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P2 Exams > Final (Trauma) > Flashcards

Final (Trauma) Flashcards

1
Q

“pressure” of electric flow

A

Voltage

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2
Q

Jacksons Theory) Zone of Stasis / “Ischemia”:

A

Less damaged area adjacent to the Zone of Coagulation (treatable & posible reversible damage)

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3
Q

Jacksons Theory) Zone of Hyperemia:

A

surrounding Area of erythema, damage with more RBC coming to area b/c/& cap/s more permeable (increased blood supply) trying to get phagocytes to inside for healing process
Sig burns have sig swelling from shift of fluid

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4
Q

Jacksons Theory) Zone of Coagulation:

A

Area of burn nearest to the heat source (most damage & tissue necrosis)Most damaged area

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5
Q

Which type of wound has a small opening into the skin, but may be quite deep, and is often caused by instruments such as nails, ice picks, or pencils?

A

= Puncture

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6
Q

The skin is known collectively as the:
Skin, considered what of body & what % of total body weight:
Which layer of skin primarily insulates the body against heat loss?
Glands w/in the dermis that secrete a lubricant are called the:
Outermost layer of skin is the:
What part of the integumentary system receives no blood supply?

A

= Integumentary system
= Organ, 16% of total body weight
= Subcutaneous Layer
= Sebaceous glands
= Epidermis
= Epidermis

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7
Q

“Laying the bike down” results in

A

the bike absorbing much of the energy

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8
Q

Sodium Bicarbonate is delivered PT’s suspected w/ hyperkalemia at:
Dose of Calcium Chloride for hyperkalemia & line of med?

A

= 50 mEq as last line
= 500-1000 mg/3mins IV as 1st line med

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9
Q

Which of the following best describes an avulsion?
Which of the following is considered an open wound?
Which soft tissue injury causes a greater amount of hemorrhage?

A

= Flap of skin partially/completely torn away from underlying tissue
= Laceration
= Avulsion

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10
Q

Injury which opening occurs in skin & organs protrude through is:

A

Evisceration

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11
Q

Injury which opening occurs in skin & organs protrude through is:

A

Evisceration

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12
Q

Most common location for compartment syndrome to occur?
1st “P” of compartment syndrome?
What ECG changes would indicate hyperkalemia?

A

= Distal leg, anterior compartment
= Pain
= Peaked T Waves

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13
Q

What is hydrostatic pressure in the vascular system & what creates it?

What is oncotic pressure in the vascular system and what creates it?

A

=Pressure from heart in blood vessels & forces water to cross the capillary membrane into the interstitial space.
=Pulling water back into the blood vessels by the presence of large proteins in the blood (pulling back in)

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14
Q

What are the three levels of penetrating trauma?

A

Lvl 1: entrance
Lvl 2: cavation
Lvl 3: exit

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15
Q

What are the 3 different levels of penetrating trauma?

A

High velocity> sniper
Medium velocity> pistol
Low velocity> knife

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16
Q

What are the 3 dif types of soft-tissue injuries?

A

Type: Open
Type: Close: Infection
Type: Burn

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17
Q

TXA) 1 Dynamics:
2 when do we admin/ it:
3 Correct dose:
4 Followed by:

A

1= Blocks fibrinolysis by binding to plasminogen, blocking plasminogen fibrin interactions.
2= Significant hemorrhage, either internal or external (after external hemorrhage has been controlled).
3= 1G/10mins (mix in 50 mL bag of NS)
4= 1G/8Hrs (500 mL bag)

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18
Q

Trauma def:
Trauma’s 2 categories:

A

= Physical injury or wound caused by external force or forces
= Penetrating & Blunt

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19
Q

tools for external hemorrhage:

Trauma Clamps:
Tourniquets:

Tourniquet use adverse effects:
Hyperkalemia & Sign:

A

= Hemostatic Agents/Dressings, (combat gauze), trauma clamp, Tourniquets,
= IT clamps “teeth chomper”
= Commercial best at least 1in diameter/width (Willis=turning stick), Improvised (ad hawk), Air inflatable (like BP cuff), Junctional (sam splint=pelvic)
= Due to distal hypo-perfusion, toxins build up>Hyperkalemia:
= tall sharp T waves & treat w/ sodium bicarb bc Acidosis

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20
Q

Thickest skin @:
Thinnest skin @:

A

= Palms & Soles have thickest skin
= eyelids 1st & genitalia 2nd

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21
Q

Thick, fibrous, inflexible membranes surrounding muscle that help bind muscle groups together are called:

A

Fascia

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22
Q

Thermal burn phases:

A

Emergent, Fluid-shift, Hypermetabolic, & Resolution phase

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23
Q

Internal Hemorrhage being forced between tissue layers (fascia):
Internal Hemorrhage:
Pregnant internal hemorrhage worry:
Internal blood loss may be self limiting:

A

= Hematoma (pocket of blood) usally from arterie)
= Blood accumulation in interstitial spaces, forming visible contusions
= multiple uterine arteries in umbilical cord
= Large body cavities (chest, ABDMN, pelvis) have little resistance & internal blood loss may be severe.

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24
Q

The stage of the burn process characterized by catecholamine and pain-mediated reaction is called the:

A

Emergent Phase

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25
Q

The most common & serious trauma associated w/ explosions is:
The most lethal explosions are those: That cause structural collapse

A

= Pulmonary injury
= That cause structural collapse

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26
Q

The health care surveillance process, put in place for trauma systems, is called

A

the Registry.

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27
Q

Frontal impact MVC rarity:
Pathways of travel w/ MVC frontal impact are:
Rear-impact MVC injuries:

A

= most common type of impact in MVCs
= Down & under or Up & Over
= commonly limited/benign especially w/ Headrest position properly

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28
Q

Form/ “mass multiplied by velocity squared, divided by two” equals:
Study of processes that bring forces to bear upon human body is:
When sig/ kinetic energy is applied to human anatomy, its called:
Branch of physics w/ objects in motion & E. exchanges w/ collision:

A

= Kinetic energy
= Kinetics of impact
= Trauma
= Kinetics

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29
Q

The following burn patterns is usually seen with child abuse:

A

“Stocking burns” to lower legs, Circumferential burns on buttocks, Multiple circular burns of the same size to the arms and legs

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30
Q

The blood volume of an infant or young child is proportionally:
Population most at risk for trauma & trauma death:

A

= ~20%> than that of an adult
= Young adult male

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31
Q

Area nearest the heat source that suffers the most damage is called the zone of:

A

Coagulation

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32
Q

Tendons:
Ligaments:
Fasciae:
Tension lines/Langer lines:

A

= connects muscle to bone, strong, full of collagen “tend to bone”
= connects bone to bone aligning joints & easily tear
= band sheet of CT stabilizes, encloses, & separates M. compartments
= “way skin is grooved together”, cut against line hard to close & leaves bigger opening, effects healing process

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33
Q

Surveillance:

A

= collection of data Epidemiology=study of disease based on med survey

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34
Q

Subdural venous nature hematoma shows symptoms:
Epidural bleed arterial nature hematoma shows symptoms:

A

= 2-3 or 3-6hrs for symptoms
= immediately

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35
Q

Subcutaneous:

A

= adipose tissue, most thermal temp/ reg/, (regs cold>heat)

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36
Q

Stroke volume:
Cardiac Output (CO):
CO form/:
3 factors that affect cardiac output:
Dynamic CO:

A

= blood amount ejected in 1 contraction> varies 60-100mL 70average
= Amount of blood moved in 1min
= HR X SV -> 5-6 L of blood moved in 1 min
= preload, afterload, contractility
= “1 up & other down”

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37
Q

Stroke volume is predicated by:
Amount of blood ejected by heart in one cardiac contraction:
Pressure w/in ventricles at the end of diastole:
Blood vol/ moved by heart in 1 min:
Measurement of peripheral vascular resistance is the:
Resistance a heart contraction must overcome in order to eject blood:

A

= Preload, afterload, and cardiac contractility
= Stroke Volume
= Preload
= Cardiac output
= Mean arterial pressure
= Afterload

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38
Q

Stridor w/ inhalation burns:

Bad Airway burns might might need:

A

= AKA “crowing” larynx last defense against heat then swells 2/3s so intubate asap bc only worsens (Press chest & follow bubbles)
= Might need to nasal endotracheal intubation w/ BAAM & Endotrol tube (ET w/ trigger) BAAM> High=inhale &Low=exhale

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39
Q

Stretch blunt trauma:

Sciwora:

A

= Tendons & Fibers that (tendons stronger) hold organs & other structures together are pulled & injured or torn
= spinal cord injury with out r a (kids in wreck overstretching neck)

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40
Q

1staph:
2Strep:
3Lymphangitis:
4Tetanus (Lockjaw):
5Gangrene:

6Wet Gangrene:
7Dry Gangrene:

A

1= staphylococcus Anaerobic bacterium infection
2= Streptococcus Anaerobic bacterium infection
3= red lines along lymph lines b/c infection
4= Clostridium tetani>Attacks NS produces toxin >M. contrac/spasms
5= Clostridum perfringen>(diabetes>risk) <peripheral> infection lacks blood supply/flow> less WBC
6= bacteria to tissue & swells then fluids outside of tissue
7= blood supply cut off and dry</peripheral>

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41
Q

Standards established by your system’s medical direction to assist you in determining which PTs require urgent transportation to a trauma center:

A

Trauma Triage Criteria

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42
Q

Specialty Centers:

A

= Neuro, Burn, Pedi trauma, Hand & limb replant microsurgery, Hyperbaric oxygen

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43
Q

Special pop of burns:
PT’s cope less b/c:

A

= GERI, Pedi, & PTs ill/injured have >dif coping w/ burn injuries
= Fluid retention, <fluid reserves, <able to combat infection, More apt to have underlying diseases

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44
Q

Site for pneumo decompression:
needs:
Never go under a rib b/c:
Locating decompression site:
Digital thoracostomy:

A

= Anterior 2nd ICS midclavicular/3rd rib & b/c air is always up/rising
= At least 3in catheter, attach 1way valve: Could use 3way valve, glove,
= vascular; have major thoracic arteries & nerves
= palp/ then slide over 3rd rib
= 1-2in incision between 4th & 5th ICS, ( “cut finger tube” )

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45
Q

(Rad) S/S of Exposure:
First sign:
Lethal Dose Exposure:

Organ shutdown:

A

= SLUDGEM PSNS S/S
= slight nausea & fatigue
= Emesis & malaise, Epistaxis, mouth, gums, & rectum (Vomiting usually lethal exposure
= Death

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46
Q

Shock) Hypovolemic:
Types:

A

= fluid loss
Hemorrhagic: blood loss & Non-hemorrhagic: V/D, Sweating

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47
Q

Shock) 1 Distributive:
2 Hives:

3 “warm shock/high space”:
4 Sick shock:
5 syncope:

A

1= uncontrolled vaso-dialation
2= Anaphylactic: release of histamine from Ige & b/c allergen
3= Neurogenic: warm b/c reverse shunting makes warm transient block of SNS
4= Wide spread of infection
5= Physcogenic: Sudden vasodilation physiological means EX hemophobic, arachnophobic

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48
Q

Shock) 1 Obstructive & types:
2 pneumothorax:
3 Pericardium:
3 traveled Embolism to lungs:

A

1= something obstructing heart} PE, Tension/Pneumo, Pericard/tamp
2= Tension/pneum: plueras so full pushing on hearts atrium
3= Pericardial tamponade: pericardium filled with blood
4= PE: emboli so big obstructs pulmonic vein

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49
Q

Shock) 1 Respiratory/Metabolic:

A

1= Disruption of O2 transfer into cells/cells unable to utilize O2 from Cyanide, CO poisoning, A change in the blood pH

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50
Q

Shock) Normal S/S of shock:
Compensate shock:
Decompensated shock:
Irreversible shock:

A

= Tachypnea&cardia, AMS, lower BP
= body is compensating “fighting” to maintain homeostasis
= can no longer maintain homeostasis
= can’t come back to life

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51
Q

Shock) How does hemophilia affect the body and the clotting of blood?

A

Does not have ability to properly clot due from ½ factors

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52
Q

Shock) S/S of neurogenic shock:
Cushing’s Triad:

A

= warm/flush, bradyC, HyperBP, AMS, Blown and/or unequal pupils
= HyperBP, BradyC, cheyenne stokes or Biots ventalations

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53
Q

Shear blunt trauma:

Axons shearing:

A

= injury occurs along edges of impacting force or at organ attachments (sudden acceleration) (liver ligament teres cuts liver) (arteriosus ligament shears middle of aorta (ductus oreriosis)
= concussion diffuse axonal injury DAI (changed pep b/c DAI)

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54
Q

Seat belts:
Maternal relation w/ seat belts:
Cullen’s sign:
Most common organ injuries:
SRS:

A

= vehicle restraints, reduced # of collision related deaths
= US #1 maternal death, hips/pelvis not ABDMN
= internal bleed abdominally
= Spleen adults Liver kids
= supplemental Restraint Systems (SRS) 1st used for front impacts, airbag inflation to cushion energy

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55
Q

Rule of palm:

A

use of PT hand = 1% of BSA (burns <10%)

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56
Q

Roll Over Car Impact:
(ROCI) injuries:

A

= car is flipping (high critical “drying machine”)
= Multiple impacts from hitting each part of car w/ each 1/4 rotation

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57
Q

Risk analysis:

A

= Examines & determines factors that impact dev

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58
Q

1 Resp/ arrest from electrical burn is a result of:
2 The “pressure” of the electric flow is known as:
3 PTs in cardiac arrest b/c electrical current have high survival rate if:
4 human body relation w/ current:
5 Electrical injuries’ usually damage:

A

1= immobilization of M.s from prolong exposure to electrical current
2= Voltage
3= Prehospital intervention is prompt
4= Body offers resistance to the flow of electricity
5= does lots of damage to muscle tissue & other tissues

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59
Q

Removing moto helmets:

A

Paramedic remove that helmet!!! For A&B,
Remove if Helmet isn’t snug &/or bad integrity
Contra: impaled through helmet & skull

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60
Q

Rear Car impact:
(RCI) common injuries:

A

= read-end, commonly most benign
= Whip lash, common C-Spine injuries

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61
Q

QA QI should NEVER be

A

punitive

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62
Q

Punctures:
Impaled:

A

= small entrance (ABDMN punctures can >evisceration)
= embedded objects

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63
Q

Pulse pressure:
Pulse pressure signifies:
Pulse pressure <25 mmHg may be seen w/

A

= dif/ between DBP & SBP pressures (PP= SBP-DBP)
= amount of force the heart generates with each contraction
= PTs w/ sings of shock

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64
Q

Public health care model:

A

= Surveillance, Risk identification, intervention dev, implement, Eval/

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65
Q

Lightning shock pathway to heart can & b/c:

A

= PSNS & SNS attach heart “defib w/o defibrillator” put in dysrhythmia or arrest

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66
Q

1 (PTs in severe pain w/ narcotic analgesia) morphine:

2 Fentanyl
3 Ketamine use:

A

1 = 2-5 mg IV increments every 5mins til’ pain is relieved. Use w/ caution b/c it can depress resp/ drive & increase any existing hypovol/
2= start w/ loading dose 25-50mcg IV & repeat doses as needed
3= may be an alternative to fentanyl in selected patients.

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67
Q

Preload:
Afterload:

Mean Arterial Pressure (MAP):

A

= pressure/vol/ w/in ventricles @ end of diastole “End-diastole vol/“
= resistance against which the heart must pump against (increase afterload= increase ventricular workload)
= average pressure in arteries during a single cardiac cycle = pressure that drives blood to tissues (ensuring organ perfusion)

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68
Q

Platelet Phase of hemostasis:

A

2nd phase, Platelets aggregate, or collect and adhere. Slows hemorrhage from capillaries and small vessels- splint fractures to decrease of clots being broken down & bleeding again

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69
Q

Penetrating:

(under penetrating) Perforating:

A

= object enters body & exchanges energy directly w/ human tissue causing damage or injury (goes in w/o exit)
= goes in & exits of body

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70
Q

Penetrating trauma:
Perforating trauma:
(3lvls of Penetrating trauma) 1st Lvl:
2nd Lvl:
3rd Lvl:
Ballistics:
Factors of bullet speed/damage:
Trajectory:
Cavitation:
Profile:

A

= object pierces the skin and enters the body
= object pierces through & through body
= Low velocity: knifes, swords, ect
= Medium: handguns
= High-velocity: Rifles
= study of projectiles in motion & effects on objects
= Trajectory, Drag, Cavitation, Velocity, Profile, Shape:
= curved path bullet follows after fired from a gun
= Outward motion of cavity due to projectiles speed & vacuums
= cross-section of bullet along its direction of travel

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71
Q

Penetrating injuries & subtypes:

A

= puncture: small entrance, Impalement: remove impedes CPR or Airway, Perfurating: through & through

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72
Q

Oxy Dissociation Curve:
Bohr Effect:
Haldane Effect:

A

= H-globin “Train” taking & dropping oxy
= Acidotic with R-shift of hemoglobin w/ decrease oxy affinity
= Alkalotic w/ L-shift Loves oxy in Lungs

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73
Q

Rad/ only sig/ hazard if inhaled/ingests contaminated material is:
Neutron radiation is:

A

= Alpha
= uncommon outside of nuclear power reactors & Bombs

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74
Q

1 One of the chief functions of the skin is:
2 The skin is comprised of 3 layers:
3 Layer that serves as stratum of insulation vs trauma & heat loss is:
4 Layer that contains blood vessels, glands, & nerve endings is:
5 Full-thickness burns can involve injury to:
6 The integumentary system relation to NS:

A

1= Temp regulation
2= Epidermis, Dermis, & Subcutaneous Tissue
3= Subcutaneous Tissue
4= Dermis
5= blood vessels, nerves, M. T., bone, & sometimes internal organs.
6= is not part of the nervous system

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75
Q

Tension pneumo & pulmonary emboli is which type of shock?
Pericardial tamponade presents w/:

A

= Obstructive
= Becks triad JVD, tachycardia, hypotension, & Muffled heart tones

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76
Q

Ohm’s law:

A

relationship between current (I), resistance (R), voltage (V)

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77
Q

Oblique Car Impact:

A

= occurs when lateral impact is off center aka “spin/rotating”

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78
Q

(Newtons laws) inertia) 2nd law:

force formula is summarized as:

A

= force is related to object’s mass (weight) & rate of its change in velocity (speed)
= Force=Mass (weight)×Acceleration (or deceleration)2

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79
Q

Newton’ s 1st law:

Newtons 2nd Law:

A

= (inertia): body in motion will stay in motion unless acted upon an outside force “Body at rest will remain at rest unless acted upon upside force”
= “law forces at work stay in work during collision”

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80
Q

Motorcycles often serious trauma b/c:
Frontal Moto/ pathway & Injuries:
Angular Moto/ pathway & Injuries:
Sliding Moto/ pathway & Injuries:
Ejection Moto/ pathway & Injuries:

A

= rider tends to absorb much of crash injuries (lots of heads injuries
= most common front dips propelling rider & handlebars catch lower
= “side swipe or lateral” impact w/ guard rails Mostly ortho-injuries
= < chances of ejections) more rashes & “most safe”
= very common, usually more serious injuries Initial Biker then Ground

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81
Q

MVC) Types of impacts:
Most common impact:
Most deadly impact:
commonly most benign impact:

A

= Frontal, Lateral, Oblique, Roll over, Rear
= Frontal
= Lateral (b/c less crumble zone & Seat belts offer lil protection)
= Rear

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82
Q

Morphine & fent drop BP by:

A

= body releasing Histamines

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83
Q

MOI:
Energy:
Inertia:

A

= mech of injury how the injury happened
= Ability to do work
= law of Inertia (Newton’s 1st law) helps explain how objects in motion behave

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84
Q

Moderate criteria) Superficial:
Partial thickness burns:
Full thickness burns:

A

= BSA >50%
= BSA <30%
= BSA <10%

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85
Q

(Moderate criteria) Superficial:
Partial thickness burns:
Full thickness burns:

A

= BSA >50%
= BSA <30%
= BSA <10%

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86
Q

mechanism of injury (MOI):

A

the circumstances and events by which an injury occurs.

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87
Q

Lightning can still strike you if proximity up to:

A

up to 50yrds can strike you

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88
Q

Light Burns:
Inhalation Burns:
Toxic inhalation:
Cyanide & carbon monoxide are released via:

A

= Intense light from arc welder, industrial laser (Ultraviolet keratitis)
= Inhaled gases, heated air, flames, steam; airway & resp/ injury
= Synthetic resins & plastics release toxic gases as they burn
= fake wood & such burning thus Toxic inhalation

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89
Q

Life threatening injuries %:
Most-life threatning trauma occurs to:
Vol per lung & body:
lethal blood loss:

A

= <10% traumas
= head and/or chest
= 3L per lung & 5L per body
= >40% or ~2L

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90
Q

Layers of skin:

A

Epidermis, Dermis (papillary & Reticular Lvls), Subcutaneous

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91
Q

Epidermis:

A

dead skin cells, no vasculature, astratum corneum, cells are pushed out & are replaced, Sebum (waxy oil lubes (hands), top layer of skin

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92
Q

Lateral Car Impact:
more deadly impact b/c:
(LCI) body pathway & injurie:

A

= hit from side aka T-bone(most dealy b/c less crumble zone)
= Seat belts offer lil protection
= Coupe-Countre-Coupe injury > neck/head toward impact & body w/ impact

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93
Q

Lacerations:

A

= “jagged” Cuts deep into dermis ( Incisions, Punctures, perfuration)

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94
Q

Lacerations & subtype:

A

= cut into dermis} Incisions: smooth Lac from sharp (scalpal, glass, ect) open against tension line, close w/ tension lines

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95
Q

1 kinetics of penetrating trauma) Ballistics:
2 Trajectory:
3 Drag:
4 Cavitation:
5 Velocity:
6 Profile:
7 Shape:

A

1= Study of projectiles in motion & effects on objects
2= Curved path bullet follows after fired from a gun
3= Drag from wind
4= Outward/ cavitation motion of cavity due to projectiles
5= Speed of object in motion
6= Cross-section of bullet along its direction of travel
7= Shape of bullet

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96
Q

1 kinetics of penetrating trauma) Study of projectiles in motion & effects on objects
2 Curved path bullet follows after fired from a gun
3 Drag from wind
4 Outward “ballooning” motion of cavity due to projectiles
5 Speed of object in motion
6 Cross-section of bullet along its direction of travel
7 shape of object

A

1= Ballistics:
2= Trajectory:
3= Drag:
4= Cavitation:
5= Velocity:
6= Profile:
7= Shape:

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97
Q

Kinetic energy:
kinetic energy formula:
Increasing mass vs. velocity directly increases what:

A

= energy of an object in motion (Fn. of object’s mass & its velocity)
= Kinetic energy=Mass(weight)×Velocity(speed)22
= kinetic energy > +velocity exponentially increases kinetic energy

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98
Q

Kinetic energy:
Kinetic Energy form:

A

=energy of a object in motion (by objects mass & its velocity
= (Mass x Velocity ^2)/ 2 ½ x mv^2

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99
Q

Jacksons Theory of Thermal Burns 3 burn zones:

A

1st Zone of Coagulation 2nd Zone of Stasis 3rd Zone of Hyperemia

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100
Q

Intervention dev:

A

= dev/mod of programs to reduce both incidence & seriousness of trauma

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101
Q

1Prehospital Infections:
2Infections cause, duration, severities, treatment:

3Risk factors:

A

1= sepsis, staph, strep, Lymphangitis, Tetanus, & Gangrene
2= Anaerobic bacterium, ~10% severe, 2-3 days pain tender warm, fight w/ steroids
3= diabetics, infirm, elderly, chronic diseases, steroids, animal/human bites,

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102
Q

Burn worries) Infection:

A

natural body bacteria can kill & become opertunicle & Most persistent killer of burn victims & Does not appear for several days following acute injury, Pathogens pose hazard to life when they grow to massive numbers

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103
Q

index of suspicion:

A

Info gathered regarding the scene & MOI for mental summation of suspected injuries based on your event analysis

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104
Q

Incisions:

A

= smooth Lac from sharp instrument (knife, razor, glass, ect) gapes open if against tension line, keeps close typically if cut w/ tension lines

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105
Q

Implementation:

A

= putting effective safety measures EX roads,

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106
Q

If you were administering isotonic crystalloid solutions, how much would move out of the intravascular compartment within 1 hour?

A

2/3s would move out

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107
Q

Burn injury in an enclosed space, always consider the possibility of:
Supraglottic structures are useful w/ burns b/c:

A

= Inhalation Burns
= B/c very moist mucosa lines the airway Supraglottic airways may absorb heat and prevent lower airway burns

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108
Q

Burn worries) Hypovolemia:

A

Tissue destruction reduces/eliminates skin’s ability to contain fluid w/in, Inability of damaged blood vessels to retain plasma causes fluid & electrolyte shift into burned tissue & Takes 4-6hrs to dev/

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109
Q

Hyperkalemia) 1st line med:
2) One of two 2nd line meds:
3) One of two 2nd line meds:
4) Hospital only med:
5) Hospital only med to poop:

A

1= Calcium Chloride IV 0.5-1G/3 mins (Stabilizes doesn’t fix)
2= Albuterol 10-20 mg LVN over 15 mins
3= Sodium Bicarb 50 mEq IV mil equivalent
4= Dextrose (25 grams)w/ Insulin IV (10 units)
5= Kayexalate to poop out hyperK via pull interstitial to GI

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110
Q

Hydroxocobalamin:
Adult Dose:
Pedi Dose:

A

= Suspected cyanide poisoning
= 5 grams IV/IO over 15 minutes. May repeat a 2nd 5 gram dose for a max of 10 grams
= 70 mg/kg IV/IO (max 5 grams)

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111
Q

Hemostasis:
Hemostasis order:
Factors that effect hemostasis:

A

= Body’s response to a local hemorrhage w/ 3 phases
= Vascular, Platelet, Coagulation “flow, stick, build”
= Wound type(can pull w/in>cant constrict), M-nt, Temp, Meds( most blood thinners stop/prevent fibrin) Warfrin/Coumadin), IV Fluids

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112
Q

Heat gradient

A

H → L heat will go

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113
Q

Haldane Effect:
Influences by:
What does it do to the hemoglobin?

A

= Alk> Hemoglobin Loves oxy in Lungs
= -CO2, -temp, +pH -BPG 2,3, in Lungs,
= +oxy affinity

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114
Q

Golden Period “hour”:
Platinum 10:

A

= incident to surgery time 1 Hr from Crash to EMS to PT to surgery
= no more than 10 mins on scene

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115
Q

Geiger Counter:
Dosimeter:

A

= Radiation emission measured w/ Dosimeter
= Cumulative exposure recorded

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116
Q

Frontal car impact:
(FCI) Restrained pathway:
(FCI) Unrestrained pathway:

A

= most common, Spider windshield, Pneumo b/c paper bag syndrome
= fold over, chest/ABDMN, <injuries
= Up & Over, down & under, ejection (most injuries)

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117
Q

Frank Starling law/mechanism:

Vascular Resistance:
SVR vs. PVR:
SVR (Systemic Vascular Resistance):
PVR (Pulmonary Vascular Resistance):

A

= more myocardium is stretched the more force/greater the next contraction will be (increase in preload increases contraction)
= Resistance to overcome to push blood through circulatory system
= Body’s circulation resistance & Lung’s circulation resistance
= resistance blood faces in systemic circulation (arteries size)
= resistance blood faces in pulmonic circulation EX CHF, R ventricle

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118
Q

Frank Starling law/mechanism:

A

= more myocardium is stretched the more force/greater the next contraction will be (increase in preload increases contraction)

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119
Q

Vascular Resistance:

A

= Resistance to overcome to push blood through circulatory system

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120
Q

SVR vs. PVR:

A

= Body’s circulation resistance & Lung’s circulation resistance

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121
Q

SVR (Systemic Vascular Resistance):

A

= resistance blood faces in systemic circulation (arteries size)

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122
Q

PVR (Pulmonary Vascular Resistance):

A

= resistance blood faces in pulmonic circulation EX CHF, R ventricle

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123
Q

Force:
Force formula:

A

= force related to a objects mass(weight) and/or achange in velocity
= mass x Acceleration

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124
Q

Thermal burn phases) Fluid-shift phase:

A

2nd phase; can last up to 24 hours; larger than 15 to 20%(BSA) of total body surface area
vasodilates & capillaries more permeable for phagocytosis

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125
Q

Fluid resuscitation is an important part of treating serious burns. The formula for the amount of IV fluid needed to be infused includes:

A

4 mL × patient weight (kg) × BSA burned <Parklands></Parklands>

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126
Q

Fluid accounts for ~% of the body’s weight, Only ~% of the fluid is contained in our vascular system

A

= 60% of the body’s weight, Only about 7% of the fluid is contained in our vascular system

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127
Q

Faster and/or mass relation to energy:
Cavitation’s relation to speed:
Energy exchange Study of:

A

= more deceleration > more transfer of energy
= Faster object greater cavitation
= “kinetics of energy compact”

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128
Q

Falls:
Examine:
Axial loading:
FOOSH (Fall onto an outstretched hand)
Colles’ fracture:
Smith’s fracture: out
>20ft greater risk of
Aortic anyrusem to tear:

A

= most common blunt trauma, risk increase w/ age, sig fall 2-3x height
= height, position, surface PT landed on, physical condition of PT
= loading on axial skelton via falling (E starts heel to lumber)
= influxing wrist fractures from fall impact
= efflucing wrist fractures from fall impact “Palm out”
= internal organ damage
= pain tearing to chest shoulders back
= tearing pain from chest goes to back

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129
Q

Factors of burn severity:

A

Duration, Exposure, temp, surface

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130
Q

Factors Affecting Exposure to Radiation:

A

Duration of exposure, Distance from source, Shielding from source

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131
Q

Parkland Burn Form) EX: 32yo male found with 10% BSA 1st degree burns, 10% BSA 2nd degree burns, and 10% BSA 3rd degree burns. The patient is 110 pounds.
1. 4 mL x BSA x Weight (kg)
2. Total mL / 2 = (Amount to give for:
3. How many mL’s per hr?
4. How many gtts/min using a 10 gtt/mL IV drip set?
5. Know w/ formula:

A
  1. 4mL X 20 (2nd + 3rd degree burns) X 50 (kg) = 4000 mL
  2. 4000 mL / 2 = 2000 mL (Amount to give 1st 8 hours then next 16Hrs)
  3. 2000 mL / 8 = 250 mL per/hour for 1st 8 hrs
  4. 42 gtts/min
  5. Pick closest option choice for gtts & Vol calculated. Use biggest bores& macro drips
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132
Q

Evaluation:

A

= Repeat surveillance “good on paper but what about practice”

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133
Q

Escharotomy =

A

= release pressure w/ cutting burn to relief fluid pressure

134
Q

Eschar:

Can be severe enough to :

A

= Burn destroys dermal cells; Skin constricts over wound site, increasing pressure of edema beneath & restricting flow of blood
=occlude all blood flow into distal extremity (compartment syndrome)

135
Q

“energy” or amount of flow in given time

A

Current; measured in amperes

136
Q

Thermal burn phases) Emergent phase:

A

Vtach, cells anaerobic Body’s initial reaction to burn; pain response (afferent nerves damage> Nor/Epi release > tachycardia ; unless on beta blockers

137
Q

Burn worries) Electrolyte imbalance:

A

Body’s ability to reg Na,K,& electrolytes is overwhelmed, Careful electrocardiogram (ECG) monitoring and fluid resuscitation help prevent hyperkalemic
Succholyine depolarzing makes hyperK worse

138
Q

Electricity follows path of

A

least resistance w/ entry & exit wound: Nerves & blood vessels

139
Q

Dynamic CO:

A

=1 up other down, L diastole P = L afterload, PVR pulmonary & oil

140
Q

Dry dressing for burns:
Wet dressing for burns:

A

= >10%
= <10%

141
Q

Direct current (DC):
Alternating current (AC):

A

= electrons flow in one direction > grab on can’t let go
= reverses flow in short intervals (60 cycles change electrons’’ flow) can let go

142
Q

5 types of shock and treat them appropriately:

A

Hypovolemic, Cardiogenic, Distributive, Obstructive, Respiratory/Metabolic

143
Q

dif types of open soft-tissue injuries:
Abrasions:

A

= Abrasions, lacerations, avulsions, and penetrating injuries
= scrape across skin skin

144
Q

Dermis:
2 layers of dermis:
Papillary:
Reticular:
Sebaceous glands:
Sudoriferous Glands:

A

= Middle layer of skin
= papillary & Reticular layer
= contains the Glands, blood vessels, nerves “nipple, Nerves”
=contains the venules arterioles, capillaries “Reticular network circul/”
= sebum lubricate palms
= SNS n postsynaptic acetylcholine for response

145
Q

Denature:

A

take away natural state (from chem burns)

146
Q

CUPS:
C:
U:
P:
S:

A

= Categories of PT severity
= Critical: ABCs FUCKed
= Unstable: hypotension, comp to decomp
= Potentially unstable: pelvic fracture, stable can unstable
= Stable: stable ex toenail fracture

147
Q

Crush syndrome occurs when trapped/crushed for how long:
Crush injury is what type of wound:
PT has lower L-leg trapped underneath a farm tractor for the last 5hrs. PT presents w/ obvious signs on hyperkalemia. What is 1st line IV med for this patient?

A

= usually for longer than 4 hours
= Closed soft tissue injury
= Sodium Bicarbonate

148
Q

Crush injuries w/ compartment syndrome occur IRL & per book:
Hyperkalemia sign:
Crush/Hyperkalemia sign:

Crush injury:

A

= ~ >3hrs & 4Hrs per book
= (T wave>10boxes/mountain hyperkalemia)
= Calcium-Chloride to “fool cell” then Sodium bi-carb 50mEq or 20mg Albuterol 15LPM
= Major compression of tissue causing them to open up, (releases K & acid)

149
Q

Criteria for critical/moderate burn in adult & Pedi PT:

A

Burns associated with respiratory injury aka inhalation burn
Chemical / high voltage
Burns with major trauma

150
Q

Contusions:
Hematoma:
Severe hematomas to major compartments may contribute to:

A

= bruise made by ecchymosis: black & blue
= artery bleed, tamponades & helps hemostasis
= hypovolemia

151
Q

Compression blunt trauma:
Hematoma:
Contusion:
Ecchymosis:

A

= impact abruptly stops body part while inertia continues (hit by bat)
= artery bleed under area
= bruise cap bleed
= discoloration ID contusion

152
Q

Compartment syndrome:

A

extrems contain M.s & swelling inside self (usually benign injury but body reacts extreme) (infection)

153
Q

Compartment syndrome 6 Ps) 1st
2nd
3rd
4th
5th
6th

A

1= Pain (always 1st) seems exaggerated from story
2= Pallor (lacking blood flow)
3= Paralysis Efferent N-Fibers damaged
4= Paresthesia afferent N-fibers pushed
5= Pressures (BP < & palpable pressure w/ palpation)
6= Pulses (dim/ gone)

154
Q

Coagulation Phase of hemostasis:

A

3rd phase Clotting factors activated and released into bloodstream through a very complex cascade of events Triggers series of chemical reactions; formation of strong protein fibers (fibrin)

155
Q

Class I Hemorrhage) 1 injuries:
2Compensation for blood:
3Blood Loss:
4Pulse:
5Vent rate, BP & Pulse Pressure:
6Cap-Refill:
7Urine Output (mL/hr):
8Mental Status:

A

1= Broken humorous 750mL
2= Healthy PTs can easily compensate for such blood volume loss
3= Blood Loss: < 15% (<750 mL’s)
4= Pulse: Slightly Tachy
5= all Normal
6= Cap-Refill <2secs
7= 30mL/Hr or more
8= Slightly Anxious

156
Q

1 Children for the Rules of Nines, the head is awarded:
2 Children for the Rules of Nines, each leg is awarded:
3 Children for the Rules of Nines, each arm is awarded:
4 Children for the Rules of Nines, the anterior trunk is awarded:
5 Children for the Rules of Nines, the posterior trunk is awarded:

A

1= 18 % of body surface area.
2= 13.5% of body surface area.
3= 9% of body surface area.
4= 18% of body surface area.
5= 18% of body surface area.

157
Q

Child Burn form:

A

(age#-1 from the head) / between 2 legs

158
Q

Chemical burns:

A

biochemical makeup of cell membranes; destroy cells

159
Q

Chemical burns effect:

A

Denature biochemical makeup of cell membranes; destroy cells

160
Q

Shock) Cardiogenic:
Types & defined:

A

= Pump prob/ not working
= Intrinsic: problem from w/in heart EX MI
& Extrinsic: pob from outside hurting heart EX TPT

161
Q

Cardiac Output:
Cardiac Output Formula:
Blood Pressure formula:

A

= amount of blood pumped by the heart in 1 min (70mL)
= SV x HR
= (SV x HR) x SVR

162
Q

Caring for chem/ burn, its keen to know if its acid or an alkali b/c:
If carbon monoxide is present should also suspect the presence of:

A

= Alkalis continue to destroy cell membranes via liquefaction necrosis
= Cyanide

163
Q

Burn worries:

A

= Hypothermia, Hypovol/, Electrolyte imbalance /HyperK, Infection

164
Q

Burn injuries should be assigned a higher priority when they affect:
You should increase the severity of a burn patient by 1Lvl w/:

A

= Pediatric PTs
= pediatric & elderly patients

165
Q

Bohr Effect:
Influences by:
What does it do to hemoglobin:

A

= Acid> Hemoglobin droping oxy off in body
= + CO2, +temp, -pH+ BPG 2,3 in body
= -oxy affinity

166
Q

Body’s response to a local hemorrhage:
Vascular Phase:

A

= hemostasis 3 steps: Vascular, Platelet, & Coagulation phase
= Blood vessel is damaged & begins to lose blood , Smooth muscle w/in walls contracts, thus vessel to withdraw into the wound, thicken vascular wall, & reduce lumen.

167
Q

body’s 1st line comp response:

A

= Blood loss > decreased arterial pressure, altered blood gases > baro&chemoreceptor reflex >cardiac stim/ systemic vasoconstriction, flow&Vol/ retribution

168
Q

1Blunt non-penetrating injuries that crush/damage lil blood vessels:
2Contusion is considered what type of injury:
3Minor bleeding associated w/ cap/ wounds often continues b/c:
4A hematoma or collection of blood beneath the skin:
5PT sustained a blow to frontal region of his head & now has a large lump present at the point of impact. This lump referred to as:

A

1= Contusions
2= Closed soft tissue blunt injury
3= Capillaries cannot contract and thus continue to bleed
4= Is most commonly caused by injury to an artery
5= Hematoma

169
Q

Blood:
Plasma:
Leukocytes:
Erythrocytes:

A

= Mixture of water, cells, proteins, & suspended elements.
= makes up 55% of the blood volume
= WBC & platelets make up the “Buffy Coat”
= RBC make up 45%

170
Q

Blood vessels:
Blood in venous system:
Most of vaso construction by:

A

= veins low pressure w/ valves, arteries no valves w/ lots tunica media
= ⅔ in venous system,
= Capillaries: most of vaso construction

171
Q

Pulse pressure:
MAP:
CPP Cerebral Perfusion:

A

= SBP-DBP
= (PP/3) + DBP
= (MAP-ICP) + 10

172
Q

Blast phases) Primary:
2ndary: flying debris hitting you
Tertiary: thrown off of feet onto something
Quaternary: misc event: tree falls on you, radioactive (dirty bomb)
Isolated blast injury:
Contra blast injury:
Underwater blasts:

A

= Primary: decompression of lungs
= flying debris hitting you
= thrown off of feet onto something/ground
= misc event: tree falls on you or radioactive injury(dirty bomb)
= injury same side of impact
= opposite side of impact
= enhances injury/death w/ pressure wave

173
Q

Blast injuries:
Conventional bomb:
Dirty bomb:

A

= Effects pulmonary system significantly
= most common >Pipe bombs, fireworks, ect
= Conventional bomb w/ reactive material

174
Q

blast injuries) Primary:
Secondary:
Tertiary:
Quaternary:

A

Primary: blast injuring hallow organs
Secondary: shrapnel injuring
Tertiary: thrown against something
Quaternary: damage from other AFTER BLAST

175
Q

Biomechanic of trauma:
Occur w/ 2 forms:

A

= manner in which energy exchange damages human tissue
= blunt or penetrating

176
Q

Beta radiation can travel and can penetrate

A

6 to 10 feet through air & a few layers of clothing.

177
Q

Shock & perfusion definitions:

A

= Perfusion: Adequate supply of well oxygenated blood & nutrients to all vital organs
= Shock: body’s lack of perfusion

178
Q

Baroreceptors:
Baroreceptors Fn.:

A

= receptors that monitor blood pressure
= Great vessels recept/ Gives feedback to brain > Sympathetic NS Activation, AArch & carotid arteries> feedback to medulla >SNS

179
Q

Avulsions & subtypes:

A

= separates & creates flap/chunk from skin (“chunk missing)>Degloving, Scalping, Amputations

180
Q

AUTOPED) 1st impact:
2nd impact:
3rd impact:
Off-road injuries:
Kids Waddell’s triad:

A

= auto strikes body
= pedestrian thrown
= body strikes ground or object
= pop increased, usually remote areas, offer less protection,
= turn toward bumper b/c stupid, bumper hits kids pelvis & femur, chest & ABDMN hit grill, head strikes ground b/c buckethead

181
Q

Any eye trauma PT:
Zofran contra=

A

= vomiting &/ B/c +ocular pressure
= prolonged QT

182
Q

An injury in which the mechanism of injury tears the skin off the underlying muscle, tissue, blood vessels, and bone is called a(n):

A

Degloving injury

183
Q

Amputation treatment:

A

= direct pressure 2in above site , never submerge in ice, keep cool,

184
Q

Alpha rad/ strength, traveling distance, & penetration:

A

very weak energy source & travels only INs in air, cannot penetrate the epidermis & stopped by paper & clothing

185
Q

Alkalotic vs acidotic burns severity

A

Alkalotic burns > Acidotic burns

186
Q

agent’s temperature relation to potential damage.

A

greater the agent’s temp, the greater its potential to cause damage.

187
Q

Afferent nerves:
Efferent nerves:

A

=sensory nerves “ahhh”
=motor “effect”

188
Q

1 Adults for the Rules of Nines, the head is awarded:
2 Adults for the Rules of Nines, the genitalia is awarded:
3 Adults for the Rules of Nines, the posterior trunk is awarded:
4 Adult for the Rules of Nines, each arm is awarded:
5 Adults for the Rules of Nines, each leg is awarded:
6 Adults for the Rules of Nines, the anterior trunk is awarded:

A

1= 9 % of body surface area.
2= 1 % of body surface area.
3= 9 % of body surface area.
4= 18 % of body surface area.
5= 18 % of body surface area.
6= 18 % of body surface area.

189
Q

A rapid trauma assessment should be performed on:
Which of the following is true regarding soft-tissue injuries?
Impaled object may only be removed during what conditions?

A

= Any patient with a significant MOI
= Most open wounds require only simple care and limited suturing
= CPR is needed and impaled object interferes with chest compressions & The impaled object is causing an obstruction of the patient’s airway

190
Q

Body maintaining steady, norm/ internal environment:
A condition in which the blood’s ability to clot is impaired:
The body’s response to stop the loss of blood:
Clotting phase when smooth blood vessel M. contracts <lumen size:
1 common factor hindering clotting process is:
aggregation:

A

= Homeostasis
= Coagulopathy
= Clotting
= Vascular phase
= Medications such as aspirin
= process of coming & sticking together

191
Q

% of all Trauma deaths:
% of GSW account for HT death:
%s of penetrating neck trauma:
%s of penetrating chest trauma are fatal:
% of great vessels injuries & due to:
minimal diameter for sucking chest wound

A

= 50% of all Trauma deaths is head trauma
= 35% GSW account for Head Trauma deaths
= 5-10% penetrating neck trauma (airway & neuro
= 70-80% penetrating chest fatal
= 90% all great vessels injuries due to a penetrating MOI
= At least ¾inch for penetrating Chest wounds to turn sucking

192
Q

1 (Burn depth) 3rd degree:
2 feeling & appearance:

A

1= full thickness burn down to SCT may involve M. bone & organs
2= leather, looks Charred, dark brown or white, hard to touch “painless”

193
Q

MVC) Phase 1:
Phase 2:
Phase 3:
Phase 4:
Phase 5:

A

= Vehicle collision (P1) deceleration
= Body collision (P2) decel/ of occupant
= Organ collision (P3) decel of internal
= 2ndary collision (P4) objects in car
= (P5) car rear end, trees,

194
Q

3 parts of circulatory system:
maintain homeostasis via:
Pos feedback:

A

= “pump fluid pipes” heart, blood, & blood vessels
= negative feedback loop
= childbirth & blood clots

195
Q

2nd line comp response:

A

Blood loss > RAAS, Catecholamine & Vasopressin released> vasoconstriction, increased Vol, cardiac stim

196
Q

2 cyanide antidote regimens are available:

Sodium nitrite dose :
Sodium thiosulfate dose:

A

= Pasadena cyanide kit (amyl nitrite, Na nitrite, & Na thiosulfate) & newer antidote Cyanokit (hydroxocobalamin)
= 300 mg sodium nitrite over 2 to 4 minutes for adults.
= administer 12.5 g of for the adult.

197
Q

1Hemostasis:
2Inflammation:
3Epithelialization:
4Neovascular:
5 rebuild/ Collagen synthesis:

A

1= vaso/strict, platelet aggregate, coagulation fibrin (normothermic)
2= Granulocytes, macrophages & Lymphocytes eat, Mast cells released
3= “rebuild” epithelial cells go to wound making scab ~48Hrs after cut
4= new capillaries made (neo new) via previous cap/s +exchanging
5 = fibroblasts go to wound & synthesize collagen creating scar (w/ tension lines quicker/better), Too much synthetization makes Keloid

198
Q

4 Stages of healing:

A

= Hemostasis, Inflam/, Epithelialization, Neovasc/, Collagen synthesis (Here I eat naked) “strict, hurt, foundation , remodel”

199
Q

Stages of healing:

A

1= Hemostasis, Inflam/, Epithelialization, Neovasc/, Remodeling (Collagen synthesis) “Here I Enter New Remodel”

200
Q

1st doc to classify trauma as a disease was:
1st EMT orange book

A

= the “white paper 1966”
1st EMT orange book

201
Q

1Lymphatic system:

2Lymph node:
3Spleen relation:
4Lymphatic pathway:
5Sign lymphatic system not working:

A

1= “body’s garbage system” macrophages eats then system of channels to tissues 1 direction, no pump, dumps into a node
2= were garbage collects
3= Carries “trash” of pathogen destruction to nodes for macrophages
4= >Vessels> nodes> spleen> up to L/R subclavian vein, to kidneys
5= Gray poop

202
Q

1Crush injury:
2Crush syndrome:

3Cellular Lvl:

4 Crush syndrome signs:
5 Crush syndrome Rx:

A

1= deep injury damage can be massive w/ minimal signs on skin itself
2= body part trapped>4hrs, cells anaerobic>hyperkalemia>TDP torsades de pointes, Aka: traumatic Rhabdomyolysis
3= accumulation of quantities of myoglobin O2, K, lactic acid, toxins, can clog kidneys, can cause severe metabolic acidosis
4= urine is dark red, Shark Peaked T waves
5= 1st Ca-Chloride, 2nd Albuterol, 3rd Sodium Bicarb, Dex w/ Insulin

203
Q

1 Types of Radiation:
2 Radioactive Particles:
3 Alpha:
4 Beta:
5 Ionizing Rays:
6 Gamma:
7 X-Rays:
8 Atomic:

A

1= Radioactive Particles & Ionizing Rays
2= Alpha &Beta:
3= least worry & deflected w/ newspaper
4= flys further w/o skin penetration
5= Gamma & X-Rays
6= worst, several ft of concrete & lead
7= penetrates skin
8= nuclear reactor

204
Q

1 Alkalis are commonly used as:
2 Acids burns:

3 Alkalis burns:

A

1= oven and drain cleaners, agricultural fertilizers, and in industry
2= form thick, insoluble mass where they contact T. via coagulation necrosis, limiting burn damage
3= continue destroy cell membranes via liquefaction necrosis, allowing them to penetrate underlying tissue & causing deeper burns

205
Q

(Wallace Rule of 9s) used only for:
Adult %s:
infants (0-1):
Form:

A

= burns >10%
= 1 genitals, 9 head thoracic & ABDMN, distal anterior (applies to other areas) arm 4 ½
= head 18, arm 9, legs 13.5, 18 front thoracic & ABDMN
= # of child -1 > take away from head then give to each leg (Applicable up 10y/o) For every year beyond age 1, subtract 1 from head / that # & add it evenly between the 2 legs.

206
Q

(Trauma centers) Lvl 1:
Lvl 2:

Lvl 3:
Lvl 4:

A

= 1 (18tx) med-uni teaching, best care, everything to Neurovascular
= 2 (23 tx) everything BUT neuro, area trauma, surgical care capable all times, typically not teaching
= 3 general hospital w/ some special staff, TIB-FIB, try avoid w/ severe
= 4 basic ER, can stable but bandage, foot ran over

207
Q

Thermal burn phases) Hypermetabolic phase:

A

3rd phase Days or weeks depending on burn severity; increase in body’s demands for nutrients; begins process of repairing damaged tissue (needs Glucose, amino acids, carbohydrates, O2 to support damage)

208
Q

Thermal burn phases) Resolution phase:

A

4th phase Scar tissue laid down and remodeled; rehabilitate and return to normal function (weeks to months) new collagen & usually doesnt remodel to original state & makes escar (burn keloid) bc overgrowth

209
Q

(Soft tissue injuries)

A

= Risk factors: age (50-70kilos blood) (1yr old ⅓ of gatorade bottle), alcohol/ drug use, Occupation

210
Q

Sodium Bicarbonate 8.4%) Dynamics:

Indications:

Contra:
Suspected acidosis Dose:
Hyperkalemia Dose:

A

= Alkalinizing Agent. Increases plasma bicarbonate, buffers excess hydrogen ion concertration, raises blood pH & reverses clinical manifestations of acidosis.
= Suspected hyperkalemia, suspected bicarbonateresponsive acidosis (DKA, OD on TCA’s, Aspirin or Cocaine)
= Patients in cardiac arrest
= 1 mEq/kg, Hyperkalemia:
= 50 mEq IV bolus.

211
Q

Shock’s 5 categories

A

Hypovolemic, Cardiogenic, Distributive, Obstructive, resp/metabolic

212
Q

(Radiation) Duration:
Distance:
Shielding:

A

= Radiation exposure accumulative danger
= Rad/ strength lessens quickly as distance from source increases
= More material between you & rad/ source, < exposure experienced

213
Q

1phagocytosis:

2Granulocytes & macrophages w/ healing:
3Lymphocytes w/ healing:
4Mast cells w/ healing:

A

1= macrophage eats & grows bacteria flag to show what antibodies to make for cellular response
2= eat dead cells parts & bacteria
3= destroys bacteria & other pathogens
4= release histamine to make capillaries more permeable to bring more RBC

214
Q

Non& Hemorrhagic treatment) If hemorrhage can be controlled:
If hemorrhage cannot be controlled:

Med for Sig/hemorrhage, in/external (after external controlled)

A

= IV/IO therapy (don’t delay transport) can administer 20 mL/kg bolus.
=administer just enough IV fluid to obtain a radial pulse (permissive hypotension therapy!)NO MORE SBP 80-90 (IV fluids Warm)
= Tranexamic Acid (TXA) Adult 1G/10 mins (mix in 50 mL of NS) follwed w/ 1G/8Hrs (500 mL bag) & Pediatric Not recommended

215
Q

Newtons laws) inertia) 1st part of 1st law
2nd Part of 1st Law:
The law of energy conservation states:

A

= “body stays in motion unless acted upon by an outside force.”
= “body remains in rest unless acted upon by an outside force.”
= “Energy can neither be created nor destroyed. It can only be changed from 1 form to another.” EX In an auto crash, the changing of energy from one form to another is what deforms the auto and can cause injury to the occupants

216
Q

(Critical Criteria) 3rd & 2nd Degree criteria:
Any 2nd or 3rd degree burns involving:
Burn types that’re critical & Rx:

A

= 3rd>10% & 2nd>30%
= Face, Hands, Genitalia, Circumferential, Feet, (Dipping), Airway
= Chem, high voltage, Burns w/ major trauma go trauma center 1st then burn center

217
Q

Class IV Hemorrhage) 1 injuries:
2= Compensation to blood:
3= blood loss:
4= Pulse:
5= Blood Pressure:
6= Pulse Pressure:
7= Capillary Refill:
8= Ventilation Rate:
9= Urine Output (mL/hr):
10= Mental Status:

A

1= GSWs, multiple major fractures, Pelvis
2= Irreversible Shock!
3= > 40% (>2000mLs) of total blood
4= > 140 & barely palpable in central arteries
5= Very low
6= Narrows more
7= > 5 seconds
8= > 40 or agonal
9= Negligible
10= Lethargic or Unconscious

218
Q

Class III Hemorrhage)1 injuries/fractures:
2 Compensation to blood:

3 Blood Loss:
4 Pulse:
5 Blood Pressure:
6 Pulse Pressure:
7 Capillary Refill:
8 Ventilation Rate:
9 Urine Output (mL/hr):
10 Mental Status:

A

1= 2 Humorous, 1-2femur, 1 full Hemopneumo
2= Both 1&2nd comp/ responses failing to maintain perfusion & entering/in Decompensated Shock! (SBP <90)
3= Blood Loss: 30 - 40%, (1500 - 2000 mL’s)
4= >120
5= Starts to decrease
6= Narrows more
7= 3-4secs
8= 30-40
9= 5-10mL/hr
10= Anxious/Confused

219
Q

Class II Hemorrhage) 1 injuries:
2Compensation for blood:
3Blood Loss: 15 - 30%
4Pulse:
5Blood Pressure:
6Pulse Pressure:
7Capillary Refill:
8Ventilation Rate:
9Urine Output (mL/hr):
10Mental Status:

A

1= 1/2 Humorous fractures, a femur fracture, 1 full Hemopneumo
2= 1st line comp/ no longer maintain perfusion & 2ndary employed
3= 15 - 30% 750mLs-1.5L
4= > 100BPM
5= Normal
6= Starts to narrow
7= 2-3 secs
8= 20-30RR
9= (mL/hr) 20-30
10= Mildly Anxious

220
Q

Burn worry) late stage Organ failure:

A

= can go into rhabdo from myglobins; Burn process releases material from damaged or dying body cells into bloodstream, May cause kidney failure, liver failure, arrhythmias, possible cardiac arrest.

221
Q

Burn worries) Hypothermia:

A

Burn may disrupt body’s ability to reg/ core temp, If burn is extensive, uncontrolled body heat loss induces rapid, severe hypothermia.

222
Q

(Burn depth) Degrees:

A

= 1st/Superficial, 2nd/partial, 3rd/full/complete

223
Q

Burn depth) 2nd degree:

A

= Partial, EPi & Dermis burned: intense pain, fluid shift comes up thus blisters, RED to WHITE, moist & mottled w/ shifts

224
Q

(Burn depth) 1st degree:

A

= Epidermis only, red skin, pain & tender, NO blister(can lose temp/reg)

225
Q

(Blood vol/ loss) Pelvis:
Femur:
Humorous:

A

= 2-3Liters
= 1.5Liters per femur
= 750ml per humorous

226
Q

60%) Fluid compartments % of water:

A

45% intracellular
15% extracellular (outside cell)
Interstitial 10.5% Intravascular 4.5%

227
Q

Haldon Mix

A

.

228
Q

Parkland Burn Form for:
form:

A

= (BSA >20% only 2 & 3 degree burns)
= 4 mL x BSA x Weight (kg) = ½ 1st 8 Hrs & ½ next 16Hrs

229
Q

What organs are contained in the thoracic cavity?

A

Heart, lungs, Liver, spleen, gallbladder

230
Q

Thoracic Skeleton:
# false ribs vs true ribs
1st rib
Angle lewie is hump @:

A

= Forms thoracic cage 12 pairs ribs
= 7-12 false ribs 1-7 true ribs
= is usually under clavicle
= directly 1-1 connects to manubrium

231
Q

Sternal Fracture
Sternal Dislocation:

A

= severe impact thus +Mortality due to underlying blunt cardiac injury, cardiac rupture, pericardial tamponade, pulmonary contusion.
= Severe imact

232
Q

2 dif/ pleura linings in the chest cavity:
Pleura Fn:
Viscera vs Parietal pleura:

A

= reduce friction 5-10mL w/ surface tension w/ pleura fluid
= Major reason for negative pressure
Viscera outer lung tissue w/o nerves
Parietal has nerves outer pleura
Flail chest can only ventilate not respirate (Usually when vent a conscious PT)
Paradoxical only w/ flail segments

233
Q

Flail chest:
reason for inability to perfuse:
Paradoxical breathing:
S/S:
Rx:

A

= 3 or more adjacent ribs fracture in 2 or more places (can be more) Severe underlying pulmonary injury
= Chest segment becomes free to move with respiratory pressure changes ( No longer able to create negative P)
= Tachypnea, crepitis, paradoxical m-nt
= Assist ventilations if needed, Consider CPAP (monitor), Load-and-go, Monitor for: Pulmonary contusion, Hemothorax, Pneumothorax (bad compliance: = bagging is easy w/o back force/ resistance)
Best Rx Positive pressure

234
Q

Pneumothorax’s

A

Simple, Open, Tension, Hemo, TensionHemo

235
Q

Simple Pneumothorax:
S/S:

A

= marfan syndrome + chance & w/ bleps
Also known as closed pneumothorax 20% & 50% usually symptomatic
Lung tissue injured, air leaks into pleural space.
= Trauma to chest, Chest pain on inspiration, Dyspnea, Diminished breath sounds on the affected sidetho

236
Q

Open Pneumothorax:
Sucking chest wound:
S/S:
Treatment:

A

= Penetrating chest injury Leads to free air passage between atmosphere and pleural space, Air compresses lung tissue
Air Mnt into & out of hole causes a “sucking chest wound”
= Exit wound bigger 4 sided in back 3 anterior& Hole ¾ inch minimal to suck into chest cavity “sucking sound”
= Trauma to chest, Chest pain on inspiration, Dyspnea, Diminished breath sounds on the affected side, Sucking chest wound, Frothy blood sputum at wound site
= GLOVE 1st, Oxygen therapy, 3-Sided Occlusive Dressing, Standard ALS care

237
Q

Tension Pneumothorax:
S/S:
Treatment:

A

= Open or simple pneumothorax that makes & maintains pressure > than atmospheric pressure, Pushes pressure against unaffected side, compressing the right atria. Decreases preload
= Severe dyspnea (gauge by words speaking “1-2word tachypneia”), Absent lung sounds on ipsilateral side, Cyanosis, +JVD at 45degree angle, Hypotension, Tachycardia, Subcutaneous emphysema, Hyperresonance on affected side (percussion indirect ICS bounding sound) hyporesonance dull= blood) tracheal deviation
= PT needs an immediate needle decompression or digital thoracostomy, Assist vent/s as needed with a BVM

238
Q

Hemothorax:
Only decompress:
S/S:
Treatment:

A

= Accumulation of blood in pleural space from internal hemorrhage, Blood loss problem Associated w/ rib fractures; blunt or penetrating mechanisms, Often accompanies pneumothorax (hemopneumothorax )
blood go down & can dispurse
= BSOLUTE needed or blood is hanging
= Dyspnea, Diminished lungs sounds on ipsilateral side, S/Sx of shock, No JVD!!!!!, Dull “thud” percussive sounds over site of collecting blood
= Treat for shock, permissive Fluid administration, Titrate to peripheral pulse (80-90 mmHg), Monitor for: Tension Hemopneumothorax, Standard ALS care

239
Q

What is a pneumomediastinum:
S/S:

A

= Abnormal presence of air in the mediastinum, air escaping & surrounding pericardium, Obstructive shock pushing R-Atrium
= Chest pain, dyspnea, subcutaneous emphysema
What sound could you hear with it? “BLOOP BLOOP BLOOP”

240
Q

!Electrical alternans:
!Pulsus alternans:
Beck’s Triad:
Pulsus Paradoxus:

A

= amplitude alternating goes w/ Pulsus alternans
= pulse alternates betweens mirrored side
= JVD muffled or narrowing BP(SBP &DBP coming together),
Kussmaul’s Sign (inhale +inthoracic P. pushes & JVD on inhale,
= drop SBP 10 or more in inhale (Manual BP Heart beat sounds inhale goes away)

241
Q

Where & how do you perform a chest decompression?

A

Anterior 2nd ICS best, 5th ICS lateral mid axillary
3 way stop cock, finger of glove, hamleick valve, Needle decompression anterior

242
Q

How can a pulmonary contusion interfere with gas exchange?
How can a cardiac contusion decrease the amount of blood that is ejected from the ventricles?
Spalding Effect:

A

= Hurts to breath normal, < inspatory vol, less O2, ect
= Soft tissue contusion or bruise to the lung
= Small, flame-shaped disruption areas throughout membrane leading to microhemorrhage & edema.

243
Q

Commotio cordis & where in the ECG complex does this affect?

A

Acute interruption during weakest point of cardiac cycle: Relative refractory period- TP seg

244
Q

aortic dissection is:
Fixation points: Ligamentum Arteriosum Aorta &
S/S:

A

= Tearing or arterial fixation points
= Ligamentum Arteriosum Aorta &
= Pulsus deficit R-hand pink left cold blue, Severe tearing chest pain w/ ripping pain radiating into back, Hypotension, Tachycardia

245
Q

What occurs with traumatic asphyxia? Severe compressive force applied to chest * Reverse blood flow from right heart into superior vena cava into venous vessels of upper extremities
S/Sx : Petechiae, Subconjunctival hemorrhages, Stagnating blood above compression point, purplish color face, eye exothalomus/protusion or blood rupture anterioer chamber,

A
246
Q

Pericardial tamponade:
S/S:
Sign’s & triads associated:
Treatment:
Monitor for:

A

= Restriction to cardiac filling caused by blood within pericardial sac, Related to penetrating injury 90%(120/5-150mL for major impediment)
= Dyspnea & cyanosis, Hypotension, muffeled heart sounds
= Kussmaul’s Sign, Pulsus & Electrical alternans, Pulsus Paradoxus
= Treat for shock, Permissive Fluid admin Titrate to peripheral pulse (80–90 mmHg), Monitor & treat dysrhythmias,
= Hemothorax, Pneumothorax, Transport ASAP for a pericardiocentesis (sub xiphoid)

247
Q

Where in the diaphragm is considered the weakest point and what occurs during a traumatic rupture of the diaphragm?
S/S similar to tension pneumothorax:
Diaphragmatic Rupture Rx:

A

= Perforation and herniation most frequently on left side weakest point BOCHDELCK
= dyspnea, hypoxia, hypotension, J V D, Scaphoid abdomen
= Rapid detection, Place the patient’s torso in an elevated position, Try to decrease the use of a BVM, Early ET intubation! Put incline position

248
Q

Tracheobronchial Injury:
S/S:
Rx:

A

= Blunt or penetrating injury treach going into bronchois gap, drop ET right there! (50% die w/in hour or so of injury)
= Respiratory distress w/ cyanosis, hemoptysis, massive subcutaneous emphysema.
= Pneumothorax & possible tension pneumothorax
If trouble be fine w/ R-bronchi

249
Q

ABDMN cavity 3 spaces:

A

the peritoneal space, retroperitoneal space, and pelvic space

250
Q

peritoneal space:
Retroperitoneal space:
pelvic space contains:

A

= contains the stomach, spleen, gall bladder, liver, pancreas, & intestines
= contains the kidneys, proximal ureters, and adrenal glands & most major vascular structures w/in ABDMN
= urinary bladder, distal ureters, proximal urethra, terminal sigmoid colon, rectum, & anal canal
Females: uterus, Fallopian tubes, ovaries, and upper vagina.
males: prostate

251
Q

Anatomic landmarks of the ABDMN & pelvic anatomy:
RUQ contains:
LUQ contains:
RLQ contains:
LLQ contains:

A

= umbilicus, the xiphoid process, the iliac crests, & pubic prominence.
= gallbladder, right kidney, most of the liver, some small bowel, a portion of the ascending & transverse colon, small portion of pancreas.
= stomach, spleen, left kidney, most of pancreas, portions of the liver, small bowel, transverse & descending colon
= Appendix, Portions of urinary bladder, small bowel, ascending colon, rectum, (right ovary).
= sigmoid colon, portions of the urinary bladder, small bowel, descending colon, rectum, (left ovary)

252
Q

Hollow organs:
Solid organs:

A

= Stomach, Intestines (small & large), Gallbladder, Bladder.
= Liver, Spleen, Pancreas, Kidneys.

253
Q

Blunt Trauma 3 most common mechanisms associated w/ blunt trauma: 1
2
3

A

1 Deceleration: Shear Injuries} AAA, ligament of teres (around liver shearing it)
2 Crushing: Solid organs} vascular & bleed a lott (Liver & Spleen most rich)
3 Compression: Hollow organs

254
Q

3 dif/ types of abdominal pain:

A

Visceral (dull), somatic (sharp), &referred

255
Q

What makes up the upper versus lower GI system and what is the separation between the two?
Lower GI System?
mL required to overcome & cause what is know as acid reflex/GERD

A

= The Ligament of Treitz @ duodnium Jujinuim junction
= the duodenjejunal junction, to include the rest of the small intestine, all the large intestine, and the rectum/anus.
= 20ml to overcome Lower esophageal Sphincer & bottom stomach pallor shoincter

256
Q

What is Kehr’s sign?

A

pain into the left shoulder classic of ruptured spleen

257
Q

What is the mesentery: The
injury:

A

= mesentery is a fold of tissue that attaches the intestines to the abdominal wall, providing support & allowing blood vessels, nerves, & lymphatics to supply the intestines. It plays a role in nutrient absorption & stabilizing the position of abdominal organs. mesentery provides circulation, innervation, and attachment for the bowel.
= Blunt injury occurs as the mesentery stretches or is compressed during impact. This injury occurs most frequently at points of relative immobility such as the duodenal/jejunal juncture (where the small bowel is affixed by the ligament of Treitz

258
Q

Cullen’s Sign:
Grey Turns

A

= aka Periumbilical bruising: contusion/eechymossis, (found w/ ectopic peg/s & #1 cause preg deaths), anything Center up fucked
= (same finding) pancretitics, , } R/L-Flank bruising from some type of organ

259
Q

Evisceration & what is the appropriate treatment of it?

A

Intestines perforate through abdomen wall Rx with wet gloves & dressing

260
Q

How do you take care of a patient with a suspected pelvic fracture?

A

Pelvic imbolization, pain management, TXA, permisive fluid,

261
Q

What muscle separates the thoracic and abdominal cavities:

A

The diaphragm. It’s a dome-shaped muscle essential for respiration, contracting to expand the thoracic cavity during inhalation & relaxing during exhalation.

262
Q

What is supine hypotensive syndrome in a pregnant female?

A

Baby compresses inferior vena cava & descending aorta

263
Q

Placenta Previa:

A

placenta dev/ before uterus so cervix dilates & tears placenta after dropping mucus plug (treat interal hemmorage for shock & pad vagina)

264
Q

Abruptio Placentae:

A

VERY PAINFUL trauma (can be fall onto but or car crash) placenta rips away from uterine way, bright red hem rips away cervix, concealed no leaking,

265
Q

The largest organ in the abdominal cavity is the:

A

Liver

266
Q

Uterine Inversion: pulling umbilicus prolapse uteris, RX:

A

slowly work back into w/ glove CUPPED so dont puncture through, More kids more likely

267
Q

Uterine trauma/ Rupture:

A

= “baby shoots through” usually seatbelts used wrong, Actual tearing, or rupture, of uterus; occurs w/ onset of labor or blunt abdominal trauma. Most common cause 3rd tri SB
Rare occurrence; extremely high maternal and fetal mortality rate
Can see all of kid, major hemmorage,

268
Q

The number one killer of pregnant females is:

A

Trauma

269
Q

Bright red hemorrhage without pain in a female that is in her third trimester most likely describes:

A

Placenta Previa

270
Q

The division of the abdominal cavity containing organs or portions of organs covered by the peritoneum is called the:

A

Peritoneal space

271
Q

Which of the following structures separates the upper and lower GI system?

A

Ligament of Treitz

272
Q

Detachment of the placenta from the uterine wall during pregnancy is called:

A

Abruptio placentae

273
Q

Peritoneum:
parietal peritoneum:
visceral peritoneum:

A

= membrane that lines ABDMN cavity & covers the ABDMN organs.
This tissue resembles the lung’s pleura & Fns in a similar manner.
= The portion that lines the cavity
= the portion that covers ABDMN organs

274
Q

most common fracture
Most common cause of orthos injuries
Bones heal/work by:
older women commonly break bones b/c:

A

= Clavicle most common fracture
MVA most common cause of orthos
Bone living & constantly braking down & building up
= Older become calcified Estrogen, big role on building
Menopause w/ reduction of estrogen can osteoporosis

275
Q

What make up the axial and appendicular skeleton?
Axial:
Appen:

A

= “axe in the trunk” trunk of bones so skull spine pevlis
= “Ape arms” extremities

276
Q

Haversian canals
Volkmann’s canals

A

= Blood vessels travel lengthwise along bone through small tubes
= Perforating canals that distribute blood to bone tissue & structures located w/in the medullary canal

277
Q

Osteocytes (bone cells):
Osteoblasts:
Osteoclasts:

A

= Maintain collagen and calcium, phosphate, carbonate, salt crystals.
= Lay down new bone in areas of stress during growth and bone repair cycle “build Ca+”
= Dissolve bone structures not carrying pressures of articulation and support “Crash Ca+”

278
Q

What would occur if a patient was to break a long bone through the very end of the bone?

A

Complications with growing normally

279
Q

What are the parts of a long bone?
Cancellous bone:
Cortical bone:

A

= Diaphysis, Epiphysis, Metaphysis, Medullary Canal, Epiphyseal plate, Articular Surface, Periosteum
= “spongy” responsible for making RBC)
= “hard bone” Central portion or shaft of long bone

280
Q

What are the different bone classifications?
Flat bones:
Short bones:
Sesamoid Bones:
Long bones:
Irregular bones:

A

= Cranium, sternum, ribs, shoulder, pelvis.
= (wider than long) Wrists, ankles, carpals, tarsals.
= (knee cap) Grows within tendinous tissue (kneecap)
= Humerus, radius, ulna, tibia, fibula, metacarpals, metatarsals,
= (most of the blood cells)
= Vertebral column, facial bones.

281
Q

What are the different bone classifications?

A

= Flat, Short bones, Sesamoid, Long, & Irregular bones

282
Q

Diaphysis:
Epiphysis:
Cancellous bone:
Articular Surface:
Metaphysis:
Periosteum:
Epiphyseal plate:
Medullary Canal:
Medullary canal fn:
Red bone marrow fn:

A

= Central portion or shaft of long bone
= Widened, articular longbone end. (most common “hip fracture”)
= “Spongy” Tissue within epiphysis; spongy (responsible for making RBC)
= Thin layer of compact bone supporting surface that meets and moves against another bone
= Intermediate region between epiphysis and diaphysis
= Tough fibrous membrane covers exterior of diaphysis
= Growth plate (where the growing originates)
= Chamber in hollow diaphysis and cancellous bone of epiphysis
= filled with yellow bone marrow Stores fat in semiliquid form Marrow fatty makes WBC cartilage, If hypoxic can make YBM to RBM,
= (hematopoietic tissue) fills cancellous bone chambers of long bones, pelvis, & sternum. (Makes RBCs and other blood cells)

283
Q

Flat bone:
Short bone:
Sesamoid bone:
Long bone:
Irregular bone:

A

= Cranium, sternum, ribs, shoulder, pelvis.
= –(wider than long) Wrists, ankles, carpals, tarsals.
= (knee cap) Grows within tendinous tissue (kneecap)
= Humerus, radius, ulna, tibia, fibula, metacarpals, metatarsals, phalanges. (most of the blood cells)
= Vertebral column, facial bones.

284
Q

What are the three basic types of joints?
Synarthrosis:
Fontenells Post 3 months, anterior 9-16 months, helps m-nt & ICP
Amphiarthrosis:
Diarthrosis:

A

= Also known as a fibrous joint Immovable joints (skull)
(gumphosis for gums) grab a tooth by crown but never ever ever root best is hanks solution & save a tooth
= Fontenells Post 3 months, anterior 9-16 months, helps m-nt & ICP
= Also known as a cartilaginous joint, Joints that allow very limited movement (vertebra, pubic symphsis
= Also known as a synovial joint, Permit free movement

285
Q

Ligaments
What is the function of synovial fluid and bursae?
Joint capsule (synovial): –
Synovial fluid:
Bursae: *

A

= (B-B) make synovial capsule
= Ligaments surrounding joint form – Chamber holds fluid to lubricate articular surfaces
= Oily, viscous substance that helps facilitates joint motion by reducing friction.
= Small sacs filled with synovial fluid that help reduce friction and absorb shock (bursitis lil sacks get filled)

286
Q

Sprain:
Grade I:
Grade II:
Grade III:

A

= Tearing of joint capsule’s connective tissues (ligament(s)). – Acute pain, inflammation and swelling.
= Minor, small tears. (MRI microtears)
= Larger than a grade I but still an incomplete tear (tear but still attach)
= Complete ligament tear/transection

287
Q

Subluxation:

A

=(c1&2 most common)Partial bone end displacement from position within joint capsule
Painful, swells quickly, range of motion limited, joint unstable.
Separates & comes back wrong
Dens c1 rotates around c2 dens

288
Q

1Closed Fracture:
2Open Fracture:
3 hairline:
4Impacted Fracture:
5Transverse Fracture:
5Comminuted Fracture:
6 oblique
7 ?
8Spiral Fracture:
9Fatigue Fracture:
10Greenstick Fracture:
11Fat Embolism:
12Epiphyseal Fracture:

A

1= Bone not significantly displaced, Fracture does not penetrate through skin
2= Sharp bone ends exit skin – Increase risk for infection
3= Bone has small crack but doesn’t disrupt total structure
4= Compression MOI, bone impacts on itself; compressed but aligned bone (usually peri incomplete)
5= Complete break in bone; runs straight across at 90-degree angle (no shards 1 of most common)
6= Runs at angle across bone (common femur)
7= Bone splintered into several smaller fragments (more bone
8= Twisting motion; results in curved break around bone shaft. (sports & up periosteum)
9= Prolonged or repeated stress
10= Flexible nature of pediatric bones; type of partial fracture; disrupts only one side of long bone. (lots of E. to break kids femur)
11= Infrequent but serious fracture complication (long bone fractures & end up in lungs) 4 Fs of PE
12= Growth plate disrupted Could cause a reduction or halt in bone growth (ibibrofrien impedes osteoblasts) Fracture repair and remodeling rapid in children

289
Q

How does a bone repair itself after a fracture?

A

Osteoclasts & blasts “break down to remodel stronger”

290
Q

Types of Synovial Joints:
Ball & Socket,
Joint Condyloid Joint,
Gliding Joint
Hinge Joint
Pivot C1atlis C2axis Joint,
Saddle Joint metacarpals

A

Ball & Socket, Joint Condyloid Joint, Gliding Joint, Hinge Joint, Pivot Joint, Saddle Joint

291
Q

Ball & Socket joint
Joint Condyloid Joint,
Gliding Joint
Hinge Joint
Pivot Joint,
Saddle Joint

A

= shoulder
= femur/pelvis
= horzontal m-nt
= door m-nt
= C1atlis C2axis
= metacarpals

292
Q

3 types of muscles found in your bod:

A

Skeletal (voluntary), Smooth (involuntary), Cardiac (involuntary)

293
Q

muscles fn:
Make heat by:
Muscle and bone protect:

A

= Uses contraction and relaxation to move and manipulate your environment
= where most heat comes from b/c ATP byproduct) product of moving (shivering)
= the structures underneath them

294
Q

Fascicle:
Origin:
Insertion:
Opposition:
Tendons:

A

= * Muscle cells layer together to form muscle fiber
= Attachment point that remains stationary as muscle contracts
= Attachment point to moving bone (Muscles are usually paired, one on each side of joint.)
= Limb straightening (extension) Limb bending (flexion)
= Connective tissue that attach of muscle to bone – Extremely strong and do not stretch

295
Q

Compartment Syndrome:
Rx
6 Ps:

A

= When injured, soft tissues within the compartment swell. Reduces blood flow to muscles and nerve tissues Deep, burning pain out of proportion to apparent injury. Leg most common location
= make pain tollerable/take edge off
= Pain – Pallor (loss of collor/ pale)– Paralysis (lack m-nt) – Paresthesia (lack of sense) – Pressure (feeling of tension) – Pulses (diminished or absent)

296
Q

Muscle Cramps:

A

Really not a direct injury but more of a painful continuous muscle contraction (spasm)
Exercise consumes oxygen and energy sources; circulatory system fails to remove metabolic waste products.
Also caused by electrolyte imbalances ; preg females cramp in legs,

297
Q

Muscle Spasm:

A

Affected muscle goes into intermittent (clonic) or continuous (tonic) contraction
May be firm enough to feel like deformity associated with fracture and can confound assessment
Usually subsides uneventfully with rest (benzo, pain control, cortical steroid, fluid replacement)

298
Q

Luxation/dislocation

A

= stay out of origin, Complete displacement of bone ends from normal joint position (luxation)
Joint fixes in abnormal position with noticeable deformity
HIGHEST CHANCE on impeachment of nerves, & ALS,

299
Q

Strain:

A

Muscle fibers overstretched by forces that exceed fiber’s strength “strain muscle” vs “sprain joint”
Stretch and tear, causing pain.
Fibers damaged without significant internal bleeding, edema, discoloration

300
Q

Thermolysis)Resp:
Evaporation: sweating & babys white soot
Convection: radiation plus moving air (window defroster) moving heat
Radiation: loosing heat via vasodialation (noncontact)
Conduction: transferring heat gradient via direct physical contact

A

= exhale heat
= sweating & babys white soot
= radiation plus moving air (window defroster) moving heat
= loosing heat via vasodialation (noncontact)
= transferring heat gradient via direct physical contact

301
Q

Thermolysis: What are the 5 different ways of thermolysis?

A

= Respiration, Evaporation, Convection, Radiation, Conduction

302
Q

Thermogenesis:
Types:

A

= Heat created by molecules in motion
= work induced, thermoregulatory, Metabolic or diet-induced thermogenesis (eating hog)

303
Q

What is a thermal gradient?

A

M-nt of temperature of body away

304
Q

What in our body is responsible for thermoregulation?

A

Hypothalamus

305
Q

Heat cramps:
S/S:
Emergency Rx:

A

= Painful muscle spasms, seen in fingers, arms, legs and/or abdomen. (Intermittent cramping of skeletal muscles may occur)
Result of excessive sweating: leads to electrolyte imbalances (Na, K, Ca)
= Painful muscle spasms Usually involves the fingers, arms, legsmost common , abdominal muscles. Mentally alert, weakness, dizzy, faint.
Vital signs stable Temperature normal; slightly elevated Skin moist and warm
= Remove patient from hot environment* Administer water or sports drink, If patient unable to take fluids orally, IV of normal saline may be needed. Antiemetic medications (Risk for heat exhaustion/stroke)
Do not administer salt tablets! Hypertonic dehydrates cells (Hypotonic saline best)

306
Q

heat exhaustion: Acute reaction to heat exposure core temp (over 100°F / 37.8°C)
Signs:
Symptoms:
Treatment:

A

= Acute reaction to heat exposure core temp (over 100°F / 37.8°C)
= Working in warm/hot environment can result in a 1-2 L loss of water, Loss of water and sodium with vasodilation, Decreased circulating blood volume, venous pooling, reduced cardiac output
= Elevated core temp (over 100°F / 37.8°C), Weak & tired, Tachypnea & weak pulse, Skin: Cool, clammy & diaphoretic, Diarrhea, muscle cramps, very weak.
= Remove PT from environment Remove outer clothing (external cooler) and fan patient Administer water or sports drink IV therapy compensating hypovolemia

307
Q

heat stroke:
SIGNS:
S/S:
Emergency Treatment:
Avoid

A

= Life or death, hypothalus can no longer help, decompensating 105˚F (40.6˚C) or high“you gone die”
True environmental emergency, Hypothalamic temperature regulation lost; uncompensated hyperthermia, Cell death, kidney damage
= Temperature of at least 105˚F (40.6˚C) or high“you gone die”, C N S disturbances (headache, anxiety, paresthesia, impaired judgment, psychosis), Cessation of sweating * Hot & dry skin, Very high core temperature
= Deep respirations; shallow, rapid at first, may later slow, Rapid, full pulse, may slow later, Hypotension <90SBP, Confusion, disorientation, or unconsciousness, AMS, Phycosis, Possible seizures, if shivering RSI
= Remove patient from environment, Initiate active cooling, Remove clothing, AC/Fan on high, Soak sheets in tepid water and cover, IV extensions coil & put ice packs on, Refrain from overcooling; watch for shivering, Administer cool O2 if the patient is hypoxic, 1-2 large bore IV’s wide open Monitor ECG (watch for signs of hyperkalemia)
= Avoid vasopressors and anticholinergic (atropine) drugs, Vaso pressing presses heat back in

308
Q

Classic Heat stroke:
Predisposing factors:
Exertional heat stroke:
Emergency Treatment:

A

old people getting hot from outside, Patients with chronic illnesses
Increased core temp caused by deficient thermoregulatory functions
= Increase age, Diabetes, Sedentary lifestyle, Medications that inhibit temp regulation
= marathon Result of activity, exercise. Hot environment for long periods * May create metabolic acidosis or hyperkalemia from lactic acid accumulation and injury to muscle cells, Rhabdo
= Remove patient from environment, Initiate active cooling, Remove clothing, AC/Fan on high, Soak sheets in tepid water and cover, IV extensions coil & put ice packs on, Refrain from overcooling; watch for shivering, Administer cool O2 if the patient is hypoxic
Administer IV fluid therapy
= Avoid vasopressors and anticholinergic (atropine) drugs
Vaso pressing presses heat back in

309
Q

Frostbite:
(ITH) Therapeutic hypothermia for:

A

= below 95˚F (35˚C) Inadequate thermogenesis, excessive cold stress, combination of both. Important to differentiate induced therapeutic hypothermia (I T H) from accidental hypothermia
= for neuron protection “hibernation”

310
Q

Mild hypothermia definer:
Moderate Hypothermia definers:
Severe Hypothermia definers:

A

= Core temp 90–95˚F (32–35˚C) Tachycardia&pnea, Shivering, Fatigue; impaired judgment UNALTERED
= Core temperature 82– 90˚F (28–32˚C) Cold-induced rhythms & arrhythmias, AMS,
= Core temp< 82˚F (28˚C) finna die: Bradycardia most common cold induced & Severe, Coma, Apnea, Ventricular arrhythmias or asystole
Only defib cold induced V-arythmia until core temp 86F

311
Q

Pyrexia:
Pyrogens:

A

= virus, Elevation of body temp above normal temp, Pathogens enter and cause infection
= substances that cause fever (viruses, bacteria, substances in body) in response to infection or inflammation.
Increased temperature fights infection by making body less hospitable environment for invading organism

312
Q

Deep Frostbite:
happens commonly too:
Treatment:
Do nots:

A

= All layers Epidermal and subcutaneous layers; white appearance, Severe Hypothermia: Core temp< 82˚F (28˚C) finna die: hard (frozen) to palpation, loss of sensation.
= Extremities, head, face.
= Cover thawed part w/ loosely applied dry, sterile dressings.
Separate toes to prevent growing back together, If transport delayed, thaw frozen part by immersion in 102 to 104˚F (39 to 40˚C) water bath
= Wrap tightly, pop bubbles

313
Q

Febrile seizure:
when pyrogen production stops:
Fever hard to differentiate from heatstroke; neuro symptoms may present w/ either Treat:

A

= fever seizure with kid & cool down
= Hypothalamic thermostat will reset to normal
= for heatstroke if you are unsure which it is * If child history of febrile seizures, treat for fever.

314
Q

As temperature falls, so does
Major mechanisms:
which temp condition kills quicker:

A

= the metabolic rate and cardiac output.
= conduction, convection, radiation, evaporation, respiration.
= Hyperthermia stroke kills quicker than hypo

315
Q

Mammalian Diving Reflex:
Water in lungs from & cause:
ARDS) Acute Respiratory Distress Syndrome:
Emergency Treatment:

A

= contact w/ cold water (<70˚F) Bradycardia, Blood shunts to core, , Breathing slows (Jump in cold water then reflex inhale) Larynx shuts down
= wet drowning from warm water (hypertonic in lungs so flash pulmonary edema)
= Fluid invades the alveoli Atelectasis, Immune system responds and increases inflammation to area, Major V/Q mismatch!
Can shock on Ice, wet surface but not puddles
= Remove PT from water ASAP, Primary assessment, if no pulse, begin immediate CPR, IV/IO & ALS airway (ET), Follow ACLS protocols, Protect from heat loss

316
Q

Boyle’s Law:

A

The volume of gas is inversely proportional to the pressure of it The more pressure, the less volume.
The less pressure, the more volume.
At sea level 1 atmosphere of pressure on your body
Every 33 feet under water adds another atmosphere
14.7PSI
Down 33ft 1000 vol, 66ft 500
Ascent pops lung

317
Q

Henry’s Law:

A

The amount of a dissolved gas in a given amount of fluid is directly proportional to the amount of pressure on top of that gas
Diving down puts more pressure on nitrogen to dissolve & into bloodstream
Usually compresses brain
Descent injurie w/ diving w/ ear infection or dental work

318
Q

Gay-Lussac’s Law:

A

As you heat a volume of gas, the pressure is going to go up.
If you cool a volume of gas, the pressure will decrease. – This would affect your oxygen tanks

319
Q

Charles’s Law:
If the temperature increases:
If the temperature decreases,

A

(temp vol) At a constant temperature, the volume of a gas is directly proportional to the absolute temperature of the gas.
= the volume increases.
= the volume will decrease.

320
Q

Acute Mountain Sickness:
S/S:
6 to 24 hours after ascent;
Treatment:

A

= Unacclimated PT ascends rapidly to 2,000 m (6,600 ft) or greater
= Lightheadedness, Breathlessness, Weakness, H/A, N/V
= more severe symptoms: –Weakness –Severe vomiting – Decreased urine output –Shortness of breath – Altered level of consciousness
= Halting ascent, lowering altitude, acetazolamide and Antinauseants., Immediate descent, definitive treatment In very severe cases, hyperbaric oxygen Necessary

321
Q

High Altitude Pulmonary Edema (HAPE)
S/S:
Early stages:
Rx

A

= Increased pulmonary pressure and hypertension caused by changes in blood flow at high altitude:
= Dry cough, shortness of breath on exertion, crackles in lungs. – Dyspnea: quite severe; causes cyanosis –
= completely reversible with descent and oxygen – Supplemental oxygen can completely reverse HAPE; 36 to 72 hours – Portable hyperbaric bag very useful – Acetazolamide used to decrease symptoms

322
Q

High-Altitude Cerebral Edema (HACE)
Treatment:
If coma develops:

A

= AMS, Ataxia (poor coordination), Decreased LOC, Coma
= Descent to lower altitude, Oxygen and steroids may help to improve recovery
= may persist for days after descent to sea level; usually resolves

323
Q

Accidents generally occur at one of the following four stages of a dive:

A

= On the surface, During descent, On the bottom, During ascent

324
Q

Dives below ? ft may require staged ascent to prevent decompression sickness,
also called: the bends or dysbarism.
This condition develops in divers subjected:

A

= Dives below 33 feet may require staged ascent to prevent
= bends or dysbarism
= to rapid reduction of air pressure while ascending to the surface following exposure to compressed air, w/ formation of expanding nitrogen bubbles causing severe pain, especially in ABDMN & joints.

325
Q

Pressure Disorders:

A

= Decompression sickness, Pulmonary overpressure, Arterial gas embolism, Pneumomediastinum, Nitrogen narcosis

326
Q

(AGE)
Injury occurs from:
Usually from divers thatL
Can occur w/ a deep dive, or as little as:

A

= an air bubble or air embolism that enters the circulatory system from the damaged lung.
= barotrauma that occurs during ascent is injury to the lung from pulmonary overpressure
= holding his breath during ascent. As diver ascends, the air in the lung, which has been compressed, expands. If it is not exhaled, the alveoli may rupture.
= 3 feet below the surface

327
Q

2 meds will limit or prevent the dev/ of medical conditions related to high altitude. They are:

A

Acetazolamide (Diamox) & Nifedipine (Procardia, Adalat)

328
Q

2 meds will limit or prevent the dev/ of medical conditions related to high altitude. They are:
Acetazolamide (Diamox):

Nifedipine (Procardia, Adalat):

A

= acts as diuretic. It forces bicarbonate out of the body, which greatly enhances the process of acclimatization, The hypoxic ventilatory response reaches a new set point more quickly. This improves ventilation & O2 transport w/ less alkalosis. periodic breathing that occurs at high altitude is resolved, thereby preventing sudden drops in oxygen.
= medication used to treat high blood pressure. It causes blood vessels to dilate, preventing the increase in pulmonary pressure that often causes pulmonary edema.

329
Q

Pathophysiology of Heat and Cold Disorders
Mechanisms of Heat Gain and Loss:
Body gains and loses heat in two ways:
From within the body itself
By contact with external environment
Thermal gradient: Difference in temperature between environment (ambient temperature) and body (H→ L Hot→cold)

A
330
Q

Medications—Various medications can affect body temperature in the following ways:
Diuretics predispose to dehydration, which worsens hyperthermia.

Beta-blockers interfere with vasodilation and reduce the capacity to increase heart rate in response to volume loss, and may also interfere with thermoregulatory input.

Psychotropics and antihistamines, such as antipsychotics and phenothiazines, interfere with central thermoregulation.

A

P2 Exams (9 decks)

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