Section 4. Trauma Emergencies

List the steps for bleeding control (In order)

- Direct pressure is the first technique. If severe bleeding is not controlled with direct pressure, use a tourniquet.- For bleeding which is not on an extremity (e.g. torso, pelvis, neck - when you can't use a tourniquet) a hemostatic agent is also an option. In some areas a hemostatic agent may be used before, in place of, or with a tourniquet.

What type of injury causes a fern-like pattern to appear on the skin?

A lighting strike (also known as Lichtenberg figure)

What is the difference between a pneumothorax and a tension pneumothorax?

A pneumothorax is the collapse of a lung. A tension pneumothorax is a pneumothorax with increased pressure that becomes severe and causes shock by limiting circulation by compressing the heart and great vessels.

Your patient is the driver of a vehicle that was rear-ended. The classic injury pattern in this scenario is

Whiplash injury to the neck caused by rapidly "whipping" the neck backward the forward. Higher headrests in cars have helped reduce the incidence of this.

In what situation can an impaled object be removed?

When an impaled object is in the cheek and is causing an airway problem the object may be removed.

How is cardiac output calculated?

Multiplying heart rate x stroke volume. Shown as ml/minute

Your patient does not have radial pulses but does have a carotid pulse. What is the most likely cause of this?

Shock. It requires more pressure to push blood out to the extremities than it does to create a carotid pulse in the neck.

What is the difference in concept between spinal immobilization and spinal motor restriction?

Spinal Motor Restriction- Spinal care provided in the field ( C-collar while placing them on a stretcher Spinal Immobilization- affixing a patient to a short device or KED and/or long board.

What level of the spine provides innervation to the diaphragm?

The phrenic nerve (C3-C5 vertebrae)

Why do the pulse and respirations increase in shock?

The pulse increases in attempt to increase cardiac output Respirations increase to maximize the oxygenation to tissues Both are a result of action by the sympathetic nervous system

What is the "Rule of Palm" for burns?

The surface area of the patient's palm is equivalent to 1% body surface area.

Which is secured to the long spine board first: Head or Torso?

Torso, securing the head first could cause movement to the neck.

What is exsanguination?

bleeding to death

List the percentage of body surface are for each of the following areas: Head- Anterior torso- Posterior torso- Arms- Legs- Groin-

Head- 9% Anterior torso- 19% (chest 9%, abdomen 9%) Posterior torso 18% (upper 9%, lower 9%) Each arm- 9% Each leg- 18% (front 9%, rear 9%) Groin- 1%

What is the difference between a hip and a pelvic fracture?

Hip Fracture- proximal femur fracture near the ball and socket hip joint Pelvic Fracture- fracture in any of the pelvic bones themselves

Why may the blood pressure differ between the two arms in an ascending aortic aneurysm?

The blood supply for the head and arms comes from three vessels on the aortic arch. If that vessel is damaged by an aneurysm (either spontaneously or traumatically) it may interfere with blood flow to the arms causing the difference in blood pressure ( and sometimes pulse quality)

You are splinting a long bone fracture. What must the splint immobilize?

The bone ends and adjacent joints

What organ in the body is most sensitive to reduced levels of oxygen?

The brain

How do you treat a nose bleed?

Encourage patient to hold pressure below the nare and lean forward for three minutes

What are the anatomic criteria for transport to a trauma center according to the CDC?

1. All penetrating injuries to the head, neck, torso, and extremities blood flow to elbows and knees 2. Flail chest 3. Two or more proximal long bone fractures 4. Crushed, devolved, or mangled extremity 5. Amputations 6. Pelvic fractures 7. Open or depressed skull fracture 8. Paralysis

List 5 components of a field spinal assessment

1. Assess mechanism of injury 2. Assess for distracting injuries (e.g. extremity fracture) and intoxication 3. Assess mental status 4. Assess for focal neurological deficit (e.g. grip strength) 5. Assess for midline spinal tenderness along the entire length of the spine

What are the three components of the Glasgow Coma Score?

1. Eye opening 3. Verbal response 4 .Best motor response

What are the physiologic criteria for transport to a trauma center according to the CDC?

1. Glasgow Coma score less than 14 2. Systolic blood pressure less than 90mmHg 3. Respirations less than 10 and greater than 29 (adult) and less than 20 (infant to 1 year)

How do you care for a patient with an impaled object?

1. Perform primary assessment and control bleeding. 2. Treat for shock 3. Stabilize the object in any way you can (typically bulky dressing are piled on each side of the object and secured)

Name two traumatic injuries to the chest that will cause jugular venous distention (JVD).

1. Tension pneumothorax 2. Cardiac Tamponade

How can you tell if a splint has been applied too tightly?

1. They may lose distal pulse 2. The skin may become discolored 3. May feel tingling or numbmess 4. Swelling

Describe the appearance of arterial, venous, and capillary bleeding.

Arterial- spurting, brighter red blood Venous- flowing, dark red blood Capillary- oozing, dark red blood

What is the difference between and avulsion and an amputation?

Avulsion- a piece of tissue is torn away (completely or partially) Amputation- when an extremity or digit is completely removed (surgically or traumatically)

Why do patients in shock sometimes experience nausea and vomiting?

Blood is diverted from the abdomen to more vital areas (brain, kidneys)

Why does the skin become cool and clammy in shock?

Blood is shunted from the skin to more vital organs. This is done through vasoconstriction resulting in the cooler temperature and moisture.

What do you check before and after splinting?

Distal circulation, sensation and motion Circulation (distal pulse and skin color, temperature and condition) Sensation (Can you tell me where I am touching?) Motion (Can you wiggle your fingers or toes?)

List signs and symptoms that would make you suspect a patient had internal bleeding

In all patients signs of shock and a complaint of pain are common. In trauma you may see outward signs of injury such as redness or bruising, have a MOI that would suggest chest or abdominal injury, or have pain and or/rigidity on palpation. Internal bleeding can also be a result of a medical condition. Medical patients may have some of the above but also can have blood in vomit or stool.

During what portion of the assessment process would you begin C-Spine stabilization?

In the primary assessment, concurrently (at the same time) with other assessment steps.

What is a greenstick fracture?

Incomplete or partial fracture which usually occurs in children because children bones are softer,

What conditions increase the risk of intracranial bleeding?

Patients on blood thinners (Coumadin, Warfarin) who experience a head injury. Gariatric and alcoholic patients.

Define: Pulse Pressure

The difference (subtract) between systolic and diastolic pressure. Ex. Blood pressure is 120/80, pulse pressure is 40