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Senior - Surgery 3 > 2 - MASCAL And Trauma > Flashcards

2 - MASCAL And Trauma Flashcards

1
Q

Trimodal death distribution?

A
  1. Second to minutes
  2. Minutes to hours
  3. Days to weeks

*all after injury

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2
Q

Seconds to minutes

A

Massive internal trauma
Transected vessels
Intracranial injuries

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3
Q

Minutes to hours

A 
Blood loss injuries
Spleen/liver lac
Subdural/epidual hematoma 
Hemo/pneumo
Pelvic fx
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4
Q

Days to weeks

A

Sepsis

MODS

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5
Q

Triage cats

A

Immediate
Delayed
Minimal
Expectant

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6
Q

Immediate patients

A

Airway obstruction or compromise

Tension PTX

Uncontrolled hemorrhage

Blunt/penetrating plus shock

Threatened limb loss

Amputations

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7
Q

Ways to stop major bleeding

A

Tourniquets
Direct pressure
Hemostatic dressings

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8
Q

Methods to secure airway

A

OPA
NPA
Supraglottic
Intubate

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9
Q

Delayed

A

Wounded but stable

Need surgery but no signs of shock

Facial fx or injury but no airway compromise

Globe injuries

Non-life threatening burns

Stable vitals but need higher level of care

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10
Q

Minimal

A

Minor lacs
Minor burns
Small bone fx

Normally can perform self-care

These patients often overwhelm resources in early stages of MASCAL

  • walking wounded
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11
Q

Expectant

A

No vitals

Transcranial GSW with coma

Shock

Severe burns

High spinal cord injuries

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12
Q

Problem with treating expectant patients

A

You need to focus on patients you can actually save

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13
Q

Is triage done once you assign a category to someone?

A

No, gotta keep reassessing

Tourniquets can loosen or fall off, bandages can migrate, gotta check pulses, assess breathing and ventilation

Document care given, stay on top of it as the even unfolds

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14
Q

Primary survey

A

X - stop blood loss

A - airway

B - breathing

C - circulation

D - disability

E - exposure

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15
Q

2 most rapid causes of death

A

Loss of airway

Massive bleeding

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16
Q

Steps of “easy” primary survery

A

Talk to your patient
Get them naked
Roll them over
Get a CXR

17
Q

Control of persistent hemorrhage not responding to direct pressure and not amenable to tourniquet?

A

Hemostatic bandage (i.e. Quick-Clot, Combat Gauze)(usually impregnated with kaolin)

18
Q

What type of injuries may cause delayed presentation of respiratory difficulties?

A

Burns or chemical inhalation injury

19
Q

Zones of the neck

A

Zone 1 -sternal notch to cricoid membrane - CXR, CT angio, EGD, bronch

Zone 2 - cricoid membrane to mouth - SURGERY if hard signs, otherwise CTA, EGD, bronch

Zone 3 - mouth - CT-head, CT-angio, direct laryngoscopy

20
Q

Hard signs of Zone 2 injury

A 
Crepitus
Hoarse
Bloody cough/saliva
Dyspnea
Drool
Stridor
Dysphagia
Expanding hematoma
Stroke
Excessive bleeding
HOTN
21
Q

How to size NPA?

A

Nare to ear lobe

22
Q

When to not give NPA?

A

Basilar skull fx

23
Q

OPA

A

Measure from corner of mouth to ramus

Insert then rotate 180

24
Q

Supraglotic airway

A

Inserted blind

Seats at epiglottis and prevents gastric inflation

Doesn’’t work if intact gag reflex

25
Q

Chest asymmetry, consider

A

Flail chest

26
Q

What is a flail chest?

A

Series of rib fx’s in two or more places

Paradoxical movement of the ribs during respiration

27
Q

Tension PTX txt?

A

Needle decomp - 14G 8cm angiocath @ 2-3 ICS MCL

28
Q

Open PTX

A

Sucking chest wound

One-way valve

Commercial chest seal

29
Q

As a rule, what is not performed during a MASCAL?

A

CPR - move onto someone you can actually help

30
Q

GCS

A

EVM / 456

31
Q

Super quick snapshot of mental status/disability:

A

AVPU

32
Q

Dilated pupil?

A

Ipsilateral injury

33
Q

Lateral gaze with dilated pupil?

A

Brain stem herniation through tentorium cerebelli

34
Q

Exposure

A

Get em naked

Head to toe, then logroll onto side to check back

35
Q

Features of a good triage area (field)

A

Proximity to LZ or ground evac area

One-way flow of traffic (vehicles and patients)

Easily identified and marked

Well-lit, open and covered

Dedicated casualty recorders (PAD)

Sufficient manual labor

36
Q

Treatment in the triage area?

A

No - just assign them a category and keep em moving

37
Q

9-line and MIST

A

Slide 27 (dunno if it’s testable)

38
Q

Did you hear about the guy who invented the knock knock joke?

A

He was given the NO Bell prize

Senior - Surgery 3 (12 decks)

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