Medical Flashcards
what type of care is TCCC considered
prehospital
benefit units that use TCCC have shown
decreased preventatble death.
developed TCCC
COTCC
CoTCCC
committed on tactical c ombat casualty care course.
reflects the msot up to date trauma literateure, best practices., lessons learned
levels of TCCC
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
ELO versus TLO
enabled/terminal learning objectives
skills taught in TCCC-ASM
All service members
- rapid assessment
tourniquet
hemostatic/pressure dressingsd
airwayu managemnt
MARCH
skills taught in TCCC0CLS
combat lifesaver
junctional hemorrhage, NPA, needle D
chest sea
steps to run a course
formulate learnign plan
determine configurate fo the lcass
select optimal approach for delivery
gather resources to deliver the course
medical kit I keep in my car
IFAK - individual first aid kit
what two things should you know before teaching TCCC to non-medical groups
know target audience
know unit mission
important thing to remember about who saves lives on the battlefield
largely by nonmedical providers
goals of TCCC
acquire fundamental knowledge
turn knowledge itno performance
attain proficiency in TCCC
key to building a good TCCC training
interesting/relevant casualty scenarios
important thing to remember about hemostatic dressings
3 minute pressure
common errors when applying tourniquets
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
TCCC card =
DD 1380
common errors with hemostatic dressings
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
common errors when using BVM
not maintaining open airway maneuver
bad seal
hyperventilate
common chest seal errors
not ID second exit wound
not adequately drying blood aroudn site to achieve appropriate chest seal adhesive
burp if tension pneumo s/s
common needle D erros
wrong site
inside nipple area
worng size needle
not inserting just over rib at at 90 degree angle to chest wall
common erros w/hypothermia
assumign it isn’t a problem b/c warm environment
fail to prevent it if burn
common erros w/TCCC card
assuming someone else will fill it outt
not handing it off
not updating with changes
KSA
knowledge, skills, and assessmetnq
NAMET
natioanl association of emergency medical technicians
who has achieved the most lifesaving impact of TCCC
largely achieved by nonmedical personnel
function of the heart valves
one directional blood flow. failure - regurgitation backwards flow
yr of the first successful heart bypass
1953
yr of the first ECMO survivor
1971
first neonatal one was in 1975 for meconium aspiration
aka propofol
Diprivan
aka prescedexd
dexmedetomidine
NE class
alpha adrenergic
differences in effect between E and NE
NE = moreso on teh vessels
Epi = more so on teh heart
where is the IABP positioned
descending aorta
benefits of the IABP
augments heart perfusion
when does an IABP increase blood flow
during diastole
- unloads L ventricle during systole
contraindication for IABP
aortic diseases, PVD
- okay for VSD or mitral regurg. just can’t have aortic dysfunction
location of the top of the heart
“base” - 2nd ICS
location of the bottom of the heat
“apex” 5th ICS mid clavicular. just above the diaphragm
indicator of the heat’s position within the htorax
PMI
tilt of the heart
L and forward so the right side is in front
weight of the heart
7-15 oz
how many times does the heart beat in a day
`10K/day
-3 billion times in a life
controls the flow of blood within the heart
valves
4 main surfaces ohte heart
anterior
posterior
lateral
inferior
3 layers of the heart
pericaridum, myocardium, endocardium
sac that surrouns/protects the heart
pericardium
outer covering of the lung
pleura
function of the pericardium
lubricates the heat ot prevent friction from the heartbeat
muscualr layer of the heart that causes contractoin
myocardium
what is thickness of the heart’s myocardium r/t
amount of resistance that it must overcome to pump blood out
tricuspid valve
right atrial from right ventricle
S1 of the heat
AV valves close.
aka heart strigns
chordae tendinea. attach to the papillary muscles
gets that last bit of blood out of heart
atrial kick = 30%
other blood flow when blod to the heat is blocked
collateral circulation
what happens when the ventricles of the heart are fileld with blood
pressure in the ventricles incerases and forces open bvalves to enect blood
neurotransmitters of the SNS and PNS
SNS = NE
PNS - Ach
what happens in teh PNS
rest/digest from AcH
slows HR, decreases spe dof conduction throgh AV
electrolyte
substance whose molecules dissociate into charge particles (ions) when in water
- cation = positive charge
anion - negative charge
ions inside/out of cells
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
polarization in teh cell
when ions are aligned, this is the resting. no electrical activity is occurring. straight link eon EKG
what happens when the cell deplarizes
K leavs/Na enters
- inside the cell becomes positive
- muscle contraction
when happens when the cell reporlarizes
na-K pump brings K back in and Na out.
- inside the cell becomes negative again
negative/positive inside cell when deplarized/repolarized
depolarized = positive inside cell
repolarized = negative inside cell
4 development states post conception
zygote
blastocyte
embryo
fetus
abdominal exploratory surgery
laparatomy. abdominal incision
surgery on fallopian tubes
salpingostomy/ectomy
rx for ectopic pregnancies
methotrexate: chemo agent and immune system suppresion
options to treat ectopic pregnancies
methotrexate: chemo agnet
salpingostomy/ectomy
laparatomy
rx for abortion
mifepristone (anti progesterone) - blocks progesterone to stop pregnancy
misoprostol: progesting to empty uterus
mifepristone
used in abortion to block progesterone to stop pregnacy
- use misprostol to empty uterus
misoprostol
second pill in abortoin to empty the uterus
One Health
collaborative approach.
multiciplinaryh
state, local, regional…
people, animals, plants, shared environmental
what % of bioterrorism originates in animals
80%
what type of virus is rabies
lyssavirus
how do you get rabies
saliva
identify animals with rabies
can’t tell which animals have it. not always foaming at the mouth
- don’t touch wildlife, feral cats and jobs
problem with rabies
can’t tell which animals have it (passes in saliva. not always foaming at the mouth)
close to 100% fatal without intervetion
how to tell a rooster is sick
swollen and cyanosis in their head
problem of bacteria in biofilm form
bacteria in biofilm form might not respond to certain ABX b/c they are not in a stage where ABX works
NIMB
not in my backyardp
what are pesticides
cholinesterase inhibitors, organophosphate (nerve agents)
- nerve agents that have been diluted enough to affect insects
how do you get histoplasmosis?
histoplasmosis = fungi
- rich moist soil grows histoplasmosis. rototilling
what is military TB
actually “millet seeds”
- firm white nodules on lungs looking like millet seeds
best test for histoplasmosis
fungi in soil that gets uprooted
- urine
what causes valley fever
a fungus
aka collecting rosks/fossils/minerals
rock hounding
rx for fungal infection
Amphoteracin B
flucanozole
Domboro soak
Burrow’s solution. aqueous solutoin with alumnium
cause of leishmaniasis
sandfly
cause of river blindness
onchocerciasis
black fly
what does the sandfly cause
leishmaniasis
psychosis
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
research for psychosis
EPINET: Early Psychosis Intervention Network
EPINET
Early Psychosis Intervention Network
- broad research initiartive aimed to find the best ways to help people experiencing early psychosis
what inactivates HIV
HIV is inactivated by soap, alcohol, chlorohexidine
when should you start HIV pep
within 2hrs but ideally under 72hrs
goal of PEP
to suppress the viral replication
SE of vaccines
pain, redness, swelling at the injection site, low grade fever, fatigue
Twinrix
vaccine Hep A and B
Typhoid vaccine
oral version = one capsule on day 0, 2, 4, 6
what is Yellow Fever
a RNA virus from genus flavivirus
host of measles
humans are the only natural host of measles
- person to person droplets
effectiveness of the measles vaccien
dose at 9m = 85% effective
2 doses after 2yrs = 97%
where is polio endemic
Afghanistan and Pakistan
vaccine for cholera
drinkable packet
where isn’t malaria transmitted
malaria doesn’t transmit above 18K ft
prophylaxis abx for traveler’s diarrhea
don’t need prophylaxis abx for traveler’s diarrhea
Pepto SE
dark stools
rx for traveler’s diarrhea
could use pepto
causes dark stools
NTD
neglected tropical diseass
intervention if rabies bite
soap and water.
aka monkeypox
MPOX
distinguishing feature of monkeypox
lymphademopathy
EMAC
emergency management assistance compact
- mutual aid agreement among states/territories of US
- enables states to share resources during natural/man made disasters
cat scratch fever
bartonella
papule/pustule
ipsilateral lympathedomapty
tropical diseas in teh Andes
Tropical batonellosis
only bacteria that infects human RBC and causes illness
bartonevirus
rx for rickettsia
doxy
reservoir for scab typhus
mites
typhus rash
spares face, palms, soles
- treat w/doxy
grooves on my thumbs
beau’s lines
stronglyoidiasis
human parasiticdisease from roundworms
characteristic of Q fever
donut granuloma
donut granuloma
characteristic fo Q fever
action to decrease risk of heat stroke
acclimitaization
ciguatera
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]
splooting aka heat dumping
- animals lie down spread eagle and spread out hind legs to decrease body heat
- squirrels, dogs…
African Swine Flu
fever w/o impact to human health
top 2 causes of preventable blindness worldwide
refractive error
cataracts
molluscum contagiosum
viral skin infection that causes umbilicated papules - small round bumps with a central pit
aka swelling
tumefaction
tumefaction
to become swollen
albumin
a protein that helps maintain fluid in interstitial spaces
exampls of colloids
albumin, hetastarch, dextramp
outcomes of pelvic fracture
massive bleeding
retroperitoneal space
hypo shock
consideration of permissive hypotension
balance BP with IVF
where do colloids move fluid
collids move fluid from interstitial/intracellular space into intravasuclar. volume expander but dont’ transport oxygenp
problem of collois
yes they volume expand but they don’t transmit oxygen
pediatric IVF
20ml/kg
electrolytes
substances that separate into charged ions when dissolved in a solution
crystalloid of choice for shock
LR b/c compositoin is the most similar to electrolyte composition if bleeding
Na K Ca Cl lactate
problem of giving a lot of NS
increased chloride
what could development of low BP mean
could mean that the earlier s/s of shock were missed
brain injuries and BP
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
where does blood in a pelvic fracture go
retropertioneal
steps in shock
control severe bleeding
adequate airway and ventilation
continue external bleeding/internal
transfer to definitive care w/blood an dIVF
confounding factors in shock
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
coagulapathy
impairment in normal clotting of the blood
- occurs
ARDS
damage to the alveolar cells
- too much IVF can cause fluid leak. so more difficult to perfuse
- causes noncardiogenic pulmonary edema
what happens to the kidneys when they don’t get oxygen
kidney cells die
over 45min = acute tubular necorsis
what happens when you have decreased renal output
can’t clear toxins , retains fluid b/c can’t excrete. increases K and m. acidosis
blood clotting when cold
blood clotting decreases in cold temperatures which worsens bleeding
use ABG
to test oxygenation and ventilation
who benefits from ABG
rx that impact LOC on impact ventilation drive and oxygen
important to do before ABG
Allen test to see if the ulnar artery is providing collateral circulation just in case there is a problem with the radial site
normal bicarb
22-26
respiratory indicator
PaCo2
metabolic indicator
HCO3
chemical formulat for bicarbonate
HCo3n
normal PaO2 at sea level
80-100 mm hg
problem with anaerobic metabolism
rquires x20 amount of fuel to produce same energy as aerobic
- produces lactic acid as a byproduct
what do all metabolic functions need
aerobic metabolism
what does PaO2 create
PaO2 creates the gradient for O2 diffusion from the alveoli into the blood and to the tissues
pH’s range incompatible with life
over 7.8
below 6.8
what does pH represent
hydrogen ions (acid) conductoin
acid-base balance in medication injestion
methanol, salicylates, ethylene glycol = m. acidosis
acid base balance in severe diarrhea
loss of pH b/c excessive loss of sodium bicarb. so m. acidosisho
how do the kidneys respond to A-B imbalance
retaining/eliminating bicarbonate
lungs increases/decrease ventilation
A-B balance of COPD
chronic elevated Co2
problem of pH imbalance if critically ill
vasoactive rx can’t work if abnormal pH
what is oxygen considered…
a drug even though it is in the atmosphere (pros/cons)
L/Min of oxygen via oxygen mask
NC at 1L/min = 24% Ox. then add 4% per each additional L
simple face mask L/min
6-10L/min
contraindications for CPAP/BiPAP/PPV
apnea, somnolence, can’t clear secretions, risk of aspiration, hemodynamically unstable, can’t protect airway
effect of CPAP
decrease alvolar dead space
incerase intrapulmonary shunting by opening the alveoli
decrease atelectasis
decrese WOB
what happens in BiPAP
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
secondary pulmonary HTN
ARDS, PE, caridothoracic surgery, L ventricular dysfunction
s/s of ARDS
pulmonary insufficiency
SOB, rapid RR, decreasd oxygenation
CXR of ARDS
bilateral diffuse infiltrates
treat ARDS
intubate
outcome of p. HTN
incresaed pulmonary artery pressure and pulmonary vascular resistance leading to right ventricular filling and death
pressure in the lungs
lung vasculature is normally a low pressure system. so pulmonary HTN matters
dx pulmonary HTN
right heart cath
manage pulmonary HTN
increased CO
decreased PAOP
increase QOL
conserve energy
vasoreaction test to see if CaChB would help
watch for r. ventilatory failure
rx class that can vasodilate arteries
phosphiinese inhibitors
vasculature in hypoxia
potent vasoC
using fetal fibronectin
negative = reassuring that you probably won’t go into labor within the next two weeks
positive = inconclusive
test that will help tell if you are likely to go into labor over the next two weeks
fetal fibronectin
trauma
injuries sustained from a sudden application fo force
IDC code
Injury Classification of Disease
ISS
injury seveity score
robot surgery
DaVinci
key to resuscitative trauma
analyze forces so you know how to assess/manage
force
dose of kinetic energy
formula for kinetic energy
KE = mass x velocity squared
divided by 2
OR
force = wt times speed squared
SMALL INCREASE in speed = significant increase inf orce
how does deceleration help in trauma
deceleration allows speed to dissapiate so it is the stop not speed that kills
newborn blood glucose
over 40
intervention if a baby is cold
need blood sugar
how to prevent bloating
drinking water.
body retains water when dehydrated
drinking water prevents constipation which is a likely cause of bloating
impact of dairy foods
gassy
examples of gassy foods
dairy, beans, broccoli, pears, onions, carbonated drinks
how does fiber help
helps everyting go through intestines quickly
intervention for constipation
exercise
what happens if you have sugary foods for breakfast
makes you feel hingry quickly b/c shorte lived sugar highs
cardio mistake
you go longer but not faster. average person picks a pace their can maintain for an activity. interval sprints to burn fat
endurance running
longer duration, low intsnsity>
impairs strenght an dmuclce growth
FITT
frequency, intensity, time, type
for exerciseimport
important thing to remember about picking an exercise plan
going through the motions doesn’t cause wight loss. its the itnensity of the activity that impats metabolism
what does it mean if you are exercising but you don’t feel winded
you have the capacity to step itup
rest between exercise ina single session
don’t dillydally in-between exercise b/c that give sthe heart time to return to normal
core strength and diet
people with stronger core get full faster
calorie intake to lose 1lb/wk
eat 3500 or less calories
do before meals to eat less
drinking water 30min before mals helps you eat fewer calories and lose up to 44$ more weight
impact of green tea
green tea has small amount of caffeine and powerful antioxidants call catechines believed to work synergistically with caffein to enhance fat burn
problem with refine carbs
refined carbs have been stripped of their nutritious part s(white bread)
problems of dieting
causes muscle loss and metabolic slow down
benefits of spicy foods
contains capsacian which can boost metabolism
how does fiber help weight loss
fiber can increase satiety and help control weight long term
benefits of fruits/veggies on diet
fewer calories, rich in fiber, filling
single most important nutrient to weight loss
protein
benefit of high protein diets during weight loss
boosts metabolism which helps you feel so satified that you eat fewe calories
single most fttening aspect of the modern diet
liquid sugar calories
problem with alcohol in diets
empty calories
fluid of choice for burns
LR
foley if genital burns
ok
Israeli colelctive communities
kibbutiz
concept that kids have a duty to care for their aging parents
filial piety
nursing home and medicare
nursing home care isn’t covered by medicare unless illnes/sinjury and even then, only covers first 100 days
golden handshake
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
voluntary late life move made by elders to a place that has community features that are desirable like opportunities,s weather…
amenity move
sperm + egg
zygote
unspecialized cells
stem cells
Bush jr and embroytic stem cell research
- 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
quote about dying/sleeping men
“a dying man needs to die as a sleeping man needs to sleep. and there coms a time when it is …
study of death/dying
thanatology
stages of grief
Kubler-Ross
denial
anger
bargainign
depression
acceptance
effect of death on a family
affects roles and relationships of everone
asynchrony
lack of coordination between pt respiratory center output and ventilator
- increase oxygen consumption/CO2 production, hemodynamic instability, sedation request, and barotrauma
SE of mechanical ventilation
increase shunt/dead space
- decerase CO/renal blood flow
- nosocomial pneumonia
- incerase ICPv
volutrauma (m. ventilation)
= lung parenchymal damage caused by m. ventilation
- damage is similar to ARDS
what is volutrauma caused by mechanical ventilation similar to
lung parenchymal damage is similar to ARDS
physiology of volutrauma caused by m. ventilation
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
m. ventilator control variables
= pressure and volume
3 breath sequences in m. ventilation
CSV = does not allow mandatory breaths
CMV- no spontaneous breaths between mandatory breaths
IMV - spontaneous breaths allowed within mandatory breaths
electrons in R. alkalosis
low K
low ionizing Ca
permissive hypercarbia
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
when is venous return the greatest during PPV
during exhalation
urine output if m. ventilation
m. ventilation can decrease urine outpt b/c low COpur
purpose of adding humidification to m. ventilation
humidificatio can eliminate insensible water loss
aka gastric distension from gas buildup
meteorism
ABCE care in m. ventilated patients
Awake
breathing
choice of sedation
delirum
early ambulation
loss of taste
ageusia
ah goose ee ah
ageusia
loss of taste
ah goose ee ah
how to measure pPLAT
measure by applying a 0.5-2 second end inspiratory breath hold
when does pulsus paradox occur
moderate to severe asthma
physiological effect of nitric oxide
Nitrogen decreases pulmonary pressure
oxygen relaxes capillary smooth muscles
decreased pulmonary pressure (PVR) improves pulmonary b. flow
why is fetal PVR increased
bc/ alveoli fill with fluid
what happens when the umbilical cord is cut
SVR increases,
ventilation from inital brath expands lungs
PVR is 80% down post delivery
newborn closure of the PDA
starts to close soon after birth and finishes within 2 weeks
normal closure of the ductus arteriossu
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
what happens in acyanotic congenital defects
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
types of acynotic congential heart defects
pink babies = increased pulmonary blood flow
PDA, ASD, VSD, pulmoanry valve stenosis, aortic valve stenosis, coarctation of aorta
LEFT TO RIGHT SHUNT
Left to right shunt = congenital heart defect
acyanotic = increased blood flow
ductus arteriousus in utero
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
acyanotic lesion
over circulation of the pulmonary vasculature so pulmonary vascular changes, fibrosis, pulmonary HTN
s/s of PDA
r/t to how big the PDA is in size. b/c that determines the amount of extra blood going to the pulmonary vascular
s/s of PDA
hepatomegaly
wide PPPstrong easily collapsible pulse
IVF if PDA
small b/c overstress heart if too large boluses
(5-10 ml/hr)
management of HF
dieuretics and inotrophs to improve CO
Atrial Septal Defect
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
CXR of Atrial Septal Defect
CXR often shows cardiomegaly w/increased pulmonary blood flow
long term effects of ATrial Septal Defect
enlarged R ventricle
pulmnary vascular vascualr disease
pulmonary HTN
CHF
dys
physiology of increased blood flow to the lung
increased work of breathing and can lead to damage to the pulmonary artery over time from pulmonary vascualr disease and thick/stiff vasulature
what is ventricular septal defect
holes in the ventricular septum
- single or multiple holes
multiple holes look like swiss cheese
when does VSD manifest
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
surgery for VSD
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
interventions for VSD
small boluses
inotropes
diuretics’
surgery
artrioventricular septal defect
mitral and tricuspid doesn’t fully form so leave large opening
what does someone with arterioventricular septal defect look like
small stature and failure to thrive
what happens in artrioventricular septal defect
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/
complication of artrioventricualr septal defect
echo sees the valve and can measure the puolmary artery pressure and degree of AV regurgitation
pulmonary valve stenosis
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
using PGA for pulmonary valve stenosis
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
SE of PGA (for congenital heart defects)
apnea so have intubation stuff
what happens to the heart when the heart’s workload increases
L ventricular hypertorphy with increased heart workload
physiology of coarctation of the aorta
- if blood can’t corss the obstruction the PDA is needed for systemci perfusion
congenital heart defect that needs PGE
severe coarctation of hte aorta
- for systemic perfusion. if severe, you’d rely on PGE as PDA closes, try to g
BP changes low/high extremities congenital defect
coarctation of the aorta
coarctation of aorta symptom manifestation
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
Boerhaaver’s syndrome
sudden increase in intra-luminal esophageal pressure leading to transmural esophogeal perforation
tear in the esophagus
Mallory-weiss
burning, pins/needle pain, electrical shock pain
neuropathies
costochondritis
inflammation of the connective tissue where ribs attach ot hte breastbone (sternum)
diabetic reports no pain
no pain r/t neuropathies
reproducible chest pain
palpate chest wall
- crepitius and point tenderness could be rib fracture of costochronditis
petechial lesions on plams/soles
janeway lesiosn
janeway lesions
petechial lesions on palms/soles
Roth’s spots
routnds spots consisting of coagulation fibrin seen in the retina in a number of diseses
- a vascular insult resulting in hemorrhage followed by
costochondritis
inflammation of the connective tissue where the ribs attach to the sternum
s/s of bacterial endocarditis
fever
chest discomfort
osler’s nodes
janeway lesions
petechial hemorrhage
importance when evaluating chest pain
is it reproducibleAb
dominal Aortic Aneurysm
true surgical emergency
0- tear pain radiate to the pale, decreased bp, pulsus sensation
s/s gastroenteritsi
N/V, cramps, hyepracive BS, colicky pain
sausage shaped mass in stomach
intussception
s/s of intussception
currant jelly stool
sausage mass
suspect pyloric stenosis
olive shaped mass
infant projectile vomiting post feding
visible peristalic wavees in abd
s/s of volvus
bilus vomit
bloody stool
visibel peristalic
coffee grounds emesis
upper GI bleed
vaginal discharge triage Q’s
odor
LMP and birth control
sexually active
last BM
urinary habits
costovertebral angle
90 degree angle between the 12th rib and the spine
- kidney problems, UTI, stones, other conditions
causes of clay olored stool
hepatic problems like cirrhosis, and hepatitis
dark tarry stool
upper GI bleed
pylenoephritsi
flank pain worse with urinartion
fever
N/V, chills,
epididymitis
classic duck waddle gait. walk with thighs spread apart
signs associated with epididiymitis
pain decreased when the scrotum is elevated
clasic duck waddle gait - walk w/thighs spread apart
action of Beta Blocksers
blocks SNS receptors
action of fibrilytics
breaks down clot
rx if can’t do ACE inhibitors
ARB
why do you get a cough if you can’t tolerate ACE inhibitors
dry hacking cough b/c ACE inhibits prevent the breakdown of bradykin
bradykinin
potent vasoD
importance of knowing the time between onset of ischemia and reprofusion
too long = decrease salvage
options for reprofusion
PCI si the most effective
CABG
fibrolytics
diathesis
unusual susceptibility or predisposition to a given disease
left sided anatomy structures
spleen and stomach
plane that divides the body into right and left
sagittal plane
sagittal plane
divides the body into right an dleft
cross-section
in physics, the measure of the probability that a specific process will take place in a collision of two particles
greek for disease
pathos
names drived from a person’s name
eponyms
- example…book robinson cruse is named after its main character
smallest stable matter
atoms
Visible Human Project
1993
cut into small sections. at 1mm-0.3mm
study of early development
embryology
hx of understanding how the heart works
anatomy of heart clearly described in the 1500s but took 200 yrs before we could demonstrate the plumping action
what process is vital to our body
homeostasis. and maintaining it
- resiliency of the human body is evident by its ability to tolerate a broad range of environmental conditions
intrinsic regulation
autoregulatoin
wht are hormones
chemical messengers
regulation of our internal body temperature
thermoregulation
anterior leg
crus
ankle
tarsus
sole of
planta
foot
pes
calf
sura
hand
manus
head
cephalon
arm
brachium
plain of the body
axis
TEAM STEPS
team strategies and tools to enhance performance and pt safety
yr of Miracle on the Hudson
2009
155 survivors
MMR
maternal mortality rate
RTT
rural training track
ways to avoid a hysterectomy for service PPH
Jad
bakari
B0lynch
“cus” in TEAMSTEPS
I’m concerned
I’m uncomfortable
this is a safety issue
talking to your team before/durng/after
briefing - before
huddle - during
debrief - after
problem of under 5hr sleep
short term memory loss, retention, cencentration, speed
4 mechanisms of heat/energy transfer
conduction
convection
radiatin
evaporation
good aspect of hypothermia
neuroprotective but worse outcomes in major trauma
futile to defibrillate if vfib
udner 28C
temperature when vasocontrcition begins if cold
36C
temperature when shivering stops
32C
when do you start seeing Osborne waves
31C
temperature w/o spontaneous repsirations
24C
Osborne J wave
positive deflection after QRS best seen in lateral and inferior leads
- almost alwasyq below 32C
EKG if cold
vfib
osborne wave
first degree frostbite
superficial edema and hyperemia.
Rewarm
no blistering
third degree frostbite
full thickness
hemorrhagic vesciles blood blisters
nonfreezing injuries
chillblains, ternchfroots
chillblains
red pruritic associate with edema or blisters from repeated expsure to cold but not freezing temperatures
do not do if frostbite
don’t reub or massage b/c tissue damage
treat trench foot
elevate, prevent pressure injury
heat stroke
delirum
seizure
hemodynamics…
heat injuries
stress-exhaustion…
temperature of heat stroke
over 40C
temperature of hea exhaustion
37-40C
temperature rise in malignant hyperthermia
rise 1C every 5min.
can get as high of 45C
Co2
muscle rigidity
cause of malignant hypethermia
succ or general -ane….
mscle can’t …CVa
treat malignant hyperthermia
dantrolene
susceptibel to malignant hyperthemia test
caffeine-halothane
EMS reprot
MIST
goal of the trauma system
match needs of injured patient to resources avaialble so optimal and cost effective care is received
COT
American Colelge of Surgeon Committee on Trauma
stats of Level I or 2 Trauma
1200 admits/yr
OR
verage of 35 major truma pt pers surgeon
difference between Level 1-2 Trauma and Below 3
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
Level 2 Truma Center staffing
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
staffing needs of Level 3 trauma
trauma surgeon/’anes mustbe available in under 20 min
- mo neuro coverage
Level 4 trauma center staffing requests
ATLS. no inouse request but must have in-house nurses
CRTS
casualty and treatmetn ships
EMEDS
Expeditionary Medical SupportMFSTmobile field support surgical team
GCS eye
4
spontaneous
verbal
pai
none
GCS motor
6
follows commands
Localizes
withdraws
flexes
extens
none
GCS verbal
5
none
orient x2
confused
inappropriate
incomprehensive
none
Injury Severity Score
correlates to mrotality and borbidity
head/neck, face, chest, abd, extremity, …
APACHE sc orign system
actue physiological and chron…
helps redict pt outcomes in ICU. not designed specifically for trauma
CERT
community emergency response team
location of decontamination zones
uphill
upstream
upwind
VO2
Oxygen consumption
intervention before apnea rx
preoxygenate for 3-5 min before giving rx that will lead to apnea
preoxgenation during apnea
allwos up to 10 min of respiratory reserve following apnea in ptl at risk for lung issues
Cormack and Lehane Scale
grade laryungoscopei views. predicts dififuclt intubatoin
two scales to predict difficult airways
Cormack and Lehane: looks at cords and larynx
Mallampati: looks a tsoft palate/uvula
intervention if you don’t have a good view of vocal cords fo rintubation
reposition
why are RSI techniques developed
developed to increse tehlikilihood of regurgitation and aspiration
- preoxygenate 5min with 100% oxygen
- intubate when airway frelexes aer lost
Sellick maneuver
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
difference between intubation blades
Macintosh: blade into the vallecula and lift 45 degrees
Miller: pass uner the laryngeal surface of hte epiglottis then lift 45
when can you do awake intubatoin
if cooperaative, calm, spontaneosu ventilatin and difficult arway predicted
Combitube
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
no NPA or nasal intubation
maxilofacial trauma b/c risk of criboform bone fracture
rx to make the nose dilate
cocaine
calculate CPP
CPP = MAP-ICP
hyperventilation and blood to head
hyperventilation to decrease cerebreal blood flow by causing cerebral vacsoconstriction which increases blodo to head
when is awake intubation indicated
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
goal of intubation
seal off the airway w/cuffed ETT
