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P2 Exams > trauma MidT > Flashcards

trauma MidT Flashcards

1
Q

Parkland Burn Form for:
form:

A

= (BSA >20% only 2 & 3 degree burns)
= 4 mL x BSA x Weight (kg) = ½ 1st 8 Hrs & ½ next 16Hrs

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2
Q

Haldon Mix

A

.

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3
Q

60%) Fluid compartments % of water:

A

45% intracellular
15% extracellular (outside cell)
Interstitial 10.5% Intravascular 4.5%

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4
Q

Blood vol/ loss) Pelvis:
Femur:
Humorous:

A

= 2-3Liters
= 1.5Liters per femur
= 750ml per humorous

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5
Q

Burn depth) 2nd degree:

A

= Partial, EPi & Dermis burned: intense pain, fluid shift comes up thus blisters, RED to WHITE, moist & mottled w/ shifts

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6
Q

Burn worries) Hypothermia:

A

Burn may disrupt body’s ability to reg/ core temp, If burn is extensive, uncontrolled body heat loss induces rapid, severe hypothermia.

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7
Q

Burn worry) late stage Organ failure:

A

= can go into rhabdo from myglobins; Burn process releases material from damaged or dying body cells into bloodstream, May cause kidney failure, liver failure, arrhythmias, possible cardiac arrest.

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8
Q

Class II Hemorrhage) 1 injuries:
2Compensation for blood:
3Blood Loss: 15 - 30%
4Pulse:
5Blood Pressure:
6Pulse Pressure:
7Capillary Refill:
8Ventilation Rate:
9Urine Output (mL/hr):
10Mental Status:

A

1= 1/2 Humorous fractures, a femur fracture, 1 full Hemopneumo
2= 1st line comp/ no longer maintain perfusion & 2ndary employed
3= 15 - 30% 750mLs-1.5L
4= > 100BPM
5= Normal
6= Starts to narrow
7= 2-3 secs
8= 20-30RR
9= (mL/hr) 20-30
10= Mildly Anxious

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9
Q

Class III Hemorrhage)1 injuries/fractures:
2 Compensation to blood:

3 Blood Loss:
4 Pulse:
5 Blood Pressure:
6 Pulse Pressure:
7 Capillary Refill:
8 Ventilation Rate:
9 Urine Output (mL/hr):
10 Mental Status:

A

1= 2 Humorous, 1-2femur, 1 full Hemopneumo
2= Both 1&2nd comp/ responses failing to maintain perfusion & entering/in Decompensated Shock! (SBP <90)
3= Blood Loss: 30 - 40%, (1500 - 2000 mL’s)
4= >120
5= Starts to decrease
6= Narrows more
7= 3-4secs
8= 30-40
9= 5-10mL/hr
10= Anxious/Confused

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10
Q

Class IV Hemorrhage) 1 injuries:
2= Compensation to blood:
3= blood loss:
4= Pulse:
5= Blood Pressure:
6= Pulse Pressure:
7= Capillary Refill:
8= Ventilation Rate:
9= Urine Output (mL/hr):
10= Mental Status:

A

1= GSWs, multiple major fractures, Pelvis
2= Irreversible Shock!
3= > 40% (>2000mLs) of total blood
4= > 140 & barely palpable in central arteries
5= Very low
6= Narrows more
7= > 5 seconds
8= > 40 or agonal
9= Negligible
10= Lethargic or Unconscious

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11
Q

Critical Criteria) 3rd & 2nd Degree criteria:
Any 2nd or 3rd degree burns involving:
Burn types that’re critical & Rx:

A

= 3rd>10% & 2nd>30%
= Face, Hands, Genitalia, Circumferential, Feet, (Dipping), Airway
= Chem, high voltage, Burns w/ major trauma go trauma center 1st then burn center

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12
Q

Methylene Blue) Dynamics:
Indications:
Contra:
Dose:

A

= Water soluable thiazine dye helps metHb to hemoglobin conversion
= Methemoglobinemia (metHb), Nitrate OD/poisoning
= Hypersensitivity
= 1 mg/kg IV/IO over 5-30 minutes.

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13
Q

Newtons laws) inertia) 1st part of 1st law
2nd Part of 1st Law:
The law of energy conservation states:

A

= “body stays in motion unless acted upon by an outside force.”
= “body remains in rest unless acted upon by an outside force.”
= “Energy can neither be created nor destroyed. It can only be changed from 1 form to another.” EX In an auto crash, the changing of energy from one form to another is what deforms the auto and can cause injury to the occupants

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14
Q

Non& Hemorrhagic treatment) If hemorrhage can be controlled:
If hemorrhage cannot be controlled:

Med for Sig/hemorrhage, in/external (after external controlled)

A

= IV/IO therapy (don’t delay transport) can administer 20 mL/kg bolus.
=administer just enough IV fluid to obtain a radial pulse (permissive hypotension therapy!)NO MORE SBP 80-90 (IV fluids Warm)
= Tranexamic Acid (TXA) Adult 1G/10 mins (mix in 50 mL of NS) follwed w/ 1G/8Hrs (500 mL bag) & Pediatric Not recommended

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15
Q

1phagocytosis:

2Granulocytes & macrophages w/ healing:
3Lymphocytes w/ healing:
4Mast cells w/ healing:

A

1= macrophage eats & grows bacteria flag to show what antibodies to make for cellular response
2= eat dead cells parts & bacteria
3= destroys bacteria & other pathogens
4= release histamine to make capillaries more permeable to bring more RBC

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16
Q

Shock’s 5 categories

A

Hypovolemic, Cardiogenic, Distributive, Obstructive, resp/metabolic

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17
Q

Sodium Bicarbonate 8.4%) Dynamics:

Indications:

Contra:
Suspected acidosis Dose:
Hyperkalemia Dose:

A

= Alkalinizing Agent. Increases plasma bicarbonate, buffers excess hydrogen ion concertration, raises blood pH & reverses clinical manifestations of acidosis.
= Suspected hyperkalemia, suspected bicarbonateresponsive acidosis (DKA, OD on TCA’s, Aspirin or Cocaine)
= Patients in cardiac arrest
= 1 mEq/kg, Hyperkalemia:
= 50 mEq IV bolus.

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18
Q

Thermal burn phases) Hypermetabolic phase:

A

3rd phase Days or weeks depending on burn severity; increase in body’s demands for nutrients; begins process of repairing damaged tissue (needs Glucose, amino acids, carbohydrates, O2 to support damage)

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19
Q

Thermal burn phases) Resolution phase:

A

4th phase Scar tissue laid down and remodeled; rehabilitate and return to normal function (weeks to months) new collagen & usually doesnt remodel to original state & makes escar (burn keloid) bc overgrowth

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20
Q

(Wallace Rule of 9s) used only for:
Adult %s:
infants (0-1):
Form:

A

= burns >10%
= 1 genitals, 9 head thoracic & ABDMN, distal anterior (applies to other areas) arm 4 ½
= head 18, arm 9, legs 13.5, 18 front thoracic & ABDMN
= # of child -1 > take away from head then give to each leg (Applicable up 10y/o) For every year beyond age 1, subtract 1 from head / that # & add it evenly between the 2 legs.

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21
Q

Rocuronium) Dynamics:
Indications:
Contra:
Dose:

A

= Nondepolarizing neuromuscular blocker Binds to ACh receptors
= DSI/RSI
= Hypersensitivity
= 0.6-1.2 mg/kg. TTP: 60-90 seconds. DOP: 45-120 minutes

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22
Q

1 (Ketamine) know:
2 Pharmacodynamics:
3 Indications:
4 Contraindications:
5 Adverse Effects:
6 Adult & Pedi Pain Dose:
7 Dissociation dose:

A

1= retrograde amnesia, Raises BP,
2= + sympathetic response, Sedative-hypnotic & analgesic med
3= Moderate to severe pain & SFI/RSI
4= History of hypersensitivity to med, Hypertension
5= Severe hallucinations and/or nightmares
6= 0.2 mg/kg/1-2min IV/IO w/ a max single dose of 20 mg
7= 0.5 mg/kg IN/IM

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23
Q

1 (Morphine)
2 Pharmacodynamics:
3 Indications:
4 Contraindications:
5 Adverse Effects:
6 Adult Dose:
7 Pediatric Dose:
8 Keep on standby:

A

1 = not same as Morphine Sulfate
2= Narcotic (opioid) Schedule II Narcotic releases histamine allergy
3= Moderate to severe pain
4= SBP<90 & Known hypersensitivity
5= HypoBP, Syncope Tachy/BradyC, Resp/Depres, Apnea, N/V
6= 2-10 mg or 0.1 mg/kg to max dose (max 20 mg) IV, IO, IM, SQ & PO
7= 0.1 mg/kg IV/IO (slow) or IM up to 10 mg
8= Narcan is an antagonist

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24
Q

1 Types of Radiation:
2 Radioactive Particles:
3 Alpha:
4 Beta:
5 Ionizing Rays:
6 Gamma:
7 X-Rays:
8 Atomic:

A

1= Radioactive Particles & Ionizing Rays
2= Alpha &Beta:
3= least worry & deflected w/ newspaper
4= flys further w/o skin penetration
5= Gamma & X-Rays
6= worst, several ft of concrete & lead
7= penetrates skin
8= nuclear reactor

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25
Q

1(Fentanyl) know:
2 Pharmacodynamics:
3 Indications:
4 Contraindications:
5 Adverse Effects:
6 Adult & Pediatric Dose same:

7 Antidote:

A

1= quicker but shorter duration than Morp (100 mcg=10 mg Morp)
2= , Schedule II Narcotic (opioid), sig/ more potent than morphine
3= Moderate to severe pain, Anesthetic
4= Known hypersensitivity to med, SBP <90
5= HypoBP, N/V, Cramps, CHEST WALL RIGIDITY, Resp/depress
6= 1mcg/kg to max of 100 mcg (IV/IO/IM/IN) may repeat PRN in 5-10 minutes w/ Max of 1 mL per nostril if administered IN
7= Narcan is an antagonist

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26
Q

1Crush injury:
2Crush syndrome:

3Cellular Lvl:

4 Crush syndrome signs:
5 Crush syndrome Rx:

A

1= deep injury damage can be massive w/ minimal signs on skin itself
2= body part trapped>4hrs, cells anaerobic>hyperkalemia>TDP torsades de pointes, Aka: traumatic Rhabdomyolysis
3= accumulation of quantities of myoglobin O2, K, lactic acid, toxins, can clog kidneys, can cause severe metabolic acidosis
4= urine is dark red, Shark Peaked T waves
5= 1st Ca-Chloride, 2nd Albuterol, 3rd Sodium Bicarb, Dex w/ Insulin

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27
Q

1Lymphatic system:

2Lymph node:
3Spleen relation:
4Lymphatic pathway:
5Sign lymphatic system not working:

A

1= “body’s garbage system” macrophages eats then system of channels to tissues 1 direction, no pump, dumps into a node
2= were garbage collects
3= Carries “trash” of pathogen destruction to nodes for macrophages
4= >Vessels> nodes> spleen> up to L/R subclavian vein, to kidneys
5= Gray poop

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28
Q

4 Stages of healing:

A

= Hemostasis, Inflam/, Epithelialization, Neovasc/, Collagen synthesis (Here I eat naked) “strict, hurt, foundation , remodel”

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29
Q

1Hemostasis:
2Inflammation:
3Epithelialization:
4Neovascular:
5Collagen synthesis:

A

1= vaso/strict, platelet aggregate, coagulation fibrin (normothermic)
2= Granulocytes, macrophages & Lymphocytes eat, Mast cells released
3= “rebuild” epithelial cells go to wound making scab ~48Hrs after cut
4= new capillaries made (neo new) via previous cap/s +exchanging
5 = fibroblasts go to wound & synthesize collagen creating scar (w/ tension lines quicker/better), Too much synthetization makes Keloid

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30
Q

2nd line comp response:

A

Blood loss > RAAS, Catecholamine & Vasopressin released> vasoconstriction, increased Vol, cardiac stim

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31
Q

3 parts of circulatory system:
maintain homeostasis via:
Pos feedback:

A

= “pump fluid pipes” heart, blood, & blood vessels
= negative feedback loop
= childbirth & blood clots

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32
Q

3 phases of VC) Phase 1:
Phase 2:
Phase 3:
Phase 4:
Phase 5:

A

= Vehicle collision (P1) deceleration
= Body collision (P2) decel/ of occupant
= Organ collision (P3) decel of internal
= 2ndary collision (P4) objects in car
= (P5) car rear end, trees,

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33
Q

% of all Trauma deaths:
% of GSW account for HT death:
%s of penetrating neck trauma:
%s of penetrating chest trauma are fatal:
% of great vessels injuries & due to:
minimal diameter for sucking chest wound

A

= 50% of all Trauma deaths is head trauma
= 35% GSW account for Head Trauma deaths
= 5-10% penetrating neck trauma (airway & neuro
= 70-80% penetrating chest fatal
= 90% all great vessels injuries due to a penetrating MOI
= At least ¾inch for penetrating Chest wounds to turn sucking

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34
Q

Body maintaining steady, norm/ internal environment:
A condition in which the blood’s ability to clot is impaired:
The body’s response to stop the loss of blood:
Clotting phase when smooth blood vessel M. contracts <lumen size:
1 common factor hindering clotting process is:
aggregation:

A

= Homeostasis
= Coagulopathy
= Clotting
= Vascular phase
= Medications such as aspirin
= process of coming & sticking together

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35
Q

1 Adults for the Rules of Nines, the head is awarded:
2 Adults for the Rules of Nines, the genitalia is awarded:
3 Adults for the Rules of Nines, the posterior trunk is awarded:
4 Adult for the Rules of Nines, each arm is awarded:
5 Adults for the Rules of Nines, each leg is awarded:
6 Adults for the Rules of Nines, the anterior trunk is awarded:

A

1= 9 % of body surface area.
2= 1 % of body surface area.
3= 9 % of body surface area.
4= 18 % of body surface area.
5= 18 % of body surface area.
6= 18 % of body surface area.

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36
Q

Alkalotic vs acidotic burns severity

A

Alkalotic burns > Acidotic burns

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37
Q

AUTOPED) 1st impact:
2nd impact:
3rd impact:
Off-road injuries:
Kids Waddell’s triad:

A

= auto strikes body
= pedestrian thrown
= body strikes ground or object
= pop increased, usually remote areas, offer less protection,
= turn toward bumper b/c stupid, bumper hits kids pelvis & femur, chest & ABDMN hit grill, head strikes ground b/c buckethead

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38
Q

Baroreceptors:
Baroreceptors Fn.:

A

= receptors that monitor blood pressure
= Great vessels recept/ Gives feedback to brain > Sympathetic NS Activation, AArch & carotid arteries> feedback to medulla >SNS

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39
Q

Pulse pressure:
MAP:
CPP Cerebral Perfusion:

A

= SBP-DBP
= (PP/3) + DBP
= (MAP-ICP) + 10

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40
Q

Blood:
Plasma:
Leukocytes:
Erythrocytes:

A

= Mixture of water, cells, proteins, & suspended elements.
= makes up 55% of the blood volume
= WBC & platelets make up the “Buffy Coat”
= RBC make up 45%

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41
Q

body’s 1st line comp response:

A

= Blood loss > decreased arterial pressure, altered blood gases > baro&chemoreceptor reflex >cardiac stim/ systemic vasoconstriction, flow&Vol/ retribution

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42
Q

Body’s response to a local hemorrhage:
Vascular Phase:

A

= hemostasis 3 steps: Vascular, Platelet, & Coagulation phase
= Blood vessel is damaged & begins to lose blood , Smooth muscle w/in walls contracts, thus vessel to withdraw into the wound, thicken vascular wall, & reduce lumen.

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43
Q

Bohr Effect:
Influences by:
What does it do to hemoglobin:

A

= Acid> Hemoglobin droping oxy off in body
= + CO2, +temp, -pH+ BPG 2,3 in body
= -oxy affinity

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44
Q

Burn worries:

A

= Hypothermia, Hypovol/, Electrolyte imbalance /HyperK, Infection

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45
Q

Caring for chem/ burn, its keen to know if its acid or an alkali b/c:
If carbon monoxide is present should also suspect the presence of:

A

= Alkalis continue to destroy cell membranes via liquefaction necrosis
= Cyanide

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46
Q

Cardiac Output:
Cardiac Output Formula:
Blood Pressure formula:

A

= amount of blood pumped by the heart in 1 min (70mL)
= SV x HR
= (SV x HR) x SVR

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47
Q

1 Children for the Rules of Nines, the head is awarded:
2 Children for the Rules of Nines, each leg is awarded:
3 Children for the Rules of Nines, each arm is awarded:
4 Children for the Rules of Nines, the anterior trunk is awarded:
5 Children for the Rules of Nines, the posterior trunk is awarded:

A

1= 18 % of body surface area.
2= 13.5% of body surface area.
3= 9% of body surface area.
4= 18% of body surface area.
5= 18% of body surface area.

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48
Q

Class I Hemorrhage) 1 injuries:
2Compensation for blood:
3Blood Loss:
4Pulse:
5Vent rate, BP & Pulse Pressure:
6Cap-Refill:
7Urine Output (mL/hr):
8Mental Status:

A

1= Broken humorous 750mL
2= Healthy PTs can easily compensate for such blood volume loss
3= Blood Loss: < 15% (<750 mL’s)
4= Pulse: Slightly Tachy
5= all Normal
6= Cap-Refill <2secs
7= 30mL/Hr or more
8= Slightly Anxious

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49
Q

Coagulation Phase of hemostasis:

A

3rd phase Clotting factors activated and released into bloodstream through a very complex cascade of events Triggers series of chemical reactions; formation of strong protein fibers (fibrin)

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50
Q

Compartment syndrome 6 Ps) 1st
2nd
3rd
4th
5th
6th

A

1= Pain (always 1st) seems exaggerated from story
2= Pallor (lacking blood flow)
3= Paralysis Efferent N-Fibers damaged
4= Paresthesia afferent N-fibers pushed
5= Pressures (BP < & palpable pressure w/ palpation)
6= Pulses (dim/ gone)

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51
Q

Compartment syndrome:

A

extrems contain M.s & swelling inside self (usually benign injury but body reacts extreme) (infection)

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52
Q

Crush injuries w/ compartment syndrome occur IRL & per book:
Hyperkalemia sign:
Crush/Hyperkalemia sign:

Crush injury:

A

= ~ >3hrs & 4Hrs per book
= (T wave>10boxes/mountain hyperkalemia)
= Calcium-Chloride to “fool cell” then Sodium bi-carb 50mEq or 20mg Albuterol 15LPM
= Major compression of tissue causing them to open up, (releases K & acid)

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53
Q

Crush syndrome occurs when trapped/crushed for how long:
Crush injury is what type of wound:
PT has lower L-leg trapped underneath a farm tractor for the last 5hrs. PT presents w/ obvious signs on hyperkalemia. What is 1st line IV med for this patient?

A

= usually for longer than 4 hours
= Closed soft tissue injury
= Sodium Bicarbonate

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54
Q

CUPS:
C:
U:
P:
S:

A

= Categories of PT severity
= Critical: ABCs FUCKed
= Unstable: hypotension, comp to decomp
= Potentially unstable: pelvic fracture, stable can unstable
= Stable: stable ex toenail fracture

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55
Q

Denature:

A

take away natural state (from chem burns)

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56
Q

Direct current (DC):
Alternating current (AC):

A

= electrons flow in one direction > grab on can’t let go
= reverses flow in short intervals (60 cycles change electrons’’ flow) can let go

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57
Q

Dry dressing for burns:
Wet dressing for burns:

A

= >10%
= <10%

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58
Q

Electricity follows path of

A

least resistance w/ entry & exit wound: Nerves & blood vessels

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59
Q

Burn worries) Electrolyte imbalance:

A

Body’s ability to reg Na,K,& electrolytes is overwhelmed, Careful electrocardiogram (ECG) monitoring and fluid resuscitation help prevent hyperkalemic
Succholyine depolarzing makes hyperK worse

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60
Q

Thermal burn phases) Emergent phase:

A

Vtach, cells anaerobic Body’s initial reaction to burn; pain response (afferent nerves damage> Nor/Epi release > tachycardia ; unless on beta blockers

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61
Q

“energy” or amount of flow in given time

A

Current; measured in amperes

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62
Q

Eschar:

Can be severe enough to :

A

= Burn destroys dermal cells; Skin constricts over wound site, increasing pressure of edema beneath & restricting flow of blood
=occlude all blood flow into distal extremity (compartment syndrome)

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63
Q

Escharotomy =

A

= release pressure w/ cutting burn to relief fluid pressure

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64
Q

Parkland Burn Form) EX: 32yo male found with 10% BSA 1st degree burns, 10% BSA 2nd degree burns, and 10% BSA 3rd degree burns. The patient is 110 pounds.
1. 4 mL x BSA x Weight (kg)
2. Total mL / 2 = (Amount to give for:
3. How many mL’s per hr?
4. How many gtts/min using a 10 gtt/mL IV drip set?
5. Know w/ formula:

A
  1. 4mL X 20 (2nd + 3rd degree burns) X 50 (kg) = 4000 mL
  2. 4000 mL / 2 = 2000 mL (Amount to give 1st 8 hours then next 16Hrs)
  3. 2000 mL / 8 = 250 mL per/hour for 1st 8 hrs
  4. 42 gtts/min
  5. Pick closest option choice for gtts & Vol calculated. Use biggest bores& macro drips
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65
Q

Falls:
Examine:
Axial loading:
FOOSH (Fall onto an outstretched hand)
Colles’ fracture:
Smith’s fracture: out
>20ft greater risk of
Aortic anyrusem to tear:

A

= most common blunt trauma, risk increase w/ age, sig fall 2-3x height
= height, position, surface PT landed on, physical condition of PT
= loading on axial skelton via falling (E starts heel to lumber)
= influxing wrist fractures from fall impact
= efflucing wrist fractures from fall impact “Palm out”
= internal organ damage
= pain tearing to chest shoulders back
= tearing pain from chest goes to back

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66
Q

Fluid accounts for ~% of the body’s weight, Only ~% of the fluid is contained in our vascular system

A

= 60% of the body’s weight, Only about 7% of the fluid is contained in our vascular system

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67
Q

Fluid resuscitation is an important part of treating serious burns. The formula for the amount of IV fluid needed to be infused includes:

A

4 mL × patient weight (kg) × BSA burned <Parklands></Parklands>

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68
Q

Thermal burn phases) Fluid-shift phase:

A

2nd phase; can last up to 24 hours; larger than 15 to 20%(BSA) of total body surface area
vasodilates & capillaries more permeable for phagocytosis

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69
Q

Force:
Force formula:

A

= force related to a objects mass(weight) and/or achange in velocity
= mass x Acceleration

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70
Q

Frank Starling law/mechanism:

Vascular Resistance:
SVR vs. PVR:
SVR (Systemic Vascular Resistance):
PVR (Pulmonary Vascular Resistance):

A

= more myocardium is stretched the more force/greater the next contraction will be (increase in preload increases contraction)
= Resistance to overcome to push blood through circulatory system
= Body’s circulation resistance & Lung’s circulation resistance
= resistance blood faces in systemic circulation (arteries size)
= resistance blood faces in pulmonic circulation EX CHF, R ventricle

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71
Q

Frank Starling law/mechanism:

A

= more myocardium is stretched the more force/greater the next contraction will be (increase in preload increases contraction)

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72
Q

Vascular Resistance:

A

= Resistance to overcome to push blood through circulatory system

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73
Q

SVR vs. PVR:

A

= Body’s circulation resistance & Lung’s circulation resistance

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74
Q

SVR (Systemic Vascular Resistance):

A

= resistance blood faces in systemic circulation (arteries size)

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75
Q

PVR (Pulmonary Vascular Resistance):

A

= resistance blood faces in pulmonic circulation EX CHF, R ventricle

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76
Q

Golden Period “hour”:
Platinum 10:

A

= incident to surgery time 1 Hr from Crash to EMS to PT to surgery
= no more than 10 mins on scene

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77
Q

Haldane Effect:
Influences by:
What does it do to the hemoglobin?

A

= Alk> Hemoglobin Loves oxy in Lungs
= -CO2, -temp, +pH -BPG 2,3, in Lungs,
= +oxy affinity

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78
Q

Hemostasis:
Hemostasis order:
Factors that effect hemostasis:

A

= Body’s response to a local hemorrhage w/ 3 phases
= Vascular, Platelet, Coagulation “flow, stick, build”
= Wound type(can pull w/in>cant constrict), M-nt, Temp, Meds( most blood thinners stop/prevent fibrin) Warfrin/Coumadin), IV Fluids

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79
Q

Burn worries) Hypovolemia:

A

Tissue destruction reduces/eliminates skin’s ability to contain fluid w/in, Inability of damaged blood vessels to retain plasma causes fluid & electrolyte shift into burned tissue & Takes 4-6hrs to dev/

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80
Q

Burn injury in an enclosed space, always consider the possibility of:
Supraglottic structures are useful w/ burns b/c:

A

= Inhalation Burns
= B/c very moist mucosa lines the airway Supraglottic airways may absorb heat and prevent lower airway burns

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81
Q

If you were administering isotonic crystalloid solutions, how much would move out of the intravascular compartment within 1 hour?

A

2/3s would move out

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82
Q

index of suspicion:

A

Info gathered regarding the scene & MOI for mental summation of suspected injuries based on your event analysis

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83
Q

Burn worries) Infection:

A

natural body bacteria can kill & become opertunicle & Most persistent killer of burn victims & Does not appear for several days following acute injury, Pathogens pose hazard to life when they grow to massive numbers

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84
Q

1Prehospital Infections:
2Infections cause, duration, severities, treatment:

3Risk factors:

A

1= sepsis, staph, strep, Lymphangitis, Tetanus, & Gangrene
2= Anaerobic bacterium, ~10% severe, 2-3 days pain tender warm, fight w/ steroids
3= diabetics, infirm, elderly, chronic diseases, steroids, animal/human bites,

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85
Q

Jacksons Theory of Thermal Burns 3 burn zones:

A

1st Zone of Coagulation 2nd Zone of Stasis 3rd Zone of Hyperemia

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86
Q

Kinetic energy:
Kinetic Energy form:

A

=energy of a object in motion (by objects mass & its velocity
= (Mass x Velocity ^2)/ 2 ½ x mv^2

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87
Q

Kinetic energy:
kinetic energy formula:
Increasing mass vs. velocity directly increases what:

A

= energy of an object in motion (Fn. of object’s mass & its velocity)
= Kinetic energy=Mass(weight)×Velocity(speed)22
= kinetic energy > +velocity exponentially increases kinetic energy

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88
Q

mechanism of injury (MOI):

A

the circumstances and events by which an injury occurs.

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89
Q

Moderate criteria) Superficial:
Partial thickness burns:
Full thickness burns:

A

= BSA >50%
= BSA <30%
= BSA <10%

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90
Q

(Newtons laws) inertia) 2nd law:

force formula is summarized as:

A

= force is related to object’s mass (weight) & rate of its change in velocity (speed)
= Force=Mass (weight)×Acceleration (or deceleration)2

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91
Q

Ohm’s law:

A

relationship between current (I), resistance (R), voltage (V)

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92
Q

Tension pneumo & pulmonary emboli is which type of shock?
Pericardial tamponade presents w/:

A

= Obstructive
= Becks triad JVD, tachycardia, hypotension, & Muffled heart tones

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93
Q

Oxy Dissociation Curve:
Bohr Effect:
Haldane Effect:

A

= H-globin “Train” taking & dropping oxy
= Acidotic with R-shift of hemoglobin w/ decrease oxy affinity
= Alkalotic w/ L-shift Loves oxy in Lungs

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94
Q

Penetrating trauma:
Perforating trauma:
(3lvls of Penetrating trauma) 1st Lvl:
2nd Lvl:
3rd Lvl:
Ballistics:
Factors of bullet speed/damage:
Trajectory:
Cavitation:
Profile:

A

= object pierces the skin and enters the body
= object pierces through & through body
= Low velocity: knifes, swords, ect
= Medium: handguns
= High-velocity: Rifles
= study of projectiles in motion & effects on objects
= Trajectory, Drag, Cavitation, Velocity, Profile, Shape:
= curved path bullet follows after fired from a gun
= Outward motion of cavity due to projectiles speed & vacuums
= cross-section of bullet along its direction of travel

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95
Q

Platelet Phase of hemostasis:

A

2nd phase, Platelets aggregate, or collect and adhere. Slows hemorrhage from capillaries and small vessels- splint fractures to decrease of clots being broken down & bleeding again

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96
Q

Preload:
Afterload:

Mean Arterial Pressure (MAP):

A

= pressure/vol/ w/in ventricles @ end of diastole “End-diastole vol/“
= resistance against which the heart must pump against (increase afterload= increase ventricular workload)
= average pressure in arteries during a single cardiac cycle = pressure that drives blood to tissues (ensuring organ perfusion)

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97
Q

Pulse pressure:
Pulse pressure signifies:
Pulse pressure <25 mmHg may be seen w/

A

= dif/ between DBP & SBP pressures (PP= SBP-DBP)
= amount of force the heart generates with each contraction
= PTs w/ sings of shock

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98
Q

QA QI should NEVER be

A

punitive

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99
Q

Rocuronium) Dynamics
Indications:
Contra:
Dose:

A

= Nondepolarizing neuromuscular blocker. Binds to ACh receptors
=DSI/RSI
= Hypersensitivity
= 0.6-1.2 mg/kg. TTP: 60-90 secs. DOP: 45-120 mins

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100
Q

Rule of palm:

A

use of PT hand = 1% of BSA (burns <10%)

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101
Q

Seat belts:
Maternal relation w/ seat belts:
Cullen’s sign:
Most common organ injuries:
SRS:

A

= vehicle restraints, reduced # of collision related deaths
= US #1 maternal death, hips/pelvis not ABDMN
= internal bleed abdominally
= Spleen adults Liver kids
= supplemental Restraint Systems (SRS) 1st used for front impacts, airbag inflation to cushion energy

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102
Q

Shear blunt trauma:

Axons shearing:

A

= injury occurs along edges of impacting force or at organ attachments (sudden acceleration) (liver ligament teres cuts liver) (arteriosus ligament shears middle of aorta (ductus oreriosis)
= concussion diffuse axonal injury DAI (changed pep b/c DAI)

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103
Q

Site for pneumo decompression:
needs:
Never go under a rib b/c:
Locating decompression site:
Digital thoracostomy:

A

= Anterior 2nd ICS midclavicular/3rd rib & b/c air is always up/rising
= At least 3in catheter, attach 1way valve: Could use 3way valve, glove,
= vascular; have major thoracic arteries & nerves
= palp/ then slide over 3rd rib
= 1-2in incision between 4th & 5th ICS, ( “cut finger tube” )

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104
Q

Special pop of burns:
PT’s cope less b/c:

A

= GERI, Pedi, & PTs ill/injured have >dif coping w/ burn injuries
= Fluid retention, <fluid reserves, <able to combat infection, More apt to have underlying diseases

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105
Q

1staph:
2Strep:
3Lymphangitis:
4Tetanus (Lockjaw):
5Gangrene:

6Wet Gangrene:
7Dry Gangrene:

A

1= staphylococcus Anaerobic bacterium infection
2= Streptococcus Anaerobic bacterium infection
3= red lines along lymph lines b/c infection
4= Clostridium tetani>Attacks NS produces toxin >M. contrac/spasms
5= Clostridum perfringen>(diabetes>risk) <peripheral> infection lacks blood supply/flow> less WBC
6= bacteria to tissue & swells then fluids outside of tissue
7= blood supply cut off and dry</peripheral>

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106
Q

Stretch blunt trauma:
Sciwora:

A

= Tendons & Fibers that (tendons stronger) hold organs & other structures together are pulled & injured or torn
= spinal cord injury with out r a (kids in wreck overstretching neck)

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107
Q

Stridor w/ inhalation burns:

Bad Airway burns might might need:

A

= AKA “crowing” larynx last defense against heat then swells 2/3s so intubate asap bc only worsens (Press chest & follow bubbles)
= Might need to nasal endotracheal intubation w/ BAAM & Endotrol tube (ET w/ trigger) BAAM> High=inhale &Low=exhale

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108
Q

Stroke volume is predicated by:
Amount of blood ejected by heart in one cardiac contraction:
Pressure w/in ventricles at the end of diastole:
Blood vol/ moved by heart in 1 min:
Measurement of peripheral vascular resistance is the:
Resistance a heart contraction must overcome in order to eject blood:

A

= Preload, afterload, and cardiac contractility
= Stroke Volume
= Preload
= Cardiac output
= Mean arterial pressure
= Afterload

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109
Q

Stroke volume:
Cardiac Output (CO):
CO form/:
3 factors that affect cardiac output:
Dynamic CO:

A

= blood amount ejected in 1 contraction> varies 60-100mL 70average
= Amount of blood moved in 1min
= HR X SV -> 5-6 L of blood moved in 1 min
= preload, afterload, contractility
= “1 up & other down”

110
Q

Area nearest the heat source that suffers the most damage is called the zone of:

A

Coagulation

111
Q

The blood volume of an infant or young child is proportionally:
Population most at risk for trauma & trauma death:

A

= ~20%> than that of an adult
= Young adult male

112
Q

The following burn patterns is usually seen with child abuse:

A

“Stocking burns” to lower legs, Circumferential burns on buttocks, Multiple circular burns of the same size to the arms and legs

113
Q

Internal Hemorrhage being forced between tissue layers (fascia):
Internal Hemorrhage:
Pregnant internal hemorrhage worry:
Internal blood loss may be self limiting:

A

= Hematoma (pocket of blood) usally from arterie)
= Blood accumulation in interstitial spaces, forming visible contusions
= multiple uterine arteries in umbilical cord
= Large body cavities (chest, ABDMN, pelvis) have little resistance & internal blood loss may be severe.

114
Q

Thermal burn phases:

A

Emergent, Fluid-shift, Hypermetabolic, & Resolution phase

115
Q

tools for external hemorrhage:

Trauma Clamps:
Tourniquets:

Tourniquet use adverse effects:
Hyperkalemia & Sign:

A

= Hemostatic Agents/Dressings, (combat gauze), trauma clamp, Tourniquets,
= IT clamps “teeth chomper”
= Commercial best at least 1in diameter/width (Willis=turning stick), Improvised (ad hawk), Air inflatable (like BP cuff), Junctional (sam splint=pelvic)
= Due to distal hypo-perfusion, toxins build up>Hyperkalemia:
= tall sharp T waves & treat w/ sodium bicarb bc Acidosis

116
Q

What is hydrostatic pressure in the vascular system & what creates it?

What is oncotic pressure in the vascular system and what creates it?

A

=Pressure from heart in blood vessels & forces water to cross the capillary membrane into the interstitial space.
=Pulling water back into the blood vessels by the presence of large proteins in the blood (pulling back in)

117
Q

Injury which opening occurs in skin & organs protrude through is:

A

Evisceration

118
Q

Most common location for compartment syndrome to occur?
1st “P” of compartment syndrome?
What ECG changes would indicate hyperkalemia?

A

= Distal leg, anterior compartment
= Pain
= Peaked T Waves

119
Q

Sodium Bicarbonate is delivered PT’s suspected w/ hyperkalemia at:
Dose of Calcium Chloride for hyperkalemia & line of med?

A

= 50 mEq as last line
= 500-1000 mg/3mins IV as 1st line med

120
Q

Jacksons Theory) Zone of Coagulation:

A

Area of burn nearest to the heat source (most damage & tissue necrosis)Most damaged area

121
Q

Jacksons Theory) Zone of Hyperemia:

A

surrounding Area of erythema, damage with more RBC coming to area b/c/& cap/s more permeable (increased blood supply) trying to get phagocytes to inside for healing process
Sig burns have sig swelling from shift of fluid

122
Q

Jacksons Theory) Zone of Stasis / “Ischemia”:

A

Less damaged area adjacent to the Zone of Coagulation (treatable & posible reversible damage)

123
Q

“pressure” of electric flow

A

Voltage

124
Q

Trauma def:
Trauma’s 2 categories:

A

= Physical injury or wound caused by external force or forces
= Penetrating & Blunt

125
Q

Penetrating:

(under penetrating) Perforating:

A

= object enters body & exchanges energy directly w/ human tissue causing damage or injury (goes in w/o exit)
= goes in & exits of body

126
Q

Standards established by your system’s medical direction to assist you in determining which PTs require urgent transportation to a trauma center:

A

Trauma Triage Criteria

127
Q

The health care surveillance process, put in place for trauma systems, is called

A

the Registry.

128
Q

Any eye trauma PT:
Zofran contra=

A

= vomiting &/ B/c +ocular pressure
= prolonged QT

129
Q

Subdural venous nature hematoma shows symptoms:
Epidural bleed arterial nature hematoma shows symptoms:

A

= 2-3 or 3-6hrs for symptoms
= immediately

130
Q

Morphine & fent drop BP by:

A

= body releasing Histamines

131
Q

Life threatening injuries %:
Most-life threatning trauma occurs to:
Vol per lung & body:
lethal blood loss:

A

= <10% traumas
= head and/or chest
= 3L per lung & 5L per body
= >40% or ~2L

132
Q

1st doc to classify trauma as a disease was:
1st EMT orange book

A

= the “white paper 1966”
1st EMT orange book

133
Q

Public health care model:

A

= Surveillance, Risk identification, intervention dev, implement, Eval/

134
Q

Implementation:

A

= putting effective safety measures EX roads,

135
Q

Surveillance:

A

= collection of data Epidemiology=study of disease based on med survey

136
Q

Risk analysis:

A

= Examines & determines factors that impact dev

137
Q

Intervention dev:

A

= dev/mod of programs to reduce both incidence & seriousness of trauma

138
Q

Evaluation:

A

= Repeat surveillance “good on paper but what about practice”

139
Q

(Trauma centers) Lvl 1:
Lvl 2:

Lvl 3:
Lvl 4:

A

= 1 (18tx) med-uni teaching, best care, everything to Neurovascular
= 2 (23 tx) everything BUT neuro, area trauma, surgical care capable all times, typically not teaching
= 3 general hospital w/ some special staff, TIB-FIB, try avoid w/ severe
= 4 basic ER, can stable but bandage, foot ran over

140
Q

Specialty Centers:

A

= Neuro, Burn, Pedi trauma, Hand & limb replant microsurgery, Hyperbaric oxygen

141
Q

MOI:
Energy:
Inertia:

A

= mech of injury how the injury happened
= Ability to do work
= law of Inertia (Newton’s 1st law) helps explain how objects in motion behave

142
Q

Newton’ s 1st law:

Newtons 2nd Law:

A

= (inertia): body in motion will stay in motion unless acted upon an outside force “Body at rest will remain at rest unless acted upon upside force”
= “law forces at work stay in work during collision”

143
Q

Kinetic energy:
Kinetic Energy form:

A

=energy of a object in motion (by objects mass & its velocity
= (Mass x Velocity ^2)/ 2 ½ x mv^2

144
Q

Force:
Force formula:

A

= force related to a objects mass(weight) and/or achange in velocity
= mass x Acceleration

145
Q

Biomechanic of trauma:
Occur w/ 2 forms:

A

= manner in which energy exchange damages human tissue
= blunt or penetrating

146
Q

Faster and/or mass relation to energy:
Cavitation’s relation to speed:
Energy exchange Study of:

A

= more deceleration > more transfer of energy
= Faster object greater cavitation
= “kinetics of energy compact”

147
Q

Compression blunt trauma:
Hematoma:
Contusion:
Ecchymosis:

A

= impact abruptly stops body part while inertia continues (hit by bat)
= artery bleed under area
= bruise cap bleed
= discoloration ID contusion

148
Q

Stretch blunt trauma:

Sciwora:

A

= Tendons & Fibers that (tendons stronger) hold organs & other structures together are pulled & injured or torn
= spinal cord injury with out r a (kids in wreck overstretching neck)

149
Q

MVC) Types of impacts:
Most common impact:
Most deadly impact:
commonly most benign impact:

A

= Frontal, Lateral, Oblique, Roll over, Rear
= Frontal
= Lateral (b/c less crumble zone & Seat belts offer lil protection)
= Rear

150
Q

MVC) Phase 1:
Phase 2:
Phase 3:
Phase 4:
Phase 5:

A

= Vehicle collision (P1) deceleration
= Body collision (P2) decel/ of occupant
= Organ collision (P3) decel of internal
= 2ndary collision (P4) objects in car
= (P5) car rear end, trees,

151
Q

Seat belts:
Maternal relation w/ seat belts:
Cullen’s sign:
Most common organ injuries:
SRS:

A

= vehicle restraints, reduced # of collision related deaths
= US #1 maternal death, hips/pelvis not ABDMN
= internal bleed abdominally
= Spleen adults Liver kids
= supplemental Restraint Systems (SRS) 1st used for front impacts, airbag inflation to cushion energy

152
Q

Frontal car impact:
(FCI) Restrained pathway:
(FCI) Unrestrained pathway:

A

= most common, Spider windshield, Pneumo b/c paper bag syndrome
= fold over, chest/ABDMN, <injuries
= Up & Over, down & under, ejection (most injuries)

153
Q

Rear Car impact:
(RCI) common injuries:

A

= read-end, commonly most benign
= Whip lash, common C-Spine injuries

154
Q

Lateral Car Impact:
more deadly impact b/c:
(LCI) body pathway & injurie:

A

= hit from side aka T-bone(most dealy b/c less crumble zone)
= Seat belts offer lil protection
= Coupe-Countre-Coupe injury > neck/head toward impact & body w/ impact

155
Q

Oblique Car Impact:

A

= occurs when lateral impact is off center aka “spin/rotating”

156
Q

Roll Over Car Impact:
(ROCI) injuries:

A

= car is flipping (high critical “drying machine”)
= Multiple impacts from hitting each part of car w/ each 1/4 rotation

157
Q

(Blood vol/ loss) Pelvis:
Femur:
Humorous:

A

= 2-3Liters
= 1.5Liters per femur
= 750ml per humorous

158
Q

Motorcycles often serious trauma b/c:
Frontal Moto/ pathway & Injuries:
Angular Moto/ pathway & Injuries:
Sliding Moto/ pathway & Injuries:
Ejection Moto/ pathway & Injuries:

A

= rider tends to absorb much of crash injuries (lots of heads injuries
= most common front dips propelling rider & handlebars catch lower
= “side swipe or lateral” impact w/ guard rails Mostly ortho-injuries
= < chances of ejections) more rashes & “most safe”
= very common, usually more serious injuries Initial Biker then Ground

159
Q

Removing moto helmets:

A

Paramedic remove that helmet!!! For A&B,
Remove if Helmet isn’t snug &/or bad integrity
Contra: impaled through helmet & skull

160
Q

AUTOPED) 1st impact:
2nd impact:
3rd impact:
Off-road injuries:
Kids Waddell’s triad:

A

= auto strikes body
= pedestrian thrown
= body strikes ground or object
= pop increased, usually remote areas, offer less protection,
= turn toward bumper b/c stupid, bumper hits kids pelvis & femur, chest & ABDMN hit grill, head strikes ground b/c buckethead

161
Q

Falls:
Examine:
Axial loading:
FOOSH (Fall onto an outstretched hand)
Colles’ fracture:
Smith’s fracture: out
>20ft greater risk of
Aortic anyrusem to tear:

A

= most common blunt trauma, risk increase w/ age, sig fall 2-3x height
= height, position, surface PT landed on, physical condition of PT
= loading on axial skelton via falling (E starts heel to lumber)
= influxing wrist fractures from fall impact
= efflucing wrist fractures from fall impact “Palm out”
= internal organ damage
= pain tearing to chest shoulders back
= tearing pain from chest goes to back

162
Q

Blast injuries:
Conventional bomb:
Dirty bomb:

A

= Effects pulmonary system significantly
= most common >Pipe bombs, fireworks, ect
= Conventional bomb w/ reactive material

163
Q

Blast phases) Primary:
2ndary: flying debris hitting you
Tertiary: thrown off of feet onto something
Quaternary: misc event: tree falls on you, radioactive (dirty bomb)
Isolated blast injury:
Contra blast injury:
Underwater blasts:

A

= Primary: decompression of lungs
= flying debris hitting you
= thrown off of feet onto something/ground
= misc event: tree falls on you or radioactive injury(dirty bomb)
= injury same side of impact
= opposite side of impact
= enhances injury/death w/ pressure wave

164
Q

“Laying the bike down” results in

A

the bike absorbing much of the energy

165
Q

Form/ “mass multiplied by velocity squared, divided by two” equals:
Study of processes that bring forces to bear upon human body is:
When sig/ kinetic energy is applied to human anatomy, its called:
Branch of physics w/ objects in motion & E. exchanges w/ collision:

A

= Kinetic energy
= Kinetics of impact
= Trauma
= Kinetics

166
Q

Frontal impact MVC rarity:
Pathways of travel w/ MVC frontal impact are:
Rear-impact MVC injuries:

A

= most common type of impact in MVCs
= Down & under or Up & Over
= commonly limited/benign especially w/ Headrest position properly

167
Q

The most common & serious trauma associated w/ explosions is:
The most lethal explosions are those: That cause structural collapse

A

= Pulmonary injury
= That cause structural collapse

168
Q

What are the 3 different levels of penetrating trauma?

A

High velocity> sniper
Medium velocity> pistol
Low velocity> knife

169
Q

1 kinetics of penetrating trauma) Ballistics:
2 Trajectory:
3 Drag:
4 Cavitation:
5 Velocity:
6 Profile:
7 Shape:

A

1= Study of projectiles in motion & effects on objects
2= Curved path bullet follows after fired from a gun
3= Drag from wind
4= Outward/ cavitation motion of cavity due to projectiles
5= Speed of object in motion
6= Cross-section of bullet along its direction of travel
7= Shape of bullet

170
Q

1 kinetics of penetrating trauma) Study of projectiles in motion & effects on objects
2 Curved path bullet follows after fired from a gun
3 Drag from wind
4 Outward “ballooning” motion of cavity due to projectiles
5 Speed of object in motion
6 Cross-section of bullet along its direction of travel
7 shape of object

A

1= Ballistics:
2= Trajectory:
3= Drag:
4= Cavitation:
5= Velocity:
6= Profile:
7= Shape:

171
Q

What are the three levels of penetrating trauma?

A

Lvl 1: entrance
Lvl 2: cavation
Lvl 3: exit

172
Q

Shock & perfusion definitions:

A

= Perfusion: Adequate supply of well oxygenated blood & nutrients to all vital organs
= Shock: body’s lack of perfusion

173
Q

Shock) Hypovolemic:
Types:

A

= fluid loss
Hemorrhagic: blood loss & Non-hemorrhagic: V/D, Sweating

174
Q

5 types of shock and treat them appropriately:

A

Hypovolemic, Cardiogenic, Distributive, Obstructive, Respiratory/Metabolic

175
Q

blast injuries) Primary:
Secondary:
Tertiary:
Quaternary:

A

Primary: blast injuring hallow organs
Secondary: shrapnel injuring
Tertiary: thrown against something
Quaternary: damage from other AFTER BLAST

176
Q

Shock) 1 Distributive:
2 Hives:

3 “warm shock/high space”:
4 Sick shock:
5 syncope:

A

1= uncontrolled vaso-dialation
2= Anaphylactic: release of histamine from Ige & b/c allergen
3= Neurogenic: warm b/c reverse shunting makes warm transient block of SNS
4= Wide spread of infection
5= Physcogenic: Sudden vasodilation physiological means EX hemophobic, arachnophobic

177
Q

Dynamic CO:

A

=1 up other down, L diastole P = L afterload, PVR pulmonary & oil

178
Q

Shock) 1 Obstructive & types:
2 pneumothorax:
3 Pericardium:
3 traveled Embolism to lungs:

A

1= something obstructing heart} PE, Tension/Pneumo, Pericard/tamp
2= Tension/pneum: plueras so full pushing on hearts atrium
3= Pericardial tamponade: pericardium filled with blood
4= PE: emboli so big obstructs pulmonic vein

179
Q

Shock) Cardiogenic:
Types & defined:

A

= Pump prob/ not working
= Intrinsic: problem from w/in heart EX MI
& Extrinsic: pob from outside hurting heart EX TPT

180
Q

Shock) 1 Respiratory/Metabolic:

A

1= Disruption of O2 transfer into cells/cells unable to utilize O2 from Cyanide, CO poisoning, A change in the blood pH

181
Q

Shock) Normal S/S of shock:
Compensate shock:
Decompensated shock:
Irreversible shock:

A

= Tachypnea&cardia, AMS, lower BP
= body is compensating “fighting” to maintain homeostasis
= can no longer maintain homeostasis
= can’t come back to life

182
Q

Shock) How does hemophilia affect the body and the clotting of blood?

A

Does not have ability to properly clot due from ½ factors

183
Q

Shock) S/S of neurogenic shock:
Cushing’s Triad:

A

= warm/flush, bradyC, HyperBP, AMS, Blown and/or unequal pupils
= HyperBP, BradyC, cheyenne stokes or Biots ventalations

184
Q

TXA) 1 Dynamics:
2 when do we admin/ it:
3 Correct dose:
4 Followed by:

A

1= Blocks fibrinolysis by binding to plasminogen, blocking plasminogen fibrin interactions.
2= Significant hemorrhage, either internal or external (after external hemorrhage has been controlled).
3= 1G/10mins (mix in 50 mL bag of NS)
4= 1G/8Hrs (500 mL bag)

185
Q

What are the 3 dif types of soft-tissue injuries?

A

Type: Open
Type: Close: Infection
Type: Burn

186
Q

Hyperkalemia) 1st line med:
2) One of two 2nd line meds:
3) One of two 2nd line meds:
4) Hospital only med:
5) Hospital only med to poop:

A

1= Calcium Chloride IV 0.5-1G/3 mins (Stabilizes doesn’t fix)
2= Albuterol 10-20 mg LVN over 15 mins
3= Sodium Bicarb 50 mEq IV mil equivalent
4= Dextrose (25 grams)w/ Insulin IV (10 units)
5= Kayexalate to poop out hyperK via pull interstitial to GI

187
Q

Avulsions & subtypes:

A

= separates & creates flap/chunk from skin (“chunk missing)>Degloving, Scalping, Amputations

188
Q

dif types of open soft-tissue injuries:
Abrasions:

A

= Abrasions, lacerations, avulsions, and penetrating injuries
= scrape across skin skin

189
Q

Lacerations & subtype:

A

= cut into dermis} Incisions: smooth Lac from sharp (scalpal, glass, ect) open against tension line, close w/ tension lines

190
Q

Penetrating injuries & subtypes:

A

= puncture: small entrance, Impalement: remove impedes CPR or Airway, Perfurating: through & through

191
Q

Criteria for critical/moderate burn in adult & Pedi PT:

A

Burns associated with respiratory injury aka inhalation burn
Chemical / high voltage
Burns with major trauma

192
Q

Hydroxocobalamin:
Adult Dose:
Pedi Dose:

A

= Suspected cyanide poisoning
= 5 grams IV/IO over 15 minutes. May repeat a 2nd 5 gram dose for a max of 10 grams
= 70 mg/kg IV/IO (max 5 grams)

193
Q

Hydroxocobalamin) Dynamics:

Indications:
Contra:
Dose:

A

= Binds w/ cyanide to form nontoxic cyanacobalamin (Vitamin B12), preventing its toxic effects.
= Suspected cyanide poisoning
= Hypersensitivity
= 5Gs IV/O over 15 mins. May repeat 2nd 5G dose (max 10G)

194
Q

Ketamine) Dynamics:
Indications:
Contra:
Sedation Dose:
Pain dose:

A

= Dissociative anesthetic. NMDA Receptor Antagonist Anesthetic
= Sedation, SFI/RSI, Analgesic
= Hypersensitivity
= Sedation: 1-2 mg/kg Onset: 30-60 secs, Duration: 10-20 mins
= Pain: 0.2 mg/kg IV/IO (max single dose 20 mg), 0.5 mg/kg IM/IN (if no IV/IO)

195
Q

Methylene Blue) Dynamics:
Indications:
Contra:
Dose:

A

= Water soluable thiazine dye helps metHb to hemoglobin conversion
= Methemoglobinemia (metHb), Nitrate OD/poisoning
= Hypersensitivity
= 1 mg/kg IV/IO over 5-30 minutes.

196
Q

Rocuronium) Dynamics
Indications:
Contra:
Dose:

A

= Nondepolarizing neuromuscular blocker. Binds to ACh receptors
=DSI/RSI
= Hypersensitivity
= 0.6-1.2 mg/kg. TTP: 60-90 secs. DOP: 45-120 mins

197
Q

Sodium Bicarbonate 8.4%) Dynamics:

Indications:

Contra:
Suspected acidosis Dose:
Hyperkalemia Dose:

A

= Alkalinizing Agent. Increases plasma bicarbonate, buffers excess hydrogen ion concertration, raises blood pH & reverses clinical manifestations of acidosis.
= Suspected hyperkalemia, suspected bicarbonateresponsive acidosis (DKA, OD on TCA’s, Aspirin or Cocaine)
= Patients in cardiac arrest
= 1 mEq/kg, Hyperkalemia:
= 50 mEq IV bolus.

198
Q

Succinylcholine) Dynamics
Indications:
Contra:
Dose:

A

= Depolarizing neuromuscular blocker. Binds to Ach recptors
= DSI/RSI
= Hyperkalemia(burns, crush injury), Increased ICP, Severe trauma
= 1-1.5 mg/kg IV/IO. TTP: 45-60 seconds. DOP: 5-10 mins.

199
Q

Fentanyl) Dynamics:
Indications:
Contra:
Dose:

A

=Synthetic Narcotic (Schedule II Opioid)
= Analgesia & sedation via binding to opiate receptor, sig/ more potent than morphine (100 mcg = 10 mg of Morphine)
= Moderate-Severe pain
= Hypersensitivity, SBP<90
=1mcg/kg to a max dose 100 mcg (IV/IO/IM/) may repeat PRN in 5-10
= 1mcg/kg IN may repeat PRN 5-10mins (Max 1mL PRN if admin/ed IN)

200
Q

Hydroxocobalamin) Dynamics:
Indications:
Contra:
Dose:

A

Binds with cyanide to form nontoxic
cyanacobalamin (Vitamin B12), preventing its
toxic effects.
Suspected cyanide poisoning Hypersensitivity 5 grams IV/IO over 15 minutes. May repeat a
2nd 5 gram dose for a max of 10 grams

201
Q

Methylene Blue) Dynamics:
Indications:
Contra:
Dose:

A

= H20 soluable thiazine dye promotes converting metHb>hemoglobin
= Methemoglobinemia (metHb), Nitrate overdose/poisoning = Hypersensitivity
= 1 mg/kg IV/IO over 5-30 mins

202
Q

Succinylcholine) Dynamics:
Indications:
Contra:
Dose:

A

= Depolarizing neuromuscular blocker. Binds to Ach recptors
= DSI/RSI
= Hyperkalemia(burns, crush injury), +ICP, Severe trauma, Neuromuscular disease.
= 1-1.5 mg/kg IV/IO. TTP: 45-60 seconds. DOP: 5-10 minutes.

203
Q

Tranexamic Acid (TXA) Dynamics:
Indications:
Contra:
Dose:

A

= Binds to plasminogen, blocking plasminogen fibrin interactions (fibrinolysis)
= Sig/ hemorrhage, either in/external (after external hemorrhage is controlled)
= SP 3 hrs past injury, allergy/Sensitivity, Suspected thromboembolism
1 gram over 10 minutes (mix in 50 mL bag of
NS), Followed by 1 gram over 8 hours (500 mL
bag NS).

204
Q

Injury which opening occurs in skin & organs protrude through is:

A

Evisceration

205
Q

Most common location for compartment syndrome to occur?
1st “P” of compartment syndrome?
What ECG changes would indicate hyperkalemia?

A

= Distal leg, anterior compartment
= Pain
= Peaked T Waves

206
Q

Crush syndrome occurs when trapped/crushed for how long:
Crush injury is what type of wound:
PT has lower L-leg trapped underneath a farm tractor for the last 5hrs. PT presents w/ obvious signs on hyperkalemia. What is 1st line IV med for this patient?

A

= usually for longer than 4 hours
= Closed soft tissue injury
= Sodium Bicarbonate

207
Q

The skin is known collectively as the:
Skin, considered what of body & what % of total body weight:
Which layer of skin primarily insulates the body against heat loss?
Glands w/in the dermis that secrete a lubricant are called the:
Outermost layer of skin is the:
What part of the integumentary system receives no blood supply?

A

= Integumentary system
= Organ, 16% of total body weight
= Subcutaneous Layer
= Sebaceous glands
= Epidermis
= Epidermis

208
Q

Sodium Bicarbonate is delivered PT’s suspected w/ hyperkalemia at:
Dose of Calcium Chloride for hyperkalemia & line of med?

A

= 50 mEq as last line
= 500-1000 mg/3mins IV as 1st line med

209
Q

Which type of wound has a small opening into the skin, but may be quite deep, and is often caused by instruments such as nails, ice picks, or pencils?

A

= Puncture

210
Q

Which of the following best describes an avulsion?
Which of the following is considered an open wound?
Which soft tissue injury causes a greater amount of hemorrhage?

A

= Flap of skin partially/completely torn away from underlying tissue
= Laceration
= Avulsion

211
Q

Thick, fibrous, inflexible membranes surrounding muscle that help bind muscle groups together are called:

A

Fascia

212
Q

1Blunt non-penetrating injuries that crush/damage lil blood vessels:
2Contusion is considered what type of injury:
3Minor bleeding associated w/ cap/ wounds often continues b/c:
4A hematoma or collection of blood beneath the skin:
5PT sustained a blow to frontal region of his head & now has a large lump present at the point of impact. This lump referred to as:

A

1= Contusions
2= Closed soft tissue blunt injury
3= Capillaries cannot contract and thus continue to bleed
4= Is most commonly caused by injury to an artery
5= Hematoma

213
Q

An injury in which the mechanism of injury tears the skin off the underlying muscle, tissue, blood vessels, and bone is called a(n):

A

Degloving injury

214
Q

A rapid trauma assessment should be performed on:
Which of the following is true regarding soft-tissue injuries?
Impaled object may only be removed during what conditions?

A

= Any patient with a significant MOI
= Most open wounds require only simple care and limited suturing
= CPR is needed and impaled object interferes with chest compressions & The impaled object is causing an obstruction of the patient’s airway

215
Q

Afferent nerves:
Efferent nerves:

A

=sensory nerves “ahhh”
=motor “effect”

216
Q

Thickest skin @:
Thinnest skin @:

A

= Palms & Soles have thickest skin
= eyelids 1st & genitalia 2nd

217
Q

(Soft tissue injuries)

A

= Risk factors: age (50-70kilos blood) (1yr old ⅓ of gatorade bottle), alcohol/ drug use, Occupation

218
Q

Layers of skin:

A

Epidermis, Dermis (papillary & Reticular Lvls), Subcutaneous

219
Q

Epidermis:

A

dead skin cells, no vasculature, astratum corneum, cells are pushed out & are replaced, Sebum (waxy oil lubes (hands), top layer of skin

220
Q

Subcutaneous:

A

= adipose tissue, most thermal temp/ reg/, (regs cold>heat)

221
Q

Dermis:
2 layers of dermis:
Papillary:
Reticular:
Sebaceous glands:
Sudoriferous Glands:

A

= Middle layer of skin
= papillary & Reticular layer
= contains the Glands, blood vessels, nerves “nipple, Nerves”
=contains the venules arterioles, capillaries “Reticular network circul/”
= sebum lubricate palms
= SNS n postsynaptic acetylcholine for response

222
Q

Blood vessels:
Blood in venous system:
Most of vaso construction by:

A

= veins low pressure w/ valves, arteries no valves w/ lots tunica media
= ⅔ in venous system,
= Capillaries: most of vaso construction

223
Q

1Lymphatic system:

2Lymph node:
3Spleen relation:
4Lymphatic pathway:
5Sign lymphatic system not working:

A

1= “body’s garbage system” macrophages eats then system of channels to tissues 1 direction, no pump, dumps into a node
2= were garbage collects
3= Carries “trash” of pathogen destruction to nodes for macrophages
4= >Vessels> nodes> spleen> up to L/R subclavian vein, to kidneys
5= Gray poop

224
Q

Tendons:
Ligaments:
Fasciae:
Tension lines/Langer lines:

A

= connects muscle to bone, strong, full of collagen “tend to bone”
= connects bone to bone aligning joints & easily tear
= band sheet of CT stabilizes, encloses, & separates M. compartments
= “way skin is grooved together”, cut against line hard to close & leaves bigger opening, effects healing process

225
Q

Contusions:
Hematoma:
Severe hematomas to major compartments may contribute to:

A

= bruise made by ecchymosis: black & blue
= artery bleed, tamponades & helps hemostasis
= hypovolemia

226
Q

Avulsion:

A

= separates & creates flap/chunk from skin (“chunk missing)
Tend to bleeds worst of cuts & more than complete amputation & Very prone to infection & can go to circulatory system > degloving

227
Q

Lacerations:

A

= “jagged” Cuts deep into dermis ( Incisions, Punctures, perfuration)

228
Q

Incisions:

A

= smooth Lac from sharp instrument (knife, razor, glass, ect) gapes open if against tension line, keeps close typically if cut w/ tension lines

229
Q

Punctures:
Impaled:

A

= small entrance (ABDMN punctures can >evisceration)
= embedded objects

230
Q

1Hemostasis:
2Inflammation:
3Epithelialization:
4Neovascular:
5 rebuild/ Collagen synthesis:

A

1= vaso/strict, platelet aggregate, coagulation fibrin (normothermic)
2= Granulocytes, macrophages & Lymphocytes eat, Mast cells released
3= “rebuild” epithelial cells go to wound making scab ~48Hrs after cut
4= new capillaries made (neo new) via previous cap/s +exchanging
5 = fibroblasts go to wound & synthesize collagen creating scar (w/ tension lines quicker/better), Too much synthetization makes Keloid

231
Q

1phagocytosis:

2Granulocytes & macrophages w/ healing:
3Lymphocytes w/ healing:
4Mast cells w/ healing:

A

1= macrophage eats & grows bacteria flag to show what antibodies to make for cellular response
2= eat dead cells parts & bacteria
3= destroys bacteria & other pathogens
4= release histamine to make capillaries more permeable to bring more RBC

232
Q

Stages of healing:

A

1= Hemostasis, Inflam/, Epithelialization, Neovasc/, Remodeling (Collagen synthesis) “Here I Enter New Remodel”

233
Q

1Prehospital Infections:
2Infections cause, duration, severities, treatment:

3Risk factors:

A

1= sepsis, staph, strep, Lymphangitis, Tetanus, & Gangrene
2= Anaerobic bacterium, ~10% severe, 2-3 days pain tender warm, fight w/ steroids
3= diabetics, infirm, elderly, chronic diseases, steroids, animal/human bites,

234
Q

Internal Hemorrhage being forced between tissue layers (fascia):
Internal Hemorrhage:
Pregnant internal hemorrhage worry:
Internal blood loss may be self limiting:

A

= Hematoma (pocket of blood) usally from arterie)
= Blood accumulation in interstitial spaces, forming visible contusions
= multiple uterine arteries in umbilical cord
= Large body cavities (chest, ABDMN, pelvis) have little resistance & internal blood loss may be severe.

235
Q

1staph:
2Strep:
3Lymphangitis:
4Tetanus (Lockjaw):
5Gangrene:

6Wet Gangrene:
7Dry Gangrene:

A

1= staphylococcus Anaerobic bacterium infection
2= Streptococcus Anaerobic bacterium infection
3= red lines along lymph lines b/c infection
4= Clostridium tetani>Attacks NS produces toxin >M. contrac/spasms
5= Clostridum perfringen>(diabetes>risk) <peripheral> infection lacks blood supply/flow> less WBC
6= bacteria to tissue & swells then fluids outside of tissue
7= blood supply cut off and dry</peripheral>

236
Q

Amputation treatment:

A

= direct pressure 2in above site , never submerge in ice, keep cool,

237
Q

Heat gradient

A

H → L heat will go

238
Q

Factors of burn severity:

A

Duration, Exposure, temp, surface

239
Q

agent’s temperature relation to potential damage.

A

greater the agent’s temp, the greater its potential to cause damage.

240
Q

Electricity follows path of

A

least resistance w/ entry & exit wound: Nerves & blood vessels

241
Q

Lightning can still strike you if proximity up to:

A

up to 50yrds can strike you

242
Q

Chemical burns:

A

biochemical makeup of cell membranes; destroy cells

243
Q

Direct current (DC):
Alternating current (AC):

A

= electrons flow in one direction > grab on can’t let go
= reverses flow in short intervals (60 cycles change electrons’’ flow) can let go

244
Q

Lightning shock pathway to heart can & b/c:

A

= PSNS & SNS attach heart “defib w/o defibrillator” put in dysrhythmia or arrest

245
Q

Alkalotic vs acidotic burns severity

A

Alkalotic burns > Acidotic burns

246
Q

Chemical burns effect:

A

Denature biochemical makeup of cell membranes; destroy cells

247
Q

(Rad) S/S of Exposure:
First sign:
Lethal Dose Exposure:

Organ shutdown:

A

= SLUDGEM PSNS S/S
= slight nausea & fatigue
= Emesis & malaise, Epistaxis, mouth, gums, & rectum (Vomiting usually lethal exposure
= Death

248
Q

Geiger Counter:
Dosimeter:

A

= Radiation emission measured w/ Dosimeter
= Cumulative exposure recorded

249
Q

1 Types of Radiation:
2 Radioactive Particles:
3 Alpha:
4 Beta:
5 Ionizing Rays:
6 Gamma:
7 X-Rays:
8 Atomic:

A

1= Radioactive Particles & Ionizing Rays
2= Alpha &Beta:
3= least worry & deflected w/ newspaper
4= flys further w/o skin penetration
5= Gamma & X-Rays
6= worst, several ft of concrete & lead
7= penetrates skin
8= nuclear reactor

250
Q

(Radiation) Duration:
Distance:
Shielding:

A

= Radiation exposure accumulative danger
= Rad/ strength lessens quickly as distance from source increases
= More material between you & rad/ source, < exposure experienced

251
Q

Light Burns:
Inhalation Burns:
Toxic inhalation:
Cyanide & carbon monoxide are released via:

A

= Intense light from arc welder, industrial laser (Ultraviolet keratitis)
= Inhaled gases, heated air, flames, steam; airway & resp/ injury
= Synthetic resins & plastics release toxic gases as they burn
= fake wood & such burning thus Toxic inhalation

252
Q

Stridor w/ inhalation burns:

Bad Airway burns might might need:

A

= AKA “crowing” larynx last defense against heat then swells 2/3s so intubate asap bc only worsens (Press chest & follow bubbles)
= Might need to nasal endotracheal intubation w/ BAAM & Endotrol tube (ET w/ trigger) BAAM> High=inhale &Low=exhale

253
Q

1 (Burn depth) 3rd degree:
2 feeling & appearance:

A

1= full thickness burn down to SCT may involve M. bone & organs
2= leather, looks Charred, dark brown or white, hard to touch “painless”

254
Q

(Burn depth) Degrees:

A

= 1st/Superficial, 2nd/partial, 3rd/full/complete

255
Q

(Burn depth) 1st degree:

A

= Epidermis only, red skin, pain & tender, NO blister(can lose temp/reg)

256
Q

(Moderate criteria) Superficial:
Partial thickness burns:
Full thickness burns:

A

= BSA >50%
= BSA <30%
= BSA <10%

257
Q

(Burn depth) 2nd degree:

A

= Partial, EPi & Dermis burned: intense pain, fluid shift comes up thus blisters, RED to WHITE, moist & mottled w/ shifts

258
Q

(Critical Criteria) 3rd & 2nd Degree criteria:
Any 2nd or 3rd degree burns involving:
Burn types that’re critical & Rx:

A

= 3rd>10% & 2nd>30%
= Face, Hands, Genitalia, Circumferential, Feet, (Dipping), Airway
= Chem, high voltage, Burns w/ major trauma go trauma center 1st then burn center

259
Q

The following burn patterns is usually seen with child abuse:

A

“Stocking burns” to lower legs, Circumferential burns on buttocks, Multiple circular burns of the same size to the arms and legs

260
Q

1 Resp/ arrest from electrical burn is a result of:
2 The “pressure” of the electric flow is known as:
3 PTs in cardiac arrest b/c electrical current have high survival rate if:
4 human body relation w/ current:
5 Electrical injuries’ usually damage:

A

1= immobilization of M.s from prolong exposure to electrical current
2= Voltage
3= Prehospital intervention is prompt
4= Body offers resistance to the flow of electricity
5= does lots of damage to muscle tissue & other tissues

261
Q

1 One of the chief functions of the skin is:
2 The skin is comprised of 3 layers:
3 Layer that serves as stratum of insulation vs trauma & heat loss is:
4 Layer that contains blood vessels, glands, & nerve endings is:
5 Full-thickness burns can involve injury to:
6 The integumentary system relation to NS:

A

1= Temp regulation
2= Epidermis, Dermis, & Subcutaneous Tissue
3= Subcutaneous Tissue
4= Dermis
5= blood vessels, nerves, M. T., bone, & sometimes internal organs.
6= is not part of the nervous system

262
Q

Burn injuries should be assigned a higher priority when they affect:
You should increase the severity of a burn patient by 1Lvl w/:

A

= Pediatric PTs
= pediatric & elderly patients

263
Q

The stage of the burn process characterized by catecholamine and pain-mediated reaction is called the:

A

Emergent Phase

264
Q

Rad/ only sig/ hazard if inhaled/ingests contaminated material is:
Neutron radiation is:

A

= Alpha
= uncommon outside of nuclear power reactors & Bombs

265
Q

1 Alkalis are commonly used as:
2 Acids burns:

3 Alkalis burns:

A

1= oven and drain cleaners, agricultural fertilizers, and in industry
2= form thick, insoluble mass where they contact T. via coagulation necrosis, limiting burn damage
3= continue destroy cell membranes via liquefaction necrosis, allowing them to penetrate underlying tissue & causing deeper burns

266
Q

Beta radiation can travel and can penetrate

A

6 to 10 feet through air & a few layers of clothing.

267
Q

Alpha rad/ strength, traveling distance, & penetration:

A

very weak energy source & travels only INs in air, cannot penetrate the epidermis & stopped by paper & clothing

268
Q

Factors Affecting Exposure to Radiation:

A

Duration of exposure, Distance from source, Shielding from source

269
Q

1 (PTs in severe pain w/ narcotic analgesia) morphine:

2 Fentanyl
3 Ketamine use:

A

1 = 2-5 mg IV increments every 5mins til’ pain is relieved. Use w/ caution b/c it can depress resp/ drive & increase any existing hypovol/
2= start w/ loading dose 25-50mcg IV & repeat doses as needed
3= may be an alternative to fentanyl in selected patients.

270
Q

2 cyanide antidote regimens are available:

Sodium nitrite dose :
Sodium thiosulfate dose:

A

= Pasadena cyanide kit (amyl nitrite, Na nitrite, & Na thiosulfate) & newer antidote Cyanokit (hydroxocobalamin)
= 300 mg sodium nitrite over 2 to 4 minutes for adults.
= administer 12.5 g of for the adult.

271
Q

Child Burn form:

A

(age#-1 from the head) / between 2 legs

P2 Exams (9 decks)

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