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most stressful unit
triage
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which vertebrae allows for the most cervicle flexion?
c3-c6
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things to consider with fall pt
- fall height
- body part that received initial force
- surface falling onto
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significant mechanism of injury
- -ejection from vehicle
- -death of someone in the same vehicle
- - rollover MVC
- -High speed collision, defined as greater tatn 40 mph
- -falls from greater than 20 feet (10 feet for pediatric patients)
- -Motorcycle and rider separation
- -penetrating trauma to the head, neck, torso, or proximal extremity
- -significant blunt trauma to the head, neck, or torso
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GCS for eyes
- 4 open eyes spontaneously
- 3 open eyes in response to voice or in response to pain
- 2 stimuli
- 1 none
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Verbal GCS
- 5 Oriented, converses normally
- 4 confused, disoriented
- 3 speaks inappropriate words
- 2 incomprehensible sounds
- 1 none
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GCS Motor
- 6 Obeys commands
- 5 localized painful stimuli
- 4 withdraws from pain
- 3 abnormal flexion to painful stimuli
- 2 extension to painful stimuli
- 1 none
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Duramater
outer menigeal layer
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pia mater
inner meningeal layer
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Arachnoid space
space between duramater and pia mater with a spider web appearance
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controls all fine thinking
Cerebrum
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controls all gross motor movement
Cerebellum
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controls vital functions
The brainstem
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regulates endocrine and autonomic nervous system functions, located above brain stem
Hyypothalamus
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controls involuntary somatic and visceral motor centers, and relays info between cerebellum and brain stem
pons
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respiratory, cardiac, vasomotor center
medulla
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neck Zone 1
below cricoid ring, carry highest mortality due to great vessel and tracheal involvement
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Neck Zone 2
more common and involve carotid arteries and larynx
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Neck Zone 3
can be hidden from view
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neck structures Vessels
Carotid bodies and Jugular Veins
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neck structures Airway
trachea and larynx
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Other neck structures
Cervical spine and esophagus
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bones of face need to know
Zygoma, Maxilla, Mandible, and Nasal Bones
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Filled with a gelatinous fluid called vitreous humor
the eye
-
the “whites” of the eye
Sclera
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what does CFS do
Allows for cushioning and “floats” the brain Provides for the exchange of nutrients and waster products
-
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Parietal
(Motor and Sensory Activities; Memory and Emotions)
-
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Temporal
(Long-Term Memory, Hearing, Speech, Taste, Smell)
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Cerebral Contusion
- Causes: blunt trauma to local tissue
- S/S: prolonged confusion
- Notes: common with blunt injury, frontal lobe most commonly injured
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Intracranial Hemorrhage
- Causes: bleeding that can occur at several locations within the brain
- S/S: dependent on area involved
- Notes: often deteriorate during your care
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Epidural Hematoma
- Causes: bleeding between the dura mater and the skull from a hih pressure vessel
- S/S: patient will quickly move toward unresponsiveness
- Notes: often the brain will be displaced and pushed toward the foramen magnum
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Subdural Hematoma
- Causes: normally bleeding beneath the dura mater in the subarachnoid space
- S/S: occurs very slowly and present with subtle changes
- Notes: suspect in medical patients with neurological complaints who have recent history of trauma
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Intracerebral Hemorrhage
- Causes: ruptured blood vessel within the brain S/S: present much like a stroke
- Notes: blood loss in minimal but damaging due to irritation
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Concussion
- Causes: blunt head trauma
- S/S: transient confusion, disorientation, amnesia followed by rapid return to normal Notes: lucid interval – occurs when multiple injuries occurs, ex. Concussion and epidural hematoma
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Moderate DAI
- Causes: bruising of brain tissue occurs, and commonly associated with basilar skull fx S/S: immediate unconsciousness, followed by persistent confusion, disorientation, and both types of amnesia
- Notes: patients may also complain for headache, photophobia, and smell disturbances
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Severe DAI
- Causes: significant damage to axons in both cerebral hemispheres and brainstem
- S/S: unconscious, shows signs of ICP increase, and both kinds of posturing
- Notes: many of these patients will not survive
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Upper Brainstem Displace can cause
Vomiting, Changes in LOC, and Pupillary dilation
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Lower Brainstem Displace
Disturbances in B/P, breathing, and HR
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Blunt trauma
Pressure wave damages air filled structures
Blast type
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Blunt trauma
-Injuries to the chest wall, diaphragm, heart, or tracheal tree
– Traumatic Asphyxia – Crush Syndrome and Rhabdo.
crushing type
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blunt force trauma
Like chest hitting steering wheel
Chest wall stops, organs move
Fixation points tear
Paper bag syndrome
Deceleration Type
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Shotgun Blasts
- – Type 1 – greater than 21 feet
- – Type 2 – between 9 and 21 ft
- – Type 3 – less than 9 feet
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• Basically air in the pleural space – A.K.A closed pneumo.
• Can be caused by rib fractures, paper bag syndrome, or penetrating trauma
• S/S – Trauma to the chest, chest pain on inspiration, hyperinflation of the chest, diminished breath sounds
Simple pneaumothorax
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• Usually caused by large exit wound
• Sucking Chest wounds – 2/3 size of trachea
• S/S – Penetrating chest trauma, sucking chest wound, frothy blood at wound site, dyspnea, hypovolemia
Open Pneumothorax
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DCAP-BTLS
- Deformity
- Contusion or crepitus
- Abrasion
- Penetrating trauma
- Burns
- Tenderness
- Lacerations
- Swelling
-
deadly dozen chest trauma
Primary Survey Detection and Treatment
- • Airway Obstruction
- • Open Pneumothorax
- • Flail Chest
- • Tension Pneumothorax
- • Massive Hemothorax
- • Cardiac Tamponade
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deadly dozen chest trauma
Secondary Survey Detection and Treatment
- • Myocardial Contusion
- • Traumatic Aortic Rupture
- • Tracheal/Bronchial Injury
- • Diaphragmatic Tears
- • Esophageal Injury
- • Pulmonary Contusion
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