1. address pt's concern

2. Dx or R/O life- and limb-threatening injuries

3. discuss w/ the pt your findings & explain the natural course of the disease

4. Instruct the pt on warning signs that would mandate a return, or when to follow up with their PCP

Airway (patent airway)

Breathing (equal breath sounds)

Circulation (pulses in extremities & hemostasis)

Disability (GCS and pupillary response)

Exposure (view front and back of patient)

at least 2

oblique third view valuable for joints and distal extremities

open joint

traumatic arthrotomies

forearm

hand

leg

foot

aka buckle

wrinkling of cortex

neurovascular status

you should also get radiographs before and after

seizure

electric shock

fall onto adducted, internally rotated arm

Requires significant amount of force

posterior

immediate reduction required

not a true dislocation

subluxation of radial head from annular ligament

occurs mainly in children

capitate displaced in dorsal direction

capitate pops out of lunate

posterior

associated with acetabular fractures

injury to sciatic nerve

violent trauma

complete disruption of all major ligaments and menisci

nonunion

adhesive capsulitis

neurovascular injury

supracondylar fractures

emergent orthopaedic referral!!!!!!!!

direct blow

forceful quadriceps contraction

refer to an orthopaedist

turns into compartment syndrome of foot and vascular compromise

direct blow to tip of finger

inability to extend DIP

injury to the ulnar collateral ligaments of the thumb secondary to forced abduction

$5 pinch test

thermal

chemical

electrical

Head 9%

back 18%

thorax 18% (abd 9%, chest 9%)

each leg 18%

each total arm 9%

children have bigger heads relative to adults

TBSA 18% for child's head

legs with less TBSA

Allergies

Meds

PMH

Last meal

Events of the injury

painful

erythematous

lacks blisters

ex: sunburn

Painful

Erythematous

blister formation and swelling; wet appearing

partial thickness burn

Painless

white and waxy; leathery and dry

involves nerves

full thickness burn

painless

white and waxy

involved bone and muscle

full thickness burn

alkali

they are deeper and cause liquefactive necrosis instead of coagulative necrosis

cardiac dysrrhythmias

respiratory arrest

myoglobinuria

generally they need admission

pain

 pallor

 numbness to the affected part

 reversible injury

hyperemia

edema

lack of tissue necrosis

hyperemia

edema

clear vesicle formation

partial thickness skin necrosis

hemorrhagic vesicle formation

full thickness tissue necrosis

subcutaneous tissue necrosis

full thickness skin necrosis

necrosis of mm and bone

gangrene

chronic exposure to wet conditions and temps slightly above freezing

first cold and anesthetic, then erythematous, painful and hyperemic

dermatologic condition as opposed to destructive

chronic exposure to damp cold temps

typically located on face, hands and feet

red-purple lesions often pruritic

may progress to ulcerations and scar formation with repetitive exposure

trench foot

chilblain/pernio

core body temp < 95F

mild 32-35C

Moderate 30-32C

severe <30C

altered level of consciousness

cardiac dysrrhythmias

remove clothing

rewarm frozen part

warm blankets

preserve damaged tissue

analgesics, tetanus, ABx if indicated

blankets

warm IVFs

warmed environment

bilateral CT's x2

peritoneal lavage

cardiopulmonary bypass

Airway

Breathing
Circulation

DECONTAMINATION

exposure

antidote and alter absorption

basics (Vitals, EKG, etc)

change catabolism

distribute differently

enhance elimination

Chelation

diuresis

hemodialysis

manipulating pH

antibody to toxin

WBI

charcoal hemoperfusion

Telemetry

Two large bore IVs

12 lead EKG

place pt in recovery position (left lat. decubitus)

Dextrose

Oxygen

Naloxone

Thiamin

chloral hydrate

heavy metals

iron

phenothiazine

enteric coated tablets

solvents

F      Iron

E     Ethanol

C     Caustics, Cations, Corrosives

A     Acids and Alkalis

L      Lithium

Anticholinergics

Cholinergics

Sympathomimetics

Sedative, EtOH and Opiods

Serotonergic

Red as a beet (flushing)

Hot as a hare (fever)

mad as a hatter (agitation)

Dry as a bone (urinary ret, dry mucous membranes)

blind as a bat (mydriasis)

TCAs

Atropine, homatropine, scopalomine

antihistamines

jimson weed

organophosphates

carbamates

pilocarpine

muscarine containing mushrooms

nerve gas

D - diarrhea

U - urination

M - miosis

B - bronchorrhea and bradycardia

E - emesis

L - lacrimation

S - Salivation

M - mydriasis

T - Tachycardia

W - weakness

H - HTN

F - fasciculations

altered mental status

mydriasis

tachycardia

diaphoresis

hyperpyrexia

HTN

Coma

Miosis

apnea

hypotension

bradycardia

opiate triad: miosis, coma, resp depression

altered mental status

fever

myoclonus or tremor

hyperreflexia

diaphoresis

shivering

IV fluids

anti-emetics

BDZs

NG lavage and charcoal

NAC

Ca+

 glucagon

ethanol or fomepazol

hypovolemic

cardiogenic

distributive

obstructive

it can be subtle

no single vital sign or value is diagnostic

it usually profoundly apparent

ABCs

IV, O2, cardiac monitor, O2 sats

FLUID RESUSCITATION

determine cause of shock

Use isotonic fluid in bolus

crystalloids then colloids

Give fluids in 1 liter at a time boluses

MI

cardiomyopathy

myocarditis

LV dysfunction

septic

neurogenic

anaphylactic

acute adrenal insufficiency

Septic shock

most cause by gram negative organisms

severe hypersensitivity reaction

basic mechanism is mast cell degranulation

Antihistamines (H1 and H2 blockade)

steroids

1. decreased cardiac input (preload)

2. decreased cardic output

Eye Opening 4 pts

Motor Response 6 pts

Verbal Response 5 pts

A - Alert

V - responsive to verbal stimuli

P - responsive to painful stimuli

U - unresponsive

drug toxins or reactions

encephalopathy

extremes of temperature

sepsis

postictal states

neoplasm

intracranial hemorrhage

CNS Infection

CNS trauma

Infarction

Seizure

ingestions

infections

abuse

lens

middle meningeal artery, high pressure