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AAOS Section 5
Trauma, Ch 18-22, pp 336-448
133
Medical
Pre-School
06/12/2011

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Term
Perfusion
Definition
the circulation of blood in adequate amounts to meet the body's need for o2, nutrients, waste removal
Term
3 Reasons we see shock (hypoperfusion)
Definition
Poor pump function
Pipe problems (blood vessels either leaking or dilated)
Low fluid volume (blood lost)
Term
6 methods to control bleeding
Definition
Direct local pressure
Elevation
Pressure Dressing
Pressure Points
Splinting Device
Term
Nose Bleeds commonly caused by:
Definition
Skull Fx
High BP
Sinus infection
Term
Compensated Shock, signs
Definition
anxiety, agitation
tachy
pale / cool / moist skin
+RR
nausea / vomiting
+thirst
Term
Decompensated Shock, signs
Definition
labored / irregular RR
ashen gray / cyanotic skin
weak / absent distal pulses
dilated pupils
profound hypotension

...Anytime a drop in BP is detected, shock is usually in an advanced stage
Term
Treat for Shock -
Definition
Maintain Patent Airway
High flow o2
Control all external bleeding
Place Pt in shock position / trendelenberg
Maintain body temp w/ blanket
Prompt Transport
Term
Anaphylaxis / shock
Definition
unusual and exaggerated allergic reaction to foreign protein of other substances;
severe shock caused by the allergic reaction
Term
Autonomic Nervous System
Definition
regulates involuntary functions
HR, BP, digestion, sweating
Term
Cardiogenic Shock
Definition
shock resulting from poor pump function
Term
Epistaxis
Definition
fancy name for NOSE BLEED
Term
Hematoma
Definition
mass of blood in tissues beneath the skin
Term
Hypovolemic shock
Definition
shock due to low blood volume, either from massive internal or external bleeding
OR extensive loss of water
Term
Irreversible shock
Definition
after compensated and decompensated; the final stage of shock resulting in death
Term
Neurogenic Shock
Definition
circulatory failure caused by paralysis of nerves that control the size of the blood vessels, leading to dilation.
SEEN OFTEN IN SPINAL INJURIES
Term
Psychogenic shock
Definition
shock caused by sudden / temporary reduction in blood to the brain that causes syncope
Term
Septic shock
Definition
shock caused by a severe infection, usually bacteria
Term
Spinal Column, # of vertebrae / names of sections
Definition
Cervical 7
Thoracic 12
Lumbar 5
Sacrum 5 (fused)
Coccyx 4 (fused)
Term
the Human Skull, bones
Definition
CRANIUM; Frontal, Parietal, Temporal, Mastoid process, Temporomandibular joint

FACE: Orbit (eye socket), Nasal, Zygoma (below eye), Maxilla (above teeth), Mandible
Term
Intracranial Hematomas
Definition
Subdural - beneath dura but outside brain
Epidural - Outside dura, puts pressure on brain
Intracerebral - bleeding within brain
Term
Skull Fx, signs
Definition
Ecchymosis,
Under the eyes (Raccoon Eyes)
Behind the ear over the mastoid process (Battle's Sign)
Term
CNS
Definition
central nervous system
Brain and Spinal cord
Term
PNS
Definition
peripheral nervous system
network of nerves to/from organs and the brain
Term
Autonomic Nervous System
Definition
Sympathetic (fight or flight)
Parasympathetic (rest and recovery)
Term
Signs of serious head injury, VS
"Cushing's Reflex"
Definition
HTN
Bradycardia
Irregular RR
Term
Brain Stem
Definition
controls nearly all functions necessary for life, including cardiac and respiratory systems
Term
Cerebellum
Definition
part of brain that coordinates body movements
Term
Cerebral Edema
Definition
fluid build up / swelling in the brain
Term
Cerebrum
Definition
largest part of brain, containing 75% of mass
Term
Closed Head Injury
Definition
brain injured but no obvious outer signs of trauma
Term
Concussion
Definition
temporary loss or alteration of part or all of brains function WITHOUT actual physical damage to brain
Term
Meninges
Definition
THREE layers of tissue that surround and protect the brain and spinal cord within the skull and spinal canal
Term
Peripheral Nervous System
Definition
31 pairs of spinal nerves and 12 pairs of cranial nerves that link the body to the CNS
Term
the 3 collisions in auto accidents include -
Definition
Car vs Car
Passenger vs Interior
Organs vs Solid structures in body
Term
Frontal Collisions,
MOI
Definition
Restraints used?
Air bags deployed?
WHen properly used, these devices decrease the damage sustained by the 2nd and 3rd collisions
Term
Rear End Collisions,
MOI
Definition
"whiplash" of head and neck
brain may collide with skull
hips / spine injuries common, esp cervical
Term
T-Bone (lateral) collision
MOI
Definition
#1 cause of death in MVAs
lateral whiplash injuries - skull vs door post; also thorax / shoulders
DANGER TO AORTA: 25% of severe injuries to aorta occur in lateral collisions
Term
Rollover collision / crash
MOI
Definition
Ejection / partial ejection most likely in this type of crash
Also, they get to roll around in the entire cab, even if restrained, so injuries to spine from side / top impacts highly likely
Term
Kids and MOI from falls
Definition
When
Fall = 3x(height of child)
Significant MOI
Remember kids are top heavy because their heads are enormous and they usually fall head first from high falls. sadz.
Term
Cavitation
Definition
pressure waves emanating from a bullet as it travels through the body can rip tissue and rupture organs / break bones
Consult Jon Wu movies for inaccurate but entertaining examples.
Term
Blunt Trauma, defined
Definition
impact on the body by objects that cause injury without penetrating the tissue
Term
Coup-contrecoup Brain Injury
Definition
occurs when force is applied to the head and energy transmission through brain tissue causes injury on the side opposite the original impact
Term
Index of Suspicion
Definition
awareness that unseen life threatening injuries may exist when determining the MOI
Term
Penetrating Trauma
Definition
injuries caused by piercing the body with an object - damage to internal structures and organs results
Term
The Six Methods to Control Bleeding
Definition
Direct pressure
elevation
pressure dressing
pressure points
splinting device
Term
Use Tourniquets when -
Definition
last resort
Term
Bleeding from the nose?
THREE REASONS WHY -
Definition
skull fx
high BP = nose bleed
sinus infection
Term
IF bleeding from nose
AND skull Fx expected, -
Definition
place gauze pad loosely under the nose
Term
IF bleeding from nose
AND no skull Fx suspected,
Definition
Pinch both nostrils together for 15 minutes.
If Pt awake and has a patent airway, put some gauze behind the upper lip to put more pressure on the area / stem flow of blood
Term
PT presenting with difficulty breathing / pain in abdomen / bruising of area indicates what kind of bleed?
Definition
internal. drive quickly. run over nuns if you have to.
Term
Signs of Significant Internal Bleeding -
Definition
Vomiting of blood (hematemesis)
black tarry stools (melena)
Coughing up blood (homoptysis)
Distended abdomen
Broken Ribs
Pain
Pt restless and unable to get comfortable
Term
Compensated Shock,
SIGNS
Definition
Anxiety
Tachy
Pale / cool / moist skin
+RR
Nausea / Vomiting
Thirst
Term
Decompensated Shock
SIGNS
Definition
Irregular RR / labored breathing
ashen gray / cyanotic skin
Weak / absent Distal Pulse
Dilated pupils
Profound HYPOtension
Term
Anticipate Shock in ALL the following cases!
Definition
severe infection
significant blunt force trauma / penetrating trauma
Massive external bleed
Index of Suspicion for Internal Bleed
Spinal Injury
Chest / Abdominal injury
MI
Anaphylaxis
Term
Treatment for Shock -
Definition
Open and maintain airway
high flow O2 w/BVM if necessary
Control all external bleeds
Lay patient down
Blankets to maintain normal body temp
Burn diesel
Term
Autonomic (involuntary) nervous system
Definition
regulates HR, BP, sweating, digestion, etc
Comprised of SYMPATHETIC (fight/flight) and PARASYMPATHETIC (rest/recovery) systems
Term
Cardiogenic shock
Definition
shock resulting from poor pump function
Term
Compensated shock
Definition
the early stage of shock when the body can still deal with losing blood
Term
Decompensated shock
Definition
the late stage of shock when BP falls
Term
Epistaxis
Definition
nose bleed
Term
Hematoma
Definition
blood pooling in soft tissues beneath skin; a gnarly bruise
Term
Hypovolemic shock
Definition
shock induced by low blood volume
Loss of blood either externally / internally
Loss of body's water
Term
Irreversible shock
Definition
last stage of shock. No turning back.
Term
Neurogenic shock
Definition
circulatory failure caused by damage to nerves that regulate blood vessel constriction, leading to total dilation
SPINAL CORD INJURIES
Term
Psychogenic shock
Definition
aka syncope. fainting.
like the first time i saw James' mustache
Term
Septic shock
Definition
shock caused by severe infection, usually bacterial
Term
Components of the Brain
Definition
CEREBRUM - 75% of brain, includes Frontal Lobe, Parietal Lobe, Temporal Lobe, Occipital Lobe. MOST VOLUNTARY MUSCLE USE AND CONSCIOUS THOUGHT.
CEREBELLUM: coordinates body movements
BRAIN STEM: controls virtually all functions necessary for life, including cardiac / respiratory systems
Term
How many pairs of nerves in the two parts of the Peripheral Nervous System?
Definition
31 pairs of spinal nerves. conduct sensory impulse from skin to brain, orders from brain to muscles
12 pairs of cranial nerves; mostly involved in function of head and face / the senses
Term
Sensory and Motor nerves
Definition
Sensory nerves usually only perceive ONE type of stimulus and send the info to the spinal cord / brain
Motor nerves, one for each muscle, carry orders from CNS to muscles
Term
Somatic (voluntary) nervous system
Definition
regulates voluntary activities
Term
Common complications of closed head injuries
Definition
cerebral edema
seizures
vomiting
CSF leakage
Term
Late signs of skull fracture / deformity / injury
Definition
raccoon eyes
battle's sign (behind ears)
Unequal pupil size
Pupils fail to react to light
loss of sensation or motor function
Term
CUSHING'S REFLEX
Definition
indicates life threatening pressure within the skull and presents with:
HTN
Bradycardia
irregular RR
Term
Attain GCS / AVPU on PTs with head injuries how often -
Definition
5 minutes. Remember that the nature of this injury indicates their mentation is UNSTABLE and has the potential to deteriorate quickly
Term
Closed Head Injury
Definition
brain injured but skin has not been broken
Term
Concussion
Definition
temporary loss or alteration of part / all of brain's functions WITHOUT actual physical damage to brain
Term
Open Head Injury
Definition
often caused by a penetrating object in which there may be bleeding and exposed brain tissue
Like when you head shot zombies with a crow bar.
Term
MENINGES; the three layers
Definition
From outside to inside
Dura Mater
Arachnoid
Pia Mater
Term
Treating a scalp laceration -
Definition
direct pressure over the wound with dry, sterile dressing
Term
Common response to head injuries / sign
Definition
vomiting
sometimes result of increased intracranial pressure
PROTECT THE AIRWAY
Term
The Rule of Nines
Definition
ADULTS: Head & Arms = 9, Legs = 18, Front & Back of Torso = 18 each side, Groin = 1
KIDS, Head / Torso Front & Back = 18 each, Arms = 9 each, Legs = 13.5 each, groin = 1
Term
Palmer Method for % body burned
Definition
PTs palm roughly = to 1% total surface area of PTs body
Term
Superficial Burns
Definition
involve only the EPIDERMIS
bad sun burn
Term
Partial Thickness Burns
Definition
EPIDERMIS and some of the DERMIS but do NOT destroy the full thickness of the skin
Skin often blistered and mottled white / red
Term
Full Thickness Burns
Definition
EPIDERMIS DERMIS SUBCUTANEOUS
may involve muscle tissue as well
Skin is dry, leathery, charred
Term
Three layers of SKIN
Definition
Epidermis: tough outer layer
Dermis: inner layer w/hair follicles, sweat glands, sebaceous glands
Subcutaneous: containing fat and muscle layers
Term
Main functions of SKIN
Definition
Keep pathogens out
Keep fluid in
maintain body temp
Provide environmental info to brain
Term
3 Categories of Soft Tissue Injuries
Definition
Open
Closed
Burns
Term
Treatment of Closed Injuries
Definition
includes hematomas, crushing injuries
RICES
Rest, Ice, Compression, Elevation, Splinting
Term
5 types of OPEN INJURIES
Definition
Abrasions, Lacerations, Incisions, Avulsions, Penetrations
Term
Treat an OPEN INJURY
Definition
Control bleeding
apply sterile dressing
DO NOT CLEAN THE OPEN WOUND, this can make bleeding worse
Term
Emergency care for BURNS
Definition
Cool burned area to prevent further damage
Remove jewelry or restrictive clothing; synthetic material might have melted to skin, don't remove it!
Ensure open / clear airway, high flow O2
Sterile dressings over burned area
Prevent Hypothermia by covering PT with clean blanket
Prompt transport
Term
Dressings / Bandages designed to -
Definition
control bleeding
prevent wound from further damage
prevent contamination of wound
prevent infection
Term
How many bones in the human body?
Definition
206
Term
What stabilizes joints?
Definition
LIGAMENTS
Term
Fracture
Dislocation
Sprain
Strain
Definition
Fracture = broken bone
Dislocation = disruption of a joint
Sprain = stretching injury to ligaments in joint
Strain = stretching of muscle
Term
ZONE OF INJURY
Definition
the area around the injury that may be compromised as well, depending on how much kinetic energy was involved
Maintain High Index of Suspicion for associated injuries!
Term
Types of Fractures
Definition
OPEN and CLOSED
REMEMBER to control bleeding on open fractures and apply a sterile dressing
Apply ice pack to closed FX to help reduce swelling / take away some of the pain
Term
Compartment Syndrome
Definition
swelling in a confined area that produces dangerous pressure and can cut off blood flow and damage sensitive tissues like nerve endings - derp!
Term
Abrasion
Definition
superficial skin layer lost due to rubbing / scraping on a rough / hard surface
like me at the roller rink
Term
Avulsion
Definition
soft tissue torn completely loose and hanging like a flap
Term
Burns - several types
Definition
thermal
friction
chemical
electrical
Nuclear Radiation (with or without resulting Super Powers)
Term
Contusion
Definition
a bruise without a break in the skin
Term
Crepitus
Definition
the scraping sound of bone on bone in a fracture
Term
Eccymosis
Definition
discoloration associated with a closed wound. indicates bleeding
Term
Evisceration
Definition
the displacement of organs outside the body
Term
Hematoma
Definition
blood collected within the body's tissues or in a body cavity
Term
Incision
Definition
a sharp / smooth cut
Term
Laceration
Definition
a jagged open wound
Term
Mucous Membranes
Definition
linings of body cavities and passages that are in direct contact with the outside environment
Term
Occlusive Dressing
Definition
made of vaseline gauze, aluminum foil, or plastic that prevents air and liquids from entering or exiting the wound
Term
treating a CHEMICAL BURN
Definition
Remove chemical from PT but DO NOT use water to remove it; some chemicals react strongly with H2O
Brush chemical off PT
THEN flush with buttloads of water to ensure chemical is properly diluted.
Flush area fror 15-20 minutes
continue to do so all the way to the ER
Term
Critical Areas of the Body include -
Definition
Face, Hands, Feet, Groin
THINK: QUALITY OF LIFE INJURIES
Term
Flail Segment
Definition
two or more ribs broken in two or more places; usually presents with paradoxical motion
Term
Treat a Flail Segment
Definition
secure with a large bulky dressing and 2" tape
Term
Treat an OPEN WOUND to the chest
Definition
Occlusive dressing / 3 sides taped down. 4th side open to allow any trapped air in the pleural space to escape.
Air building up in pleural space will cause collapse of the lungs - PNEUMOTHORAX
Term
Spontaneous Pneumothorax
Definition
rupture of weak spot in lung (bleb) which can allow air to accumulate in pleural space.
Coughing / physical activity can cause this
Term
Pneumothorax can progress to Tension Pneumothorax and cause -
Definition
Cardiac Arrest
Term
Hemothorax
Definition
blood accumulates in pleural space after traumatic injury when the vessels of the lungs are lacerated / bleed
Term
Pulmonary Contusion
Definition
That's fancy talk for Bruised Lung. Can interfere with gas exchange in lung
Term
Cardiac Contusion
Definition
bruised heart after trauma.
CAN HAVE SAME SIGNS/SYMPTOMS AS HEART ATTACK
Irregular pulse, etc.
Term
Pericardial Tamponade
Definition
when blood collects in the space between the PERICARDIAL SAC and the heart until the heart cannot pump effectively. Cardiac arrest can occur quickly
Term
PT has signs of shock but no external / open injuries
Definition
HIGH INDEX OF SUSPICION for internal hemorrhage
Term
Treat an evisceration
Definition
Never shove crap (or organs, for that matter) back into the body cavity.
Keep tissues moist and warm
Cover the site with a large, sterile, moist, bulky dressing
Term
Guarding -
Definition
contracting the stomach muscles to minimize the pain of abdominal injuries; a sign of PERITONITIS
Term
Hemoptysis
Definition
spitting or coughing up blood
(QUICK DRIVE A STAKE THROUGH THE HEART IT'S A VAMPIRE!!!)
Term
Hemothorax
Definition
collection of blood in the pleural cavity
Term
Hollow organs
Definition
stomach, intestines, ureter, bladder... etc?
Term
Myocardial Contusion
Definition
bruise of heart muscle
Term
Pericardium
Definition
fibrous sac surrounding heart
Term
Solid Organs
Definition
liver, spleen, pancreas, kidneys, etc?
Term
Signs of TENSION PNEUMOTHORAX
Definition
distended neck veins
tachycardia
hypotension
Term
Muscle work during Ventilation
Definition
contraction of intercostal muscles and diaphragm
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