but are not diagnostic due to inaiblity to differentiate from cause and effect

examples of other symptoms with chronic fatigue syndrome

pharyngitis

lymphadenopaty

myalgia

splenomegaly

treatment of chronic fatigue injuries

CBT

team approach to management of associated pathologies

acute injuries force

sudden force

acute injuries

fractures

contusions

articulation injuries

articulation injuries

strains

sprains

dislocations

chronic cause

overuse

chronic injuries

stress fractures (no time to heal from acute injury)

strains and sprains with no time to heal adequately

musculoskeletal system percent of body mass

70%

msk includes

bone

cartillage

soft tissue

soft tissue in

articulations (joints) weakest link

ligaments

tendons

muscle

soft tissue in ligaments

bone to bone connection attack articulating ends together

soft tissue tendons

muscle to bone connection, join muscle to bone periostium

sprain

mechanical overload of a joint

mechanical overload of joint causes

ligement injury=stretch, tear complete or incomplete associated bone injury potentially

signs and symptoms of sprain

pain

inflammation

contusion

decreased function

common sprains

ankle inversion

knee ACL and MCL

elbow

wrist

things that tear

ACL

strain

mechanical overload of muscle or muscle tendon complex

mechanical overload of muscle or muscle tendon complex

excessive stretch or contraction = tearing of fascia, muscle, joint structures

high risk supports

signs and symptoms of strain

inflammation

pain

increased pain with aggravating activity

common strains

muscles lower back

c spine

joints elbow and shoulder

itis an inflammation of tendon usually chronic in nature

strain can tear

achilles tendon

bicep tendon

lateral epicondylitis

overuse of the forearm muscles, inflaming the lateral epicondyle muscle/tendon complex

treatment strain and sprain

compressess

compression of affected area

drugs

rest

rehabilitation

surgery

prevention

treatment of strain and sprain dependent on

degree of injury

compresses sprain/strain

cold, warm/cold

cold timing

less than 48 hours for 15-20 minutes, allow to return to body temp, decrease inflammation

warm timing

more than 48 hours for 15-20 minutes/time; increase healing decreases stiffness

compression of affected area

supports and decreases inflammation

immobilization (splint, cast)

drugs sprain/strain

antispasmodics and NSAID

rest timing

weeks

rehabilitation

return to function and strength exersizes

surgery

asap if at all

prevention of sprain/strain

posture

exercise mechanics

warm up and cool down

limit overuse

antispasmodics

centrally acting muscle relexants for muscle spasm or chornic pain

moa antispasmodics

decrease somatic nervous system activity CNS interruption/depression

outcome of antispasmodics

decreased muscle spasm, CNS effects (drowsiness)

antispasmodic drugs

cyclobenzoaprine

methocarbamol

methocarbamol combo drugs

robaxacet

robaxisal

robaxacet

methocarbamol and acetaminophen

robaxisal

methocarbamol and ASA

treatment if pain becomes chronic

underlying cause and treatment

chronic pain clinics

CNS drugs

decrease the excitatory neurotransmitters

enhance serotonin

antispasmodies

chronic pain clinics

counselling; CBT

physiotherapy