FISDAP - Paramedic Trauma Unit Exam Review/Study Guide
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Course
EMS 110
Institution
EMS 110
Understand the Concepts:
Disseminating intravascular coagulation: it is a condition in which small blood clots develop throughout the bloodstream, blocking small blood vessels. The increased clotting depletes the platelets and clotting factors needed to control bleeding, causing excessive bleeding...
Understand the Concepts:
Disseminating intravascular coagulation: it is a condition in which small blood clots develop
throughout the bloodstream, blocking small blood vessels. The increased clotting depletes the
platelets and clotting factors needed to control bleeding, causing excessive bleeding.
Hemorrhagic compensatory mechanisms: the reduction of blood during acute blood loss causes
the body to use its compensatory mechanisms. The body has a number of compensatory
mechanisms that become activated in an attempt to restore arterial pressure and blood volume
back to normal, such as: baroreceptor reflexes, chemoreceptor reflexes, circulating
vasoconstrictors, renal reabsorption of sodium and water, activation of thirst mechanisms,
reabsorption of tissue fluids.
Pathophys of referred pain (such as Kehr’s sign): Referred pain is characterized as pain in a
location not associated with the affected origin. Kehrs sign is an example of this because it is
pain in the shoulders due to blood or fluids in the peritoneal cavity.
Pleural decompression: This is performed when a pt presents with an open pneumothorax and the
symptoms associated with that condition (JVD, unequal breath sounds, chest trauma, tracheal
deviation). To perform this treatment you must first identify the 2 landmarks for needle placement
on the affected side (1st - second intercostal space, midclavicular line, just above the third rib to
avoid the nerve endings that lie just inferior to the rib above) (2nd- fifth intercostal space,
midaxillary line, just above the 6th rib), then cleanse the site, insert a large bore IV (>16g) at a 90
degree angle to the skin and push it all the way to the hub. Then remove the needle from the
catheter leaving the catheter in place - air, blood or both may be visualized or heard coming from
the catheter.
Rhabdomyolysis: the breakdown of skeletal muscle, which releases myoglobin into the
bloodstream. This is caused by prolonged crush injuries, which in turn releases toxins/waste
products into the body and can cause acute renal failure if not treated aggressively.
Subcutaneous emphysema: This is air that has escaped the lungs and become trapped in the
skin. Palpating this area will feel like there is popping under the skin or inflated.
Transected aorta: AKA traumatic aortic disruption, is arguably the most severe of all deceleration
injuries. The body stops moving suddenly from a relatively high speed, but the heart continues
its forward momentum and swings on the aorta, which is securely attached to the posterior chest
wall. With sufficient speed, the aorta wall fails and tears. With a large enough tear, the patient will
bleed out into the chest cavity within 1-2 minutes of the collision. The treatment for this patient is
largely supportive. Only very few patients with this condition survive until EMS arrives and even
fewer survive until arrival of the hospital. Maintenance of BP, provision of airway and 02, and CPR
if needed are the mainstays of treatment for this patient.
Perform the Skills:
Assess a patient with a tension pneumo: Assessment of a pt with a pneumo should include
, assessment of the chest for trauma, looking for penetrating trauma. S/s that suggests a pneumo
include chest trauma, diminished or absent lung sounds, subcutaneous emphysema,
hyperresonant to percussion, JVD, tracheal deviation, pulse ox decreased and not improving with
supplemental 02,
Calculate total BSA: Rule of nines - this identifies 11 topographical adult body regions which
approximates 9 percent of the patient's BSA. These regions include the entire head & neck
(9%) , anterior chest (9%), anterior abdomen (9%), posterior chest (9%), lower back (posterior
abdomen) (9%), anterior surface of each lower extremity & the entirety of each upper
extremity (9% each). The genitalia make up the remaining 1%. The rule of nines must be
modified for infant and child anatomies.
Categorize burn severity:
Critical burns: full thickness burns involving hands, feet, face or genitalia. Circumferential burns
of torso, arms or legs. >10% BSA. Partial thickness: >30% BSA. Any thickness: airway or
respiratory involvement, other trauma such as fractures, patient age <5 or >55 with any moderate
burn.
Moderate: Full thickness burns 2%-10% with 0% in hands,feet or genitals. Partial thickness 15%-
30% BSA, superficial >50% BSA.
Minor: Full thickness <2% BSA with 0% in hands, feet, face or genitals. Partial thickness <15%
BSA, superficial <50% BSA.
Compare TBI’s: A traumatic brain injury is an injury to the brain that results in transient or
permanent cognitive, intellectual or emotional changes. A primary brain injury is the actual injury
to the brain as a direct result of the insult. This injury can be through penetrating trauma such as
a gunshot wound; however it is much more likely the result of trauma to the head and brain. After
the head is impacted the brain will continue to move within the cranium until it collides with the
inner wall of the cranium, at this point the brain is injured in the same area of initial impact - this
is called a coup injury. If the force was great enough the brain may bounce off the cranial wall
onto the opposite point of impact, this is called a contrecoup injury.
Specific types of TBIs: Concussion - it is a diffuse brain injury that can occur with any blow to the
brain. They are most common in deceleration injuries. It is not associated with long term
debilitation. Diffuse axonal injury - is characterized only once in the hospital, these injuries are
differentiated from a concussion because the brain has sustained more extensive damage to the
axons of the neurons, resulting in interrupted transmission of nerve signals. Intracranial bleeds-
cerebral contusion is a bruise within the cerebrum in a local area. This is worse than a concussion
because it results in structural damage to the brain and loss of the blood-brain barrier, resulting in
a longer period of neurological deficits. Epidural hematoma is located outside the dura mater
between the meninges and the skull. They are most commonly caused by blunt trauma and linear
fracture to the temporal bone and a laceration to the middle meningeal artery that underlies it.
This trauma normally causes the pt to become unconscious, then regain consciousness and have
a period of “lucid interval” before becoming unconscious again due to ICP. Subdural hematoma
results when one or more of the veins that lie between the dura and the brain are torn during a
traumatic event. Blood will accumulate beneath the dura but still outside the brain tissue. It takes
much longer for ICP to develop and is sometimes not clinically present for days or weeks after
the injury. Intracerebral hematoma is worse than a cerebral contusion because the bleeding is
heavier and affects a larger area of the cerebrum. Survival rate for this is much lower than with a
cerebral
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