CHAPTER 31 - CHEST & ABDOMINAL TRAUMA

CHEST INJURIES

• blunt trauma: most common injury, can fracture ribs/sternum/costal cartilages

• compression: develop from severe blunt trauma, disrupts normal chest motion

• penetration: bullets/knives/metal or glass pieces/rods/pipes/etc.

• flail chest: occurs when blunt trauma creates a fracture of 2+ ribs in two or more places, reduces lung expansion

• paradoxical motion: movement of ribs in a flail segment that is opposite the direction of movement of the rest of the chest cavity

• pneumothorax: air in the pleural cavity

• tension pneumothorax: begins to affect the unaffected lung or the heart because air cannot escape (if created from an occlusive dressing, burp it)

  • tracheal deviation: trachea moves away from affected lung

• hemothorax: chest cavity fills with blood

• hemopneumothorax: chest cavity fills with blood & air

  • jugular veins may be flat due to volume loss

• traumatic asphyxia: sudden compression of the chest forces blood out of the organs and ruptures blood vessels

  • neck/face are darker color than rest of body

  • possible bulging eyes/JVD/broken blood vessels in face

• cardiac tamponade: occurs when blood entes the pericardial sac

  • signs: JVD, muffled heart tones, narrowing BP

• aortic dissection: marked by tearing pain (in chest, back, stomach, etc.)

• commotio cordis: uncommon, caused by trauma to the chest at time when heart is vulnerable → V fib

  • Tx: CPR + defibrillation

ABDOMINAL INJURIES

• evisceration: organs protruding through a wound opening

  • place pt on back with knees flexed to chest

  • apply saline-moistened sterile dressing over wound site & cover with occlusive dressing

CHAPTER 32- MUSKULOSKELETAL TRAUMA

• compartment syndrome: severe swelling & bleeding within an extremity

  • signs: sensation of internal pressure, may feel hard on palpations, reduced CMS

SIX Ps OF ASSESSMENT

Pain/tenderness

Palor

Paresthesia (pins & needles)

Pulses (diminished or absent)

Paralysis

Pressure

***can attempt to realign a PULSELESS extremity once in the field

SPLINTING

• rigid splint

• formable splint

• traction splint: used for mid-femur injuries ONLY

CHAPTER 33 - TRAUMA TO THE HEAD, NECK & SPINE

SKULL/BRAIN INJURIES

• coup injury: occurs @ site of injury

• contrecoup injury: occurs opposite the site of injury

• hematomas:

  • subdural: between brain & dura

  • epidural: between dura & skull

  • intracerebral: inside brain

• decorticate posturing (hands/feet towards core) or decerebrate posturing (hands/feet away from core)

signs: visible skull bone fragments or brain tissue, Battle sign, pupils unequal/nonreactive to light, depressions/deformities/swelling of skull, altered mental status, “racoon eyes”, Cushing reflex, projectile vomiting, ringing of ears, etc.

***ICP (intracranial pressure)

NECK INJURIES

1. stop bleeding

2. prevent embolus

SPINE INJURIES

***look for loss of bowel/bladder control

CHAPTER 34 - MULTISYSTEM TRAUMA

***high priority (physiologic findings): altered mental status, abnormally slow or rapid resp rate, cool/pale/clammy

***high priority (anatomical findings): amputation above wrist, pelvic or chest instability, 2+ long bone injuries, etc.

remember ABCs, golden hour, limit on-scene time, request ALS & rapid transport

CHAPTER 35 - ENVIRONMENTAL EMERGENCIES

COLD EXPOSURE

• hypothermia: can be increased by alcohol ingestion, underlying illness, major trauma, etc.

  • infants/children and older adults are most prone to hypothermia

  • signs: shivering, numbness, stiff/rigid posture, drowsiness, rapid HR and resp rate, LOC, cool/red/pale/cyanotic skin

  • extreme: no detectable vital signs, HR 10 bpm, very cold to touch

passive rewarming: cover pt, remove wet clothing

active rewarming: apply external heat source

• frostnip (early/superficial): remove from cover & cover

• frostbite (late/deep): oxygenate and cover affected area !DO NOT RUB OR MASSAGE!

HEAT EXPOSURE

• hyperthermia: any heat not needed for temperature maintenance

• heat cramps/exhaustion: moist/pale/normal or cool skin, usually occurs @ beginning of summer

  • Tx: remove from environment, lay in supine position, apply moist towels over cramped muscles

• heat stroke: temperature-regulating mechanism fails, marked by stoppage of sweating

  • Sx: hot skin (may be dry or moist), altered mental status, LOC, rapid/shallow breathing, N/V, dilated pupils, temp 104+, potential seizures, no muscle cramps

  • Tx: apply cool packs, remove clothing, administer high-concentration O2

WATER-RELATED

• drowning: experiencing respiratory impairment from submersion/immersion in liquid; triggers spasm of larynx; final attempt at breath allows water to enter lungs

• arterial gas embolism: bubbles in the bloodstream due to diver holding breath upon resurfacing

• air embolism: stroke-like symptoms

• decompression sickness: caused by rapid surfacing after deep, prolonged dive (takes 1-48 hours to appear)

HIGH-ALTITUDE ILLNESS

• acute mountain sickness: Tx may consist of anything from rest & rehydration to supplemental O2 & immediate descent

• high-altitude cerebral edema (HACE): severe form of acute mountain sickness, often takes 2-3 hours to appear

• high-altitude pulmonary edema (HAPE): severe form of acute mountain sickness, results in respiratory failure/arrest

BITES & STINGS

***all spiders are venomous

1. treat for shock

2. contact medical direction

3. remove stinger or venom sac