Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Critical Care 2 > PHTLS > Flashcards

PHTLS Flashcards

1
Q

EMT course

A

PHTLS = Prehospital Trauma Life SUpport

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

First Battle of Bull Run

A

1861

3K wounded in the field for 3 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

TCCC

A

tactical combat casulaty care

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

EMT

A

emergency medical technition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

national registry of EMTs

A

NREMT (national association of EMT)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

First Geneva COnvention

A

1864 INternational REd cross

*recognized hospital neutrality and safe ambulaton passage. equality of medical care regardless of side

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

DOD JTS

A

Dep of Defense JOint Trauam SYstem

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

collection of data/statistics on wounded military personnel and the care they receive

A

DOD Trauma Registry

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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* congress repealed the authoitty inb 1975 and states began to repeal toe mandatory helmets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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

differences between level I and II trauma

A

medical education
specialty services
reserach

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

DMRTI

A

Defense Medical Readiness Training INstbute

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

CME

A

continuing medical educaiotn

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Frank Starling Law

A

increased end diastolic ovlume increases stroke volume

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Fick Principle

A

CO & oxygen delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

TEMS

A

tactical emergency medical support

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

3 stages of TCCC

A

Care Under FIre
Tactical Field Care
Tactical Evauation Care

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

first do no harm

A

primum non nocere

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

designated to make medical decisions for you

A

surrogateq

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

distribution of medical resources ethically

A

justice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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..

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what drives the metabolic processes

A

fuel like oygen, glucose (complex carbs)

ATP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

stages in metabolic processes

A

glycolysis
KReb’s cycle
electron transport

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

height of a one story building

A

10ft

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

adult fall that is triaged straight to a trauma center

A

over 20ft

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

considered a major fall for adults

A

20ft

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

child fall that is triaged stright to a trauma center

A

10ft fall or 2-3x a kid’s height

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

considered a major fall for a child

A

10ft or 2-3x a kid’s height

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

car accident intrusion that is a direct transfer to a trauma center

A

vechcle intrusion over 12 inches on occupant side or 18 in on any side

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

criteria where the EMT will immediately take you to a trauma center

A 
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

too slow/fast RR

A

tachy ves bradypnea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

sometimes the only way to control bleeding from a freacture in the field

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

goal time on site if a critical injury

A

critical injury = EM doesn’t have blood to cary oxygne or plasma to control internal hemoorhage
*under 10min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

IVF given in emergencies

A

warm IVF givne to prevent hypothermia as part of the trauma triad

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

giving crystalloids in a trauma

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

quick assessmet

A

SAMPLE

s/s allergies medication past mecial hx last meal events piro

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

how do cells maintain their normal metabolic funciton

A

cells maintain their normal metabolic function by using energy in the form of ATP made via aerobic metabolism using oxygen and glucose as fuel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

anaerobic metabolism

A 
backup power 
uses stored fat as energy source
runs short time
byporoduct is lactic acid
might be enough to keep you until trauma intervaetnion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

ischemia time tolerated by heart/brain/lungs

A

4-6min w/o oxygen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

how long can the kidney tolerate ischemia

A

45-90min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

how long can the liver tolerate ischemia

A

45-90 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

how long can the GI system tolerate ischemia

A

45-90min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

how long can the muscles tolerate ischemia

A

4-6hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

how long can the bones tolerate ischemia

A

4-6hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

how long can the skin tolerate ischemia

A

4-6hr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

shock

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

main driver of metabolism

A

aerobic

backup is anaerobic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

ATP produced from glucose

A

every molecule of glucose leads to 38 ATP molecules

  • oxygen and glucose are metabolizes
  • byproducts are water and co2
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

ATP produced from aerobic versus anaerobic

A

36ATP
2ATP
anaerobic metabolism is a 19fold decreaes in energy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

problem if enough kidney cells die

A

if enough kidney cells die of hypoxia, kidney function decreases, inadequate buildup of toxic boyproducts taht aren’t eliminated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Fick Principles

A
  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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

prehospital treatment of shock

A

ensure critical components of ht FIck principle are maintained w/goal of preventing/reversing anaerobic metabolism they avoid at the cellular/organ/pt dealth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

actions to ensure Fick’s Principle

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

complication of MI

A

cardiogenic shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

complication of heart pump performance being impaired

A

cardiogenic shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

end organ perfusion pressure

A

MAP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

MAP of 120/80

A

93

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

normal CO

A

4-6L/nin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

aka afterload

A

systemic vascular resistance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

fluid between the cell membrane and capillary wall

A

interstitial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

interstitial fluid

A

between cell membrane and capillary wall

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

capillary thickness

A

capillarys can be as thin as 1 cell

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

3 fluid compamrtments

A

intravascular
interstitial
interacellular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

fluid inside vessels

A

intravascualr

66
Q

fluid inside cells

A

intercellualr

location of 45% of all body water

67
Q

fluid between cells and vessels

A

interstitital

68
Q

location of 45% of cell body water

A

intracellular (within cells)

69
Q

body’s reaction to low blood rpessure

A

ADH released from pituitary and aldosterone from adrenal

70
Q

shocks in trauma

A

Hyopovolemic
Distributive -vascualr spaces larger than nromal
cardiogenic-heart not pumping adequately

71
Q

easy explaination of neuorgenic shock

A

vascualr space is larger than normal

72
Q

blood volune in a 150lb person

A

5L

73
Q

how does the body react to blood loss

A

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
Q

blood loss in class 1 hemorrhage

A

750ml

15%

75
Q

vitals in class I hemorrhage

A

normal vital signs with slightly elevated HR.

anxiety

76
Q

blood loss in class II hemorrhage

A

1500ml

15-30%

77
Q

vitals in class II hemorrhage

A

pulse up
normal bp
decreased pulse rpessure
increased RR

78
Q

blood loss in class III hemorrhage

A

1500-2000

30-40%

79
Q

vitals in class III hemorrage

A

decresed ;BP, pulse pressurei, RR

confusion/andiety

80
Q

blood loss in class IV hemorerhage

A

over 2L

40%

81
Q

mentation in shock hemorrhage

A 
anxiety in class I-II
confusion/lethargic in III-IV
82
Q

goal in hemorrhage

A

stop source of the bleed

83
Q

pulse pressure in hemorrhage

A

narrowed in class II-IV

84
Q

how does TXA work

A

bindings to plasminogen and prevents it from becoming plasma. therebyt preventing breakdown of fibrin in a clot

85
Q

IVF crystalloid repolacement for each L of blood lost

A

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
Q

risk of flooding the body w/crystalloids post trauma

A

might bust a clot

87
Q

identify neurogenic shock

A

hypotension in absence of increased HR

88
Q

what happens in neuorgenic shock

A

SCI interrupts the SNS pathway and vasoDi below the level of injury

89
Q

pulse pressure in neurogenci shock

A

narrow

90
Q

how to decide to trat hypovolemic versus neurogenic shock

A

treat as if blood l oss is present

91
Q

neurogenic shock versus spinal shock

A 
NS = disruption of SNS 
SS= injury to SC that leads to temperature loss of spinal cord fiunctiyon
92
Q

cardiac tamponade

A

fluid in the pericardial sac taht prevents the heat from refilling during diastole/relaxation

93
Q

fluid in the pericardial sac

A

cardiac tamponade

94
Q

pathology of cardiac tamponade caused by trauma

A

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
Q

4 problems of pneumothorax

A
  • 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
Q

shifts in tension pneumothorax

A

increased pressure oj the lungs, mediastinum is pushe daway fromt eh side of th injury when pression opposite lungs

97
Q

why does shock occur in tension pneumothorax

A

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
Q

overall assessment for presence of shock

A

evidence of hypoperfusion

99
Q

assumption to make about shock s/p trauma

A

b/c hemorrhage is the most common cause of shock in all trauma, consider it hypovolemic shock untl ro

100
Q

compare obstructive to hemorrhagic shock

A

cardiacl tamponade/t. pneumo/ = obstuctive
*distended neck veins
hypovolemic= flattened

101
Q

neck veins & shock

A

obstructive/cardiac tamponade/t. pneumo = distended

hypovelmic is flat

102
Q

late sign of pneumothorax

A

tracheal deviation

103
Q

intervention for tension pneumo

A

needle D

104
Q

muffled heart sounds

A

cardiac tamponade

105
Q

intervention when the body perceives high CO2

A

respiratory center of te brain is stimulated to increase RR/depth to blow off CO2

106
Q

early warning sign of high retained CO2

A

high RR b/c respiratory center of the brain is trying to blow it off

107
Q

pt who try to remove the oxygen mask

A

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
Q

benefit of ETCO2

A

monitor perfusion changes

109
Q

what does the loss of blood mean…

A

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
Q

when in the TCCC algorithm do you check LOC

A

C and D

  • b/c metnal status represents end organ peruion
  • anxioious/confusion shoudl be assume dto be cerebral ischemia/anaerobic metabolism
111
Q

what does cyanosis/mottled skin represent

A

unoxygenated hemoglobin and lack of adqute oxygen

112
Q

3 causes of pale/mottled/cyanotic

A

peripheral vasoC
decreased RBC supply
interruption of blood supply

113
Q

expected skin temperature in trauma

A

cool b/c blood is shunted away
“clammy skin”
clammy if hypovolemia
dry if low bp from SCI

114
Q

causes of poor perfusion/delayed capillary refill

A 
shock
arterial interruption from fracture
Vessel wound from trauma
atherosclerosis
hyptothermai
hypovolemia
115
Q

assessed in “C”

A 
hemorrhage
pulse
LOC
skin color
skin tenp
skin quality (warm v clammy)
cap refill
116
Q

algorith in TCCC/C4

A 
MARCH
*massive bleeding
airway
respirations
circulation
head/hypovolemia
117
Q

steps in “M” of MARCH

A

massive bleeding

pressure dressing, tourniquet, hemostatic dressing

118
Q

steps in “R” of MARCH

A

penetrating chest wound, t. pneumo, sucking chest wound

119
Q

steps in “C” of MARCH

A

IO/IV and give IVF

120
Q

6 explainations of altered “D” in trauma

A

hypoxia, stroke, shock w/imapired cerebral persuion, TBI, intixocaiton, emtabolic preocesses

121
Q

types of TBI

A 
primary = direct trauma
secondary = caused by effects of hypoxia, hypoperfusion, edema, loss of enderyg produciton
122
Q

adult urine output

A

0.5ml/kg/hr

123
Q

pediatrics urine oputput

A

1ml/kg/hr

124
Q

under 1yr urine oputut

A

2ml/kg/hjr

125
Q

IO sites

A

humoral head, distal femur, tibia, sternum

126
Q

IO sites for kids

A

anterior-medial proximal tibia joint, below tibial tuberosity

127
Q

doing IO

A

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
Q

procedure to apply a hemostatic agent

A

direct pressure on wounds using a topical hemostatic dressing. minimi 3min

129
Q

brain injuries as a cause of hypotension

A

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
Q

4 Q’s to ask when treating a pt in shock

A
  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
Q

field management of hemorrhage

A 
hand direct pressure
compression dressing
wound packign
Tourniquet
elastic wrap
hemostatic agent
junctional tourniquet
132
Q

why do we apply direct pressure over bleeding

A

b/c Bernoulli’s principle

133
Q

fluid leak =

A

transmural pressure x size of hole int eh vessel wall

134
Q

transmural pressure

A

difference betwen the pressure inside and outside the vessel

135
Q

difference between the pressure inside and outside the vessel

A

transmural pressure

136
Q

intramural pressure

A

pressure exerted against the inside of hte b. vessel walls by intravasuclar fluid and BP

137
Q

ability of the body to control a laceration bleed

A
  • 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
Q

remember if hemorrhage and giving IVF

A

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
Q

field intervention for impaled objects

A

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
Q

hemorrhage intervention that take prescedence

A

applying direct pressure takes preescendencei over IVF?IV

141
Q

how long can you use tourniquets in OR

A

up to 150min w/o muscle damageq

142
Q

marking time on a tourniquet

A

TK #### (time in military)

143
Q

tourniquests often used for IED

A

junctional

144
Q

groin/axilla tourniquets

A

junctional

145
Q

junctional tourniquets

A

for locations where extremities can’t use regualr tourniquet

146
Q

too deep/quick reapsiations

A

alkalosis

147
Q

normal CO2

A

eucapnia

148
Q

greatest concern of hypothermia in trauma

A

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
Q

feet overhead

A

Trendelenberg

150
Q

risk of trendelenberg

A

aspiration, high ICP in TBI, airway obstrufiont

151
Q

HOB if TBI (isolated TBI w/o other injuries)

A

HOB 30 degrees to decrease ICP and impreove CPP

152
Q

HOB if intubated

A

HOBV 30 to decrease aspiration and ventyilatyor=associated pneumoa

153
Q

rate of fluid administration =

A

proportional to the radius raised to the 4th power and inverwely
*short thick is faster

154
Q

IO device

A

EZ-IO NOT in sjternum

155
Q

lyophilized plasma

A

human plasma that has been freeze dried. stable shelf life of 2 yrs
*doesn’t need refrigeration, msut be reconstituted prior to use

156
Q

electrolytes

A

substances that separate into charged ions when dissolved in solutions

157
Q

crystalloid of choice for shock

A

LR bc/ composition is the most similair to the elcectrolyte composoition of blood

158
Q

complication of high volumes of NS

A

high choloried

159
Q

why isn’t D5W used in shock IVF resuscitaiton

A

b/c not effective w/expansion

*anything with glucose increases b. glucose which as a dieuretic effect

160
Q

temperature of warmed IVF

A

102F/39C

161
Q

effect 30-60 minutes after crystalloid is viven

A

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

Critical Care 2 (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions