ABC – this is a standard abbreviation for Airway\Breathing\Circulation, and is the way we prioritise our trauma patients. These 3 criteria must be met before we look at anything else.

ABDOMEN – this is another name for your tummy, but it also includes organs that are found underneath the lower ribs, like the spleen, liver and kidneys. There can be lots of damage that can occur from something like a high speed car crash, and so it is important that the abdomen is fully examined.

ABDOMINAL AORTA – this is one of the biggest blood vessels the body has, it supplies blood to many important places. It sits in the middle of the tummy, and is sometimes injured in car accidents when the lap sash of the seat belt puts pressure on it. Big injuries like this have to be operated on straight away, otherwise the patient may die.

ABRASION – these happen from a shearing force, usually like sliding over concrete or gravel. It is usually dirty, and can get infected, and is very painful. In the emergency room we look at all of these carefully, sometimes there may be broken bones, or organ injuries underneath.

ABSCESS – a cavity containing pus, usually from a local infection. These can occur in almost any part of the body, and are either drained by making a slit in the cavity, or by removing the whole cavity.

ACETABULUM – this is part of the joint where the pelvis and the thigh bone connect. The acetabulum is the ‘cup’ that holds the head or ‘ball’ of the thigh bone. This part of the pelvis is well known for being damaged, and depending what other bones around that area are broken, and how badly they are damaged, the treatment may be traction (see defn) or an operation.

ADRENALINE – another name for this is epinephrine. The body naturally secretes this hormone, but in times of severe reactions, spasm of the lungs, or other airway problems, it may also be given through injection.

ADULT RESPIRATORY DISTRESS SYNDROME – this syndrome can occur anywhere from 1 – 5 days after an injury and is rare. It develops in stages, the symptoms start as difficulty breathing, but taking breaths quickly. They may progress to the 2^nd stage after a few hours, where they will not be receiving as much oxygen as they need, and they will become distressed. The third stage is when the problem shows on chest x-ray, and ventilation(see defn) will be given. If the problem is not dealt with, the patient will reach the fourth stage, where assistance usually fails, and the patient will not survive.

AIR EMBOLISM – this can occur whenever a vein is open, especially if the pressure inside that vein is low. It occurs mostly after a lung injury. This is a serious problem, because the air enters the blood stream, and the air may reach the heart or the brain, this is a problem that can be fatal.

AIRWAY MANAGEMENT – This is the first step taken with trauma patients, because it is the most important part of caring for them. Most of the patients will have a ‘patent’ airway, this means that they are breathing on their own. For some people we will give oxygen through a mask, with gives them more oxygen supply than what they are getting in room air. If the patient is not breathing, or if they are not awake enough to keep breathing deeply, they have to be given an oxygen supply, otherwise they may have permanent brain damage, or they may die. To manually deliver oxygen, we ‘intubate’ (see defn).

AMNESIA (POSTTRAUMATIC) – this is a loss of memory caused by brain damage, or severe emotional trauma. This is common after events like a horrific car accident, or an assault, where the patient cannot remember the accident, or up until the day after. We start an assessment of these patients known as Post Traumatic Amnesia Assessment (PTA), which just asks a variety of simple questions to ensure there is no permanent brain injury. Some patients will never remember the accident, this is considered normal.

AMPUTATION – the removal of a body part or limb, either surgically, (because the body part has permanent nerve damage, or the circulation has stopped sending blood to that part) or traumatically, as in the instance of a car accident where the person was entrapped for a long time.

ANAPHYLACTIC REACTION – an exaggerated reaction to a substance the body has received before. The reaction can be as small as an itch, or can be as much as weakness, sweating, shortness of breath, or shock. These symptoms can occur minutes after the event Things like insect bites, drugs like penicillin, and blood transfusions are some items that can create these reactions, although overall, anaphylaxis is rare.

ANATOMY – this is how we identify the location of parts of the body

ANAEMIA – a decrease in haemoglobin in the blood below normal levels, or blood loss, this is mostly caused by an iron deficiency. People who are anaemic can show signs of fatigue, dizziness, headache, insomnia, and they are usually pale. If this drop in haemoglobin is low enough the patient may require a blood transfusion, otherwise it is usually treated with a diet high in iron, and iron tablets.

ANAESTHESIA – the loss of normal sensation, or feeling. This may be due to nerve damage, but may also be created by doctors for surgery, and can be local, which is only a region of the body, or general, for a procedure that the patient needs to be asleep for.

ANASTOMOSIS – where two ducts or blood vessels are joined together to allow flow between the two. This can be done where there is an obstruction in the intestines, for example. The piece of bowel that is obstructed can be taken out and the two ends can be joined together to allow the flow of the bowel to continue.

ANEURYSM – a thinning and out-pouching of a wall of a blood vessel. With the constant pressure of the blood flow, the wall gets thinner and thinner, until eventually it bursts. Aneurysms can occur almost anyway, but the most likely places are those that are under the most pressure. These are the abdominal aorta, hence the term, abdominal aortic aneurysm (AAA), or a cerebral aneurysm. If either of these injuries go undiagnosed, they can be fatal.

ANGIOGRAPHY – is a test performed to highlight the outlines of the heart and blood vessels. It is mainly used to see if there is any blockages or malformations of the heart or vessels which could lead to a problem. They use this test to look for aneurysms.

ANTERIOR – the front of the body.

ANTICOAGULANTS – a substance that prevents or delays clotting of the blood. There is a drug routinely used for this, and it is called heparin. It is given twice a day through a small needle into the fat layers. TEDS stockings are white stockings that also prevent clots in the legs. These precautions are taken because patients do not move around as much as normal, for various reasons. They also may have to go to theatre, and these are all factors that increase the chances of blood clots.

ARRHYTHMIA – any deviation from a normal heart beat.

ARTERIAL BLOOD GASES – one of the most accurate ways of measuring how much oxygen is in the blood. It is taken like a normal blood test, but the blood is taken out of the artery, not the vein. Arteries are located further underneath the skin than veins, and so the needle has to reach deeper than when the tests are for other values. These are usually taken for patients with lung complications, or who are unconscious.

ARTERIAL INJURY – any damage to an artery. Because arteries take oxygen to the vital organs, they are bigger, carry more blood, and are probably considered more important. When an injury to an artery occurs there are two main things that happen, the bleeding must be stopped, and the vital organs still have to receive the oxygen they need. Arterial injury can be dangerous, and sometimes fatal. These injuries are usually repaired in theatre.

ARTIFICIAL RESPIRATION – this is required when there is a patient who is not breathing on their own. Their body still needs the same amount of oxygen, but is not receiving it. There are a few different ways of maintaining the persons need for oxygen. The first is one that the majority of people know about, and this is part of first aid and CPR. This is where another person blows air into the patients mouth to provide them with oxygen. The hospital has other devices that mean that we can provide them with oxygen, but we either pump the oxygen through a bag and a mask, or we put a tube into their airway and hook them up to a machine that pumps the oxygen in for us.

ASEPTIC TECHNIQUE – this is a procedure that health care professionals use to avoid infections. It is what we use in our operating theatres, and what we use in a number of dressings on the wards. It is ensuring that the materials we use for procedures are sterilised, and remain the same throughout the procedure.

ASPIRATION – the act of taking a breath. Generally, there are no complications with this act, but occasionally, when a patient cannot protect their airway, they may not only take a breath, they may also take in vomit, or mucus. This means that instead of swallowing the food that is supposed to go to their stomach, it goes into their lungs. This can lead to problems such as pneumonia, which may mean the patient stays in hospital twice as long as originally planned.

ASYSTOLE – the absence of a heart beat.

ATELECTASIS – a collapsed lung.

AUSCULTATION – listening of sounds within the body, to find out if there are any abnormalities. A stethoscope is used usually, and this step of examination can be used on the heart, the chest or the intestines.

AVULSION – separation by tearing, of any part of the body from the whole. Arms and legs, and spinal injuries are sometimes explained with term, and are usually very serious. This term means that a large amount of damage has been done.

BILATERAL – two sides, for example, if a patient has bilateral broken arms, it means that both arms are broken.

BLADDER INJURY – any injury of the bladder. This organ is responsible for holding urine. It is commonly injured in bike accidents, as the driver will fall forward, striking their lower abdomen on the handle bars.

BLOOD TRANSFUSION – to give whole blood, or a component of blood, to replace blood lost from trauma, surgery, or disease.

BLUNT INJURY – this is one of two main types of injury. Blunt injury is when a reasonably flat, solid object injures a person and does not break the skin. The injury is generalised, or ‘all over’. An example of this type of injury is a person falling onto concrete from a height. There is nothing that is going to penetrate the skin, but the impact can still do lots of damage.

BOWEL PERFORATION – any piercing or puncturing of the bowel (the intestines), to make a hole. This happens commonly in trauma patients, for instance, when a driver of a car has his tummy hit the steering wheel with great force. Bowel perforations are sewn up in theatre as soon as they are found. Not fixing the holes can lead to complications, and even death, when the digested food from the bowel leaks out into the sterile cavity around all of the abdominal organs.

BRACHIAL PLEXUS INJURY – an injury to the network of nerves in the neck that pass under the collar bone and into the under arm. These nerves assist the skin and the muscles of the chest, shoulders and arms. Some of these injuries impair fine coordination of the fingers, while others are more severe, and may be so bad that the arm becomes flaccid and of little use.

BRADYCARDIA – a slow heart rate (pulse), which is around 60 beats per minute or less. Some people who are fit have resting pulses that are low, but in trauma, heart rates are used to determine how good the blood supply is around the body.

BRONCHIAL INJURY – the bronchus and bronchioles are the branches of tubing that lead to the lungs. Bronchial injury is injury to any of these tubes. Injury of this nature can be a medical emergency, as an injury can lead to a lower amount of oxygen supplying the body, and vital organs. This injury should be treated immediately.

BRONCHIAL SPASM – this occurs when the tubes that lead down to the lungs become tight, and restrict the amount of air moving in and out.

BURNS – are any injury to tissues caused by heat, electricity or chemicals. There are different degrees of burns, and these are classified by their depth. Sunburn is a form of burn, but generally only involves the first layers of the skin, and so they are referred to as 1^st degree burns. Other burns are 2^nd and 3^rd degree, with 3^rd degree being full thickness burns, and the worst. The 2^nd degree burns are the most painful, though, because 3^rd degree burns go deep enough to burn nerve endings, which leads to some loss of sensation. Burns are easily infected, and the patients become in need of extra fluids and nutrition to help them heal, pain relief is also essential. Burns can lead to death, especially if they involve the head and neck, because inhaling smoke, and throat swelling can cause airway obstruction, and lack of oxygenation.

BURST FRACTURE – and break in a bone that leaves the bone in many pieces. This happens usually at, or near the end of a bone, and happens to vertebrae as well. It takes tremendous force to do this to large bones, such as in high speed car accidents.

CARDIOPULMONARY RESUSCITATION – is the emergency life saving support given to a patient who is not breathing, and does not have a pulse. This is taught at first aid courses, and is initiating breathing and circulation through outside means.

CARDIOVERSION – is giving the patient an ‘electric shock’ through two paddles to restore a normal heart beat. It is used when the patients heart beat is in a rhythm that may lead to cardiac arrest.

CENTRAL VENOUS ACCESS (CVC) – sometimes it is necessary to have constant access to a patients veins, this is usually because they need medication, and intravenously (through the vein), is the most effective way to do it. The little needles (cannula) that are put into the hand or arm have to be changed every one to two days, and if we need to use the patients veins for a month, changing those needles everyday becomes painful, and a site for infection. In these cases, a central line is used, this is a line that is either put into the elbow fold, or the neck, and can stay there for much longer than a cannula.

CERVICAL COLLAR – this is a hard plastic collar that is used to support the neck in transit and until it is known if there is an injury to the spinal cord at the neck. It is common practice in trauma patients to assume that there is a broken neck until it is found to be otherwise. This is because a broken neck can be fatal, or just as serious as a head, chest, or abdominal injury. A series of xrays are done to exclude a break, but if the patient has neck pain, there are other tests that are performed to see if there is ligament damage.

CERVICAL SPINE INJURY – this is an injury that relates to the vertebrae and ligaments of the neck. As mentioned above, a collar is worn until there is no evidence of injury. If there is an injury, the patient may need to go to theatre, may need to lie in bed in traction or may need a Halo brace, which is a ring of metal that is screwed in around the persons head, and attached to a jacket by metal rods. This jacket cannot be taken off for around 3 months, but the person can walk around with it on.

CLOSED REDUCTION – this is used when a bone has been dislocated or shifted from its normal place. A closed reduction means that the person does not have to be operated on, but they may be taken to theatre to have it done, because the procedure is painful. For example, for a dislocated hip, the doctors will attempt to re-align it by actually pulling on the leg, and slipping it back into the pelvis.

COLLES FRACTURE – a broken radius (one of the forearm bones) about 1 inch away from the wrist. These usually occur when someone falls onto their wrist.

COLOSTOMY – these can be made when there is bowel cancer, where there is an obstruction, or in severe damage through trauma of the bowel. A colostomy is formed by cutting a loop of bowel in half, sewing up the end that is furthest away from the stomach, and taking the part still connected to the stomach and sewing it onto the outside of the tummy. Although there may be some discharge still from the anus, all of the bowel motions then come out of the ‘stoma’ on the tummy, into a bag that is regularly changed. Colostomy may be permanent or temporary, where the bowel just needed a break, and the part of bowel is then reconnected.

COMA – where the patient is unconscious. When they will not open their eyes spontaneously, they do not respond to pain, and they do not talk. This may be temporary, and the patient may slowly recover from the head injury, or the effects may be permanent.

COMMUNITED FRACTURE – where there is several breaks in the bone, creating lots of fragments.

COMPARTMENT SYNDROME – progressive development of arterial compression and reduced blood supply. This happens after severe injury, or an operation, where the swelling becomes so great that the important structure are squeezed, and cannot keep up the blood supply. The effects can be permanent, unless it is stopped quickly with medical attention.

COMPOUND FRACTURE – this is where a broken bone has pierced through the skin. It is also called an open fracture. These breaks are a priority, because they could have severed arteries, nerves, or other important vessels. They are also the most likely to become infected because they have been exposed to the open air.

COMPUTERISED TOMOGRAPHY (CT) – this is like a x-ray, except it is performed in a tunnel. It is not invasive, and does not hurt. But it does give details about the patient that a xray cannot. Instead of looking at one view of the patient, it looks at cross sections of the patient in a 3 dimensional view.

CONTINOUS POSITIVE AIRWAY PRESSURE (CPAP) – this is given to a patient who can still initiate breathing, but who cannot breathe deep enough to get the amount of oxygen they require. It delivers a flow of air at a constant rate throughout the breathing cycle. It can be given through a big mask over the patients face, or if a patient has a tube in their mouth that is protecting their airway, it can be given through the tube.

CONTUSION – also called bruise. Made by a blunt object, and does not break the skin. It may become swollen, discoloured and painful, and may mean that there is an underlying injury.

CRICOTHYROTOMY – an emergency cut into the neck to allow someone who is choking to take in air. The cut is made below the Adam’s apple and is kept open until the obstruction is cleared. This is only performed in the trauma room by an experienced staff member, and should not be performed instead of first aid procedure.

CRANIOTOMY – any surgical opening into the skull. This is performed by making a skull flap, which is folded back over when the surgery is complete. Sometimes in severe trauma, where the brain will swell to the point where the pressure inside the skull is too great, the skull flap will be removed completely, and will be replaced when the swelling goes down.

CRUSH SYNDROME – a life threatening condition that is associated with severe crushing injury from trauma. It involves destruction of muscles and bone tissue, massive haemorrhage, and coma. Critical care nursing and close observation is usually required.

DEBRIDEMENT – to remove dirt, foreign bodies and dead tissue to clean wounds, promote healing and decrease risk of infection. This is usually done in theatre, and is performed on burns or dirty wounds.

DEEP VENOUS THROMBOSIS (DVT) – blood clot that can form from theatre of from being on bed rest. The blood is most likely to pool in the calf due to gravity, which is why we use TEDS stockings. Patients are also ordered heparin, a medication to decrease the chance of blood clots. If a clot is present in the calf, the calf generally will become hot, painful and inflamed. These clots can be treated with a larger dose of heparin, but if it is not found soon enough, the clot may move into the blood stream, and enter the lungs, heart or brain. All of these problems are potentially fatal, especially if they go untreated.

DEFIBRILLATION – where two paddles are placed on the patients chest, and an ‘electric shock’ is delivered through their heart. This is used for patients whose heart is beating in a fatal rhythm known as ventricular tachycardia (VF).

DEGLOVING INJURY – generally when the skin is torn of the body. This happens mostly to arms and legs, and in industrial accidents where limbs are also entrapped.

DIALYSIS – a way of physically taking waste products out of the body when the body cannot dispose of them by itself. It can be done to remove poisons or excessive amounts of drugs out of the blood stream, or it can be used to correct salt and fluid imbalances in the body.

DIAPHRAGM – a dome shaped muscle that separates the chest cavity from the abdominal cavity. It also assists with breathing, moving down when a breath is taken (to allow more room), and moving up when taking a breath out (to push all of the air out).

DIAGNOSTIC PERITONEAL LAVAGE (DPL) – this is where a special needle is put through the belly, and into the same cavity where the abdominal organs are. If there is blood that comes back into the needle, it means that the test is positive, and there is an organ injury. These people usually go straight to theatre for surgery to stop the bleeding.

DIFFUSE AXONAL INJURY – this is a head injury that involves a large number of nerve cells within the brain. These people have usually sustained it through a traumatic injury, like coming of a bike without wearing a helmet. These people usually need to spend time in a brain injury rehabilitation unit, before they go home, and some of the problems that they caused may exist for the rest of their lives.

DISLOCATION – the displacement of any body part from its normal location. This is usually referred to with bones, and is treated with a closed reduction (see defn).

DISTENTION – swollen. This term is used when talking about the tummy. A swollen abdomen can mean a number of things, such as injury, or it can be from complications from an operation. It can need further investigation.

DISTAL – the furthest away from a point of origin. For example, the body’s middle is the centre, and the wrist is more distal than the elbow.

ELECTROLYTE BALANCE – when all of the fluids and salts in the body are at normal levels. There are many reasons why these balances can be out, such as fluid loss from an accident, vomiting, diarrhoea, or from surgery. Some of these imbalances can be life threatening and need to be corrected. This can be done by fluids through the veins, or by liquids and tablets taken by mouth.

EMPYEMA – a collection of pus in a body cavity, and is from an infection. The pus is usually drained in an operation, and the patient is put on antibiotics to treat the infection.

ENDOTRACHEAL INTUBATION – sometimes if a patient is unconscious, they block their airway with their tongue. The only way to keep their airway clear for the passage of air is to put a tube down their mouth or nose and into the trachea (their windpipe). Other reasons to use the tube are to prevent the patient taking stomach contents into their lungs, to give them more oxygen through their tube, or to take secretions out of their windpipe, because these patients find it difficult to cough the secretions up.

ENUCLEATION – removal of an organ or tumour in one piece. This term is commonly used in traumatic injury of the eye, where the whole eye must be removed. This is then referred to as enucleation of the eye.

EPIDURAL – the epidural space is the space that surrounds the brain and the spinal cord. For an epidural block, (which is what they use in selected trauma patients, and mothers giving birth) a needle is inserted into this space, and pain killers can be continuously given, which will affect the spinal nerves in that area and give pain relief.

EPISTAXIS – a bleeding nose. If there are other injuries to the face, and not just a bleeding nose, the patient requires urgent attention. This is because the patients breathing may be compromised, if both their nose and their mouth are bleeding and swollen.

ESCHARATOMY – these are performed in theatre, and are an incision into dead tissue as a result of a severe burn. It is done to alleviate pressure on the skin from all of the swelling. This commonly happens to severe burns to the arms or legs.

EXTERNAL FIXATION – this is fixing a broken bone by putting metal pins through the fragments of bone. All of these metal pins are joined together by rods that are outside the skin, so you can actually see them. After the bone has healed in about 2 months the rods are taken out.

FALCIFORM LIGAMENT – a triangular shaped ligament of the body.

FASCIOTOMY – a surgical incision in to the fascia – which is the surrounding tendons and ligaments. This is used when the swelling underneath the skin is so great that the only way to relieve the pressure is to cut through the skin and the fascia. Once the swelling goes down the skin is then sewn back up again.

FAT EMBOLISM – is where a particle of fat dislodges, travels around the blood stream, and becomes lodged in a blood vessel. This is not common, but can happen after bone surgery. If the particle gets caught in the heart, brain or lungs, it can be fatal.

FEMORAL ARTERY – this is a big blood vessel that starts in the lower abdomen and continues down the thigh. It is an artery, therefore it comes from the heart, and it splits into different branches and supplies some of the lower limb and trunk. The femoral vein also lies along a similar path to the femoral artery, and is used in trauma when it is to difficult to find a vein in the arm.

FISTULA – a passage from an organ to the body surface, or from an organ to an organ, that is not normal. These can be birth defects, they can be caused by trauma, and they also be used to get direct access to a patients blood stream for dialysis.

FLAIL CHEST - this is where there are broken ribs in more than one place, so the ribs are broken into a segment, totally separate to the rest of the rib cage. This can cause underlying lung injury, that may have to be treated, and the actual rib fractures are very painful. These patients are admitted for rest, observation and pain relief.

FLOATING KNEE – this is a severe injury of the knee whereby all of the bone, muscle, and most of the ligaments and tendons are separated, and it is only the skin that is holding the joint together. This can also happen in shoulder injuries.

FLUID CHALLENGE – when a patient is showing signs of dehydration, like decreased urine output, staff attempt to correct the problem by giving them a fluid challenge. This is where a larger than normal amount of fluid is given to the patient, usually intravenously, and the response is noted.

FLUID RESUSCITATION – patients who have lost a large amount of blood through an open wound, or internally in the tummy, need to have fluid replaced to keep their circulation going. There are different types of fluids that are used, depending on the amount of fluid loss, and the type of fluid loss the patient had.

FRACTURE – a broken bone. There are many types of fractures, such as butterfly, comminuted, displaced, segmented, spiral, undisplaced, incomplete, complete, compound, transverse, simple, stable, unstable. All of these terms are to identify location, and how the bone was broken.

FRESH FROZEN PLASMA – a watery, colourless fluid which is part of the blood, where cells that fight infections and platelets (that help clotting) are stored. This plasma can be extracted from blood that is donated, and it is given to patients for different reasons. It is given to most to help the blood clot.

FOREIGN BODY – any object that is in the body that is not usually there. This can be a bullet in the leg, dust in the eye, or food obstructing the windpipe.

FULL BLOOD COUNT – this is a blood test that is done to see if there is any internal bleeding, infection, or other abnormalities in the body that cannot be seen on examination.

FUNDOSCOPIC EXAMINATION – this is an examination of a part of the eye through a special light. This can determine if there is any increased pressure inside the skull, as well as eye problems.

GALEAZZZI’S FRACTURE – a broken bone wrist with a dislocation of the joint.

GASTRIC DECOMPRESSION – removal of gas or fluid in the stomach. The collection of gas or fluid is a complication that can occur after surgery, and is called an ileus.

GASTROINTESTINAL BLEEDING – bleeding of any of the organs responsible for digestion of food, such as the stomach or intestines. These organs bleeding can lead to serious complications and death. An operation is the only alternative to fix the problem.

GASTROSTOMY – sometimes a patient is unable to eat, because they are too drowsy, and so they can only be fed by a tube. This is called a nasogastric tube, and is inserted through the nose. It is very uncomfortable, and confused patients find it easy to pull out. Putting a new tube in everyday is traumatic to the patient physically and emotionally. For patients who are expected to need this feeding for a long time, a gastrostomy tube is inserted. This is a tube that is put straight from the stomach, through the skin on the tummy. If the patient improves, it can be taken out, otherwise, it can be kept in for an extended period.

GLASGOW COMA SCORE (GCS) – a standardised system of assessing a patient and their level of consciousness. There are 3 main parts to the score, eyes open, best verbal response, and obeying commands. A 15 is the best score, and means that the patient is orientated to time, place and person. A 3 is the lowest score, and means that the patient is comatose. A person who has died will also score a 3.

GREENSTICK FRACTURE – this is where a bone is only bent or partially broken. It usually only requires rest or a plaster.

HAEMATURIA – blood in the urine. If this is present in a trauma patient, a bladder injury may be suspected.

HAEMOGLOBIN – a compound in the blood that carries oxygen from the lungs to the cells, and carries carbon dioxide from the cells to the lungs. This value can become low after trauma, sometimes so low that the patient requires a blood transfusion. A low haemoglobin can cause breathing complications, and is referred to as anaemia.

HAEMOPNEUMOTHORAX – this is a combination of a pneumothorax (an accumulation of air) and a haemothorax (a collection of blood and fluid) in the pleural cavity, which is a cavity that surrounds the lungs. These injuries are result of trauma, from a penetrating injury to the chest, or from a rib puncturing the lung. A big tube is placed into the collection, and the fluid or air is drained out of the cavity. This can lead to fatal complications if the injury is not found and managed in the trauma room.

HAEMOPTSIS – coughing up blood stained sputum.

HAEMATOMA – a collection of blood trapped in the tissues, skin, or in an organ. If it presents in the skin it is identified as a bruise, but it is only seen in organs after doing tests like CTs. Haematomas are common in the layers around the brain, and are sucked out after opening the skull in an operation.

HAEMORRHAGE – loss of a large amount of blood over a short period of time. This can be external, where the loss can be seen, or bleeding internally, which is typical of chest or abdominal wounds. Although the blood is still in the body, it is not able to circulate in the body, and so the loss is just as great as if the bleeding was external. If the loss is great enough, the patient may go into shock, which is a life threatening condition. If the bleeding is external, pressure is applied to stop bleeding, if the bleeding is internal, the patient is taken to theatre as soon as possible.

HANGMANS FRACTURE – a broken and dislocated neck, which needs to be treated by either surgery, traction or a brace. The broken or dislocated bones may cut or compress the spinal cord, which, at such a high level, can be life threatening.

HARTMANNS SOLUTION – a solution that has fluid and electrolytes in it.

This is used to replenish patients when required, and is given intravenously.

HISTORY – a medical history is taken as soon as possible after a trauma patient arrives into the emergency department. This is very important, and can sometimes determine the treatment the patient receives, and the outcome of the patient. Chest, heart problems and any allergies prior to the accident are some of the issues that are important to know about before any major intervention is performed.

HEPATIC INJURY – any injury to the liver. The liver is an organ that requires a large amount of blood to operate, and is one of the biggest organs in the body. Injury to the liver, or any of the main veins around it bleed quickly. Liver injuries need to be fixed as soon as possible.

HYPOGLYCAEMIA – a low blood sugar level in anyone, not just someone who has diabetes. This is a sugar level that is about 3mmols or less. People who have levels this low are usually confused, inappropriate, and some are even comatose. Blood sugar levels are taken regularly in the emergency department, because it is difficult to get a health history from a patient who is confused, and a low blood sugar level is easy to exclude - the test only takes a minute.

HYPOTHERMIA – this is when the body temperature of a person is 35C or less. The patient will breath shallow and slowly, and heart rate is slow. Treatment is to warm slowly.

HYPOVOLEMIA – an abnormally low volume of blood circulating around the body. If the source of this problem is not corrected (such as the bleeding is not stopped), the patient may go into shock.

HYPOXIA – an inadequate amount of oxygen circulating the body. The places most sensitive to this problem are the brain, heart and liver. Oxygen through a mask is usually given, and regular checks of oxygen in the blood are taken.

HYPERKALEMIA – hyper – means high, and kalemia refers to potassium in the blood. The problem of high potassium in the blood can be treated by a medication, but the original side effects of having an elevated potassium are changes in the heart cycle, nausea, diarrhoea and muscle weakness. This problem is seen in people with failing kidneys, but can happen to trauma patients, and should be corrected as soon as practical.

HYPERNATREMIA – a high sodium (or salt) in the blood, and is caused by an excessive loss of water and electrolytes in the body. The losses can be from not enough water intake, increased urination or sweating. People who have this problem may have symptoms such as confusion, and it may become so severe, the patient may slip into a coma. Management of this problem is correcting the balance by giving fluid orally or intravenously.

HYPERTENSION – high blood pressure. This can differ from person to person, but generally a normal blood pressure is 120/80, and an elevated blood pressure is one over 140/90.

IATROGENIC – caused by treatment or a test.

IDIOPATHIC – without a known cause.

INDWELLING CATHETER (IDC) – any tube which is expected to remain in for a period of time. The main type of catheter that is used in this instance is a catheter that is put into the bladder to drain out urine so that the patient does not have to worry about going to the toilet. This is particularly true of patients who have lots of injuries and are very sore, and cannot get out of bed to go.

INFECTION – an invasion of the body by bacteria. This is one of the most common complications of hospitalisation, and can lengthen the stay of the patient by twice as much. Wounds that break down do not heal as quickly, and this may lead to other problems.

INHALATION INJURY – this occurs whenever there is an injury from inhaling material such as toxic fumes, or smoke from a fire. These can lead to swelling of the windpipe, and problems with breathing. These problems are potentially very dangerous, and the patient should be monitored closely.

INCISION – a cut made surgically with a scalpel.

INNOMINATE ARTERY – one of three arteries that branch out from the arch of the aorta (the biggest vessel of the body) and travel in different directions from the upper chest.

INSPECTION – this is part of the head to toe assessment in the emergency department. It involves looking at the patient all over to see if there are any injuries that have been overlooked.

INTERCOSTAL CATHETER (ICC) – this is the big tube that is put into the lungs through the ribs to treat blood or airthat has collected in the space covering the lungs. (See haemopneumothorax)

INTRAVENOUS CANNULA (IVC) – this is a plastic tube that is put into the veins in the hands or arms with a needle. It is put there to give a patient intravenous fluids through a drip, or to give life saving drugs in an emergency.

INTRAVENOUS THERAPY – this is fluid given through the vein either by a cannula or a central venous catheter. It is used for people who cannot eat or drink, and it is the most direct way of giving fluid and medication.

IRRIGATION – to wash out or clean a wound with a stream of fluid – usually salt water. This is done for a number of dressings, and is also done internally with catheters.

ISCHAEMIA – decreased blood supply to an organ or body part. This may lead to necrosis.

JEJUNOSTOMY – this is a tube that runs from part of the bowel, outside of the skin. Patients who have problems with their stomach, can have liquid food put straight into the bowel to bi-pass the stomach. This may only be temporary, when the stomach needs a rest, or it can be permanent, depending on why the patient cannot be fed normally.

JORDAN FRAME – this is a frame that consists of a rectangle frame, and slats. The frame is put around the patient, and the slats are put underneath the patient. All of the slats are joined to the frame, and the whole frame is lifted by a machine. This is commonly used on patients who cannot be moved off their back, and need to lie flat because of a back injury. It is used to move the patient off the bed to another, or to give their back relief from the hard bed. If the patient is not lifted regularly their skin can break down, causing other problems.

LACERATION – the tearing of skin or tissue, with a jagged edge. People who have injuries from glass windows, or shattered windscreens will usually have lacerations. Deep lacerations will usually have to be sutured.

LAPAROTOMY – and incision into the cavity surrounding all of the organs in the tummy. This is done to explore the organs and repair the damaged ones, and is done in theatre.

LAVAGE – washing out an organ.

LEVEL OF CONSCIOUSNESS – a special test is used to assess level of consciousness, this is used almost everywhere, and is called the Glasgow Coma Score. (see defn).

LIGAMENT – a white, shiny flexible band of tissue that binds the joints, bones and cartilages together. Treatment is generally rest. These commonly occur in the knee and are related to sports injuries.

LIVER FUNCTION TESTS – a blood test used to see if the liver has been injured, or is still working effectively.

LUMBAR SPINE – this is the part of the spine that joins to the thoracic spine. There are 5 lumbar vertebrae, they start at the waist line, and finish at the tail bone. Depending on the type of break, people who have broken lumber vertebrae may need an operation, or may need to stay lying flat in bed for 6 weeks. Unstable broken vertebrae can sever the spinal cord, which can result in paraplegia.

MANDIBULAR FRACTURE – a broken jaw. These are not routinely operated on until the swelling goes down. The patient may need the jaw wired to keep the bones in place to heal. This means that they can only drink through a straw until the jaw heals.

MECHANISM OF INJURY – this is how the person was hurt. This is a big clue when trying to identify injuries. For example, what was the person burnt with?, was the person wearing a seatbelt?, how fast was the car going?, was the person trapped in a car for a long time?, was the person wearing a helmet?, how high was the ladder the person fell off?, in what position did they land?, was the person trampled by the horse?. All of these questions can assist with the location of injuries, and the extent of the injuries.

MEDIASTINUM – part of the chest cavity between the lungs. It exists all the way from the front of the body, near the rib cage, to the back near the spine. Sometimes the chest x-ray may show up that this part is widened. This may mean that there are other injuries in the chest that must be followed up.

METABOLIC ACIDOSIS – excess acid is added to the body fluids from injury. It can occur in heart failure or shock.

MIDSHAFT FRACTURE – a break that happens in a bone, not at the end, but rather at any part of the middle of it.

MOTOR BIKE ACCIDENT (MBA) a rider or a passenger on the bike when an accident occurred. In the emergency department, it is relatively easy to tell which patients have worn helmets and leather clothes. These are the patients who generally have less severe injuries. Patients who have not worn protective gear have multiple abrasions all over, and injuries to the head and neck.

MOTOR VEHICLE ACCIDENT (MVA) – any person who has been in a car accident. In can be meaningful to find out where the patient was sitting in the vehicle and whether they were wearing a seat belt. Drivers can sometimes have more head and abdominal injuries when they hit the steering wheel, although anyone wearing a seatbelt can have burns across their tummy and chest and injuries to the same. People who were not wearing seatbelts usually go through the windscreen, and so have multiple lacerations to their face and hands.

MULTISYSTEM TRAUMA – an accident that has injured more than one system of the body, for example, the bones, the chest and the tummy. These patients are cared for by doctors who are specialists in different fields, and it is up to each doctor to keep everyone up to date with what is happening. It is also a job of the doctors to decide what the worst injury is, and to treat each injury in order of importance.

NASOGASTRIC TUBE – a tube that is inserted through the nose and into the stomach. This is used in patients who cannot swallow properly, so that they can still be fed. It is also used in patients who are not eating, but their stomach is still making secretions that need to be taken out. These are then taken out via the tube.

NECROSIS – localised tissue death. This skin becomes black and is it not supplied with any oxygen, due to injury or a disease process. These injuries more often than not occur in places like the toes, and the end treatment is amputation.

NERVE BLOCK – this is a loss of sensation, especially pain, in an area that is covered by a nerve. A local anaesthetic is injected along the course of the nerve, and the pain is blocked out. Such as an epidural block.

NEUROLOGICAL ASSESSMENT – this is an assessment tool that may indicate if there is any problems with the brain or spinal cord. It is a combination of a lot of tests that produce an overall picture of the patient. It assesses level of consciousness, strength in arms and legs, sight, smell, touch, taste and hearing, and involves getting a full medical history.

NEUROVASCULAR OBSERVATIONS – this is a set of observations performed to monitor the nerves and vessels of an arm of leg. They are used on people who have large lacerations, broken bones, burns, or any other damage which may result in swelling and complications. These observations are also done on the arm or leg after surgery.

NORMAL SALINE – a special mixture of salt and water that is the most common fluid used in drips, and is used to clean wounds.

NUTRITIONAL SUPPORT – patients who have traumatic injuries need an increasing demand for nutrients. This is extremely important for patients who are nil by mouth for theatre, or who cannot eat because of an injury. If the patient does not have a diet high in protein, fibre, vitamins and minerals, the patient will not heal as quickly, which can lead to other complications.

OBSTRUCTION – blocked. This can be something as serious an a windpipe obstruction, all the way to a bowel obstruction.

OCULAR INJURY – injury to the eye, such as a burn, or a penetrating injury.

OEDEMA – swelling from excess fluid in the tissues. It can be noted in arms and legs, and it also occurs commonly to the brain after head injury. This may sometimes require a monitor put into the brain to measure the pressure inside the brain. This is called an Intra Cranial Pressure monitor (ICP).

OLIGURIA – difficulty passing urine. This is common after surgery, and when on bed rest. For these people, an indwelling catheter (see defn) may be placed.

OPEN REDUCTION INTERNAL FIXATION (ORIF) – this is an operation that is performed on bones. When bones are broken, and they cannot be fixed by a plaster, the patient is taken to theatre, and the bone is put back together with pins, plates, screws, or a combination of these things.

ORBITAL FLOOR – the cavity in the skull that holds the eyes is called the orbit. The bottom part of this cavity is the orbital floor. This is a common facial fracture in trauma, and is mostly operated on by plastic surgeons.

OESOPHAGEAL INJURY – and injury to the oesophagus, which is the pipe that takes food from the mouth to the stomach. These injuries are not as common as others, probably because the oesophagus is protected by the windpipe that sits in front of it.

OXYGEN SATURATION – this is a method of measuring the amount of oxygen in the blood by putting a sensor on a persons finger. It is not as accurate as an arterial blood test, but it is a non –invasive way of checking the approximate value. An average person should have an oxygen saturation of about 97% or higher. People who are older, or who have a history of respiratory problems may have a lower average, but in a healthy person, someone who has not got a saturation of 97% or higher may have a problem. The person may be confused, and if this occurs over a long time period, the effects may be permanent. Oxygen through a mask may be required. Checking oxygen saturations is sometimes referred to as pulse oximetry.

OXYGEN THERAPY – delivering of oxygen to the patient. This is either through masks, prongs inserted into the nose, or through a machine called a ventilator, when the patient is unable to breathe on their own.

PALPATION – the process of feeling the tummy all over. This is part of the examination in the trauma room, because any tenderness can be investigated. Certain organs can be felt through gentle palpation, and if these feel abnormal they can also be investigated.

PANCREATIC INJURY – any injury to the pancreas. This is the organ responsible for secreting insulin, and if it is damaged, it may not function as well as before. The injury is corrected in an operation, and blood tests and blood sugar tests are taken regularly to make sure it is operating alright.

PARALYSIS – loss of sensation and/or muscle strength. It is classified into groups of what caused the paralysis, and what body area is affected, for example, paraplegia and quadriplegia.

PATHOLOGICAL FRACTURE – a broken bone resulting from weakened bone tissue, in other words, the bone is not broken from trauma, but because it was weak, or unhealthy.

PATHOPHYSIOLOGY – is the description of the disease processes that occur, it also describes how and why the body breaks down

PATIENT CONTROLLED ANALGESIA (PCA) – As a general rule, all patients with trauma injuries must have pain control. Some patients require a pain relief that is known as a PCA. This is a machine that gives a dose of pain relief into a vein, every time a patient pushes a button. These machines have proven very useful in patients with pain, and are more effective, because they allow us to give drugs into the vein without having to give the patients injections.

PENETRATING INJURY – an injury that involves an object with a sharp end. It does not usually create general damage, like a blunt injury, but it can do a great deal more damage to the part that the object pierces. An example of this is the injury a knife makes. Penetrating injuries can also be impaling injuries, where for instance a pole has gone through one side of a person, and exited through the other side of them.

PERFORATION – to pierce or puncture. See bowel perforation.

PERFUSION – passage of a fluid (usually blood) through a part of the body. In a trauma situation, where a patient is bleeding and the amount of blood they have circulating the body has decreased, the body will automatically adjust to make sure the vital organs receive the blood first. This means that the blood to the arms and especially the legs is decreased, and the fingers and toes may become cool and blue tinged. Management is identifying why the patient has less blood circulating and correcting the problem.

PHYSIOLOGY – this is the description of how the body functions

PERCUSSION – this involves assessment of the body, generally the tummy. The act is placing the middle finger on the tummy and striking it with the other middle finger. By the sounds that the tapping makes the size of the organs can be guessed, and where the organs start or end. It can also determine if there is any fluid underneath the skin in a cavity of the body.

PERICARDIAL TAMPONADE – compression of the heart from an increase in fluid in the sac around the heart.

PERITONEAL CAVITY – the area between the organs in the tummy and the sac that holds them.

PLATLETS – this is the part of the blood that helps the blood form clots. The platelets are used when there is internal or external bleeding. In massive bleeding, there is usually not enough platelets in the blood to stop the bleeding and so outside help like compression is necessary.

PLEURAL EFFUSION – this is an abnormal collection of fluid in the tissues and the air spaces of the lungs. The treatment depends on the cause.

PNEUMOTHORAX – see haemopneumothorax.

POPLITEAL ARTERY INJURY – this is an artery that joins the big artery at the groin, and travels into the legs, dividing into branches at the knee. It supplies blood to the thigh, leg and foot. It is a big artery, and supplies important areas. Bleeding from this artery can be extensive, and it can compromise blood supply to the lower leg.

POSITIVE END EXPIRATORY PRESSURE (PEEP) – this is a part of pushing the air into the lungs when the patient cannot breathe alone. The patient will need to be sedated for this, because for patients who can still breathe, it is hard to breathe with the machine, and in the cycles it has set.

POSTERIOR – the back of the body. This includes the back of the head, arms and legs, as well as the back.

POSTURAL DRAINAGE – the use of gravity and positioning of the patient to get secretions out of the lungs. This is used when the patient cannot cough, or not cough enough to remove secretions on their own.

PREHOSPITAL RETRIVAL – how the patient got tot he hospital, some people are picked by the ambulance service (CDA), some are bought in privately, and some patients even walk in off the street. The question of how they got to the hospital is important to know, as they may have made the injuries worse, depending on how they got to the hospital.

PRIMARY SURVEY This is the first survey that is performed when the patient is bought in to the emergency department. It consists of A B C. This is airway, breathing, and circulation. The way they are presented is the order that they are assessed, and nothing else is done for the patient until these three things are clear or being managed.

PROGNOSIS – the expected outcome of the patient.

PROPHYLACTIC – used to prevent or decrease the risk of infection. For example, giving a patient who has open wounds antibiotics before any infection occurs, may stop an infection.

PROXIMAL – closer to a point of reference. This term is used when describing the location of an injury. The opposite is distal.

PULMONARY OEDEMA – the accumulation of fluid in lung tissues, usually from heart failure. This decreases the ability for the patient to breathe, so action is undertaken quickly. Drugs are given into the vein to take fluid out of the body, and oxygen is given through a mask.

PULMONARY EMBOLUS – a blocked artery in the lung. It can be blocked with fat, air or a blood clot. The patient has chest pain and has difficulty breathing, and the blockage can usually be seen on x-ray This can happen after major surgery, especially bone surgery and is a high priority situation to deal with.

RADIOGRAPHY – x-rays. A series of x-rays are always taken for the trauma patients. These are views of the neck, chest and pelvis, and wherever else the patient has pain. These are bone injuries that are probably the most serious.

RECTAL EXAMINATION – this is a routine examination in the trauma room, where the doctor explores the anus. This is done for a number or reasons, to see if there has been any trauma to that area, to see if there may have been any bowel injury, and also to see if there is muscle strength, because some broken vertebrae can lead to loss of bowel and bladder control.

REFLEXES – reflex checks are not part of a trauma examination, unless the patient is suspected to have a spinal cord injury. Reflexes are responses to stimulus that the body makes without thinking about it. One of the most common known reflexes is the one where the doctor hits underneath the knee with a soft hammer, and the leg jerks forward. All of these are tested to see if there is any injury in the trauma patient and their spinal cord.

RENAL INJURY – any injury to the kidney. These may be considered in a patient who has blood in their urine. If there is severe injury to one kidney, it can be operated on or removed, as it is possible to live with only one kidney.

RENAL FAILURE – the role of the kidneys are to sort out the good from the bad, and dispose of the matter accordingly. So all of the good matter is put back into the circulation, and all of the bad is in urine that is secreted out. In renal failure, the kidney losses its ability to choose. This type of injury can be from trauma, bleeding, burns or injury to the kidney. Once the cause of the injury is corrected, the effects are usually reversible with a restriction of the amount of fluid the patient can have.

RESECTION – where a large part of an organ or structure has been cut out, such as when an injury to the bowel has been found, and it is not repairable, a part may be cut out, and the two ends are joined together.

RESUSCITATION – to revive a patient, this is usually CPR or first aid.

RETROPERITONEAL – the organs that are attached closely to the wall of the tummy, and covered partly in a membrane.

RUPTURE – a tear or break in an organ or tissue.

SAPHENOUS VEIN GRAFT – the saphenous veins are the longest veins in the body, and it basically runs from the foot all the way up to the thigh. When doctors need to use a vein in another part of the body to repair, for example, an arm, they may choose to use this vein. This is called a saphenous vein graft.

SECONDARY SURVEY – this is a head to toe assessment that is performed on trauma patients after the airway, breathing, circulation check is clear. It assesses pain, tenderness, restrictions in movements, abrasions, lacerations, and other factors. A plan is identified, deciding which are the worst injuries, and which tests or operations should take priority.

SEDATION – where the patient is asleep, cal or quiet because of medication given. Sometimes this is necessary to keep agitated patients still for tests, or to stop them from injuring themselves or others.

SEPSIS – severe infection, these patients will sometimes go into septic shock.

SHOCK – a life threatening condition where circulation to the fingers and toes are almost non existent. It is usually caused because the heart is not putting out enough blood, this can be because the patient is bleeding, and there is not enough blood circulating anyway. Fluid replacement is essential.

SKELETAL TRACTION – sometimes broken bones are better not to be operated on. This is especially true of children, where their bones are still growing. Another way of helping the bones to heal besides plaster, is traction. This is where a wire is put into the skin (skin traction) or a bone (skeletal traction), and a weight is put on the bone through a rope and pulley. This actually pulls the broken bones apart and keeps them there so that they can heal. Patients usually stay like this for about 6 weeks, or sometimes only stay in traction a few days before the doctors can fix it in theatre.

SKIN GRAFT – if a patient has lost all layers of skin from an injury, like a burn, it can help the wound heal if some layers of skin are over it. What can be done, is a few layers of skin can be taken from another part of the body (this is usually the thigh, and the site it is taken from is called the donor site) and placed on top of the wound. The skin from the thigh can then grow with the skin around the wound, which can heal the wound quicker, and with less infection.

SKIN TRACTION – see skeletal traction.

SMITHS FRACTURE – one of the types of broken wrists.

SPEENECTOMY – this is removal of the spleen. People can function well without a spleen, throughout life, as it has not yet proven to be of great use to the body.

SPLENIC INJURY – any injury to the spleen. This is an organ that sits near the stomach, and produces red blood cells before birth, and produces cells that fight bacteria through life. In a traumatic incident, the spleen may rupture, this requires emergency management, the spleen is an organ that holds a large amount of blood, the management is removal of part or all of the spleen.

STERNAL FRACTURE – a broken breast bone. These are quite painful, and some patients need to be kept in for pain relief and deep breathing exercises. There is no other intervention needed.

SUB ARACHNOID HAEMORRHAGE (SAH) – a bleed inside the brain. This is graded into different categories with 1 being the best and 5 being the worst. Although this happens mainly with aneurysms, it can also happen due to trauma. These problems are serious, and the patient has to be monitored closely.

SUBDURAL HAEMATOMA (SDH) – a bleed in one of the layers surrounding the brain. These injuries can cause confusion, and some patients may have life long side effects. Some of these bleeds are small enough to just watch, others must be taken to theatre, and the blood must be drained out.

SUBLUXATION – a partial dislocation. This can occur with almost any joint, but the term is mostly used in spinal injuries, where one vertebrae is out of line. These vertebrae can actually enter the spinal canal where the spinal cord sits, and the results can be devastating. An operation is required on bad dislocations.

SWAN-GANZ CATHETER – a tube that is inserted into the heart during open heart surgery to measure pressures.

SYNCOPE – light headedness, or a lapse in consciousness.

TACHYCARDIA – a high heart rate, usually 100 beats per minute or more.

TACHYPNEA – a high amount of breaths taken per minute.

TENDON – bands of tissue that attach muscle to bone. They are strong and flexible. Although bones are usually high priority to fix in theatre, tendons sometimes have to be repaired in an operation too.

TENTANUS INJECTIONS – a tetanus injection is given to patients in the trauma department if they have not had one in the last five years. This is precautionary, because patients have exposed dirty abrasions or lacerations.

TERTIARY SURVEY – this is the third and final trauma survey that is completed by the team of doctors looking after the patient. It is usually done within 24 hours of the patient being admitted, and is a head to toe assessment. This is done to ensure there is nothing missed. It is significantly important, because when patients come in after a traumatic incident, they can be overwhelmed by what happens. They generalise pain, and may not have realised that they have pain in a place not investigated.

THORACIC SPINE – consists of 12 vertebrae, which start at the base of the neck, and continue to around the waist. They are numbered and referred to as T1 to T12. T12 joins the start of the lumbar spine, and this junction is a common site for broken vertebrae. The impact of a car accident, for example, leads to excess force placed on the vertebrae, and so they are compressed under pressure. Although that site is common, and vertebrae can be broken in an accident, and these breaks can lead to many complications, depending on where it is broken, and the overall damage, it can lead to paralysis.

THORACOTOMY – a surgical cut into the chest.

THORAX – the rib cage and lungs and heart inside the rib cage. Anyone who has a major injury to the chest will have a problem with breathing, and this problem can be an emergency situation. This is when a thoracotomy may be used.

THROMBECTOMY – sometimes blood clots may lodge in the vessels of the body and obstruct flow of blood to parts of the body. In an emergency, the patient is taken to theatre, and the clot is removed under general anaesthetic.

THYROID INJURY – an organ in the front of the neck that secretes hormones to allow normal body growth.

TOTAL PARENTAL NUTRITION (TPN) – sometimes patients have injuries of internal organs, and after the organs are operated on, they need a rest. The only way to rest the organs responsible for digesting food, is to stop eating and drinking. TPN is a way of feeding a patient vital vitamins and minerals while they cannot eat. It is given into a vein, and some people are on this form of nutrition for as long as 2 months.

TRACHEAL INJURY – any injury to the windpipe. These can be obstructions, like food, or it can be traumatic injuries from external means, like a knife in the throat. These can compromise airway and breathing, and are an emergency.

TRACHEOSTOMY – a purposeful cut in the windpipe to gain access to the airway and let the patient breathe. This is sometimes made for people with an obstruction that won’t come out, and it may also be done for people who cannot cough up their secretions, which can, in turn, become another windpipe blockage. A tracheostomy tube is then placed into the opening, which means that the patient has a permanent opening in their neck for as long as needed. Some patients may need it for the rest of their lives, some may only need it until they become alert after a head injury.

TRANSECTION – to sever or cut across.

TRAUMA CALL – this is an alert that is sent out to a selected group of doctors and nurses that may need to get involved with a patient who is on their way to the hospital. It gives advanced notice to all of these people so that everyone is there and waiting for the patient to arrive. There is certain criteria for sending out this message, some examples are a person in a car accident that was ejected out of the vehicle, a pedestrian hit by a car, fall greater than 5 metres, injury to 2 or more body parts, and burns to the head and neck.

TRIAGE NURSE – the nurse that decides the urgency of treatment in the emergency department.

UNCONSCIOUS – complete unawareness and lack of response. If a patient comes in this state to the emergency department a number of tests are done to see if there is a brain injury, and how and if it can be fixed.

UNSTABLE FRACTURE – this is a broken bone that may sever nerves or blood supply, or may leave permanent damage to the patient if it moved. There can be broken arms and legs that can be classed as unstable, but this mostly corresponds to broken vertebrae. Unstable vertebrae mean that if the bone moves into the spinal canal it may sever the spinal cord, resulting in paralysis, and even death in broken necks.

VASCULAR INJURY – injury to a blood vessel. There are vast injuries that can be covered by this, because the whole body is vascular. The injuries in the situation of an emergency have to be considered individual. Some injuries are only minor, and may need stitching with local anaesthetic. Others may need to be cleaned up and operated on in theatre.

VASOCONSTRICTION – when the vessels in the extremities, like the hands and the feet, and the skin, get smaller. This happens for a number of reasons, but it is mainly to give the major organs the blood supply they need. In the case of large amounts of blood loss, the body will respond by doing this.

VENOUS CUTDOWN – when it is not possible to find a vein in a patient in the arms, it may be necessary to perform a venous cut down. This is where the doctor must cut through the skin until a vein is found. This is done as a last resort, because it is very painful, but is necessary to give the patient fluids or taking blood out to test.

VENTILATOR – a machine that either helps the patient breathe, or makes the patient breathe when they cannot.

VENTRICULAR FIBRILLATION – a potentially fatal pattern that the heart is pumping in. The heart usually pumps from an electrical impulse telling it to. Sometimes the impulses get mixed up, and the heart moves in no pattern at all. The blood cannot get through one side of the heart and out the other like normal, and the body does not get the blood supply and oxygen it needs. The heart needs to have an electric shock to get it back into a rhythm, this is called defibrillation.

VERTEBRAL COMPRESSION INJURIES – this is when the vertebrae (the bones supporting the spine) are squashed between each other, flattening them out. This happens when people fall, and land on their feet. If these broken bones are stable, the patient needs no treatment. If they are unstable (if the patient puts weight through them, they may do damage), they may need to lie in bed for 6 weeks, or they may need an operation.

VITAL SIGNS – these signs are some of the signs that decide whether the patient is in a stable condition. These are temperature, pulse, blood pressure, respirations, and level of consciousness.

WHIPLASH – this is usually an injury to the neck, that has not done any major damage, but the patient complains of a stiff, sore neck. This is common in car accidents, because the head is thrown forward and back.

ZIMMERSPLINT – a splint that is applied to the leg that stops the patient from bending the knee. This is used on patients who have hand injuries on or around the knee.

ZYGOMA – the cheek bone on the face.

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