TBI, Assault, Enviro, Peds, Geri Flashcards
Main contributor to secondary brain injury
Cellular hypoxia
Cerebral perfusion pressure formula?
Surrogate?
MAP - ICP
Surrogate is systolic blood pressure in EMS
GCS and TBI severity
Mild: 14-15
Moderate: 9-13
Severe: 3-8
Concussion def:
A trauma induced alteration in mental status that may or may not include a loss of consciousness
Any alteration
Typical duration of concussion
7-10 days
% of women that experience IPV worldwide
Risk factors
30%
Separated or divorced
Disabled
Pregnant
Transgender
Lower SES
Most common time for IPV
Right around time partner is leaving
4 types of IPF (Per Johnson)
Situational couples: both sides violent
Coercive controlling: one partner with goal to maintain power
Violent resistance: One controlling, other resisting
Separation-instigated: nonviolent until separation (both M and F equal)
4 Cardinal rules for EMS safety
Never confront abuse
Never get between couple that is arguing
Always ensure that you have an escape route
Never let abuse block your exit
4 Rs for IPV
Recognize
Respond
Refer
Record
Don’t have what present when trying to help IPV in field
Children - they can snitch
4 Rs’ for trauma informed approach
Realization
Recognition
Response
Resisting re-traumatization
AMP model of human trafficing
Action - recruits, transports, obtains victims
Means - forced, fraud, coersion
Purpose - commercial sex or labor services (2 types of sex trafficking)
Most common trafficker
Family members (36%)
Goal of what when suspecting human trafficking
NOT disclosure or in depth interview
Gather enough info to provide necessary resources
Most common form of child abuse
Neglect (60%) - acts of omission
child abuse risk factors
<1 years old
Non verbal
Chronic diseases
no gender difference
4 mechanisms of losing heat
Radiation
Convection
Conduction
Evaporation
Mild hypothermia
32-35
Shivering, progressive loss of function
Moderate Hypothermia
28-32
loss of shivering
cardiac arrhythmias
confusion
Severe hypothermia
<28
Muscular rigidity
Loss of vital signs
V-fib, LOC
Trenchfoot description
before treatment: limb is blanched and yellowish white, edematous, not painful
after treatment: hyperemic phase - hot, red swollen and painful. Bilsters over weeks
Post hyperemic: cold sensitivity and paresthesias that may last years
Rescuer ppl for altitude
Acclimatization
Chemoprophylaxis (acetazolamide, dexamethasone)
O2 supplementation
Decent equivalent for portable hyperbaric chamber
3000 ft
3 diving injuries at depth
Nitrogen narcosis
O2 toxicity
Immersion pulmonary edema (even with just swimming)
3 diving injuries of ascent
Overpressure - barotrauma
Arterial gas embolism
Decompression sickness
Why reverse triage in lightning
Temporary loss of respiratory drive (medulla)
Two ABCDE caveats in peds
- AVPU for airway
- Caveat on Exposure, very prone to hypothermia
HR to promp action in kids
> 220 in infants
180 in children
<60 and symptomatic
BP formula for kids
70 + (2 x age)
Best pain scale for kids 4-12
Pictorial (Wong Baker Faces)
Best pain scales < 4
Observational :
1. FLACC - Face, Legs, Activity, Cry, Consolability
2. CHEOPS
What to give sick croup kids
Nebulized epi
Mist does not work
BRUE criteria
Sudden, brief (<1 minute), resolved with 1 of: cyanosis or pallor, irregular breathing, change in tone, decreased responsiveness
BRUE age range
<1 year, highest in <3 months
% of pediatric responses that are seizures?
10%
What % of children will have febrile seizures
5%
Most common finding in pediatric shock
Tachycardia
Higher ROSC in non shockable adult vs bed arrest?
Peds (but numbers still low)
Waddels triad
- Femur fx
- Chest + Abd trauma
- Head injury
Lap belt complex
Hyperflexion during deceleration in MVC
Abdominal trauma (hollow viscous) + vertebral compression fractures
Most common technology dependent child device
G or J tubes
What terminates seizure from vagal stimulator
Magnets
But if benozs are option use that first
Test for cognitive decline
Six item screener
3 words
Date, month, year
recall 3 words
Patient health questionnaire 2 tests?
Depression
Age as “special consideration” for trauma transfer
Systolic BP cutoff?
> 55
Systolic of 110
Drugs to consider as IBW dosing
Opioids, Ketamine
Propofol, versed, etomidate
Non weight based EMS drugs
Haldol
Quetapine