ATLS Flashcards
1
Q
Trimodal distribution of deaths - first peak:
A
- sec to minutes following injury
= severe brain/high spinal cord injury
= rupture of the heart / aorta / large blood vessels
2
Q
Trimodal distribution of deaths - second peak:
A
- min to several hours following injury
= subdural/epidural hematoma, hemopneumothorax
= ruptured spleen, liver lacerations
= pelvic fractures etc.
3
Q
Trimodal distribution of deaths - third peak:
A
- several days to weeks
= sepsis / MOF
4
Q
ATLS - ABCDE:
A
A = airway with cervical spine protection B = breathing C = circulation, stop the bleeding D = disability/neurological status E = exposure (undress) + Environment (temp.control)
5
Q
GCS - E (eye opening):
A
4 Spontaneous
3 To speech
2 To pain
1 None
6
Q
GCS - V (verbal response):
A
5 Oriented conversation 4 Confused conversation 3 Inappropriate words 2 Incomprehensible sounds 1 None
7
Q
GCS - M (best motor response):
A
6 Obeys commands 5 Localizes pain 4 Flexion withdrawal to pain 3 Abnormal flexion (decorticate) 2 Abnormal extension (decerebrate) 1 None
8
Q
Golden hour is defined as :
A
window of opportunity during which provider can have a positive impact on morbidity and mortality associated with injury
9
Q
Standart precautions for personell:
A
- eye protection
- face mask
- gown
- gloves
10
Q
Triage is defined as:
A
- sorting of patients based on their needs for treatment and the resources available to provide that treatment
=> appropriate patient arrives at appropriate hospital
11
Q
Multiple casualties situation is defined:
A
- the number of patients and the severity of their injuries don’t exceed the capability of the facility to render care
=> pt. with life-threatening problems’re treated first
12
Q
Mass casualties situation is defined:
A
- the number of patients and the severity of their injuries exceed the capability of the facility to render care
=> pt. having the greatest chance to survive’re treated first
13
Q
How to quick assess ABCD:
A
- Identify yourself
- Ask for the name
- Ask what happened
=> failure indicates abnormalities in A, B or C
14
Q
Disability (neurological evaluation) consits of:
A
- Level of consciousness (GCS)
- Pupillary size and reaction
- Lateralizing signs
- Spinal cord injury level
15
Q
At the time of IV insertion must be taken:
A
- blood type + crossmatch
- FBC
- blood gas incl. lactate
- pregnancy test (hCG)
16
Q
How to definitively control hemorrhage:
A
- pelvic stabilization
- surgery
- angioembolization
17
Q
Best solution to prevent hypotermia in trauma pt.:
A
stop the bleeding
18
Q
Blunt cardiac injury - ECG:
A
- AF, tachycardia
- premature beats
- ST segment changes
19
Q
PEA usually indicates:
A
- cardiac tamponade
- tension PNO
- profound hypovolemia
20
Q
Hypoxia - ECG:
A
- bradycardia
- premature beats
- aberant conduction
21
Q
Bladder catheterization is contraindicated:
A
- blood at the urethral meatus
- perineal ecchymosis
- high-riding or nonpalpable prostate
=> retrograde urethrogram is indicated
22
Q
Chain - ATLS:
A
Preparation + Triage
- Primary survey (ABCDE) + Resus
- Transfer consideration
- Secondary survey (History, head-to-toe exam)
23
Q
History - AMPLE (sec.survey):
A
A = Allergies M = Medication currently used P = Past ilnesses / Pregnancy L = Last meal E = Events / Environment related to the injury
24
Q
Don’t ever forget during eye-exam:
A
- visual acuity (read something)
- ocular mobility (to exclude entrapment)
- take the lenses out
25
Seat-belt mark indicates potential:
- nerve root injury
- carotid artery injury (palpate + listen)
CAVE: can develop late!!
26
When the pelvic fracture is highly suspicious:
Ecchymosis over:
- iliac wing
- pubis
- labia / scrotum
27
Definitive airway is defined:
- ET placed in the trachea, cuff inflated below vocal cords, connected to O2, taped
28
Fracture of the larynx is indicated by:
- hoarseness
- subcut. emphysema
- palpable fracture
29
Difficult intubation - LEMON:
```
L = Look externally
E = Evaluate the 3-3-2 rule
M = Mallampati
O = Obstruction
N = Neck mobility
```
30
BURP means:
Backward Upward Rightward Pressure
= laryngeal manipulation
31
With bougie can be used ET:
6 and more
32
Needle cricothyroidotomy - jet insufflation technique:
- adult: G 12 - 14
- child: G 16 - 18
=> 1 sec On, 4 sec Off, O2 15l/min (5 - 7 l/min when glottic obstr.pres)
=> 30 - 45 min, pCO2 is rising
33
Surgical cricothyroidotomy:
> 12 yrs
- ET 5 - 7 can be inserted
34
Approximate PaO2 x spO2:
100 % 90mmHg
90 % 60mmHg
60 % 30mmHg
50 % 25mmHg
35
Air flow for face-mask:
> 11 l/min
usually 15 l/min
36
Proper size of airway:
corner of mouth to the ear lobe
37
Colorimetric device - pCO2 detection:
- air: purple
- +-: tan
- ok: yellow
should be checked after at least 6 breaths
38
Preload - determinants:
- Venous capacitance
- Volum status
MVP - RAP
39
How much blood is in the venous system:
70%
40
How much of blood can be lost before BPs drops?
- up to 30%
41
HR varies with age:
- infant 160
- preschool 140
- school 120
- adult 100
42
Sources of potential blood loss:
- chest / abdomen / retroperitoneum / pelvis
- extremities
- external bleeding
43
Nonhemorrhagic shock - classification:
- cardiogenic shock (blunt injury, embolus, MI)
- obstructive (tamponade, tension PNO)
- neurogenic
- septic
44
Classic picture of neurogenic shock:
- hypotension
- no tachycardia
- no cutaneous vasocontriction
- no narrowed pulse pressure
45
Estimated blood volume:
- adult: 70 ml/kg
| - child: 80-90 ml/kg
46
Class I hemmorage:
loss up to 15% 750ml
| HR
47
Blood loss and consciousness:
loss of more than 50% of blood volume results in loss of consc.
48
Definition of shock:
an abnormality of the circulatory system that results in inadequate organ perfusion and tissue oxygenation
49
The earliest measurable sign of shock:
tachycardia
50
Normal pulse pressure:
30 - 40 mmHg
lower than 30% of BPs
51
Blood loss by the location:
- tibia, humerus: 750ml
- femur: 1500ml
- pelvis: a few litres
+ edema in soft tissues
52
Gastric dilatation can cause:
- unexplained hypotension
- cardiac dysrhytmia (vagal stimulation)
- especially in children
53
Excessive fluid administration - lethal triad:
- coagulopathy
- acidosis
- hypotermia
54
Adequate resus - urinary output:
- adult: 0.5 ml/kg/hod
- child: 1 ml/kg/hour
- infant: 2 ml/kg/hour
55
Patterns of response to initial fluid therapy (initial 2l):
- Rapid loss up to 20%
- Transient loss up to 40% shows deterioration, blood
- Minimal loss above 40%
56
Blood transfusion - types:
- fully crossmatched 1 hour
- type-specific 10 min
- O
0- for woman of childbearing age
57
Massive transfusion is defined:
> 10 units of BPacks within first 24hours
58
Coagulation study:
- Prothrombin
- Partial Tromboplastin Time
- Platelet Count
- Fibrinogen Levels
59
Who is particulary prone to coagulation abnormalities:
major brain injury
60
Aging and trauma:
- decrease in sympatethic activity (deficit in receptors)
- decreased cardiac compliance
- atherosclerosis
- reduced kidney ability to preserve volume in response to aldos.
61
Flail chest is defined:
segment of the chest wall with no continuity with the rest
62
Massive hemothorax is defined:
- rapid accumulation of 1500ml of blood
- or 1/3 of patient's blood volume
CAVE: neck veins may be flat 'cos of hypovolemia
63
Chest tubes for hemothorax:
- 36 to 40 Fr
- if >1500ml is evacuated early thoracotomy is very likely
- collect for autotransfusion
64
When is thoracotomy indicated:
- 1500ml immediately evacuated
- ongoing loses 200ml/hr for 2-4 hrs
- persistent need for blood transfusions
65
Cardiac tamponade - Beck's triade:
- venous pressure elevation
- decline in arterial pressure
- muffled heart tones
66
Kussmaul's sign:
- rise in venous pressure with inspiration
=> right ventricular compliance is low
67
Pulmonary contusion - indications for intubation:
spO2
68
Tracheobronchial injury - locations:
- majority within 2.5cm (1 inch) of the carina
=> selective intubation
CAVE: usually when incomplete expansion of the lung after drain
69
Traumatic aortic disruption - location:
- near lig.arteriosum
=> usually goes to the left chest -> deviation of trachea to the right
+ depression of the left bronchus
+ elevation of the right bronchus
70
Traumatic diaphragmatic injury - which side is more likely:
left (no liver)
NGT in thoracic cavity => left diaphragm injury
- eventually contrast X-rays when in doubt
71
Blunt esophageal injury - clinical signs:
- left PNO/Hemothorax without rib fracture
- blow to the epigastrium or lower sternum and is in shock
- particulate matter in chest tube is present
72
Which ribs are usually traumatized:
4 - 9
73
Class II hemorrhage:
loss up to 30% 1500ml
| HR
74
Class III hemorrhage:
loss up to 40% 2000ml
| HR
75
Class IV hemorrhage:
loss above 40% >2000ml HR>140
PP decreased, BPs decreased
confused, lethargic
76
Pericardiocentesis - initial setup:
- 2 cm inferior to left xiphochondral junction
- angle of 45 degrees
- aim toward the tip of left scapula
77
Anterior abdomes is defined:
- costal margin superiorly
- anterior axillary lines laterally
- inquinal ligaments and symphysis inferiorly
78
The thoraco-abdomen is defined:
= diaphragm, liver, spleen, stomach
- trans-nipple line + infra-scapular line
- costal margins inferiorly
79
When inspiration - diaphragm rises to:
4 intercostal space
80
The flank area is defined:
- from anterior to posterior axillary lines
| - from 6th intercostal space to iliac crest
81
The back area is defined:
- from posterior axillary lines
| - from tips of scapulae to the iliac crest
82
The most frequently injured organs with blunt trauma:
- spleen 50%
- liver 40%
- small bowel 10%
- retroperitoneal hematoma 15%
83
The most frequently injured organs with penetrating injury:
- liver 40%
- small bowel 30%
- diaphragm 20%
- colon 15%
84
Bucket handle injury:
= tear or avulsion of mesentery
- usually caused by seat-belt
85
FAST scans:
- pericardial sac
- hepatorenal fossa
- splenorenal fossa
- pelvis/pouch of Douglas
86
DPL:
| decompress stomach and urinary bladder before
- 98% sensitivity
- with pelvic fractures and pregnancy -> supraumbilical approach
- open technique -> just below the umbilicus
- closed techique -> 18G below the umbilicus
87
DPL - indication for laparotomy:
- blood (>10ml), GIT content is aspirated
- in not => lavage (10ml/kg, 1000ml for adult)
positive: RBC>100000/mm3, WBC 500, Gram stain bact.
88
CT abdominal scan can be used:
- hemodynamically normal patient
- id there is no apparent indication for laparotomy
- for unstable patient => FAST, DPL
89
Urethrography - how to perform:
- 8 Fr urinary catether secured in meatal fossa by balloon (2ml)
- 35ml of undiluted contrast is instilled
- check the bladder for contrast
90
Cystogram - how is performed:
350ml syringe barrel held above 40cm with water-soluble contrast
another 50ml may be added
91
Intravenous pyelogram - how to perform:
- 100 ml of 60% iodine (1.5 ml/kg) IV
| - X-ray after 2min
92
Pelvic fractures - mechanism:
- lateral compression (70%)
- A-P compression (20%)
- vertical shear (10%, height over 3.6m)
93
Pelvis - posterior osseous ligamentous complex:
| tearing often goes with disruption of symphysis
- l.sacroiliac
- l.sacrospinous
- l.sacrotuberous
- fibromuscular pelvis floor
94
What is the best option for definitive management - pelvic fracture:
- angiographic embolization
95
FAST - right upper quadrant:
- sagittal view in the midaxillary line 10 - 11th rib space
96
FAST - left upper quadrant:
sagittal view in the midaxillary line 8 - 9th rib space
97
Which is the most commonly injured meningeal vessel?
middle meningeal artery over temporal fossa
98
Uncal herniation - signs:
- ipsilateral pupilary dilatation
| - contralateral hemiparesis
99
How is coma / severe brain injury defined:
GCS of 8 or less
100
Intracranial lesions - classification:
- Diffuse brain injury (hypoxia, diffuse axonal injury)
| - Focal brain injury (epidural, subdural, intracerebral hematoma)
101
TBI - hematomas:
- epidural 9% severe TBI (lucid interval)
- subdural 30%
- > subdural is usually much more severe brain damage
- intracerebral contusions 30%
102
Intracerebral contusions can develope into:
```
Intracerebral hematoma (20%)
-> rescan within 24hrs
```
103
MTBI - high risk factors for intervention:
- GCS less than 15
- susp.open or depressed fracture/basilar fracture
- vomiting more than twice
- age > 65 yrs
104
MTBI - moderate risk for neurosurgical intervention:
- loss of consciousness more than 5mins
- retrograde amnesia more than 30mins
- dangerous mechanism
105
Ventilation goals:
pCO2 35 +- 3 mmHg (4.7 kPa)
-> in deterioration for a while 3.3 - 4.7
spO2 98%
106
TBI - CT scan:
- initial hemodynamic resus is the priority
- when after resus is BPs >100 then go to CT
- if not able stabilize the patient => FAST/DPL => OR
107
CT head - shift:
5 mm
108
TBI - Manitol:
- solution 20% (20g per 100ml)
- 1 g/kg over 5 min
- not for hypotensive patients
109
Posttraumatic epilepsy - numbers:
- closed head injury 5%
| - severe 15%
110
Anticonvulsants:
1. Phenytoin
- loading dose: 1g (max 50mg/min)
- then 100mg/8hours
111
Brain death confirmation:
- GCS 3
- nonreactive pupils
- no brain stem reflexes (oculocephalic, corneal, no gag)
- apnea test
112
Spinal injury - locations:
- 55% cervical region
- 15% thoracic
- 15% thoracolumbar
- 15% lumbosacral
113
How many % of pt. with cervical spine fracture has a second injury:
10%
114
Cervical spine injury in children - % cases:
1%
relatively rare
115
For how long can pt. lay on backboard:
2 hours
then remove and logroll every 2 hours
116
Which spinal tracts can be assessed:
- tr.corticospinal lat.
- tr.spinothalamic
- dorsal column
117
Tr. corticospinal lateralis - assesment:
- posterolateral segment of the cord
- motor power on the same side
- voluntary muscle contr., response to painful stimuli
118
Tr.spinothalamicus - assesment:
- anterolateral aspect of the cord
- transmits pain and temperature of the opposite side
- pinprick or light touch
119
Dorsal columns - assesment:
- posteromedial aspect of the cord
- proprioception, vibration sense, some light touch from the same side
- position sense in the toes and fingers, vibration sense
120
Complete spinal cord injury is defined:
no demonstrable sensory or motor function below a certain level
(spinal shock is possible during first weeks)
121
Incomplete spinal cord injury is defined:
any degree of motor or sensory function remains
122
Sacral sparing is:
sparing of sensation in the perianal region
any perception in the perineal region and/or voluntary contraction of rectal sphincter
123
Dermatome definition:
= the area of skin innervated by the sensory axon within a particular segmental nerve root
124
Sensory level is defined:
= lowest dermatome with normal sensory function
125
Dermatomes innervated from C-spine:
C2 - zadni polovina hlavy
C3 - krk
C4 - dekolt (C2 through C4)
C5 - lateralni strana paze a deltoid area
C6 - lat.strana predlokti a palec/C7,8 zbytek ruky
126
Dermatomes - T:
```
T1 medialni strana predlokti
T2 medialni strana paze
T4 nipples, T8 xiphisternum
T10 navel
T12 suprapubic area
```
127
Dermatomes - L:
L1 - inquiny, penis
L3 - koleno
L4 - medialni lytko
L5 - lateralni lytko a palec
128
Dermatomes - S:
S1 - lateralni polovina nohy
S2 - zadek stehna
S3 - ischial tuberosity area
S4,5 - perianal region
129
Muscle strenght grading:
```
0 total paralysis
1 palpable or visible contraction
2 full range of motion when gravity eliminated
3 against gravity
4 less than normal strenght
5 normal strenght
```
130
Myotomes - C:
```
C5 deltoid
C6 biceps (flexes forearm)
C7 tricpes (extends forearm)
C8 flexes wrist and fingers
```
131
Myotomes - T:
T1 small fingers abduction
132
Myotomes - L:
L2 iliopsoas - hip flexors
L3,4 quadriceps
L4,5 hamstrings
L5 ankle ang big toe dorsiflexors
133
Myotomes - S:
S1 ankle plantar flexors
134
Neurogenic shock - results:
- impairment of the descending sympathetics pathways => vasomotor tone and in sympathetic innervatuon of the heart
- rare below T6
- use vasopressors, fluids, atropine
135
Spinal shock means:
flaccidity and loss of reflexes
136
Diaphragm is innervated:
C3 to C5 via n.phrenicus
137
Motor level is defined:
lowest key muscle which has grade at least 3
138
Neurologic level is defined:
the most caudal segment that has normal sensory and motor function
139
Zone of partial preservation is defined:
some impaired sensory and/or motor function
140
Bony level of the injury is defined:
the vertebra at which bones are damaged
141
Severity of neurologic defect categorization:
- paraplegia incomplete/complete
| - quadriplegia incomplete/complete
142
Central cord syndrome:
- disproportionately greater loss of motor strenght in the upper ex.
- hyperextension injury
- vascular compromise in anterior spinal artery (central cord)
143
Anterior cord syndrome:
- paraplegia, sensory loss of temperature and pain
- position, vibration and deep pressure is ok (dorsal column)
- infarction of anterior spinal artery
- worst prognose
144
Brown - Seguard syndrome:
- ipsilateral motor and position sense loss
- contralateral loss of pain and temp. sensation
- hemisection of the cord
145
SCIWORA is:
spinal cord injury without radiographic abnormalities
146
Children - which part of C-spine is likely to be injured?
C1-4 twice more than lower
147
C-spine fractures:
- > atlanto-occipital dislocation
- > atlas (C1) fracture
- > atlas (C1) rotary subluxation
- > C2 fracture
- > C5 (adults, vertebral body fr.), subluxation C5 on C6
148
Atlas (C1) fractures:
- 40% associated with fracture of axis
- most common is burst (Jefferson's) fracture
disruption of both rings with displacement of lat.masses
149
C1 rotary subluxation:
- most often seen in children
- persistent rotation of the head (torticollis)
- X: odontoid is not equidistant from lateral masses
150
Axis (C2) fractures:
- odontoid fractures (60%, type I, II, III)
| - posterior elements of C2 (20%, hangman's fracture)
151
Epyphisis of C2 may look like fracture till age of:
6 years
152
Thiracic spine fractures:
- anterior wedge compression injury (rarely >25%), only this stable
- burst injuries
- Chance fracture = transverse fracture through the body
- fracture dislocations
153
Blunt carotid and vascular injuries - risk factors:
- C1-3 fracture
- cervical spine fracture with subluxation
- fractures involving foramen transversaruim
=> 30% positive -> CT angio -> LMWH, Aspirin
154
X- rays of spine indications:
- midline neck pain or tenderness
- neurologic deficit referable to cervical spine
- altered level of consciousness
- distraction injury
155
If just ligaments're damaged, then go for:
- MRI
| - flexion-extension X-rays films (or collar for 2-3 weeks)
156
If neurologic deficit is present and CT is negative:
MRI or CT myelography
| - spinal/epidural hematoma, herniated disc, contusions, ligaments
157
Cervical spine immobilization consists of:
- semirigid cervical collar
- head immobilization with blocks and tape
- backboard
- straps
158
X-rays assesement:
- adequacy and alignment (C1 - T1 must be present)
- identify the lines (anterior vertebral, spinal, post.spinal, spinous pr)
- assess the bone (height and integrity)
- cartilaginous disc spaces (narrowing, widening)
- dens and soft tissues
159
Dens assessement:
- outline of the dens
- predental space (3mm)
- clivus should point to the dens
160
Extraaxial soft tissues assessement:
C3 7mm
C7 3cm
- distance between the spinous processess
161
Atlanto-occipital joint assessment:
- Power's ratio =
162
Child and spine board:
- padding from lumbar spine to the top of shoulders
- blanket rolls along entire sides of the child
- head is larger than adults -> result in flexion on board
163
Blast injury - classification:
- primary - force of blast wave
- secondary - debris accelerated by the blast effect
- terriary - throw against other objects
164
Limb trauma - what to assess:
- skin integrity
- neuromuscular function
- circulatiry status (distal pulses, refill time)
- skeletal and ligamentous integrity
165
Ankle/brachial doppler index:
= BPs ankle/BPs brachial
| abnormal flow
166
Potentially life-threating extremity injuries:
- major arterial hemorrhage
- crush syndrome (most often thigh, calf)
may lead to MAC, hyperkalemia, hypocalcemia, DIC
- maintain urinary output >100 ml/hour
167
When myoglobinuria - urinary output:
>100 ml/hr
168
The amputated part should be:
- washed in isotonic solution
- wrapped on sterila gauze (100000 U of PNC in 50ml)
- sterile moistened towel
- plastic bag, crushed ice
169
Signs of compartment syndrome:
- increasing pain greater than expected
- palpable tenseness of the compartment
- assymetry of muscle compartments
- pain on passive stretch
- altered sensation
170
Tissue pressures when compartment sy. is suspected:
>30 mmHg
BPd - tissue
171
Fractures are defined:
break in the continuity of bone cortex
172
X-rays and fractured bone:
- 2 shots at right angles to one another
| - joint above and below must be x-rayed and immobilized
173
Knee immobilization - proper angle:
10 degrees
174
Capillary refill time:
2 sec
175
Extremities - physical examination:
- look (position, color, spont.activity)
- feel (pulse, refill, muscle comp, joint stability)
- neurological exam (senzation, motor)
176
Nerve - n.ulnaris:
- index and little finger abduction
- little finger senzation
- elbow injury
177
Nerve - n.medianus (distal)
- thenar contraction with opozition
- senzory index finger
- wrist fracture
178
Nerve - n.medianus (proximal, interosseous)
- index tip flexion
| - supracondylar fracture of humerus (children)
179
Nerve - n.musculocutaneus:
- elbow flexion
- senzory radial forearm
- anterior shoulder dislocation
180
Nerve - n.radialis
- thumb and finger metacarpophalangeal extension
- senzory first dorsal web space
- anterior shoulder dislocation, distal humerus
181
Nerve - n.axillaris:
- deltoid
- senzory lateral shoulder
- anterior shoulder dislocation, proximal humerus
182
Inhalation injury - intubation indications:
- face/neck burns
- singeing of the eyebrows and nasal vibrisae
- carbon deposits in mouth/nose/sputum
- hoarseness/impaired mentation
- explosions with burns to head nad torso
- carboxyhemoglobin >10% when involved in a fire
183
Fluid resus require patient with more than % burns:
20
- NGT insertion is indicated as well
184
Rule of nines:
- ok for adults
| - children (head 9%, legs 2x7%)
185
Clinical manifestation of inhalation injury - time:
may be subtle, quite often don't appear within the first 24 hours
doubles mortality
186
CO exposure:
| levels of carboxyhemoglobin HbCO
60% death
187
CO exposure - treatment:
- halftime on air 4hrs
- halftime on O2 40min
=> high-flow O2 via nonrebreathing mask
188
Diagnosis of smoke inhalation injury - requirements:
- exposure to a combustible agent
| - signs of exposure in a lower airway below vocal cords (bronchoscopy)
189
Burns - fluids:
2 - 4 ml/kg/% postizene plochy za 24hod
- 50% in first 8 hours
=> odhad, ridime podle diurezy -> adult 0.5ml/kg/hrs (deti
190
Burns - blood gas:
cyanide causes persistent acidemia
191
Don't forget with burns:
- tetanus immunization
- compartment syndrome
- with excessive fluids -> abdominal comp. sy.
192
Escharotomy - chest and abdominal:
- anterior axillary lines
| - cross-incision at the junction of the torax and abdomen
193
Burns - cold water can be applied up to:
10% BSA
194
ATB when burned:
NO
195
Chemical burns - first aid:
- flush with water 20-30 min
- if dry-> brush it away first
- neutralization has no advantage over water
- alkali burns to the eye - 8 hours of cont.irrigation
196
When myoglobinuria suspected - urinary output:
- adult >100ml/hr
| -
197
Burns - criteria for transfer:
- partial thickness and full-thickness >10% BSA
- face, eyes, ears, hands, feets, genitalia and perineum
- full-thickness any size
- electrical, chemical, inhalation injury
- preexisting ilness that can complicate treatment
198
Frostnip is defined:
pain, pallor and numbness
| reversible with rewarmig
199
Frostbite is classified:
1 - hyperemie, edema
2 - hyperemia, edema, vesicles, partial-thickness skin necrosis
3 - full-thickness and s.c. necrosis
4 - including muscle and bone with gangrene
200
Nonfreezing injury:
- microvascular endothelial damage, stasis, vascular occlusion
- 1.6 to 10 degree
- deep tissue destruction may not be present
201
Frostbite - treatment:
- hot drinks
- circulating water 40 degree (no dry heat)
- cardiac monitoring
- tetanus
- uninfected blebs let be for 10 days, stop smoking (vasocontriction)
202
Hypotermia classification by core temperature:
203
Geriatric - falls accounts for what % of deaths:
40%
204
Trauma - risk age:
- 65 years
- 50% of population has coronary artery stenosis
- maximal HR is decreasing
205
Maximal heart rate formula:
220 - age
206
The aged kidney is less able to:
- resorb Na
- excrete K, H+
- max concentration ability: 850 mOsm/kg
- decreased responsiveness to Renin, Angiotensin
207
Geriatric - fluid requirements:
- correct for lean body mass (then like young)
| - when on diuretics then have contracted vascular volume and K deficit
208
Geriatric - CNS:
- brain mass decreases by 10%
- cerebral blood flow is decreased by 20%
- intervertebral disc loses water -> load goes to facets, ligaments
- spinal stenosis likely due to osteophytes
209
Geriatric - hypotermia - notattributabke to shock:
- sepsis
- endocrine disease
- pharmacology causes
210
The most common locations of fractures in elderly:
ribs
proximal femur
hip
humerus and wrist
211
Impacted fracture:
- ends are driven into each other
| - no false motion
212
Colle's fracture:
- fall on the outstreteched hands
- metaphyseal fracture of the distal radius (usually base of styloid ulnar process)
- test n.medianus and flexion of fingers
213
Chronic use of calcium-chanell blockers may result in:
limited peripheral vasoconstriction in shock
214
The position of the uterus during pregnancy:
- intrapelvic till 12th week, thick walled uterus
- umbilicus at 20th week, lot of amniotic fluid
- costal margin at 34-36 week, thin walled, head in the pelvis
pelvic fracture can cause serious intracranial injury
215
Abrupt decrease in maternal volume :
increase of uterine vascular resistence reducing fetal oxygenation despite reasonably normal maternal vital signs
216
Physiologic anemia in pregnancy:
- plasma volume increases till its plateau at 34 week
| - smaller increase in RBC
217
Pregnant woman can loss how much of blood:
up to 1200-1500ml before exhibiting any signs of hypovolemia
but fetal distress can be present
218
Pregnancy and clotting:
- clotting factors and fibrinogen mildy elevated
| - prothrombin and aPTT may be shortened
219
Normal lab values during pregnancy:
- Hct 32-42%
- WBC 5-12
- pH 7.4-7.45
- bicarbonate 17-22
- PaCO2 3.3-4
220
Pregnancy - HR, CI, BP:
- HR increased by 10-15 beats/min
- CI increased by 1-1.5 l/min (uterus and placenta 20% of CO)
- BP decreases by 5-15mmHg but just in 2nd trimestr
221
Pregnancy - ECG:
- axis shits leftward by 15 degrees
- inverted T in III and aVF is ok
- ectopic beats
222
Pregnancy - urinary system:
- fall in U, Creat by 50%
| - glycosuria is common
223
Pregnancy - musculosceletal system:
- symphisis widens to 3-8 mm by 7 month
| - sacroiliac joint space widens as well by 7 month
224
Eclampsia - priznaky:
- late pregnancy
- HN, hyperreflexia
- proteinuria
- peripheral edema
- can mimic head injury
225
The causes of fetal death:
- death of the mother
| - placental abruption
226
Abruptio placentae is suggested:
- vaginal bleeding (70%)
- uterine tenderness
- frequent. contractions, tetany or irritability
- abdominal pain
227
Uterine rupture is suggested:
- abdominal tenderness, guarding, rigidity
- abdominal fetal lie (oblique, transverse), easy palpation
- unability to palpate fundus when fundal rupture
228
Fetal heart tones:
- by 10 week doppler ultrasound
- by 20 week continual monitoring with tocodynamometer
- no risk factors: 6hrs
- risk factor: 24hrs
229
Risk factors for fetal loss or placental abruption:
- HR>110
- ISS>9
- evidence of placental abruption
- fetal HR 160
- ejection from car, pedestrian
230
The presence of amniotic fluid in vagina is confirmed:
pH 7-7.5
231
Rh- mother must be given:
Rh immunoglobulin therapy within72hrs
232
Child - equations:
```
Weigt = (Age x 2) + 10
Tube = Age/4 + 4
Depth= Age/2 + 12 (Tube x 3)
BPs = 2 x Age + 90 (lower limit +70)
```
233
Child - by age:
- infant
234
Tube cuff pressure :
235
Lenght of trachea:
- infant 5cm
| - toddler 7cm
236
Intubation - child:
- SUX (2mg/kg
237
Problems with tube - DOPE:
```
D = dislodgement
O = obstruction
P = PNO
E = equipment failure
```
238
Use of pediatric bag mask is for children:
239
RR in children:
- infant 30-40
| - older 15-20
240
What hypotension in child represents:
- decomp.shock
- indicates loss >45%
- fluids and blood
241
IO needles in child:
- infants 18G
| - older 15G
242
Child - fluid boluses:
- up to 3 x 20 ml/kg
| - Blood 10 ml/kg
243
Child - chest injury:
- 8% of injuries
- 2/3 have multiple injury
- the mostcommon lifethreating injury in child is PNO
244
Child - what dictates laparotomy:
- just hemodynamic condition
| - free fluid NOT
245
Child - consider intracranial monitoring when:
- GCS of 8 or M of 2
- multiple injuries associated with brain injury
- positive CT scan
246
Pediatric verbal score:
```
5 social smile, fixes and follows
4 cries, but consolable
3 persistently irritable
2 restless, agitated
1 none
```
247
CT spine in child:
- anterior displacement of C2 on C3 is usuall up to 3mm
to correct put child on hard surface and padding
- basilar odontoid synchndrosis up to 5 yrs
- apical odontoid synchondrosis betwen 5-11 yrs
248
Clear the spine:
- awake, no drugs, no alcohol
- no distracting injury
- neurologically normal
- no neck pain or midline tenderness
