Clinical Flashcards by Carys Hooper

How do you normally treat spinal injuries (and what is a risk of doing it)?

Lying down for 6-8 weeks

Big risk of sepsis/blood clots

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Why do you always do limb surgery under a tourniquet?

Blood is not available
Lower HIV infection risk

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How does laminar flow lower risk of infection?

Removes dead skin and infectious material

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How do you treat long bone fractures?

Use skin/skeletal traction by putting a rod through the bone and pull
Attach weight at the end

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What are complications with skin/skeletal traction?

Malunights (the bone doesn’t bind again)

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How do you surgically treat a major wound?

First you debride - leave wound open with no dressing

Then you can go back after a suitable period and close the wound

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When do you change dressings?

Only under anaesthesia

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Why do you debride all the dead tissue away?

Dead tissue causes infection

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What are the general features of civilian war surgery?

Late presentation
No onward evacuation
Normal burden of disease continues
Difficult environments due to geography/weather/fighting
Limited resources/staff

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What are the minimum standards of management of casualties?

Rapid primary survey
Resuscitation of vital functions
Secondary survey
Definitive care

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What are features of a wound in disasters and conflict?

Multiple wounds and systems
Fragments, bullets, burns and blast
Contaminated

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What are the general features of wound management?

Resuscitation
Wound incision
Debridement
Wound excision
Stabilisation
Wound dressing and splintage
Evacuation for secondary procedures

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What do solid organ injuries normally present with?

Signs of haemorrhage

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What might hollow visceral injury present with?

Late sepsis if initially overlooked

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How can most chest wounds be managed?

Chest drain to remove blood and re-inflate the lung

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What is the immediate concern with head, neck and face injuries?

Airway safety

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What are the signs of shock?

Sweat
Low blood pressure
Pale
Tachycardia and tachypnoea
Low consciousness/anxiety
Cold skin
Low urine output

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What are the two types of shock?

Haemorrhagic
Nonhaemorrhagic

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What causes haemorrhagic shock?

Blood loss

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What causes nonhaemorrhagic shock?

Tension pneumothorax
Cardiac tamponade
Cardiogenic
Neurogenic
Septic

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How can you stop bleeding?

Pressure
Tourniquets
Raise limb
Operation
Reduce pelvic volume

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How do you treat shock?

Restore blood volume and prevent hypothermia

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What are the three types of response to shock treatment?

Rapid responder
Transient responder
Nonresponder

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What is a transient responder after shock treatment?

Gets better then worse again (normally due to blood loss)

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What are the four consequences of disaster on health services?

Structural Non-structural (technical gap) Functional (funds) Professional (brain drain)

What is the maternal health triad?

Access Quality Utilisation

What are the access challenges in maternal health?

Safety Funds Logistics

What are the utilisation challenges in maternal health?

Culture Acceptance Language

What % of mothers experience complications?

40%

What % of mothers develop life threatening complications?

15%

What % of maternal deaths happen in the first 24 hrs??

50%

How long can post-partum infections take to develop?

6 days

What % of lives can emergency obstetric care save?

80%

What are some treatments used in emergency obstetric care?

Prenatal antibiotics Utero tonic drugs Anticonvulsants Manual placental removal

What are some treatments used in basic emergency obstetric care?

Removal of retained products (vacuum or dilation) Assisted vaginal delivery

What are some treatments used in comprehensive emergency obstetric care?

Surgery Blood transfusion

What are some indirect maternal death causes?

Rheumatic heart disease TB Anaemia Hepatitis

What are the leading causes of child death?

Preterm birth complications Pneumonia Birth asphyxia Diarrhoea Malaria

What does a dehydrated baby look like?

Sunken eyes/fontanelle Acidotic Drowsy Stop passing urine

What do you treat sepsis with?

Oxygen Fluids Antibiotics

What are the most likely presentations after an earthquake?

Drowning Asphyxia Dust inhalation Burns and electric shock Environmental exposure Multiple fractures, internal injuries and crush syndrome

What are the range of injuries you see in terrorist attacks?

Blast Ballistic Trauma Crush

What diseases cause 60-95% deaths in displaced populations?

Acute respiratory infection Malnutrition Diarrhoea Measles Malaria TB HIV/AIDS

What are common respiratory diseases in displaced populations?

Acute respiratory infection Measles Diptheria Pneumonic plague Bacterial meningitis COVID

What are the big three Diarrhoeal diseases?

Cholera Dysentery Typhoid

How can you control communicable diseases?

Rapid assessment Prevention Surveillance Outbreak control Disease management

What are the types of anti flu drugs?

Neuraminidase inhibitors M2 inhibitors

How do you treat patients with severe clinical illness associated with flu virus infection?

Treat with antivirals for a minimum of 5 days Do not use corticosteroids unless needed for other reasons

What are the most common presentations in newly displaced populations?

Accidents, hypothermia, burns GI illnesses CVD events OB complications Diabetes Hypertension Mental health emergencies

How can burns cause mortality?

From inhalation injury and multisystem organ failure

How do you treat burns in primary care?

ABCDE Analgesia, cleaning, cooling, covering etc

What are the boundaries for malnutrition in mid upper arm circumference?

140mm =normal 115-125 = moderate malnutrition <115 = severe malnutrition

How to test for bilateral oedema?

Gentle thumb pressure to lower limb - if it indents and doesnt go away, oedema is present

What happens in kwashiorkor protein energy malnutrition?

Little muscle loss Oedema

What happens in marasmus protein energy malnutrition?

Massive muscle loss Very thin

What are the methods of wounding by bullets?

Direct laceration Stretching (and therefore cavitation) Contamination

What influences bullet wound size?

What the bullet hits Yaw cycle of bullet within tissue Fragmentation of the bullet

What type of cavitation does a handgun cause?

In and straight for 15cm Then spins and causes massive cavity (which shrinks)

What type of cavitation does a softpoint pistol bullet cause?

Almost immediate temporary cavity that causes massive stretching (but then shrinks)

What type of cavitation does an AK-47 cause?

In and straight for roughly 15cm Turns once, goes backwards, turns again and goes out 2 cavities Basically the longer the passage the bigger the damage

What type of cavitation does an AK-74 cause?

Turns quickly so causes cavities quickly

What does bullet wound contamination depend on?

Amount of external contaminant introduced Volume of dead tissue in the wound Adequacy of surgery Antibiotics

What is a type 1 land mine injury?

From standing on a brief blast mine Amputation of detonating limb

What is a type 2 land mine injury?

From fragmentation mine Multiple small fragment wounds esp to lower limbs

What is type 3 land mine injury?

Upper limb amputation When detonation occurs while handling or clearing mines

What are the features of a traumatic blast amputation?

Large contamination deep into tissue Delayed swelling of muscles days after injury Bone destruction (fragmentation not just break)

What are the symptoms of acute mountain sickness?

Headache Nausea Difficulty sleeping

What is the difference between acute mountain sickness and cerebral oedema?

Cerebral oedema = acute mountain sickness + ataxia and confusion

What are the most common illnesses when climbing mountains?

Falls Frostbite Altitude illness High altitude cerebral oedema High altitude pulmonary oedema

How often do you need a rest day when climbing?

Every 1000m or 3 days

What are symptoms of high altitude pulmonary oedema?

Shortness of breath Dry cough Pink frothy sputum at a late stage

How do you treat mild altitude illness?

Acetaxolamide Rest Fluid

How do you treat moderate altitude sickness?

Acetezolamide O2 Descend

How do you treat severe altitude sickness?

Acetazolamide Descend In a bag?

What are the major illnesses associated with diving?

Trauma drowning hypothermia Barotrauma Decompression illness Gas problems

What is PTSD?

An extreme reaction to a stressful event

What are the priority status’ In triage?

Priority 1 - immediate (red) Priority 2 - urgent (yellow) can wait 1-2 hrs Priority 3 - delayed (green) walking wounded Dead (black/white)

What does CABC stand for?

Circulation Airway Breathing Circulation