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Trauma
Trauma course cards
| Question | Answer |
|---|---|
| trauma was first classified as a disease by what document? | White Paper "Accidental Death and disability the neglected disease of modern society" |
| Modern 5-step approach to prevent or reduce impact of diease | surveillance, risk identification/analysis, intervention development, implementation, evaluation |
| when prioritizing trauma patients, what does the pneumonic CUPS stand for? | critical, unstable, potentially unstable, stable |
| what used to be the golden hour in reference to onset of trauma to definitive care? | golden period |
| Uniform and standard set of data collected by trauma centers to recognize trauma care practices and procedures that benefit the pt | trauma registry |
| guiedlines for triage in trauma | GCS, MOI, physical exam findings, Age, medical conditions |
| collecting data to identify existence, significance, and characteristics of disease. | surveillance |
| process to examine a disease and determine various factors that affect development, course, and consequences | risk analysis |
| body in motion stays in motion unless acted on outside force; stay at rest unless acted on outside force | Newton's first law of motion; inertia |
| (first law of thermodynamics): energy cannot be created or destroyed only transformed | Law of Conservation of energy |
| Forces at work during collision; Force strength is related to objects mass and or change in velocity; F=ma | Newtons second law of motion |
| formula for kinetic energy (energy in motion) | K = 1/2MV^2 |
| These types of energy exchange with tissue describe what type of impact? compression (impact abruptly stops portion of body while inertia causes remaining structures to continue), stretch, and shearing (along edges of impacting force or organ attachment) | Blunt trauma |
| what are the 5 phases of a vehicle collision? | Phase 1: vehicle collision, Phase 2: body collision, Phase 3: organ collision, Phase 4: secondary collision from objects in the car hitting occupant, Phase 5: additional impacts received by vehicle from environmental factors = most ugly |
| these all describe what kind of vehicle impact: restrained path, up-and-over, down-and-under path, and ejection | Frontal |
| types of vehicle impacts | frontal, lateral, oblique, rear-end, roll over |
| blunt trauma to what areas of the body account for 85% of vehicular mortality? | head and abdominal cavity |
| what are the impacts of a motorcycle accidents? | frontal, angular, sliding, ejection |
| 3 impacts of motorcycle ejection | initial bike/object collision, rider/object impact, rider/ground impacts |
| Waddell triad | same side femoral fracture, same side thoracic/abdominal injury, and opposite side head injury |
| most common blunt MOI | falls |
| primary, secondary, tertiary, and quaternary blast injuries | primary = hollow organs worst with lungs, secondary = struck by flying debris, tertiary = person thrown against stationary rigid objects, quaternary = miscellaneous (burns, crushing, entrapment) |
| 6 p's of compartment syndrome | pain out of proportion to injury, pallor, paralysis, paresthesia, pressure, pulses diminished or absent |
| perforating penetrating trauma specifically means what? | object enters AND exits body |
| good predictors of trauma center need | death of another occupant in vehicle, fall distance, extrication time |
| what are considered the most lethal blasts | those causing structural collapse |
| most common life-threatening trauma associated with explosions | pulmonary injury |
| #1 killer of all trauma and medical patients? | shock |
| what is a measure of systemic vascular resistance? | MAP |
| what signifies amount of force the heart generates with each contraction? | pulse pressure (SBP-DBP) |
| what percentage does plasma, WBC and plasma, and RBC's make up in the blood? | plasma 55%, WBC and plasma <1%, RBC's 45% |
| 3 step process of hemostasis | vascular phase (contract and withdraw), platelet phase (aggregate), coagulation phase (clotting factors from liver forming fibrin clot) |
| factors affecting hemostasis | wound type, movement, temperature, medications, IV fluids, hemophilia |
| hemophilia type A vs type b; which is the most common? | type a (most common) missing factor VIII type b missing factor IX |
| what is factor VIII and IX important for with clotting? | they help create thrombin which activates fibrinogen released from platelet plug resulting in fibrin |
| vascular and platelet phase of hemostasis are considered primary or secondary hemostasis? coagulation phase? | primary for vascular and platelet, secondary for coagulation |
| categories of shock | hypovolemic, distributive, cardiogenic, obstructive, and respiratory/metabolic |
| what is the treatment for hemorrhagic shock | permissive hypotension, TXA 1g/10min in 50mL bag, 1g/8hrs in 500 bag |
| 3 stages of shock | compensated, decompensated, irreversible |
| classes of hemorrhage and volume lost in each | class I (up to 15% 750mL), class II (15-30% 750-1500mL), class III (30-40% 1500-2000mL), Class IV (>40% >2000mL) |
| blood volume in arteries, capillaries, and veins % | arteries 13%, capillaries 7%, veins 64% |
| trauma triad of death | coagulopathy, acidosis, hypothermia |
| volume of internal hemorrhage at these sites: long bone excluding femur, femur, pelvis, abdomen | long bone 500-700mL, femur up to 1500mL, pelvis 1500+, abdomen up to 5L+ |
| how much time does it usually take to develop crush syndrome (traumatic rhabdomyolysis) | >4hrs |
| what accumulates during traumatic rhabdomyolysis | accumulation of myoglobin, potassium, lactic acid, toxins |
| treatment for hyperkalemia and their amounts | fluids 30mL/kg, calcium 0.5-1g over 3min, albuterol 10-20mg LVN over 15min, sodium bicarb 50mEq, dextrose 25g and insulin 10units |
| stages of wound healing | hemostasis, inflammation, epithelialization, neovascularization, collagen synthesis |
| Jacksons theory of thermal burns | zone of coagulation (nearest to heat source and most damaged), zone of stasis, zone of hyperemia (area of erythema) |
| thermal burn phases | emergent (initial pain response), fluid shift (larger than 15-20%), hypermetabolic (increased demand for nutrients begin repair), and resolution (scar tissue and return to normal) |
| what is the parkland burn formula for 24 hours and what can you change to get first hour? | 4mL x BSA burned (secondary and third only) x weight in kg; dived in half and first half goes to first 8 hours, second for the remaining 16; can change 4mL to 0.25 to get first hour amount |
| how much CSF is present at any given time and how much is made per day on average? | 125-150mL at any given time, 500mL total/day |
| when treating suspected brain herniation, what do you aim to keep the EtCO2 at? hyperventilation rate for adults, children, and infants? | EtCO2 between 30-35, adults 20/min, children 25/min, infants 30/min |
| syndrome resulting from bony fragments or pressure compressing anterior spinal cord arteries usually resulting from extension-flexion injury; loss of motor function, sensation to pain, light touch, and temperature below injury site | anterior cord syndrome |
| syndrome resulting from hyperextension of cervical spine and considered incomplete cord injury that usually presents with loss of motor/weakness to upper extremities and loss of bladder control; common in 50+ | central cord syndrome |
| syndrome caused by penetrating injury/hemitransection of the spinal cord losing motor and sensory on the same side and pain and temp to the opposite side | brown-sequard syndrome |
| syndrome that involves compression of the nerve roots to the lower end of the spinal cord usually caused by herniated disc/tumor/infection and causes incontinence and saddle anesthesia | cauda equina syndrome |
| temporary insult to spinal cord affecting body below level of injury, area becomes flaccid and loses feeling, paralysis just below level injury, loss bladder/bowel control, loss temperature control below injury site | spinal shock |
| what kind of burn does an acid and alkalotic solution cause? | acid: coagulation necrosis alkalotic: liquefaction necrosis |
| radioactive particles versus ionizing rays | radioactive are alpha and beta particles; ionizing are gamma/x-rays |
| where is external respiration and what is it also known as? | in the alveoli and called pulmonary respiration |
| where is internal respiration and what is it also known as? | its in the tissues/cells and is also called cellular respiration |
| pleural space as about what number of negative pressure? | -2 cmH2O |
| Severe compression force applied to chest, reverses blood flow from right into superior vena cava into venous vessels of upper extremities S&S: petechiae, subconjunctival hemorrhages, stagnating blood above compression point | Traumatic asphyxia |
| traumatic chest injury resulting in dyspnea, diminished lung sounds, shock, no JVD, dull percussive sounds | hemothorax |
| trauma to chest resulting in severe dyspnea, absent lung sounds ipsilateral side, cyanosis, JVD, hypotension, tachycardia, subQ emphysema, hyperresonance on affected side | tension pneumo |
| what condition can you hear a Hamman's crunch? | pneumomediastinum |
| penetrating injury causing beck's triad, JVD (kussmals sign; JVD with inhalation), pulses paradoxus (systolic drop 10+ during inhalation) | cardiac tamponade |
| most obvious indicator of chest trauma is? | MOI |
| MOI common reason for blunt abdominal/pelvic injuries | MVC's due to seatbelts |
| 3 common mechanisms for blunt trauma | deceleration (shear- liver attachment), crushing(solid organs), and compression (hollow organs) |
| most common organ hit by GSW and knives | GSW small intestine, liver = knives |
| accessory organs of digestive system | liver, salivary glands, gallbladder, and pancreas |
| supine hypotensive syndrome is defined as? | decrease in systolic by 15-30mmHG when lying supine in the last trimester |
| what kind of organ is the placenta | cardiovascular and endocrine (organ of pregnancy) |
| what is the greatest cause of MSK injuries? | auto crashes |
| within bones : blood vessels travel lengthwise along bone through small tubes | haversian canals |
| within bones: perforating canals distributing blood to bone tissue and structures located within medullary canal | Volkmann's |
| longest living bone cell comprising of 95% of them | osteocytes |
| fibrous joint, immovable (sutures) | synarthrosis |
| cartilaginous joints that allow limited movement (spine, ribcage, growth plates) | amphiarthrosis |
| synovial joint permits free movement (ball and socket, saddle joint, pivot, hinge, condyloid) | diarthrosis |
| joint between tooth and gum | gomphosis |
| what is the point called where the attachment of muscle to bone remains stationary | the origin |
| what is the point called where the attachment of muscle is on the moving bone | insertion |
| deep burning pain out of proportion to apparent injury with leg most common location anteriorly; 6 p's: pain, pallor, paralysis, paresthesia, pressure, pulses diminished or absent | compartment syndrome |
| separate and turn and come back out of alignment; partial bone end displacement from capsule. Painful and swelling quickly, ROM limited, joint unstable | subluxation |
| complete displacement of bone ends from normal joint position (luxation); joint fixes in abnormal position with noticeable deformity | dislocation or luxation |
| most common type of femur fracture but least common in pedi | oblique |
| what kind of veins leave long bones | emissary and nutrient |
| bone repair cycle | fracture hematoma, internal and external callus, bony callus, bony remodeling |
| 1g of TXA over 10min is the dose for suspected exsanguination what is the maintenance dose | 1g over 8hrs in 500mL |
| what are two positive feedback loops in the body | birth and clotting |
| difference in temperature between ambient temp and body; heat always moves from hot to cold | thermal gradient |
| how do you convert Celsius to Fahrenheit | (C * 1.8) + 32 |
| thermogenesis is created via 3 mechanisms, what are they | exercise, thermoregulatory via endocrine/thyroid with increased cellular metabolism, or metabolic/diet induced |
| term for loss of heat | thermolysis |
| what ways is heat lost from the body | respiration, evaporation, convection, radiation, conduction |
| what part of the brain is in control of temp regulation | hypothalamus |
| type of heat injury with body temp >100F up to 104, weak and tired, tachypneic and weak pulse, muscle cramps and weak | heat exhaustion |
| true environmental heat emergency >105F, cessation of sweating, hot and dry skin, AMS, seizures | heat stroke |
| what is considered hypothermia | CBT < 95F |
| mild hypothermia, moderate, and severe | mild >90-95F shivering AMS, moderate 90-82F loss of shivering with most common arrythmia of bradycardia, severe <82F leading to coma ventricular arrythmia or asystole |
| what body temp does the patient need to be in order to continue shock therapy in CPR | 86F |
| - Environment induced freezing of tissues forming ice crystals within drawing water drawn out of cells into extracellular space expanding destroying cells--increases electrolyte concentrations intracellularly | frostbite |
| some freezing of epidermal tissue, redness, blanching, diminished sensation | superficial frostbite (frostnip) |
| epidural and subQ layers; white appearance hard(frozen) to palpation, loss sensation; extremities, head, face; subfreezing temps required for frostbite to occur | deep frostbite |
| can thaw frozen parts by immersion in 102-104F water but not if what can happen | refreezing |
| what else can you do for frostbite? | treat like burn; sterile dry dressing, elevate, immobilize |
| Immersion foot; occurs at temps above freezing Similar symptoms to frostbite May be pain and blisters may form on spontaneous rewarming | trench foot |
| Respiratory impairment as result of submersion or immersion in liquid | drowning |
| most common places for drownings of children <1, ages 1-5, adolescents and young adults | <1: bathtubs 1-5: pools adolescents: lakes/rivers/ocean |
| <70F cold water: bradycardia, blood shunts to core/vital organs, breathing slows, laryngeal spasm | mammalian diving reflex |
| changes in pressure "the squeeze"; can't equilibrate pressure btwn nasopharynx and middle ear through Eustachian tube | barotrauma |
| state of stupor = "raptures of the deep" effects on cerebral function of N or any gas in high concentration; may seem intoxicated and take unnecessary risks | nitrogen narcosis |
| bends or dysbarism; rapid reduction of air pressure while ascending to surface following exposure to compressed air Decrease pressure = increased volume (boyle's law) | decompression sickness |
| holding breath during ascent can cause this kind of diving injury | pulmonary overpressure |
| a diving injury that can cause stroke like symptoms from structural damage to the lungs with onset of 2-20 minutes after ascent | air embolism from alveoli rupture |
| gas law that states the volume of gas is inversely proportional to the pressure of it | boyles law |
| the pressure at sea level is 1 atm, every how many feet deeper adds another atm of pressure and losing half the volume? | 33 feet |
| amount dissolved gas in given amount of fluid is directly proportional to amount of pressure on top of that gas | henry's law |
| at constant temp, volume of gas is directly proportional to absolute temp of gas; â—‹ Temp increases then volume increases; decrease temp then volume decrease | charles law |
| as you heat a volume of gas, pressure is going to increase; cool goes down-- definitely affects O2 tanks | gay-lussac's law |
| total pressure of mixture of gases equal to sum of partial pressure of individual gases | dalton's law |
| % nitrogen, oxygen, and other gases in the air | N 78%, O 21%, other 1% |
| atm at sea level = 1, torr? psi? | torr = 760, PSI = 14.7 |
| - Unacclimated person ascends rapidly to 2000m(6600ft) or greater: lightheadedness, breathlessness, weakness, HA/N/V | acute mountain sickness |
| high altitude pulmonary edema (HAPE) occurs usually above what height? how does it happen? | 8000ft; pulmonary circulation constricts in hypoxic environment and due to decreased availability of oxygen (daltons law) the hydrostatic pressure overcomes the alveolar pressure and causes edema |
| most extreme high altitude injury over 11-13,000 ft | High altitude cerebral edema (HACE) |
| pulse site for newborn up to 1 hour, neonate, infant up to 1year, >1 | newborn apical, neonate, brachial, infant <1 brachial, 1+ carotid |
| who is part of the command staff in an MCI | public information officer, safety officer, liaison officer |
| who is part of general staff in an MCI | operations (medical: triage, treatment, transport), planning, logistics, finance/admin section |
Created by:
Lindsey.George