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The supply of oxygen to and removal of wastes from the cells and tissues of the body as a result of the flow of blood through the capillaries.
Inability of the body to adequately circulate blood to the body's cells to supply them with oxygen and nutrients.
The inability of the body to adequately circualte blood to the body's cells to supply them with oxygen and nutrients. A life-threatenting condition.
Bleeding from an artery, which is characterized by bright red blood and as rapid, profuse, and difficult to control.
Bleeding from a vein, which is characterized by dark red or maroon blood and as a steady flow, easy to control.
Bleeding from the capillaries, which is characterized by a slow oozing flow of blood.
A bulky dressing held in position with a tightly wrapped bandage to apply pressure to help control bleeding.
A site where a main artery lies near the surface of the body and directly over a bone. Pressure on such a point can stop distal bleeding.
A device used for bleeding control that constricts all blood flow to and from an extremity.
When the patient is developing shock but the body is still able to maintain perfusion.
signs of bone injury
1. Pain and tenderness 2. deformity or angulation 3. grating or crepitus 4. swelling 5. bruising 6. exposed bone ends 7. joints locked in position 8. nerve and blood vessel compromise
7 steps in patient care for injuries
1. standard precautions 2. initial assessment (ABCs) 3. rapid trauma exam 4. apply cervical collar 5. splint 6. apply dressing to wounds 7. cold pack/elevate
load and go
initial assessment reveals unstable patient address ABCs use long spine board do not splint individual extremities
immobilize adjacent joints and bone ends decreases pain and movement * prevents additional injury
if extremity is cynotic or lacks pulse restores effective circulation splint may be ineffective otherwise decreases circulatory compromise reduction in pain
3 rules for realignment
1. grasp distal extremity for support 2. splint in position found (realign if extremity is cyanotic or lacks pulse) 3. manual traction ( resistance - stop realignment and splint in position no resistance - maintain traction until splint applied)
ways to treat bone injury
1. treat life - threats first 2. expose 3. assess distal pulse, motor function, and sensation before and after 4. align long bone to anatomical position 5. choose method to be used 6. do not push protruding bones 7. immobilize both injury site and adjacent joints 8. pad voids
how to apply traction splint
1. standard precautions 2. expose 3. stabilize injury site 4. assess pulses and circulation, motor function, and sensation 5. check for disability 6. realign if deformed or if distal extremity is cyanotic or pulseless 7. measure or adjust the splint 8. maintain manual stabilization or traction 9. apply or secure the splint 10. reassess CMS
3 indications for using traction splint
1. painful 2. swollen 3. deformed thigh with no joint or lower leg pain
10 guidelines for traction splints
1. standard precautions 2. manual stabilization and traction 3. assess CMS 4. adjust splint to proper length 5. apply proximal securing device (ischial strap) 6. apply distal securing device (ankle hitch) 7. apply mechanical traction 8. position and secure support straps 9. reevaluate 10. secure torso and traction splint to long board
5 steps in patient care for shoulder girdle injuries
1. assess distal PMS function 2. rigid splint is not practical 3. sling and swathe 4. do not attempt to straighten or reduce dislocations 5. reassess distal PMS function
9 steps in patient care for pelvic injuries
1. limit patient movement 2. determine CMS distally 3. straighten and stabilize lower limbs 4. apply pneumatic anti-shock garment (PASC) when BP less than 90 5. immobilize on long spine board 6. reasses 7. provide 02 and treat shock 8. transport 9. monitor vital signs
signs and symptoms of hip dislocation
anterior - lower limb rotated outward and hip flexed posterior - lower limb rotated inward, hip flexed, knee bent, foot may hang loose
7 steps in patient care for hip
1. asses distal CMS 2. apply long spine board 3. immobilize limb with pillows or blankets 4. secure patient 5. reassess distal CMS 6. treat shock and provide o2 7. transport
signs and symptoms of hip fracture
localized pain (sometimes in the knee) sensitive to pressure laterally (greater trochanter) discolored tissue swelling unable to move limb unable to stand foot rotated outward injured limb appears shorter
femoral shaft fracture
pain open fracture with deformity closed fracture with deformity injured limb shortened
5 steps in patient care for femoral shaft fracture
1. control any bleeding with direct pressure 2. manage patient shock 3. assess distal PMS function 4. apply a traction splint 5. reassess distal CMS function
7 steps in patient care for knee injury
1. assess distal CMS function 2. padded board splints 3. pillow 4. reassess distal CMS funtion 5. immobilize with padded board splint 6. pad the voids 7. reassess distal CMS function
10 steps in patient care for ankle/foot injury
1. assess distal CMS 2. stabilize and lift limb 3. place 3 cravats on ground and put pillow on top 4. leg onto pillow 5. tie pillow to ankle/foot 6. 4th cravat loosely at arch of foot 7. elevate with 2nd pillow or blanket 8. reassess distal CMS 9. check for shock 10. apply ice pack
peripheral nervous system
nerves enter and exit spinal cord between vertebrae 12 pairs of cranial nerves * motor and sensory nerves
autonomic nervous system
controls the involuntary actions of the body (heartbeat, breathing, control of diameter of vessels, sphincter muscles)
thick, outermost layer of the meninges surrounding and protecting the brain and spinal cord
blood vessels bleeds profusely control bleed dress and bandage * caution when applying pressure
a bruiselike injury of the brain that occurs when the soft tissue of the brain collides against the skull (mild, no detectable damage, may/may not lose consciousness, headache)
injury that doesn't break the skin, characterized by pain, swellin, and discoloration; bruise
the collection of blood within the tissue from damaged blood vessels. (names bases on location in brain - subdural, epidural, and intracerebral)
a violent shaking up or jarring of the brain that may result in a temporary loss of awareness and function
below the dura mater bleeding due to tearing of blood vessels on the surface of brain * 3 types (acute, subacute, chronic)
above the dura mater usually rapid bleeding * bleeding between skull and protective covering of brain
9 steps in patient care for head injuries
1. standard precautions 2. stabilize c-spine 3. evaluate breathing 4. provide o2 5. control bleeding 6. keep patient at rest 7. emotional support 8. treat shock 9. transport
5 things to do with impaled objects
1. do not remove 2. stabilize in place 3. pad around object 4. use hacksaw if needed 5. consult medical control
9 possible injuries to face and jaw
1. fractures 2. bone fragments 3. dislocations 4. airway management 5. suction 6. jaw thrust 7. control bleeding 8. c-spine precautions 9. treat shock
non-traumatic brain injuries
caused by internal brain events (hemorrhage or blood clot) no evidence of trauma * no mechanism of injury
7 steps in patient care for spinal injury
1. manual in-line stabilization 2. asses ABCs 3. rapid trauma exam 4. asses sensory and motor function 5. apply spinal immobilization device 6. provide o2 7. reassess motor function
immobilization of seated patient (low priority)
use short spine board extrication vest * transfer to long spine board
immobilization of seated patient (high priority)
rapid extrication immobilize manually * transfer to long board
6 indications of when to leave the helmet in place
1. helmet is snug 2. no impending airway or breathing problems 3. no resuscitation needed 4. removal would cause further injury 5. immobilization can be done with it in place 6. no interference with airway and breathing assessment
6 indications of when to remove the helmet
1. interferes with assessment 2. airway and breathing issues 3. improperly fitted 4. interferes with immobilization 5. cardiac arrest 6. per medical direction
Shock, or lack of perfusion, brought on not by blood loss, but by inadequate pumping action of the heart. It is often the result of a heart attack or congestive heart failure.
Hypoperfusion due to nerve paralysis (sometimes caused by spinal cord injuries) resulting in the dialation of blood vessels that increses the volume of the circulatory system beyond the point where it can be filled.
Occurs when the body can no longer compensate for low blood volume or lack of perfusion. Late signs such as decreasing blood pressure become evident.
When the body has lost the battle to maintain perfusion to vital organs. Even if adequate vital signs return, the patient may die days later due to organ failure.
connective tissue outside of the bone (epiphysis) surface for articulation smooth movements of joints less rigid * forms flexible structures (septum of nose, external ear, trachea, connections between ribs and sternum
portions of the skeleton that includes the clavicles, scapulae, arms, wrists, and hands (upper extremities) as well as the pelvis, thighs, legs, ankles, and feet (lower extremities)
any material (preferably sterile) used to cover a wound that will help control bleeding and help prevent additional contamination
rule of nines
a method of estimating the extent of a burn. For an adult, each of the following surfaces represents 9% of the body surface: the head and neck, each upper extremity, the chest, the abdomen, the upper back, the lower back and buttocks, the front of each lower extremity, and the back of each lower extremity. The remaining 1% is assigned to the genital region. For an infant or child the percentages are modified so that 18% is assigned to the head, 14% to each lower extremity.
full thickness burn
a burn in which all the layers of the skin are damaged. There are usually areas that are charred black or areas that are dry and white. Also called a third-degree burn.
partial thickness burn
a burn in which the first layer of skin (epidermis) is burned through and the dermis (second layer) is damaged. Burns of this type cause reddening, blistering, and a mottled appearence. (Also called second-degree burn).
a burn that involves only the epidermis, the outer layer of the skin. It is characterized by reddening of the skin and perhaps some swelling. An example is a sunburn. Also called a first-degree burn.
a type of pneumothorax in which air that enters the chest cavity is prevented from escaping
movement of ribs in a flail segment that is opposite to the direction of the rest of the chest cavity.
fracture of two or more adjacent ribs in two or more places that allows for free movement of the fractured segment.
the tearing away or tearing off of a piece or flap of skin or other soft tissue. Also, an eye pulled from its socket or a tooth dislodged from its socket
An open wound that tears through the skin and destroys underlaying tissues. A penetrating puncture wound can be shallow or deep. A perforating puncture wound has both an entrance and an exit wound.
an injury caused when force is transmitted from the body's exterior to its internal structures. Bones can be broken, muscles, nerves, and tissues damaged, and internal organs ruptured, causing internal bleeding
tissue composed of fibers that can contract, causing movement of an organ or part of the body
A splint that applies constant pull along the lenght of the lower extremity to help stabilize the fractured bone and to reduce muscle spasm in the limb. Traction splints are used primarily on femoral shaft fractures.
The process of applying tension to straighten and realign a fractured limb before splinting. Also called tension.
bone that forms parts of the side of the skull and floor of the cranial activity. There is a right and left temporal bone.
the movable joint formed between the mandible and the temporal bone, also called the TMJ.
cerebrospinal fluid (CSF)
plasma like clear fluid circulationg in and around the brain and spinal cord
4 steps in patient assessment of bleeding
1. estimate amount of external blood loss 2. triage 3. predict potential shock 4. control external bleeding ****important to find the bleed and stop it****
5 steps of patient care for external bleeding
1. standard precautions 2. open airway 3. monitor respirations 4. ventilate if necessary 5. control bleeding ****airway is ALWAYS the main concern****
4 steps in direct pressure
1. apply pressure to wound 2. hold pressure firmly 3. bandage 4. don't remove dressing
5 steps to elevation
1. used at the same time as direct pressure 2. above the level of the heart 3. gravity helps 4. slows bleeding 5. do NOT use with impaled objects or spinal injury ****works better for veinous bleed than arterial bleed****
4 facts about a tourniquet
1. device that closes off blood flow to and from an extremity 2. controls life-threatening bleeding 3. commonly used in military and tactical settings 4. direct pressure and elevation are usually successful
5 steps of application for tourniquet
1. select site 2. tighten tourniquet 3. attach notation to patient 4. BP cuff may be used 5. contact medical direction
5 steps in controlling nosebleeds
1. have patient sit down and lean forward 2. apply or instruct patient to apply direct pressure 3. keep patient quiet and calm 4. do not let patient lean back 5. position patient on side if unconscious ****encourage to spit blood out, don't swallow it****
8 signs of internal bleeding
1. injuries to surface of body 2. bruising 3. painful, swollen, or deformed extremities 4. bleeding from mouth, rectum, vagina, etc 5. tender, rigid, or distended abdomen 6. vomiting 7. dark, tarry stools or bright red blood 8. signs and symptoms of shock
4 steps of patient care of internal bleeding
1. maintain ABCs 2. administer high flow o2 via NRB 3. control external bleeding 4. prompt transport ****surgery is the only way to save the patient****
4 causes of shock
1. inability of heart to pump 2. decreased supply of blood 3. lack of integrity in blood vessels 4. failure of vessels to dilate and constrict
3 steps in the development of shock
1. heart fails as a pump 2. blood volume is lost 3. blood vessels dilate
classification of shock when heart rate and respiration are increased and constriction of periphery , Body senses decrease in profusion and tries to compensate for it. Increased heart rate, increased respirations, constriction of peripheral circulation results in pale, cool skin. Increased capillary refill in infants.
classification of shock when blood pressure falls, Occurs when the body can no longer compensate for low blood volume or lack of perfusion. Late signs such as decreasing blood pressure become evident.
classification of shock when unable to maintain perfusion of vital organs and cell damage occurs, When the body has lost the battle to maintain perfusion to vital organs. Even if adequate vital signs return, the patient may die days later due to organ failure.
results from fluid volume loss after severe hemorrhage or loss of plasma in burn patients.
Shock, or lack of perfusion, brought on not by blood loss, but by inadequate pumping action of the heart. It is often the result of a heart attack or congestive heart failure.
Occurs when the nervous system is unable to control the diameter of the blood vessels. Often seen with brain and spinal injuries
4 signs and symptoms of shock
1. restlessness, AMS 2. pale, cool, and clammy skin 3. nausea and vomiting 4. vital sign changes (pulse and respirations increase, blood pressure drops, inaccurate pulse oximetry)
have efficient compensating mechanisms when BP drops, it is due to their body has tired out (serious problem) * consider shock and treat early
7 ways to check cyanosis
1. skin color 2. fingernails and lips 3. mouth 4. eyelids 5. palms of hands 6. soles of feet 7. ask the family
4 steps for trending vital sign when treating shock
1. elevated pulse 2. elevated respiratory rates 3. identifies patient's condition 4. unstable vital signs taken every 5 minutes
9 steps of patient care in a trauma
1. standard precautions 2. maintain open airway and assess respiratory rate 3. control external bleeding 4. apply and inflate PASG 5. elevate legs 8-12 inches (no spine injury) 6. splint bone injuries or joints 7. prevent heat loss 8. transport 9. reassure patient
8 soft tissues
1. skin 2. fatty tissues 3. muscles 4. blood vessels 5. fibrous tissues 6. membranes 7. glands 8. nerves
5 functions of the skin
1. protection 2. water balance 3. temperature regulation 4. excretion 5. shock absorption
8 steps on patient care of a closed wound
1. standard precautions 2. manage ABCs 3. high flow o2 via NRB 4. assume internal bleeding 5. shock management 6. splint extremities 7. stay alert for vomiting 8. monitor for deterioration
9 steps in patient care for open wounds
1. expose the wound 2. clean the wound surface 3. control bleeding 4. provide care for shock 5. provide o2 6. prevent further contamination 7. bandage after bleeding is controlled 8. keep patient lying still 9. provide reassurance
5 key points in treating puncture wounds
1. object may be embedded to the bone 2. look for exit wound 3. gunshot wounds can fracture bones 4. seriousness connot be determined by caliber 5. stab wounds (head, neck, chest, abdomen, or groin)
8 steps of patient care for puncture wounds
1. reassure patient 2. search for exit wound 3. occlusive dressing on chest wounds 4. assess need for ALS 5. care for shock 6. provide o2 7. immobilize the spine 8. transport
3 reasons to remove an impaled object
1. through the cheek 2. interferes with breathing or ventilation 3. interferes with transport
8 steps in patient care for impaled objects
1. expose the wound 2. control bleeding 3. stabilize object 4. secure dressing 5. treat shock 6. provide oxygen 7. keep patient at rest 8. transport and reassure
7 steps in patient care of an impaled cheek wound
1. examine wound site 2. remove object 3. position the patient 4. monitor the airway 5. apply dressing to the site 6. provide o2 7. treat for shock
7 steps in patient care for eye impalement
1. stabilize 2. apply rigid protection 3. stabilize dressings 4. dress and bandage uninjured eye 5. provide o2 6. care for shock 7. reassure patient
4 steps for treating avulsions
1. clean the wound surface 2. fold skin back to normal position 3. control bleeding 4. apply bulky pressure dressing
7 procedures for avulsions
1. wrap avulsed part in dry sterile gauze 2. place in plastic bag or aluminum foil 3. label 4. document approximate time 5. keep cool 6. no dry ice 7. do not immerse in ice, cooled water, or saline
3 steps in patient treatment for amputations
1. apply pressure dressing to stump 2. pressure points 3. care for amputated part
7 steps in patient care for neck wounds
1. ensure airway open 2. gloved hand over wound 3. apply occlusive dressing 4. place dressing over occlusive dressing 5. apply pressure as needed 6. bandage dressing 7. immobilize cervical spine
kinds of chest injury
blunt trauma (blow to chest) severe blunt trauma penetrating object (bullets, knives, steel rods) compression (motor vehicle collision)
kinds of closed chest injury
closed (skin not broken) open (skin is broken) flail chest (fracture of 2 or more consecutive ribs in 2 or more places) paradoxical motion (opposite movement of flail verses chest cavity)
4 steps of patient care for flail chest
1. perform initial assessment 2. provide o2/assist ventilation 3. apply bulky dressing to stabilize flail segment 4. monitor respiratory rate and depth
kinds of open chest injury
sucking chest wound open to atmosphere signs of severe difficulty breathing (wound to the chest, characteristic sucking sound, gasping for air)
6 steps of patient care for open chest wounds
1. maintain open airway 2. seal open chest wound 3. apply occlusive dressing 4. provide o2 5. treat shock 6. transport
occlusive dressing that is taped on 3 sides allows air out, but not in * used for sucking wounds
mechanical compression of the heart resulting from large amounts of fluid collecting in the pericardial space and limiting the heart's normal range of motion
separation of the layers of the aortic wall, inner layer tears, most occur because artery's wall deteriorates due to high blood pressure
signs of traumatic asphyxia
sudden compression of chest severe pressure exerted on heart and lungs blood forced out of right atrium into jugular veins blood vessels rupture neck and face darker color bulging eyes, distended neck veins
signs of pneumothorax
increased respiratory difficulty rapid, weak pulse, cyanosis, narrowing pulse pressure, low blood pressure distended neck veins tracheal deviation uneven chest wall movement decreased or absent breath sounds
signs of hemopneumothorax
increased respiratory difficulty rapid and weak pulse, cyanosis, low blood pressure uneven chest wall movement decreased breath sounds * blood tinged sputum
signs of cardiac tamponade
distended neck veins weak pulse low blood pressure decreasing pulse pressure
signs of aortic injury or dissection
tearing chest pain radiating to back differences in pulse and blood pressure between right and left arms and legs * cardiac arrest
6 steps of patient care for chest injury
1. maintain open airway 2. provide o2 3. follow local protocols 4. care for shock 5. transport asap 6. consider ALS intercept
5 types of abdominal injuries
1. closed 2. open 3. blunt trauma 4. internal bleeding 5. protruding organs
7 signs of internal bleeding
1. pain, cramps, nausea 2. weakness, thirst 3. lacerations and punctures 4. bruising, developing shock 5. coughing up or vomiting blood 6. rigid and/or tender abdomen 7. distended abdomen
3 additional steps for open injuries
1. control external bleeding 2. do not touch or try to replace eviscerated organs 3. do not remove impaled objects
6 important factors in determining the severity of burns
1. agent or source 2. body region involved 3. depth 4. extent 5. age of patient 6. other illness or injury
rule of palm
a method for estimating the extent of a burn. The palm of the patient's hand, which equals about 1% of the body's surface area, is compared with the patient's burn to estimate its size
5 factors about burns in a pediatric patient
1. at greater risk 2. body surface area 3. higher risk of shock 4. severity differs in less than 5 years old 5. consider child abuse
5 factors about burns in a geriatric patient
1. minor to moderate burns are fatal to old people 2. tissue healing is lessened 3. time of healing is increased 4. consider other illnesses and injuries 5. moderate burns become critical when older than 55
with injuries to respitory tract, soft tissue, bones Full thickness burns > 10% partial thickness burns > 30% burns with painful, swollen, or deformed extremity moderate burns in young or elderly burns to face, hands, feet, or genitalia * burns encircling any body part
6 steps in patient care for chemical burns
1. requires immediate care 2. wash away chemicals with water for at least 20 minutes 3. if chemical is dry, brush away 4. apply sterile dressing or burn sheet 5. treat for shock 6. transport
4 steps for patient care for burns to the eyes
1. immediately flood eyes with water 2. flow from nose to outside corner of the eye 3. transport and continue washing eye 4. cover both eyes
8 steps in patient care to treat internal bleeding
1. stay alert for vomiting and keep airway open 2. patient supine with legs flexed 3. provide o2 4. care for shock 5. apply anti-shock garments 6. nothing by mouth 7. monitor vitals 8. transport
treatment of specific chemicals
dry lime - do not wash with water (brush away) carbolic acid - does not mix with water sulfuric acid - heat is produced when water is added hydrofluoric acid - flood with water
10 signs and symptoms of electrical burns
1. burns 2. disrupted nerve pathways 3. muscle tenderness 4. respiratory difficulties 5. irregular heartbeat 6. elevated BP 7. restlessness or irritability, loss of consciousness 8. visual difficulties 9. fractures 10. seizures
8 steps in patient care for electrical burns
1. airway 2. basic life support 3. manage shock and provide o2 4. care for spine and head injuries 5. evaluate electrical burns for entrance and exit wounds 6. cool burn if still hot 7. apply dry sterile dressings 8. transport
Tough, tight-fitting membrane that coves a bone's surface and contains blood vessels that transport nutrients into the bone
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