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Chap 25 Trauma
Trauma
| Question | Answer |
|---|---|
| Traumatic and unintentional injuries are? | The leading cause of death in the US from 1 to 44y/o |
| Patients who need EMS are categorized as? | A Medical or Trauma emergency |
| Trauma Emergencies occur as? | A result of physical forces applied to the body |
| Medical Emergencies occur as? | A result of illness or conditions (disease, bacteria, drugs, environmental, etc); not cause by an outside force/strike/blow |
| A Traumatic injury can be caused by a medical emergency by? | An underlying medical issue causing an accident. A fall or a crash as an example |
| A Medical emergency can be cause by trauma by? | An injury creating an environment for a disease. Example: patient develops pneumonia after a fall. Patient fractured their ribs, didn't treat, and it lead to developing pneumonia) |
| Index of suspicion | Is your awareness and concern for potentially serious underlying and unseen injuries |
| Traumatic injuries occur when? | The body's tissues are exposed to energy levels beyond their tolerance |
| Mechanism of Injury (MOI) | The way a traumatic injury occurs. It does describes the force or energy transmission acting on the body. |
| The 3 concepts of energy associated with injury? | Potential Kinetic Energy of work |
| The kinetic energy of a speeding car is converted into ________ of stopping the car, usually by crushing the car at the point of impact | Work energy. The energy required to halt kinetic energy. The work of bringing the body to a hault is what fractures bones and damages tissue |
| Work Energy | Force acting over a distance Example: bending metal Force (in lbs) needed to bend it x Distance you need to cover = Work Energy |
| Kinetic Energy | Energy of a moving object Mass x Speed/Velocity = Kinetic energy |
| Which energy causes injury to a person involved in a car wreck? | Work energy Kinetic energy is what got the car moving, but work energy is what bends or damages things Kinetic energy becomes work energy as velocity abruptly changes |
| Potential Energy | The product of mass (weight), force of gravity, and height Mostly associated with falling objects Everything has potential energy, that's converted to kinetic, then work energy |
| Newtons First Law of Motion | Objects at rest tend to stay at rest and objects in motion tend to stay in motion unless acted on by some force. (applies to both) |
| Newtons Second Law of Motion | Force = Mass x Acceleration Acceleration is the change in velocity (speed) over time It's not speed that kills, but the sudden stop (change of speed or Force) |
| Newtons Third Law of Motion | For every action is an equal and opposite reaction If you push on a door, the door "reacts" with the same force but in the opposite direction. It opens. |
| MOI Profiles | Blunt Penetrating Insignificant Significant |
| Nonsignificant injury | Injury to an isolated body part or a fall without loss of consciousness |
| Significant injury | Injury to more than one body system Falls from heights, motor vehicle/cycle crashes, car (bike/motorcycle) vs pedestrian, gun shot wound (GSW), stabbing Maintain high suspicion for unseen injury |
| Blunt trauma | Result of force to the body that causes injury without penetration to tissue, organs or cavities |
| Penetrating trauma | Injury by objects that pierce and penetrate the surface (skin), soft tissues, organs and body cavities |
| Types of motor vehicle crashes | Frontal (head-on) Rear-end Lateral (T-bone) Roll-over Rotational (spins) |
| Differences of crashes: Rotational, Spins | Possibility of multiple impacts after initial impact |
| Differences of crashes: Frontal, Lateral, Rear-end | Crash usually has one impact |
| 3 collisions in a crash: first collision | The vehicle against another object. Usually the most dramatic, but does not affect patient care, except maybe for extraction. Can give info of the severity, and severy can impact the patient Can also give MOI predictions |
| 3 collisions in a crash: second collision | Impact of the passenger into the inside of the vehicle. Damage to the interior can provide information to the patients injuries |
| Common injuries in the second collision | Lower extremity fractures (knees to dash board) Rib fractures (ribs to steering wheel) Head trauma (head to windshield) |
| There's a high risk of injury in what types of crashes? | Lateral and Roll-over |
| 3 collisions in a crash: third collision | Impact of the passengers organs against solid structures. Like the brain impacting the skull after the head hit the windshield |
| A coup-contrecoup injury is? | When the brain continues forward and strikes the inside of the skull (the coup) causing a compression and tension (stretching) injury |
| Who is at high risk when seat belts are place inappropriately or are too close to airbags? | Children and Pregnant women |
| When you see the damage to a vehicle after a high-speed crash, what should you suspect? | Serious injuries to the passengers, even if they're not readily apparent/visable |
| Your initial general impression of the patient and evaluation of the MOI can help do what? | Direct live-saving care and provide critical information to hospital staff |
| Significant MOIs | Death of a vehicle occupant Severe deformity of the vehicle Intrusion into the vehicle Moderate lateral collisions Severe rear damage Rotation/Roll-over crashes Ejection |
| Anything not secured in a vehicle can become what? | A projectile |
| If there are two or more passengers in a car and one dies, what can you assume of the others? | That they have suffered the same or similar injuries, even if they don't show right away |
| When checking a Frontal Crash, what should you inspect first? | Air Bag and Seat Belts. If both we deployed/used correctly that can greatly reduce the Third Impact (organs on bone) |
| Airbags provide what? | The final capture point and decrease deceleration (work) injuries. You should still inspect the patient |
| Height requirement for car seats | 4'9" (145cm) or shorter |
| Should car seats be place in the front seat? | No. Even with rear facing car seats, the airbag can still cause injury to the individual in the car seat |
| Seat Belt Injuries: Belt worn too high | Lower body can strike the dashboard Abdominal and Organ damage Example: pelvis hits the dashboard and fractures |
| Seat Belt Injuries: Belt worn too low | Hip dislocations |
| Seat Belt Injuries: Children and Geriatrics | Unseen abdominal injuries Lumbar Spine Fractures |
| When using extraction tools what should you be careful of? | Undeployed Airbags. Even after the battery is disconnected, impacts can deploy them |
| What should you look for on an unconscious patient? | Abrasions, traction-type injuries on the face, the lower part of the neck and the chest |
| If the knees and dashboard came in contact with each other, you should expect? | Femur and pelvis injuries |
| Most common rear-end collision injury? | Whiplash, which can damage the C-Spine and cause a 3rd collision (brain against skull) |
| Rear-end collision - Back passenger injuries: | Suspect: Pelvis Lumbar spine Thoracic spine |
| Lateral impacts are? | Common cause of car accident deaths |
| What happens in a Lateral Impact? | Car is typically struck above center, rocks away from the side of the impact, causing lateral whiplash and potentially slamming the patient back into the doo/window |
| What happens in a Lateral Impact? 2/2 | C-Spine. It has little lateral flexion Lateral chest and abdomen injuries on the side of the impact Possible fractures of: Pelvis, ribs, organs in the abdomen |
| Lateral crashes cause ____ of severe injuries to the aorta and approx _____ of all fatalities in car crashes | 25% and 30% |
| Vehicles more susceptible to roll-overs? | Large trucks (like our ambulances) Some sport utility vehicles |
| Unrestrained passengers in a roll-over might? | Strike the inside of the vehicle multiple times and could get ejected. If ejected they can also hit things outside the vehicle, like a tree |
| Passengers partially ejected | Could become sandwiched between the car and the outside environment |
| Ejections and Partial ejections are significant MOIs. Prepare to look for? | Life-threats |
| A passenger on the outboard side will experience? | Injury from centrifugal force, being pinned to the door of the vehicle |
| Passengers with a seatbelt can still experience ______ in a rollover | C-spine injuries Even with a seatbelt, the passenger can still strike the roof |
| Roll-overs have multiple opportunities for _____ and _____ collisions | Second and Third |
| Rotational passengers can experience both ____ and _____ | Rotational motion and Lateral impacts (if the vehicle strikes something) |
| Car vs Pedestrian crashes often result in? | Broken bones, abrasions and serious unseen injuries |
| Car vs Ped: MOI Evaluation | Estimate the speed of the vehicle Was the patient thrown and what did they land on? (surface, object) Struck or Pulled under Vehicle damage/contact points Blunt trauma Presume C-spine |
| Car vs Bike: MOI Evaluation | Similar to the Car vs Ped Inspect the Bike and Helmet for damage Presume C-Spine Blunt trauma |
| Car vs Motor Cycle: MOI Evaluation | Similar to Car vs Ped/Bike Inspect motor cycle, helmet, leather clothing Skid distance Presume C-spine Check for abrasions, breaks, fractions, etc Blunt trauma |
| 4 types of motorcycle impacts | Head-on: Strikes an object head on Angular: Struck at an angle. Direct crushing injuries to the lower body, neurovascular compromise, often requires amputation |
| 4 types of motorcycle impacts 2/2 | Ejection: Rider travels a long distance off the bike. Abrasion, even down to the bone Controlled: Technique used to separate the rider from the bike before impact |
| Controlled Crash | Developed by racers, motorcycle is turned flat, tipped sideways at 90deg in the direction of travel. One leg is dropped to grass or asphalt |
| Falls | Common MOIs for blunt trauma 20ft or more is a Significant injury (acts similar to a vehicle crash 2nd and 3rd collisions) Landing on your feet may reduce injuries slightly to internal organs, but will likely injure the lower body |
| Falls: Children | Falls greater than 10ft = significant Medium to high speed crashes = significant (>25mph) Also top heavy and tend to hit their heads on falls |
| Fall evaluation | Height of the fall Type of surface struck Part of the body that high first Path of energy displacement |
| Falls: Older patients | Not usually high-energy trauma, but will still have broken bones because of osteoporosis (weakened bones) Can fracture a bone from falling from standing height |
| Penetrating Trauma | Second leading cause of trauma death 38,000 firearm deaths in 2017 |
| Low-energy trauma | Knife, ice pick, pole, etc |
| Often difficult to determine entrance and exit wounds from a _______ pre-hospital | Prjectile |
| GSW: First | Number of penetrating injuries |
| GSW: Second | Form an index of suspicion about unseen life-threatening injuries |
| Low-energy penetration | Cause by sharp edges Injuries are close to the objects path Can get moved around internally, causing more damage Try to determine the length Do not remove unless in the way of CPR |
| Medium-high energy | Projectile path may be difficult to determine (especially bullets) Bullets can flatten, tumble, and ricochet |
| Path of an object is called? | Trajectory |
| Fragmentation will increase _______ | Damage Increased chance of multiple organ/vessel damage |
| Full metal jacket bullets usually cause _________ because they pass through the target | Less damage |
| Cavitation | Result from rapid changes in tissue and fluid pressure with the passage of a projectile Can cause damage to to tissues not in the direct path |
| Permanent cavitation | injury/damage along the bullets path |
| Distance can affect? | Severity The farther away, the less damage can typically be done |
| Drag | Air resistance Slows the projectile Can decrease energy and depth of the injury Reduce damage |
| Cavitation Med-High Veloicty | Can be several times larger than the entry wound |
| Motor Vehicles and Bullets | Velocity causes more damage than mass Mass = 2x Velocity = 4x |
| Medium Velocity | Handguns, some rifles |
| High Velocity | Military grade weapons |
| Most civilian weapons are | Low-Velocity |
| Important GSW factors | Type of tissue Muscle - high elasticity - tolerate the stretch Solid organs - low elasticity - minimal stretch |
| GSW can transfer _______ into the wound | Clothing Skin Hair |
| Blast injuries | Usually in military conflicts Also seen in ship yards, underground mines, chem plants, terrorist activities |
| Risk of contamination to wounds from blasts from? | Environment Toxins, chemicals Dirty bombs |
| 4 Blast Mechanisms | Primary - Pressure waves Secondary - Shrapnel Tertiary - Thrown/hurled - Ground shock Quaternary - Everything else: burns, suffocation, poisoning, crushing etc |
| Primary blast injuries | Can damage vessels and organs with air in them Ear drums, lungs, intestines |
| Patients who survive a blast will have? | A combination of all 4 mechanisms |
| Secondary blasts cause the most _______ Primary blasts are the most ________ | Trauma (from shrapnel) Overlooked (most the damage can be internal) |
| Multisystem Trauma | Describes a persona who has multiple traumatic injuries, such as Head and spine or Chest and a leg |
| When finding a patient with Multisystem Trauma | Provide rapid treatment, transport and alert medical control of their injuries |
| Golden Principles of Prehospital Trauma Care | You and your teams safety first Additional personnel or equipment MOI Identify/manage Life Threats |
| Hemorrhage control has the? | Highest priority Severe bleeding or complete/partial amputations must be treated with dressings or tourniquets High-flow O2 Shock Therapy |
| Crush victims should be removed with? | Extraction and transportation |
| Multisystem Trauma Transport | Requires surgical intervention On-scene time 10min or less (platinum 10) SAMPLE/secondary assessment during transport Have ALS intercept or call air transport |
| Multisystem Trauma patients with a TBI (traumatic brain injury) have? | Twice the risk of death than someone without a TBI |
| Head Injuries | High chance of unseen injury May tear, bruise, bleed or swell Must include a Neuro Examination, PERRL, LOC |
| Head Injuries 2/2 | Some patients don't have obvious signs and of unseen brain injury until minutes or hours after injury |
| Neck/Throat Injuries | DCAP-BTLS the neck region JVD and Tracheal deviation, swelling, bruising, redness |
| Neck/Throat Injuries 2/3 | Penetrating injuries could let air into the wound, creating an air embolism and may lead to cardiac arrest Occlusive dressings can prevent this Can cause rapid death |
| Neck/Throat Injuries 3/3 | Crush injury may cause the cartilages of the upper airway and larynx to fracture, lead to air leaking into the neck tissue, trapping air in the subcutaneous tissue Can cause rapid death |
| Chest Injuries | Blunt trauma can fracture/break ribs or sternum, stopping the lungs from expanding If severe enough, may tear large vessels in the chest, causing rapid bleeding |
| Chest Injuries 2/3 | Lungs can become bruised Air collection can collapse lungs (pneumothorax) Air collection that squeezes the lungs and heart is Tension pneumothorax |
| Chest Injuries 3/3 | Penetration or perforation to the chest is called an Open Chest Wound. Air can enter the chest. If untreated can cause shock and/or death. Unstable, check every 5min DCAP-BTLS + Lung sounds + Chest rise/fall |
| Abdomen Injuries | High blood flow Includes Abdomen and retroperitoneum Solid organs can tear, lacerate or fracture Hollow organs can rupture and leak toxins Holds a large amount of blood and can bleed out internally |
| Scene time | Platinum 10. Critically injured should be transported within 10 minutes Identify MOI, Decreased LOC, Treat threats to ABCs Young/old/chronic illness should be considered High-risk |
| Destination Selection: Trauma Centers | Level 1: Regional/Large cities/Heavy population/Teaching hospitals Level 2: Less populated/Initial definitive care Level 3: Communities that don't have Level 1 or 2 - ALS centers Level 4: Remote locations. Prepare for higher level facilities |
| Types of transport | EMS: Paramedic/EMT ambulances and fire rescue Air Transport (HEMS: helicopter emergency medical services) |
Created by:
cmoney833
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