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Smurd Flashcards

1
Q

Scop evaluare primara

A

Identificarea si tratarea imediata a leziunilor amenintatoare de viata

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2
Q

Algoritm ABCDE

A

A( airway)= eliberarea cailor aeriene cu mentinerea capului si a coloanei cervicale in ax
B( breathing)= evaluarea si controlul respiratiei
C( circulation)= evaluarea si controlul hemoragiilor masive
D( disability)= evaluarea statusului neurologic si stabilirea CGS
E( Exposure/ Environment)= expunerea la factorii de mediu; se va dezbraca complet pt. a fi examinat, dar se vor lua masuri de prevenire a hipotermiei

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3
Q

Cum se face evaluarea primara?

A
  1. Siguranta salvatorului
  2. Evaluarea starii de constienta
  3. ABCDE
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4
Q

A

A

Deschiderea caii aeriene
Inspectia cavitatii bucale: corpi straini
-lichide- sonda yankauer conectata la aspirator
-solide-pensa Magill
-pipa Guedel- pacient inconstient dar care respira

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5
Q

B

A

PAS 10 SEC MAX!!!
Simetrie/ asimetrie torace, deviere trahee
Palpare/ percutie/ ascultatie
Pulsoximetrie=> oxigenoterapie

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6
Q

Intubatia oro-traheala indicatii

A
  • mentinere permeabilitate cai aeriene( apnee, afectiuni resp., obstructii mecanice/ functionale cai, stop cardio resp.)
  • CGS<8
  • ventilatie mecanica invaziva
  • profilactic: arsuri cai aeriene sup.
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7
Q

Avantaje intubatie oro-traheala

A
  • previne sindromul de aspiratie pulmonara
  • faciliteaza ventilatia si oxigenarea
  • permite aspiratia cailor aeriene inf.
  • previne distentia gastrica datorata ventilatiei
  • protejeaza caile aeriene impotriva edemului si a compresiei
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8
Q

Etapele intubatiei

A
  • aspiratia secretilor patologice si eliminarea corpilor straini
  • preoxigenarea-masca cu balon si rezervor
  • laringoscopie directa
  • se introduce sonda endotraheala in care s-a introdus mandrenul in prealabil, se umfla balonasul folosind o seringa de 10 ml
  • verificare pozitie sonda prin ascultatie
  • filtru bacterian, balon =>ventilatie
  • monitorizare spo2 si etco2( capnografie)
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9
Q

Tipuri de la laringoscop

A

Drept: miller
Curbat: macintosh

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10
Q

Unde se verifica pozitia sondei prin ascultatie

A
  1. Epigastru

2. Pulmonar bilateral, bazal, apical

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11
Q

Dispozitive intubatie dificila

A
  • Bujie

- dispozitive supraglotice: i-gel, masca laringiana, combitube

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12
Q

Dispozitive intubatie dificila

A
  • Bujie

- dispozitive supraglotice: i-gel, masca laringiana, combitube

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13
Q

Bujie cum trebuie sa fie pt. folosire?

A

Sterila si lubrifiata inainte

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14
Q

I-Gel( Gold standard)

A

Se muleaza pe orificiul glotic la temp. corpului
Se pot aspira secretile gastrice
Se poate utiliza pt. introd. bujiei/sonda de intubatie de diametru redus

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15
Q

Masca laringiana

A

5 marimi
Se introd dezumflata/semiumflata, lubrifiata POST.
NU PROTEJEAZA IMPOTRIVA ASPIRATIEI GASTRICE
NU se pot aspira caile aeriene inf.
Introd. Bujie+sonda mica

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16
Q

Masca laringiana poate det. obstructie?

A

Deplasare in jos cai a epiglotei

Laringospasn

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17
Q

Combitube(alcatuire)

A

2 tuburi 2 baloane

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18
Q

Combitube instruire speciala?

A

Nu

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19
Q

Conteaza daca e in esofag/ trahee?

A

Nu

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20
Q

C- Evaluare

A
  • wet check- hemoragii
  • soc hemoragic TA<90mmHg
  • timp reumplere capilara <2sex normal
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21
Q

C( management)

A
  • hemostaza rapida
  • abord venos periferic
  • transfuzie
  • abord intraosos
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22
Q

C( management)

A
  • hemostaza rapida
  • abord venos periferic
  • transfuzie
  • abord intraosos
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23
Q

Hemostaza rapida

A
  • bandaj compresiv
  • compresia vasului direct in plaga
  • compresie arteriala proximal de leziune
  • elevare membru afectat
  • garou
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24
Q

Abord venos periferic

A
  • 2 branule mari minim 18G( verde)

- perfuzabile: initial cristaloide(2L); coloide

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25
Q

C( monitorizare)

A

Puls
Tensiune
Ritm

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26
Q

D( disability)

A

Scurt examen neurologic

  • pupile
  • glicemie
  • avpu
  • GCS
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27
Q

Pupilele

A

Fiecare ochi in parte apoi bilateral comparativ

Dimensiune, egalitate, reactivitate, deviere globi oculari

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28
Q

Glicemie

A

<80mg/dl SE TRATEAZA

ATENTIE TOXICE/ DROGURI/ ALCOOL

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29
Q

AVPU

A

A-alert= constient, nu neaparat orientat
V-voice= raspuns la stimuli verbali
P-pain= raspuns la stimuli durerosi
U-unresponsive

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30
Q

Glasgow Coma Scale

A 
=>nivelul de constienta: min. 3,max. 15
-deschidere ochi
-raspuns verbal
-raspuns motor
Flexie la durere=decorticare 3p
Extensie la durere= decerebrare 2p
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31
Q

E( Exposure)

A
  • dezbracarea rapida si completa fara intreruperea tratamentului/ agravarea leziunilor
  • evaluare externa rapida
  • protejare de hipotermie-paturi/ folie supravietuire cu partea argintie spre pacient
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32
Q

Lantul supravietuirii

A
  • apel corect 112
  • cpr precoce
  • defibrilare precoce
  • transport unitate medicala
  • als
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33
Q

BLS

A
  1. Siguranta salvatorului
  2. Verificarea starii de constienta
  3. ABCDE
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34
Q

Victima constienta respira

A

PLS

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35
Q

Victima constienta nu respira

A

CPR

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36
Q

Apel 112

A

B-breathing

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37
Q

Raport compresiuni:ventilatii

A

30:2

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38
Q

Cat se apasa cutia toracica in compresiuni

A

5-6cm

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39
Q

Frecventa compresiuni

A

100/min

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40
Q

Pozitionarea mainilor compresiuni

A

Centru torace, 1/2 dist. dintre apendice xifoid si manubriu

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41
Q

La cat daca e posibil se schimba cel care face compresiuni

A

2 min.

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42
Q

Cum se fac respiratiile artificiale?

A 
Pensezi nasul
Tii barbia ridicata
Inspiri normal
Buze etans pe ale victimei
Expir continuu 1 sec pana se ridica pieptul victimei
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43
Q

BLS pediatric

A
  1. SS
  2. Stare de constienta->ajutor, 112
  3. Respiratie absenta/normala
  4. 5 RESPIRATII SALVATORII
  5. 15 compresiuni:2 resp
44
Q

OCSCA

A

Obstructia cu corp strain a cailor aeriene superioare

45
Q

Tratament OCSCA

A 
Evaluarea gravitatii
Obstructie usoara( tuse eficienta)
Obstructie severa( tuse ineficienta)
-inconstient CPR
-constient 5 lovituri interscapulare, 5 compresii abdominale
46
Q

Ritmuri socabile

A

FV

TV FARA PULS

47
Q

Ritmuri non socabile

A

Asistolie

AEP( activitate electrica fara puls)

48
Q

FV

A

Unde neregulate
Complexe QRS neidentificabile
Frecventa si amplititud random
Activitate electrica necoordonata

49
Q

Definitie defribilatie

A

Curent continuu, traverseaza miocardul, aduce celulele la acelasi potential electric membranar, permite pacemaker urilor naturali sa preia controlul activitatii electrice cardiace

50
Q

Mecanism definrilare

A

Anulare activitatea focarelor ectopice

51
Q

Factori care influenteaza defibrilarea

A

Pozitia electrozilor
Energia eliberata
Impedanta transtoracica( rezistenta)
Dimensiunile toracelui

52
Q

Impedanta minima

A

Sfarsitul expirului

53
Q

Cand se incarca padelele

A

Numai dupa aplicarea lor pe torace

54
Q

Intrerupere max. La defibrilare

A

5 sec

55
Q

Cand se incepe medicatia in ritmuri socabile persistente

Cu ce si cat

A

Dupa al 3 lea soc
Adrenalina 1mg iv/io
Amiodarona 300mg iv/io diluata in 20 ml glucoza 5%

56
Q

Dupa inceperea medicatiei cat si la cat timp

A

Adr 1mg 3-5 min( la 2 cicluri)

Dupa socul 5 amiodarina 150 mg diluata 20 ml glucoza 5%

57
Q

Ce si cat cand nu avem amiodarona

A

Lidocaina 100mg, doar daca nu s-a administrat amiodarona

58
Q

Pacient monitorizat care intra in soc, cu ritm socabil

A

3 socuri consecutive

59
Q

Ritmuri fara indicatie de soc medicatie

A

Adr iv/io 1 mg la 2 cicluri

60
Q

Asistolie cu unde p

A

Pacing transtoracic

61
Q

Socurile electrice repetate cresc injuria miocardica

A

Direct: actiunea curentului
Indirect: intreruperea rcp si astfel a fluxului sanguin coronarian

62
Q

Vol tidal

A

500-600 ml( 6-7ml/kg)

63
Q

Capnografie utilitate

A

Plasare corecta iot

Detectare revenire circulatie spontanta

64
Q

Ce se face dupa administraeea de med

A

Bolus de 20 ml fluid si ridicarea membrului

65
Q

Efect amiodarona

A

Creste durata pa in miocard

66
Q

Med. Torsada varfurilor

A

Sulfat de Mg, 2g bolus iv se poate repeta dupa 10- 15 min

67
Q

Rcp continuu si corect poate

A

Poate creste amplitudinea undelor fv si sanselede defibrilare eficienta

68
Q

Pauza pre soc ideal

A

<5sec

69
Q

4H

A

Hipoxie
Hipotermie
Hipo/hiper kalemie, calcemie
Hipovolemie

70
Q

4T

A

Tensiune toracica- pneumoTorax
Tamponada cardiaca
Toxice
Tromboza( cardiaca/ pulmonara)

71
Q

Hipoxie

A

Patenta cailor aeriene
Administrare o2
Evitare hiperventilatie

72
Q

Pneumotorace diagnostic

A 
Asimetrie
MV absent
Hipersonoritate la percutie
Deviere trahee
Eco
73
Q

Trombembolia pulmonara

A

Tromboliza

Cpr 60-90 min

74
Q

Capnografie roluri

A 
Verificare plasare sonda iot
Evitarea hipervent
Calitate compresiuni
Identif rcss
Prognostic( nu se obt. >10 mmhg dupa 20 min =>esec)
75
Q

Terapie postresuscitare

A 
Abcde
Oxigenare( 94-98) ventilatie
Ecg 12 derivatii
Cauze precipitante tratament
Temperatura -36
76
Q

ALS diferente abc fata de bls

A

A-la fel
B-intubatie
C-abord venos/intraosos si monitorizare ritm stop

77
Q

Tablou clinic chestii toracale hemo, pneumo…

A 
Agitatie
Dispnee extrema
Senzatie de sufocare si moarte
Cianoza
Tahicardie
Hipotensiune
Hipoxie
Hipercapnie
Deviatie trahee
78
Q

Traumatopnee?

A

Pneumotorace deschis sunetul aerului care iese in expir

79
Q

Pneumotorace characteristici

A

Ascultatie: silentiu resp
Percutie: timpanism
Jugulare destinse

80
Q

Pneumotorace characteristici

A

Ascultatie: silentiu resp
Percutie: timpanism
Jugulare destinse

81
Q

Hemotorace

A

Ascultatie: silentiu
Percutie: matitate
Jugulare colabate

82
Q

Volet costal

A

3 coaste alaturate 2 puncte=> miscari paradoxale

83
Q

Tratament volet

A

Leucoplast/ faza adeziva pe cele 4 laturi

84
Q

Tamponada cardiaca

Triada beck

A

Hipotensiune
Distensie jugulare
Zgomote cardiace asurzite

85
Q

La ce duce imposibilitatea expansiunii ventriculilor in Tamponada

A

Insuficienta cardiaca acuta hipodiastolica

86
Q

Evaluarea secundara cand?

A

Dupa cea primara, dupa resuscitate cand pacientul e stabilizat
Inventariere completa leziuni stabilire prioritati ulterioare

87
Q

Ora de aur

A

Prima ora de la traumatism in care sansele de supravietuire cresc semnificativ

88
Q

Examinare cap:

A

Examinare craniu si fata si scalp
Prin: inspectie si palpare pentru plagi, tumefieri, zone dureroase, crepitatii/ discontinuitati osoase
Evitare apasare excesiva zone depresionate

89
Q

Fracturi de baza craniului implica:

A

Stanca temporalului, canal auditiv ext, mb timpanica

90
Q

Semne si simptome fractura baza craniu

A 
Otolicvoree
Rinolicvoree
Hematomul periorbital
Semnul Battle( echimoza mastoidiana)
Hemotimpanul
Vertij hipoacuzie
Paralizie VII
91
Q

Tratament leziuni scalp

A

Toaletare
Oprire hemoragie
Pansamente
Capelina

92
Q

Epistaxis necontrolat

A

Pansament prastie nazala

93
Q

Fractura clavicula semn

A

Pozitia umila a lui dessault

94
Q

Tratament prespital ruptura de clavicula

A

Bandaj in 8

95
Q

Nr. Persoane intoarcere victima in ax examinare cv

A

Minim 4

96
Q

Traumatisme pelvine cei 5 p

A 
Pain 
Pallor
Pocket 
Penis
Pulse
97
Q

Leziune deasupra c3

A

Intrerupere respiratie, mortalitate crescuta

98
Q

Leziune c4-c6

A

Volum curent insuficient=> hipoxie, creste co2

Complicatii: obstructia ca; atelectaziile si pneumonie

99
Q

E obligatoriu intubatia deasupra c5

A

Da

100
Q

Deasupra t5

A

Hipotensiune

101
Q

acuze traumatisme cv

A

Durere vertebrala, anestezii, parestezii, pierderea functiei motorii

102
Q

Cea mai vulnerabila zona cv

A

Jonctiunea toraco lombara t11 l2

103
Q

Zona cv cu cel mai mic risc

A

Zona toracala

104
Q

Transport pacienti cu suspiciune leziune cv

A

Bord sau targa cu lopeti

105
Q

Procente arsuri adult

A

9 cap brate
18 trunchi ant/post, mb inf
1 org genitale

106
Q

Procente arsuri bebe

A

18 cap trunchi ant/post
9 mb sup
14 mb inf
1 org genit

107
Q

Comprese arsuri calmare durere

A

Aluduren
Flamaderm
Unguent dermazin

Smurd (1 decks)

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