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122 Cards in this Set
- Front
- Back
8 Musculoskeletal Conditions (8)
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Traumatic
- fracture - sprain - strain - dislocation - compartment syndrome Non Traumatic - scoliosis - osteoporosis - arthritis |
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Fracture: pathophysiology (1)
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- force applied to bone tissue beyond its tolerance levels usually via direct, indirect, twisting or high energy injuries
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Fracture Classifications (4)
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- closed fracture
- open fracture - non-displaced fracture - displaced fracture |
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Closed Fracture (1)
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a fracture that does not break the skin
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Open Fracture (1)
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external wound associated with a fracture
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Non-displaced Fracture (1)
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simple crack of the bone with no deformity
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Displaced Fracture (1)
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fracture in which there is an actually deformity of the bone
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Fracture: signs / symptoms (10)
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- deformity
- tenderness - guarding - swelling - ecchymosis - crepitus - false motion (appearance of a joint where there should not be one) - exposed fragments - pain - locked joint |
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Fracture: treatment (6)
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- high flow O2
- AMPLE - OPQRSTA - vital signs - transport - immobilize the injury |
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Greenstick Fracture (1)
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an incomplete fracture that passes only partway through the shaft of the bone, may still cause angulations, often occurs in children
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Comminuted Fracture (1)
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when the bone is broken into more than two fragments
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Pathological Fracture (1)
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a fracture of weakened or diseased none; osteoporosis, osteogenesis imperfecta
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Epiphyseal Fracture (1)
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a fracture that occurs in the growth section of a child's bone which may prematurely stung growth if not properly treated, occurs in fractures of bone ends
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Dislocation: pathophysiology (2)
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- a disruption of a joint in which the bones ends are no longer in contact
- supporting ligaments are stretched or torn allowing the bone ends to separate completely from each other |
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Dislocation: signs / symptoms (6)
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- marked deformity
- swelling - pain aggravated by movement - tenderness on palpation - complete loss of normal joint motion - numbness or impaired circulation distal to the injury |
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Dislocation: treatment (6)
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- high flow O2
- AMPLE - OPQRSTA - vital signs - transport - immobilize the injury (do not manipulate it at all) |
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Are EMR's allowed to put dislocations? (1)
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no, only allowed to immobilize in the position found
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Sprain: pathophysiology (2)
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- the stretching or tearing of ligaments
- occurs at a joint, most commonly the knee and ankle |
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Sprain: signs / symptoms (6)
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- point tenderness
- swelling - ecchymosis - pain - increased range of motion - due to ligaments being damaged, the joint can move more then it is supposed to - guarding |
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Ecchymosis
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bruise
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Sprain: treatment (6)
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- high flow O2
- AMPLE - OPQRSTA - vital signs - transport - immobilize the injury |
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Strain: pathophysiology (5)
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- the stretching of tearing of tendons or muscles
- AKA "muscle pull" - commonly the result of quick sprints while running - there is localized tenderness or a "bulge" more commonly at the inner region of the back of the leg - pain is aggravated by walking, descending stairs, or raising heel of the affected leg off the ground |
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Strain: treatment (6)
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- high flow O2
- AMPLE - OPQRSTA - vital signs - transport - immobilize the injury |
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Possible complications of Musculoskeletal Injuries (7)
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- hemorrhage
- instability - loss of tissue - simple laceration and contamination - interruption of blood supply - nerve damage - long term disability |
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Compartment Syndrome: pathophysiology (3)
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- elevated pressure within the fascial compartment (fibrous tissue that surrounds muscles and neuromuscular structures)
- occurs up to 12 hours after injury, usually as a result of excessive bleeding, a severely crushed extremity, or a rapid return of blood to an ischemic limb - lack of blood flow to an area results in toxic build ip of metabolites at site, followed by necrosis |
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Compartment Syndrom: signs / symptoms (4)
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- pain that is disproportionate to the injury
- pallor - decreased sensation - decreased power |
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Compartment Syndrom: treatment (6)
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- high flow O2
- AMPLE - OPQRSTA - vital signs - transport - immobilize the injury |
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What is the definitive treatment for compartment syndrome in a hospital setting? (1)
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surgical intervention
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Scoliosis: pathophysiology (1)
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- an abnormal curvature of the spine, results in S-curving of the spin laterally
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Scoliosis: signs / symptoms (6)
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- uneven waist and shoulders
- prominent shoulder blade(s) - elevated hips - leaning to one side - pain from disc degeneration - possibility of pinching a nerve or slipping a disc |
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Scoliosis: treatment (5)
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- high flow O2
- AMPLE - OPQRSTA - vital signs - transport (commonly for pain management) |
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Another possible effect of scoliosis on respiration is.. (1)
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respiration dysfunction due to severe curvature
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Osteoporosis: pathophysiology (3)
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- is a disease characterized by low bone mass and deterioration of bone tissue
- this leads to increased bone fragility and risk of fracture, particularly of the hip, spine and wrist - is often known as "the silent thief" because bone loss occurs without symptoms |
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Osteoporosis: signs / symptoms (1)
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kyphosis (unusual curvature of upper spine)
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Osteoporosis: Risk Factors (4)
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- age >65
- family history - post menopausal - low dietary calcium intake |
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Osteoporosis: treatment (6)
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- high flow O2
- AMPLE - OPQRSTA - vital signs - transport - immobilize any musculoskeletal injury appropriately as you find it |
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Arthritis: pathophysiology (2)
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- an inflammation of a joint
- this disease has many forms and varies widely in its effects, two common ones are (osteoarthritis Arthritis, rheumatoid arthritis) |
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Osteoarthritis Arthritis (1)
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- results from cartilage loss and ware and tear of the joints (common in the elderly)
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Rheumatoid Arthritis (1)
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- an autoimmune disorder that damages joints and surrounding tissues
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Arthritis: signs / symptoms (4)
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- pain in joints
- pain can be increased with barometric pressure changes - stiffness of joints - swelling of joints |
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Arthritis: treatment (8)
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- may have to modify exam due to decreased range of motion
- equipment must be made to "fit the patient" (think backboard) - high flow O2 - AMPLE - OPQRSTA - vital signs - transport * these patients are commonly on Analgesics, ensure to BRING them! |
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Generalized Musculoskeletal Assessment & Treatment (5)
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- rapid respirations and pulse accompany pain, may not be signs of shock
- if patient critically injured, transport immediately (DO NOT SPLINT ON SCENE- if the patient is a load and go) - be alert for compartment syndrome - splint injury after assessing it in the secondary - check CMS status before and after splinting and after palpating in the primary survey |
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Generalized Musculoskeletal Assessment & Treatment: Evaluating CMS Function (3)
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- examination of the injured limb should include assessment of the following: circulation, motor function, sensation
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Generalized Musculoskeletal Assessment & Treatment: Capillary Refill (relevant in children and infants) (2)
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- should be less than 2 seconds
- should be the same as the uninjured limb |
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Generalized Musculoskeletal Assessment & Treatment: Critical Musculoskeletal injuries (3)
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- multiple open fractures of limbs
- pelvic fractures with hemodynamic instability - bilateral femur fractures |
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Splinting (4)
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- flexible or rigide device used to protect extremity
- injuries should be splinted prior to moving patient, unless the patient is critical (we manually mobilize on scene only) - splinting helps prevent further injury to muscles, nerves, blood vessels and bid and decrease pain |
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Types of splints (8)
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- Traction splints
- KED - Sling & Swathe - Wood splints - Vacuum splints - Air splints - Wire splints - Speed splints |
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Rigid Splints (3)
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- cannot change shape
- required body part to be positioned to fit splint (board splints, some cardboard splints) - pad before use |
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Soft or Formable Splints (1)
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- mild into various shapes to accommodate injured body part
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Examples of Soft or Formable Splints (8)
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- pillows
- blankets - slings & swathes - vacuum splints - some cardboard splints - wire ladder splints - padded, flexible aluminum splints - inflatable splints (not used for injuries close to knee or below) |
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Traction Splints (2)
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- mid-shaft femur fractures only
- provide traction to stabilize and align the femur or femurs |
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RICE
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R - rest
I - immobilize C - cold E - elevate |
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Splinting Fractures / Splints: RICE (9)
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Immobilize
- assess pulse, motor & sensory function - prepare equipment prior to patient movement - 1 move allowed to position patient for splinting - generously pad the splint - splint above & below injury site - immobilize the joint above and below - cover the minimum amount of anatomy requires, ensure visibility of deformity site - reassess pulse, motor & sensory function - requires one EMS practitioner to maintain stabilization as the other applies splinting materials |
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Splinting Joints / Dislocations / Sprains: RICE (8)
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Immobilize
- assess pulse, motor & sensory function - prepare equipment prior to patient movement - 1 move allowed to position patient for splinting - generously pad the splint - immobilize in position found - cover the minimum amount of anatomy requires, ensure visibility of deformity site - reassess pulse, motor & sensory function - requires one EMS practitioner to maintain stabilization as the other applies splinting materials |
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Hazardous of Improper Splinting (5)
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- compression and/or injury to nerves, tissues, and blood vessels
- delay in transport of a patient with a life-threatening condition ("splinting a patient to death") - reduction of distal circulation - aggravation of the injury - splinting should be done en route for Load & Go patients, NEVER on scene. However, manual immobilization needs to occur during movement on scene |
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In-Line Traction Splinting of a Femur Only (6)
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- act of exerting a pulling force on a bony structure in the direction of it's normal alignment
- realigns fracture of the shaft of a long bone and decreases leg muscle spasm lending itself to decreasing pain - use the least amount of force necessary (max 10% of the pt's body weight, max 15lbs of traction for any sized patient - if resistance is met or pain increases, splint in deformed position - only a traction splint can apply traction, the EMR should manually immobilize the leg until a traction splint is available (usually done en-route) - used only for mid-shaft femur fracture, single or bilateral if you have a bilateral sager splint (injury must be located one hand width distal to hip joint and one hand width proximal to the knee |
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Contraindications to an in- line traction splinting of a femur (3)
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- hip, knee, lower leg or ankle are injured on affected side
- inability to properly size the device (really tall pt) - ensure the rear ambulance doors to not impact the traction splint as it sticks out about 12" pas patients heel |
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Applying an Air Splint (6)
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- hold the injured limb, apply gentle traction and support the injury site
- partner should place splint around extremity - if splint has a zipper, zip the splint up - inflate by pump or by mouth, to the point where complete compression is still possible - check and record distal neurovascular function - consider changes in altitude and temperature changes and their effects on the air pressure inside the splint |
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Applying a Vacuum Splint (5)
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- stabilize and support the injury
- place the splint and wrap it around the limb - draw the air out of the splint with the supplied vacuum device and seal the valve - check and record distal neurovascular function - rare on ambulances due to exceptional cost |
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Why would you realign a fracture? (1)
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if circulation is impaired
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Realignment (1)
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attempt to reposition to anatomical position, any grossly deformed mid-shaft fractures of extremities
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Rules of Realignment of a grossly deformed mid-shaft fracture (3)
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- never realign if it COULD be a joint
- only 1 attempt can be made - mid-shaft is defined as "more than 1 hand width away from the joint" |
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Realignment Technique & guideline (8)
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- handle injury carefully
- gentle manipulation to anatomical position or until circulation returns - if obvious resistance to alignment, splint extremity without repositioning - one attempt at realignment is made in prehospital setting - only if there is a circulation compromise - consult with medical direction (if unsure) - perform manipulation as soon as possible after injury - assess and document circulation, motor function and sensation before and after manipulating injured extremity |
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Perfusion (1)
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the circulation of blood within an organ or tissue in adequate amounts to meet the cells current needs for oxygen, nutrients and waste removal
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Hemorrhage (1)
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to bleed
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Coagulation (1)
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the contracting of a blood vessel and formation of a clot plugging a hole in a injured blood vessel
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Closed Injuries (1)
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soft tissue damage beneath the skin
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Open injuries (1)
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break in the surface of the skin
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Burns (1)
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soft tissue receives more energy than it can absorb
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Which tissues/organs require a constant supply of blood? (4)
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- brain
- heart - lungs - kidneys |
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Which tissues/organs only require blood when active? (2)
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- muscles
- GI tract |
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When the cardiovascular system fails to provide sufficient circulation for every body part to perform its function, it is called …. or …… (2)
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- shock
- hypoperfusion |
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The body can tolerate …….% loss of blood rapidly or a …..% loss of blood over a period of time. (2)
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10 %
20% |
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Arterial Bleeding: pathophysiology (1)
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some form of trauma has broken through the skin and cut a blood vessel leading away from the heart
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Arterial Bleeding: signs / symptoms (6)
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- spurting, bright red blood
- a lot of blood around the patient - tachycardia - tachypnea - hypotension - altered LOC |
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Arterial Bleeding: treatment (6)
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- control the bleeding
- high O2 - AMPLE - OPQRSTA - vital signs - transport |
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When dealing with Arterial Bleeding, what must you ensure for your own safety? (1)
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BSI, wear appropriate PPE
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Venous Bleeding: pathophysiology (1)
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some form of trauma has broken through the skin and cut a blood vessel leading towards the heart
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Venous Bleeding: signs / symptoms (2)
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- oozing or flowing, dark red blood
- anxious patient |
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Venous Bleeding: treatment (6)
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- control the bleeding
- high row O2 - AMPLE - OPQRSTA - vital signs - transport (consider for stitches) |
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Capillary Bleeding: pathophysiology (1)
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nasty encounter with pavement of the edges of a piece of paper or envelope
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Capillary Bleeding: signs / symptoms (2)
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- oozing small quantity of blood
- unusual amounts of pain relative to the injury |
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Capillary Bleeding: treatment (7)
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- control the bleeding
- consider high O2 - AMPLE - OPQRSTA - vital signs - consider transport - inquire about hemophilia (high O2 & transport in this case) |
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Generalized External Hemorrhaging Assessment & Treatment (4)
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- ensure BSI, including eye protection and the possibility of a gown
- treat deadly (arterial) bleeding as soon as possible (delegate) - bleeding should stop within 10 minutes - all bleeding will stop eventually |
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Methods to Control External Hemorrhaging (7)
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- direct pressure
- pressure point - pressure dressing - elevation - cryogenic therapy - tourniquet - patient position |
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Direct Pressure (2)
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- assists clotting by decreasing blood flow through vessels and stimulated clotting factor
- may be easily delegated |
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Pressure Point (3)
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- assists clotting by decreasing blood flow through the vessel NOT stopping it
- may be delegated - often used in conjunction with pressure dressing |
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Pressure Dressing (4)
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- assists clotting by decreasing blood flow
- stimulating clotting factor - providing stopping point for blood exiting the body (dressing) - are designed to be snug, but not restrict blood flow distal to where they are applied |
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Elevation (3)
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- this assists clotting by decreasing blood flow through the vessel
- may be delegated - direct pressure and elevation go hand in hand |
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Cryogenic Therapy / Cold Therapy (
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- assists clotting by causing vasoconstriction at the site, thereby reducing blood flow through the affected area
- area should be cold, NOT frozen - this is used in conjunction with pressure dressing and possibly pressure point |
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Tourniquet (1)
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- assists clotting by completely cutting off ALL blood flow distal to where the tourniquet is applied
- consult with on line medical direction first - DO NOT loosen the tourniquet once applied |
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Applying a Tourniquet (10)
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- fold a triangular bandage into 4" wide cravat
- wrap the bandage around the extremity (as close to injury as possible, but not over a joint) - use a stick as a handle to twist and secure the stick as tight as needed/tolerated - write "TK" and time and place on patient's forehead |
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Patient Position assisting in Blood Clotting (2)
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- assists blood clotting by reducing the force that is required by the heart to adequately perfuse all tissues
- place the patient in Supine (and elevating the part that's bleeding) reduces workload on the heart, thereby the force of blood traveling past an injured site is slowed |
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List of Dressing and Bandage Materials (13)
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- field dressing
- bandage - sterile and Non sterile Dressings - Occlusive/ Non occlusive dressings - adherent/ Non adherent dressings - absorbent/ Non absorbent - wet / dry dressings - self adherent roller bandages - gauze bandages - adhesive bandages - elastic (tensor) bandages - triangular bandages - steril strips |
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Field Dressing (1)
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material placed directly on the wound to control bleeding and maintain would cleanliness
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Bandagen (1)
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material used to hold a dressing in place and to apply pressure to control hemorrhaging
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Sterile and Non-sterile Dressings (2)
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- sterile: direct wound contact like a abdominal pad
- non sterile: bulk dressing above sterile layer to add bulk or absorptive power |
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Occlusive / Non-occlusive Dressings (1)
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sterilized plastic wrap and petroleum impregnated gauze are designed to prevent the movement of fluid and air through them
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Adherent / Non adherent Dressings (2)
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- adherent: stick to drying blood and fluid, they promote clot formation and reduce hemorrhage
- non adherent: specially treated with chemicals to prevent the wound fluids and clotting materials from adhering to the dressings - preferred for most uncomplicated wounds |
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Wet / Dry Dressings (2)
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- wet: sometimes applied to special types of wounds (burns), sterile saline is the usual fluid used to wet dressings, they provide a medium for the movement of infectious mater into wounds
- dry: most often employed for wounds in prehospital care |
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Self adherent Roller Bandages (2)
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- have limited stretch and resist unraveling, conforms well to body contours and is quick to apply
- this bandage is appropriate for injuries which require circumferential wrapping |
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Gauze Bandages (2)
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- convenient for securing dressings, they do not stretch and thus do not conform to body contours
- because they do not stretch, they may increase the pressure associated with tissues swelling at injury sites |
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Adhesive Bandages (3)
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- this is a strong plastic, paper or fabric material with adhesive applied to one side
- it can effectively secure a small dressing where circumferential wrapping is impractical - if used circumferentially they DO NOT stretch to allow for tissue swelling |
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Elastic (Tensor) bandages (2)
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- stretch easily to conform to body contours, provide stability and support for minor musculoskeletal injuries
* it is very easy to apply too much pressure with them effectively causing compartment syndrome - like effect |
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Triangular bandages (3)
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- AKA cravats
- are strong, non-elastic bandages commonly used to make slings, swathes and to affix splints - they do not maintain pressure or immobilize wound dressings very well |
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Steri Strip (5)
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- also known as temporary stitch
- surgical strips of adhesive backed paper tape that are places across an incision or minor cut - they keep the wound sterilized, however they are not used to keep the wound together - they may be taken off 2-3 days after having stitches - these are sometimes used instead of sutures because they lessen scarring and are easier to care for |
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Internal Bleeding: pathophysiology (1)
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some form of trauma has caused internal structures to be compressed, torn or lacerated by other internal (or occasionally external) structures
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Internal Bleeding: Signs and symptoms (14)
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- *main* signs of hypovolemic shock without obvious cause (likely bleeding or blood around the patient)
- low volume shock - tachycardia - tachypnea - hypotension - LOC - discolouration (usually in abdomen or femoral areas) - hematoma - hematemesis - melena - hematochezia - hemoptysis - pain, tenderness, brushing, guarding, or swelling - broken ribs, bruises over the lower chest, or rigid, distended abdomen |
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Hematoma (1)
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bleeding beneath the skin, the EMR may see the formation of the hematoma
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Hematemesis (1)
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blood in vomit
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Melena (1)
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black, tarry stool
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Hematochezia (1)
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red runny stool
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Hemoptysis (1)
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coughing up blood
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Internal Bleeding: treatment (4)
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- high flow O2
- AMPLE/OPQRSTA - vital signs - transport |
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Internal Bleeding: Other notes (2)
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- definitive (corrective) care for this patient is the OR
- always suspect internal bleeding when high velocity trauma has been sustained |
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4 Specific bleeding conditions (4)
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- skull fractures
- facial injuries - sinusitis - digital trauma / epistaxis |
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Skull Fractures: pathophysiology (1)
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a large amount of force has been applied to the cranium possibly resulting in internal bleeding and/or spinal injury
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Skull Fractures: signs & symptoms (7)
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- blood or CSF from ears
- ecchymosis behind ears (battle signs) - ecchymosis around eyes (raccoon eyes) - altered LOC - possibly Cushing's Triad - nausea & vomiting - seizures |
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Skull Fractures: Treatment (3)
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- high flow O2, AMPLE/OPQRSTA, vitals signs, transport
- full spinal motion restriction protocols - loosely cover ear to allow for drainage |
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Skull Fractures: (1)
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the fluid the is escaping the cranium (usually the ears) may be acting as a "pressure reliever" therefore we never try to stop any fluids coming from the head
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Facial Injuries: pathophysiology (1)
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a large amount of force has been applied to the face possibly resulting in bleeding and / or spinal injury
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Facial Injuries: Signs & symptoms (
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.
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