EMT Chapter 24/25*60 Gynecologic Emergencies/ Trauma Overview

arterial air embolism

Air bubbles in the arterial blood vessels.

Blunt trauma

An impact on the body by objects that cause injury without penetrating soft tissues or internal organs and cavities.

Cavitation

A phenomenon in which speed causes a bullet to generate pressure waves, which cause damage distant from the bullet's path; results from rapid changes in tissue and fluid pressure that occur with the passage of the projectile

coup-contrecoup brain injury

A brain injury that occurs when force is applied to the head and energy transmission through brain tissue causes injury on the opposite side of original impact.

Declaration

The slowing of an object

Drag

Resistance that slows a projectile, such as air.

Glasgow Coma Scale (GCS)

An evaluation tool used to determine level of consciousness, which evaluates and assigns point values (scores) for eye opening, verbal response, and motor response, which are then totaled; effective in helping predict patient outcomes.

index of suspicion

Awareness that unseen life-threatening injuries may exist when determining the mechanism of injury.

kinetic energy

The energy of a moving object

mechanism of injury

The forces, or energy transmission, applied to the body that cause injury.

multisystem trauma

Trauma that affects more than one body system.

Penetrating trauma

Injury caused by objects, usually bullets, that pierce the surface of the body and damage internal tissues and organs (Second-leading cause of trauma death after blunt trauma)

Potential energy

The product of mass, gravity, and height, which is converted into kinetic energy and results in injury, such as from a fall.

Projectile

Any object propelled by force, such as a bullet by a weapon.

Pulmonary blast injuries

trauma resulting from short-range exposure to the detonation of explosives.

Revised Trauma Score (RTS)

A scoring system used for patients with head trauma.

Trajectory

the path a projectile takes once it is propelled

Trauma emergencies

are the result of physical forces applied to a patient's body.

Trauma score

A score calculated from 1 to 16, with 16 being the best possible score. It relates to the likelihood of patient survival with the exception of a severe head injury. It takes into account the Glasgow Coma Scale (GCS) score, respiratory rate, respiratory expansion, systolic blood pressure, and capillary refill.

Tympanic membrane

The eardrum; a thin, semitransparent membrane in the middle ear that transmits sound vibrations to the internal ear by means of auditory ossicles.

Work (energy of work)

The measure of force over distance.

Medical emergencies

emergencies that require EMS attention because of illness or conditions not cause by an outside force

Bacterial vaginosis

An overgrowth of bacteria in the vagina; characterized by itching, burning, or pain, and possibly a "fishy" smelling discharge; "Trichomoniasis", milky discharge; if untreated, progress to premature birth/ low birth weight in pregnancy and PID

Cervix

The lower third, or neck, of the uterus.

Chalamydia

A sexually transmitted disease caused by the bacterium chlamydia trachomatis

Fallopian tubes

The tubes that connect each ovary with the uterus and are the primary location for fertilization of the ovum.

Gonorrhea

A sexually transmitted bacterial disease caused by neiisseria gonorrhoeae; Grows and multiplies rapidly in warm, moist areas of reproductive tract; If untreated, can enter bloodstream and spread to other parts of body

Labia majora

Outer fleshy lips covered with pubic hair that protects the vagina

Labia minora

Inner fleshy "lips" devoid of pubic hair that protect the vagina.

Ovaries

The primary female reproductive organs that produce an ovum, or egg, that, if fertilized, will develop into a fetus.

Ovulation

The process in which an ovum is released from a follicle

pelvic inflammatory disease (PID)

An infection of the fallopian tubes and the surrounding tissues of the pelvis; upper organs of reproduction

Perineum

The area of skin between the vagina and the anus.

Rape

Sexual intercourse forcibly inflicted on another person, against that person's will.

sexual assault

An attack against a person that is sexual in nature., the most common is rape

Uterus

The muscular organ where the fetus grows, also called the womb; responsible for contractions during labor.

Vagina

The outermost cavity of a woman's reproductive system; the lower part of the birth canal; The process of fertilization begins here

Chlamydia

Most common STD, Caused by bacteria, Usually mild or absent symptoms, Can spread to rectum and progress to PID

Vaginal Bleeding Possible causes include

Abnormal menstruation, Vaginal trauma, Ectopic pregnancy, Spontaneous abortion, Cervical polyps or cancer

For abdominal pain, ask about

Onset, duration, quality, and radiation; Provoking or relieving factors; Associated symptoms such as syncope, light-headedness, nausea, vomiting, and fever

For vaginal bleeding, ask about

Onset, Duration, Quantity (number of sanitary pads soaked), Associated symptoms such as syncope and light-headedness

Pertinent secondary assessment findings should include

Vital signs (BP, pulse, skin color, orthostatic vital signs), Abdomen (distention and tenderness), Genitourinary (visible bleeding), Neurologic (mental status)

There are very few interventions with a

gynecologic emergency *Treat for hypoperfusion or shock; Transport promptly

Communicate all relevant information to staff at receiving hospital, include possibility of

pregnancy

Be aware of drugs

used to facilitate sexual assault or rape

If possible, give the patient the option of being treated by a

female EMT

Traumatic emergencies

occur as result of physical forces applied to the body

Traumatic injury occurs when the

body’s tissues are exposed to energy levels beyond their tolerance

Example of Energy - Worker on a scaffold

Has potential energy because he is some height above the ground; If worker falls, potential energy is converted into kinetic energy; As worker hits ground, kinetic energy is converted into work, the work of bringing the body to a stop, and fracturing bones

Kinematics introduces the basic physical concepts that dictate

how injuries occur and affect the human body

Newtons First Law

Objects at rest tend to stay at rest, and objects in motion tend to stay in motion, unless they are acted upon by some force (Even though the car comes to an abrupt stop, the passenger inside the vehicle is still moving at the same speed that the car was originally traveling)

Newtons Second Law

The greater the mass, the greater amount of force is needed to accelerate an object (Heavy objects require more force to move the same distance as lighter objects; You can lower the acceleration which is produced by your body in a collision by using safety features like crumple zones and air bags)

Newtons Third Law

For every action, there is an equal and opposite reaction.

Nonsignificant injuries

Injury to an isolated body part; Fall without the loss of consciousness

A crash consists of three collisions

Car against another car, tree, or object; Passenger against the interior of the car; Passenger’s internal organs against solid structures of the body

Machine collision (1)

By assessing the vehicle, you can often determine the MOI; Greater damage to the car, the greater the energy was involved, and the greater potential of injury

Body collision (2)

Common passenger injuries include lower extremity fractures, flail chest, and head trauma; Such injuries occur more frequently when patients are not restrained

Organ collision (3)

Internal injuries may not be as obvious as external injuries but are often the most life threatening; Brain can strike inside of skull, causing bruising and bleeding *coup-contrecoup injury can occur; Heart can slam into sternum, causing aorta rupture

Coup

point of impact

Contrecoup

opposite side of impact, as brain rebounds

Motor vehicle crashes are classified as

Frontal, Rear-end, Lateral/Side Impact (T-bone), Rollovers (tips to side/roof), Rotational (spins)

Despite airbags, suspect injuries to

Extremities (resulting from the second collision), Internal organs (resulting from the third collision), Steering wheels can also cause chest injuries, especially if no airbag is present

Children shorter than _____ should ride in the rear seat

4’ 9"

Even with wires cut, airbag may still deploy for up to

30 min

Frontal Crashes

Look for contact points between the patient and the vehicle as you perform a simple, quick evaluation of the interior of the vehicle

Rear-End Crashes

Known to cause whiplash-type injuries, Particularly in absence of a headrest

Lateral Crashes

Highest cause of death associated with motor vehicle crashes

Rollover Crashes

Most common life-threatening event is ejection or partial ejection of the passenger from the vehicle

Rotational Crashes

Rotation of the vehicle provides opportunities for the vehicle to strike objects such as utility poles *Combines force with lateral impact

Car Versus Pedestrian You should determine

Speed of the vehicle, Whether the patient was thrown through the air, Surface the patient landed on, Whether the patient was struck and pulled under the vehicle

Car Versus Motorcycle When assessing the scene, look for

Deformity of the motorcycle, Side of most damage, Distance of skid in the road, Deformity of stationary objects or other vehicles, Extent and location of deformity in the helmet (bring to ER)

Head-on crash

Motorcycle strikes another object and stops its forward motion while the rider continues moving forward

Angular crash

Motorcycle strikes an object at an angle so that the rider sustains direct crushing injuries to the lower extremity

Ejection

Rider will travel at high speed until stopped by a stationary object, another vehicle, or road drag *Severe abrasions can occur

Controlled crash

Technique used to separate the rider from the body of the motorcycle (Laying the bike down)

Falls - More than _______ is considered significant

20 ft (6 m)

Patients who fall and land on their feet may have

less-severe internal injuries

Falls - Take the following factors into account

The height of the fall, The type of surface struck, The part of the body that hit first, followed by the path of energy displacement, Always consider syncope or other medical conditions as an underlying cause

Path the projectile takes is called its

trajectory

Bullet’s speed is called

velocity

Temporary cavitation

caused by acceleration of the bullet

Permanent cavitation

caused by the bullet path

Relationship between distance and severity of injury varies depending on

the type of weapon involved

_______ slows the projectile

air resistance (drag)

If possible try to determine type of weapon used, and relay info to medical control

Low velocity = hand driven weapons, knives, ice picks; Medium velocity = handgun, some rifles, bow & arrow; High velocity = military weapons, assault & hunting rifles

If mass of a bullet is doubled

the energy available to cause in injury is doubled

If velocity of a bullet is doubled

the energy available to cause in injury is quadrupled

If the cars speed doubles

the kinetic energy is quadrupled

Primary blast injuries

Due entirely to the blast itself; Damage to the body by pressure wave

Secondary blast injuries

Damage to the body results from being struck by flying debris

Tertiary blast injuries

Victim is hurled by the force of the explosion

Quaternary (miscellaneous) blast injuries

Burns from hot gases or fires started by the blast; Respiratory injury from inhaling toxic gases; Crush injury from the collapse of buildings

Organs that contain air are most susceptible to

pressure changes

The ear is most sensitive to

blast injuries

Pulmonary blast injuries result from

short-range exposure to the detonation of explosives

Arterial air embolisms can produce

Disturbances in vision, Changes in behavior and state of consciousness, Variety of other neurologic signs

Golden Principles of Prehospital Trauma Care

Identify and manage life threats; XABC’s - Exsanguination (hemorrhage) / Airway, Breathing, Circulation / Shock / Spinal immobilization; Transport immediately to the appropriate facility *10 min or less

When a patient has experienced a significant MOI and is critical condition

rapidly perform a physical examination

When a patient has experienced a nonsignificant MOI

focus on the chief complaint

A penetration or perforation of the integrity of the chest is called

an open chest wound *assess every 5 min