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Medicine > ATLS > Flashcards

ATLS Flashcards

1
Q

Trimodal distribution of deaths - first peak:

A
  • sec to minutes following injury

= severe brain/high spinal cord injury
= rupture of the heart / aorta / large blood vessels

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2
Q

Trimodal distribution of deaths - second peak:

A
  • min to several hours following injury

= subdural/epidural hematoma, hemopneumothorax
= ruptured spleen, liver lacerations
= pelvic fractures etc.

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3
Q

Trimodal distribution of deaths - third peak:

A
  • several days to weeks

= sepsis / MOF

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4
Q

ATLS - ABCDE:

A 
A = airway with cervical spine protection
B = breathing
C = circulation, stop the bleeding
D = disability/neurological status
E = exposure (undress) + Environment (temp.control)
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5
Q

GCS - E (eye opening):

A

4 Spontaneous
3 To speech
2 To pain
1 None

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6
Q

GCS - V (verbal response):

A 
5    Oriented conversation
4    Confused conversation
3    Inappropriate words
2    Incomprehensible sounds
1    None
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7
Q

GCS - M (best motor response):

A 
6   Obeys commands
5   Localizes pain
4   Flexion withdrawal to pain
3   Abnormal flexion (decorticate)
2   Abnormal extension (decerebrate)
1   None
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8
Q

Golden hour is defined as :

A

window of opportunity during which provider can have a positive impact on morbidity and mortality associated with injury

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9
Q

Standart precautions for personell:

A
  • eye protection
  • face mask
  • gown
  • gloves
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10
Q

Triage is defined as:

A
  • sorting of patients based on their needs for treatment and the resources available to provide that treatment

=> appropriate patient arrives at appropriate hospital

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11
Q

Multiple casualties situation is defined:

A
  • the number of patients and the severity of their injuries don’t exceed the capability of the facility to render care

=> pt. with life-threatening problems’re treated first

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12
Q

Mass casualties situation is defined:

A
  • the number of patients and the severity of their injuries exceed the capability of the facility to render care

=> pt. having the greatest chance to survive’re treated first

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13
Q

How to quick assess ABCD:

A
  1. Identify yourself
  2. Ask for the name
  3. Ask what happened

=> failure indicates abnormalities in A, B or C

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14
Q

Disability (neurological evaluation) consits of:

A
  1. Level of consciousness (GCS)
  2. Pupillary size and reaction
  3. Lateralizing signs
  4. Spinal cord injury level
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15
Q

At the time of IV insertion must be taken:

A
  • blood type + crossmatch
  • FBC
  • blood gas incl. lactate
  • pregnancy test (hCG)
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16
Q

How to definitively control hemorrhage:

A
  • pelvic stabilization
  • surgery
  • angioembolization
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17
Q

Best solution to prevent hypotermia in trauma pt.:

A

stop the bleeding

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18
Q

Blunt cardiac injury - ECG:

A
  • AF, tachycardia
  • premature beats
  • ST segment changes
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19
Q

PEA usually indicates:

A
  • cardiac tamponade
  • tension PNO
  • profound hypovolemia
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20
Q

Hypoxia - ECG:

A
  • bradycardia
  • premature beats
  • aberant conduction
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21
Q

Bladder catheterization is contraindicated:

A
  • blood at the urethral meatus
  • perineal ecchymosis
  • high-riding or nonpalpable prostate
     => retrograde urethrogram is indicated
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22
Q

Chain - ATLS:

A

Preparation + Triage

  1. Primary survey (ABCDE) + Resus
  2. Transfer consideration
  3. Secondary survey (History, head-to-toe exam)
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23
Q

History - AMPLE (sec.survey):

A 
A =  Allergies
M = Medication currently used
P =  Past ilnesses  / Pregnancy
L =  Last meal
E =  Events / Environment related to the injury
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24
Q

Don’t ever forget during eye-exam:

A
  • visual acuity (read something)
  • ocular mobility (to exclude entrapment)
  • take the lenses out
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25
Q

Seat-belt mark indicates potential:

A
  • nerve root injury
  • carotid artery injury (palpate + listen)

CAVE: can develop late!!

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26
Q

When the pelvic fracture is highly suspicious:

A

Ecchymosis over:

  • iliac wing
  • pubis
  • labia / scrotum
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27
Q

Definitive airway is defined:

A
  • ET placed in the trachea, cuff inflated below vocal cords, connected to O2, taped
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28
Q

Fracture of the larynx is indicated by:

A
  • hoarseness
  • subcut. emphysema
  • palpable fracture
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29
Q

Difficult intubation - LEMON:

A 
L  =  Look externally
E  =  Evaluate the 3-3-2 rule
M =  Mallampati
O =  Obstruction
N =  Neck mobility
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30
Q

BURP means:

A

Backward Upward Rightward Pressure

= laryngeal manipulation

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31
Q

With bougie can be used ET:

A

6 and more

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32
Q

Needle cricothyroidotomy - jet insufflation technique:

A
  • adult: G 12 - 14
  • child: G 16 - 18

=> 1 sec On, 4 sec Off, O2 15l/min (5 - 7 l/min when glottic obstr.pres)
=> 30 - 45 min, pCO2 is rising

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33
Q

Surgical cricothyroidotomy:

A

> 12 yrs

  • ET 5 - 7 can be inserted
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34
Q

Approximate PaO2 x spO2:

A

100 % 90mmHg
90 % 60mmHg
60 % 30mmHg
50 % 25mmHg

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35
Q

Air flow for face-mask:

A

> 11 l/min

usually 15 l/min

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36
Q

Proper size of airway:

A

corner of mouth to the ear lobe

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37
Q

Colorimetric device - pCO2 detection:

A
  • air: purple
  • +-: tan
  • ok: yellow

should be checked after at least 6 breaths

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38
Q

Preload - determinants:

A
  • Venous capacitance
  • Volum status

MVP - RAP

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39
Q

How much blood is in the venous system:

A

70%

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40
Q

How much of blood can be lost before BPs drops?

A
  • up to 30%
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41
Q

HR varies with age:

A
  • infant 160
  • preschool 140
  • school 120
  • adult 100
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42
Q

Sources of potential blood loss:

A
  • chest / abdomen / retroperitoneum / pelvis
  • extremities
  • external bleeding
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43
Q

Nonhemorrhagic shock - classification:

A
  • cardiogenic shock (blunt injury, embolus, MI)
  • obstructive (tamponade, tension PNO)
  • neurogenic
  • septic
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44
Q

Classic picture of neurogenic shock:

A
  • hypotension
  • no tachycardia
  • no cutaneous vasocontriction
  • no narrowed pulse pressure
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45
Q

Estimated blood volume:

A
  • adult: 70 ml/kg

- child: 80-90 ml/kg

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46
Q

Class I hemmorage:

A

loss up to 15% 750ml

HR

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47
Q

Blood loss and consciousness:

A

loss of more than 50% of blood volume results in loss of consc.

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48
Q

Definition of shock:

A

an abnormality of the circulatory system that results in inadequate organ perfusion and tissue oxygenation

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49
Q

The earliest measurable sign of shock:

A

tachycardia

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50
Q

Normal pulse pressure:

A

30 - 40 mmHg

lower than 30% of BPs

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51
Q

Blood loss by the location:

A
  • tibia, humerus: 750ml
  • femur: 1500ml
  • pelvis: a few litres
      \+ edema in soft tissues
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52
Q

Gastric dilatation can cause:

A
  • unexplained hypotension
  • cardiac dysrhytmia (vagal stimulation)
  • especially in children
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53
Q

Excessive fluid administration - lethal triad:

A
  • coagulopathy
  • acidosis
  • hypotermia
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54
Q

Adequate resus - urinary output:

A
  • adult: 0.5 ml/kg/hod
  • child: 1 ml/kg/hour
  • infant: 2 ml/kg/hour
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55
Q

Patterns of response to initial fluid therapy (initial 2l):

A
  • Rapid loss up to 20%
  • Transient loss up to 40% shows deterioration, blood
  • Minimal loss above 40%
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56
Q

Blood transfusion - types:

A
  • fully crossmatched 1 hour
  • type-specific 10 min
  • O

0- for woman of childbearing age

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57
Q

Massive transfusion is defined:

A

> 10 units of BPacks within first 24hours

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58
Q

Coagulation study:

A
  • Prothrombin
  • Partial Tromboplastin Time
  • Platelet Count
  • Fibrinogen Levels
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59
Q

Who is particulary prone to coagulation abnormalities:

A

major brain injury

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60
Q

Aging and trauma:

A
  • decrease in sympatethic activity (deficit in receptors)
  • decreased cardiac compliance
  • atherosclerosis
  • reduced kidney ability to preserve volume in response to aldos.
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61
Q

Flail chest is defined:

A

segment of the chest wall with no continuity with the rest

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62
Q

Massive hemothorax is defined:

A
  • rapid accumulation of 1500ml of blood
  • or 1/3 of patient’s blood volume

CAVE: neck veins may be flat ‘cos of hypovolemia

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63
Q

Chest tubes for hemothorax:

A
  • 36 to 40 Fr
  • if >1500ml is evacuated early thoracotomy is very likely
  • collect for autotransfusion
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64
Q

When is thoracotomy indicated:

A
  • 1500ml immediately evacuated
  • ongoing loses 200ml/hr for 2-4 hrs
  • persistent need for blood transfusions
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65
Q

Cardiac tamponade - Beck’s triade:

A
  • venous pressure elevation
  • decline in arterial pressure
  • muffled heart tones
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66
Q

Kussmaul’s sign:

A
  • rise in venous pressure with inspiration
      => right ventricular compliance is low
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67
Q

Pulmonary contusion - indications for intubation:

A

spO2

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68
Q

Tracheobronchial injury - locations:

A
  • majority within 2.5cm (1 inch) of the carina

=> selective intubation

CAVE: usually when incomplete expansion of the lung after drain

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69
Q

Traumatic aortic disruption - location:

A
  • near lig.arteriosum

=> usually goes to the left chest -> deviation of trachea to the right
+ depression of the left bronchus
+ elevation of the right bronchus

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70
Q

Traumatic diaphragmatic injury - which side is more likely:

A

left (no liver)

NGT in thoracic cavity => left diaphragm injury
- eventually contrast X-rays when in doubt

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71
Q

Blunt esophageal injury - clinical signs:

A
  • left PNO/Hemothorax without rib fracture
  • blow to the epigastrium or lower sternum and is in shock
  • particulate matter in chest tube is present
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72
Q

Which ribs are usually traumatized:

A

4 - 9

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73
Q

Class II hemorrhage:

A

loss up to 30% 1500ml

HR

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74
Q

Class III hemorrhage:

A

loss up to 40% 2000ml

HR

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75
Q

Class IV hemorrhage:

A

loss above 40% >2000ml HR>140

PP decreased, BPs decreased
confused, lethargic

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76
Q

Pericardiocentesis - initial setup:

A
  • 2 cm inferior to left xiphochondral junction
  • angle of 45 degrees
  • aim toward the tip of left scapula
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77
Q

Anterior abdomes is defined:

A
  • costal margin superiorly
  • anterior axillary lines laterally
  • inquinal ligaments and symphysis inferiorly
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78
Q

The thoraco-abdomen is defined:

A

= diaphragm, liver, spleen, stomach

  • trans-nipple line + infra-scapular line
  • costal margins inferiorly
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79
Q

When inspiration - diaphragm rises to:

A

4 intercostal space

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80
Q

The flank area is defined:

A
  • from anterior to posterior axillary lines

- from 6th intercostal space to iliac crest

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81
Q

The back area is defined:

A
  • from posterior axillary lines

- from tips of scapulae to the iliac crest

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82
Q

The most frequently injured organs with blunt trauma:

A
  • spleen 50%
  • liver 40%
  • small bowel 10%
  • retroperitoneal hematoma 15%
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83
Q

The most frequently injured organs with penetrating injury:

A
  • liver 40%
  • small bowel 30%
  • diaphragm 20%
  • colon 15%
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84
Q

Bucket handle injury:

A

= tear or avulsion of mesentery

  • usually caused by seat-belt
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85
Q

FAST scans:

A
  • pericardial sac
  • hepatorenal fossa
  • splenorenal fossa
  • pelvis/pouch of Douglas
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86
Q

DPL:

decompress stomach and urinary bladder before

A
  • 98% sensitivity
  • with pelvic fractures and pregnancy -> supraumbilical approach
  • open technique -> just below the umbilicus
  • closed techique -> 18G below the umbilicus
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87
Q

DPL - indication for laparotomy:

A
  • blood (>10ml), GIT content is aspirated
  • in not => lavage (10ml/kg, 1000ml for adult)
    positive: RBC>100000/mm3, WBC 500, Gram stain bact.
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88
Q

CT abdominal scan can be used:

A
  • hemodynamically normal patient
  • id there is no apparent indication for laparotomy
  • for unstable patient => FAST, DPL
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89
Q

Urethrography - how to perform:

A
  • 8 Fr urinary catether secured in meatal fossa by balloon (2ml)
  • 35ml of undiluted contrast is instilled
  • check the bladder for contrast
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90
Q

Cystogram - how is performed:

A

350ml syringe barrel held above 40cm with water-soluble contrast
another 50ml may be added

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91
Q

Intravenous pyelogram - how to perform:

A
  • 100 ml of 60% iodine (1.5 ml/kg) IV

- X-ray after 2min

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92
Q

Pelvic fractures - mechanism:

A
  • lateral compression (70%)
  • A-P compression (20%)
  • vertical shear (10%, height over 3.6m)
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93
Q

Pelvis - posterior osseous ligamentous complex:

tearing often goes with disruption of symphysis

A
  • l.sacroiliac
  • l.sacrospinous
  • l.sacrotuberous
  • fibromuscular pelvis floor
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94
Q

What is the best option for definitive management - pelvic fracture:

A
  • angiographic embolization
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95
Q

FAST - right upper quadrant:

A
  • sagittal view in the midaxillary line 10 - 11th rib space
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96
Q

FAST - left upper quadrant:

A

sagittal view in the midaxillary line 8 - 9th rib space

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97
Q

Which is the most commonly injured meningeal vessel?

A

middle meningeal artery over temporal fossa

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98
Q

Uncal herniation - signs:

A
  • ipsilateral pupilary dilatation

- contralateral hemiparesis

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99
Q

How is coma / severe brain injury defined:

A

GCS of 8 or less

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100
Q

Intracranial lesions - classification:

A
  • Diffuse brain injury (hypoxia, diffuse axonal injury)

- Focal brain injury (epidural, subdural, intracerebral hematoma)

101
Q

TBI - hematomas:

A
  • epidural 9% severe TBI (lucid interval)
  • subdural 30%
    - > subdural is usually much more severe brain damage
  • intracerebral contusions 30%
102
Q

Intracerebral contusions can develope into:

A 
Intracerebral hematoma (20%)
   -> rescan within 24hrs
103
Q

MTBI - high risk factors for intervention:

A
  • GCS less than 15
  • susp.open or depressed fracture/basilar fracture
  • vomiting more than twice
  • age > 65 yrs
104
Q

MTBI - moderate risk for neurosurgical intervention:

A
  • loss of consciousness more than 5mins
  • retrograde amnesia more than 30mins
  • dangerous mechanism
105
Q

Ventilation goals:

A

pCO2 35 +- 3 mmHg (4.7 kPa)
-> in deterioration for a while 3.3 - 4.7

spO2 98%

106
Q

TBI - CT scan:

A
  • initial hemodynamic resus is the priority
  • when after resus is BPs >100 then go to CT
  • if not able stabilize the patient => FAST/DPL => OR
107
Q

CT head - shift:

A

5 mm

108
Q

TBI - Manitol:

A
  • solution 20% (20g per 100ml)
  • 1 g/kg over 5 min
  • not for hypotensive patients
109
Q

Posttraumatic epilepsy - numbers:

A
  • closed head injury 5%

- severe 15%

110
Q

Anticonvulsants:

A
  1. Phenytoin
    - loading dose: 1g (max 50mg/min)
    - then 100mg/8hours
111
Q

Brain death confirmation:

A
  • GCS 3
  • nonreactive pupils
  • no brain stem reflexes (oculocephalic, corneal, no gag)
  • apnea test
112
Q

Spinal injury - locations:

A
  • 55% cervical region
  • 15% thoracic
  • 15% thoracolumbar
  • 15% lumbosacral
113
Q

How many % of pt. with cervical spine fracture has a second injury:

A

10%

114
Q

Cervical spine injury in children - % cases:

A

1%

relatively rare

115
Q

For how long can pt. lay on backboard:

A

2 hours

then remove and logroll every 2 hours

116
Q

Which spinal tracts can be assessed:

A
  • tr.corticospinal lat.
  • tr.spinothalamic
  • dorsal column
117
Q

Tr. corticospinal lateralis - assesment:

A
  • posterolateral segment of the cord
  • motor power on the same side
  • voluntary muscle contr., response to painful stimuli
118
Q

Tr.spinothalamicus - assesment:

A
  • anterolateral aspect of the cord
  • transmits pain and temperature of the opposite side
  • pinprick or light touch
119
Q

Dorsal columns - assesment:

A
  • posteromedial aspect of the cord
  • proprioception, vibration sense, some light touch from the same side
  • position sense in the toes and fingers, vibration sense
120
Q

Complete spinal cord injury is defined:

A

no demonstrable sensory or motor function below a certain level

(spinal shock is possible during first weeks)

121
Q

Incomplete spinal cord injury is defined:

A

any degree of motor or sensory function remains

122
Q

Sacral sparing is:

A

sparing of sensation in the perianal region

any perception in the perineal region and/or voluntary contraction of rectal sphincter

123
Q

Dermatome definition:

A

= the area of skin innervated by the sensory axon within a particular segmental nerve root

124
Q

Sensory level is defined:

A

= lowest dermatome with normal sensory function

125
Q

Dermatomes innervated from C-spine:

A

C2 - zadni polovina hlavy
C3 - krk
C4 - dekolt (C2 through C4)
C5 - lateralni strana paze a deltoid area
C6 - lat.strana predlokti a palec/C7,8 zbytek ruky

126
Q

Dermatomes - T:

A 
T1 medialni strana predlokti
T2 medialni strana paze
T4 nipples, T8 xiphisternum
T10 navel
T12 suprapubic area
127
Q

Dermatomes - L:

A

L1 - inquiny, penis
L3 - koleno
L4 - medialni lytko
L5 - lateralni lytko a palec

128
Q

Dermatomes - S:

A

S1 - lateralni polovina nohy
S2 - zadek stehna
S3 - ischial tuberosity area
S4,5 - perianal region

129
Q

Muscle strenght grading:

A 
0 total paralysis
1 palpable or visible contraction
2 full range of motion when gravity eliminated
3 against gravity
4 less than normal strenght 
5 normal strenght
130
Q

Myotomes - C:

A 
C5 deltoid
C6 biceps (flexes forearm)
C7 tricpes (extends forearm)
C8 flexes wrist and fingers
131
Q

Myotomes - T:

A

T1 small fingers abduction

132
Q

Myotomes - L:

A

L2 iliopsoas - hip flexors
L3,4 quadriceps
L4,5 hamstrings
L5 ankle ang big toe dorsiflexors

133
Q

Myotomes - S:

A

S1 ankle plantar flexors

134
Q

Neurogenic shock - results:

A
  • impairment of the descending sympathetics pathways => vasomotor tone and in sympathetic innervatuon of the heart
  • rare below T6
  • use vasopressors, fluids, atropine
135
Q

Spinal shock means:

A

flaccidity and loss of reflexes

136
Q

Diaphragm is innervated:

A

C3 to C5 via n.phrenicus

137
Q

Motor level is defined:

A

lowest key muscle which has grade at least 3

138
Q

Neurologic level is defined:

A

the most caudal segment that has normal sensory and motor function

139
Q

Zone of partial preservation is defined:

A

some impaired sensory and/or motor function

140
Q

Bony level of the injury is defined:

A

the vertebra at which bones are damaged

141
Q

Severity of neurologic defect categorization:

A
  • paraplegia incomplete/complete

- quadriplegia incomplete/complete

142
Q

Central cord syndrome:

A
  • disproportionately greater loss of motor strenght in the upper ex.
  • hyperextension injury
  • vascular compromise in anterior spinal artery (central cord)
143
Q

Anterior cord syndrome:

A
  • paraplegia, sensory loss of temperature and pain
  • position, vibration and deep pressure is ok (dorsal column)
  • infarction of anterior spinal artery
  • worst prognose
144
Q

Brown - Seguard syndrome:

A
  • ipsilateral motor and position sense loss
  • contralateral loss of pain and temp. sensation
  • hemisection of the cord
145
Q

SCIWORA is:

A

spinal cord injury without radiographic abnormalities

146
Q

Children - which part of C-spine is likely to be injured?

A

C1-4 twice more than lower

147
Q

C-spine fractures:

A
  • > atlanto-occipital dislocation
  • > atlas (C1) fracture
  • > atlas (C1) rotary subluxation
  • > C2 fracture
  • > C5 (adults, vertebral body fr.), subluxation C5 on C6
148
Q

Atlas (C1) fractures:

A
  • 40% associated with fracture of axis
  • most common is burst (Jefferson’s) fracture
    disruption of both rings with displacement of lat.masses
149
Q

C1 rotary subluxation:

A
  • most often seen in children
  • persistent rotation of the head (torticollis)
  • X: odontoid is not equidistant from lateral masses
150
Q

Axis (C2) fractures:

A
  • odontoid fractures (60%, type I, II, III)

- posterior elements of C2 (20%, hangman’s fracture)

151
Q

Epyphisis of C2 may look like fracture till age of:

A

6 years

152
Q

Thiracic spine fractures:

A
  • anterior wedge compression injury (rarely >25%), only this stable
  • burst injuries
  • Chance fracture = transverse fracture through the body
  • fracture dislocations
153
Q

Blunt carotid and vascular injuries - risk factors:

A
  • C1-3 fracture
  • cervical spine fracture with subluxation
  • fractures involving foramen transversaruim

=> 30% positive -> CT angio -> LMWH, Aspirin

154
Q

X- rays of spine indications:

A
  • midline neck pain or tenderness
  • neurologic deficit referable to cervical spine
  • altered level of consciousness
  • distraction injury
155
Q

If just ligaments’re damaged, then go for:

A
  • MRI

- flexion-extension X-rays films (or collar for 2-3 weeks)

156
Q

If neurologic deficit is present and CT is negative:

A

MRI or CT myelography

- spinal/epidural hematoma, herniated disc, contusions, ligaments

157
Q

Cervical spine immobilization consists of:

A
  • semirigid cervical collar
  • head immobilization with blocks and tape
  • backboard
  • straps
158
Q

X-rays assesement:

A
  • adequacy and alignment (C1 - T1 must be present)
  • identify the lines (anterior vertebral, spinal, post.spinal, spinous pr)
  • assess the bone (height and integrity)
  • cartilaginous disc spaces (narrowing, widening)
  • dens and soft tissues
159
Q

Dens assessement:

A
  • outline of the dens
  • predental space (3mm)
  • clivus should point to the dens
160
Q

Extraaxial soft tissues assessement:

A

C3 7mm
C7 3cm
- distance between the spinous processess

161
Q

Atlanto-occipital joint assessment:

A
  • Power’s ratio =
162
Q

Child and spine board:

A
  • padding from lumbar spine to the top of shoulders
  • blanket rolls along entire sides of the child
  • head is larger than adults -> result in flexion on board
163
Q

Blast injury - classification:

A
  • primary - force of blast wave
  • secondary - debris accelerated by the blast effect
  • terriary - throw against other objects
164
Q

Limb trauma - what to assess:

A
  • skin integrity
  • neuromuscular function
  • circulatiry status (distal pulses, refill time)
  • skeletal and ligamentous integrity
165
Q

Ankle/brachial doppler index:

A

= BPs ankle/BPs brachial

abnormal flow

166
Q

Potentially life-threating extremity injuries:

A
  • major arterial hemorrhage
  • crush syndrome (most often thigh, calf)
    may lead to MAC, hyperkalemia, hypocalcemia, DIC
  • maintain urinary output >100 ml/hour
167
Q

When myoglobinuria - urinary output:

A

> 100 ml/hr

168
Q

The amputated part should be:

A
  • washed in isotonic solution
  • wrapped on sterila gauze (100000 U of PNC in 50ml)
  • sterile moistened towel
  • plastic bag, crushed ice
169
Q

Signs of compartment syndrome:

A
  • increasing pain greater than expected
  • palpable tenseness of the compartment
  • assymetry of muscle compartments
  • pain on passive stretch
  • altered sensation
170
Q

Tissue pressures when compartment sy. is suspected:

A

> 30 mmHg

BPd - tissue

171
Q

Fractures are defined:

A

break in the continuity of bone cortex

172
Q

X-rays and fractured bone:

A
  • 2 shots at right angles to one another

- joint above and below must be x-rayed and immobilized

173
Q

Knee immobilization - proper angle:

A

10 degrees

174
Q

Capillary refill time:

A

2 sec

175
Q

Extremities - physical examination:

A
  • look (position, color, spont.activity)
  • feel (pulse, refill, muscle comp, joint stability)
  • neurological exam (senzation, motor)
176
Q

Nerve - n.ulnaris:

A
  • index and little finger abduction
  • little finger senzation
  • elbow injury
177
Q

Nerve - n.medianus (distal)

A
  • thenar contraction with opozition
  • senzory index finger
  • wrist fracture
178
Q

Nerve - n.medianus (proximal, interosseous)

A
  • index tip flexion

- supracondylar fracture of humerus (children)

179
Q

Nerve - n.musculocutaneus:

A
  • elbow flexion
  • senzory radial forearm
  • anterior shoulder dislocation
180
Q

Nerve - n.radialis

A
  • thumb and finger metacarpophalangeal extension
  • senzory first dorsal web space
  • anterior shoulder dislocation, distal humerus
181
Q

Nerve - n.axillaris:

A
  • deltoid
  • senzory lateral shoulder
  • anterior shoulder dislocation, proximal humerus
182
Q

Inhalation injury - intubation indications:

A
  • face/neck burns
  • singeing of the eyebrows and nasal vibrisae
  • carbon deposits in mouth/nose/sputum
  • hoarseness/impaired mentation
  • explosions with burns to head nad torso
  • carboxyhemoglobin >10% when involved in a fire
183
Q

Fluid resus require patient with more than % burns:

A

20

  • NGT insertion is indicated as well
184
Q

Rule of nines:

A
  • ok for adults

- children (head 9%, legs 2x7%)

185
Q

Clinical manifestation of inhalation injury - time:

A

may be subtle, quite often don’t appear within the first 24 hours

doubles mortality

186
Q

CO exposure:

levels of carboxyhemoglobin HbCO

A

60% death

187
Q

CO exposure - treatment:

A
  • halftime on air 4hrs
  • halftime on O2 40min=> high-flow O2 via nonrebreathing mask
188
Q

Diagnosis of smoke inhalation injury - requirements:

A
  • exposure to a combustible agent

- signs of exposure in a lower airway below vocal cords (bronchoscopy)

189
Q

Burns - fluids:

A

2 - 4 ml/kg/% postizene plochy za 24hod

  • 50% in first 8 hours
    => odhad, ridime podle diurezy -> adult 0.5ml/kg/hrs (deti
190
Q

Burns - blood gas:

A

cyanide causes persistent acidemia

191
Q

Don’t forget with burns:

A
  • tetanus immunization
  • compartment syndrome
  • with excessive fluids -> abdominal comp. sy.
192
Q

Escharotomy - chest and abdominal:

A
  • anterior axillary lines

- cross-incision at the junction of the torax and abdomen

193
Q

Burns - cold water can be applied up to:

A

10% BSA

194
Q

ATB when burned:

A

NO

195
Q

Chemical burns - first aid:

A
  • flush with water 20-30 min
  • if dry-> brush it away first
  • neutralization has no advantage over water
  • alkali burns to the eye - 8 hours of cont.irrigation
196
Q

When myoglobinuria suspected - urinary output:

A
  • adult >100ml/hr

-

197
Q

Burns - criteria for transfer:

A
  • partial thickness and full-thickness >10% BSA
  • face, eyes, ears, hands, feets, genitalia and perineum
  • full-thickness any size
  • electrical, chemical, inhalation injury
  • preexisting ilness that can complicate treatment
198
Q

Frostnip is defined:

A

pain, pallor and numbness

reversible with rewarmig

199
Q

Frostbite is classified:

A

1 - hyperemie, edema
2 - hyperemia, edema, vesicles, partial-thickness skin necrosis
3 - full-thickness and s.c. necrosis
4 - including muscle and bone with gangrene

200
Q

Nonfreezing injury:

A
  • microvascular endothelial damage, stasis, vascular occlusion
  • 1.6 to 10 degree
  • deep tissue destruction may not be present
201
Q

Frostbite - treatment:

A
  • hot drinks
  • circulating water 40 degree (no dry heat)
  • cardiac monitoring
  • tetanus
  • uninfected blebs let be for 10 days, stop smoking (vasocontriction)
202
Q

Hypotermia classification by core temperature:

A
203
Q

Geriatric - falls accounts for what % of deaths:

A

40%

204
Q

Trauma - risk age:

A
  • 65 years
  • 50% of population has coronary artery stenosis
  • maximal HR is decreasing
205
Q

Maximal heart rate formula:

A

220 - age

206
Q

The aged kidney is less able to:

A
  • resorb Na
  • excrete K, H+
  • max concentration ability: 850 mOsm/kg
  • decreased responsiveness to Renin, Angiotensin
207
Q

Geriatric - fluid requirements:

A
  • correct for lean body mass (then like young)

- when on diuretics then have contracted vascular volume and K deficit

208
Q

Geriatric - CNS:

A
  • brain mass decreases by 10%
  • cerebral blood flow is decreased by 20%
  • intervertebral disc loses water -> load goes to facets, ligaments
  • spinal stenosis likely due to osteophytes
209
Q

Geriatric - hypotermia - notattributabke to shock:

A
  • sepsis
  • endocrine disease
  • pharmacology causes
210
Q

The most common locations of fractures in elderly:

A

ribs
proximal femur
hip
humerus and wrist

211
Q

Impacted fracture:

A
  • ends are driven into each other

- no false motion

212
Q

Colle’s fracture:

A
  • fall on the outstreteched hands
  • metaphyseal fracture of the distal radius (usually base of styloid ulnar process)
  • test n.medianus and flexion of fingers
213
Q

Chronic use of calcium-chanell blockers may result in:

A

limited peripheral vasoconstriction in shock

214
Q

The position of the uterus during pregnancy:

A
  • intrapelvic till 12th week, thick walled uterus
  • umbilicus at 20th week, lot of amniotic fluid
  • costal margin at 34-36 week, thin walled, head in the pelvis
    pelvic fracture can cause serious intracranial injury
215
Q

Abrupt decrease in maternal volume :

A

increase of uterine vascular resistence reducing fetal oxygenation despite reasonably normal maternal vital signs

216
Q

Physiologic anemia in pregnancy:

A
  • plasma volume increases till its plateau at 34 week

- smaller increase in RBC

217
Q

Pregnant woman can loss how much of blood:

A

up to 1200-1500ml before exhibiting any signs of hypovolemia

but fetal distress can be present

218
Q

Pregnancy and clotting:

A
  • clotting factors and fibrinogen mildy elevated

- prothrombin and aPTT may be shortened

219
Q

Normal lab values during pregnancy:

A
  • Hct 32-42%
  • WBC 5-12
  • pH 7.4-7.45
  • bicarbonate 17-22
  • PaCO2 3.3-4
220
Q

Pregnancy - HR, CI, BP:

A
  • HR increased by 10-15 beats/min
  • CI increased by 1-1.5 l/min (uterus and placenta 20% of CO)
  • BP decreases by 5-15mmHg but just in 2nd trimestr
221
Q

Pregnancy - ECG:

A
  • axis shits leftward by 15 degrees
  • inverted T in III and aVF is ok
  • ectopic beats
222
Q

Pregnancy - urinary system:

A
  • fall in U, Creat by 50%

- glycosuria is common

223
Q

Pregnancy - musculosceletal system:

A
  • symphisis widens to 3-8 mm by 7 month

- sacroiliac joint space widens as well by 7 month

224
Q

Eclampsia - priznaky:

A
  • late pregnancy
  • HN, hyperreflexia
  • proteinuria
  • peripheral edema
  • can mimic head injury
225
Q

The causes of fetal death:

A
  • death of the mother

- placental abruption

226
Q

Abruptio placentae is suggested:

A
  • vaginal bleeding (70%)
  • uterine tenderness
  • frequent. contractions, tetany or irritability
  • abdominal pain
227
Q

Uterine rupture is suggested:

A
  • abdominal tenderness, guarding, rigidity
  • abdominal fetal lie (oblique, transverse), easy palpation
  • unability to palpate fundus when fundal rupture
228
Q

Fetal heart tones:

A
  • by 10 week doppler ultrasound
  • by 20 week continual monitoring with tocodynamometer
    • no risk factors: 6hrs
    • risk factor: 24hrs
229
Q

Risk factors for fetal loss or placental abruption:

A
  • HR>110
  • ISS>9
  • evidence of placental abruption
  • fetal HR 160
  • ejection from car, pedestrian
230
Q

The presence of amniotic fluid in vagina is confirmed:

A

pH 7-7.5

231
Q

Rh- mother must be given:

A

Rh immunoglobulin therapy within72hrs

232
Q

Child - equations:

A 
Weigt = (Age x 2) + 10
Tube  = Age/4 + 4
Depth= Age/2 + 12 (Tube x 3)
BPs = 2 x Age + 90 (lower limit +70)
233
Q

Child - by age:

A
  • infant
234
Q

Tube cuff pressure :

A
235
Q

Lenght of trachea:

A
  • infant 5cm

- toddler 7cm

236
Q

Intubation - child:

A
  • SUX (2mg/kg
237
Q

Problems with tube - DOPE:

A 
D = dislodgement
O = obstruction
P = PNO
E = equipment failure
238
Q

Use of pediatric bag mask is for children:

A
239
Q

RR in children:

A
  • infant 30-40

- older 15-20

240
Q

What hypotension in child represents:

A
  • decomp.shock
  • indicates loss >45%
  • fluids and blood
241
Q

IO needles in child:

A
  • infants 18G

- older 15G

242
Q

Child - fluid boluses:

A
  • up to 3 x 20 ml/kg

- Blood 10 ml/kg

243
Q

Child - chest injury:

A
  • 8% of injuries
  • 2/3 have multiple injury
  • the mostcommon lifethreating injury in child is PNO
244
Q

Child - what dictates laparotomy:

A
  • just hemodynamic condition

- free fluid NOT

245
Q

Child - consider intracranial monitoring when:

A
  • GCS of 8 or M of 2
  • multiple injuries associated with brain injury
  • positive CT scan
246
Q

Pediatric verbal score:

A 
5 social smile, fixes and follows
4 cries, but consolable
3 persistently irritable
2 restless, agitated
1 none
247
Q

CT spine in child:

A
  • anterior displacement of C2 on C3 is usuall up to 3mm
    to correct put child on hard surface and padding
  • basilar odontoid synchndrosis up to 5 yrs
  • apical odontoid synchondrosis betwen 5-11 yrs
248
Q

Clear the spine:

A
  • awake, no drugs, no alcohol
  • no distracting injury
  • neurologically normal
  • no neck pain or midline tenderness

Medicine (9 decks)

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