PHTLS Flashcards
1
Q
EMT course
A
PHTLS = Prehospital Trauma Life SUpport
2
Q
First Battle of Bull Run
A
1861
3K wounded in the field for 3 days
3
Q
TCCC
A
tactical combat casulaty care
4
Q
EMT
A
emergency medical technition
5
Q
national registry of EMTs
A
NREMT (national association of EMT)
6
Q
First Geneva COnvention
A
1864 INternational REd cross
*recognized hospital neutrality and safe ambulaton passage. equality of medical care regardless of side
7
Q
DOD JTS
A
Dep of Defense JOint Trauam SYstem
8
Q
collection of data/statistics on wounded military personnel and the care they receive
A
DOD Trauma Registry
9
Q
states & motorcycle helmet rules
A
1966: COngress gave the DOT authority to penalize states taht failed to pass legislation mandating helmets (over next 10 yrs, 47 states did)
* congress repealed the authoitty inb 1975 and states began to repeal toe mandatory helmets
* in 2017: 19 states mandated hellmets and 3 states including NHY did not have helmet laws regardless of age
10
Q
Q’s to ask at teh scene for all trauma
A
is what I’m doing going to greatly benefit the pt?
does tghe benefit outweight the risk of delaying transport?
11
Q
differences between level I and II trauma
A
medical education
specialty services
reserach
12
Q
DMRTI
A
Defense Medical Readiness Training INstbute
13
Q
CME
A
continuing medical educaiotn
14
Q
Frank Starling Law
A
increased end diastolic ovlume increases stroke volume
15
Q
Fick Principle
A
CO & oxygen delivery
16
Q
TEMS
A
tactical emergency medical support
17
Q
3 stages of TCCC
A
Care Under FIre
Tactical Field Care
Tactical Evauation Care
18
Q
critical thinking w/pts-7
A
assess situation assess pt assess available resoruces analyze possible solutions develop plan initiate plan reassess pt response to plan and adjust
19
Q
first do no harm
A
primum non nocere
20
Q
designated to make medical decisions for you
A
surrogateq
21
Q
distribution of medical resources ethically
A
justice
22
Q
% of reasons people die on scene
A
36%: massive hemorrhage
30%: severe injiury to vital organs like braib
25%: respiratory obstruction/ventilation failure
**76% die of nonsurvivabel injuries to head/heart/aorta..
23
Q
what drives the metabolic processes
A
fuel like oygen, glucose (complex carbs)
ATP
24
Q
stages in metabolic processes
A
glycolysis
KReb’s cycle
electron transport
25
height of a one story building
10ft
26
adult fall that is triaged straight to a trauma center
over 20ft
27
considered a major fall for adults
20ft
28
child fall that is triaged stright to a trauma center
10ft fall or 2-3x a kid's height
29
considered a major fall for a child
10ft or 2-3x a kid's height
30
car accident intrusion that is a direct transfer to a trauma center
vechcle intrusion over 12 inches on occupant side or 18 in on any side
31
criteria where the EMT will immediately take you to a trauma center
```
adult fall from over 20ft
child fall over 10ft or 2-3x chil hight
car ejection
death in teh same compartment
motorcycle over 20mph
vehicle v pedestrian who is thrown/run over/significant impact at over 20mpH
intrusion over 12 in on occupant side
intrusion over 18in on any side
```
32
too slow/fast RR
tachy ves bradypnea
33
sometimes the only way to control bleeding from a freacture in the field
fractures can lead to internal bleeding that can't be visualized and can't be stopped under pressure
*realignment may be to only wayt o control b,eeeding in the field
34
goal time on site if a critical injury
critical injury = EM doesn't have blood to cary oxygne or plasma to control internal hemoorhage
*under 10min
35
IVF given in emergencies
warm IVF givne to prevent hypothermia as part of the trauma triad
36
giving crystalloids in a trauma
do restore lost blood vlulume and improve perfusion but doesn't transport oxygen
*restoring normal bp may lead to additional hemorrhage from clot disruption in damaged blood vessels immediately clotted off
37
quick assessmet
SAMPLE
| s/s allergies medication past mecial hx last meal events piro
38
how do cells maintain their normal metabolic funciton
cells maintain their normal metabolic function by using energy in the form of ATP made via aerobic metabolism using oxygen and glucose as fuel
39
anaerobic metabolism
```
backup power
uses stored fat as energy source
runs short time
byporoduct is lactic acid
might be enough to keep you until trauma intervaetnion
```
40
ischemia time tolerated by heart/brain/lungs
4-6min w/o oxygen
41
how long can the kidney tolerate ischemia
45-90min
42
how long can the liver tolerate ischemia
45-90 minutes
43
how long can the GI system tolerate ischemia
45-90min
44
how long can the muscles tolerate ischemia
4-6hrs
45
how long can the bones tolerate ischemia
4-6hrs
46
how long can the skin tolerate ischemia
4-6hr
47
shock
state of change in cellular function fro aerobic to anaerobic secondary to tissue hypoperfusion
*oxygen at cellualr level can't meet the body's needs
48
main driver of metabolism
aerobic
| backup is anaerobic
49
ATP produced from glucose
every molecule of glucose leads to 38 ATP molecules
* oxygen and glucose are metabolizes
* byproducts are water and co2
50
ATP produced from aerobic versus anaerobic
36ATP
2ATP
anaerobic metabolism is a 19fold decreaes in energy
51
problem if enough kidney cells die
if enough kidney cells die of hypoxia, kidney function decreases, inadequate buildup of toxic boyproducts taht aren't eliminated
52
Fick Principles
1. offload oxygen in the lungs
2. delivery of RBC to tissue cells
3. offloading oxygen form RBC to tissue cells
* requires that the pt has enough available RBC to delviyer adequate oxygen to tissue celsl so cells can provide energy
53
prehospital treatment of shock
ensure critical components of ht FIck principle are maintained w/goal of preventing/reversing anaerobic metabolism they avoid at the cellular/organ/pt dealth
54
actions to ensure Fick's Principle
control hemorrhage
maointain pateint airwya/ventilation (to provide adequate oxygen to RBC)
keep pt warm to facilitatre oxygen offloading that might hinder hypothermic state
maintain adequate ciruclation to ensrue avilable RBC to carry oxygen
55
complication of MI
cardiogenic shock
56
complication of heart pump performance being impaired
cardiogenic shock
57
end organ perfusion pressure
MAP
58
MAP of 120/80
93
59
normal CO
4-6L/nin
60
aka afterload
systemic vascular resistance
61
fluid between the cell membrane and capillary wall
interstitial
62
interstitial fluid
between cell membrane and capillary wall
63
capillary thickness
capillarys can be as thin as 1 cell
64
3 fluid compamrtments
intravascular
interstitial
interacellular
65
fluid inside vessels
intravascualr
66
fluid inside cells
intercellualr
| location of 45% of all body water
67
fluid between cells and vessels
interstitital
68
location of 45% of cell body water
intracellular (within cells)
69
body's reaction to low blood rpessure
ADH released from pituitary and aldosterone from adrenal
70
shocks in trauma
Hyopovolemic
Distributive -vascualr spaces larger than nromal
cardiogenic-heart not pumping adequately
71
easy explaination of neuorgenic shock
vascualr space is larger than normal
72
blood volune in a 150lb person
5L
73
how does the body react to blood loss
increase HR to increase CO by increasing strenght/rate of
* epi released fromadrenal gland and NE vasoc
* pt w/signs of compensation in shock will swithc from compensated to uncompensated
74
blood loss in class 1 hemorrhage
750ml
| 15%
75
vitals in class I hemorrhage
normal vital signs with slightly elevated HR.
| anxiety
76
blood loss in class II hemorrhage
1500ml
| 15-30%
77
vitals in class II hemorrhage
pulse up
normal bp
decreased pulse rpessure
increased RR
78
blood loss in class III hemorrhage
1500-2000
| 30-40%
79
vitals in class III hemorrage
decresed ;BP, pulse pressurei, RR
| confusion/andiety
80
blood loss in class IV hemorerhage
over 2L
| 40%
81
mentation in shock hemorrhage
```
anxiety in class I-II
confusion/lethargic in III-IV
```
82
goal in hemorrhage
stop source of the bleed
83
pulse pressure in hemorrhage
narrowed in class II-IV
84
how does TXA work
bindings to plasminogen and prevents it from becoming plasma. therebyt preventing breakdown of fibrin in a clot
85
IVF crystalloid repolacement for each L of blood lost
3L electrolyte replacemenbt for each liter of blood loss
* *1/4-1/3 of volume of an isotonic solution of NS?LR remains in teh intravascualr space 30-60 monutes after infusions
* *rasing bp to normal levels may dilute clotting factors disrupt any clot that has formed and increased hemorrhage
86
risk of flooding the body w/crystalloids post trauma
might bust a clot
87
identify neurogenic shock
hypotension in absence of increased HR
88
what happens in neuorgenic shock
SCI interrupts the SNS pathway and vasoDi below the level of injury
89
pulse pressure in neurogenci shock
narrow
90
how to decide to trat hypovolemic versus neurogenic shock
treat as if blood l oss is present
91
neurogenic shock versus spinal shock
```
NS = disruption of SNS
SS= injury to SC that leads to temperature loss of spinal cord fiunctiyon
```
92
cardiac tamponade
fluid in the pericardial sac taht prevents the heat from refilling during diastole/relaxation
93
fluid in the pericardial sac
cardiac tamponade
94
pathology of cardiac tamponade caused by trauma
blood leaks into the sac, the blood accumulates and occupies space and prevents the cells of the ventricles from expanding
1. lesss volume available b/c the ventircles can't contract fully
2. inadequate filling, decreased stretch of hte heart muscles, and results in diminished strengh o fht eheat contractions
95
4 problems of pneumothorax
- decreased tidal volumes w/each breath
- collapsed alveoli aren't available for oxgyen transfer to RBC
- pulmonary b. vessels are collapsed
- greater forc eof heart contracfti is requred to force blood to mvoe throught 6e pulmoanry vessls
96
shifts in tension pneumothorax
increased pressure oj the lungs, mediastinum is pushe daway fromt eh side of th injury when pression opposite lungs
97
why does shock occur in tension pneumothorax
obstruction b/c mediastium is pushed towards the opposite site. vena cava is kinked which impedes venous return to the heart so ssignificant decrease in prelead. leads to decreased CO and cardiogenic shock as well
98
overall assessment for presence of shock
evidence of hypoperfusion
99
assumption to make about shock s/p trauma
b/c hemorrhage is the most common cause of shock in all trauma, consider it hypovolemic shock untl ro
100
compare obstructive to hemorrhagic shock
cardiacl tamponade/t. pneumo/ = obstuctive
*distended neck veins
hypovolemic= flattened
101
neck veins & shock
obstructive/cardiac tamponade/t. pneumo = distended
| hypovelmic is flat
102
late sign of pneumothorax
tracheal deviation
103
intervention for tension pneumo
needle D
104
muffled heart sounds
cardiac tamponade
105
intervention when the body perceives high CO2
respiratory center of te brain is stimulated to increase RR/depth to blow off CO2
106
early warning sign of high retained CO2
high RR b/c respiratory center of the brain is trying to blow it off
107
pt who try to remove the oxygen mask
might be "air hungry". they feel the need for more ventilation and the mask creates a physiological feeling of ventilation restriction. taking as a clue that sthey are hypoxic
108
benefit of ETCO2
monitor perfusion changes
109
what does the loss of blood mean...
loss of blood means loss of RBC?Oxygen capacity.
| so may have nornal SpO2 btu RBC that remain are suflly saturated yet dkjjinished total oxygen bc diminsihed RBC
110
when in the TCCC algorithm do you check LOC
C and D
* b/c metnal status represents end organ peruion
* anxioious/confusion shoudl be assume dto be cerebral ischemia/anaerobic metabolism
111
what does cyanosis/mottled skin represent
unoxygenated hemoglobin and lack of adqute oxygen
112
3 causes of pale/mottled/cyanotic
peripheral vasoC
decreased RBC supply
interruption of blood supply
113
expected skin temperature in trauma
cool b/c blood is shunted away
"clammy skin"
clammy if hypovolemia
dry if low bp from SCI
114
causes of poor perfusion/delayed capillary refill
```
shock
arterial interruption from fracture
Vessel wound from trauma
atherosclerosis
hyptothermai
hypovolemia
```
115
assessed in "C"
```
hemorrhage
pulse
LOC
skin color
skin tenp
skin quality (warm v clammy)
cap refill
```
116
algorith in TCCC/C4
```
MARCH
*massive bleeding
airway
respirations
circulation
head/hypovolemia
```
117
steps in "M" of MARCH
massive bleeding
| pressure dressing, tourniquet, hemostatic dressing
118
steps in "R" of MARCH
penetrating chest wound, t. pneumo, sucking chest wound
119
steps in "C" of MARCH
IO/IV and give IVF
120
6 explainations of altered "D" in trauma
hypoxia, stroke, shock w/imapired cerebral persuion, TBI, intixocaiton, emtabolic preocesses
121
types of TBI
```
primary = direct trauma
secondary = caused by effects of hypoxia, hypoperfusion, edema, loss of enderyg produciton
```
122
adult urine output
0.5ml/kg/hr
123
pediatrics urine oputput
1ml/kg/hr
124
under 1yr urine oputut
2ml/kg/hjr
125
IO sites
humoral head, distal femur, tibia, sternum
126
IO sites for kids
anterior-medial proximal tibia joint, below tibial tuberosity
127
doing IO
drill at 90 degrees when entering the bone
remove trocar while hodign the needle. attack fluish. draw bakc to see if bone marrow.
5ml NS to check for infilatration
128
procedure to apply a hemostatic agent
direct pressure on wounds using a topical hemostatic dressing. minimi 3min
129
brain injuries as a cause of hypotension
brain injuries downt' cause hypotension until brain herniates...so brain injury plus low bp should wnot assume the heald injuury is the cause of hypoovelemic shock and you should search for other injuries
****EXCEPT: babies under 6 months b/c they can bleed into the head to produce hypovolemic shock b/c opens utures/that can spread apart and accommoodate large amounts of blood
130
4 Q's to ask when treating a pt in shock
1. what is the cause of the shock
2. what is the definitive cause fo rhtis shock?
3. where can the pt best receive definitive care
4. what interium steps can I do to support hte pt
131
field management of hemorrhage
```
hand direct pressure
compression dressing
wound packign
Tourniquet
elastic wrap
hemostatic agent
junctional tourniquet
```
132
why do we apply direct pressure over bleeding
b/c Bernoulli's principle
133
fluid leak =
transmural pressure x size of hole int eh vessel wall
134
transmural pressure
difference betwen the pressure inside and outside the vessel
135
difference between the pressure inside and outside the vessel
transmural pressure
136
intramural pressure
pressure exerted against the inside of hte b. vessel walls by intravasuclar fluid and BP
137
ability of the body to control a laceration bleed
- size of hte vessel
- pressure within theg vessel
- ability of hte vessel to go into spasm and decreased size of hte holdblood flow at site
138
remember if hemorrhage and giving IVF
might pop a clot.
*keep SBP 80-90 to perfuse until organs but not pop clots. use hypotensive resuscitaiton to nto excessive increase intraluminal pressure
139
field intervention for impaled objects
don't remove an impaled object in the field bn/c the object may damage a fessel further. it may also be providing lifesaving tamponade. removal may cause massiv ehemorrahge
-apply pressure over each side ofhte objet and not ob the object
140
hemorrhage intervention that take prescedence
applying direct pressure takes preescendencei over IVF?IV
141
how long can you use tourniquets in OR
up to 150min w/o muscle damageq
142
marking time on a tourniquet
TK #### (time in military)
143
tourniquests often used for IED
junctional
144
groin/axilla tourniquets
junctional
145
junctional tourniquets
for locations where extremities can't use regualr tourniquet
146
too deep/quick reapsiations
alkalosis
147
normal CO2
eucapnia
148
greatest concern of hypothermia in trauma
triad of dath
* imparied clotting, worsening coagulaopathy, hgigh K, vasoC
* cold temp can preserve tissue for a short time but the drop must be low and rapid for preservation
149
feet overhead
Trendelenberg
150
risk of trendelenberg
aspiration, high ICP in TBI, airway obstrufiont
151
HOB if TBI (isolated TBI w/o other injuries)
HOB 30 degrees to decrease ICP and impreove CPP
152
HOB if intubated
HOBV 30 to decrease aspiration and ventyilatyor=associated pneumoa
153
rate of fluid administration =
proportional to the radius raised to the 4th power and inverwely
*short thick is faster
154
IO device
EZ-IO NOT in sjternum
155
lyophilized plasma
human plasma that has been freeze dried. stable shelf life of 2 yrs
*doesn't need refrigeration, msut be reconstituted prior to use
156
electrolytes
substances that separate into charged ions when dissolved in solutions
157
crystalloid of choice for shock
LR bc/ composition is the most similair to the elcectrolyte composoition of blood
158
complication of high volumes of NS
high choloried
159
why isn't D5W used in shock IVF resuscitaiton
b/c not effective w/expansion
| *anything with glucose increases b. glucose which as a dieuretic effect
160
temperature of warmed IVF
102F/39C
161
effect 30-60 minutes after crystalloid is viven
30-60min after gfiving crystalllids, 1/4-1/3 of the volume remainsin cardiovascualr
*the rest shifts into intersitityial space and becomes edema in soft tissue and organs
