George Romero

P.5

3/13/23

Trauma Overview Lecture Chapter 14 - 15

Bleeding , Shock and Soft Tissue Injuries

Constitution

• Any kind of blunt force trauma that causes bruising/ internal injuries to underlying tissue internal bleeding

• Epidermis remains intact

• Ecchymosis is the discoloration resulting from a contusions

Hematoma

• Blood that collects within damage tissue or in a body cavity

• Occurs due to a large blood vessel that is ruptured and bleeds internally rapidly

Crushing injury

• If a patient crush injury last longer than 4 hours, they can develop crush syndrome due to compromised circulation

• Crush syndrome is caused by dead muscle tissue releasing harmful substance to the surrounding tissue

• AlS is needed to begun IV therapy before freeing the crushed injury to help prevent crush syndrome

• The harmful substance may cause renal failure and/or cardiac arrest

• Compartment syndrome is when serve swelling causes too much constriction on internal tissue and limits circulation it commonly affects extremities

Treatment for closed injuries

R- REST

I- ICE (20 to 30 minutes) (not directly in the skin)

C- COMPRESS

E- ELEVATE (6 inches off the ground)

S- SPLINT

OPEN INJURIES

Abrasion

• Essentially a scrape, to be cleaned with sterile saline and dress with sterile dressing that may need to be moistened to prevented the dressing from sticking to the wound

• Utilize non-adherent dressing if saline is not available

• There wounds are very painfully

Laceration

• Essentially a cut

• May need status at the hospital

• Clean and dress it like and abrasion

• May need to use skin closure strips

Avulsion

• Ripping and/ or tearing of flesh

• Flesh will need to be irrigated and cleaned

• The flesh strip may also need to be replaced

• Use moist sterile dressing them dry sterile dressing always replace in anatomically correct position

Amputation

• When a part of the body is completely removed

• You may need to use a tourniquet

• Blessing control is essential

• Take amputated part to the hospital covered in sterile dressing and on ice

Penetrating wounds (punctures)

• These wounds can be seen as stab wounds,splinters, or gunshot wounds

• These wounds can be life treating and have unseen internal bleeding

• Be on the lookout for shook

• A penetrating wound where the object is still left inside the patient is called impaled object

Capillary bleed

• Least serious bleed

• Dark red blood

• Blood drips out of wound

• Easily controlled with direct pressure

Bemius bleed

• Moderately serious bleed

• Dark red blood

• Blood flows out like a river

• May be difficult to control for larger wounds

• Direct pressure and pressure bandages

• If bleeding is not stopped use hemostatic gauze and tourniquet

Arterial bleed

• Most serials bleed

• Bright red blood

• Blood sprays and supports out of the body with each heartbeat

• Very difficult to control

• Direct pressure, hemostatic gauze and tourniquet

Impaled object

Treatment for impaled objects

• Never remove them..unless

• A - It is impaled through cheek or mouth and is causing airway obstruction

• B - It is in the chest or back and impede CPR

• Stabilize the object with bulk trauma dressing

• Protect with cup or contained that surrounds the object

Neck injuries

• Neck trauma can cause neck veins to be exposed witch can lead to an air embolism

• Cover with airtight plastic occlusive dressing and apply direct pressure

Abdominal evisceration

• Your internal organs spill out of your abdomen

• You will treat it with a bulk trauma dressing covered in sterile saline

• Then you will place it over the expose injuries

• DO NOT PUT ORGANS BACK IN THE ABDOMEN

• Then you will cover the moist dressing with a dry sterile occlusive dressing taped on 4 sides

Bites

• Human, dog, cat or any other animal bites pose a serious risk to infection

• Clean the affected area and place moist sterile dressing around the wounds

• Transport to the hospital

• See if animal may be exhibiting rabies symptoms

• Some bites result in complex mangled tissue damage that requires surgical repair

Burns

• 1st degree (superficial)

• Burns on epidermis

• Redness

• 2 degree (partial thickness)

• Burns on determines

• Blistering

• 3 degree (full of thickness)

• Burns on subcutaneous

• Charred adipose

Rule of nine

18,9,18,1

Burn severity

• Severer burns

• • 3 deg involving airway,hands, feet,face and genitalia and/or 10% of body

• • 2 deg involving 30% of the body

• • burns complicated by others injuries like fractures

Moderate burns

• 3 deg involving 2% to 10% of the body (eclusting hands,face, feet and genital)

• 2 deg involving 15 to 30% of the body

• 1 deg involving more than 50% of the body

Minors burns

• 3 deg involving less than 2% of the body

• 2 def involving less than 15% of the body

• 1 deg involving less than 50% of the body

SHOCK = HYPOPERFUSION

-PERFUSION

• Perfusion = circulation of blood within an organ or tissue

• Oxygenation is required for perfusion to work

• Systemic circulation = 02 to cell

• Pulmonary circulation = 02 to blood

Hypoperfusion pathophysiology examples

• Pump failure

• Myocardial infarction- heart attack

• Pipe failure

• Anaphylaxis - allergic/ trauma to vessels or tissue

• Fluid failure

• Hemorrhaging - bleeding

Compensated shock

• First stage

• Hard to detect

• Body is still compensating for blood lost

• Patients will be having; anxiety, restlessness, amd, impending doom, cool pale diaphoretic skin, weak rapid thready pulse, nv, delayed capillary refill, thirst

Decompensated shock

• Late stage

• Decreased blood pressure

• Systolic below 90 mm/hg

• Shortness of breath

• cyanosis/ ashes skin

• Absent distal pulse

• Dilated pupil

• Lack of urination

Irresistible shock - Death of the patient

Pump failure

• Cardiogenic shock

• Obstructive shock

Pipe failure

• Distributive shock

• Septic shock

• Neurogenic shock

• Anaphylactic shock

• Psychogenic shock

Fluid failure

• Hypovolemic shock -

• Hemorrhagic shock -

• non -hemorrhagic shock -

Treatment for shock

• Control bleeding

• Rehydrate

• Spinal motion restriction (neurogenic)

• Epinephrine (anaphylactic)

• Warming the patient

• Elevate the legs (unless spinal injury is suspected)

• Give high flow oxygen

HEAD AND NECK TRAUMA

• Any DCAP BTLS - all the tissue

deformity/constitutions(hit or punch)/ abrasion/punctures/burns/tenderness/lastirations /swelling

• CSF drainage

• Battle signs

• Raccoon eyes

• Crepitus

• Unequal pupils

• Amnesia

• Ams

• Unconsciousness

• Dysarthria - difficulty to speak

• Aphasia - cannot talk anymore or speak anymore

• Bradycardia -

• Confusing

• Dizziness

• Irregular breathing breathing patterns - breathing fast and slow

• Pupils are nor reactive to light

• Widening pulse pressure

• Numbness

• Seizures

• Nausea or vomiting

• Visual disturbances

• Decorticate or decerebrate posturing - football player

Skull fractures

Linear

Depressed

Basilar

Open

Traumatic brain injuries (TBI)

• Most serious of all head trauma

• Two categories

• Primary (direct) injury

-Result instantaneously from impact to the head

• Secondary (indirect) Injury

- refers to a multiple of this that occur foloiu=ng the primary injury

Examples cerebral edema, intracranial Hemorrhage, cerebral ischemia increase pressure, infection, hypoxia

-secondary injuries may take minutes to days to occur

Most common TBI MOI

• Motor vehicles accidents

• A patient slamming their skull on the windshield

• These injuries and ,amy other lea to idp due to

• Coup-contrecoup injuries

-brain slams into the frontal bone ten afterward the occipital bone inside the cranium

-leads to cerebral edema (may takes hours to days)

Concussion

• Mild traumatic brain injuries

• A closed injury with temporary neurological deficits

• Retrograde amnesia = can't remember sustaining the injury

• Anterograde amnesia = can't remember events after the injury

Spinal injury MOI indications

• Motor vehicles crashes

• Car vs pedestrian

• Fall greater than 20ft (adults)

• Fall grates than 10ft (peds)

• Blunt trauma to head, neck, chest or back

• Penetrating trauma to head,neck chest or back

• Hangings

• Axial loading injuries

• Oceanic drowning

• Diving accidents

IF SUSPECTED SPINAL MOI YOU MUST INITIATE SOMEONE TO HOLE MANUAL INLINE STABILIZE OF THE HEAD AND NECK BEFORE MOVING ON INTO YOUR INTRODUCTION

Vertebral trauma

• C3 may result in inability to control diaphragm

• C5, C6 may results in quadriplegia

• L1 may result in paraplegia

Chest trauma

• Closed injury

May cause cardiac and pulmonary constitution cardiac constitutions/ damage may lead to cardiogenic shock rib fix may cause unseen internal damage blunt trauma may cause fx, damage to aorta, brisoan to cardiac tissue vial organs been torn from their connective tissue or mayor structures

• Open chest injury

Opening in chest wall caused by GSW, punctures, impaled objects ( never removed impaled objects)
SIGNS AND SYMPTOMS OF CHEST TRAUMA

• Pain upon inspiration

• Visible bruising

• Crepitus

• Dyspnea

• Hemoptysis

• Paradoxical movement

• Rapid weak pulse, hypotension

• Cyanosis

Deadly dozen chest injuries

1. Airway obstruction

2. Bronchial disruption

3. Diaphragmatic tear

4. Esophageal injury

5. Open pneumothorax

6. Tension pneumothorax

7. Massive hemothorax

8. Flail chest

9. Cardiac tamponade

10. Thoracic aortic dissection

11. myocardial constitution

12. Pulmonary constitution

Open pneumothorax (sucking chest wound)

• Occlusive dressing taped on 3 sides gravity side down

Pneumothorax

• Essentially a collapsed lung

Pneumothorax, hemothorax and hemopneumothorax

Fali chest

• 3 or more ribs fracture in 2 or more places

• May cause paradoxical movement half of the chest rises and the other collapse

• Extremely painful

• No bls treatment for this

Circulation

• Check distal pulse and capillary refill

Sensory

• Touch patient finger toes and see if they can tell which finger, you are touching

Motor

• Having a patient move fingers and toes along with squeeze test with push pull test

RULES OF SPLITTING

1. Check distal CSM before and after

2. Spling in position founded unless angulated with no distal CSM then you can move it once to restore CSM

3. Splini must extend past both distal and proximal joints pertaining to the injury

4. Never tape of strap over an open wound or joint