thx simon Flashcards
burn degrees
- by layer
Superficial = 1st degree burns, red skin, painful
Partial thickness burns = 2nd degree burns: blister formation, very painful
Full thickness burns = 3rd degree burns : nerve endings burns, painless, Eschar formation, black or waxy look
Full thickness - 4th degree burns: involves bone destruction
burn degrees
- by percentages (minor vs moderate)
Minor burn criteria:
3rd degree: <2% BSA; 2nd degree <15% BSA or <10% ped; 1st degree <20% BSA
Moderate burn criteria:
3rd degree 2-10% BSA, 2nd degree 15-30% BSA or 10-20% ped, excluding hands, face, feet, genitalia, without complicating factors
pediatric vs geriatric burns
Pediatric burns: thin skin, large surface/volume ratio, immature immunological response
Geriatric burns: decreased myocardial reserve, peripheral vascular disease, diabetes, COPD, poor immunological response
ECG heart rhythm
P wave (depolarization of SA node; related to atrial contraction); upright, well rounded
QRS complex: ventricular depolarization; along with pulse (same timing)
- Q: first negative deflection from isoelectric line
- R: first positive deflection from isoelectric line
- S: second negative deflection from isoelectric line
T wave- ventricular repolarization
Line between P and Q- represents AV node stalling the electrical signal
contra/indications for activated charcoal
Indications: oral overdose of certain medications/pills
Contraindications: unresponsive PT, absent gag reflex, refusal by medical control, certain medications, intake greater than 1 hour prior to administration
define the following:
- false motion
- position of function for hand
- diving reflex
False motion: movement that occurs in a bone where there is no joint; indicates fracture
Hand position of function: wrist is slightly dorsiflexed, all finger joints are moderately flexed
Diving reflex: slowing of HR caused by submersion in cold water
what is reverse triage and when would you use it
used in treating multiple victims of a lightning strike, focus efforts on those in respiratory and cardiac arrest
treatment of patient w TIA
- what is it
- conscious
- unconscious
Transient Ischemic Attack (TIA)- small clots temporarily block circulation to part of brain, stroke-like symptoms, resolves when clots break up within 24 hours
Conscious: calm/reassure, monitor airway, high conc o2, transport in semi-sitting position (semi-Fowlers)
Unconscious: maintain airway, high conc O2, transport with PT lying on affected side
questions to ask during a poisoning incident (8)
Medications, petroleum products, cosmetics, pesticides, plants, food
What substance was involved
When did poisoning occur
How much was ingested
Over how long a time
What interventions have been taken
What is patient’s weight
What effects has Pt experienced?
Symptoms of nerve agents: SLUDGEM
Salivation, lacrimation, urination, defecation, gastric upset, emesis, miosis
3 types of agents + examples
B2 P2 M2
Blister agents: mustard, lewisite
Pulmonary agent: phosgene, chlorine
Metabolic agents: hydrogen cyanide and cyanogen chloride
mandatory reporting is required of what circumstances (10)
domestic violence child/elder abuse criminal acts gunshot wound stabbing assault animal bites communicable diseases out of hospital deaths possession of controlled substances
Skin color and what they mean
Pink = normal
pale / white / gray = shock
Flushed (red) = CO, B/P, fever
Blue = hypoxia
Yellow / jaundice = liver injury / failure, hepatitis, cirrhosis
Pressure of CO2 vs O2 in the blood
Pressure of CO2 in blood
- in arteries: 35 - 45 mmHg
- in veins: 40 - 50 mmHg
O2
- in arteries: 75 - 100 mmHg
- in veins: 30 - 40 mmHg
Types of irregular breathing (4)
Cheyne Stokes: period of increased RR, apnea, period of decreased RR (increased ICP)
Kussmaul: rapid, deep breathing; commonly observed in cases of metabolic acidosis
Biot’s: periods of normal/shallow breathing interspersed with apnea, stroke
Ataxic: complete irregularity with periods of apnea
SAMPLE mnemonic
Signs and symptoms—What signs and symptoms occurred at the onset of the incident?
Allergies—Is the patient allergic to any medication, food, or other substance?
Medications—What medications is the patient prescribed?
Pertinent past medical history—Does the patient have any history of medical, surgical, or trauma occurrences?
Last oral intake—When did the patient last eat or drink?
Events leading up to the injury or illness—What the key events that led up to this incident?
routes of administration (8)
Intravenous injection: into the vein, fastest delivery
Intraosseous injection: into the bone, reach bloodstream through bone marrow
Subcutaneous (SC, SQ, sub-Q) injection: under the skin; absorb more slowly
Intramuscular injection (IM): into the muscle – eg. epipen
Inhalation: aerosols, fine powders, sprays
Sublingual: under the tongue
Transcutaneous (transdermal):
Through the skin – eg. nicotine patches
Intranasal (IN): medication is pushed through a mucosal atomizer device (MAD) that aerosolizes the liquid for delivery into the nostril
Basic medication forms (7)
- Tablets and capsules
- Solutions and suspensions
- Metered-dose inhalers (MDIs)
- Topical medications
- Transcutaneous medications
- Gels
- Gases for inhalation
dyspnea is commonly caused by… (3)
always some form of obstruction:
a. Mucus and secretions obstructing airflow in major passages (cold, diphtheria)
b. Swelling of soft tissues in upper airways (epiglottitis, croup)
c. Impaired exchange of gases in the alveoli (pneumonia)
AHA chain of survival
Recognition and activation of emergency response system
Immediate, high-quality CPR
Rapid defibrillation (AEDs)
Basic and advanced emergency medical services
Advanced life support and post-arrest care
Once you begin CPR, continue until one of the following occur (using the mnemonic STOP)
S—Patient Starts breathing and has a pulse
T—Patient is Transferred to another provider of equal or higher-level training
O—You are Out of strength
P—Physician directs you to discontinue
narrowest part of female reproductive organs
cervix, which opens into the vagina
during first stage of labor, max dilation is 10 cm
blast injuries (4)
Primary blast injury is a direct result of the overpressurization wave’s impact on the body
Secondary blast injuries result from flying debris and bomb fragments – the fragmentation effect
Tertiary blast injuries occur as a result of individuals being thrown by the blast wind.
Quaternary blast injuries are defined as any explosion-related injury or illness not due to any of the above such as burns and inhalational injuries; can exacerbate pre-existing conditions.
define the following:
- abrasion
- laceration
- avulsion
- penetrating wound
Abrasion is a wound of the superficial layer of the skin, caused by friction when a body part rubs or scrapes across a rough or hard surface.
Laceration is a jagged cut caused by a sharp object or a blunt force that tears the tissue.
Avulsion separates various layers of soft tissue (usually between the subcutaneous layer and fascia) so that they become either completely detached or hang as a flap.
A penetrating wound is an injury resulting from a piercing object
Treat a closed soft-tissue injury using the RICES mnemonic
rest ice compression elevation splinting
Remove an impaled object only in two circumstances
otherwise
The object is in the cheek or mouth and obstructs the airway
The object is in the chest and directly interferes with CPR.
otherwise, secure for transport using bandages
rule of nines ; burns
ADULTS
9% for 8 locations
4.5% x 2 for 3 locations
1% for 1 location
9% each for the following: Chest Abdomen Upper back Lower back Front left leg Back left leg Front right leg Back right left
9% total bc 4.5% for front + 4.5% for back
Head
Left arm
Right arm
1% total
Genitalia
rule of nines ; burns
CHILDREN
9% for 6 locations
7% for 4 locations
4.5% x 2 for 2 locations
9% each for the following: Front of head Back of head Chest Abdomen Upper back Lower back
7% each Front left leg Back left leg Front right leg Back right left
9% total bc 4.5% for front + 4.5% for back
Left arm
Right arm
what’s in each quadrant . of the body
RUQ: liver, gallbladder, duodenum, small portion of pancreas
RLQ: appendix, ascending colon, right half of transverse colon
LUQ: stomach, spleen
LLQ: descending colon, left half of transverse colon
define the following:
- fracture
- dislocation
- sprain
- strain
A fracture is a break in the continuity of the bone, often occurring as a result of an external force.
Dislocations: A disruption of a joint in which the bone ends are no longer in contact
Sprain: joint is twisted or stretched beyond its normal range of motion.
Strain: pulled muscle
three types of fractures
A nondisplaced fracture (also known as a hairline fracture) is a simple crack of the bone that may be difficult to distinguish from a sprain or simple contusion.
A displaced fracture produces an actual deformity, or distortion, of the limb by shortening, rotating, or angulating it.
Suspect fracture: deformity, tenderness, guarding, swelling, bruising, crepitus, false motion, exposed fragments, pain, locked joint
when do you splint the limb in the position of deformity
When the deformity is severe
When you encounter resistance or extreme pain when applying gentle traction to the fracture of a shaft of a long bone
Fractures about the knee
If there is an adequate distal pulse and no significant deformity, splint the limb with the knee straight.
If there is an adequate pulse and significant deformity, splint the joint in the position of deformity.
If the pulse is absent below the level of the injury, suspect possible vascular and nerve damage, and contact medical control.
Never use a traction splint if you suspect a fractured knee.
Compartment syndrome
most often occurs with a fractured tibia or forearm of children.
Pain that is out of proportion to the injury, pain on passive stretching of muscles within compartment, pallor, decreased sensation, decreased power
If you suspect that a patient has compartment syndrome, splint the affected limb, keeping it at the level of the heart, and provide immediate transport.
define the following
- hyperthermia
- heat emergency
- heat cramps
Hyperthermia is a core temperature of 101°F (38.3°C) or higher. [LOOK FOR HOT AND DRY SKIN -> RAPID TRANSPORT]
– patients will present as tachycardic and tachypneic
Heat emergency: heat cramps, heat exhaustion, heat stroke
Heat cramps: painful muscle spasms after vigorous exercise [due to electrolyte deficiency]
– Cramps in lower limbs and abdomen, normal temp
heat exhaustion
most common; hypovolemia due to loss of water and electrolytes from heavy sweating; vigorous exercise;
other symptoms: dizziness / weakness, muscle cramps, thirst, normal vitals except pulse is often rapid and weak
Severe cramps in lower extremities and abdomen, moist pale skin
Heat stroke
least common but most serious
Hot dry flushed skin, skin may be moist, rising body temp (106>), falling LOC, behavior change, unresponsive, seizures, strong rapid pulse at first becoming weaker with falling BP, increased RR, lack of perspiration
may result in convulsions, coma, muscular twitching, hot/dry/moist skin
APGAR
used to assess state of newborn within 1 minute of birth, then again at 5 minutes
Appearance-: 0 for cyanosis; 1 for blue body but cyanotic extremities; 2 for pink
Pulse: 0 for no pulse; 1 for under 100; 2 for over 100
Grimace/irritability; 1 for weak; 2 for strong cry
Activity/muscle tone; 0 for no response; 1 for weak response; 2 for strong response to action
Respirations; 0 for no respirations; 1 for weak; 2 for strong
heart rate for each age group
neonate: 100 to 205 bpm
infants: 100 to 190
toddler: 98 to 140
pre school age: 80 to 120
school age: 75 to 118
adolescent / adult: 60 to 100
croup
infection of the airway below the level of the vocal cords, usually caused by a virus.
stridor and a seal-bark cough
Croup often responds well to the administration of humidified oxygen.
– Bronchodilators are not indicated for croup and can make the child worse.
define the following:
- cleaning
- disinfection
- highlevel disinfection
- sterilization
Cleaning: the process of removing dirt, dust, blood, or other visible contaminants from a surface or equipment
Disinfection: the killing of pathogenic agents by directly applying a chemical made for that purpose to a surface or equipment
High-level disinfection: the killing of pathogenic agents by the use of potent means of disinfection
Sterilization: a process, such as the use of heat, that removes all microbial contamination
types of WMD or WMC
B-NICE mnemonic (ironically)
weapons of mass destruction / casualty
B-NICE: biological, nuclear, incendiary, chemical, explosive
