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Trauma > Trauma > Flashcards

Trauma Flashcards

1
Q

Influences on triage (5)

A

Number of injured
Available resources
Nature/extent of injuries
Change in condition
Hostile threat

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2
Q

Multiple Casualty

A

number of patients and severity do not exceed recourses

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3
Q

Mass Casualty

A

number of patients and severity exceed recourses

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4
Q

Principles of triage (5)

A

degree of life threat
Injury severity
Salvageability
Resources
Time/distance/environment

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5
Q

Injury severity entails

A

seeing the patient in a total global fashion

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6
Q

Triage categories

A

delayed
immediate
minimal
expectant

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7
Q

Immediate timeline

A

needs life saving within 1min-2H

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8
Q

Immediate examples

A

massive hemo
airway obstruction
tension pnuemo
retrobulbar hematoma****

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9
Q

Delayed examples

A

soft tissue injury
fracture
compartment syndrome
moderate burns

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10
Q

Minimal

A

self aid/buddy aid
aka walking wounded

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11
Q

What is essential to immediate life sustaining care

A

speed and accuracy

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12
Q

Secondary Triage

A

document, reassess, sort patients, 9-line

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13
Q

Tertiary Triage

A

manage patients, consider complicated procedures, resources

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14
Q

CPR only three situations

A

hypothermia, near drownings, electrocution

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15
Q

Early tauma deaths are to due to interuptions in what three systems

A

respiratory, vascular, central nervous

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16
Q

Trauma casualties typically die within

A

the first hour from inabilty to breath or bleeding

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17
Q

Light Combat Stress return to duty

A

immediate return to duty or units noncombat element

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18
Q

Heavy Combat Stress return to duty

A

combat stress control restoration for up to 3 days

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19
Q

Combat stress BICEP (SR)

A

Brief: 3 days or less
Immediate: treatment
Central: keep in one area
Expectant: expect to return to duty
Proximal: to unit
(Simple or refer)

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20
Q

3 phases of TCCC

A

CUF
TFC
TACEVAC

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21
Q

Soft tissue injuries are not lethal unless acompanied with

A

shock

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22
Q

Choose a CCP based on proximity to

A

PT
vehicular access
HLZ
Geography

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23
Q

Echelon 1

A

Self aid/Buddy aid/CLS/Medical Personel

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24
Q

Self aid Buddy aid performs

A

hemorrhage control

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25
Q

CLS performs

A

basic first aid

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26
Q

Echelon 2 mission

A

inital resusicative care to save life or limb

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27
Q

Largest Echelon 2 CRTS by size

A
  1. LHD
  2. LHA
  3. LCVN
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28
Q

Echelon 2 (6)

A

CRTS
Med BN
STP (no surgery)
FRSS
Role 2 Light
Role 2 Enhanced (ward beds)

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29
Q

Who provides surgical care to the MEF

A

Med BN

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30
Q

How long does Med Bn hold a patient

A

72 hours

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31
Q

Med Bn breakdown

A

1 HS and 3 surgical companies

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32
Q

Echelon 3 mission

A

highest level of care in combat zone

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33
Q

Echelon 3 examples

A

Fleet hospitals
hospital ships

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34
Q

Echelon 4 mission

A

definitive medical care

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35
Q

Echelon 4

A

OCONUS hospitals

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36
Q

Echelon 5 mission

A

resotre and rehab

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37
Q

Echelon 5

A

NMRTC SD
WRNMC

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38
Q

MEDEVAC priorities

A

urgent: 2 hours; life limb eyesight
priority: 4 hours; open fx, flail chest; burns
routine: 24 hours

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39
Q

9 line: Line 7 options

A
  1. Method of marking
    A - panels
    B - pyrotechnics
    C - smoke
    D - none
    E - other
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40
Q

Forms of energy

A

Mechanical
Thermal
Electrical
Chemical

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41
Q

Theodor Kocher

A

first proposed kinetic injury possessed by a bullet was dissipated in four ways

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42
Q

Four ways kinetic energy is dissapaited

A

Heat
Energy used to move tissue radically outward
Energy used to form a primary path by direct crush of the tissue
Energy expended in deforming the projectile

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43
Q

Temporary Cavity

A

momentary stretch or movement of tissue away

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44
Q

Permanent cavity

A

forms at time of impact and is caused by compression or tearing of tissue

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45
Q

Yaw

A

deviation of projectile in its longitudinal axis

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46
Q

Tumbling

A

forward rotation around center mass

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47
Q

Deformation

A

mushrooming of projecting that increases in diameter by a factor of 2

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48
Q

Low energy projectile

A

Knives or needles
throat, thoracic, abdominal, and back stabbing

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49
Q

Medium energy projectile

A

9mm

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50
Q

High energy projectile

A

.44 magnum

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51
Q

Indications for a laparotomy for blunt abdominal trauma

A

peritonitis
hemodynamic instability

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52
Q

Primary blast

A

effects of pressure form a blast wave; damages tympanic membranes in surviving casualties

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53
Q

Secondary blast

A

flying debris and fragments with blast wind; causes gross mutilation

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54
Q

Tertiary blast

A

body displacement

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55
Q

Quaternary blast

A

burns

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56
Q

CoTCCC TQs

A

CAT
SOFT-T
EMT (Emergency and Military TQ)

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57
Q

Most common cause of death on battlefield; when to use permissive hypotension

A

hemorrhage; internal bleeding

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58
Q

CoTCCC approved hemostatic agents

A

combat gauze (first choice)
celox/chito
XStat

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59
Q

Chito/Celox active ingredient

A

chotosan; mucoidal binding

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60
Q

XStat

A

first expanding wound dressing to be cleared by FDA

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61
Q

3 junctional TQs

A

CROC
JETT
SAM

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62
Q

Hemostatic dressings require how much direct pressure

A

3 minutes

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63
Q

Respiratory control center

A

medulla and pons

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64
Q

Hypoxia

A

deficient oxygen in tissue

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65
Q

Indications for oxygen therapy

A

Cardiac/Respiratory arrest
O2 sat <90
Systolic <100
RR >24

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66
Q

Nasal cannula flow rate

A

1-6 lpm

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67
Q

Partial rebreather flow rate

A

6-10 lpm

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68
Q

Non-rebreather mask flow rate

A

10-15 lpm

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69
Q

BVM flow rate

A

15+ lpm

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70
Q

Hypoxemia

A

insufficient oxygenation in blood

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71
Q

Hyperbaric chamber used for (2)

A

decompression illness
carbon monoxide poisoning

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72
Q

Most common cause of airway obstruction

A

tongue

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73
Q

Sellick’s manuever

A

during BVM ventilation to prevent aspiration; apply gentle posterior pressure to patients cricoid cartilage.

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74
Q

BURP manuever

A

backward, upward, and rightward pressure on the larynx to prepare for intubation

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75
Q

NPA contraindication

A

basilar skull fracture (battle sign/raccoon eyes/CSF)

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76
Q

Indications for cric

A

tracheobronchial hemorrhage
unable to use BVM
anaphylaxis
burns
neck trauma

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77
Q

Longest a cric can be left in place

A

24 hours

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78
Q

OPA contrainications

A

conscious patient due to gag reflex

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79
Q

Airway for air evac

A

iGel

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80
Q

ET Tube contraindications

A

cervical fracture

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81
Q

Complications of ET tube intubation

A

broken teeth
injury to vocal cords
hypoxemia

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82
Q

ET intubation position

A

Sniffing

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83
Q

ET tube too deep causes

A

right mainstem bronchi intubation

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84
Q

ET tube in wrong anatomy complication

A

gastritis; foul smell from contents

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85
Q

Combitube indications

A

trapped patient

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86
Q

Combitube complications

A

esophageal rupture
upper airway hematoma

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87
Q

3 methods to check airway placement

A

visualize chest rise and fall
auscultate breath sounds
CO2 monitoring

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88
Q

Cric incision length

A

3cm

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89
Q

3 indications for Needle D

A

decreased or absent breath sounds
Sytolic <90
worsening respiratory distress

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90
Q

Spontaneous simple pneumothorax disposition

A

tall lanky runners build

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91
Q

Pleural space can accomodate how mane MLSs of blood

A

2500-3000

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92
Q

Chest tube indications

A

large pneumothorax >25%
hemothorax

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93
Q

Contraindications of chest tube

A

uncontorlled bleeding diathis
infection

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94
Q

Chest tube sizes

A

Teen/Adult male 28-32fr
Teen/Adult Female 28fr
child 18fr

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95
Q

Chest tube insertion site

A

mid axillary between 4th and 5th rib

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96
Q

Flail chest

A

breaking of 2 or more ribs in 2 or more places

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97
Q

Pulmonary contusion impact on respiration

A

prevention of gas exchange because no air enters alveoli

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98
Q

Pulmonary contusion tx

A

vetntilation/ O2/ BVM

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99
Q

FWB components 4

A

RBC
platelets
plasma
immunological components

100
Q

2 main blood types

A

ABO and Rh

101
Q

ABO

A

classification determined by presence or absence of antigens

102
Q

Type O markers

103
Q

Females of child bearing age should only recieve what blood

104
Q

What class shock indicates a blood transfusion?

105
Q

Class 3 shock

A

1500-20000 ml blood loss; 30%

106
Q

Class 4 shock

A

2000ml blood loss; 40%

107
Q

Radial pulse systolic BP

108
Q

Hemolytic reaction sx

A

fever, chills, flank pain, oozing from IV site

109
Q

Hemolytic reaction tx

A

aggressive hyrdation and diuresis

110
Q

Anaphylaxis reaction tx

A

Antihistamines/Vasopressors

111
Q

Citrate Toxicity prevention

A

1 amp of Calcium Gluconate per 4 FWB units

112
Q

How many units of blood can a liver process without additional calcium?

113
Q

Febrile non-Hemolytic reaction most common cause

A

cytokines releaed from WBCs

114
Q

Febrile non-hemolytic reaction tx

A

1g tylenol PO Q8

115
Q

Febrile non-hemolytic reaction sx

A

fever and chills without systemic symptoms

116
Q

Urticarial Reaction

A

reaction with hives but no other allergic findings caused by serum proteins

117
Q

ATR actions

A

stop transfusion
Fluid bolus with crystalloid
confirm correct product and patient
MEDADVICE

118
Q

Single unit wole blood collection capacity

A

600ml with 63ml of CPDA-1 anticoagulant

119
Q

Stimulate collection bag how often

120
Q

Allergic reaction to transfusion prophylaxis

A

25-50mg Diphenhydramine

121
Q

TXA administration

A

1g in 100NS within 3 hours over ten minutes
Don’t forget this is only for the test and not real life

122
Q

TXA side effects

A

hypotension
seizures
visual changes

123
Q

TXA storage temp

124
Q

Colloid use

A

increase blood volume; expand

125
Q

Crystalloid vs Colloid expanding

A

more crystalloid required to accomplish same as colloid

126
Q

Crystalloid use

A

maintenance fluid to correct body fluid and electrolytes

127
Q

Tonicity

A

concentration of electrolytes

128
Q

Isotonic

A

crystalloid contains same amount of electrolytes as plasma

129
Q

Hypertonic

A

more electrolytes than plasma; causes cells to shrink

130
Q

Hypotonic

A

contains fewer electrolytes than plasma; cells expand

131
Q

IO cotraindications

A

inability to locate landmark
brittle bones
infection
previous attempts in same bone

132
Q

Best IO sites

A

anteromedial aspect of tibia
anterior aspect of femur
sternum

133
Q

Tibia site location

A

1-3cm below tibial tuberosity

134
Q

Pain triple option

A

1:Tylenol 625mg x2
Meloxicam 15mg

2: OTFC 800ug

3: Ketamine 50mg IM or 20mg IV

Alternative: Morphine 5mg IV with max of 15mg

135
Q

Odanestron dose

136
Q

Combat pill pack antibiotic

A

Moxifloxacin 400mg Q24

137
Q

Ertapenem dose

138
Q

Levofloxacin dose

139
Q

Initial blood drip rate

A

10-30ml for first 15min; monitor every 5
increase to 200ml

140
Q

Urine output rate

A

0.5 cc per kg

141
Q

Foramina

A

small openings for nerves and blood vessels to pass

142
Q

Foramen magnum

A

brain stem and spinal passes through

143
Q

How much CSF surrounds brain

144
Q

ICP

A

pressure exerted by brain tissue, blood, and CSF

145
Q

Cushing’s triad

A

inc BP
irregular respirations
bradycardia

146
Q

Cushing’s triad

A

inc BP
irregular respirations
bradycardia

147
Q

Secondary Brain Injury

A

ongoing injury process set in motion
(hypoxia, hypotension, ICP)

148
Q

2 biggest predictors of poor outcome in head trauma

A

time spent with ICP >20
time spent with systolic BP <90

149
Q

in TBI maintain SPO2 above

150
Q

Epidural Hematoma

A

bleeding between skull and dura mater

151
Q

Epidural Hematoma hallmark

A

brief LOC; regains conciousness before rapid decline

152
Q

Pupil dialition from TBI associated with what CN

A

tres leches

153
Q

Subdural Hematoma MOI in trauma

A

MVC or falls

154
Q

SAH bleeding location

A

between arachnoid membrane

155
Q

SAH hallmark

A

worst headache of my life and meningeal signs

156
Q

SAH Ottawa rule (5)

A

headache that peaks within 1 hour (thunderclap)
40 y/o +
Witnessed LOC
onset at exertion
limited neck flexion

157
Q

All suspected TBI patients recieve

158
Q

Target sytolic for TBI

159
Q

Minimal recovery period for mild TBI/Concussion

160
Q

TBI red flags

A

LOC
double vision
AMS
vomiting
seizures
weakness in extremity
headache
unsteady on feet
unequal pupils
changes in senses
blacking out/passing out

161
Q

Brain layers

A

dura mater
pia mater
arachnoid

162
Q

Headache pain management for TBI

A

naproxen
Tylenol

163
Q

If symptom free after 24 hours with 1st concussion

A

return to full duty

164
Q

Hypothermia stages

A

mild 90-95
moderate 82-90
severe <82

165
Q

Most common mechanisms of accidental hypothermia

A

convective heat loss to cold air
conductive heat loss to water

166
Q

Hypothermia ECG findings

A

Osborne Waves

167
Q

Hypothermia temp

168
Q

Mild hypothermia tx

A

passive external

169
Q

Moderate and refactory hypothermia tx

A

active external

170
Q

Severe hypothermia tx

A

active external and internal

171
Q

IO attempt after

A

3 failed IVs or 90 sec

172
Q

IO complications

A

skin necrosis
OM
Tib fracture

173
Q

IO flush

A

Lidocaine without epi

174
Q

Moderate pain oral treatment

A

Mobic 7.5-10mg

175
Q

Max morphine dose

176
Q

Class 3 and class 4 blood loss

177
Q

Palpable systolics

A

radial >80
femoral >70
carotid >60

178
Q

AMPLE

A

allergies
medications
PMH
last meal
events

179
Q

First sign of compartment syndrome; treatment

A

pain; fasciotomy

180
Q

Anaphylaxis involved systems

A

cardio and respiratory

181
Q

Anaphylaxis symptoms within

182
Q

Anaphylaxis med tx Line 1 and Line 2

A
  1. Epinephrine .5mg IM
  2. Solumedrol and Diphenhydramine IV
183
Q

Allergic Bronchospasm Tx

A

Nebulized SABA

184
Q

2 drug allergy reactions

A

Steven Johnson Syndrome and Toxic Epidermal Necrolysis

185
Q

Upper airway typically injured by

186
Q

Tracheobronchial tree typically injured by

A

chemicals in smoke

187
Q

2 common gases of sytemic toxicity

A

carbon monoxide and hydrogen cyanide

188
Q

Hydrogen properties

A

colorless and smells like almonds

189
Q

Carbon Monoxide properties

A

colorless and odorless

190
Q

Smoke Inhalation tx

A

ABC
intubation
O2
IV
SABA
Hypothermia tx

191
Q

Carbon Monoxide affinity for hemoglobin vs Oxygen

192
Q

Rhabdo involved anatomy (2)

A

muscle fiber (sarcomere)
intracellular components (potassium, CK, Myoglobin)

193
Q

Rhabdo breaks down what kind of muscle?

194
Q

Rhabdo pathophysiology

A

contents of muscle fibers enter circulation in large quantities adversely affecting kidneys and causing obstruction

195
Q

Rhabdo causes

A

trauma
crush
compartment syndroe
electrical injury

196
Q

Exertional rhabdo causes

A

not conditioned
hot and humid
heat stroke
seizures

197
Q

Non exertional rhabdo causes

A

drug use
-statins
toxins/poisons

198
Q

Rhabdo sx

A

dark urine (Coca-Cola)
weakness
edema
AMS

199
Q

Rhabdo lab findings (4)

A

Elevated CK
UA pos for blood
Hyperkalemia
peaked T waves

200
Q

Rhabdo tx

A

IV 1.5L/HR to maintain 2ml/KG per hour output

201
Q

Retroperitoneal contents

A

kidneys
aorta
espophagus
ureters
pancreas
rectum
stomach
colon

202
Q

Most common abdominal blunt injuries

A
  1. spleen**
  2. Liver
    GSW/Penetrating: small bowel
203
Q

Most reliable indicator of intra-abdominal bleeding

A

bleeding from an unknown source

204
Q

MAP formula

A

SP + DP (2)
___________
3

205
Q

Cerebral pressure

206
Q

GCS score

207
Q

Class 1 Sock

208
Q

3 abdominal regions

A

retroperitoneal/ true abdomen/ thoracic

209
Q

Most common finding in compartment syndrome

A

paresthesia or pain

210
Q

Gold standard study for pelvic injury

211
Q

Initial burn fluid rate (scenario)

A

500ml/hour

212
Q

Burn target urine output

213
Q

PFC target urine output per hour aka UOP

A

0.5-1ml/hour

214
Q

MAP goal

215
Q

Zone of coagulation

A

central zone; not capable of repair

216
Q

Zone of hyperemia

A

outermost zone; perfusion increased

217
Q

Zone of stasis

A

adjacent to necrosis; cells are injured and deprived of blood flow

218
Q

UOP

A

primary index of adequate resuscitation

219
Q

Initial hourly rate

220
Q

Parkland Formula

A

4 x TBSA x KG over 24 hours; half in first 8 hours

221
Q

3 phases of PFC

A

Evaluation
Resuscitation
Transport

222
Q

Evaluation phase of PFC

A

MARCH/initial evac

223
Q

Resuscitation Phase

A

procedures to normalize vitals

224
Q

Transport phase

A

hypothermia/pain/package to move PT/documentation

225
Q

Do not TQ convert after how long

226
Q

According to TG place second TQ

227
Q

Most common pelvic bleed

A

venous plexus

228
Q

Glans penis bleed with scrotal edema tx

A

retrograde urethrogram

229
Q

Pelvic injury tx following blood transfussion (scenario)

A

pelvic binder

230
Q

FWB aka

A

low titer O

231
Q

FWB shelf life

232
Q

Vomiting patient tx following jaw thrust and O2

233
Q

Tactical indicators of shock

A

consciousness and radial pulse

234
Q

What organ not in peritoneum

235
Q

What is not isotonic

236
Q

Most benefeical use of pelvic binder

237
Q

NS type of fluid

A

isotonic crystalloid

238
Q

Standard thermometer lowest reading

239
Q

IO contraindication (scenario)

240
Q

Not a chest injury

A

diaphragm hernia

241
Q

Greatest destruction and necrosis zone

A

coagulation

242
Q

Deteriation of resp within

243
Q

Colloid examples

A

albumin hetatarch

244
Q

Crystalloid examples

245
Q

Bleeding from scalp can be masked by

A

thicc hair

246
Q

Reassess before evac

A

neuro-vascular

247
Q

Avoid what range of ketamine

A

Mid: 0.3-1mg/kg

Trauma (3 decks)

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