Ch. 30 Trauma Systems and MOI

kinetic energy formula

(Mass/2) x Velocity²

rotational or quarter-panel impacts

-occurs when a lateral crash is off center -the vehicle's forward motion stops, but the side continues in rotational motion -greatest damage occurs at point of vehicle's greatest loss of speed

Waddell's Triad

1. Femur Fracture 2. Intra-abdominal or intra-thoracic injury 3. Head injury Pattern of vehicle pedestrian injuries in children and short people

Five phases of progressive deceleration

1: Deceleration of the vehicle : vehicle strikes an object and stops 2: Deceleration of the occupants: occupant's forward motion is stopped by the vehicle 3: Deceleration of internal organs: Body's supporting structures & organs, they continue their forward momentum and absorb energy 4: Result of secondary collisions: hit by objects in the vehicle 5: Additional impacts that the vehicle receives

How much blood does a person need to lose before significant changes in vital signs occur?

2 pints

What is the revised trauma score calculation for a patient with a GCS of 11, SBP of 80, and a RR of 20?

3

Parkland formula

4mg/ kg of body weight, and first half within the first 8 hours

quaternary blast injury

A blast injury that falls into one of the following categories: burns, crush injuries, toxic inhalation, medical emergencies, or mental health disorders.

Trauma lethal triad

A combination of hypothermia, coagulopathy (poor blood clotting), and acidosis that is a major contributor to death in patients with severe traumatic bleeding.

Which of the following is the highest risk wound?

A deep human bite wound

missile fragmentation

A primary mechanism of tissue disruption from certain rifles in which pieces of the projectile break apart, allowing the pieces to create their own separate paths through tissues

What should you do for a patient whose shock is caused by vasodilation due to a spinal cord injury?

Administer alpha-adrenoceptor agonist.

tertiary blast injury

An injury from whole body displacement and subsequent traumatic impact with environmental objects.

Which of the following is the most important predictor of damage sustained from a gunshot wound?

Anatomic location and structures struck

Frontal or head-on impacts

Can cause shearing, avulsing or rupturing of organs. Can impact head, chest or abdomen.

alpha adrenoceptor agonists

Clonidine

What happens in the third phase of a motor vehicle collision?

Deceleration of internal organs

Which of the following is the most likely to be fatal?

Ejection

Law of Conservation of Energy

Energy cannot be created or destroyed

Chemical energy

Energy stored in chemical bonds, can be found in an explosive or an acid

GCS scoring

Eyes -4 Open spontaneously -3 Opens on verbal -2 Opens on pain -1 Unresponsive Speech -5 Speaks spontaneously, makes sense -4 Speaks spontaneously, but is confused -3 Speaks spontaneously, does NOT make sense -2 Makes only sounds -1 Unresponsive Motor -6 Obeys verbal commands to move +Moves due to stimuli -5 Localizes pain -4 Flexion/Withdrawal from pain -3 Decorticate posture -2 Decerebrate posture -1 Unresponsive

Possible chest injuries w/ head-on impacts

Fractured sternum, larynx/tracheal trauma, myocardial contusion, pericardial tamponade, pulmonary contusion, hemothorax, rib fxs, flail chest, ruptured aorta, intra-abd injuries

What are the components of the trauma lethal triad?

Hypothermia, coagulopathy, and acidosis

primary blast injury

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

In the instance of an adult pedestrian being struck by a vehicle, which type of energy is the patient initially hit with?

Kinetic energy

How should you manage a burn blister?

Leave it intact and cover it loosely

In which of the following organs would temporary cavitation leave fewer permanent effects?

Lungs

Which of the following is true about factors that affect types of injuries?

Rapidly applied amounts of energy are less tolerated than an identical amount of energy delivered over a longer period.

Which type of impact has the greatest chance of survivability?

Rear end

Airbags reduce deaths in direct frontal MVCs by

Roughly 30%

In an explosion, ______ blast injuries are due to impact with another object.

Tertiary

Newton's Second Law of Motion

The acceleration of an object depends on the mass of the object and the amount of force applied.

What is fluid creep?

The administration of more fluid than necessary prior to the patients arrival at a burn center

Angle of impact

The angle at which an object hits another; this characterizes the force vectors involved and has a bearing on patterns of energy dissipation.

Tissues at Risk from Blast Injuries

The ear is the organ system that is most sensitive to blast injuries. The tympanic membrane evolved to detect minor changes in pressure and will rupture at pressures of 5 to 7 pounds per square inch above atmospheric pressure. The patient may report ringing or pain in the ears, or some loss of hearing, and blood may be visible in the ear canal. Dislocation of structural components of the ear, such as the ossicles conforming the inner ear, may occur. These findings can be used to assist in triaging patients, as they indicate risk of pressure injuries to the lungs. Pulmonary blast injuries are pulmonary trauma, consisting of contusions and hemorrhages, that result from short-range exposure to the detonation of explosives. When the explosion occurs in an open space, both lungs are usually injured. Primary blast injury is often characterized by a lack of external visible injuries and can go unrecognized. The patient may report tightness or pain in the chest and may cough up blood and have tachypnea or other signs of respiratory distress. Subcutaneous emphysema (crackling under the skin) can be detected over the chest through the use of palpation, indicating air in the thorax. Pneumothorax is a common injury and may require emergency decompression in the field for your patient to survive. Pulmonary edema may ensue rapidly. If there is any reason to suspect lung injury in a blast victim, administer oxygen. Avoid giving oxygen under positive pressure (by demand valve) because that may simply increase the damage to the lung. Be cautious with intravenous fluids, which may be poorly tolerated and result in pulmonary edema. One of the most concerning pulmonary blast injuries is arterial air embolism, which occurs on alveolar disruption with subsequent air embolization into the pulmonary vasculature. Even small air bubbles can enter a coronary artery and cause myocardial injury. Air embolisms to the cerebrovascular system can produce disturbances in vision, changes in behavior, changes in state of consciousness, and a variety of other neurologic signs. You may find anything from petechiae to large hematomas in patients with blast injuries. Perforation or rupture of the bowel and colon is a risk. Underwater explosions res

Barometric energy

The energy that results from sudden changes in pressure as may occur in a diving accident or sudden decompression in an airplane.

Blast front

The leading edge of the shock wave.

What is the Waddell triad?

The pattern of vehicle pedestrian injuries in children and people of short stature

Negative wave pulse

The phase of an explosion in which pressure from the blast is less than atmospheric pressure

Positive wave pulse

The phase of the explosion in which there is a pressure front with a pressure higher than atmospheric pressure.

What is brisance?

The shattering effect of a shock wave and its ability to cause disruption of tissues

Brisance

The shattering effect of a shock wave and its ability to cause disruption of tissues and structures.

What are the predominant MOIs that would you expect to find in an adult pedestrian hit by a motor vehicle?

Tibia-fibula fractures and coup-contrecoup traumatic brain injuries

______ has the greatest effect on kinetic energy.

Velocity

You have responded to a car-pedestrian accident and find a 20-year old male on the ground. He has a deformed right lower leg and significant swelling in the right thigh, abrasions on his chest and forehead, unequal pupils, a pulse rate of 52, and is breathing at a rate of 6 breaths/min. What should you do first?

Ventilate the pt. via BVM at 20RR/min

Revised Trauma Score (RTS)

a scoring system used to assess the severity of a traumatic wound and to determine the condition of a patient

Which type of chemicals cause liquefaction necrosis?

alkalis

Newton's first law of motion

an object in motion will remain in motion unless acted upon by another force

According to the American College of Surgeons Committee on Trauma classes, in a Class III blood loss, what would a patient's mental status be?

anxious and confused

What should you do if your patient has a hydrofluoric acid burn?

apply calcium gluconate gel

What is the most serious problem you need to consider in a patient with an electrical burn?

cardiac dysrhythmia or arrest

When encountering a patient with multiple injuries who is visibly bleeding, what should you do first?

check the pulse. in the case of bleeding, follow CAB instead of ABC. Circulation is key.

Your primary survey of a patient with external hemorrhage identifies rapid but weak peripheral pulses. What does this indicate?

compensated shock

Quinary blast injuries

contamination by chemical, biological, or radiological material

Which of the following is the best early indicator of a significant change in tissue perfusion?

decrease in BP

Which of the following should you NOT use to secure a dressing in place?

elastic bandages

What does a bull's-eye lesion, with a central, charred zone of full-thickness burns; a middle zone of cold, gray, dry tissue; and an outer, red zone of coagulation necrosis indicate?

electrical burn

Electrical energy

electricity, can be from lightning strike or electrocution

kinetic energy

energy associated w/ motion (moving vehicle)

Thermal energy

energy from heat, can be flames, hot water, steam

The Parkland formula is used to determine ____________.

estimates the amount of fluids a burn victim will need in the first 24 hours after injury.

What is the first thing you need to do when treating an open wound?

expose the wound

Half of all fluid administered to a burn victim needs to be administered during what period?

in the first 8hrs from the time of injury

Rollover chance of death

increases by 8 times when an occupant is ejected.

Secondary blast injury

injuries due to flying debris

You have responded to a house fire and encounter a 35-year-old woman with partial-thickness burns on her hands and stomach. She is displaying signs of shock. What should you do?

inspect for additional injuries

You are managing an open abdominal wound. The bandage you have placed is soaked with blood. What is your next step

leave the bandage in place and put additional bandages over the first.

What is the general rule for dealing with a puncture wound involving an impaled object?

leave the object in place

Which of the following indicates lower GI bleeding?

melena

multisystem trauma

one or more injuries that affect more than one body system

You are treating a patient with a groin wound that is bleeding profusely. What should you do?

pack the wound and apply direct pressure for at least 3 minutes

What is the first thing you should do for a burn victim?

stop the burn

potential energy

stored energy

Which of the following is an early sign of hypoperfusion?

tachycardia

Permanent cavity

the path of crushed tissue produced by a missile traversing part of the body

Pathway expansion

the tissue displacement that occurs as a result of low-displacement shock waves that travel at the speed of sound in tissue

You are treating a patient who weighs approximately 150 pounds (68 kg). She has lost about 1 L of blood from a femur fracture and another 500 mL from an open tibial fracture. In addition, you suspect that she has other injuries that may be causing blood loss. When you deliver fluids, what should you do?

titration of systolic blood pressure to 80 to 90 mm Hg is preferred for hemorrhagic shock. This low pressure allows the body to clot better and not dislodge clots already formed.

What is the best bleeding control for an arterial extremity wound?

tourniquet

When should you remove other dressings from a bleeding wound?

when applying hemostatic dressing

Rear impacts commonly produce what type of injury

whiplash