Paramedic - Major Trauma Flashcards by Binyameen Imran

What are the different methods used to control external cat Hem

1) direct pressure - hands, haemostatic gauze,
2) indirect pressure - tourniquet, blast bandage

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Why should times be taken when tourniquet are applied

Over 2 hour increase risk of ischemia post isolation point. Rabdomutlsis compartment syndrome, nerve damage, tissue death

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What does the first c stand for I’m drccabc

Cat hem

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What is the 1st collum in the major trauma triage tool (WMAS) - vital signs

Respiratory rate - 10-29 (outside problem)
Bp: under 90mmgh - (problem )
GCS : moter score less than 4

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What is the second column in trauma triage tool (WMAS) - anatomy (full body)

Any depressed or open skull fracture
Any chest injury with hypoxia
Any torso penetration trauma
Any spinal injury with paralysis
Major pelvic injury
2+ long bone injury
Any amputation /open fracture / or mess above ankle and wrist

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Where do major trauma patient go

MTC - major trauma centre

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What is silver trauma safety net: + what is the age range for this to be in place

Patient must be over 65 with
-Bp of under 110 post injury
-Any femur or open fractures
-Hugh mechanism of injury

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when you attended any patient especially children, elderly and vulnerable people - what should you ensure matches id the incident is accidental or intentional think safeguarding

Does the history, match the presentation match what I know about a&p

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What does DRCCABC stand for

Danger
Response
Cat hem
C spine
Airway
Breathing
Circulation

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In a CAR RTC - frontal impact. What types of injuries are more likely.
Quick stop - delegation

Up and over
Chest - hit steering wheel
Abdominal - hitting steering wheel

Down and under
Knee hit under steering
Face plant into steering wheels

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In a car RTC - rear impact what is the likely injuries.

Neck - quick flextion and extension.
Whip lash

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I’m a car RTC with Lateral impact.
What are the suspected Injuries

Injuries to impact side - arm, pelvis
Rational of neck

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I’m a car RTC with rotational collision what are the suspect injuries

Combination of frontal and lateral
Person closest to impact = worse injuryies

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In a car RTC with roller over
What are suspect injuries

All types. With person not wearing seatbelt - will be in the front out out of the car.

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in a RTC - car vs predestrian, what are the suspected injuryies

hip and leg - from inual impact
torso - from hitting windscreen
head- from hitting ground

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in a RTC - pedestrian vs car - adult vs child, where do you suspect they will have injuries ( posterior/ anterior and why

child - anterior = they look at th vechile and freeze
adult - posterior - they tend to run away

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what are the managment principle of DR CCABCde

c– Control of exsanguinating haemorrhage
ca– Airway and cervical spine control
B– Breathing with high-flow oxygen
C– Circulation with haemorrhage control
D– Disability with prevention of secondary injury
E– Exposure with temperature control

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what are the main point for cat hem to occur

injury site
junctional areas - axilla, neck groin, perituim

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when dealing with petrating chest injury what is the preferable bandage to apply

Russel chest seal - valve - air out not in = less chance of tension pneumothorax

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how to apply a cat hem torniquet
- what must you note

Identify site needs bleed stop
2/3 cm above
Clip on and tighten
Twist to further close and secure
Ensure to mark the time ( 2 hours plus = risk of rando/ compartment syndrome

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how di you apply a kendrick traction splint
- what are the pre and post check before traction

Measure bar against good leg
Place blue strap against the groin
Get the ankle strap lengthen the orange strap
Fix the ankle strap on the ankle
Place the bar peg bit on the orange bit
Get the knee strap on
Place traction via the red strap
Fix the leg in place via the traffic light system
Recheck leg - pulse and cap refill & warmth & sensation( feel) and moter

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how do you apply a pelvic binder

Make sure patient is trauma naked
Open the binder
Place black side under patients knees
Slide it up so the middle of the minder is against the greater trochontor
Cut the binder
Get the straps on
Apply equal strength and secure the binder

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what is the algorium used for the management of traumatic cardiac arrest

HOTT
H- Hypovolemia = stop cat hem, 2L saline rapid, binder and straight legs, TXA
O- Oxygenation = 15L bvm
T- Tension pneumothorax - bilateral needle
T- cardiac tamponade - merit

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how does a paramedic manage the “A” in DRCCABCDE

P- patient

V - voice

B- bone ( teeth / jaw

L - liquid ( vomit/ Blood - where from ( tongue gums vomit)

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how does a paramedic manage the "B" in DRCCABCDE

through 12 flaps Tracheal Deviatio n Wounds Surgical Emphysema Laryngeal Fracture Distended Neck Veins evaluate - IPPA **PLACE PATIENT ON 15L OF O2** any raise in RR or in dropped RR with profound trauma - peri arrest DO NOT Rely on spo2 - lack volume ( remaining blood full saturated)

what is the mnemonic to remember the cavities in the body for internal haemorrhaging

blood on the floor and 4 more -check: chest abdomen pelvis long bones

how does a paramedic manage the "c" in DRCCABCDE

-check pulses - rate, quality (strong ect) -Check skin - colour ( 02 / perfusion) -check capillary refill -blood on the floor and 4 more- check chest abdomen pelvis long bones

how does a paramedic manage the "D" in DRCCABCDE

Head injury GCS pupils Bm + temp + alcohol/ drugs check Sensation + move each limb

how does a paramedic manage the "E" in DRCCABCDE

coldness - trauma naked (prevent hypoxia

what is **COMA** in trauma

clothing oxygenation montering access (IV/IO)

how long can the heart and brain last without oxygen before coming ischemic

4-6 minutes

how long can the abdomen and last without oxygen before coming ischemic

45 minutes

how long can the peripheries last without oxygen before coming ischemic

4-6 hours

-what generates hydorstatic pressure -what happens if the pressure is too high/low

pressure generated by the heart - 2 mcuh water leaves blood, 2 less no blood movement

how can you work out pulse pressure

systolic - diastolic = pulse pressure ( 120-80=40)

what is MAP what is it a measure of What is the normal range

Mean arterial pressure - measures end organ prefusion- normal map is 70-100mmgh

what is the normal valves of MAP

70- 100mmgh

what is shock

hypoperfusion of organs leading to change in rr - problem with cardiac ouput and o2 supply therfore kidney failure = death

what is the key in preventing worsening of shock

02 and glucose

how does shock cause decrease in cardiac output

lack of blood flow to pumonary veins and vena cava - less fill = less strech = less force of contraction = less stroke volume

what is oncotic pressure

the pull of water from the outside into the blood via the solutes in it

why is having to much water ( oedema ) in the intercial space a bad thing

creates a barrier stopping oxygen getting to the cell - facilitating anaerobic respiration

When the body is experiencing shock ( hypovolemic) what pathway is activated - what are the action on of this

Sympathetic pathway Increase RR and HR due to adrenline Vasoconstriction of peripheral circulation - started anaerobic respiration periphery

What is a sign of irreversible shock also known as the switch from compensation to decomposition

Drop in blood pressure - volume loss to great

How many stages of hemorrhagic shock are. There

What is classified as 1st stage hemorrhagic shock

Upto 750ml - no signs

What is classified as 2st stage hemorrhagic shock

Upto 1500ml of blood - tachycardia + tachponea + decreased pulse pressure = Fluids

What is classified as 3st stage hemorrhagic shock

Upto 2000ml of loss Tachycardia - 130++++ Tachypnea - 30++++

What is classified as 4th stage hemorrhagic shock

Loss of 2000ml +++ HR - high 130 +++ Rr - 35+++ BP below 90mmgh systolic Confused

What is distributive shock

Problem with pipes Pipes bigger than blood supply - vasodilation

What are the sign of neurogenic shock

Low BP but **NO TACHYCARDIA** Vasodilation past injury site - **warm**, perfused ect **Widening pulse pressure** Should be treated same as hypovolemic pt

What are the clinical signs of hypovolemia

Weak pulse **Sweaty cold cyanotic skin** **Delayed CRT** Loc or.confusion

What is cardiogenic shock

Problem with the pump Electrical mechanical - causing lack of blood flow **Cool clammy cyonosed skin** **Delayed cap refill**

What is a tension penumothorax

Air enter into the pluerix space Causes pressure on lung - reducing inflation = lack O2 for RBC - shock

What is valvular disruption

Sudden force direct on heart - causes defect with heart valves - causes acute heart failure - odema New heart murmur

What is cardiac tamponade

When blood or fluids fill the pericardial sack - compressing and rigidity to the heart muscle - eventually stopping movement = cardiac arrest

What are the signs of life threatening conditions in major trauma ( Phbts w

Pulses - absent radial or peripheral Tachycardia -120+ Breathing - quick Hypothermia - cold Skin - cyanosis or pale Thirst

If the patient RR is above 30 what should the clinician do

BVM

What is the guidelines for fluid resuscitation - peripheral or blunt

To maintain a palpable radial pulse or BP of 90mmgh in penetration or blunt

What is the guidelines for penetrative trunk injury

Maintain a central pulse or a BP of 60mmgh - in all other injury's a BP of 90mmgh or radial pulse

What is permissive hypotension

When you give fluids increase BP but not to normal non trauma values

Why is promissive hypotension a thing

As fluid = increased hydodtatic pressure - blowes clots Can slow down bleed internally by not diluting clotting factors left

What is the fluid resuscitation guidelines on burns coving over 25% BSA

Give 1L over 1 hour

What is a drug given to patients who have severe bleeding within 3 hours and what is the pathophycology of the drug

TXA stop the breakdown of clots to plasmin and stabilisers the clots

Why is preventing hypothermia important in trauma patients

Under 36 degree it affects the clothing process

What is the trauma triad

What are signs of larageal obstruction ( cartilage breakage

Horse or changed voice Stidor

How can a person be hyperventilating but still be a dropping sats rate

Due to shallow breaking - tidal volumes 500ml + 150 dead space - reduced tidal volume = shit

Why is over infusion of saline bad or why is permissive hypotension good

As it prevent water leakage in-between the intrsuiual space - barrier for O2

Your arrive to patient who is gurgling or snoring - what the cause and what's the difference

Obstruction - giggling= fluid, snoring - tongue to debree

What is the effect of hypoventilation

co2 build up = blood acidic increase and anaerobic respiratorn

What is the effect of hyperventilation

Vasoconstriction - causes worsening tbi

Paramedic - Major Trauma Flashcards

(72 cards)