Emergency Med Flashcards
(255 cards)
1
Q
Beck’s Triad
A
Distended jugular veins
Hypotension
Muffled heart sound
2
Q
the pump that drives the system
preload
myocardial contractility
afterload
A
myocardial contractility
3
Q
Presents with classic sign of inadequate perfusion
Class 1 Hemorrhage
Class 2 Hemorrhage
Class 3 Hemorrhage
Class 4 Hemorrhage
A
Class 3 Hemorrhage
Presents with classic sign of inadequate perfusion:
. Marked tachycardia and tachypnea
. Significant changes in mental status
. Measurable fall in systolic blood pressure
4
Q
Nonsurgical removal of the limb from the body
Abrasions Punctures Incisions Avulsions Lacerations Amputations
A
Amputations
5
Q
Alpha-granules liberate
A
platelet-derived growth factor (PDGF), platelet factor IV, and transforming growth factor (TGF)–β).
6
Q
Pt is breathing with 29 breaths/min. What is next step?
A
measure perfusion (less than 30/min)
7
Q
Massive burns (>85% BSA)
Disaster Response Level Level I Level II Level III Level IV
A
Level I
8
Q
Disposition: depends on patient condition vs. resources
Triage Level Level 1 Level 2 Level 3 Level 4 Level 5
A
Level 2
9
Q
Initial patient assessment and treatment in START should take how long?
A
less than 30 seconds/pt
10
Q
What type of wounds rquire flaps?
A
radiation
11
Q
Dx for Flail Chest
A
paradoxical movement of chest segment
12
Q
Vitamin A deficiency role in wound healing is
A
collagen synthesis, antioxidant
13
Q
Patients who are on steroids should receive this for wound healing
A
vitamin A
14
Q
Triage mnemonic for triage Respiration, Perfusion and Mental Status?
A
R 30
P 2
M Can do
15
Q
management of contaminated or infected wounds
Primary Closure
Spontaneous Healing
Delayed Primary Closure
A
Spontaneous Healing
16
Q
How is perfusion measured in children?
A
palpable pulse
17
Q
Uncomplicated hemorrhage for which crystalloid fluid resuscitation is required
Class 1 Hemorrhage
Class 2 Hemorrhage
Class 3 Hemorrhage
Class 4 Hemorrhage
A
Class 2 Hemorrhage
18
Q
Victims seen 12-24 hrs
Disaster Response Level Level I Level II Level III Level IV
A
Level III
19
Q
Types of wound healing
A
Primary Wound Healing or Primary Closure
Secondary Wound Healing or Spontaneous Healing
Tertiary Wound Healing or Delayed Primary Closure
20
Q
What local anesthetic has the longest duration?
A
bupivacaine
21
Q
Blood transfusion is required
Class 1 Hemorrhage
Class 2 Hemorrhage
Class 3 Hemorrhage
Class 4 Hemorrhage
A
Class 4 Hemorrhage
22
Q
What are local anesthetic drugs used?
A
cocaine, procaine, tetracaine, lidocaine, lidocain with epi, bupivacaine
23
Q
Second step in managing shock is to
A
identify the probable cause of shock and adjust treatment accordingly
24
Q
Indications for systemic antibiotic for traumatic wounds
A
.Injury 6 hours old on the extremities .Injury 24 hours old on the face and scalp . Tendon, joint or bony involvement . Cartilage involvement . Mammalian bite . Co-morbidity (DM, extremes of age, steroid use, morbid obesity) . Puncture wound . Complex intraoral wound
25
BASICS OF PRIMARY SURVEY
```
Airway and Protection of Spinal Cord
Breathing and Ventilation
Circulation
Disability
Exposure and Control of the Environment
```
26
Diabetes affects wound healing by
Diminishing sensation and arterial inflow (plus plus) acute loss of diabetic control (arrow) diminished cardiac output, poor peripheral perfusion, and impaired polymorphonuclear leukocyte phagocytosis
27
Gradually disappearing contusion is how may days old?
. 14-15 days
28
In Disaster Response, what classifies as a massive burn?
> 85% BSA
29
Victim needs to be seen < 2 hr
```
Disaster Response Level
Level I
Level II
Level III
Level IV
```
Level I
30
hyperbaric medicine Raises the dissolved oxygen saturation in plasma from X to Y
0.3% to nearly 7%
31
Most important thing to know in disaster as Doctor
where the triage officer should be
32
US-FDA approved for diabetic foot ulcers
PDGF
EDGF
VEGF
PDGF - Becaplermin
33
Yellow contusion is how may days old?
. 7-10 days
34
Reverse triage
prioritzing the greatest number of people that can be treated
35
can reduce venous return and produce obstructive shock
Tension pneumothorax
36
What type of burn is TL 1?
respiratory tract burns
37
Low-velocity missile damages
only the tissues it comes into contact with
38
Pt has red triage color. What are possible wounds?
```
Respiratory arrest
Airway obstruction
Sucking Chest Wound
Cardiac arrest
Severe bleeding
Shock
Unconsciousness
Respiratory tract burns
Acute Coronary Syndromes
Suicidal attempts
Status epilepticus
```
39
where victims and the injured are collected in casualty
primary collection point
40
What are the respiratory requirements for children in JumpSTART?
between 15 and 45
41
Who is prioritised during mass casualty?
walking injured
42
Use trucks to transport them
```
Triage Level
Level 1
Level 2
Level 3
Level 4
Level 5
```
Level 3
43
Green contusion is how may days old?
. 4-5 days
44
Cardiac tamponade also produces obstructive shock
as blood in the pericardial sac inhibits cardiac contractility and cardiac output
45
GOALS OF WOUND CARE
Facilitate hemostasis, Decrease tissue loss, Promote wound healing, Minimize scar formation
46
Local anesthesia for wound preparation are
Direct infiltration:
. 1% lidocaine with or without epinephrine
. Bupivacaine or sensorcaine for longer acting anesthesia
47
different types of tagging triage pt
classic, fluorescent flagging ribbons, tear-off, pre-labeled
48
Blood tumors
Petechiae
Contusion
Hematoma
Hematoma
49
Indications of Primary Closure
Indications: Recent (<24 hr old), Clean, Viable tissue, Tension-free
50
What is the difference between military and civilian triage?
Military triage prioritizes getting people back onto the battle field
51
FAST Exam
(Focused Abdominal Sonography in Trauma)
52
Provides definitive care in wide range of complex traumatic patients
Level 1
Level 2
Level 3
Level 4
Level 2
53
What type of burn is TL 3?
Partial-thickness burns of <20% BSA
54
Circumscribed extravasation of blood in the
subcutaneous tissue or underneath the mucous
membrane
Petechiae
Contusion
Hematoma
Petechiae
55
GCS at which we intubate
equal or less than 8
56
Drugs affects wound healing by
Steroids and antimetabolites impede proliferation of fibroblasts and collagen synthesis
57
Negative pressure wound therapy is used in what basic of wound healing? How is it done?
. Reduce edema
. Removes pericellular transudate & wound exudate as well as deleterious enzymes
. Cannot be used in ischemic, badly infected or inadequately debrided wounds or in malignancy
58
What are the open wounds?
```
Abrasions
Punctures
Incisions
Avulsions
Lacerations
Amputations
```
59
may be given to trauma patients with signs of significant hemorrhage who present within three hours of injury
Tranexamic acid (TXA)
60
Clean, sharp edges, clean nonmobile areas, laceration less than 5cm in length
staples
adhesives
tape
adhesives
61
Another wound affects wound healing by
Competition for the substrates for wound healing
62
When is compression contraindicated?
in patients with ABI <0.7
63
Tensile strength develops as with primary closure
Primary Closure
Spontaneous Healing
Delayed Primary Closure
Delayed Primary Closure
64
Factors that affect wound healing mnemonic
DIDN'T HEAL
```
Diabetes
Infection
Drugs
Nutritional
Tissue Necrosis
Hypoxia
Excessive tension on wound edges
Another wound
Low temperature
```
65
Hypotension, without tachycardia or cutaneous vasoconstriction
Cardiogenic Shock
Cardiac Tamponade
Tension Pneumothorax
Neurogenic Shock
Neurogenic Shock
66
In Disaster Response, what GCS is considered advanced neurological defect?
<8
67
Provides initial stabilization and
treatment. May care for uncomplicated trauma
patients
Level 1
Level 2
Level 3
Level 5
Level 3
68
Role of epinephrin in wound prep and closure
```
Vasoconstrictive
Increases duration of action
Promotes hemostasis
Avoid end-arterial blood supply areas
May increase pain (low pH)
```
69
(shock) SV x HR = to?
CO
70
Most desirable sites for vascular access
forearms and antecubital veins
71
Indications for Delayed Primary Closure
Indications are
Infected or unhealthy wounds with high bacterial content
Wounds with a long time lapse since injury
Wounds with a severe crush component with significant tissue devitalization
72
If mental test is satisfactory, what is next step?
place pt in green or acute
73
Sequence of wound healing
Homeostasis, Inflammation, granulation proliferation
74
What are closed wounds?
Petechiae, Contusion, Hematoma
75
If crossmatched blood is unavailable and indicated for exsanguinating hemorrhage use this
type O PRBC
76
Complications include Late wound contracture and Hypertrophic scarring
Primary Closure
Spontaneous Healing
Delayed Primary Closure
Spontaneous Healing
77
Green
```
Triage Level
Level 1
Level 2
Level 3
Level 4
Level 5
```
Level 3
78
In pregnancy, what is supine hypotensive syndrome. What is tx
. After 20 weeks, enlarged uterus with fetus and amniotic
fluid compresses inferior vena cava
. Decreases venous return and decrease cardiac output
. Keep pregnant patients in left lateral decubitus position to
avoid excessive hypotension
79
Contraindication for NPWT/VAC wound dressing
malignancy, ischemia, inadequately debrided or badly infected wounds
80
Procedure for Needle Thoracostomy
Midclavicular line
14 gauge angiocath
Over the 2nd rib
Rush of air is heard
81
15-30% Blood loss
Class 1 Hemorrhage
Class 2 Hemorrhage
Class 3 Hemorrhage
Class 4 Hemorrhage
Class 2 Hemorrhage
82
Role of hyperbaric O2 therapy in wound healing
limb salvage
83
Penetrating vs perforating
Penetrating: entered the body
Perforating: entered the visceral part
84
What is the name of tape used in wound closure
Steri-strips
85
sacrificing for the greatest good of the greatest number
```
Principle of Rights
Medical Disaster
Multiple, Major, Mass Casualty Incidents
Spock Principle
Triage
```
Spock Principle
86
Hydrocolloids promote wound debridement by
autolysis
87
peripheral vascular resistance
preload
myocardial contractility
afterload
afterload
88
Inadequately perfused and poorly oxygenated cells compensate by
shift to anaerobic metabolism resulting in formation of lactic acid and development of metabolic acidosis
89
Evaluates for fluid in the pouch of Douglas (Posterior to bladder)
Dependent potential space
RUQ/Morrison’s pouch
Sub-xiphoid:
LUQ:
Bladder:
Bladder
90
Evaluate for pericardial fluid
View through liver
Transhepatic or Parasternal
Searches for fluid between heart and pericardium
RUQ/Morrison’s pouch
Sub-xiphoid:
LUQ:
Bladder:
Sub-xiphoid:
91
best choice for wounds in well-vascularized areas
Primary Closure
Spontaneous Healing
Delayed Primary Closure
Primary closure
92
How many casualties to qualify as mass casualty?
100 or more
93
Administer an initial, warmed fluid bolus of isotonic fluid. The usual dose
is 1 liter for adults and 20ml/kg for pediatric patients weighing less than 40kg
94
If perfusion test is unsatisfactory, what is the next step?
look for gross bleeding and apply direct pressure
95
EBW for male and female
Male: 50 kg + 2.3 kg for every inch over 5 feet
Female: 45.5 kg + 2.3 kg for every inch over 5 feet
96
Urinary output is only mildly affected (20-30ml/hour in an adult)
Class 1 Hemorrhage
Class 2 Hemorrhage
Class 3 Hemorrhage
Class 4 Hemorrhage
Class 2 Hemorrhage
97
What are requirements of tagging triage pt
Durable, Visible from great distances, Simple/Self-explanatory, Cost effective, Numbered
98
This is essential for venous stasis ulcers
compression
99
Commonly injured with compression forces
spleen
100
Partial thickness burns 12% BSA including respiratory tract
```
Triage Level
Level 1
Level 2
Level 3
Level 4
Level 5
```
Level 1
101
Black
```
Triage Level
Level 1
Level 2
Level 3
Level 4
Level 5
```
Level 4
102
What is JumpStart triage?
triage in disasters for children
103
31-40% blood loss
Class 1 Hemorrhage
Class 2 Hemorrhage
Class 3 Hemorrhage
Class 4 Hemorrhage
Class 3 Hemorrhage
104
Nutritional affects wound healing by
. Protein-calorie malnutrition and deficiencies of vitamin A (collagen synthesis, antioxidant), C (collagen synthesis), and zinc (fibroblast proliferation)
. Malnutrition: impaired organ function, impaired collagen synthesis, impaired immune function, reduced antioxidant activity
105
Vitamin C deficiency role in wound healing is
collagen synthesis
106
Life-threatening
```
Triage Level
Level 1
Level 2
Level 3
Level 4
Level 5
```
Level 1
107
wound left open and allowed to close by epithelialization and contraction
Primary Closure
Spontaneous Healing
Delayed Primary Closure
Spontaneous Healing
108
In triage what does Kiss-U principle mean?
KEEP IT STUPIDLY SIMPLE + UNIFORM
109
What local anesthetic has the shortest duration?
cocaine, procaine
110
JumpSTART children in yellow for non-ambulatory signifies?
significant external signs of injury are found
111
What parameters are used to categorize them?
Respiration, Perfusion and Mental Status
112
wounds created and closed in the operating room
Primary Closure
Spontaneous Healing
Delayed Primary Closure
Primary closure
113
Excessive tension on wound edges affects wound healing by
Local tissue ischemia and necrosis
114
It is the resistance to the forward flow of the blood
preload
myocardial contractility
afterload
afterload
115
White
```
Level 1
Level 2
Level 3
Level 4
Level 5
```
Level 5
116
In casualties what does START stand for?
```
Simple
Triage
And
Rapid
Treatment
```
117
If mental test is unsatisfactory, what is next step?
pt in immediate
118
Could be internal or External
```
Principle of Rights
Medical Disaster
Multiple, Major, Mass Casualty Incidents
Spock Principle
Triage
```
Medical Disaster
119
Traige success factors?
Pre-planning (conduct drills), Medical Triage Officer, Kiss-U Principle
120
Urinary output is one f the prime indicators of resuscitation and patient response
Adequate volume replacement: 0.5ml/kg/hr (adult); 1ml/kg/hr (under 1 year)
121
How does hyperbaric medicine promote wound healing?
Stimulates angiogenesis and fibroblast migration, enhances neutrophil and antibiotic killing action, and suppresses alpha toxin production in gas gangrene
122
Normal adult blood volume percentage of tbw. Child?
7% of body weight
| child: 8-9%
123
Triage patient not breathing. Next step is?
If they breath, what TL? If not, what TL?
open airway; use Positioning the airway
yes: immediate or red
no: black, pt is dead or dying
124
Superficial, straight laceration under little tension
staples
adhesives
tape
tape
125
Degree of exsanguination is immediately life-threatening
Class 1 Hemorrhage
Class 2 Hemorrhage
Class 3 Hemorrhage
Class 4 Hemorrhage
Class 4 Hemorrhage
126
Rights to proper healthcare / rights to be seen by a who would want to see us / Everybody has their own right
```
Principle of Rights
Medical Disaster
Multiple, Major, Mass Casualty Incidents
Spock Principle
Triage
```
Principle of Rights
127
Rank these dressing's absorption characteristics from low to high
Films
Foams, alginates, collagen
hydrocolloids
hydrogels
None: films
Low: hydrogels
Moderate: hydrocolloids
High: foams, alginates, collagen
128
Walking injured prioritised
```
Principle of Rights
Medical Disaster
Multiple, Major, Mass Casualty Incidents
Spock Principle
Triage
```
Multiple, Major, Mass Casualty Incidents
129
Exemplified by the condition of an individual who has donated 1 unit of blood
Class 1 Hemorrhage
Class 2 Hemorrhage
Class 3 Hemorrhage
Class 4 Hemorrhage
Class 1 Hemorrhage
130
Damage Control Resuscitation (DCR) in combination with Damage Control Surgery
to control hemorrhage rapidly and prevent
coagulopathy by minimizing crystalloid use and
transfusing early
131
View between the spleen and kidney
Another dependent place that fluid collects
Also see diaphragm in this view
RUQ/Morrison’s pouch
Sub-xiphoid:
LUQ:
Bladder:
LUQ:
132
Force applied causes the subcutaneous tissue will lead to
the accumulation of blood causing it to elevate
Petechiae
Contusion
Hematoma
Hematoma
133
Zinc deficiency role in wound healing is
fibroblast proliferation
134
Hypoxia affects wound healing by
. Especially the distal extent of the extremities
. Blood volume deficit, unrelieved pain, or hypothermia (arrow) sympathetic overactivity (arrow) local vasoconstriction (arrow) inadequate tissue oxygenation
135
<15% blood loss
Class 1 Hemorrhage
Class 2 Hemorrhage
Class 3 Hemorrhage
Class 4 Hemorrhage
Class 1 Hemorrhage
136
Deteriorating neurovital signs
```
Disaster Response Level
Level I
Level II
Level III
Level IV
```
Level II
137
Progressive vasoconstriction of cutaneous, muscular, and visceral circulation to preserve blood flow to the
kidneys, heart, and brain
138
Disposition: custodial care
```
Triage Level
Level 1
Level 2
Level 3
Level 4
Level 5
```
Level 4
139
Infection affects wound healing by
. Potentiates collagen lysis
. Bacterial contamination (plus) susceptible host (plus) wound environment (equals) wound infection
. Foreign bodies (including sutures) potentiate wound infection
140
Triage Level I victims
```
Disaster Response Level
Level I
Level II
Level III
Level IV
```
Level IV
141
What is used for recalcitrant ulcers?
electrical stimulation
142
Complications of Spontaneous Healing
Late wound contracture
| Hypertrophic scarring
143
BASIC OF TRAUMA ASSESSMENT
```
Preparation
Triage
Primary Survey
Resuscitation
Secondary Survey
Monitoring and Evaluation, Secondary adjuncts
Transfer to Definitive Care
```
144
What are disadvantages of tagging triage pt?
Organizational uncertainty, Tunnel-vision mentality. Some studies: no improvement in patient outcome, Expensive, Delays patient care and transport
145
Most common sign of shock
Tachycardia (HR > 100)
146
Important consideration for avulsion skin
Do not allow the avulsed portion to freeze
| Do not immerse it in water or saline
147
Regional block anesthesia in important in wound preparation because
. Local infiltration proximally in order to avoid tissue disruption
. Smaller amount of anesthesia required
148
Pt has yellow triage color. What are possible wounds?
```
Open thoracic wound
Penetrating Abdominal wound
Severe eye injury
Avascular limb
Significant burns other than the face, neck or perineum
Moderate bleeding
Conscious patients with head injuries
Anxiety states
Multiple fractures
```
149
No Care
```
Triage Level
Level 1
Level 2
Level 3
Level 4
Level 5
```
Level 5
150
wound closed by approximation of wound margins or by placement of a graft or flap
Primary Closure
Spontaneous Healing
Delayed Primary Closure
Primary closure
151
Determined by venous capacitance, volume status, venous flow
preload
myocardial contractility
afterload
preload
152
Delay of a few minutes: Fatal
```
Triage Level
Level 1
Level 2
Level 3
Level 4
Level 5
```
Level 1
153
What type of burn is TL 2?
Significant burns other than the face, neck or perineum
154
Without surgical intervention
Primary Closure
Spontaneous Healing
Delayed Primary Closure
Spontaneous Healing
155
Dead and Dying
```
Triage Level
Level 1
Level 2
Level 3
Level 4
Level 5
```
Level 4
156
What are the differences in prophylaxis for tetanus in clean wounds vs tetanus prone wounds?
clean: give toxoid after 10 yo
| tetanus prone: give toxoid after 5 yo
157
EBW for pediactrics
1-11 months: (0.5 x age in months) + 4
1-5 years: (2 x age in years) + 8
6-12 years: (3 x age in years) + 7
158
Evacuees
```
Triage Level
Level 1
Level 2
Level 3
Level 4
Level 5
```
Level 5
159
Ambulatory or Primary Care
```
Triage Level
Level 1
Level 2
Level 3
Level 4
Level 5
```
Level 3
160
High-velocity missile damages
by forcing the tissues and body parts away from the track of the missile with a velocity only slightly less than that of the missile itself
161
Airway Interventions
Maintenance of Airway Patency
Airway Support
Definitive Airway
162
How is perfusion measured?
capillary filling time - press nail, wait 2 seconds
163
requiring prolonged life support in an intensive care unit
```
Disaster Response Level
Level I
Level II
Level III
Level IV
```
Level III
164
What is the AVPU scale
Alert
Responds to verbal stimulation
Responds to pain
Unresponsive
165
>40% blood loss
Class 1 Hemorrhage
Class 2 Hemorrhage
Class 3 Hemorrhage
Class 4 Hemorrhage
Class 4 Hemorrhage
166
Much delayed degree of urgency
```
Triage Level
Level 1
Level 2
Level 3
Level 4
Level 5
```
Level 3
167
Expectant or Pending Care
```
Triage Level
Level 1
Level 2
Level 3
Level 4
Level 5
```
Level 4
168
Tissue Necrosis affects wound healing by
From local or systemic ischemia or radiation injury. Blood supply is important
169
is the earliest measurable circulatory sign of shock
Tachycardia
170
a lot of patients fall under this category
```
Triage Level
Level 1
Level 2
Level 3
Level 4
Level 5
```
Level 3
171
What is show bridging?
Connective tissue or blood vessels are flattened
| against the underlying hard surface
172
Disposition: Safe evacuation
```
Triage Level
Level 1
Level 2
Level 3
Level 4
Level 5
```
Level 5
173
Only large puncture wounds are susceptible to infection?
True or false
False; possible in all puncture wounds
174
Tachycardia, muffled heart sounds, and dilated, engorged neck veins with hypotension and insufficient response to fluid therapy
Cardiogenic Shock
Cardiac Tamponade
Tension Pneumothorax
Neurogenic Shock
Cardiac Tamponade
175
Important consideration for grease contamination in wounds
Very hard to remove and so you make sure to give your Pt. anesthetic agent first.
176
If perfusion test is satisfactory, what is the next step?
measure mental status by giving simple command
177
Delayed, Acute or Non-ambulatory Care
```
Triage Level
Level 1
Level 2
Level 3
Level 4
Level 5
```
Level 2
178
Includes: Open thoracic wound, Penetrating Abdominal wound, Severe eye injury, Avascular limb, Significant burns other than the face, neck or perineum
```
Triage Level
Level 1
Level 2
Level 3
Level 4
Level 5
```
Level 2
179
Indications are
Infected or unhealthy wounds with high bacterial content
Wounds with a long time lapse since injury
Wounds with a severe crush component with significant tissue devitalization
Primary Closure
Spontaneous Healing
Delayed Primary Closure
Delayed Primary Closure
180
What pressure should compression be?
30 - 40 mmHg
181
Procedure for Tube Thoracostomy
Insertion site: 5th ICS; Anterior axillary line
| 2-3 cm incision along rib margin with #10
182
When does granulation tissue develop?
> 24hrs
183
can cause unexplained hypotension, cardiac dysrhythmia, usually bradycardia; insert nasal or oral tube
Gastric Dilation/ Decompression
184
Disaster Response Level 2 victims
```
Disaster Response Level
Level I
Level II
Level III
Level IV
```
Level III
185
Caused by a clean, sharp-edged object
Involve only the epidermis
Tend to bleed freely
```
Abrasions
Punctures
Incisions
Avulsions
Lacerations
Amputations
```
Incisions
186
wounds that are too heavily contaminated for primary closure but appear clean and well vascularized after 4-5 days of open observation
Primary Closure
Spontaneous Healing
Delayed Primary Closure
Delayed Primary Closure
187
Tx for Hemothorax
Large Caliber Tube Thoracostomy
188
Why are vasopressors are contraindicated as a first-line treatment of hemorrhagic shock?
because they worsen tissue perfusion
189
Disability check in basic trauma
```
. Pupillary exam
. AVPU scale
. Gross neurological exam - extremity of movement
. Glasgow Coma Scale: 3-15
. Rectal Exam
```
190
Low temperature affects wound healing by
(relatively) distal aspects of the upper and lower extremities (a reduction of 1-1.5C (2-3F) from normal core body temperature) is responsible for slower healing of wounds at these sites
191
Volume of venous blood return to the left and right sides of the heart
preload
myocardial contractility
afterload
preload
192
Secondary survey history mnemonic
AMPLE
```
Allergies
Medications
Past medical history, ob
Last meal
Events surrounding injury
```
193
What is the role of glucose in wound healing?
give energy for angiogenesis and the deposition of new tissue
194
Presence of granulation tissue
Primary Closure
Spontaneous Healing
Delayed Primary Closure
Spontaneous Healing
195
Suture removal guides in days for
```
Face
Arm
Anterior trunk
Back
Feet and hand
Joint scalp
```
Face (3-5)
Arm (7)
Anterior trunk
Back (10-14)
Feet and hand
Joint
scalp
196
Topical anesthesia for wound preparation are
solution or paste: LET, TAC, EMLA
197
Neurogenic shock results from
extensive injury to the cervical or upper thoracic spinal cord caused by a loss of sympathetic tone and subsequent vasodilation
198
What is the role of fatty acids in wound healing?
essential for cell structure and have an important role in the inflammatory process
199
What is considered a massive transfusion?
>10 of PRBC within the first 24 hours of admission or more than 4 units in 1 hour
200
Differences in head to body ratio and relative size and
location of anatomic features make children more
susceptible to
head injury, abdominal injury
201
Disposition: Immediate resuscitation and transport (Trauma and Tertiary Hospitals)
```
Triage Level
Level 1
Level 2
Level 3
Level 4
Level 5
```
Level 1
202
What are the determinants of stroke volume?
preload, myocardial contractility, afterload
203
FAST can identify pericardial fluid, which suggests cardiac tamponade as the cause of shock
Cardiogenic Shock
Cardiac Tamponade
Tension Pneumothorax
Neurogenic Shock
Cardiac Tamponade
204
100 or more casualty
```
Principle of Rights
Medical Disaster
Multiple, Major, Mass Casualty Incidents
Spock Principle
Triage
```
Multiple, Major, Mass Casualty Incidents
205
Pt is breathing with 35 breaths/min. What is next step?
classify as immediate (more than 30/min)
206
What chemicals can be used for hemostasis? (stop the bleeding)
Epinephrine, Gelfoam, Oxycel, Act
207
Tension Pneumothorax
. Develops when air enters the pleural space, but a flap-valve mechanism prevents its escape
. Intrapleural pressure rises, causing total lung collapse and a shift of the mediastinum to the opposite side, with subsequent impairment of venous return and a fall in cardiac output
208
The first step in managing shock in trauma is to
recognize its presence.
209
Tx for Tension Pneumothorax
Needle Decompression
2nd Intercostal space, Midclavicular line
Tube Thoracostomy
5th Intercostal space, Anterior axillary line
210
approximation of wound margins occurs via reepithelialization and wound contraction by myofibroblasts
Primary Closure
Spontaneous Healing
Delayed Primary Closure
Spontaneous Healing
211
Includes: Minor bleeding, Minor soft tissue injuries, Contusions, sprains, Superficial burns, Partial-thickness burns of <20% BSA
```
Triage Level
Level 1
Level 2
Level 3
Level 4
Level 5
```
Level 3
212
Transient response to initial fluid resuscitatoin
. Transient improvement, recurrence of decreased, blood pressure and increased heart rate
. Moderate blood loss (15-40%)
. Moderate to high need for blood
. Type specific blood adequate
213
Peeling
```
Abrasions
Punctures
Incisions
Avulsions
Lacerations
Amputations
```
Avulsions
214
No changes in blood pressure, pulse pressure, or respiratory rate
Class 1 Hemorrhage
Class 2 Hemorrhage
Class 3 Hemorrhage
Class 4 Hemorrhage
Class 1 Hemorrhage
215
Wounds are torn rather than cut
Ragged irregular edges and masses of torn tissue
underneath
```
Abrasions
Punctures
Incisions
Avulsions
Lacerations
Amputations
```
Lacerations
216
Where scar is less of an issue (hairy scalp)
staples
adhesives
tape
staples
217
What is the role of protein deficiency in wound healing?
contribute to poor healing rates with reduced collagen formation and wound dehiscence
218
In FAST exam
| 4 views of the abdomen to look for fluid.
RUQ/Morrison’s pouch
Sub-xiphoid: view of heart
LUQ: view of spleno-renal junction
Bladder: view of pelvis
219
Arterial hypotension in shock
Arterial Hypotension (SBP < 120)
Femoral Pulse – SBP > 80
Radial Pulse – SBP > 90
Carotid Pulse – SBP > 60
220
Disposition: depends on space availability
```
Triage Level
Level 1
Level 2
Level 3
Level 4
Level 5
```
Level 3
221
Immediate or Critical Care
```
Triage Level
Level 1
Level 2
Level 3
Level 4
Level 5
```
Level 1
222
Wound edges are approximated within 3-4 days
Primary Closure
Spontaneous Healing
Delayed Primary Closure
Delayed Primary Closure
223
Victim seen in 2-12 hrs
```
Disaster Response Level
Level I
Level II
Level III
Level IV
```
Level II
224
Advanced neurological deficits (GCS<8)
```
Disaster Response Level
Level I
Level II
Level III
Level IV
```
Level I
225
Primary closures are not made to prevent anaerobic infections
```
Abrasions
Punctures
Incisions
Avulsions
Lacerations
Amputations
```
Punctures
226
requiring formal surgical care
```
Disaster Response Level
Level I
Level II
Level III
Level IV
```
Level III
227
How do you label geographic sorting?
Disaster flags, Chemical light sticks, Colored strobe lights
228
Usual response to acute circulating volume depletion is an (decrease/increase) in heart rate in an attempt to preserve cardiac output
Usual response to acute circulating volume depletion is an increase in heart rate in an attempt to preserve cardiac output
229
Yellow
```
Triage Level
Level 1
Level 2
Level 3
Level 4
Level 5
```
Level 2
230
Red
```
Triage Level
Level 1
Level 2
Level 3
Level 4
Level 5
```
Level 1
231
Between the liver and kidney in RUQ.
First place that fluid collects in supine patient
RUQ/Morrison’s pouch
Sub-xiphoid:
LUQ:
Bladder:
RUQ/Morrison’s pouch
232
Delay has no impact
```
Triage Level
Level 1
Level 2
Level 3
Level 4
Level 5
```
Level 3, Level 4, Level 5
233
Second or third degree burns involving more than 50% of total BSA
```
Disaster Response Level
Level I
Level II
Level III
Level IV
```
Level II
234
Victims who do not require hospitalization
```
Triage Level
Level 1
Level 2
Level 3
Level 4
Level 5
```
Level 3
235
BP of < 50 mmHg systolic and below despite initial resuscitation
```
Disaster Response Level
Level I
Level II
Level III
Level IV
```
Level I
236
Indications: Recent (<24 hr old), Clean, Viable tissue, Tension-free
Primary Closure
Spontaneous Healing
Delayed Primary Closure
Primary closure
237
Bleeding not profuse; Need medical attention for
disinfection
```
Abrasions
Punctures
Incisions
Avulsions
Lacerations
Amputations
```
abrasion
238
Show bridging
```
Abrasions
Punctures
Incisions
Avulsions
Lacerations
Amputations
```
Lacerations
239
Use refrigerated trucks
```
Triage Level
Level 1
Level 2
Level 3
Level 4
Level 5
```
Level 4
240
Any injured patient who in what condition should be considered to be in shock until proven otherwise?
is cool to the touch and is tachycardic
241
Serious but stable
```
Triage Level
Level 1
Level 2
Level 3
Level 4
Level 5
```
Level 2
242
Includes: Respiratory arrest, Airway obstruction, Sucking Chest Wound, Cardiac arrest, Severe bleeding
```
Triage Level
Level 1
Level 2
Level 3
Level 4
Level 5
```
Level 1
243
Breakage of capillary vessels
Petechiae
Contusion
Hematoma
Petechiae
244
Anesthesia is what basic step in wound healing
Wound preparation and closure
245
shear force trauma from
. Acceleration/Deceleration Injury, E.g. Aorta
| . Shearing force = Spectrum from Full thickness tear (Exsanguination) to Partial tear (Pseudoaneurysm)
246
Which is the most painful?
Abrasion
Incision
Lacerations
abrasion
247
Wound dressing requirements
. Maintain moist 24-48 hours (augments reepithelialization)
| . Be “water-tight” after 48 hours
248
Those brought to you non-walking or stretcher will be what color/s?
red, yellow, black
249
(Shock) CO = to?
SV x HR
250
Basics in wound healing (IMPORTANT)
```
Wound evaluation and history
Wound preparation and closure
Optimize systemic parameters
Debride nonviable tissue
Reduced wound burden
Optimize blood flow
Reduce edema
Use dressings appropriately
Use pharmacologic therapy
Close wounds with suturing/grafts/flaps as indicated
```
251
Early administration of blood products must be considered in
class 3 and 4 hemorrhage
252
Delay of few hours: no impact
```
Triage Level
Level 1
Level 2
Level 3
Level 4
Level 5
```
Level 2
253
How is high pressure irrigation to wound done?
. High pressure irrigation (Normal Saline)
. Minimum 100-300 ml with continued irrigation
. At least 8 psi force to the wound (arrow) irrigation fluid dislodges foreign bodies, contaminants, and bacteria
254
After a wound the platelets do this
adhere to damaged endothelium and discharge adenosine diphosphate (ADP), promoting thrombocyte clumping, which dams the wound
255
Pt has green triage color. What are possible wounds?
```
Minor bleeding
Minor soft tissue injuries
Contusions, sprains
Superficial burns
Partial-thickness burns of <20% BSA
```
