Midterm Flashcards
1
Q
XABCDE
A
- eXanguation
- airway
- breathing
- circulation
- disability
- expose/environment
2
Q
MARCH
A
- massive bleeding
- airway
- respirations
- circulation
- head
3
Q
event phase
A
- moment of actual trauma
- Actions taken during this phase aim to minimize injuries as a result of trauma.
- Motor vehicle safety restraint systems, air bags, and motorcycle helmets play a role in injury reduction.
4
Q
post event phase
A
- Outcome from a traumatic event.
- 1st phase of death occurs within first hour after an incident (hemorrhage)
- 2nd phase of death occurs within the first few hours of an incident -> Preventable with quality prehospital and hospital care.
- 3rd phase of death occurs several days to several weeks after the incident (multiple organ failure)
- Early and aggressive treatment of shock in prehospital setting can prevent come of these deaths.
5
Q
pre event phase
A
- Circumstances leading up to injury
- Primarily focuses on injury prevention
- Legal enforcement is aimed specifically to prevent traffic accidents.
- Preparation of prehospital care providers for events that are not preventable
- education
6
Q
principle vs preference
A
- principle- based on patient needs
- preference- how the principle is accomplished
- preferences may change depending on:
- situation at scene
- patient severity
- prehospital care provider knowledge and skills
- resources available
- PHTLS teaches the principles of care rather than focusing on preferences
- principle is what needs to be done for apt based on the pt assessment
- preference is how the principle is accomplished
7
Q
DCAP-BTLS
A
- D- deformities
- C- contusion
- A- abrasions
- P- punctures
- B- burns
- T- tenderness- pain only when you touch it
- L- lacerations
- S- Swelling
8
Q
the most important factor for seriousness of wound
A
type of tissue
9
Q
energy dissipation
A
process by which KE is transformed into mechanical energy
10
Q
factors affecting types of injury
A
- Ability of body to disperse energy delivered
- Force and energy
- duration and direction
- position of victim
11
Q
5 phases of trauma
A
-phase 1- deceleration of the motor vehicle
-phase 2- deceleration of the passenger
-phase 3- deceleration of internal organs
-phase 4- secondary collisions
phase 5- additional impacts received by the vehicle
12
Q
Impact patterns
A
- Rollovers- Patient may be ejected or struck hard against the interior of the vehicle -> Most dangerous because there is no protection**
- Lateral/side- Body is pushed in one direction while the head moves towards the impacting object -> seatbelt offers little protection
- Head on/frontal- Front end of car is hit, passengers decelerate at the same rate as the car -> unrestrained passengers either go down and under or up and over
- Rear- Energy is imparted to the front of the vehicle -> whiplash is common -> have the most survivors
- Rotational/quarter panel- Off center lateral crash -> forward energy becomes lateral
13
Q
four types of motorcycle impacts
A
- head on impact
- angular impact
- ejected
- laying the bike down
14
Q
3 predominant MOIs for pedestrains
A
- 1st impact- auto strikes body with its bumpers
- 2nd impact- adult is thrown on hood and/or grille of vehicle
- 3rd impact- body strike the ground or some other object
15
Q
Blast injuries
A
- Primary Blast- Pressure wave from the explosion carries a high risk of injury or death that can rupture membranes and affect organs ex. Lungs, ears
- Secondary Blast Caused by flying debris from wind -> can cause penetrating and blunt injuries -> Most common**
- Tertiary Blast- Occur when a person is hurled against stationary rigid obtectsion (ground shock) ex. Amputations, broken bones, penetrations
- Quaternary Blast- Occurs from miscellaneous events from the blast ex. Burns, respiratory injury, crushing injury, entrapment
- Quinary Blast- Caused by biologic, chemical, or radioactive contaminants in explosive ex. Dirty bombs
16
Q
cavitation
A
- Exit wounds occur when projectile’s energy is not entirely dissipated.
- Size depends on energy dissipated and degree of cavitation.
17
Q
types of shock
A
- Hypovolemic- Dehydration, Hemorrhage
- Distributive- Neurogenic, Septic, Anaphylactic, Psychogenic
- Cardiogenic- Pump failure (intrinsic versus extrinsic)
18
Q
cell dysfunction
A
- lactic acid buildup
- low pH
- autodigestion of cells- leads to cellular death and organ failure
- entry of sodium and water into the cell- cellular edema (swelling) worsens with overhydration
- if further loss of intravascular (blood) volume- the cycle continues
- inadequate ATP
- cells and organs do not function properly
- hypothermia- decreased heat production
19
Q
triangle of death
A
- acidosis- what little ATP is being produced is used to shiver and lactic acid production increases
- hypothermia
- coagulopathy- as body temperature drops, blood clotting becomes impaired
20
Q
cascade of death
A
- anaerobic metabolism
- decreased energy production
- cellular death
- organ death
- patient death
21
Q
neurogenic shock
A
- associated with spinal cord injury
- interruption of the sympathetic nervous system resulting in vasodilation
- patient has normal blood volume but vascular container has enlarged, thus decreasing blood pressure
- low BP
22
Q
starlings law
A
- heart must be an effective pump
- primed by return of blood through the vena cavae
23
Q
microvascular changes in shock
A
- early- pre and post capillary sphincters constrict -> ischemia -> anaerobic respiration
- as acidosis increases…- pre-capillary sphincters relax -> stagnation of blood in capillary beds
- final- pre and post capillary sphincters relax -> wash out -> release microemobli -> infarction of organs
24
Q
organ sensitivity to shock
A
- extremely sensitive- brain, heart, lungs
- moderately sensitive- kidneys, liver, gastrointestinal tract
- least sensitive- muscle, bone, skin
25
Q
acute respiratory distress syndrome (ARDS)
A
- Results from:
- Damage to the alveolar cells
- Hyper-resuscitation (fluid overload)
- Results in:
- Leakage of fluid into the interstitial spaces and alveoli
26
Q
hematologic failure from shock
A
-Impaired clotting cascade
-May result from:
-Hypothermia
-Dilution of clotting factors from fluid
administration
-Depletion of clotting factors
27
Q
hemorrhagic shock chart
A
As you lose more and more blood….
- pulse increases
- blood pressure decreases
- pulse pressure decreases
- RR increases
- urinary output decreases
- LOC decreases
28
Q
I PASS O2
A
- inspection
- palpation
- auscultation- aortic, pulmonary, tricuspid, mitral valves
- seal holes
- stabilize flail segments- two or more ribs broken in two or more places
- oxygen/ventilation
29
Q
PEARRL: pupils
A
- pupils
- equal
- and
- round
- regular in size
- react to light
30
Q
stabilization of spine is the first step of assessing disability
A
- false
- ??
- assessment of cerebral function
- primary concern is the patients level of consciousness
- glasgow coma scale is a tool use to measure consciousness/mental status
- patient can have other causes that can cause decrease neurological function
- medical issues can cause trauma
- pupillary response is also a good indication of internal head injury
- extremity function, sensation will also be good indicators of injury
- measures GSC, pupil response, extremity function
- factors that can contribute to decreased LOC:
- CNS injury
- decreased oxygenations
- metabolic
- drug/alcohol
31
Q
rhonci, rales, wheezing
A
- rhonci -course bubbling sound indicating sever fluid
- rales -fine crackling; indicating fluid build up
- wheezing- high pitch sounds, indication bronchi constriction
32
Q
crepitus
A
- bony
- subcutaneous emphysema
- a grating sound or sensation produced by friction between bone and cartilage or the fractured parts of a bone
33
Q
tension pneumothorax
A
- hemodynamic compromise
- obstructs blood flow
- obstructive shock
34
Q
paradoxical movement of the chest wall
A
- ribs broken and you can see it -> chest moves out during exhalation and inward during inhalation
- pneumothorax, hemothorax, pulmonary contusion
- positive pressure ventilation to treat
35
Q
capnography
A
- 25-45 mm Hg
- can be inaccurate with hypotension but can track patterns
36
Q
ventilatory rates and tidal volumes for adult, children, and infant
A
- Adult- 10-12; 500-800 ml
- Child- 16-20; 100-500 ml
- Infant- 25; 6-8 ml/kg
- inadvertent hyperventilation may lead to poor outcomes in patients with a traumatic brain injury
37
Q
needle decompression placement
A
- secondary intercostal space, midclavicular line, over the rib (preferred site)
- fifth intercostal space, midaxillary line, over the rib (alternate site)
- over the rib is always better
38
Q
location of chemoreceptors for respiration
A
chemoreceptors located in the aorta and carotid arteries stimulate the respiratory center
39
Q
SCALP
A
- skin
- connective tissue
- aponeurotica
- layer of alveolar tissue
- periosteum of skull
40
Q
hypovolemia: SBP
A
- Maintain SBP 90 mmHg in an adult.
- Maintain SBP 80 mmHg in a child.
- Maintain SBP 75 mmHg in a young child.
- Maintain SBP 65 mmHg in an infant.
41
Q
lobes of cerebrum
A
-Frontal- Contains emotions, motor function, expression of
speech
-Parietal- Contains sensory function and spatial orientation
-Occipital- Contains vision
-Temporal- Reg. memory functions, are of speech
reception & integration
42
Q
meninges and layers
A
- Epidural- -under normal circumstance it does not exist, middle meningeal arteries follow grooves in the temporal bone here
- Dura Mater- Made of rough fibrous tissue and Forms Tentorium: divides cerebrum and cerebellum
- Subdural space- spanned with veins -> low pressure
- Arachnoid- covers brain vasculature
- Subarachnoid- vasculature runs
- Pia mater- thin covering directly over the brain
43
Q
normal intracranial pressure
A
7-15 mmHG
44
Q
minimal MAP to perfusion organs
A
-60 mmHg
45
Q
cerebral perfusion pressure
A
- amount of pressure that is needed to push blood through the cerebral circulation
- accounts for cerebral pressure
- CPP = MAP - ICP (intracranial pressure)
- normal intracranial pressure = 7-15 mmHG
46
Q
cranial volume is fixed
A
- 80% = cerebrum, cerebellum, and brainstem
- 12% blood vessels and blood
- 8% CSF
- increase in size of one component diminishes size of another
- inability to adjust = increased ICP
- increase in any one of these things will displace CSF and eventually brain and eventually herniation
47
Q
four lobes
A
-Frontal- Contains emotions, motor function, expression of
speech
-Parietal- Contains sensory function and spatial orientation
-Occipital- Contains vision
-Temporal- Reg. memory functions, are of speech
reception & integration
48
Q
brainstem
A
- Medulla- path way for ascending and descending nerve tracts -> Regulations of heart rate, blood vessel diameter, breathing, swallowing, vomiting, coughing, sneezing
- Pons- Contains ascending and descending nerve tracts -> Relays information from the cerebrum to cerebellum, Houses the sleep center and respiratory center, Like medulla helps in the regulation of breathing
- Midbrain- Involved in hearing through audio pathways in the CNS, Responsible for visual tracking of moving objects, turning the eyes, Coordinates regulation of the automatic functions that require no conscious thought
49
Q
basal skull fracture
A
- may tear dura
- permit CSF to drain through an external passageway
- may mediate rise of ICP
- evaluate for target or halo sign
- clear part of the CSF will be on the outside ring of a blood drop coming from the ear
- battle signs- retroauricular ecchymosis (bruising behind ear) -> associated with fracture of auditory canal and lower of skull
- racoon eyes- bilateral periorbital ecchymosis -> associated with orbital fractures
50
Q
direct brain injury: focal and diffuse
A
FOCAL -occur at a specific location in brain -cerebral contusion -intracranial hemorrhage- epidural and subdural hematoma -intracerebral hemorrhage DIFFUSE -concussion -moderate diffusion axonal injury -severe diffusion axonal injury
51
Q
focal injuries
A
CEREBRAL CONTUSION -blunt trauma to local brain tissue -capillary bleeding into brain tissue -confusion -neurologic deficit -personality changes -vision changes -speech changes -result from coup-contrecoup injury EPIDURAL HEMATOMA -bleeding between dura mater and skull -blood is where the brain should be -> herniation -involves arteries - middle meningeal artery most common -rapid bleeding and reduction of oxygen to tissues -patients will have lucid interval- unconscious goes unconscious again SUBDURAL HEMATOMA -bleeding within meninges -slow bleeding- superior sagittal sinus -signs progress over several days -slow deterioration of mentation -blood is displacing the brain INTRACEREBRAL HEMMORHAGE -ruptured blood vessel within the brain -presentation similar to stroke symptoms -Signs and symptoms worsen over time
52
Q
increase in CO2 -> ICP
A
- cerebral vasodilation
- encourage blood flow
- reduce hypercarbia
- reduce hypoxia
- contribute to increased ICP
- causes classic hyperventilation and hypertension
53
Q
cascade of head injury
A
-cranial insult -> tissue edema -> increased ICP -> compression of arteries -> decrease cerebral blood flow -> decrease O2 with death of brain cells -> edema around necrotic tissue -> increase ICP with compression of brain stem and respiratory center -> CO2 accumulates -> vasodilation -> increase ICP due to increased blood volume -> death
54
Q
upper brainstem
A
-displacement- vomiting, altered mental state, pupillary dilation
55
Q
diffuse brain injury
A
- Due to stretching forces placed on axons
- distributed throughout brain
- CONCUSSION
- Mild to moderate form of diffuse axonal injury (DAI)
- Nerve dysfunction without anatomic damage
- Confusion, disorientation, event amnesia
- momentary loss of consciousness
- MODERATE DIFFUSE AXONAL INJURY
- Classic Concussion
- Additional: minute bruising of brain tissue
- Unconsciousness -> confusion
- May exist with a basilar skull fracture
- Loss of concentration, disorientation
- Retrograde and antegrade amnesia
- Visual and sensory disturbances
- Mood or personality changes
- SEVERE DIFFUSE AXONAL INJURY
- Brainstem Injury*
- Significant mechanical disruption of axons
- High mortality rate
- Prolonged unconsciousness
- Cushing’s reflex
- Decorticate (flexion) or decerebrate (extension) posturing
56
Q
injury to the lobes
A
- frontal lobe injury- alterations in personality
- occipital lobe injury- visual disturbances
- cortical disruption- reduced mental status or amnesia
- > retrograde- unable to recall events before injury
- > antegrade unable to recall events after trauma -> repetitive questioning
- focal deficits- Hemiplegia, weakness, or seizures
57
Q
brainstem compression
A
UPPER BRAINSTEM COMPRESSION -Increasing blood pressure -bradycardia -Vagus nerve stimulation -Cheyne-Stokes respirations -Pupils become small and reactive -Decorticate posturing MIDDLE BRAINSTEM COMPRESSION -Widening pulse pressure -bradycardia -Hyperventilation- Deep and rapid -Bilateral pupil sluggishness or inactivity -Decerebrate posturing LOWER BRAINSTEM COMPRESSION -Pupils dilated and unreactive -Ataxic respirations -Erratic with no pattern -Irregular and erratic pulse rate -ECG changes -Hypotension -Loss of response to painful stimulus
58
Q
blowout fracture
A
Increased pressure due to outside insult causes the base of orbital socket to fracture inward
59
Q
midface injuries
A
- Le fort 1: Involves a horizontal detachment of the maxilla from the nasal floor
- Le fort 2- Fracture of the right and left maxillae, medial orbital floor and nasal bones.
- Le fort 3- Involves the facial bones being fractured off the skull “Craniofacial disjunction”
60
Q
glasgow coma scale
A
- eye opening- spontaneous (4), to verbal command (3), to pain (2), no response (1)
- verbal response- oriented and converses (5), disoriented conversation (4), speaking but nonsensical (3), moans or makes unintelligible sounds (2), no response (1)
- motor response- follows commands (6), localized pain (5), withdraws to pain (4) decorticate flexion (3), decerebrate extension (2), no response (1)
- higher GCS (15)- no neurologic disability
- 13-14- mild dysfunction
- 9-12- moderate to severe dysfunction
- 8 or less- severe dysfunction (lowest possible is 3)
