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V Med > Emergency Medicine Midterm > Flashcards

Emergency Medicine Midterm Flashcards

1
Q

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

A

Incised wounds

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2
Q

Legally classified as cuts, rather than wounds

A

Incised wounds

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3
Q

Ragged irregular edges and masses of torn tissue underneath

A

LACERATIONS

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4
Q

Wounds are torn rather than cut

A

Lacerations

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5
Q

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

A

Laceration- irregular wounds

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6
Q

commonly misused in reference to injury with sharp
objects

A

Lacerations
Must show bridging

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7
Q

Very likely to become infected

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

Laceration

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8
Q

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

A

Abrasions /Grazes

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9
Q

Very painful (due to many sensory
nerve endings)

A

ABRASIONS (GRAZES)

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10
Q

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

A

Abrasions

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11
Q

penetrate into the tissues leaving a small surface opening

A

Punctured wounds

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12
Q

Possibility of infection is great because of
anaerobic infections

A

in all puncture wounds

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13
Q

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

A

True

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14
Q

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

A

PENETRATING WOUNDS

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15
Q

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

A

GUNSHOT WOUNDS
When shot at a farther distance

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16
Q

Profuse bleeding
Serious internal injury

A

Gunshot wound

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17
Q

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

A

Gunshot wounds

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18
Q

Tearing away of tissue from a body part

A

Avulsion

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19
Q

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

A

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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20
Q

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

A

Amputation

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21
Q

Types of closed wounds:

A

o Petechia
o Contusions
o Hematomas
o Crushing injuries

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22
Q

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

A

Petechiae

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23
Q

May coalesce to form a bigger hemorrhagic area

A

Petechia

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24
Q

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

A

Contusions

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

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25
Q

Occasional spitting of the skin
•

A

Contusions

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26
Q

True or False

Color changes stars from the periphery inwards

A

True

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27
Q

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

A

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

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28
Q

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

A

Hematomas

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29
Q

Blood tumors, With humps and bumps and lumps

A

Hematomas

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30
Q

Extreme amount of force applied over a long period of time

A

Crushing injuries

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31
Q

The basic types of wound

A

Open and closed

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32
Q

Caused by a clean sharp-edged object

A

Incised wounds

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33
Q

Imbalance in tissue oxygen supply and demand

A

Shock

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34
Q

Pump that drives the system

A

Myocardial contractility

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35
Q

Shock results eventually to

A

End-organ dysfunction

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36
Q

The first measurable circulatory sign of shock

A

Tahycardia

37
Q

the most common cause of shock after injur and trauma

A

Hemorrhagic

38
Q

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

A

8

39
Q

This class of hemorrhage is akin to donating blood

A

Class I

40
Q

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

A

Stopping the bleeding and replacing lost volume

41
Q

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

A

More than 4

42
Q

Triage prioritizes patients based on

A

Clinical urgency

43
Q

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

A

Overtriage

44
Q

Level of triage if immediately life threatening

A

Category 1

45
Q

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

A

Category 2 - envenomations

46
Q

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

A

Category 2 - very severe pain

47
Q

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

A

Category 4

48
Q

Patients triaged to category 4 can be seen within

A

60 minutes

49
Q

This is the name of the PREHOSPITAL triage system

A

START

50
Q

Patients tagged as green prehospitally

A

Walking wounded

51
Q

A pedia patient that has inappropriate posturing when pain is applied

A

Red

52
Q

The meaning of triage is to

A

Sort

53
Q

Modern triage systems consists of how many levels?

A

5

54
Q

It is the resistance to the forward flow of the blood

A

Afterload

55
Q

continuous presence of inadequate blood
volume (very terminal stage)

A

Patients with delirium

56
Q

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

A

False. Contraindicated because they worsen tissue perfusion.

57
Q

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

A

True

58
Q

Normal adult blood volume

A

7% of body weight

59
Q

Uncomplicated hemorrhage for which crystalloid
fluid resuscitation is required

A

CLASS 2 HEMORRHAGE (15-30%)

60
Q

classic signs of inadequate perfusion in Class 3 hemorrhage

A

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

61
Q

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

A

CLASS 4 HEMORRHAGE (>40%)

62
Q

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

A

restoring VR to normal by locating and stopping
source of bleeding

63
Q

Blood loss in bones:
-Humerus
-Femoral

A

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

64
Q

Myocardial dysfunction can be caused by

A

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

65
Q

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

A

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

66
Q

Beck’s triad:

A

hypotension, muffled heart sound and distended neck
veins

67
Q

Cardiac tamponade signs

A

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

68
Q

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

A

FAST - focused assessment sonography in trauma

69
Q

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

A

TENSION PNEUMOTHORAX

70
Q

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

A

Tension pneumothorax

71
Q

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

A

Needle or finger decompression
Then chest tube thoracostomy

72
Q

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

A

Neurogenic shock

73
Q

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

A

Early septic shock

74
Q

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

A

Septic shock

75
Q

one of the prime indicators of resuscitation and patient
response

A

urinary output

76
Q

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

A

20ml per kg if weighing <40kg

77
Q

Adequate volume replacement for adults

A

0.5 mL/kg/hr

78
Q

How to prevent hypothermia in blood transfusions

A

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

79
Q

True or False

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

A

True

80
Q

valuable baseline
studies to obtain in the first hour

A

Prothrombin time and partial thromboplastin
time, and platelet count

81
Q

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

A

Tranexamic acid

82
Q

Tranexamic acid dose

A

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

83
Q

Tranexamic acid works by

A

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

84
Q

True or False

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

A

True

85
Q

Earliest sign of tachycardia seen in class what

A

Class II starting to increase

86
Q

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

A

True

87
Q

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

A

False. Needs greater amount of blood

88
Q

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

A

NSAIDS

89
Q

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

A

True

V Med (6 decks)

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