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IPAP > EMED: Block 5 > Flashcards

EMED: Block 5 Flashcards

1
Q

___ is the number one cause of death for PTs <46y/o

? are the 3 major causes of death following trauma?

A

Trauma

Head Chest Vascular injury

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2
Q

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

A

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

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3
Q

Prior to PTs arrival to hospital, EMS provides ? info on PT

What 3 things are prepared for in the ER prior to arrival?

A

Sxs Txs Exam Mechanism Injuries VS

Assign team tasks
Prepare equipment
Surgical consults present

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4
Q

Discovery of ? types of injuries during primary survey need immediate attention

A 
Flail chest
Tamponade
Massive hemorrhage
Open PTX
Air obstruction
TnPTX
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5
Q

What are the NEXUS rules for C-spine

What mechanisms of injury classify as dangerous for Canadian rules?

A 
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
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6
Q

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

A

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

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7
Q

How are Tension PTx, HemPTx and sucking wounds Tx

PTs w/ no breath sounds and suspected massive injury of what criteria need a thoracotomy?

A

T: Needle thoracostomy
H: 36F chest tube
S: occlusive dressing

Initial output >1500mL
>200mL/hr

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8
Q

Class 1 Hemorrhage

Class 2 Hemorrhage

Class 3 Hemorrhage

Class 4 Hemorrhage

A

<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

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9
Q

Initial fluid of choice for ER trauma is ?

What is the next step if 2L are pushed and no improvement is seen?

A

LR w/ 18g or larger

Type O blood
Type O- child bearing age

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10
Q

PTs receiving >10 units of PRBCs show decreased mortality when they received ?

What two factors contribute to these PTs coagulopathy

A

FFP : PRBC of 1 : 1

Acidosis
Hypothermia

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11
Q

Define the REBOA

When/why is tranexamic acid used?

A

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

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12
Q

? PT presentation has a significant head injury until r/o

GCS Motor
GCS Verbal
GCS Eye

A

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

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13
Q

How do cardiac tamponades lead to death?

How much fluid does it take to cause this?

A

Dec RV/LV filling
Septum shifts to L
Dec CO, shock/death

65-100mL

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14
Q

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

A

Sinus Tachy

HOTN

Narrow pulse pressure
Inc CVP

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15
Q

When are cardiac tamponade Tx considered futile

PTs presenting w/ abdominal tenderness or distension and HOTN need ?

A 
>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

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16
Q

? image is not needed for PTs w/ gunshots to the abdomen?

What intervention can be used during secondary survey to Tx scalp lacs

A

US/CT, all go to emergent exploratory laparotomy

Raney clips

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17
Q

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

A

Normal prostate
No blood at meatus

Retrograde urethrography

Esophagus Diaphragm Small bowel

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18
Q

What routine labs are ordered?

What orders are added if PT presents w/ AMS?

A 
Hgb/Hcg
Drug screen
Urine dipstick
Ethanol
Type, screen

Glucose
>55y/o ECG, troponin

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19
Q

What are the non-invasive methods to airway management?

What are the invasive methods?

A

Passive oxygenation
BVM ventilation
Supraglotic airway
Non-invasive PPV

ET intubation
Cric
Transcutaneous jet
Tracheostomy

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20
Q

Define Hypoventilation

Define Hypoxia

A

Inadequate CO2 excretion

Inadequate alveolar O2 content

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21
Q

What are the two types of respiratory failure

A

Type 1: PE, PNA
Hypoxia w/out hypercapnia; oxygenation affected

Type 2: COPD
Hypoxia w/ hypercapnia; ventilation affected

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22
Q

When are high flow NC best used?

Unconscious PTs create ? airway obstructions while foreign bodies create ?

A

Hypoxia and intact respiratory drive

Upper functional
Mechanical obstructions

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23
Q

What is the key to airway management?

How much O2 is delivered by the 3 types of masks?

A

PT positioning

NC: 2-6L/min
FM: 5-10L/min
Non-rebreath: 10-15mL

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24
Q

Sequence of Tx steps for tension PTx

Sequence of Tx steps for PTs in stable PTs

A

Needle D
Tube thoracostomy

Tube thoracostomy

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25
Q

How do OPAs work and who are they used for

How do NPAs work and who are they used for

A

Prevents tongue from blocking hypopharynx
Comatose/deeply obtunded PT w/out gag reflex

Displaces soft palate and posterior tongue
PTs w/ gag reflex and no midface trauma

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26
Q

Define NIPPV and what this includes

This form of airway helps augment for ?

A

Pos pressure airway through mask w/out ET tubes
BiPAP/CPAP

Spontaneous respirations

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27
Q

Who is the ideal PT for NIPPV methods?

These need to be used w/ caution in ? PTs

A

Protective reflexes
Intact ventilation efforts
Cooperative

HOTN- worsens volume depletion of CO

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28
Q

Advantages of NIPPV

Disadvantages of NIPPV

A 
Reduces work of breathing
Atelectic aveoli recruitment
Improves pulm compliance
Less sedation
Shorter hospital stays

Barotrauma Alkalosis Inc pressure Trapped air

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29
Q

MC use for NIPPV is ?

What other instances is it used for?

A

Cardiogenic pulmonary edema

Flail chest
Pneumonia
Burns
COPD
Asthma exacerbation
Blunt chest trauma
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30
Q

Supraglottic airways are placed into ? part of the body

What PTs can they be used in

What are the complications that can arise from using these airways

A

Oropharynx

Apneic
Unconscious

Laryngospasm
Sore throat

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31
Q

What do King LTs block to allow for ventilation

What complications can arise from using King LTs and LMAs

A

Prox- posterior oropharynx
Dist: esophagus

King: tongue engorgement
LMA: obstruction, aspiration

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32
Q

Tracheal intubation is a cornerstone to emergency medicine and allows ? five benefits

What other tests can be done to verify correct placement

A 
Conduit
Airway
Sedation/paralysis
Prevents aspiration
Aids O2/ventilation

Expired CO2 measurement,
Gold= good
Capnography >30mmHg

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33
Q

Define Mactintosh blade

Define Miller blade

A

Curved blade placed in vallecula, indirectly lifts epiglottis off larynx w/ less trauma/air way stimulation

Straight blade, physically lifts epiglottis to see larynx; easier in PTs w/out central incisors

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34
Q

What is usually the best PT position for RSI

How are these PTs pre-oxygenated

A

Ear horizontal to sternal notch

100% O2 x 3min w/ NRB at 15L/min

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35
Q

Why would adults be pre-treated prior to RSI

Why adverse effect is usually seen in Peds

A

Reflex sympathetic response, harmful in Pts w/ elevated ICP, MI, dissections

Vagal responses

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36
Q

What are the 3 RSI induction agents

A

Etomidate-
Non-barbituate hypnotic
No sympathetic blunting

Propofol-
Sedative w/ anti convulsant/emetic ability

Ketamine-
Dissociative/amnesia, only one w/ analgesia

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37
Q

Benefits of using Etomidate

Caveats of its use

A

Dec ICP, occular pressure
Neutral BP

Decreases cortisol
Myoclonic jerking
Vomit

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38
Q

Benefits of using Propofol

Caveats to its use

A

Anti emetic/convulsant
Dec ICP

HOTN
Apnea

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39
Q

Benefits of using Ketamine

Caveats to its use

A

Bronchodilator
Analgesia
Dissociative amnesia

Inc BP/secretions
Emergence phenomenon

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40
Q

What depolarizing neuromuscular blockers are used for RSI paralytics

What non-depolarizing neuromuscular blockers are used for RSI paralytics

A

Succinylcholine- high affinity for receptors and resistant to Ach-esterase

Vecu/Rocuronium
Compete w/ Ach for receptor and antagonized by anti-cholingerics

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41
Q

3 benefits of RSI paralytics

What complications arise from using Succinylcholine

A

Control intracranial HTN
Improve mech ventilation
Facilitate intubation

Bradycardia
Apnea
Malignant hyperthermia
Fasciculations
Increased pressures
Spasm, masseter
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42
Q

What are the 3 ventilator methods

What are the 3 classifications of TBI by GCS score

A

Continuous- OR
Assisted- resp distress, ED
Synchronized Intermittent Mandatory Vent- predetermined rate

Mild: 14-15, concussion
Mod: 9-13, disability
Sev: 3-8, death <48hrs

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43
Q

HTN, Hypocarbia and Alkalosis affect cerebral blood flow by causing ?

Normal CPP is ?

Maintain MAP above ?

A

Constriction

<60mm- lower limit of autoregulation

80mm or higher
(85-90 if CV complications)

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44
Q

What happens after the primary brain injury during the secondary injury?

What is the difference between secondary neurotoxic cascade w/ secondary insults?

A

Presynapatic glutamate release- activates enzymes, induces mitochondiral damage, death, necrosis

Neurotoxic- glutamate

Insult: catalysts to neurotoxic damage- HOTN, Hypoxemia, Hyperglycemia, hypercarbia

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45
Q

How does brain edema occur

A

Cellular swelling/cytotoxic edema: large ionic shifts, lost membrane integrity

Extracellular damage: BBB breakdown, altered water exchange mechanism

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46
Q

Define Uncal Herniation

What type of brain injury can cause this herniation

A

MC, temporal lobe through medial tentorium to CN3=
Ipsilateral Fixed/Dilated pupil
Pyramidal tract compression, contralateral motor paralysis

Football shape epidural bleed

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47
Q

Central Transtentorial Herniation causes ? prominent Sxs

What findings can develop later?

A

Mid-line lesions causing:
Bilateral pin point pupil
Inc muscle tone*
Bilateral Babinski

Prolonged hyperventilation
Decorticate posture
Fixed mid point pupil

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48
Q

Define Cerebellotonsillar herniation

Define Upward Transterorial Herniation

A

Tonsil herniates through foramen magnum:
Sudden death
Pinpoint pupil
Flaccid paralysis*

Posterior fossa lesion:
Pinpoint pupils
Conjugate downward gaze
No vertical eye movement

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49
Q

PTs presenting to ER w/ ? 4 findings increase concern for brain injuries

A

Focal neuro deficit
Emesis
Dec LoC
Seizure

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50
Q

Single fixed, dilated pupil indicates ?

Bilaterally fixed, dilated pupils indicates ?

Bilateral pinpoint pupils indicates ?

A

Intracranial hematoma w/ uncal herniation
Tx: STAT decompression

Bilateral uncal herniation
Inc ICP w/ poor perfusion
Atropine use
Severe hypoxia

Opiates
Central pontine lesions

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51
Q

Define Decorticate Posture

Define Decerebrate Posture

A

UE flexion, LE extension
Intracranial injury above midbrain

Arm extend, wrist/finger flexion w/ internal rotation
LE extension
Caudal injury

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52
Q

Why does hyperventilation need to be avoided in head trauma PTs

What range is used to guide airway Txs

A

Cerebral vasoconstriction

PCO2 35-45mmHg

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53
Q

PTs presenting w/ head injuries and what two VS findings have 150% inc or mortality

What are CT findings of intracranial HTN

A

SBP <90
Hypoxemia- PaO2 <60

Compressed lat ventricles
Attenuation of sulci/gyri
Poor grey/white distinction

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54
Q

Brain pressure equation

When monitoring these PTs keep CPP between ? range to prevent ? end result

Maintain SBP and MAP above ?

A

CPP= MAP - ICP

55-60
>70= organ damage

SBP >90
MAP >80

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55
Q

Isolated head injuries rarely produce HOTN except ?

In order to prevent hyperglycemia, what is the glucose goal range?

A

Pre-terminal indication

100-180mg/dL
5.55-9.99mmol/L

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56
Q

What are the 4 signs of impending transterntorial herniation?

What two meds can be used to lower ICP

A

Neuro deterioration
Pupillary dilation
Motor posturing
Hemiparesis

Mannitol
Hypertonic saline

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57
Q

ICP monitoring is needed w/ normal CTs and PT meets ? criteria

An increase of ?mmHg increases a PTs MnM

Linear skull Fx w/ overlying lac is categorized as ?

A

Two of:
SBP <90
Age >40y/o
Motor posturing

> 20mm

Open Fx

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58
Q

Skull Fxs that cross ? have high complication rates?

When would IV Vanc and Ceftriaxone need to be given

When do these Fxs need surgical repair

A

Middle meningeal artery Major venous sinus
Linear occipital Fxs

Sinus involvement
Open/depressed Fxs
Pneumocephalus Fxs

Depression> skull thick

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59
Q

MC basilar skull Fxs involve ? 3 structures

Presenting indications PT may have Basilar Skull Fx

A

Petrous temporal bone
EAC
TM

CSF leak
Raccoon/Battle
Hemotympanium
Vertigo
Dec hearing/deaf
CN7 palsy
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60
Q

PTs w/ CSF leaks are at risk for ? and need ? ABX

What type of cerebral contusions are associated w/ SAH?

A

Meningitis
Ceftriax and Vanc

Subfrontal cortex
Frontal/temporal bones
Occipital lobes

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61
Q

When are CT scans more likely to find trauma induced SAH

Define Epidural Hematoma

What is the classic PT presentation

A

6-8hrs after injury

Blood between skull/dura from blunt trauma to temporal= Fx, meningeal artery disruption

Trauma LoC Lucid Rapid decline

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62
Q

What causes subdural hematomas

Why do these present so much later?

A

Accel/Decel tearing dural vein
Hematoma between dura and arachnoid

Venous origin causes slower accumulation

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63
Q

What PT populations are more likely to develop subdural hematomas

Criteria for these to be categorized as acute and how do they present

A

Elderly/Alcoholic (atrophy)
Peds <2y/o

Acute: <14d, unconscious
Chronic: >14d, no memory of fall/trauma

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64
Q

How doe acute subdural hematomas look on CT scans

How do chronic cases look?

A

Hyerpdense/white crescent, crosses suture lines

Hypodense/dark due to metabolized Fe in blood

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65
Q

Table Slide 74

A

Deck Head trauma

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66
Q

Define Diffuse Axon Injury

What types of injuries can cause this

Severe cases can cause ? to develop rapidly

A

Axon fiber disruption in white matter/brain stem from sudden deceleration

MVC
Shaken baby

Edema

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67
Q

What are the classic CT findings of diffuse axonal injury

What holds C1 and C2 together

A

Punctuate hemorrhage along grey/white junction of cortex/deep structures

Odontoid of axis held against C1 w/ Transverse ligament

68
Q

Where do most vertebral column injuries occur at?

Spinal cord is continuous w/ ? brain structure and terminates at ?

How many pairs of spinal nerves are there

A

MC: C2 , C5-7
2nd MC: TL transition zone

Medulla oblongata
L1-2

31- 8C 12T 5L 5S 1C

69
Q

What is the transition zone between the thoracic and lumbar spine

This also serves as the transition zone for ?

What is the benefit of having a vertebral injury at the TL junction

A

T11-L2

End of spinal cord to cauda equina roots

Partial, no neuro deficits
Thoracic injury-complete

70
Q

What are the 4 lines used for plain film reading from ant to post

How does the prevertebral thickness change between C-spine vertebrae

A

Anterior vertebral
Posterior vertebral
Spinolaminar
Posterior spinous

C2: 7mm
C7: 2cm

71
Q

Anterior Subluxation of C-Spine

A

MOI: flexion, usually stable

Plain films- normal

Ligament failure, no Fx
Serious injury- fanning at injury level

72
Q

Atlantoaxial dislocation

A

MOI: flexion, unstable

Transverse ligament rupture w/out Fx = direct blow to occiput

Dx w/ predental space:
>2mm= injury
>5mm- rupture

73
Q

Bilateral Interfacetal Dislocation

A

MOI- flexion, unstable

Anterior, superior facet dislocation

Xray shows >50% anterior dislocation

Locked facet- neuro Sxs
Perched facet- no neuro Sxs

74
Q

Simple Wedge/Compression Fx

A

MOI: flexion, usually stable

MC thoracic Fx
Fx of superior end plate, spares inferior end plate

Isolated- stable
Posterior ligament disruption- unstable

75
Q

Spinous Process Avulsion Fx/Clay Shoveler’s Fx

A

MOI: flexion, stable

Usually C7 process avulsion from muscle contraction pulling bone via ligamentous complex

No neuro compromise

76
Q

Tear drop Fx

A

MOI: flexion, highly unstable

Extreme hyperflexion disrupts ligaments

Teardrop= anteroinferior portion of vertebral body displaced by anterior spinal ligament

Saggital Fx on CT

Causes Anterior Spinal Cord syndrome

77
Q

Lateral Mass Fx

A

MOI: Flexion-roation, unstable

Unilateral facet dislocation pointing to side of dislocation

Sever pain, radiculopathy Sxs
Brown Sequard syndrome

MRA r/o vertebral artery injury

78
Q

Anterior Compression W/ Transverse Vertebral Body Fx

A

MOI: flexion-distraction, unstable

Seat belt injury, lap belt alone causing posterior vertebral wall Fx

Chance Fx- T11-L2 zone Fx/ligament distraction

Order CT, abdominal injuries common

79
Q

Jefferson Burst Fx of Atlas

A

MOI: vertical compression, potentially unstable

Vertical compression pushes occipital condyles, burst Fx of C1

Order Odontoid xray
Sum of lateral masses displacement >7mm= transverse ligament rupture, unstable

80
Q

Burst Fx

A

MOI: vertical compression, unstable

Vertebrae compressed by axial load, fragments displace in all directions

81
Q

Hyperextension dislocation

A

Extension, unstable

Extreme hyperextension tears ALL and intervetebral disc

Prevertebral swelling may be only radiographic finding

Central Cord Syndrome presentation

82
Q

Hyperextension Tear Drop Fx

A

Extension, unstable w/ extension

ALL avulses from hyper extension

Common in older PTs w/ osteoporosis

83
Q

Traumatic Spondylolisthesis

A

Hangman Fx
Extension, unstable

C2 pedicles Fx w/ anterior displacement of C2 on C3

Judicial hanging causing hyperextension not seen in suicide hangings

No neuro injury

84
Q

Atlanto-Occipital Dissociation

A

High energy impact, highly unstable

UE paralysis, normal LE=
Cruciate paralysis

85
Q

Odontoid/Dens Fxs

Translational Fx-Dislocation

A 
2 and 3 unstable
Combo/high energy
Severe cervical pain w/ muscle spasms
Radiating pain to occiput
En face- can be missed on CT

All 3 spinal columns disrupted= severe neuro presentation
Absence of unstable rib Fx, above T7 can be stable

86
Q

Transverse sacral Fx cause ?

Longitudinal sacral Fx cause ?

Central sacral Fxs cause ?

A

Cauda Equina Syndrome

Radiculopathy

Incontinence

87
Q

? system splits the spinal column into 3 elements

When is a spine Fx considered unstable

A

Denis column system- ant, mid, post

Two regional columns involved

88
Q

Damage to Spinal Cord is a result of what two types of injury

What are the two phases of tissue injury that follow?

A

Mechanical force
Vascular/chemical processes

Initial: hemorrhage into cord
Secondary: tissue degeneration from Na channel, Ca influx and Glutamine release

89
Q

Cell death from spine trauma can happen due to ? trifecta of events?

What are the 3 spinal tracts involved in spinal cord lesions

A

E+ imbalance
Cell edema
Oxidants

Corticospinal
Spinothalamic
Dorsal column

90
Q

Define Corticospinal tract

Where do these tracts cross over?

Damage to these tracts result in ipsilateral findings of ?

A

Descending motor pathway

Lower medulla

Weakness
Inc DTRs
Spasticity
Pos Babinksi

91
Q

Define Spinothalamic Tract

What happens when these tracts are damaged

A

Transmits pain, temp sensations

Contralateral loss of pain, temp

92
Q

Define the Dorsal Column

What happens when these are injured?

A

Vibration, proprioception transmission

Ipsilateral loss of senses

93
Q

Since light touch is transmitted through ? and ?, this sensation is not lost unless both are damaged

What is the difference in naming of cervical and thoracic nerves

A

Spinothalamic and dorsal column

C: exit foramen above vertebral body (C8 exits below C7)
T: exit foramen below vertebral body

94
Q

Spinal immobilization is no longer recommended for ? PTs

HOTN in Pts w/ spinal injuries are assumed to be d/t ? until r/o and Tx w/ ?

A

Fully conscious
Isolated penetrating neck injury
Neuro intact

Blood loss
IV crystalloid

95
Q

What types of presenting Sxs from spinal injury indicate a high cervical injury

Define Sacral Sparing

A

Dyspnea
Anxiety
Palpitations
Abdominal breathing

Anal wink, anogenital reflex= incomplete spinal cord lesion

96
Q

Define Anterior Cord Syndrome MOIs and findings

A

Poor prognosis
Corticospinal/spinothalamic damage- tear drop fx

Direct anterior compression, Flexed cervical spine=
Paralysis below lesion
Loss of pain/temp

Anterior spine thrombosis= proprioception, vibration preserved

97
Q

Define Central Cord Syndrome MOIs and PE findings

A

Hyperextension
Disrupted blood flow
Cervical stenosis

Quadriparesis, most in UE
Loss of pain/temp, most in UE

98
Q

Define Brown-Sequard Syndrome MOIs and PE findings

A

MC from penetrating trauma

Transverse hemisection
Unilateral cord compression

Ipsilateral spastic paresis
Lost proprioception/vibration
Contralateral loss of pain/temp

99
Q

? is not a true spinal cord syndrome

How can it present?

What image is ordered

A

Cauda equina syndrome

Saddle anesthesia
Incontinence dysfunction
Motor/sensory loss
Dec rectal tone
Dec LE reflexes
Sciatica

MRI of lumbosacral spine

100
Q

Define neurogenic shock

How will PT look

A

Type of distributive shock- lost peripheral sympathetic tone causes vasodilation

HOTN, warm, tachy
(T1-4 compromise= brady)

101
Q

Define Spinal Shock

How do PTs present

What will be the first reflexes to return

A

Temporary loss of spinal reflex

Flaccid, no reflexes, no voluntary movement

Delayed plantar/bulbar reflexes

102
Q

Standard C-spine x-rays include what views

For a neck x-ray to be “good” what landmarks must be included?

What type of view may be needed to visualize the C-T junction

A

Lat Ant-Post Odontoid

C1-7 and Superior T1

Swimmer’s- assistant pulls shoulders down during x-ray

103
Q

What do PTs complain of who have cervical ligamentous injuries

What imaging is needed for these presentations

What is done if this next imaging is not available

A

Focal neuro w/ normal x-ray/CT
Extremity parethesias
Persistent/midline pain

MRI

D/c w/ rigid C-collar and f/u in 3-5 days

104
Q

When is MRI preferred over CT for spinal cord injuries

Thoracolumbar Fxs are at high risk for ?

A

Herniated disc
Nerve injury
Cord contusion

Spinal cord injury
Aortic/visceral injuries

105
Q

When can wedge Fxs of the spine be d/c and managed outpatient

When are wedge Fxs conisdered unstable

Compression Fxs must have ? r/o

A

<40% loss of height

50% or more loss of height
>25% difference between damage/healthy bone

Burst Fx- compression of posterior half of vertebrae

106
Q

What is the next step if a pathologic compression Fx is discovered on CXR

What criteria must be met to Tx them outpatient

A

CT

Stable wedge compression Fx w/ no neuro compromise

107
Q

? vasopressor is used for CV complications when hemodynamically significant bradycardia

What are the MC injured abdominal organs

PTs are at risk of dying from ? of from ? if they survive initial trauma

A

Atropine

Liver- MC organ injured
Spleen- MC organ injured from sports

Hemorrhage
Infection, sepsis

108
Q

What is the preferred imaging modality for abdominal trauma work ups?

? is the MC MOI for blunt abdominal trauma

? is the typical intra-abdominal injury

A

CT w/ contrast

MCV

Hollow viscous ruptures

109
Q

How do PTs w/ abdmoninal wall contusions present

How do these present as they develop?

A

Pain w/ trunk flexion/rotation
Focal tenderness to percussion

Carnnets Sign- pain inferior to umbilicus inc w/ sit up

110
Q

Pts w/ splenic injuries complain of ? while liver injuries complain of ?

PTs w/ ? two conditions can predispose them to splenic issues

A

Spleen- L shoulder pain
Liver- R shoulder pain

Mono
Pregnancy

111
Q

Chemical irritation to the peritoneum differs from bacterial contamination in ? way

Pancreatic injuries commonly occur from ? MOI

A

Chemical/Blood- immediate
Bacteria- delayed

Rapid deceleration- unrestrained drivers, cyclists

112
Q

How do duodenal injuries present

What causes duodenal ruptures to occur in trauma

PTs w/ delayed presentations usually have ? signs

A

S/Sxs outlet obstructions- ab pain, distension, vomit

High velocity deceleration causing intralumenal pressure increase in pylorus/prox SB

Fever, Leukocytosis herald development of abscess/sepsis

113
Q

What causes discomfort when “getting wind knocked out”?

Diaphragm ruptures are almost always on ? side

A

Diaphragm inability to relax

L side= herniation/strangulation of abdominal contents

114
Q

What does FAST stand for

How long does this take?

A

Focused Assessment w/ Sonography for Trauma

4min

115
Q

Massive hemoperitoneum is going to first be seen ? on FAST

Where is it going to collect first on the opposite side of the body?

What is the disadvantage of FAST over CT

A

Morrison’s pouch, RUQ

Splenocholic ligament causes accumulation between diaphragm/spleen

Can’t ID source of bleeds

116
Q

? is the non-invasive gold standard Dx study of choice for abdominal injuries

When is this gold standard c/i

CT is the ideal study assessment for what two structures?

A

CT w/ IV contrast

PT w/ contrast allergy

Pancreas
Duodenum

117
Q

What is the gold standard therapy for significant intra-abdominal injuries

All PTs w/ persistent HOTN, abdominal wall disruption or peritonitis need ?

If abdominal trauma PT is d/c from ER, what are the f/u orders given?

A

Laparotomy

Surgical exploration

Fever
Inc pain
Vomit
Sxs of blood loss

118
Q

What are the five roles of medical care in military medicine

A

1: self/buddy aid to BAS
2: Brigade/Division- first level w/ blood, x-ray/lab, PT hold ability x 72hrs
3: Corps level- full surgical, lab/rad w/ CT, stabilize for evac
4: Definitive care- Longsthool, out of theater, full rehab, tertiary care
5: US hospital, BAMCI

119
Q

What are the 3 phases of care for TCCC

These are developed to address preventable causes of death like ?

A

Care Under Fire
Tactical Field Care
Casualty Evac

Extremity hemorrhage
Hemo/Pneumo thorax
Hypothermia/coagulopathy

120
Q

What is the only medical care delivered during Care Under Fire

What occurs during Tactical Field Care?

A

Tourniquets
Field/Pressure dressings

Longest phase, perform primary survey

121
Q

Needle-D during Tactical Field Care is as effective as a chest tube x __hrs

What Tx step is allowed here and why

A

4hrs

Permissive HOTN, prevent dislodging formed clots

122
Q

In sequence of preference, what fluids are preferred for use during tactical field care

A 
FWB
Plasma/PRBC/Platelet
Plasma/PRBC
Plasma
PRBCs
Hextend
LR/Plasmalyte
123
Q

What is in a Combat Pill pack?

What other pain and anti-nausea meds may be issued?

A

Acetaminophen Meloxicam
Moxifloxacin

Fentanyl Ketamine Ondansetron

124
Q

What ABXs can be substituted for Moxifloxacin if PT is HOTN or AMS?

Airway protection is needed for burn PTs w/ burns covering more than __% TBSA

A

Cefotetan 2gm
Ertapenem 1gm

40%

125
Q

How are fluids calculated for burn PTs

What is the desired urine output ranges for adults?

A

40-80kg adults
10mL x %TBSA per hr

Every 10kg above 80kg, add 100mL/hr

30-50mL/hr

126
Q

Trench foot is AKA ? and progresses through ?

Define Hyperemic Phase of Trench foot

What sequelae may remain or persist?

A

Immersion foot- tingle/numb, pale, pulseless, immobile

Hours of rewarming, severe burning as sensation returns

Anesthesia
Gangrene
Cold insensitivity
Hyperhidrosis

127
Q

Define Chilblains

What PT populations are these more common in?

A

AKA Pernio- mild, uncomfortable inflammatory lesions from long term damp, non-freezing temps

Women, kids in UK
Raynauds, Lupus

128
Q

What is the difference between Chilblains and Trench foot?

What meds can be used for Tx

A

Chilblains rarely has bullae/ulcerations

Nifedipine- dilation
Pentoxifylline- dec blood viscosity

129
Q

Define Panniculitis

How can this present in kids?

A

Mild necrosis of SQ fat tissue from prolonged temp just above freezing

Popsicle cheeks
Thigh/butt in equestrian sports

130
Q

Define Cold Urticaria

How is it Tx

A

Hypersensitivity to cold air/water, rarely anaphylaxis

Antihistamines
Epinephrine

131
Q

What is the critical event of frostbite

What sequelaes can occur and increase damaged tissue?

A

Endothelial damage from thawing

Thrombosis Ischemia Necrosis Gangrene

132
Q

What are the 3 zones of frostbite

A

Coagulation: most severe, distal damage is irreversible

Hyperemia: most superficial, least cellular damage, can recover w/out Tx

Stasis: middle area of severe cell damage, possible reversible

133
Q

What are the 4 classifications of frost bite severity

A

1st: “nip”-numb, central pallor, desquamation
2nd: full thickness freeze w/ clear blisters, erythema and edema
3rd: entire thickness into subdermal plexus, hemorrhagic blisters, necrosis, block of wood sensation- begin poor prognosis
4th: deep involvement, mummy skin, loss

134
Q

What tests may be ordered for frostbite for prognostic value and therapy guidance

What is the most effective and first definitive step for Tx

What other steps can be taken for Tx

A

T-99 bone scan
Angiogram after rewarming

Rapid rewarming in water 98-102F (37-39C) x 20-30min

Tetanus
Opioid w/ elevation

135
Q

Hypothermia begins at ? temp

What are the Primary and Secondary causes

A

<95F/35C

P: exposure
S: impaired regulation

136
Q

PTs can lose body heat through what 4 mechanisms

What is the sequence of physiological changes that can lead to death

A

Conduction Convection
Evaporation Radiation

Constriction Brady HOTN Myocardial irritability

137
Q

Body temps below ? put PTs at risk for cardiac arrest

What EKG finding is seen at this point

A

<32C/89.6F

Osborn J wave

138
Q

Why are PTs cooled after ROSC activity

If PT is intubated, what is the preferred location to measure body temps?

A

50% at 28C
19% at 18C
11% at 8* C

Lower 1/3 of esophagus
Bladder/rectal probes

139
Q

What are two common DDxs of accidental hypothermia

What is the underlying cause if hyperglycemia is present after rewarming?

A

Intoxication
Sepsis

DKA
Pancreatitis

140
Q

Hypothermia PTs in stage ? and serum K levels above ? will not survive

When body temp and humidity are over, convection does not remove heat well

Temps above ? prevent body from radiating heat to environment

A

4, 12mmol or higher

32.2C/90F and 35%

35C/95F

141
Q

Hypothalamus loses ability to regulate body temps below ? or above ?

Why is there inc sweat production?

A

<95F or >104F

Inc cholinergic stimulation

142
Q

What medications can interfere w/ body heat removal mechanisms

A 
Anticholinergic- Benadryl
Diuretics
Phenothiazine
BBs
CCBs
Sympathomimetics
143
Q

PTs are at increased risk for heat injury w/out an acclamation period of ?

Define Confinement Hyperpyrexia

A

7days

PTs in cars/boxes

144
Q

What are the 4 minor heat injuries

What is the major

A

Head edema
Prickly heat
Heat cramps
Exhaustion

Stoke

145
Q

Prickly heat is AKA ?

How is it Tx

What co-infection is common?

A

Lichen tropics
Miliaria rubra
Heat rash

Antihistamines
PO Vitamin C

Staph A infection, Tx w/ 1% salicyclic acid

146
Q

What catalyst usually presents w/ heat cramps

Deficiency of ? E+ can be cause

A

Fluid replacement w/ hypotonic solutions

Na K Mg Cl

147
Q

Heat stress is usually due to deficiency in ?

? can be seen here

A

Water and Na

Rhabdo

148
Q

How does heat stroke present

Since the CNS is vulnerable during this condition, what may be seen?

A

> 104* and AMS

Ataxia- early
Seizure- common

149
Q

What is the temp goal when Tx heat stroke

All heat stroke Pts have ? disposition

A

102.2

Admit

150
Q

What is the definitive form of imaging trauma PTs

What are the predictors of difficult non-invasive airway management

A

Head/C-spine: CT w/out contrast
Chest/Abdomen/Pelvis- CT w/ contrast

BVM= MOANS- 
Mask seal
Obesity/obstruction
Age >55y/o
No teeth
Stiff lungs/chest wall
Supraglottic = RODS
Restricted mouth opening
Obesity/obstruction
Disrupted/orted airway
Stiff lung/c-spine
151
Q

What are two types of PTs that would not need RSI prior to intubation?

Unconscious PTs create ? obstructions

A

Deep comatose
Cardiac/Respiratory arrest

Upper airway

152
Q

C/is for using succinylcholine

What are the 4 parts of controlling cerebral blood flow

A

HyperK
Burn Denervation Infection
Crush >5d old

CPP Autoregulation MAP ICP

153
Q

Low BP + high ICP= ?

What HTN PE finding may not be present if pressure suddenly/rapidly increases?

A

Low CPP and brain injury

Papilledema

154
Q

Etomidate

Propofol

A

Neuroprotective
Lowers ICP
Low risk for adrenal suppression

Rapid on/off
Anti-seizure
HOTN

155
Q

Succinylcholine

Rocuronium

A

Avoid in burns/muscle injury

Safe for HyperK

156
Q

What is the benefit of using Mannitol for ICP control

How long does it take for benefits to be seen?

A

Improves O2 carrying
Dec ICP
Improves cerebral blood flow, CPP, metabolism
Expands plasma volume

30min

157
Q

If Mannitol is not available, how much hypertonic saline can be used on adult PTs?

Basilar skull Fxs are associated w/ tearing of ? structure leading to ?

A

250mL over 30min

Dura- oto/rhinorrhea

158
Q

Basilar skull Fxs can occur anywhere in skull from ? to ?

? is the MC CT abnormality in PTs w/ Mod-Sev TBIs

A

Cribiform to Occipital condyles

Traumatic SAH

159
Q

What part of the vertebral column is narrower than other areas increasing change of neuro injury

Potentially unstable neck trauma

A

Thoracic

Jefferson burst atlas Fx

160
Q

Unstable neck trauma

A 
Anterior compression w/ transverse Fx
Lateral mass Fx
Atlantoaxial dislocation
Bilateral interfacet dislocation
Burst Fx
Hyperextension dislocation
Hyperextension tear drop (only w/ extension)
Traumatic spondylolisthesis/Hangman Fx
Type 2, 3 Odontoid/Dens Fx
Translocational Fx
161
Q

Highly unstable neck trauma

Stable

A

Flexion teardrop Fx
Atlanto-occipital dislocaiton

Anterior subluxation
Simple Wedge/Compression
Spinous process avulsion
Unilateral facet dislocation

162
Q

Reflexes

Chance Fx can be mis-Dx as ?

? may be the only clue of blood loss <15% from solid organ injuries

A

as

Wedge Fx

Inc pulse pressure

163
Q

How much fluid is needed for a FAST exam to be pos

Relative reasons blunt trauma PTs need to go to OR?

A

Abdomen- 250mL
Pleural- 20mL

Pos FAST/DPL and hemodynamically stable

Solid visceral injury, stable PT

Hemoperitoneum on CT w/ou clear source

164
Q

What are the 3 zones of the aorta

How long can REBOA remain in place

A

1: descending aorta between subclavian/celiac origins
2: between celiac and lowest renal artery
3: lowest renal artery and aortic bifurcation

60min

165
Q

Triage of airway

Triage of breathing

Triage of Circulation

A 
Moving Air?
Yes- assess
No- open airway, reassess
Yes- assess 
No- expectant

> 30resp/min
Yes- immediate
No- circulation

Weak/absent radial or HR>140
Yes- immediate
No- assess mental status

Responds to simple commands:
Yes- not immediate
No- immediate

166
Q

Gold is = to 30

A

tada

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