trauma/spine
The law of conservation of energy states that: A. a body at rest will remain at rest unless acted upon by an outside force. B. energy can be neither created nor destroyed; it can only change form. C. the force that an object can exert is the product of its mass multiplied by its acceleration. D. kinetic energy can be converted only to thermal or chemical energy.
B. energy can be neither created nor destroyed; it can only change form.
The third phase of a motor vehicle accident involves: A. impact by another vehicle. B. deceleration of internal organs. C. injuries caused by flying debris. D. crush injuries to the body
B. deceleration of internal organs.
Paradoxical chest wall movement is a classic sign of a
is a classic sign of a flail chest.
posturing is a sing of what
is a sign of brainstem injury
what is significant about the lederly brain shrinking?
it leads to increased subdural space, which if there was a bleed it would retain a larger amount of blood
Bones are connected to other bones by bands of tough fibrous tissues called
ligaments.
4 types of skull fractures
linear, depressed, basilar and open
diffuse axonal injury presentation(mild)
loss of consciousness, confusion, disorientation, amnesia
MOI in MVC`s decribed as the 3rd collision?
organs that shear or tear(liver kidneys small intestines spleen)from there point of contact.
massive hemothorax
parietal and visceral pleura are violated and blood begins to accumulate within this space. 1500ml of blood within the pleural space, 25-30% of blood loss in the average adult.
answer is C
patients with major or multiple bone or joint injuries and neck or back injuries would be triaged as delayed
Which of the following fractures has the greatest potential for internal blood loss and shock?
pelvis
Which of the following is not a contraindication to the use of the pneumatic antishock garment (PASG)?
pelvis fracture
Baroreceptors, also known as
pressure" receptors, are located within the carotid arteries and aorta. They are extremely sensitive to changes in arterial perfusion pressure (ie, blood pressure
patients with maxillofacial trauma
protect C-spine, monitor patients neurological status
A "hip" fracture is actually a fracture of the:
proximal femur
what is Tinnitus
ringing in the ears
fourth phase
secondary collisions, occurs when the vehicles occupants are hit by moveable objects(packages, purses, etc..) within the vehicle. These objects are traveling at the automobiles speed at impact.
When ligaments are torn or stretched, it is called a:
sprain
hollow organs
stomach, gallbladder, urinary bladder, intestines, uterus
Shearing
stress that pushes masses of somthing in opposite directions, in a sideways movement
Skeletal muscle is also referred to as __________ muscle.
striated
NSAID
such as ibuprofen
what are the 2 divisions of the automatic nervous system
sympathetic and parasympathetic
Femoral shaft fractures can result in up to _____ mL of internal blood loss.
1,000 mL
A femur fracture my account for as much as
1,500 ml of blood loss
Approximately how many bones are in the human body?
206
A pelvic fracture may account for hemorrhage of more then?
2liters
optic nerve
2nd cranial nerve, provides the sense of vision
oculomotor nerve
3rd cranial nerve, innervates the muscles that cause motion of the eyeballs and upper eyelids also caries the nerve fibers that cause constriction and accommodation of the pupils.
How many phases of a MVC are there?
5 phases tied to the effects of progressive deceleration
A healthy adult can tolerate blood loss of up to ____ mL over a period of 15 to 20 minutes without any negative effects. A. 500 B. 1,500 C. 750 D. 1,000
500
liver
A large solid organ that lies in the right upper quadrant immediately below the diaphragm
A; This is correct!
A pattern of irregular breathing that varies in depth and rate with sudden periods of apnea is referred to as Biot's respirations, also known as ataxic breathing. This respiratory pattern is commonly seen in patients with increased intracranial pressure, either from closed head trauma or hemorrhagic stroke. Clearly, patients displaying this respiratory pattern need ventilatory assistance
Which of the following spinal cord injuries classically presents with weakness of the upper and lower extremities on the ipsilateral side and loss of pain and temperature sensation on the contralateral side? A:Brown-Séquard syndrome B:Central cord syndrome C:Complete cord transection D:Anterior cord syndrome
A.
A patient with hemorrhagic shock would be expected to have: A. flattened jugular veins. B. warm, flushed skin. C. a widened pulse pressure. D. an increased hematocrit.
A. flattened jugular veins.
You and your partner are triaging patients at the scene of a motor-vehicle crash while awaiting the arrival of additional ambulances. Which of the following patients would be triaged as delayed?
A:Abdominal distention; pallor; responds appropriately to questions B:Anterior neck pain; stridorous breathing; history of type 2 diabetes C:Bilaterally deformed femurs; severe neck pain; conscious and alert D:Tibial fracture; hematoma to the forehead; conscious but confused
You are assessing an unresponsive man's respirations and note that he is taking irregular breaths that vary in volume and rate with periods of apnea. This breathing pattern is MOST consistent with:
A:Biot's respirations. B:Cheyne-Stokes respirations. C:Kussmaul's respirations. D:agonal respirations.
Which of the following injuries would pose the MOST immediate threat to a patient's life?
A:Cerebral contusion B:Bilateral femur fractures C:Crushed pelvis D:Laryngeal fracture
You are called to an assisted living facility for a sick resident. The patient, a 70-year-old woman, reports tinnitus and difficulty concentrating. The patient's neighbor, who is present at the scene, tells you that the patient has consumed five or six cups of ice over the past hour. You should suspect:
A:acute leukemia. B:lymphoma. C:polycythemia. D:chronic anemia.
When assessing a patient with a closed head injury, you note the presence of trismus. This is defined as:
A:leftward gaze of the eyes. B:unequal pupils. C:clenching of the teeth. D:unusual breath odor.
You would expect to encounter trismus in a patient with:
A:tetanus. B:mumps. C:meningitis. D:rabies.
After a motorcyclist is ejected from his or her motorcycle, secondary collisions: A. typically cause bilateral fractures of the femurs and tibias. B. cause an unpredictable combination of blunt injuries. C. result in less severe injuries if the rider is wearing leather. D. most commonly involve a stationary object.
B. cause an unpredictable combination of blunt injuries
Epidural hematoma
Accumulation of blood between the dura mater and cranium
Retroauricular ecchymosis
Also called battles sign, is black and blue discoloration over the mastoid process( just behind the ear) that is a characteristic of a basilar skull fracture.
Bilateral periorbital ecchymosis
Also called raccoon eyes. Is a black and blue discoloration of the area surrounding he eyes, is a characteristic of basilar skull fracture.
Halo sign is an indication of basilar skull fracture
Also nasal discharged is a indication
unequal pupils are called?
Anisocoria
answer is D
Any problem with the airway poses an immediate threat to life. Examples include laryngeal fracture, crushing injury to the trachea, and airway obstruction, among others. Bilateral femur fractures and crushing injuries to the pelvis frequently cause severe internal bleeding, but airway problems, especially those previously mentioned, always pose an immediate threat to life. Cerebral contusions uncommonly result in death.
Pericardial tamponade is another injury that can result in obstructive shock.
As the pericardium fills with blood, the more pliable structures—namely the atria and vena cavae—become compressed, which reduces the preload being delivered to the heart and thereby diminishes stroke volume and cardiac output
Which of the following spinal cord injuries classically presents with weakness of the upper and lower extremities on the ipsilateral side and loss of pain and temperature sensation on the contralateral side?
Brown-Séquard syndrome
According to the Waddell triad, the second impact from a motor vehicle occurs when the: A. child is run over by the car as he or she is propelled to the ground. B. car's bumper strikes the pelvis and femurs instead of the knees. C. chest and abdomen strike the grille or low on the hood of the car. D. head strikes the ground, resulting in skull and facial fractures.
C. chest and abdomen strike the grille or low on the hood of the car.
what causes respiratory acidosis to occur?
CO2 retention leads to increased Paco2 levels
Subdural hematoma
Collection of blood directly beneath the dura matter
diffuse axonal injury presentation(moderate)
immediate loss of consciousness, persistent confusion and disorientation, mood swings anxiety and motor deficits
The MOST commonly fractured bone(s) in the body is the:
clavicle.
A 16-year-old boy has a severe headache and vomiting that has progressively worsened over the past 36 hours. Which of the following questions would be MOST important to ask him? A:Do you have a history of hypertension? B:Is there a history of meningitis in your family? C:Do you have any abdominal pain or diarrhea? D:Have you experienced a recent head injury?
D. A severe headache and vomiting that progressively worsens could indicate a subdural hemorrhage; therefore, one of the most important questions to ask the patient is if he has experienced any recent head injury, even as far back as a week. Subdural hematomas are the result of venous bleeding and can be insidious in their presentation, with symptoms that often appear hours to days after the initial injury. Hypertension is unlikely in a 16-year-old patient, and meningitis is not a hereditary disease.
catecholamines
epinephrine and norepinephrine,the sympathetic nervous system
the oculomotor nerve (cranial nerve III) arises from the midbrain and exits the brain to each eye. It controls the upper eyelid muscle, which raises the eyelid; the extraocular muscle, which moves the eye inward; and the pupillary muscle, which constricts the pupil.
Damage to or pressure on this nerve will cause the pupils to dilate and fail to constrict when light is shone into them. Common causes of this include increased intracranial pressure, stroke (both ischemic and hemorrhagic), and cerebral hypoxia.
Status epilepticus is defined as a prolonged (> 10 minutes) seizure or consecutive seizures that occur without an intervening return to consciousness.
During a seizure, neurons are using huge amounts of glucose and producing lactic acid. For short periods, this does not cause long-term damage. If the seizure continues, however, the body can't remove the waste products effectively or ensure adequate glucose supplies; this can cause neuronal damage or death.
what is the number 1 cause of injury in the elderly?
Falls, the elderly account for more then 75% of fall related deaths.
which plasma proteins assist with clotting?
Globulin, Fibrinogen, Prothrombin
primary blast injury
injury from the pressure wave
common amongst the elderly?
Hip fracture, the most common risk factor is osteoporosis. They tend to only stay alive a year after fracturing their hips.
pancreas location
Horizontally along posterior ab wall, adjacent to the greater curvature of the stomach
What situations does respiratory acidosis occur?
Hypoventilation(HEROIN OVERDOSES!!!) or intrinsic lung diseases(asthma, COPD)
commotio cortis
If the chest receives a direct blow during the critical portion of the heart's repolarization period (relative refractory period), the result may be immediate cardiac arrest. This phenomenon is called commotion cortis
diffuse axonal injury presentation(severe)
Immediate and prolonged loss of consciousness, posturing and other signs of increased ICP
Burn shock
Interrupt integrity of capillaries and vessels and allow them to leak plasma and plasma proteins. The push from hydrostatic pressure forces fluid outside into interstitial space. The pull of plasma proteins that are outside draws fluid into interstitial space
A tension pneumothorax occurs when
excessive air in the pleural space causes tension, which collapses the lung and then shifts to the contralateral (opposite) side of the chest. As pressure shifts across the mediastinum, preload is impaired due to kinking of the vena cavae, and cardiac output is obstructed due to myocardial compression and kinking of the aorta
Bipolar meds
Lithium and valproic will be used front line but some patients may develop toxicity and in this case valproic acid and trgetol(carbamazepine) are used
Which of the following organs is LEAST susceptible to pressure changes caused by an explosion? A. Liver B. Tympanic membrane C. Lungs D. Gastrointestinal tract
Liver
what is the number 2 cause of injury in the elderly?
MVC, the elderly account for 10% of all traffic deaths
stomach location
Most Upper left quadrant
Direct injurys to brain
Page 996 it's high lighted
carina
Point at which the trachea divides into the left and right mainstream bronchi.
gallbladder location
RUQ Pear shaped sack in the depression of the posterior surface of liver.
Basilar skull fracture presents with
Retroauricular and bilateral periorbital ecchymosis
kidneys location
Retroperitoneal [behind the peritoneum] on dorsal body wall; Superior lumbar region from T12 to L3; Right Kidney is lower due to the presence of the Liver.
. The resulting symptoms can be remembered using the mnemonic "DUMBELS," which stands for defecation, urination, miosis (pupillary constriction), bradycardia and bronchorrhea, emesis, lacrimation, and salivation. Another useful mnemonic is "SLUDGEM," which stands for salivation, lacrimation, urination, defecation, GI distress, emesis, and miosis.
Which of the following clinical presentations is MOST consistent with exposure to a chemical nerve agent?
basilar skull fracture
extension of linear fracture to base of the skull, CSF draining from ears, raccoon eyes, battle signs
conjugate gaze
eyes move in different direction
solid organs
Spleen, liver, pancreas, kidneys
duodenum
The first 12 inches (30 cm) of the human small intestine
answer is A;
The most common presenting manifestation in patients with tetanus is trismus—spasm of the jaw muscles that causes difficulty opening the mouth—hence the term "lockjaw." Tetanus is a potentially fatal disease of the central nervous system caused by the bacterium Clostridium tetani. If spores of C tetani enter the circulatory system, they multiply and produce a neurotoxin called tetanospasmin, which attacks the nerves that regulate muscular activity. As tetanospasmin circulates more widely, it interferes with the normal activity of nerves throughout the body, resulting in generalized muscle spasms. Any open wound that is contaminated with soil, saliva, or feces—especially if not properly cleaned—and puncture wounds from nonsterile items such as nails or needles, are at high risk of being infected with C tetani. Rabies, mumps, and meningitis—all of which can be fatal—are typically not associated with trismus.
D; This is correct
Tinnitus (ringing in the ears), a craving for ice, and difficulty concentrating are hallmark findings of chronic anemia. Anemia is defined as a deficiency of red blood cells. Other findings may include a headache, dizziness, and tachycardia. Polycythemia, an overproduction of red blood cells, causes flushing of the skin; it is not commonly associated with the clinical signs that this patient is exhibiting. Leukemia and lymphoma are types of cancer that commonly manifest with persistent weakness, fever, and swollen lymph nodes (lymphadenopathy).
Trismus is defined as clenching of the teeth due to spasm of the jaw muscles; it is a common finding in patients with severe head trauma.
To most effectively control the airway, patients with trismus often require rapid sequence intubation (RSI).
Full-thickness burns should be covered with dry, sterile dressings or a sterile burn sheet. .
Unless associated with occult internal bleeding from another injury, burn patients are typically not hypotensive in the field; therefore, IV fluid boluses are usually not indicated
A subluxation occurs when
a joint is incompletely dislocated.
what is the abdominal cavity lined with?
a membrane called the peritoneum which is similar to the pleura of the thoracic cavity
patient is bleeding from the nose is a sign of what due to trauma
a skull fracture.................. nasotracheal intubation is contraindicated
Anterior cord syndrome is caused by
caused by pressure on the anterior part of the spinal cord by a vertebral fragment that is forced posteriorly into the spinal canal; signs and symptoms include decreased sensation of temperature and pain distal to the injury, while light touch and position sensation (proprioception) remain intact.
what is the largest cavity in the body?
abdominal cavity
fifth phase
additional impacts, when the vehicle is struck by other vehicles after the crash or falling trees which may increase the seriousness of the other injuries.
The condition in which the pupils are unequal is called
anisocoria
The condition in which the pupils are unequal is called
anisocoria.
anxiolytic medications and examples?
benzodiazepines, drugs for a sedative effect for anxiety. xanax, valium, clonazepam(klonopin), lorazepam(ativan), and no benzo`s-Buspiarone(buSpar
An important aspect in the management of a patient with extensive full-thickness burns includes
continuous assessment of the airway
secondary blast injuries
damage results from being struck by flying debris, shrapnel, glass, or splinters set in motion by the expolsion.
secondary blast injury
debris or fragments from the explosion
third phase
deceleration of the internal organs, involves the bodies supporting structures and the moveable organs
second phase
deceleration of the occupant, which starts during sudden braking and continues during impact and collision. results in compression, deceleration and shear trauma.
first phase
deceleration of the vehicle, the vehicle strikes another vehicle and is brought to an abrupt stop
what are the two Posturing called
decorticate (flexor) or decerebrate (extensor), is a sign of brainstem injury
what changes in the elderly`s respiratory system with age?
decrease in elasticity of the lungs and in the decrease in the size and strength of the respiratory muscles and calcification of the cartilage makes the chest wall stiffer. VITAL CAPACITY DECREASES and residual volume increases.
What happens to an elderly persons brain
decreases in terms of weight by 5-10%, it shrinks leaving space.
"DUMBELS," which stands for
defecation, urination, miosis (pupillary constriction), bradycardia and bronchorrhea, emesis, lacrimation, and salivation
A supracondylar or intercondylar fracture is also known as a fracture of the:
distal humerus.
primary blast injuries
due to the blast itself, damage to the body is caused by the pressure wave itself
defecation
elimination of feces from the digestive tract through the anus
miscellaneous blast injury
from burns or scrapes as a result of the blast
tertiary blast injury
from the victim being propelled
During your rapid assessment of a man who sustained blunt trauma to the anterior chest, you note paradoxical movement to the left hemithorax. You should:
have your partner stabilize the segment with his or her hand.
Once this is discovered
immediate hand stabilization should be applied until the flail segment can be stabilized with a bulky dressing.
Brown-Séquard syndrome
syndrome is caused by partial transection (hemitransection) of the spinal cord, typically from intervertebral disk rupture or an unstable vertebral fragment that puts pressure on the spinal cord. Classically, pressure on half of the spinal cord causes extremity weakness on the ipsilateral (same) side as the cord injury, and loss of pain and temperature sensation on the contralateral (opposite) side. is caused by partial transection (hemitransection) of the spinal cord, typically from intervertebral disk rupture or an unstable vertebral fragment that puts pressure on the spinal cord. Classically, pressure on half of the spinal cord causes extremity weakness on the ipsilateral (same) side as the cord injury, and loss of pain and temperature sensation on the contralateral (opposite) side.
Skeletal muscle is attached to the bone by tough, ropelike fibrous structures called:
tendons
Where does the abdominal cavity extend from?
the diaphragm to the pelvis
Whom does osteoporosis affect the most
the most rapid loss of bone occurs in women during the years following menopause, and many postmenopausal women use hormone therapy as a means to reduce the loss of bone.
central cord syndrome,
the patient experiences greater motor deficit to the upper extremities; he or she often has paralyzed arms, but retains the ability to move his or her legs
what are the 2 divisions of the peripheral nervous system
the somatic nervous system and automatic nervous system
spleen
upper left quadrant
spleen location
upper left quadrant
What do the catecholamines cause?
vasoconstriction, increased systemic vascular resistance
kehr`s sign
when patients report pain in the left shoulder because of referred pain from diaphragmatic injury or ruptured spleen
Catecholamines are responsible for the signs of shock that are classically observed in patients with hypovolemic shock (eg, tachycardia, pallor, and diaphoresis).
A: BP, 70/50 mm Hg; pulse rate, 56 beats/min; respirations, 24 breaths/min B:BP, 60/40 mm Hg, pulse rate, 122 beats/min; respirations, 26 breaths/min C:BP, 112/60 mm Hg; pulse rate, 68 beats/min; respirations, 16 breaths/min D:BP, 180/100 mm Hg; pulse rate, 44 beats/min; respirations, 8 breaths/min
Mastoid bruising and cerebrospinal otorrhea following diffuse impact to the head are MOST indicative of: A:a basilar skull fracture. B:herniation of the brainstem. C:massive cerebral edema. D:a fractured cribriform plate
A: basilar skull fracture. Mastoid bruising (Battle's sign) and cerebrospinal otorrhea (cerebrospinal fluid [CSF] leakage from the ears) are classic signs of a basilar skull fracture. Basilar skull fractures are associated with high-energy trauma, and usually occur following diffuse impact to the head (eg, falls, motor-vehicle crashes). A basilar skull fracture generally results from extension of a linear fracture to the base of the skull.
During your assessment of a patient with a closed head injury, you note the presence of a pinkish fluid draining from the nose. This is MOST indicative of:
A:a cribriform plate fracture.
cribriform plate fracture
Cerebrospinal rhinorrhea (CSF draining from the nose) suggests a fractured cribriform plate. The cribriform plate of the ethmoid bone is a horizontal bone that is perforated with numerous foramina (openings) that allow passage of the olfactory nerve filaments from the nasal cavity.
paralysis
loss of voluntary movement
parenthesis
numbness and tingling
tertiary blast injuries
occur when the patient is hurled against a stationary object by the blast. The blast wind causes the patient to be hurled or thrown and in some cases cause amputation
open skull fracture
often associated with multi-body system trauma, brain tissue may be exposed, high mortality rate.
lower thoracic nerves, what is there function?
provide abdominal muscle control and contain nerves of the sympathetic nervous system
Shearing injuries of the great vessels—the aorta and vena cavae—are also the result of ?
rapid deceleration of the body with resultant separation (shearing or tearing) of the structures from which these vessels are suspended.
obstructive shock. A tension pneumothorax occurs when excessive air in the pleural space causes tension, which collapses the lung and then shifts to the contralateral (opposite) side of the chest. As pressure shifts across the mediastinum, preload is impaired due to kinking of the vena cavae, and cardiac output is obstructed due to myocardial compression and kinking of the aorta
refers to inadequate tissue perfusion secondary to any injury or condition that physically obstructs cardiopulmonary function. A pulmonary embolism, for example, causes obstructive shock because of a clot in a pulmonary artery that obstructs blood flow to the lungs for reoxygenation
Signs of brainstem herniation—which represent significant intracranial pressure—include abnormal
respiratory patterns (ie, Biot's respirations, ataxic respirations), posturing (flexor or extensor), and pupillary abnormalities (asymmetric or fixed and dilated pupils).
depressed skull fracture
result from high energy direct trauma to a small surface area of the head with a blunt object(baseball bat). Often present with neurological signs(loss of consciousness) skull fragments could be driven into brain
Complete cord transection
results in loss of all sensory and motor function distal to the site of the injury; nothing is spared.
contralateral
(opposite) side
ipsilateral
(same) side as the cord injury
linear skull fracture
80% of all fractures to the skull are linear, often no gross physical signs(deformity, depression) therefore radiographic evaluation is required
A is the correct answer
Neurogenic shock (also called vasomotor shock) results from the loss of normal sympathetic nervous system tone; it is commonly caused by a spinal injury. In neurogenic shock, there is no release of the catecholamines epinephrine and norepinephrine. This causes widespread vasodilation and hypotension (relative hypovolemia); pink, dry skin below the level of the injury; and relative bradycardia. The classic signs of shock—tachycardia, diaphoresis, and pallor—are not observed in patients with neurogenic shock. Unless concomitant head injury is present, the patient's respirations are generally rapid and shallow. Hypotension, tachycardia, and tachypnea are consistent with shock not involving a loss of sympathetic nervous system tone (ie, hypovolemia, anaphylaxis). Hypertension, bradycardia, and abnormal respirations (Cushing's triad) are consistent with increased intracranial pressure.
major threats of nasal fractures and facial trauma
anterior bleeding from the face as well as posterior epistaxis, blood drains into the stomach and the patient vomits.
what lies in the retroperitoneal space?
aorta, vena cava, pancrease, kidneys, ureters, portions of the large intestines and duodenum.
Axial loading
causes vertical compression of the spine when direct forces are transmitted down the spinal column
Myocardial contusions are common when the ?
chest strikes the steering wheel of a vehicle following rapid deceleration, and the heart collides with the posterior aspect of the sternum. Most myocardial contusions do not result in cardiac arrest, although cardiac dysrhythmias (ie, PVCs, PACs) may occur
When assessing a patient with a closed head injury, you note the presence of trismus. This is defined as:
clenching of the teeth
Complete cord transection results
in loss of all sensory and motor function distal to the site of the injury; nothing is spared.
SLUDGEM," which stands for
salivation, lacrimation, urination, defecation, GI distress, emesis, and miosis
upper thoracic spinal nerves, what is there function?
supply muscles of the chest that help with breathing and coughing
Priapism
sustained penile erection
In central cord syndrome,
the patient experiences greater motor deficit to the upper extremities; he or she often has paralyzed arms, but retains the ability to move his or her legs.
why would bleeding in the abdomen and retroperitoneum produce few signs and symptoms?
they can both accommodate for large amounts of blood, the bleeding may produce few signs and symptoms of trauma, even the patients vitals may not indicate bleeding but there vitals will be your tell tale sign.
What does a patient have to do to get a compression or burst fracture?
typically result from a direct blow to the crown or a rapid deceleration from a fall through the feet, legs and pelvis. Forces transmitted through the vertebral body cause fractures, producing a shatter or bursting fracture without Spinal Cord Injury.
Neurogenic shock occurs
when sympathetic nervous system pathways are interrupted (for example, by a spinal injury), thereby inhibiting the release of catacholamines (epinephrine and norepinephrine
You must constantly monitor the patient for signs of swelling/closure
which include singed nasal hairs, a brassy cough, hoarseness, stridor, and progressive respiratory distress. In addition to monitoring the airway, the patient must be protected from hypothermia
