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Conflict And Catastrophe Medicine > Clinical > Flashcards

Clinical Flashcards

1
Q

How do you normally treat spinal injuries (and what is a risk of doing it)?

A

Lying down for 6-8 weeks

Big risk of sepsis/blood clots

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2
Q

Why do you always do limb surgery under a tourniquet?

A

Blood is not available
Lower HIV infection risk

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3
Q

How does laminar flow lower risk of infection?

A

Removes dead skin and infectious material

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4
Q

How do you treat long bone fractures?

A

Use skin/skeletal traction by putting a rod through the bone and pull
Attach weight at the end

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5
Q

What are complications with skin/skeletal traction?

A

Malunights (the bone doesn’t bind again)

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6
Q

How do you surgically treat a major wound?

A

First you debride - leave wound open with no dressing

Then you can go back after a suitable period and close the wound

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7
Q

When do you change dressings?

A

Only under anaesthesia

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8
Q

Why do you debride all the dead tissue away?

A

Dead tissue causes infection

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9
Q

What are the general features of civilian war surgery?

A

Late presentation
No onward evacuation
Normal burden of disease continues
Difficult environments due to geography/weather/fighting
Limited resources/staff

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10
Q

What are the minimum standards of management of casualties?

A

Rapid primary survey
Resuscitation of vital functions
Secondary survey
Definitive care

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11
Q

What are features of a wound in disasters and conflict?

A

Multiple wounds and systems
Fragments, bullets, burns and blast
Contaminated

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12
Q

What are the general features of wound management?

A

Resuscitation
Wound incision
Debridement
Wound excision
Stabilisation
Wound dressing and splintage
Evacuation for secondary procedures

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13
Q

What do solid organ injuries normally present with?

A

Signs of haemorrhage

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14
Q

What might hollow visceral injury present with?

A

Late sepsis if initially overlooked

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15
Q

How can most chest wounds be managed?

A

Chest drain to remove blood and re-inflate the lung

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16
Q

What is the immediate concern with head, neck and face injuries?

A

Airway safety

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17
Q

What are the signs of shock?

A

Sweat
Low blood pressure
Pale
Tachycardia and tachypnoea
Low consciousness/anxiety
Cold skin
Low urine output

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18
Q

What are the two types of shock?

A

Haemorrhagic
Nonhaemorrhagic

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19
Q

What causes haemorrhagic shock?

A

Blood loss

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20
Q

What causes nonhaemorrhagic shock?

A

Tension pneumothorax
Cardiac tamponade
Cardiogenic
Neurogenic
Septic

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21
Q

How can you stop bleeding?

A

Pressure
Tourniquets
Raise limb
Operation
Reduce pelvic volume

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22
Q

How do you treat shock?

A

Restore blood volume and prevent hypothermia

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23
Q

What are the three types of response to shock treatment?

A

Rapid responder
Transient responder
Nonresponder

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24
Q

What is a transient responder after shock treatment?

A

Gets better then worse again (normally due to blood loss)

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25
Q

What are the four consequences of disaster on health services?

A

Structural
Non-structural (technical gap)
Functional (funds)
Professional (brain drain)

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26
Q

What is the maternal health triad?

A

Access
Quality
Utilisation

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27
Q

What are the access challenges in maternal health?

A

Safety
Funds
Logistics

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28
Q

What are the utilisation challenges in maternal health?

A

Culture
Acceptance
Language

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29
Q

What % of mothers experience complications?

A

40%

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30
Q

What % of mothers develop life threatening complications?

A

15%

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31
Q

What % of maternal deaths happen in the first 24 hrs??

A

50%

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32
Q

How long can post-partum infections take to develop?

A

6 days

33
Q

What % of lives can emergency obstetric care save?

A

80%

34
Q

What are some treatments used in emergency obstetric care?

A

Prenatal antibiotics
Utero tonic drugs
Anticonvulsants
Manual placental removal

35
Q

What are some treatments used in basic emergency obstetric care?

A

Removal of retained products (vacuum or dilation)
Assisted vaginal delivery

36
Q

What are some treatments used in comprehensive emergency obstetric care?

A

Surgery
Blood transfusion

37
Q

What are some indirect maternal death causes?

A

Rheumatic heart disease
TB
Anaemia
Hepatitis

38
Q

What are the leading causes of child death?

A

Preterm birth complications
Pneumonia
Birth asphyxia
Diarrhoea
Malaria

39
Q

What does a dehydrated baby look like?

A

Sunken eyes/fontanelle
Acidotic
Drowsy
Stop passing urine

40
Q

What do you treat sepsis with?

A

Oxygen
Fluids
Antibiotics

41
Q

What are the most likely presentations after an earthquake?

A

Drowning
Asphyxia
Dust inhalation
Burns and electric shock
Environmental exposure
Multiple fractures, internal injuries and crush syndrome

42
Q

What are the range of injuries you see in terrorist attacks?

A

Blast
Ballistic
Trauma
Crush

43
Q

What diseases cause 60-95% deaths in displaced populations?

A

Acute respiratory infection
Malnutrition
Diarrhoea
Measles
Malaria
TB
HIV/AIDS

44
Q

What are common respiratory diseases in displaced populations?

A

Acute respiratory infection
Measles
Diptheria
Pneumonic plague
Bacterial meningitis
COVID

45
Q

What are the big three Diarrhoeal diseases?

A

Cholera
Dysentery
Typhoid

46
Q

How can you control communicable diseases?

A

Rapid assessment
Prevention
Surveillance
Outbreak control
Disease management

47
Q

What are the types of anti flu drugs?

A

Neuraminidase inhibitors
M2 inhibitors

48
Q

How do you treat patients with severe clinical illness associated with flu virus infection?

A

Treat with antivirals for a minimum of 5 days
Do not use corticosteroids unless needed for other reasons

49
Q

What are the most common presentations in newly displaced populations?

A

Accidents, hypothermia, burns
GI illnesses
CVD events
OB complications
Diabetes
Hypertension
Mental health emergencies

50
Q

How can burns cause mortality?

A

From inhalation injury and multisystem organ failure

51
Q

How do you treat burns in primary care?

A

ABCDE
Analgesia, cleaning, cooling, covering etc

52
Q

What are the boundaries for malnutrition in mid upper arm circumference?

A

140mm =normal
115-125 = moderate malnutrition
<115 = severe malnutrition

53
Q

How to test for bilateral oedema?

A

Gentle thumb pressure to lower limb
- if it indents and doesnt go away, oedema is present

54
Q

What happens in kwashiorkor protein energy malnutrition?

A

Little muscle loss
Oedema

55
Q

What happens in marasmus protein energy malnutrition?

A

Massive muscle loss
Very thin

56
Q

What are the methods of wounding by bullets?

A

Direct laceration
Stretching (and therefore cavitation)
Contamination

57
Q

What influences bullet wound size?

A

What the bullet hits
Yaw cycle of bullet within tissue
Fragmentation of the bullet

58
Q

What type of cavitation does a handgun cause?

A

In and straight for 15cm
Then spins and causes massive cavity (which shrinks)

59
Q

What type of cavitation does a softpoint pistol bullet cause?

A

Almost immediate temporary cavity that causes massive stretching (but then shrinks)

60
Q

What type of cavitation does an AK-47 cause?

A

In and straight for roughly 15cm
Turns once, goes backwards, turns again and goes out

2 cavities

Basically the longer the passage the bigger the damage

61
Q

What type of cavitation does an AK-74 cause?

A

Turns quickly so causes cavities quickly

62
Q

What does bullet wound contamination depend on?

A

Amount of external contaminant introduced
Volume of dead tissue in the wound
Adequacy of surgery
Antibiotics

63
Q

What is a type 1 land mine injury?

A

From standing on a brief blast mine
Amputation of detonating limb

64
Q

What is a type 2 land mine injury?

A

From fragmentation mine
Multiple small fragment wounds esp to lower limbs

65
Q

What is type 3 land mine injury?

A

Upper limb amputation
When detonation occurs while handling or clearing mines

66
Q

What are the features of a traumatic blast amputation?

A

Large contamination deep into tissue
Delayed swelling of muscles days after injury
Bone destruction (fragmentation not just break)

67
Q

What are the symptoms of acute mountain sickness?

A

Headache
Nausea
Difficulty sleeping

68
Q

What is the difference between acute mountain sickness and cerebral oedema?

A

Cerebral oedema = acute mountain sickness + ataxia and confusion

69
Q

What are the most common illnesses when climbing mountains?

A

Falls
Frostbite
Altitude illness
High altitude cerebral oedema
High altitude pulmonary oedema

70
Q

How often do you need a rest day when climbing?

A

Every 1000m or 3 days

71
Q

What are symptoms of high altitude pulmonary oedema?

A

Shortness of breath
Dry cough
Pink frothy sputum at a late stage

72
Q

How do you treat mild altitude illness?

A

Acetaxolamide
Rest
Fluid

73
Q

How do you treat moderate altitude sickness?

A

Acetezolamide
O2
Descend

74
Q

How do you treat severe altitude sickness?

A

Acetazolamide
Descend
In a bag?

75
Q

What are the major illnesses associated with diving?

A

Trauma
drowning
hypothermia
Barotrauma
Decompression illness
Gas problems

76
Q

What is PTSD?

A

An extreme reaction to a stressful event

77
Q

What are the priority status’ In triage?

A

Priority 1 - immediate (red)
Priority 2 - urgent (yellow) can wait 1-2 hrs
Priority 3 - delayed (green) walking wounded
Dead (black/white)

78
Q

What does CABC stand for?

A

Circulation
Airway
Breathing
Circulation

Conflict And Catastrophe Medicine (4 decks)

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