CMT1 Gen Med Flashcards
(171 cards)
1
Q
What are the 4 S&S of raised ICP?
A
Hypertension & Bradycardia
Reduction in Consciousness
Abnormal resp patterns
Abnormal Posturing
2
Q
What are the 4 managements of ICP?
A
Primary Survey
Monitor Regularly
Evacuate ASAP
Give Oxygen
3
Q
What is Shock?
A
A Series of signs and symptoms which occur as a result of reduced tissue perfusion with blood. the result of inadequate delivery of oxygen and nutrients to all parts of the body, skin, kidneys & brain.
4
Q
What are the types of shock?
A
Hypovolemic
Anaphylactic
Septic
Neurogenic
Cardiogenic
5
Q
What are the Sign & Symptoms of hypovolaemic shock?
A
Peripherial Vasoconstriction
Tachypnoea
Reduced Pule Pressure
Sweating
6
Q
What are the 4 stages of shock?
A
Initial
Compensatory
Progressive
Refractory
7
Q
What are the complications of ET intubation?
A
Hypoxia
Damage to teeth
Spinal Cord injury
Failed intubation
8
Q
Define surgical cricothyroidotomy
A
Placement of a small cuffed tracheostomy tube, usually size 6 into trachea via an incision in the cricothyroid membrane.
9
Q
3 Do’s and Don’ts of snake bites/scorpion stings?
A
DO:
Gain IV Access,
Pressure Immobilisation,
Arrange Transfer
DON’T:
Feed
Elevate
Wash
10
Q
4 Signs & Symptoms of poisoning?
A
Nasal bleeding
Puncture Marks
Drowsiness
Excessive sweating
Pinpoint pupils
Cyanosis
11
Q
Management of poisoning
A
Initial assessment
Give antidote
Evacuate with poison.
12
Q
What is the treatment of Hypovolaemic shock?
A
Control any bleeding
Fluid resuscitation
Bolus’s of 250ml crystalloid fluid
13
Q
General signs and symptoms of shock?
A
-Reduced Blood pressure.
-Increased Pulse and Respiratory rate.
-Pale, Cold & Clammy skin.
-Poor urine output
-Altered level of consciousness (ALOC).
-Anxiety
-Hypoxia
-Death
14
Q
When would you NOT use an ET tube?
A
Trismus (lock jaw)
Conscious
15
Q
What difficulties could you come across when wanting to use an ET tube?
A
Facial Trauma
Shape of Trachea
Pre-existing disease
16
Q
When would a casualty require needle decompression?
A
-Tension Pneumothorax
-Developed open pneumothorax
-MOI
17
Q
What are the post complications of needle decompression?
A
-Local, pleural infection.
-Local haematoma
-Pneumothorax
18
Q
Define ET intubation
A
Passing a cuffed endotracheal tube through the vocal cords into the trachea.
19
Q
What are 4 indications for ET-tube intubation?
A
- Deeply Unconscious
- Management of cardiac arrest
- Potential airway obstruction
- Chest / Head injuries.
20
Q
What is Penthrox?
A
Inhaled analgesia. Contains methoxyflurane.
21
Q
When can you use Penthrox (indications)?
A
Dislocations
Fractures
Burns
Neck Of Femur
22
Q
When in Penthrox Contra-indicated?
A
Liver Damage
Unconscious
Kidney impairment
difficulty breathing
23
Q
Acute Severe Asthma?
A
- PEF 33%-50% best or predicted.
- RR >25/min
- HR >110/min
- Inability to complete sentences in one breath.
24
Q
Moderate Asthma?
A
- Increasing Symptoms
- PEF >50%-75% best or predicted
- No features of acute severe asthma.
25
What are the signs of hypothermia?
Severe:
- Not Shivering
- Unresponsive
- Confused
- Slurred Speech
- Slow irregular pulse
- May appear dead
Moderate:
-Feel cold
- Shivering
- Say they feel cold
- Loss of dexterity
- Cold, pale hands & feet
26
Life threatening Asthma
- PEF <33% best or predicted
- SP02 <92%
- Silent chest
- Cyanosis
- Poor respiratory effort
- Arrythmia
- Exhaustion
- ALOC
- Hypotension
27
How would you recognise an open pneumothorax?
Mechanism of injury
Dyspnoea
Tachypnoea
Obvious wound
Emphysema
Cyanosis
28
What is Dyspnoea?
Shortness of breath / Breathlessness
29
What is the management of open pneumothorax?
- Safety
- Check, Clear, maintain
- Apply Russel chest seal
- 100% 02
30
What are the complications associated with drowning?
- Hypothermia
- Prolonged immersion
31
How long after can secondary drowning occur?
up to 72hrs after
32
When not to give oral fluids?
- Those requiring surgery
- Risk of vomiting
- Major abdominal trauma
33
Why do we gain IV access?
- Fluid resus
- Administration of drugs
- Prior to chest drain
- Prolonged entrapment
34
When would you gain IO access?
- Other access failed
- Emergency
- Major Burns
- Prolonged shock
- Overwhelming Sepsis
- Cardiopulmonary arrest
35
Contra-indications to IO?
Fractures
Infection
Osteoporosis
36
Contra-indications to FAST IO?
Under 12yrs
Sternotomy
37
What injuries should we take care with when administering fluids?
- Isolated head injury ICP
- Renal trauma
- Cardiac Failure
- Cerebro-vascular incident
38
What are complications with IV/Cannulation?
- Perforated vein
- Haematoma
- Shearing
- Needle breakage
39
What is triage?
The assignment of treatment and evacuation priorities to the wounded and sick at each echelon of medical care.
40
What are the indications of nasal gastric intubation?
- Pre/Post abdominal surgery
- Abdominal injury
- Intestinal blockage
41
What are some medical emergencies?
- Airway
- Breathing
- Cardiac
- Nervous system
- Vascular
- Diabetes
- Tropical disease
- Appendicitis
- Drowning
42
What are the five types of drowning?
- Near drowning
- Freshwater drowning
- Saltwater drowning
- Secondary drowning
- Dry drowning
43
What is the management of hypoglycaemia?
- Ensure A, B, C stable
- BM level
- Recovery position
- Evacuate
44
Define diabetic coma?
Collapse or acute illness caused by hypo/hyper glycemia.
45
What % of fentanyl is absorbed through the mucosa membrane?
25%
46
What are the 3 contra-indications of fentanyl?
- P or U on AVPU
- Respiratory rate below 10
- Head injury
47
Define poisoning?
Any substance which if taken into the body in sufficient amounts may cause harm or even death
48
What are the 4 common poisons we encounter in the military?
- Carbon monoxide
- Opiates
- Alcohol
- Toxins
49
What are the three types of EZ-IO needles?
Pink - 15mm - Children
Blue - 25mm - Adults
Yellow - 45mm - Large Adults
50
What are some complications to EZ-IO / FAST?
- Painful to use
- Extravasation
- Compartment syndrome
- Skin infection
51
What are four common breathing conditions?
- Asthma
- Drowning
- Anaphylaxis
- Opiate overdose
52
What is anaphylaxis?
An allergic reaction that can be fatal and effects the whole body.
53
What is the management of anaphylaxis?
- Lay casualty down, legs elevated.
- Adrenaline 1:1000 Intramuscular
- Salbutamol 5mg
- 4mg Chlorphenamine
54
What is an open wound?
Where there is a disruption in the continuity of the skin.
55
What is a closed wound?
Trauma has caused damage to the underlying tissue and not broken the skin.
56
What is a fracture?
Chip, crack or break in the continuity of a bone.
57
What are the signs and symptoms of a fracture?
- Tenderness/pain at site
- Deformity
- Inability of movement
- Possible reduced sensitivity
- Possible loss of distal pulse
58
What are internal haemorrhage signs and symptoms?
- Increase pulse rate
- Swelling over site
- Tenderness
- Rigid areas
- Hypo resonance
59
Typical blood loss for Fractured rib?
150ml per rib
60
Typical blood loss for closed femoral fracture
1.5litres
61
Typical blood loss Haemothorax?
Up to 2litres per lung
62
Typical blood loss for Closed Tibial fracture?
500ml
63
Typical blood loss for fractured pelvis?
3litres +
64
Typical volume of a fist sized clot?
500ml
65
What causes a tension pneumothorax?
- Blunt chest trauma
- penetrating chest trauma
66
What is a Haemothorax?
Presence of blood in the chest cavity (up to 2l per lung)
67
What is flail chest?
Breaking of two or more ribs in two or more adjacent places
68
Define asthma?
Recurring sudden attacks of difficult breathing characterised by wheezing and difficulty in expiration.
69
What are the three categories of Asthma?
Acute moderate, Severe & Life threatening
70
What is the treatment of Asthma?
- 02
- Salbutamol Nebuliser with 02
- Salbutamol inhaler 1-2 puffs
71
What are the symptoms of a head injury?
- Headache
- Aggression
- Dizziness
- Headache
- Nausea / Vomiting
72
Name4 Signs and symptoms of basal skull fracture?
- 'Raccoon eyes'
- Bleeding from the ear
- Battle signs
- Rhinorrhoea (runny nose)
- Otorrhea (ear drainage)
73
What are the triage priorities?
T1 - Immediate - 1hr - RED
T2 - Urgent - 2hrs - YELLOW
T3 - Delayed - 4hrs - GREEN
T4 - Expectant - BLUE
DEAD - BLACK
74
What are the timings of trauma death?
Instantaneously - Seconds
Early - Minutes to hours
Late - hours to day and a week
75
What are the causes of injury?
Blunt trauma - RTC, Fall, Blast, crush.
Penetrating trauma - GSW, Shrapnel, knife.
Climate - Hot and Cold
76
Wallace rule of 9's % TBSA
Head & Neck - 9%
Chest and Abdomen - 18%
Back - 18%
Arm & hand - 9%
Leg and foot - 18%
Genitals - 1%
77
What are 5 Initial managements of burns?
- Check ABCDE
- Rinse with cold water >10min
- Entonox/ High concentration 02
- Remove constrictions
- Remove Hot/wet clothing not adhering to skin.
78
What are 5 further/later managements of burns?
- Cling film dressing
- Treat for shock
- Place extremities in Burns bag
- Leave facial burns uncovered
- Encourage mobility
79
3 do NOT's of burn management?
- Apply creams/ointments/lotions
- Pop blisters
- Cut away skin
80
What are the signs & symptoms of smoke inhalation?
- Hoarse voice
- Soot around nose or mouth
- Stained sputum (spit)
- Signed nasal & facial hair
- Breathing difficulties
- Redness, swelling or actual burning of the tongue
- (Casualty has been in confined space.)
81
What are the two sites for EZ - IO?
Tibial Plateau
Humeral Head
82
What are the additional causes of impact injuries? (RTC)
Lap Belt
Diagonal Belt
Airbag
83
What are the blast injury phases?
- Primary
- Secondary
- Tertiary
- Quaternary
84
Define the rate of tachycardia?
More than 100bpm (>)
85
Define the rate of bradycardia?
Less than 60bpm (<)
86
What are the 5 burn categories?
- Thermal
- Electrical
- Chemical
- Radiation
- Friction
87
What are the 3 burn depths?
- Superficial
- Partial thickness
- Full thickness
88
What is hypoglycaemia?
Low blood sugar < 4mmols
89
What are the 4 signs and symptoms of hypoglycaemia?
- Sweating
- Tachycardia
- Irritable
- History
- Anxiety
- ALOC
90
What is respiratory arrest?
Cessation of breathing
91
What are the typical causes of respiratory arrest?
- Airway obstruction
- Damaged respiratory centre
- Trauma
- Drugs
92
How would you recognise a haemothorax?
- MOI
- Hypo-resonance
- Tachypnoea/Dyspnoea
- Obvious wound
- Unequal chest movement
- Pain on palpation
- Cyanosis
93
How would you recognise a flail chest?
- Paradoxical movement
- Cyanosis
- Obvious wound
- Tachypnoea / Dyspnoea
94
What are the 6 priorities of extrication?
1. Safety & Scene management
2. Stability and initial access
3. Glass management
4. Space creation
5. Full access for treatment
6. Immobilisation and Extrication.
95
What are the principles of extraction?
- Teamwork
- Training
- Preparation
- Correct equipment
96
What are the indications for a surgical cricothyroidotomy?
- Severe facial trauma
- Upper airway burns
- Upper airway obstruction
- Trismus
97
What are the potential complications of surgical cricothyroidotomy?
- Asphyxia
- Bleeding
- Aspiration of blood
- Laceration of trachea
- False passage to tissues
98
What are the effects of a tension pneumothorax?
- Compression of the lung
- Mediastinal shift
- Cardiac arrest
- Death
99
What are the Signs & Symptoms of a tension pneumothorax?
- Hyperresonance
- Cyanosis
- Distended neck veins
- ALOC
100
What difficulties can you face when inserting a surgical airway?
- Casualty Movement
- Poor neck anatomy
- Light (enough to see)
- Correct equipment
- Position of operator
101
What is a needle thoracentesis?
Insertion of a wide bore cannula through the 2nd intercostal space in the mid clavicular line, on affected side to alleviate a life threatening tension pneumothorax.
102
What are the three treatment aims for the mother in emergency childbirth?
- Pain relief
- Prevent trauma
- Prevent infection
103
What are the 3 treatment aims for the baby in emergency childbirth?
- Prepare resus
- Prevent trauma
- Regulate body temp
104
What are the contra-indications of naloxone?
known hypersensitivity
105
What are the side effects of fentanyl?
- Dizziness
- Drowsiness
- Nausea
- Vomiting
- Constipation
- Abdominal pain
- Headache
106
What is Entonox made up of?
50% Oxygen / 50% Nitrous oxide
107
When would you use Entonox?
Prior to applying traction or splints
108
What are the contra-indications of Entonox?
- Chest injuries
- Severe Head injuries
- Diving injuries
- Intoxication
109
What are the two types of entrapment?
Actual & Relative
110
What are the 3 levels of extraction?
ROUTINE: 30+ mins (planned)
URGENT: -30 mins (planned)
EMERGNCY: Immediate (hasty)
111
Class 1 fluid loss?
<750ml (15%)
112
Class 2 fluid loss?
750ml - 1500ml (15-30%)
113
Class 3 fluid loss?
1500ml - 2000ml (30-40%)
114
Class 4 fluid loss?
>2000ml (>40%)
115
What are 4 trauma chest injuries?
- Open pneumothorax
- Tension pneumothorax
- (Massive) Haemothorax
- Flail chest
116
What is a pneumothorax?
Air or gas in the pleural cavity
117
What can cause a pneumothorax?
- Trauma
- Penetrating
- Blunt
- Disease
- Spontaneous
118
What are the 5 limitation to CUF?
- Hostile forces and enemy fire
- Equipment limited
- Time
- Limited visibility
- Comms difficulty
119
What does HITMANN stand for?
Head to Toe / Hygiene
Infection
Tubes
Medication
Analgesia
Nutrition & Hydration
Notes and Nursing
120
What is CSCATTT & what is it used for?
C ommand and control
S afety
C omms
A ssess
T riage
T reatment
T ransport
Scene management.
121
What does METHANE stand for?
M ajor incident declared / my C/S
E xact location
T ype of incident
H azards identified
A ccess and egress
N umber & Serveries of Casualties
E mergency services required
122
What are the collision types?
- Frontal
- Rear end
- Lateral / Side
- Rotational
- Rollover
123
What are the 3 types of Pneumothorax?
- Simple
- Open/sucking
- Tension
124
What are 4 types of fracture?
- Closed/Simple
- Open
- Complicated
- Comminuted
125
What is a closed fracture?
The bone is fractured, without a break in the overlying skin.
126
What is a hazard?
Something that has the potential to cause harm
127
What are the 3 types of bleeding?
- Arterial
- Venous
- Capillary
128
What is the Parkland formula?
Body weight x % of burn x 4ml
129
What are the hazard spectrum(s)?
Trauma / Burns
Environment
Medical / Toxicological
130
What are the categories in the operational spectrum?
ODP - Operations during peacetime.
OOTW - Operations other than war.
War -
131
Name some of the technical rescue skills?
Rope rescue
Water rescue
Search rescue
Confined space rescue
Heavy rescue
132
Name some tools / devices used for extrication?
- Telford extraction device
- Cervical Collar
- Scoop stretcher
- Recue board
- Xtract2 stretcher
- MIBS stretcher
133
What defines a major incident?
When the number of casualties temporarily overwhelms the available medical and logistical capabilities.
134
What are the levels of command in a major incident?
Gold
Silver
Bronze
135
What drug is used to reverse an opioid overdose?
Naloxone hydrochloride.
136
How many doses can you give naloxone and how long to wait between doses?
1st - 400mg
2nd - 800mg
3rd - 800mg
1 minute apart.
137
Give 3 reasons why you would insert an NPA?
- Cannot tolerate OPA
- Trismus
- Jaw injury
138
What is Hyperglycaemia?
Abnormally high blood sugar levels >8mmol
139
When might eyes be bilaterally fixed?
- Dead
- Hypoxia
- Hypovolaemic
- Atropine / Ecstasy OD
140
When might eyes be unilaterally fixed?
Brain injury
Stroke
141
What are some causes of anaphylaxis?
- Drugs / medication
- Blood Transfusion
- Food ingestion
- Bites & Stings
142
Name some immobilisation equipment?
- Triangular Bandage
- Splints (SAM / Frac immobiliser)
- Cervical Collars
- Long Board
- Fracture Straps
143
What is a compressible haemorrhage controlled by?
- CAT (tourniquet).
- Pressure points.
- ECB.
- Elevation.
- Celox.
144
What is a non-compressible haemorrhage controlled by?
- Urgent Evacuation
- Blood Transfusion
- Surgery
145
Name 5 types of haemorrhage control?
- Direct Pressure
- Elevation
- Splinting
- Indirect pressure
- Haemostatic agents
146
What are the 4 steps of continuous care?
- Monitor
- Reassess
- Documenting
- Caring
147
What are the 4 signs of acute severe asthma?
RR >25/min
HR >110/min
Cannot complete sentences
Reduced PEFR >33% - 50% of predicted
148
What are 9 signs of life threatening Asthma?
- Silent Chest
- Cyanosis
- Exhaustion
- Arrythmia
- SP02 <92
- Poor respiratory effort
- ALOC
- Hypotension
- PEFR of <33% predicted.
149
What are the 3 classifications of head injuries?
- Skull fractures
- Brain injuries
- Scalp wounds
150
What is a complicated fracture?
Bone ends cause injury to important structures
151
what is a comminuted fracture?
Bone has fractured into many pieces.
152
What is the treatment for smoke inhalation?
- Maintain Airway
- Humidified 02
- Nebulised Salbutamol
- Urgent evacuation
153
Three types of brain injuries?
- Subdural Haematoma
- Extradural Haematoma
- Subarachnoid Haemorrhage
154
What are the evacuation priorities of burns?
T1 - Airway Burn
T1 - >25% burns
T2 - 12-25% Burns
T2 - Chemical / Electrical Burns
T3 - <12% Burns
155
What are the types of posturing during raised ICP?
Decorticate (Arms in)
Decerebrate (Arms out)
156
What are the 3 levels of raised ICP?
Level 1 - Decorticate
Level 2 - Decerebrate
Level 3 - Flaccid
157
What are the 3 common pressure points?
- Subclavian
- Femoral
- Brachial
158
What are the 7 types of open wound?
- Laceration
- Impalement
- Puncture
- Abrasion
- Burn
- GSW (velocity)
- Incision
159
What are 2 types of closed wounds?
- Fractures
- Non-Compressible Haemorrhage
160
What are two types of seizures?
- Centralised
- Partial
161
What are the 4 aims of splintage?
- Support
- Immobilise
- Elevate
- Relieve Pain
162
What exposures should we consider when packaging?
- Safety
- Tactical
- Climate
163
What are the three methods of assessing consciousness?
- AVPU
- PERLA
- GCS
164
What are some typical causes of seizures?
- Brain Tumour
- Stroke
- High fever
- Lack of sleep
- Head trauma
- Drugs / Intoxication
- Mental illness.
165
What can be done to manage a seizing casualty?
- Obtain history
- Protect patient
- Primary survey
- Oxygen
- Evacuation
166
What are the 3 P's of pain relief?
- Physiological
- Pharmacological
- Psychological
167
How often should you take Obs in prolonged field care?
Under direction from the MO, or...
- Every 15 Mins for the first 2 hours
- If stable; Every 30mins for the next 4 hours.
168
10 principles of continuous care?
- Maintaining Dignity
- Controlling Body Temperature
- Pressure Areas
- Personal Hygiene
- Safe environment
- Toileting
- Food & Drink
- Dressing Changes
- Communication
- Death / Dying
169
What is catheterisation?
Passing a urethral catheter into the bladder.
170
Why would you catheterise a patient?
- Monitoring fluid balance
- Unable to pass urine
- Abdominal / Pelvic injury
- Post aesthetic
- Unmanageable incontinence
171
