Quiz 3: Head traumas, drowning, FBAO, and OD Flashcards
Which of the following are signs and symptoms of FBA?
- Acute onset
- Cough
- Dyspnea
- Bradycardia
- Unilateral wheezing/stridor
1, 2, 3, and 5
Bradycardia is not a sign of FBA. Tachypnea and tachycardia are some S/S associated with FBA.
T/F: Cyanosis and retractions are a possible sign of FBAO.
True. Cyanosis and retractions are signs depending on the degree of obstruction. Worse retractions = worse obstruction.
If object went below the ____, it is considered aspiration.
Cords
T/F: Crackles or wheezing can be a sign of FBAO.
True
What percent of FBAs go to right main stem bronchus in adults?
a. 30%
b. 50%
c. 70%
d. 90%
c. 70%
What are some classic signs of FBAO on a CXR?
- Air-trapping on expiration
- Atelectasis
- Pneumothorax
1 and 2
What is the treatment for FBAO?
Rigid bronchoscopy. Or ACT if necessary.
When are tracheotomies performed for patients with FBAO?
When large foreign body is subglottic or in proximal trachea and -
unable to removed,
too big or sharp to pass back through glottic opening,
or significant laryngeal edema.
Drowning causes ____ leading to cardiac arrest.
Asphyxia
What is cold shock cardiac reflexes?
Sudden immersion in <25 degrees C water. Breathing becomes shallow, vasoconstriction and increase SVR can lead to cardiac collapse.
T/F: Wet drowning is when laryngospasm with glottic closure prevents aspiration of large amounts of liquid, and dry drowning is when the liquid is completely aspirated.
False. Other way around. Wet drowning is when liquid is completely aspirated.
Why is the type of water aspirated important to know?
Different types of aspiration cause disruptions in respiratory function and blood chemistry.
Aspiration of large volumes of water regardless of type almost always leads to:
a. ARDS
b. bronchospasm
c. pneumonia
d. bronchiectasis
a. ARDS
Which type of water can introduce pathogens, therefore infections?
a. freshwater
b. salt water
c. fluvial/brackish
d. stagnant
c and d
Both fluvial/brackish and stagnant/contaminated can introduce pathogens and lead to secondary complications/infections. Pneumonitis and ARDS.
Which of the following are treatments for drowning?
- Vital signs
- O2
- Bronchodilators
- Bronchoscopy
- Proning techniques
- Apnea testing
All except apnea testing.
How is decompression sickness (bends) caused?
Ascending too quickly from depth.
T/F: Decompression sickness applies to both scuba and free diving.
False. Only applies to scuba diving. Free divers must worry about ascent hypoxia.
“As a diver goes deeper in the water, the pressure around them increases which left unchecked would decrease the volume in the lungs to the point of collapse” is describing which law?
Boyle’s Law
“The result is gas being inhaled at above-atmospheric pressure. This means the partial pressure of the gases in the breathing mix have gone up and are more soluble in the divers’ blood” describes which law?
Henry’s Law
Why does ascent time matter?
Because it is very easy to dissolve gas in blood at a high pressure. Gas bobbles can form in the tissues, joints, and blood stream and eventually lead to an air embolism.
How is decompression sickness prevented?
By using proper ascent time and hold times when diving.
What is the common therapy for decompression sickness?
Hyperbaric chamber
How does a hyperbaric chamber work?
Physician prescribes pressure (atm) and duration of tx to replicate or exceed divers depth. Increased pressure forces gas bubbles back into solution, then hyperbaric chamber is slowly decompressed.
What are some other uses of the hyperbaric chamber?
CO poisoning, wound healing, crush injuries, and acute peripheral ischemia.
CO has 200x the affinity for Hbg than O2.
Ex: FiO2 1.0 at 3 ATA is 23 minute half life
What are toxidromes?
A group of S/S used as a basis for diagnosis of poisoning.
Which of the following are opiods?
- Alprazolam
- Meperidine
- Codeine
- Hydrocodone
- Fentanyl
All except 1, Alprazolam (xanax). Xanax is a benzo.
What poisoning is associated with methemoglobinemia?
Nitrate poisoning
T/F: Albuterol is an alternative treatment for hyperkalemia.
True
What kind of breathing is a sign of DKA?
Kussmaul’s breathing
T/F: Men have a higher chance of TBI than women.
True
What are the “lines” between the skull bones called?
Sutures
What 3 layers make the protective layer of meninges?
Dura
Arachnoid
Pia Matter
Which cranial nerve is in charge of pupil activity?
3rd cranial nerve
The 3rd cranial nerve is what kind of nerve?
a. sympathetic
b. muscarinic
c. parasympathetic
d. anticholinergic
c. parasympathetic
What does the acronym PERRLA stand for?
Pupils should be Equal, Round, Reactive to Light and Accommodation.
T/F: Skull fractures are when only certain bones of the skull are broken.
False. Break in continuity of any bones of the skull. Diagnose with xrays/CT scan.
T/F: Primary head injuries is immediate trauma damage, while secondary injury is anoxia because of the time without effective O2 delivery.
True
T/F: Linear skull fractures are the most common and usually require no intervention.
True
T/F: Diastatic fractures are most common in young children.
True
T/F: Brain injuries can only occur with open head injuries.
False. Can occur in both closed and open head injuries.
T/F: A cerebral contusion is another way of saying concussion.
False. A cerebral contusion is a bruised brain (critical) while a concussion is temporary alteration in LOC.
Which of the following intracranial hemorrhages are bleeding within the SKULL?
- Intracerebral hemorrhage
- Epidural hemorrhage
- Subdural hemorrhage
- Subarachnoid hemorrhage
2, 3, and 4.
Intracerebral hemorrhage is bleeding within the brain parenchyma. “Intracerebral” is a big giveaway!
Same goes for intraventricular hemorrhage.
T/F: Both bleeding within the skull and brain parenchyma can increase ICP.
True
T/F: Epidural hematomas are venous bleeding while Subdural hematomas are arterial bleeding.
False. Subdural is venous, epidural is arterial.
Just think “E with A” (both vowels) and S with V (not vowels).
If a patient is unconcious for more than __ minutes, you should suspect more serious injury.
a. 3
b. 5
c. 10
d. 15
b. 5 minutes
What is the most important assessment for head injuries?
Altered level of consciousness
T/F: Raccoon eyes (Periorbital Ecchymosis) and Battle’s sign (mastoid ecchymosis) are late signs of brain injury.
True
T/F: Nasal airways are the preferred artificial airways.
False
Oral or tracheal airways are preferred, while nasal airways are contraindicated.
Intubation is indicated at what GCS score?
<8
Are higher or lower scores better for GCS?
Higher
When monitoring ICP, you should always keep pressure at what level?
<15 mmHg
T/F: GCS is not useful after patient is sedated. It must only be done during early interactions with the patient.
True
Which of the following factors are relevent in evaluating and describing LOC with GCS?
- eye opening
- verbal response
- motor response
- all of the above
- all of the above
Babinski/plantar reflex is normal in older children and adults.
False. It is abnormal and indicates damage to corticospinal tract or upper motor neurons.
What is normal ICP pressure in adults?
a. 10 mmHg
b. 15 mmHg
c. 20 mmHg
d. 5 mmHg
a. 10 mmHg
An ICP cannot surpass ___ mmHg without causing harm.
40 mmHg
What is the formula for Cerebral Perfusion Pressure (CPP)?
CPP = MAP - ICP
ICP at ___ mmHg is usually treated. We try to keep closed head injuries at this level.
20 mmHg
What type of respirations are an early sign of increased ICP?
Cheyne-Stokes respirations
What respirations are a late sign of increased ICP?
Biot’s respirations
Cushing reflex/triad is also a late sign, aka cns ischemic response. Last ditch effort to keep brain perfused.
T/F: You can use hypertonic saline to reduce ICP.
True. Along with Mannitol infusions.
A vegetative state is called “persistent” if it lasts longer than:
a. 1 week
b. 72 hours
c. 2 months
d. 4 weeks
d. 4 weeks
T/F: Fixed and dilated pupils are indicators of brain death
True
T/F: Brain death is reversible.
False. Brain death is irreversible
While performing an apnea test for brain death, you should observe carefully for any respiratory movement for how long?
a. 3-5 minutes
b. 8-10 minutes
c. 10-15 minutes
b. 8-10 minutes
