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Post TAV II > Trauma > Flashcards

Trauma Flashcards

1
Q

Triage categories can change based upon what

A

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

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2
Q

How do you define multiple casualties

A

The number of patients and the severities of their injuries do NOT exceed the resources and capabilities

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3
Q

How do you define mass casualties

A

The number of patients and the severities of their injuries DO exceed the resources and capabilities

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4
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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5
Q

Which principal of triage entails looking at each patient in a total global fashion

A

Injury severity

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6
Q

When is application of triage principles used

A

Decisions made are based on the best information available at the time
A large number of patients into small manageable groups
Mode of evacuating and transporting patients

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7
Q

What are the categories of military triage

A

Delayed
Immediate
Minimal
Expectant

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8
Q

Define the immediate military triage category

A

Needs lifesaving interventions within minutes up to 2 hours on arrival to avoid death or major disability

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9
Q

What are examples of an immediate patient

A

Penetrating chest wound WITH respiratory distress
Torso, neck, or pelvis injuries WITH shock
Threatened loss of limb
Retrobulbar hematoma (threat to loss of sight)

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10
Q

Define the delayed military triage category

A

Requires medical attention but CAN wait

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11
Q

What are examples of a delayed patient

A

Moderate to severe burns with less than 20% of total body surface area (greater than 20% is immediate)

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12
Q

Define the minimal triage category

A

Can be treated with self aid, buddy aid, or corpsman aid

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13
Q

Define the expectant military triage category

A

Require complicated treatments that may not improve life expectancy

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14
Q

What is the fourth stripe on the tag - casualties are dead or non-salvageable and entails no care is needed

A

Black (deceased/expectant)

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15
Q

What is the third stripe on the tag - casualties have minor injuries and will need minimal care

A

Green (minimal)

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16
Q

What is the second stripe on the tag - casualties are in the most need of care and/or transport to a higher echelon of care

A

Red (immediate)

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17
Q

What is the first stripe on the tag - casualties will need care, but in no hurry

A

Yellow (delayed)

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18
Q

What is primary triage

A

Simple and quickly categorizing patients; identifying and stop life threats. Breaks patients down into more manageable patients

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19
Q

Immediate life sustaining care and situation awareness are part of what triage

A

Primary triage

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20
Q

What is secondary triage

A

Allows for adjustment on patient response, to direct more in-depth treatment and prepare for a nine-line medical evacuation request

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21
Q

What is tertiary triage

A

Continued management of patients where more complicated procedures should be weighed against situation

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22
Q

Early trauma deaths are due to disruptions in one, or all, of the three bodily systems - what are those

A

The respiratory system
The vascular system
Or the central nervous system

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23
Q

What is combat stress

A

Rapid identification and immediate segregation of stress casualties from injured patients will improve the odds of a rapid recovery

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24
Q

What are the categories of combat stress

A

Light stress
Heavy stress

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25
Q

Define light stress

A

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

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26
Q

Define heavy stress

A

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

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27
Q

What is the pneumonic used where resources and tactical situations allow

A

BICEP:
Brief
Immediate
Central
Expectant
Proximal
Simple
Or refer

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28
Q

Define brief from “BICEP”

A

Keep interventions to 3 days or less of rest, food and reconditioning

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29
Q

Define immediate from “BICEP”

A

Treat as soon as symptoms are recognized. Do not delay ***

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30
Q

Define central from “BICEP”

A

Keep in one area for mutual support and identity as service member

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31
Q

Define expectant from “BICEP”

A

Reaffirm that we expect them to return to duty after brief rest; normalize the reaction and their duty to return to their duty

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32
Q

Define proximal from “BICEP”

A

Keep them as close as possible to the unit

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33
Q

Define simple from “BICEP”

A

Do not engage in psychotherapy… address the present stress response and situation only, using rest, limited catharsis and brief support

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34
Q

Define the “or refer” of “BICEP”

A

Must be referred to a facility that is better quipped or staffed for care

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35
Q

Define level 1 echelon of care

A

First medical care military personnel receive. Includes immediate life-saving measures, disease and non-battle injury prevention and care, combat and operational stress control (COSC), patient location and acquisition.

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36
Q

What treatment is provided by level 1 echelon of care

A

Self-aid and buddy aid
Combat life saver
Medical personnel
Examples include: BAS, cruisers, destroyers

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37
Q

What is level 2 echelon of care

A

Initial resuscitative care is primary objective of care - saving life, limb and when necessary - stabilization for evacuation to level 3

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38
Q

What are examples of level 2 echelon of care

A

CRTS: LHD (largest medical capability), LHA, CVN
MEDBN - provides surgical care for the MEF (Consists of 1 HQ company and 3 surgical companies)
STP (shock trauma platoon) - a small forward unit with one physician supporting the MEF
FRSS (forward resuscitative surgical suite)

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39
Q

What is R2LM and R2E and what echelon of care do they fall under

A

R2LM - Role 2 Light Maneuver; light, highly mobile medical units designed to support lane maneuver formations
R2E - role 2 enhanced; provides basic secondary healthcare built around primary surgery, intensive care unit, and ward beds

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40
Q

Define level 3 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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41
Q

What are examples of level 3 echelon of care

A

Fleet hospitals, fleet ships (USNS comfort/mercy)

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42
Q

Define level 4 echelon of care

A

Definitive medical care is the primary objective at this level

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43
Q

What is an example of level 4 echelon of care

A

OCONUS hospital - NH Yokosuka

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44
Q

Define level 5 echelon of care

A

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

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45
Q

What is an example of level 5 echelon of care

A

CONUS hospital - NMCSD

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46
Q

What is a MEDEVAC

A

Timely, efficient movement and en route care provided by medical personnel to the wounded being evacuated from the battlefield to the MTF

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47
Q

What is a CASEVAC

A

Movement of casualties from the point of injury to medical treatment by non-medical personnel (may not receive en route medical care

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48
Q

What is AE

A

Aeromedical evacuation - generally utilizes USAF fixed-winged aircraft to move sick or injured personnel within the theater of operations (intra-theater) or between two theaters (Inter-theater)

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49
Q

What litters are used to transport casualties

A

Standard litter - prefabricated and may have accessories to be used with them
Stokes litter - most commonly used litter onboard ships
SKED litter - compact and lightweight transport system
Improvised litter - made from various materials

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50
Q

What are methods of ground evacuation

A

M997 Ambulance: protection for crew and patients
M1035 Ambulance: removable soft top
MK 23 7 ton: non-medical vehicle that may be utilized for casualty transport when available

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51
Q

What are the methods of air evacuation

A

UH-60A Blackhawk
UH-60B Seahawk
CH-46 Sea Knight
CH-53 D/E Sea Stallion
CH-1 Huey
MV-22 Osprey
C-2 Greyhound
P-3 Orion
C-130 Hercules

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52
Q

What are the MEDEVAC/CASEVAC priorities

A

Urgent - casualty must be evacuated within 2 hours in order to save life, limb or eyesight
Priority - casualty must be evacuated within 4 hours or condition could worsen
Routine - casualty must be evacuated within 24 hours for further care

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53
Q

What are examples of an urgent MEDEVAC/CASEEVAC

A

Cardio respiratory distress
Uncontrolled hemorrhage
Shock not responding to IV therapy
Head injuries with signs of increased ICP
Extremities with neurovascular compromise

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54
Q

What are examples of a priority MEDEVAC/CASEVAC

A

Flail chest segments without respiratory compromise
Open fractures
Spinal injuries
Major burns

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55
Q

What are examples of routine MEDEVAC/CASEVAC

A

Minor to moderate burns
Simple, closed fractures
Minor open wounds
Terminal casualties

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56
Q

What is line 3 of the 9 line

A

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

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57
Q

What is line 4 of the 9 line

A

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

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58
Q

What is line 7 of the 9 line

A

Method of marking pickup site
A - panels
B - pyrotechnics ***
C - smoke
D - none
E - other

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59
Q

The MIST report consists of what categories

A

Mechanism of Injury
Injuries sustained
Signs/symptoms
Treatment

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60
Q

What states that every object will remain at rest or in uniform motion unless compelled to change its state by the action of an external force

A

Newton’s first law - commonly known as inertia

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61
Q

What is Newton’s second law

A

Builds on the first and further defines a force (F) as equal to the product of the mass (M) and acceleration (A): F=ma

Force = mass x acceleration/deceleration

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62
Q

What forms can energy take

A

Mechanical
Thermal
Electrical
Chemical

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63
Q

Who first proposed that the kinetic energy possessed by the bullet was dissipated in four ways

A

Theodore Kocher

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64
Q

What are the ways a bullet is dissipated

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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65
Q

What is cavitation

A

When a solid object strikes the human body or when the body is in motion and strikes a stationary object, the tissue particles are knocked out of their normal position creating a hole or cavity

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66
Q

What is the momentary stretch or movements of tissue away from the path of the bullet

A

The temporary cavity (think a vaccine)

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67
Q

What forms at the time of impact and is caused by compression or tearing of tissue, but it does not necessarily rebound to its original shape and can be seen later

A

The permanent cavity (think GSW)

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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 rotation around the center of mass

A

Tumbling

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70
Q

What is a mushrooming of the projectile that increases the diameter of the projectile, usually by a factor of 2, increases the surface area, and, hence, the tissue contact area by four times; hollow point, soft nose, and dum-dum bullets all promise deformation

A

Deformation

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71
Q

What is multiple projectiles can weaken the tissue in multiple places and enhance the damage rendered by cavitation. This usually occurs in high-velocity misses

A

Fragmentation

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72
Q

What are the energy levels of projectiles

A

Low
Medium
High

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73
Q

What is an example of a low level energy projectile

A

Knives, needles, ice picks

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74
Q

What is an example of medium energy projectiles

A

9 mm

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75
Q

What is an example of a high energy level of projectiles

A

.44 magnum

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76
Q

Elastic tissue tolerate damage better than non-elastic organs, what are examples of each organ group

A

Elastic tissue - bowel and lung
Non-elastic tissue - heart, liver, kidney and brain

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77
Q

The approach to thoracic injuries typically depends upon the mechanism, severity, and the location of injury, list examples of each

A

Mechanism - penetrating vs. blunt
Severity - life threatening vs. stable
Location of injury - chest wall vs. pleura vs. lung

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78
Q

What categories are blast injuries subdivided into

A

Primary - remember perforated tympanic membrane
Secondary - flying debris/fragments
Tertiary - body displacement
Quaternary - burns

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79
Q

What are the TCCC approved tourniquets

A

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

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80
Q

What can be used as a temporary measure and works most of the time for external bleeding and can even be used for carotid and femoral bleeding

A

Direct pressure

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81
Q

What are the TCCC approved hemostatic agent

A

Combat gauze
Celox gauze or chito gauze - active ingredient is chotosan, a mucoadhesive, it functions independent of the coagulation cascade
XStat - best for deep narrow tract junctional wounds

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82
Q

What are the locations of junctional wounds

A

Groin
Buttocks
Perineum
Axillae
Base of the neck
Extremities

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83
Q

What are the CoTCCC Junctional tourniquets

A

Combat ready clamp
Junctional emergency treatment tool
SAM junctional tourniquet

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84
Q

What is the primary involuntary respiratory center

A

Medulla

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85
Q

What is connected to the respiratory muscles by the vagus nerve

A

The pons

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86
Q

Primary control centers come from the medulla and pons; what is this called

A

Neural control

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87
Q

What factors increase and decrease respirations

A

Increases respirations: body temperature, emotion, pain, hypoxia, acidosis, stimulant drugs
Deceases respirations: depressant drugs, sleeping agents, drugs like morphine

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88
Q

What is anoxia

A

There is no oxygen available at all

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89
Q

What is hypoxia

A

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

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90
Q

What is hypoxemia

A

Insufficient oxygenation; that is decreased partial pressure of oxygen in blood

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91
Q

True or false: All trauma casualties should receive appropriate ventilator support with supplemental oxygen to ensure that hypoxia is corrected or averted entirely

A

True

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92
Q

What are indications for oxygen therapy

A

Cardiac and respiratory arrest
Hypoxemia
Hypotension
Low cardiac output and metabolic acidosis
Respiratory distress

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93
Q

When is hyperbaric oxygen used

A

For decompression illness (the “bends”)
Carbon monoxide poisoning

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94
Q

Why is Sellick’s maneuver helpful

A

Aids in preventing aspiration, particularly during BVM ventilation

Prevention of gastric aspiration is one of the key components in airway maintenance

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95
Q

Which maneuver improves the visualization of the larynx structures and eases the intubation

A

BURP maneuver

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96
Q

What is an indication to apply an OPA on a patient

A

Casualty who are unable to maintain their airway

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97
Q

What is a complication to using an OPA

A

Due to gag reflex stimulation, use of the OPA may lead to gagging, vomiting, and laryngospasm in casualties who are conscious

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98
Q

What are complications to using an NPA

A

Bleeding cause by insertion may be a complication
Inserting the NPA into the brain with a basilar skull fracture
Nasal turbinate injury

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99
Q

What is an i-Gel

A

A supraglottic airway

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100
Q

What is a contraindication to doing endotracheal intubation

A

Cervical fractures

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101
Q

What are complications of endotracheal intubation

A

Hypoxemia from prolonged intubation attempts
Trauma to the airway with resultant hemorrhage
Right mainstem bronchus intubation
Esophageal intubation
Vomiting leading to aspiration
Loose or broken teeth
Injury to vocal cords

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102
Q

What is the sniffing position

A

The head is extended, and the neck is flexed

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103
Q

What is also known as a blind insertion airway device (BIAD) often used in the pre-hospital, emergency setting

A

The Combitube - esophageal tracheal airway

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104
Q

What is an indication to use the combitube airway

A

Airway management in trapped patients

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105
Q

What is a contraindication of using the combitube airway

A

Patients with known esophageal pathology
Patients with intact gag reflexes

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106
Q

What are complications os using the combitube airway

A

Increased incidence of sore throat, dysphasia and upper airway hematoma when compared to endotracheal intubation and LMA
Esophageal rupture is a rare complication but has been described
May be partially preventable by avoiding over-inflation of the distal and proximal cuffs

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107
Q

Confirm tube placement of the combitube airway can be confirmed using what

A

End tidal CO2 detector or esophageal bulb device

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108
Q

What does not provide a definitive airway, and proper placement of the device is difficullt without appropriate training

A

The LMA

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109
Q

What are complications of using an LMA

A

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

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110
Q

What is not a definitive airway device and plans to provide a definitive airway are necessary

A

LTA

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111
Q

What are complications of using an LTA

A

The laryngeal tube may be displaced during repositioning the patients head and neck for operation
Aspiration
Poor seal with inability to ventilate

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112
Q

What is the purpose for doing surgical cricothyrotomy

A

To provide an emergency breathing passage for a patient whose airway is closed by:
Traumatic injury to the neck
Burn inhalation injuries
By closing of the airway due to an allergic reaction to bee or wasp stings
Or by unconsciousness

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113
Q

What is considered a technique of “last resort” in prehospital airway management

A

Surgical cricothyrotomy

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114
Q

What are indications to performing surgical cricothyrotomy

A

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

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115
Q

What is a contraindication to performing surgical cricothyrotomy

A

casulaties with acute laryngeal disease of traumatic or infectious origin

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116
Q

What are complications of performing a surgical cricothyrotomy

A

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

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117
Q

True or false: with the non-dominant hand to immobilize the thyroid cartilage and hold the skin taut over the membrane. Make a 3cm vertical incision centered over the cricothyroid membrane

A

True

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118
Q

A surgical cricothyrotomy can be left in place for how long

A

24 hours but should be replaced within that time period by a formal tracheotomy performed in a higher level of care

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119
Q

Needle decompression should be performed when what criteria is met

A

Evidence of worsening respiratory distress or difficulty with BVM device
Decrease or absent breath sounds
Decompressed shock (SBP <90 mm Hg)

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120
Q

What is a simple pneumothorax

A

A collapsed lung caused by the rupture of a congenitally weak area lung

I.e. spontaneous pneumothorax

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121
Q

When does a simple pneumothorax usually occur

A

Young white males
Age 16 to 25 year olds
Those who possess a very lanky, thin, runners build

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122
Q

Spontaneous simple pneumothorax occur WITH or WITHOUT evidence of trauma

A

WITHOUT

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123
Q

What is released air that becomes trapped within the subcutaneous tissue. Feels like “rice crispies” underneath the skin

A

Subcutaneous emphysema

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124
Q

Hemothorax occurs when blood enters the pleural space. Because this space can accommodate how much liquid

A

2500 and 3000 ml, hemothorax can represent a source of significant blood loss

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125
Q

The mechanisms resulting in hemothorax are the same as those causing the various types of pneumothorax. The bleeding may come from where

A

The chest wall musculature, the intercostal vessels, the lung parenchyma, pulmonary vessels, or the great vessels of the chest

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126
Q

The primary cause of hemothorax is lung laceration or laceration of an intercostal vessel or internal mammary artery due to what

A

Either penetrating or blunt trauma

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127
Q

What are the indications for performing a chest tube

A

Drainage of large pneumothorax
Drainage of hemothorax
After needle decompression of a tension pneumothorax
Pleural effusion
Emphysema
Simple/closed pneumothorax
Open pneumothorax

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128
Q

What are contraindications to placing a chest tube

A

Infection over insertion site
Uncontrolled bleeding
No contraindication if the procedure is emergent

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129
Q

What is a flail chest

A

The breaking of 2 or more ribs in 2 or more places

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130
Q

What are some signs/symptoms of a patient with a flail chest

A

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

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131
Q

What is the chief physiological abnormality of a pulmonary contusion

A

Prevention of gas exchange because no air enters these alveoli; blood and edema fluid in the tissue between the alveoli further impedes gas exchange in the alveoli that are ventilated

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132
Q

Fresh whole blood contains all the functional components required by the body such as what

A

Red blood cells
Platelets
Plasma

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133
Q

FWB has a shelf life of what

A

24-48 hours for collected FWB

134
Q

All males can receive what blood at any time

A

O positive or
O negative

135
Q

All females of childbearing age receive what blood

A

O negative - unless it is a matter of life and death and there is no O negative blood available

136
Q

Why can females only receive O negative blood

A

It can induce what is termed Rh disease

If the female becomes pregnant with an Rh-positive baby, then 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

137
Q

What is class III hemorrhagic shock

A

Class III - 30% of blood loss
1500-2000 ml of blood loss
>120 pulse rate per minute
Decreased blood pressure
30-40 respirations per minute
Urine output 5-15 ml per hour
Level of consciousness exhibiting confused demeanor

138
Q

What is class IV shock

A

Class IV - >40% of blood loss
>2000 ml of blood loss
>140 pulse rate per minute
Decreased blood pressure
>35 respirations per minute
Urine output negligible
LOC exhibiting lethargic demeanor
absent radial pulse/SBP below 80 mm Hg

139
Q

If you were to encounter a patient with citrate toxicity, how do you manage the patient

A

Recommendation is to give 1 amp of calcium glaucoma temperature every 4 units of FWB to avoid toxicity and hypocalcemia

140
Q

How do you manage patients with a febrile non-hemolytic reaction

A

Treat as you would any other fever with 1 gram of Tylenol PO every 8 hours

141
Q

What should be filled out prior to blood transfusion and record vital signs every 10-15 minutes during transfusion

A

Fill out the back of the TCCC card or an SF 518

142
Q

How often are vitals being assessed for a patient undergoing a blood transfusion

A

Record baseline vitals and continue to record them through and following the transfusion at minimum every 15 minutes. For the first 15 minutes of the transfusion, record them every 5 minutes

143
Q

If a casualty is anticipated to need a significant volume of blood transfusion due to what would TXA be given

A

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

144
Q

What is TXA

A

Tranexamic acid

145
Q

What is the administration for TXA

A

Survival benefits are greater when given within 1 hour of injury
Administer 1 gram of TXA in 100 ml normal saline or lactated ringers as soon as possible, but not later 3 hours after injury
When administering TXA is should be administered over 10 minutes

146
Q

What is a side effect of administering TXA

A

Hypotension with rapid IV infusion, seizures, visual changes

147
Q

What is storage and handling of TXA

A

Recommended temperature range for storage: 59 - 86 F

148
Q

What are the types of solutions IV fluids come in

A

Colloids
Crystalloids (isotonic, hypotonic, hypertonic)
Blood ad blood products

149
Q

When the crystalloid contains the amount of electrolytes as the plasma, it is referred to as what

A

Isotonic

150
Q

If a crystalloid contains more electrolytes than the body plasma, it is more concentrated and referred to as what

A

Hypertonic

151
Q

True or false: placement of an intraosseous needle is indicated during traumatic situations when attempts at venous access fail (3 attempts or 90 seconds) or in cases where it is likely to fail, and speed is of the essence

A

True

152
Q

What are some contraindications of IO placement

A

Ipsilateral fracture or crush injury of an extremity
Previous orthopedic procedure near the selected insertion site
Previous IOVA attempts in the same bone
Infection at the selected insertion site
Inability to locate landmarks
Brittle bones

153
Q

How do you flush an IO

A

Two 10ml syringes for aspirating medullary contents and flushing with normal saline

154
Q

What are complications of an IO

A

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

155
Q

What do you give to a patient in mild to moderate pain and casualty IS still able to fight

A

Tylenol
Meloxicam (Mobic) - for moderate pain: 7.5 to 15 mg PO daily

156
Q

What do you give to a patient in moderate to severe pain and casualty is NOT in shock or respiratory distress and is not at significant risk of developing either

A

Oral transmucosal fentanyl citrate (OTFC): 800 ug

157
Q

What do you give to a patient in moderate to severe pain and casualty IS in shock or respiratory distress or casualty is at significant risk of developing either

A

Ketamine: 50 mg IM with repeat dose every 30 minutes/ 20 mg IV and repeat every 20 minutes

Often has side effect of vivid hallucinations

158
Q

What is an alternative to OTFC if IV access has been established

A

Morphine: 5 mg IV/IO, max of 15 mg

159
Q

What are the TCCC antibiotic recommendations

A

Moxifloxacin (Avelox): 400 mg IV/IO q 24 hours
Ertapenem (Invanz): 1 gram IV q 24 hours
Levofloxacin (Levaquin): 750 mg IV/PO q 24 hours
Cefazolin (Ancef, Kefzol): 1 gram IV every 8 hours for 7 days
Ceftriaxone (Rocephin) 2 grams IV every 12 hours

160
Q

What is the small opening for blood vessels and nerves to pass in the skull

A

Foramina

161
Q

What is it called where the brain stem and spinal cord passes

A

Foramen magnum ***

162
Q

What is the layers that cover the brain

A

Meninges

163
Q

What is inside the skull and is made of a tough fibrous layer and has epidural space (potential space)

A

Dura mater

164
Q

What is closely adhered to the brain

A

Pia mater

165
Q

What is layered on top of blood vessels adhered to pia

A

Arachnoid membranes

166
Q

What are the regions of the brain

A

Cerebrum
Cerebellum
Brain stem

167
Q

What is the brain surrounded by that is produced in the ventricular system and functions to cushion the brain

A

Cerebrospinal fluid (CSF) - approx. 150ml

168
Q

What controls pupillary constriction and crosses surface of tentorium

A

Cranial nerve III (oculomotor) - hemorrhage or edema that leads to herniation of the brain will compress the nerve leading to pupillary dilation

169
Q

What is CPP

A

Cerebral perfusion pressure

170
Q

What are the biggest predictors of poor outcome in head trauma

A

Amount of time spent with ICP >20 mmHg (usually below 15mmHg)
Time spent with systolic BP <90mmHg. A single episode of hypotension can lead to a worse outcome

171
Q

What is assessing for adequate airway and ventilator effort is crucial in early stages

A

Breathing

Essential to keep SpO2 >90mmHg

172
Q

What is Cushings triad

A

Refers to elevated systolic BP, bradycardia and abnormal respirations (Cheyne-stokes)

173
Q

When should a patient be intubated

A

GCS <8

174
Q

Depressed vs non depressed skull fractures

A

Depressed can often be palpated and may require surgical intervention

175
Q

When should a Basilar skull fracture be suspected

A

Suspect if CSF drainage or delayed (several hours) findings of periorbital ecchymosis or battle signs are seen

176
Q

What is a hyphema

A

Blood in anterior orbit

177
Q

How is a concussion defined

A

A head injury from a hit, blow or jolt to the head that:
Briefly knocks you out
May affect your ability to remember information before, during, or after the event
Makes you feel dazed (bell rung)

178
Q

Where is an epidural hematoma, how could it happen, and what should you watch for

A

Bleeding between skull and dura mater
Usually happens from low velocity blow to temporal bone
Watch for dilated, sluggish non-reactive pupil

179
Q

Where is a sub Duran hematoma, and what does this usually happen from

A

Account for 30% of severe brain injuries
Happens from MVC and falls
Blood collects between dura and arachnoid membrane

180
Q

How is a subarachnoid hemorrhage described as and what are the signs and symptoms

A

Commonly associated with ruptured cerebral aneurysm and onset of worst headache of life
Signs and symptoms: severe HA
Nausea/vomiting
Dizziness
May have meningeal signs***
Seizures

181
Q

What is the recovery period after a mild concussion/TBI

A

24-hour minimal recovery period

182
Q

What are red flags of a mild concussion/TBI

A

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

183
Q

How should an aggressive headache be managed

A

Use acetaminophen every 6 hours, for 48 hours - after 48 hours, may use Naproxen as needed
Avoid tramadol, fioricet, and narcotics

184
Q

How is an initial concussion patient managed

A

Mandatory 24 hour rest period
Reevaluate after 24 hours

185
Q

If a patient is symptom free at rest after a TBI/concussion, what should be performed next

A

Exertional testing

If symptom free during exertional testing and first concussion in the past 12 months - return to duty
If sx free during exertional testing and second concussion in the past 12 months - stage 2 light routine activity for the next 5 days

186
Q

What are the do’s and don’t’s of Stage 2 light routine activity

A

May wear uniform and boots, can do stuff no longer than 30 minutes
DO NOT: drink alcohol, play video games, do resistance training or repetitive lifting, do sit-ups, push-ups, or pull-ups, go to crowded areas where you may be bumped into

187
Q

For a patient that was symptom free following 5 days of Stage 2 activity, what is the next step

A

Patient may progress through stages 3, 4, and 5 for 24 hours each

188
Q

What are the do’s and don’t’s of Stage 3 light occupation-oriented activity

A

May perform activities for no longer than 60 minutes - lift/carry objects less than 20 lbs
May perform activities for no longer than 30 minutes - gently expose to light and noise
DO NOT: drink alcohol, drive, play video games, do resistance training or relative lifting, go to crowded places, participate in combative or contact sports

189
Q

What are the do’s and don’t’s of stage 4 moderate activity

A

You may wear PPE
Can perform activities for no longer than 90 minutes - brisk walk, light resistance training
Can perform activities for no longer than 40 minutes - play video games
DO NOT: drink alcohol, participate in combative or contact sports, drive

190
Q

What are the do’s and don’t’s of Stage 5 Intensive activity

A

Resume normal routine and exercise, participate in normal military routine
DO NOT: drink alcohol, participate in combative or contact sports, go outside the wire in a combat zone

191
Q

If symptoms develop/return during any stage of mild concussion/TBI recovery, what should be done

A

Patient must restart protocol and start at Stage 1 (rest), provide sx management, refer to rehabilitation provider

192
Q

Where should a patient be referred to if there are 3 or more documented concussions in the past 12 months

A

Stage 1 rest and refer to Neurology for a comprehensive work-up with imaging and assessment

193
Q

What are the temperature stages of hypothermia

A

Mild: 90 - 95 F
Moderate: 82-90 F
Severe: below 82 F

194
Q

How do patients present in each stage of hypothermia

A

Cold stressed (not hypothermic) - temp is 95 - 98.6 F… they’re okay, just cold
Mild hypothermia: alert but mental status may be altered, shivering present, not able to care for self
Moderate hypothermia: decreased LOC, could be conscious or unconscious, with or without shivering
Severe/profound hypothermia: unconscious, NOT shivering

195
Q

What is vaporization of water through both insensible losses and sweat

A

Evaporation

196
Q

What is emission of infrared electromagnetic energy

A

Radiation

197
Q

What is direct transfer of heat to an adjacent, cooler object

A

Conduction

198
Q

What is direct transfer of heat to convective currents of air or water

A

Convection

199
Q

What are the most common mechanisms of accidental hypothermia

A

Convective heat loss to cold air and conductive heat loss to water

200
Q

What symptoms may be present for a patient with moderate hypothermia

A

At lower ends of temp, loss of shivering, dysrythmias (A fib), and dilated pupils below 29 C

201
Q

What symptoms may be present in a patient with severe hypothermia

A

Pulmonary edema, oliguria, hypotension, bradycardia, ventricular dysrhythmias (V fib/tach/asystole)

202
Q

Many standard thermometers only read to a minimum temp of what

A

93 F

203
Q

What labs should be collected for a hypothermic patient

A

Finger stick glucose
ECG (Osborne waves)

204
Q

How is mild hypothermia treated

A

Passive external warming

205
Q

How is moderate and refractory mild hypothermia treated

A

Active external rewarming

206
Q

How is a severe hypothermic patient treated

A

Active internal rewarding and possibly extracorporeal rewarming

207
Q

The primary survey for both ATLS and TCCC consists of what

A

5 systematic steps to assess life threatening injuries with slight variations

208
Q

What is the TCCC primary survey

A

M - massive hemorrhage
A - airway
R - respirations
C - circulation
H - head trauma/hypothermia

209
Q

What is a class I hemorrhage

A

Loss of up to 15% (about 750ml) of circulating blood volume - tolerated well in healthy patients

210
Q

What is a class II hemorrhage

A

Blood loss of 15-30% (about 750-1500ml) of total blood volume - results in tachycardia and narrowed pulse pressure

211
Q

What is a class III hemorrhage

A

Blood loss increases beyond 30% (1500ml) - worsening hypotension, tachycardia, peripheral hypoperfusion and decline in mental status

212
Q

What is a class IV hemorrhage

A

Blood loss greater than 40% (2L) - the ability of the body to compensate has reached its limits and hemodynamic decompensation is imminent without effective resuscitation

213
Q

When assessing respirations, what findings warrant immediate intervention

A

Needle thoracostomy for tension pneumothorax
Insertion of large-bore chest tubes to relieve hemopneumothorax
Application of an occlusive dressing to a sucking chest wound

214
Q

When assessing circulation, what should be assessed for hemodynamic status

A

Consciousness, skin color and presence and magnitude of peripheral pulses
Formal BP should NOT be performed at this point in the survey - important information can be rapidly obtained regarding perfusion and oxygenation from the level of consciousness, pulse, skin color and capillary refill

215
Q

What are the expected palpable pulses of a patient

A

Radial pulse: pressure >80mmHg
Femoral pulse: pressure >70mmHg
Carotid pulse: pressure >60mmHg

216
Q

What is the lowest and normal score for a GCS

A

Lowest score: 3
Normal score: 15
Intubation: <8 - indicates severe head injury/coma

217
Q

What is the pneumonic used to collect the history of a trauma patient

A

A - allergies
M- medications and supplements
P - past medical illnesses and injuries
L - last meal
E - events associated to the injury

218
Q

What is hemotympanum

A

Disruption of the auditory canal on otoscopic exam are additional findings suggestive of a basilar skull fracture (blood behind the TM) - CSF leaking from the ear is confirmatory

219
Q

What does the presence of bruising around the eyes (raccoon eyes) or behind the ears (battle signs) indicate

A

Basilar skull fracture

220
Q

What is the most commonly injured organ in blunt trauma

A

The spleen

221
Q

What is the second most common solid organ injury

A

The liver

222
Q

Hollow viscous injuries can involve what

A

Stomach, bowel, or mesentary

223
Q

What may develop insidiously, and every patient with an injured extremity should be at risk, particularly those with fractures and crush injuries

A

Compartment syndrome

224
Q

What presents as the first sign of ischemia and should be aggressively evaluated

A

Pain - frequent reevaluation of the extremity is essential and if compartment syndrome is present, a fasciotomy should be performed

225
Q

For crush injuries, what should be considered

A

Rhabdomyolysis

226
Q

When should transportation begins for a trauma patient

A

MEDEVAC/CASEVAC should begin as soon as the patient is stabilized and packaged or when operationally possible

227
Q

What is an ongoing assessment

A

After the primary survey and initial care are complete, the patient should be continuously monitored

228
Q

What is the definition of anaphylaxis

A

Defined by airway compromise or hypotension, is obviously a true medical emergency and must be rapidly assessed and treated

229
Q

What are triggers for anaphylaxis

A

Drugs
Food
Additives
Toxins
Chemicals

230
Q

What is a classic presentation of an allergic reaction

A

Pruritis
Flushing
Urticaria

231
Q

What is progression of an allergic reaction

A

Throat fullness
Anxiety
Chest tightness, SOB, lightheadedness

232
Q

What are signs and symptoms of a severe allergic reaction

A

Loss of consciousness
Cardiorespiratory arrest

233
Q

When do signs and symptoms begin of an allergic exposure

A

Begin within 60 minutes

The faster the onset, the more severe the reaction

234
Q

What is the management of a patient in anaphylaxis

A

The single most important step in treatment is the rapid administration of EPINEPHRINE

235
Q

What are 2nd line therapies for a patient in anaphylaxis

A

Corticosteroids: Methylprednisolone (Solumedrol) 125mg IM/IV daily x2 days
Antihistamines: loratidine (Claritin) 10mg, Clarinex 5mg, Allegra 60mg twice a day, Zyrtec 10mg, Benadryl 25050mg IV (Preferred Agent)

236
Q

What is the preferred mNgement of n allergic bronchospasm

A

Nebulized albuterol (SABA) - 5mg every 15-30 minutes

237
Q

Smoke inhalation injury usually effects what

A

Upper airway
Trachea
Pulmonary parenchyma
Alveoli

238
Q

What causes smoke inhalation injuries

A

Caused by heat, smoke, or chemicals

Fire is the leading cause of smoke inhalation injuries

239
Q

Upper airway injuries due to smoke inhalation usually effect what

A

Above the vocal cords - usually due to thermal injuries
Leads to erythema, ulcers and edema
Injury can cause impaired ciliary function as well
Can lead to airway compromise

240
Q

Tracheobronchial tree injuries is usually caused by what

A

Caused by chemicals in the smoke and can lead to pulmonary edema and subsequent mismatches in ventilation and perfusion within the lungs

241
Q

Where is a parenchymal injury usually located and what does it mean

A

Injury to the lung tissue, usually a delayed process - results in alveolar collapse and impaired oxygenation, risk for pneumonia

242
Q

What is systemic toxicity caused by

A

Caused by breathing toxic substances

243
Q

What are the most relevant gases that cause systemic toxicity

A

Carbon monoxide
Hydrogen cyanide

244
Q

What are some symptoms of the upper airway when dealing with systemic toxicity

A

Dyspnea of the upper airway and clinical findings of: soot around nares, carbonaceous sputum, obvious burns to neck and face, stridor, drooling, dysphonia

245
Q

When should a chest x-ray be done for a patient with smoke inhalation

A

Typically obtained early in the course - may be normal initially however, it is useful as a baseline

246
Q

When should an EKG be collected on a patient with smoke inhalation injury

A

Useful in any patient being evaluated for toxicological purposes

247
Q

What can lead to myocardial ischemia

A

CO poisoning

248
Q

What is the first step to treating a patient with smoke inhalation injuries

A

Rescue from source and limit exposure time - ABCs and ATLS protocols with frequent re-assessment

249
Q

What should be performed if a patient has signs of thermal injury to the airway

A

Intubation is indicated

250
Q

What are the steps of treatment for a smoke inhalation injury patient after intubation

A

Provide 100% O2
IV fluids for burns
Inhaled bronchodilators for bronchospasm (albuterol)
Prevent hypothermia

251
Q

What is the definition of rhabdomyolysis

A

Striated muscle breakdown

252
Q

What are some causes of rhabdomyolysis

A

Trauma
Crush injuries
Prolonged restraints or immobilization
Compartment syndrome
Electrical injuries

253
Q

What are causes of exertional rhabdomyolysis

A

Individual is not conditioned (new recruits)
Hot, humid conditions
Impaired sweating
Seizures and delirium tremens
Meth and cocaine use

254
Q

What are causes of non-exertional rhabdomyolysis

A

Coma induced by drugs
Medications
Toxins

255
Q

What are common symptoms and exam findings for a patient with rhabdomyolysis

A

Muscle tenderness
Edema
Muscle weakness
Dark urine (dark honey/coca cola)
Altered mental status may occur from underlying etiology

256
Q

What are some differentials for a patient with rhabdomyolysis

A

Compartment syndrome
Crush injury
Meth/cocaine use
DVT
Heat cramps

257
Q

What labs should be drawn on a patient with rhabdomyolysis

A

Elevation in CK (Hallmark) typically fivefold increase from normal
UA dipstick is usually positive fr blood
Electrolyte abnormalities (hyperkalemia)
EKG to evaluate electrolyte abnormalities (causes peaked T waves)

258
Q

What is the treatment for a patient with rhabdomyolysis

A

Large volume IV resuscitation (1.5L/hr) to maintain 2ml/kg/hr urine output
Usually can be maintained on platform if no AMS and maintaining above ^

If AMS, temp >105, or unresponsive to IV fluids then need to immediate MEDEVAC
Some patients may have progressive renal failure and require hemodialysis

259
Q

What are complications of rhabdomyolysis

A

Acute renal failure, acute kidney injury
Compartment syndrome
Electrolyte abnormalities
Cardiac arrhythmias
Death

260
Q

What are the three sections of the Glasgow Coma Scale

A

Eye opening response
Verbal response
Motor response

261
Q

What is being scaled and what are the scores respectively for eye opening response

A

Eyes open spontaneously - 4 points
Eyes open to verbal command, speech, or shout - 3 points
Eyes open to pain (not applied to face) - 2 points
No eye opening - 1 point

262
Q

What is being scaled and what are the scores respectively for verbal response

A

Oriented - 5 points
Confused conversation, but able to answer questions - 4 points
Inappropriate responses, words discernible - 3 points
Incomprehensible sounds or speech - 2 points
No verbal response - 1 point

263
Q

What is being scaled and what are the scores respectively for motor response

A

Obeys commands for movement - 6 points
Purposeful movement to painful stimuli - 5 points
Withdraws from pain - 4 points
Abnormal (spastic) flexion, decorticate posture - 3 points
Extensor (rigid) response, decerebrate posture - 2 points
No motor response - 1 point

264
Q

What is the definition of triage and its meaning in French

A

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

French word “to sort”

265
Q

How are patients managed for care under fire during triage in TCCC

A

Get the patients who are not clearly dead to cover if possible - continue with the mission/fight and gain fire superiority

266
Q

How are patients managed for tactical field care during triage in TCCC

A

Perform an initial rapid assessment of the casualty for triage purposes (should not take more than 1 minute per patient)……

267
Q

A casualty collection point should be quickly chosen based on what

A

Proximity to patients
Proximity to vehicle access
Proximity to HLZ (helicopter landing zone)
Geography, safety “geographic triage”

268
Q

What is tested in ISR safety model, widely fielded in the DoD and recommended by the CoTCCC first choice

A

Combat gauze

269
Q

What may be used when combat gauze is not available and has the active ingredient of chotosan

A

Celox gauze/chito gauze

270
Q

What is the first expanding wound dressing FDA-cleared for life threatening junctional bleeding

A

XStat (best for deep narrow tract junctional wounds)

271
Q

Where should a tourniquet be placed

A

Apply 2-3 inches above bleeding site - if unable to identify site, apply “high and tight” - if still unable to control, apply 2nd tourniquet directly above the first or directly below if “high and tight”

272
Q

How long should hemostatic dressings be applied for

A

At least 3 minutes of direct pressure

273
Q

What is a non-invasive method allowing the monitoring of the saturation of a patient’s hemoglobin

A

Pulse oximeter

274
Q

What are the indications for oxygen therapy

A

All trauma casualties should receive appropriate ventilator support with supplemental oxygen to ensure hypoxia is corrected or avoided
If oxygen saturation is 94% or lower, the patient is hypoxia and needs to be treated quickly

275
Q

What gives 100% oxygen at an increased pressure of 3 atm

A

Hyperbaric oxygen

276
Q

What are examples of manual airway maneuvers

A

Head tilt/chin lift
Jaw thrust maneuver
Sellick’s maneuver
BURP maneuver

277
Q

What is the most frequently used artificial airway device and its complication

A

OPA - complication due to gag reflex stimulation

278
Q

What are the disadvantages of the NPA

A

Smaller size
the risk of nasal bleeding during insertion
Cannot be used if a basilar skull fracture is suspected

279
Q

What is the preferred supraglottic airway because it makes it simpler to use and avoids the need for cuff inflation and monitoring

A

I-Gel (supraglottic airway)

280
Q

According to ATLS, what is the preferred definitive airway

A

Tracheal intubation through the mouth using direct layngoscopy

281
Q

What is a complication of endotracheal intubation

A

Hypoxemia from prolonged intubation attempts

282
Q

What is an indication to use the Combitube airway

A

Airway management in trapped patients

283
Q

What is the difference between performing a needle cricothyrotomy and surgical cricothyrotomy

A

Needle - a syringe with a needle attached is used to make a puncture hole through the cricothyroid membrane

Surgical - incision is made through the cricothyroid membrane in order to place tubing for ventilating the patient

284
Q

What type of pneumothorax presents with air in the pleural space

A

Simple (closed) pneumothorax

285
Q

What are the anatomical landmarks for performing a simple pneumothorax decompression

A

Mid-clavicular line
Sternum
Jugular notch
2nd intercostal space
Second rib
Clavicle

286
Q

What are the signs and symptoms of a patient that presents with a hemothorax

A

Anxiety/restlessness
Chest pain
Tachypnea
Signs of shock (pallor, confusion, hypotension)
Frothy, blood sputum
Diminished breath sounds on the affected side
Tachycardia
Flat neck veins

287
Q

What is the management of a flail chest patient

A

It is directed toward support of ventilation in addition to high flow oxygen such as BVM, IV fluids, analgesia to improve ventilation

288
Q

What is drawn directly from an on-site donor and does not undergo processing into separate components

A

Fresh whole blood

289
Q

What a was the first approved protocol in the ARMY for whole blood

A

Low titer O whole blood (LTOWB)

290
Q

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

A

13 units

291
Q

What is the recommended number of amps every 4 units of FWB to avoid toxicity and hypocalcemia

A

1 amp of calcium gluconate

292
Q

In a patient with allergies or history of a previous allergic transfusion reaction, how much diphenhydramine and what route do you use

A

25-50mg IM/PO/IV (through a separate line) prophylactically before transfusion

293
Q

If a casualty is anticipated to need a significant volume of blood transfusion, why would TXA be given

A

For:
Hemorrhagic shock
One or more amputations
Penetrating torso trauma
Evidence of severe bleeding

294
Q

What is used to increase the blood volume following severe loss of blood (hemorrhage) or loss of plasma (severe burns)

A

Colloids (volume expanders)

295
Q

How do expanders present

A

In dextran, plasma, and albumin

Colloids are expensive, have specific storage requirements, and have short shelf life (more suitable in hospital setting)

296
Q

What are fluids that consist of water and dissolved crystals, such as salts and sugar and is used as maintenance fluids to correct body fluids and electrolyte deficit

A

Crystalloids - contain electrolytes (sodium, potassium, calcium, chloride) but lack the large proteins and molecules found in colloids

297
Q

What is the equation for mean arterial pressure (MAP)

A

Systole + diastole x2/3 OR diastole + 1/3 pulse pressure

298
Q

When performing a secondary survey for the head, what should be taken into consideration

A

Brisk bleeding from the scalp can be masked by thick hair, and a significant amount of blood may be lost before adequate evaluation is performed

299
Q

What are the basic regions of the abdomen that are encompassed in the peritoneal cavity

A

Intrathoracic component
Retroperitoneum
The pelvic portion

300
Q

What are the second line therapies for anaphylaxis

A

Methylprednisolone (Solumedrol) 125mg IM/IV daily x2 days
Antihistamines (block H1 and/or H2

301
Q

Carbon monoxide has an affinity for hemoglobin by how much

A

260 times greater than oxygen

302
Q

GSW most commonly injure what

A

Small bowel - 50%
Colon - 40%
Liver - 30%
Abdominal vessels - 25%

303
Q

What injuries most often involved in blunt abdominal trauma include

A

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

304
Q

What are signs of compartment syndrome

A

Paresthesia (most common)
Pain (most common)
Pulselessness
Pallor

305
Q

What is the gold standard imaging for a pelvic fracture

A

CT scan

306
Q

What is a region of greatest destruction resulting in Necrosis and not capable of repair

A

Zone of coagulation - central zone

307
Q

What is adjacent to zone of necrosis, immediately after injury blood flow is stagnant - cells are injured but not irreversible

A

Zone of stasis

308
Q

What is the outermost zone - minimal cellular injury and characterized by increased blood flow secondary to inflammatory reaction initiated by the brain injury

A

Zone of hyperemia

309
Q

What is a superficial burn

A

Used to be called first degree - involve only the EPIDERMIS, red and painful

310
Q

What is a partial thickness burn

A

Involve epidermis and varying portions of the DERMIS - will appear as BLISTERS or denuded burned areas with glistening or wet appearing base

311
Q

What is a full thickness burn

A

May have several appearances - most often appear thick, dry, white, and leathery regardless of skin color, thick leathery damaged skin referred to as eschar

312
Q

When treating burns, how do you begin resuscitation

A

Use LR solution or similar
Continue during evacuation
Starting rate 500ml/hr for adults

313
Q

What is the estimation of fluid resuscitation for the hourly fluid rate

A

Initial hourly rate = % TBSA burn x 10 ml/hr

314
Q

What is the primary index of adequate resuscitation

A

UOP - important to avoid over or under resuscitation

315
Q

Foley placement is essential part of the resuscitation process, what is the target UOP

A

0.5 ml/kg/hr

316
Q

What are reasons for prolonged field care (PFC)

A

Long evac times
Indigenous capabilities
Requires different skills
Different environments

317
Q

What are the three phases of PFC

A

Evaluation phase
Resuscitation phase
Transport phase

318
Q

What is the evaluation phase of prolonged field care

A

A systematic approach priority to treat life threats in order of severity - resuscitation and life saving procedures, treat shock, completion or MARCH and upgrading stopgaps, initiate evacuation plan

319
Q

What is the resuscitation phase of PFC

A

During this time, procedures and steps taken to normalize vitals and reverse physiological effects based on skill set available - lethal triad addressed of hypothermia, acidosis, coagulopathy + sepsis

320
Q

What is the transport phase of PFC

A

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

321
Q

For sedation and pain management, what is the better capability

A

Additional training to provide sedation with ketamine and added midazolam (versed)

322
Q

What should not be attempted for TQ’s in place longer than 6 hours unless it occurs at definitive care facility

A

Tourniquet conversion

323
Q

What are the important timings for performing a tourniquet conversion

A

<2 hours is considered safe (attempt conversion)
2-6 hours is likely safe (attempt conversion)
>6 hours require caution (conversion not advised in PFC)

324
Q

What is the fluid of choice for patients in hemorrhagic shock as well the capability to provide transfusion should be a basic capability of any clinician providing PFC

A

Fresh whole blood (FWB)

325
Q

What is a very easy tool available to monitor the patient’s response and guide resuscitative efforts

A

Urine output (UOP)

326
Q

What is the goal for adequate UOP

A

0.5-1 mg/kg/hr
This reflects adequate kidney perfusion and volume

327
Q

What medications are given which produce a diminished sensation to pain without producing a loss of consciousness

A

Analgesia

328
Q

What type of medication is the depression of a patients awareness to the environment and reduction of responsiveness - various levels including minimal, moderate and deep

A

Sedation

329
Q

What medication can stable patients

A

Morphine

330
Q

What medication can hemodynamically unstable patients get

A

Fentanyl or ketamine

Post TAV II (7 decks)

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