Sports Medicine Unit 4: Trauma

Trauma Unit; Discretion advised

shock

inadequate tissue perfusion (tissues not getting enough nutrients+O2)

normal state / point of assault / compensatory / decompensated / irreversible

stages of shock

cardiogenic / obstructive / distributive

types of shock

cardiogenic shock

pump failure,

obstructive shock

pipe blockage (usually in or near heart),

distributive shock

not enough fluid, body can't get enough blood to your heart, brain and kidneys

Arrythmia / heart failure / pericardial tamponade / valve failure / heart attack

subtypes of cardiogenic shock

Arrythmia

arrythmic shock (bad rhythm)

heart failure

cardiac shock, congestive; occurs when the heart muscle doesn't pump blood as well as it should

pericardial tamponade

cardiac shock; Compression of the heart caused by fluid collecting in the sac surrounding the heart.

valve failure

cardio regression;

heart attack

heart stops, demi lovato song

aortic blockage / failure of venous return / catheterization failure

subtypes of obstructive shock

aortic blockage

aortic wall delamination/ dissection, atherosclerosis (clogged artery from fats, cholesterol, etc.), thrombosis/ embolism (blocked artery from air or blood clot)

failure of venous return

venous pinching / dissection, embolism/thrombosis, disseminated intravascular coagulation (abnormal blood clotting), pulmonary embolism (blood clot in lung)

catheterization failure

central line failure, swan-ganz catheterization

loss of peripheral vascular resistance / septic / anaphylactic / neurogenic / overwhelming burns / anemic / hypoxia

subtypes of distributive shock

loss of peripheral vascular resistance

expansion of vascular tone

septic shock

overwhelming infection causing vasodilation (widening of blood vessels) & hypotension (low bp)

anaphylactic shock

overwhelming histamine mediated immune response

neurogenic shock

CNS fails causing loss of vascular tone, can also be cardiogenic if results in heart failure only

overwhelming burns

extreme loss of interstitial fluid resulting in hypotension, loss of thermal control resulting in vasodilation

anemic / hypoxia

not enough blood cells to distribute O2

hypovolemic shock

blood volume loss; special type of distributive shock

5 L

How much blood does the average adult have?

stage 1

this stage of hypovolemic shock has:

stage 2

this stage of hypovolemic shock has:
15-30% blood loss, 750-1500 cm3 blood loss, PT feels mildly anxious

stage 3

this stage of hypovolemic shock has: 30-40% blood loss, 1500-2000 cm3 blood loss, PT feels confused+lethargic

stage 4

this stage of hypovolemic shock has: >40% blood loss, >2000 cm3 blood loss

profuse brain / keep PT warm / slightly raise legs / call ems

what should you do to treat shock? (4)

200-500 mL

blood loss into humeral that's bad

150-700mL

blood loss into cranial compartment that's bad

500 mL-2L

blood loss into femoral compartment that's bad

1 L-2.5 L

blood loss into thoracic compartment that's bad

500 mL <

blood loss into abdominopelvic compartment that's bad

heat index

a measure of risk that an athlete will experience a heat emergency, depends on humidity and temperature, Four levels

Caution / Extreme Caution / Danger / Extreme Danger

four levels of risk on the heat index

heat cramps

Earliest sign of heat risk, electrolyte imbalance, cramps of abdomen, back, and arms.

Heat Exhaustion

The heat risk with body's compensation mechanism failure, need to take immediate action to stop progression; includes faint or dizziness, excessive sweating, cool or clammy skin, nausea or vomiting, rapid, weak pulse, muscle cramps

Heat Stroke

the heat risk that's in the form of distributive shock, immediate life threat; includes throbbing headache, no sweating, red, hot, dry, skin, nausea or vomiting, rapid, strong pulse, possible loss of consciousness

remove from sunlight / remove pads / get wet and cold / hydrate with ice cold electrolytes

To treat heat, do this to the PT

wind chill

function of wind and temperature

frostnip

First stage of cold injury, Only destroyed upper layers, No subdermal freezing, Incredibly Painful

early frostbite

Subdermal freezing of tissues, Widespread cell death, Delineation of permanent damage, Similar to a burn, blistering

late frostbite

Clear delineation of living / death tissues, Dry gangrene, Autoamputation

Frostbite treatment

If possible, warm the affected part (Only if no possibility of refreezing!!!), Separate any affected digits, Wrap in sterile dry gauze, Transport to Trauma center, Minimize Friction, Do NOT pop blisters

hypothermia

Core temp, Esophageal or Rectal, Slowing of functions, Enzymatic Function Decay, Arrhythmias

mild hypothermia

Temp: 90-95F, cardiac: excitation response (HR, BP, RR), shivering and mild confusion

severe hypothermia

Temp:

moderate hypothermia

Temp: 86-90F, cardiac: slowing of all physiologic functions, negative inotropic effect, cessation of shivering, worsening ataxia (poor muscle movement), and loss of papillary reflex, EKG: changes (osborn waves)

green flag

this flag means no restrictions, low humidity heat from 65-90F

Yellow flag

this flag means Moderate Restrictions, Heat from 50-68 F or 85-95 F, limit extreme activity to 120 min, Caution or Extreme Caution on Heat Index, Rain, Over 1 hour to frostbite on exposed skin

red flag

this flag means Significant Restrictions, Elevated caution for injury, Check in 20 min, Limit extreme activity to 90 minutes for heat, Limit exposure activity to 30 minutes for cold, For heat, make sure more electrolytes are available, Heat from 85-105F, Danger on Heat Index, AQI 50-150, Rain, cold under 60F, or sleet, At least 30 min to frostbite on exposed skin

black flag

This flag means Heavily Restricted, Extreme monitoring for injury, Check in 5 min, Limit extreme activity to 20 minutes heat, Limit exposure activity to 15 minutes cold, For heat: Make sure more electrolytes are available, Make sure active cooling available, Heat from 105F+, Extreme Danger on Heat Index, AQI 150 to 200, Rain with cold under 45F; Sleet; or Snow, At least 10 min to frostbite on exposed skin

white flag

this flag means NO outdoor practice, Only activities in air conditioned / heated spaces, AQI above 200, Heat index beyond mark, Less than 5 min to frostbite, Wind Chill less than 25 F

primary intention

wound ends come together, leaves scar tissue; includes acute inflammation then wound closure

secondary intention

wound ends can't communicate, scab has to form, scar tissue is left; includes acute inflammation then reconstructing phase, then maturation phase

interruptions to wound healing

wounds in joints, high friction areas, thin areas, concurrent drug use, diff kind of med conditions and diseases

high risk wounds

dog/cat/human bites, foreign bodies, wounds requiring significant debridement, immunocompromised PTs, poor peripheral circulation, no health insurance, wounds in areas of social stigma, compounded mechanism injuries

contusion

bruise, blood and serum (?) breaking down

hematoma

pocket of blood built up under skin, in arteriols

abrasion

scrapes, needs debridement (removal of damaged tissue or foreign objects from a wound)

laceration

cuts that have 2ndary intention, jagged

incision

cuts that'll be primary intention, clean cut

avulsion

flap of flesh created from a cut

degloving injury

something constricts and skin comes off like a glove, to prevent, take off bracelets ,rings, etc.

puncture

A wound when something was poked and removed

no

are all punctures penetrations?

penetration

impaled object left in skin, can come out if blocking airway

amputation

what was once connected to a body part is no longer connected

sprain

injury to a ligament, grade 1: microtear, grade 2: tear goes thru ligament, some laxity, endpoint

strain

injuries in tendons or muscles

fracture

broken bone

transverse fracture

a break that occurs straight across the bone

oblique fracture with offset

occurs at an angle across the bone, ends are SHARP

oblique fracture

occurs at an angle across the bone

longitudinal fracture

a fracture that runs parallel to the long axis of the bone

spiral fracture

a fracture in which the bone has been twisted apart

impacted fracture

broken bone ends are forced into each other

avulsion fracture

fragment of bone chipped away from the main bone

segmental fracture

free floating piece of bone between well-defined fracture lines

Torus fracture

cortex buckles but does not break

greenstick fracture

bone breaks incompletely

comminuted fracture

bone breaks into many fragments

displaced fracture

bone ends are out of normal alignment

linear fracture

usually in flat bones, a break in the bone, but it does not move the bone

Colles fracture

fracture of the distal radius at the wrist

buckled fracture

ends are driven into each other a little bit

Fibrin

An insoluble protein which is produced in response to bleeding, formed from fibrinogen which is a soluble protein found in the liver and in blood plasma, essential for blood clot contraction, or spontaneous shrinkage of the clot. Ex: when an injury occurs, this is the protein which allows for clotting to occur, which ensures healing of the wound and a stop to the flow of blood seen.

Histamine

A type of substance which has many effects in the body depending on its reason for existing in that moment. Ex: released from some types of white blood cells during allergic reactions (anti\___ is a drug which treats numerous types of allergies).

Granulocytes

A common white blood cell capable of secretion in its cytoplasm. It is an immune cell that releases enzymes through granules during infection. Ex: neutrophil, basophil, eosinophil

Phagocyte

An immune cell that engulfs materials such as small cells, particles, and bacteria using its plasma membrane (pinching off), ingests foreign materials, kills microorganisms, and removes dead cells. Ex: when phagocytosis occurs & pinocytosis with liquids

Macrophages

A big phagocytic cell in tissues found at sites of infection responsible for killing harmful organisms (bacteria). Ex: A mobile white blood cell

Endothelial Cells

These types of cells are the main cells found inside the lining of the blood vessels, lymph vessels, and heart, regulate the exchanges between the surrounding tissues and the bloodstream that interacts with them, Organizes the connective tissue cells' growth and development surrounding the blood vessel wall

Neovascularization

The process in which new blood vessels are formed from existing blood vessels. EX: Many diseases of the eyes, including macular degeneration and uveitis, allow this process to take place often.

Epithelialization

process of epithelial cells migrating up to heal and repair wounded skin, occurs during proliferative phase of wound healing, allows the epidermis to regenerate over the surface of a wound. EX: The lighter pink tissue that surrounds a wound

Fibroblasts

Located inside of connective tissue, this type of cell secretes collagen, which is a structural protein found in skin, as well as other fibers, and allows the structural framework of tissues to be stable.
Ex: Injury to tissue stimulates the formation of this, as they help to stabilize the structure of the tissue.

Hydroxylysine

This amino acid is found only within collagens, and usually within animal proteins. They serve as sites of attachment for carbohydrates, and stabilize molecular crosslinks.

crush injury

mechanism any time the body or a part of it is compressed beyond the structural or physiological limit of the organism

compartment syndrome

a part of the body, a compartment, swells to the point that the pressure w/in the compartment increases