Module 5: Guided Review, Module Five: Comparing Chest Injuries, MOD 5: Disease Review

Signs and symptoms of neurogenic shock

-bradycardia -hypotension -signs of neck injury -altered mental status -hypothermia

Rule of nine's for the infant

18 percent for head, 18 percent for front, 18 percent for back, 14 percent for one leg, 14 percent for another leg, 9 percent for arm, 9 percent for other arm, genitals is 1 percent

Secondary blast injury

A penetrating or nonpenetrating injury caused by ordnance projectiles or secondary missiles.

Decompensation shock

A period when the oy can no longer compensate for low blood volume or lack of perfusion. Late signs such as decreasing blood pressure become evident.

Treatment of obstructive shock

ALS assist and/or rapid transport

Patient assessment for late or deep cold injury (frostbite)

Affect skin appears to be white and waxy. In deep cold injury tissue death occurs. Days later the ski will turn dark black (dead) necrotic. (requires surgery) Do not Squeeze or poke the tissue. The condition of deeper tissues can be determined by gently feeling th area. Do the assessment as if the affected area was a broken bone.

Determining the Severity of burns

Agent or source Body region involved Depth Extent Age Other illness or injuries

What are the three components of determining patient severity?

Agent or source of the burn Body region burned Depth of Burn Extent of burn Age of patient Oher illness and injuries

List the anatomical criteria for patient severity

All penetrating injuries to head, neck , torso, and extremities to elbow and knees Chest wall instability or deformity (frail chest) Two or more proximal lone bone fractures Crushed, degloved, mangled, or pulseless extremity. Amputation proximal to wrist and ankle pelvic fractures, open or depressed skull fracture paralysis

Superficial burns

Also called a first degree burn; it only involves the epidural layer of the skin. Ex/sunburn

Signs and symptoms of compensated shock (OUTSIDE)

Altered mental status (earliest), anxious confused, or lethargic, or lethargic, changes in mentation, decreased urinary output, pale skin, delayed capillary refill time, narrowing pulse pressure, increasing heart rate, increasing pulse rate, increasing respiratory rate.

Define active rewarming

Application of an external heat source to rewarm the body of a hypothermic patient

List steps for caring an unamputated part

Apply direct pressure first and use a tourniquet if direct pressure fails or it die pressure is not possible, then want consider the use of a pressure dressing over the site of the ambulation.

List the steps to control bleeding

Apply firm pressure with the palm of your hand Hold the pressure firmly until the bleeding is controlled when apply direct pressure while resisting the temptation to apply layers of absorbent dressing. Once the bleeding is controlled, bandage a dressing firmly in place to form a pressure dressing. Do not remove dressing it has been placed on wound.

The patient must be what to do active rewarming

Be alert and responding appropriately without delaying transport and rewarm the patient while en route.

Tertiary blast injuries

Blast wind propel the patient to the ground or against the objects causing further injury.

Sign and symptoms of decompensated shock

Blood flow drops causing a drop in blood pressure. Muscle struggle causing hypo perfused states to fail leading to be bradycardic, irregular respiratory patterns while slowing down, will lead to poorly perfused respiratory muscles will stop.

Signs and symptoms of internal bleeding

Bruising, swelling, or tenderness over vital organs, painful, swollen, or deformed extremities, bleeding from the mouth, rectum, vagina, or other body orifices, vomiting coffee grounds or bright red vomitus, dark tarry stools, and signs and symptoms of shock.

Define classifications of burns

By agent, by depth, and by severity

What is the treatment and care for dry powdered burns

Carefully remove any contaminated clothing while avoiding raising a cloud agent, then use continuous amounts of flooding to the affected area for at least twenty mins, and continue to en route to the hospital while applying a sterile dressing or burn sheet, possibility treating for shock.

Flail Chest

Chest expansion paradoxical and depends on underlying injuries.

Signs and symptoms of cardiogenic shock?

Chest pain, Irregular or weak pulse, Hypotension Cyanosis , cool, clammy, skin, anxiety rales, and pulmonary edema

List and describe the five mechanisms for heat loss

Conduction, convection, radiation, evaporation, and respiration

What is the impalaed object is to big to fit in the ambulance?

Contact emergency department physician for special instructions, challenge is to stabilization of object while leaving the object as found.

Define passive rewarming

Covering a hypothermic patient and taking other steps to prevent further heat loss and help the body rewarm its self.

Signs and symptoms of anaphylactic shock?

Develops within secs - mild itching or rash, burning skin - vascular dilation - generalized edema - rapid death.

List all methods to control bleeding

Direct pressure, hemostatic agents, wound packing, tourniquet use on extremities, and specialized compression devices for junctional bleeding.

Scene safety with burns

Do not approach a burn patient if there is a risk of electricity or a chemical/radiological threat.

Signs and symptoms of obstructive shock

Dyspnea, rapid, weak - rapid shallow breaths - decreased lung compliance - unilateral, decreased or absent breath sounds - decreased blood pressure, JVD, subcutaneous emphysema, cyanosis, tracheal deviation, towards affected side - beck's triad (cardiac tamponade), JVD, narrowing pulse pressure, and muffled heart sounds.

Steps of treatment and care of impaled object including the cheek

Examine the wound site. Remove object if you find perforation and you can see both ends of the object. Pull it out by the direction it entered the cheek, do not twist the object, if you find perforation but the tip of the object is also impaled into a deeper structure (palate) then stabilize the object and do not try to remove it. Position the patient to allow for drainage, unless spinal injury is indicated. Dress the outside by using pressure dressing and bandage or apply a sterile dressing and use direct hand pressure to control bleeding. Consider the need for oxygen and care for shock.

Burn location that are considered serious

Face, hands, feet, and genitals

List four burn areas that are considered significant

Face, hands, feet, genitalia, perineum, or major joints

List the MOI criteria for patient severity

Falls (adult >20 feet or one story equal to 10 feet, children >10 feet or 2-3 tens their height) High-risk auto crashes - Intrusion, partial or complete ejection, death in same passenger compartment, vehicle telemetry stat consistent with high risk of injury. AUTO VERSUS PEDESTRIAN/BICYCLIST THROWN, RUN OVER, OR SIGNIFICANT >20 MPH IMPACT. MOTORCYCLE CRASH >20 MPH

Compensation in children with shock is a key indicator of what?

Fast heart rate due to fewer contractile heart cells

List the steps for caring for burns

Flame - wet down, smother, then remove any affected clothing Semi-solid - cool with water Ensure open airway, assess breathing Looks for signs of airway injury such as hoarse voice, stridor, soot deposits, burned nasal hair, or facial burns. Complete the primary assessment treat for shock evaluate burns Do not clear debris, remove clothing and jewelry wrap with dry sterile dressing consider requesting ALS for pain management burns to hands or feet need to be separated with sterile gauze pads reduce pain by applying cool wet dressing to burn area if burn is less than 10 percent of total body area burns to eyes do not open the patients eyelids if burned, apply sterile gauze to both eyes to prevent sympatric movement. TRANSPORT ALL BURN PATIENTS ASAP

List the physiologic criteria for patient severity.

Glasgow coma scale - below 14 Systolic blood pressure - below 90 Respiratory rate below 10 or over 29 (infants less than 20)

Rule of Nines for Adults

Head (entire)- 9% Chest (front)- 9% Chest (back)- 9% Abdominal (front)- 9% Abdominal (back)- 9% Entire Arm- 9% Genitals- 1% Entire Leg-9%

Rule of Nines Child

Head 18%, Back 18%, Chest 9%, Abdomen 9%, Arms 9% each, legs 14% each.

Rewarming a frozen body part

Heat water between 100-105 Fill the container with the heated water Fully immerse the injured part Dry affected area and apply dry sterile dressing, placing between fingers or toes. Keep patient at rest Warm without over heating such as covering the patients head with a towel leaving the face exposed. Continue to monitor Do not allow lib to freeze Transport STAT with the affected limb slightly elevated.

Distributive shock

Hypo perfusion due to the lack of blood vessel tone. Blood vessel dilation leads to decreased pressure within the circulatory system

Signs and symptoms of compensated shock (INSIDE)

Hypo perfusion, effecting sensitive body cells and disrupting function, regulation of volume, reduction of excretion, vasoconstriction, Cardiopulmonary response increases heart rate and contractile force, increased respiratory rate.

Neurogenic shock

Hypoperfusion caused by spinal cord injury that results in systemic vasodilation.

List and define all five types of shock

Hypovolemic, hemorrhagic, cardiogenic, distributive, and neurogenic shock.

What is the treatment and care for chemical burns to the eyes

Immediately flood the eyes with water, keep running water from a faucet, low pressure hose, bucket, cup, bottle, rubber, bulb syringe, IV set-up, IF ALS is available request them start transport and continue to wash the eye for at least 20 mins, after washing cover both eyes with moisten pads, and wash patients eyes for 5 more mins if patient complains of pain.

When performing direct pressure, what do I do if dressing material is not immediately able?

In cases of profuse bleeding, do not waste time finding a dressings, instead use your gloved hand to apply direct pressure.

What are the causes of cardiogenic shock?

Inadequate heart function. Disease of muscle tissue. Impaired electrical system.

Shock

Inadequate tissue perfusion that potential problems involves volume loss, pump failure, loss of blood tone, and obstruction of blood flow.

Primary blast injury

Injuries caused by an explosive pressure wave on the hollow organs of the body.

Write out the steps to stop bleeding and treating for shock

Maintain A-B-C's and provide support as needed, consider high-concertation oxygen, control external bleeding, if bleeding is in an injury extremity, apply appropriate splint, persevere body temperature, provide prompt transport to appropriate medical facility, internal bleeding is to be controlled in the operating room.

What are the possible causes of obstructive shock?

Mechanical obstruction of the cardiac muscle causing a decrease in cardiac output.

Signs and symptoms of shock

Moist, pale, cold, clammy skin Weak rapid pulse, increasing shallow respiration decreased blood pressure Urinary retention and fecal incontinence Irritability or excitement, and potentially thirst

List the assessment for heat injury with moist pale to normal skin

Muscle cramps (legs and abdomen) Weakness or exhaustion and dizziness, periods of faintness Rapid, shallow breathing Weak pulse Heavy Perspirations Loss of consciousness

Patient treatment for late or deep cold injury (frostbite)

Oxygen is hypoxia or vital signs indicate or suggest for shock Transport to medical facility without delay, protecting frostbite or frozen area by covering it and handling it a gently as possible.. If transport is delayed get patient indoors and maintain warmth and request further medical direction if needed.

Treatment of cardiogenic shock

Position of comfort, oxygen, assist ventilations is needed, and transport promptly.

List the four functions of skin

Protection, water balance, temperature regulation, excretion, and shock absorption.

List patient care for heat injury to the skin

Remove patient from hot environment, place in cool environment with the a/c running high. Remove the patients clothing and apply cool packs to neck, groin, and armpits. Keep skin wet by applying water by sponge or wet towels. Aggressively fan the patient. For children cool in tepid water. Administer high-flow oxygen Transport immediately.

List patient care for heat injury with moist pale to normal skin

Remove patient from the hot environment and place in cool one. If there are signs of hypoxia, or the patients vital signs indicate shock, administer oxygen Loosen or remove clothing and cool the patient by fanning without chilling the patient. Watch for shivering Put the patient in the supine position while at rest. If patient is responsive and not nauseated you will not transport, but give small sips of water. If nausea or vomiting is indicated, do not give water and transport patient on left side.

What are the four principles of multisystem-trauma management?

Scene safety Ensure open airway Perform or emergency moves as necessary, Adapt to the situation

Criteria for burn center treatment by severity

Second-degree or greater than 10 percent of burns on the body Burns involving the face Third-degree full thickness burn Electrical burns Inhalation burns other medical problems/trauma Other needs not met by the hospital,

What causes septic shock?

Severe bacterial infection

Hypovolemic shock

Shock resulting from blood or fluid loss

Cardiogenic shock

Shock, or lack of perfusion, brought on not by blood loss, but by inadequate pumping action of the heart. It is often the result of a heart attack or congestive heart failure.

What is the treatment for an impaled object in the eye?

Stabilize the object by placing a 3-inch gauze bandage or folded 4 x 4 on either side of object Apply rigid protection - paper drinking cup Have rescuer help to stabilize the dressing and cup while you secure them Dress and bandage the uninjured eye (prevent movement) Consider oxygen and care for shock Reassure emotional support.

Classifying burns by depth

Superficial, partial thickness, and full thickness.

Signs and symptoms Psychogenic shock?

Syncopal episode (fainting) non-life threatening

Avulsion

Tearing away or tearing off of a piece of flap of skin or other soft tissue.

Examples of obstructive shock

Tension pneumothorax and cardiac tamponade

Tension Pneumothorax

Trachea is away, chest expansion is decreased chest rise uneven with absent breath sounds and JVD present with the presence of shock (cold, pale, and clammy).

Hemothorax

Trachea is midline with decreased chest expansion, the breath sounds are diminished if large, possible JVD with hemopneumo with shock or hemoptysis present (coughing up blood).

Aortic injury and dissection

Trachea midline, normal chest expansion, normal breath sounds, JDV present. Tearing chest/back pain, pulse or B/P difference in R or L extremities, or between arms and legs, palpable, and pulsating mass.

Pneumothorax

Trachea will be midline, chest expansion decreased, breath sounds are diminished with no JVD present

Traumatic Asphyxia

Trachea will be midline, chest expansion will be normal, reduced breath sounds, JVD present, Purplish color above injury, bulging eyes, swollen tongues, and lips.

List the patient care steps for bites and stings

Treat for shock, even if no present signs exist. Call medical direction. Remove stinger or venom sac Remove Jewelry from the affect limb If wound is on an extremity (not joint), place constricting bands above or below the sting or bite, (helps slow the spread of venom to lymph nodes). Always use if scorpion or black widow spider is involved.

When can I remove an impaled object and when do I leave it in place?

When a patient with a puncture wound involving a impaled object you DO NOT REMOVE and you CAN REMOVE if the object you found perforation and you can see both ends of the object

List steps for caring an amputated part

Wrap it in a sterile dressing and secure the dressing with a self-adhesive gauze bandage then wrap or bag the amputated part in a plastic bag and keep it cool with ice packs. NEVER IMMERSE THE AMPUTATED PART AND NEVER IN DIRECT CONTACT WITH ICE. SDO NOT COMPLETE THE AMPUTAION

Full thickness burn

a burn in which all the layers of the skin are damaged. There are usually areas that are charred black or areas that are dry and white. Also called a third-degree burn.

Partial thickness burn

a burn involving the epidermis and dermis that usually involves blisters; commonly called a second-degree burn

Laceration

a cut, tear

Compensated shock

a period when the patient is developing shock but the body is still able to maintain perfusion

Abrasion

a scratch or scrape

Classifying burns by agent and source

against causing burn such as a chemical or electricity.

Crush injuries

an injury caused when force is transmitted from the body's exterior to its internal structures. Bones can be broken, muscles, nerves, and tissues damaged causing internal bleeding. In extreme cases where the torso is compressed, internal organs such as the stomach or urinary bladder can be ruptured, causing internal bleeding, and allowing digested food or urine to spread to the abdominal cavities.

Puncture

an open wound that tears through the skin an destroys underlying tissues. Penetrating wound can be swallow or deep and a Perforating puncture wound has both entrance and an exit wound.

What are the causes for neurogenic shock?

damaged cervical spine which causes widespread vasodilation.

What causes anaphylactic shock?

extreme life-threatening allergic reaction

Compartment syndrome

involves the compression of nerves and blood vessels due to swelling within the enclosed space created by the fascia that separates groups of muscles

Treatment of anaphylactic shock

manage the airway, assist ventilations, administer high flow O2, determine cause, assist with epinephrine, transport

Treatment of neurogenic shock

secure airway - spinal stabilization - assist ventilations assist with ventilations - administer oxygen - persevere body heat, transport promptly.

Hemorrhagic shock

shock resulting from blood loss

Capillaries bleeding

slow, even flow

Arterial Bleeding

spurting blood, pulsating flow, and bright red color

Venous bleeding

steady, slow flow, dark red color

Perfusion

the supply of oxygen to and removal of wastes from the body's cells and tissues as a result of the flow of blood though capillaries.

Amputation

the surgical removal or traumatic severing of a body part

Cardiac tamponade

trachea will be midline chest expansion will be normal, breath sounds are normal, JVD present, heart sounds are muffled with a narrow pulse pressure, very weak pulse, hypotension present.

Treatment for septic shock

transport promptly - oxygen - ventilations - keep patient warm

What are the major causes of shock in a trauma patient?

volume loss, pump failure, loss of blood vessel tones, and obstruction of blood flow.

What is the signs and symptoms of septic shock?

warm skin, tachycardia, low blood pressure