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BradyPmed 4, 1-5

Volume 4 Chapters 1-5

How many deaths does trauma account for each year? 155,000
What are the two leading mechanisms of trauma mortality? Auto Crashes with 45,000 deaths/year, Gunshots with 30,000 deaths/year.
Trauma is the leading killer of which age group? Persons under the age of 44 (United States)
The document "Accidental Death and Disability; The Neglected Disease" resulted in the passing of what? The Highway Safety Act of 1966
What is epidemiology? The study of disease.
What elements make up the Haddon Matrix? Pre-Event Elements, Event Elements, Post Event Elements and The Host, The Agent, The Environment.
Level I Trauma Center Regional Trauma Center. Commits resources to address all types of specialty trauma 24/7.
Level II Trauma Center Area Trauma Center. Commits the resources to address the most common trauma emergencies with surgical capability 24/7; will stabilize and transport specialty cases to the regional trauma center.
Level III Trauma Center Community Trauma Center. Commits to special emergency department training and has some surgical capability, but will usually stabilize and transfer the seriously injured trauma patients to a higher level trauma center.
Level IV Trauma Center Will stabilize and prepare trauma patients for transport to a higher level facility.
What helps increase your index of suspicion? Information gathered at the scene and your consideration of the MOI.
Golden Period The concept that a trauma patient must reach a trauma facility in an hour or less.
The best and most cost effective way to reduce mortality and morbidity in trauma? To prevent the trauma from occurring.
A data retrieval system for trauma cases used as a basis for evaluating and improving the trauma system. Trauma Registry.
Kinetics A branch of physics dealing with objects in motion and energy expended when objects collide.
A body in motion will... ...remain in motion unless acted upon by an outside force.
Energy can be... ... neither created nor destroyed. It can only be changed from one for to another.
The energy of an object in motion. Kinetic Energy.
Kinetic Energy = Mass(weight) X Velocity(speed) squared divided by 2
Force = Mass X Acceleration
Compression Injury occurs as a result of what? As a blunt impact stops a portion of the body while inertia causes the remaining structures to continue their motion. Results in one tissue or organ being pushed into another.
What is stretch? The opposite of compression. Connective fibers that hold tissue together are pulled and thereby injured or torn apart.
What is shear? A tear of tissue similar to scissor blades.
What are the four events of a vehicle collision? 1-Vehicle Collision. 2-Body Collision. 3-Organ Collision. 4-Secondary Collision.
How should the child safety seat be placed with infants and small children? Facing the rear and held firmly to the seat with the seatbelt.
What are headrests designed for? To prevent unopposed rearward motion.
What are the three pathways of patient travel in a frontal impact? 1- Up and Over. 2- Down and Under. 3- Ejection.
What percentage of fatal auto collisions involve alcohol? More than %50 involve drivers legally intoxicated.
What two body regions account for 85% of all vehicular mortality? Trauma to the head and body cavity (Chest and Abdomen).
What are primary blast injuries? Injuries caused by the heat of an explosion and the overpressure wave.
What are secondary blast injuries? Trauma caused by projectiles from an explosion.
What are tertiary blast injuries? Injuries resulting from personnel displacement (being thrown) and structural collapse.
Which organ is the most frequently damaged to the point of becoming life threatening in a blast injury? The lungs.
What height constitutes a severe fall? Falling from greater than 3 times a persons height. (20 feet for adults, 10 feet for children)
What is a primary concern in crush injuries? The crushing factor remaining in place and cutting off blood flow to a body part.
What causes the highest amount of trauma deaths? Motor Vehicle Accidents
What should you consider as a transport method to attain the Golden Hour? Consider Air Transport.
What constitutes a 2nd degree injury? One covering >9% of the body, requires immediate transport.
What types of interventions can a paramedic perform for a trauma victim? All interventions except surgical.
Will falls <5' represent significant MOI in pediatric patients? No. Falls of 10' or greater.
How should serious trauma be classified from a pathological prospective? As a surgical disease.
Which exam technique is most crucial on a trauma patient? Palpation - it helps reveal problems hidden from visualization.
Which type of energy would an airbag absorb during a MVA? Kinetic Energy.
What is a common cardiac problem associated with crush injuries? Toxic buildup and subsequent release can induce Ventricular Tachycardia.
Which age group is most prone to fall trauma? Geriatric.
What are common injuries associated with rear end collisions? Head and Neck trauma.
Which area of the spine is most susceptible to crush injuries in a fall? Lumbar.
What area of the body should be cause for concern after a fall? C-Spine precautions, head and neck trauma, and clavicular damage due to outstretched arms attempting to brace the fall.
Which pathway of travel induces the highest mortality rate in front end collisions? Up and Over.
What type of injuries should be suspected upon finding a 'spider web' on the windshield of an MVA? Means the patient was likely not restrained, and cervical spine compression fractures should be suspected.
What type of injuries should be suspected in a motorcycle frontal collision? Femur and Abdominal trauma associated with the up and over pathway.
What should always be considered in a shallow water dive? C-Spine precautions.
What two forces affect kinetic injury? Mass and Velocity.
What is a 'paper bag' injury? Lung injury from impact with the steering wheel.
What type of trauma should be suspected from a down and under pathway? Femoral, Tibial, and Knee injury.
What is a possible negative result of airway management in a blast victim? Aggressive ventilation may produce and emboli.
What is the most common collision type in a rural setting? Frontal Collision.
What is the danger of SRS (supplemental restraint system) in a rescue operation. Injury to EMS personnel due to late activation.
How many deaths occur each year as a result of shooting? 30,000, and increasing.
What relationship does velocity have to it's kinetic energy? The relationship is squared. ie x2 speed = x4 energy.
What is ballistics? The study of the characteristics of projectiles in motion and their effects upon objects they impact.
How is a handgun classified? A small caliber, short barreled, medium velocity weapon.
How is a rifle classified? Small caliber, long barreled, high velocity weapon.
What is the difference between and assault rifle and a rifle? The assault rifle posses semi-automatic and automatic fire capability as well and an extended magazine of ammunition.
How are knives classified? Slow moving, low velocity, penetrating objects.
What three factors effect the damage pathway of a high velocity projectile? Direct injury, pressure shock wave, and cavitation.
What is direct injury? The damage done by a projectile as it strikes tissue, contuses and tears the tissue, and displaces the tissue. It is limited to the profile of the bullet or the resulting fragments as the bullet breaks apart.
What is the pressure shock wave? The pushing of adjacent tissue away from the projectile due to the transference of the projectiles kinetic energy to the bodies tissue.
What is the temporary cavity? The space created behind the high energy bullet as the tissue moves rapidly away from the projectiles path.
How large can the temporary cavity become? As much as 12 times wider than the bullets profile.
What type of wounds are common to knife attacks? Deep upper extremity wounds ( commonly called defense wounds).
What is the damage profile upon solid organs? These tissue compress and stretch, resulting in greater damage more closely associated with the size of the temporary cavity. Hemorrhage is often severe.
What is the damage profile upon hollow organs? The organ usually contains fluid that is non compressible and rapidly transmit energy outward. If the container is filled it can tear the organ apart explosively upon impact.
What is the damage profile upon the lungs? Generally less extensive than other organs. If penetrated, it may upon air flow to the surrounding areas creating a pneumothorax.
What is the damage profile upon bone? Bone resists damage until it fractures.
What percentage of injuries occur to the extremities? 60-80% of injuries occur to the extremities, but only 10% of fatalities.
Which area of the extremities are more problematic during a trauma? Proximal to the knee and elbow may cause extensive vascular damage.
Which area of the abdomen should be cause for greatest concern? Upper abdomen due to the potential for extensive hemorrhage.
What is of concern from any large chest wound? Any large chest wound may compromise breathing and/or cause extensive damage to the multiple great vessels that occupy the area.
What is a concern with penetrating trauma to the neck? Airway comprise with the potential for massive hemorrhage and air emboli with damage to the jugular veins.
What is the difference between projectile entrance and exit wounds? Entrance wounds are typically limited to the size of the bullets profile, while exit wounds are larger and reflect the damage done within the bodies cavities.
How should you approach the scene of a violent crime? Stage your vehicle at least one block away and await dispatch's all clear from law enforcement.
What type of s/s should raise your index of suspicion of a tension pneumothorax? Frothy blood associated with a chest wound.
How should you handle objects impaled in the body? Immobilize the object in place with a bulky dressing.
How should you handle objects impaled in the face, neck, or cheek? Objects should not be moved unless they interfere with CPR. Objects in the cheek may be removed if both sides of the damage can be seen.
What is shock? A state of inadequate perfusion. The transitional stage between normal life and death.
What is glycolosis? The breakdown of glucose through anaerobic respiration forming CO2, Pyruvic Acid, and 2 ATP.
What is the second stage of cellular metabolism? Kreb's Cycle. Aerobic respiration converting pyruvic acid into H2O, CO2, and 2 ATP.
What is the third stage of cellular metabolism? Electron Transport Chain. Kreb's cycle compounds are broken down into 32 ATP.
What is the end result of cellular metabolism? CO2, Water, 36 ATP.
What problems can occur with metabolism when there is an O2 deficiency? Without adequate O2 cellular metabolism is strictly anaerobic, accumulating lactic acid in the cells.
How much oxygen is present in the atmosphere? 21% under normal atmospheric conditions (760 mmHg) resulting in a partial pressure of 160 mmHg.
How much air is moved with each breath in an adult male? 500 mL
What is external respiration? The movement of oxygen from the alveolus to the red blood cells.
Where is the lowest level of O2 concentration in the body? In the capillaries, where the blood is rich in CO2.
What is internal respiration? Where O2 diffuses across capillary walls into the interstital fluid and into the cell.
What is systolic blood pressure indicative of? The strength and volume of cardiac output and the elasticity of major vessels.
What does diastolic blood pressure represent? Peripheral vascular resistance.
What circulation situation causes a release of histamines? A build up of CO2 and the resulting drop in blood pH.
What percentage of the time do most tissues require blood to survive? 5 to 20%
How does the body move fluid from the interstital spaces into the vascular spaces? Precapillary sphincters and vessels constrict and the post capillary sphincters and vessels dialate.
What is the thoracoabdominal pump? A mechanism occuring during respiration in which flucating pressures draw blood towards the heart, while valves in veins prevent backflow.
How much of an adult males weight is the cardiovasular system comprised of? 7% or 5L of blood.
What percentage of blood in contained in the capilaries, venous system, and heart, arteries, and pulmonary system? Heart-7%, Arteries-13%, Capillaries-7%, Venous System-64%, Pulmonary-9%
What does an increase in parasympathetic stimulation cause? Decrease in heart rate, strength of contractions, and blood pressure. Decrease in respiratory rate, inducing brochoconstriction. Stimulation of the digestive system and kidneys.
What does an increase in sympathetic stimulation cause? Increase in heart rate, contractile strength, and respiratory rate. Contricts digestive blood vessels, dilates skeletal blood vessels, causes broncohdilation and decreases urine production.
Where are the baroreceptors located? In the aortic arch and carotid sinus.
Where are the chemoreceptors located? In the brain.
What is the cardioacceleratory center? A sympathetic nervous system center that increase HR through stimulation of the cardiac plexus.
What is the cardioinhibitory center? A parasympathetic center that decreases the HR through stimulation of the vagus nerve,
What is the vasomotor center? A sympathetic nervous center that regulates arterial and venous tone.
What causes the most rapid hormonal response to hemorrhage and cardiovascular insufficency? Epinepherine and norepinepherine.
What do Alpha1 properties cause? Vasoconstriction and increases both vascular resistance and cardiac afterload.
What do Beta1 properties cause? Increased heart rate, increase cardiac contractility, and increased cardiac conductivity.
What do Beta2 properties cause? Bronchodilation and smooth bowel muscle dilation.
Why is ADH released? In response to low blood pressure and dehydration.
What does ADH accomplish? Increase in peripheral vascular resistance and causes the kidneys to retain water, decreasing urine output.
What effect does ADH have on the spleen? Causes spleenic constriction, returning up to 200 mL of blood to the circulatory system.
What causes the creation of angiontensin? Released by the kidneys in response to low blood pressure.
What is angiontensin II? A potent vasoconstrictor lasting up to an hour.
What does aldosterone do? Cause the kidneys to retain sodium and water.
How do gluccocorticoids effect the bodies response to damage? Increase glucose production, reduce the bodies inflammatory response, prolong clotting time, wound healing, and infection fighting processes.
What is the first response of the body to a decrease in blood pressure? Boaroreceptors recognize the decrease and signal the vasomotor center to increase peripheral vascular resistance and venous tone, and the cardioacceleratory center to increase HR.
What occurs to the pule pressure as the body continues to compensate for low blood pressure? The pule pressure narrows and the pulse weakens.
How does the body s respirations respond to compensated shock? As the body compensates and wastes accumlate, lactic acid builds due to decreased O2 availability in non critical organs. This causes an acidic shift in the blood, causing increased and deeper respirations for a short period of time.
What occurs to pre and post capillary sphincters with increasing levels of lactic acid? The relax and release even more lactic acid into the blood stream.
What is a critical difference of compensated shock from decompensated shock? In compensated shock the body is still able to meet its metabolic needs.
What are the signs and symptoms of compensated shock? Pule rate increases, pulse strength decreases, skin become cool and clammy, building anxiety, restlessness, and combativeness, with increased thirst, weakness, and air hunger.
What are the signs and symptoms of decompensated shock? Pulse becomes unpalpable, blood pressure drops, patient becomes unconscious, respirations slow or cease.
What is the cause of hypovolemic shock? Caused by any significant reduction in the cardiovascular system.
What is distributive shock? Shock resulting from mechanisms that prevent the appropriate distribution of nutrients and remove of metabolic waste.
What are forms of distributive shock? Nuerogenic shock, anaphalactic shock, and septic shock.
What is obstructive shock? Shock resulting from the interference with the blood flowing through the cardiovascular system.
What is cardiogenic shock? Shock resulting from a problem with the cardiovasular pump, the heart.
What is the prognosis for cardiogenic shock? 80% mortality rate.
What is respiratory shock? Shock resulting from the failure of the respiratory system to supply O2 and remove CO2.
What is neurogenic shock? Shock resulting from and interruption in the communication pathway between the central nervous system and the rest of the body.
What pulse rate increase indicates possible shock? An increase in 20 bpm above the demographics upper normal limit.
What ETCO2 readings suggest the need for ventilatory support? >40mmHg
What ETCO2 readings suggest the need for circulatory support? <30mmGh
What s/s may indicate spinal trauma? Presence of pink and warm skin below the point of nervous system injury while the skin above the injury is pale, cool, and clammy.
What is the fluid of choice for significant blood loss? Whole blood
What is the most practical fluid for prehospital treatment? An isotonic crystalloid solution.
In regards to fluid resuscitation, when should you recheck blood pressure? If your patient improves or you infuse 250-500 mL of fluid.
What is the target BP for hypovolemic patients during fluid resuscitation? 80mmHg, 90mmHg for head injury patients.
How much fluid should be infused into children in regards to shock management? 20mL/kg
What is the ideal catheter length for trauma patients? 1 1/2" or shorter. The shorter the better.
What drugs may be considered for cardiogenic shock? Fluid challenge, casopressors like dopamine, and other cardiac drugs.
What drugs may be considered for spinal and obstructive shock? IV fluids.
What drugs may be considered for distributive shock? IV fluids, dopamine, and PASG.
What type of injuries are the most common form of trauma? Soft tissue injuries, accounting for over 10 million ER visits annually.
How many of these wounds will become infected? 0.07
Lacerations cutting across tensions lines have a tendancy to what? Be pulled apart and thus spread widely or gape.
How many ER visits result in infection? 1 in 15, most commonly by Staphylococcus and Streptococcus.
What is lymphangitis? Inflammation of the lymph channels resulting in red streaks.
How much pressure is required to cause compartment syndrome? 45 - 60 mmHg in a muscle compartment.
How long is a limb required to be crushed before crush injury typically sets in? 4 hours
What complication can result from high levels of myoglubin after a crush injury? Renal failure due to occlusion of filtering tubules.
What type of dressing is preferred for uncomplicated wounds? Non adherant dressings.
What is the advantage of adherent dressings? The promote clot formation.
How should you being you initial assessment in a soft tissue injury? Recognizing and immobilizing C-Spine where applicable.
When should you obtain your baseline set of vital signs in a soft tissue injury patient? After the rapid assessment.
What is the objective of bandaging? To control all hemorrhage, to keep the wound as clean as possible, and to immobilize the wound.
What is the most effective method of wound control? Direct Pressure.
When should you clean a wound? If it is grossly contaminated. This is not typically necessary.
What can be used to help control pain and edema? The application of cold packs and moderate pressure bandages.
What pharmacological interventions may be used to relieve pain for soft tissue injuries? Morphine in 2mg increments up to a total of 10mg. Fentanyl 25-50mcg initial dose followed by 25 mcg doses.
What special consideration should be made while bandaging the scalp and head? Observe for the presence of deformity and skull fracture.
What special consideration should be made when bandaging the ear and mastoid? Consideration should be made to not stop the flow of blood or CSF from the ear.
What are some complications of bandaging? Pain, pallor, tingling, loss of pulse, prolonged capillary refill may indicate developing pressure and ischemia.
What pharmacological interventions may be necessary for crush injuries? IV access. Sodium Bicorbonate 1mEq/kg followed by 0.25 mEq/kg/hr. Mannitol. Calcium Chloride 500mg IVP. NS 30mL/kg/hr
What rhythms should you be aware of in crush injuries? Tenting or peaking of the t-wave, a prolonged P-R interval, and S-T segment depression.
How long is it likely to take to develop compartment syndrome? 6-8 hours
Which types of wounds require transport? Wounds involving or possibly involving nerves, blood vessels, ligaments, tendons, or muscles. Also, significantly contaminated wounds, an impaled object, or a wound received from an unclean environment.
Created by: PMED