Trauma skills - IO, Decompress, pressure infusers, decompression, hemorrhage control Flashcards

1
Q

IO indications

A

Cardiac arrest, difficult IV in hypovolemia, needs fluid or drugs within 5 minutes, two IV attempts or 90 seconds

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2
Q

Equipment

A

Gun, needle, IV solutions tubing fluid, stopcock 60cc and 10cc syringe, gauze, extension tubing and tape

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3
Q

Landmarks for proximal tibia

A

2cm below patella 2 cm medial to tibial tuberosity

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4
Q

Landmarks for distial tibia

A

3cm proximal to most prominent aspect of medial malleolous. Palpate anterior and posterior borders of tibia to ensure your insertion site is on flat central aspect

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5
Q

Once you’ve drilled

A

Slowly inject 10mL of NS and attempt to aspirate marrow/blood. Check for increased resistance, extravasation, bleeding, occlusion, dislodgement.
Attach infuser, labels EZ-IO wristband on pt, reasses pt

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6
Q

Complications of IO

A

Extravasation, compartment syndrome, dislodgement, fracture, failure, pain, ,infection

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7
Q

Contras to IO

A

Infection, fractures, prosthesis, IO within 24 hours, don’t do two IOs in same extremity, osteogenesis imperfecta, excessive tissue or unable to landmark

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8
Q

Indications for decompression

A

Poor compliance, decrease/loss of consciousness, hypotension, hyper-resonance, absent breath sounds, respiratory distress, JVD, tracheal deviation

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9
Q

Oxygenation for tension pneumo

A

Supplemental high flow oxygen to patient and/or ventilation support NRB/BVM

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10
Q

Equipment for decompression

A

10-14G IV catheter optimum length 5cm 10mL syringe
Iodine/betadine/alcohol swabs
Tape/securing device and heimlich valve with connection tubing or other type of flutter valve

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11
Q

Landmarking

A

Explain procedure to pt, landmark 2nd or 3rd intercostal space midclavicular or 4th or 5th intercostal midaxillary

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12
Q

Decompression procedure

A

Swab, take cap off and attach 10mL syringe with 5mL. Stick it in then tape, avoid kinking/bending. Reassess lung sounds, attach heimlich valve. Constant monitoring

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13
Q

Bleeding control procedure

A

Direct constant pressure, compress as much as possible
Maintain pressure, only move once to identify correct spot if needed
Horizontal or slightly head down positioning.
CAT
Wound packing dressing with hemostatic agent

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14
Q

Bleeding control others

A

Support airway/oxygenation and ventilation

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15
Q

Fluids

A

Lactated ringers increase cytokine which contributes to lactic acidosis
NS can cause hyperchloremia
Both can cause neutrophil release

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16
Q

Bleeding control

A

Constant monitoring
Large bore IVs, MAP 65 or SBP 80-90
TXA infusion (hypotension tachycardia over 16) 1g in 250mL over 10mL (4 drops per second)

17
Q

Lido IO amount

A

2-4mL of 2% in adults which is 20-40mg of Lido if pt complains of pain

18
Q

IO sizse

A

15mm 3-39kg
25mm 40kg and greater
45mm for 40kg and greater with excessive tissue

19
Q

Pressure infuser

A

300mmHg will get 150mL/minute through an IO

20
Q

More on pressure infuser

A

Adjusts volume of air as needed to maintain flow

Monitors IV site for patency

21
Q

First six deadly dozen

TCFOAM

A
Tension pneumo
Cardiac tamponade 
Flail chest
Open pneumo
Airway obstruction 
Massive hemo
22
Q

Deadly dozen second six

DAMPTB

A
Diaphragmatic tear
Aortic rupture 
Myocardial contusion
Pulmonary contusion
Tracheal/bronchial tree injury 
Blast injuries