EMT Test 7

Hypovolemic Shock

A condition in which low blood volume, due to massive internal or external bleeding or extensive loss of body water, results in inadequate perfusion

Open-Book Pelvic Fracture

A life-threatening fracture of the pelvis caused by a force that displaces one or both sides of the pelvis laterally and posteriorly

Hematoma

A mass of blood that has collected within damaged tissue beneath the skin or in a body cavity (May contain over a liter of blood) -Large blood vessel is damaged and bleeds rapidly Usually associated with extensive tissue damage.

Cavitation

A phenomenon in which speed causes a bullet to generate pressure waves, which cause damage distant from the bullet's path

Hematuria

Blood in the urine

Blunt Injuries to Neck

Blunt injuries a. Any crushing injury of the upper part of the neck is likely to involve the larynx or trachea. b. Examples include: i. Collision with a steering wheel ii. Attempted suicide by hanging iii. Clothesline injury sustained while riding a bicycle c. Once cartilages of upper airway and larynx are fractured, they don't spring back to normal position i. Can lead to loss of voice, difficulty swallowing, severe and sometimes fatal airway obstruction, and leakage of air into soft tissues of neck ii. Subcutaneous emphysema is a characteristic crackling sensation produced by the presence of air in the soft tissues of neck. iii. If you feel this when palpating the neck, maintain the airway as best you can and transport immediately. iv. Complete airway obstruction can develop rapidly. d. Incidents involving an injury to the throat may also have caused a cervical spine injury (Spinal immobilization may be needed).

Jaw

About 1 inch posterior to the external opening of the ear is the mastoid process. i. Bony mass at the base of the skull h. The mandible forms the jaw and chin. i. The jaw is the lower border of the mouth, where the tongue and 32 teeth are located. ii. Motion of the mandible occurs at the temporomandibular joint, which lies just in front of the ear on either side of the face. iii. Below the ear and anterior to the mastoid process, the angle of the mandible is easily palpated.

Rear-End Crashes

Causes whip-lash injuries, especially when head and neck are not restrained by headrest (Body propelled forward, head and neck are left behind) -Cervical spine and surrounding area may be damaged (Cervical spine less tolerant when back is bent) -Other parts of spine and pelvis may be injured -Backseat passengers have higher risks for lumbar and thoracic injuries -Acceleration-type injury to the brain is possible. i. Third collision of the brain within the skull

Ecchymosis

Characteristic blue or black discoloration as the result of an injury Discoloration associated with a closed wound- Signifies bleeding AKA Contusion

Barotrauma

Commonly seen in blast injury victims Refers to injuries that result from sudden or extreme changes in air pressure.

The methods to control bleeding in order are:

Direct, local pressure Pressure Dressing Tourniquet Splinting Device

SAMPLE History

For conscious patients during history taking Signs and Symptoms, allergies, medications, pertinent past medical history, last oral intake, events leading up to illness or injury

Newton's Third Law

For every action, there is a equal and opposite reaction

Newton's Second Law

Force=Mass X Acceleration Acceleration is change in velocity (speed) that occurs over time

Turbinates

Layers of bone within the nasal cavity

Falls

More than 20 ft (6m) or 3X height is considered significant - high energy trauma -10 feet or three time height for children Controlled fall: patients land on their feet - Heels and ankles - Calcaneus Axial Loading - lumbar spinal injury could occur Internal injuries pose the greatest threat to life. Take into account: a. The height of the fall b. The type of surface struck c. The part of the body that hit first, followed by the path of energy displacement

Anisocoria

Naturally occurring uneven pupil size in dim light

Blunt Trauma to Eye

Ordinary black eye to a severely damaged globe. b. Hyphema (bleeding into the anterior chamber of the eye) obscures all or part of the iris. i. Common in blunt trauma and may cause seriously impaired vision -25% of hyphemas are globe injuries ii. Cover the eye to protect it from further injury and provide transportation to the hospital. c. Orbit fracture (blow-out fracture) i. Fracture of bones that form the eye floor and support the globe ii. Place on a stretcher and transport immediately. iii. Protect the eye with a metal shield. iv. Cover other eye to minimize eye movement. -Also watch out for retinal detachment

Sebaceous gland

Part of dermis Produces sebum (oil material that waterproofs skin and keeps it supple) Sebum travels to skin's surface along shifts of adjacent hair follicles *Hair follicles are small organs that produce hair (There is one follicle for each hair, each connected with a sebaceous gland and tiny muscle - This muscle pulls hair erect when person cold/frightened)

Cranium

Part of the head a. Also referred to as the skull b. Contains the brain, which connects to the spinal cord through the foramen magnum, a large opening at the base of the skull. c. The most posterior portion of the cranium is called the occiput. d. On each side of the cranium, the lateral portions are called the temples or temporal regions. i. Between the temporal regions and the occiput lie the parietal regions. e. The forehead is called the frontal region. f. Anterior to the ear, in the temporal region, you can feel the pulse of the superficial temporal artery.

Compartment Syndrome

Swelling in a confined space that produces dangerous pressure (Common in extremities) -Edema and swelling result in increased pressure within closed soft tissue compartment -Interferes with circulation -May cut off blood flow or damage sensitive tissue -Delivery of nutrients and oxygen is impaired and by-products of normal metabolism accumulate. c. There is pain, especially on passive movement. d. The longer this situation persists, the greater the chance for tissue death. e. EMTs must continually reassess skin color, temperature, and pulses distal to the injury site if crush injury is suspected.

Whiplash injuries are most common in:

Rear end accidents

Blunt Trauma

Result of force (Or energy transmission) An impact on the body by objects that cause injury without penetrating soft tissues of internal organs and cavities. Results from an object making contact with the body - No penetration 1. Motor vehicle crashes and falls are the most common MOIs. 2. Be alert to skin discoloration and pain. a. These may be the only signs of blunt trauma. -Two most common examples are falls and motor vehicle crashes 3. Maintain a high index of suspicion for hidden (internal) injuries.

RTS

Revised Trauma Score A scoring system used for patients with head trauma -Scores range from 0-12 with 12 being the best

Lateral Crashes

Side Impact/T-Bone Very common cause of death associated with motor vehicle crashes. A vehicle struck from the side is usually struck above its center of gravity- High risk of rollover i. Begins to rock away from the side of impact ii. This results in the passenger sustaining a lateral whiplash injury. -Body may be thrust against door post -Cervical spine has little tolerance to lateral bending If there is substantial intrusion into the passenger compartment, suspect: i. Lateral chest and abdomen injuries on the side of the impact ii. Possible fractures of the lower extremities, pelvis, and ribs iii. Organ damage from the third collision d. Approximately 25% of all severe injuries to the aorta that occur in motor vehicle crashes and 30% of fatalities are a result of lateral collisions.

Epidermis

The outer layer of skin that acts as a water tight protective covering i. The epidermis is composed of several layers. -Cells are constantly worn away, new cells produced in bottom of epidermis called Germinal Layer -Deeper cells in germinal layer contain pigment granules, that produce skin color along with blood vessels in dermis

Trajectory

The path a projectile takes once it is propelled

Full-Thickness Burns

Third-degree burns Burns that affect all skin-layers and may affect the subcutaneous layers, muscle, bone, and internal organs, leaving the area dry, leathery, and white, dark, brown, or charred -Feels hard to the touch iii. If the nerve endings have been destroyed, a severely burned area may have no feeling. iv. The surrounding, less severely burned areas may be extremely painful.

Vitreous Humor VS Aqueous Humor

Vitreous humor: jelly part of eye in back Aqueous humor is in the front

Hematemesis

Vomited blood

Blood Stasis

b. Changes in the blood vessel walls (such as a wound) c. Blood's ability to clot (affected by disease or medication) Blood clotting depends on blood stasis

The body will not tolerate an acute blood loss of greater than:

-20% of blood volume (about 2 pints). a. Typical adult male has approximately 70 mL of blood per kilogram of body weight (about 10-12 pints) b. Typical adult female has approximately 65 mL of blood per kilogram of body weight Because infants and children have less blood volume to begin with, the same effect is seen with smaller amounts of blood loss. (Even with loss as small as 3-6 oz) How well people compensate for blood loss is related to how rapidly they bleed. a. An adult can comfortably donate 1 unit (500 mL) of blood over a period of 15 to 20 minutes. b. If a similar blood loss occurs in a much shorter period of time, the person may rapidly develop symptoms of hypovolemic shock. *When describing blood loss, instead of estimating amount, say things like "soaked through two towels"

Car VS Motorcycle

-Helmet can't protect against cervical injuries When assessing the scene of a motorcycle crash, look for: a. Deformity of the motorcycle b. Side of most damage c. Distance of skid in the road d. Deformity of stationary objects or other vehicles e. Extent and location of deformity in the helmet . There are four types of motorcycle impacts. a. Head-on crash i. The motorcycle strikes another object and stops its forward motion while the rider continues his or her forward motion until stopped by an outside force. b. Angular crash i. The motorcycle strikes an object or another vehicle at an angle so that the rider sustains direct crushing injuries to the lower extremity between the object and the motorcycle- Potential for neurovascular compromise and surgery. c. Ejection i. The rider will travel at high speed until stopped by a stationary object, another vehicle, or road drag. ii. Severe abrasion injuries (road rash) down to bone can occur with drag. d. Controlled crash i. A technique used to separate the rider from the body of the motorcycle and the object to be hit is referred to as laying the bike down. *Bring helmet to hospital

Lacerations to Eye

-Requires very careful repair to restore appearance and function. i. Bleeding may be heavy, but usually can be controlled with gentle, manual pressure. b. If there is a laceration of globe itself, apply no pressure to the eye. i. Compression can interfere with the blood supply and result in loss of vision - pressure may squeeze eye juices out i. Never exert pressure on or manipulate the injured globe. ii. If part of eyeball is exposed, gently apply a moist, sterile dressing to prevent drying. iii. Cover injured eye with protective metal eye shield, cup, or sterile dressing. Apply soft dressings to both eyes, and provide prompt transport.

3 collisions in a vehicle crash

. A crash typically consists of three collisions. 1. Car against another car, tree, or object i. Most dramatic, but does not directly affect patient care - Greater damage=greater energy ii. By assessing the vehicle that has crashed, you can often determine the MOI. 2. Passenger against the interior of the car i. Kinetic energy produced by the passenger's mass and velocity is converted into the work of stopping his or her body. ii. Common passenger injuries include lower extremity fractures, rib fractures, and head trauma. -External injuries are especially likely in lateral and rollover 3. Passenger's internal organs against the solid structures of the body i. Internal injuries may not be as obvious as external injuries, but they are often the most life threatening.

Eye Injuries Following Head Injuries

. Any of the following eye findings should alert you to the possibility of a head injury: i. One pupil larger than the other ii. Eyes not moving together or pointing in different directions iii. Failure of eyes to follow movement of finger as instructed iv. Bleeding under the conjunctiva v. Protrusion or bulging of one eye b. For an unconscious patient, keep eyelids closed. i. Cover the lids with moist gauze, or hold them closed with clear tape. ii. Normal tears will keep tissues moist.

6 Major Bones in Face

. The six major bones of the face include: i. Nasal bone ii. Two zygomas (Cheek bones) iii. Two maxillae (Upper jaw bones) iv. Mandible (Jaw bone)

Emergency Medical Care for Face and Neck Injuries

. Treat soft-tissue injuries to the face and neck the same as soft-tissue injuries elsewhere on the body. 1. Assess ABCs and life threats first. a. Follow standard precautions. b. In the absence of life-threatening bleeding, the first step is to open and clear the airway. i. The patient may need frequent suctioning of blood draining into the throat. c. Avoid moving the neck in patients with suspected cervical spine injuries. i. Use the jaw-thrust maneuver to open the airway and then suction the mouth. ii. Once the patient is immobilized, you can turn the backboard to one side to allow blood or vomitus to drain from the mouth. B. Control bleeding by applying direct manual pressure with a dry, sterile dressing. 1. Use roller gauze, wrapped around the circumference of the head, to hold a pressure dressing in place. 2. Do not apply excessive pressure if there is a possibility of an underlying skull fracture. 3. When an injury exposes the brain, eye, or other structures, cover the exposed parts with a moist, sterile dressing. 4. Apply ice locally to injuries that do not break the skin. 5. For soft-tissue injuries around the mouth, check for bleeding inside the mouth. a. Broken teeth and lacerations to the tongue may cause profuse bleeding and obstruction of the upper airway. b. Often, the patient will swallow the blood, so the hemorrhage may not be apparent. c. Patients who swallow blood are prone to vomiting.

Radiation Burns

1. Acute radiation exposure has become more than a theoretical issue because the use of radioactive materials has increased in industry and medicine. 2. Potential threats include incidents related to the use and transportation of radioactive isotopes and intentionally released radioactivity in terrorist attacks. 3. You must determine if there has been a radiation exposure and then attempt to determine whether ongoing exposure continues to exist. Three types of ionizing radiation: a. Alpha i. Alpha particles have little penetrating energy. ii. They are easily stopped by the skin. b. Beta i. Beta particles have greater penetrating power and can travel much farther in air than alpha particles. ii. They can penetrate the skin but can be blocked by simple protective clothing designed for this purpose. c. Gamma i. The threat from gamma radiation is directly proportional to its wavelength. ii. This type of radiation is very penetrating and easily passes through the body and solid materials 5. Most ionizing radiation accidents involve gamma radiation (x-rays). 6. People who have sustained a radiation exposure generally do not pose a risk to others, but in incidents involving explosions, patients may be contaminated. 7. Management of radiation burns a. Maintain a safe distance and wait for the HazMat team to decontaminate the patient before initiating care. b. Most contaminants can be removed by simply removing the patient's clothes. Call for additional resources. c. Once there is no threat to you, begin treating the ABCs and treat the patient for any burns or trauma. d. Irrigate open wounds. e. Notify the emergency department. f. Identify the radioactive source and the length of the patient's exposure to it. g. Limit your duration of exposure, increase your distance from the source, and attempt to place shielding between yourself and sources of gamma radiation

Bleeding from the nose, ears, and mouth:

1. Bleeding around the face presents a risk for airway obstruction or aspiration. 2. Several conditions can result in bleeding from the nose, ears, and/or mouth, including the following: a. Skull fracture b. Facial injuries, including those caused by a direct blow to the nose c. Sinusitis, infections, use and abuse of nose drops, dried or cracked nasal mucosa, or other abnormalities d. High blood pressure e. Coagulation disorders f. Digital trauma (nose picking)

Laryngeal Injuries

1. Blunt force trauma to the larynx can occur when: a. Unrestrained driver strikes steering wheel b. Snowmobile rider or off-road biker strikes a clothesline or a fixed wire 2. The larynx becomes crushed against the cervical spine, resulting in soft-tissue injury, fractures, and/or separation of the fascia. a. These strangulation injuries can also be found in either intentional or unintentional hangings. b. Any time there is a suspected injury to the larynx, suspect possible cervical spine injury. Penetrating or impaled objects in the larynx should not be removed unless they interfere with cardiopulmonary resuscitation. a. Stabilize all impaled objects if they are not obstructing the airway Significant injuries to the larynx pose an immediate risk of airway compromise. a. Signs and symptoms of larynx injuries include: i. Respiratory distress ii. Hoarseness iii. Pain iv. Difficulty swallowing (dysphagia) v. Cyanosis vi. Pale skin vii. Sputum in the wound viii. Subcutaneous emphysema ix. Bruising on the neck x. Hematoma xi. Bleeding b. To manage a laryngeal injury: i. Provide oxygen and ventilation. ii. Apply cervical immobilization, but avoid the use of rigid collars.

Neck

1. Contains many important structures 2. Supported by the cervical spine a. First seven vertebrae in the spinal column (C1 through C7) b. The spinal cord exits from the foramen magnum and lies within the spinal canal formed by the vertebrae. 3. The upper part of the esophagus and the trachea lie in the midline of the neck. a. The carotid arteries are found on either side of the trachea, along with the jugular veins and several nerves. -Larynx is made up of thyroid and cricoid cartilage, upper part contains adam's apple Easily Palpable Landmarks: -Adam's Apple (Formed by thyroid cartilage) -7th cervical vertebra -Pinna -Mandible -Occiput -Temporomandibular joint Important Landmarks: -Cricoid (Below thyroid, only complete circular cartilage structure in trachea) and thyroid cartilage -Cricothyroid membrane -Carotid Arteries -Stemocleidomastoid muscles

Methods to control external bleeding

1. Direct, even pressure 2. Pressure dressings and/or splints 3. Tourniquets

Pressure Dressing

1. Firmly wrap a sterile, self-adhering roller bandage around the entire wound. 2. Use 4" 4" sterile gauze pads for small wounds and sterile universal dressings for larger wounds. 3. Cover the entire dressing above and below the wound. 4. Stretch the bandage tight enough to control bleeding. 5. You should still be able to palpate a distal pulse on the injured extremity after applying the dressing. 6. Do not remove a dressing until a physician has evaluated the patient. a. Apply additional manual pressure through the dressing. b. If necessary, add more dressings over the first. 7. Bleeding will almost always stop when the pressure of the dressing exceeds arterial pressure.

Burn Severity

1. Five factors to help determine the severity of a burn (the first two factors are the most important): a. What is the depth of the burn? b. What is the extent of the burn? c. Are any critical areas involved? i. Face, upper airway, hands, feet, genitalia d. Does the patient have any preexisting medical conditions or other injuries? e. Is the patient younger than 5 years or older than 55 years? -Upgrade classification if answer to three questions is yes 2. Burns to the face are of particular importance owning to the potential of airway involvement. 3. Burns to the hands or feet or over joints are considered serious because of the potential for loss of function as the result of scarring.

The Eye

1. Globe-shaped, approximately 1 inch in diameter 2. Located within a bony socket in the skull called the orbit a. The orbit is composed of adjacent bones of the face and skull - forms the base of the floor of the cranial cavity - frontal lobes are directly above it. b. In adults, the orbit protects over 80% of the eyeball. c. Between and below the orbits are the nasal bone and the sinuses. The orbit of the eye is composed of: i. Lower edge of the frontal bone of the skull ii. Zygoma iii. Maxilla iv. Nasal bone d. The bony orbit protects the eye from injury The eyeball, or globe, keeps its shape as a result of pressure from the fluid contained within its two chambers. a. Clear, jellylike fluid near the back of the eye is called the vitreous humor. b. In front of the lens is a clear fluid called the aqueous humor. i. In penetrating injuries of the eye, aqueous humor can leak out. ii. With time and appropriate medical treatment, the body can make more.

Pathophysiology of Closed and Open Wounds

1. Healing of wounds is a natural process that involves several overlapping stages, all directed toward the larger goal of maintaining homeostasis (balance). 2. Cessation of bleeding is the primary concern. a. Loss of blood hinders the provision of vital nutrients and oxygen to the affected area. b. It also impairs the tissue's ability to eliminate wastes. c. The end result is abnormal or absent function, which interferes with homeostasis. -To stop flow of blood, vessels, platelets, and clotting cascade must work in unison 3. The next wound healing stage is inflammation. a. Additional cells move into the damaged area to begin repair. b. White blood cells migrate to the area to combat pathogens that have invaded the exposed tissue. c. Lymphocytes destroy bacteria and other pathogens. d. Mast cells release histamine (Dilates blood vessels, makes capillaries more permeable). e. Inflammation ultimately leads to removal of: i. Foreign material ii. Damaged cellular parts iii. Invading microorganisms a. Cells quickly multiply and redevelop across the edges of the wound. b. Except in cases of clean incisions, the appearance of restructured area seldom returns to preinjury state, but function may be restored to near normal.

Taser

1. In recent years, law enforcement has increased its use of Tasers. 2. These weapons fire two small darts (electrodes) that puncture the patient's skin. a. Barbs are 13mm in length and generally treated as impaled objects and removed by a physician. b. In some jurisdictions, depending on local protocol, EMTs are permitted to remove these barbs from patients. 3. There are potential complications for the patient when these devices have been used, particularly when the patient is experiencing certain underlying disorders. a. Excited delirium is commonly associated with illegal drug ingestion. b. Excited delirium is a true emergency and warrants assisted ALS response. c. Using a Taser device in patients with true excited delirium has been previously associated with dysrhythmias and sudden cardiac arrest. 4. Make sure you have access to an AED when you respond to patients who have been exposed to Taser shots.

Destination Selection

1. It is important for you to be familiar with how the American College of Surgeons' Committee on Trauma classifies trauma care. 2. Trauma centers are classified into Levels I through IV, with Level I having the most resources. a. Level I facility i. Generally serves large cities or heavily populated areas ii. Provides every aspect of trauma care iii. Most Level I facilities are university-based teaching hospitals. b. Level II facility i. Located in less population-dense areas ii. Provides initial definitive care c. Level III facility i. Provides assessment, resuscitation, emergency care, and stabilization ii. Transfers patients to Level I or Level II facility when necessary d. Level IV facility i. Typically found in remote outlying areas where no higher level of care is available ii. Provides advanced trauma life support iii. Transfers to a higher-level trauma center Trauma centers are categorized as either adult trauma centers or pediatric trauma centers, but not necessarily both. a. Pediatric trauma centers are not nearly as common. b. Do not make the mistake of transporting a pediatric patient to an adult trauma center when a pediatric trauma center is available.

Anatomy of Skin

1. It is the largest organ in the body. -First line of defense against external forces/infection -Varies in thickness, depending on the person's age and the skin's location. -Thinner in the very young and the very old. 2. Skin is thinner on eyelids, lips, and ears than on scalp, back, and soles of feet. 3. Thin skin is more easily damaged than thick skin. -Skin has 2 principal layers: Epidermis and dermis. a. The epidermis is the tough, exterior layer that forms a watertight covering for the body. b. The dermis is the inner layer of the skin. Skin covers all external surfaces of the body. -Openings in body are lined with wet mucous membranes Skin serves many functions: a. Keeps pathogens out b. Keeps fluids in c. Helps to regulate body temperature d. The nerves in skin report to the brain on the environment and many sensations. e. This nerve pathway connection allows body to adapt to environment through responses in skin and surrounding tissues. -Any break in skin may allow bacteria to enter & increases possibility of infection, fluid loss, and loss of temperature control. a. Any one of these conditions can cause serious illness and even death.

Dental Injuries

1. Mandible injuries are common because of its prominence. (Secondly only to nasal fractures in frequency). 2. Most of these fractures are the result of vehicle collisions and assaults. Signs of mandible fracture include: i. Misalignment of the teeth ii. Numbness of the chin iii. An inability to open the mouth 3. Maxillary fractures are usually found after blunt-force, high-energy impacts. a. The signs of maxillary fractures include: i. Massive facial swelling ii. Instability of the facial bones iii. Misalignment of teeth 4. Fractured and avulsed teeth are common following facial trauma. a. Teeth fragments or crack/loose teeth can become an airway obstruction and should be removed immediately. -Bleeding will occur whenever a tooth is violently displaced from its socket. a. Apply direct pressure to stop the bleeding. b. Perform suctioning if needed. Save and transport an avulsed tooth, handling it by the crown rather than by the root. a. Place the tooth in tooth storage solution, cold milk, or sterile saline. b. Notify receiving facility of avulsed teeth. i. Reimplantation is recommended within 20 minutes to 1 hour after the trauma.

Direct Pressure

1. Most effective way to control external bleeding 2. Pressure stops the flow of blood and permits normal coagulation to occur. 3. Apply pressure with your gloved fingertip or hand over the top of a sterile dressing. 4. For an object protruding from the wound, apply bulky dressings to stabilize the object in place, and apply pressure as best you can. 5. Never remove an impaled object from a wound, unless it is in the cheek and blocking the patient's airway. 6. Hold uninterrupted pressure for at least 5 minutes. -Elevation has not been proven to help, and it may aggravate injuries -In most cases, direct pressure will stop bleeding

Injuries of the Nose

1. Nosebleeds (epistaxis) are a common problem. a. One of the most common causes is digital trauma. b. Nosebleeds are further categorized into anterior and posterior epistaxis. c. Anterior nosebleeds usually originate from area of the septum and bleed fairly slowly. i. Usually self-limiting and resolve quickly d. Posterior nosebleeds are usually more severe and often cause blood to drain into the patient's throat. i. Attempting to insert nasopharyngeal airway in patient with suspected basilar skull fracture or with facial injuries is controversial; follow local protocols. 2. The nose often takes the brunt of physical assaults and car crashes. a. Blunt injuries to the nose may be associated with fractures and soft-tissue injuries of the face, head injuries, and/or injuries to the cervical spine. -Cerebrospinal fluid (CSF) may escape down through the nose or ears following a fracture at the base of the skull. i. Use piece of gauze to absorb blood. ii. If CSF is present, the blood will be surrounded by a lighter ring of fluid (halo test). 4. Control bleeding by applying a sterile dressing. a. If the patient is bleeding heavily, it could be the result of significant trauma. i. Consider cervical spine injury. ii. The patient should not be moved if airway can be managed in patient's present position. b. For nontrauma patient who is bleeding from nose, place the patient in a sitting position, leaning forward, and pinch the nostrils together.

Blast Injuries

1. Organs that contain air, such as the middle ear, lung, and gastrointestinal tract, are the most susceptible to pressure changes. 2. Junctions between tissues of different densities and exposed areas such as head and neck tissues are prone to injury as well. 3. The ear is most sensitive to blast injuries. a. 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. 6. Solid organs are relatively protected from shock wave injury but may be injured by secondary missiles or a hurled body. -Bowel and colon are at risk for perforation or ruptures -Underwater explosions result in most severe abdominal injuries 7. Neurologic injuries and head trauma are the MOST COMMON CAUSE OF DEATH from blast injuries. a. Subarachnoid and subdural hematomas are often seen. b. Bradycardia and hypotension are common. 8. Extremity injures, including traumatic amputations, are common.

Signs and symptoms of internal bleeding:

1. Pain (most common) 2. Swelling in the area of bleeding 3. Distention 4. Bleeding into the chest cavity or lung may cause dyspnea, tachycardia, and hypotension, and hemoptysis (bright red blood that is coughed up) 5. Hematoma—a mass of blood in the soft tissues beneath the skin -The only sign of pelvic or abdominal trauma may be redness, skin abrasions, or pain 6. Bruising—a contusion or ecchymosis (may not be present initially) Bleeding from any body opening a. Bright red bleeding from the mouth or rectum b. Hematuria—blood in the urine c. Nonmenstrual vaginal bleeding 8. Hematemesis—vomited blood a. Bright red or dark red b. Coffee-grounds appearance 9. Melena—black, foul-smelling, tarry stool with digested blood 10. Pain, tenderness, bruising, guarding, or swelling (possible closed fracture) 11. Broken ribs; bruises over the lower part of the chest; or a rigid, distended abdomen (indicate possible lacerated spleen or liver -If spleen is injured, there may be pain in left shoulder or right for liver) 12. Hypoperfusion (hypovolemic shock) Very serious signs: -Broken ribs -Hematemesis -Melena -Distended Abdomen -Hemoptysis

Bites

1. Small-animal bites and rabies a. Consider the scene and crew safety prior to entering the environment. b. A small animal's mouth is heavily contaminated with virulent bacteria. c. Consider all small-animal bites to be contaminated and potentially infected wounds. d. Treatment may require: i. Debridement (removal of damaged tissue) ii. Antibiotics iii. Tetanus prophylaxis iv. Surgical repair e. All small-animal bites should be evaluated by a physician. -Place dry, sterile dressing over wound and consider splinting if extremity A major concern is the spread of rabies -In many areas, bites are required to be reported Human bites a. The human mouth, more so than even the small animal's mouth, contains an exceptionally wide range of bacteria and viruses. b. Regard any human bite that has penetrated the skin as a very serious injury. c. Any laceration caused by a human tooth can result in a serious, spreading infection. -If someone punches someone else's mouth, they may need treatment too. Emergency treatment consists of the following steps: i. Apply a dry, sterile dressing. ii. Promptly immobilize the area with a splint or bandage. iii. Provide transport to the ED for surgical cleansing of the wound and antibiotic therapy.

Injuries to the abdomen

1. The abdomen contains vital organs that require a very high amount of blood flow to perform the functions necessary for life. 2. The organs of the abdomen and retroperitoneum can be classified into two categories: solid and hollow. a. Solid organs include the liver, spleen, pancreas, and kidneys. b. Hollow organs include the stomach, large and small intestines, and urinary bladder. 3. When injuries from trauma occur in this region of the body, serious and life-threatening problems may occur. a. Solid organs may tear, lacerate, or fracture, which can cause serious bleeding into the abdomen. b. Hollow organs may rupture and leak toxic digestive chemicals. i. The patient may eventually develop a life-threatening infection. c. The rupture of large blood vessels can cause serious unseen bleeding. 4. Reassess the abdominal region using DCAP-BTLS.

Facial Fractures

1. Typically result from blunt impact 2. You should assume that any patient who has sustained a direct blow to the mouth or nose has a facial fracture. 3. Other clues include: a. Bleeding in the mouth b. Inability to swallow or talk c. Absent or loose teeth d. Loose or movable bone fragments 4. Facial fractures alone are not acute emergencies unless there is serious bleeding. a. In addition to external hemorrhage, there is the danger of blood clots lodging in the upper airway and causing an obstruction. 5. Plastic surgeons can repair damage to face and mouth if the injuries are treated within 7 to 10 days. a. Remove and save loose teeth or bone fragments from the mouth because it is often possible to replant them. b. Remove any loose dentures or dental bridges to protect against airway obstruction. 6. Another source of airway obstruction is swelling, can be extreme within first 24 hours after injury.

Artery

A blood-vessel, consisting of three layers of tissue and smooth muscle, that carries blood away from the heart

Coup-Countrecoup Brain Injury

A brain injury that occurs when force is applied to the head and energy transmission through the brain tissue causes injury on the opposite side of original impact. -Compression or bruising to anterior portion and stretching or tearing of posterior portion

Eustachian Tube

A branch of the internal auditory canal that connects the middle ear to the oropharynx

Contusion

A bruise from an injury that causes bleeding beneath the skin without breaking the skin -Result from blunt force -Epidermis remains intact, but cells in dermis are damaged and small BV are torn AKA Ecchymosis

Flame Burn

A burn caused by an open flame

Steam Burn

A burn caused by exposure to hot steam -Can produce a topical (scald) burn -Also responsible for airway burns

Flash Burn

A burn caused by exposure to very intense heat, such as in an explosion -Lightening -Usually not as bad as other injuries from what caused blast

Scald Burn

A burn caused by hot liquids -Most commonly seen in children and disabled -Often cover large surfaces

Subcutaneous Emphysema

A characteristic crackling sensation felt on palpation of the skin, caused by the presence of air in soft tissues -Fractures of larynx or trachea can cause air to leak from airway = Subcutaneous emphysema

Hypoperfusion

A condition in which the circulatory system fails to provide sufficient circulation to maintain normal cellular functioins AKA Shock a.First Sign: Change in mental status, such as anxiety, restlessness, or combativeness b. Weakness, faintness, or dizziness on standing c. Changes in skin color or pallor (pale skin) d. Later signs of hypoperfusion suggesting internal bleeding include: i. Tachycardia ii. Weakness, fainting, or dizziness at rest iii. Thirst iv. Nausea and vomiting v. Cold, moist (clammy) skin vi. Shallow, rapid breathing vii. Dull eyes viii. Slightly dilated pupils that are slow to respond to light ix. Capillary refill of more than 2 seconds in infants and children x. Weak, rapid (thready) pulse xi. Decreasing blood pressure xii. Altered level of consciousness H. Patients with these signs and symptoms require prompt transport.

Shock

A condition in which the circulatory system fails to provide sufficient circulation to maintain normal cellular functions AKA Hypoperfusion

Optic Nerve

A cranial nerve that transmits visual information to the brain

Laceration

A deep, jagged cut in the skin -Caused by sharp object or blunt force that tears tissue c. Lacerations and incisions may appear linear (regular) or stellate (irregular). -Can extend down to muscle -Some lacerations can be smooth

Pelvic Binder

A device to splint the bony pelvis to reduce hemorrhage from bone ends, venous disruption, and pain -Especially useful for open-book pelvic fracture

Blow-Out Fracture

A fracture of the orbit or of the bones that support and form the eye floor of the orbit i. Fragments of fractured bone can entrap muscles that control eye movement = double vision -Any patient that reports pain, double vision, or decreased vision after blunt trauma should be placed on a stretcher and transport immediately. iii. Protect the eye with a metal shield. iv. Cover the other eye to minimize eye movement.

Hemophilia

A hereditary condition in which the patient lacks one or more of the blood's normal clotting factors a. The patient lacks one or more of the blood's clotting factors. b. Several forms i. Most are hereditary. ii. Some are severe. c. Bleeding may occur spontaneously. d. All injuries, no matter how trivial, are potentially serious. e. Patients should be transported immediately.

Trauma Score

A score calculated from 1-16, with 16 being the best possible score It relates to the likelyhood of patient survival with the exception of a severe HEAD INJURY It takes into account the GCS score, respiratory rate, respiratory expansion, systolic BP, and capillary refill -Predicts patient outcome -Two most commonly used numeric trauma scoring systems are glasgow and RTS

Excited Delirium

A serious behavioral condition in which a person exhibits agitated behavior combined with with disorientation, hallucinations, or delusions Also called agitated delirium or exhaustive mania

Incision

A sharp, smooth cut in the skin c. Lacerations and incisions may appear linear (regular) or stellate (irregular).

Rule of Nines

A system that assigns percentages to sections of the body, allowing calculation of the amount of skin surface involved in the burn area Helps estimate extent of burn area Adult is divided in 11 main area Each represents 9% of body surface -Anterior side of arm or arm below elbow are both 4.5% -Chest and abdomen front and back together = 36% (In picture, add up front and back, for example each leg is 18)

Contact Burn

A thermal burn caused by direct contact with a hot object -Rarely deep thanks to human reflexes

Injuries to face and neck:

A. Injuries to face and neck can often lead to partial or complete obstruction of the upper airway. 1. Several factors may contribute to the obstruction. a. Blood clots in upper airway from heavy facial bleeding i. Can lead to complete obstruction, especially in unconscious patients b. Direct injuries to the nose and mouth, larynx, and the trachea are often the source of significant bleeding and/or respiratory compromise. i. May need to suction the airway c. Injuries may cause teeth or dentures to become dislodged into throat. d. Swelling that accompanies direct/indirect injury to soft tissues can also contribute to airway obstruction. e. The airway may also be affected when the patient's head is turned to the side. -Often the case with altered LOC or unconscious patients. f. Possible injuries to the brain and/or cervical spine may interfere with normal respirations. i. If the great vessels in the neck are injured, significant bleeding and pressure on the upper airway are common.

Arterial Air Embolism

Air bubbles in the arterial blood vessels One of the most concerning pulmonary blast injuries a. Can produce: i. Disturbances in vision ii. Changes in behavior iii. Changes in state of consciousness iv. Variety of other neurologic signs Occurs on alveolar disruption with subsequent air embolization into the pulmonary vasculature. -Even small air bubbles can enter coronary artery or travel to cerebrovasacular system

Treating Open Wounds

All open wounds are assumed to be contaminated and present a risk of infection. 1. Applying a sterile dressing reduces the risk of further contamination - May moisten them with saline to keep wound from drying 2. Do not remove material from an open wound, no matter how dirty the wound is. 3. Small wound surfaces without significant bleeding can be flushed with sterile saline prior to applying a dressing. 4. In most circumstances, hospital personnel, rather than EMTs, will clean open wounds. -Chemical burns should be flushed C. In some cases, you can better control bleeding from open soft-tissue wounds by splinting the extremity, even if there is no fracture. Open injuries = sterile dressings d. Consider flushing small wound surfaces without significant bleeding with sterile saline prior to applying a dressing. e. If any material is "stuck" in the wound, do not remove it, as this may worsen bleeding and shock.

Glasgow Coma Scale (GCS) Score

An evaluation tool used to determine LOC, which evaluates and assists point values (scores) for eye opening, verbal response, and motor response, which are then totaled Effective in helping predict patient outcomes

Amputation

An injury in which part of the body is completely severed -Similar to avulsion -Lips, ear, nose, and scalp can also be amputated -May have massive bleeding Keep it cold, and keep it away from air or water

Avulsion

An injury in which soft tissue is torn completely loose or is hanging as a flap -Injury separates various layers of soft tissue (Usually between subcutaneous and fascia) -Often significant bleeding -Serious infection risks Physicians sometimes graft a piece of avulsed skin back into the appropriate position. a. If you find portions of avulsed skin, wrap them in a sterile dressing, place them in a plastic bag, and keep them cool. -Never remove skin i. Never place tissue on ice because freezing will destroy the tissue and make it unusable. ii. Deliver the bag labeled with the patient's name to the emergency department. If the skin is still attached in a loose flap, place the flap in a position that is as close to normal as possible. i. Hold it in place with a dry, sterile dressing.

Crushing Injury

An injury that occurs when a great amount of force is applied to the body -Damage depends on how much force is applied and for how long -Continued compression can cut off circulation

Which of the following mechanisms of injury would MOST likely cause a crushing injury of the larynx and/or trachea? Attempted suicide by hanging Gunshot wound to the lateral neck Car crash involving lateral impact Patient whose head hits the windshield

Answer: A Rationale: Any crushing injury of the upper part of the neck is likely to involve the larynx or trachea. Examples include the anterior neck impacting a steering wheel, hanging (distraction) mechanisms, and clothesline injuries.

An unrestrained driver collided with a bridge pillar. Upon inspection of the interior of his vehicle, you note that the lower dashboard is crushed. During your assessment of the patient, you will MOST likely encounter: trauma to the pelvis. blunt abdominal trauma. a severe closed head injury. penetrating thoracic trauma.

Answer: A Rationale: Impact points are often obvious from a quick inspection of the vehicle's interior. During a frontal collision, the unrestrained occupant's knees often impact the lower dashboard. With this type of impact, energy is transferred from the knees to the femurs, and then to the pelvis or hip. *Down and under

Which of the following sets of vital signs is LEAST indicative of internal bleeding? BP, 140/90 mm Hg; pulse rate, 58 beats/min; respirations, 8 breaths/min BP, 100/50 mm Hg; pulse rate, 120 beats/min; respirations, 24 breaths/min BP, 98/60 mm Hg; pulse rate, 110 beats/min; respirations, 28 breaths/min BP, 102/48 mm Hg; pulse rate, 100 beats/min; respirations, 22 breaths/min

Answer: A Rationale: Internal hemorrhage typically reveals vital signs that are consistent with shock: hypotension, tachycardia, and tachypnea. Hypertension, bradycardia, and bradypnea (choice "A") is consistent with a closed head injury, not internal bleeding.

Which of the following statements regarding the "Adam's apple" is FALSE? It is inferior to the cricoid cartilage. It is formed by the thyroid cartilage. It is the uppermost part of the larynx. It is more prominent in men than in women.

Answer: A Rationale: The most obvious prominence in the center of the anterior neck is the Adam's apple. This prominence is the upper part of the larynx, formed by the thyroid cartilage. It is more prominent in men than in women. The other portion of the larynx is the cricoid cartilage, a firm ridge that is inferior to the thyroid cartilage.

A young male experienced severe blunt chest trauma when his passenger car struck another vehicle head-on. During your inspection of the interior of his vehicle, you would MOST likely find: deployed airbags. steering wheel deformity. starring of the windshield. a crushed instrument panel.

Answer: B Rationale: Blunt chest injuries during a motor vehicle crash typically occur when the chest impacts the steering wheel. Therefore, your inspection of the vehicle's interior will most likely reveal a deformed steering wheel Deployed airbags will typically cause abrasions to the face, head, and arms

The quickest and MOST effective way to control external bleeding from an extremity is: a pressure bandage. direct pressure and elevation. a splint. a tourniquet.

Answer: B Rationale: Direct pressure is the quickest, most effective way to control external bleeding from an extremity. This will effectively control external bleeding in most cases.

Kinetic energy is a calculation of: weight and size. weight and speed. mass and weight. speed and force.

Answer: B Rationale: Kinetic energy is a calculation of mass (weight) and velocity (speed). Energy cannot be destroyed, only converted.

Which of the following signs is LEAST indicative of a head injury? Asymmetrical pupils Pupillary constriction to bright light Both eyes moving in opposite directions Inability to look upward when instructed to

Answer: B Rationale: The pupils normally constrict in bright light and dilate in dim light. Suspect a head injury if the pupils do not react appropriately, are asymmetrical (unequal), do not move together, or if the patient is unable to look upward.

When a person is looking at an object up close, the pupils should: dilate. constrict. remain the same size. dilate, and then constrict.

Answer: B Rationale: The pupils, which allow light to move to the back of the eye, constrict in bright light and dilate in dim light. The pupils should also constrict when looking at an object up close and dilate when looking at an object farther away; this is called pupillary accommodation. These pupillary adjustments occur almost instantaneously.

The presence of subcutaneous emphysema following trauma to the face and throat is MOST suggestive of: esophageal injury. cervical spine fracture. crushing tracheal injury. carotid artery laceration.

Answer: C Rationale: Crushing injuries or fractures of the larynx or trachea can result in a leakage of air into the soft tissues of the neck. The presence of air in the soft tissues produces a characteristic crackling sensation called subcutaneous emphysema.

Severe abrasion injuries can occur when motorcycle riders are slowed after a collision by road drag. Road drag is most often associated with which type of motorcycle impact? Head-on collision Angular collision Ejection Controlled crash

Answer: C Rationale: During an ejection, the rider will travel at high speed until stopped by a stationary object, another vehicle, or road drag. Severe abrasion injuries (road rash) down to bone can occur with drag.

A 21-year-old male has a large laceration to his neck. When you assess him, you note that bright red blood is spurting from the left side of his neck. You should immediately: apply a pressure dressing to his neck. sit the patient up to slow the bleeding. place your gloved hand over the wound. apply 100% oxygen via nonrebreathing mask.

Answer: C Rationale: Laceration of the carotid artery—as evidenced by bright red blood spurting from the wound—can cause profuse bleeding, profound shock, and death very quickly. You must immediately control the bleeding with the use of direct pressure. Cover the wound with your gloved hand initially and then apply a bulky pressure dressing. After the bleeding has been controlled, apply high-flow oxygen and transport promptly.

A 40-year-old man was standing near a building when it exploded. He has multiple injuries, including a depressed skull fracture, severe burns, and an impaled object in his abdomen. His head injury was MOST likely caused by ___________ blast injuries. primary secondary tertiary quaternary

Answer: C Rationale: Primary blast injuries are caused by the pressure wave and include ruptured eardrums and hollow organ rupture. Secondary blast injuries are caused by flying debris and include impaled objects and shrapnel injuries. Tertiary blast injuries occur when the victim is thrown into a solid object, resulting in blunt trauma to virtually any part of the body. Quaternary blast injuries include other miscellaneous injuries.

The purpose of the eustachian tube is to: move in response to sound waves. transmit impulses from the brain to the ear. equalize pressure in the middle ear when external pressure changes. house fluid within the inner chamber of the ear and support balance.

Answer: C Rationale: The middle ear is connected to the nasal cavity by the eustachian tube, which permits equalization of pressure in the middle ear when external atmospheric pressure changes.

When caring for a patient with internal bleeding, the EMT must first: ensure a patent airway. obtain baseline vital signs. control any external bleeding. take appropriate standard precautions.

Answer: D Rationale: All of the interventions in this question must be performed. However, before providing patient care—whether the patient is bleeding or not—the EMT must first ensure that he or she has taken the appropriate standard precautions.

Which of the following would MOST likely result from the third collision in the "three-collision" effect that occurs during a high-speed, frontal impact motor vehicle crash? Extensive damage to the automobile Flail chest and lower extremity fractures Massive external trauma with severe bleeding Aortic rupture or compression injury to the brain

Answer: D Rationale: During the third collision, the body's internal organs collide with the inside of the body. These injuries are usually not as obvious, but are often the most life-threatening. Injuries that may result from this include internal injuries of the brain (compression injuries) and aortic tears, resulting in massive internal bleeding.

Death from a rollover motor vehicle crash is MOST often secondary to: crushing injuries. airbag-related trauma. multiple collisions to the interior of the car. ejection of the patient from the motor vehicle.

Answer: D Rationale: Rollover crashes are the most unpredictable with regard to injuries sustained by the patient. An unrestrained passenger may have struck multiple points within the vehicle. However, the most life-threatening event in a rollover is ejection or partial ejection of the patient from the vehicle.

The globe of the eye is also called the: lens. orbit. retina. eyeball.

Answer: D Rationale: The globe of the eye is also called the eyeball. The lens, which sits behind the iris, focuses images on the retina—the light-sensitive area at the back of the globe. The globe is located within a bony socket in the skull called the orbit.

Hemostatic Agent

Any chemical compound that slows or stops bleeding by assisting with clot formation -Primarily used in military medicine Two forms: a. Granular powder i. Can be inserted into small wounds to create a tight seal (Gunshot wound) b. Gauze impregnated with a clay substance, which speeds blood clot formation 3. Can be used together with direct pressure when direct pressure alone is ineffective -Gauze can also be packed into larger wounds to control hemorrhage 4. The use of hemostatic agents in EMS remains largely experimental. -Can be used with direct pressure when there is massive chest injury or you can't use a tourniquet!

Projectile

Any object propelled by force, such as a bullet by a weapon

Index of Suspicion

Awareness that unseen life-threatening injuries may exist when determining the mechanism of injury Evaluation of the MOI for trauma patient will provide you with index of suspicion

Hyphema

Bleeding into anterior chamber of eye -Common following blunt trauma -Seriously impairs vision

Battle Signs

Basal skull fracture (bruising behind the ear) Look for raccoon eyes under both eyes

Car VS Bicycle

Bicycle: Presume spinal cord injury unless proven otherwise -Spinal stabilization must be initiated and maintained during the encounter. *Bring helmet to hospital

Melena

Black, foul-smelling, tarry stool containing digested blood

Hemorrhage

Bleeding

Classification of Burns in Infants and Children

Burns are generally considered more severe for children because they have more surface area relative to body mass, which means greater fluid and heat loss - Greater risk for shock Severe: Any full-thickness burn Partial thickness burn covering more than 20% of body Moderate: Partial burn covering 10-20% Minor: Partial thickness covering less than 10%

Thermal Burns

Burns caused by heat Thermal burns can occur when skin is exposed to temperatures higher than 111°F (44°C). -Burn injuries are progressive - greater the heat, deeper the wound -Severity depends on temp, concentration, amount of energy possessed by object, and duration -Remove all jewlery -Apply dry, sterile dressing

Penetrating Injuries to Neck

Can cause profuse bleeding from laceration of great vessels in neck - Carotid arteries and jugular veins - Can cause the body to bleed out, also known as exsanguination. i. Injuries to these large vessels may also allow air to enter the circulatory system. ii. If a vein has been punctured, air may be sucked through it to the heart. iii. This condition is called an air embolism. iv. A large amount of air in right atrium and right ventricle of heart can lead to cardiac arrest. c. The airway, the esophagus, and the spinal cord can be damaged by a penetrating injury. d. Direct pressure over the bleeding site will control most neck bleeding - Airtight/Occlusive dressing! -Apply manual pressure, both don't compress arteries -Wrap gauze under patients opposite shoulder/axilla so its not around neck -Cervical collar may assist in holding dressings in place -Apply high flow O2

Chemical Burns

Can occur whenever a toxic substance contacts the body. 2. Most chemical burns are caused by strong acids or strong alkalis. 3. The eyes are particularly vulnerable. -Sometimes fumes alone can cause burns (Especially respiratory tract burns) -Severity of burn depends on chemical and duration -Consider HazMat -Wear chemical resistant gloves and eye wear Treatment for chemical burns can be specific to the chemical agent. 8. Management of chemical burns a. The severity of the burn depends on type of chemical, its strength, duration of exposure, and area of the body exposed. b. To stop burning process, remove any chemical from the patient. c. Always brush dry chemicals off skin and clothing before flushing the patient with water. d. Remove the patient's clothing, including shoes, stockings, gloves, and any jewelry or eyeglasses. f. For liquid chemicals, immediately begin to flush the burned area with large amounts of water. g. Continue flooding the area with gallons of water for 15 to 20 minutes after the patient says the burning pain has stopped. -If eye burned, hold it open and irrigate

Vehicular Crashes

Classified as either: a. Frontal (head-on) b. Rear-end c. Lateral (T-bone) d. Rollovers e. Rotational (spins) The principal difference is the direction of the force of impact. With spins and rollovers there is a possibility for multiple impacts Usually consists of a series of three collisions

In a cold environment, the blood vessels in skin:

Constrict, diverting blood away from skin and decreasing heat that radiates from body surface.

Occlusive Dressings

Dressings made of petroleum (Vaseline) gauze, aluminum foil, or plastic that prevent air and liquids from entering or exiting a wound -Prevents air from entering veins/air embolism -Use for penetrating trauma

Injuries to Ears

Ears are often injured, but do not usually bleed very much. -First, place soft, padded dressing between back of ear and scalp a. If local pressure does not control bleeding, apply a roller dressing. 4. In case of an ear avulsion, wrap the avulsed part in a moist, sterile dressing and put it in a plastic bag labeled with the patient's name. 5. Tympanic membrane rupture a. Sudden changes in pressure created by blast wave or insertion of objects may cause rupture b. Patients will report severe pain, difficulty hearing, or ringing in the affected ear. -Never remove object from ear in field Fluid coming from ear = basal skull fracture

Electrical Burns

Electrical burns may be result of contact with high- or low-voltage electricity. a. High-voltage burns may occur when utility workers make direct contact with power lines. b. Ordinary household current can cause severe burns and cardiac arrhythmias. 2. For electricity to flow, there must be a complete circuit between electrical source and ground. a. Insulator; any substance that prevents this circuit from being completed b. Conductor: any substance that allows a current to flow through it c. The human body is a good conductor. d. Electrical burns occur when the body, or a part of it, completes a circuit connecting a power source to the ground. -The type of electric current, magnitude of current, and voltage have effects on the seriousness of burns. -Damage can be from heat or chemical -Always assume power line is live -Entrance wound is usually small, exit wound can be extensive/deep

Trauma Emergencies

Emergencies that are the result of physical forces applied to a patient's body.

Medical Emergencies

Emergencies that require EMS attention because of illnesses or conditions not caused by an outside force.

Kinetic Energy

Energy of a moving object 1. Reflects the relationship between the mass (weight) of the object and the velocity (speech) at which it is traveling KE = ½ mass x velocity^2 (Speed is a more important factor) - When car speed increases from 50 to 70, energy available to cause injury doubles 2. According to the equation for kinetic energy, the energy that is available to cause injury doubles when an object's weight doubles but quadruples when its speed doubles. D. Potential energy is the product of mass (weight), force of gravity, and height. 1. Mostly associated with the energy of falling objects -Converted to work

Eye Injuries

Especially common in sports A damaged cornea quickly loses its smooth, wet appearance. On rare occasions, eyeball may be displaced from its socket. i. Do not attempt to reposition it. ii. Cover the eye and stabilize it with a moist sterile dressing. iii. Cover both eyes to prevent further injury because of sympathetic movement. iv. Have the patient lie supine to prevent loss of fluid from the eye.

Middle ear is connected to the nasal cavity by the:

Eustachian tube - Inner auditory canal -This connection permits equalization of pressure in middle ear when external pressure changes

Frontal Crashes

Evaluate the supplemental restraint system. i. Determine whether the passenger was restrained by a full and properly applied three-point restraint. ii. Determine whether the air bag was deployed. -Knees can strike dashboard, resulting in hip fracture/dislocation -Chest and abdominal injuries can occur when body strikes steering wheel -Head and spinal can result when striking windshield

The Face

Face and neck are particularly vulnerable to injuries -Soft-tissue injuries and fractures are especially common -If hematoma forms in face or neck, it could cut off air to brain Composed of: i. Eyes ii. Ears iii. Nose iv. Mouth v. Cheeks Only the proximal third of the nose is formed by bone. i. The remaining two thirds are composed of cartilage. About 1 inch posterior to the external opening of the ear is the mastoid process. i. Bony mass at the base of the skull h. The mandible forms the jaw and chin. i. The jaw is the lower border of the mouth, where the tongue and 32 teeth are located. ii. Motion of the mandible occurs at the temporomandibular joint, which lies just in front of the ear on either side of the face. iii. Below the ear and anterior to the mastoid process, the angle of the mandible is easily palpated.

Superficial Burns

First Degree Burns that affect only the top layer of skin (epidermis), characterized by skin that is red but not blistered or actually burned through. iii. The burn site is often painful. iv. Example: sunburn -Heal without scaring

Contact Lenses and Artificial Eyes

In general, do not attempt to remove contact lenses - Only exception is for chemical burns. b. To remove a hard contact lens, use a small suction cup, moistening the end with saline. c. To remove soft contact lenses, place one or two drops of saline in the eye, gently pinch the lens between your gloved thumb and index finger, and lift it off the surface of the eye. d. Place the lens in a container with sterile saline solution. e. Advise the hospital staff if patient is wearing contact lenses. Patient wearing an eye prosthesis: Suspect artificial eye when it does not respond to light, move in concert with the opposite eye, or appear quite the same as the opposite eye - Ask about it

Rabid

Infected with rabies An acute, potentially fatal viral infection of the central nervous system that can affect all warm-blooded animals. i. The virus is in the saliva of a rabid, or infected, animal and is transmitted through biting or licking an open wound. ii. Infection can be prevented only by a series of special vaccine injections. g. Children, particularly young ones, may be seriously injured or even killed by dogs. i. The animal may turn and attack you as well. ii. Do not enter scene until animal has been secured by police or animal control officer.

Conjunctivitis

Inflammation of the conjunctiva -Often associated with the presence of foreign object in eye

Inhalation Burns

Inhalation injuries can occur when burning takes place in enclosed spaces without ventilation. a. When upper airway is exposed to excessive heat, patient can experience rapid and serious airway compromise. b. Upper airway damage is often associated with inhalation of superheated gases. c. Lower airway damage is often associated with inhalation of chemicals and particulate matter. -Upper airway swelling, which requires immediate intervention. a. Consider requesting ALS backup if the patient has signs and symptoms of edema. i. Stridor ii. Hoarse voice iii. Singed nasal hairs iv. Burns of the face v. Carbon particles in the sputum b. Apply cool mist, aerosol therapy, or humidified oxygen to help reduce some minor edema. c. Apply ice pack to throat to reduce swelling, provided tissue in that area does not have burns. 3. Combustion process produces a variety of toxic gases. (the less efficient the combustion process, the more toxic the gases that may be created). 4. Carbon monoxide (CO) intoxication should be considered whenever a group of people in the same place all report a headache or nausea. 5. Cherry red skin, lips, and nail beds are commonly observed in patients who have died from CO exposure. (Do not rule out CO exposure simply because the patient's skin is not cherry red). 6. Hydrogen cyanide (HCN) is generated by combustion (Produced by combustion of cotton, paper, and wool - smells like bitter almonds a. Signs and symptoms involve the central nervous, respiratory, and cardiovascular systems: i. Faintness ii. Anxiety iii. Abnormal vital signs iv. Headache vi. Seizures vii. Paralysis viii. Coma Prehospital treatment of a patient with suspected hydrogen cyanide poisoning includes decontamination and supportive care until antidote can be administered by ALS providers. c. Care for any toxic gas exposure: i. Recognition ii. Identification iii. Supportive treatment

Closed Injuries

Injuries in which damage occurs beneath the skin or mucous membrane but the surface if the skin remains intact -Harder to assess than open injuries 1. Closed soft-tissue injuries are characterized by: a. History of blunt trauma b. Pain at the site of injury c. Swelling beneath the skin d. Discoloration

Burns

Injuries in which soft-tissue damage occurs as a result of thermal heat, frictional heat, toxic chemicals, electricity, or nuclear radiation -Created by the transfer of radiation, thermal, or electrical energy. Burns account for approximately 3,400 deaths per year. -Classified by depth -Among the most serious and painful of all injuries. 1. A burn occurs when the body, or a body part, receives more radiant energy than it can absorb, resulting in an injury. -Always perform a complete assessment to determine whether other serious injuries are present. 3. Children, older patients, and patients with chronic illnesses are more likely to experience shock from burn injuries. *Many fires generate toxic compounds - enter only if you have been equipped to. Significant airway burns are serious. i. May be associated with stridor, singed hair within the nostrils, soot around the nose and mouth, hoarseness, and hypoxia ii. These patients should be rapidly transported to an ED or facility capable of advanced airway management. -Airway becomes more difficult once swelling begins

Open Injuries

Injuries in which there is a break in the surface of the skin or the mucous membrane, exposing deeper tissue to potential contamination -Protective layer of skin is damaged b. Address both excessive bleeding and contamination in your treatment of open soft-tissue wounds. c. Four types of open soft-tissue wounds: i. Abrasions ii. Lacerations iii. Avulsions iv. Penetrating wounds An open injury may allow an air embolism to enter the circulatory system

Internal Bleeding

Internal bleeding is any bleeding in a cavity or space inside the body. B. Can be very serious, because it is not easy to detect immediately 1. Injury or damage to internal organs commonly results in extensive internal bleeding. 2. Can cause hypovolemic shock Possible conditions causing internal bleeding include: 1. Stomach ulcer (Large amount of blood loss quickly) 2. Lacerated liver (Lot of bleeding with no visible signs) 3. Ruptured spleen (Lot of bleeding with no visible signs) 4. Broken bones, especially ribs or femur 5. Pelvic fracture (Can easily result in loss of 2 pints or more into soft tissues in thigh) -Often the only signs of bleeding are local swelling and bruising (Contusion or ecchymosis) Internal bleeding is possible whenever the MOI suggests that severe forces affected the body. (Blunt trauma, Penetrating trauma) 1. Not always caused by trauma -Possible non traumatic causes include: a. Bleeding ulcers b. Bleeding from the colon c. Ruptured ectopic pregnancy d. Aneurysms e, Severe nosebleeds/dialysis shunt These signs are frequent but not always present: a. Abdominal tenderness b. Guarding c. Rigidity d. Pain e. Distention In older patients, first signs include: Dizziness, Faintness (syncope), and Weakness. 5. Ulcers or other gastrointestinal problems may cause: a. Vomiting of blood b. Bloody diarrhea or urine Patients who may have significant bleeding will quickly become unstable. c. Signs that imply the need for rapid transport include: i. Tachycardia ii. Tachypnea iii. Low blood pressure iv. Weak pulse v. Clammy skin Emergency Medical Care for Internal Bleeding A. Controlling internal bleeding or bleeding from major organs usually requires surgery or other hospital procedures.. 2. Provide high-flow oxygen. 3. Maintain body temperature. 4. Splint the injured extremity (usually with an air splint). 5. Never use a tourniquet to control the bleeding from closed, internal, and/or soft-tissue injuries.

Abrasion

Loss or damage of the superficial layer of skin as a result of a body part rubbing or scraping across a rough or hard surface -Wound to superficial layer Caused by friction when a body part rubs or scrapes across a rough or hard surface. a. An abrasion usually does not penetrate completely through the dermis, but blood may ooze from the injured capillaries in the dermis. i. Examples: road rash, road burn, strawberry, rug burn b. Abrasions can be extremely painful because the nerve endings are located in this area.

Collagen

Makes up scars In the last stage of wound healing, collagen provides stability to the damaged tissue and joins wound borders, thereby closing the open tissue. a. Collagen is a tough, fibrous protein found in scar tissue, hair, bones, and connective tissue. b. Collagen cannot restore the damaged tissue to its original strength.

MOI

Mechanism of injury The forces, or energy transmission, applied to the body that cause injury

Epistaxis

Nosebleed a. Common emergency b. Occasionally causes enough blood loss to lead to shock c. The blood seen may be only small part of total blood loss - Much of the blood may pass down throat into the stomach as patient swallows. ii. A person who swallows a large amount of blood may become nauseated/start vomiting (may be confused with internal bleeding). d. Most nontraumatic nosebleeds occur from sites in the septum, the tissue dividing the nostrils. e. You can usually handle this type of bleeding effectively by pinching the nostrils together. -Don't lean back, lean forward - often result of high BP Apply ice- You can also apply pressure with roller gauze between upper lip and gum -Apply direct pressure for at least 15 minutes Bleeding from nose or ears following a head injury: a. May indicate skull fracture b. May be difficult to control c. Do not attempt to stop blood flow! i. Applying excessive pressure to injury may force blood leaking through the ear or nose to collect within the head - This could increase the pressure on brain and possibly cause permanent damage. If you suspect a skull fracture: i. Loosely cover the bleeding site with a sterile gauze pad to collect blood and help keep contaminants away from the site. ii. Apply light compression by wrapping the dressing loosely around head. A target or halo-shaped stain may occur on dressing if blood or drainage contains cerebrospinal fluid.

Newton's First Law

Object at rest tends to stay at rest and an object at motion tends to stay at motion unless acted on by another force (Like a dashboard)

Impaled Objects

Objects that penetrate the skin but remain in place -May have little external bleeding -Do not attempt to remove object unless it is in cheek/mouth or impairs airway/CPR (Object in chest) Concerns with this type of injury: i. Damage to structures deep inside the body ii. Presence of foreign materials inside the tissue that can lead to infection -If object is very long, secure and then shorten it. -Remove clothing and apply bulky dressings (Tape, gauze, and soft dressings)

Blood Thinners

Often prescribed for patients with history of stroke, pulmonary embolism, or heart attack -Aspirin, warfarin (Coumadin), rivaroxaban (Xarelto), dabigatran (Pradaxa), apixaban (Eliquis), and clopidogrel (Plavix)

Petechiae

Pinpoint, reddish-purple hemorrhages that show up on skin

Pulmonary Blast Injuries

Pulmonary trauma resulting from short-range exposure to the detonation of explosives -Contusions and hemorrhages -Both lungs are usually injured -Patient may report tightness in chest, tachypnea, cough up blood, subcutaneous emphysema (Air in thorax), respiratory distress b. Pneumothorax is a common injury and may require emergency decompression in the field. c. Pulmonary edema may ensue rapidly. 5. One of the most concerning pulmonary blast injuries is arterial air embolism -Administer oxygen, even if patient just has a ruptured eardrum (Avoid positive pressure)

Drag

Resistance that slows a projectile, such as a air

Seat-belts and Airbags

Seatbelts and air bags are effective in preventing a second collision inside the motor vehicle. i. Seatbelts may decrease the severity of the third collision. ii. Air bags decrease the severity of deceleration injuries and decrease injury to the chest, face, and head. -In a pickup truck or single-seated vehicle, the air bag should be turned off. e. Remember that if the air bag did not inflate during the accident, it may deploy during extrication . Remember that supplemental restraint systems can cause harm whether they are used properly or improperly. i. Hip dislocations may result if seatbelts are worn too low. ii. Internal injuries can occur when the belt is worn too high. iii. Lumbar spine fractures are also possible, particularly in children and older patients. Seatbelts are designed to worn over iliac crests in pelvis

Partial-Thickness Burns

Second Degree Burns that affect the epidermis and some portion of the dermis but not the subcutaneous tissue, characterized by blisters and skin that is white to red, moist, and mottled -Intense pain -Small partial thickness burns heal without scaring, but deep partial thickness and full-thickness are prone to scaring and best managed surgically -It is impossible to estimate depth of partial burn shortly after injury

Penetrating Trauma/Wound

Second leading cause of trauma death (after blunt) Many times it is difficult to determine entrance and exit wounds from projectiles in a prehospital setting (Don't waste time trying to tell the difference)- Entrance is usually small and may have burns around it Injury caused by objects, such as knives and bullets, that pierce or penetrate the surface of the body and damage internal tissues and organs -Injury resulting from a sharp, piercing object Low energy penetrations are caused by sharp weapons (Injuries are close to wound path) In medium & high-velocity (speed) penetrating trauma, path of projectile (usually a bullet) may not be easy to predict. 1. Bullet may flatten out, tumble, or even ricochet within the body before exiting. 2. The path the projectile takes is its trajectory. 3. Fragmentation will increase damage (Frangible bullets) 4. Bullet's speed is factor in resulting injury pattern. -.22 is notorious for hitting and changing directions -Speed is more important than size- determine what weapon was used Majority of gunshot wounds in US are low caliber Sometimes called puncture wound -Hard to determine how much damage is done -May have little external bleeding Treat all penetrating wounds to neck, chest, back, and upper abdomen with occlusive dressing

Retinal Detachment

Separation of the retina from its attachments at the back of the eye -Especially seen in sports/boxing -Painless -Produces flashing lights, specks, or "floaters" -Cloud or shade over vision iii. Requires prompt medical attention to preserve vision -Retina separated from nourishing choroid

Classification of burns in adults

Severe: Full thickness, involves hands, feet, face, upper airway, genitalia, circumferential burns -Full thickness burns over more than 10% -Partial thickness burns over 30% -Burns associated with respiratoyr injury -Burns complicated by fractures -Patient younger than 5 or older than 55 that would be classified as moderate on young adults Moderate: Full thickness burns involving 2-10% (Excluding hands,feet, face, upper airway, genitalia) -Partial burn covering 15-30% -Superficial burns covering more than 50% Minor: Full thickness covering less than 2%,partial thickness covering less than 15%, superficial covering less than 50%

Crush Syndrome

Significant metabolic derangement that develops when crushed extremities or body parts remain trapped for prolonged periods Can develop when area of body is trapped for longer than 4 hours and arterial blood flow is compromised When a patient's tissues are crushed beyond repair, muscle cells die and release harmful substances into the surrounding tissues. a. Harmful substances are released into the body's circulation after the limb is freed and blood flow is returned. b. Advanced life support (ALS) providers should administer IV fluid before the crushing object is lifted off the body. c. Freeing the body part from entrapment also creates the potential for cardiac arrest and renal failure.

Capillary Bleeding

Slow, even flow Venous and Capillary are more likely to clot spontaneously than arterial bleed

Tourniquet

The bleeding control method used when a wound continues to bleed despite the use of direct pressure Useful if patient is bleeding severely from a partial or complete amputation -Should make pulses distal to the tourniquet no longer palpable -Different types include MAT, CAT, RMT, and SWAT-T Observe the following precautions: a. Do not apply a tourniquet directly over any joint. b. Always place the tourniquet proximal to the injury. c. Make sure the tourniquet is tightened securely. d. Never use wire, rope, a belt, or any other narrow material because it could cut into the skin- Bandage should be at least 4 inches wide. e. Place padding under the tourniquet if possible to protect the tissues and help with arterial compression. f. Never cover a tourniquet with a bandage. -Never use a tourniquet to control the bleeding from closed, internal, and/or soft-tissue injuries. g. Do not loosen the tourniquet after you have applied it. 6. Mark the exact time the tourniquet was applied and be sure to communicate the time and site of application, and the rationale of application clearly and specifically to hospital personnel - Tape time to person's forhead 7. BP cuff can be used if there are no other options -Consider tourniquet for open fractures -Preferably apply tourniquet by groin for legs and axilla for arms

Veins

The blood vessels that carry blood from the tissues to the heart

Pupil

The circular opening in the middle of the iris that admits light to the back of the eye a. Allows light to move to the back of the eye b. Anisocoria is a condition in which a person is born with different-sized pupils. i. In unconscious patients, unequal pupil size may indicate serious injury or illness of the brain or eye. -Becomes smaller in bright light and dilates in dark -Becomes smaller when looking at things close

Perfusion

The circulation of blood within an organ or tissue in adequate amounts to meet the cells' current needs for oxygen, nutrients, and waste removal.

Hemoptysis

The coughing up of blood

Conjunctiva

The delicate membrane that lines the eyelids and covers the exposed surface of the eye -Kept moist by fluid produced in lacrimal glands

Evisceration

The displacement of organs outside the body -Common with abdominal wounds -Don't move a. Cover the wound with sterile gauze moistened with sterile saline solution. b. Secure the gauze with an occlusive dressing. c. Keep the organs moist and warm. -If no spinal injury is suspected and legs are uninjured, flex them to relieve abdomen pressure

External Auditory Canal

The ear canal Lead to the tympanic membrane

Tympanic Membrane

The eardrum Lies between external and middle ear A thin, semi-transparent membrane in the membrane in the middle ear that transmits sound vibrations to the internal ear by means of auditory ossicles Evolved to detect minor changes in pressure and will rupture at pressures of 5 to 7 pounds per square inch above atmospheric pressure. -Patient will report ringing in ears, pain, loss of hearing, blood may be visible in ear canal (Permanent hearing loss is possible)

Ears

The exposed portion of the ear is composed entirely of cartilage covered by skin. -Associated with hearing and balance. Divided into three parts: External, middle, and inner External: Divided into pinna, external auditory canal, which leads toward tympanic membrne i. The external, visible part is called the pinna. i. The external auditory canal leads in toward the tympanic membrane (eardrum). Middle ear: i. Contains three small bones (hammer, anvil, and stirrup) that move in response to sound waves hitting the tympanic membrane (eardrum). ii. The middle ear is connected to the nasal cavity by the eustachian tube, which is the internal auditory canal. Inner ear: Composed of bony chambers filled with fluid ii. As the head moves, so does the fluid. iii. In response, fine nerve endings within fluid send impulses to brain about the position of head. ii. The tragus is a small, rounded, fleshy bulge immediately anterior to the ear canal. iii. The superficial temporal artery can be palpated just anterior to the tragus. *One inch below ear is mastoid process

Pinna

The external, visible part of the ear AKA auricle, lies outside of the head.

Globe

The eye ball The eyeball, or globe, keeps its shape as a result of pressure from the fluid contained within its two chambers.

Fascia

The fiber-like, thin connective tissue that covers arteries, veins, tendons, and ligaments

Coagulation

The formation of clots to plug openings in injured blood vessels and stop blood flow

Lacrimal Glands

The glands that produce fluids to keep the eye moist AKA Tear glands Lacrimal system consists of tear glands and ducts -Tears act as lubricants and keep the eye from drying out -Blinking sweeps fluid over eyes - tears drain on the inner side of eye through two lacrimal ducts into nasal cavity

Emergency Medical Care for Burns

The goal in treating burns is to: a. Stop the burning process. b. Assess and treat breathing. c. Support circulation. -Consider covering large burned area with sterile burn sheet Burn on left hand: get the ring off Provide high flow oxygen Do not apply ice, use cool water if needed -Cover wound in wet, cool dressing

How long can different parts of the body survive without blood?

The heart requires a constant supply of blood. -Some areas of boy require more blood during certain times (Gastro after meal) 1. The brain and spinal cord may last 4 to 6 minutes without perfusion. 2. The lungs can survive only 15-20 minutes without perfusion. 3. Kidneys may survive 45 minutes. 4. Skeletal muscles may last 2-3 hours. 5. The gastrointestinal tract can tolerate slightly longer periods. 6. Times are based on a normal body temperature (98.6°F [37.0°C]). a. Colder temperatures will lengthen survival times. 2. Some tissues need a constant supply of blood, while others can survive with very little.

Temporomandibular Joint

The joint formed where the mandible and cranium meet, just in front of the ear

Retina

The light-sensitive area of the eye where images are projected A layer of cells at the back of the eye that changes the light image into electric impulses, which are carried by the optic nerve to the brain The retina contains nerve endings, which respond to light by transmitting nerve impulses through the optic nerve to the brain. -Lens focuses images on retina a. The retina is nourished by a layer of blood vessels between it and the back of the globe. i. Called the choroid b. Retinal detachment is when the retina detaches from the underlying choroid and sclera. i. Causes blindness

Mucous Membranes

The linings of body cavities and passages that are in direct contact with outside environment

Aorta

The main artery that recieves blood from the left ventricle an delivers it to all the other arteries that carry blood to the tissues of the body

Work

The measure of force over distance Forces that bend, pull, or compress tissues beyond their inherent limits result in the work that causes injury.

Iris

The muscle and surrounding tissue behind the cornea that dilate and constrict the pupil, regulating the amount of light that enters the eye The iris acts like a camera to adjust the size of the opening to regulate the amount of light that enters the eye. The iris is a circular muscle behind the cornea. Pigment in this tissue gives eye color

Sternocleidomastoid Muscles

The muscles on either side of the neck that allow movement of the head Originate from the mastoid process of the cranium and insert into the medial border of each collarbone and the sternum at the base of the neck

Vasoconstriction

The narrowing of a blood vessel, such as with hypoperfusion? or cold extremities

Injuries of the Neck

The neck contains many structures vulnerable to injury by blunt trauma, including: a. Upper airway b. Esophagus c. Carotid arteries and jugular veins d. Thyroid cartilage (Adam's apple) e. Cricoid cartilage f. Upper part of the trachea -Any injury to neck should be considered serious

Air Embolism

The presence of air in the veins, which can lead to cardiac arrest if it enters the heart

Contamination

The presence of infective organisms or foreign bodies such as dirt, gravel, or metal

Potential Energy

The product of mass (weight), gravity, and height, which is converted into kinetic energy and results in injury, such as from a fall. -Height person fell from and ground they landed on. -Converted into kinetic energy, which is converted into work

Mastoid Process

The prominent bony mass at the base of the skull about 1 inch posterior to the external opening of the ear

Burn Complications

The skin serves as a barrier between the environment and the body. a. When a person is burned, this barrier is destroyed. b. Burns create a high risk for: i. Infection ii. Hypothermia iii. Hypovolemia iv. Shock -Can also cause acidosis and prevent blood from clotting correctly 2. Burns to the airway are of significant importance because the loose mucosa in the hypopharynx can swell and lead to complete airway obstruction. 3. Circumferential burns of the chest can compromise breathing. 4. Circumferential burns of an extremity can lead to compartment syndrome, resulting in neurovascular compromise and irreversible damage if not appropriately treated.

Deceleration

The slowing of an object

Capillaries

The small blood vessels that connect arterioles and venules Various substances pass through capillary walls, into and out of the interstitial fluid, and then on to the cells

Tragus

The small, rounded, fleshy bulge that lies immediately anterior to the ear canal

Arterioles

The smallest branches of arteries leading to the vast network of capillaries

Sclera

The tough, fibrous, white portion of the eye that protects the more delicate inner structures. -Extends over surface of globe -Helps maintain globe shape -Color changes here indicate medical problems (Yellow for jaundice) -On the front of the eye, the sclera is replaced by a clear, transparent membrane called the cornea. Helps maintain the globular shape and protects the more delicate inner structures.

Lens

The transparent part of the eye through which images are focused on the retina The lens lies behind the iris. a. The lens focuses images on the retina at the back of the globe.

Cornea

The transparent tissue layer in front of the pupil and iris of the eye a. Allows light to enter the eye b. The iris is a circular muscle behind the cornea.

Dermis

The vascular inner layer of the skin, containing hair follicles, sweat glands, nerve endings, and blood vessels -Lies below germinal cells -Blood vessels in dermis provide skin with nutrients and oxygen. -Specialized nerve endings within dermis *Sweat glands primary function is to cool body (Discharge sweat through ducts that pass through epidermis) -Contains sebaceous gland

Energy

Three concepts of energy are typically associated with injury: a. Potential energy b. Kinetic energy c. Energy of work 3. Energy can be neither created nor destroyed, but can only be converted or transformed.

Multi-System Trauma

Trauma that affects more than one body system -High level of morbidity and mortality -On-scene time should be limited o 10 minutes (platinum 10)

Treat a closed soft-tissue injury using:

Treat a closed soft-tissue injury using the RICES mnemonic: 1. Rest 2. Ice 3. Compression 4. Elevation 5. Splinting *Anxiety, agitation, and changing mental status are early indicators of developing shock

DCAP-BTLS

Use to assess for signs of injury. a. Deformities b. Contusions c. Abrasions d. Punctures/penetrations e. Burns f. Tenderness g. Lacerations h. Swelling

Venules

Very small, thin-walled blood vessels

Car VS Pedestrian

You should determine: a. Speed of the vehicle b. Whether the patient was thrown through the air and at what distance c. Surface the patient landed on d. Whether the patient was struck and pulled under the vehicle -Multi-system injuries are common

Burns of the Eye

Your role is to stop the burn and prevent further damage. b. Chemical burns: Usually caused by acid or alkaline solutions -Flush the eye with water or sterile saline irrigation solution. -Direct the greatest amount of irrigating solution or water into the eye as gently as possible. iv. You may have to force lids open to irrigate. v. Use a bulb, irrigation syringe, nasal cannula, basin, or running faucet. vi. You can even have the patient immerse his or her face in a large pan or basin of water and rapidly blink- don't contaminate good eye vii. Flush from the inner corner of the affected eye toward the outside corner. viii. If burn was caused by an alkali or strong acid, irrigate the eye continuously for at least 20 min. ix. After irrigation, apply a clean, dry dressing to cover the eye, and transport the patient. c. Thermal burns: i. During fire, eyes close to protect from heat. ii. Eyelids are frequently burned and require specialized care. iii. Transport promptly without further examination. iv. Cover both eyes with a sterile dressing moistened with sterile saline. - You may apply eye shields over the dressing. d. Light burns: i. Infrared rays, eclipse light, and laser beams all can cause significant damage to the sensory cells of the eye. ii. Retinal injuries caused by exposure to extremely bright light are generally not painful but may result in permanent damage. iii. Superficial burns of the eye can result from ultraviolet rays from an arc welding unit; light from prolonged exposure to a sunlamp; or reflected light from a bright, snow-covered area. iv. May not be painful at first, but may become so 3 to 5 hours later v. Severe conjunctivitis usually develops, with redness, swelling, and excessive tear production. vi. You can ease the pain by covering each eye with a sterile, moist pad and an eye shield - Have patient lie down vii. The patient should be examined by a physician as soon as possible.

Air Splints

a. Also known as soft splints or pressure splints b. Can control internal or external bleeding associated with severe extremity injuries (Not as effective as tourniquet) c. Immobilize fractures d. Act like a pressure dressing applied to an entire extremity rather than to a small, local area e. Use only approved, clean, or disposable valve stems when orally inflating air splints.

Trachea

a. Below the larynx b. The trachea connects the oropharynx and the larynx with the main passages of the lungs (the bronchi). c. On either side of the lower larynx and the upper trachea lies the thyroid gland (Usually not palpable).

Clotting

a. Bleeding tends to stop rather quickly, within about 10 minutes, in response to internal mechanisms and exposure to air. b. When the skin is broken, blood flows rapidly from the open vessel. c. The cut ends of the vessel begin to narrow (vasoconstriction), reducing the amount of bleeding. d. Next, a clot forms, plugging the hole and sealing the injured portions of the blood vessel (coagulation). e. Bleeding will never stop if a clot does not form, unless the injured vessel is completely cut off from the main blood supply by direct pressure or a tourniquet. Despite the efficiency of the circulatory system, it may fail in certain situations: i. Movement ii. Disease iii. Medications iv. Removal of bandages v. External environment vi. Body temperature vii. Severe injury

Three Types of Soft-Tissue Injuries

a. Closed injuries i. Damage occurs beneath the skin or mucous membrane. ii. The surface of the skin or mucous membrane remains intact. b. Open injuries i. There is a break in the surface of the skin or mucous membrane. ii. Exposes deeper tissues to contamination c. Burns i. Damage results from: (a) Thermal heat (b) Frictional heat (c) Toxic chemicals (d) Electricity (e) Nuclear radiation

Venous Bleeding

a. Dark red (low in oxygen) b. Flows slowly or rapidly, depending on the size of the vein c. Does not spurt and is easier to manage d. Can be profuse and life threatening e. More likely to clot spontaneously than arterial blood Steady slow flow, dark red color Venous bleeding is controlled after arterial bleeding

Significant Car Crash MOIs are suggested by:

a. Death of an occupant in the vehicle b. Severe deformity of vehicle or intrusion into vehicle (T-bone accident- watch out for spleen on left side of body) - Even if person looks fine there could be internal injuries -Severe deformities to front, even without intrusion c. Moderate intrusion from a lateral (T-Bone) accident d. Severe damage from the rear e. Crashes in which rotation is involved - significant g-force f. Ejection from the vehicle - three times more likely to die

Rollover and Rotational Crashes

a. Large trucks and sport utility vehicles are prone to rollovers because of their high center of gravity. b. Injuries depend on whether the passenger was restrained. c. The most unpredictable types of injuries are caused by rollover crashes in which a passenger is unrestrained. d. The most common life-threatening event in a rollover is ejection or partial ejection of the passenger from the vehicle. -Centrifugal Force: Patient is pinned against door Rotational: Spins May result in lateral impact

Autonomic Nervous System

a. Monitors the body's needs from moment to moment b. Adjusts blood flow by constricting or dilating blood vessels c. Automatically redirects blood away from other organs to the heart, brain, lungs, and kidneys in an emergency d. Adapts to changing conditions in the body to maintain homeostasis and perfusion i. If the system fails to provide sufficient circulation for every body part to perform its function, shock results.

Arterial Bleeding

a. Pressure causes blood to spurt and makes bleeding difficult to control. b. Typically brighter red (rich in oxygen) and spurts in time with the pulse c. Decreases as the amount of blood circulating in the body drops and blood pressure drops Spurting blood, pulsating flow, bright red color

Extent of Burns

a. Rule of palm: estimates the surface area that has been burned by comparing it to the size of the patient's palm, which is roughly equal to 1% of the patient's total body surface area b. Rule of nines: estimates he extent of a burn by dividing the body into sections, each representing approximately 9% of the total body surface area c. The proportions differ for infants, children, and adults. d. When you calculate the extent of burn injury, include only partial- and full-thickness burns. Document superficial burns, but do not include them in the body surface area estimation of extent of burn injury.

Blast Injuries: Eyes

a. Signs and symptoms of blast injuries range from severe pain and loss of vision to foreign bodies within the globe. i. Before responding, ensure that scene is safe. b. Management of injuries to the eye depends on the severity of the injury. i. If there is a foreign body within the globe, do not attempt to remove it. Use a clean cup or similar item to protect the area. ii. If only one eye is injured, follow local protocol. iii. Patients with sudden loss or decrease of vision will have to be verbally instructed on what is going on around them. iv. If patient has severe swelling or hematoma to eyelid, do not attempt to force eyelid open to examine- this increases pressure

Larynx

a. The Adam's apple is located in the center of the anterior of the neck. i. The Adam's apple is the upper part of the larynx. ii. It is formed by the thyroid cartilage. iii. More prominent in men than in women b. The other portion of the larynx is the cricoid cartilage, a firm ridge of cartilage below the thyroid cartilage. c. Cricothyroid membrane i. Lies between the thyroid cartilage and the cricoid cartilage ii. Soft depression in the midline of the neck iii. A thin sheet of connective tissue that joins the two cartilages

Foreign Objects in Eyes

a. The orbit protects the eye from the penetration of large objects. b. Even a very small object may produce severe irritation. i. The conjunctiva becomes inflamed and red—a condition known as conjunctivitis—and the eye begins to produce tears in an attempt to flush out the object. ii. Irritation of the cornea of conjunctiva causes intense pain -bright light makes it worse c. Irrigation with a sterile saline solution will frequently flush away loose, small particles. i. Use a bulb syringe, or nasal airway/cannula, to direct saline into affected eye. ii. Always flush from the nose side of the eye toward the outside to avoid flushing material into the other eye. -Foreign body will leave small abrasion on conjunctiva - Patient may still report irritation. e. Gentle irrigation usually will not wash out foreign bodies stuck to the cornea or lying under the upper eyelid. i. If you spot a foreign object on the surface of the eyelid, you may be able to remove it with a moist, sterile, cotton-tipped applicator. iii. Never attempt to remove an object that is stuck to the cornea. f. Foreign bodies may be impaled in the eye. i. Must be removed by a physician g. Your care involves stabilizing the object and preparing the patient for transport. i. Bandage the object in place to support it. ii. Cover the eye with a moist, sterile dressing. iii. Surround the object with a doughnut-shaped collar made from roller gauze or a small gauze pack. h. When you see impaled object(s) in the eye, bandage both eyes with soft, bulky dressings to prevent further injury - Greater length of object from eye= more important stabilization is i. Bandage should be loose enough to hold eyelid closed but not cause pressure on eye itself. -Bandage both eyes with soft, bulky dressings- Prevents sympathetic motion ii. This type of injury must be handled by an ophthalmologist on an urgent basis.

The Association of Air Medical Services (AAMS) and MedEvac Foundation International identify the following criteria for appropriate use of emergency air medical services for trauma patients:

a. There is an extended period required to access or extricate a remote or trapped patient. b. The distance to the trauma center is more than 20 to 25 miles. c. The patient needs ALS care and there is no ALS-level ground ambulance service available within a reasonable time frame. d. Traffic conditions or hospital availability make it unlikely that the patient will get to a trauma center via ground ambulance within the ideal time frame. e. There are multiple trauma patients who will overwhelm resources at the nearby trauma center(s). f. EMS systems require bringing a patient to the nearest hospital, rather than bypassing facilities to go directly to a trauma center. This may add delay to receiving definitive surgical care. g. There is a mass-casualty incident.

Rigid Splints

a. Will help immobilize fractures b. Reduce pain c. Prevent further damage to soft-tissue injuries d. Before and after splint is applied, monitor pulse and motor and sensory function in the distal extremity.

Quaternary (miscellaneous) blast injuries

i. Burns from hot gases or fires started by the blast ii. Respiratory injury from inhaling toxic gases iii. Crush injury from the collapse of buildings iv. Suffocation, poisoning, other medical emergencies v. Contamination of wounds from environmental, chemical, or toxic substances

Secondary Blast Injuries

i. Damage to the body results from being struck by flying debris. -Shrapenal, glass, splinters -May cause multiple penetration wounds -Can travel at speeds up to 3000 mph

Signs of Hypoperfusion

i. Tachycardia ii. Tachypnea iii. Low blood pressure iv. Weak pulse v. Cool, moist, pale skin

Tertiary Blast Injuries

i. The victim is hurled by the force of the explosion against a stationary object. -A blast wind (sudden change in surrounding atmosphere) creates a pressure wave Physical displacement is also referred to as ground shock

Two dangers specifically associated with electrical burns:

i. There may be large amount of deep tissue injury. -Electrical burns are always more severe than they appear ii. The patient may go into cardiac or respiratory arrest from the electric shock. (a) If the patient is not in cardiac arrest on your arrival, he or she is unlikely to experience this problem during transport.

Primary Blast Injuries

i. These are due entirely to the blast itself. ii. Damage to the body is caused by the pressure wave generated by the explosion. -May cause disruption of major blood vessels and rupture of eardrums/major organs -Hollow organs are most susceptible to pressure wave -Pressure wave can amputate limbs -Most easily overlooked injuries