Monday, March 18, 2024
Tissues at Risk
Trauma Bible
• Organs susceptible to pressure
Chapter 30 Introduction to Trauma changes include, middle ear, heart,
lungs, major blood vessels, and GI
• Newton’s first law of motion - objects Tract
in motion stay in motion, objects at rest
stay at rest unless acted upon outside • Tympanic membrane (eardrum) - is
force the most susceptible to pressure
changes & will rupture at 5-7 PSI
• Newton’s second law of motion - above atm pressure
force = mass x acceleration
Blast Injuries
Blast Injuries • Pulmonary blast injuries - take form
in contusions and hemorrhage.
• Primary Blast - from blast itself Subcutaneous emphysema in the
• Secondary Blast - secondary debris chest may indicate pneumothorax
such as shrapnel • Use caution with PPV as it may
• Tertiary Blast - person is thrown create tension pneumothorax
against other stationary objects such • Use caution with IV fluid as it may
as a wall cause pulmonary edema to
• Quinary Blast - Biologic, chemical or damaged lungs
radioactive contaminants added to the • Arterial Air Embolism - very
blast concerning, air may enter pulmonary
vasculature from alveolar disruption
potentially lodging air emboli in the
Components of a Blast Shock Wave heart or brain
• Positive wave pulse - phase of • Solid Organs are relatively safe against
explosion pressure front higher than blast waves
atm pressure
• Hollow Organs are much more
• Negative wave pulse - phase of vulnerable to blast injuries, particularly
explosion pressure is less than atm rupture of bowel or colon
pressure
• Underwater explosions result in severe
• Brisance - shock waves, characteristic abdominal injuries
shattering effect of the wave
• Bradycardia & hypotension common
• Underwater explosions carry the after blast due to vagal nerve-mediated
velocity much better, potentially form of shock compensatory response
receiving injuries at 3x the distance (similar to vasovagal syncope)
1
, Monday, March 18, 2024
(PVR) that the left ventricle must pump
Trauma Scores against
• Stroke Volume (SV) - amount of blood
ejected per contraction
• increased Afterload reduces SV
• Cardiac Output (CO) - amount of
blood pumped in 1 min
• expressed in L/min
• Ejection Fraction (EF) - % of total
Revised Trauma Score (RTS) - used to blood pumped per contraction
assess the severity of head injuries
• EF does not change, although
blood returning to right atrium
Trauma Lethal Triad varies min to min, a normal heart
still pumps the same % of blood
Blood Components
1. 55% Plasma,
2. 45% RBC’s
3. < 1% WBC’s & Platelets
• Plasma is water, straw colored fluid
• 92% & 8% Dissolved substances
• Platelets - small cell fragments
essential for clotting
Trauma Center Levels Low Blood Pressures for Age
1. Comprehensive care for all levels, • Pediatric - 70mmHg systolic
including prevention & rehabilitation
• Adult - 90mmHg systolic
2. Definitive Care for all patients • Geriatric - 110mmHg systolic
3. Assessment, resuscitation &
stabilization
Blood Circulation & Perfusion
4. Provides ATLS before transfer to
higher level trauma center • Perfusion - circulation of blood to
provide adequate oxygen, nutrients &
waste management to suit the organ or
Cardiac Cycle tissues needs
• Preload - amount of blood returned to • Vasomotor center in medulla oblongata
heart to be pumped out regulates BP
• After load - pressure in aorta or • Baroreceptors in aortic arch or carotid
Peripheral Vasculature resistance sinus detects changes in BP then send
2
, Monday, March 18, 2024
signals through nerves IX & X to Types of Shock
increase or decrease sympathetic stim
• Stages of Shock
• Endocrine system also detects 1. Compensated shock - BP &
changes in BP and plasma osmolality HR high
causing release of aldosterone (from
adrenal glands) and antidiuretic 2. Decompensated shock - HR
hormone (from pituitary gland), these will still be high but, BP
two combined cause peripheral dropping
vasoconstriction and promotes water 3. Irreversible shock - BP & HR
conservation in kidneys dropping
• Hemorrhagic Shock - blood loss
Chapter 31 Bleeding • Tranexamic acid (TXA) is effective
for treating internal bleeding within
3 hours of trauma
Pathophysiology of Hemorrhage
• Blood Thinners
• Exsanguination - loss of all blood
resulting in death • Aspirin
• 10 pints (5L) of blood in avg person • Warfarin (Coumadin)
• Body must compensate for any blood • Rivaroxaban (Xarelto)
loss totaling 20% of the total blood • Dabigatran (Pradaxa)
• Hemostasis - blood clotting • Apixaban (Eliquis)
1. Vasoconstriction • Clopidogrel (Plavix)
2. Platelet Aggregation • Patient’s w/ Hx of MI likely take
3. Fibrinogen - forms fibrin to hold anticoagulants
clot/platelets together • Drugs affecting shock
• Hemophilia - blood lacking clotting compensation:
factors • Beta blockers - interferes with
• Aspirin, anticoagulants & Beta sympathetic response and stops
blockers (prevents heart from beating faster
vasoconstriction) can complicate • Calcium channel blockers -
this process interfere with vasoconstriction not
allowing blood to be shunted to core
3
, Monday, March 18, 2024
• Antidysrhythmic Drugs - can 2. Cover bleeding loosely with gauze
interfere with heart force & speed of
• Drainage containing CSF will appear
contraction with a bull’s eye target on gauze
• Nitroglycerin - can stop • A glucometer can detect excess
vasoconstriction due to the glucose in CSF since it is high in
vasodilation glucose
• Nosebleed
• Blood Signs 1. Lean patient forward
• Grey turner sign - bruising in flanks 2. Apply cold compress to bridge of
form internal hemorrhage nose
• Cullen sign - bruising around 3. Compress maxilla with gauze
umbilicus from internal hemorrhage
• Cushing Reflex - shock state w/
elevated BP but slow pulse due to Tourniquets
head injury w/ increased ICP • never apply over a joint
• Raccoon Eyes - battle sign, bruising • always write time it was applied
around mastoid process indicating
skull fracture
• always leave in plain view
• Hematoma - mass of blood in soft
tissues Splints
• Hematemesis - vomiting blood • can help control bleeding by
preventing further movement and the
• Melena - black, foul-smell tarry breakup of clots
stools indicating upper GI bleed
• stops further damage
• Hematuria - blood in urine
• Air Splints
• Hematochezia - passage of bloody
stools, contains bright red blood • Controls venous bleeding
• Hemoptysis - coughed up blood • applied to entire extremity
• Broken ribs, lower chest bruises, • acts as pressure bandage
distended abdomen may indicate • inflated to 50mmHg
lacerated liver or spleen. Can cause
referred pain to right shoulder (liver) • NOT indicated for arterial bleeds as
pressure from arterial bleeds
and left shoulder (spleen)
exceeds 50mmHg of the splint
• Vasoconstriction from shock may make • Rigid Splints
a pulse oximeter ineffective
• helps control bleeding and
stabilization
Hemorrhage from Nose, Ears & Mouth
• Traction Splints
1. Do NOT stop blood flow, extra
pressure may cause blood pooling in • For stabilizing femur fractures
head leading to increased ICP • Hemostatic Agents
4
Tissues at Risk
Trauma Bible
• Organs susceptible to pressure
Chapter 30 Introduction to Trauma changes include, middle ear, heart,
lungs, major blood vessels, and GI
• Newton’s first law of motion - objects Tract
in motion stay in motion, objects at rest
stay at rest unless acted upon outside • Tympanic membrane (eardrum) - is
force the most susceptible to pressure
changes & will rupture at 5-7 PSI
• Newton’s second law of motion - above atm pressure
force = mass x acceleration
Blast Injuries
Blast Injuries • Pulmonary blast injuries - take form
in contusions and hemorrhage.
• Primary Blast - from blast itself Subcutaneous emphysema in the
• Secondary Blast - secondary debris chest may indicate pneumothorax
such as shrapnel • Use caution with PPV as it may
• Tertiary Blast - person is thrown create tension pneumothorax
against other stationary objects such • Use caution with IV fluid as it may
as a wall cause pulmonary edema to
• Quinary Blast - Biologic, chemical or damaged lungs
radioactive contaminants added to the • Arterial Air Embolism - very
blast concerning, air may enter pulmonary
vasculature from alveolar disruption
potentially lodging air emboli in the
Components of a Blast Shock Wave heart or brain
• Positive wave pulse - phase of • Solid Organs are relatively safe against
explosion pressure front higher than blast waves
atm pressure
• Hollow Organs are much more
• Negative wave pulse - phase of vulnerable to blast injuries, particularly
explosion pressure is less than atm rupture of bowel or colon
pressure
• Underwater explosions result in severe
• Brisance - shock waves, characteristic abdominal injuries
shattering effect of the wave
• Bradycardia & hypotension common
• Underwater explosions carry the after blast due to vagal nerve-mediated
velocity much better, potentially form of shock compensatory response
receiving injuries at 3x the distance (similar to vasovagal syncope)
1
, Monday, March 18, 2024
(PVR) that the left ventricle must pump
Trauma Scores against
• Stroke Volume (SV) - amount of blood
ejected per contraction
• increased Afterload reduces SV
• Cardiac Output (CO) - amount of
blood pumped in 1 min
• expressed in L/min
• Ejection Fraction (EF) - % of total
Revised Trauma Score (RTS) - used to blood pumped per contraction
assess the severity of head injuries
• EF does not change, although
blood returning to right atrium
Trauma Lethal Triad varies min to min, a normal heart
still pumps the same % of blood
Blood Components
1. 55% Plasma,
2. 45% RBC’s
3. < 1% WBC’s & Platelets
• Plasma is water, straw colored fluid
• 92% & 8% Dissolved substances
• Platelets - small cell fragments
essential for clotting
Trauma Center Levels Low Blood Pressures for Age
1. Comprehensive care for all levels, • Pediatric - 70mmHg systolic
including prevention & rehabilitation
• Adult - 90mmHg systolic
2. Definitive Care for all patients • Geriatric - 110mmHg systolic
3. Assessment, resuscitation &
stabilization
Blood Circulation & Perfusion
4. Provides ATLS before transfer to
higher level trauma center • Perfusion - circulation of blood to
provide adequate oxygen, nutrients &
waste management to suit the organ or
Cardiac Cycle tissues needs
• Preload - amount of blood returned to • Vasomotor center in medulla oblongata
heart to be pumped out regulates BP
• After load - pressure in aorta or • Baroreceptors in aortic arch or carotid
Peripheral Vasculature resistance sinus detects changes in BP then send
2
, Monday, March 18, 2024
signals through nerves IX & X to Types of Shock
increase or decrease sympathetic stim
• Stages of Shock
• Endocrine system also detects 1. Compensated shock - BP &
changes in BP and plasma osmolality HR high
causing release of aldosterone (from
adrenal glands) and antidiuretic 2. Decompensated shock - HR
hormone (from pituitary gland), these will still be high but, BP
two combined cause peripheral dropping
vasoconstriction and promotes water 3. Irreversible shock - BP & HR
conservation in kidneys dropping
• Hemorrhagic Shock - blood loss
Chapter 31 Bleeding • Tranexamic acid (TXA) is effective
for treating internal bleeding within
3 hours of trauma
Pathophysiology of Hemorrhage
• Blood Thinners
• Exsanguination - loss of all blood
resulting in death • Aspirin
• 10 pints (5L) of blood in avg person • Warfarin (Coumadin)
• Body must compensate for any blood • Rivaroxaban (Xarelto)
loss totaling 20% of the total blood • Dabigatran (Pradaxa)
• Hemostasis - blood clotting • Apixaban (Eliquis)
1. Vasoconstriction • Clopidogrel (Plavix)
2. Platelet Aggregation • Patient’s w/ Hx of MI likely take
3. Fibrinogen - forms fibrin to hold anticoagulants
clot/platelets together • Drugs affecting shock
• Hemophilia - blood lacking clotting compensation:
factors • Beta blockers - interferes with
• Aspirin, anticoagulants & Beta sympathetic response and stops
blockers (prevents heart from beating faster
vasoconstriction) can complicate • Calcium channel blockers -
this process interfere with vasoconstriction not
allowing blood to be shunted to core
3
, Monday, March 18, 2024
• Antidysrhythmic Drugs - can 2. Cover bleeding loosely with gauze
interfere with heart force & speed of
• Drainage containing CSF will appear
contraction with a bull’s eye target on gauze
• Nitroglycerin - can stop • A glucometer can detect excess
vasoconstriction due to the glucose in CSF since it is high in
vasodilation glucose
• Nosebleed
• Blood Signs 1. Lean patient forward
• Grey turner sign - bruising in flanks 2. Apply cold compress to bridge of
form internal hemorrhage nose
• Cullen sign - bruising around 3. Compress maxilla with gauze
umbilicus from internal hemorrhage
• Cushing Reflex - shock state w/
elevated BP but slow pulse due to Tourniquets
head injury w/ increased ICP • never apply over a joint
• Raccoon Eyes - battle sign, bruising • always write time it was applied
around mastoid process indicating
skull fracture
• always leave in plain view
• Hematoma - mass of blood in soft
tissues Splints
• Hematemesis - vomiting blood • can help control bleeding by
preventing further movement and the
• Melena - black, foul-smell tarry breakup of clots
stools indicating upper GI bleed
• stops further damage
• Hematuria - blood in urine
• Air Splints
• Hematochezia - passage of bloody
stools, contains bright red blood • Controls venous bleeding
• Hemoptysis - coughed up blood • applied to entire extremity
• Broken ribs, lower chest bruises, • acts as pressure bandage
distended abdomen may indicate • inflated to 50mmHg
lacerated liver or spleen. Can cause
referred pain to right shoulder (liver) • NOT indicated for arterial bleeds as
pressure from arterial bleeds
and left shoulder (spleen)
exceeds 50mmHg of the splint
• Vasoconstriction from shock may make • Rigid Splints
a pulse oximeter ineffective
• helps control bleeding and
stabilization
Hemorrhage from Nose, Ears & Mouth
• Traction Splints
1. Do NOT stop blood flow, extra
pressure may cause blood pooling in • For stabilizing femur fractures
head leading to increased ICP • Hemostatic Agents
4
