Trauma Flashcards by Harold Hoffberg

If a trauma facility is on bypass then where do we go?

To the next closest APPROVED trauma facility

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Jump START triage is for ages?

1-8

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On scene times of for trauma alerts > 10min are to be documented where?

in the ePCR report

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IV fluids are to be given for SBP under ____ and at what rate?

less than 90 at a rate to maintain peripheral puses typically 80-90.

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What is the minimum persons to accompany T.A.s?

1 paramedic and 1 EMT

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What are the ONLY things to interrupt the primary survey?

Unsafe scene or Airway obstruction

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What is the goal of START triage ?

greatest good for the greatest number of patients.

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In secondary triage, where do infants start the evaluation from?

The Entire JUMP START algorithm.

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What are the Gray criteria for T.A?

On blood thinnners with high risk of bleeding or hx, or bleeding disorder

65yrs or > blunt trauma w/ borderline criteria or symptoms
65yrs or > w/ SBP < 110mmHg
MVC > 20mph with seatbelt marks on the torso.
MVC w/ partial ejection from automobile
End stage renal ds or dialysis

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Trauma alert ages are what?

Adult 16 or older

pedi 15 or younger

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What are the Pediatric Gray criteria?

Musculoskeletal trauma on blood thinners w/ high risk of bleeding or hx of bleeding ds.

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What are the T.A airway criteria in pediatrics?

RR < 20 in infant < 1yr.

RR< 10 in children 1-15yrs of age

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Systolic BP in pediatric T.A criteria is?

BP < 50mmHg.

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What is the height requirement for T.A in pediatrics?

Fall > 10ft or 2-3x height of the child

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Resuscitation should not be attempted for trauma pts that have?

All 3 presumptive signs of death:
Fixed and dilated pupils
apnic
pulseless.

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Injuries incompatible with life are:

Massive crush injury, decapitation, incineration

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No resuscitation on trauma pts in cardiac arrest unless?

Occurred in presence of Fire Rescue
regained pulses after needle decompression
result of electrocution or lightning injury

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When MAY bilateral needle decompression be performed?

Pt’s having sustained PENETRATING chest trauma and are in cardiac arrest or arrested in the presence of fire rescue.

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When can CELOX RAPID be used?

with a severe Junctional hemorrage.

ie. neck, axillary, thoracic, abd, pelvis or groin

What size ET tubes should be considered in pedi for controlling a burn pt and why?

0.5-1.0 size smaller to accommodate swelling

What is the treatment for a flail segment?

Bulky dressing

What are the s/s of Tension Pneumo?

Absent or diminished breath sounds on the affected side with any or all:
SOB
pluretic CP
Tracheal deviation
HYPERresonance on the affected side
JVD
poor compliance w/ BVM
hypotension

What are the indications for Needle decompression?

S/S of tension pneumo and 1 or more of the following?

respiratory Distress AND cyanosis
decreasing LOC
Loss of a radial pulse

Where is the preferred site for needle decompression?

Anterior side- 2nd or 3rd intercostal space.

Extremity fractures should be splinted how and how many attempts?

Splinted in place unless no pulse or unusual position of extremity. No more than 2 attempts .

What are the contraindications for a sager splint?

``` Life threatening injuries hip fx pelvic fx open femur fx fx distal to the mid shaft femur avulsion/ amputation to the ankle or foot ```

Fluid resuscitation with severe head injures ( GCS of 8 or less) regardless of penetrating trauma receive fluids till?

SBP maintained at 110-120

A single instance of hypotension in an adult with a brain injury increases mortality by what percent?

150 %

What are the S/S of ICP and herniation?

decline of GCS 2 or more points development of sluggish or non-reactive pupil paralysis or weakness on one side of the body Cushings triad

Pts with ICP or herniation should be ______ at ___/____?

hyperventilated 20 breaths/ min

Ventilatory rates in pediatrics w/ ICP or herniation are?

children 25breaths/ min | Infants 30 breaths/min

Pediatrics BP with TBI should be maintained at:?

SBP normal for their age. 20mg/kg repeat PRN.

Pediatric pt's with a head injury should be ventilated at ______ which is different than ICP or herniation.

children 20 breaths / min' | infants 25 breaths / min

Assessing the pelvis is done by?

gentle pressure anterior to posterior and from the sides to identify crepitus or instability. Do not repeat.

What are the fluid bolus amts for INTERNAL hemorrage in adults?

500ml max of 2L

What are the bolus amounts for Adults with ISOLATED EXTERNAL hemorrhage controlled?

Only enough saline to maintain peripheral perfusion 1-2L

What are fluid resuscitation requirements for suspected internal or external hemorrhage in PEDIATRICS? (same as post resuscitation medical)

``` 20mg/kg titrated to maintain SBP as noted. may repeat 1x neonates 60mmHg Infants 70mmHg Children 1-10yrs of age (age x2 plus 70) Children > 10yrs 90mmHg. ```

What are S/S of compensated shock in pediatrics?

``` Anxiety, agitation, restlessness, normotensive, normal to delayed cap refill Tachycardia > 130bpm ****except in neonates**** ```

What are s/s of DECOMPENSATED shock in pediatrics?

``` Decreased LOC hypotension peripheral cyanosis delayed cap refill inequality of central to distal pulses tachycardia going to bradycardia ```

When should a cervical collar be applied?

complaint or finding of focal neurological deficit on motor sensory exam. Complaint or finding of pain to the neck or back Distracting injury Altered LOC w/ MOI Intoxication w/ MOI

Helmet removal is under which circumstances?

Unable to manage airway cardiac arrest too loose to allow for proper immobilization if the shoulder pads are removed

What are the S/S of Neurogenic shock?

Skin - W/D Hypotension with HR WNL paralysis

What is the tx for neurogenic shock w/ BP< 90mmHg?

NS 1-2L assess LS and BP q 500ml if remains hypotensive: Dopamine 5-20mcg/kg to SBP 90mmHg.

If a pregnant female is in cardiac arrest where is the uterus displaced to?

the left side for transport.

What are the physiological changes during pregnancy?

HR INCREASES, and can be 15-20 bpm above normal systolic and diaystolic Bp DROPS 5-15mmHg but may return in the 36week. Mothers cardiac output and volume INCREASE and can loose 30-35% of blood volume before S/S appear.

When does supine hypotension usually occur?

3rd trimester

What is the consideration if pt remains HYPOtensive after displacing uterus to Left?

significant amt of blood loss.