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PCT 2


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Krystal Pickard


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[Front]


low-energy/ low velocity weapons
[Back]


knives and arrows

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PCT 2 - Marcador

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PCT 2 - Detalles

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High-energy/ high velocity weapons
Assault rifles, hunting rifles slightly heavier bullet (600 - 1000 mps)
Cavitation
The outward motion of tissues due to a projectile's passage, resulting in a temporary cavity and vacuum
Trajectory
The path a projectile follows
Drag
The forces acting on a projectile in motion to slow its progress
High or medium velocity projectiles sets what?
A portion of the semifluid body tissue in motion, creating a shock wave and temporary cavity
Your patient has been shot in the chest with a handgun. Care would include
High-concentration oxygen by nonrebreather mask, consideration of needle decompression for tension pneumothorax, preparation for endotracheal intubation if breathing becomes inadequate.
The appearance of the entrance wound caused by a bullet:
May indicate signs of subcutaneous emphysema if the shot was fired at very close range.
Ballistics
The study of the characteristics of projectiles in motion and their effects on objects they strike
Profile
Size and shape of a projectile as it contacts a target; it is the energy exchange surface of the contact
Factors in energy dissipation
Drag, cavitation, profile, stability, expansion, shape
For scene assessment
Ensure police secured the scene before entering, look to make there is no weapons within reach of the PT, preserve crime scenes as much as possible
Medium-energy/ medium velocity weapons
Handguns, shotguns, low powered rifles (bullets, slugs, pellets) Handgun bullets - smaller and much slower (250 - 400 mps)
When spleen is damaged it will
Bleed profusely so frequently results in shock and life threat, blood accumulates under diaphragm so pain can be referred to left shoulder pain
When kidney is injured where is pain often located?
Radiates from flank to groin and hematuria(blood in urine)
What are the hollow organs in body?
Stomach, gall bladder, large/small intestines, ureters/urinary bladder
What is important to consider when hollow organs rupture?
Content spillage which causes inflammation of peritoneum
When stomach is injured what happens?
Immediate peritonitis, pain, tenderness, guarding, rigidity
When colon is injured what is to be considered?
Spillage of bacteria, may take 6 hrs to develop peritonitis
When small bowel is injured what is to be considered?
Fewer bacteria, may take 24-48 hrs to develop peritonitis, a gradual onset of diffuse pain when bacterial
What are the % for penetrating trauma ?
Liver 40%, small bowel 25% large bowel 10%
Injury to abdominal wall may lead to
Evisceration (spilling of abdominal contents)
What is the major concern when hollow organs rupture
Spillage of contents into - retroperitoneal space - peritoneal space- pelvic space
If there is a leakage from large intestines
There is a large amount of bacteria with can result in sepsis
Manifestations of blood loss
Hematochezia, hematemesis, hematuria
Hematochezia
Blood in stool
Hematemesis
Blood in emesis
Hematuria
Blood in urine
Solid organs
Spleen, pancreas, kidney, liver
Solid organs are prone to?
Contusion, profuse bleeding which will cause abdo distention, fracture, unrestricted hemorrhage if organ is ruptured
Injury to vascular structures
Blood accumulates beneath diaphragm causing : irritation of muscular structures, pain referred to shoulder region, greater volume of blood can be lost, presence of blood in abdo may stimulate vagus nerve resulting in slowing of HR
When this is a disruption to blood vessels supplying bowel:
It can lead to ischemia, necrosis, or rupture
When the peritoneum is injured where is pain often located and what happens?
Slight tenderness @ location of injury, rebound tenderness (associated w/peritonitis ), guarding, rigid, board like feel
If your PT has eviscerated intestines what steps should you follow
Make no attempt to replace them back into abdo, cover the eviscerated intestines with moist, sterile large,bulky dressings and if possible seal with a sterile occlusive dressing and transport
Tears in the diaphragm may cause compromise during respiration and also:
Force parts of the liver into the thoracic cavity
The ligamentum teres restrains the:
Liver from forward motion.
Volvulus
Twisting of intestine on itself
Presentation of Hepatitis
URQ abdominal tenderness May radiate into right shoulder Loss of appetite, weight loss, malaise Clay-colored stool, jaundice, scleral icterus Photophobia, nausea/vomiting May appear jaundiced May have fever due to infection or tissue necrosis May reveal liver enlargement
HEV
Hepatitis E; Waterborne infections, Epidemic in Africa, Mexico and other less-developed nations
HDV
Hepatitis D; less common Pathogen is dormant until activated by HBV
HCV
Hepatitis C; Pathogen most commonly responsible for spreading hepatitis through blood transfusions Marked by chronic and often debilitating damage to the liver
HAV
Hepatitis A; Most common, Infectious hepatitis, Spread by oral-fecal contamination, Self limiting, lasting ~2-8 weeks, Rarely causes severe hepatic injury and thus has a low mortality
HBV
Hepatitis B; Serum hepatitis, Blood borne pathogen, Can stay active in body fluids outside the body for days, ~310 million carriers worldwide, Effects may be minimal but can also range to severe liver ischemia and necrosis
Hepatitis
Injury to hepatocytes associated with infection of inflammation
Cholecystitis
Inflammation of the gallbladder
What most often causes Appendicitis
Obstruction of the appendiceal lumen by fecal material.
Tx for Appendicitis
Recognition and supportive care, Hemodynamically stable as long as appendix hasn’t ruptured Follow general management guidelines
Appendicitis
Inflammation of the vermiform appendix at the juncture of the large and small intestines
S&S of Hiatus hernia
Burning sensation like heart burn, sharp easily localized pain
Hiatus Hernia
When the esophageal spincter allows the top of the stomach to herniate through the diaphragm into the esophagus
Adhesion
Union of normally separate tissue surfaces by a fibrous band of new tissue
Intussusception
Condition that occurs when part of the intestine slips into the part just distal to itself
Hernia
Protrusion of an organ through its protective sheath
What causes hemorrhoids
Idiopathic, from pregnancy, or external may result from heavy lifting
What are common causes of Bowel obstruction
Hernia – intestine has pushed through muscle wall • most dangerous is strangulate hernia Intussusception Adhesion Volvulus  Chronic as in tumour growth or adhesion or
Tx for Bowel Obstruction
BOMB Fluid resuscitation
Bowel Obstruction
Blockage of the hollow space within the intestines; Can be catastrophic if not rapidly diagnosed and treated. - The most dangerous result is sepsis.
Hemorrhoids
Small masses of swollen veins that occur in the anus or rectum
Diverticulosis
Presence of diverticula, with or without associated bleeding
Diverticulitis
Inflammation of the diverticulosis : secondary to infection - Small outpockets that push through the outermost mucosal and submucosal lining (muscle) secondary to infection, Bleeding or infection
Tx for Crohn's
BOMB, Airway management,Transport to hospital, Usually hemo stable so Tx is usually pallative
Crohn's Disease
Idiopathic inflammatory bowel disorder associated with the small intestine
When can you administer gravol
If your PT has N/V >25 and unaltered Has no allergy or sensitivity to dimenhydrinnate or other antihistamines did not overdose on antihistamines or anticholinergics or tricycilic antidepressants
Structures of the lower GI tract
Jejunum, ileum, large intestine, rectum, anus
Functions of lower GI tract
Absorbing nutrients, reabsorption of water, formation of wastes
With severe peritoneal irritation how with PT usually be positioned
Will be lying as still as possible usually in the fetal position
Where does upper GI tract bleeds occur
Proximal to the ligament of Treitz
General complaints of Upper GI bleed
Malaise, weakness, syncopal and near syncopal, tachycardia, indigestion
Referred pain
Pain originates in a region other than where it is felt
Conditions that cause upper GI bleeding
Peptic ulcer disease, Gastritis, Esophageal varicies, Mallory-Weiss tear, Esophagitis, Doudenitis