Emergency Medicine Midterm Flashcards by Josh Sap

Tend to bleed freely / profusely → blood vessels are cut cleanly and
without ragged edges

Incised wounds

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Legally classified as cuts, rather than wounds

Incised wounds

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Ragged irregular edges and masses of torn tissue underneath

LACERATIONS

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Wounds are torn rather than cut

Lacerations

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Tearing of skin and other tissues (e.g., childbirth) o Rough brushing against a surface

Laceration- irregular wounds

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commonly misused in reference to injury with sharp
objects

Lacerations
Must show bridging

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Very likely to become infected

Usually bigger and can cause more tissue damage due to the size of the wound

Laceration

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Infected quite easily: as dirt and germs are usually embedded in the
tissues

Abrasions /Grazes

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Very painful (due to many sensory
nerve endings)

ABRASIONS (GRAZES)

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Sliding fall onto a rough surface
o Rope burns
o Floor burns
o Skinned knees or elbows (usually affects the bony prominence)

Abrasions

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penetrate into the tissues leaving a small surface opening

Punctured wounds

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Possibility of infection is great because of
anaerobic infections

in all puncture wounds

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True or False
To prevent infections in all puncture wounds, primary closures are not made

True

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Edges are well-define/well-delineated (but some tissue may be averted)

PENETRATING WOUNDS

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well-circumscribed and exit won’t
always be parallel and tissue eversion can be seen

GUNSHOT WOUNDS
When shot at a farther distance

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Profuse bleeding
Serious internal injury

Gunshot wound

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Can suck in the contaminants from the air → susceptible to infection

Gunshot wounds

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Tearing away of tissue from a body part

Avulsion

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True or False
In avulsion and amputate wound,
Do not allow the avulsed portion to freeze
Immerse it in water or saline

False.
Do not allow the avulsed portion to freeze
Do not immerse it in water or saline

Wrapping in a sterile dressing
Placing in a cool container (NOT ICED) →
vessels will vasoconstrict → hard for MD to re-anastomose the vessels
o Rushing it along with the victim to a medical facility

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Bleeding is heavy: tourniquet to stop the flow, but not too long • Shock is certain to develop

Amputation

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Types of closed wounds:

o Petechia
o Contusions
o Hematomas
o Crushing injuries

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

Petechiae

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May coalesce to form a bigger hemorrhagic area

Petechia

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Rupture certain brittle capillaries that are
found under the skin o Blood then leaks into the tissues

Contusions

Blood then leaks into the tissues → “blue-
black” discoloration

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Occasional spitting of the skin •

Contusions

True or False Color changes stars from the periphery inwards

True

The ultimate disappearance of color varies from one to four weeks depending upon the severity and the constitution of the body.

Contusions 4 to 5 days – color changes to green • 7 to 10 days – becomes yellow • 14 to 15 days – gradually disappears

Blunt instrument is applied in part of the body where bony tissue is superficially located

Hematomas

Blood tumors, With humps and bumps and lumps

Hematomas

Extreme amount of force applied over a long period of time

Crushing injuries

The basic types of wound

Open and closed

Caused by a clean sharp-edged object

Incised wounds

Imbalance in tissue oxygen supply and demand

Shock

Pump that drives the system

Myocardial contractility

Shock results eventually to

End-organ dysfunction

The first measurable circulatory sign of shock

Tahycardia

the most common cause of shock after injur and trauma

Hemorrhagic

The blood volume of a child is approx this percentage of body weight

This class of hemorrhage is akin to donating blood

Class I

The basic principle of management of hemorrhagic shock will be to:

Stopping the bleeding and replacing lost volume

Massive transfusion is defined as the administration of how many units of pRBCs in the 1st hour

More than 4

Triage prioritizes patients based on

Clinical urgency

A stable patient complaining of a cat bite is triaged to a critical bed

Overtriage

Level of triage if immediately life threatening

Category 1

A patient bitten by a snake should be triaged to this level

Category 2 - envenomations

A patient complaining of severe scrotal pain should be triage to this level

Category 2 - very severe pain

A stable patient that appears to require referral to an ENT should be triaged to this level

Category 4

Patients triaged to category 4 can be seen within

60 minutes

This is the name of the PREHOSPITAL triage system

START

Patients tagged as green prehospitally

Walking wounded

A pedia patient that has inappropriate posturing when pain is applied

Red

The meaning of triage is to

Sort

Modern triage systems consists of how many levels?

It is the resistance to the forward flow of the blood

Afterload

continuous presence of inadequate blood volume (very terminal stage)

Patients with delirium

True or False Vasopressors are first-line treatment of hemorrhagic shock.

False. Contraindicated because they worsen tissue perfusion.

Any injured patient who is cool to the touch and is tachycardic should be considered to be in shock until proven otherwise True or False

True

Normal adult blood volume

7% of body weight

Uncomplicated hemorrhage for which crystalloid fluid resuscitation is required

CLASS 2 HEMORRHAGE (15-30%)

classic signs of inadequate perfusion in Class 3 hemorrhage

▪ Marked tachycardia and tachypnea ▪ Significant changes in mental status ▪ Measurable fall in systolic blood pressure

Marked tachycardia, significant decrease in blood pressure and very narrow pulse pressure or unmeasurable diastolic blood pressure

CLASS 4 HEMORRHAGE (>40%)

The most effective method of restoring CO, end-organ perfusion and tissue oxygenation is

restoring VR to normal by locating and stopping source of bleeding

Blood loss in bones: -Humerus -Femoral

bones can cause a blood loss of 750 mL such as in humerus fracture but in femoral fracture, patients can bleed as much as 1.5 L of blood

Myocardial dysfunction can be caused by

blunt cardiac injury, cardiac tamponade, an air embolus, or rarely, myocardial infarction

Commonly seen in patients with penetrating thoracic injury (GSW or stab wound)

Cardiac tamponade And Tension pneumothorax (to the anterior wall) May also lead to septic shock

Beck’s triad:

hypotension, muffled heart sound and distended neck veins

Cardiac tamponade signs

Tachycardia, Beck’s triad [muffled heart sounds, and dilated, engorged neck veins with hypotension] and insufficient response to fluid therapy

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

FAST - focused assessment sonography in trauma

Develops when air enters the pleural space, but a flap-valve mechanism prevents its escape

TENSION PNEUMOTHORAX

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

Tension pneumothorax

Tension pneumothorax is temporarily relieves by ____ and subsequently followed by _____

Needle or finger decompression Then chest tube thoracostomy

Classic presentation: hypotension, without tachycardia or cutaneous ! vasoconstriction (px is blushed rather than pale)

Neurogenic shock

Can have a normal circulating volume, modest tachycardia, warm skin, near normal SBP, and a wide pulse pressure

Early septic shock

Occur when a patient’s arrival at the ED is delayed for several hrs , but very rare

Septic shock

one of the prime indicators of resuscitation and patient response

urinary output

warmed fluid bolus of isotonic fluid, the usual dose for pediatric px is

20ml per kg if weighing <40kg

Adequate volume replacement for adults

0.5 mL/kg/hr

How to prevent hypothermia in blood transfusions

Heat the fluid to 39°C before infusion o This can be accomplished by storing crystalloids in a warmer or infusing them thru intravenous fluid warmers

True or False Early administration of PRBC, plasma and platelets in a balanced ratio to minimize excessive crystalloid administration may improve patient survival

True

valuable baseline studies to obtain in the first hour

Prothrombin time and partial thromboplastin time, and platelet count

Must be given immediately so that we can achieve 70% improvement in survival because for every 15-minute delay in giving it, there is a decrease of 10% in survival and after 3 hours, there is no benefit at all

Tranexamic acid

Tranexamic acid dose

First dose: 1 gram over 10 minutes • Follow-up dose: 1 gram over 8 hours

Tranexamic acid works by

inhibiting the conversion of plasminogen to plasmin → inhibit formation of FDP to control the bleeding

True or False It is only in Class III where you will see a drop in BP

True

Earliest sign of tachycardia seen in class what

Class II starting to increase

Athletes have a remarkable ability to compensate blood loss, may manifest late True or False

True

True or False It needs only a small amount of blood for pregnant patients to manifest perfusion abnormalities

False. Needs greater amount of blood

Medications that can affect a patient’s response to shock. Affects platelet function - increased bleeding

NSAIDS

Trauma measurements have a lower threshold for older people True or False

True