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BradyPmed 4,6-9
Volume 4 Chapters 6-9
| What can most of the national decline in burn mortality be attributed to? | Improved building codes, safer construction techniques, sprinkler systems, and use of smoke detectors. |
| What relation are burns to soft tissue injuries? | Burns are a specific subset of soft tissue injury with a specific pathological process. |
| How does the bodies tissue change in regards to burns? | Body tissues change chemically, evaporating water and denaturing the proteins that make up cell membranes. |
| What is the epidermis? | The outermost layer of the skin. |
| What is the dermis? | A layer of tissue beneath the epidermis. |
| What is subcutaneous tissue? | Fatty layer of tissue beneath the dermis. |
| What are the four basic types of burns? | Thermal, Electrical, Chemical, Radiation |
| What is denaturing? | Altering the normal substance of something. (An egg in a frying pan changes from liquid to solid due to a change in its proteins) |
| What factors effect the amount of heat energy of a burning agent? | Its temperature, the concentration of the heat energy it possesses, and the length of its contact time with the patients skin. |
| What is the explanation of the physical effects of thermal burns known as? | Jackson's theory of thermal wounds. |
| What is the most damaged area of a burn? | The zone of coagulation. |
| What are some characteristics of the zone of coagulation? | This area suffers the most profound changes during a burn. Cell membranes rupture and are destroyed, blood coagulates, and structural protein denatures. |
| What occurs if the zone of coagulation penetrates the dermis? | Full thickness burns. |
| What zone accounts for redness associated with some burns? | The zone of hyperemia. |
| What is the zone of stasis in a burn? | Area in a burn surrounding the zone of coagulation that is characterized by decreased blood flow. |
| What is the emergent phase of a burn? | First stage of burn process that includes a pain response as well as an outpouring of catecholamine release. |
| What are some s/s of patients in the emergent phase of a burn? | Tachycardia, Tachypnea, mild hypertension, and mild anxiety. |
| What burn phase follows the emergent phase and can last up to 24 hours? | The fluid shift phase. |
| What occurs during the fluid shift phase of a burn? | Damaged cells begin the inflammatory response in the body. This increases blood flow to capillaries surrounding the burn, causing massive edema as fluids shift from intravascular spaces to extra vascular spaces. |
| What body surface area percentage is typically required to enter the fluid shift phase of a burn? | >15-20% |
| What is the hypermetabolic phase of a burn? | Stage of a burn in which there is increased metabolism in the body in an effort to repair itself. |
| When does the hypermetabolic phase of a burn begin? | After the fluid shift phase, lasting from several days to many weeks depending on the severity of the burn. |
| What occurs during the resolution phase of a burn? | Scar tissue is formed and rehabilitation begins. |
| What is the primary difference between AC (alternation current) and DC (direct current)? | In DC electrons flow in one directions. In AC electrons constantly reverse direction. |
| In an electrical burn, where does the highest heat occur? | At the point of greatest resistance, often at the skin. |
| What accounts for severe entry and exit wounds in electrical burns? | The skin offering the greatest point of resistance. |
| How much resistance to electricity can dry, calloused skin produce? | 500,000 to 1,000,000 ohms/cm |
| How much resistance to electricity can wet, think can produce? | 300 to 10,000 ohms/cm |
| In electrical burns, what occurs as the length of contact time increases? | The potential for injury increases. |
| Which path is electricity likely to follow inside the body? | Blood vessels and especially nerves, as they offer less resistance than muscle and bone. |
| What conditions can occur as a result of contact with currents of 20 to 50 mA? | The muscles of respiration may be immobilized, causing respiratory arrest, anoxia, hypoxemia and eventually death. |
| What are flash burns? | Burns created as a result of the heat of current passing through adjacent air. |
| How do chemical burns cause damage to the body? | By denaturing the biochemical makeup of cell membranes and destroying cells. |
| What is liquefaction necrosis? | The process in which an alkali liquefies and dissolves tissues. |
| What is beta radiation? | Medium strength radiation that is stopped with light clothing or the uppermost layers of skin. It can travel 6-10' through the air and penetrate a couple layers of clothing. |
| What three factors are important to keep in mind during radiation exposure? | Duration of exposure, distance from the radiation sources, and the shielding between you and the source. |
| How often does toxic inhalation occur compared to thermal burns? | More often. |
| What should raise your index of suspicion of a patient having CO poisoning? | If the patient was in an enclosed space during combustion. |
| What is CO's affinity to hemoglobin? | 200 times greater than that of O2. |
| What temperature can superheated steam produce? | 212 degree F |
| What types of airway burns can super heated steam cause? | Sub glottic airway burns. |
| What is a partial thickness burn? | Burn in which the epidermis is burned through and the dermis is damaged. |
| What are s/s of partial thickness burns? | Redness, blistering, edema, pain. |
| What differentiates partial thickness burns from superficial burns? | Blistering. |
| What are the 11 body regions encompassed by the rule of 9's? | ENTIRE head and neck, ANTERIOR chest, ANTERIOR abdomen, POSTERIOR chest, POSTERIOR abdomen (lower back), ANTERIOR of EACH lower extremity, POSTERIOR of EACH lower extremity, ANTERIOR of EACH upper extremity, POSTERIOR of EACH upper extremity, 1% groin. |
| How much BSA does the palm represent in the rule of palms? | 1.00% |
| When should the rule of palms be used? | It is easier to use in burns </= 10% |
| What percentage of BSA burned represents an increased risk for hypovolemia? | >15-20% |
| What is the cause of hypovolemia in burn patients? | Loss of fluid plasma to edema reduces the bloods ability to draw fluid from uninjured tissue via osmosis, which compromises the bodies natural response to fluid loss. |
| What is eschar? | Hard, leathery product of a deep full thickness burn. |
| What is a special concern with burns on a pediatric patient? | The pediatric patient has a high body surface area to body weight ratio, meaning it has lower fluid reserves. |
| What is a special concern with burns in regards to a geriatric patient? | Geriatrics have a reduced mechanism for fluid retention and lower fluid reserves. |
| What size ETT should be used in burn patients? | The largest tube possible. |
| Which areas, when burned, are of special concern to the paramedic? | The face, hands, feet, joints, genitalia, and any circumferential burns. |
| What represents minor burn severity? | Superficial- BSA <50%, Partial Thickness- BSA<10% |
| What represents moderate burn severity? | Superficial- BSA >50%, Partial Thickness- BSA <30%, Full Thickness- BSA<10% |
| What represents critical burn severity? | Partial Thickness- BSA>30%, Full Thickness- BSA>10%, Inhalation Injury, Partial/Full Thickness involving hands, feet, joints, face, genitals. |
| How should burn severity be categorized with geriatric, pediatric, and additional trauma patients? | The level of severity should be increased by one |
| Should cool water immersion be used on minor localized burns? | Yes, it may be effective if accomplished in the first few minutes after a burn. |
| What drugs should be considered for pain management in burn victims? | Morphine Sulfate or Fentanyl. |
| What is the parkland formula? | 4mL X Pts Weight in kg X BSA burned = Amount of fluid in 24 hours. |
| How much of the fluid from parkland's formula should be given in the first 8 hours after a burn? | Approximately half. |
| What relation does pain have with regards to the severity of a burn? | Pain is often paradoxical to burn severity. More severe = less pain. |
| How is an emergency escharotomy performed? | Bu incising burned tissue through the eschar, perpendicular to the constriction, about 1 cm deeper than developing eschar. |
| What type of assessment tool is important in electrical burn patients? | ECG monitoring for possible cardiac disturbances. |
| What are the characteristics of lightening? | High voltage (100,000 V), high current (50,000 A), high temperature (50,000 F) lasting only a fraction of a second. |
| How should cardiac or respiratory arrest patients of electrical burns be treated? | With aggressive airway, ventilatory, and circulatory management. |
| Who should be considered first for a rescue team in a radiation incident? | The oldest member of the team. |
| How frequently do musculoskeletal injuries occur? | Second only to soft tissue injuries. |
| What is the optimal way of dealing with muscoloskeletal injuries? | Preventing them before they occur. |
| What is the greatest single cause of musculoskeletal injuries? | Motor Vehicle Accidents. |
| What percentage of bone mass is replaced each year by the body? | 20.00% |
| What are the functions of the skeleton? | Give body structural form, protect vital organs, allow for efficient movement, stores salts and other metabolic materials, and produces red blood cells. |
| What is the diaphysis? | The central portion, or shaft, of the long bone. |
| What is the epiphysis? | The widened, articular end of the bone. |
| What is the metaphysis? | Tan intermediate region between the epiphysis and the diaphysis. |
| Where is the epiphyseal plate located? | In the metaphysis. |
| What is the medullary canal? | A cavity within a bone that contains the marrow. |
| What is the significance of the periosteum? | Its extensive vasulature and innervation allows it to transmit the sensation of pain when the bone fractures, as well as initiate the bone repair cycle. |
| What are the long bones? | Humerus, radius, ulna, tibia, fibula, femur, metacarpals, metatarsals, and phalanges. |
| What are the short bones? | Wrists, ankles, carpals, and tarsals. |
| What are the flat bones? | Cranial, sternal, ribs, shoulder, and pelvis. |
| What are sesamoid bones? | Patella. |
| What are the types of joints? | Synarthroses, Amphiarthroses, and Diarthroses. |
| Which joints are immoveable? | Synarthroses. |
| Which joints have very limited movement? | Amphiarthroses. |
| Which joints have relatively free movement? | Diarthroses. |
| What is adduction? | When a body part moves towards the midline. |
| What is abduction? | When a body part moves away from the midline. |
| What are ligaments? | Bands of connective tissue that connect bone and hold joints together. |
| What are bursa? | Sacs containing synovial fluid that cushion adjacent structures. |
| How many bones make up the human skeleton? | 206 |
| What is the axial skeleton? | Bones of the head, thorax, and spine. |
| What is the appendicular skeleton? | Bones of the extremities, shoulder girdle, and pelvis (excluding the sacral spine). |
| How much pressure can the femur withstand along its diaphysis? | 1,200 PSI (pounds per square inch) |
| Which is the only distal bone to articulate with the femur? | Tibia. |
| When do bones reach maximum strength? | Usually by 18-20 years of age. |
| When do bones begin to lose their ability to maintain structure? | Age 40 or greater. |
| How many muscles make up the muscular system? | More than 600 muscle groups. |
| What are the three classifications of muscles? | Cardiac, smooth, and skeletal (striated or voluntary) |
| What is the muscles origin? | The attachment of a muscle to a bone that does not move. |
| What is the muscle insertion? | Attachment of a muscle to bone that moves when the muscle contracts. |
| What is opposition in regards to the muscoluskeletal system? | The pairing of muscles that permits extension and flexion of limbs. |
| What are tendons? | Specialized bands of connective tissue attaching muscle to bone. |
| What is tone in regards to muscle? | State of slight contraction of muscles that gives them firmness and keeps the ready to contract. |
| What types of muscular injury can occur? | Contusion, Compartment Syndrome, Penetrating Injury, Muscle Fatigue, Muscle Cramp, Muscle Spasm, and Muscle Strain. |
| What is a contusion? | Small blood vessels rupture, leaking blood into the interstital spaces, causing pain, erythema, and ecchymosis. |
| What are the s/s of compartment syndrome? | Deep burning pain out of proportion with the injury, not reduced by positioning. An increase in pain when YOU move the extremity. Distal pulse and capillary refill may be normal. Increased distal sensitivity and numbness. |
| What is a s/s of penetrating injury to a muscle or tendon? | Movement in one direction with the inability to move in the opposing direction. |
| Describe the muscle environment during muscle fatigue. | Cellular environment become hypoxic, toxic, and energy deprived. Exertion becomes painful. |
| What is a muscle cramp? | A painful spasm of the muscle usually relived with a change in muscle position or massage. |
| What is a muscle spasm? | A muscle in intermittent or continuous spasm. Usually subsides with rest. |
| What is a muscle strain? | An overstretching of muscle fibers causing pain with any use of the muscle. Site is typically painful to palpation. |
| What is a sprain? | A joint injury caused by the tearing of the joints connective tissue. Causes acute pain, inflammation, and swelling. |
| What defines a Grade I Sprain? | A minor and incomplete tear. Painful with minimal swelling. Joint is stable. |
| What defines a Grade II Sprain? | Significant but incomplete tear. Swelling and pain range from moderate to severe. Join in intact but unstable. |
| What defines a Grade III Sprain? | Complete tear of the ligament. Severe pain and spasm may make it look like a fracture. Join is unstable. |
| What is subluxation? | Partial displacement of a bone end from its position in a joint capsule. |
| What are common causes of subluxation? | Hyperflexion, hyperextension, lateral rotation beyond normal range of motion, or application of extreme axial forces. |
| What is a dislocation? | A complete displacement of bone ends from their normal joint position. |
| What is a comminuted fracture? | A fracture in which a bone is broken into several pieces. |
| What causes a fatigue fracture? | Prolonged or repeated stress. |
| What is a greenstrick fracture? | A fracture that disrupts only one side of the long bone and remains angulated, resisting alignment. |
| What is osteoperosis? | An accelerated degeneration of bone tissue due to loss of bone minerals, principally calcium. More prevalent in women. |
| What are some problems affecting bone development? | Tumors of the bone, periosteum, or articular cartilage or by diseases that release agents that increase osteoclast activity. Radition treatment. Medical history of cancer. |
| How long does it take for a broken bone to return to original strength? | Approximately four months. |
| What is bursitus? | Acute or chronic inflammation of the bursae. |
| What are some predisposing factors to arthritis? | Trauma, obesity, and aging. |
| How should a person with an isolated fracture, dislocation, or trauma to tissue be managed? | receive complete assessment and management on scene. |
| What should you suspect with any serious musculoskeletal injury? | Always consider spinal precautions, as the energy required to cause the damage would be sufficient to cause spinal injury. |
| How are patients with musculoskeletal injuries classified? | Life and limb threatening, life threatening but minor limb, non life threatening but serious limb threat, and non life threat and minor limb injury. |
| When is the rapid trauma assessment performed in regard to musculoskeletal injuries? | On any patient with any sign, symptom, or mechanism of injury that suggests serious injury. |
| How much blood can be lost to a pelvic fracture? | Can account for a loss of more than 2L. |
| How much blood can be lost per femur fracture? | Can account for as much as 1,500mL of blood loss per femur. |
| What are the six Ps of limb injuries? | Pain, Pallor, Paralysis, Paresthesia, Pressure, and Pulses. |
| What is of concern during the assessment of sports players? | Their competitive nature may cause them to downplay and injury. |
| What is a specific and serious musculoskeletal injury associated with sports? | A sprain, particularly of the knee. |
| When should you not attempt alignment of dislocations and serious injuries? | When it is within 3 inches of a joint. |
| What should be done first in regards to splint/immobilizing an injured limb? | Checking for pulse, sensation, and motion in both the injured limb and the uninjured limb (if available). |
| In what position should you immobilize an injured limb? | In the position of function, unless within 3 inches of a joint, in which case in the position found. |
| What indicates the need to cease realignment or repositioning of a limb? | If you feel any resistance to movement or notice great increase in patient discomfort. |
| How should you manage muscle, tendon, or ligament injury? | Immobilize the limb and region surrounding it. Provide gentle circumferential bandaging. Apply local cooling. Only apply heat after 48 hours. Elevate the extremity above the heart. |
| What is different about the veins in the pelvic ring region? | These veins are without valves, have limited musculature, and may experience retrograde blood flow when torn. |
| How will femoral fractures present? | Some limb shortening, external rotation, and limited deformity. |
| How should you care for a femur fracture? | Immobilize the limb as found and provide gentle transport. |
| What is the difference in care for a degenerative break in the femur and a traumatic one? | Degenerative breaks will not produce spasms and do not require traction splints. Traumatic breaks usually induce great pain and will cause spasming, indicating traction splint use. |
| When is a traction splint not indicated in traumatic femoral breaks? | When injury also exists to the pelvis, knee, tibia, or foot. |
| What is the most commonly fractured bone of the leg? | The tibia. |
| What is the most frequently fractured bone of the human body? | The clavicle. |
| How should you care for a clavicular fracture? | Splint the fracture with a sling and swathe against the chest. |
| How does an anterior hip dislocation present? | With foot turned outward and the head of the femur palpable in the inguinal area. |
| How does a posterior dislocation present? | Presents with the knee flexed and foot rotated inward. |
| How should you immobilize a knee injury? | In the position found unless it effects distal PMS. |
| How should you immobilize finger injuries? | Use tongue blades and/or tape to adjacent fingers. |
| How should nitrous oxide be administered? | As a 50/50 solution of NO and O2. Should be self administered, as this prevents ove rmedication. |
| How long do the effects of nitrous oxide last? | Effects dissipate 2-5 minutes after discontinuation of use. |
| What qualities does Diazepam (Valium) have? | Anti-anxiety and skeletal muscle relaxation. |
| What is the dosage and rate of Diazepam (Valium) | Slow IV bolus of 5-15mg, not to exceed 5mg/minute. Repeat every 10-15 minutes if necessary. |
| What is Diazepam (Valium)'s peak and max duration? | Peak effects at 15 minutes, max duration from 15-60 minutes. |
| What should you NOT do with Diazepma (Valium)? | Do not mix with any other drugs or mix in an IV bag. Plastic absorbs diazepam, |
| Which drug reverses the effects of diazepam (Valium)? | Flumazenil, 2mL of 0.1 mg/mL solution IV. |
| What is morphine? | An opium alkaloid used to relieve pain, sedate, and reduce anxiety. |
| What are some concerns with Morphine Sulfate? | Should not be used with hypovolemia or hypotension. Can cause respiratory depression and nausea and vomitting. |
| What is the dosage for morphine sulfate? | 2 mg IV bolus repeated every few minutes as needed. |
| What reverses the effects of morphine sulfate? | Naloxone (Narcan) via IV bolus 0.4-2mg repeated every 2-3 minutes as needed. |
| What is fentanyl? | An opiate narcotic used to relive pain. |
| What is the dosage rate for fentanyl? | 25-50 mcg IV, repeating with 25 mcg as needed. |
| What reverses the effects of fentanyl? | Naloxone (Narcan) via IV bolus 0.4-2mg repeated every 2-3 minutes as needed. |
| What is Nalbuphine Hydrochloride (Nubain)? | A synthetic narcotic analgesic. |
| What is the dosage rate for nubain? | 5mg IV repeating with 2mg as needed up to 20mg. |
| Why are children at higher risk for musculoskeletal injuries than adults? | Due to their activity levels and incompletely developed coordination. |
| How many people experience head trauma each year? | Approximately 4 million people. |
| How many people experiencing head trauma require hospitalization? | 1 in 10. |
| What is the most frequent cause of trauma death? | Head injury. |
| Which population is most at risk for serious head injury? | Males between the age of 15 and 24, infants, young children, and the elderly. |
| By what percentage does helmet use reduce serious head injury in motorcycle crashes? | 50.00% |
| What is the mnemonic SCALP? | Skin- Connective tissue- Aponeurotica- Layer of subaponeurotica tissue- Periosteum |
| What is the cribiform plate? | An irregular portion of the etemoid process at the base of the skull with a rough surface that may abrade, lacerate, or contuse the brain during severe deceleration. |
| What are the layers of the meninges from outer to inner? | Dura Mater, Arachnoid Membrane, and Pia Mater. |
| Which layer of meninges is highly vascular with large vessels supplying the superficial layer of the brain? | Pia Mater |
| Where is cerebrospinal fluid produced? | In the largest two of the four ventricles within the brain. |
| How much of the interior of the cranium does the brain occupy? | 80.00% |
| What divides the brain cerebrum into right and left hemispheres? | The Falx Cerebri. |
| What does Cranial Nerve III do? | Oculomotor Nerve controlling pupil size. |
| Which nerve is likely to be compressed as intercranial pressure increases? | CN III |
| Which area of the brain fine tunes motor control and maintains muscle tone? | The cerebellum |
| What process of the brain established consciousness? | The ascending reticular activating system. |
| Which area of the brain is responsible for sleep? | The pons. |
| Which area of the brain contains the respiratory center, the cardiac center, and the vasomotor center? | The medulla oblongota. |
| How much of a persons body weight does the brain account for? | 2.00% |
| How much of the bodies cardiac output does the brain recieve? | About 15%, receiving about 20% of the bodies total oxygen. |
| Where do the internal carotid and basilar arteries connect? | At the circle of Willis. |
| What happens in the cranium as the volume of extrinsic factors increase? | One of the other factors must be decreased to maintain ICP. |
| What happens as ICP mechanisms reach there limit of ability to compensate? | ICP will start to rise and the brain will be compressed |
| What happens as ICP continues to rise without compensation? | Pressures within the cranium become very high and the brain may herniate. |
| What does rising ICP cause the autoregulation system to do? | Causes it to further raise the blood pressure in an attempt to further perfuse the brain. |
| What does rising blood pressure do to ICP? | Causes it to rise even higher and diminish cerebral blood perfusion even more. |
| Which artery provides blood flow to the face? | External carotid artery. |
| What are the most important Cranial Nerves transversing the face? | Cranial Nerve V and VII |
| What does Cranial Nerve V do? | Trigeminal, providing sensation for the face and some motor control over eye movement, and enables the chewing process. |
| What does Cranial Nerve VII do? | Facial Nerve, provides motor control to the facial muscles and contributes to sensation of taste. |
| Where are the salivary glands located? | Anterior and inferior to the ear, under the tongue, and just inside the inferior mandible. |
| What are important Cranial Nerves of the oral region? | CN XII, CN V, CN VII, CN IX |
| What does Cranial Nerve XII do? | Hypoglossal, directs swallowing and tongue movement. |
| What does Cranial Nerve IX do? | Glossopharyngeal, control saliva production and taste. |
| What do the sinuses do? | Lighten the head, protect the eyes and nasal cavity, helps produce resonant tones of the voice, and helps strengthen the face to the forces of trauma. |
| Where does light enter the eye? | Through the pupil. |
| What is the sclera? | The white, vascular portion of the eye. |
| Which Cranial Nerves play an important role in the function of the eye? | CN III, CN IV, and CN VI. |
| What does CN VI do? | Abducens, controls the eyes outward gaze. |
| What is zone I of the neck? | Below the cricoid ring, carries the highest incidence of mortality in neck wounds. |
| What is zone II of the neck? | Above the cricoid ring and below the angle of the jaw, injuries are more common because of limited protection of anterior neck. |
| What is zone III of the neck? | Above the angle of the jaw, are a concern because the involve both the cranial nerves and the larger vascular structures. |
| Which Cranial Nerves transverse the neck? | CN IX, CN X |
| What does Cranial Nerve X do? | Vagus Nerve, essential for speech, swallowing, and cardiac, respiratory, and visceral function. |
| What are the brachial plexus? | A network of nerves in the lower neck and shoulder responsible for lower arm and hand function. |
| From what do head injuries most frequently result? | Auto and motorcycle crashes account for more than half. |
| Which area of the body is often the target of bows from fists or from impact-enhancing objects like sticks? | The face! |
| How is the neck anatomically protected from most blunt trauma? | Because the head and chest protrude more anteriorly, and the shoulders protrude laterally. |
| Which mechanisms typically cause penetrating injuries to the face? | Gunshot wounds or stabbings. |
| What is the definition of head injury? | A traumatic insult to the cranial region that may result in injury to soft tissue, bony structures, and the brain. |
| What is a common occurance in scalp wounds? | They tend to bleed heavily. |
| Why are scalp wounds prone to infection? | Because emissary veins drain from the dural sinuses, through the cranium, and into the superficial venous circulation. |
| What is a hematoma? | An accumulation of blood. |
| What is a depression in relation to the head? | Blow that results in a tear of the fascial layers under the scalp and results in a depression, with or without skull fracture. |
| What is the most common type of skull fracture? | Linear fractures (Small cracks in the cranium), accounting for 80%. |
| What is one of the thinnest and most commonly fractured bones in the head? | The temporal bone. |
| What is the weakest area of the skull? | The basilar skull. |
| Why is the basilar skull the weakest area of the skull? | Because of the sinuses, the orbits of the eye, the nasal cavities, the external auditory canals, and the middles and inner ears. |
| How can you differentiate CSF from other substances? | It will exhibit a 'halo' sign when dropped on a white cloth. Also, use a glucometer. |
| What is brain injury? | A traumatic insult to the brain capable of producing physical, intellectual, emotional, social, and vocational changes. |
| What is direct brain injury? | Injury caused by the forces of trauma. |
| What are coup injuries? | Tissue disruptions that occur directly at the point of impact. |
| What are countercoup injuries? | Tissue damage away from the point of impact as the brain 'sloshes' away from the initial impact. |
| What is a cerebral contusion? | Capillary bleeding into the substance of the brain. |
| How do s/s of cranial contusions manifest themselves? | With dysfunctions related to the site of the injury. |
| What is an epidural hematoma? | Bleeding between the dura meter and the skull's interior surface. |
| How does an epidural hematoma present? | Because the bleeding is from a high pressure vessel, ICP builds rapidly, compressing the cerebrum and increasing ICP. Progression is rapid and life threatening. |
| What is a subdural hematoma? | Bleeding beneth the dura mater and within the subarachnoid space. |
| How do subdural hematomas present? | Subtle presentation because blood loss is usually from a small vessel. Usually does not show over s/s until hours or days later. |
| What is intracerebral hemorrhage? | Ruptured blood vessel that releases blood into the substances of the brain. |
| How does intracerebral hemorrhage present? | Much like a stroke with progressively worsening s/s. |
| What is diffuse axonal injury? | A type of brain injury chracterized by shearing, stretching, or tearing of nerve fibers with subsequent axonal damage. |
| What is a concussion? | AI with nerve dysfunction without substantial damage. |
| What are the s/s of a concussion? | Transient confusion, disorientation, and event amnesia followed by a rapid return to normal function. |
| What is a moderate diffuse axonal injury, or 'classic concussion'? | Shearing, stretching, or tearing of the axons with minute bruising of brain tissue. |
| What are the s/s of a 'classic concussion'? | Persistent confusion, inability to concentrate, disorientation, retrograde and anterograde amnesia, headache, focal nuerological deficits, light sensitivity, disturbances in smell or other senses, and modd swings. |
| What is severe axonal injury? | Significant disruption of many axons in both hemispheres of the brain with extension into the brainstem. |
| What are the s/s of severe axonal injury? | Prolonged unconsciousness, Cushings Response, decerebrate or decorticate posturing. |
| What is indirect brain injury? | Injuries resulting because of, though after, the initial injury. |
| What causes indirect brain injury? | Diminished circulation to the brain tissue or progressive pressure against, or physical displacement of, brain tissue. |
| What occurs in cerebral arteries as carbon dioxide levels rise? | The arteries dialate to encourage greater blood flow, which can be devastating in the presence of ICP. |
| What s/s occur as ICP increases and the brain stem begins to herniate? | Projectile vomiting, changes in LOC, pupillary dilation, and in severe cases disturbances in breathing, blood pressure, and heart rate. |
| What happens as the frontal lobe is damaged? | Patient will likely present with alterations in personality. |
| What happens as the occipital lobe is damaged? | Visual disturbances can be expected. |
| What is it when a patient is unaware of the circumstances leading up to an incident? | Retrograde amnesia. |
| What is it when a patient is unaware of the circumstances following an incident? | Anterograde amnesia. |
| What s/s does upper brainstem pressure produce? | Increase in blood pressure, decrease in heart rate, Cheyne-Stokes breathing, vomiting, body temperature changes, pupils small and reactive, decorticate posturing to pain. |
| What s/s do middle brainstem pressure involve? | Pulse widens, bradycardia, deep & rapid respirations, sluggish or non reactive pupils, decerebrate posturing. |
| What s/s are produced with lower brainstem pressure? | Pupils become fully dilated and unreactive, respirations become ataxic, pulse becomes irratic, hypotension, unresponsive and flaccid muscles. |
| What are critical s/s to recognize brain herniation? | Will have a history of head trauma, increasing BP, decreasing HR, irregular respirations (Cushing's Triad), GCS <9, singular or bilaterally dilated and fixed pupils, posturing or no movement with painful stimuli. |
| What are some key differences between pediatric and adult head trauma? | Pediatrics can accommodate some ICP because of the fontanelles, however intercranial hemorrhage is more concern for hypovolemia. Infants most have a clear nasal passage for breathing. |
| What are the responses for EYE opening on the GCS scale? | 4-Spontaneous, 3- Verbal Command, 2- To Pain, 1- No Response. |
| What are the responses for MOTOR response on the GCS scale? | 6-Obeys, 5-Localizes Pain, 4-Flexion/Withdrawl, 3-Flexion/Abnormal, 2-Extension, 1-No Response. |
| What are the responses for VERBAL response on the GCS scale? | 5- Oriented and Converses, 4- Disoriented and Converses, 3- Inappropriate Words, 2- Incomprehensible Sounds, 1- No Response. |
| What do depressant drugs or cerebral hypoxia cause the pupils to do? | Reduce pupillary responsiveness. |
| What does extreme hypoxia cause the pupils to do? | Fix and Dilate. |
| What is likely the cause if one pupil is fixed yet shows some response to consensual stimulation? | Pressure on the occulomotor nerve. |
| Why do facial wounds tend to bleed so much? | Because of the ample supply of arterial and venous vessels. |
| What is of primary concern with any deep facial wounds? | Airway compromise. |
| What is of primary concern with mandibular fracture of dislocation? | Airway compromise. |
| What should you not do with a patient with a mandibular fracture? | DO NO place the patient supine, as they may have lost control over their tongue and risk airway compromise. |
| What is a Le Fort I facial fracture? | Slight instability to maxilla, no displacement. |
| What is a Le Fort II facial fracture? | Fracture to both maxilla and nasal bones. |
| What is a Le Fort III facial fracture? | Fracture involving entire face bellow the brow ridge. |
| How do orbital fractures usually present? | With unilateral depression over the prominence of one cheek. May reduce the eyes range of motion and cause blurred or double vision. |
| What typically causes injury to the middle and inner ear? | Objects inserted into the ear canal or rapid changes in pressure. |
| How would blunt trauma to the eye present? | With hemorrhage in the anterior chamber, displaying a collection of blood in front of the iris and pupil. |
| What causes subconjunctival hemorrhage? | Strong sneeze, vomiting episode, direct eye trauma. |
| How does subconjunctival hemorrhage present? | A portion of the eyes surface is red (with blood). |
| What is acute retinal artery occlusion? | An embolus blocks the blood supply to one eye. |
| How does an acute retinal artery occlusion present? | Patient complains of sudden, painless loss of vision in one eye. |
| What is a retinal detachment? | When the retina detaches from the eyes posterior wall. |
| How does a retinal detachment present? | Patient complains of a dark curtain obstructing part of the field of view. |
| What can arterial interruption leading to brain hypoxia and infarct mimic? | May mimic s/s of a stroke. |
| What can a disruption of the vagus nerve cause? | Tachycardia and GI disturbances. |
| What s/s can occur from damage to the spinal cord? | bilateral partesthesia, weakness, paralysis, neurogenic shock. |
| Why is it important to determine a patients level of orientation? | It may be critical in early identification of brain injury. |
| When should you apply a cervical collar? | At the end of the initial assessment. |
| What should you anticipate in an injury to the brain in regards to the airway? | Sudden vomiting without provocation. Protect the airway. |
| What should you attempt to maintain as end tidal CO2 readings? | Between 35 and 40 mmHg. |
| What should your end tidal CO2 reading be for patients with suspected brain herniation? | Between 30 and 35 mmHg. |
| What should be the lowest allowable O2 sat? | 95.00% |
| What type of pulse is an early sign of building ICP? | A slow and strong bounding pulse. |
| Which drug should you consider for seizures in a head injury? | Diazepam. |
| What is the most important care priority with the head, face, and neck? | The airway. |
| What is an unwanted side effect of suctioning in head injury patients? | May lead to increased ICP. |
| What is the best position for the patient with a suspected head injury? | Left lateral recumbent. |
| What is the best position for the patient with suspected head and neck injury? | LSB with the head of the board raised 30 degrees, helping to reduce ICP. |
| What is the best position for the patient with an open neck injury? | Trendelenburg position. |
| What does an open neck injury carry the risk of? | Carries the risk of air entering the external jugular vein during strong inhalation. |
| How much fluid should you provide to a patient with significant head injury who you suspect of brain injury? | 1000mL followed by additional fluid to maintain 90mmHg pressure. |
| What should you not treat in the suspected brain injury patient? | Hypertension. |
| What is the primary first-line drug used in the care of suspected head injury patients? | Oxygen. |
| What is Mannitol? | An osmotic diuretic that draws water from the interstital space and into the cardiovascular system. |
| What theraputic effect does Mannitol have for the suspected head injury patient? | May draw fluid from the cerebrum and help reduce cerebral edema and ICP. |
| What patients require you to use cation in the use of Mannitol? | Patients with reduced kidney function or those with hypotension. |
| What is the dose for Mannitol? | Slow IV bolus of 0.25 to 1g/kg over 10 to 20 minutes. |
| What is Midazolam (Versed)? | A benzodiazepine similar to diazepam though it is three to four times as potent. |
| What are some side effects of Midazolam (Versed)? | May cause cardiorespiratory arrest, hypotension, vomiting and nausea. |
| What is the dose for Midazloam (Versed)? | Very slowly in small increments (no more than 1mg/min) to the desired effect or max dose of 2.5mg. |
| What is atropine? | An anticholinergic (parasymptholytic) agent used to reduce vagal stimulation, oral and airway secretions. |
| What are some side effects of atropine? | May cause pupillary dilation, vomiting, nausea, headache, and blurred vision. |
| What is the dose for atropine? | 0.5 mg bolus for RSI. |
| How long do topical anesthetic agents last? | Typically 15 minutes. |
| How long do topical anesthetic agents take until effects begin? | Usually about 15 seconds. |
| What is the danger of using air transport on a head injury patient? | The potential for the patient to go into seizures. |
| How should you care for a scalp avulsion? | Cleanse gross contamination. Cover both the open wound and the undersurface of the exposed scalp flap with large bulky dressing. |
| How should you treat a pinna injury? | Place the pinna in as close to its anatomical position as possible. Place a dressing between the head and medial surface of the injured ear and cover the exposed ear with a sterile dressing. Bandage the dressed injury to the head. |
| What should be done when one eye is bandaged? | Both eyes should be bandaged to prevent sympathetic movement. |
| How should you treat possible corneal abrasion or laceration? | Gently invert the eyelid to search for the possible cause. Attempt to remove with saline moistened cotton swab. Cover both eyes with soft dressings. |
| What should be done with dislodged teeth? | Rinse the teeth in normal saline and wrap them in saline soaked gauze. |
| What should be done with impaled objects? | Should be left in place and dressed and bandaged so that it does not move during transport. |
| How many people sustain spinal cord injuries annually in the US? | 10000 |
| Approximately how many of these spinal cord injuries are due to trauma? | 90.00% |
| What age is most common for spinal cord injuries? | Between 15 and 24. |
| What is the most common cause of spinal cord trauma? | MVA 50%, followed by Falls 25%, and Sports Related Injury 10%. |
| How much can lifelong care cost a spinal cord injured person? | In excess of One Million dollars. |
| What is the best treatment for spinal cord injuries? | Prevention. |
| How many bones are in the spinal column? | 33 |
| What separates each pair of vertebrae? | An invertebral disk, |
| What is the common feature among all vertebra? | A vertebral body and a vertebral arch forming a vertebral canal. |
| Which spinal ligament helps prevent hyperextension of the vertebral arch? | The anterior vertebral ligament. |
| Which spinal ligament helps prevent hyperflexion of the vertebral column? | The posterior longitudinal ligament. |
| Where does the spinal cords blood supply come from? | Primarily the anterior spinal artery and the two posterior spinal arteries. |
| How many vertebrae are in the cervical spine? | Seven. |
| Which spinal section provides sole support for the head? | Cervical. |
| What is another name for C1? | The Atlas. |
| What is another name for C2? | The axis. |
| What is the strongest cervical vertebrae? | The axis. |
| What is the name of the bony tooth on C2? | The odontoid process or dens. |
| How can you identify C7? | It is the first bony prominence along the spine and just above the shoulders. |
| How many vertebrae are in the thoracic spine? | 12 |
| How does the TI differ from other T vertebrae? | It has a full facet with the first rib and a demifacet for the second rib. |
| How many vertebrae make up the lumbar spine? | 5 |
| How many vertebrae make up the sacral spine? | 5 fused vertebrae. |
| What additional functions can the sacral spine provide? | Help protect the urinary and reproductive organs. |
| How many vertebrae make up the coccygeal spine? | 4 fused. |
| What is the spinal cords function? | Transmitting sensory input from the body to the brain and for conducting motor and control impulses from the brain to the various muscles and organs. |
| How long is the spinal cord in a fetus? | It fills the entire length of the vertebral column. |
| Where does the spinal cord taper in an adult? | At L1. |
| What is the 'H' shape of the spinal cord made up of? | Grey Matter |
| What are the areas outside of the “h” in the spinal cord made of? | White Matter |
| What are the sensory pathways in the spinal cord? | The ascending tracts. |
| What are the motor pathways in the spinal cord? | The descending tracts. |
| How many spinal nerve roots are there? | 31 pairs |
| Where are the spinal pairs concentrated? | 8 C pairs, 12 T pairs, 5 L pairs, 5 S pairs, and 1 Coccygeal pair. |
| Which nerve pairs do not have sensory roots? | C1 and Coccygeal 1. |
| What is responsible for control of the diaphram? | The phrenic nerve C3-C5. |
| Where are the brachial plexes innervated? | C5-T1. |
| What are dermatones? | The areas where sensory components innervate specific and discrete areas of the body surface. |
| What are key locations to recognize for assessments of spinal damage? | Collar Region (C3), Little Finger (C7), Nipple Line (T4), Umbilicus (T10), and Small Toe (S1) |
| What are key myotomes for neurological evaluation? | Arm Extension (C5), Elbow Extension (C7), Small Finger Abduction (T1), Knee Extension (L3) and Ankle Flexion (S1) |
| Which system adjusts the bodies metabolic rate to waking activity and “fight or flight” functions? | The sympathetic system. |
| Which areas of the spinal cord or most often injured? | Cervical and Lumbar. |
| What can hyper extension injuries cause? | Disk disruption, compression of the interspinous ligaments, and fracture of the posterior vertebral elements. |
| Where are the most common sites for axial loading injuries? | Between T12 and L2 (For lifting and heal first falls) and the C-Spine for head impacts. |
| How many electrocution cause spinal injury? | By causing extreme and uncontrolled muscular contraction. |
| Which region accounts for over half of all spinal injuries? | The C-Spine. |
| What can a spinal cord concussion cause? | Transient disruption of cord function. Generally does not produce any residual effect. |
| What can a spinal cord contusion cause? | Transient disruption of cord function when edema or swelling occurs. Generally does not produce any residual effect. |
| What can spinal cord compression cause? | Restricted circulation, ischemic damage, and possible physical cord damage. |
| What can spinal cord laceration cause? | Hemorrhage into the cord, swelling due to the injury, disruption of parts of the cord or its pathways. May result in permanent damage. |
| What can spinal cord transection cause? | Potential to send nervous impulses below, and receive signals from below the cut or lost. |
| What are effects of spinal cord damage to C1-C5? | Paralysis of muscles for breathing and of all arm and leg muscles, usually fatal. |
| What are effects of spinal cord damage to C5-C6? | Legs paralyzed, slight ability to flex arms. |
| What are effects of spinal cord damage to C6-C7? | Paralysis of legs and part of wrists and hands, shoulder movement and elbow bending relatively preserved. |
| What are effects of spinal cord damage to C8-T1? | Legs and trunk paralyzed, eyelids droops, loss of sweating to forehead, arms relatively normal, hands paralyzed. |
| What are effects of spinal cord damage to T2-T4? | Legs and trunk paralyzed, loss of feeling below nipples. |
| What are effects of spinal cord damage to T5-T8? | Legs and lower trunk paralyzed, loss of feeling below the rib cage. |
| What are effects of spinal cord damage to T9-T11? | Legs paralyzed, loss of feeling below the umbilicus. |
| What are effects of spinal cord damage to T12-L1? | Paralysis and loss of feeling below the groin. |
| What are effects of spinal cord damage to L2-L5? | Different patterns of leg weakness and numbness. |
| What are effects of spinal cord damage to S1-S2? | Different patterns of leg weakness and numbness. |
| What are effects of spinal cord damage to S3-S5? | Loss of bladder and bowel control, numbness in the perineum. |
| What can you expect to see during the acute phase of a high spinal cord injury? | Respiratory insufficiency, quadriplegia, absent upper and lower extremity reflexes, lack of sensation below effected area, loss of rectal and bladder sphincter tone, hypothermia is common. |
| What is anterior cord syndrome? | Condition that is caused by bony fragments or pressure compressing the arteries of the anterior spinal cord and resulting in loss of motor function and sensation to pain, light touch, and temperature below the injury site. |
| What is central cord syndrome? | Condition usually related to hyperextension of the cervical spine that results in motor weakness, usually in the upper extremities and possible bladder dysfunction. |
| What is Brown-Sequard syndrome? | Condition caused by partial cutting of one side of the spinal cord resulting in sensory and motor loss to that side of the body. |
| What is neurogenic shock? | Vasodilation caused by spinal cord injury, cerebral trauma, or hemorrhage. |
| How does neurogenic shock present? | Presents with slow HR, low BP, pale, cool, clammy skin above the injury site and warm, dry and flushed skin below the injury site. Possible priapism in males. |
| What are the s/s of autonomic hyoerreflexia syndrome? | Sudden hypertension, bradycardia, pounding headache, blurred vision, sweating and flushing of the skin above the point of injury, nasal congestion, nausea, bladder and rectum distension. |
| What is the likelihood of a repeat episode of transient spinal cord syndromes after the first has occured? | 40.00% |
| What percentage of spinal injuries do pediatrics account for? | 10.00% |
| Why are spinal cord injuries often missed in pediatrics? | Because of spinal cord injuries without radiographic abnormality(SCIWORA) because of the childs ability to hyperflex without damaging the spinal column. |
| How should you handle spinal precautions in a patient distracted by another injury? | Apply full spinal precaution. |
| After the initial assessment, what phase of management should you begin with suspected spinal cord injury? | Rapid trauma assessment , ensuring to palpate the entire spinal region. |
| Why do some midcervical spinal patients hold their arms above their heads? | Because the injury paralyzes the adductor and extensor muscles while the patient has control over the abductor and flexors. |
| What is important in the ongoing assessment of the spinal trauma patient? | Monitoring for any changes in neurological condition. |
| What is considered a neutral inline position in the supine? | Hips and knees should be somewhat flexed for maximum comfort and minimum stress. Head should be lifted gently 1-2 inches off the ground |
| What does the C-Collar accomplish? | Limits cervical spine motion and reduces forces of compression (axial loading) but does not completely prevent flexion/extension, rotation, or lateral bending. |
| What is a key factor in moving spinal cord patients? | The coordination of movement, moving as a unit. |
| What is the initial treatment for hypovolemia from suspected neurogenic shock? | IV NS 1,000 mL with 250mL push. Dopamine, Atropine |
| What medications should be considered to calm a patient? | Fentanyl, benzodiazepams. |
| What Is the second leading cause of death in children under the age of 12? | Burns |
| What is the fourth overall cause of trauma death? | Burns |
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