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E Med > Emergency Med > Flashcards

Emergency Med Flashcards

1
Q

Beck’s Triad

A

Distended jugular veins
Hypotension
Muffled heart sound

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2
Q

the pump that drives the system

preload
myocardial contractility
afterload

A

myocardial contractility

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3
Q

Presents with classic sign of inadequate perfusion

Class 1 Hemorrhage
Class 2 Hemorrhage
Class 3 Hemorrhage
Class 4 Hemorrhage

A

Class 3 Hemorrhage

Presents with classic sign of inadequate perfusion:
. Marked tachycardia and tachypnea
. Significant changes in mental status
. Measurable fall in systolic blood pressure

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4
Q

Nonsurgical removal of the limb from the body

Abrasions
Punctures
Incisions
Avulsions
Lacerations
Amputations
A

Amputations

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5
Q

Alpha-granules liberate

A

platelet-derived growth factor (PDGF), platelet factor IV, and transforming growth factor (TGF)–β).

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6
Q

Pt is breathing with 29 breaths/min. What is next step?

A

measure perfusion (less than 30/min)

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7
Q

Massive burns (>85% BSA)

Disaster Response Level
Level I
Level II
Level III
Level IV
A

Level I

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8
Q

Disposition: depends on patient condition vs. resources

Triage Level
Level 1
Level 2
Level 3
Level 4
Level 5
A

Level 2

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9
Q

Initial patient assessment and treatment in START should take how long?

A

less than 30 seconds/pt

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10
Q

What type of wounds rquire flaps?

A

radiation

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11
Q

Dx for Flail Chest

A

paradoxical movement of chest segment

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12
Q

Vitamin A deficiency role in wound healing is

A

collagen synthesis, antioxidant

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13
Q

Patients who are on steroids should receive this for wound healing

A

vitamin A

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14
Q

Triage mnemonic for triage Respiration, Perfusion and Mental Status?

A

R 30
P 2
M Can do

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15
Q

management of contaminated or infected wounds

Primary Closure
Spontaneous Healing
Delayed Primary Closure

A

Spontaneous Healing

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16
Q

How is perfusion measured in children?

A

palpable pulse

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17
Q

Uncomplicated hemorrhage for which crystalloid fluid resuscitation is required

Class 1 Hemorrhage
Class 2 Hemorrhage
Class 3 Hemorrhage
Class 4 Hemorrhage

A

Class 2 Hemorrhage

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18
Q

Victims seen 12-24 hrs

Disaster Response Level
Level I
Level II
Level III
Level IV
A

Level III

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19
Q

Types of wound healing

A

Primary Wound Healing or Primary Closure
Secondary Wound Healing or Spontaneous Healing
Tertiary Wound Healing or Delayed Primary Closure

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20
Q

What local anesthetic has the longest duration?

A

bupivacaine

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21
Q

Blood transfusion is required

Class 1 Hemorrhage
Class 2 Hemorrhage
Class 3 Hemorrhage
Class 4 Hemorrhage

A

Class 4 Hemorrhage

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22
Q

What are local anesthetic drugs used?

A

cocaine, procaine, tetracaine, lidocaine, lidocain with epi, bupivacaine

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23
Q

Second step in managing shock is to

A

identify the probable cause of shock and adjust treatment accordingly

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24
Q

Indications for systemic antibiotic for traumatic wounds

A 
.Injury 6 hours old on the extremities
.Injury 24 hours old on the face and scalp
. Tendon, joint or bony involvement
. Cartilage involvement
. Mammalian bite
. Co-morbidity (DM, extremes of age, steroid use, morbid obesity)
. Puncture wound
. Complex intraoral wound
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25
Q

BASICS OF PRIMARY SURVEY

A 
Airway and Protection of Spinal Cord
Breathing and Ventilation
Circulation
Disability
Exposure and Control of the Environment
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26
Q

Diabetes affects wound healing by

A

Diminishing sensation and arterial inflow (plus plus) acute loss of diabetic control (arrow) diminished cardiac output, poor peripheral perfusion, and impaired polymorphonuclear leukocyte phagocytosis

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27
Q

Gradually disappearing contusion is how may days old?

A

. 14-15 days

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28
Q

In Disaster Response, what classifies as a massive burn?

A

> 85% BSA

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29
Q

Victim needs to be seen < 2 hr

Disaster Response Level
Level I
Level II
Level III
Level IV
A

Level I

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30
Q

hyperbaric medicine Raises the dissolved oxygen saturation in plasma from X to Y

A

0.3% to nearly 7%

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31
Q

Most important thing to know in disaster as Doctor

A

where the triage officer should be

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32
Q

US-FDA approved for diabetic foot ulcers

PDGF
EDGF
VEGF

A

PDGF - Becaplermin

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33
Q

Yellow contusion is how may days old?

A

. 7-10 days

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34
Q

Reverse triage

A

prioritzing the greatest number of people that can be treated

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35
Q

can reduce venous return and produce obstructive shock

A

Tension pneumothorax

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36
Q

What type of burn is TL 1?

A

respiratory tract burns

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37
Q

Low-velocity missile damages

A

only the tissues it comes into contact with

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38
Q

Pt has red triage color. What are possible wounds?

A 
Respiratory arrest
Airway obstruction
Sucking Chest Wound
Cardiac arrest
Severe bleeding
Shock
Unconsciousness
Respiratory tract burns
Acute Coronary Syndromes
Suicidal attempts
Status epilepticus
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39
Q

where victims and the injured are collected in casualty

A

primary collection point

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40
Q

What are the respiratory requirements for children in JumpSTART?

A

between 15 and 45

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41
Q

Who is prioritised during mass casualty?

A

walking injured

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42
Q

Use trucks to transport them

Triage Level
Level 1
Level 2
Level 3
Level 4
Level 5
A

Level 3

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43
Q

Green contusion is how may days old?

A

. 4-5 days

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44
Q

Cardiac tamponade also produces obstructive shock

A

as blood in the pericardial sac inhibits cardiac contractility and cardiac output

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45
Q

GOALS OF WOUND CARE

A

Facilitate hemostasis, Decrease tissue loss, Promote wound healing, Minimize scar formation

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46
Q

Local anesthesia for wound preparation are

A

Direct infiltration:
. 1% lidocaine with or without epinephrine
. Bupivacaine or sensorcaine for longer acting anesthesia

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47
Q

different types of tagging triage pt

A

classic, fluorescent flagging ribbons, tear-off, pre-labeled

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48
Q

Blood tumors

Petechiae
Contusion
Hematoma

A

Hematoma

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49
Q

Indications of Primary Closure

A

Indications: Recent (<24 hr old), Clean, Viable tissue, Tension-free

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50
Q

What is the difference between military and civilian triage?

A

Military triage prioritizes getting people back onto the battle field

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51
Q

FAST Exam

A

(Focused Abdominal Sonography in Trauma)

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52
Q

Provides definitive care in wide range of complex traumatic patients

Level 1
Level 2
Level 3
Level 4

A

Level 2

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53
Q

What type of burn is TL 3?

A

Partial-thickness burns of <20% BSA

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54
Q

Circumscribed extravasation of blood in the
subcutaneous tissue or underneath the mucous
membrane

Petechiae
Contusion
Hematoma

A

Petechiae

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55
Q

GCS at which we intubate

A

equal or less than 8

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56
Q

Drugs affects wound healing by

A

Steroids and antimetabolites impede proliferation of fibroblasts and collagen synthesis

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57
Q

Negative pressure wound therapy is used in what basic of wound healing? How is it done?

A

. Reduce edema

. Removes pericellular transudate & wound exudate as well as deleterious enzymes
. Cannot be used in ischemic, badly infected or inadequately debrided wounds or in malignancy

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58
Q

What are the open wounds?

A 
Abrasions
Punctures
Incisions
Avulsions
Lacerations
Amputations
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59
Q

may be given to trauma patients with signs of significant hemorrhage who present within three hours of injury

A

Tranexamic acid (TXA)

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60
Q

Clean, sharp edges, clean nonmobile areas, laceration less than 5cm in length

staples
adhesives
tape

A

adhesives

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61
Q

Another wound affects wound healing by

A

Competition for the substrates for wound healing

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62
Q

When is compression contraindicated?

A

in patients with ABI <0.7

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63
Q

Tensile strength develops as with primary closure

Primary Closure
Spontaneous Healing
Delayed Primary Closure

A

Delayed Primary Closure

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64
Q

Factors that affect wound healing mnemonic

A

DIDN’T HEAL

Diabetes
Infection
Drugs
Nutritional
Tissue Necrosis
Hypoxia
Excessive tension on wound edges
Another wound
Low temperature
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65
Q

Hypotension, without tachycardia or cutaneous vasoconstriction

Cardiogenic Shock
Cardiac Tamponade
Tension Pneumothorax
Neurogenic Shock

A

Neurogenic Shock

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66
Q

In Disaster Response, what GCS is considered advanced neurological defect?

A

<8

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67
Q

Provides initial stabilization and
treatment. May care for uncomplicated trauma
patients

Level 1
Level 2
Level 3
Level 5

A

Level 3

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68
Q

Role of epinephrin in wound prep and closure

A 
Vasoconstrictive
Increases duration of action
Promotes hemostasis
Avoid end-arterial blood supply areas
May increase pain (low pH)
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69
Q

(shock) SV x HR = to?

A

CO

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70
Q

Most desirable sites for vascular access

A

forearms and antecubital veins

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71
Q

Indications for Delayed Primary Closure

A

Indications are
Infected or unhealthy wounds with high bacterial content
Wounds with a long time lapse since injury
Wounds with a severe crush component with significant tissue devitalization

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72
Q

If mental test is satisfactory, what is next step?

A

place pt in green or acute

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73
Q

Sequence of wound healing

A

Homeostasis, Inflammation, granulation proliferation

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74
Q

What are closed wounds?

A

Petechiae, Contusion, Hematoma

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75
Q

If crossmatched blood is unavailable and indicated for exsanguinating hemorrhage use this

A

type O PRBC

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76
Q

Complications include Late wound contracture and Hypertrophic scarring

Primary Closure
Spontaneous Healing
Delayed Primary Closure

A

Spontaneous Healing

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77
Q

Green

Triage Level
Level 1
Level 2
Level 3
Level 4
Level 5
A

Level 3

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78
Q

In pregnancy, what is supine hypotensive syndrome. What is tx

A

. After 20 weeks, enlarged uterus with fetus and amniotic
fluid compresses inferior vena cava
. Decreases venous return and decrease cardiac output
. Keep pregnant patients in left lateral decubitus position to
avoid excessive hypotension

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79
Q

Contraindication for NPWT/VAC wound dressing

A

malignancy, ischemia, inadequately debrided or badly infected wounds

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80
Q

Procedure for Needle Thoracostomy

A

Midclavicular line
14 gauge angiocath
Over the 2nd rib
Rush of air is heard

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81
Q

15-30% Blood loss

Class 1 Hemorrhage
Class 2 Hemorrhage
Class 3 Hemorrhage
Class 4 Hemorrhage

A

Class 2 Hemorrhage

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82
Q

Role of hyperbaric O2 therapy in wound healing

A

limb salvage

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83
Q

Penetrating vs perforating

A

Penetrating: entered the body
Perforating: entered the visceral part

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84
Q

What is the name of tape used in wound closure

A

Steri-strips

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85
Q

sacrificing for the greatest good of the greatest number

Principle of Rights
Medical Disaster
Multiple, Major, Mass Casualty Incidents
Spock Principle
Triage
A

Spock Principle

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86
Q

Hydrocolloids promote wound debridement by

A

autolysis

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87
Q

peripheral vascular resistance

preload
myocardial contractility
afterload

A

afterload

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88
Q

Inadequately perfused and poorly oxygenated cells compensate by

A

shift to anaerobic metabolism resulting in formation of lactic acid and development of metabolic acidosis

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89
Q

Evaluates for fluid in the pouch of Douglas (Posterior to bladder)
Dependent potential space

RUQ/Morrison’s pouch
Sub-xiphoid:
LUQ:
Bladder:

A

Bladder

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90
Q

Evaluate for pericardial fluid
View through liver
Transhepatic or Parasternal
Searches for fluid between heart and pericardium

RUQ/Morrison’s pouch
Sub-xiphoid:
LUQ:
Bladder:

A

Sub-xiphoid:

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91
Q

best choice for wounds in well-vascularized areas

Primary Closure
Spontaneous Healing
Delayed Primary Closure

A

Primary closure

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92
Q

How many casualties to qualify as mass casualty?

A

100 or more

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93
Q

Administer an initial, warmed fluid bolus of isotonic fluid. The usual dose

A

is 1 liter for adults and 20ml/kg for pediatric patients weighing less than 40kg

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94
Q

If perfusion test is unsatisfactory, what is the next step?

A

look for gross bleeding and apply direct pressure

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95
Q

EBW for male and female

A

Male: 50 kg + 2.3 kg for every inch over 5 feet
Female: 45.5 kg + 2.3 kg for every inch over 5 feet

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96
Q

Urinary output is only mildly affected (20-30ml/hour in an adult)

Class 1 Hemorrhage
Class 2 Hemorrhage
Class 3 Hemorrhage
Class 4 Hemorrhage

A

Class 2 Hemorrhage

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97
Q

What are requirements of tagging triage pt

A

Durable, Visible from great distances, Simple/Self-explanatory, Cost effective, Numbered

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98
Q

This is essential for venous stasis ulcers

A

compression

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99
Q

Commonly injured with compression forces

A

spleen

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100
Q

Partial thickness burns 12% BSA including respiratory tract

Triage Level
Level 1
Level 2
Level 3
Level 4
Level 5
A

Level 1

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101
Q

Black

Triage Level
Level 1
Level 2
Level 3
Level 4
Level 5
A

Level 4

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102
Q

What is JumpStart triage?

A

triage in disasters for children

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103
Q

31-40% blood loss

Class 1 Hemorrhage
Class 2 Hemorrhage
Class 3 Hemorrhage
Class 4 Hemorrhage

A

Class 3 Hemorrhage

104
Q

Nutritional affects wound healing by

A

. Protein-calorie malnutrition and deficiencies of vitamin A (collagen synthesis, antioxidant), C (collagen synthesis), and zinc (fibroblast proliferation)
. Malnutrition: impaired organ function, impaired collagen synthesis, impaired immune function, reduced antioxidant activity

105
Q

Vitamin C deficiency role in wound healing is

A

collagen synthesis

106
Q

Life-threatening

Triage Level
Level 1
Level 2
Level 3
Level 4
Level 5
A

Level 1

107
Q

wound left open and allowed to close by epithelialization and contraction

Primary Closure
Spontaneous Healing
Delayed Primary Closure

A

Spontaneous Healing

108
Q

In triage what does Kiss-U principle mean?

A

KEEP IT STUPIDLY SIMPLE + UNIFORM

109
Q

What local anesthetic has the shortest duration?

A

cocaine, procaine

110
Q

JumpSTART children in yellow for non-ambulatory signifies?

A

significant external signs of injury are found

111
Q

What parameters are used to categorize them?

A

Respiration, Perfusion and Mental Status

112
Q

wounds created and closed in the operating room

Primary Closure
Spontaneous Healing
Delayed Primary Closure

A

Primary closure

113
Q

Excessive tension on wound edges affects wound healing by

A

Local tissue ischemia and necrosis

114
Q

It is the resistance to the forward flow of the blood

preload
myocardial contractility
afterload

A

afterload

115
Q

White

Level 1
Level 2
Level 3
Level 4
Level 5
A

Level 5

116
Q

In casualties what does START stand for?

A 
Simple
Triage
And
Rapid
Treatment
117
Q

If mental test is unsatisfactory, what is next step?

A

pt in immediate

118
Q

Could be internal or External

Principle of Rights
Medical Disaster
Multiple, Major, Mass Casualty Incidents
Spock Principle
Triage
A

Medical Disaster

119
Q

Traige success factors?

A

Pre-planning (conduct drills), Medical Triage Officer, Kiss-U Principle

120
Q

Urinary output is one f the prime indicators of resuscitation and patient response

A

Adequate volume replacement: 0.5ml/kg/hr (adult); 1ml/kg/hr (under 1 year)

121
Q

How does hyperbaric medicine promote wound healing?

A

Stimulates angiogenesis and fibroblast migration, enhances neutrophil and antibiotic killing action, and suppresses alpha toxin production in gas gangrene

122
Q

Normal adult blood volume percentage of tbw. Child?

A

7% of body weight

child: 8-9%

123
Q

Triage patient not breathing. Next step is?

If they breath, what TL? If not, what TL?

A

open airway; use Positioning the airway

yes: immediate or red
no: black, pt is dead or dying

124
Q

Superficial, straight laceration under little tension

staples
adhesives
tape

A

tape

125
Q

Degree of exsanguination is immediately life-threatening

Class 1 Hemorrhage
Class 2 Hemorrhage
Class 3 Hemorrhage
Class 4 Hemorrhage

A

Class 4 Hemorrhage

126
Q

Rights to proper healthcare / rights to be seen by a who would want to see us / Everybody has their own right

Principle of Rights
Medical Disaster
Multiple, Major, Mass Casualty Incidents
Spock Principle
Triage
A

Principle of Rights

127
Q

Rank these dressing’s absorption characteristics from low to high

Films
Foams, alginates, collagen
hydrocolloids
hydrogels

A

None: films
Low: hydrogels
Moderate: hydrocolloids
High: foams, alginates, collagen

128
Q

Walking injured prioritised

Principle of Rights
Medical Disaster
Multiple, Major, Mass Casualty Incidents
Spock Principle
Triage
A

Multiple, Major, Mass Casualty Incidents

129
Q

Exemplified by the condition of an individual who has donated 1 unit of blood

Class 1 Hemorrhage
Class 2 Hemorrhage
Class 3 Hemorrhage
Class 4 Hemorrhage

A

Class 1 Hemorrhage

130
Q

Damage Control Resuscitation (DCR) in combination with Damage Control Surgery

A

to control hemorrhage rapidly and prevent
coagulopathy by minimizing crystalloid use and
transfusing early

131
Q

View between the spleen and kidney
Another dependent place that fluid collects
Also see diaphragm in this view

RUQ/Morrison’s pouch
Sub-xiphoid:
LUQ:
Bladder:

A

LUQ:

132
Q

Force applied causes the subcutaneous tissue will lead to
the accumulation of blood causing it to elevate

Petechiae
Contusion
Hematoma

A

Hematoma

133
Q

Zinc deficiency role in wound healing is

A

fibroblast proliferation

134
Q

Hypoxia affects wound healing by

A

. Especially the distal extent of the extremities
. Blood volume deficit, unrelieved pain, or hypothermia (arrow) sympathetic overactivity (arrow) local vasoconstriction (arrow) inadequate tissue oxygenation

135
Q

<15% blood loss

Class 1 Hemorrhage
Class 2 Hemorrhage
Class 3 Hemorrhage
Class 4 Hemorrhage

A

Class 1 Hemorrhage

136
Q

Deteriorating neurovital signs

Disaster Response Level
Level I
Level II
Level III
Level IV
A

Level II

137
Q

Progressive vasoconstriction of cutaneous, muscular, and visceral circulation to preserve blood flow to the

A

kidneys, heart, and brain

138
Q

Disposition: custodial care

Triage Level
Level 1
Level 2
Level 3
Level 4
Level 5
A

Level 4

139
Q

Infection affects wound healing by

A

. Potentiates collagen lysis
. Bacterial contamination (plus) susceptible host (plus) wound environment (equals) wound infection
. Foreign bodies (including sutures) potentiate wound infection

140
Q

Triage Level I victims

Disaster Response Level
Level I
Level II
Level III
Level IV
A

Level IV

141
Q

What is used for recalcitrant ulcers?

A

electrical stimulation

142
Q

Complications of Spontaneous Healing

A

Late wound contracture

Hypertrophic scarring

143
Q

BASIC OF TRAUMA ASSESSMENT

A 
Preparation
Triage
Primary Survey
Resuscitation
Secondary Survey
Monitoring and Evaluation, Secondary adjuncts
Transfer to Definitive Care
144
Q

What are disadvantages of tagging triage pt?

A

Organizational uncertainty, Tunnel-vision mentality. Some studies: no improvement in patient outcome, Expensive, Delays patient care and transport

145
Q

Most common sign of shock

A

Tachycardia (HR > 100)

146
Q

Important consideration for avulsion skin

A

Do not allow the avulsed portion to freeze

Do not immerse it in water or saline

147
Q

Regional block anesthesia in important in wound preparation because

A

. Local infiltration proximally in order to avoid tissue disruption
. Smaller amount of anesthesia required

148
Q

Pt has yellow triage color. What are possible wounds?

A 
Open thoracic wound
Penetrating Abdominal wound
Severe eye injury
Avascular limb
Significant burns other than the face, neck or perineum
Moderate bleeding
Conscious patients with head injuries
Anxiety states
Multiple fractures
149
Q

No Care

Triage Level
Level 1
Level 2
Level 3
Level 4
Level 5
A

Level 5

150
Q

wound closed by approximation of wound margins or by placement of a graft or flap

Primary Closure
Spontaneous Healing
Delayed Primary Closure

A

Primary closure

151
Q

Determined by venous capacitance, volume status, venous flow

preload
myocardial contractility
afterload

A

preload

152
Q

Delay of a few minutes: Fatal

Triage Level
Level 1
Level 2
Level 3
Level 4
Level 5
A

Level 1

153
Q

What type of burn is TL 2?

A

Significant burns other than the face, neck or perineum

154
Q

Without surgical intervention

Primary Closure
Spontaneous Healing
Delayed Primary Closure

A

Spontaneous Healing

155
Q

Dead and Dying

Triage Level
Level 1
Level 2
Level 3
Level 4
Level 5
A

Level 4

156
Q

What are the differences in prophylaxis for tetanus in clean wounds vs tetanus prone wounds?

A

clean: give toxoid after 10 yo

tetanus prone: give toxoid after 5 yo

157
Q

EBW for pediactrics

A

1-11 months: (0.5 x age in months) + 4
1-5 years: (2 x age in years) + 8
6-12 years: (3 x age in years) + 7

158
Q

Evacuees

Triage Level
Level 1
Level 2
Level 3
Level 4
Level 5
A

Level 5

159
Q

Ambulatory or Primary Care

Triage Level
Level 1
Level 2
Level 3
Level 4
Level 5
A

Level 3

160
Q

High-velocity missile damages

A

by forcing the tissues and body parts away from the track of the missile with a velocity only slightly less than that of the missile itself

161
Q

Airway Interventions

A

Maintenance of Airway Patency
Airway Support
Definitive Airway

162
Q

How is perfusion measured?

A

capillary filling time - press nail, wait 2 seconds

163
Q

requiring prolonged life support in an intensive care unit

Disaster Response Level
Level I
Level II
Level III
Level IV
A

Level III

164
Q

What is the AVPU scale

A

Alert
Responds to verbal stimulation
Responds to pain
Unresponsive

165
Q

> 40% blood loss

Class 1 Hemorrhage
Class 2 Hemorrhage
Class 3 Hemorrhage
Class 4 Hemorrhage

A

Class 4 Hemorrhage

166
Q

Much delayed degree of urgency

Triage Level
Level 1
Level 2
Level 3
Level 4
Level 5
A

Level 3

167
Q

Expectant or Pending Care

Triage Level
Level 1
Level 2
Level 3
Level 4
Level 5
A

Level 4

168
Q

Tissue Necrosis affects wound healing by

A

From local or systemic ischemia or radiation injury. Blood supply is important

169
Q

is the earliest measurable circulatory sign of shock

A

Tachycardia

170
Q

a lot of patients fall under this category

Triage Level
Level 1
Level 2
Level 3
Level 4
Level 5
A

Level 3

171
Q

What is show bridging?

A

Connective tissue or blood vessels are flattened

against the underlying hard surface

172
Q

Disposition: Safe evacuation

Triage Level
Level 1
Level 2
Level 3
Level 4
Level 5
A

Level 5

173
Q

Only large puncture wounds are susceptible to infection?

True or false

A

False; possible in all puncture wounds

174
Q

Tachycardia, muffled heart sounds, and dilated, engorged neck veins with hypotension and insufficient response to fluid therapy

Cardiogenic Shock
Cardiac Tamponade
Tension Pneumothorax
Neurogenic Shock

A

Cardiac Tamponade

175
Q

Important consideration for grease contamination in wounds

A

Very hard to remove and so you make sure to give your Pt. anesthetic agent first.

176
Q

If perfusion test is satisfactory, what is the next step?

A

measure mental status by giving simple command

177
Q

Delayed, Acute or Non-ambulatory Care

Triage Level
Level 1
Level 2
Level 3
Level 4
Level 5
A

Level 2

178
Q

Includes: Open thoracic wound, Penetrating Abdominal wound, Severe eye injury, Avascular limb, Significant burns other than the face, neck or perineum

Triage Level
Level 1
Level 2
Level 3
Level 4
Level 5
A

Level 2

179
Q

Indications are
Infected or unhealthy wounds with high bacterial content
Wounds with a long time lapse since injury
Wounds with a severe crush component with significant tissue devitalization

Primary Closure
Spontaneous Healing
Delayed Primary Closure

A

Delayed Primary Closure

180
Q

What pressure should compression be?

A

30 - 40 mmHg

181
Q

Procedure for Tube Thoracostomy

A

Insertion site: 5th ICS; Anterior axillary line

2-3 cm incision along rib margin with #10

182
Q

When does granulation tissue develop?

A

> 24hrs

183
Q

can cause unexplained hypotension, cardiac dysrhythmia, usually bradycardia; insert nasal or oral tube

A

Gastric Dilation/ Decompression

184
Q

Disaster Response Level 2 victims

Disaster Response Level
Level I
Level II
Level III
Level IV
A

Level III

185
Q

Caused by a clean, sharp-edged object
Involve only the epidermis
Tend to bleed freely

Abrasions
Punctures
Incisions
Avulsions
Lacerations
Amputations
A

Incisions

186
Q

wounds that are too heavily contaminated for primary closure but appear clean and well vascularized after 4-5 days of open observation

Primary Closure
Spontaneous Healing
Delayed Primary Closure

A

Delayed Primary Closure

187
Q

Tx for Hemothorax

A

Large Caliber Tube Thoracostomy

188
Q

Why are vasopressors are contraindicated as a first-line treatment of hemorrhagic shock?

A

because they worsen tissue perfusion

189
Q

Disability check in basic trauma

A 
. Pupillary exam
. AVPU scale
. Gross neurological exam - extremity of movement
. Glasgow Coma Scale: 3-15
. Rectal Exam
190
Q

Low temperature affects wound healing by

A

(relatively) distal aspects of the upper and lower extremities (a reduction of 1-1.5C (2-3F) from normal core body temperature) is responsible for slower healing of wounds at these sites

191
Q

Volume of venous blood return to the left and right sides of the heart

preload
myocardial contractility
afterload

A

preload

192
Q

Secondary survey history mnemonic

A

AMPLE

Allergies
Medications
Past medical history, ob
Last meal
Events surrounding injury
193
Q

What is the role of glucose in wound healing?

A

give energy for angiogenesis and the deposition of new tissue

194
Q

Presence of granulation tissue

Primary Closure
Spontaneous Healing
Delayed Primary Closure

A

Spontaneous Healing

195
Q

Suture removal guides in days for

Face
Arm
Anterior trunk
Back
Feet and hand
Joint scalp
A

Face (3-5)

Arm (7)
Anterior trunk

Back (10-14)
Feet and hand
Joint
scalp

196
Q

Topical anesthesia for wound preparation are

A

solution or paste: LET, TAC, EMLA

197
Q

Neurogenic shock results from

A

extensive injury to the cervical or upper thoracic spinal cord caused by a loss of sympathetic tone and subsequent vasodilation

198
Q

What is the role of fatty acids in wound healing?

A

essential for cell structure and have an important role in the inflammatory process

199
Q

What is considered a massive transfusion?

A

> 10 of PRBC within the first 24 hours of admission or more than 4 units in 1 hour

200
Q

Differences in head to body ratio and relative size and
location of anatomic features make children more
susceptible to

A

head injury, abdominal injury

201
Q

Disposition: Immediate resuscitation and transport (Trauma and Tertiary Hospitals)

Triage Level
Level 1
Level 2
Level 3
Level 4
Level 5
A

Level 1

202
Q

What are the determinants of stroke volume?

A

preload, myocardial contractility, afterload

203
Q

FAST can identify pericardial fluid, which suggests cardiac tamponade as the cause of shock

Cardiogenic Shock
Cardiac Tamponade
Tension Pneumothorax
Neurogenic Shock

A

Cardiac Tamponade

204
Q

100 or more casualty

Principle of Rights
Medical Disaster
Multiple, Major, Mass Casualty Incidents
Spock Principle
Triage
A

Multiple, Major, Mass Casualty Incidents

205
Q

Pt is breathing with 35 breaths/min. What is next step?

A

classify as immediate (more than 30/min)

206
Q

What chemicals can be used for hemostasis? (stop the bleeding)

A

Epinephrine, Gelfoam, Oxycel, Act

207
Q

Tension Pneumothorax

A

. Develops when air enters the pleural space, but a flap-valve mechanism prevents its escape
. Intrapleural pressure rises, causing total lung collapse and a shift of the mediastinum to the opposite side, with subsequent impairment of venous return and a fall in cardiac output

208
Q

The first step in managing shock in trauma is to

A

recognize its presence.

209
Q

Tx for Tension Pneumothorax

A

Needle Decompression
2nd Intercostal space, Midclavicular line

Tube Thoracostomy
5th Intercostal space, Anterior axillary line

210
Q

approximation of wound margins occurs via reepithelialization and wound contraction by myofibroblasts

Primary Closure
Spontaneous Healing
Delayed Primary Closure

A

Spontaneous Healing

211
Q

Includes: Minor bleeding, Minor soft tissue injuries, Contusions, sprains, Superficial burns, Partial-thickness burns of <20% BSA

Triage Level
Level 1
Level 2
Level 3
Level 4
Level 5
A

Level 3

212
Q

Transient response to initial fluid resuscitatoin

A

. Transient improvement, recurrence of decreased, blood pressure and increased heart rate
. Moderate blood loss (15-40%)
. Moderate to high need for blood
. Type specific blood adequate

213
Q

Peeling

Abrasions
Punctures
Incisions
Avulsions
Lacerations
Amputations
A

Avulsions

214
Q

No changes in blood pressure, pulse pressure, or respiratory rate

Class 1 Hemorrhage
Class 2 Hemorrhage
Class 3 Hemorrhage
Class 4 Hemorrhage

A

Class 1 Hemorrhage

215
Q

Wounds are torn rather than cut
Ragged irregular edges and masses of torn tissue
underneath

Abrasions
Punctures
Incisions
Avulsions
Lacerations
Amputations
A

Lacerations

216
Q

Where scar is less of an issue (hairy scalp)

staples
adhesives
tape

A

staples

217
Q

What is the role of protein deficiency in wound healing?

A

contribute to poor healing rates with reduced collagen formation and wound dehiscence

218
Q

In FAST exam

4 views of the abdomen to look for fluid.

A

RUQ/Morrison’s pouch
Sub-xiphoid: view of heart
LUQ: view of spleno-renal junction
Bladder: view of pelvis

219
Q

Arterial hypotension in shock

A

Arterial Hypotension (SBP < 120)
Femoral Pulse – SBP > 80
Radial Pulse – SBP > 90
Carotid Pulse – SBP > 60

220
Q

Disposition: depends on space availability

Triage Level
Level 1
Level 2
Level 3
Level 4
Level 5
A

Level 3

221
Q

Immediate or Critical Care

Triage Level
Level 1
Level 2
Level 3
Level 4
Level 5
A

Level 1

222
Q

Wound edges are approximated within 3-4 days

Primary Closure
Spontaneous Healing
Delayed Primary Closure

A

Delayed Primary Closure

223
Q

Victim seen in 2-12 hrs

Disaster Response Level
Level I
Level II
Level III
Level IV
A

Level II

224
Q

Advanced neurological deficits (GCS<8)

Disaster Response Level
Level I
Level II
Level III
Level IV
A

Level I

225
Q

Primary closures are not made to prevent anaerobic infections

Abrasions
Punctures
Incisions
Avulsions
Lacerations
Amputations
A

Punctures

226
Q

requiring formal surgical care

Disaster Response Level
Level I
Level II
Level III
Level IV
A

Level III

227
Q

How do you label geographic sorting?

A

Disaster flags, Chemical light sticks, Colored strobe lights

228
Q

Usual response to acute circulating volume depletion is an (decrease/increase) in heart rate in an attempt to preserve cardiac output

A

Usual response to acute circulating volume depletion is an increase in heart rate in an attempt to preserve cardiac output

229
Q

Yellow

Triage Level
Level 1
Level 2
Level 3
Level 4
Level 5
A

Level 2

230
Q

Red

Triage Level
Level 1
Level 2
Level 3
Level 4
Level 5
A

Level 1

231
Q

Between the liver and kidney in RUQ.
First place that fluid collects in supine patient

RUQ/Morrison’s pouch
Sub-xiphoid:
LUQ:
Bladder:

A

RUQ/Morrison’s pouch

232
Q

Delay has no impact

Triage Level
Level 1
Level 2
Level 3
Level 4
Level 5
A

Level 3, Level 4, Level 5

233
Q

Second or third degree burns involving more than 50% of total BSA

Disaster Response Level
Level I
Level II
Level III
Level IV
A

Level II

234
Q

Victims who do not require hospitalization

Triage Level
Level 1
Level 2
Level 3
Level 4
Level 5
A

Level 3

235
Q

BP of < 50 mmHg systolic and below despite initial resuscitation

Disaster Response Level
Level I
Level II
Level III
Level IV
A

Level I

236
Q

Indications: Recent (<24 hr old), Clean, Viable tissue, Tension-free

Primary Closure
Spontaneous Healing
Delayed Primary Closure

A

Primary closure

237
Q

Bleeding not profuse; Need medical attention for
disinfection

Abrasions
Punctures
Incisions
Avulsions
Lacerations
Amputations
A

abrasion

238
Q

Show bridging

Abrasions
Punctures
Incisions
Avulsions
Lacerations
Amputations
A

Lacerations

239
Q

Use refrigerated trucks

Triage Level
Level 1
Level 2
Level 3
Level 4
Level 5
A

Level 4

240
Q

Any injured patient who in what condition should be considered to be in shock until proven otherwise?

A

is cool to the touch and is tachycardic

241
Q

Serious but stable

Triage Level
Level 1
Level 2
Level 3
Level 4
Level 5
A

Level 2

242
Q

Includes: Respiratory arrest, Airway obstruction, Sucking Chest Wound, Cardiac arrest, Severe bleeding

Triage Level
Level 1
Level 2
Level 3
Level 4
Level 5
A

Level 1

243
Q

Breakage of capillary vessels

Petechiae
Contusion
Hematoma

A

Petechiae

244
Q

Anesthesia is what basic step in wound healing

A

Wound preparation and closure

245
Q

shear force trauma from

A

. Acceleration/Deceleration Injury, E.g. Aorta

. Shearing force = Spectrum from Full thickness tear (Exsanguination) to Partial tear (Pseudoaneurysm)

246
Q

Which is the most painful?

Abrasion
Incision
Lacerations

A

abrasion

247
Q

Wound dressing requirements

A

. Maintain moist 24-48 hours (augments reepithelialization)

. Be “water-tight” after 48 hours

248
Q

Those brought to you non-walking or stretcher will be what color/s?

A

red, yellow, black

249
Q

(Shock) CO = to?

A

SV x HR

250
Q

Basics in wound healing (IMPORTANT)

A 
Wound evaluation and history
Wound preparation and closure
Optimize systemic parameters
Debride nonviable tissue
Reduced wound burden
Optimize blood flow
Reduce edema
Use dressings appropriately
Use pharmacologic therapy
Close wounds with suturing/grafts/flaps as indicated
251
Q

Early administration of blood products must be considered in

A

class 3 and 4 hemorrhage

252
Q

Delay of few hours: no impact

Triage Level
Level 1
Level 2
Level 3
Level 4
Level 5
A

Level 2

253
Q

How is high pressure irrigation to wound done?

A

. High pressure irrigation (Normal Saline)
. Minimum 100-300 ml with continued irrigation
. At least 8 psi force to the wound (arrow) irrigation fluid dislodges foreign bodies, contaminants, and bacteria

254
Q

After a wound the platelets do this

A

adhere to damaged endothelium and discharge adenosine diphosphate (ADP), promoting thrombocyte clumping, which dams the wound

255
Q

Pt has green triage color. What are possible wounds?

A 
Minor bleeding
Minor soft tissue injuries
Contusions, sprains
Superficial burns
Partial-thickness burns of <20% BSA

E Med (13 decks)

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