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Critical Care > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

This remains the number one cause of death

A

Trauma

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2
Q

These fractures can result in blood loss up to 125 mL

A

rib fractures

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3
Q

This is the most common cause of death from a lightning strike

A

cardiopulmonary arrest

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4
Q

This is considered to be the best way to monitor safe ventilation rates for severe head injury patients

A

waveform capnography

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5
Q

Maintaining a SBP of 80-100 mmHg is party of this type of resuscitation

A

damage control resuscitation

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6
Q

This fracture should be splinted as found with no attempts made to correct angular deficiency

A

fracture as knee

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7
Q

This is the result of hyperventilation in severe TBI patients

A

cerebral vasoconstriction and reduced cerebral perfusion

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8
Q

These are the three types of inhalation injuries

A

asphyxiation, Supraglottic, and Infraglottic

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9
Q

These influence the extent of a burn injury

A

intensity, duration, and tissue conductance

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10
Q

This is the most common cause of colon injuries

A

penetrating trauma

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11
Q

Force and acceleration

A

factors determining the extent of injury

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12
Q

This is considered to be the normal adult ICP range

A

3-15 mmHG
5 to 20 cm H2O

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13
Q

A patient with a GCS at or below this level has an increased risk for aspiration and hypoventilation

A

GCS 8 or less

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14
Q

These are common entry points for electrical current

A

hand and head/skull

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15
Q

This is the most common type of force applied

A

compression

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16
Q

Narrowed pulse pressure, JVD, and muffled heart tones

A

Beck’s Triad

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17
Q

Spontaneous abortion can occur with burns of this percentage or higher

A

60%

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18
Q

This nerve allows a person to touch their thumb to their pinky

A

median nerve

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19
Q

These are the two types of force delivered by penetrating

A

crushing and stretching

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20
Q

Most common cause of immediate death from falls and MVAs

A

Aortic disruption

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21
Q

A balloon is placed in the aorta to control hemorrhage and augment after load in traumatic arrest and hemorrhagic shock states

A

REBOA

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22
Q

A patient with a head injury from a call with a GCS of 10 would be classified with this severity level

A

Moderate

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23
Q

This is recommended EtCO2 range for patients with severe TBI and increased ICP

A

35-40

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24
Q

These splints are used to reduce a fracture

A

traction splints

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25
Q

Severe violence often results in these fractures

A

impacted and compression

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26
Q

This is one of the most problematic interpretations in electrocardiography due to the diffuse J-point in the right precordial leads in V1 and V3, downward concavity of the complexes in V4 and V5 with an asymmetric T-wave, and flat or downward lay depressed strain pattern in V5 and V5

A

LVH with strain

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27
Q

This is the litter/seat configuration for a UH-60A

A

6 litter, 7 ambulatory, or a 3 / 4 combo

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28
Q

These are signs of moderate respiratory distress

A

anxiety, restlessness, decreased breath sounds, intercostal retractions

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29
Q

This is an immediate intervention used for patients with postpartum hemorrhage

A

Fundal Massage

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30
Q

This age group has the highest incidence of TBIs

A

25 years and younger

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31
Q

This is the proper technique to sanction the newborn

A

mouth then the nares with a bulb syringe

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32
Q

These congenital defects cause left to right shunting

A

Acyanotic defects

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33
Q

These are signs of intestinal obstruction in an infant

A

distention, bilious vomiting, feeding intolerance, no stool in 24 hours

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34
Q

Extreme pain with passive movement

A

Compartment Syndrome

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35
Q

Special operations rescue teams have at least one member trained to this level

A

Paramedic

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36
Q

This course provides training to joint services, coalition forces, and the DoD

A

Joint Enroute Care Course

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37
Q

These 4 defects are necessary to diagnose Tetralogy of Fallot

A

Aortic Displacement, Ventricular Septal Defect, Right Ventricular Hypertrophy: Pulmonary Stenosis

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38
Q

Stretcher straps can be placed over the abdomen to hold fetal heart transducers in place

A

FALSE

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39
Q

This is the typical maximum patient hold capability for a Role 2 Facility

A

72 hours

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40
Q

This is the most common cause of RDS in preterm infants

A

lack of surfactant

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41
Q

2-3 mL/kg D10 with ongoing D5-D20 to maintain euglycemia

A

Emergent treatment for pediatric hypoglycemia

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42
Q

Alcohol consumption releases this hormone

A

Adrenaline

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43
Q

This can occur when a pregnant patient is placed supine on a backboard with resulting hypotension and tachycardia

A

Inferior Vena Cava Syndrome

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44
Q

This occurs when a pregnant patient experiences maternal blood loss

A

blood shunting away from the uterus

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45
Q

Initial IV resuscitation for a hypovolemic neonate

A

10 mL/kg NS for 5-10 minutes

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46
Q

This is the number of critical incidents stress management components

A

7

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47
Q

Intervention to relieve fetal distress

A

Mom in left lateral recumbent, placing on NRB, administering Terbutaline

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48
Q

The P.A.S.S. Mnemonic

A

Pediatric Asthma Severity Score

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49
Q

Where role 1 begins

A

Point of Injury

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50
Q

When your newborn has an SpO2 of 84% at the 5 minute mark you should do this

A

continue to monitor

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51
Q

This response can occur with ETT suctioning

A

Vagal response

52
Q

This is the minimum urine output for children experiencing electrical burns

A

1.5 to 2 mL/kg/hr

53
Q

What is considered when determining the extent of an injury?

A

The type and amount of force and the tissues response to the force (215)

54
Q

What is the most common force applied?

A

Compression (216)

55
Q

What 2 forces are involved w/ penetrating trauma?

A

Crushing and stretching (218)

56
Q

What GCS level is concerning for possible aspiration/intubation?

A

GCS of 8 or less (GCS <9) (222)

57
Q

The accepted ratio for blood product administration?

A

1:1:1 ratio of PRBC, plasma and platelets (228)

58
Q

Describe damage control resuscitation considerations

A

Early transfusion of 1:1:1 while restricting crystalloid using the goal of a SBP of 80-100 mmHg and while previnting/ correcting coagulopathy and hypothermia. (228)

59
Q

Recommended ETCO2 for a patient w/ a TBI and inc ICP?

A

35-40 (240)

60
Q

What happens if you hyperventilate a patient w/ a severe TBI?

A

The patients PaCO2 decreases triggering cerebral vasoconstriction. This constriction leads to decreased cerebral blood volume, decreasing ICP; however, the constriction can lead to cerebral ischemia (240)

61
Q

Be able to calculate GCS

A

“Just do it” -George washington prolly

Side note theres a chart on 238

62
Q

Normal ICP range for adults

A

3-15 mmHg; 5-20 cmH2O (289)

63
Q

Head injury deaths are commonly the result of this MOI

A

MVC (231)

64
Q

Best method to ensure safe ventilation rates for severe TBI patients during controlled hyperventilation?

A

ETCO2

65
Q

Age group w/ highest incidence of TBI?

A

25 years old or younger (231)

66
Q

How can adequate cerebral blood flow be optimized for a TBI patient?

A

Maintaining a CPP of 60-70 mmHg (239)

67
Q

The number one cause of death?

A

Trauma (250)

68
Q

Beck’s triad

A

Jugular Venous distension, muffled heart sounds, narrowed pulse pressures —–> Cardiac Tamponade

69
Q

Lethal triad

A

hypothermia, acidosis, coagulopathy

(Add hypocalcemia for the deadly diamond)

70
Q

Cushing’s triad

A

Signs of increased intracranial pressure:

  1. widening pulse pressures
  2. bradycardia
  3. irregular respirations
71
Q

Most common cause of death from falls and MVAs>

A

Aortic disruption (254)

72
Q

How is REBOA accomplished?

A

Resuscitative endovascular balloon occlusion

Placement of the balloon in the Aorta to control hemorrhage and augment afterload in traumatic arrest and hemorrhagic shock states. (256)

73
Q

Most common cause of colon injuries?

A

Penetrating trauma (257) (90%)

74
Q

Uretheral injuries

A

Although rare it is generally a result of penetrating trauma such as GSW’s or stab wounds. Rapid deceleration injuries may result in avulsion of the ureter from the renal pelvis. (259)

75
Q

Rib fractures can result in how much blood loss?

A

125ml of blood loss - American college of surgeons in 2012 (263)

76
Q

How should an amputated part be handled?

A

Flush the amputated part w/ crystalloid solution, wrap it in saline moistened gauze or a clean sheet and place it in a plastic bag or container. Then the severed part should be put in another container and cooled w/ another plastic bag that contains ice. (265)

77
Q

What fractures are the result of severe violence?

A

Impacted fractures and compression fractures (267)

78
Q

How are traction splints used?

A

Not used to reduce a fracture but to align it and immobilize the bone to prevent further damage during movement and transport. The traction splint immobilizes with a steady longitudinal traction pull exerted on the injured extremity. DO NOT USE ON UPPER EXTREMITY DUE TO RISK OF FURTHER DAMAGE OR IMPEDING CIRCULATION. (268-269)

79
Q

How do you check the median nerve?

A

Fractures of the elbow endanger the radial, ulnar and median nerves and the brachial artery. Check the median nerve by having the patient hold 3 fingers like in the hunger games.

Side note: Ulnar test: fingers together and spread the pinky. Radial test: Spread all fingers

80
Q

Types of dislocations

A

Complete (luxation- Complete seperation of the bones that normally articulate to form a joint

Compound- Joint communicates w/ outside air through a wound

Subluxation- Partial seperation of the joint (joint surfaces still touch but are not in normal relation).

(Slides)

81
Q

What fracture should be splinted as found w/ no attempt to correct angulation?

A

Knee or elbow (269)

82
Q

Hallmark symptom of compartment syndrome

A

Extremity pain w/ passive movement

and

POOP- Pain out of proportion (272)

83
Q

What influences the extent of a burn injury?

A

The intensity of the energy source

The duration of exposure to the energy source

The conductance of the tissue exposed (274)

84
Q

At what percent of burns is capillary permeability affected?

A

30% (275)

The pathophys for those intersted: Although inflammatory activity is a necessary part of the healing process, excess production of mediators, especially oxidants and proteases causes more capillary endothelial and skin cell damage. This increases capillary permeability particularly once the burned are reaches a size that is approximately 30% of the BSA which causes intravascular fluid loss and wound edema.

85
Q

When can a pregnant burn victim be expected to spontaneously abort?

A

With burns greater than or equal to 60% BSA (275)

86
Q

Which is worse AC or DC?

A

Low voltage AC exposure due to production of tetanic contraction of muscles causing the victim to freeze and remain in contact w/ the source. AC also has a greater potential to produce ventricular fibrillation from chest muscle contractions. (275)

87
Q

What can they cause? (AC vs DC)

A

DC typically causes asystole from depolarizing the entire myocardium.

AC has a greater potential to produce ventricular fibrillation from chest muscle contractions.

DC- Discreet exit wound

AC- Explosive exit wound (275-276)

88
Q

Mortality rates for electrical current passage paths?

A

Hand-to-hand: 60%

Hand-to-foot: 20%

Foot-to-foot: 5% (276)

89
Q

Common entry point for electrical current?

A

The skull is a common entry point for electrical current thus the brainstem is often affected which can lead to respiratory arrest and potential cerebral hemorrhage or edema. Nervous system tissue is highly conductive so damage to CNS is possible. (276)

90
Q

Assessment of a thermal burn includes?

A

Estimating burn size and depth, associated inhalation injuries and calculation of fluid resus needs (277)

91
Q

Three types of inhalation injuries?

A

Asphyxiation from CO poisoning

Supraglottic injury which is primarily thermal in nature

Infraglottic injury which is primarily chemical in nature

Side Note (G-Wiz info): Inhalation injuries are the primary cause of death at burn injury scene (278)

92
Q

How long should a inhalation injury patient be observed for potential complications?

A

24 hours (279)

93
Q

Most common cause of death in a lightning strike?

A

Cardiopulmonary arrest (280)

94
Q

Alkalis vs Acids (injury patterns)

A

Alkalis cause deeper more significant wounds than acids (280)

95
Q

Parkland and modified brooks formula?

A

Parkland: 4ml x TBSA x Kg

Modified brooks: 2ml x TBSAx kg

96
Q

Urinary output rates for burn patients (thermal and electrical)

A

Adults: 0.5-1 ml/kg/hr (thermal) 100 ml/hr (electrical)

Peds: 1-1.5 ml/kg/hr (thermal) 1.5-2 ml/kg/hr (electrical)

97
Q

Maternal blood loss effects on mom and fetus

A

Loss of variability and increased FHR are the first signs of maternal blood loss. Moms body will shunt blood to vital organs which excludes the uterus thereby lowering fetal blood flow. (slides)

98
Q

Interventions for a prolapsed cord?

A

Elevating the presenting part off the cord with a hand in the vagina that must remain there during the entire transport.

Mother should be placed in a trendelenburg or knee to chest position to further reduce cord compression.

DO NOT TOUCH THE EXPOSED CORD (VASOSPASM) and it should be wrapped in moist gauze and plastic to prevent it from drying out

Other considerations: Supplemental O2, A tocolytic medication such as terbutaline 0.25 mg/kg should be given subcutaneously or via IVP to slow contractions and reduce pressure on the cord during contractions. (449)

99
Q

Inferior vena cava syndrome

A

When a pregnant patient lies supine she compresses the IVC. Venous blood return is dramatically decreased which causes a decrease in CO. Mimics hypovolemic shock.

SXS: Hypotension, Reflexive tachycardia, skin CCT changes, and potential mental status changes.

Tilt the pregnant patient to prevent IVCS*** (433-434)

100
Q

What should a medic consider when treating a pregnant trauma patient?

A

Placing a towel roll under the backboard at the patients hips to relieve compression of IVC. Or tilting them to relieve pressure (433)

101
Q

Treatment for post-partum hemorrhage?

A

Palpate and vigorously massage the fundus at least every 5-15 minutes.

Having the patient void or inserting a foley cath has been shown to decrease uterine bleeding.

Rapid infusion of 20-40 units of oxytocin in 1000ml LR solution or methylergonovine 0.2mg administered IM or IV.

If lacerations are present apply a sterile pad and have patient squeeze legs together. Monitor for DIC. (445-446)

102
Q

Correct suctioning technique for a newborn?

A

Suction the mouth and then nose as stimulation of the nares may cause the infant to gasp and aspirate secretions in the oropharynx. (470)

103
Q

APGAR scoring

A

Appearance: Blue, pale (0); Acrocyanosis (1); Completely pink (2)

Pulse: None (0); Less than 100 (1); >100 (2)

Grimace: No response (0); Grimace (1); Cough, gag, cry (2)

Activity: (Flaccid/limp (0); Some flexion (1); Well flexed/ active motion (2)

Respiratory effort: None (0); Weak/irregular (1); Good/crying (2)

104
Q

Neonatal SPO2 considerations?

A

Take up to 10 minutes to get to normal extrauterine values. Consider supplemental O2 only if not improving.

1 minute of life: 60-65%

2 MOL: 65-70%

3 MOL: 70-75%

4 MOL: 75-80%

5 MOL: 80-85%

10 MOL: 85-95%

105
Q

IV fluid resuscitation for neonates?

A

10 ml/kg over 5-10 minutes. Type O-Rh neg blood should be considered if svere fetal anemia is documented (471)

106
Q

Respiratory distress syndrome in preterm infants (causes)?

A

Primarily caused by a deficiency of surfactant but can also occur in the presence of extreme stress such as hypoxia. Consider use of nCPAP. (479)

107
Q

Intestinal obstruction SXS?

A

Bilious vomiting, abdominal distension, feeding intolerance, large quantities of gastric contents at delivery, absence of an anal opening and lack of stooling in first 24 hours.

108
Q

Gatrochisis SXS?

A

What it is: Disruption of abdominal wall formation in the embryonic period, usually to the right of the umbilical cord

SXS: ABD Eviserations. Occurs early in gestation so the intestines may appear edematous with adhesions.

109
Q

Esophageal atresia SXS?

A

What it is: Congenital defect that results in an interruption of the esophagus causing a loss of connection to the lower esophagus and stomach.

SXS: Obstetric hx of polyhrdraminos should increase suspicion. Inability to pass a gastric tube to the stomach, excessive oral secretions, and choking or coughing during feeding. Confirm w/ radiographs

110
Q

Classic respiratory distress in peds?

A

Mild: No color changes, absent or mild retractions, air entry is mildly decreased, and LOC is normal or child may be restless

Moderate: No changes in color w/ moderate retractions present. Air entry is moderately decreased and patient starts to become anxious/restless.

Severe: Presents pale, dusky or cyanotic; retractions are severe w/ use of accessory muscles; air entry is significantly decreased and LOC is decreasing or patient is becoming lethargic. (493-494)

111
Q

Calculate correct ET tube size for a ped?

A

Age in years/4 + 4 (Un-cuffed) (499)

112
Q

PASS for evaluating an asthma patient>

A

Pediatric asthma severity score

Measures 3 clinical measures: wheezing, prolonged expiration, and work of breathing (504)

113
Q

Emergent treatment for a hypoglycemic ped?

A

2-3 ml/kg of D10 and ongoing dextrose infusion 5-20% to maintain euglycemia (512)

114
Q

How long to correct low sodium level?

A

Initially treated with levels of 125 mEq/L with 3% hypertonic saline of 1 ml/kg per hour IV infusion. This corrects the sodium level by 1 mEq/L per hour. (Slides)

115
Q

Left to right shunting vs Right to left shunting?

A

L-R is acyanotic whereas R-L is a cyanoti condition

L-R causes:

PDA

Atrial septal defect

Ventricular septal defect

AV canal defect

R-L causes:

Tricuspid atresia

Pulmonary atresia

Pulmonary stenosis (Slides)

116
Q

Tetralogy of fallot

A

Right to Left shunting

Made up of four defects

1.) Ventricular septal defect

2.) Pulmonary stenosis

3.) Displaced aorta

4.) Right Ventricular Hypertrophy

Patient may present with : Arrhythmias Dizziness, fainting, or seizures Delayed growth and development (Slides)

117
Q

When does role 1 begin?

A

At the POI; Triage, treatment and evacuation; No surgical or hold capability. (Slides)

118
Q

What is the typical patient capacity at a role 2?

A

20-40 cots (564)

119
Q

Maximum patient hold time (Role 2)

A

72 hours (564)

120
Q

Litter/ seat configuration for a UH-60A?

A

6 Litter max, 7 Ambulatory max, Combination of litter and ambulatory: 3 litter 4 ambulatory max (566)

121
Q

CASEVAC transport from role 1-3 considerations?

A

CASEVAC may or may not be coordinated or announced, minimal defenses, most rapid option for transport from POI (567)

122
Q

The ambulance capable of transporting 4 litter patients and 1 ambulatory patient or 8 ambulatory patients?

A

M997 four litter HMMWV and M113 tracked ambulance (568)

123
Q

Who does JECC train?

A

Joint service coalition forces, DOD and other federal government organizations. It teaches patient transport specifics for rotary wing aircraft. (570)

124
Q

Training level for special operations rescue teams?

A

Paramedic level (slides)

125
Q

Components of CISM?

A

Critical incident stress management (602), Preincident education, Individual crisis or peer support , Demobilization, Defusing, debriefing, family support, referral services

126
Q

Effects of alcohol?

A

Stimulates the secretion of adrenaline and results in nervous tension, irritability, and insomnia thus increasing stress. (600)

127
Q

G-Wiz info slide from burn lecture

A

Burn shock is caused by third spacing, Focus on trauma before burns, Phosphorus is found in fireworks and is ignited by air, Zones of burns: Zone of coagulation, zone of stasis and zone of hyperemia

Critical Care (4 decks)

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