EMED: Block 5 Flashcards
___ is the number one cause of death for PTs <46y/o
? are the 3 major causes of death following trauma?
Trauma
Head Chest Vascular injury
In what year did Congress pass something important for EMED
What criteria must be met for a facility to be a Level 1 Trauma Center
1990
Trauma Care Systems Planning/Development Act
Admit 1200 PTs/year or,
240 w/ severity score >15
Conduct trauma research
Train residents/lead education and outreach activities
Maintain surgically directed critical care service
Prior to PTs arrival to hospital, EMS provides ? info on PT
What 3 things are prepared for in the ER prior to arrival?
Sxs Txs Exam Mechanism Injuries VS
Assign team tasks
Prepare equipment
Surgical consults present
Discovery of ? types of injuries during primary survey need immediate attention
Flail chest Tamponade Massive hemorrhage Open PTX Air obstruction TnPTX
What are the NEXUS rules for C-spine
What mechanisms of injury classify as dangerous for Canadian rules?
No neuro deficit Evidence of ETOH X distracting injuries Unconscious Spine pain midline
High speed MVC Fall from >3ft Collision Axial loading injury Rollover/ejection
What are the high risk factors of the Canadian Cervical Spine rules that if met need images?
What are the low risk factors that if No, need imaging
If PTs can’t rotate head past ?*, imaging needed
Age >65yo
Mechanism was dangerous
Parathesia in extremity
Sitting in ED Ambulatory at any time Delayed neck pain Absent cervical tenderness Rear end collision
45* L/R
How are Tension PTx, HemPTx and sucking wounds Tx
PTs w/ no breath sounds and suspected massive injury of what criteria need a thoracotomy?
T: Needle thoracostomy
H: 36F chest tube
S: occlusive dressing
Initial output >1500mL
>200mL/hr
Class 1 Hemorrhage
Class 2 Hemorrhage
Class 3 Hemorrhage
Class 4 Hemorrhage
<750mL/15%
Pulse <100
Normal BP
Norm/Inc pulse pressure
750-1500mL/15-30%
Pulse 100-120
Normal BP
Dec Pulse Pressure
1500-2000ml/30-40%
Pulse 120-140
Dec BP/pulse pressure
> 2000mL/40%
Pulse >140
Dec BP/Pulse pressure
Initial fluid of choice for ER trauma is ?
What is the next step if 2L are pushed and no improvement is seen?
LR w/ 18g or larger
Type O blood
Type O- child bearing age
PTs receiving >10 units of PRBCs show decreased mortality when they received ?
What two factors contribute to these PTs coagulopathy
FFP : PRBC of 1 : 1
Acidosis
Hypothermia
Define the REBOA
When/why is tranexamic acid used?
Resuscitative endovascular balloon occlusion of aorta through common femoral artery for non-compressible torso hemorrhages x 60min
Antifibrinolytic, dec blood loss, prevents plasmin cleavage or fibirin degradation
? PT presentation has a significant head injury until r/o
GCS Motor
GCS Verbal
GCS Eye
Appropriate MOI w/ AMS or GCS <15
6- Obey Local W/draw Flex Extend No
5- Orient Confused Word Sound No
4- Spont Verbal Pain No
How do cardiac tamponades lead to death?
How much fluid does it take to cause this?
Dec RV/LV filling
Septum shifts to L
Dec CO, shock/death
65-100mL
What is often the only clinical sign of a cardiac tamponade
What finding is an ominous sign
? presenting trifecta is a tamponade until r/o
Sinus Tachy
HOTN
Narrow pulse pressure
Inc CVP
When are cardiac tamponade Tx considered futile
PTs presenting w/ abdominal tenderness or distension and HOTN need ?
>15m w/out pulse Blunt trauma arrest Asystole at presentation No pulse/BP in field Non-survivable injury
Immediate transport to OR for Ex-Lap
? image is not needed for PTs w/ gunshots to the abdomen?
What intervention can be used during secondary survey to Tx scalp lacs
US/CT, all go to emergent exploratory laparotomy
Raney clips
What two PE findings have to be normal during Secondary Survey prior to placing catheter?
What is done if these requirements are not met?
What 3 areas of the body can be injured and missed during secondary survey
Normal prostate
No blood at meatus
Retrograde urethrography
Esophagus Diaphragm Small bowel
What routine labs are ordered?
What orders are added if PT presents w/ AMS?
Hgb/Hcg Drug screen Urine dipstick Ethanol Type, screen
Glucose
>55y/o ECG, troponin
What are the non-invasive methods to airway management?
What are the invasive methods?
Passive oxygenation
BVM ventilation
Supraglotic airway
Non-invasive PPV
ET intubation
Cric
Transcutaneous jet
Tracheostomy
Define Hypoventilation
Define Hypoxia
Inadequate CO2 excretion
Inadequate alveolar O2 content
What are the two types of respiratory failure
Type 1: PE, PNA
Hypoxia w/out hypercapnia; oxygenation affected
Type 2: COPD
Hypoxia w/ hypercapnia; ventilation affected
When are high flow NC best used?
Unconscious PTs create ? airway obstructions while foreign bodies create ?
Hypoxia and intact respiratory drive
Upper functional
Mechanical obstructions
What is the key to airway management?
How much O2 is delivered by the 3 types of masks?
PT positioning
NC: 2-6L/min
FM: 5-10L/min
Non-rebreath: 10-15mL
Sequence of Tx steps for tension PTx
Sequence of Tx steps for PTs in stable PTs
Needle D
Tube thoracostomy
Tube thoracostomy