PHTLS and Trauma Review Flashcards
How many people die from trauma annually?
Over 5 million
What is the leading cause of trauma deaths?
MVA
Where do over 90% of trauma deaths occur?
Low-middle income countries
What is the leading cause of death in people aged 1-44?
Trauma
What are the goals of PHTLS?
Reduce morbidity and mortality from trauma, and provide appropriate care to the patient in the field
What is the PHTLS philosophy?
Deliver the patient to the right facility, utilizing the right mode of transportation, in the right amount of time, as safely as possible
What are the components of scene assessment?
Safety, pre-arrival information, arrival on-scene, MOI, and patients
What is paramount for scene assessment?
Personal and Personnel safety
What is the global view?
What you get before you get out of your vehicle
What is the goal of the Primary Survey?
To immediately identify life threatening situations and manage them as they are identified
What are the components of the Primary Survey?
Airway, Breathing, Circulation, Disability, Exposure
When does assessment of the incident begin?
Before arriving at the patient’s side
The findings of the scene assessment and primary survey help to determine what?
If the patient is sick, not yet sick, or not sick
When should the secondary survey be completed?
Only if time and situation permit
What are the components of the secondary survey?
Vital signs, History, Physical Examination, Treatment, Level of Care, Transportation, and Communication
What are the components of a radio report?
Timely, Scene Description, Number of Patients, Current Patient Status, Treatment Provided, ETA
What is a tracheal consideration with pediatric patients in regards to ET intubation?
Potential for right main-stem intubation
What is the most common cause of airway obstruction in the trauma patient?
The tongue
When are basic maneuvers applied in regards to trauma airway management?
First
When are advanced airway maneuvers performed for trauma patients?
After basic, only if needed
What is the goal of managing a patient’s airway?
Maintain an open and patent airway that allows for adequate breathing, ventilation, and oxygenation
What does airway management entail?
Anticipating difficulties and planning for alternate methods of airway control
What is always the first airway maneuver for the trauma patient?
Trauma Jaw Thrust / Chin Lift
What should be considered second for maintaining a patent airway in a trauma patient?
OPA or NPA
What adjunct should be considered third for airway management in the trauma patient?
Supra-Glottic Airways
When should glottic airways be considered?
After jaw thrusts, OPA/NPA, and Supra-Glottic airways have failed
What are some assessment criteria for Endotracheal Intubation?
Decreased LOC (GCS<8), Inability to maintain patent airway, Upper airway burns, Signs of pending airway obstructions
Which type of airway management should be considered last?
Surgical
What types of methods should be used to verify tube placement?
One physiological and mechanical method
When the patient’s breathing draws your attention, you should:
Assume there is a problem until proven otherwise
What are some signs and symptoms you are looking for in a trauma patient’s breathing assessment?
Increased respiratory effort, visible trauma, paradoxical chest wall movement, sucking chest wound
What are some signs and symptoms you are feeling for in a trauma patient’s breathing assessment?
Boney crepitus, subcutaneous emphysema
What is the biggest difference between a simple and a tension pneumothorax?
A tension pneumothorax has a hemodynamic compromise
Which ribs are most at risk for rib fractures?
Ribs 4-8 laterally
What is the most common cause of hemothorax?
Fractures to ribs 4-8
What are common complaints of rib fractures?
Pain and Shortness of Breath
Under what circumstances should you withhold oxygen from a patient?
Never withhold oxygen from a patient in respiratory distress
When should you assist ventilations?
When the respiratory rate is above 28 or less than 10
What is the ventilatory rate for adults?
10-12 bpm for 500-800 cc
What is the ventilatory rate for children?
16-20 bpm for 100-500 cc or good chest rise
What is the ventilatory rate for infants?
25 bpm for 6-8 mL/kg
What end tidal CO2 reading should you maintain?
35-45 mm Hg
Where should a needed decompression be placed?
2nd intercostal space mid clavicular line, over the 3rd rib
What is shock?
A result of inadequate energy production to sustain life
What are the brain, heart and lungs tolerance to hypoxia?
4-6 minutes
What are the kidneys, liver and GI tracts tolerance to hypoxia?
45-90 minutes
What are the muscle, bone, and skin tolerance to hypoxia?
4-6 hours
What is the most common cause of shock in the trauma patient?
Hypovolemia due to hemorrhage until proven otherwise
What is the most common cause of neurogenic shock in the trauma patient?
Spinal Cord Injury
What does adequate perfusion of the body tissues require?
An effective pump, intact blood vessels, adequate blood volume, vascular resistance
What is cardiac output?
Stroke Volume x Heart Rate
What is blood pressure?
Cardiac Output x Systemic Vascular Resistance
Vasoconstriction leads to which phase of shock?
The ischemic phase
What causes an altered LOC in a shock patient?
Decreased cerebral perfusion
What may be the earliest sign of shock?
Increasing respiratory rate caused by hypoxia and acidosis stimulating the respiratory centers of the brain
How much blood loss is required before a drop in BP occurs?
30%
In shock without obvious cause what should you assume?
The patient is bleeding somewhere, internal hemorrhage, fracture
Where is a significant container of blood volumes lost to hemorrhage?
The abdomen
What is the mortality rate of aortic rupture in the prehospital setting?
80-85%
How much blood can each hemithorax hold?
3000-4000 mL of blood
How much blood loss can occur from a single rib fracture?
125 mL
How much blood loss can occur from a fractured radius or ulnar?
250-500 mL
How much blood loss can occur from a fractured humerus?
750 mL
How much blood loss can occur from a fractured tibia or fibula?
500-1000 mL
How much blood loss can occur from a fractured femur?
1000-2000 mL
How much blood loss can occur from a fractured pelvis?
Massive
What is the most common thoracic injury?
Rib fractures
What four questions guide management of shock?
What is the cause of the shock? What is the care for this type of shock? What can and should be done between now and the time the patient reached definitive care? Where is the best place for the patient to get definitive care?
What does proper management of shock achieve?
Improves the oxygenation of RBCs and improves the delivery of RBCs to tissues
How should the shock patients be positioned?
Supine, as the trendelenburg position is no longer recommended
What temperature should the patient compartment be maintained at?
85F
What are the three responses to fluid therapy?
Rapid response, Transient Response, Minimal or No Response
What is the frontal lobe responsible for?
Foresight, personality and judgment
What is the parietal lobe responsible for?
Sensation from the body
What is the temporal lobe responsible for?
Hearing and Speech
What is the occipital lobe responsible for?
Vision
What is primary damage?
Damage that occurs at the moment of impact
What is secondary damage?
Damage that occurs subsequent to the initial impact
What are some systemic causes of secondary brain injury?
Hypoxia, CO2 abnormalities, Anemia, Hypotension, CBG abnormalities
What are some intrinsic causes of secondary brain injury?
Seizures, Edema, Hematomas, Increased ICP
What is typical ICP?
10-15 mm Hg
What does hypercarbia cause?
Cerebral vasodilation
Onto which brain structure does pressure produce vomiting?
The hypothalamus
What are the six components of a complete prehospital neurological exam?
Mental status, Cranial Nerves, Motor Responses, Sensory Response, Coordination. Reflexes
When do you score the GCS?
After the correctable causes a ALOC have been addressed
What is normal pupil size?
3-5 mm. Difference greater than 1 mm is abnormal
What does paralysis of lateral gaze indicate?
Possible rising ICP
What does paralysis of upward gaze indicate?
Possible fracture of orbital floor
Most of the severe TBI symptoms presents in which way?
Headache, Vomiting, Altered Mentation, Neurological Deficits
What is the earliest and best indicator of a patients ICP?
A change in LOC
What are the warning signs of possible increasing ICP and impending herniation?
GCS drop of 2 or more, development of sluggish or no reactive pupils, development of hemiplegia or hemiparesis, Cushing’s phenomenon
What is the ventilatory rate for adults with suspected intercranial herniation?
20 bpm
What is the ventilatory rate for children with suspected intercranial herniation?
25 bpm
What is the ventilatory rate for infants with suspected intercranial herniation?
30 bpm
How much blood must be lost before children show signs of hypotension?
30%
What is fourth degree burn?
A burn to the bone
What is special in the fluid therapy of a child in burn management?
They should receive 5% dextrose in LR solution
acceleration (a)
The rate of change in velocity; speeding up
angle of impact
The angle at which an object hits another; this characterizes the force vectors involved and has a bearing on patterns of energy dissipation
arterial air embolism
Air bubbles in the arterial blood vessels
avulsing
A tearing away or forcing separation
barometric energy
The energy that results from sudden changes in pressure as may occur in a diving accident or sudden decompression in an airplane
biomechanics
The study of the physiology and mechanics of a living organism using the tools of mechanical engineering
blast front
The leading edge of the shock wave
blunt trauma
An impact on the body by objects that cause injury without penetrating soft tissues or internal organs and cavities
brisance
The shattering effect of a shock wave and its ability to cause disruption of tissues and structures
cavitation
Cavity formation; shock waves that push tissues in front of and lateral to the projectile and may not necessarily increase the wound size or cause permanent injury but can result in cavitation
chemical energy
The energy released as a result of a chemical reaction
deceleration
A negative acceleration – that is, slowing down
electrical energy
The energy delivered in the form of high voltage
entry wound
The point at which a penetrating object enters the body
exit wound
The point at which a penetrating object leaves the body; which may or may not be in a straight line from the entry wound
gravity (g)
The acceleration of a body by the attraction of the earth’s gravitational force, normally 32.2 ft/sec2
implosion
A bursting inward
index of suspicion
Anticipating the possibility of specific types of injury
kinetic energy (KE)
The energy associated with bodies in motion, expressed mathematically as half the mass times the square of the velocity
kinetics
The study of the relationship among speed, mass, vector direction, and physical injury
law of conservation of energy
The principle that energy can be neither created nor destroyed; it can only change form
mechanical energy
The energy that results from motion (kinetic energy) or that is stored in an object (potential energy)
mechanism of injury (MOI)
The way in which traumatic injuries occur; the forces that act on the body to cause damage