HAN 471

FINAL

Number of Bones in the Body

206 bones

How to manage musculoskeletal trauma:

General principles: protect open wounds, position the limb, immobilize the injury, check neurovascular function (pulse, motor, sensation)

What are some Splinting devices

rigid splints,

formable splints (vacuum and air),

soft splints

traction splints

What assessment tools we need before and after immobilizing any fracture

Rapid Trauma Assessment, only press on pelvis if no clinical signs of injury are present such as pain

Focused H&P

Focused H&P:

6Ps: Pain, Pallor, Paralysis, Paraesthesia, Pressure, Pulses

Check for Neurovascular function following immobilization

Pulse (palpate, utilize pulse oximetry)

Motor

Sensation

Long-term musculoskeletal injuries to a patient, extreme disabling effect (not amputation)

Hand/Foot Injuries, common fractures, not life-threatening but highly disabily

How to immobilize joint injuries

Joint injuries immoblize above and below the joint

Most commonly fractured bone in the body

Clavicle

Transmitted to 1st and 2nd Rib,

Be alert for Lung Injuries

Tendon

Muscle to Bone

Ligament

Bone to Bone

Axial Skeleton

Head, Thorax, and spine

Appendicular skeleton

upper and lower extremities

What do we do with those for musculoskeletal trauma

When to apply tourniquet

When direct pressure and all other bleeding control methods have failed, apply tourniquet.

When to apply pelvic binder

Splint and control suspected internal hemorrhage form pelvic injury

When to apply traction splint

Femur fractures can be lethal due to blood loss, attraction splint is needed.

Pelvic Fractures are the most concerning

Femur fracture take extreme force but as long as femoral artery isn't lacerated it's fine

Unstable pelvis is going to have a lot of bleeding, force to do that will create a lot of internal injuries

Hypothalamus job and thermolysis

Hypothalamus: It hosts the main thermoregulatory centers: thermogenic and thermolytic

Thermolysis

Release of stored heat and energy of the body

Increase in CBT causes vasodilation and sweating which causes increased effective vascular system volume, cardiac output, pulse rate and stroke volume

Radiation

cooler air temps, heat leaves body; 65% of heat loss

Conduction

heat loss from skin touching a cold surface

Convection

wind-chill factor

Evaporation

sweating

Heat Syncope

Seen w/prolonged standing in warm environments and is caused by low blood pressure that results in fainting, feeling faint, or light-headed.

Heat exposure causes vasodilation and blood pooling in the legs, cause the low bp

Most commonly experienced on transition from sitting to standing

Exhaustion

Exhaustion: milder form of heat illness with volume depression and heat stress. There are two types: water depleted and sodium depleted

Heat Stroke

least common but most deadly; caused by severe disturbance in body's thermoregulation

Findings that determine: elevated core temperature, altered mental status

Consequences: classic heatstroke and exertional heatstroke

How we protect ourselves from heat exposure

Acclimatize when possible, maintain personal fitness, limit time spent in heavy activity in PPE, main hydration, eat appropriately, rest, improve cardiovascular and muscular strength

What population of people is most at risk for burns

Very young, the elderly, infants, and workers

Males suffer burns more often than females

Prevention tools for burn victims + reasons for decrease in burn victims

Improved building codes, safer construction techniques, sprinkler systems, and smoke detector usage

Function of Skin

Provides protection from the environment

Regulates temperature and fluids

Contains sensory nerves that communicate with the brain

Aids in healing by responding to injury with inflammation

Epidermis

the outermost, it's dying and dead cells

Dermis

is underneath it, contains blood vessels, glands, and nerve endings

Zone of hyperemia:

least affected by thermal injury; cells recover in 7 to 10 days

Zone of stasis:

has decreased blood flow and inflammation; may undergo necrosis within 24-48 hours

Zone of coagulation:

nearest to the heat source, suffers the most profound cellular changes; little to no blood flow to this area

Superficial/1st degree:

involves the epidermis

Skin is red and swollen, blisters are usually not present; e.g: sunburn

Partial thickness/2nd degree:

epidermis and dermis

Divided into superficial and deep partial-thickness; may be difficult to distinguish between the two

Superficial: skin is red, when touched the color will blanch then return, blisters or moisture present,

Deep: damages the hair follicle, sweat, and sebaceous glands; often due to hot liquids, steam, or grease

Full thickness/3rd degree:

destruction of both layers of the skin

Skin is incapable of self-regeneration; skin may appear white and waxy, brown and leathery, or charred; sensory nerves are destroyed

Treatment involves skin grafting

Affinity of carbon monoxide

Binds to receptor sites 250x more easily than oxygen

Patients will present with normal or better pulse ox levels because they only measure how saturated the hemoglobin is

Treatment for CO poisoning

High flow non-rebreather

Hyperbaric chambers which force oxygen into the cells and displace CO

What population of patients have delayed signs of shock?

Pediatric patients

Why do pediatric patients have delayed signs of shock?

They are able to compensate for blood loss secondary to trauma and do not show overt signs of compensation as quickly.

What happens once pediatric patients can no longer compensate for blood loss?

They move very quickly toward irreversible shock.

What is the general treatment for burns?

XABCDE, intubate, stop burning, prevent further contamination

What is the treatment for superficial burns?

Immerse in cool water, do NOT use salves/similar, never apply ice

What is the treatment for partial-thickness burns?

Cool with water or wet dressing; IV fluids; pain meds; take to burn center

What is the treatment for full-thickness burns?

Pain meds, dry dressing, fluid resuscitation, take to a burn center

What is the preferred fluid for resuscitation in burn patients?

Lactated Ringer's solution

What is the formula for fluid resuscitation in burn patients?

4 ml * kg * BSA; ½ in first 8 hours; rest in next 16 hours

Which population of patients have delayed signs of shock?

Pediatric Patients

What are the effects of aging in the geriatric?

Reduced reflexes, hearing, eyesight; brittle bones

What might make it difficult for geriatric to recover from traumatic events?

Body is weaker and cannot physiologically handle the same amount of stress

How does the body regulate cold stress?

Production of heat and energy; hypothalamic center and sympathetic nervous system increase muscle tone and initiate shivering; increase thyroid levels

What is the highest level of trauma activation at Stony Brook?

Code T

What are the different levels of trauma activation?

Acute Level: Trauma alert Stable Level: trauma consult

Why do we utilize different trauma activation criteria?

To bring different clinical providers from multiple departments within the trauma center

When should trauma activations be made?

15 mins prior to patient arrival if possible

Who are the ones who run the trauma and determine life saving treatments?

Trauma team (surgery)

Which clinical providers are required to be in the room within 15 mins of the activation?

Doctors from surgery, ER staff, anesthesia, NSX, orthopedics and more

What is the first thing that occurs when a patient is brought into the trauma resuscitation bay?

EMS 'Time Out': everyone is quiet except for EMS personnel who give a brief rundown of everything they have about the patient

What happens during the 'Time Out'?

Everyone gets the information they need right away at the start at the same time

Where do providers stand during trauma resuscitation?

What is MVIT and what is it used for?

Mechanism, Vitals, Injury, Treatment and Timing. Used in EMS time out to assess patients.

What is the FAST exam, its intent, and when is it used?

Focused Assessment with Sonography in Trauma. Used to assess for hemoperitoneum and hemopericardium.

What is ultrasound and how is it engineered to produce imaging?

Imaging method that uses sound waves to produce images of structures within your body.

What are the four different types of imaging studies on critical trauma patients and when is each one supposed to be used?

X-ray, CT Scan, Ultrasound, MRI

What is the intent of definitive care?

To transfer the patient to the appropriate facility for surgery or other interventions after stabilization.

What is the goal of the MTP?

Rapid administration of large amounts of blood products in fixed ratios for the management of hemorrhagic shock.

What are the complications of MTP?

Hyperkalemia, hypothermia, hypomagnesemia, and acidosis.

What is Code Snap at Stony Brook?

ABX given within the first 15 minutes of patient arrival.

When and why are antibiotics given?

Given ASAP to prevent severe infections which prevent proper healing.

What is REBOA used for?

Resuscitative endovascular balloon occlusion of the aorta. Indicated for traumatic life-threatening hemorrhage below the diaphragm in patients in hemorrhagic shock who are unresponsive or transiently responsive to resuscitation.