Trauma Study Guide for the EMT Test

Orthopaedic Injuries

Orthopaedic injuries are extremely common. In most cases, they are not life-threatening, but may be painful and might appear massive. These injuries can occur with or without trauma and can include bone fractures and musculoskeletal injuries.

Musculoskeletal Anatomy and Physiology

There are three types of muscle: cardiac, smooth and skeletal. Cardiac muscle supports the functions of the cardiac system. Smooth muscle is found within the blood vessels and intestines. Skeletal muscle makes up the greatest amount of muscle in the body. The skeletal, or striated, muscle is attached to the bones and joints. It functions to support the skeletal system posture and voluntary movements.

Terms/Concepts to Know: striated muscle, fascia, tibia, fibula, calcaneus, major bones, skeletal system, joints, ligaments, articular cartilage

Musculoskeletal Injuries

When dealing with injuries of this nature, you need an understanding of the relationship between and functions of muscles, ligaments, nerves, and joints. It is also important to know the mechanism of injury and the five types of musculoskeletal injuries, including the various degrees or types of fractures, dislocations, sprains, strains, and amputations. Signs and symptoms may include guarding, pain, tenderness, swelling, bruising, crepitus, shortening, deformity, rotation, angulation, exposed fracture, false motion, dislocation, and reduced fracture. Complications are often related to the impact that caused the injury. The extent of damage can be bone-related and cause bleeding or bone impact to muscle, blood vessels, arteries, and nerves. Additional complications can be seen with open fractures, including deformity and long-term disability.

Terms/Concepts to Know: four mechanisms of injury, zone of injury, two fracture classifications, three terms for description of movement, the eight types of fractures, false motion, exposed fracture, locked joint, reduced fracture

Patient Assessment

The patient assessment of musculoskeletal injuries are scene size-up/MOI, primary assessment, patient history, secondary assessment, and reassessment. The chief complaint may or may not be related to the musculoskeletal injury. It is important to consider further investigation outside of the orthopaedic injury. This will help to ensure there is not a more life-threatening injury present. The musculoskeletal injury grading system is a key tool during the patient assessment when dealing with these types of injuries.

Terms/Concepts to Know: four mechanisms of injury, musculoskeletal injury grading system

Emergency Care for Musculoskeletal Injuries

The general framework for providing emergency care for the patient with musculoskeletal injuries include ensuring stability of airway, breathing, and circulation (ABC). Use sterile dressings to cover wounds or control bleeding. Assess distal pulses and check motor and sensory function. Splint, treat swelling, and stabilize for transport. Important guides for use of splinting include: use of an appropriate device for type of injury and application technique to reduce further injury, such as compression of nerves, blood vessels, or tissue. An example is avoiding the use of traction splints on upper extremities and the evaluation of weather and altitude conditions before using air splints.

Terms/Concepts to Know: various types of splinting and rationale for their use

Other Musculoskeletal Injuries

Other musculoskeletal injuries that occur with less frequency are injuries to the scapula, clavicle, shoulder, and acromioclavicular (AC) joint. This may include fractures and dislocation injuries. These areas are shielded from frequent injury due to the large muscles surrounding them. Be aware of signs and symptoms if this type of injury is encountered. The humerus, elbow, forearm, wrist, hand, pelvis, hip, patella, foot, ankle, and ligaments are at risk for sprains, strains, fractures, and/or dislocation injuries occurring with falls, trips, sports and motor vehicle accidents, and other activity mishaps.

Terms/Concepts to Know: acromioclavicular (AC) joint, sling, swathe, glenoid fossa, position of function, retroperitoneal space, sciatic nerve

Compartment Syndrome

Compartment syndrome can be categorized as an acute or chronic condition. It is described as pressure in the muscle that has built up abnormally. This abnormal pressure prevents blood flow and oxygenation to nerves and muscle cells. Compartment syndrome caused by a severe injury is considered emergent.

Environmental Emergencies

Concerns during an environmental emergency include identification, assessment, and management. Emergencies may be a result of submersion, temperature, and radiation.

Exposure Factors

There are four factors that impact the patient’s ability to tolerate temperature variations. These variables include: physical condition, age, environment impacts, and nutrition/hydration.

Terms/Concepts to Know: homeostasis, conduction, ambient temperature, convection, evaporation, radiation, respiration

Exposure to Cold

The body can be damaged when exposed to extremely cold elements. It can usually handle and self-regulate temperature. It can even tolerate cold to a certain point below the core body temperature for a limited time. Then, continued exposure to cold, below the core body temperature of 95 degrees, begins to cause injury and impact organ and body system functions.

Types

There are various types of local cold injuries. When a part of the body is exposed to very cold temperatures, it may develop a local cold injury. When the skin is frozen and deeper tissue is not, it may cause frostnip and immersion foot, or trench foot. When the body part and deeper tissues freeze, cell damage occurs. The skin looks waxy, firm, or frozen to the touch. It may have blisters and be cyanotic or mottled in color. This condition is considered frostbite.

Patient Assessment and General Management

It is important that an emergency team prepares to prevent personal harm by limiting exposure and wearing appropriate gear to match the elements. Normal patient assessment should be completed, including scene size-up/MOI, primary assessment, patient history, secondary assessment, and reassessment. When appropriate for the patient’s clinical situation and environmental options, carefully move the patient (without having him or her walk) to a sheltered or indoor environment. Remove wet clothes, replacing them with dry blankets, and cover frostbites with thick sterile cotton gauze. Avoid friction, massage, or rubbing of any frozen area, ingestion of stimulants, and smoking.

Terms/Concepts to Know: hypothermia, core temperature, trench foot, frostbite, frostnip, characteristics of systemic hypothermia

Exposure to Heat

The body can also neglect to self-regulate when exposed to extreme heat. Heat exposure and the ability to self-regulate in these cases may be related to the environment, exercise, medical conditions, and substances. If the body’s core temperature rises to 101°F, the diagnosis would be hyperthermia.

Types of Heat Exposure Injuries

Types of heat exposure injuries include heat cramps, heat exhaustion, and heat stroke. A person can experience more than one of these types of exposure during a single event.

Patient Assessment and Emergency Care Management

It is important for the emergency team to prepare to prevent personal harm by limiting their exposure and wearing appropriate gear to match the elements. The patient assessment and management of heat injuries begins with scene size-up/MOI and continues with primary assessment, patient history, secondary assessment, and reassessment. Perform a skin assessment to check the condition, turgor, moisture, and temperature. Manage the environment to prevent further injury by moving the patient to a cooler or shaded area, as appropriate, operate a fan, and/or dampen the skin.

Terms/Concepts to Know: hyperthermia, heat exhaustion, heat stroke, heat cramps, turgor

Drowning and Diving Injuries

Drowning and diving injuries can happen at any age and to even the experienced swimmer or diver. In addition, not all of these injuries occur in swimming pools and many of them happen in fairly shallow water. The EMT needs to understand how drownings occur and the specifics on diving emergencies, spinal injuries, recovery techniques, and resuscitation efforts.

Characteristics of Drowning and Diving Emergencies

In many cases, drowning persons are discovered without information about how the incident occurred or the length of exposure. Key characteristics of which to be aware include water temperature, submersion timeframe, water purity, signs and symptoms, injuries, co-morbids, medication, and drug or alcohol usage.

Patient Assessment and Emergency Care

To assess the patient in drowning, near drowning, and diving emergencies, perform all of these: scene size-up/MOI, primary assessment, patient history, secondary assessment, and reassessment. In addition to paying attention to the characteristics, it is important to understand the possibilities for other related injuries or underlying causes. When appropriate, use spinal immobilization during ABC before removing the victim from water. Provide oxygen and monitor for pneumothorax and decompression illness and other signs and symptoms relevant to prehospital care. For infants and children, even in a near drowning episode where there appears to be no harm and the patient is stable, medical examination should be sought.

Other Water Hazards

Observe for other potential hazards related to injuries in and around water. Assess for critical head trauma or bleeding injuries, and signs and symptoms of breath-holding syncope.

Prevention

Community awareness of water safety is the key to prevention. EMTs can assist in sharing this information with the public. Key tactics for prevention include safe water-related equipment and the use of trained lifeguards in public places. Installation of appropriate and safe fences around pools and the use of the buddy swimming system also prevent many of these accidents. Avoid the use of alcohol, drugs, and narcotics when swimming, boating, diving, and recreating in or near water. There should be a working phone and an AED in areas where there are public water activities.

Terms/Concepts to Know: breath-holding syncope

High Altitude

High altitudes can cause unbalanced pressure between the atmosphere and total gas pressure upon the body’s tissue, fluids, and cavities of the body. This is referred to as dysbarism. A person not accustomed to high altitude may suffer symptoms related to pulmonary and central nervous system problems. The EMT should have the ability to identify and assist in managing these symptoms.

Terms/Concepts to Know: dysbarism injury, HAPE, HACE

Lightning

Heat and electricity is generated from lighting. Many lightning injuries occur in large open areas. Persons can be impacted by lighting via indirect or direct strikes. The most common injuries associated with a lightning strike are to the cardiovascular and nervous systems, resulting in respiratory and/or cardiac arrest. The key to medical treatment starts with ensuring the team and patient are in a safe environment and are protected from further injury. Ensure reverse triage for any patient in respiratory or cardiac arrest. Assess them for entrance and exit wounds and any other related injuries.

Terms/Concepts to Know: category of lightning injuries, reverse triage

Bites and Venom

Serious medical conditions can result from bites or stings from spiders, bees, wasps, yellow jackets, ants, ticks, scorpions, and snakes. Not all bites and stings are venomous or poisonous. However, many patients experience reactions up to and including immunologic emergencies. The EMT should be aware of minor reactions and how to treat them. Knowledge of common insects and snakes in your jurisdiction is helpful in responding to venomous and poisonous bites and stings.

Terms/Concepts to Know: antivenin, hymenoptera, urticaria, anaphylaxis

Injuries Caused by Marine Animals

This section is an overview of types of marine life and the injuries they may cause. An example is the group of coelenterates, including jellyfish. The stings from these types of creatures cause pain, redness, dizziness, headaches, etc. The best way to treat this injury is to remove the patient from the water and use a stiff object, like a credit card, to scrape the skin where the sting occurred. Stings from urchins and sting rays produce toxins that can be treated with hot water or vinegar soaks. Some patients may experience allergic reactions, and the EMT must be prepared to handle cases where anaphylaxis or shock occurs.

Terms/Concepts to Know: coelenterates, common marine envenomations