Trauma Final

What must be present in an open wound?

(Bone doesn't have to be sticking out) Abrasions, lacerations, punctures, avulsion, amputations, and bites

Pick the least severe injury related to a thermal burn

(head, hands, face, feet, genitals, joints are severe)

Patient is injured with a laceration. Which medications will interfere with inflammatory response of the injury?

Drugs that interfere/delay wound healing: Corticosteroids Nonsteroidal anti-inflammatory drugs (aspirin, colchicine, anticoagulants)

Heat emergency (abnormal sign)

Dry hot skin is really bad

High voltage electrocution

Early fluid administration is crucial to prevent hypovolemia and renal failure (lactated ringers or NS). Sodium bicarb may be administered to maintain alkaline urine. Apply clean sterile dressing and pain management.

Dive patient complaining after ascending S&S for those complications:

Barotrauma of ascent (reverse squeeze) The opposite of squeeze. Typically occurs from breath holding. POPS (pulmonary overpressurization syndrome) A form of reverse squeeze. Can occur as a result of expansion of air in the lungs and can lead to alveolar rupture. It can also lead to leakage of air outside the alveoli. POPS usually only requires administration of oxygen, observation, and transport, unless it causes a more serious syndrome (tension pneumo, air embolism) Air Embolism MOST SERIOUS COMPLICATION OF PULMONARY BAROTRAUMA Major cause of death and disability of divers, caused by ascending to rapidly or holding breath during ascent. (Commonly caused by a rapid ascent caused by panic). Typically manifests as the diver surfaces and exhales, relieving the intrathoracic pressure and releasing bubbles in the blood stream. Most common presentation is similar to that of a stroke and includes vertigo, confusion, loss of consciousness, visual disturbances, and focal neurologic deficits. Air embolism should be suspected if diver loses consciousness immediately after surfacing. Also, thoroughly evaluate these pts for signs of POPS, such as pneumothorax. Transport in the left lateral recumbent position. Pts will likely be treated with recompression via hyperbaric chambers. Decompression sickness (the bends, dysbarism, caisson disease, divers paralysis) A multisystem disorder that results when nitrogen in compressed air converts back from solution to a gas, resulting in bubbles in the tissues and blood. Caused by ascending too rapidly, not stopping for decompression during ascent. May cause lymphedema, cellular distension, and cellular rupture. Net effect is poor tissue perfusion and ischemia. Most commonly affects the joints and spinal cord. S/S may include rashes, itching and a complaint of bubbles under the skin. Chest pain, cough, and shortness of breath. Should suspect in any pt who has symptoms within 48 hours after dive. Prehospital care include support of vital functions, high flow oxygen, fluid resuscitation, and rapid transport. Example: a pt has unexplained joint pain and had been diving 24 hours ago. #thebends

Scuba diving question

Barotrauma of descent (squeeze) Air trapped in noncollapsible chambers is compressed, leading to a vacuum type effect that results in severe, sharp pain caused by the distortion, vascular engorgement, edema, and hemmorhage of the exposed tissue. Typically results from blocked eustachian tube or from failure of diver to clear (open) eustachian tube with exhalation during descent. Occurs in the ears, sinuses, lungs and airways, gastrointesinal tract, thorax, teeth, or added air spaces (facemask or diving suit). Prehospital care is mainly supportive. Barotrauma of ascent (reverse squeeze) The opposite of squeeze. Typically occurs from breath holding. POPS (pulmonary overpressurization syndrome) A form of reverse squeeze. Can occur as a result of expansion of air in the lungs and can lead to alveolar rupture. It can also lead to leakage of air outside the alveoli. POPS usually only requires administration of oxygen, observation, and transport, unless it causes a more serious syndrome (tension pneumo, air embolism) Air Embolism MOST SERIOUS COMPLICATION OF PULMONARY BAROTRAUMA Major cause of death and disability of divers, caused by ascending to rapidly or holding breath during ascent. (Commonly caused by a rapid ascent caused by panic). Typically manifests as the diver surfaces and exhales, relieving the intrathoracic pressure and releasing bubbles in the blood stream. Most common presentation is similar to that of a stroke and includes vertigo, confusion, loss of consciousness, visual disturbances, and focal neurologic deficits. Air embolism should be suspected if diver loses consciousness immediately after surfacing. Also, thoroughly evaluate these pts for signs of POPS, such as pneumothorax. Transport in the left lateral recumbent position. Pts will likely be treated with recompression via hyperbaric chambers. Decompression sickness (the bends, dysbarism, caisson disease, divers paralysis) A multisystem disorder that results when nitrogen in compressed air converts back from solution to a gas, resulting in bubbles in the tissues and blood. Caused by ascending too rapidly, not stopping for decompression during ascent. May cause lymphedema, cellular distension, and cellular rupture. Net effect is poor tissue perfusion and ischemia. Most commonly affects the joints and spinal cord. S/S may include rashes, itching and a complaint of bubbles under the skin. Chest pain, cough, and shortness of breath. Should suspect in any pt who has symptoms within 48 hours after dive. Prehospital care include support of vital functions, high flow oxygen, fluid resuscitation, and rapid transport. Example: a pt has unexplained joint pain and had been diving 24 hours ago. #thebends Nitrogen Narcosis (rapture of the deep) Nitrogen becomes dissolved in the blood. Caused by a higher than normal partial pressure of nitrogen. Produces depressant effects similar to those of alcohol, impairing the divers thinking. Symptoms usually become evident at 75 to 100 ft, below 300 ft divers with nitrogen narcosis will suffer loss of consciousness. Trimix or heliox (helium/oxygen mixtures) are used in deep dives to improve the condition.

Abdominal injury; firm and painful. What do you do next?

DO NOT touch it Provide supplemental oxygen and appropriate airway Treat as internal hemorrhage W/fluids titrated to systolic of 80-90mmHg Rapid transport

Determine what condition the patient is in based on vitals (high or low BP, HR, respirations)

Hypovolemic - high HR, low BP, respirations increased Increased ICP - low HR, High BP, respirations irregular Neurogenic (relative hypovolemic) - low HR, low BP Cushing's triad for head injuries Increased SBP, decreased HR, irregular respirations due to ICP Beck's triad (cardiac tamponade) JVD, muffled heart tones, hypotension

What is decompensated shock? When does it happen?

Occurs when the body is no longer able to maintain systemic blood pressure (systolic drops before diastolic) Hypotension Tachycardia Tachypnea Delayed cap refill Decreased urinary output Compensatory mechanism begin to fail, systolic/diastolic pressures drop and cerebral blood flow decreases

What kind of fracture would you expect from a high velocity missile through a bone? .

Open fracture, comminuted? Bone can be deformed and fragmented directly if struck by a penetrating object or indirectly from the penetrating object, or indirectly from the pressure created by the sonic wave of the temporary cavity.

Which of the following would you expect to see in patient with decompensated shock? (5 or 6 P's)

Pain/tenderness Pallor (pale skin/poor cap refill) Paresthesia (pins-and-needles) Pulselessness Paralysis Poikilothermia (unable to regulate body temp)

Pericardial tamponade most likely occurs from which MOI

Penetrating trauma such as stab wounds and gunshots.

What to do if you find a suckin chest wound?

Place gloved hand over it, then use an occlusive dressing or 3 sided dressing

80 year old female fell, has hip problem, which of the following would you LEAST likely do for treatment? She's been on the floor for a day or longer

Place on a hard backboard (avoid hard surfaces, padding is recommended)

S&S hemothorax, tension pneumothorax, simple pneumothorax, or pericardial tamponade?

Hemothorax (ITLS pg 133-34): s/s produced by hypovolemia and respiratory compromise- hypotension, anxiety, confusion, possible signs of shock, flat neck veins, decreased breath sounds, dull percussion, trachea midline, rapid/shallow labored respirations, pulse weak/thready, absent radials, skin cool/clammy /diaphoretic/pale/ashen Tension Pneumo (ITLS pg 134-35): dyspnea, anxiety, tachypnea, jvd, possible tracheal deviation, diminished/absent breath sounds on affected side, rapid/shallow/labored breaths, cool/clammy/diaphoretic/cyanotic skin, hyperresonant percussion Simple Pneumo (ITLS pg 142): pleuritic chest pain, dyspnea, decreased breath sounds on affected side, monitor for development into tension pneumo Pericardial Tamponade (ITLS pg 137): Beck's triad--jvd, muffled heart tones, hypotension; narrow pulse pressure, pulsus paradoxus, equal breath sounds, midline trachea (unless there's a pneumo or hemothorax), pt will be in shock

Ventilating a patient with head injuries; only hyperventilate with herniation syndrome.

Hyperventilation causes vasoconstriction and ischemia to the brain

Hemothorax signs and symptoms.

absent lung sounds without JVD signs of shock dullness upon percussion

Increased ICP -

low HR, High BP, respirations irregular

Neurogenic (relative hypovolemic) shock-

low HR, low BP

How do we know there's a tracheobronchial injury?

A constant rush of air with a pleural decompression Subcutaneous emphysema

How to backboard a patient? -

Torso Head/neck Legs/arms

Significant blow to the head, what do we have a high suspicion is also injured?

consider Neck/spine

Rule of Nines pg 1400 most accurate method to use for adults and children over 10 yo

head--9% chest and abdomen--18% back--18% legs--18% each arms--9% each genitals--1%

Hypovolemic shock

high HR, low BP, respirations increased

Hydrochloride acid (Pg. 1412) -

hydrochloric acid is stronger than hydrofloric.

If you need to decompress the chest, what S&S will you see?

Absent lung sounds, JVD, Tracheal Deviation, signs of shock

How to treat neck lacerations

- Aggressive airway management, ventilatory support, suction and hemorrhage control by direct pressure and fluid replacement.

Penetrating trauma to the neck

- Aggressive airway management, ventilatory support, suction and hemorrhage control by direct pressure and fluid replacement.

S&S decide if the patient is decompensated, compensated, etc from various injuries

- Compensated -- Mild tachycardia, lethargic, delay cap-refill, normal BP Decompensated -- moderate tachycardia, unconscious, cold extremities(cyanosis), Low BP

Elderly patient that has fallen, what is true in head injury concerns with elderly vs younger patients?

- Elderly -- adults 75 yrs and older have the highest rates of TBI related hospitalization and death. More susceptible to internal bleeds because of decreased bone density and brain matter reduction. - young -- healthier bone tissue and resistant to impact.

Tilt test and what does it indicate (orthostatic hypotension)

- From a recumbent position to a sitting or standing position. Drop of 10-15 mmHg and/or rise of 10-15 beats per minute. Indicates at least 10% of volume depletion.

Le fort S&S

- LeForte I -- Maxilla up the level of the nasal fosa. ( midfacial edema, unstable maxilla, long face, epistaxis, numb upper teeth, CSF leakage) - LeForte II -- Nasal bones, Medial orbits( pyramid like shape, high risk of airway problems, swelling and bleeding, altered vision) - LeForte III -- Complex fractures causing facial bones to separate from cranial bones ( blowout fracture, periorbital edema, subconjunctival ecchymosis, diplopia or double vision, recessed globe, epistaxis, impaired extraocular movements)

How do we immobilize a femur fracture, elbow dislocation, tib/fib fracture?

- Long bone fractures -- Stabilize joint above and below the fracture with rigid splints or vacuum splints (use swathe and sling for humerus) - Joint dislocation -- Splint above and below the joint with rigid splints or vacuum splints (use swathe and sling for shoulder or elbow) - Femoral fracture -- use traction splint (contraindicated if...hip,pelvic, knee, ankle injuries are present OR amputations)

What goes away in extremely hypothermic patients?

- Loss of deep tendon reflexes. (Shivering)

Mean arterial pressure calculation

- MAP = [(DBP X 2) + SBP] /3 - MAP = [(80 X 2) + 120] /3

Location of pleural decompression

- Place laterally midaxillary of the affected side in the 4th or 5th intercostal space OR anteriorly mid clavicular below 2nd but just above the 3rd rib.

Patient has been stabbed, what organ has been injured?

- RUQ -- liver, gallbladder - RLQ -- cecum, appendix - LUQ -- spleen, stomach - LLQ -- small intestine, colon

Which of these is more common in a patient with a fever due to illness vs heat stroke? (What might the sick patient have that the other won't) iac dysrhythmias.

- SIRS (illness or sepsis) Temp parameters, below 96.8F or greater than 100.4F also ETCO2 will be below 35 mmHg - Heat stroke Temp of 104.4F or greater due to failure of temp regulating mechanisms, cardiac dysrhythmias.

Thought is was a pericardial tamponade, but what if it wasn't? What else causes JVD or those S&S?

- Tension Pneumothorax -- hypotension, JVD, diminished or absent breath sounds - Traumatic Asphyxia -- JVD, head and neck have purple-red appearance,

What is compliance?

- The ease with which the lungs and thorax expand with pressure changes. The greater the compliance the easier the expansion.

Pericardial tamponade

- caused by penetrating trauma(rare cases blunt trauma) - injury to the heart chamber wall, causing blood to leak into the pericardial space and causes increase pressure to heart which affects contractility - Becks triad JVD, muffled heart sounds and hypotension.( 60-100ml can cause tamponade)

Spinal precautions with intubations

- must not interfere with airway management and ability to properly ventilate a patient. - use of C-collar on an intubated patient can help dislodging of tube while moving the patient.

Which of the following is secreted by the adrenal cortex during shock and what happens?

- sympathetic stimulation release of Epi and Nor-Epi ( increase in vasoconstriction, HR, Stroke volume) - Renin-angio-oldos -- increase in venous return and BP, acts on kidneys to retain sodium and water - Vasopressin ADH -- vasoconstriction, decrease in urine production, enhancing reabsorption of water. ADH is the only thing released by the adrenal cortex that causes vasoconstriction. Renin is released from the macula densa in the kidneys and epi is released from the adrenal medulla.

Steps in bleeding control -

1. Apply bulky dressing with pressure.. 2. After soak through apply second bulky dressing with pressure on top of the first. 3. Apply tourniquet 2" proximal to the wound or "high and tight".

Burn victim, severe dyspnea, deteriorating. What's your highest priority?

Aggresive Airway management,

Definition of hypothermia

An abnormal body temp below 95 F (35 C)

Hypothermia questions

An abnormal body temp below 95*F (35*C), can result from a decrease in heat production, an increase in heat loss or a combination. Exposure to cold causes vasoconstriction, an increase rate of metabolism, increase in blood pressure, heart and respiratory rates. The body generates heat in the form of shivering until the body temp reaches 86*F, glucose or glycogen is depleted or insulin is no longer available for glucose transfer. When shivering stops cooling is rapid and a general decline in function of all body systems begins. Significant ECG changes occur producing prolonged PR, QRS and QT intervals and obscure or absent P waves a J wave (Osborne wave might be present) cardiac arrest generally follows. Three classes of hypothermia - Mild = body temp 95*F-89.8*F, moderate = body temps 89.7*-82.5*F, Severe= body temp below 82.4*F Management includes immediately evacuate the PT to a site of warm shelter, remove cold, wet clothing, prevent further drop in body temp. Cover with warm blankets and increase the temp in the ambulance, rapidly and gently transport to hospital. Rewarming techniques- Passive - moving the pt to a warm environment, removing wet clothing and applying warm blankets (if wet clothing can not be removed immediately, a vapor barrier should be used over warmed dry blankets. Active external : heating methods or devices such as radiant heat, forced hot air, warm water packs. Active internal: administer warm I.V fluids, warm humidified O2 to a max temp of 104*F-108*F

Controlling bleeding

Apply direct pressure Apply a tourniquet 2 inches proximal to the wound.

Heat cramps

Brief, intermittent, and often severe muscular cramps that frequently occur in muscles fatigued by heavy work or exercise.

Motorcycle helmets and can't manage the airway, what do you do?

Carefully remove the helmet maintaining C-spine. Contact med control if pt complains of severe pain during removal or removal is difficult. Manage airway after helmet removal and apply C-collar.

When does the cellular ischemic phase of hemorrhagic shock begin?

Cellular ischemia and necrosis and subsequent organ death even with oxygenation and perfusion restored, indicate irreversible shock, the third phase of shock.

Heat exhaustion (core temp up to 103)

Characterized by dizziness, nausea, headache, and a mild to moderate increase in the core body temp.

Closed vs open soft tissue injuries

Closed - associated with little blood loss some of these injuries can cause significant hemorrhage in the cavities of the thorax, abdomen, pelvis, or soft tissues of the legs. Closed soft tissue wounds are classified as contusions, hematomas or crush injuries. Open - Classified as abrasions, lacerations, punctures, avulsions, amputations, and bites.

Blunt trauma to the chest (S&S) (ITLS pg 127)

Contusion, open wounds, subcutaneous emphysema, hemoptysis, distended neck veins, tracheal deviation, asymmetrical chest movement--paradoxical motion, cyanosis, and shock; palpation can reveal tenderness, instability and crepitus; absent/diminished breath sounds;

How do we handle fluid leaking from the ear?

Cover ear with loose sterile dressing

Isolated head injury, lucid period..

Epidural hematoma (meningeal artery hemorrhage)

Subdural hematoma is venous, epidural is arterial, which artery causes the most severe bleed, etc? Not sure i wrote this correctly

Epidural hematomas are usually caused by the middle meningeal artery.

Calculating the GCS score

Eye opening: 4 (spontaneous) 3 (to verbal command) 2 (to pain) 1(no response) Best verbal response: 5(oriented conversation) 4(disoriented conversation) 3(nonsensical speech) 2(unintelligible sounds) 1(no response) Best Motor Response: 6(follows commands) 5(localizes pain) 4(withdraws to pain) 3(abnormal flexion) 2(abnormal extension) 1(no response)

Spinal shock vital signs -

Flacid paralysis distal to the injury site and loss of autonomic function - hypotension vasodilation loss of and bladder control Priapism loss of thermoregulation.

Early hypothermia S&S-

Initially, vasoconstriction in peripheral vessels occurs Rate of metabolism by the CNS increases BP and HR and RR increase dramatically Muscle tone increases Body generates heat called shivering; shivering will continue until CBT reaches 86 F, glucose/glycogen is depleted, or insulin is no longer available for glucose transfer

Getting someone out of a pool

Float pt to shallow area limiting C-spine movement, if prone support head-neck-torso and roll pt to supine position and assess airway-breathing, can assist ventilations in water. Slide rigid device under pt maintaining C-spine to immobilize pt. Float to edge of water and lift out.

Transporting 3rd trimester pregnancy on a backboard

Fully immobilize pt on a backboard and tilt board on its side 10-15°.

S&S of chest injury; is it cardiac tamponade, just in shock, etc. What is the most critical intervention?

If a wound is not indicating it's sucking..sealing it is not your highest priority

What is the term used to describe an increase in JVD upon inspiration when a patient has pericardial tamponade?

Kussmaul's sign

Head trauma (assault); Le Fort and how it can cause airway management problems:

Le Fort I fracture involves teh maxilla up to the level of the nasal fossa Le Fort II involves the nasal bones and medial orbits. Le Fort III is a complex fracture in which the facial bones are seperated from the cranial bones. Le Fort II & III fractures are at increased risk of causing severe airway management problems. Risk due to swelling and bleeding and risk of placing nasogastric tube and devices in the nasal cavity.

Multisystem trauma, where is the best place to take them? Levels & distance -

Level 1 - Full range of specialists and equipment at all times for critical pts. Has a research program. Referral source for local communities and regions. Level 2 - Works with level 1 but may be the only local resource. 24hr specialized staff, equipment, and immediate surgery. Can stabilize critical pts but will most likely be transferred to level 1. Level 3 - Emergency resuscitation, stabilization, emergent surgery, and intensive care for trauma pts. 24hr emergency physicians and on call surgeons and anesthesiologists. Does not have full ability of specialists except surgery. Level 4 - Initial evaluation, emergency resuscitation and stabilization. Will need to transfer to higher level trauma centers. 24 hr. physician and lab. Level 5 - Has basic emergency department and transfer agreements with level 1 and 2 centers. Distance depends on pt. symptom severity. Goal is the golden hour. Air transport considered when available. Pt. Stabilization is key. Air transport - when ground transport poses a threat to pt. survival, weather or road conditions delay care, critical care staff and equipment.

Tracheobronchial injury. Where are most disruptions anatomically located?

Localized within 2 cm of the carina in up to 80% of cases (ITLS pg 140) Penetrating/blunt trauma, subcutaneous emphysema associated with hemo/tension pnemo/deformed chest

Choose most common complication of applying splint, bandage, etc

Loss of PMS distal to splint/bandage. Wrapping too tight.

Nasal fractures

Nasal bones have the least structural strength, fractured most frequently, which results in epistaxis and swelling without apparent skeletal deformity

Primary and secondary (swelling and ischemia) injuries with spinal cord and brain injuries

Primary Direct trauma to the brain Secondary Hypoxia, hypocapnia, hypercapnia Intracellular and extracellular derangement initiated either at the time of injury or as a result

Explosion scenario

Primary Sudden changes in environmental pressure Injuries usually occur in gas-containing organs Secondary Injuries result when people are stuck by flying debris Tertiary Injuries occur when people are propelled through space Injuries similar to that of vertical falls Sudden deceleration causes more damage than acceleration Quaternary Illnesses or diseases Inhalation injuries Burns Radiation injuries Crush injuries Closed/open brain injuries

Strengthening and weakening of pulses during tamponade?

Pulsus paradoxus

Convection, conduction, radiation, evaporation heat loss -

Radiation - release of body heat to cooler surroundings. Constantly emits heat by infrared rays. If the surface of the body is warmer than the environment, heat is lost through radiation. Conduction - transfer of heat from a warmer object to a cooler object. Heat moves from higher temperature to a lower temperature. The body surface loses or gains heat by direct contact with cooler or warmer surfaces, including air. Convection - Transfer of heat from one object to another. Moving relative to one another, mass motion of a fluid such as air or water.Ex. If air or water next to the body is heated, moves away, and is replaced by cool air or water, heat loss occurs by convection. It can be greatly aided by external forces, i.e wind or fans. Evaporation - a process by which fluid changes from a liquid to a gas and lowers the temperature on the surface where evaporation occurred.

Critical trauma patients; what's the most important thing you can do for them?

Rapid transport

Deep penetrating wound to chest. Painful swallowing. What's the most important intervention?

Rapid transport Suspect esophageal injury, subcutaneous emphysema, inflammation of the mediastinum Aggressive airway management and circulatory support

What's our major concern when a patient has significant facial injuries?

Rich vascular supply causing excessive bleeding, airway compromise

Which situations do you have to stay on scene before you transport and what do you do?

Scene time should be limited to that required for control of exsanguinating hemorrhage, airway, breathing, and circulatory support and spinal immobilization.

Scenario. Diagnosis simple pneumo, tension pneumo, thoracic aortic rupture syndrome

Simple (closed) pneumothorax: Air in the pleural space Lung will partially/totally collapse Common causes: rib that penetrates the pleura, excessive pressure on the chest wall against a closed glottis, or rupture/tearing of lung tissue Occurs in almost 100% of penetrating chest traumas Open (communicating) pneumothorax: Chest injury exposed the pleural space to atmospheric pressure Severity is directly proportional to the size of the wound Sucking chest wound Tension pneumothorax Air cannot exit pleural space (under pressure) Profound hypoventilation and impaired perfusion and decreased cardiac output Cyanosis, increased dyspnea, tachycardia, hypotension, shock, absent breath sounds on injured side, JVD, unequal expansion of chest, etc Traumatic aortic rupture - thought to be the result of shearing forces that develop between tissues that decelerate at different rates. Common MOI's are rapid deceleration in high speed vehicles, falls from great height, crushing injuries. Blood pressure may be normal or elevated with significant difference in pressures between the two arms. Upper extremity hypertension with absent or weak femoral pulses can occur.

Person fell down stairs and they have hip/pelvic pain. Which of the following nervous system assessment findings would be abnormal in an old person?

Slowing in sensory responses such as perception of pain. Elderly patients may have a higher pain tolerance.

What bleeds more? Solid or hollow organ

Solid

Triage: what is it?

Sorting patients to prioritize care based on the severity of illness or injuries and their potential to survive.

How do you handle vomit in the mouth?

Suction, and turn them on their side if you can

Diaphragmatic rupture

Sudden compression of the abdomen, blunt trauma to the trunk, results in a sharp increase in intra-abdominal pressure which may cause abdominal contents to rupture through the thin diaphragmatic wall and enter the chest cavity. This is more commonly detected on the left side of the diaphragm then on the liver shielded right side. However rupture on either side may allow abdominal organs to enter the thoracic cavity where they may compress the lung, resulting in reduced ventilation, decreased venous return, decreased cardiac output and shock. Because of the force applied to the abdomen patients may often have multiple injuries. Signs and Symptoms - abdominal pain, shortness of breath, decreased breath sounds, may have hollow or empty appearance, bowel sounds may be heard in the chest. Treat with Oxygen, ventilatory support as needed (positive pressure may worsen the injury). Volume expanding fluids and rapid transport.

Classify burn as superficial, minor, moderate, or critical (study what makes critical burns).

Superficial: First degree Only superficial layer of epidermal cells is destroyed (sunburn) Heal within 2-3 days Minor: Superficial partial-thickness Dermis and basal layers of the skin may be damaged Blisters (protects would from infection and excessive fluid loss) Heals without scarring within 2 weeks Moderate: Deep partial-thickness Reticular layer of the dermis Sensation in and around wound may be diminished Red/wet or white/dry Generally heal within 3-4 weeks Critical: Full-thickness (3rd degree) Entire thickness of epidermis and dermis along with hypodermics (subcutaneous tissue) Skin graft is necessary White, charred, or leathery Thrombosed veins are visible and Escher (tough collagen) is present

Patient has infection in hand. What would you do?

Support vitals (which may include fluid resuscitation) Patient transport to ED may be needed (or direct referral to private physician) S/S of wound infection: increasing inflammation/edema, purulent drainage, foul odor, persistent pain, delayed healing, enlarged lymph nodes proximal to the wound, fever Inflammation, edema, and bloody drainage are normal during first 3 days but should subside

How does the body respond to fluid loss or shift? (compensatory mechanisms)

Swelling (esp with burns) occurs bc of the release of chemical mediators Mediators cause increase in capillary permeability and a shift from the intravascular space into the injured tissues Sodium follows into the injured cells increasing the osmotic pressure and creates and influx of fluid into the wound Produces class inflammatory response (pain, redness, swelling) and when it occurs large scale it can cause severe hypovolemia

Occlusive dressing

Taped on three sides, leave a small section untaped to allow air to escape but not come back in.

Drowning

The most important factors that determine outcome are the duration of submersion and the duration and severity of hypoxia. All victims who require any form of resuscitation (including rescue breathing alone) should be transported to the hospital.

Heat stroke (core body temp 104 or higher)

Thermoregulatory mechanisms normally in place to meet the demands of heat stress break down entirely. Mental status becomes altered, and the core body temp increases to extreme levels. Multisystem tissue damage and physiologic collapse also occur.

Identify most common assessment findings in patient who is allergic and was stung?

Wheezing, difficulty breathing, urticaria (hives), laryngospasm

Hemorrhagic shock; most important intervention, how much fluid should we give, elderly patient considerations

When external hemorrhage has been controlled and the patient exhibits signs of shock, 250ml boluses up to a total of 1-2 L of warmed crystalloid solution can be infused (20ml/kg for children).

High altitude illnesses; how do we treat them?

airway , ventilatory, circulatory support, and descent to lower altitude

Breathing shallowly...

assist ventilations

Hypothermia or frostbite; which is more common?

hypothermia