ITLS Flashcards
Diaphramtic breathing
BVM
2 adjacent ribs in 2 or more places
flail chest
4 sides
occlusive
always shock first
80 of arrest is vtach or vfib
always give oxygen by nrb
because for exam you never know
blunt force trauma is most common moi in general regardless
aystmetrical pupils
stroke
myocradical contusion just like heart attack has
dysrtyhmia
you can’t lose enough blood in the head to show shock
if the patient has a head injury and instead of brachydia and hypertension
they have tachy and hypo tension
they are bleeding somewhere
Successful placement of an OPA should not give you a false sense of security as patients who tolerate an OPA are likely
patients who will require endotracheal intubation because their protective reflexes are so depressed, they cannot protect their lower airways
from aspiration.
Endotracheal intubation is the gold standard of airway management and could be
considered in the prehospital setting when all other preceding options have failed
to support the patient’s oxygenation and ventilation
in increasing icp there is pressure on the medulla which can cause irregular breathing
Compensatory Mechanisms:
In the early stages of shock, the body may compensate for falling blood pressure through mechanisms like tachycardia (increased heart rate) and peripheral vasoconstriction. This can maintain blood pressure temporarily even as perfusion to vital organs diminishes.
Decompensation:
As shock progresses and compensatory mechanisms fail, blood pressure may continue to fall, leading to severe hypotension and multi-organ failure if not promptly treated.
ICP is considered dangerous when it rises above 15 mmHg; cerebral herniation
may occur at pressures above 25 mmHg
cpp the pressure inside the brain must be atleast 50-60 or 60 in order to perfuse the brain
cerbreal perfusion pressure
ICP: The pressure within the skull.
MAP is pressure in the vascular system
If icp increases and map stays the same
a cpp of 60 is no longer good enough to perfuse the brain and it has to be higher
systolic of 110-120 needed to maintain sufficient cpp
Placement of an ETT can safely occur under three scenarios: cardiac arrest during
which no pharmacology is required, following administration of a sedative and paralytic as part of a drug-assisted intubation (DAI), or during an awake intubation
facilitated with appropriate topical airway medications (not typically an option in
the prehospital environment), Attempting to place an ETT in a patient with depressed
loss of consciousness (LOC) with intact reflexes and muscle tone is a difficult and
dangerous endeavour with a well-documented incidence of increased difficulty (Frerk
et al. 2015).
Administration of a paralytic is the only
intervention shown to improve first-attempt success rates with intubation, with the
additional benefit of improving compliance of bag-valve mask (BVM) and placement
of SGA
. Additionally, the
unrecognized esophageal intubation (often delayed in the prehospital environment
due to equipment limitations (etCO2) or the profound shock states of patients) will
quickly lead to critical hypoxemia and cardiac arrest. Given these considerations,
endotracheal intubation is a procedure that should be deferred when possible until the
patient is in a more stable environment with more experienced personnel and more
equipment and monitoring capabilities
n. Remember, patients who have spontaneous yet inadequate respiratory effort
are often better off with noninvasive support than the patient who has been given a
paralytic and can neither be intubatex nor mask-ventilated.
A patient who is maintaining oxygenation and ventilation is often better transported, with continuous observation for deterioration, out of an austere environment
for definitive airway management to occur in a hospital or other monitored setting.
Ventilation with a BVM or SGA and immediate transport of the patient may be a
better option in certain instances than taking the additional time required to perform
rapid sequence intubation (RSI). A spontaneously breathing patient with an appropriate O2 saturation is always better than an ill-equipped RSI.
A patient who is maintaining oxygenation and ventilation is often better transported, with continuous observation for deterioration, out of an austere environment
for definitive airway management to occur in a hospital or other monitored setting.
Ventilation with a BVM or SGA and immediate transport of the patient may be a
better option in certain instances than taking the additional time required to perform
rapid sequence intubation (RSI). A spontaneously breathing patient with an appropriate O2 saturation is always better than an ill-equipped RSI.
ROSC
Decontamination must occur before any patients can be properly cared for.
Emergency Medical Responders may be asked to assist with the decontamination process
due regard
Once the decision to intubate has been made, emergency care providers must identify an appropriate approach for that patient, with consideration given to alternative
techniques available should difficulty be encountered
Although direct-vision orotracheal intubation is considered the primary method of
placing an ETT in the trachea, the procedure is not always easy. In the management of
trauma patients particularly, options must be available to permit successful intubation
in even the most challenging of situations and patients. There is evidence that the technique of direct-vision orotracheal intubation results in some movement of the head
and neck, the clinical significance of which is unclear (Robitaille et al. 2008). Although
intubation of supine trauma patients using direct laryngoscopy is a safe option with a
high success rate, emergency care providers must consider that if difficulty is encountered it may be from an inability to optimally align the oral–pharyngeal–laryngeal axis
due to C-spine immobilization. As such, alternative intubating approaches such as
the use of a video laryngoscope (VL) designed to “look around the corner” should be
considered. VL, however, in the soiled or bloody airway may be impossible relative
to direct laryngoscopy.
In situations of significant craniofacial trauma with an obstructed airway, rapidly
moving to an emergency surgical airway may be required, even in the prehospital
environment. The indication for a surgical airway is the inability to secure an airway
by any other means, and the provider should perform a cricothyrotomy using a bougie, scalpel, and a small-caliber ETT
Those with a low risk of cervical spine injury can be intubated in the conventional
way, using a direct laryngoscope. Intubation by video laryngoscopy, the nasotracheal
route, the tactile or transillumination methods, or a combination should be reserved
for patients with specific indication for alternative techniques. In short, the method
of intubation should be suited to each patient on a case by case basis
This decision should not be
taken lightly, however, as several problems may be encountered when you decide to
intubate a trauma patient. Due to the possibility of unstable cervical spine injuries,
all trauma patients should be intubated supine with in-line cervical stabilization, a
practice that makes all trauma intubations potentially difficult
The goal of prehospital trauma care is to minimize injury and reduce preventable
death. To accomplish these goals, the prehospital care provider must focus on treating
the preventable causes of death on scene, minimizing secondary insults, and rapidly
transporting to a facility capable of definitively addressing the patient’s injuries. The
organized evaluation of the trauma patient and treatment of the associated signs and
symptoms in a time-sensitive manner can be potentially lifesaving.
Unless the patient is
entrapped or the ambulance
has not arrived on scene, start
intravenous therapy while
transporting the patient to
the receiving facility
- Control major bleeding.
- Provide airway management.
- Assist ventilation.
- Begin CPR.
- Seal sucking chest wounds.
- Decompress a tension pneumothorax.
- Stabilize impaled objects.
ITLS Ask close-ended questions when getting a history from patients. Close-ended
questions can be answered with a yes or a no. Patients may only be able to
concentrate for short periods of time, and they may ramble when asked openended questions that require a full answer. Consider getting as much of the history as you can from relatives, friends, or bystanders. This might help improve
the reliability of what you discover. Get as much relevant history as you can, but
do not delay transport
Narcotics/opiates Heroin, horse, big H, Darvon,
codeine, stuff, morphine, smack,
fentanyl, Percocet, opana
Altered mental status, constricted
pupils, bradycardia, hypotension,
respiratory depression, hypothermia
When ICP increases, the systemic blood pressure increases to try to preserve blood flow to the brain. The body senses the rise in systemic blood pressure,
and this triggers a drop in the pulse rate as the body tries to lower the systemic blood
pressure by lowering cardiac output. With severe injury or ischemia, the pressure
within the skull continues in an upward spiral until a critical point at which ICP
approaches the MAP and there is no cerebral perfusion. Because CPP depends on
both the arterial pressure and ICP, hypotension will also have a devastating effect
if ICP is high.
You must maintain a CPP of 60–70 mmHg (see earlier formula), which
requires maintaining a MAP of greater than 70 mmHg in the patient with severe
TBI. Hypotension due to TBI alone is rare, occurring in about 5% of patients with
isolated severe TBI (Glasgow Coma Scale [GCS] score of 69). A patient with a
significant TBI who is hypotensive is bleeding from somewhere or has a spinal
cord injury causing neurogenic shock
number 1 in genreally i think is rapid transport
the face and the scalp is highly vascular
if there is no
adults with a scalp wound probably won’t bleed that much
but a child with head face or scalp injury it can be very problamatic
if bone is stable undert there or there you can use direct pressure
you want to consider intubation and suction
you are going to have trouble with intubation with facial injuries