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PHTLS and Trauma Review > PHTLS and Trauma Review Flashcards > Flashcards

PHTLS and Trauma Review Flashcards

1
Q

How many people die from trauma annually?

A

Over 5 million

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2
Q

What is the leading cause of trauma deaths?

A

MVA

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3
Q

Where do over 90% of trauma deaths occur?

A

Low-middle income countries

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4
Q

What is the leading cause of death in people aged 1-44?

A

Trauma

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5
Q

What are the goals of PHTLS?

A

Reduce morbidity and mortality from trauma, and provide appropriate care to the patient in the field

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6
Q

What is the PHTLS philosophy?

A

Deliver the patient to the right facility, utilizing the right mode of transportation, in the right amount of time, as safely as possible

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7
Q

What are the components of scene assessment?

A

Safety, pre-arrival information, arrival on-scene, MOI, and patients

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8
Q

What is paramount for scene assessment?

A

Personal and Personnel safety

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9
Q

What is the global view?

A

What you get before you get out of your vehicle

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10
Q

What is the goal of the Primary Survey?

A

To immediately identify life threatening situations and manage them as they are identified

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11
Q

What are the components of the Primary Survey?

A

Airway, Breathing, Circulation, Disability, Exposure

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12
Q

When does assessment of the incident begin?

A

Before arriving at the patient’s side

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13
Q

The findings of the scene assessment and primary survey help to determine what?

A

If the patient is sick, not yet sick, or not sick

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14
Q

When should the secondary survey be completed?

A

Only if time and situation permit

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15
Q

What are the components of the secondary survey?

A

Vital signs, History, Physical Examination, Treatment, Level of Care, Transportation, and Communication

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16
Q

What are the components of a radio report?

A

Timely, Scene Description, Number of Patients, Current Patient Status, Treatment Provided, ETA

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17
Q

What is a tracheal consideration with pediatric patients in regards to ET intubation?

A

Potential for right main-stem intubation

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18
Q

What is the most common cause of airway obstruction in the trauma patient?

A

The tongue

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19
Q

When are basic maneuvers applied in regards to trauma airway management?

A

First

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20
Q

When are advanced airway maneuvers performed for trauma patients?

A

After basic, only if needed

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21
Q

What is the goal of managing a patient’s airway?

A

Maintain an open and patent airway that allows for adequate breathing, ventilation, and oxygenation

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22
Q

What does airway management entail?

A

Anticipating difficulties and planning for alternate methods of airway control

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23
Q

What is always the first airway maneuver for the trauma patient?

A

Trauma Jaw Thrust / Chin Lift

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24
Q

What should be considered second for maintaining a patent airway in a trauma patient?

A

OPA or NPA

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25
Q

What adjunct should be considered third for airway management in the trauma patient?

A

Supra-Glottic Airways

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26
Q

When should glottic airways be considered?

A

After jaw thrusts, OPA/NPA, and Supra-Glottic airways have failed

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27
Q

What are some assessment criteria for Endotracheal Intubation?

A

Decreased LOC (GCS<8), Inability to maintain patent airway, Upper airway burns, Signs of pending airway obstructions

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28
Q

Which type of airway management should be considered last?

A

Surgical

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29
Q

What types of methods should be used to verify tube placement?

A

One physiological and mechanical method

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30
Q

When the patient’s breathing draws your attention, you should:

A

Assume there is a problem until proven otherwise

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31
Q

What are some signs and symptoms you are looking for in a trauma patient’s breathing assessment?

A

Increased respiratory effort, visible trauma, paradoxical chest wall movement, sucking chest wound

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32
Q

What are some signs and symptoms you are feeling for in a trauma patient’s breathing assessment?

A

Boney crepitus, subcutaneous emphysema

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33
Q

What is the biggest difference between a simple and a tension pneumothorax?

A

A tension pneumothorax has a hemodynamic compromise

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34
Q

Which ribs are most at risk for rib fractures?

A

Ribs 4-8 laterally

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35
Q

What is the most common cause of hemothorax?

A

Fractures to ribs 4-8

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36
Q

What are common complaints of rib fractures?

A

Pain and Shortness of Breath

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37
Q

Under what circumstances should you withhold oxygen from a patient?

A

Never withhold oxygen from a patient in respiratory distress

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38
Q

When should you assist ventilations?

A

When the respiratory rate is above 28 or less than 10

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39
Q

What is the ventilatory rate for adults?

A

10-12 bpm for 500-800 cc

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40
Q

What is the ventilatory rate for children?

A

16-20 bpm for 100-500 cc or good chest rise

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41
Q

What is the ventilatory rate for infants?

A

25 bpm for 6-8 mL/kg

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42
Q

What end tidal CO2 reading should you maintain?

A

35-45 mm Hg

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43
Q

Where should a needed decompression be placed?

A

2nd intercostal space mid clavicular line, over the 3rd rib

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44
Q

What is shock?

A

A result of inadequate energy production to sustain life

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45
Q

What are the brain, heart and lungs tolerance to hypoxia?

A

4-6 minutes

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46
Q

What are the kidneys, liver and GI tracts tolerance to hypoxia?

A

45-90 minutes

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47
Q

What are the muscle, bone, and skin tolerance to hypoxia?

A

4-6 hours

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48
Q

What is the most common cause of shock in the trauma patient?

A

Hypovolemia due to hemorrhage until proven otherwise

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49
Q

What is the most common cause of neurogenic shock in the trauma patient?

A

Spinal Cord Injury

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50
Q

What does adequate perfusion of the body tissues require?

A

An effective pump, intact blood vessels, adequate blood volume, vascular resistance

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51
Q

What is cardiac output?

A

Stroke Volume x Heart Rate

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52
Q

What is blood pressure?

A

Cardiac Output x Systemic Vascular Resistance

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53
Q

Vasoconstriction leads to which phase of shock?

A

The ischemic phase

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54
Q

What causes an altered LOC in a shock patient?

A

Decreased cerebral perfusion

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55
Q

What may be the earliest sign of shock?

A

Increasing respiratory rate caused by hypoxia and acidosis stimulating the respiratory centers of the brain

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56
Q

How much blood loss is required before a drop in BP occurs?

A

30%

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57
Q

In shock without obvious cause what should you assume?

A

The patient is bleeding somewhere, internal hemorrhage, fracture

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58
Q

Where is a significant container of blood volumes lost to hemorrhage?

A

The abdomen

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59
Q

What is the mortality rate of aortic rupture in the prehospital setting?

A

80-85%

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60
Q

How much blood can each hemithorax hold?

A

3000-4000 mL of blood

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61
Q

How much blood loss can occur from a single rib fracture?

A

125 mL

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62
Q

How much blood loss can occur from a fractured radius or ulnar?

A

250-500 mL

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63
Q

How much blood loss can occur from a fractured humerus?

A

750 mL

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64
Q

How much blood loss can occur from a fractured tibia or fibula?

A

500-1000 mL

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65
Q

How much blood loss can occur from a fractured femur?

A

1000-2000 mL

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66
Q

How much blood loss can occur from a fractured pelvis?

A

Massive

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67
Q

What is the most common thoracic injury?

A

Rib fractures

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68
Q

What four questions guide management of shock?

A
  • What is the cause of the shock?
  • What is the care for this type of shock?
  • What can and should be done between now and the time the patient reached definitive care?
  • Where is the best place for the patient to get definitive care?
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69
Q

What does proper management of shock achieve?

A

Improves the oxygenation of RBCs and improves the delivery of RBCs to tissues

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70
Q

How should the shock patients be positioned?

A

Supine, as the trendelenburg position is no longer recommended

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71
Q

What temperature should the patient compartment be maintained at?

A

85F

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72
Q

What are the three responses to fluid therapy?

A

Rapid response, Transient Response, Minimal or No Response

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73
Q

What is the frontal lobe responsible for?

A

Foresight, personality and judgment

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74
Q

What is the parietal lobe responsible for?

A

Sensation from the body

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75
Q

What is the temporal lobe responsible for?

A

Hearing and Speech

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76
Q

What is the occipital lobe responsible for?

A

Vision

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77
Q

What is primary damage?

A

Damage that occurs at the moment of impact

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78
Q

What is secondary damage?

A

Damage that occurs subsequent to the initial impact

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79
Q

What are some systemic causes of secondary brain injury?

A

Hypoxia, CO2 abnormalities, Anemia, Hypotension, CBG abnormalities

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80
Q

What are some intrinsic causes of secondary brain injury?

A

Seizures, Edema, Hematomas, Increased ICP

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81
Q

What is typical ICP?

A

10-15 mm Hg

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82
Q

What does hypercarbia cause?

A

Cerebral vasodilation

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83
Q

Onto which brain structure does pressure produce vomiting?

A

The hypothalamus

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84
Q

What are the six components of a complete prehospital neurological exam?

A
  • Mental status
  • Cranial Nerves
  • Motor Responses
  • Sensory Response
  • Coordination, Reflexes
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85
Q

When do you score the GCS?

A

After the correctable causes a ALOC have been addressed

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86
Q

What is normal pupil size?

A

3-5 mm. Difference greater than 1 mm is abnormal

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87
Q

What does paralysis of lateral gaze indicate?

A

Possible rising ICP

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88
Q

What does paralysis of upward gaze indicate?

A

Possible fracture of orbital floor

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89
Q

Most of the severe TBI symptoms presents in which way?

A

Headache, Vomiting, Altered Mentation, Neurological Deficits

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90
Q

What is the earliest and best indicator of a patients ICP?

A

A change in LOC

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91
Q

What are the warning signs of possible increasing ICP and impending herniation?

A

GCS drop of 2 or more, development of sluggish or no reactive pupils, development of hemiplegia or hemiparesis, Cushing’s phenomenon

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92
Q

What is the ventilatory rate for adults with suspected intercranial herniation?

A

20 bpm

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93
Q

What is the ventilatory rate for children with suspected intercranial herniation?

A

25 bpm

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94
Q

What is the ventilatory rate for infants with suspected intercranial herniation?

A

30 bpm

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95
Q

How much blood must be lost before children show signs of hypotension?

A

30%

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96
Q

What is fourth degree burn?

A

A burn to the bone

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97
Q

What is special in the fluid therapy of a child in burn management?

A

They should receive 5% dextrose in LR solution

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98
Q

acceleration (a)

A

The rate of change in velocity; speeding up

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99
Q

angle of impact

A

The angle at which an object hits another; this characterizes the force vectors involved and has a bearing on patterns of energy dissipation

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100
Q

arterial air embolism

A

Air bubbles in the arterial blood vessels

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101
Q

avulsing

A

A tearing away or forcing separation

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102
Q

barometric energy

A

The energy that results from sudden changes in pressure as may occur in a diving accident or sudden decompression in an airplane

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103
Q

biomechanics

A

The study of the physiology and mechanics of a living organism using the tools of mechanical engineering

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104
Q

blast front

A

The leading edge of the shock wave

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105
Q

blunt trauma

A

An impact on the body by objects that cause injury without penetrating soft tissues or internal organs and cavities

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106
Q

brisance

A

The shattering effect of a shock wave and its ability to cause disruption of tissues and structures

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107
Q

cavitation

A

Cavity formation; shock waves that push tissues in front of and lateral to the projectile and may not necessarily increase the wound size or cause permanent injury but can result in cavitation

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108
Q

chemical energy

A

The energy released as a result of a chemical reaction

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109
Q

deceleration

A

A negative acceleration – that is, slowing down

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110
Q

electrical energy

A

The energy delivered in the form of high voltage

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111
Q

entry wound

A

The point at which a penetrating object enters the body

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112
Q

exit wound

A

The point at which a penetrating object leaves the body; which may or may not be in a straight line from the entry wound

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113
Q

gravity (g)

A

The acceleration of a body by the attraction of the earth’s gravitational force, normally 32.2 ft/sec2

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114
Q

implosion

A

A bursting inward

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115
Q

index of suspicion

A

Anticipating the possibility of specific types of injury

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116
Q

kinetic energy (KE)

A

The energy associated with bodies in motion, expressed mathematically as half the mass times the square of the velocity

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117
Q

kinetics

A

The study of the relationship among speed, mass, vector direction, and physical injury

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118
Q

law of conservation of energy

A

The principle that energy can be neither created nor destroyed; it can only change form

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119
Q

mechanical energy

A

The energy that results from motion (kinetic energy) or that is stored in an object (potential energy)

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120
Q

mechanism of injury (MOI)

A

The way in which traumatic injuries occur; the forces that act on the body to cause damage

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121
Q

missile fragmentation

A

A primary mechanism of tissue disruption from certain rifles in which pieces of the projectile break apart, allowing the pieces to create their own separate paths through tissues

122
Q

multisystem trauma

A

Trauma caused by generalized mechanisms which affect numerous body systems

123
Q

negative wave pulse

A

The phase of an explosion in which pressure from the blast is less than atmospheric pressure

124
Q

Newton’s first law of motion

A

The principle that a body at rest will remain at rest unless acted on by an outside force

125
Q

Newton’s second law of motion

A

The principle that the force that an object can exert is the product of its mass times its acceleration

Mass X Acceleration

126
Q

pathway expansion

A

The tissue displacement that occurs as a result of low-displacement shock waves that travel at the speed of sound in tissue

127
Q

penetrating trauma

A

Injury caused by objects that pierce the surface of the body; such as knives and bullets, damage internal tissues and organs

128
Q

permanent cavity

A

The path of crushing tissue produced by a missile traversing part of the body

129
Q

positive wave pulse

A

The phase of the explosion in which there is a pressure front with a pressure higher that atmospheric pressure

130
Q

potential energy

A

The amount of energy stored in an object, the product of mass, gravity, and height, that is converted into kinetic energy and results in injury, such as a fall

131
Q

pulmonary blast injuries

A

Pulmonary trauma resulting from short-range exposure to the detonation of high explosives

132
Q

Revised Trauma Score (RTS)

A

A scoring system used for patients with head trauma

133
Q

shearing

A

An applied force or pressure exerted against the surface and layers of the skin as tissues slide in opposite but parallel planes

134
Q

spalling

A

Delaminating or breaking off into chips and pieces

135
Q

trauma

A

Acute physiologic and structural change that occurs in a victim as a result of the rapid dissipation of energy delivered by an external force

136
Q

trauma score

A

A score that relates to the likelihood of patient survival with the exception of a severe head injury. It is calculated on a scale from 1 to 16, with 16 being the best possible score. It takes into account the Glascow Coma Scale score, respiratory rate, respiratory expansion, systolic blood pressure, and capillary refill

137
Q

tympanic membrane

A

The eardrum; a thin, semitransparent membrane in the middle ear that transmits sound vibrations to the internal ear by means of the auditory ossicles

138
Q

velocity (v)

A

The distance an object travels per unit time

139
Q

Waddell triad

A

A pattern of automobile-pedestrian injuries in children and people short stature in which (1) the bumper hits pelvis and femur, (2) the chest and abdomen hit the grille or low hood, and (3) the head strikes the ground

140
Q

whiplash

A

An injury to the cervical vertebrae or their supporting ligaments and muscles, usually resulting from sudden acceleration or deceleration

141
Q

Seat belts (lap and diagonal) and supplemental restraint systems (air bags) have clearly demonstrated that they reduce serious injury and death in automobile collisions. Tests have shown, however, that the use of one of these devices by itself can result in serious injury or even death. This single restraint device is the:
a. diagonal belt
b. lap belt
c. supplemental restraint system
d. lap belt without a diagonal belt

A

diagonal belt

142
Q

The mechanics of energy exchange between two objects is relatively simple. When one object strikes another, energy is transferred. In evaluating energy exchange in a patient, the EMT must remember the concept of cavitation. When an object strikes the patient, it displaces particles (tissue). If this displacement of tissue is more forceful than the elasticity of the tissue __________ will result. a. a transdermal cavity b. deformation of the object c. a temporary cavity d. a permanent cavity

A

a permanent cavity

143
Q

Lateral or side impact type collisions can often produce more severe energy transfer patterns to an occupant of the vehicle. This is due in large part to the fact that the head is supported in an off-center position by the spine. This off-center positioning places the center of gravity forward and superior to the point of support. This places the neck at the greatest risk from injuries from: a. lateral flexion and rotation b. lateral extension and rotation c. hyperextension and rotation d. hyperflexion and rotation

A

lateral flexion and rotation

144
Q

One of the first concepts of energy and trauma injuries that an EMT must understand comes for Newton’s first law of motion. This law states: a. For every force of acceleration a patient experiences, they will experience an equal and opposite deceleration force. b. A body in motion will become a body at rest without any influence of outside forces. c. Energy can be created as easily as it can be destroyed. d. A body in motion or at rest will remain that way until acted upon by some outside force.

A

A body in motion or at rest will remain that way until acted upon by some outside force.

145
Q

Injuries to patients from energy transfer can occur in many different ways. One of these is a fall. The EMT would consider as potentially serious to the patient any fall from a height that is at least _______ the height of the patient. a. three times b. four times c. five times d. twice

A

three times

146
Q

Motor vehicle collisions take on five (5) different impact types. The type known as “head-on” or “frontal impact” can result in two possible paths for the occupants of the vehicle. The down-and-under path will generally result in the unrestrained driver or occupants of the front seat experiencing the first impact with the vehicle on which part of the body? a. abdomen b. knees c. chest d. head

A

knees

147
Q

Blast injuries (explosions) have three phases associated with them. In general, any one of these phases can produce serious or even fatal injuries to victims. The EMT who is knowledgeable in kinematics would be most concerned with injuries occurring in which of the phases? a. the first and second phase b. the first and thrid phase c. the second and third phase d. the first phase only

A

the second and third phase

148
Q

Kinetic energy is defined as being a function of an object’s weight and speed. The kinetic energy production rate is influenced to a greater degree by which factor? a. The stopping distance after impact. b. The speed at the time of the collision. c. The angle at which the impact occurs and energy is transferred. d. The patient’s body weight.

A

The speed at the time of the collision

149
Q

The most common cause of airway obstruction in unconscious patients is: A. Flaccid tongue blocking the hypopharynx B. Crush injury to the trachea C. Foreign body obstruction D. Edema of the vocal cords

A

Flaccid tongue blocking the hypopharynx

150
Q

Which of the following manual airway maneuvers is NOT recommended for use on trauma patients? A. Trauma mandible lift B. Trauma jaw thrust C. Head tilt, chin lift D. Trauma chin lift

A

Head tilt, chin lift

151
Q

The first priority of trauma management and resuscitation is: A. Assuring scene safety B. Rapid completion of primary patient survey C. Ensuring a patent airway D. Control of external hemmorrhage

A

Ensuring a patent airway

152
Q

_______________ is the most desirable method of achieving maximum control of the airway for trauma patients who are apneic or require assisted ventilation. A. The pharyngeal lumen (PTL) airway B. Endotracheal intubation C. An oral airway D. Percutaneous transtracheal catheter ventilation (PTLV)

A

Endotracheal intubation

153
Q

Potential complications of endotracheal intubation include: A. Esophageal intubation B. Hypoxemia from prolonged intubation attempts C. Conversion of cervical injury without neurological deficit to a cervical spine injury with neurologic deficits D. All of the above

A

All of the above

154
Q

In a normal adult, the control of respiration by chemoreceptors in the brain is determined by sensing which of the following chemicals? A. Carbon monoxide (CO) B. Carbon dioxide (CO2) C. Oxygen (O2) D. Nitrogen (N)

A

Carbon dioxide (CO2)

155
Q

The most important early observation that reveals developing respiratory compromise after trauma is: A. Intercostal nerve decreased blood pressure B. Increased pulse rate C. Increased respiratory rate D. Decreased respiratory rate

A

Increased respiratory rate

156
Q

The most important concern about a rib fracture is: A. Intercostal nerve or vessel injury B. Pain with inspiration C. Underlying organ injury D. Associated thoracic spine injury

A

Underlying organ injury

157
Q

A patient with a suspected flail chest develops increasing respirations and difficulty breathing. Which of the following interventions would be most likely to help the patient? A. Needle decompression B. Pericardiocentesis C. Administration of an analgesic D. Endotracheal intubation

A

Endotracheal intubation

158
Q

Patients with pulmonary contusion should not be given too much intravenous fluid because fluid will: A. Increase blood pressure and intra-abdominal bleeding B. Increase intracerebral edema C. Increase interstitial and intra-alveolar fluid and bleeding D. Cause thoracic compartment syndrome

A

Increase interstitial and intra-alveolar fluid and bleeding

159
Q

A patient with a suspected simple pneumothorax will benefit from which of the following interventions? A. Rapid transport B. Needle decompression C. Administration of an analgesic D. Positive pressure ventilation

A

Rapid transport

160
Q

Which of the following is a sign and symptom of shock? A. Warm, dry skin temperature in spinal shock B. Falling blood pressure during compensated shock C. Normal pulse during septic shock D. Pink skin color in hypovolemic shock

A

Warm, dry skin temperature in spinal shock

161
Q

The organs most commonly injured in the abdomen by blunt trauma are the: A. Stomach and duodenum B. Small intestines and kidneys C. Colon and pancreas D. Liver and spleen

A

Liver and spleen

162
Q

Injuries to hollow organs in the abdomen cause peritonitis secondary to hemorrhage into the peritoneal cavity. True False

A

FALSE

163
Q

A 35 year old man falls off a 10-foot ladder. Based on this information, which injuries would you attend to first? A. Fractured femur B. Angulated wrist C. C-spine precautions D. Hip fracture

A

C-spine precautions

164
Q

What condition would you assess for when dealing with a crushing injury? A. Infection B. Degloving C. Compartment syndrome D. Absence of mobility

A

Compartment syndrome

165
Q

The proper way to dress most burn injuries in the pre-hospital setting is to use: A. Moist dressings B. Dry sterile dressings C. Water soluble gels D. Silvadene

A

Dry sterile dressings

166
Q

The biggest concern with electrical burns is: A. The wick effect B. Tissue loss C. Entry and exit wounds D. Cardiac arrest

A

Cardiac arrest

167
Q

Level 1 Trauma Center

A

Regional Trauma Center, All types of specialty surgical care 24/7, (Surgical suites, Surgeons, Blood, CT, X-Ray … all in house), Tertiary - all levels of care

168
Q

Level 2 Trauma Center

A

Area Trauma Center, Most common trauma emergencies with surgical capabilities 24/7, (can handle most common types of trauma)

169
Q

Level 3 Trauma Center

A

Community Trauma Center, Specialized ED and some surgical capability (the speciality staff is on call and has 30 mins to get to hospital)

170
Q

Level 4 Trauma Center

A

small community hospitals, (they have to stabilize and transfer) Have ER DR but no surgeon

171
Q

What are run sheets used for?

A

QI, Research, Trauma Registry,

172
Q

What are the 4 E’s?

A

Engineering -(roads, airbags, pool alarms) Enforcement -(laws) Education -(safety classes) Economics -(government grants)

173
Q

What is an injury?

A

being hurt or killed

174
Q

What is trauma?

A

inflicted wounds or injury

175
Q

What is an accident?

A

an event that is unforeseen or without apparent cause

176
Q

What is a disease?

A

an unhealthy condition, illness, or disorder

177
Q

Why is the Highway Safety Act of 1966 important?

A

lead to development of EMS “White Paper” - Accidental Death & Disability, The Neglected Disease of a Modern Society

178
Q

Why is the American College of Surgeons important?

A

1990: trauma care systems planning and development act (established guidelines, funding and state-level leadership for the development of trauma systems)

179
Q

What are the leading causes of death in adults & children?

A

Adults - MVC Children - Falls

180
Q

In trauma how many die in 1st hr?

A

50% Fix = Injury Prevention

181
Q

In trauma how many die days or weeks later?

A

20% (due to hypoxia, hypotension, end organ failure) Fix = aggressive shock management

182
Q

What is Precrash?

A

Age, medical hx, drugs, alcohol

183
Q

What are the 3 phases of a Crash?

A
  1. car into tree 2. person into steering wheel 3. organs into body
184
Q

What is the main purpose of car restraints?

A

to slow the occupant down with the vehicle

185
Q

Platinum 10 mins are used for what?

A
  1. identify life-threats 2. perform key interventions 3. rapid extrication were indicated 4. timely transport to an appropriate facility 5. early notification to the receiving facility
186
Q

Trauma is the leading cause of death in what age group?

A

1 - 44

187
Q

What is anatomical trauma criteria?

A

Specific injuries (bi-lat femur fx)

188
Q

What is mechanical trauma criteria?

A

Type of incident / MOI (blunt head, penetrating trauma, PSI)

189
Q

What is physiological trauma criteria?

A

vitals signs (ALOC, hypotension GCS < 15)

190
Q

What is the formula for kinetic energy?

A

1/2 of mass x velocity(squared)

191
Q

What is more important velocity of mass?

A

velocity

192
Q

If you increase the stopping distance what happens to the potential for injury?

A

potential for injury is decreased

193
Q

What is important info in regards to GSWs?

Hand guns/rifles vs shotguns

A
  • hand guns & rifles: velocity
  • shotguns: what was the distance
194
Q

What is permanent cavitation?

A

tissue that is destroyed and not coming back

195
Q

What is temporary cavitation?

A

tissue that falls back into place 6x the diameter of permanent cavitation

196
Q

Concerns with up & over injuries?

A

Laryngeal fx (may hear stridor) Sub-Q Emphysema Diaphragmatic tear

197
Q

Concerns with down & under injuries?

A

Pelvic fx Femur fx Patellar fx

198
Q

Concerns with lateral impacts?

A

Less metal to protect people in car Look for injuries to that same side of body

199
Q

Concerns with rotational forces?

A

shearing forces to heart, liver, kidneys

200
Q

What % of ejection victims die?

A

75%

201
Q

How much more likely are you to die if you are involved in a rollover?

A

6x

202
Q

Concern with rear impacts?

A

whiplash injuries

203
Q

Good thing about wearing helmets?

A

they save lives & decrease injuries

204
Q

Auto vs. Ped facts?

A

Child - Freeze “deer in headlights”, get drug under car,multi-system trauma
Adult - turn & run, extremity trauma

205
Q

Important aspects of falls?

A

15 feet or 3x their height & the surface they land on = (severity of fall) Body part they land on = (type of injury)

206
Q

what are the 5 phases of blast injuries?

A
  1. Primary - pressure wave, effects hollow organs 2. Secondary - Bomb fragments 3. Tertiary - person in thrown, or falling debris 4. Quaternary - heat/thermal burns 5. Quinary - bio/chemical/implanted objects sprayed from the object
207
Q

What is an intimate injury?

A

Stabbing. Close proximity. Look for more than one wound, be cautious of “cone of injury, any direction”, length of knife?

208
Q

In regards to violence what should you do?

A
  1. DONT BE THERE!!!! 2. Retreat 3. Defuse the situation (word ninja) 4. Defend yourself
209
Q

30 - 2, Can Do = what color?

A

Green

210
Q

30 - 2, Cant Do = what color?

A

Yellow

211
Q

Deficit to 30 - 2, Can Do (ALOC, Respirations, Circulation) = what color?

A

Red

212
Q

What is the goal of the primary assessment?

A

to find & correct life threats

213
Q

What is the most common threat to life?

A

inadequate tissue perfusion/shock (a early sign is ALOC)

214
Q

If you dont know ______ then your already behind the 8 ball?!

A

the MOI

215
Q

Injury to solid organs = ?

A

hemmorage

216
Q

Injury to hollow organs = ?

A

Spill which leads to infection/peritonitis)

217
Q

What is Grey Turners sign?

A

ecchymosis at the flank due to retroperitoneal bleed

218
Q

What is Cullens Sign?

A

ecchymosis at the umbilicus due to retroperitoneal bleed

219
Q

Mass pants can be used for what?

A
  1. belly, retroperitoneal, pelvis bleed w/ BP less than 90 & pelvis fx stabilization 2. wide spread hemorrhage with BP less than 60 (NOT FOR USE ON PENETRATING TRAUMA)
220
Q

What is the % for Fi02?

A

at least 85%

221
Q

What is the % for SP02?

A

95%

222
Q

Can you typically remove impaled objects?

A

Only if it is occluding the airway otherwise No, it maybe stopping the bleeding!!

223
Q

Abdominal evisceration key points are what?

A
  1. moist sterile dressing 2. occlusive dressing 3. keep PT warm 4. keep PT still
224
Q

What is more important minute volume or tidal volume?

A

Minute volume

225
Q

What is the most important mechanism for ventilation?

A

the plural linings staying intact

226
Q

In the PHTLS world what are the essential airway skills?

A

bls skills

227
Q

What is the PHTLS airway key factor?

A

Dont do the same thing over & over, try something different

228
Q

In PHTLS what is the best ET-Tube confirmation in a PT with a pulse?

A

capnography

229
Q

What is the best ET-Tube confirmation in a PT without a pulse?

A

lung sounds

230
Q

If you cant intubate or ventilate then what?

A

needle / surgical cric

231
Q

Normal capography value?

A

35-45

232
Q

Closed head injury capography range is what?

A

35 or less

233
Q

What is the most common type of shock?

A

hypovolemic / hemorrhagic

234
Q

What is most sensitive to ischemia?

A

The brain, heart and lungs (can last about 4-6 mins w/o 02)

235
Q

What the 2nd most sensitive to ischemia?

A

The kidneys, liver & GI tract (can last 45-90 mins w/o 02)

236
Q

What is the least sensitive to ischemia?

A

Skin and bones (can last 4-6 hrs w/o 02)

237
Q

What is cell & organ death?

A
  1. it starts with aerobic to anaerobic metabolism 2. Na and H20 go into the cell (edema) 3. Potassium and lactic acid leak out of cell and enter blood stream (makes body acidic & hyperkalemic)
238
Q

What happens during the ischemic phase?

A

vascular sphincters shut closed

239
Q

What happens during the stagnant phase?

A

Sphincters relax and blood pools in the extremities

240
Q

What happens during the wash out phase?

A

systemic acidosis

241
Q

What is Shock Class 1?

A

1-15% 750 ml compensated> HR normal

242
Q

What is Shock Class 2?

A

15-30% 750-1500 ml> HR greater 100

243
Q

What is Shock Class 3?

A

30-40% 1500-2000ml (BP goes down here)> HR greater 120

244
Q

What is Shock Class 4?

A

greater than 40% 2L or more> HR greater 140

245
Q

What systolic BP number do you want to see in a trauma and/or traumatic brain injury patient?

A

Trauma 80-90 TBI 90-100 (just shoot for BP or 90 systolic, & titrate your fluid bolus to meet these values)

246
Q

How warm should you warm your fluids to if possible?

A

102 degrees

247
Q

What is the ratio of fluids given to blood lost during trauma?

A

3:1 (3 liters of fluid per 1 liter of blood)

248
Q

Distributive Shock key factors are what?

A
  1. vasodilation below the injury site 2. warm skin below the injury site 3. Bradycardia & Hypotension 4. Priapism (Difference between this and hemorrhagic shock is the bradycardia due to parasympathetic system)
249
Q

What is the TX for rib fx?

A
  1. pain management 2. positive pressure ventilation
250
Q

How do you treat a sucking/open chest wound?

A

First action is to cover it Make occlusive dressing Diameter of sucking chest wound is about 2/3 size trachea

251
Q

Signs of hemothorax are?

A
  1. Diminished or absent lung sounds 2. Hemodynamic compromise 3. Flat neck veins 4. Dull to chest percussion (3L of blood in each plural cavity, JVD is not a reliable source)
252
Q

What are signs of Beacks Triad?

A

(penetrating trauma causes cardiac tamponade) 1. Muffled heart tone 2. JVD 3. Hypotension 4. 50cc of fluid can cause of dysrhythmias 5. 300cc or fluid can causes PEA

253
Q

What is a pulmonary contusion?

A

blood filled alveoli, causes a decrease in 02 & C02 exchange

254
Q

What is traumatic asphyxia?

A

related to crush injury, blood is unable to drain from head and top half of body

255
Q

What is an aortic rupture?

A

a tear in the aorta, bleed out fast

256
Q

What happens in Tracheobronchial Detachment?

A
  1. Detachment usually occurs at the carina 2. Air leaks into the chest cavity 3. pneumothorax / tension
257
Q

What happens in Commotio Cordis?

A
  1. impact to chest 2. heart goes into v-fib 3. is survivable of recognized early, need to do CPR and defibrillate ASAP
258
Q

If patient is shocky and you suspect a bleed but cant find it, where should you assume it is?

A

abdominal until proven other wise!! 1. abdominal pain and tenderness are an early sign 2. abdominal distension are late signs

259
Q

What are the important time frames of protection during pregnancy?

A
  1. up to 12 weeks fetus is protected by the pelvis 2. up to 20th week fetus is at the umbilicus 3. up to the xiphoid process by week 38
260
Q

What are signs of Cushings Tirad?

A
  1. hypertension 2. bradycardia 3. Ab. Normal Respirations 4. +1 (ALOC, Blown Pupils ect.) = brain steam herniation
261
Q

What is autoregulation?

A

CPP increases due to ICP increase

262
Q

What is a potent vasodilator?

A

C02

263
Q

What is broken in a basilar skull fx?

A

Cribriform plate (look for blood/fluid from nose and/or ears w/o direct injury to nose or ears)

264
Q

Important facts of an epidural bleed are what?

A
  1. Fast bleeds arterial (medial meningeal artery) 2. Usually die in about 1 hr 3. Lucid intervals (knockd out, wake up & act normal, knock back out)
265
Q

What are important facts about subdural bleeds?

A
  1. slower bleeds- veins (bridging veins) 2. doesnt usually experience lucid intervals
266
Q

What is a primary brain injury?

A

the insult to the brain itself (ex. gsw to head)

267
Q

What is the secondary brain injury?

A

something we can prevent (ex. hypoxia post primary injury)

268
Q

What is retrograde amnesia?

A

forgetting what happened before the accident happened (retro=past)

269
Q

What is anterograde amnesia?

A

cant remember the accident or post accident

270
Q

Where is the atlas?

A

C1

271
Q

Where is the axis?

A

C2

272
Q

Where is the odontoid process?

A

is off the axis C2, allows head rotation 180 degrees

273
Q

What are the biggest vertebra?

A

Lumbar, they carry the most weight

274
Q

How many pairs of spinal nerves do we have?

A

31 pairs

275
Q

Where do the motor nerves travel?

A

the ventral root, down the front of the body (efferent)

276
Q

Where do the sensory nerves travel?

A

the dorsal root, up the back of the body (afferent)

277
Q

What are dermatomes?

A

the bodies sensory boarders T4 - nipple line down T10 - umbilicus down

278
Q

C 3-5 are what nerves?

A

the phrenic nerve, control the diaphragm. If severed no intercostal or diaphragmatic movement

279
Q

What is axial loading?

A

spinal cord compression (ex. shallow water diving accident, leading on head & pressing down)

280
Q

What is a distracting injury?

A

the spinal cord in stretched or disconnected (ex. hanging accident)

281
Q

Do you need to C-Spine a penetrating injury?

A

No, unless there is a neuro deficit

282
Q

What happens during an anterior cord injury?

A

Loss of motor, pain, and temp. (involves injury to spinal arteries)

283
Q

What happens during central cord injury?

A
  1. hyperextension of spinal cord 2. weakness in the upper extremities, but good lower extremity function 3. loss of bladder control
284
Q

What happens during Brown Sequard injury?

A
  1. loss of function on one side of the body (typically from penetrating injury)
285
Q

On a stable patient what do you do before moving the patient?

A

splint fxs and pain meds

286
Q

Ligaments connect what?

A

bone to bone

287
Q

Tendons connect what?

A

muscle to bone

288
Q

What is a subluxation injury?

A

dislocation partially out of the socket

289
Q

What is compartment syndrome?

A

The tissues is tight (ex. circumferential burns) 1. after 6 hrs there is lots of damage to tissue 2. Check color of urine

290
Q

What is crush syndrome?

A
  1. release of pressure from compartment syndrome 2. lactic acid rushes into the body
291
Q

Second degree burns?

A
  1. affect the epidermis 2. blisters
292
Q

Third degree burns?

A
  1. affect down to the dermis 2. waxy and leathery looking
293
Q

Fourth degree burns?

A
  1. affect down to the bone and muscle
294
Q

Nerves are a good conductor for what type of burns?

A

electrical burns

295
Q

The hands, feet, face, and genitilia are what kind of burns?

A

specialty type of burns

296
Q

What is the fluid formula for fluids in the burn patient?

A

4cc/kg/BSA = 50% in 1st 24 hr period (divide # by 2 = amount in first 8 hrs) (divide # by 8 = amount in 1st hr)

297
Q

What 3 things affect the severity of radiation?

A
  1. distance 2. shielding 3. time
298
Q

What is toxic inhalation?

A

death by delayed respiratory compromise post fire exposure

299
Q

What is important about acid burns?

A

coagulate necrosis

300
Q

What is important about alkaline burns?

A

liquifaction necrosis

PHTLS and Trauma Review (1 decks)

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