Triage

Question 1

Primary Survey
A
B
C
D
E

Answer 1

Airway
Breathing, Bleeding
Circulation, Consciousness
Disorders
Externa Factors

Question 2

Description of Class 1, First Priority cases on triage

Answer 2

Treatment must be initiated within seconds. Patient needs immediate care and stabilization.

Class 1: actively dying; catastrophic

Question 3

Description of Class II, Second priority cases

Answer 3

Critical: Can be actively dying
At risk for rapid decompensation. Must be seen within minutes, limit stress, rapid assessment and doctor should be present to assess patient within minutes.

Question 4

Description of Class III, Third Priority cases.

Answer 4

Urgent: Patient is stable but at risk for decompensation.
Presenting problem that is non critical.
Initiate treatment within the hour.

Question 5

Description of Class IV, Fourth Priority Cases

Answer 5

Less urgent: Patient is completely stable. Needs evaluation, but not urgently
To be seen within 12-24 hours.

Question 6

Description of Class V, Fifth Priority

Answer 6

Non-life threatening.
Patient is fully stable with no underlying comorbidities.
No risk for decompensation.
Can be seen within 24-48 hours without risk.

Question 7

Morbidity vs Mortality

Answer 7

Morbidity refers to an illness or disease
Mortality refers to death

Question 8

What are the six perfusion parameters?

Answer 8

Mucous membrane
Capillary refill time
Heart rate
Pulse quality
Extremity temperature
Mentation

Question 9

What can muffled heart sounds indicate?

Answer 9

• pericardial effusion
• pleural air or fluid
• abdominal organs in chest

Question 10

Normal

Inspiration:expiration ratio

Answer 10

1:2

Question 11

What do slow deep breaths indicate?

Answer 11

Upper airway obstruction
dynamic airway collapse
bronchitis
Slow deep breaths minimize resistance

Question 12

What does increased effort on inspiration indicate?

Answer 12

Laryngeal disease
Extrathoracic tracheal collapse or obstruction

Question 13

What does increased effort on expiration indicate?

Answer 13

Intrathoracic collapse
lung pathology

Question 14

What does increased effort on both inspiration and expiration indicate?

Answer 14

mass or foreign body causing airway obstruction

Question 15

What kind of breathing indicates a restrictive breathing pattern?

What is the pathology?

Answer 15

minimized tidal volume
increased respiratory rate

Indicative of pulmonary parenchymal disease

Question 16

Stridor

Answer 16

Abnormal high-pitched sound produced by turbulent airflow through the upper airway.

Consistent with upper airway obstruction.

Question 17

Stertor

Answer 17

Abnormal low pitch sound produced lower in the airway and consistent with partial airway obstruction

Question 18

What does asynchronous breathing indicate?

Answer 18

plural space pathology

Question 19

What is kussmaul breathing? What does it indicate?

Answer 19

slower & very deep breathing pattern.

Seen with severe metabolic acidosis and kidney disease.

https://youtu.be/uAnnFscr4LQ

Question 20

What kind of breathing pattern indicates brain injury or heart failure? Can also be seen with hyponatremia.

Describe the breathing pattern.

Answer 20

Cheyne Stokes

Abnormal breathing is characterized by a gradual increase in breathing, then a decrease. This pattern is followed by a period of apnea.

Can also be seen in dying patients.

https://youtu.be/eAx4fxy7WbA?si=F-WhzFiZ2c8RMbT4

Question 21

Capillary Refill Time <2 seconds

Answer 21

hyperdynamic state and vasodilation

associated with systemic inflammation, distributive shock, heat stroke/hyperthermia

Question 22

What does venous distension indicate?

Answer 22

Signs of volume overload.

Right-sided congestive heart failure

Increased right-sided filling pressure.

If patient is in lateral recumbency, raise up limb above the heart and if vein remains distended, it is suggestive of elevated central venous pressure

Question 23

3 causes of elevated central venous pressure

Answer 23

1. volume overload
2. pericardial effusion
3. Right-sided congestive heart failure

Question 24

Clinical signs of cardiogenic shock with biventricular failure

Answer 24

pale mucous membranes
prolonged capillary refill time
venous distension

Question 25

What is pulsus paradoxus and what does it indicate?

Answer 25

Pulse volume appears to decrease during inspiration and becomes normal during expiration.

It can indicate pericardial effusion or tamponade.

Question 26

What is pulsus alternans and what does it indicate?

Answer 26

Alternating small and large volume pulses.

Commonly seen with left ventricular heart failure.

Question 27

Pulse deficits

Answer 27

Difference between auscultated heart rate and palpated heart rate.

Significant difference is considered a true emergency

Question 28

Enteral malnutrition can cause a predisposition to __________ and ___________.

Answer 28

bacterial translocation and secondary sepsis

Question 29

Scale the levels of consciousness and define (7):

Answer 29

Alert: responds immediately
Disoriented: disorientation in place, impaired memory
lethargic: drowsy but easily rousable with minimal stimulation
Delirium: inability to focus, sustain or shift attention.
Obtunded: Asleep but rousable with stimulation. Cessation of stimulation -> falls back asleep.
Stuporous: Responsive to painful stimuli
Comatose: Unresponsive. Check gag reflex.

Question 30

AVPU

Answer 30

A: Alert and responsive
V: Responsiveness to verbal stimuli
P: Responsive to painful stimuli
U: unresponsive

Question 31

Neonates: Thermoregulation

Answer 31

Undeveloped
- lack insulating fat
-shivering reflex
- peripheral vasoconstriction

Last two are not fully developed for at least a week

Question 32

Mass casualty incident and disaster triage

Acronym: START

Answer 32

Simple Triage and Rapid Treatment

Question 33

Mass Casualty
Start Method: RAP status

Answer 33

Respiratory
Alertness
Perfusion Status

Question 34

Mass casualty and Disaster Triage:
SAVE method

Answer 34

Secondary Assessment of Victim Endpoint

Question 35

Mass casualty and Disaster Triage
SAVE (3 categories)
What is the order of treatment?

Answer 35

Group 1: those that will die regardless of treatment
Group 2: those that will survive regardless of treatment
Group 3: those that will benefit if medical intervention is immediate.
Treatment order: Group 3, then Group 2

Question 36

Where is the thermoregulatory center located?

Answer 36

Anterior hypothalamus

Question 37

4 primary mechanisms for heat loss and heat gain. Define each

Answer 37

1. Convection: heat transfer between skin and moving air (loss and gain)
2. Conduction: heat transfer between skin and objects in contact with skin (loss and gain)
3. Radiation: Heat loss or gain to the environment with temperature gradient without direct contact (loss and gain).
4. Evaporation: Moisture evaporates into the air pulling heat away from the body (heat only)

Question 38

Convection

Answer 38

Heat transfer between skin and moving air or water (loss or gain)

Question 39

Conduction

Answer 39

Heat transfer between skin and objects in contact with skin (loss and gain).

Question 40

Radiation

Answer 40

Heat loss or gain to the environment along with temperature gradient without direct contact (loss and gain)

Question 41

Evaporation

Answer 41

Moisture evaporating into the air pulling heat away from the body (heat loss only).

Question 42

Ophthalmological emergencies

Answer 42

Conditions that if left unattended could result in permanent blindness or loss of an eye.