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NCERT ECC IMPROVE INTERNATIONAL > The trauma patient > Flashcards

The trauma patient Flashcards

1
Q

what do patients require when presenting with a traumatic wound

A

Rapid and accurate triage
Initial stabilisation (ABCD)
Stop any bleeding with direct pressure
Control of contamination

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2
Q

Is initial assessment the same regardless of the treatment plan?

A

YES

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3
Q

What is the correct pressure for wound lavage

A

8-12psi

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4
Q

The more fluid used in wound lavage the less risk of what?

A

infection

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5
Q

What could a pressure over than 12 cause

A

infection to go deeper into the cells

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6
Q

What is wound lavage

A

a process which removes loose foreign material and necrotic tissue

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7
Q

What does wound lavage do

A

Removed impediments to healing and reduced infection

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8
Q

What is the best gauge needle to use in wound lavage

A

18-20

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9
Q

What solution is not recommended for wound lavage

A

chlorhexidine/ detergents

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10
Q

What is debridement

A

The removal of necrotic tissue and foreign material from a wound

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11
Q

What are the four different types of debridement

A

Sharp
Mechanical
Autolytic
Larval

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12
Q

What is an example of sharp debridement

A

use to a blade to remove tissue (surgical procedure)

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13
Q

What is an example of mechanical debridement

A

wet to dry dressing

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14
Q

What is an example of autolytic debridement

A

Honey therapy

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15
Q

When is autolytic debridement not reccomended

A

in infected or dry wounds

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16
Q

How many days should debridement be over in

A

3 days

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17
Q

What is the concertation of chlorhexidine scrub

A

50:50

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18
Q

What is the contact time of chlorhexidine scrub

A

6 MINS

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19
Q

What does mechanical debridement rely on

A

the adherence or friction to remove necrotic tissue

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20
Q

What does autolytic debridement promote

A

Promotes the bodies own debridement by activating the phagocytes (WBC) around the wound

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21
Q

What is the pH of honey

A

3.5 - 5.5

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22
Q

What action what would you take if the wound was at a stage of infection/inflammation etc

A

remove foreign material and debride

absorb exudate

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23
Q

What would you do if a wound was granulating

A

dress the wound with a non adherent dressing,
maintain a moist environment.
Do not disturb the process of epithelialisation

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24
Q

What would you do if a wound showed to have chronic granulation

A

debride the chronic granulation and kick start the process

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25
Q

What would you do if a wound was static

A

Investigate (biopsy)

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26
Q

what are 4 functions of dressings

A

absorption of exudate
protection of the wound
promote wound healing
prevention of infection

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27
Q

What are 4 characteristics of dressings

A

non irritant
absorptive
Sterile
maintain a moist environment

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28
Q

What is an example of a perforate polyurethane membrane dressing

A

Melolin

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29
Q

What is a perforate polyurethane membrane dressing

A

a dressing that has a thin perforated polyurethane membrane that is coated with an absorbent backing layer

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30
Q

What is an example of a vapour permeable film

A

Tegaderm or Ioban (iodine)

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31
Q

What do vapour permeable film dressings do

A

Aid moist wound healing while providing a barrier to protect the wound from environmental contamination and trauma

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32
Q

What is an example of a polyurethane foam dressing

A

Allyven

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33
Q

What is a polyurethane foam dressing

A

A foam that has a high absorbent capacity and draws exudate away from the wound

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34
Q

What is a hydrocolloid dressing

A

Natural or synthetic polymers (e.g gelatin) that allows moist wound healing and provided a gentle debridement and encourages granulation tissue to form

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35
Q

How does a hydrogel function

A

They function by aiding moisture wound healing providing gentle debridement and encourage growth of granulation tissue

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36
Q

What is an example of a hydrogel

A

intrasite

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37
Q

What is the function of a alginate dressing

A

They function by aiding moisture wound healing providing gentle debridement and encourage growth of granulation tissue

38
Q

What is an example of a alginate dressing

A

katlostat

39
Q

When is a polyacrylate (super absorbent) dressing be used for

A

when a penrose drain is in situ

40
Q

What are 3 examples of antimicrobial dressings

A

PHMB impregnated dressing
Silver dressings
Manuka honey

41
Q

What is PHMB

A

a antimicrobial agent exhibiting board spectrum activity against bacteria and fungi

42
Q

When is PHMB effective

A

Pseudomonas MRSA

43
Q

What are some clinical signs of a uroabdomen

A 
Acities 
Azotemia 
Hyperkalemia 
Bradycardia 
Arrhythmias 
Hypovolemic shock
44
Q

What MUST you do for a patient with a uroabdomen prior to fixing the abdomen

A

Stabilise the patient

45
Q

How do you stabilise a patient with a uroabdomen

A

Manage acid-base and electrolyte imbalance
Volume resucitation with isotonic crystalloids
treat the hyperkalemia - calcium gluconate

46
Q

What are the 3 steps to take with a uroabdomen

A
  1. fluids
  2. sort electrolytes
  3. get urine out
47
Q

What are the two types of head trauma

A

primary and secondary

48
Q

What is a primary head trauma

A

Direct tissue trauma

49
Q

What is an example of primary head trauma

A

skull fracture

cerebral haemorrhage

50
Q

what are the forces applied in primary head trauma that brain cannot handle

A

acceleration
deceleration
rotational

51
Q

What is secondary trauma

A

It comes after primary trauma it is the cascade of biomolecular events causing continued and progressive brain pathology

52
Q

What is an example of secondary head trauma

A 
cerebral ischemia (blood flow is restricted) 
hydrocephalus
intracranial pressure
53
Q

What are the main 3 parts of the brain

A

cerebrum
cerebellum
brainstem

54
Q

What is the brain dependant on

A

sufficient blood flow and energy supply and oxygen

55
Q

What consumes 20% of the bodies oxygen

A

brain

56
Q

how much glucose does the brain require %

A

more than 25 %

57
Q

What is cerebral blood flow dependant on?

A

cerebral perfusion pressure (CCP) and cardiovascular resistance

58
Q

What is cerebral perfusion pressure (CCP)

A

the amount of blood that gets to the brain

59
Q

What is the normal range of CCP

A

50-150mmhg

60
Q

Complete the equations CCP= x - x

A

CCP = MAP - ICP

61
Q

What are some clinical signs/consequences of a brain injury

A 
hypoxia 
increased ICP 
Haemorrhage 
oedema 
Nystagmus 
Comatosed
62
Q

What fluids are recommended for ICP

A

Hypertonic

63
Q

Why is isotonic fluids not recommended in a case of ICP

A

Because the fluid will go into the interstitum of the brain causing ICP to worsen.

64
Q

What is the cushings response

A

increased BP and decreased HR reflex bradycardia

65
Q

Why shouldnt you raise the jugular vein on a patient with head trauma

A

its raises ICP

66
Q

What is the Seldinger technique

A

it is a technique using a preplaced guide wire directing a long flexible catheter

67
Q

When is the Seldinger technique used

A

Chest drain placement

Central line placement

68
Q

What are the 5 important sections of CPR/CPA

A 
Prepare/prevent 
Basic life support 
Advanced life support 
monitoring 
post arrest care
69
Q

What is important when preparing people for CPR

A 
Train the staff 
have a designated section 
Crash trolley (stocked) 
CPR protocol 
emergency drug dose and chart 
Recognition of arrest
70
Q

What does basic life support consist of

A

Circulation
Airway
Breathing

71
Q

What is the 1st thing that should be addressed in CPR and how

A

Circulation

Compressions

72
Q

Why should circulation be addressed first in a patient that has CPA

A

Patients don’t have any blood outflow to the heart or o2 delivery

73
Q

What position should chest compressions be done in

A

lateral recumbency

74
Q

in a bull dog what position should chest compressions be done

A

dorsal recumbency

75
Q

in a greyhound what position should chest compressions be done?

A

lateral recumbency on the deepest part of the chest

76
Q

how deep should you do chest compressions

A

1/3-1/2 of the width of the chest

77
Q

how many chest compressions per min should you do regardless of species

A

100-120 bpm

78
Q

What should be done first in terms of addressing a patients ventilation if in severe resp distress or comatosed

A

Intubate the patient with an ET tube

79
Q

What does the cardiac pump consist of?

A

The left and right ventricles are directly compressed causing an increasing pressure, causing the ventricles to open the pulmonic and aortic valves, providing blood blow to the lungs and tissues.

80
Q

What causes a recoil in the chest allowing the ventricles to fill?

A

Negative pressure

81
Q

Why is low minute ventilation important in a CPA

A

Hyperventilated patients lead to a low CO2. Causing a cerebral vasocontriction and decreases oxygen to the brain

82
Q

What are the main emergency drugs in CPR

A 
Adrenaline (epinephrine) 
Vasopressor 
Atropine 
Reversal agents 
Fluids 
Calcium Bicarbonate
83
Q

Whats the dose of adrenaline

A

0.01mg/kg-0.1mg/kg

84
Q

How often do you administer adrenaline in CPR

A

every 3-5 mins

85
Q

How many compressions to breaths should you do in CPR

A

30 compressions : 2 breaths

86
Q

What intercoastal space should you place a chest drain or perform thoracentesis

A

7-8 intercostal space

87
Q

When placing a chest drain where should you make a skin incision

A

10th intercostal space

88
Q

What does ETCO2 (Capno) tell you in a CPR

A

If the ET tube is in

ETCO2 is proportional of blood flow.

89
Q

What tracheal ring should you incise when doing a tracheostomy

A

3-4 or 4-5 ring

90
Q

what size of trach tube should you place when performing a tracheostomy

A

no more than 50%

91
Q

What rib should you measure when placing an o tube

A

10th rib.

NCERT ECC IMPROVE INTERNATIONAL (8 decks)

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