So Shocking!
Inadequate cellular perfusion
What is shock?
One rescuer CPR rate for adults
30:2
The human body will not tolerate a blood loss greater than ______%
What is 20%?
The 6 major facial bones
Nasal bone, zygoma (x2), maxillae (x2), and mandible
Halo Sign: What is it and how to test for it
A sign of severe head/spinal injury. Take gauze and place it where the fluid is leaking (Ears, nose, and rarely the mouth) of a patient with a head injury. It will show a golden halo around the fluid.
Cavitation
occurs as the pressure wave from the projectile is transferred to the tissues, allowing the wound to "close" as the projectile moves through (small/invisible entry wound, large/explosive exit wound)
Factors that affect exposure
Physical condition, age, nutrition/hydration, and environmental conditions
Pump function > Container function > Content function
What is the perfusion triangle?
ABC's
Airway Breathing and Circulation
Patient that lacks blood clotting factors and may bleed spontaneously.
What is hemophilia?
When one eye is impaled, you
secure it and bandage both eyes
Racoon Eyes Vs. Battle Sing
What is bruising around the eyes vs bruising behind the ears?
Evisceration: What is it and how do you treat it?
Abdominal organs exposed/sticking out. Do not shove back in. Place a sterile dressing moistened with saline over the wound, apply a bandage, and transport.
Five Ways the Body Can Lose heat
Conduction: Transfer of heat through direct contact (touching something cold)
Convection: Transfer of heat through circulating air (cold air moves across a body like wind, or a ghost)
Evaporation: conversion of liquid to gas (sweat)
Radiation: transfer of heat by radiant energy (standing in a cold room)
Respiration: warm air exhaled and cooler air is inhaled
Stages of shock
What is Compensated, Decompensated, Irreversible?
Primary cause of cardiac arrest in infants and children
What is respiratory arrest?
DCAP-BTLS
Deformities, contusions, abrasions, puncture/penetration, burns, tenderness, lacerations, and swelling
An avulsed tooth should be transported in
cold milk or sterile saline
Coup-contrecoup Injury
What is the initial impact to the front of the brain then the head falling back causing damage to the back of the brain
Hollow Organ Injuries vs. Solid Organ Injuries
Hollow: "pop" Usually delayed signs/symptoms, spill contents into abdomen such as the gallbladder and urinary bladder. Free air can cause pain and usually a sign that a hollow organ or loop bowel perforated.
Solid: "tear" Very vascular and cause rapid blood loss into the abdomen. Examples are the liver, spleen, and pancreas.
Hypothermia Vs Hyperthermia
1) Core temp below 95 degrees, organs slow down as mental status deteriorates, leads to death (table 33-1 in book)
2)Core temp above 101 degrees, stages of heat cramps, to heat exhaustion, to heat stroke (officially heat stroke when pt stops sweating and is hot/dry).
A passive process in which molecules move from an area with higher concentration to an area of lower concentration
What is diffusion?
Head tilt-chin lift vs. Jaw thrust
No spinal injury vs spinal injury
Primary blast injury vs secondary vs tertiary
Damage caused by blast wave/pressure change vs. damage from flying debris vs. the person hitting something as they were thrown back.
Paradoxical movement
When two things move in different direction. Ex. Flail chest
Cushing reflex
What is the symptom triad of increased systolic blood pressure, decreased pulse rate, and irregular respirations
Displaced Fracture vs. Non-displaced Fracture
Causes deformity, distortion, shortening etc vs. a simple crack (hairline fracture) that is hard to distinguish without x-ray
Spider vs Snake Bites
1) Black Widow: Found in every state but Alaska, venom is a neurotoxin that destroys nerve tissues, will subside over 48 hours but will cause severe pain.
2) Brown Recluse: Lives in the southern/central part of the country, cytotoxin that causes severe tissue damage. Pain develops over several hours and leave a mottled, pale, area with a cyanotic center.
3) Only 19 venomous snakes in US out of 115 different species we have. Rattlesnake, copperhead, cottonmouth/water moccasin, and coral snakes. "Red and Yellow Poison Fellow". Classic sign, two puncture wounds with discoloration swelling and pain.
-Pit Vipers: Rattlesnakes, copperheads, and cottonmouths. Triangular flat heads, cat like eyes, and pits on the face. Copperheads are almost never fatal, but can cause significant damage to extremities. Cottonmouths are aggressive water snakes that cause severe tissue destruction. Use pen to mark edges of swelling so it can be tracked as it spreads. Try and get picture of the snake.
-Coral snakes: Lives mostly in southern states, powerful neurotoxin that causes paralysis of the nervous system. Within a few hours, the pt will exhibit bizarre behavior, followed by paralysis of eye movements and, eventually respiration.
Distributive Shock
Septic, Neurogenic, Anaphylactic, Psychogenic
What is poor vessel function?
Reasons not to start CPR
What is scene safety, rigor mortis, dependent lividity, putrefaction/decomp, injuries incompatible with life
ONLY remove an impaled object when________...
The object obstructs the airway or interferes with CPR
Injury caused by a sudden, direct blow to the chest during a critical portion of the heartbeat that generally results in cardiac arrest
Commotio Cordis
Decerebrate vs. decorticate
Posturing outward vs posturing inward
Compartment Syndrome
Blood flow decreases inside a muscle compartment; ischemia and anaerobic metabolism result. Tissue becomes damaged and can die. Critical and can be limb/life threatening. Treated with fasciotomy.
Descent emergencies Vs. Ascent Emergencies
1) Usually a problem equalizing and pain will force diver to RTS or seek medical attention for tympanic membrane eval.
2) Multiple issues can occur during ascent.
-Air Embolism: bubbles of air in blood vessels. Air pressure in the lungs remains high while pressure on the chest decreases, immediately at surface
- Decompressions sickness (the bends), bubbles of gas (mainly nitrogen), obstruct blood vessels. Can be from rapid ascent, too long of a deep dive, too short surface interval, usually causes a lot of pain in joints/abdomen, can take several hours
-both require hyperbaric treatment
Hypovolemic Shock
Hemorrhagic, Nonhemorrhagic
What is low fluid volume?
S.T.O.P
Starts breathing, Transferred over care, Out of strength, Physician orders
The two biggest concerns for electrical burns
Large amount of deep tissue injury & cardiac/resp arrest from the shock
Blood and air filling up the pleural space
hemopneumothorax
Epidural Hematoma vs. Subdural Hematoma
Accumulation of blood between the skull and dura mater vs bleeding beneath the dura mater but above the pia mater
The amount of blood that can be held in the pelvis
2-3 liters
Dysbarism Injuries
Caused by the difference between the surrounding atmospheric pressure and the total gas pressure in the body
Cardiogenic Shock
Obstructive Shock
Tension Pneumo, Tamponade, PE
What is pump failure?
Brain damage is very likely in a brain that does not receive oxygen for _____
6-10min
An adult has burns to the abdomen, R am, and groin after spilling a pot of boiling water. Name the burn percentage
19% - 9% abdomen, 9% arm, and 1% groin
The Deadly Dozen: Chest Injuries
Airway obstruction, bronchial disruption, diaphragmatic tear, esophageal injury, open pneumo, tension pneumo, hemo, flail chest, tamponade, thoracic aortic dissection, myocardial contusion, pulmonary contusion
Linear Skull Fracture
Depressed Skull Fracture
Basilar Skull Fracture
Open Skull Fracture
1)Account for approximately 80% of all fractures to the skull, no physical deformity
2)Result from high-energy direct trauma to the head by a blunt object. The frontal and parietal bones of the skull are most susceptible. Bony fragments may be driven into the brain, resulting in injury. Patients often present with signs of neurologic injury (such as loss of consciousness).
3) Associated with high-energy trauma, but usually occur following diffuse impact to the head. These injuries generally result from extension of a linear fracture to the base of the skull and are usually diagnosed with a CT of the head. Signs of a basilar skull fracture include CSF drainage from the ears, raccoon eyes, and Battle sign.
4) Often associated with trauma to multiple body systems. Brain tissue may be exposed to the environment, which significantly increases the risk of a bacterial infection. Have a very high mortality rate
The 8 Fractures
a. Comminuted: A fracture in which the bone is broken into more than two fragments
b. Epiphyseal: A fracture that occurs in a growth section of a child’s bone and may lead to growth abnormalities
c. Greenstick: An incomplete fracture that passes only partway through the shaft of a bone
d. Incomplete: A fracture that does not run completely through the bone
e. Oblique: A fracture in which the bone is broken at an angle across the bone
f. Pathologic: A fracture of weakened or diseased bone generally produced by minimal force
g. Spiral: A fracture caused by a twisting force, causing an oblique fracture around the bone and through the bone
h. Transverse: A fracture that occurs straight across the bone
HAPE Vs. HACE
High Altitude Pulmonary Edema Vs. High Altitude Cerebral Edema
1) Fluid build up in lungs, Flash, frothy pink sputum. cyanosis
2) May accompany HAPE, severe headache, ataxia, LOC, vomiting