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Bachelor of Paramedic Science > TEM > Flashcards

TEM Flashcards

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1
Q

What should you be thinking about enroute to the call?

A
  • Major trauma centre
  • Helicopter availability
  • Landing sites
  • CCP availability
  • High Acuity Response Unit
  • Speed zone of accident
  • Weather
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2
Q

What does the mnemonic ETHANE stand for?

A

Exact location
Type of incident
Hazards on scene
Access/egress
Number of patients
Emergency services required

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3
Q

What is the primary survey order in trauma?

A

D – Danger
R – Response – AVPU
A – Airway – suction, OP/NP if not patent
B – Breathing – Y/N
C – Circulation – Y/N, Control bleeding
D – Disability – Pupils, GCS
E – Expose (if unconscious cut clothes off)

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4
Q

What takes priority over airway and breathing interventions in trauma?

A

life-threatening bleeding

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5
Q

What order are the secondary surveys done in trauma?

A

Head to toe
life threats
CVS
SAMPLE
Neuro
Respiratory
Pain

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6
Q

What gross abnormalities are you looking for in a H2T?

A
  • Angulated limbs
  • Unequal chest movement
  • Flail chest
  • Rigid or bruised abdomen
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7
Q

What are the four major life threat areas and why?

A

chest
abdomen
pelvis
femur

they bleed out internally

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8
Q

When will a tension pneumothorax be apparent in the assessments?

A

when assessing life threats

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9
Q

What criteria ascertain if you stay and play or load and go?

A
  • Isolated (eg compound fracture) or multisystem trauma (chest and abdomen)
  • Time (choking, cardiac arrest) or transport criticality (internal bleeding, closed head injury)
  • Downstream thinking
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10
Q

With a time critical injury do you stay and play or load and go?

A

stay and play

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11
Q

With a transport critical injury do you stay and play or load and go?

A

load and go

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12
Q

What does downstream thinking take into account?

A

what does the patient need and can we do it

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13
Q

What are the Nexus Criteria components?

A
  • no ALOC
  • no focal neurological deficit
  • no midline tenderness
  • no intoxication
  • no distracting injury
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14
Q

What are the methods of vehicle extrication?

A

self extrication
combi carrier

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15
Q

What are the options for self extrication from a car?

A
  • Pt step out of their car themselves? (Pts can self manage their spines better than rescuers)
  • Rescuers apply a c-spine collar and ask the patient to self extricate
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16
Q

What are the options for combi carrier extrication from a car for patients unable to self extricate?

A
  • Board inserted under patient’s backside, they are rotated while providing MILS and slid out onto the stretcher
  • Extricate via rear windscreen
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17
Q

What should you avoid doing when a pt is entrapped?

A

impeding the fire department

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18
Q

How many of the Nexus criteria does a Pt need to meet to clear them from needing cervical spine imaging

A

all

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19
Q

What is the normal intracranial pressure (ICP)?

A

5 - 15 mmHg

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20
Q

What contents does intracranial pressure (ICP) include?

A

brain and contents in the skull

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21
Q

What is the normal Cerebral perfusion pressure (CPP)?

A

50 - 70 mmHg

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22
Q

What is cerebral perfusion pressure (CPP)?

A

Pressure required to perfuse brain

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23
Q

How do you calculate mean arterial pressure (MAP)?

A

Diastolic BP + 1/3 pulse pressure

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24
Q

How do you calculate cerebral perfusion pressure (CPP)?

A

CPP = MAP – ICP

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25
Q

What is the MAP range for CPP?

A

50 - 150 mmHg

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26
Q

What is autoregulation?

A

the brain maintaining the same cerebral perfusion pressure (CPP)

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27
Q

Is autoregulation lost in traumatic brain injury?

A

yes

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28
Q

What is the goal MAP for head injury Pts?

A

90 mmHg

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29
Q

How do you calculate pulse pressure (PP)?

A

PP = SBP - DBP

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30
Q

What is Cushing Reflex?

A

a physiological nervous system response to acute elevations of intracranial pressure (ICP)

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31
Q

What are the components of cushings triad?

A

hypertension
bradycardia
increased ventilations

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32
Q

What is cerebral herniation syndrome?

A

Displacement of any part of the brain within the skull due to raised ICP

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33
Q

What are the 6 types of cerebral herniation syndrome?

A

subfalcine (cingulate)
central (tentorial)
transcalvarial (external)
uncal (transtentorial)
upward
tonsillar (downward cerebellar)

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34
Q

What is the Monroe Kellie Doctrine

A

Skull is a closed vault – Can only fit a certain amount in there
If the amount of blood increases, something else has to go

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35
Q

What are the percentages of brain tissue, CSF and blood within the skull?

A

brain tissue 80%
CSF 10%
blood 10%

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36
Q

What is the Mass Effect?

A

Brain swelling causes CSF into spinal column followed by herniation

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37
Q

In a brain herniation, what do constricted pupils indicate?

A

posterior herniation

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38
Q

In a brain herniation, what do dilated pupils indicate?

A

both optic nerves getting squashed

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39
Q

In a brain herniation, what does unequal pupils indicate?

A

only one optic nerve is being squashed

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40
Q

What are is are the 2 severe signs of TBI?

A

decorticate (flexion) - arms flexed and legs extended
decerebrate (extension) - arms and legs extended

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41
Q

What is the GCS score when you should suspect severe brain injury?

A

GCS <9

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42
Q

What is a primary head injury?

A

Initial traumatic insult to the brain

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43
Q

What is a secondary head injury?

A

The cascade of events following primary injury that can worsen the injury

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44
Q

What are the 2 primary goals in head injury/TBI management?

A

Avoid hypoxia & hyperoxia
Avoid hypotension

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45
Q

What do hypoxia, hyperoxia and hypotension do in a traumatic brain injury (TBI)?

A
  • dramatically increase mortality
    • Hypoxia increases brain damage
    • Hyperoxia increases oxygen free radical production further damaging injured cells
  • Hypotension stops brain auto-regulating CPP so maintain blood pressure and MAP to ensure brain perfusion
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46
Q

What is the traumatic brain injury (TBI) management for Pts with a GCS 15?

A

Consider:
bleeding control
C spine support
oxygen
IV access
analgesia
IV fluids

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47
Q

What is the traumatic brain injury (TBI) management for Pts with a GCS <15?

A

maintain airway, oxygen, BP and then transport

oxygen
IV access
IV fluids - MAP around 90 (SBP 100 - 120 mmHg)

Consider:
basic airway adjuncts
c spine support
semi recumbent position at 30 degrees if isolated head injury
analgesia
antiemetic
CCP backup
midazolam/ketamine - CCP only
hypertonic saline 7.5 % - HARU
transport
pre-notify as appropriate

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48
Q

What is the scalp injury management?

A

explore to determine severity (see skull OK, see yellow CSF or brain matter - transport quickly)
pad and bandage
transport

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49
Q

What are the four types of skull fractures?

A

depressed
impaled object
linear nondisplaced
open

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50
Q

What are the 2 bruising signs of a basilar skull fracture?

A

battle’s sign
raccoon eyes

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51
Q

What are the 4 types of traumatic brain injury (TBI)?

A

Bleeding
Contusion
Concussion
Diffuse axonal injury

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52
Q

What are the 4 types of bleeding traumatic brain injury (TBI)?

A

Epidural - Between skull and dura
Subdural - Between dura and arachnoid
Subarachnoid - Between the arachnoid and pia mater
Intracerebral - Directly into brain tissue

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53
Q

What are some of the secondary brain injuries?

A
  • Brain herniation and death results from untreated cerebral haemorrhage
  • Breach of blood-brain barrier causes severe meningitis
  • Hypoventilation results in hypercarbia, increasing ICP
  • Raised ICP reduces cerebral perfusion pressure (CPP), causing anoxia injury
  • Subarachnoid haemorrhage causes vasospasm, causing large area of ischaemia
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54
Q

How does traumatic brain injury (TBI) bleeding cause problems?

A
  • Blood irritates brain tissue causing pain and symptoms such as neck stiffness
  • Monroe-Kellie Doctrine – Mass effect –intracranial pressure – reduced brain perfusion
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55
Q

What is the epidural haematoma aetiology?

A
  • rupture of middle meningeal artery causing rapid rise in ICP as haematoma accumulates within the extradural space
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56
Q

What are the epidural haematoma signs and symptoms?

(above the dura mater)

A

Initial loss of consciousness followed by ‘lucid interval’ of coherence
Progressive deterioration over minutes to hours

Signs of raised ICP:
ALOC or LOC
severe headache
Ipsilateral fixed & dilated pupil
Contralateral paralysis
vomiting

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57
Q

What is the subdural haematoma aetiology?

(between dura mater and arachnoid mater)

A
  • Bleeding into the subdural space from bridging veins
  • Very slow progression due to venous origin and compensation
  • traumatic or spontaneous
  • Severe cases associated with catastrophic TBI
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58
Q

What are the subdural haematoma signs and symptoms?

(between dura mater and arachnoid mater)

A

Possible initial LOC followed by lucid intervals
conscious state may fluctuate
Headache
Focal neurological deficits relate to underlying brain region

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59
Q

Who are at higher risk of subdural haematoma?

A

elderly
people on anticoagulants
PMHx alcohol abuse

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60
Q

What is the subarachnoid haemorrage aetiology?

A

Arterial bleed into the subarachnoid space
trauma or spontaneous

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61
Q

What are the subarachnoid haemorrage signs and symptoms?

A

sudden onset of ‘thunderclap’ headache
Meningeal irritation
Photophobia
visual impairment
Focal neurological deficits, increasing severity
nausea and vomiting
+/- mild hypertension and/or mild hyperthermia

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62
Q

What are the two types of intracerebral haemorrhage (CVA)?

A

arterial
venous

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63
Q

What are the intracerebral haemorrhage (CVA) signs and symptoms?

A

ALOC
Stroke symptoms
Headache
vomiting
plus others depending on region/degree

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64
Q

What is a concussion?

A

brain hits inside of skull - no structural injury to brain

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65
Q

What are the concussion signs and symptoms?

A

LOC or confusion followed by return to normal
Retrograde short-term amnesia - May repeat questions over and over
dizziness
headache
ringing in ears
nausea

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66
Q

What is a cerebral contusion?

A

Bruising of brain tissue (from hitting inside skull)
Swelling may be rapid and severe

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67
Q

What are the cerebral contusion signs and symptoms?

A

Prolonged unconsciousness
Profound confusion or amnesia
Focal neurological signs

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68
Q

What is diffuse axonal injury?

A

shearing of the axons

generally seen in vehicle rollovers - significant cause of morbity and mortality

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69
Q

What is the diffuse axonal injury aetiology?

A

Extreme acceleration/decelation causes shearing forces within the brain that stretches and tears the axons of neurons

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70
Q

What are the minor/mild diffuse axonal injury signs and symptoms?

A

Unconsciousness or confusion followed by return to normal
Retrograde short-term amnesia - May repeat questions over and over
Dizziness
headache
ringing in ears
nausea

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71
Q

What are the severe diffuse axonal injury signs and symptoms?

A

unconscious
DAI determined with GCS <8 for >8hrs
Seizures in acute and sub-acute stages

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72
Q

What are the common causes of facial trauma?

A

assaults
falls
motor vehicle accidents

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73
Q

What is a Le Forte I fracture?

A

fracture under cheek bones
Pain, numb upper teeth, mobile upper teeth

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74
Q

What is a Le Forte II fracture?

A

fracture from bridge of nose across both cheeks

Pain, numb upper lip and nose, midface mobility

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75
Q

What is a Le Forte III fracture?

A

fracture across face through eye sockets

Pain, difficulty breathing, marked facial deformity and swelling

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76
Q

How are orbit fractures caused?

A

Direct impact to the hard structures surrounding the eye can transmit the force to the weaker thinner bones at the rear and base of the eye socket

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77
Q

What is the orbit fracture treatment?

A

icepacks
have the patient avoid nose blowing, vomiting, etc as it can lead to air trapping under the eye

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78
Q

What is the treatment for eye trauma to the surface of the eye?

A

irrigate continuously with saline or water

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79
Q

What is the treatment for eye trauma penetration?

A

cover the eye without applying pressure to the eyeball or the embedded object (Styrofoam cup)
position in semi recumbent
anti-emetic

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80
Q

What is the treatment for eye trauma extrusion?

A

support with a saline soaked dressing and tape it in place

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81
Q

What is the epistaxis treatment?

A

advise patient to lean forward to allow for drainage out
pinch the sides of the nose until bleeding stops

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82
Q

What is the jaw fracture treatment?

A

icepacks
pain relief
soft collar may help splint the jaw

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83
Q

What is the jaw fracture signs and symptoms?

A

pain
swelling
reduced jaw mobility

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84
Q

What is tooth avulsion?

A

whole tooth has been knocked out

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85
Q

What is tooth avulsion treatment?

A

If <1 hours the empty socket and tooth should be cleaned in saline then tooth re-implanted.
The patient will have to hold it in place with a pad for several hours to allow the reattachment to take place.
If re-implantation cannot occur transport the tooth in milk, saline, or in the patient’s mouth.

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86
Q

How do you manage the airway in a facial trauma Pt?

A

if conscious - sit up and lean forward to clear airway
if unconscious - lateral positioning to allow for passive drainage
preferred is rapid sequence intubation - consdier when performing interventions that delay transport

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87
Q

What is hyperextension of the neck?

A

excessive posterior movement of the head or neck

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88
Q

What is hyperflexion of the neck?

A

excessive anterior movement of the head or neck

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89
Q

What is compression of the neck?

A

weight of head or pelvis driven into the stationary neck or torso

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90
Q

What is rotation of the neck?

A

excessive rotation of the torso, head and neck moving one side of the spinal column against the other

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91
Q

What is lateral stress of the neck?

A

direct lateral force on the spinal column typically shearing one level of cord from the other

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92
Q

What is distraction of the neck?

A

excessive stretching of the column and cord

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93
Q

In vertebral vs spinal cord injuries, what will vertebral fractures will present with?

A

pain

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94
Q

In vertebral vs spinal cord injuries, what will spinal cord injuries present with?

A

neurological signs of loss of:
* sensation/altered sensation
* motor function/weakness

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95
Q

What does a complete spinal cord injury result in?

A

No motor function or sensation below the point of injury (paraplegic or quadriplegic)

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96
Q

What does an incomplete spinal cord injury result in?

A

Some function remains below the injury

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97
Q

What are the three types of incomplete spinal cord injury?

A

central cord syndrome
anterior cord syndrome
brown-sequard’s syndrome

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98
Q

What part of the spinal cord is damaged in central cord syndrome?

A

the centre of the cord is damaged, typically by hyperextension

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99
Q

What does central cord syndrome result in?

A

Usually the arms lose more function than the lower body

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100
Q

What part of the spinal cord is damaged in anterior cord syndrome?

A

The anterior section of the spinal cord
usually caused by a blood clot but can be traumatic, occluding blood supply to the anterior section of the spinal cord

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101
Q

What does anterior cord syndrome result in?

A

the ability to feel sensation and proprioception is preserved

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102
Q

What part of the spinal cord is damaged in brown-sequard’s syndrome?

A

The cord is split in half along its length for a variable distance, typically
caused by penetrating trauma

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103
Q

What does brown-sequard’s syndrome result in?

A

preserved motor function on one side of the body and preserved sensory function on the other side

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104
Q

What does compression or burst spinal fracture present with?

A

pain and muscle spasm at site
+/- neurological involvement

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105
Q

What is the pathophysiology of neurogenic shock?

A

vagus nerve runs through C3 and spared from injury in severe spinal cord damage allowing parasympathetic innervation only below level of injury causing large scale vasodilation with associated shock

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106
Q

What are the neurogenic shock signs and symptoms?

A

Hypotensive
+/- Bradycardia
warm and dry (as opposed to cool/clammy in hypovolemic shock)
decreased body temp over time

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107
Q

What is the neurogenic shock management?

A

Consider:
Cervical pain:
* soft collar
* supine or semi-recumbent positioning

Thoracic, lumbar or sacral pain:
* soft collar (even if no cervical pain)
* supine positioning
* +/- immobilisation to a longboard (depend on Pts behaviour)

Neurological signs:
* soft collar
* supine positioning
* immobilisation on a longboard

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108
Q

How do you maintain the neutral head position in infants?

A

infants have big heads – raise their shoulders a
little to keep their cervical spine straight

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109
Q

How do you maintain the neutral head position in older children?

A

Older children are just right

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110
Q

How do you maintain the neutral head position in adults?

A

Adults have small heads – raise their heads a little to keep their cervical spine straight

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111
Q

What documentation requirements are there in spinal injuries where there is a loss of sensation or motor function?

A

document this carefully to enable identification of improvement or worsening especially at what
level the loss occurs (e.g cant feel pinky but can feel rest of hand) as this correlates to the affected
dermatomes

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112
Q

What are the 2 types of thoracic trauma mechanisms of injury?

A

blunt
penetrating

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113
Q

What are the 2 types of blunt thoracic trauma?

A

Direct compression
* Fracture of solid organs
* Blowout of hollow organs
Deceleration forces
* Tearing of organs and blood vessels

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114
Q

What can cause penetrating trauma to the thorax?

A

edged weapons
gun shot wounds

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115
Q

What is an open pneumothorax?

A

hole through chest and lung/sucking chest wound

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116
Q

What happens in an open pneumothorax/sucking chest wound?

A

Air enters pleural space
Ventilation impaired (no gas exchange)
Hypoxia results

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117
Q

What is the treatment for an open pneumothorax/sucking chest wound?

A

Close chest wall defect
Load-and-go

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118
Q

What can an open pneumothorax/sucking chest wound develop into?

A

tension pneumothorax

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119
Q

What are the signs and symptoms of a tension pneumothorax?

A

Anxiety
Jugular distension
Tracheal deviation (rare)
Dyspnea
Tachypnea
Breath sounds diminished
Hyper-resonance if percussed
Shock with hypotension

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120
Q

What is the location for the needle thoracostomy (chest decompression)?

A

2nd intercostal space mid-clavicular line

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121
Q

Do you load and go or stay and play for a tension pneumothorax?

A

load and go

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122
Q

What are the signs and symptoms of massive haemothorax?

A

Anxiety and confusion
Neck veins
- Flat: hypovolemia
- Distended: mediastinal compression
decreased breath sounds
Hyporesonance on percussion
Shock

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123
Q

What is the Tx for a massive haemothorax?

A

Load-and-go–
Treat for shock
- Fluid administration (Titrate to peripheral pulse (80-90 mmHg)
Monitor for tension hemopneumothorax

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124
Q

What is a flail chest?

A

rib fracture that separates whole section of ribs - broken section will pull in when breathe in and blow out when breathe out

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125
Q

What is the Tx for a flail chest?

A

Assist ventilation (IPPV if unconscious)
Load-and-go
Stabilize flail segment (with big pad)
Monitor for:
- Pulmonary contusion
- Haemothorax
- Pneumothorax

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126
Q

What is a cardiac tamponade?

A

Blood in the pericardial sac (it can’t stretch)

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127
Q

What are the components of Beck’s triad?
(Seen in cardiac tamponade)

A

Hypotension
JVD (backing up as heart not filling properly and back pressure into vena cava)
Heart sounds muffled (fluid dulls sound)

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128
Q

What are the signs and symptoms of a cardiac tamponade?

A

jugular vein distention
decreased or muffled heart sounds
hypotension
tachycardia
narrow pulse pressure
electrical alternans
low voltage QRS complex

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129
Q

What is the Tx for a cardiac tamponade?

A

Load-and-go
Treat for shock
Fluid administration titrated to peripheral pulse (80–90 mmHg)
Prepare for resuscitation
Monitor for:
- Hemothorax
- Pneumothorax

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130
Q

What is a myocardial contusion?

A

bruising on heart (can’t contract properly)

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131
Q

What causes a myocardial contusion?

A

blunt anterior chest injury

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132
Q

What is the most common cardiac injury?

A

myocardial contusion

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133
Q

What are the signs and symptoms of a myocardial contusion?

A

Chest pain
Dysrhythmias (often shows as STEMI pattern)
Cardiogenic shock (rare)

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134
Q

What is the Tx for a myocardial contusion?

A

Fluid administration titrated for peripheral pulse (80–90 mmHg)
Prepare for resuscitation
Monitor for Haemothorax and Pneumothorax

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135
Q

What is the Tx for a traumatic aortic rupture?

A

load and go - nothing we can do - 80% die immediately
titrate fluids to maintain radial pulse
scene size up and Hx extremely important (pt may not exhibit obvious signs of chest trauma)

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136
Q

What is a Tracheal or bronchial tree injury?

A

injury to upper part of chest to below vocal cords

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137
Q

What are the signs and symptoms of a tracheal or bronchial tree injury?

A

hoarseness of voice or aphonia
haemoptysis
subcutaneous emphysema (chest, face, neck)
dysphagia
stridor
respiratory failure

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138
Q

What is the Tx for a tracheal or bronchial tree injury?

A

oxygenation
CCP for intubation if unconscious (cuffed ET tube pst site of injury)
monitor for pneumotharax and haemothorax

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139
Q

What causes a diaphragmatic tear?

A

Severe blow to abdomen

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140
Q

What is a diaphragmatic tear?

A

Herniation of abdominal organs into chest cavity (liver, stomach, pancreas)

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141
Q

What are the signs and symptoms of a diaphragmatic tear?

A

More common on left
Breath sounds diminished
Bowel sounds auscultated in chest (rare)
Abdomen appears scaphoid

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142
Q

What is a pulmonary contusion?

A

bruising on lungs causing blood and transidate to leak from microvascular bruising

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143
Q

What is the most common cause of pulmonary contusion?

A

blunt trauma

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144
Q

What is the treatment for a pulmonary contusion?

A

Oxygen/CPAP

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145
Q

What is the treatment for impaled objects in the chest?

A

Do not remove
Stabilize the object (circular bandage/padding taped around)
Monitor for:
- Tension pneumothorax
- Hemothorax
- Cardiac tamponade
Rapid transport

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146
Q

Why don’t we remove the impaled object from the chest?

A

removing causes bleeding, sucking chest wound and cardiac tamponade

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147
Q

What is traumatic asphyxia?

A

severe compression of the chest causes all blood to be shunted into upper body, rupturing capilliaries

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148
Q

What are the signs and symptoms of traumatic asphyxia?

A

Cyanosis above crush
Swelling of head, neck, lips and tongue
Conjunctival hemorrhage

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149
Q

What causes a sternal fracture?

A

Significant blunt trauma to anterior chest

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150
Q

What are the signs and symptoms of a sternal fracture?

A

Signs of fracture on palpation
Myocardial contusion presumed (shock, circulatory failure, collapse)

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151
Q

What is the Tx for a simple rib fracture?

A

aggressive pain relief
encourage to take full breath
Monitor for Pneumothorax & Haemothorax

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152
Q

What is the priority in all chest injuries?

A

oxygen and airway

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153
Q

What should you pay attention to when evaluting abdominal trauma?

A

scene
mechanism of injury

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154
Q

What are the major causes of preventable death associated with trauma?

A

haemorrhage
infection

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155
Q

What happens to solid organs in trauma?

A

split and fracture and bleed intensely

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156
Q

What are the solid abdominal organs?

A

kidneys
liver
pancreas
spleen

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157
Q

What happens to hollow organs in trauma?

A

can rupture and spill contents (food, faeces) into the perineum

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158
Q

What are the hollow organs in the abdomen?

A

duodenum
small intestine
large intestine
bladder

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159
Q

What is the perineum?

A

big fibrous sac that encapsulates most of the abdomen

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160
Q

What are the major abdominal injuries in the thoracic region?

A

life threatening harmorrhage to liver and spleen

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161
Q

What are the major abdominal injuries in the true abdomen region?

A

Infection, peritonitis, shock: intestines
Severe haemorrhage with signs

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162
Q

What are the major abdominal injuries in the retroperitoneal (outside perineum) abdomen region?

A

Severe haemorrhage hidden: major vessels

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163
Q

What are the concerns with blunt and penetrating abdominal trauma?

A
  • Intra-abdominal bleed with hemorrhagic shock
  • Sepsis and/or peritonitis
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164
Q

What are you looking and feeling for in an abdominal assessment?

A

Abrasions
Contusions
Deformities
Distension
Evisceration
Punctures
Tenderness

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165
Q

How do you palpate the abdomen

A

pressing and rolling fingers over all of the quadrants

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166
Q

What is the pain sign for a splenic injury?

A

Referred left posterior shoulder pain

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167
Q

What is the pain sign for a liver injury?

A

Referred right posterior shoulder pain

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168
Q

What are the signs and symptoms of abdominal trauma?

A
  • Splenic injury - Referred left posterior shoulder pain
  • Liver injury - Referred right posterior shoulder pain
  • Severe hemorrhage (bruising around flanks)
  • Distention, tenderness, tenseness
  • Pelvic tenderness or bony crepitation or bruising around flanks
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169
Q

What is the mechanism for a blunt abdominal injury?

A

direct compression of abdomen
deceleration forces

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170
Q

What injuries can a direct compression of the abdomen cause?

A

Fracture of solid organs (spleen/liver)
Blowout of hollow organs (intestines)

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171
Q

What injuries can deceleration forces to the abdomen cause?

A

tearing of organs and blood vessels

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172
Q

What accompanying injuries should you look for when assessing blunt abdominal injuries?

A

head, chest, extremity
liver and spleen

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173
Q

What evidence of injury/signs are there in blunt abdominal trauma injury?

A
  • Often no or minimal external evidence
  • Often no pain or overshadowed distracting injuries
  • Pain or tenderness
  • Seat-belt sign
  • Significant blood volume concealed in regions
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174
Q

What can cause a penetrating abdominal injury?

A
  • Direct trauma to organ and vasculature
  • Projectile and fragments
  • Energy transmitted from mass and velocity (cavitation from bullets)
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175
Q

If a person is shot in the chest or abdomen, what do you need to assume?

A

that the other is involved as well (eg chest involved in abdomen injury and abdoment involved in chest injury)

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176
Q

Is the size of a penetrating wound an indicator of internal damage?

A

No, velocity is more important than caliber

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177
Q

What is the Young-Burgess classification?

A

Classification used to identify type of pelvic fractures

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178
Q

What are the 3 types of Young-Burgess classifications of pelvic ring fractures?

A

anterior posterior compression (APC)
lateral compression (LC)
vertical shear (VS)

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179
Q

What are APC II and III fractures referred to as?

A

open book fractures

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180
Q

What are the complications of pelvic fractures?

A

life-threatening haemorrhage
nerve damage
urethral damage

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181
Q

What do you need to know about life-threatening haemorrhage in pelvic fractures?

A
  • Blood loss from pelvis itself and/or local vasculature; venous in 90% of cases
  • Retroperitoneal space can accommodate your entire blood volume
  • High likelihood of associated intra-abdominal bleeding due to kinematics
  • Must assume potential or actual haemodynamic instability
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182
Q

What do you need to know about nerve damage in pelvic fractures?

A
  • Nerve bundles through the pelvic ring run close to vasculature
  • Damage can result in bowel, bladder, and sexual dysfunction
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183
Q

What do you need to know about urethral damage in pelvic fractures?

A

Incidence of 5-25% of pelvic fractures; most common in children & elderly
High-velocity pelvic fractures with destabilisation sits directly inside pelvis

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184
Q

What sign can indicate urethral or bladder damage in pelvic injuries?

A

PV bleed or bleeding from genitals in a person with an abdominal injury

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185
Q

Do we still ‘spring the pelvis’?

A

No

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186
Q

Why don’t we spring the pelvis?

A

due to the likelihood of clot disruption and further damage

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187
Q

How do we identify a pelvic injury if we can’t ‘spring’ the pelvis?

A

on mechanism of injury and patient presentation without significant palpation by the paramedic

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188
Q

What is the prehospital management for penetrating wounds?

A

direct pressure

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189
Q

Why do we limit fluid administration and allow permissive hypotension in Pt’s with a pelvic #?

A

increased BP increases bleeding and dilutes clotting factors

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190
Q

Why do we maintain normothermia in a Pt with a pelvic fracture?

A

to limit coagulopathy

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191
Q

How do we treat evisceration?

A
  • Do not push viscera back into abdomen
  • Gently rinse with sterile water cover with moistened gauze and cling wrap
  • Apply non-adherent material to prevent drying
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192
Q

How do we treat an impaled object?

A
  • Do not remove as will cause an uncontrollable hemorrhage
  • Gently stabilize object
  • Avoid movement
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193
Q

When is extremity trauma life-threatening?

A

When exsanguinating haemorrhage is occuring

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194
Q

What are the 2 potential dangers from extremity trauma?

A
  • haemorrhagic shock (reduced tissue perfusion, resulting in the inadequate delivery of oxygen and nutrients)
  • neurovascular compromise
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195
Q

What is a sprain?

A

stretching or tearing of ligaments of a joint becauseof a sudden twist

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196
Q

What are the signs and symptoms of a sprain?

A

pain
swelling

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197
Q

Can sprains be differentiated from a fracture?

A

No

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198
Q

How do you treat a sprain?

A

splinted as though it is a fracture

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199
Q

What is a strain?

A

stretching or tearing of a muscle or musculotendinous unit

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200
Q

How do you treat a strain?

A

splinted for comfort

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201
Q

Can you differentiate between a strain and a fracture?

A

Usually (not always)

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202
Q

What are the two types of fracture?

A

open (compound)
closed (simple

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203
Q

What are the features of an open fracture?

A

Communication to outside
Danger of contamination
Blood loss outside body

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204
Q

What are the features of a simple (closed) fracture?

A

No communication to outside
No danger of contamination
Blood loss inside body

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205
Q

How to you treat hand and foot injuries?

A

Manage haemorrhage
irrigate and cover
bandage carefully

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206
Q

What type of splint should be considered for hand injuries?

A

vacuum
cardboard

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207
Q

In a foot injury, what can you consider in regards to splinting?

A

pillows
pads
splinting against opposite limb

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208
Q

What is a colles fracture?

A

distal fracture of the radius

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209
Q

How much blood can you lose in a closed femur fracture?

A

1.5 litres

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210
Q

What is the treatment for a closed femur fracture?

A

CT6 or slishman’s splint
analgesia

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211
Q

What is the treatment for an open femur fracture?

A

analgesia
rinse with 1-2L of saline
CT6 or slishman’s traction splint

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212
Q

What is the management for dislocations?

A
  • Splint in position found (Bind it as you find it)
  • Shoulder dislocations may be most comfortable hanging freely or resting on a pillow. (Applying a sling can increase the rotation of the shoulder joint and increase pain.)
  • If there is neurovascular compromise transport code 1 (loss of pulse/numbness)
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213
Q

What is the most common type of shoulder dislocation at 90% of dislocations?

A

anterior dislocation

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214
Q

What 2 nerves can be pinched if the shoulder is relocated incorrectly?

A

radial nerve
axillary nerve

215
Q

What type of patella dislocation can paramedics reduce?

A

lateral patella dislocation

216
Q

What is the procedure for a lateral patella dislocation?

A
  • Provide analgesia (typically methoxyflurane)
  • Apply firm medial pressure to the lateral aspect of the patella while extending the knee slowly
217
Q

Is a knee dislocation an orthopaedic emergency?

A

yes, transport code 1

218
Q

Why is a knee dislocation an othopedic emergency?

A

Significant vasculature surrounding the knee joint can lead to significant bleeding and limb loss if not corrected surgically

219
Q

What is the treatment for an open fracture?

A
  • Reassurance
  • analgesia
  • consider backup for procedural sedation
  • Remove gross contamination where possible
  • irrigate with 1-2L normal saline unless major haemorrhage
  • Cover with sterile dressings
  • Consider haemostatic agent for significant haemorrhage/tourniquet if uncontrollable arterial bleed
  • throrough HTT
220
Q

What should be considered when assessing a femur fracture patient?

A

kinematics
thorough head to toe

221
Q

Where do hip fractures occur?

A

anywhere from proximal femoral head to first 5cm of femoral shaft

222
Q

What is the most common type of hip fracture?

A

NOF

223
Q

What is the presentation for a NOF?

A

external rotation
abduction of joint (away from body)
shortening

224
Q

What is the presentation for interotrochanter hip fracture?

A

shortening
swelling

225
Q

What is the presentation for subtrochanter hip fracture?

A

internal rotation
flexed knee

226
Q

What sign provides a high index of suspicion for a hip fracture?

A

Hip pain upon rotation of extended leg

227
Q

What should you not assume with a hip fracture?

A

haemodynamic stability
isolated injury

228
Q

What is the treatment for a hip fracture?

A

analegesia
providing stabilisation and support for the affected leg (tie legs together using triangular bandages)

229
Q

How are hip dislocations classified?

A

by the direction of dislocation, i.e. anterior or posterior

230
Q

What causes posterior dislocation of the hip?

A

direct force applied to flexed hip (eg head on car accident)

231
Q

What causes anterior dislocation of the hip?

A

forced external rotation of the abducted hip (eg car T boned)

232
Q

What can force the femoral head to dislocate medially in a central dislocation?

A

enough pelvic damage

233
Q

What are hip dislocations most commonly associated with?

A

acetabular fractures

234
Q

What type of forces in a hip dislocation can result in vascular compromise that is an emergency requiring reduction?

A

shearing forces

235
Q

What is the presentation of a hip dislocation?

A

Leg is typically shortened, and;
* Rotated internally in posterior dislocation
* Rotated externally in anterior dislocation

236
Q

What is the percentage of patients that have other concoitant musculoskeletal and/or internal injuries in hip dislocations due to the forces involved?

A

40%

237
Q

What is the management of a suspected hip fracture?

A
  • Inspect for pelvic and hip tenderness, distal neurovascular function
  • Look for leg shortening, rotation, bruising and swelling, movement loss
  • Consider haemodynamic stability and reassess frequently
  • Adequate pain relief and consider fentanyl over morphine if hypotensive
  • attempt to return leg to anatomical position and splint legs together with triangular bandages to prevent rotating again
  • Do not apply traction splint or pelvic binder
238
Q

What is the management of a suspected hip dislocation?

A
  • Inspect for pelvic and hip tenderness, distal neurovascular function
  • Look for leg shortening, rotation, bruising and swelling, movement loss
  • Consider haemodynamic stability and reassess frequently
  • Adequate pain relief and consider fentanyl over morphine if hypotensive
  • do not move the leg
  • Do not apply traction splint or pelvic binder
239
Q

What is the treatment for amputations?

A
  • Control any exsanguinating haemorrhage
  • Irrigate stump, cover with damp sterile dressing
  • Bandage firmly with even pressure across the area
  • Do your best to find the amputated part
  • Cover the amputated part with a saline moistened dressing and place into an airtight bag
  • Place airtight bag containing body part within 1:3 ice and water mix
  • Consider receiving facility
240
Q

Why should you find the amputated body part?

A

Even if irreparably damaged it can be used for skin & vascular grafts when resecting the stump & managing other injuries

241
Q

What is the treatment for an impaled object?

A

Do not remove unless airway is obstructed
Apply very bulky padding
Transport object in place
No unnecessary movement as motion is magnified in tissues

242
Q

What causes compartment syndrome?

A

crush injuries that have been in place for a long time

243
Q

What is compartment syndrome?

A

the external crushing of compartments within muscle fascia, increasing pressure that then decreases blood flow and prevents nutrients and oxygen from reaching nerve and muscle cells

244
Q

What can cause compartment syndrome?

A
  • casts dressing or splints
  • Increased compartment content from vascular injury or swelling
  • tight dressing, crushing object, or circumfrential burns
245
Q

What is crush syndrome?

A

follows compartment syndrome
release of potassium and myoglobin from damaged cells that is released into the bloodstream once the entrapment is released

246
Q

What does potassium in crush syndrome cause?

A

cardiac dysrhythmias

247
Q

What ECG changes are seen in crush syndrome from the potassium?

A

no P waves
wide QRS
peaked T waves

248
Q

What does the release of myoglobin from damaged striated muscle cells (rhabdomyoloysis) do?

A

enters plasma and filtered by glomerulus and if pH is low, clog up the kidneys, reducing their function

249
Q

How do you treat the crush syndrome (rhabdomyolysis)?

A

Fluids – 10-20ml/kg of saline - to increase urine output allowing kidneys to flush the toxins and reduce the impact of myoglobin on the nephrons
CCP backup – calcium gluconate and sodium bicarbonate for hyperkalaemia and acidosis

250
Q

What 2 mechanisms cause acidosis (low pH)?

A
  • Blood loss causing anaerobic metabolism and a resultant lactic acid buildup and clearance issue
  • acid components from injured muscle cells
251
Q

Why get CCP backup for hyperkalaemia?

A

They can administer:
salbutamol
sodium bicarbonate
calcium gluconate

252
Q

What is the management for crush injuries?

A

standard cares

253
Q

What type of transport are fluid injection injuries?

A

Code 1

254
Q

What causes fluid injection injuries?

A

Injection of high pressure fluid such as hydraulic oil or paint

255
Q

How does high pressure fluid cause internal injuries?

A

Fluid disperses internally along tissue plains causing damage and swelling

256
Q

What is the presentation of fluid injection injuries?

A

Often benign presentation
pinpoint wound and minimal pain
progresses over several hours to severe pain

257
Q

What is there a high risk of with fluid injection injuries?

A

amputation if not surgically treated

258
Q

Should distal pulses be affected in splinting simple fractures?

A

no

259
Q

In what position should limbs be splinted in most simple fractures?

A

in its current position

260
Q

When should you consider manipulating a simple limb fracture?

A

if limb is threatened

261
Q

When is traction contraindicated in femoral fractures?

A

in fracture / dislocation of knee or ankle

262
Q

What should you check before and after splinting?

A

pulse & perfusion (leave pulse points visible in vacuum splints)

263
Q

What is the go to analgesia for trauma?

A

morphine (unless very hypotensive)

264
Q

What 2 effects does morphine have?

A

Analgesic and anxiolytic effects

265
Q

In what patients should fentanyl be used in trauma?

A

hypovolaemic/hypotensive patients

266
Q

What are non-pharmacological pain management options in splinting?

A

RICE, positioning for comfort (pillows = gold), warmth, reassurance
Splinting alone will significantly reduce pain

267
Q

Why is a burn considered trauma?

A

due to the acute and rapid nature of the injury

268
Q

What is a burn?

A

damage to the skin and underlying tissues caused by heat, cold, electricity, chemicals, friction, or radiation

269
Q

In burn pathophysiology, what happens in the Zone of Coagulation?

A

Cell death occurs immediately, this area isn on-salvageable

270
Q

In burn pathophysiology, what happens in the Zone of Stasis?

A
  • Cells are alive but have compromised circulation
  • can fully recover or become part of zone of coagulation depending on treatment
271
Q

In burn pathophysiology, what happens in the Zone of Hyperaemia?

A

Cell damage is minimal and full recovery is expected

272
Q

What type layers of skin are damaged in a 1st degree or superficial burn?

A

Minor epithelial damage to the epidermis

273
Q

What type layers of skin are damaged in a 2nd degree or partial burn?

A

Complete damage of epidermis;
may have superficial or deep dermal damage

274
Q

What type layers of skin are damaged in a 3rd degree or full burn?

A

Destruction of epidermal and dermal layers

275
Q

What type layers of skin are damaged in a 4th degree or full+++ burn?

A
  • Complete destruction of skin layers
  • subcutaneous adipose tissues, fascia, muscles, bones, and/or organs burnt
276
Q

What are the clinical features of a superficial (1st degree) burn?

A
  • Red and warm to touch
  • Tissue damage to outer epidermal layer
  • Intense and painful inflammatory response–
277
Q

How do you manage a superficial (1st degree) burn?

A

Symptomatic treatment:
paracetamol
ibuprofen
soothing creams

278
Q

What are the clinical features of a partial thickness (2nd degree) burn?

A
  • Entire epidermis into variable depth of dermis
  • Can progress to full thickness burn with poor management
279
Q

How do you manage a partial thickness (2nd degree) burn?

A
  • cool burn
  • cover with clean, dry dressing
  • analgesia
280
Q

What are the clinical features of a full thickness (3rd or 4th degree) burn?

A
  • Often white, dry, leathery regardless of skin tone /race, or;
  • Charred appearance in high heat / severe cases
  • Area of full-thickness necrosis will be insensitive but surrounding areas very painful
281
Q

What are the hospital treatments for a full thickness (3rd or 4th degree burn)?

A
  • surgery
  • may require emergency escharotomy to cut skin and relieve pressure
282
Q

What skin layers does the coagulation zone comprise of in a full thickness (3rd or 4th degree) burn?

A

all three skin layers

283
Q

What causes superficial (1st degree) burns?

A

sun or minor flash

284
Q

What causes partial thickness (2nd degree) burns?

A

hot liquids, flashes or flame

285
Q

What causes full thickness (3rd or 4th degree) burns?

A

chemicals
electricity
flame
hot metals

286
Q

What is the skin colour in a superficial (1st degree) burn?

A

red

287
Q

What is the skin colour in a partial thickness (2nd degree) burn?

A

mottled red

288
Q

What is the skin colour in a full thickness (3rd or 4th degree) burn?

A

early white and/or charred, translucent and parchment-like

289
Q

What does the skin surface look like in a superficial (1st degree) burn?

A

dry with no blisters

290
Q

What does the skin surface look like in a partial (2nd degree) burn?

A

blisters with weeping

291
Q

What does the skin surface look like in a full thickness (3rd or 4th degree) burn?

A

dry with thrombosed blood vessels

292
Q

What is the sensation of a superficial (1st degree) burn?

A

painful

293
Q

What is the sensation of a partial thickness (2nd degree) burn?

A

painful

294
Q

What is the sensation of a full thickness (3rd or 4th degree) burn?

A

anesthetic with peripheral pain

295
Q

What is the healing time of a partial thickness (2nd degree) burn?

A

2-4 weeks depending on depth

296
Q

What is the healing time of a full thickness (3rd or 4th degree) burn?

A

requires skin grafting

297
Q

What is the healing time of a superficial (1st degree) burn?

A

3-6 days

298
Q

what is the systemic response to a burn?

A

Burned tissue releases inflammatory mediators in the surrounding circulation

299
Q

What does the systemic response in a burn achieve in small burns?

A

helps expand the zone of hyperaemia to bring more blood, oxygen, and nutrients to the zone of stasis to assist with healing

300
Q

What can the systemic response in a burn achieve in burns >20% TBSA?

A

systemic vasodilation causing albumin to move into intracellular spaces and sodium into cells, depleting intravascular space and increasing tissue oedema as cells and extracellular spaces swell

301
Q

What are the 6 types of burns?

A

airway
chemical
electrical
friction
radiation
thermal

302
Q

What are the 2 types of thermal burns?

A

hot
cold

303
Q

What are the 2 types of chemical burns?

A

Acidic (coagulative necrosis)
Alkali (liquefactive necrosis)

304
Q

What can cause thermal - heat burns?

A

fire, water, oil, steam

305
Q

What is the most common type of burn?

A

thermal - heat

306
Q

What is the pathophysiology of a thermal - heat burn?

A

coagulates proteins wihtin tissues causing cell death

307
Q

What type of thermal - heat burn are very common in children and how do they occur?

A
  • scalds
  • from pulling a hot drink or pot onto themselves while exploring
308
Q

What is the characteristic burn pattern in a paediatric scald?

A

V pattern over face and chest

309
Q

What causes thermal - cold burns?

A

liquid nitrogen or dry ice

310
Q

Are thermal - cold burns deep or shallow?

A

shallow

311
Q

What is the treatment for a thermal - cold burn?

A

rewarm affected area in warm water

312
Q

Are thermal - cold burns common or uncommon?

A

uncommon

313
Q

What is the pathophysiology of a thermal - cold burn?

A

tissue proteins are coagulated causing cell death

314
Q

How do you treat a chemical - acid burn?

A
  • Brush off powders before commencing irrigation
  • Irrigate with water until burning process stops (to remove the agent, not cool the burn)
315
Q

What are the common acids that cause a chemical - acid burn?

A
  • hydrochloric acid (toilet & drain cleaner)
  • sulphuric acid (car batteries)
  • hydrogen peroxide (bleaching agent)
316
Q

What is the pathophysiology of an acid burn?

A

tissue proteins are coagulated, causing cell death

317
Q

What is the pathophysiology of a chemical - alkali burn?

A
  • liquefy tissue, leaving the next level down available for more burning
  • typically work slower than acid
318
Q

How do you treat a chemical - alkali burn?

A

Brush off powders before commencing irrigation
Irrigate with water until burning process stops, may take >30 mins for alkali (to remove the agent, not cool the burn)

319
Q

What are the common acids that cause a chemical - alkali burn?

A
  • lime (calcium oxide, used in agriculture)
  • sodium hypochlorite (bleaching agent)
  • sodium hydroxide (oven cleaner).
320
Q

What causes a friction burn?

A

rapid abrasion of skin causing direct damage and heat generation

321
Q

What is the treatment for friction burns?

A

first aid

322
Q

What is the pathophysiology of radiation - sunburn/windburn?

A

UV radiation from the sun damages the DNA in skin cells, causing an inflammatory response

323
Q

What skin layers can radation - sunburn/windburn damage?

A

epidermal to dermal

324
Q

Why can large (typically ful body) radiatio - sunburn/windburn cause hospitalisation?

A

large release of inflammatory mediators can cause systemic effects

325
Q

What is the treatment for radiation - sunburn/windburn?

A

oral analgesia and topical creams

326
Q

What is radiation - flash burn (welders burn)?

A

UV damage to the cornea

327
Q

What causes radiation - flash burn (welders burn)?

A

welding without a mask or looking at the sun

328
Q

What are the clinical features of a radiation - flash burn (welders burn)?

A

painful bloodshot eyes

329
Q

What is the treatment for radiation - flash burn (welders burn)?

A

typically self resolves

330
Q

What is the mechanism of electrical burns?

A

Electrical current passes through body, potentially creating entry & exit wounds

331
Q

Is tissue damage proportional to voltage in electrical burns?

A

yes

332
Q

What is low voltage in relation to electrical burns?

A

household 240V

333
Q

What is high voltage in relation to electrical burns?

A

> 1,000V

334
Q

What is fatal voltage in relation to electrical burns?

A

> 70,000V

335
Q

What do low voltage entry and exit wounds look like?

A

small, deep wounds

336
Q

What do high voltage entry and exit wounds look like?

A
  • extensive damage
  • charring
  • limb loss
  • often massive tissue loss
337
Q

What secondary injuries can electrical burns cause?

A
  • musculoskeletal injuries due to intense musclecontraction
  • rhabdomylosis
338
Q

What causes airway burns?

A

Inhalation of hot gasses:
smoke, steam, fumes, etc

339
Q

What do airway burns predominately affect?

A

upper airways as heat not transferred to lungs

340
Q

What are the clinical features of airway burns?

A
  • Sooty sputum, swollen lips, tongue, throat, difficulty swallowing
  • Stridor, laryngeoedema, progressive obstruction due to swelling, constantly clearing throat
341
Q

Is the onset of airway swelling in airway burns rapid or delayed?

A

delayed but can progress rapidly once begins

342
Q

What can cause lung injury in airway burns?

A

steam - due to high heat carrying capacity of water vapour

343
Q

What does a thermal injury to the lungs cause?

A

damage to lower airways
may cause bronchspasm
results in pulmonary oedema

344
Q

What area is the focus of burns management?

A

zone of stasis

345
Q

What is the recovery of the zone of stasis dependent on?

A
  • Good first aid
  • Prevention of hypothermia
  • Good fluid resuscitation
  • Elevation of affected limbs
  • Prevention of infection
  • Covering of the burn
  • Analgesia
346
Q

How long should a burn be cooled under running water and how long this effective?

A

20 minutes
effective up to 3 hours post burn

347
Q

What does first aid for burns consist of?

A
  • Cooling - 20 minutes under running water
  • Remove rings, watches, etc. from affected limb – oedema will develop
  • Remove loose, non adherent clothing
  • Don’t remove adherent or burned-on clothing or substances
348
Q

When should IV access be gained and fluids started in a burns patient?

A

ASAP

349
Q

What is the formula for PHIFTEEN-B volume guidelines for burns?

A

15mL/hr x TBSA, rounded to nearest 10%

350
Q

In airway burns, when should you administer fluids?

A

after the airway is secure due to risk of rapid airway oedema and obstruction

351
Q

If a burns patient has hypovolamia, what should you do?

A

look for an additional injury

352
Q

What does raising the burned limb achieve?

A

increased passive drainage and reduced swelling

353
Q

How do you prevent infection and cover a burn?

A
  • patted dry (rubbing will tear the skin)
  • clear plastic cling wrap should be applied to the burn
  • Circumferential wrapping is fine as long as it is not tight
354
Q

What type of burns can BurnAid dressing be used on?

A

small burns <10% TBSA

355
Q

What should you consider with regards to analgesia in burn patients?

A
  • among the most painful types of injuries
  • early, aggressive analgesia for significant burns
  • Place IV early or administer IM fentanyl prior to turning off cool running water as it controls pain but it will spike dramatically when the water is removed
  • Poor pain management makes every other aspect of the case extremely challenging due to patient agitation.
  • CCP’s can administer several analgesic agents (midazolam, ketamine)
356
Q

What is the management for chemical burns?

A
  • PPE, and provide glasses & mask to Pt if you have them
  • Remove patient & yourselves from source
  • Remove patient’s clothing and place into plastic bags
  • Brush chemical from skin if dry in nature
  • Flush copiously with water; be careful where it splashes & drains
  • Check for any retained matter, repeat flush
  • Apply non-adherent dressing even if no obvious wound
  • Never apply cling wrap or BurnAid to chemical burns
357
Q

Why are airway burns potentially dangerous?

A

due to damage and associated oedema of the upper airway

358
Q

What signs indicate airway burns?

A

singed hair
soot in nose or mouth
hoarse voice

359
Q

How long does it take for oedema and associated airway compromise to develop?

A

several hours

360
Q

What is the focus and priority of airway burns?

A

recognition and early transport to a tertiary hospital

361
Q

What causes high voltage burns?

A

Lightning or electric shock

362
Q

How do high voltage burns cause death?

A

Current causes immediate cardiac arrest
Tissue between entry and exit wounds is damaged and leaks K+ causing cardiac arrest (get CCP as they can give meds for this)

363
Q

When should a burns patient be taken to a dedicated burns unit?

A
  • Partial thickness burns >20% all ages; or >10% in patients younger than 10 or older than 50
  • Full thickness burns >5%
  • Burns involving face, eyes, ears, hands, feet, genitalia, buttocks, perineum or overlying a major joint
  • All inhalation burns
  • All significant electrical burns
  • Burns in people with significant co-morbidities (e.g. heart failure)
364
Q

What is multi system trauma?

A

Trauma involving more than one part of the body

365
Q

What kills in multi-system trauma?

A

Multisystem trauma life threats:
* Airway compromise
* Tension pneumothorax
* Hypovolaemicshock
* Traumatic Brain Injury

(cardiac tamponade and hamothorax but we cant fix)

366
Q

What are the 2 options for managing the airway in multi trauma?

A
  • Basic management – Simple, proven, often requires lateral positioning, no protection from aspiration or trismus, patient agitation complicates.
  • RSI – complex, proven, adds to on scene time, patient remains supine, total airway protection, pt is controlled (HARU or HEMS)
367
Q

What are the 2 options for managing tension
pneumothorax?

A
  • Needle thoracostomy (decompression) –Pneumodart
  • Finger thoracostomy (HARU or HEMS)
368
Q

What is a finger thoracostomy?

A

incision in made in the upper mid axilla, forceps used to dissect through to the pleural space and finger used to sweep the inside of the cavity

creates an open chest wound – requires intubation

369
Q

What can cause hypovolaemic shock?

A
  • external bleeding
  • internal bleeding
370
Q

How do you treat external bleeding?

A
  • Pad & bandage
  • Tourniquet
  • Wound packing with haemostatic dressings
371
Q

How do you treat internal bleeding?

A

Tranexamic acid (TXA)

372
Q

What are the variables in the coagulopathy of severe trauma (COAST) score?

A
  • entrapment
  • systolic blood pressure
  • temperature
  • major chest injury likey to require intervention
  • likely intra-abdominal or pelvic injury
373
Q

How much blood is lost in a fractured rib?

A

150ml per rib

374
Q

How much blood is lost in a fractured tibula, fibula or humerus?

A

500ml each

375
Q

How much blood is lost in a fractured femur?

A

1500ml each

376
Q

How much blood is lost in a fractured pelvis?

A

entire blood volume

377
Q

Why is early notification of a multi-trauma
that may require MTP essential?

A

Takes time to prepare blood for massive transfusion protocol

378
Q

What components of blood are required to prepare for massive transfusion protocol?

A

red blood cells
fresh frozen plasma
platelets

379
Q

What MAP is required in a suspected TBI?

A

90

380
Q

What is the preferred minimum volume resuscitation goal in all multi-trauma (without a known/suspected TBI)?

A

MAP 65 or radial pulse

381
Q

What MAP is rquired in the multi-trauma patient with a suspected TBI?

A

MAP 90
(SBP 100-120)

382
Q

In multi system trauma what specific interventions can paramedics do to improve outcome?

A
  • Early control of airway + maximise oxygenation
  • Early control of bleeding – internal (pelvic splint +traction splint) and external (tourniquet, pad andbandage, wound packing)
  • Recognition and correction of tension pneumothorax
  • Early transport to trauma centre
383
Q

What Damage Control Resuscitation components are to be used in multi-trauma or the severely injured trauma patient?

A

Minimum volume resuscitation
Managing the lethal triad

384
Q

What are some of the unfavourable side efftects of saline when treating hypovoleamia?

A

dilutional coagulopathy
hypothermia

385
Q

What is the end goal for minimum volume resuscitation?

A

Maintain a radial pulse
MAP of 65 - ‘65 kidneys alive’

386
Q

What is the order of organ demise in hypovolaemia?

A

kidneys
liver
spleen
intestines
heart
lungs
brain

387
Q

What are the components of the lethal triad in trauma (part of damage control resuscitation)?

A

hypothermia
coagulopathy
acidosis

388
Q

What causes the hypothermia component of the lethal triad in trauma?

A

Remove clothes
IV access –fluids
Move to air conditioned ambulance

389
Q

What do paramedics need to do to prevent the hypothermia component of the lethal triad when treating trauma patients?

A

Give minimal fluids
Apply blankets, ideally self warming blankets early
Warm ambulance, in major trauma you should be sweating from the ambient heat in the vehicle

390
Q

What causes the acidosis component of the lethal triad in trauma?

A

Hypoxia from poor perfusion
leads to anaerobic metabolism
(ATP created from differnt fuel source resulting in lactic acid causing blood to become acidic)

391
Q

What do paramedics need to do to prevent the acidosis component of the lethal triad when treating trauma patients?

A

Maximise oxygen delivery
Mildly hyperventilate where possible to maintain EtCO2 at 35-45 mmHg
Minimise normal saline (which has a pH of 5.5!)

392
Q

What causes the coagulopathy component of the lethal triad in trauma?

A

blood’s clotting factors depleted or imbalanced in massive bleeding

worsened by dilutional anaemia, acidosis and hypothermia

393
Q

What do paramedics need to do to prevent the coagulopathy component of the lethal triad when treating trauma patients?

A
  • Avoid hypothermia
  • Administer fluid according to minimum volume resuscitation principles
  • Provide early notification to hospital of incoming trauma so blood products can be prepared
394
Q

What is shock?

A

circulatory failure resulting in cellular and tissue hypoxia causing cellular death and vital organ dysfunction.

395
Q

What are the types of shock?

A

Distributive
Obstructive
Cardiogenic
Hypovolaemic

396
Q

What does ‘Shock’ in the public vernacular refer to?

A

psychological shock as opposed to physiological shock
(they’re upset)

397
Q

What determines blood pressure?

A

cardiac output x peripheral vascular resistance

398
Q

What determines cardiac output?

A

stroke volume x heart rate

399
Q

What are the signs of shock?

A

tachycardic
tachypnoeic
mottled peripheries

400
Q

When can you begin treating shock?

A

When you know what type of shock it is

401
Q

What causes distributive shock?

A

hypotension (pipes expanding)
sepsis
anaphylaxis
neurogenic shock

402
Q

What causes neurogenic shock?

A

trauma from injury in spinal cord and body loses sympathetic tone below level of injury

403
Q

What causes obstructive shock?

A

Hypotension (pipes or pump blocked)
massive PE - pipe
tension pneumothorax - pump
tamponade - pump

404
Q

How does a tension pneumothorax cause obstructive shock?

A

air trapping in chest moves lungs and squashes heart

405
Q

How does a tamponade cause obstructive shock?

A

pericardial sac can’t expand so crushes heart

406
Q

What causes cardiogenic shock?

A

hypotension (pump failure)
penetrating injury to heart
myocardial infarction
contusion (bruise stops cells from contracting properly as they are damaged)

407
Q

What causes hypovolaemic shock?

A

hypotension (pipes empty)
bleeding
dehydration (over longer term)

408
Q

What are the signs and symptoms of 15% blood loss?
(750ml in 70 kg)

A

minimal or no tachycardiac response
BP changes do not usually occur

409
Q

What are the signs and symptoms of 15-30% blood loss?
(750ml - 1500ml in 70 kg)

A

tachycardia
hypotension
peripheral hypoperfusion
ALOC

410
Q

What are the signs and symptoms of >40% blood loss?
(>2L in 70 kg)

A

haemodynamic compensation at liit
decompensation imminent
ALOC

411
Q

When should a major trauma hospital be the primary destination?

A

if patient i5 60 minutes or less from major trauma hospital

(if urgent interventions are needed eg airway - take to nearest tertiary centre)

412
Q

What do you do if you are more than 60 minutes from a major trauma centre?

A

notify the communications department that a transfer will be required and transport to the nearest regional centre

413
Q

What vital signs are associated with major trauma?

A

conscious state
respiratory rate
SPO2
heart rate
systolic BP

414
Q

What are the mechanisms of injury that define major trauma?

A
  • Ejected from a vehicle
  • Fall from a height of 3 metres or more
  • Explosion
  • High impact RTC with incursion into the occupant’s compartment
  • Vehicle rollover
  • RTC with a fatality in the same vehicle
  • Entrapped for longer than 30 minutes
415
Q

What are the patterns of injury that define major trauma?

A

Injuries to the head, neck, chest, abdomen, pelvis, axilla, or groin that:
- are penetrating
- are sustained from blasts
- involve two or more of those regions
* Limb amputation above the wrist or ankle.
* Suspected spinal cord injuries
* Burns in adults >20%, or in children >10%, or other complicated burn injury including burn injury to the hand, face, genitals, airway, or respiratory tract
* Serious crush injury
* Major open fracture, or open dislocation with vascular compromise
* Fractured pelvis
* Fractures involving two or more of femur, tibia, or humerus

416
Q

When does HEMS not add value?

A

If road transport time to a major trauma service is less than 30 minutes

417
Q

What are some considerations regarding Helicopter Emergency Medical Service (HEMS)?

A
  • The helicopter will need somewhere to land
  • Flat surface away from trees and overhead wires
  • A road is often ideal. Police will need to block or diverttraffic to create space
  • Do not approach the helicopter until the rotors have stopped turning
418
Q

What are the common causes of preventable early death in trauma?

A

60% haemorrhage
33% tension pneumothorax
10% cardiac tamponade (we can’t treat this one)
7% airway obstruction

419
Q

In traumatic cardiac arrest, what takes priority over all other interventions?

A

external haemorrhage control

420
Q

Where do you direct your attention after haemorrhage control in a traumatic cardiac arrest?

A

airway or breathing
(unless there are sufficient people to perform interventions simultaneously)

421
Q

Which type of trauma has better outcomes in traumatic cardiac arrest - blunt or penetrating?

A

penetrating as damage is more isolated

422
Q

What are the methods of haemorrhage control in trauma?

A

direct presure
emergency bandage
tourniquet
wound packing

423
Q

What are the most common methods of haemorrhage control in traumatic cardiac arrest?

A

emergency bandage
tourniquet

424
Q

How many points of access should you aim to get in a trauma patient with low blood volume and why?

A

multiple points of access as a large volume of fluid is required very quickly

If IO being drilled still look for IV access

425
Q

What is the rapid infusion rate for hypovolaemia in trauma?

A

20ml/kg normal saline followed by 5-10ml/kg

426
Q

What is the preferred substance for volume replacement in the trauma patient?

A

Blood is preferred if HARU or the flight team are available

427
Q

What are the initial steps in airway management in traumatic cardiac arrest?

A

Double or triple airway maneuver
Suction
Basic airway adjuncts (if eneffective and have time igel can be used)
Opening of the airway may be all that is needed

428
Q

What type of airway adjunct will direct trauma to the airway require?

A

advanced airway

429
Q

When should traumatic cardiac arrest patients have their chests decompressed?

A

suspected chest trauma who do not respond to airway opening and restoration of blood volume

430
Q

What are the classic signs of cardiac tamponade that may not be present in traumatic cardiac arrest?

A

Distended jugular vein
Hypotension
Decreased heart sounds

431
Q

What are the ECG signs of cardiac tamponade?

A
  • Electrical Alternans (onsecutive, normally-conducted QRS complexes that alternate in height)
  • Low voltage QRS complex
  • Tachycardia
432
Q

What causes electrcial alternans?

A

when the heart swings backwards and forwards within a large fluid-filled pericardium

433
Q

What is the management for cardiac tamponade in the traumatic cardiac arrest?

A

resuscitative thoracotomy
(clam shell)

434
Q

What is Resuscitative thoracotomy?

A

Involves cutting through the ribs and sternum to open the chest. Very unlikely for this to occur prehospitally (although it does happen)

435
Q

What are the benefits of a Resuscitative thoracotomy?

A
  • release tension pneumothorax or cardiac tamponade;
  • allow direct control of intrathoracic haemorrhage;
  • allow cross-clamping the descending aorta (in so doing stopping blood loss below the diaphragm and improving brain and cardiac perfusion); and
  • permit open cardiac compression and defibrillation
436
Q

Who can do a resuscitative thoracotomy?

A

appropriately trained doctor

437
Q

What is the primary survey in a traumatic cardiac arrest?

A

Danger
External haemorrhage control
Response
Circulation
Airway
Breathing

438
Q

In what order do you treat reversible causes?

A

prioritised based on the patient presentation

439
Q

What procedures should you do in traumatic cardiac arrest patients when you don’t know what the reversible cause is?

A

it is ok to attempt all options for reversible causes

440
Q

When do you administer adrenaline in the traumatic cardiac arrest?

A

as normal after all the reversible causes have been addressed

441
Q

When do you do CPR in traumatic cardiac arrest?

A

only after haemorrhage control, airway control, and IV access with fluids running, and chest decompression

If you have another crew or bystanders, one of them can do CPR

442
Q

What type of rhythm will over 90% of trauatic arrest patients be in?

A

PEA or asytole

443
Q

What does a narrow complex PEA suggest?

A

a reversible cause may be present

444
Q

What heart rate in a PEA in traumatic cardiac arrest is an indicator of survival?

A

> 40

445
Q

What is Impact Brain Apnoea?

A

Rare presentation of head injury where a concussive impact to the brainstem causes apnoea, generally without other significant brain injury

446
Q

What type of treatment does impact brain apnoe require?

A

ventilation

447
Q

When do you initiate transport in a traumatic cardiac arrest?

A

when ROSC is achieved on scene

448
Q

When do you initiate transport in a traumatic cardiac arrest prior to ROSC being achieved?

A

when the hospital is insuch close proximity that there is a realistic chance of a resuscitative thoracotomy being performed within 10 minutes

449
Q

What is the management of traumatic cardiac arrest after ROSC is achieved?

A
  • If bleeding is suspected as the cause of the arrest, aim for a systolic BP of 90 to avoid further bleeding
  • If TBI is suspected as the cause aim for a higher systolic BP of 110
450
Q

When do you stop resuscitation in traumatic cardiac arrest?

A
  • Standard 20 minute resuscitation with all the reversible interventions performed.
  • If after this time there is no ROSC, resuscitation can cease
451
Q

Inside an upside down car you find a patient still wearing their seatbelt, breathing with a weak, but fast corotid pulse. They do not appear to be entrapped. How are you going to get them out?

A

Focus on getting her out as quickly as possible with best attempts to maintain C spine support. But as has significant trauma, haemorrhage is priority.

452
Q

Your primary survey of a trauma patient reveals:
D – None
R – Groans to pain (AVPU)
A – No blood but patient snores in supine position
B – Yes, seems fast, around 1 breath every 2 seconds (30 per minute)
C – Weak carotid, no radial, feels fast
D – Sluggish size 5
E – Multiple abrasions, compound L tib/fib fracture. Yellowish fluid seeping from L ear.

What actions will you undertake in the next 5 minutes?

A
  • OPA & oxygen
  • Remove clothing
  • Auscultate chest – decompress if needed (no breaths sounds on one side)
  • Pelvic binder
  • Torniquet around L leg – can remove for something better as case continues – emergency bandage
  • IV access
  • IV fluids to maintain radial pulse/MAP 65 (due to suspected TBI)
  • Actively warm
  • CCP backup
453
Q

How would you administer fluid in a severely hypotensive patient eg around 60/40 and what is your end point?

A

500ml saline bolus via rapid infusion to reach MAP 90/SBP 100-120 due to brain injury. Ongoing reassessments and reducing saline infusion if required to maintain MAP 90/SBP 100-120

454
Q

When is a major trauma centre the primary destination over a regional hospital?

A

if a pt is 60 minutes or less from the major trauma centre

455
Q

When do you transport a major trauma patient to a regional hospital?

A

when the major trauma centre is more than 60 minutes away

456
Q

How can you differentiate between hip dislocation and hip fracture?

A
  • Hip fractures typically elderly pts from simple falls or a similarly minor mechanism
  • Hip dislocations require very significant mechanisms such as car crashes or long falls
457
Q

What is a crush injury?

A

tissue trauma produced directly from a crushing force

458
Q

What can cause a crush injury?

A

being crushed by a falling object
crushing pressure of the body on a hard surface (eg elderly person lying on tiles for several days unable to move)

459
Q

What toxins cause damage in crush syndrome?

A

potassium
myoglobin
lactic acid

460
Q

How does lactic acid occur in compartment syndrome?

A

byproduct of the hypoxic and hypo perfused tissues switching to anaerobic metabolism

461
Q

What is the primary objective/role of the first crew on scene in a multi casualty incident?

A
  • initiate command and control of incident
  • ensure personal safety and safe approach
  • initial triage
  • site control
462
Q

Who assumes the role of Forward Commander?

A

most senior officer (of first crew on scent)

463
Q

Who assumes the role of Triage Officer?

A

Second officer (of first crew on scene)

464
Q

What are the responsibilities of the Forward Commander who is located in the Forward Command Post?

A
  • all ambulance resources (assigning officers to roles as ambulances arrive)
  • liaising with other agency commanders in joint management of the incident
  • keeps comms updated
465
Q

What are the responsibilities of the Triage Officer who is located in the Casualty Clearing Post?

A

initial triage
organise the casualty clearing area
oversee SORT
organise priority of transport
keep the commander updated
should be a hands off role (depending on resourcing)

466
Q

What are the steps on arrival to a multi-casualty event?

A
  • Arrive and identify multi-cas event
  • Sitrep 1
  • Decide who is forward commander (senior officer)
  • Other officer becomes triage officer
  • Triage officer opens SMART triage tags and begins to tag patients (SIEVE)
  • Scene commander does not touch patients but:
    • Provide Sitrep 2, update regularly
    • Create casualty clearing area
467
Q

What does a multi-cas SitRep 1 (windscreen) provide/include?

A
  • Confirm arrival
  • Confirm location
  • Provide snapshot of “what can been seen”
468
Q

What does a multi-cas SitRep 2 (METHANE) provide/include?

A

Major incident confirmation
Exact location
Type of incident
Hazards – prevent potential
Access to incident site
Number of casualties
Emergency Services required

469
Q

What are the categories in SIEVE?

A

Priority (red) - immediate interventions
Delayed (yellow) - will require interventions
Walking wounded (green)

470
Q

What is the purpose of SIEVE?

A

determine which area of the casualty clearing area to take the patient to

471
Q

What is the purpose of SORT?

A

determine the order of transport to hospital
(may change with time as score can be updated)

472
Q

What does CBR stand for?

A

chemical
biological
radiological

473
Q

What are the chemical poisoning agents?

A

Nerve – Sarin, VX gas
Blister – Mustard gas
Choking – Phosgene, Chlorine
Blood – Cyanide
Riot control – Tear gas, capsicum spray

474
Q

What is the management for chemical poisoning/exposure?

A

Decontamination by fire department
- extensive irrigation
Airway control
- Oxygen therapy
– Bronchodilators (salbutamol/ipratropium)
Antidote
– Atropine (nerve gas or bradycardia)
– Hydroxocobalamin (cyanide)

475
Q

What are the biological poisoning agents?

A

Viruses – Influenza, smallpox, ebola
Bacteria – Anthrax, bubonic plague, smallpox
Toxins – Botulism, Ricin

476
Q

What are the effects of nerve (sarin, VX gas) exposure?

A

parasympathetic overstimulation (SLUDGE/DUMBBELLS)

477
Q

What does SLUDGE stand for?

A

Salivation
Lacrimation
Urination
Diarrhoea/diaphoresis
Gastrointestinal
Emesis

478
Q

What does DUMBBELLS stand for?

A

Diarrhoea
Urination
Miosis
Bronchospsm
Bronchorrhea
Emesis
Lacrimation
Lethargy
Salivation

479
Q

What are the effects of Blister chemical exposure?

A

chemical burns - eyes and airways especially

480
Q

What are the effects of choking (phosgene chlorine) chemical exposure?

A

airway damage

481
Q

What are the effects of blood (cyanide) chemical exposure?

A

histotoxic hypoxia leading to multi organ failure

482
Q

What are the effects of riot control (tear gas) chemical exposure?

A

Irritation of eyes and mucous membranes, not lethal

483
Q

What are the effects of viruses (influenza, smallpox, ebola) biological exposure?

A

Variable incubation period and symptoms

484
Q

What are the effects of bacteria (anthrax, bubonic plague, smallpox) biological exposure?

A

Usually fatal if aerosolised as a powder and inhaled

485
Q

What are the effects of toxins (botulism, ricin) biological exposure?

A

Variable symptoms, usually not fatal with treatment

486
Q

What is the management of biological poisoning/exposure?

A

If at exposure:
PPE
Decontaminate

If at onset:
PPE
treat symptomatically

487
Q

How does radiological poisoning/exposure occur?

A

accidental - laboratories, medical devices
intentional - terrorism (nuclear or dirty bomb)

488
Q

What is the management for radiation exposure?

A

Decontamination
– Fire department - to remove irradiated material attached to person or clothes and bag them
Symptomatic management
– Acute radiation poisoning affects cell division so does not produce immediate effects (hair and mucous membranes affected first)

489
Q

How do you decontaminate the pt?

A

PPE for yourself
Wet down the victim
Remove wet clothing
Wash with soap and warmwater
Cover in clean clothes /blanket

490
Q

Do you still need to wear PPE when treating a decontaminated patient?

A

yes

491
Q

What type of PPE is required for CBR cases?

A

N95 mask
coveralls
eye protection
gloves

492
Q

Where does a pelvis fracture in an APC Type I?

A

Pubic symphyseal diastasis, <2.5 cm, no significant posterior ring injury (stable)

493
Q

Where does a pelvis fracture in an APC Type II?

A

Pubic symphyseal diastasis >2.5 cm, tearing of anterior sacral ligaments (rotationally unstable, vertically stable)

494
Q

Where does a pelvis fracture in an APC Type III?

A

Hemipelvis separation with complete disruption of pubic symphysis and posterior ligament complexes (completely unstable)

495
Q

Where does a pelvis fracture in a LCI?

A

Posterior compression of sacroiliac (SI) joint without ligament disruption (stable)

496
Q

Where does a pelvis fracture in a LCII?

A

Posterior SI ligament rupture, sacral crush injury or iliac wing fracture (rotationally unstable, vertically stable)

497
Q

Where does a pelvis fracture in a LCIII?

A

LC II, with open book (APC) injury to contralateral pelvis (completely unstable)

498
Q

Where does a pelvis fracture in a vertical shear?

A
  • vertical fracture of the pubic rami
  • displaced fractures of the anterior rami and posterior columns, including SI dislocation (completely unstable)
499
Q

What are the reversible causes of traumatic cardiac arrest?

A

Hypoxia
Hypokalaemia/hyperkalaemia
Hypothermia/hyperthermia
Hypovolaemia
Tension pneumothorax
Tamponade
Thrombosis
Toxins

500
Q

What are the regions and points for the rule of nines in adults?

A

head (front and back) 9%
chest 9%
abdomen 9%
upper back 9%
lower back 9%
left arm 9%
right arm 9%
left leg 18%
right leg 18%
genitals 1%

501
Q

What are the regions and points for the rule of nines in children?

A

head (front and back) 18%
chest 9%
abdomen 9%
upper back 9%
lower back 9%
left arm 9%
right arm 9%
left leg 14%
right leg 14%

502
Q

What are the regions and points for the rule of nines in infants?

A

head (front and back) 18%
front torso 18%
back torso 18%
left arm 9%
right arm 9%
left leg 13%
right leg 13%
genitals 1%

503
Q

What are the four abdominal quadrants?

A

right upper quadrant
left upper quadrant
right lower quadrant
left lower quadrant

504
Q

What organs are in the right upper quadrant?

A

liver
gallbladder
stomach
duodenum
right kidney
right adrenal gland
pancreas
transverse colon
small intestine

505
Q

What organs are in the left upper quadrant?

A

liver
stomach
left kidney
left adrenal gland
pancreas
spleen
transverse colon small intestine

506
Q

What organs are in the right lower quadrant?

A

small intestine
large intestine
cecum
appendix
right ureter
right reproductive organs

507
Q

What organs are in the left lower quadrant?

A

small intestine
large intestine
left ureter
left reproductive organs
sigmoid colon

508
Q

What is the weight indication for a pneumodart?

A

50+kgs

509
Q

What is the weight indication for a 14g cannula for chest decompression?

A

15-50kg (4-14yrs)

510
Q

What is the weight indication for a 16g cannula for chest decompression?

A

<15kg (less than 4yrs)

511
Q

What is the COAST score for entrapment?

A

yes - 1
no - 0

512
Q

What is the COAST score for SBP?

A

> 100 - 0
90-100 - 1
<90 - 2

513
Q

What is the COAST score for temperature?

A

> 35 - 0
32-35 - 1
<32 - 2

514
Q

What is the COAST score for major chest injury likely to require intervention?

A

yes - 1
no - 0

515
Q

What is the COAST score for likely intra-abdominal or pelvic injury?

A

yes - 1
no - 0

516
Q

What organs are in the Right hypochondriac region?

A

liver
gallbladder
right kidney
small intestine

517
Q

What organs are in the right lumbar region?

A

liver
gallbladder
right colon

518
Q

What organs are in the right iliac region?

A

appendix
cecum

519
Q

What organs are in the epigastric region?

A

adrenal glands
spleen
pancreas
stomach
duodenum
liver

520
Q

What organs are in the umbilical region?

A

duodenum
small intestine
umbilicus

521
Q

What organs are in the hypogastric or pubic region?

A

urinary bladder
sigmoid colon
female reproductive organs

522
Q

What organs are in the left hypochondriac region?

A

spleen
pancreas
left kidney
colon

523
Q

What organs are in the left lumbar region?

A

left kidney
descending colon

524
Q

What organs are in the left iliac region?

A

descending colon
sigmoid colon

525
Q

When would it be appropriate to initiate early transport for a traumatic cardiac arrest?

A

When there is a realistic change of a resuscitative thoracotomy being performed within 10 mins from loss of output

526
Q

What is hypovolaemic shock?

A

shock due to circulatory failure from intravascular volume loss

527
Q

Is distributive shock a pump or pipe issue?

A

pipe
expansion = hypotension

528
Q

Is obstructive shock a pump or pipe issue?

A

both
pump blocked = hypotension
pipes blocked = hypotension

529
Q

Is cardiogenic shock a pump or pipe issue?

A

pump
pump failure = hypotension

530
Q

Is hypovolaemic shock a pump or pipe issue?

A

pipes
pipes empty (have holes) = hypotension

531
Q

How long do you irrigate the eyes with water or sodium chloride for if exposed to chemicals?

A

30 mins or longer

532
Q

How long do you irrigate the eyes with water or sodium chloride for if not penetratin or exposed to chemicals?

A

<15 minutes

533
Q

If you see a non penetrating foreing body when irrigating eyes, how do you remove it?

A

moist cotton bud

Bachelor of Paramedic Science (19 decks)

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