Goljan Environmental Path - Mech Injury
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68 terms
Terms | Definitions |
|---|---|
 Types of skin wounds (3) | Contusion (bruise) Abrasion Laceration |
| Contusion (bruise) | Blunt force injury to blood vessels with subsequent escape of blood into tissue |
| Abrasion | Superficial excoriation of the epidermis |
| Laceration | Jagged tear with intact bridging blood vessels, nerves, and connective tissue |
| Incision | Wound with sharp margins with severed bridging blood vessels |
| Gunshot wounds (2) | (1) Contact wounds (2) Stellate-shaped |
| Gunshot wounds | Contain soot and gunpowder (fouling) |
| Contact gunshot wound: | fouling |
| Gunshot wounds Intermediate-range wounds | Powder tattooing (stippling) of the skin around the entrance site |
| Gunshot wounds Long-range wounds | No powder tattooing |
| Exit wounds | Typically larger and more irregular than entrance wounds |
| Motor vehicle collisions | most common cause of accidental death in people ages 1 to 39 years |
| Motor vehicle collisions | Frequently cause mechanical injury Frequently alcohol-related |
| Shaken baby syndrome | More than 50% of deaths in child abuse are due to this syndrome. |
| Shaken baby syndrome (age) | Majority are <1 year old |
| Characteristic signs of shaken baby syndrome (3) | (1) Retinal hemorrhages (2) Multiple fractures of long bones (3) Subdural hematomas |
| First-degree burns (2) | (1) Painful partial-thickness burns (e.g., sunburn) (2) Heal without scarring |
| Second-degree burns (4) | (1) Painful partial-thickness burns (2) Damage to entire epidermis (3) Blister formation (4) Usually heal without scarring |
| First- and second-degree burns: no permanent | scarring |
| Third-degree burns (4) | (1) Painless full-thickness burns (2) Extensive necrosis of epidermis and adnexa (3) Scarring is inevitable. (4) Healing of epithelial surface |
| Scarin in third-degree burns | (a) Keloids (exaggerated scars) commonly occur. (b) Potential for developing squamous cell carcinoma |
| Healing of epithelial surface in third-degree burns | Proliferation of residual epithelium located at burn margins and lining adnexal structures |
| Complications of burns (2) | (1) Infection (2) Curling's ulcers (stomach) |
| Most common cause of death in burn patients | sepsis caused by Pseudomonas aeruginosa |
| Minor heat syndromes (3) | Heat edema Heat cramps Heat exhaustion |
| Heat edema (1) Mild ______ of feet, ankles, and hands (2) Cutaneous ___________ with pooling of blood in gravity-dependent extremities (3) Occurs in the _________nonacclimatized individuals; healthy travelers coming from __________ environment (4) Self-_________ | swelling vasodilation elderly/cold to hot limited |
| Heat exhaustion: ≤ 40°C (<104°F); | no anhidrosis/no mental status changes |
| Heat exhaustion (1) Significant ____________ (salt and water depletion) with or without increase in body temperature (a) Orthostatic __________, dizziness, headache, nausea/vomiting (b) Core temperature ________; normal to 40°C (104°F) (c) No __________ (absence of sweating); normal mental status examination | volume depletion hypotension variable anhidrosis |
| Heat exhaustion Laboratory studies (a) ________________________ (b) Variable serum ___ depending on previous intake ______________ (no intake), normal, or _____________ (patient drank water without electrolytes) | Hemoconcentration (e.g., ↑ hemoglobin/hematocrit) Na+ Hypernatremia hyponatremia |
| Heat exhaustion Treatment | Intravenous volume and electrolyte replacement |
| Heat exhaustion may progress to | heat stroke if not treated promptly |
| Major heat syndrome: | heat stroke |
| Major heat syndrome Similar presentation as heat exhaustion, except the following | (1) Core body temperature > 40°C (104°F) (2) Anhidrosis; mental status (e.g., do not know time, date) and CNS dysfunction (e.g., ataxia, cerebral edema, seizures) |
| Major heat syndrome treatment | (1) High-flow O2; intravenous fluids (normal saline, Ringer's lactate) (2) Rapid cooling to < 40°C (104°F) |
| Heat stroke | > 40° C (>104° F), anhidrosis (absence of sweating), impaired consciousness |
| Frostbite Pathogenesis | (1) Localized tissue injury caused by direct damage (e.g., ice crystallization in cells) (2) Indirect damage (e.g., vasodilation, thrombosis) |
| Frosbite Clinical findings (1) Loss of __________ or burning/tingling sensation (2) ________ of the skin; waxy appearance; cold to the touch (3) Left untreated, skin gradually ____________________ and blisters | pain sensation Discoloration darkens (becomes completely black) |
| Frostbite treatment principles (1) Pre-thaw:_______________________________ (2) Thaw: immerse in circulating water 37°C to 40°C; ibuprofen (3) Post-thaw __________________________ | stabilize core body temperature; rehydration dry and elevate body part |
| Electrical injury | Produced by alternating current (AC) and direct current (DC) |
| __ is more dangerous than __. AC/DC | AC DC |
| AC produces | tetanic contractions. |
| DC produces a | single shock. |
| Wet skin decreases _______, which increases ________. | resistance current |
| Dry skin increases resistance, which decreases _______. | current |
| Tissue damage increases with increased voltage and | duration of exposure. |
| Current moving from the left arm to the right leg (1) Most dangerous route, because ___________ (2) Death results from _________________. | it affects the heart cardiorespiratory arrest |
| Lightning injury _________ deaths/year Hair on end; buzzing Mortality rate ___ with direct strike | 100 to 200 30% |
| Drowning Common cause of death in | children from 1 to 14 years of age |
| Drowning refers to | death by suffocation from immersion in liquid. |
| Near drowning is defined as | survival following asphyxia secondary to submersion |
| Diving reflex occurs in water | that is colder than 20°C (70°F). |
| Diving reflex (1) __________ (2) Peripheral _________ Shunts blood to more vital areas. (3) Blood shifting Shift to thoracic cavity to prevent ________ (4) Allows both conscious and unconscious person to _________________ | Bradycardia vasoconstriction lung collapse survive longer without O2 |
| Most common drowning | wet drowning ∼90% of cases |
| wet drowning Initial laryngospasm on contact with water followed by | relaxation and aspiration of water |
| Dry drowning is characterized by intense laryngospasm without | aspiration |
| Lung aspiration of fresh water (90% of cases) (1) Due to its hypotonicity, water is reabsorbed from the alveoli into the _____________ (2) Plasma is diluted causing ___________________ (hemoglobinuria), hyponatremia, hyperkalemia. (3) Electrolyte abnormalities precipitate ______________. Most common cause of death (4) Hemoglobinuria can produce ________________. | pulmonary circulation. hemolysis of RBCs ventricular fibrillation acute renal failure |
| Lung aspiration of salt water (10% of cases) (1) Salt water is more isotonic to blood (no ___________). (2) Cause of death is _________________ | RBC hemolysis asphyxia from pulmonary edema. |
| High altitude: O2 concentration 21%, ↓ | atmospheric pressure |
| High altitude Decreased | barometric pressure |
| Hypoxemic stimulus to chemoreceptors increases the | respiratory rate producing respiratory alkalosis. |
| Decrease in Paco2 causes a corresponding increase in | Pao2 |
| Respiratory alkalosis activates ________ Increased synthesis of _____________________ | glycolysis 2,3-bisphosphoglycerate |
| High altitude: | respiratory alkalosis; right-shifted OBC |
| Right-shifts O2-binding curve (OBC) increases | release of O2 to tissue |
| Acute mountain sickness usually occurs at | above 8000 feet (2440 m) elevation |
| Risk factors of acute mountain sickness (2) | Increased rate of ascent Extreme altitude |
| Clinical findings of acute mountain sickness: | (1) Headache (most common) (2) Fatigue, dizziness, anorexia, insomnia (3) Acute pulmonary edema Noncardiogenic (exudate) (4) Acute cerebral edema Ataxia, stupor, coma |
| Acute mountain sickness treatment | Immediate descent (if severe complications) |
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