How can we help?

You can also find more resources in our Help Center.

90 terms

PHTLS

STUDY
PLAY
Class I Hemorrhage
up to 15% blood loss, minimal tachicardia, no measurable changes in BP or pulse pressure, or RR
Class II Hemorrhage
15-30% Most adults are capable of compensating, incresed RR, Tachycardia, narrowed pulse pressure,
Class III Hemorrhage
30-40% no longer able to compensate for volume loss, hypotension occurs, HR >120 BPM, RR 30-40, severe anxiety or confusion
Class IV Hemorrhage
more than 40% loss, severe shock, HR >140 BPM, RR >35, confusion lethargy, decresed systolic blood pressure, typically in the range of 60 mm Hg.
Ratio for loss blood replacement
3 litres of electrolyte solution replacement for each liter of blood lost
Distributive Shock
uncontrolled vasodialation causes reduced resistance causing a decrease in the diastolic blood pressure
Distributive Shock
Decrease in preload+decrease in cardiac output
Psychogenic Shock
Vasovagal - stimulation of the tenth cranial nerve (vagus nerve) produces bradycardia. May also cause vasodilation.
Typically occurs in a very brief period.
Septic Shock
Cytokines released because of an infection can cause damage to blood vessel walls and cause vasodilation
Anaphylactic Shock
Respiratory distress, airway obstruction and vasodilation
Potential Blood loss from a single femoral fracture
30-40%
Amount of blood loss that can happen before signs of compensatory mechanisms fail and BP become <90 mmHq
Greater than 30%
Hypertension medications that may prevent compensatory tachycardia to maintain BP
Beta Adrenergic blocking agents and calcium channel blockers
Managing Volume Resuscitation
Uncontrolled hemorrhage-suspected chest, abdomen, retroperitonium
Maintain a systolic bp 80-90 or MAP 60-65
Managing Volume Resuscitation
CNS injuries or TBI
maintaining the systolic BP (SBP) above 90 or MAP 85-90
Managing Volume Resuscitation
Controlled Hemorrhage
large scalp or extremity controlled with a tourniquet, PT falls into class II,III,IV shock
rapid bolus of 1-2 litres
Three responses of initial fluid bolus
Rapid Response
vital signs return indicating that PT lost less than 20%
PT is best managed at SBP between 80-90, IV fluid should be titrated
Three responses of initial fluid bolus
Transient Response
Vital signs improve (pulse slows, BP increases) however PT shows deterioration. PT has typically lost 20-40% of blood volume
Three responses of initial fluid bolus
Minimal or no response
No change in PT after 1-2 liter Bolus
Leading cause of TBI
MVC
Three seperate membranes that surround the brain
meninges
Outer most meninges
Dura mater- composed of tough fibrous tissue
The inner most meninges that is directly in contact with the brain
Pia Mater-
Vessels that lay on top of the Pia Mater
Cerebral Blood Vessels
The meninge that lays in the middle between the dura and pia matter
Arachnoid membrane-loosely covers the brain and its blood vessels
MAP-Mean Arterial Pressure
The average pressure for the entire cardiac cycle
MAP=Diastolic Pressure + 1/3 of the Pulse Pressure
PP- Pulse Pressure
The difference between the systolic and diastolic
PP= Systolic (SBP) - Distolic (DBP)
CPP- Cerebral Perfusion Pressure
The amount of pressure it takes to push blood through the cerebral circulation. CPP=Mean Arterial pressure (MAP) - Intercranial pressure (ICP)
CPP- is normally below ? mmHg
CPP is normally 15 mmHg or below
Autoregulation
The brain changes the cerebral blood vessel resistance (CVR) to compensate for changes in the cerebral pulse pressure (CPP)
For neurological injured PT's the systolic blood pressure is best if maintained at or above
90 mmHg
Hyperventilation and TBI
Hyperventilation can reduced CBF by causing vasoconstriction due to hypocapnia, PaCO2 >35 increases risk of cerebral ischemia
Primary Brain injury
The direct trauma or mechanical injury, includes contusions, hemorrhages and lacerations
Secondary brain injury
pathologic mechanisms that related to intercranial mass effect, elevated ICP, and herniation, hemotoma, hypoxia and hypotension
Mass effect
The effect of a growing mass or tumor
Uncal Herniation
temporal lobe epidural hematoma forces pressure on the medial portion of the temporal lobe (uncus) which in turn puts pressure on the 3rd cranial nerve causing dilation or blown pupil on the side of the herniation. May also cause loss of function of the motor track on the same side.
Final stage of uncal herniation
The RAS is affected patient lapses into coma
decorticate posturing
flexion of the upper extremities with rigidity and extension of the lower extremities.
decerebrate posturing
all extrem become flaccid and motor activity is absent
Cheyne strokes ventilation
repeating cycle of slow hallow breaths that become deeper and more rapid and then return to slow
Central neurogenic hyperventilation
rapid deep breaths
Ataxic breathing
erratic ventilatory efforts that lack any discernible pattern
Cushings phenomenon
greatly increased arterial blood pressure and the resultant bradycardia (increase BP + decreased HR) may occur with severely increasing ICP
Hypercapnia (high CO2)
causes vasodilation
Hypocapnia (low CO2)
causes vasoconstriction
When people have 20 mmHg CO2 in their blood (half of the official norm),
they have about 40% less blood supply to the brain in comparison with normal conditions
Indication of TBI
Hemiparesis
One sided weakness
Indication of TBI
Hemiplegia
One sided paralysis
Indications for a nose fracture
ecchymosis, edema, nasal deformity, swelling, epistaxis
Epidural Hematoma
1-brief Loss of consciousness
2-Lucid Interval
3-Rapid decline in level of consciousness
The period of time after a brief loss of consciousness where the PT may be oriented, lethargic or confused followed by a rapid decline of consciousness
Subdural Hematoma
Account for 30% of TBI-Generally results from venous blood from bridging viens that are torn during a violent blow to the head.
Epidural Hematoma
Account for 2% of TBI-Arterial blood starts to dissect or peal the dura off of the inner table of the skull creating an epidural space filled with blood
Epidural Hematoma Signs
Altered LOC, dilated and sluggish non reactive pupil on the side of herniation, hemiparesis or hemiplegia on opposite side of injury.
Subdural Hematoma
Can be chronic or acute. Pt on coumadin are at high risk of un identified subdural hematomas that may be chronic. Often may be confused with stroke, infection or general decline of PT
Cerebral Contusions
actual bleeding into the substance of the brain, CC's often take 12-24 hrs to appear on CT scans, only indicator is a depressed GCS of 9-13
Subarachnoid Hemorrhage
rarely causes mass effect and does not require surgery, it does increase the risk of cerebral contusion by 63-73%
Normal ventilatory rates
Adults=
10 BPM
Normal ventilatory rates
Children=
20 BPM
Normal ventilatory rates
Infants=
25BPM
Warning signs of possible ICP
Decline in GCS
sluggish or non reactive pupils
Hemiplegia or hemiparesis
Cushings phenomenon
Osmotherapy
the use of osmotically active agents that may assist in the treatment of intracranial hypertension`
Number of cervical vertebrae
7
Number of thoracic vertebrae
12
Number of lumbar vertebrae
5
Number of coccygeal vertebrae
4
Number of pounds the human head averages
16-22 pounds
Space between the spinal cord and the spinal canal wall
3mm
Name of the 1st cervical vertebrae
Atlas
Name of the 2nd cervical vertebrae
Axis
Function of the ascending nervee tracts
Sensory impulses from body parts through the cord up to the brain
Function of the descending nerve tracts
impulses from the brain through the cord down to the body
Dorsal root=
sensory
Ventral root=
motor
Dermatome
The sensory area on the body for which a nerve root is responsible
The phrenic nerve originates from
the cervical vertebrae c2-c5
Skeletal Injuries
Compression
Compression fractures that produce wedge compression or total flattening of the body of the vertebra
Skeletal Injuries
Fractures
Produce small fragments of bone that may lie in the spinal canal near the cord
Skeletal Injuries
Sublaxation
a partial dislocation of the vertebra from its normal alignment in the spinal column
Skeletal Injuries
Overstretching
Tearing of the ligaments and muscles producing instability between the vertebrae
Skeletal Injuries
Percentage of falls from a height greater than 15 feet involve an associated lumbar spine fracture
20%
Cause and Symptoms
Anterior Cord syndrome
Results from bony fragments or pressure on spinal arteries
Symptoms-loss of motor function and pain, temperature and light touch PT's will have some light touch sensations such as vibration.
Cause and Symptoms
Central cord syndrome
usually occurs with hyperextension
Symptoms include weakness or paresthesia (tickling, tingling, burning, pricking, or numbness) in the upper extremities but normal strength in the lower extremities
Cause and Symptoms
Brown Sequard syndrome
Caused by penetrating injury and involves hemi-transection of the cord.
Symptoms include complete cord damage and loss of function of the affected side with loss of pain, temp and sensation on the opposite side of the injury
Conditions that should mandate spinal immobilization
Altered LOC
Spinal Pain or tenderness
Neurologic deficit or complaint
Anatomic deformity of the spine
Pulmonary Volume Terminology
Dead Space
Amount of air brought into the lungs that does not have the opportunity to exchange oxygen and carbon dioxide
Pulmonary Volume Terminology
Minute Volume (Ve)
Total volume of air moved into and out of during a 1 minute interval.
Pulmonary Volume Terminology
Tidal Volume (Vo)
Amount of air that is inhaled then exhaled druing a normal breath (.4-.5 litres)
Pulmonary Volume Terminology
Total Lung Capacity (TLC)
Total volume the lungs contain when maximally inflated. This volume declines with age from 6 L. in young adults to 4 L. in elderly.
Pulmonary Contusion
Blunt force can tear lung tissue resulting in bleeding into the alveoli
Thoracic Trauma
Assessment
Four components to the phys exam
Observation, palpation, percussion, auscultation