HM MAN ch 21: Emergency medical care procedures Flashcards
what encompasses all international law regulating the conduct of nations and individual engaged in armed conflict?
law of armed conflict
what are the five priorities for non-tactical triage?
Priority I- Immediate Priority II- Delayed Priority III- Minor Priority IV- Expectant Priority V- Dead
what priority of non-tactical triage involves casualties whose injuries are critical but who will require only minimal time or equipment to manage and who have a god prognosis for survival?
Priority I- Immediate
What is an example of injuries that would fall into Priority I, immediate, for non-tactical triage?
compromised airway or massive external hemorrhage
what priority of non-tactical triage involves casualties whose injuries are debilitating but who do not require immediate management to salvage life or limb.
Priority II- delayed
What would be an example of injuries for priority II of non-tactical triage?
long bone fracture
What priority of non-tactical triage involves casualties, often called walking wounded?
Priority III- minor
what priority of non-tactical triage involves casualties whose injuries are so severe that they have only minimal chance of survival?
Priority IV-expectant
what are the four tactical triage categories?
immediate
Delayed
Minimal
Expectant
what are the two types of suction catheters?
tonsil tip (yankauer) Flexible (French or whistle tip)
Never suction for how long in an adults mouth?
15 seconds
Never suction for how long in a child’s mouth?
10 seconds
Never Suction for how long in an infant’s mouth?
5 seconds
how do you measure the appropriate size for a flexible catheter suction?
from the patient’s earlobe to the corner of the mouth or center of the mouth to the angle of the jaw
when can a combitube be used?
for an unconscious casualty that has no cervical spine injury
what size ET Tube is preferred for use during the field insertion of a cricothyrodiotomy?
6.0 to 7.0
how long of an incision is used and where for a cricothyroidotomy?
1-1/2 inch vertical incision through the skin over the cricothyroid membrane
what size needle is used for chest decompression?
3.25 in
14 gauge
what are the land marks for chest decompresion
second intercoastal space
mid clavicular
___ is a state of inadequate tissue perfusion resulting in decreased amount of oxygen to vital tissues and organs?
Shock
what are the three major types of shock?
hypovolemic
distributive (vasogenic)
cariogenic
Which of the three major types of shock is describes as a loss of intravascular volume, which may occur from blood, plasma, or fluid loss.
hypovolemic
Which of the three major types of shock is describes as hemorrhagic shock?
hypovolemic
what is Hypovolemic shock also known as?
hemorrhagic
Which of the three major types of shock is describes as occurring when the vascular container dilates without a proportional increase in fluid volume?
distributive or vasogenic
As a result of what type of shock, the heart’s preload decreases and thus cardiac output falls leaving the tissues hypoxic and starve for energy
distributive or vasogenic
what are the three types of distributive shock?
neurogenic shock
septic shock
psychogenic shock
Which type of shock is caused by the failure of the nervous system to control the diameter of blood vessels.
Neurogenic
Which type of shock is caused by the presence of severe infection which leads to vasodilation?
septic shock
Which type of shock is typically mediated through the para-sympathetic nervous system?
Psychogenic shock
which type of shock involves stimulation of the vagus nerve producing bradycardia which can lead to fainting?
psychogenic
Which of the three major types of shock is describes as being caused by the heart failing to pump blood adequately to all vital parts of the body?
cardiogenic
which stage of shock is also known as non-progressive?
compensated
which stage of shock is also known as progressive?
decompensated
at what stage of shock is the blood pressure maintained, however there is a narrowing of the pulse pressure?
compensated (non-progressive)
At what stage of shock is the blood pressure falling because the blood volume has dropped 15-25%?
decompensated (progressive)
decompensated (Progressive) stage of shock is caused by the blood volume dropping by what amount?
15-25%
Which stage of shock involves the arterial blood pressure to be abnormally low?
irreversible shock
how much blood does the average adult have?
5-6 litters
Normally a loss of how much total blood volume will create a life threatening condition?
25-40%
massive hemorrhage may be fatal with in how much time?
60-120 seconds
the brain can go how long with out oxygen before permanent damage or death?
four to six minutes
how many classes of hemorrhagic shock are there?
4
which stage of hemorrhagic shock has few clinical manifestations?
Class I shock
which stage of hemorrhagic shock is able to maintain blood pressure and tissue perfusion though various mechanisms of the sympathetic nervous system?
class II shock
which stage of hemorrhagic shock has unfavorable signs begin to appear?
class III shock
which stage of hemorrhagic shock is severe and truly have only minutest to live?
class IV shock
what causes septic shock?
a systemic infection
how is septic shock dangerous?
toxins cause the blood vessels in the periphery to dilate which pulls the blood away from critical areas like the brain and heart.
how long does it typically take for septic shock to develop?
5-7 days
the casualty with neurogenic shock, in the absence of traumatic brain injury, is alert, orientated, and lucid when in what position?
supine
what is the treatment for psychogenic shock?
place the casualty in a horizontal position
cardiogenic shock can be caused by what two factors?
intrinsic and extrinsic
what is a CVA?
cerebrovascular accident
what is the name for a stoke or apoplexy?
CVA
Emergency treatment for a cerebrovascular accident is mainly what?
supportive
how should a CVA patient be placed?
a semi reclining position
or
on the paralyzed side
convulsive episodes occur in what percent of the general population?
1-2%
___ is a condition characterized by an abnormal focus of activity in the brain that produces severe motor responses or changes in consciousness.
epilepsy
___ is the more serious type of epilepsy.
grand mal
Grand mal seizures may be but is not always preceded by what?
an aura
___ seizures are short in duration and are characterized by an altered state of awareness or partial LOC, and muscular contrations.
Petit mal
which type of seizure has a warning?
grand mal
which type of seizure has no memory of the attack after it is over?
petit mal
What is OPQRST?
Onset Provocation Quality Radiation Severity Time Interventions
what are three conditions that are commonly referred to as heart attacks?
angina pectoris,
acute myocardial infarction
Congestive heart failure
what causes angina pectoris?
insufficient oxygen being circulated to the heart muscle
how is angina differentiated from other forms of heart problems?
angina’s pain is a result of exertion and subsides with rest
what is the cause of an acute MI?
when a coronary artery is severely occluded by arteriosclerosis or completely blocked by a clot.
The pain associated with ___ is similar to that of angina pectoris but is longer in duration, not related to exertion or relieved by nitro, and leads to death of heart muscle tissue.
Acute MI
which heart condition is accompanied with an overwhelming feeling od doom?
Acute MI
which heart condition is caused by prolonged hypertension, valve disease, or heart disease?
Congestive Heart Failure
in CHF the heart will try to compensate for decreased function by doing what?
increasing the size of the left ventricular pumping chamber and increasing the heart rate.
in CHF patients, ___ leads to rapid shallow respirations, the appearance of pink frothy bubbles at the nose and mouth and distinctive rattling sounds in the chest?
Pulmonary edema caused by hypertension
how much IV fluids do PTs with CHF need?
as little as possible.
slowest rate possible
which solution of epinephrine is used as treatment for an anaphylactic reaction?
1:1000
after administering epi to an anaphylactic patient, vital signs must be assessed how frequent?
every 3-5 minutes until the casualty is stable.
what is the usual adult dose of activated charcoal?
25-50 grams
Adults and children: __ grams of activated charcoal/kg of body weight
1
what is the usual pediatric dose of activated charcoal?
12.5-25 grams
Activated charcoal is contraindicated for patients that have an altered mental status that are suspected of swallowing what? or have an inability to swallow
acids or alkalis
what is the most common cause of diabetic ketoacidosis?
forgetting to take insulin or from taking too little insulin to maintain a balanced condition
The lack of glucose in the cells leads to an increase in metabolic acids in the blood. What is this called?
acidosis
what is the most common of all diabetic emergencies?
hypoglycemia
what is a concussion cause by?
a violent jar or shock to the head
what is a contusion?
head injury
an internal bruise or injury
If the time between contraction is less than ___, then delivery is approaching.
less than 3 minuets
in a breech delivery, if the head does not emerge within 3 minutes what must you do?
try to maintain an airway by gently pushing fingers into the vagina. then push the vaginal away from the baby’s face and open their mouth with one finger.
what must be done if the umbilical cord precedes the baby?
protect it with moist, sterile wraps
in the case on a prolapsed cord during child birth, if the physician cannot be reached quickly what must be done for the mother?
put her in an extreme shock position and give her oxygen
in combat, if a PT has a penetrating eye trauma ensure that they take what medication?
400 mg moxifloxacin tablet
found in the combat pill pack
what two medications should be carried by the combatant and self administered as soon as possible after the wound is sustained?
Mobic 15mg PO
Tylenol 650mg
what is the most effective of all pain relieving drugs?
morphine
how is morphine most commonly available?
in pre measured doses in syrettes or tubexes
what is the adult does of morphine?
10-20 mg repeated if necessary in no less than 4 hours
what type of wound are torn, rater than cut?
laceration
what type of wound is the tearing away of tissue from a body part?
avulsion
what is hematemesis?
vomiting right red blood
what is it called when a patient vomits bright red blood?
hematemesis
what is hemoptysis?
coughing up bright red blood
what is it called when a patient coughs up bright red blood?
hemoptysis
what is melena?
excretion of tarry black stools
what is it called if a PT excretes tarry black stools?
melena
what is hematochezia?
excretion of bright red blood from the rectum
what is it called when a patient excretes bright red blood from the rectum
hematochezia
what is epistaxis?
nose bleed
what is a nose bleed?
eepistaxis
what is ecchymosis?
pooling of the blood near the skin surface
what is pooling of the blood near the skin surface called?
ecchymosis
what is the advice to HMs regarding the suturing of wounds?
DO NOT ATTEMPT IT
what is the medical word for brining together?
coaptation
what are the four types of non-absorbable sutures?
silk cotton linen synthetic materials rust-proof metal
which type of suture frequently reacts with tissue and can be “spit” from the wound?
silk
Which type of suture loses tensile strength with each autoclaving?
cotton
which type of suture is better than silk or cotton but more expensive?
linen
what is an example of synthetic material sutures?
nylon
dermalon
rust proof metal sutures are made of what?
stainless steel wire
what is an example of an absorbable suture?
catgut
though it is referred to as “catgut”, surgical gut is derived from what?
submucosal connective tissue of the first one-third of the small intestine of health government-inspected sheep
what are the available sizes of catgut?
6.0-0
1 to 4
4 being the largest
what are the four types of gut?
A: plain
B: Mild
C: medium
D: extra
what is the absorption time for type A gut?
10 days
what is the absorption time for type B gut?
20 days
what is the absorption time for type C gut?
30 days
what is the absorption time for type D gut?
40 days
what are the four characteristics of suture needles?
size
taper point
cutting edge point
atraumatic
what is the most common local anesthetic used?
xylocain
what are the various strengths of xylocain?
0.5%
1%
2%
Xylocain with Epi is contraindicated for patients with what four diagnosis?
hypertension
diabetes
CHF
what are the thre methods of anesthesia administrations?
topical
local infiltration
nerve block
what size needle is used to infiltrate into the lateral and medial aspects of the base of the digit for anesthesia?
25 or 26 gauge
what is the maximum recommended amount of Xylocain t be used?
50 ml for 1% solution or the equivalent
what is the general rule for time to apply sutures?
6-14 hours old may be closed if they are not grossly contaminated and are meticulously cleaned
14-24 hours old should not be closed
what suture size should be used to suture in G- tube or chest tubes?
2-0
what suture size should be used on the foot or deeply in the chest, abd, or back?
3-0
what suture size should be used on the scalp, chest, abd, foot, extemiteies?
4-0
what suture size should be used on the scalp, brown, oral, chest, abd, hands, penis
5-0
what suture size should be used on the ear, lids, brow, nose, lip, face, penis?
6-0
what suture size should be used on eyelids, lips, or face?
7-0
as a general rule how many days should you wait to remove facial sutures?
4 or 5
as a general rule how many days should you wait to remove body and scalp sutures?
7 days
as a general rule how many days should you wait to remove sutures on the soles, palms, back, or over joints?
10 days
as a general rule how many days should you wait to remove wire sutures?
10-14 days
When a bone is forcibly displaced from it joint, the injury is called what?
dislocation
___ are injuries to the ligaments and soft tissues that support a joint.
sprain
___ are injuries caused by the forcible overstretching or tearing of muscles
strain
___ is characterized by ischemia and muscle damage.
crush syndrome
with ____ there is an efflux of potassium, nephrotoxic metabolites, myopglobin, purine,, and phosphorous into the circulation, resulting in cardiac and renal dysfunction.
rhabdomyolysis
what is rabies sometimes called?
hydrophobia
is rabies in man fatal?
normally yes
When a person has been bitten by an animal what should be done to that animal?
every effort must be made to catch the animal and keep it confined for a minimum of 8-10 days
DO NOT kill it
First degree burns affect what layer of skin?
epidermal layer
second degree burns affect what layer of skin?
epidermal and dermis
which type of burn is referred to as full thickness?
third degree
what are two names for white phosphorus?
WP
Willy Peter
what is the treatment for White phosphorus?
continually flush the area and pull out the WP with tweezers
Under no circumstances should copper sulfate be applied to what?
a wet dressing
What is the most common condition caused by working or exercising in hot environments?
heat exhaustion
what is the mortality rate for heat stroke?
20%
what is the temperature of a heat stock victim?
105
death results as the core temperature approaches what?
80 degrees F
___ is a mild cold injury caused by prolonged and repeated exposure for several hours to air temperatures from above freezing to as high as 60 degree
chilblain
____ occurs in the hands and feel as a result from prolonged exposure to wet cold at temperatures ranging from just above freezing to 50 degrees F.
immersion foot
Never do what to a frostbite area?
rub it
___ is defined as damage to tissues caused by a change in ambient pressure.
barotrauma
what is the most common type of barotrauma and how can it be experienced?
middle ear squeeze
simply jumping in a swimming pool and swimming to the bottom
what is barotrauma of the lungs?
pulmonary over inflation syndrome (POIS)
___ is the tearing of the lung with air leaking out and remaining inside the chest cavity.
mediastinal emphysema
___ is tearing of the lung with air leaking out of the lung then migrating up and out the chest cavity and stopping at the base of the neck.
subcutaneous emphysema
