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5th Time I've made a new class > TRAUMA > Flashcards

TRAUMA Flashcards

1
Q

What is the process of prioritizing patient treatment during mass casualty events based on their need for or likely benefit from immediate medical attention

A

Triage

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2
Q

What is the French word to sort

A

Triage

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3
Q

What can change the categories of triage

A

Number of injured
Available resources
Nature and extend of injuries
Change in patients condition
Hostile threat in the area

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4
Q

What is it called when the number of patients and the severities of their injuries DO NOT exceed the resources and capabilities.

A

Multiple casualties

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5
Q

What is it called when the number of patients and the severities of their injuries DO exceed the resources and capabilities

A

Mass casualty

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6
Q

What are the five principles of triage

A

Degree of life threat posed by the injuries sustained
Injury severity
Salvageability
Resources
Time, distance and environment

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7
Q

What principle of triage is determined by considering the order of priorities identified during the primary survey of an individual patient and applying these same principles to a group of patients

A

Degree of life posed by the injuries sustained

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8
Q

What principle of triage entails looking at each patient in a total global fashion and assessing the patient as a whole and not focusing on one severe injury

A

Injury severity

  • ideally patients should be triaged solely on the severity of their injuries and not nationality
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9
Q

What are the categories of military triage

A

IDME or DIME

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10
Q

In military triage, what category is when the patient needs lifesaving interventions within minutes to up to 2 hours on arrival to avoid death or major disability

A

Immediate

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11
Q

If a patient has controlled massive hemorrhage, retrobulbar hematoma, tension pneumothorax, a torso/neck/pelvis injury WITH shock or multiple extremity amputations. What military triage category would they be

A

Immediate

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12
Q

If a patient has soft tissue injuries without significant bleeding, fractures, compartment syndrome, moderate to severe burns with less than 20% total, blunt or penetrating torso injuries WITHOUT signs of shock, or facial fractures without airway compromise, what military triage category would they be in

A

Delayed - require medical attention but CAN wait

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13
Q

If a patient has minor burns, lacerations, contusions, sprains/strains, simple closed fractures without neuro compromise, or has a combat stress reaction what category of military triage would they be in

A

Minimal - can be treated with self aid, buddy aid or corpsman aid

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14
Q

If a patient has massive head injuries with signs of impending death or coma, Cardiopulmonary failure, second and third degree burns in excess of 85% of the body, open pelvic fractures with uncontrolled bleeding and class IV shock or high spinal cord injury what military triage category would they be in

A

Expectant - requires complicated treatments that may not improve life expectancy

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15
Q

When would you consider giving CPR on the battle field

A

Hypothermia
Near drowning
Electrocution

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16
Q

When do casualties usually die in a field setting and why

A

Casualties typically die within the first hour due to the inability to breath, they bleed to death, or they have injuries which are so severe that the regulation by the brain of breathing and profusion is lost

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17
Q

What are the two categories of combat stress

A

Light stress
Heavy stress

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18
Q

If a patient is placed into the light stress category of combat stress what does that entail

A

Immediate return to duty or return to unit or units non combat support element with duty limitations or rest

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19
Q

If a patient is placed in the heavy stress category of combat stress what does that entail

A

Send to combat stress control restoration center for up to 3 days reconstitution

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20
Q

What is the mnemonic used when situation allows to manage combat stress

A

BICEP
Brief - keep interventions to 3 days or less
Immediate - treat as soon as symptoms are recognized
Central - keep in one area for mutual support
Expectant - reaffirm that we expect them to return to duty
Proximal - keep them as close as possible to the unit
Simple- do not engage in psychotherapy
Or refer

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21
Q

In care under fire triaging of patients what is the priority

A

Get the patients who are not clearly dead to cover (not concealment) if possible
Continue the mission/fight. Gain fire superiority

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22
Q

In tactical field care you should perform an initial rapid assessment of the casualty for triage purposes but this should take no longer than what time

A

No more than 1 minute per patient

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23
Q

What should you base your causality collection point location on

A

Proximity to patients
Proximity to vehicle access
Proximity to HLZ
Geography, safety “geographic triage”

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24
Q

What is level I (role/echelon)

A

First medical care they receive, includes immediate life saving measures, disease and non-battle injury prevention, combat and operational stress control and treatment is provided by:
Self aid/buddy aid
Combat life saver
Medical personnel - BAS or DDG/cruiser/destroyer

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25
Q

What are examples of medical personnel in level I care

A

Battalion aid station
Cruiser
Destroyer

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26
Q

What is level II (role/echelon)

A

Initial resuscitative care is the primary objective of care at this level. Saving life, limb and when necessary stabilizing for evacuation to level 3

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27
Q

What are examples of level II (role/echelon) at sea

A

(Sea) Casualty receiving and treatment ships (CRTS) deploy as part of an expeditionary strike group.
LHD - largest medical capability
LHA
CVN

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28
Q

What are examples of level II (role/echelon) on ground

A

(Ground) medical battalion- provides surgical care for the MEF
Shock trauma platoon(STP) - smll fwd unit supporting the MEF
Forward Resuscitative surgical suite(FRSS) - fwd deployed surgical suite due to MedBN being too big
Role 2 light maneuver (R2LM) - mobile medical unit designed to support large maneuver formation - sends to role 3 or R2E
Role 2 enhanced (R2E) - provides basic secondary health care built around primary surgery, ICU and ward beds - they can send straight to role 4 without stop at 3

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29
Q

What is level III (role/echelon) of care

A

The highest level of care available within a combat zone. Advanced resuscitative care is the primary objective of care

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30
Q

What are examples of level III (role/echelon) of care

A

Fleet hospitals
Hospital ships (USNS Comfort/Mercy)

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31
Q

What is the highest level of care in a combat zone

A

Level III (role/echelon) of care

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32
Q

What is level IV (role/echelon) of care

A

Definitive medical care is the primary objective at this level

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33
Q

What are examples of level IV (role/echelon) of care

A

OCONUS hospitals
- NH Yokosuka
- Landstuhl regional medical center

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34
Q

What is level V (role/echelon) of care

A

Restorative and rehabilitation care is the primary objective of care at this level

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35
Q

What are examples of level V (role/echelon) of care?

A

NMCSD
Walter reed medical center

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36
Q

What is timely, efficient movement and en route care provided by medical personnel to the wounded by being evacuated from the battlefield to a MTF using a medically equipped vehicle or aircraft

A

Medical evacuation (MEDEVAC)

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37
Q

What is the movement of casualties from the point of injury to medical treatment by non-medical personnel. Causalities transported under these circumstances may not receive en route medical care

A

Casualty evacuation (CASEVAC)

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38
Q

What utilizes the USAF FIXED WING aircraft to move sick or injured personnel within the theater or operations

A

Aeromedical evacuation

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39
Q

What is the maintenance of treatment initiated prior to evacuation and sustainment of the patients medical condition during evacuation

A

En route care

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40
Q

What are some litters that can be used to transport patients

A

Standard
Stokes
SKED
improvised

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41
Q

How should the patient be moved on a litter

A

Patients must be carried on the litter FEET first except when going uphill or up stairs, then their head should be forward unless the patient has a fracture of the lower extremities then they should be carried uphill or up stairs feet first and down hill or down stairs head first to prevent the weight of the body from pressing on the injury

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42
Q

What command should be used by litter bearers in order to prevent undue haste

A

Steady

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43
Q

What are some methods of ground evacuation

A

M997 ambulance
M1035 ambulance
MK23 and 7 ton: non medical vehicle

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44
Q

What are some methods of air evacuation

A

UH 60 Blackhawk
SH-60B seahawk
CH-46 Sea Knight
CH-53 D/E Sea Stallion
CH-1 Huey
MV-22 Osprey
C-2 Grey hound
P-3 Orion
C-130 Hercules

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45
Q

When would cabin altitude restriction (CAR) be considered

A

Penetrating eye injuries
Free air in body cavity
Severe pulmonary disease
Decompression sickness or arterial gas embolism

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46
Q

What medevac/casevac priority is must the casualty be evacuated within 2 hours in order to save life, limb or eye sight

A

Urgent

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47
Q

If a patient has uncontrolled hemorrhage, shock not responding to IV therapy, head injuries with signs of ICP, or extremities with neuro compromise what medevac/casevac category is the patient

A

Urgent

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48
Q

What medevac/casevac category is when the casualty must be evacuated within 4 hours or condition could worsen

A

Priority

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49
Q

If a patient has flail chest segments without respiratory compromise, open fractures, spinal injury, or major burns what medevac/casevac category would they be

A

Priority

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50
Q

What medevac/casevac category is when casualty must be evacuated within 24 hours for further care

A

Routine

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51
Q

If a patient has mild/moderate burns, simple closed fractures, minor open wound, or is a terminal casualty what medevac/casevac category would the patient be

A

Routine

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52
Q

What is line one of a 9 line

A

Location of pickup (grid coordinates)

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53
Q

What is line 2 of a 9 line

A

Frequency/ call sign of pick up site

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54
Q

What is line 3 of a 9-line

A

Number of patients by precedence
A- urgent
C- priority
D- routine

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55
Q

What is line 4 of a 9-line

A

Special equipment needed
A- none
B- hoist
C- extraction equipment
D- ventilator

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56
Q

What is line 5 of a 9 line

A

Number of patients by type
L - # of litter
A- ambulatory

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57
Q

What is line 6 of a 9 line

A

Security at the pick up site
N- no enemy
P- possible enemy
E- Enemy in area
X - armed escort required

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58
Q

What is line 7 of a 9 line

A

Method of marking
A- panels
B- PYROTECNICS
C- Smoke
D - None
E - other

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59
Q

What is line 8 of a 9 line

A

Patient nationality and status
A- US military
B- US civilian
C- Non US military
D - Non US Civilian
E - EPW

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60
Q

What is line 9 of a 9 line

A

NBC contamination
N - Nuclear
B - biological
C- chemical

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61
Q

What are the four categories of a MIST report

A

Mechanism of injury
Injuries sustained
Signs/symptoms
Treatment

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62
Q

What is the branch of mechanics that studies the motion of a body or a system of bodies without consideration given to its mass or the forces acting on it, its essence revolves around motion

A

Kinematic

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63
Q

What is Newton’s first law

A

States every object will remain at rest or in uniform motion unless compelled to change its state by the action of an external force. We know it more commonly as inertia

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64
Q

What is Newton’s second law

A

Defines force (F) is equal to the product of the mass (m) and acceleration (a)
F=ma

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65
Q

What are the forms energy can take in relation to kinematics

A

Mechanical
Thermal
Electrical
Chemical

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66
Q

What are the four ways a bullet dissipates

A

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

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67
Q

What is it called when a solid object strikes the human body or when the body is in motion and strikes a stations object the tissue particles are knocked out of their normal position creating a hole or cavity

A

Cavitation

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68
Q

What is the deviation of the projectile in its longitudinal axis from the straight line of flight

A

Yaw

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69
Q

What is the forward motion around the center of mass

A

Tumbling

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70
Q

What is the mushrooming of the projectile that increases the diameter of the projectile, usually a factor of 2, increases the surface area and hence the tissue contact area by four time

A

Deformation

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71
Q

What is it when multiple projectiles can weaken the tissue in multiple places and enhance the damage rendered by cavitation

A

Fragmentation

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72
Q

What are the four ways a bullet can be enhanced

A

Yaw
Tumbling
Deformation
Fragmentation

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73
Q

What is an example of low energy level projectiles

A

Knives
Needle
Ice pick
- hand driven weapons

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74
Q

What is examples of medium energy level projectile

A

Firearms with muzzle velocity of less than 1500 feet
9mm
45 auto

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75
Q

What are examples of high energy level projectiles

A

Firearms with muzzle velocity more than 1500 feet per second
.44 magnum

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76
Q

What are two signs that are absolute indications for laparotomy following penetrating or blunt abdominal trauma

A

Peritonitis
Hemodynamic instability

a third relates to the inability to examine the patient reliably after a penetrating injury

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77
Q

Penetrating injuries to what area of the body carry a 90% mortality rate

A

Head
Victims with GCS of 3-5 have only a small chance of an acceptable outcome

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78
Q

What are the four categories of a blast injury

A

Primary
Secondary
Tertiary
Quaternary

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79
Q

What is a primary blast injury

A

Effects of over pressure and under pressure of a blast wave - uncommon except in form of a PERFORATED TYMPANIC MEMBRANE

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80
Q

What is secondary blast injuries

A

Flying debris/fragments, mussels in conjunction with the “blast wind” (mass of air displaced by the explosion)- penetrating ballistic fragmentation or eye penetrating

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81
Q

What is tertiary blast injury

A

Body displacement - fracture or traumatic amputation, closed/open head injury

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82
Q

What is quaternary blast injury

A

Burns - burns, crust, asthma, COPD, breathing problems

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83
Q

What is the leading cause of preventable death on the battle field

A

Hemorrhage

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84
Q

What is the most common cause of massive external blood loss in combat

A

External extremity injury

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85
Q

For internal massive hemorrhage what is should be implemented

A

Controlled (hypotensive) resuscitation should be implemented

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86
Q

What are the TCCC approved TQ’s

A

Combat application tourniquet (C.A.T)
Special operations forces tourniquet tactical (SOFT-T)
Emergency and military tourniquet (EMT)

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87
Q

What are the TCCC approved hemostatic agents

A

Combat gauze - recommended first choice
Celox gauze or Chito Gauze
XStat - First expanding wound dressing FDA approved

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88
Q

Junctional wounds refer to what body structures

A

Groin
Buttocks
Perineum
Axillae
Base of neck
Extremities at sires to proximal limb tourniquets

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89
Q

What are the TCCC approved junctional tourniquets

A

Combat ready clamp (CROC)
Junctional emergency treatment tool (JETT)
SAM junctional tourniquet

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90
Q

Where should a tourniquet be applied

A

2-3 inches above the site
Or
If unable to identify - high and tight

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91
Q

What is the time frame that hemostatic dressings should be applied

A

Should be applied with at least 3 minutes of direct pressure (optional for XStat).

If one fails to control the bleeding, it may be removed and a fresh dressing of the same type or different type can be applied

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92
Q

After a JETT has been applied, how often should it be assessed

A

Every 5 minutes to ensure the bleeding is still controlled

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93
Q

What should the application of junctional tourniquets be documented on

A

The CRoC label and the TCCC Card

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94
Q

JETT device application should not exceed what time limit

A

4 hours

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95
Q

The airway system is an open path that leads to atmospheric air through what structures

A

The nose, mouth, pharynx, trachea, and bronchi to the alveoli

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96
Q

Where is the respiratory control center

A

Neural control - primary control comes from the MEDULLA and PONS

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97
Q

What is the primary involuntary respiratory center

A

Medulla

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98
Q

What is the primary control of respiratory center stimulation

A

Cerebrospinal fluid pH

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99
Q

What is it called when there is no oxygen available at all

A

Anoxia

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100
Q

What is the fraction or percentage of oxygen in the space being measured

A

Fraction of inspired oxygen (FiO2)

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101
Q

Room air FiO2 is equal to what

A

21%

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102
Q

What literally means “deficient in oxygen” that is an abnormally low oxygen availability to the body or an individual tissue organ

A

Hypoxia

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103
Q

What is insufficient oxygenation, that is decreased partial pressure of oxygen in blood called

A

Hypoxemia

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104
Q

What are indications of O2 therapy

A

Cardiac and respiratory arrest
Hypoxemia (Sat <90%)
Hypotension (Systolic <100)
Low cardiac output and metabolic acidosis
Respiratory distress (RR >24/min)

  • all trauma patients will get O2
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105
Q

How much oxygen is supplied by a nasal cannula

A

1-6 liters/ min

(TG says 1-4 liters/min)

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106
Q

What are indications for using hyperbaric oxygen

A

Decompression illness (the bends)
Carbon monoxide poison
Radiation necrosis
Reconstructive surgery
Some infection, wounds

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107
Q

What is 100% oxygen given at an increased pressure of 3 atm. Since normal air is 20% oxygen, pure oxygen is 5 times more oxygen and at 3 times normal air pressure, a patient gets 15 times more oxygen than normal

A

Hyperbaric oxygen

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108
Q

What is the first step in airway management

A

A quick visual inspection of the oropharyngeal cavity

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109
Q

What is the most common cause of airway obstruction

A

The tongue

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110
Q

What air way maneuver is given in casualties with suspected head, neck or facial trauma

A

Jaw thrust

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111
Q

What is one of the key components in airway maintenance

A

Prevention of gastric aspiration

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112
Q

Sellicks maneuver is used for what

A

Prevention of gastric aspiration

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113
Q

What is the BURP maneuver

A

Backward, upward, rightward pressure on the larynx

The maneuver improves visualization of the larynx structures and eases intubation

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114
Q

What is the most frequently used artificial airway device

A

Oropharyngeal airway

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115
Q

When would you use an OPA

A

Unable to maintain airway
Tongue continues to fall back
Assist in improving ventilation
Prevent intubated patient from biting an ET tube

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116
Q

What is the contraindications of using an OPA

A

Causality that is conscious or semiconscious

Complications due to gag reflex stimulation and use of OPA may lead to gagging, vomit. And laryngospasm in patients who are conscious

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117
Q

When can an NPA not be used

A

If a basilar skull fracture is suspected

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118
Q

What are complications of an NPA

A

Bleeding
Inserting into the brain with a basilar skull fracture
Nasal turbinate injury

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119
Q

What nare is preferred when using an NPA

A

Right because it is typically larger

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120
Q

What is the preferred supraglottic airway

A

I-gel

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121
Q

What is the indication for an i gel placement

A

An unconscious patient without significant direct trauma to airway/facial structures

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122
Q

What size of i gel is used in a typical adult

A

Size 4

Size 5 is used for adults over 200 IBS

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123
Q

When would you place an endotracheal tube

A

Unable to protect airway
Significant oxygenation problems, requiring need for high concentration oxygen
Casualty requiring assisted ventilation
Cardiac arrest
Severe hemorrhagic shock

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124
Q

What are contraindications of placing an endotracheal tube

A

PATIENT WITH EPIGLOTITIS
LACK OF TRAINING
Lack of proper indications
Obstruction of upper airway
CERVICAL FRACTURES

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125
Q

What are some complications of placing an endotracheal tube

A

Hypoxemia from prolonged intubation attempts
Trauma to the airway
Right mainstem intubation
Esophageal intubation
Vomiting leading to aspiration
Loose or broken teeth
Injury to vocal cords
Conversion of a cervical spine injury without neurological deficit to one with neurological deficit

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126
Q

What is the “universally accepted” size of endotracheal tube for unknown victim

A

7.5mm

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127
Q

What size ET tube is used in men

A

8.0mm

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128
Q

What size ET tube is used in women

A

7.0mm

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129
Q

What two types of blades are used for endotracheal tube intubation

A

Miller blade (straight)
Macintosh blade (curved)

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130
Q

What position is the patient in if the head is extended and the neck is flexed

A

Sniffing

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131
Q

The insertion of an endotracheal tube should be no longer than what from the time you stop ventilating the patient until the time you remove the stylet

A

No longer than 30 seconds

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132
Q

What can be used in environments where you cannot auscultate the lungs due to environmental noise

A

End tidal O2 monitor (purple to gold window)

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133
Q

If the endotracheal tube is placed into the stomach/esophagus what will you hear

A

Will produce a gurgle sound in the Epigastric area

If this happens remove the tube and attempt placement after 1 minute of oxygenation and ventilation

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134
Q

What airway is designed to facilitate the placement of an advanced airway in a patient in respiratory distress by providers with minimal training

A

Esophageal tracheal combitube airway

135
Q

What are the two sizes of comitube airways

A

37 Fr (patients 6ft or 122 to 183 cm tall)
41 Fr (patients more than 5ft or 152cm tall)

136
Q

What are the contraindications of using a combitube

A

Patients with intact gag reflex
Patient with known esophageal pathology (like GERD)
Used in patients under 5 feet with standard combitube under 4 feet with combitube SA

137
Q

What are the complications of using a combitube

A

Sore throat, dysphagia, and upper airway hematoma
Esophageal rupture is rare

These complications may be partially preventable by avoiding overinflation of the distal and proximal cuffs

138
Q

What are the complications of placing an laryngeal mask airway

A

Aspiration because LMA does not completely prevent regurgitation and protect the trachea
Laryngospasm
Sore throat

139
Q

What is the optimal position the patient should be in when placing an LMA

A

Sniffing

140
Q

What are three ways to verify placement of ET tube

A

Auscultate the Lungs
Auscultate the Epigastric
End tidal

141
Q

What is the most important instrument for surgical cricothyrotomy

A

Scalpel

142
Q

What is the primary purpose of a crcothyroidotomy

A

Provide an emergency breathing passage for a patient whose airway is closed by:
TRAUMATIC INJURY TO THE NECK
BURN INHALATION INJURY
CLOSING OF AN AIRWAY DUE TO ALLERGIC REACTION TO BEE OR WASP STINGS
Or unconscious

143
Q

What are the two types of cricothyroidotomy

A

Needle
Surgical

144
Q

What are indications for a cricothyroidotomy

A

Massive midface trauma precluding the use of BVM
Inability to control airway using less invasive maneuvers
Ongoing tracheobronchial hemorrhage

145
Q

What are complications of a cricothyroidotomy

A

Prolonged procedure time
Hemorrhage
Aspiration
Misplaced or false passage of ET tube
Injury to neck structures or vessels
Perforation of the esophagus
The longer the period of use the greater the risk of complications

146
Q

How big of a vertical incision over the cricothyroid membrane will you make

A

3 cm

147
Q

How long can a surgical cricothyroidotomy be left in place for

A

24 hours

148
Q

What is the disruption of heart rhythm that occurs as a result of a blow to the area directly over the heart at a critical time during the cycle of the heart beat causing cardiac arrest

A

Commotio cordis

149
Q

What is a simple pneumothorax

A

Presence of air in the pleural space

150
Q

What is an open pneumothorax

A

Also called a sucking chest wound
Involves a pneumothorax associated with a defect in the chest wall

151
Q

What is a tension pneumothorax

A

Occurs when air continues to enter the pleural space but has not avenue to egress

152
Q

What is the initial management of an open pneumothorax

A

Close the defect in the chest wall and administer supplemental oxygen

153
Q

What is a possible complication of a simple pneumothorax

A

Could turn into a tension pneumothorax at any moment

154
Q

When should a needle decompression be performed

A

When the following three criteria are met:
Evidence of worsening respiratory distress or difficulty with BVM device
Decreased or absent breath sounds
Decompensated shock (SBP <90)

155
Q

Who does spontaneous simple pneumothorax occur in

A

Young white males
Age 16-25 years old
Very lanky, thin, runners build

156
Q

What are some complications associated with a needle thoracentesis

A

Hemothorax
Bacterial infection (cellulitis)
Air embolism

157
Q

What size catheter is used in a needle thoracentesis

A

10-16g catheter with 3-10cc syringe attached

158
Q

How much blood can the pleural space accommodate

A

2500-3000mL therefore a hemothorax can represent a source of significant blood loss

159
Q

Where can the bleeding come from with a hemothorax

A

The bleeding may come from the chest wall musculature, the intercostal vessels, the lung parenchyma, pulmonary vessels, or the great vessels of the chest

160
Q

What is the primary cause of hemothorax (<1500ml of blood)

A

Lung laceration
Or
Laceration of an intercostal vessel or internal Mammary artery due to either penetrating or blunt trauma

161
Q

What are the indications for performing a chest tube

A

Drainage of large pneumothorax (>25%)
Drain hemothorax
After needle decompression of a tension pneumothorax
Pleural effusion
Emphyema
Simple/closed pneumo
Open pneumo

162
Q

What is the chest tube size for adult or teen male

A

28-32 Fr

163
Q

What is the chest tube size for adult to teen female

A

28Fr

164
Q

What is the chest tube size for a child

A

18Fr

165
Q

How do you measure the length of the chest tube

A

Midaxillary line at the 5th intercostal space to the inferior tip of the scapula

166
Q

Where is the incision made for the chest tube

A

At the 5th intercostal space in the midaxillary line where the lower skin wheal was anesthetized, create a 2-4cm incision that follows the rib

167
Q

How often should chest tube dressing be changed

A

Every 24 hours or if the dressing becomes saturated

168
Q

What is the breaking of 2 or more ribs in 2 or more places called

A

Flail chest

169
Q

What are signs of flail chest

A

Shortness of breath
Paradoxical chest movement
Bruising/swelling of affected chest area
Crepitus

170
Q

What is a abnormality associated with pulmonary contusion

A

Prevention of gas exchange because no air enters these alveoli

171
Q

What is the shelf life of collected fresh whole blood

A

24-48 hours but the sooner you can deliver it to the patient, the more plentiful the functional components remain

172
Q

All males can receive what blood product

A

O pos or O neg at anytime

173
Q

All females of childbearing years should receive what type of blood

A

O negative unless it is a matter of life or death

174
Q

If a female receives O positive blood what is a complication that occur

A

The Rh negative mother that was exposed to Rh positive blood will start to attack the fetal blood cells inducing HYDROPS FETALIS leading to fetal death

175
Q

If a patient has lost 1500-2000mL of blood, pulse > 120, decreased blood pressure, 30-40 RR, and urine output of 5-15mL what class of hemorrhagic shock is this

A

Class III - 30% blood loss

176
Q

If a patient has lost more than 2000mL of blood, HR >140, decreased b/p, >35 RR, and urine output negligible what class of hemorrhagic shock is this

A

Class IV - >40% of blood loss

177
Q

What does an radial pulse mean in terms of possible systolic b/p

A

Systolic is below 80mmhg

178
Q

1 amp of calcium glucose is given every ____ units of blood

A

4 units to avoid toxicity and hypocalcemia

179
Q

The normal human liver can process how many units of fresh whole blood without needing additional calcium

A

13 units

16 units is when a reaction happens if no calcium is given

180
Q

What will you do if a blood transfusion reaction occurs

A

Immediately stop the transfusion
Maintain a patent IV/IO Line, start fluid bolus with balanced crystaloid
Assess the patient

181
Q

What is the flow rate for a blood transfusion over the first 15 minutes

A

Set flow to deliver 10-30mL of blood (1gtt/4-6 sec=1ml/min)

182
Q

How often will you measure vital signs for the first 15 minutes of a blood transfusion

A

Every 5 minutes

183
Q

After the first 15 minutes of a blood transfusion if there is no evidence of a reaction what will the drip rate then be

A

200ml/min and monitor vital signs at least every 15 minutes

184
Q

What will you do if there is a transfusion reaction

A

Flush the tubing and filter with approximately 50ml of NS to deliver residual blood

185
Q

What is the blood transfusion documented on

A

SF 518 and SF 600 and forward to role III hospital in country

186
Q

When would you administer TXA

A

Hemorrhagic shock
One or more amputations
Penetration torso trauma
Evidence of severe bleeding

187
Q

What does TXA do

A

Prevents the clots from breaking down by keeping fibrin strands around longer to maintain the clot and thus helps to prevent internal bleeding and ultimately prevent death from hemorrhage

188
Q

When is survival benefit greatest to admin TXA

A

Within the first hour

189
Q

What is the dose for TXA

A

1 Gram in 100ml NS or LR as soon as possible but no later than 3 hours after injury

190
Q

TXA should be administered over what time frame

A

10 minutes

191
Q

What temperature range should TXA be stored at

A

59-86F

192
Q

What is used to crease the blood volume following severe loss of blood or loss of plasma

A

Colloids (volume expanders)

193
Q

What is used as maintenance fluids to correct body fluids and electrolyte deficits

A

Crystalloids - contain sodium/potassium/calcium/chloride

194
Q

What is the mainstay IV therapy in prehospital settings

A

Crystalloids

195
Q

What are the most common Crystalloid aka isotonic solutions

A

LR
NS
D5W

196
Q

Isotonic have a tonicity equal to what

A

Body plasma

197
Q

When is placement of an IO indicated

A

3 failed venous attempts Or 90 seconds
Or
In cases where it is likely to fail and speed is of the essence

198
Q

What are contraindications of IO placement

A

Ipsilateral fracture or crush injury
Previous ortho procedure
Previous IO attempt in same bone
INFECTION AT INSERTION POINT
Inability to locate landmark

199
Q

What are complications of an IO

A

Tibial fracture, especially in small framed people
Compartment syndrome
Osteomyelitis
Skin necrosis

200
Q

If the patient is still in the fight and needs mild to moderate pain treatment what is given

A

Combat wound medication pack
- Tylenol 625mg 2 tabs PO q8hrs
- Meloxicam 7.5-15mg PO daily

201
Q

If the patient is in moderate to severe pain and is not in shock and not in Resp distress and is not at risk for either, what medication can be given

A

Oral transmuscosal fentanyl citrate 800ug placed between the cheek and the gum and instruct the patient not to chew

202
Q

If the patient is in moderate to severe pain and is in shock/Resp distress what medication is given

A

Ketamine 50mg IM or IN with repeat dose every 30 minutes or 20mg IV/IO every 20 minutes

203
Q

What can be given at an alternate to OTFC if IV access has been established

A

Morphine 5mg IV
MAX DOSE IS 15MG
Reasses in 10 minutes

204
Q

If given morphine, what should you have on hand

A

Naloxone IV/IM/SubQ 0.4-2mg may repeat dose every 2-3 minutes

205
Q

What can be used for nausea after admin of narcotics

A

Ondanestron
4mg PO/IV/IM q8 hours as needed

206
Q

If the patient is able to tolerate oral medication what antibiotic should be used

A

Moxifloxacin 400mg IV/PO q24 hours

207
Q

If the patient is in shock or unconscious what antibiotic is given

A

Ertapenum 1G IV q24hrs

208
Q

What are the other AMAL antibiotics that could be given

A

Levofloxacin 750mg IV/PO q24h
Cefazolin 1 Gram IV every 8 hours for 7 days
Ceftriaxone 2 grams IV q24h

209
Q

What is are the leading causes of traumatic brain injuries

A

Motor vehicle collision
Falls in the elderly

210
Q

What structure does the brain stem and spinal cord pass through

A

Foramen magnum

211
Q

What are the meninge layers of the brain

A

Dura mater - epidural space
Pia mater - closely adhered to the brain
Arachnoid membrane - layered on top of blood vessels

212
Q

What are the regions of the brain

A

Cerebrum
Cerebellum
Brain stem

213
Q

What surrounds the brain and functions as a cushion to the brain

A

Cerebrospinal fluid (150mL)

214
Q

What controls pupillary constriction. Crosses the surface of tentorium and hemorrhage or edema that leads to herniation of brain will compress the nerve and lead to pupillary dilation

A

Cranial nerve III (oculomotor)

215
Q

What are the two biggest predictors of poor outcome in head trauma

A

Amount of time spent with ICP >20mmHg and
Time spent with systolic b/p <90. A single episode of hypotension can lead to worse outcome

216
Q

It is essential to keep spo2 above what

A

90%

217
Q

Increased ICP can lead to cardiovascular changes and a response known as cushings reflex. What is cushings triad

A

Elevated BP
Bradycardia
Abnormal breathing (Cheyenne stokes)

218
Q

In secondary assessment what is the single most important observation

A

Constant continuous observation of mental status

219
Q

What is bleeding between skull and dura mater and what might cause this

A

Epidural hematoma - usually low velocity blow to temporal bone
WATCH FOR DILATED, SLUGGISH NON REACTIVE PUPIL

220
Q

What is blood between dura and arachnoid membrane and what typically causes this

A

Subdural hematoma - MVC or falls

221
Q

If a patient complains of having the worst headache of their life with nausea/vomiting, dizziness, seizures or may have meningeal signs what might this be

A

Subarachnoid hemorrhage (SAH)

222
Q

After a mild tbi/concussion what is the minimal recovery period

A

24 hours

223
Q

What are red flags to look out for in someone who had a concussion/ mild tbi

A

Deteriorating level of consciousness
Double vision
Increased restlessness, combative or agitated behavior
Repeated vomiting
Seizures
Weakness/tingle in arms or legs
Severe or worsening headache
Unsteady on feet
One pupil larger or smaller than the other
Changes in hearing, vision or taste
Repeated episodes of blacking out or passing out

224
Q

What is part of the 24 hour rest period following a concussion

A

Rest with extremely limited cognitive activity (no reading, video games, word puzzles)
Limit physical activities to only daily living activities
Avoid work, exercise, reading or driving
Avoid caffeine/alcohol

225
Q

What pain management can be used in someone with a concussion

A

Acetaminophen every 6 hours, for 48 hours
After 48, may use naproxen as needed

AVOID TRAMADOL, FIORICET AND NARCOTICS

226
Q

for concussion management what is stage one

A

If symptom free during exertion testing and this is their first concussion in the last 12 months then return to duty

227
Q

What is stage 2 in concussion management

A

If symptom free following 5 days of stage 2 activity then progress to stages 3/4/5 each for 24 hours and if symptom free during this, perform exertion testing and if no symptoms then return to duty

228
Q

What is stage 3 in concussion management

A

Light tasks no longer than 60 minutes

Heavy tasks no longer than 30 minutes

229
Q

What is stage 4 of concussion management

A

Can wear PPE

Light activity no longer than 90 minutes

Heavy activity no longer than 40 minutes

230
Q

If there are 3 or more documented concussions and/or TBI in the past 12 months then what will you do

A

Stage 1 rest and refer to neurology

231
Q

Hypothermia is defines as a core temperature below what

A

95F

232
Q

What is the core temp of someone who has mild hypothermia

A

90-95F

233
Q

What is the core temp of someone who has moderate hypothermia

A

82-90F

234
Q

What is the core temp of someone who has severe hypothermia

A

Below 82F

235
Q

What are the most common mechanisms of accidental hypothermia

A

Convective heat loss to cold air
Conductive heat loss to water

236
Q

What heart arrhythmia may be present in someone with moderate hypothermia

A

A Fib

237
Q

What heart arrhythmia may be present in someone with severe hypothermia

A

V fib/tach/asystole

238
Q

Many standard thermometers only read to minimum of what degrees

A

93F

239
Q

What are the two most important lab studies of someone who has hypothermia

A

Finger stick glucose
ECG to look for OSBORNE WAVES

240
Q

How is someone with mild hypothermia rewarmed

A

Passive external warming - blanket

241
Q

What rewarming is used for someone with moderate and refractory mild hypothermia

A

Active external rewarming - hypothermia blanket

242
Q

What rewarming method is used in someone with severe and some cases of refractory moderate hypothermia

A

Active internal rewarming

243
Q

Blood loss of 15-30 percent (750ml to 1500ml) is considered what class of hemorrhage

A

Class II

244
Q

If a radial pulse is felt, what is the assumed pressure

A

> 80mmhg

245
Q

If a femoral pulse is felt what is the assumed pressure

A

> 70mmhg

246
Q

If a carotid pulse is felt what is the assumed pressure

A

> 60mmhg

247
Q

What are signs of a basilar skull fracture

A

Bruising around the eyes
Bruising behind the ears

248
Q

What is the most commonly injured organ in blunt trauma

A

Spleen

249
Q

what is the second most commonly injured organ in blunt trauma

A

liver

250
Q

what is the 5 systematic steps to assess life threatening injuries in primary survey for TCCC

A

MARCH

251
Q

what is the primary survey in ATLS

A

focus is airway breathing and circulation

252
Q

what is a head to toe physical examination to include a reassessment of vital signs

A

secondary assessment

253
Q

how is history obtained in a trauma patient

A

AMPLE
allergies
medications/supplements
past medical illness/injuries
last meal
events

254
Q

what is hemotympanum and/or distruption of the auditory canal suggestive of

A

basilar skull fracture

255
Q

what patients are at risk for compartment syndrome

A

those with fractures or crush injuries.

  • pain is the first sign of ischemia and should be aggressively evaluated
  • if there is suspcion then compartment pressures should be measured or fasciotomy performed
256
Q

the primary survey is comprised of what

A

evaluation circulation, airway, c-spine, disability (mental status) and environmental exposures

257
Q

secondary survey is what

A

includes a total evaluation of the patient from head to toe

258
Q

when do signs and symptoms of anaphylaxis begin

A

within 60 minutes of exposure

259
Q

after resolution of symptoms, what percentage of patients will have a reoccurrence within 12 hours after resolution of the first episode

A

21%

260
Q

what is the most important step in the treatment of suspected anaphylaxis

A

rapid administration of epinephrine

261
Q

what leads to erythema, ulcers, edema and causes impaired ciliary function of the upper airway

A

usually due to thermal injury

262
Q

what leads to pulmonary edema and susequent mistatches in ventilation and perfusion of the lungs which can cause hypoxemia

A

tracheobronchial tree injury usually caused by chemicals in the smoke

263
Q

what results in alveolar collapse and impaired oxygenation and puts the patient at risk for pneumonia

A

parenchymal injury

264
Q

with carbon monoxide affinity for hemoglobin is how many times grater than oxygen

A

260 times greater than oxygen

265
Q

what are important historical factors that should be obtained with a smoke inhalation patient

A

flame, smoke, fire
duration of exposure
enclosed space
associated loss of consciousness

266
Q

what is the first step in treatment of a smoke inhalation patient

A

rescue from source and limit exposure time

267
Q

what treatment is indicated if there are signs of thermal injury to the airway

A

intubation is indicated

268
Q

what medications can be given for a smoke inhalation patient

A

albuterol - SABA
acute tx: 1-2 inhale every 2 hours for first 4 hours
maintenance (in combo with corticosteroid): 1-2 inhale q4-6hrs as needed MAX: 8 inhale

269
Q

what are some causes of rhabdomyolysis

A

trauma/muscle compression
trauma
crush injury
prolonged restraints
compartment syndrome
electrical injuries

270
Q

what are causes of exertional rhabdomyolysis

A

individual not conditioned (new recruits)
hot humid conditions
impaired sweating (heat stroke)
seizures and delirium tremens
meth and cocaine use

271
Q

what are symptoms and exam findings of someone with rhabdo

A

muscle tenderness
edema
muscle weakness
DARK URINE COCA COLA URINE
altered mental staus may occur from underlying cause

272
Q

what are lab findings of rhabdo

A

ELEVATION IN CK (hallmark)
UA dipstick positive for blood but no RBC on micro
HYPERKALEMIA - peaked T waves seen in EKG

273
Q

what is the treatment for rhabdo

A

LArge volume IV fluid resuscitation to maintain 2mL/kg/hr urine output
if alt mental status, Temp > 105 or unresponsive to IV fluids then MEDEVAC
some patients may hav eprogreessive renal failure and reuire hemodialysis

274
Q

what are some causes of non exertional rhabdo

A

coma induced by drugs
medications (statins)
Toxins (snake venom & CO)

275
Q

what is it when contents of the muscle fibers leak into circulation and is a result of an injury/necrosis to the muscle fiber

A

rhabdomyolysis

276
Q

what are the structures in the peritoneal cavity - the true abdomen

A

solid organs
portions of large intestine
most of the small intestine
female reproductive organs

277
Q

GSW most commonly injure what organs

A

small bowel (50%)
colon (40%)
Liver (30%)
abdominal vessels (25%)

278
Q

injuries most often associated in blunt abdominal trauma includes what structures**

A

Spleen (40-55%)**
Liver (35-45%)
Small bowel (5-10%)

279
Q

what structures are located in the retroperitoneal space**

A

kidneys
ureters
inferior vena cava
aorta
pancreas
much of the duodenum
ascending descending colon and rectum

280
Q

shock from intra-abdominal bleeding may present with what symptoms **

A

mild tachycardia with few other findings to severe tachycardia with pale, cool skin findings

281
Q

if a seat belt sign is present what organ is likely to be damaged **

A

bowel

282
Q

significant tenderness to percussion or pain with coughing on abdominal exam is a strong indicator for what

A

perotonitis

283
Q

what is the primary treatment goal of someone with a crush injury

A

primary goal is to prevent ARF. Suspect, recognize and treat rhabdo

initiate therapy ASAP and establish IV access in a free arm or leg vein

284
Q

what is given for fluid resuscitation in a crush injury victim

A

1 L should be given prior to extrication and up to 1 L/h (short extrication time) to a max of 6-10 L/d in prolonged entrapments

285
Q

what is the most common sign of compartment syndrome

A

Paresthesia
pain

lower extremity is more prone

286
Q

what is avulsed skin and subcutaneous fat off underlying structures, these areas can become ischemic and requires skin grafting

A

degloving injury

287
Q

what is the gold standard imaging in a pelvic fracture

A

CT scan

288
Q

in regard to third degree full thickness burns, what is adjacent to zone of necrosis, immediately after injury blood flow is stagnant

A

zone of stasis

289
Q

what is the outermost zone of a third degree full thickness burn called

A

zone of hyperemia

290
Q

what type of burn only involves the epidermis, is red and painful, will heal in about a week without a scar. and is not included when calculating the percentage of body surface burn

A

superficial burn

1st degree

291
Q

what type of burn involves epidermis and varying portions of the DERMIS, will appear as blisters or denuded burned areas with glistening or wet appearing base

A

partial thickness burn

2nd degree

292
Q

what type of burn appears thick, dry, white and leathery

A

full thickness burn

thick leathery damaged skin referred to as eschar

293
Q

in a burn victim what is the starting rate for fluid resuscitation

A

starting rate 500ml/hr for adults

294
Q

what is the initial hourly rate fluid resuscitation calculation

A

%TBSA burn x 10ml/hr

ex: 40% TBSA burn = 400ml/hr

295
Q

when monitoring a burn patient, what is the target urine output

A

0.5ml/kg/hr

30mL

296
Q

what is the single most reliable indicator of adequate resuscitation

A

uop

297
Q

what are reasons for prolonged field care

A

long evac times
indigenous capabilities
requires different skills
different enviroments

298
Q

what are the three phases of prolonged field care

A

evaluation phase
resuscitation phase
transport phase

299
Q

what is the lethal triad

A

hypothermia
acidosis
coagulopathy
+sepsis

300
Q

what should be done in the transport phase

A

prevent hypothermia
secure patient and litter
splinting
monitors and cuffs
emergency meds
sedation pain
secure tubing
document of patients condition, response to therapy and treatment rendered

301
Q

in prolonged field care what is the goal for adequate urine output

A

UOP 0.5-1mg/kg/hr

302
Q

what is a non invasive method allowing the monitoring of the saturation of a patients hemoglobin

A

pulse oximeter

303
Q

according to ATLS what is the preferred definitive airway

A

tracheal intubation through the mouth using direct laryngoscopy

304
Q

if there is a patient trappedm what is the indicated airway

A

esophageal tracheal combitube

305
Q

what are the anatomical landmarks in a needle decompression

A

mid-clavicular line
sternum
jugular notch
2nd intercostal space
second rib
clavicle

306
Q

a patient presents with tachypnea, pallow, hypotension, frothy bloody sputum, and flat neck veins. what might be the cause

A

hemothorax

307
Q

for pain management of a flail chest patient what can you do

A

splint ribs with trauma bandage/triangle bandage
IV fluid bag on area and tape down
IV ketamine

308
Q

what is fresh whole blood also referred to as and was the first approved protocol in the ARMY

A

LOW TITER O WHOLE BLOOD (LTOWB)

309
Q

for a febrile non-hemolytic reaction what is the treatment

A

1 gram of tylenol PO/PR q8hr

310
Q

how much blood is drawn into the bag

A

450ml (overfilling may cause clotting). a trip scale may be used or alternatively a 9.5 inch piece of 550 cord around the bag

311
Q

in a patient who has had a previous allergic blood transfusion,, how will you proceed

A

give 25-50mg diphenhydramine IM/PO/IV in a seperate line

312
Q

what are side effects of txa admin

A

hypotension with rapid IV infusion
seizures
visual changes

313
Q

if TXA is given and patient is still bleeding out what can you do

A

admin a second infusion of 1 gram TXA after inital has been completed

314
Q

what type of technique is used in an IO

A

sterile

315
Q

what equipment is used to aspirate medullary contents in an IO

A

two 10mL syringes with normal saline

316
Q

how is the mean artierial pressure calculated

A

systolic+dystolic x2/3 or diastolic + 1/3 pulse pressure

317
Q

what is normal CPP (cerebral perfusion pressure)

A

70-80mmhg

CPP=MAP-ICP

318
Q

what can brisk bleeding of the scalp be masked by

A

thick hair

319
Q

in a patient who has anaphylaxis epi is given and what else

A

methylpredisolone (solumedrol) 125mg IM/IV daily x2 days

320
Q

in Carbon monoxide the affinity for hemoglobin is how much greater than oxygen

A

260 times greater than oxygen

321
Q

in full thickness burn what is the region of greatest destruction resulting in necrosis and not capable of repair called

A

zone of coagulation - central zone

322
Q

what stage of prolonged field care is the lethal triad addressed

A

resusciatation phase

323
Q

when should you NOT attempt to convert a TQ

A

for any TQ in place longer than 6 hours unless it occurs at definitive care

<2 hours = safe
2-6 hours = likely safe
>6 = requires caution, not advised

324
Q

what is the better capability of sedation and pain management in prolonged field care

A

provide sedation with ketamine and added midazolam (Versed)

325
Q

why do you put one additional TQ in place when converting a TQ

A

if the TQ already in place breaks during the conversion process, there is already a backup in place ready to be tightened

326
Q

what is the fluid of choice for patients in hemorrhagic shock

A

Fresh whole blood

MAP of 65mmhg
adequate UOP at least 05cc/kg/hr
Adequate mentation (mental activity)

327
Q

what is a common source of bleeding in a pelvic fracture

A

venous plexus

328
Q

if a patient has a suspected pelvic fracture, blood from the meatus and swelling what will you do

A

retrograde urethral gram

329
Q

patient has a GCS of 3, face swollen and gargling you already gave o2 and performed the jaw thrust what will you do next

A

suction

330
Q

what is the landmark for placing a pelvic binder

A

greater trochanter

331
Q

what other injury is likely when someone has a flail chest

A

pulmonary contusion

332
Q

you’ve got a patient with a fracture and you have splint but before they are loaded into the medevac, what should be done

A

check neurovascular status

333
Q

what is the target urine output for a burn

A

0.5mg/kg/hr

334
Q

when can you d/c fluid resuscitation

A

hemodynamically stable and mental stability

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