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Medical Flashcards

1
Q

what type of care is TCCC considered

A

prehospital

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2
Q

benefit units that use TCCC have shown

A

decreased preventatble death.

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3
Q

developed TCCC

A

COTCC

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4
Q

CoTCCC

A

committed on tactical c ombat casualty care course.
reflects the msot up to date trauma literateure, best practices., lessons learned

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5
Q

levels of TCCC

A

TCC-ASM: all service members
TCC-CLS- combat lifesaver
TCC-CMC- combat medic/corpsman
TCC-CPP: combat paramedic/provider

  • must know what level you are teachign
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6
Q

ELO versus TLO

A

enabled/terminal learning objectives

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7
Q

skills taught in TCCC-ASM

A

All service members
- rapid assessment
tourniquet
hemostatic/pressure dressingsd
airwayu managemnt
MARCH

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8
Q

skills taught in TCCC0CLS

A

combat lifesaver
junctional hemorrhage, NPA, needle D
chest sea

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9
Q

steps to run a course

A

formulate learnign plan
determine configurate fo the lcass
select optimal approach for delivery
gather resources to deliver the course

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10
Q

medical kit I keep in my car

A

IFAK - individual first aid kit

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11
Q

what two things should you know before teaching TCCC to non-medical groups

A

know target audience
know unit mission

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12
Q

important thing to remember about who saves lives on the battlefield

A

largely by nonmedical providers

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13
Q

goals of TCCC

A

acquire fundamental knowledge
turn knowledge itno performance
attain proficiency in TCCC

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14
Q

key to building a good TCCC training

A

interesting/relevant casualty scenarios

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15
Q

important thing to remember about hemostatic dressings

A

3 minute pressure

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16
Q

common errors when applying tourniquets

A

improper position
not on fast enough
not tight enough
don’t check to see if leeidng stop
don’t makr time on TCCC card and on body

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17
Q

TCCC card =

A

DD 1380

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18
Q

common errors with hemostatic dressings

A

blind packng and not fighing site of bleeding
don’t just pack the cavity
not deliberately guiding dressings into entire area of wound cavity
not applyign/maining 3min pressure

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19
Q

common errors when using BVM

A

not maintaining open airway maneuver
bad seal
hyperventilate

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20
Q

common chest seal errors

A

not ID second exit wound
not adequately drying blood aroudn site to achieve appropriate chest seal adhesive
burp if tension pneumo s/s

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21
Q

common needle D erros

A

wrong site
inside nipple area
worng size needle
not inserting just over rib at at 90 degree angle to chest wall

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22
Q

common erros w/hypothermia

A

assumign it isn’t a problem b/c warm environment
fail to prevent it if burn

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23
Q

common erros w/TCCC card

A

assuming someone else will fill it outt
not handing it off
not updating with changes

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24
Q

KSA

A

knowledge, skills, and assessmetnq

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25
Q

NAMET

A

natioanl association of emergency medical technicians

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26
Q

who has achieved the most lifesaving impact of TCCC

A

largely achieved by nonmedical personnel

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27
Q

function of the heart valves

A

one directional blood flow. failure - regurgitation backwards flow

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28
Q

yr of the first successful heart bypass

A

1953

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29
Q

yr of the first ECMO survivor

A

1971
first neonatal one was in 1975 for meconium aspiration

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30
Q

aka propofol

A

Diprivan

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31
Q

aka prescedexd

A

dexmedetomidine

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32
Q

NE class

A

alpha adrenergic

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33
Q

differences in effect between E and NE

A

NE = moreso on teh vessels
Epi = more so on teh heart

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34
Q

where is the IABP positioned

A

descending aorta

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35
Q

benefits of the IABP

A

augments heart perfusion

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36
Q

when does an IABP increase blood flow

A

during diastole
- unloads L ventricle during systole

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37
Q

contraindication for IABP

A

aortic diseases, PVD
- okay for VSD or mitral regurg. just can’t have aortic dysfunction

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38
Q

location of the top of the heart

A

“base” - 2nd ICS

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39
Q

location of the bottom of the heat

A

“apex” 5th ICS mid clavicular. just above the diaphragm

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40
Q

indicator of the heat’s position within the htorax

A

PMI

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41
Q

tilt of the heart

A

L and forward so the right side is in front

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42
Q

weight of the heart

A

7-15 oz

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43
Q

how many times does the heart beat in a day

A

`10K/day
-3 billion times in a life

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44
Q

controls the flow of blood within the heart

A

valves

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45
Q

4 main surfaces ohte heart

A

anterior
posterior
lateral
inferior

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46
Q

3 layers of the heart

A

pericaridum, myocardium, endocardium

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47
Q

sac that surrouns/protects the heart

A

pericardium

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48
Q

outer covering of the lung

A

pleura

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49
Q

function of the pericardium

A

lubricates the heat ot prevent friction from the heartbeat

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50
Q

muscualr layer of the heart that causes contractoin

A

myocardium

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51
Q

what is thickness of the heart’s myocardium r/t

A

amount of resistance that it must overcome to pump blood out

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52
Q

tricuspid valve

A

right atrial from right ventricle

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53
Q
A
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54
Q

S1 of the heat

A

AV valves close.

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55
Q

aka heart strigns

A

chordae tendinea. attach to the papillary muscles

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56
Q

gets that last bit of blood out of heart

A

atrial kick = 30%

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57
Q

other blood flow when blod to the heat is blocked

A

collateral circulation

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58
Q

what happens when the ventricles of the heart are fileld with blood

A

pressure in the ventricles incerases and forces open bvalves to enect blood

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59
Q

neurotransmitters of the SNS and PNS

A

SNS = NE
PNS - Ach

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60
Q

what happens in teh PNS

A

rest/digest from AcH
slows HR, decreases spe dof conduction throgh AV

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61
Q

electrolyte

A

substance whose molecules dissociate into charge particles (ions) when in water
- cation = positive charge
anion - negative charge

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62
Q

ions inside/out of cells

A

K - primary ion inside cell
Na - primary outside the cell
* the difference of concentrations of ions inside cells determiens its electrical charge
- Na-K pump helps reestablish resting concentrations of Na-AK afte the heart deplarizes

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63
Q

polarization in teh cell

A

when ions are aligned, this is the resting. no electrical activity is occurring. straight link eon EKG

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64
Q

what happens when the cell deplarizes

A

K leavs/Na enters
- inside the cell becomes positive
- muscle contraction

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65
Q

when happens when the cell reporlarizes

A

na-K pump brings K back in and Na out.
- inside the cell becomes negative again

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66
Q

negative/positive inside cell when deplarized/repolarized

A

depolarized = positive inside cell
repolarized = negative inside cell

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67
Q

4 development states post conception

A

zygote
blastocyte
embryo
fetus

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68
Q

abdominal exploratory surgery

A

laparatomy. abdominal incision

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69
Q

surgery on fallopian tubes

A

salpingostomy/ectomy

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70
Q

rx for ectopic pregnancies

A

methotrexate: chemo agent and immune system suppresion

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71
Q

options to treat ectopic pregnancies

A

methotrexate: chemo agnet
salpingostomy/ectomy
laparatomy

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72
Q

rx for abortion

A

mifepristone (anti progesterone) - blocks progesterone to stop pregnancy
misoprostol: progesting to empty uterus

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73
Q

mifepristone

A

used in abortion to block progesterone to stop pregnacy
- use misprostol to empty uterus

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74
Q

misoprostol

A

second pill in abortoin to empty the uterus

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75
Q

One Health

A

collaborative approach.
multiciplinaryh
state, local, regional…
people, animals, plants, shared environmental

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76
Q

what % of bioterrorism originates in animals

A

80%

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77
Q

what type of virus is rabies

A

lyssavirus

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78
Q

how do you get rabies

A

saliva

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79
Q

identify animals with rabies

A

can’t tell which animals have it. not always foaming at the mouth
- don’t touch wildlife, feral cats and jobs

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80
Q

problem with rabies

A

can’t tell which animals have it (passes in saliva. not always foaming at the mouth)

close to 100% fatal without intervetion

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81
Q

how to tell a rooster is sick

A

swollen and cyanosis in their head

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82
Q

problem of bacteria in biofilm form

A

bacteria in biofilm form might not respond to certain ABX b/c they are not in a stage where ABX works

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83
Q

NIMB

A

not in my backyardp

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84
Q

what are pesticides

A

cholinesterase inhibitors, organophosphate (nerve agents)
- nerve agents that have been diluted enough to affect insects

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85
Q

how do you get histoplasmosis?

A

histoplasmosis = fungi
- rich moist soil grows histoplasmosis. rototilling

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86
Q

what is military TB

A

actually “millet seeds”
- firm white nodules on lungs looking like millet seeds

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87
Q

best test for histoplasmosis

A

fungi in soil that gets uprooted
- urine

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88
Q

what causes valley fever

A

a fungus

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89
Q

aka collecting rosks/fossils/minerals

A

rock hounding

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90
Q

rx for fungal infection

A

Amphoteracin B
flucanozole

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91
Q

Domboro soak

A

Burrow’s solution. aqueous solutoin with alumnium

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92
Q

cause of leishmaniasis

A

sandfly

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93
Q

cause of river blindness

A

onchocerciasis
black fly

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94
Q

what does the sandfly cause

A

leishmaniasis

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95
Q

psychosis

A

collection of symptoms that affect the mind. where there’s been some loss of contact with reality
- a person’s thoughts/perceptions are disrupted and they have difficulty recognizing what is real/not
- untreated, this strains relationships, separation from friends, drupts work/school

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96
Q

research for psychosis

A

EPINET: Early Psychosis Intervention Network

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97
Q

EPINET

A

Early Psychosis Intervention Network
- broad research initiartive aimed to find the best ways to help people experiencing early psychosis

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98
Q

what inactivates HIV

A

HIV is inactivated by soap, alcohol, chlorohexidine

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99
Q

when should you start HIV pep

A

within 2hrs but ideally under 72hrs

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100
Q

goal of PEP

A

to suppress the viral replication

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101
Q

SE of vaccines

A

pain, redness, swelling at the injection site, low grade fever, fatigue

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102
Q

Twinrix

A

vaccine Hep A and B

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103
Q

Typhoid vaccine

A

oral version = one capsule on day 0, 2, 4, 6

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104
Q

what is Yellow Fever

A

a RNA virus from genus flavivirus

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105
Q

host of measles

A

humans are the only natural host of measles
- person to person droplets

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106
Q

effectiveness of the measles vaccien

A

dose at 9m = 85% effective
2 doses after 2yrs = 97%

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107
Q

where is polio endemic

A

Afghanistan and Pakistan

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108
Q

vaccine for cholera

A

drinkable packet

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109
Q

where isn’t malaria transmitted

A

malaria doesn’t transmit above 18K ft

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110
Q

prophylaxis abx for traveler’s diarrhea

A

don’t need prophylaxis abx for traveler’s diarrhea

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111
Q

Pepto SE

A

dark stools

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112
Q

rx for traveler’s diarrhea

A

could use pepto
causes dark stools

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113
Q

NTD

A

neglected tropical diseass

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114
Q

intervention if rabies bite

A

soap and water.

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115
Q

aka monkeypox

A

MPOX

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116
Q

distinguishing feature of monkeypox

A

lymphademopathy

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117
Q

EMAC

A

emergency management assistance compact
- mutual aid agreement among states/territories of US
- enables states to share resources during natural/man made disasters

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118
Q

cat scratch fever

A

bartonella
papule/pustule
ipsilateral lympathedomapty

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119
Q

tropical diseas in teh Andes

A

Tropical batonellosis

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120
Q

only bacteria that infects human RBC and causes illness

A

bartonevirus

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121
Q

rx for rickettsia

A

doxy

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122
Q

reservoir for scab typhus

A

mites

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123
Q

typhus rash

A

spares face, palms, soles
- treat w/doxy

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124
Q

grooves on my thumbs

A

beau’s lines

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125
Q

stronglyoidiasis

A

human parasiticdisease from roundworms

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126
Q

characteristic of Q fever

A

donut granuloma

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127
Q

donut granuloma

A

characteristic fo Q fever

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128
Q

action to decrease risk of heat stroke

A

acclimitaization

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129
Q

ciguatera

A

Ciguatera fish poisoning (CFP), also known as ciguatera, is a foodborne illness caused by eating reef fish contaminated with ciguatoxins.[4][2] Such individual fish are said to be ciguatoxic. Symptoms may include diarrhea, vomiting, numbness, itchiness, sensitivity to hot and cold, dizziness, and weakness.[1][2] The onset of symptoms varies with the amount of toxin eaten. If a lot of toxins are consumed symptoms may appear within half an hour. If a low amount of toxins are consumed symptoms make take a few days to appear.[3] Diarrhea may last up to four days.[1] Symptoms may last a few weeks to a few months.[3] Heart problems such as slow heart rate and low blood pressure may occur.[2]

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130
Q
A

splooting aka heat dumping
- animals lie down spread eagle and spread out hind legs to decrease body heat
- squirrels, dogs…

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131
Q

African Swine Flu

A

fever w/o impact to human health

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132
Q

top 2 causes of preventable blindness worldwide

A

refractive error
cataracts

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133
Q

molluscum contagiosum

A

viral skin infection that causes umbilicated papules - small round bumps with a central pit

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134
Q

aka swelling

A

tumefaction

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135
Q

tumefaction

A

to become swollen

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136
Q

albumin

A

a protein that helps maintain fluid in interstitial spaces

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137
Q

exampls of colloids

A

albumin, hetastarch, dextramp

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138
Q

outcomes of pelvic fracture

A

massive bleeding
retroperitoneal space
hypo shock

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139
Q

consideration of permissive hypotension

A

balance BP with IVF

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140
Q

where do colloids move fluid

A

collids move fluid from interstitial/intracellular space into intravasuclar. volume expander but dont’ transport oxygenp

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141
Q

problem of collois

A

yes they volume expand but they don’t transmit oxygen

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142
Q

pediatric IVF

A

20ml/kg

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143
Q

electrolytes

A

substances that separate into charged ions when dissolved in a solution

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144
Q

crystalloid of choice for shock

A

LR b/c compositoin is the most similar to electrolyte composition if bleeding
Na K Ca Cl lactate

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145
Q

problem of giving a lot of NS

A

increased chloride

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146
Q

what could development of low BP mean

A

could mean that the earlier s/s of shock were missed

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147
Q

brain injuries and BP

A

brain injuries don’t cause low BP until brain herniates
SO
brain inuury and low BP should nto assume the head injury is the cause of hypovolemic shock. you should look for other injuries
UNLESS
babies under 6m b/c they can bleed enough int the head to produce hypovolemia shock b/c open sutures can spred apart and accommodate a large amount of blood

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148
Q

where does blood in a pelvic fracture go

A

retropertioneal

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149
Q

steps in shock

A

control severe bleeding
adequate airway and ventilation
continue external bleeding/internal
transfer to definitive care w/blood an dIVF

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150
Q

confounding factors in shock

A

age/neonate/elder have decreased ability com compensate

athletes have a resting HR of 40-50 so HR of shock could be 100-120

pregnancy increases blood volume by up to 50% so HR/CO incrase might mask shock until catagory 3-4 shock
- placenta is the msot adversaely affected by vasoC so the fetus is at risk

Rx like CaChB or BB may keep a person from developing the high HR signs to compensate for shock stees

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151
Q

coagulapathy

A

impairment in normal clotting of the blood
- occurs

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152
Q

ARDS

A

damage to the alveolar cells
- too much IVF can cause fluid leak. so more difficult to perfuse
- causes noncardiogenic pulmonary edema

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153
Q

what happens to the kidneys when they don’t get oxygen

A

kidney cells die
over 45min = acute tubular necorsis

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154
Q

what happens when you have decreased renal output

A

can’t clear toxins , retains fluid b/c can’t excrete. increases K and m. acidosis

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155
Q

blood clotting when cold

A

blood clotting decreases in cold temperatures which worsens bleeding

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156
Q

use ABG

A

to test oxygenation and ventilation

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157
Q

who benefits from ABG

A

rx that impact LOC on impact ventilation drive and oxygen

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158
Q

important to do before ABG

A

Allen test to see if the ulnar artery is providing collateral circulation just in case there is a problem with the radial site

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159
Q

normal bicarb

A

22-26

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160
Q

respiratory indicator

A

PaCo2

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161
Q

metabolic indicator

A

HCO3

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162
Q

chemical formulat for bicarbonate

A

HCo3n

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163
Q

normal PaO2 at sea level

A

80-100 mm hg

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164
Q

problem with anaerobic metabolism

A

rquires x20 amount of fuel to produce same energy as aerobic
- produces lactic acid as a byproduct

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165
Q

what do all metabolic functions need

A

aerobic metabolism

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166
Q

what does PaO2 create

A

PaO2 creates the gradient for O2 diffusion from the alveoli into the blood and to the tissues

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167
Q

pH’s range incompatible with life

A

over 7.8
below 6.8

168
Q

what does pH represent

A

hydrogen ions (acid) conductoin

169
Q

acid-base balance in medication injestion

A

methanol, salicylates, ethylene glycol = m. acidosis

170
Q

acid base balance in severe diarrhea

A

loss of pH b/c excessive loss of sodium bicarb. so m. acidosisho

171
Q

how do the kidneys respond to A-B imbalance

A

retaining/eliminating bicarbonate
lungs increases/decrease ventilation

172
Q

A-B balance of COPD

A

chronic elevated Co2

173
Q

problem of pH imbalance if critically ill

A

vasoactive rx can’t work if abnormal pH

174
Q

what is oxygen considered…

A

a drug even though it is in the atmosphere (pros/cons)

175
Q

L/Min of oxygen via oxygen mask

A

NC at 1L/min = 24% Ox. then add 4% per each additional L

176
Q

simple face mask L/min

A

6-10L/min

177
Q

contraindications for CPAP/BiPAP/PPV

A

apnea, somnolence, can’t clear secretions, risk of aspiration, hemodynamically unstable, can’t protect airway

178
Q

effect of CPAP

A

decrease alvolar dead space
incerase intrapulmonary shunting by opening the alveoli
decrease atelectasis
decrese WOB

179
Q

what happens in BiPAP

A

inspiration pressure > expiratory pressure
I: open airway, increase t, improve hypercarbia
E: helps increase functional residual capacity, improve hypoxemia by keeping alveoli inflated during expiration

180
Q

secondary pulmonary HTN

A

ARDS, PE, caridothoracic surgery, L ventricular dysfunction

181
Q

s/s of ARDS

A

pulmonary insufficiency
SOB, rapid RR, decreasd oxygenation

182
Q

CXR of ARDS

A

bilateral diffuse infiltrates

183
Q

treat ARDS

A

intubate

184
Q

outcome of p. HTN

A

incresaed pulmonary artery pressure and pulmonary vascular resistance leading to right ventricular filling and death

185
Q

pressure in the lungs

A

lung vasculature is normally a low pressure system. so pulmonary HTN matters

186
Q

dx pulmonary HTN

A

right heart cath

187
Q

manage pulmonary HTN

A

increased CO
decreased PAOP
increase QOL
conserve energy
vasoreaction test to see if CaChB would help
watch for r. ventilatory failure

188
Q

rx class that can vasodilate arteries

A

phosphiinese inhibitors

189
Q

vasculature in hypoxia

A

potent vasoC

190
Q

using fetal fibronectin

A

negative = reassuring that you probably won’t go into labor within the next two weeks
positive = inconclusive

191
Q

test that will help tell if you are likely to go into labor over the next two weeks

A

fetal fibronectin

192
Q

trauma

A

injuries sustained from a sudden application fo force

193
Q

IDC code

A

Injury Classification of Disease

194
Q

ISS

A

injury seveity score

195
Q

robot surgery

A

DaVinci

196
Q

key to resuscitative trauma

A

analyze forces so you know how to assess/manage

197
Q

force

A

dose of kinetic energy

198
Q

formula for kinetic energy

A

KE = mass x velocity squared
divided by 2
OR
force = wt times speed squared
SMALL INCREASE in speed = significant increase inf orce

199
Q

how does deceleration help in trauma

A

deceleration allows speed to dissapiate so it is the stop not speed that kills

200
Q

newborn blood glucose

A

over 40

201
Q

intervention if a baby is cold

A

need blood sugar

202
Q

how to prevent bloating

A

drinking water.
body retains water when dehydrated
drinking water prevents constipation which is a likely cause of bloating

203
Q

impact of dairy foods

A

gassy

204
Q

examples of gassy foods

A

dairy, beans, broccoli, pears, onions, carbonated drinks

205
Q

how does fiber help

A

helps everyting go through intestines quickly

206
Q

intervention for constipation

A

exercise

207
Q

what happens if you have sugary foods for breakfast

A

makes you feel hingry quickly b/c shorte lived sugar highs

208
Q

cardio mistake

A

you go longer but not faster. average person picks a pace their can maintain for an activity. interval sprints to burn fat

209
Q

endurance running

A

longer duration, low intsnsity>
impairs strenght an dmuclce growth

210
Q

FITT

A

frequency, intensity, time, type
for exerciseimport

211
Q

important thing to remember about picking an exercise plan

A

going through the motions doesn’t cause wight loss. its the itnensity of the activity that impats metabolism

212
Q

what does it mean if you are exercising but you don’t feel winded

A

you have the capacity to step itup

213
Q

rest between exercise ina single session

A

don’t dillydally in-between exercise b/c that give sthe heart time to return to normal

214
Q

core strength and diet

A

people with stronger core get full faster

215
Q

calorie intake to lose 1lb/wk

A

eat 3500 or less calories

216
Q

do before meals to eat less

A

drinking water 30min before mals helps you eat fewer calories and lose up to 44$ more weight

217
Q

impact of green tea

A

green tea has small amount of caffeine and powerful antioxidants call catechines believed to work synergistically with caffein to enhance fat burn

218
Q

problem with refine carbs

A

refined carbs have been stripped of their nutritious part s(white bread)

219
Q

problems of dieting

A

causes muscle loss and metabolic slow down

220
Q

benefits of spicy foods

A

contains capsacian which can boost metabolism

221
Q

how does fiber help weight loss

A

fiber can increase satiety and help control weight long term

222
Q

benefits of fruits/veggies on diet

A

fewer calories, rich in fiber, filling

223
Q

single most important nutrient to weight loss

A

protein

224
Q

benefit of high protein diets during weight loss

A

boosts metabolism which helps you feel so satified that you eat fewe calories

225
Q

single most fttening aspect of the modern diet

A

liquid sugar calories

226
Q

problem with alcohol in diets

A

empty calories

227
Q

fluid of choice for burns

A

LR

228
Q

foley if genital burns

A

ok

229
Q

Israeli colelctive communities

A

kibbutiz

230
Q

concept that kids have a duty to care for their aging parents

A

filial piety

231
Q

nursing home and medicare

A

nursing home care isn’t covered by medicare unless illnes/sinjury and even then, only covers first 100 days

232
Q

golden handshake

A

clause in an executive employment contract that provides the executive with a significant severance package in case the exec loses their job through firing, restructing, or even scheduled retirement

233
Q

voluntary late life move made by elders to a place that has community features that are desirable like opportunities,s weather…

A

amenity move

234
Q

sperm + egg

A

zygote

235
Q

unspecialized cells

A

stem cells

236
Q

Bush jr and embroytic stem cell research

A
  1. Bush jr signed a directive that, with few exceptions, banned US taxpayer money for embryotic stem scell reserch. but this left teh private sector unregulated so private facilities could
237
Q

quote about dying/sleeping men

A

“a dying man needs to die as a sleeping man needs to sleep. and there coms a time when it is …

238
Q

study of death/dying

A

thanatology

239
Q

stages of grief

A

Kubler-Ross
denial
anger
bargainign
depression
acceptance

240
Q

effect of death on a family

A

affects roles and relationships of everone

241
Q

asynchrony

A

lack of coordination between pt respiratory center output and ventilator
- increase oxygen consumption/CO2 production, hemodynamic instability, sedation request, and barotrauma

242
Q

SE of mechanical ventilation

A

increase shunt/dead space
- decerase CO/renal blood flow
- nosocomial pneumonia
- incerase ICPv

243
Q

volutrauma (m. ventilation)

A

= lung parenchymal damage caused by m. ventilation
- damage is similar to ARDS

244
Q

what is volutrauma caused by mechanical ventilation similar to

A

lung parenchymal damage is similar to ARDS

245
Q

physiology of volutrauma caused by m. ventilation

A

lung parenchymal damage similar to ARDS
- increased permeability of alveolar capillary membrane, development of p. edema, accumulation of neutrophils and proteins, disrupt surfactant production, decreased compliance, develop by aline

246
Q

m. ventilator control variables

A

= pressure and volume

247
Q

3 breath sequences in m. ventilation

A

CSV = does not allow mandatory breaths
CMV- no spontaneous breaths between mandatory breaths
IMV - spontaneous breaths allowed within mandatory breaths

248
Q

electrons in R. alkalosis

A

low K
low ionizing Ca

249
Q

permissive hypercarbia

A

deliberately to avoid alveolar d
so let PaCO2 be over 50
- even small increases in PaCo2 increase cerebral blood flow. so contraindicated in increased intracranial pressure
- also stimulates ventil so may cause asynchronous
- may cause R Oxygen curve to facilitate offload

250
Q

when is venous return the greatest during PPV

A

during exhalation

251
Q

urine output if m. ventilation

A

m. ventilation can decrease urine outpt b/c low COpur

252
Q

purpose of adding humidification to m. ventilation

A

humidificatio can eliminate insensible water loss

253
Q

aka gastric distension from gas buildup

A

meteorism

254
Q

ABCE care in m. ventilated patients

A

Awake
breathing
choice of sedation
delirum
early ambulation

255
Q

loss of taste

A

ageusia
ah goose ee ah

256
Q

ageusia

A

loss of taste
ah goose ee ah

257
Q

how to measure pPLAT

A

measure by applying a 0.5-2 second end inspiratory breath hold

258
Q

when does pulsus paradox occur

A

moderate to severe asthma

259
Q

physiological effect of nitric oxide

A

Nitrogen decreases pulmonary pressure
oxygen relaxes capillary smooth muscles
decreased pulmonary pressure (PVR) improves pulmonary b. flow

260
Q

why is fetal PVR increased

A

bc/ alveoli fill with fluid

261
Q

what happens when the umbilical cord is cut

A

SVR increases,
ventilation from inital brath expands lungs
PVR is 80% down post delivery

262
Q

newborn closure of the PDA

A

starts to close soon after birth and finishes within 2 weeks

263
Q

normal closure of the ductus arteriossu

A

lets blood from teh right ventricle enter the lungs
- closure takes 2 weeks but increased PaO2 and loss of maternal prostaglandins post birth leads to initial closure

264
Q

what happens in acyanotic congenital defects

A

increased pulmonary blood flow = pink babies
- increased b flow to lungs demages lung tissue/vasculature

leads to fibrosis then causes pulmonary HTN due to icnreased PVR. creased increased heart workload b/c heart muscle pumps against increased heart pressure

more blood to lungs = pulmonary HTN and increased PVR

265
Q

types of acynotic congential heart defects

A

pink babies = increased pulmonary blood flow
PDA, ASD, VSD, pulmoanry valve stenosis, aortic valve stenosis, coarctation of aorta
LEFT TO RIGHT SHUNT

266
Q

Left to right shunt = congenital heart defect

A

acyanotic = increased blood flow

267
Q

ductus arteriousus in utero

A

connects the aorta to the pulmonary artery
- usually spontaneously closes at one year but functional closing soon after birth
SO
inability to functionally close is PDA. duct between aorta and pulmonary artery is open
THUS
some blood from the aorta flows back tot he poulmnary artery via the duct which causes extra poulmonary blodo flow
increased pulmonary blood flow to lung = increased WOB and can lead to damage to the pulmonary artery over time from pulmnary vascualr disease and thick/stiff vasculature

268
Q

acyanotic lesion

A

over circulation of the pulmonary vasculature so pulmonary vascular changes, fibrosis, pulmonary HTN

269
Q

s/s of PDA

A

r/t to how big the PDA is in size. b/c that determines the amount of extra blood going to the pulmonary vascular

269
Q
A
270
Q

s/s of PDA

A

hepatomegaly
wide PPPstrong easily collapsible pulse

271
Q

IVF if PDA

A

small b/c overstress heart if too large boluses
(5-10 ml/hr)

272
Q

management of HF

A

dieuretics and inotrophs to improve CO

273
Q

Atrial Septal Defect

A

abnormal opening in the atrial septum
size is r/t how much blood returns to the lungs
- if large, 2-3x bloo drecirculates
- enlarged R side of heart

274
Q

CXR of Atrial Septal Defect

A

CXR often shows cardiomegaly w/increased pulmonary blood flow

275
Q

long term effects of ATrial Septal Defect

A

enlarged R ventricle
pulmnary vascular vascualr disease
pulmonary HTN
CHF
dys

276
Q

physiology of increased blood flow to the lung

A

increased work of breathing and can lead to damage to the pulmonary artery over time from pulmonary vascualr disease and thick/stiff vasulature

277
Q

what is ventricular septal defect

A

holes in the ventricular septum
- single or multiple holes
multiple holes look like swiss cheese

278
Q

when does VSD manifest

A

often manifest for first 2-4 wks of live b/c PVR still low but pas pulmonary vascular resistance fills the L-R shunting increse3s increased pulmonary blood flow leading pulmony HTN

279
Q

surgery for VSD

A

banding pulmonary artery to decrease pulmary blood flow is a treatment while waiting for a final treatmetn decision
- flow from left to r ventricle so recirculated into the lungs

280
Q

interventions for VSD

A

small boluses
inotropes
diuretics’
surgery

281
Q

artrioventricular septal defect

A

mitral and tricuspid doesn’t fully form so leave large opening

282
Q

what does someone with arterioventricular septal defect look like

A

small stature and failure to thrive

283
Q

what happens in artrioventricular septal defect

A

increased pulmonary blood flow b/c pulmonary vasculature is a low pressure system. so blood flows mroe easily and large open system leads to pulmnary HTN and pulmonary vascular disease. over time that causes CHF/

284
Q

complication of artrioventricualr septal defect

A

echo sees the valve and can measure the puolmary artery pressure and degree of AV regurgitation

285
Q

pulmonary valve stenosis

A

narrow valve between R ventricule and pulmonary
- cause the heart to pump harder can’t enough blood through teh narrowed valve - leadign to R ventricle hyeprtrophy b/c heat pumps aginst a restricted valve

286
Q

using PGA for pulmonary valve stenosis

A

might use pga but short acting so the effects stop quickly after pump stops
- need enough Rx to last teh trip and enough pump b
- SE is apnea so have intubatin stuff

287
Q

SE of PGA (for congenital heart defects)

A

apnea so have intubation stuff

288
Q

what happens to the heart when the heart’s workload increases

A

L ventricular hypertorphy with increased heart workload

289
Q

physiology of coarctation of the aorta

A

  • if blood can’t corss the obstruction the PDA is needed for systemci perfusion
290
Q

congenital heart defect that needs PGE

A

severe coarctation of hte aorta
- for systemic perfusion. if severe, you’d rely on PGE as PDA closes, try to g

291
Q

BP changes low/high extremities congenital defect

A

coarctation of the aorta

292
Q

coarctation of aorta symptom manifestation

A

typically at hospital dc/ post birth but returns to ER 2 weeks later for per perfusion, resp, b/c that’s when the PDA closes

293
Q

Boerhaaver’s syndrome

A

sudden increase in intra-luminal esophageal pressure leading to transmural esophogeal perforation

294
Q

tear in the esophagus

A

Mallory-weiss

295
Q

burning, pins/needle pain, electrical shock pain

A

neuropathies

296
Q

costochondritis

A

inflammation of the connective tissue where ribs attach ot hte breastbone (sternum)

297
Q

diabetic reports no pain

A

no pain r/t neuropathies

298
Q

reproducible chest pain

A

palpate chest wall
- crepitius and point tenderness could be rib fracture of costochronditis

299
Q

petechial lesions on plams/soles

A

janeway lesiosn

300
Q

janeway lesions

A

petechial lesions on palms/soles

301
Q

Roth’s spots

A

routnds spots consisting of coagulation fibrin seen in the retina in a number of diseses
- a vascular insult resulting in hemorrhage followed by

302
Q

costochondritis

A

inflammation of the connective tissue where the ribs attach to the sternum

303
Q

s/s of bacterial endocarditis

A

fever
chest discomfort
osler’s nodes
janeway lesions
petechial hemorrhage

304
Q

importance when evaluating chest pain

A

is it reproducibleAb

305
Q

dominal Aortic Aneurysm

A

true surgical emergency
0- tear pain radiate to the pale, decreased bp, pulsus sensation

306
Q

s/s gastroenteritsi

A

N/V, cramps, hyepracive BS, colicky pain

307
Q

sausage shaped mass in stomach

A

intussception

308
Q

s/s of intussception

A

currant jelly stool
sausage mass

309
Q

suspect pyloric stenosis

A

olive shaped mass
infant projectile vomiting post feding
visible peristalic wavees in abd

310
Q

s/s of volvus

A

bilus vomit
bloody stool
visibel peristalic

311
Q

coffee grounds emesis

A

upper GI bleed

312
Q

vaginal discharge triage Q’s

A

odor
LMP and birth control
sexually active
last BM
urinary habits

313
Q

costovertebral angle

A

90 degree angle between the 12th rib and the spine
- kidney problems, UTI, stones, other conditions

314
Q

causes of clay olored stool

A

hepatic problems like cirrhosis, and hepatitis

315
Q

dark tarry stool

A

upper GI bleed

316
Q

pylenoephritsi

A

flank pain worse with urinartion
fever
N/V, chills,

317
Q

epididymitis

A

classic duck waddle gait. walk with thighs spread apart

318
Q

signs associated with epididiymitis

A

pain decreased when the scrotum is elevated
clasic duck waddle gait - walk w/thighs spread apart

319
Q

action of Beta Blocksers

A

blocks SNS receptors

320
Q

action of fibrilytics

A

breaks down clot

321
Q

rx if can’t do ACE inhibitors

A

ARB

322
Q

why do you get a cough if you can’t tolerate ACE inhibitors

A

dry hacking cough b/c ACE inhibits prevent the breakdown of bradykin

323
Q

bradykinin

A

potent vasoD

324
Q

importance of knowing the time between onset of ischemia and reprofusion

A

too long = decrease salvage

325
Q

options for reprofusion

A

PCI si the most effective
CABG
fibrolytics

326
Q

diathesis

A

unusual susceptibility or predisposition to a given disease

327
Q

left sided anatomy structures

A

spleen and stomach

328
Q

plane that divides the body into right and left

A

sagittal plane

329
Q

sagittal plane

A

divides the body into right an dleft

330
Q

cross-section

A

in physics, the measure of the probability that a specific process will take place in a collision of two particles

331
Q

greek for disease

A

pathos

332
Q

names drived from a person’s name

A

eponyms
- example…book robinson cruse is named after its main character

333
Q

smallest stable matter

A

atoms

334
Q

Visible Human Project

A

1993
cut into small sections. at 1mm-0.3mm

335
Q

study of early development

A

embryology

336
Q

hx of understanding how the heart works

A

anatomy of heart clearly described in the 1500s but took 200 yrs before we could demonstrate the plumping action

337
Q

what process is vital to our body

A

homeostasis. and maintaining it
- resiliency of the human body is evident by its ability to tolerate a broad range of environmental conditions

338
Q

intrinsic regulation

A

autoregulatoin

339
Q

wht are hormones

A

chemical messengers

340
Q

regulation of our internal body temperature

A

thermoregulation

341
Q

anterior leg

A

crus

342
Q

ankle

A

tarsus

343
Q

sole of

A

planta

344
Q

foot

A

pes

345
Q

calf

A

sura

346
Q

hand

A

manus

347
Q

head

A

cephalon

348
Q

arm

A

brachium

349
Q

plain of the body

A

axis

350
Q

TEAM STEPS

A

team strategies and tools to enhance performance and pt safety

351
Q

yr of Miracle on the Hudson

A

2009
155 survivors

352
Q

MMR

A

maternal mortality rate

353
Q

RTT

A

rural training track

354
Q

ways to avoid a hysterectomy for service PPH

A

Jad
bakari
B0lynch

355
Q

“cus” in TEAMSTEPS

A

I’m concerned
I’m uncomfortable
this is a safety issue

356
Q

talking to your team before/durng/after

A

briefing - before
huddle - during
debrief - after

357
Q

problem of under 5hr sleep

A

short term memory loss, retention, cencentration, speed

358
Q

4 mechanisms of heat/energy transfer

A

conduction
convection
radiatin
evaporation

359
Q

good aspect of hypothermia

A

neuroprotective but worse outcomes in major trauma

360
Q

futile to defibrillate if vfib

A

udner 28C

361
Q

temperature when vasocontrcition begins if cold

A

36C

362
Q

temperature when shivering stops

A

32C

363
Q

when do you start seeing Osborne waves

A

31C

364
Q

temperature w/o spontaneous repsirations

A

24C

365
Q

Osborne J wave

A

positive deflection after QRS best seen in lateral and inferior leads
- almost alwasyq below 32C

366
Q

EKG if cold

A

vfib
osborne wave

367
Q

first degree frostbite

A

superficial edema and hyperemia.
Rewarm
no blistering

368
Q

third degree frostbite

A

full thickness
hemorrhagic vesciles blood blisters

369
Q

nonfreezing injuries

A

chillblains, ternchfroots

370
Q

chillblains

A

red pruritic associate with edema or blisters from repeated expsure to cold but not freezing temperatures

371
Q

do not do if frostbite

A

don’t reub or massage b/c tissue damage

372
Q

treat trench foot

A

elevate, prevent pressure injury

373
Q

heat stroke

A

delirum
seizure
hemodynamics…

374
Q

heat injuries

A

stress-exhaustion…

375
Q

temperature of heat stroke

A

over 40C

376
Q

temperature of hea exhaustion

A

37-40C

377
Q

temperature rise in malignant hyperthermia

A

rise 1C every 5min.
can get as high of 45C
Co2
muscle rigidity

378
Q

cause of malignant hypethermia

A

succ or general -ane….
mscle can’t …CVa

379
Q

treat malignant hyperthermia

A

dantrolene

380
Q

susceptibel to malignant hyperthemia test

A

caffeine-halothane

381
Q

EMS reprot

A

MIST

382
Q

goal of the trauma system

A

match needs of injured patient to resources avaialble so optimal and cost effective care is received

383
Q

COT

A

American Colelge of Surgeon Committee on Trauma

384
Q

stats of Level I or 2 Trauma

A

1200 admits/yr
OR
verage of 35 major truma pt pers surgeon

385
Q

difference between Level 1-2 Trauma and Below 3

A

below Level 3 have no volume and research standards
Level 1-2: 120 admits/yr, 240 major trauma pts per year, or average fo 35 major trauma pts per surgeon

386
Q

Level 2 Truma Center staffing

A

ANES must be in OR at the time the pt arrives
- Neuro/Trauma surgeon can be out of the hospital but must be there in under 20 min

387
Q

staffing needs of Level 3 trauma

A

trauma surgeon/’anes mustbe available in under 20 min
- mo neuro coverage

388
Q

Level 4 trauma center staffing requests

A

ATLS. no inouse request but must have in-house nurses

389
Q

CRTS

A

casualty and treatmetn ships

390
Q

EMEDS

A

Expeditionary Medical SupportMFSTmobile field support surgical team

391
Q

GCS eye

A

4
spontaneous
verbal
pai
none

392
Q

GCS motor

A

6
follows commands
Localizes
withdraws
flexes
extens
none

393
Q

GCS verbal

A

5
none
orient x2
confused
inappropriate
incomprehensive
none

394
Q

Injury Severity Score

A

correlates to mrotality and borbidity
head/neck, face, chest, abd, extremity, …

395
Q

APACHE sc orign system

A

actue physiological and chron…
helps redict pt outcomes in ICU. not designed specifically for trauma

396
Q

CERT

A

community emergency response team

397
Q

location of decontamination zones

A

uphill
upstream
upwind

398
Q

VO2

A

Oxygen consumption

399
Q

intervention before apnea rx

A

preoxygenate for 3-5 min before giving rx that will lead to apnea

400
Q

preoxgenation during apnea

A

allwos up to 10 min of respiratory reserve following apnea in ptl at risk for lung issues

401
Q

Cormack and Lehane Scale

A

grade laryungoscopei views. predicts dififuclt intubatoin

402
Q

two scales to predict difficult airways

A

Cormack and Lehane: looks at cords and larynx
Mallampati: looks a tsoft palate/uvula

403
Q

intervention if you don’t have a good view of vocal cords fo rintubation

A

reposition

404
Q

why are RSI techniques developed

A

developed to increse tehlikilihood of regurgitation and aspiration
- preoxygenate 5min with 100% oxygen
- intubate when airway frelexes aer lost

405
Q

Sellick maneuver

A

cricoid pressrue by downward pressure on teh neck over the cricoid cartliage
- compresses the esophagus and is intended to decrease likelihood fo gastric ontents lieakign into pharynx

406
Q

difference between intubation blades

A

Macintosh: blade into the vallecula and lift 45 degrees
Miller: pass uner the laryngeal surface of hte epiglottis then lift 45

407
Q

when can you do awake intubatoin

A

if cooperaative, calm, spontaneosu ventilatin and difficult arway predicted

408
Q

Combitube

A

2 balloons - esophagus and larynx
- inset until 2 black rings at level fo incisionsrs
- proximal blue =- 100ml air
distal esophagus white = 15ml air
confirm placement with PETCO2 de3tectd

409
Q

no NPA or nasal intubation

A

maxilofacial trauma b/c risk of criboform bone fracture

410
Q

rx to make the nose dilate

A

cocaine

411
Q

calculate CPP

A

CPP = MAP-ICP

412
Q

hyperventilation and blood to head

A

hyperventilation to decrease cerebreal blood flow by causing cerebral vacsoconstriction which increases blodo to head

413
Q

when is awake intubation indicated

A

major ireawy tear b/c this avoids exposign tot he disruption to PPV
- risk for further injury to airway iand increased likelihood that air will dissect into the mediastinal tissue

414
Q

goal of intubation

A

seal off the airway w/cuffed ETT

415
Q
A

Notebooks (13 decks)

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