Trauma Emergencies

what nerve provides the only motor control to the diaphragm

phrenic nerve which is derived from the C3-C5 vertebrae

3 types of patients that have an increased risk of intracranial bleeding

patients on blood thinners, geriatric, and alcoholic patients

why are geriatric and alcoholic patients at a higher risk of intracranial bleeding

they undergo a slight shrinking of the brain, which stretches bridging veins that are more easily ruptured during a head injury

3 components of the Glasgow Coma Score

eye opening, verbal response, motor response

If your patient does not have radial pulses, but has a carotid, what is the most likely cause of this

shock

List the percentage of body surface area for each of the following areas:

- Head
- Anterior torso
- Posterior torso
- Arms
- Legs
- Groin

Head - 9%

Anterior torso - 18% (chest 9%, abdomen 9%)

Posterior torso - 18% (upper 9%, lower 9%)

each arm - 9%

each leg - 18% (front 9%, rear 9%)

groin - 1%

Why does the skin become cool and clammy in shock

blood is shunted from the skin to more vital organs, which is done through vasoconstriction

why do patients in shock normally experience N/V

shock diverts blood from the abdomen and GI system to more vital areas

8 anatomic criteria for transport to a trauma center

penetrating injuries to head, neck, torso and extremities proximal to elbows and knees

flail chest

2 or more proximal long bone fx

crushed, degloved or mangled extremity

amputations proximal to wrist and ankle

pelvic fx

open or depressed skull fx

paralysis

what is secured to long spine board first: head or torso

torso first

your patient is the driver of a vehicle that was rear ended. what is the classic injury pattern in this scenario?

whiplash

5 S/Sx to suspect a patient with internal bleeding

signs of shock

redness or bruising

pain and/or rigidity on palpation

MOI suggesting abdominal or chest injury

blood in vomit or stool

3 physiologic criteria for transport to a trauma center

Glasgow Coma Score less than 14

Systolic BP < 90

respirations < 100 and >29 (adult) or <20 (infant to one year)

5 components of field spinal assessment

MOI, distracting injuries and intoxication, mental status, focal neurological deficit, midline spinal tenderness along entire length of spine

what organ in the body is most sensitive to reduced levels of oxygen and how long until it starts to feel the effects

the brain and in less than a minute

appearance of arterial bleeding

spurting, brighter red blood

appearance of venous bleeding

flowing, dark red blood

appearance of capillary bleeding

oozing, dark red blood

what type of injury causes a fern-like pattern to appear on the skin

caused by a lightning strike

where does the blood supply for the head and arms come from

3 vessels on the aortic arch

what happens if one of the vessels on the aortic arch are damaged by an anuersym

interferes with blood flow to the arms causing a difference in BP

You are splinting a long bone fracture. What must the splint immobilize?

the bone ends and the adjacent joints

steps for bleeding control in order

Direct pressure, then if that does not work, use a tourniquet

on an extremity where you can’t use a tourniquet, a hemostatic agent is also an option

hip fx

proximal femur fracture near ball and socket hip joint

pelvic fx

fx in any of the pelvic bones themselves

2 traumatic injuries to chest that will cause JVD

tension pneumothorax and cardiac tamponade

pneumothorax

collapse of part of a lung

tension pneumothroax

begins as pneumothorax but increasing pressure in thorax limits circulation when compressing the heart and great vessels