Verication of death and major trauma

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  • Created by: Louisa
  • Created on: 07-10-19 19:42
What conditions would unequivocally associate with death
Decapitation, Massive crantal or cerebral destrction, hemicoporectomy or similar massive injury, Decomposition, incineratio, rigor mortis, hypostasis, fetal macerationin a newborn
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Define the meaning of massive cranial or cerebral destruction
a point where there is such an injury caused to the head, life cannot be sustained
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Decompostion
Where tissue damage indicates death for some days
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Incineration
Precenseof full thickness burns for 95% of the body
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Fetal Maceration i a new born
a child is born with such severe abnormalities its considered incompatible with life
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Hypostasis
pooling of blood in congested vessels in dependent part of the body of which the person is lying on
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Initally hypostasis may appear
samll round patches like bruisesa nd merge as a familar pattern over time
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an extremely cold patient presents hypostasis
as bright red
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carbon monxide poisonied patient presents hypostasis
as a cherry red
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Rigor mortis
Stiffness occurs from breakdown of enzymes in muscle fibres
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Where does rigor mortis occur and how long
starts in small muscles in the face and moves to the arms and legs. this can take between 30 minutes and 3 hrs. in children the signs can show more rapidly
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not to be confised with what condition
cadaveric spasm, where the whole body will spasm, where as in rigor mortis its only 1 group of muscles
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In the conditions listed above it is not appropriate to commene CPRm, expect with what 3, and what would you have to do?
Rigor mortsis, hypostasis, and fetal maceration. you would have to take an ECG while confirming the absence of a pulse and breathing
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Other conditions where resus would with withheld or discontinued
DNACPR do not attempt cardiopulmonary resuscitation if a person is known to be i nthe final stages in advanced and irreversible condition = where CPR is inappropriate and unsuccessful
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If there is any doubt
CPR should always be attempted, until information is provided to prove otherwise
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Another conditon is when someone has been submerged for
longer than 90 minutes
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Final stages of an advanced and irreversible condition must be defined as all three conditions
may be treated, but can never be cured or eliminated, leaves the person unable to care or make decision for themselves, without life-sustaining treatment is fatal
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There are quite a few grey areas for paramedics so
you have to make an informed decision
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There is no realstic chance that CPR will work if all the following exist
- 15 minutes has elapsed since the start of cardiac arrest - no evidence of a bystander CPR in 15 minutes before an ambulance arrives - exculsion factors are absent - asystole for over 30 secs of ecg monitor
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what are exculsion factors
drowning, hypothermic, poisoning, overdose, pregnany, child
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confirmation by Asystole can only be confirmed if...
all criteria are met, and CPR is paused for a 30 second check for aystole. it should then be documented as evidence. all cardiac output should have ceased. and all carers/relatives should be informed
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If there is a realistic chance than CPR culd be successful then
resus should continue to establish the patients repsonse to ALS.
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If after ALS intervantons occur and asystole has occured for 20 mins then... unless...
Resus can stop unless any electrical activity has occured, in which can you restart the 20 minutes.
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what factors mean you cannot stop resus after 20 minutes of asystole
if they are pregnant, in they are hypothermic, if you suspect a drig overdose or poisoning, or they are a child
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In the cases listed above what should you do?
Transport them to the nearest facility with ongoing resus
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If PEA occurs what should you do
Take them straight to a hospital or request advance support so an ultra sound can be carried out
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For advanced decisons to refuse treatment paramedics are protected if
they withheld or stop treatmentin tge presence of an advanced decision, that is valid or applicable. or the person they threat a person having taken all the steps and think the decison is invalid or not applicable
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In a major incident a dead perosn must have a
mass casulaty assessment/ triage card attached to them
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The card will contain the following details
Patient identified as dead, time of deathm abd identity of the paramedic
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the dead patient should only be moved in a mjor incident if
if they are blocking an exit or other casulties
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After death what should you do with the patient
leave all instuments in, its treated as a crime scene. complete documents, get in touch with coroners service, hand leaflet to bereaved relative
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what shoukd you do when talking to bystanders (including relative/carers)
Use the word dead or died, speak to their gp and always prepare you personal appearance before seeing them (they are going to be feeling pretty rough, treat them as another pateint)
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During a death of a child you will likely have to call the
police, this can be distressing for the parents, so prehaps tell the family that the police are here to check that we did our job properly and are here to help
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What must always occur after a childs death
A post mortem
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Weh ndont you take a child to the ed
If they were expected to die and a care plan for death is in place. you then recognise life extinct, contacted named clinician and leave the child at home
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What does the global overview involve in major trauma
Who/what, visisble mechaniam, visible injuries, reading the scene
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Who is what is involved example
Number, elderly/young, vehicles, machinery or water
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what is the visible mechanism
damage to vehicle =, debris, airbag deployment
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what are visble injuries
up and walking, laying on floor, screaming/crying,casualty laying on floor in relations to scene
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in a major incident you cannot predict the extent of injury from
the mechanism alone
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Danger in major trauma
high levels on danger
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Response, consider?
c-spine injury and appraoch head on to prevent further injury
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carastrpophic haemorrage, look for evidence of
internal/external bloodloss and manage
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Airway, consider
c-spine and performing a jaw thrust
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Breathing, consider
underlying injuries, needle thoarcicentesis, oxygen
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CIRULATION
haemodunamic status, control of blidding
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disibilty
AVPU, GCS, pupils, bm, what is causing reduced level of conciousness (LoC)
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exposure
expose known injury then expose rest of whole body for a secondary survey, however consider environmental conditions, and patient dignity
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Truama primary survey stemmed from
Military practice
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involves the use of and the idea that no blood=
Combat app tourniquets, and plug holes.no point of cpr
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Secondary survey involves
Head to toe, trunk, long bones, extremeties, look, feel, listen, move, sensation, pulses
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Why do we do a seconday survey
to identify potential life threateing injuries that could have been missed, or patient didn't notice. identify distracting injury
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what is a distracting injury
if a patient has an extremely painful injury they might not have noticed the other injures
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head truama, how many bones and involes what
28 bones, = cranium, brain, CSF, blood
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Orbit are what structure and contain what
cone-shaped and protect the eyes. blood vessels, nerves and fat
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what makes then susceptible to fracture and what type?
extremely thin and breaks easily. a blowout fracture
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scalp and head lacerations, are very
common and vasular = heavy blood loss
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usually correctable by, but difficult to, may also indicate
correctable with compression, difficult to assess, and indicate underlying injuries
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Skull fracture types
linear, depressed, basilar, open
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linear, are and show no signs off, but still have a risk of...
non-displaced, so show no physical gross signs = easily missed, and still have a risk or bleed, infection and injury to the brain
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Depressed, caused by
high energy direct truama to a small area, usually blunt object trauma
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May or may not be and what bones as susceptible
open, and frontal and parietal bones
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basilar, caused by
high energy diffused impact trauma, eg RTC and falls
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characteried by
Raccoon eyes, battle signs, CSF leakage from the ears
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open skull fracure usually caused by, associated with and characterised by
massive impact, and multi trauma, brain tissue often exposed
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Traumatic brain injury types
primary - direct, secondary - indirect, coup-contrecoup injury, swelling, initially becuase on cerebral vasodilation, and increase of cerebral water
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what causes an increase in pressure in the cranial vault
accumulations of bloo d within the skull or sweeling of the brain can lead to an increase in pressure within the crainial vault
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A decrease i nthe cerebral perfusion pressure and cerebral blood flow causes the body to respond by
increasing mean arterial pressure = increase in intracranial pressure
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cerebral perfusion pressure cannot be
calculated in a prehospitalised setting
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What history should you take in relation to head truama
Bystanders, Loc or reduced loc, confusion, repitition, amnesia, abnormal posture or behaviour, convulsions, dizziness, visual disturbance, nausea
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Assessment in head trauma
Primary survey, AVPU, GCS, pupil, loc
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assessment of head injury
type, active bleeding, location, and size and cause
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what bones in spine and and stable by
33 irregualr bones, ligaments and muscle
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c -spine
7 cervical
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t spine
12 thoracic
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l spine
5 lumbar
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sacral
5 fused sacral
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coccyx
4 fused coccyx
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injury to t1 - l2 possible affecting
sns
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c1-c5 - what type of plexus and controls what
cervical plexus, diaphragm, and breathing
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C5 - T1
Brachial plexus, upper extremities
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L1-L4
Lumbar plexus, skin and msucles of abdominal wall, external genitalia, part of lower limbs
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L4-s$
Sacral plexus, buttocks, perineum, lower limbs
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Injury to vertebrea affecting spinal nerve will affect
all other nerves below that point
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during spinal truama assessment maintain a high
level of suspision
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Evaluate the
Mechanism of the incident
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Primary survey involves
Correcting problems sequentially and maintain manual c-spine control, until secured or cleared
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C-spine and spine management involves
immobillisation and precuationary. assess for pain, loss of movement, sensation, burning and or electric shock
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what is the aim of immobilisation
to minimise further movement of spinal column and reduce further injury
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Other cards in this set

Card 2

Front

Define the meaning of massive cranial or cerebral destruction

Back

a point where there is such an injury caused to the head, life cannot be sustained

Card 3

Front

Decompostion

Back

Preview of the front of card 3

Card 4

Front

Incineration

Back

Preview of the front of card 4

Card 5

Front

Fetal Maceration i a new born

Back

Preview of the front of card 5
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