Exam 4 Knowledge Objectives

Describe MOI's that would allow penetrating trauma to occur. (pp 904-915)

*Penetrating trauma*- stabbings Gun shot wounds Projectiles Accidental penetrations

Provide examples of the MOI that would cause blunt trauma to occur (pp 904-915)

*blunt trauma*- Car crashes Car vs pedestrian Car vs bike Car vs motorcycle Falls

Describe the steps to follow in the emergency care of the patient with various types of shock. (pp 543-548)

*cardiogenic shock*- position comfortably admin high flow oxygen assist ventilations transport promptly consider ALS *obstructive shock*- depends on cause: ALS/ and or high/ rapid transport admin high flow oxygen *septic shock*- transport promptly admin high flow oxygen assist ventilations keep pt warm consider ALS *neurogenic shock*- secure airway spinal immobilization assist ventilations admin high flow oxygen preserve body heat transport promptly consider ALS *anaphylactic*- manage airway assist ventilations admin high flow oxygen determine cause epinephrine transport promptly consider ALS *psychogenic (fainting) shock*- determine duration of unconsciousness position pt supine record initial vital signs record initial mental status suspect head injury/ c-spine transport promptly *hypovolemic shock*- secure airway assist ventilations admin high flow oxygen control external bleeding keep warm transport promptly consider ALS

Describe the signs and symptoms compensated shock (pp 540)

*compensated shock*- Agitation Anxiety Restlessness Feeling of impending doom Weak, rapid (thready) pulse Clammy (pale, cool, moist) skin Pallor, with cyanosis about the lips Shallow, rapid breathing Nausea or vomiting Capillary refill of longer than 2 seconds in infants and children Marked thirst Narrowing pulse pressure

Describe signs and symptoms of decompensated shock (pp. 540)

*decompensated shock*- Falling blood pressure (systolic blood pressure of 90 mm Hg or lower in an adult) Declining mental status, altered level of consciousness Labored or irregular breathing Ashen, mottled, or cyanotic skin Thready or absent peripheral pulses Dull eyes, dilated pupils Poor urinary output

Differentiate among the various types of shock. (pp 534-539)

*pump failure*- cardiogenic shock OR obstructive shock (tension pneumo/ cardiac tamponade/ pulmonary embolism) *poor vessel function*- distributive shock (septic shock/ neurogenic shock/ anaphylactic shock/ psychogenic shock) *low fluid volume*- hypovolemic shock (hemorrhagic shock/ nonhemorrhagic shock)

Demonstrate how to complete an EMS patient care report for a patient with shock. (p 551)

Date Incident number Nature of call Location Dispatch time En route time At scene time At hospital time In service time Age/ sex/ weight Allergies/ medications/ past medical history/ cc Vital signs- bp, hr, respirations, SpO2 Treatment given *NARRATIVE* (the most important thing)

blunt trauma definition

is the result of force (or energy transmission) to the body that causes injury without anything penetrating the soft tissues or internal organs and cavities

mechanism of injury (MOI) definition

is the way in which traumatic injuries occur; it describes the forces (or energy transmission) acting on the body that cause injury

Discuss key components of patient assessment for shock. (pp 540-542)

primary- rapid head to toe to look for hemorrhaging. manage life threats. ABC, high flow oxygen, request ALS history- determine cc, SAMPLE, OPQRST, ask about anticoagulants (ex. blood pressure medications) secondary- more detailed exam. focused assessment. vitals. use monitoring devices. reassessment- vitals, interventions, ccc, mental status. focus on supporting cardiovascular sys. treat shock with LOB

penetrating trauma definition

results in injury by objects that pierce and penetrate the surface of the body and injure the underlying soft tissues, internal organs, and body cavities

Identify the causes of shock. (p 534)

1. pump failure 2. low fluid volume 3. poor vessel function

Describe the pathophysiology of shock (hypoperfusion). (pp 531-534)

1. systemic vasodilation -> blood pooling -> 2. organ hypoperfusion -> 3. activation of endothelium & injury -> 4. hypercoagulability -> 5. multiple organ dysfunction syndrome (MODS)

Explain the relationship of the MOI to potential energy, kinetic energy, and work. (pp 901-902)

Kinetic energy = ½ mass × velocity2 OR KE = ½ m × v2