trauma 1 Flashcards
1
Q
Sudden ecological phenomenon of sufficient magnitude to require external assistance
A
Disaster
2
Q
When is the best time for changes in disaster preparedness
A
After a major disaster
3
Q
What is the most devastating natural phenomena
A
Earthquake
4
Q
local emergency response personnel/organizations able to contain/deal effectively with disaster/aftermath
A
level I disaster
5
Q
requires regional efforts/mutual aid from surrounding communities
A
Level II disaster
6
Q
magnitude that local and regional overwhelmed, requires state/federal aid
A
Level III disaster
7
Q
name natural external events
A
earthquakes, tornados, fire, storms, flood, hurricaine
8
Q
name manmade external events
A
terrorism (WTC)
transportation related (airplan crash)
Nuclear/biological/chemical
Mass gathering (hysteria or unrest
9
Q
name internal events
A
electrical power failure water loss fire explosion loss of Rx gases hostage taking elevator emergencies inability of staff to reach hospital
10
Q
what are the 4 phases of the disaster cycle
A
mitigation
planning
response
recovery
11
Q
what reduces devastating effects (evacuations, sprinklers, early warning)
A
mitigation
12
Q
what are detailed paper plans (unworkable in the heat of initial response)
A
planning
13
Q
activation and implementation (search/rescue, extrication, triage, stabilization, transport)
A
response
14
Q
order is restored, this phase is usually underemphasized, Tx of responders vitally important during this phase
A
recovery
15
Q
DMAT
A
disaster medical assitance teams
groups of volunteer MDs, nurses, EMS personnel, that are transported to disaster sites for help
16
Q
the hospital disaster plan includes protocols/policies that meet the following needs
A
recognition and notification, assessment of hospital capabilities and personnel recall, est. facility control center, maintenacne of accurate records, public relations
17
Q
medical triage process at several levels to rapidly identify critical injuries from total number of casualties
A
disaster triage
18
Q
Red
A
emergent
life or death
19
Q
yellow
A
urgent
can delay but needs to be handled
20
Q
green
A
non urgent
21
Q
black
A
dead or severly injuried and not expected to survive
22
Q
brief clinical assessment
A
triage
23
Q
wat does triage do
A
determines time/sequence pateints are seen in ED, decisions based on short evaluations and assesment of VS
24
Q
trauma triage
A
MOI
anatomic criteria
medical criteria
25
MSE
| medical screening examination
federal law requires MSE performed on all who present to ED/request medical care, can not be delayed to collect payer info, or insurance
MD on durty in ED performs MSE in some EDs triage nurse perfomrs MSE
26
what must be assesed during an MSE
C/O high risk or true emergency
VS
mental status
general apperance
27
what role does the MSE serve
degree of urgency
| to ID if no emergency medical conditions
28
when does reevaluation of triage have to happen
within 2 hours of initial triage
29
what are the 3 tiers of the ED triage system
emergent
urgent
non urgent
30
Category I/Emergent
Red-priority 1
life/limb threat
ex. severe chest pain, cardiac arrest, massive vomit of blood, sudden LOC, major trauma with hypotension
31
category 2/urgent
yellow-priority 2
needs full eval tx by MD with 20 min-2 hours, reevaluate Q 30-6- minutes
Ex. acute dyspnea, Abd. Pain, ches pain, confusion, severe pain, high temp, diastolic BP over 130
32
category 3/non urgent
red-priortiy 3
can wait for hours, reevaluate 1-2 hours
ex. lacerations, sprain, rash, cold
33
category 4 (optional)
appt. with MD, disorders are chronic, minor or self limiting
| ex. Rx refill, acne, mild sore troat, BP check
34
what are pitfalls to triage
failure to recoginize:
c/o severe pain, high risk chief complaints
take VS, adequately document triage and or MSE, failure to retriage pts in waiting room
35
Level 1 trauma center
tertiary care hospital, 24 hour care of trauma pt, education, research,
36
level 2 trauma center
24 hour definitive care, may not provide definitive are for more complex injuries (replantation, cardiac surgery)
37
level 3 trauma center
manage minor trauma independently (resuscitaiton, stabilization rapid transfer to level 1 or 2
38
level 4 trama center
facility in rural or remote areas no other level of care availble, may not be a hospital, may have limited or no Md coverage, primary function is resuscitation and transfer
39
major objectives of ED management
perserve life, prevent deterioration after definitive tx given, restore pt to useful living
40
Primary survey
Airway
breathing
circulation
disability (nuero status)
41
what do you always assume
c-spine
42
what are almost all drauma dealth due to
airway obstruction
43
if you have an airway issue what do you do
suction, jaw thrust, nasal/oral airway, endotracheal tube, cricothyroidotmoy, C-spine, backboard, BVM, rapid sequence intubation (sedation/paralysis)
44
what are common causes of breathing problems
anaphylazis, astma, flail chest, hemothorax,
45
what do you do for breathing problems
ventilation, accessory muscles, feel and listen, RR, color, JVD, intubate, O2, needle thoracotomy
46
Circulation problems
direct cardiac injury (MI, trauma)
| pericardial tamponade, shock, uncontrolled external emorrhage
47
what do yhou do for circulatory problems
check pulses, color, temp, cap refill, bleeding, BP
if absent pulse-CPR, shock-IV, control bleeding with direct pressure, obtain blood sample for cross match for blood products
48
disability problems
head injury and stroke
49
secondary survey
```
follows primary survey,
exposure
full set of vitals, 5 interventions, facilitate family presence
give comfort measures
history (AMPLE) and head to toe
inspect
```
50
Exposure
remove cloting from exam, keep warm blankets, warm IV fluids
51
Full set of vitals, 5 interventions, facilitate family presence
Obtain BVS
5 inter: heart monitor, O2 sat, foley/NG, blood for labs
determine familys desire to be present during invasive procedures/CPR
52
give comfort measures
level of pain/anxiety
53
history & head to toe
```
Allergery
medication
Pertant health history
lsat oral intake
events leading up to
```
54
batlle sign
ecchymosis behing ear
55
acute widespread process of tissue perfusion which results in cellular metabulism & hemodynamic derangements, imbalnce between O2 supply and demand, can result in cellular dysfunction and multiple organ dysfunction syndrome (MODS)
shock
55
acute widespread process of tissue perfusion which results in cellular metabulism & hemodynamic derangements, imbalnce between O2 supply and demand, can result in cellular dysfunction and multiple organ dysfunction syndrome (MODS)
shock
56
initial phase of shock
patho: decrease of CO, tissue perfusion impaired
energy source from aerobic to anaerobic
lactic acid is produced
56
initial phase of shock
patho: decrease of CO, tissue perfusion impaired
energy source from aerobic to anaerobic
lactic acid is produced
58
compensaroty stage
reversible stage, compensatory mechanisms maintain adequate tissue perfusion to vital organs, most metabolic needs are being met at this stage, they are sick but able to fight it
59
patho of compensatory stage
decrease arterial pressure, fluid moves from interstitial to vascular space, maintains normal pressure, activation of Symp. NS, release epi & nor epi, causes vasoconstriction, blood flow to heart and brain miantained, but decreases blood flow to kidney, GI, lungs, muscles, skin, stimulates renin into blood, angiotension to angio 1, converts to 2, increases venous return = increase blood pressure
60
signs and symptoms of shock
LOC*, restelssness, increase HR, RR, decrease UO (due to vasoconstriction)
61
what is a contraindication of shock
sedation (cant assess LOC)
62
progressive stage of shock
compensatory mechanisms are becoming ineffective and may be detrimental to pt
63
patho of progessive stage of shock
profound vasoconstriction occurs, and some vessels become totoally occluded, decrease in CO, leads to tissue hypoxia, cells undergo anaerobic metabolism, increase in lactic acid production worsens, which correlates with severity of shock state
64
signs and symptoms of progressive stage of shock
listless, apathy, confusion, decrease response to painful stimuli, pupils are dilated with decrease reaction to light, tachycardia, weak thready pulse, hypotension, RR rapid, skin is cold clammy mottles, cyanosis,
65
irreversible or refractory stage
compensatory mechanisms are either nonfunctioning or totally ineffective, cellular necrosis and MODS may occur, attempts to restore BP have failed, death is imminent
66
MODS
multi organ dysfunction system
67
patho of irreversible or refractory stage
sympathetic NS can no longer compenstate to maintain homeostasis, thrombosis of small blood vessels, results in cell death, fluid moves out of vascular space, vicious cycle of hypotension and decompensation
68
signs and symptoms of irreversible or refractory shock stage
unconsious , unresponsive, BP falls, diastolic falls to 0, HR, slow, pulse weak, cardiac arrhythmias, RR shallow, mechanical ventilations neccessary, skin cool and clammy, BUN and creatinine critical high, cyanosis
69
hypovolemic shock
most ccommon type of shock, decrease of circulating volume, decrease venous return, decrease stroke volume, decrase CO, Decrease O2, impaired tissue perfusion, impaired cellular metabolism
70
what asessments need to be done for hypovolemic shock
VS Q5 min, UO Q hour, LOC-orientation, skin (color and temp)
71
what needs to be done for hypovolemic shock
control bleeding, vitamin K prn, IV fluids, accurate I & O (foley), O2, consider intubation, maintain airway, position supine, legs elevated 45 degrees,
72
what is the best way to determine effective fluid resuscitation
urine output (30 ml/hour
73
what shuold be done on scene of a hypovolemic shock pt
NS or LR for SBP greater than 90, avoid aggressive fluid infusion as it may precipitate renewed internal bleeding
74
what fluid/colume replacement should be done in the ED if not started in the field
2 large bore IVs, warmed fluid replacement, NS or LR (crystalloids) if still hypotensive after 2 liters, transfuse, use packed RBC's for blood replacement,
75
universal donor for blood
type O, Rh negative if female pt of childbearing age
76
blood product replacement
after 7 units of packed RBC's, give a platelet transfusion and an infusion of cryoprecipitate to replenish lost clotting factors
