Download Section 4 part 2 exam chapters 13

Section 4 part 2 exam chapters 13-21
Miami Dade Hatzalah
1. The brain is divided into 3 major parts: the brain stem, cerebellum, and the largest part, the
cerebrum. (pg. 440)
2. Risk factors for hemorrhagic stroke are patients who have very high blood pressure or long term
elevated blood pressure that is not treated. After many years of high blood pressure, the blood
vessels in the brain weaken. Eventually, one of the vessels may rupture, and blood will spurt out
of the hole and into the brain, increasing the pressure inside the cranium. If the brain problem is
caused by disorders in the heart or lungs, the entire brain will be affected (pg. 442)
3. Many EMS services utilize the Cincinnati Stroke Scale, which tests speech, facial droop, and arm
drift. To test speech, ask the patient to say “the sky is blue in Cincinnati.” If the patient does this
correctly, you know that he/she understands and can produce speech. If not, the problem may
be with either function: understanding speech or producing it. To test facial movement, as the
patient to show her teeth. Watch to see if both sides of the face around the mouth move
equally. If only one side is moving well, you know that something is wrong with the control of
the muscles on the other side. To test arm movement, ask the patient to hold both arms in front
of his or her body, palms up toward the sky, with eyes closed and without moving. Over the next
10 seconds watch the patient’s hands. If you see one side drift toward the ground, you know
that side is weak. If both arms stay up and do not move, you know that both sides of the brain
are working. (pg 448)
4. Seizure can also result from sudden high fevers, particularly in children. Such convulsions,
known as febrile seizures, are usually very unnerving for patients to observe but are generally
well tolerated by the child. Nevertheless you must transport a child who has had a febrile
seizure, as this condition needs to be evaluated in the hospital. (pg. 451)
5. For a seizure patient, as with any other situations, you should focus on the patient’s ABC’s upon
arrival. In an unconscious patient, you should assist with ventilations, perform a rapid exam and
prepare/package for immediate transport (pg. 453-454)
6. Patients with seizures, when obtaining a SAMPLE history, it is important to find out how the
patient’s seizures typically occur and whether this episode differs in some way from previous
episode. You should also ask what medications the patient has been taking. These patients
should have an evaluation by ALS as soon as possible. If the patient has no history of convulsions
and now has a sudden seizure, a serious condition, such as brain tumor, intracranial bleeding, or
serious infection should be suspected. (pg. 455)
7. Hypoglycemic patients due to AMS are very complex. Patients can have signs and symptoms of a
stroke and seizures. The principal difference, however, is that patients who has had a stroke
may be alert and attempting to communicate normally, whereas a patient with hypoglycemia
almost always has an altered or decreased level of consciousness. Patients with hypoglycemia
can also experience seizures. You may arrive at the scene to find someone in a postictal state.
The mental status of a patient who has had a seizure is likely to improve; however, in a patient
with hypoglycemia, the mental status is not likely to improve, even after several minutes.
8.
9.
10.
11.
12.
13.
Therefore, you should consider the possibility of hypoglycemia in a patient who has had a
seizure, especially if the blood glucose level tested below normal. Hypoglycemia in regards to a
diabetic patient is a state in which the blood glucose levels is below normal, and will progress
into unresponsiveness and eventually insulin shock. Insulin shock develops more quickly than
diabetic coma. Hypoglycemia can be associated with the following signs and symptoms: normal
or rapid respirations, pale skin, diaphoresis, dizziness, headache, rapid pulse, normal to low
blood pressure, altered mental status, anxious or combative behavior, hunger, seizure, fainting,
or coma, weakness on one side of the body. (pg. 457, 485-486)
Infections are another possible cause of AMS, particularly those involving the brain or
bloodstream. Infections in these areas are life threatening and need immediate attention.
Patients may not demonstrate typical signs of infection, such as fever, particularly if they are
very young or very old or have impaired immune systems.(pg. 458)
The kidneys can be affected by stones that form from materials normally passed in the urine.
The pain of a kidney infection will generally begin with costovertebral angle tenderness and
radiate to the genitalia in the case of kidney stones. Another more common infection in the
kidneys is a bladder infection, called cystitis, which is commonly found in women. (table 14-1 pg
468)
With someone who has abdominal pain and nausea, do not give the patient anything by mouth.
Food or fluid will only aggravate many of the symptoms, because intestinal paralysis will prevent
it from passing out of the stomach. The only way the stomach can empty itself is by emesis, or
vomiting. Similarly, anorexia, loss of hunger or appetite is a nonspecific symptom. Peritonitis is
associated with loss of body fluid into the abdominal cavity. The loss of fluid usually results from
abnormal shifts of fluid from the blood stream into the body tissues. The fluid shift decreases
the volume of circulating blood and may lead to decreased BP or even shock. (pg. 470)
Using OPQRST to ask the patient what makes the patient better or worse:  O—Onset = when
the problem begin and what caused it  P—Provocation or Palliation = Does anything make it
feel better or worse?  Q – Quality = what is the pain like (sharp, dull, crushing, tearing, piercing)
 R – Region/Radiation = Where does it hurt? Does the pain move anywhere?  S – Severity = on
a scale of 0 to 10, how would you rate your pain?  T – Timing of pain = has the pain been
constant? Does it come and go? How long have you had it? (this is often answered under Onset
too). (pg. 472)
The causes of acute abdominal illnesses are often complicated or nonspecific. Identifying the
cause of pain may be difficult. A cause may be identified with a more detailed physical exam,
but it should not delay your transport and may even be omitted depending on your transport
distance and the seriousness of your patient’s condition. In the event of shock, the patient may
have internal bleeding in the abdomen and will be distended or guarded to help for the pain. A
patient with shock should as well be transported without delay, differing a thorough history and
focused physical exam. (pg. 473)
In older individuals, the wall of the aorta sometimes develops weak areas that swell to form an
aneurysm. A pulsating mass may be felt in the abdomen. The patient may also experience sever
back pain, because the peritoneum can, at times, be rapidly stripped away from the wall of the
main abdominal cavity by the hemorrhage. A patient with these symptoms, you should give
oxygen and transport, because there isn’t much that can be done in the field and needs
immediate assistance. A hernia is a protrusion of an organ or tissue through a hole in the body
wall covering its normal size. Hernias do not always produce a mass or lump that the patient will
be aware of. At times, the mass will disappear back into the body cavity in which it belongs. In
this case the hernia is said to be reducible. If the mass cannot be pushed back within the body, it
is said to be incarcerated. Note, however, that you should never attempt to push the mass back
into the body. (pg. 469 & 473)
14. Diabetes is a very common disease, affecting about 6% of the population. It is a disorder of
glucose metabolism or difficulty metabolizing carbohydrates, fats, and proteins. Without
treatment, blood glucose levels become too high and can cause coma or death. There are 2
types of diabetes: Type I and Type II. Type I diabetes, most patients do not produce insulin at all;
they are insulin dependent. They need daily injections of supplemental, synthetic insulin
throughout their lives to control blood glucose. Type II diabetes, usually appears later in life,
patients produce inadequate amounts of insulin or they may produce a normal amount but the
insulin does not function effectively. The 2 types of diabetes are equally serious, although noninsulin-dependent diabetes is easier to regulate. Glucose is the major source of energy for the
body, and all cells need it to function properly. A constant supply of glucose is as important as
oxygen to the brain. Without glucose, or with very low levels, brain cells rapidly suffer
permanent damage. Without insulin, glucose from food remains in the blood stream and
gradually rises to extremely high levels, hyperglycemia. Once the blood glucose levels reach 200
mg/dl, excess glucose is excreted by the kidney. This requires large amounts of water. The loss
of this water will result in the “3 P’s”: Polyuria- frequent and plentiful urination, Polydipsiafrequent drinking of liquid to satisfy continuous thirst, and Polyphagia- excessive eating as a
result of cellular “hunger.” When doing an assessment with a patient that is a diabetic, check
there glucose levels and administer oral glucose if needed, only to a consciousness patient. The
patient may show signs of weakness and shallow breathing make sure to give positive pressure
ventilations of supplemental oxygen before administering oral glucose. When taking your
sample history, it is important to ask if they take any insulin pills, if they’ve taken their usual
dose for the day, if they’ve eaten normally that day, and if they have any illness, unusual
amount of activity, or stress on that day. Transport as needed. (pg. 482-483, 487-490)
15. Contrary to what many people think, an allergic reaction, an exaggerated immune response to
any substance, is not caused by an outside stimulus, such as a bite or sting. Rather it is a reaction
by the body’s immune system, which releases chemicals to combat stimulus. Anaphylaxis is an
extreme allergic reaction that is usually life threatening and typically involves multiple organ
systems. Negative effects of anaphylaxis would be fatal in a case of upper airway swelling. The 2
most common signs of anaphylaxis are wheezing, a high pitched, whistling breath sound usually
resulting from bronchospasm and typically heard on expiration, and widespread urticaria, or
hives. Urticaria consists of small areas of generalized itching or burning that appear as multiple,
small, raised areas on the skin. With a patient who’s having an allergic reaction, give the patient
epinephrine. Epinephrine inhibits the allergic reaction and dilates the bronchioles. The
epinephrine is delivered through an EpiPen, which is injected into the lateral portion of the
thigh. After administering the shot, make sure first to dispose of the syringe. The effects of the
16.
17.
18.
19.
20.
21.
22.
epinephrine are typically observed within 1 minute. Someone who ingests something will have a
much more delayed reaction to it, than someone who inhales it. If you don’t have an EpiPen or
an AnaKit, give oxygen and transport at once. (pg. 500, 507-512)
When dealing with a patient that has ingested a substance, consider asking the patient the
following questions:  What substance did you take?  When did you take it?  How much did
you ingest?  What actions have been taken?  How much do you weigh? ( pg. 518 & 526)
Signs of symptoms of sympathomimetic (epinephrine, albuterol, cocaine, methamphetamine)
drug overdose include: hypertension, tachycardia, dilated pupils, agitation or seizures,
hyperthermia. (pg. 519)
A patient who has inhaled poisons may report the following signs and symptoms: burning eyes,
sore throat, cough, chest pain, hoarseness, wheezing, respiratory distress, dizziness, confusion,
headache, or stridor in severe cases. The patient may also have seizures or altered mental
status. Some inhaled agents cause progressive lung damage, even after the patient has been
removed from the direct exposure; the damage may not be evident for a few hours.
Meanwhile, it may take 2 to 3 days or more of intensive care to reestablish normal lung
function. (pg. 521)
If local protocol permits, you will likely carry plastic bottle of premixed suspension, each
containing up to 50g of activated charcoal. Some common trade names for the suspension form
are InstaChar, Actidose, and LiquiChar. The usual dose for an Adult is 1 g of activated charcoal
per kilogram of body weight. The usual adult dose is 25 to 50 g, and the usual pediatric dose is
12.5 to 25. The major side effect of ingesting activated charcoal is black stools. If the patient
has ingested a poison that causes nausea, he or she may vomit after taking activated charcoal,
and the dose will have to be repeated. As you reassess the patient, be prepared for vomiting,
nausea, and possible airway problems. (pg. 527)
A patient in alcohol withdrawal may experience frightening hallucinations, or Delirium Tremens
(DTs), a syndrome characterized by restlessness, fever, sweating, disorientations, agitations, and
even seizures. (pg 529)
The pain relievers called Opioids analgesics are named for the opium in poppy seeds, the origin
of heroin, codeine, and morphine. These include Demerol, Dilaudid, Darvon, Percocet,
OxyContin, Vicodin, and methadone. These agents are CNS depressants and can cause severe
respiratory depression. In general, emergency medical problems related to opioids are caused
by respiratory depression, including decreased volume of inspired air and decreased
respirations. Patients typically appear sedated and cyanotic and have pinpoint pupils.
Treatment includes supporting the airway and breathing. You may try to arouse the patient by
talking loudly to them or shaking them gently. Always open the airway, give supplemental
oxygen, and be prepared for vomiting. ( 529)
Several thousand cases of poisoning from plants occur each year. Many household plants are
poisonous if ingested, as they may be by children who like to nibble leaves. Some poisonous
plants cause local irritation of the skin; others can affect the circulatory system, the
gastrointestinal tract, or CNS. It is impossible for you to memorize every plant and poison, let
alone their effects. You can and should do the following:
a. Assess the patient’s airway
23.
24.
25.
26.
27.
28.
29.
b. Notify the regional poison control center for assistance in identifying the plant
c. Take the plant to the emergency department
d. Provide prompt transport. (pg. 535-536)
Hypothermia literally means “low temperature”. It is diagnosed when the core temperature of
the body – heart, lungs, and vital organs – falls below 95F (35C). More severe hypothermia
occurs when the core temperature is less than 90F (32C). Shivering stops, and muscular
activity decreases. At first, small, fine muscle activity such as coordinated finger motion ceases.
Eventually, as the temperature falls further, all muscle activity stops. (pg. 546-547)
In cases of severe hypothermia, if you cannot feel a radial pulse, gently palpate for a carotid
pulse and wait for 30-45 seconds before your decide that the patient is pulse less. Physicians
disagree about the wisdom of performing BLS (i.e., CPR) on a patient with hypothermia who
appears to be pulse less. Such a patient actually may be in a kind of “metabolic ice box,” having
achieved a metabolic balance that BLS may upset. Even a pulse rate of 1 to 2 beats per minute
indicates cardiac activity, and cardiac activity may spontaneously recover once the core is
warmed. (pg. 548)
Evaporation is the conversion of any liquid to a gas, a process that requires energy, or heat.
Evaporation is the natural mechanism by which sweating cools the body. This is why swimmers
coming out of the water feel a sensation of cold as the water evaporates from their skin.
Individuals who exercise vigorously in a cool environment may sweat and feel warm at first, but
later, as their sweat evaporates, they can become exceedingly cool. Measures should be taken
to keep a person dry if s/he is too cold.
Radiation is the transfer of heat by radiant energy. Radiant energy is a type of invisible
light that transfers heat. He body can lose heat by radiation, such as when a person stands in a
cold room. Heat can also be gained by radiation, for example when a person stands by a fire.
(pg. 545)
Frostbite can be identified by the hard, frozen feel of the effected tissues. Most frost bitten
parts are hard and waxy. The injured part feels firm to frozen as you gently touch it. If the
frostbite is only skin deep it will feel leathery or think, not hard and frozen through. Blisters and
swelling may be present. In light-skinned individuals with deep injury that has thawed or
partially thawed, the skin may appear red with purple and white or it may be mottled and
cyanotic. (pg. 552)
High air temperature can reduce the body’s ability to lose heat by radiation; high humidity
reduces the body’s ability to lose heat through evaporation. (pg. 554)
The signs and symptoms of heat exhaustion and those of associated hypovolemia are as follows:
Dizziness, weakness, faintness accompanied by nausea or headache  cold clammy skin with
ashen pallor  Dry tongue and thirst  normal vital signs, often a rapid pulse and low diastolic
pressure  Body temperature is normal to slightly elevated (up to 104F) . (pg. 555)
Patients with inadequate oral intake, or who are taking diuretics, may have difficulty tolerating
exposure to heat. Many psychiatric medications used in geriatric patients affect how well they
tolerate heat. (pg. 559)
30. A person swimming in shallow water may experience Breath-holding syncope, a loss of
consciousness caused by a decreased stimulus for breathing. This happens to swimmers who
breathe in and out rapidly and deeply before entering the water in an effort to expand their
capacity to stay under water. While increasing the oxygen level, this hyperventilation lowers the
carbon dioxide level. Because an elevated level of carbon dioxide in the blood is the strongest
stimulus for breathing. The swimmer may not feel the need to breathe even after using all of the
oxygen in his/her lungs. The emergency treatment for a breath-holding syncope is the same as
that for a drowning or neat drowning. (pg. 567)
31. In contract to the venom of the black widow spider, the venom of the brown recluse spider is
not neurotoxic but cytotoxic; that is, it causes severe local tissue damage. Typically, the bite is
not painful at first but becomes so within hours. The area becomes swollen and tender,
developing a pale mottled, cyanotic center and possibly a small blister. Over the next several
days, a scab of dead skin, fat, and debris will form and dig down into the skin, producing a large
ulcer that may not heal unless treated promptly. Transport patients with such symptoms as
soon as possible. (pg. 570)
32. When a psychiatric emergency arises, the patient may show agitation or violence or become a
threat to himself, herself, or others. This is more serious than a more typical behavioral
emergency that causes inappropriate behavior such as interference with ADL (activities of daily
living) or bizarre behavior. (pg. 585)
33. Usually, if an abnormal or disturbing pattern of behavior lasts for at least a month it is regarded
as a matter of concern from a mental health standpoint. (585)
34. Safety guidelines for behavioral emergencies include:  BE prepared to spend extra time have a
definite plan of action  identify yourself calmly be direct – state your intentions and what you
expect of the patient  assess the scene  stay with the patient  encourage purposeful
movement  express interest in the patient’s story  do NOT get too close to the patient  avoid
fighting with the patient  be honest and reassuring  do NOT judge  (pg. 586)
35. When dealing with suicidal patients, one of the most important things is to gain their trust and
confidence. If you begin shouting, the patient is likely to shout louder or become more excited.
A low calm voice is often a quieting influence.(pg 586-587)
36. When dealing with behavioral emergencies, you should be aware of 2 basic categories of
diagnosis a physician will use to figure out the cause of the problem: Organic (physical) and
functional (psychological). Organic Brain Syndrome is a temporary or permanent dysfunction of
the brain caused by disturbance in the physical or physiologic functioning of the brain tissue.
Causes of this include sudden illness, recent trauma, drug or alcohol intoxication, and diseases
of the brain, such as Alzheimer’s. Altered mental status can arise from low levels of blood
glucose, lack of oxygen, inadequate blood flow to the brain, and excessive heat or cold.
Functional Disorder is one in which the abnormal operation of an organ cannot be traced to an
obvious change in the actual structure, or physiology, of the organ. Examples of this are
schizophrenia and depression. The two may look very much alike. Altered mental status is one
indicator of CNS diseases. (pg. 586)
37. During assessment of a Behavioral Emergency, if your patient is in physical distress, assess the
ABCs as for any other patient. Provide the appropriate interventions based on your assessment
38.
39.
40.
41.
42.
43.
44.
findings. Some behavioral situations will involve compromised airway and inadequate breathing
secondary to a suicide attempt from ingesting a handful of sleeping pills with alcohol. (pg. 587)
When performing your SAMPLE history in a behavioral emergency, reflective listening is a
technique frequently used by mental health professionals to gain insight into a patients thinking.
It involves repeating, in question form, what the patient has said, encouraging the patient to
expand on the thoughts. Although this process may take longer than the amount of time
allotted to you in the field he may be helpful to use when other techniques are unsuccessful.
Following that during your focused physical exam, if he is not responding to your questions, you
will be able to tell a lot from the patient’s facial expressions, pulse, and respirations. Also, make
sure that you look at the patient’s eyes; a patient who has a blank gaze or rapidly moving eyes
may be experiencing CNS dysfunction. (pg. 588-589)
Unless there us an accompanying physical complaint, the detailed physical exam is rarely called
for in a patient with behavioral problems and may, in fact, be detrimental to gaining the
patient’s trust. (pg. 589)
As much as your heart may go out to the emotionally distressed patient, there often is little you
will be able to do for the patient during the short time you will be treating him/her. Your job is
to diffuse and control the situation and safely transport the patient to the hospital. Intervene
only as much as it takes to accomplish these tasks. Be caring and careful. If you have
determined that it is necessary to restrain the patient, release the restraints only if necessary to
provide patient care. (pg. 589)
The single most factor that contributes to suicide is depression. Suicide is a cry for help.
Threatening suicide is an indication that someone’s in a crisis he or she cannot handle.
Immediate intervention is necessary. Remember, the suicidal patient may be homicidal as well.
Do not jeopardize your life or the lives of your fellow EMT. If you have reason to believe that you
are in danger, you must obtain police intervention. In the meantime try not to frighten the
patient or make him or her suspicious. (pg 590-591)
The uterus, or womb, is the muscular organ where the fetus grows. It is responsible for
contractions during labor and ultimately helps to push the infant through the birth canal. The
birth canal is made up of the vagina and the lower third, or neck, of the uterus, called the cervix.
The cervix contains the mucous plug that seals the uterine opening, preventing contamination
from the outside world. When the cervix begins to dilate, this plug is discharged as pink tinged
mucus, which may occur with bloody show, a small amount of blood at the vagina that appears
to be the beginning of labor. (pg. 600)
There are 3 stages of labor: dilation of the cervix, expulsion of the baby, and delivery of the
placenta. The first stage begins with the onset of contractions and ends with the cervix fully
dilated. Because the cervix has to be stretched thin by uterine contractions until the opening is
large enough for the baby to pass through the vagina, the first stage is usually the longest,
lasting an average of 16 hours for a first delivery. You will usually have time to transport the
mother during the first stage of labor. (pg. 602)
As the time for delivery nears, certain complications can occur. Preeclamsia or pregnancyinduced-hypertension is a condition that can develop after the 20th week of gestation, most
commonly in the primigravidas (1st time pregnancy will take longer). Signs & symptoms include:
45.
46.
47.
48.
headache, seeing spots, swelling in extremities, anxiety, high BP. Another condition is
eclampsia, or seizers that result from sever hypertension. To treat, lay the mother on her left
side, maintain ABC’s and transport. If the patient is hypotensive, transport on her left side,
because this can prevent supine hypotensive syndrome, a problem due to compression by the
pregnant uterus on the inferior vena cava, resulting in low BP. Ectopic pregnancy is where the
fetus develops in the fallopian tube, usually noticeable within 6-8 weeks of the pregnancy. A
history of pelvic inflammatory disease, tubal ligation, or previous ectopic pregnancies should
heighten your suspicion of a possible ectopic pregnancy. Hemorrhage from the vagina that
occurs before labor begins may be very serious. In early pregnancy, it may be signs of a
spontaneous abortion, or miscarriage. In the later stages of pregnancy vaginal hemorrhage may
indicate problems with the placenta. In placenta abruptio, the placenta separates prematurely
from the wall of the uterus. In placenta previa, the placenta develops over and covers the
cervix. (pg. 603-604)
During delivery, your partner should be by the mothers head to comfort, soothe, and reassure
her during the delivery. She may want to grip someone’s hand. She may yell, cry, or say nothing
at all. Some mothers may vomit. If this occurs, have your partner turn the mothers head to the
side so that her mouth and airway can be cleared manually or with suction, as needed. Once the
head is delivered, use the index finger of your hand to feel whether the umbilical cord is
wrapped around the neck. This is commonly called a nuchal cord. This can cause the baby to
strangle. It must therefore be released from the neck immediately. Usually you can slip the cord
gently over the infants delivered head. If not then cut it by placing 2 clamps about 2” apart on
the cord and cutting the cord between the clamps. As soon as the baby is born, dry the baby off
and wrap it immediately in a blanket or towel, and place it on one side, with the head slightly
lower than the rest of the body. Newborns also are very sensitive to cold, so if possible try to
warm the blanket before hand. Since the babies body temperature will drop very quickly make
sure to dry and warm the infant as soon as possible. Only then will you clamp and cut the
umbilical cord. (pg. 608-612)
A newborn infant will usually begin breathing spontaneously within 15-20 seconds after birth. If
not, gently tap or flick the soles of the feet or rub the baby’s back to stimulate breathing. If the
baby does not breathe after 10-15 seconds, begin resuscitation efforts. You should use the
APGAR scale to asses 5 areas of activity of the infant, Appearance, Pulse, Grimace or irritability,
Activity or muscle tone, Respirations. The total of the 5 numbers is the Apgar scale. A perfect
score is 10. Most newborn infants will have a score of 7 or 8 at 1 minute and score of 8-10 four
minutes later. (pg 614)
The energy of a moving object is called kinetic energy and is calculated as follows: kinetic
energy= ½mv₂, where m = mass (weight) and v = velocity (speed). Remember that energy cannot
be created or destroyed, only converted. ( pg 632)
Motor vehicle crashes are classified traditionally as frontal (head-on), lateral (T-bone), rear-end,
rotational (spins), and rollovers. The most common life threatening event in a rollover is ejection
or partial ejection of the passenger from the vehicle. The principal difference among these
collision types is the direction of the force of impact; also, with spins and rollovers, there is the
possibility of multiple impacts. There are 3 types of collisions in a frontal impact. Collision #1 is
49.
50.
51.
52.
the collision of the car against another car, a tree, or some other object. Damage to the car is
the most dramatic part of the collision, but it does not affect patient care, except possibly to
make extraction difficult. However it does provide information about how sever the patient is.
Collision #2 is the collision of the passenger against the interior of the car. Common injuries
include: lower extremity fractures (knees into the dashboard), flail chest (rib cage into the
steering wheel), and head trauma (head into the windshield). Collision #3 is the collision of the
passenger’s internal organs against the solid structures of the body. These injuries may not be as
obvious, but they are often most life threatening. For example, as the head hits the windshield
the brain continues to move forward until it comes to a rest by striking the inside of the skull.
(pg 634-635)
Damage to the vehicle that was involved and information obtained from the patient assessment
are not the only clues to crash severity. Clearly if one or more of the passengers are dead, you
should suspect that the other passengers have sustained serious injuries, even if the injuries
aren’t obvious. Therefore, focus on treating life threatening injuries and transport to a trauma
center. (pg 637)
Contact points are often obvious from a simple quick evaluation of the interior of the vehicle. If
there is no intrusion, you might see that an unrestrained front-seat passenger in a frontal
collision will come into contact with the dashboard or instrument panel at the knees and
transfer loads from the knees through the femur to the pelvis and hip joint. The chest and/or
abdomen may also hit the steering wheel. In addition the face often hits the steering wheel or
may launch forward and up, hitting the windshield and/or the roof header in the area of the
visors. Signs of most of these injuries can be found by simply inspecting the interior of the
vehicle during extrication of the patient. (pg. 638)
Rear-end impacts are known to cause whiplash-type injuries, particularly when the head and/or
neck is not restrained by an appropriate head rest. On impact, the body and torso move
forward. As the body is propelled forward, the head and neck are left behind because the head
is relatively heavy, and they appear to be whipped back relative to the torso. As the vehicle
comes to rest, the unrestrained passenger moves forward, striking the dashboard. In this type
of collision, the cervical spine and surrounding area may be injured. The cervical spine is less
tolerant of damage when it is bent back. Headrests decrease extension during a collision and,
therefore, help reduce injury. Other parts of the spine and the pelvis may also be in risk of
injury. In addition, the patient may sustain an acceleration-type injury to the brain, that is, the
third collision of the brain within the skull. Passengers in the back seat wearing only lap belts
might have a higher incidence of injuries to the thoracic and lumbar spine. (pg. 639)
Patients who fall and land on their feet many have less severe internal injuries because their
legs may have absorbed much of the energy of the fall. Of course, as a result, they may have
very serious injuries to the lower extremities and pelvic and spinal injuries from the energy that.
The legs do not absorb and is transmitted to the spine. (pg. 642)
There are 2 types of penetrating trauma: low energy and medium-high energy. Low energy may
be caused accidentally by impalement or intentionally by a knife, ice pick, or other weapon.
With low-energy penetrations, injuries are caused by the sharp edges of the object moving
through the body and are, therefore, close to the object’s path. Weapons such as knives,
however, may have been deliberately moved around internally, causing more damage than the
external wound might suggest. Medium-high velocity penetrating trauma, usually a bullet, may
not be as easy to predict. This is because the bullet may flatten out, tumble, or even ricochet
within the body before exiting. (pg. 643)