Skin/Musculoskeletal
Trauma
Trauma
What areas of the body is the skin the thickest vs the thinnest?
Palms of hands, soles of feet, scalp = thick
eyelids, ears, lips = thin
What do you assess for on the chest?
DCAPBTLSICS
Palpate anterior and lateral costals, palpate intercostal spaces, palpate sternum stability
Check for sucking chest wound, subcutaneous emphysema, flail segments, sternum instability
Auscultate lungs (listen for crackles, diminished, or absent sounds) and heart tones (may be muffled)
What is the rapid head to toe assessment in trauma?
An assessment of the head, neck, chest, abdomen, pelvis, upper/lower extremities, and back in a quick methodical manner assessing for DCAPBTLSICS:
Deformities, Contusions, Abrasions, Punctures, Penetrations, Burns, Tenderness, Lacerations, Swelling , Instability, Crepitus, Secretions
In a patient with a suspected head injury how can we help reduce intracranial pressure?
lie them supine & Elevate the head to 30 degrees
What is significant blood loss? How much can you lose into each femoral shaft? How much can you lose into the pelvic cavity?
20% blood loss or approximately 1 L in an adult patient;
1L into each femoral shaft
1L+ into pelvic cavity
How should you assess musculoskeletal injuries?
Assess for DCAPBTLSICS, PMSCs, off-put pressure, and assess 7 Ps: Pain, paresthesia, paralysis, pulselessness, pallor, poikilothermia, pressure
What is the mediastinum?
Area including the heart, large blood vessels, trachea, and esophagus (NOT LUNGS)
At what point is a fall considered a significant height
3 or more times the patients height (20ft + for an adult or 10ft + for a child)
or any height on bloodthinners or w/ hemophilia
Rollover MVA with crushed roof, patient has numbness tingling extremities. What kind of injuries would you suspect? What will you do if you find injuries?
Head injury, cervical spinal cord injury.
EMT: maintain C-spine
consider cervical spine damage: be wary of impaired connection between diaphragm and phrenic nerve C3-C5... ventilate the patient 15LPM O2
At what temperature does the body stop shivering? Why is this significant?
During moderate hypothermia below 90 degrees Fahrenheit; shivering is one of our compensatory temperature regulatory mechanisms... if we stop shivering pt is headed towards further hypothermia
A ___ type of injury can occur when significant force cuts off arterial blood supply to an injury for an extended period of time causing delayed PMSCs or significant pain, swelling, numbness/tingling to an extremity
Crush injury
Crush syndrome if greater than 4 hours
What are some s/sx of a chest injury following a traumatic mechanism?
What can you do to help a patient in this state?
Circumoral cyanosis, Paradoxical chest wall movement, Subcutaneous emphysema, open pneumothorax, diminished lung sounds, chest tightness or pain, flail segments, disarticulation of the ribs & sternum, coughing up blood, bruising of chest wall, unequal expansion of the chest wall, crepitus on palpation of the chest wall, jugular vein distension, impaired/absent diaphragm movement, low O2 sat
Ventilate high flow O2 15LPM
What do you do for the abdominal assessment and What is the acronym for the abdominal assessment?
Palpate all 4 quadrants and assess for DRGERM: Distension, Rigidity, Guarding, Evisceration, Rebound Tenderness, Pulsating Masses
What injuries happen to the brain during rapid deceleration (Coup-Counter Coup)?
Compression/bruising to anterior, tearing/stretching to posterior.
High humidity reduces body's ability to lose heat by...
Evaporation.
What are characteristics of a third-degree burn or full thickness burn?
Skin may be black/charred, white, or red with leathery appearance, may not feel pain due to burned nerve endings, loss of hair follicles
If pressure waves emanate from a bullet causiung damage to its path what do we call that? if its pressure waves include damage to the right upper abdominal organs what organs would be affected?
Cavitation
Liver, gallbladder
If you have a patient that became pulseless, apneic, and unresponsive after a lightning strike or a direct blow to the chest, what should you do?
Begin CPR and apply AED
Commotio cordis is sudden cardiac arrest following blunt traumatic injury to the chest during the upslope of the T wave in the cardiac cycle when the ventricles are refilling with blood
This patient needs early defibrillation (CPR & AED)
Common physical exam findings indicating skull fracture?
Bruising of mastoid process (battle sign) or around eyes (racoon eyes), skull deformity, CSF leakage from ears
For electrical wounds and penetrating wounds: compare and contrast Entrance wounds vs internal trauma vs exit wounds
Electrical: entrance wound is smaller for electrical burns, does not accurately represent the extent of internal damage, exit wound is typically larger
Projectile/Penetrating wounds: entrance wounds and exit wounds may not match up, wound size doesn't depict internal damage due to temporary cavitation process for medium-high velocity projectiles, if abd cavity is penetrated assume thoracic is also penetrated and vice-versa
What is the rule of 9's? Rule of palm? What's different for an adult vs pediatric w/ rule of 9s?
Rule of palm = patient's palm = 1% TBSA
Adult: head is worth 9%, each leg is worth 18%
Pediatric: head is worth 12%, each leg is worth 16.5%
Infant: head is worth 18%, each leg is worth 13.5%
What is Becks Triade? and when do we find signs of Becks Triade? What do we do?
JVD, Muffled Heart Tones, Narrowing Pulse Pressure
Pericardial sac fills up with blood; typically occurs following blunt force trauma to the chest with Cardiac Tamponade (obstructive shock)
High flow O2 BVM 15LPM, supine, maintain body temp
What do you assess for in the Pelvis? What does the presence of those things indicate?
Stability, PIG: priapism , incontinence, genital bleeding
instability indicates pt experienced a major mechanism of injury --> need pelvic binder so they don't lacerate femoral artery
PI indicates Potential brainstem/spinal cord injury
Genital bleeding can indicate assault or patient is bleeding internally (from kidneys, from fallopian tubes/ectopic pregnancy or from abd with peritoneal laceration or lac of femoral artery into pelvic cavity)
What is Cushings Triad, what does it mean, and what can cause it?
high systolic BP/Low HR/irregular resp pattern, is means that there is cerebral edema and the brain is herniating, likely due to a ruptured cerebral artery can be medical (hemorrhagic stroke) or traumatic (or TBI : Subdural/Epidural/intracerebral hematoma etc..)
Increased Intracranial Pressure is what causes it
What's the difference between an Epidural bleed vs a Subdural bleed vs Subarachnoid bleed vs Intracerebral bleed?
Epidural = arterial bleed between dura and skull, blood accumulates quickly, very fast progression; initial loss of consciousness followed by lucid interval --> unresponsive
Subdural bleed = venous bleed below dura, slower onset of symptoms, gradual decline of function, may take up to a month to accumulate enough blood to cause alteration of mental status
Subarachnoid bleed = can be caused by ruptured berry aneurysm, potential mixing of blood and csf; characteristic sudden onset of stiff neck, photophobia, headache, aloc
Intracerebral hemorrhage = bleeding w/in brain, headache, symptoms like stroke, sudden onset vomiting, aloc