PHEC Flashcards
(115 cards)
1
Q
In emergency childbirth, what history should be taken?
A
Duration of pregnancy
Age of expectant mother
Number of previous deliveries.
Previous complications / pregnancies
Any known abnormalities / pre-existing health conditions.
Any illness during pregnancy
2
Q
In Emergency childbirth, what observations should be taken of the mother?
A
Does she look pregnant?
Has she lost mucous plug?
Have waters broken?
Is she having regular, powerful contractions?
Signs of Breathlessness/ Shock?
Signs of Anaemia?
Is the baby moving / kicking?
BP and Urine test
3
Q
In emergency childbirth, what are the 3 immediate treatment aims for the mother?
A
Prevent Infection
Prevent Trauma
Relieve Pain
4
Q
In emergency childbirth, what are the immediate treatment aims for the baby?
A
Resuscitate if required
Maintain body heat
Prevent trauma
5
Q
What are the 4 treatment aims after birth in emergency childbirth.
A
Keep Assessing vitals signs of both mother and baby.
Both to be checked by midwife/ obstetrician ASAP.
Both Kept warm and dry
Mother observed for excessive vaginal bleeding.
6
Q
What are the 3 timings of trauma death?
A
Instantaneous - Seconds to Minutes.
Early- Minutes to hours
Late- Hours to Weeks
7
Q
What are the 3 Stages of impact in an RTC?
A
- The vehicle collides with object.
- Occupant collides with inside of vehicle
- Occupants internal organs collide with each other, or the wall of the cavity that contains them.
8
Q
What is the definition of shock?
A
Series of signs and symptoms, which occur as a result of reduced tissue perfusion with blood. The result of inadequate delivery of o2 and nutrients to all parts of the body, most obviously the skin, kidneys and the brain
9
Q
What are the 5 types of shock?
A
Anaphalactic
Septic
Neurogenic
Cardiogenic
Hypovolaemic
10
Q
What are signs and symptoms of shock?
A
Reduced blood pressure
Increase in pulse and resp rate
Pale, cold, clammy skin.
Poor urine output
Altered Consciousness
Anxiety
Hypoxia, organ failure
DEATH DUN DUN DUN
11
Q
What are the 4 lobes of the brain, and where are they?
A
Frontal lobe - at the front
Temporal Lobe- Middle Lower
Parietal Lobe- Middle Upper
Occipital Lobe - Back
12
Q
What are the 6 components of the central nervous system?
A
Cerebrum
Midbrain
Pons
Medulla Oblongata
Cerebellum
Spinal Cord
13
Q
What are the causes of Unconsciousness? FISHH and SHAPED
A
Faint
Infections (Not all)
Shock
Head Injury
Heart Attack
Stroke
Hypoxia
Abnormal Body Temperature
Poisoning
Epilepsy
Diabetes
14
Q
What are the 3 methods of assessing levels of consciousness
A
AVPU- Quick mini neurological assessment
PEARLA- Quickly assessing pupil size and reaction
GCS- Method to asses motor, verbal and eye response.
15
Q
What do Bilaterally fixed and dilated pupils indicate?
A
Death
Hypoxia
Hypovoaemic Shock
Atropine and Ecstasy
Massive fear response
16
Q
What do Unilaterally fixed and dilated pupils indicate?
A
Brain Injury
Stroke
17
Q
What do Bilaterally pinpoint pupils indicate?
A
Opiate Overdose
Nerve Agent Poisoning
18
Q
What do Irregular pupils Indicate?
A
Trauma
Eye Operations
Stigmatism
19
Q
What are the 3Ps of pain relief- give examples
A
Physical- Spiltage, cooling burns
Pharmacological- Controlled Drugs, Analgesia
Psychological - Reassurance.
20
Q
What are Contraindications for Fentanyl?
A
Hypersensitivity to opiates
Severe respiratory depression
Severe Obstructive lung conditions.
21
Q
When should an MO Be consulted before giving the first dose of Fentanyl?
A
Reduced Consciousness (PU)
Difficulty Breathing
Head Injury
22
Q
What are contraindications for using Penthrox?
A
Shallow / Difficulty Breathing
Unconscious
Liver Damage
Kidney Impairment
23
Q
What is the indication and contraindication of Naloxone?
A
Indication: Opiate related overdose
Contraindication: Known Hypersensitivity
24
Q
At what intervals should IM Naloxone be administered until consciousness regained?
A
Every 2-3 Mins.
25
What are the 6 Types of Burns?
Dry Burn
Scald
Electrical
Cold Injury
Chemical Burn
Radiation Burn
26
What are the 3 depths of burn, and what layers of skins do they affect?
Superficial- Epidermis
Partial thickness- Dermis
Full thickness- Subcutaneous fat
27
How should burns be managed? (10)
Check CABCDE
Cool for at least 20 mins
Give Entonox / high flow o2
Remove constrictions
Remove hot/ wet clothing not adhering to skin
Apply cling film / sterile dressing
Leave facial burns uncovered
Place Extremities in burns bags
Encourage mobility
Treat for shock
28
What should you NOT do with a Burn
Apply creams of lotions
Pop Blisters
Cut away skin
29
What are 6 signs and symptoms of Airway burns
Soot around nose or mouth
Singed nasal hair
Redness, swelling or burning of the tongue
Change in voice
Coughing
Breathing Difficulties.
30
How can airway burns be treated?
Maintain the airway
Ice water to reduce pain and swelling
Oxygen
Pain Relief and Reassurance
Be Prepared to secure the airway early
31
How is smoke inhalation recognised?
Has the casualty been in a confined space with smoke?
Burns or soot around the mouth
Singed nasal and facial hair
Stained Sputum
Swelling around face, lips and mouth
32
What are potential problems from smoke inhalation?
Upper Airway Oedema
Inflammatory Response in Lungs
Tissue Hypoxia
33
What are the Triage Categories for burns?
T1- Airway burn, burns 25% + of body.
T2- burns 12-25% of body, Chemical / electrical burns
T3- Burns under 12%
34
What is the formula for post burns fluid maintenance
4ml x weight in KG x % of burn
/2 (1st half given over 8 hours, 2nd half given over following 16 hours)
35
What are the 3 parts of the operational spectrum?
Operations During Peace
Operations other than War
War
36
What are the 3 parts of the Hazard Spectrum
Trauma / burns
Medical / toxicological
Environmental
37
In Scene Management, what does CSCATTT Stand for?
Command and Control
Safety
Communication
Assessment
Triage
Treatment
Transport
38
On a 9 Liner, which lines does the medic fill out?
3 (Number of patients and priorities)
4 (Special Equipment)
5 Number to be carried lying or sitting.
39
What does METHANE Stand for?
My callsign OR Major Incident (Declared or standby)
Exact location
Type of Incident
Hazards
Access
Number and priorities of casualties.
Emergency services present or required.
40
What are the Indications for an Advanced Airway intervention?
Protect airway from obstruction.
Control oxygenation and ventilation
Inability to clear and maintain airway using simple techniques.
41
Define ET Intubation
Passing of a cuffed endotracheal tube through the vocal cords and into the trachea.
42
What are indications for ET Indications (With and without anaestetic)
Without Anaesthetic
Deeply unconscious casualty
Management of Cardiac Arrest
With Anaesthetic
Casualty Transport
Pre-empt/ potential airway obstruction
management of head or chest injuries.
43
What are contra-indiciations for ET Intubation
Conscious Patients
Trismus
44
What can make ET Intubation difficult?
Trauma
Shape
Pre-existing disease
45
What are 7 potential complications of ET Intubation
Hypoxia
Failed Intubation
Spinal Cord Injury
Damage to teeth, mouth or larynx
Laryngeal spasm
Oesophageal Intubation
Intubation of R Bronchus
46
Define Surgical Cricothyroidotomy
Placement of a small cuffed tracheostomy tube into the trachea via an incision in the cricothyroid membrane
47
What are indications for Cricothyroidotomy
Trauma / burns to face and neck preventing safe ET Intubation.
Conscious casualty
Total upper airway obstruction
48
What are potential complications of Cricothyroidotomy
Damage to Carotid Arteries
Creation of flase passage into tissues
Bleeding
Asphyxia
Aspiration of Blood
Laceration of Trachea / Oesophagus
49
Define Anaphalaxis and name 5 causes
An Immediate, systemic, life threatening allergic reaction.
Causes:
Drugs (E.g. Penicillin)
Blood Transfusion
Foods (E.g Nuts)
Bites (Inc snake venom)
Stings (Scorpions or bees)
50
Define Asthma
Reccuring sudden attacks of difficult breathing characterised by wheezing and difficulty in expiration
51
What categorises moderate Asthma?
Increasing Symptoms
PEFR 50-75% of best predicted
No Features of acute severe asthma.
52
What categories Severe Asthma?
Any one of:
PEFR 33-50% of best or predicted.
RR 25 / min or higher
HR 110 bpm or higher
Inability to complete sentences in one breath.
53
What categories Life Threatening Asthma
PEFR below 33% of best or predicted.
SpO2 under 92%
Silent Chest
Cyanosis
Poor respiratory effort
Arrythmia
Exhaustion
Altered consciousness
Hypotension
54
Define a poison
Any substance which if taken into the body in sufficent amounts may cause harm or even death.
55
How can Opiate poisoning be recognised?
Nausea
Seizures
AVPU - Voice to unresponsive
Euphoria
Pinpoint Pupils
Pale, lips cyanosed
Reduced Resp rate (Less than 10)
Coma
56
How can poisoning be managed?
Full history if possible
Check, clear, maintain airway.
High concentration O2
Ventilation
Assess circulation
Specific Antidote if cause known - Naloxone for Opiates
Evacuate ASAP and bring any evidence.
57
What are the 4 stages of shock?
Initial
Compensatory
Progressive
Refractory
58
How can Hypovolaemic shock be treated?
Control and Bleeding, Internal / external
Fluid Resuscitation: Boluses of 250ml Crystalloid fluid until radial pulse detected.
59
What are 4 indiciations for IV Access?
Administration of Drugs
Access for fluid resuscitation
Prior to a chest drain
Prolonged entrapment
60
with what 4 conditions must care be taken when administering fluids?
Isolated Head injury with suspected ICP
Renal trauma
Cardiac Failure
Cerebro Vascular Accident (Stroke)
61
What 7 Pieces of equipment are required for cannulation?
Disposable Tourniquet
Cannula
Cleaning product
10ml Syringe of saline flush
PPE
Dressing
Sharps box.
62
What are the 7 early complications of Cannulation?
Perforation of Vein
Haematoma
Damage to other structures
Air Embolus
Shearing
Needle Breakage
Extravasation
63
What are 3 late complications of cannulation?
Thrombophlebitis - Inflammation of vein just under the skin
Localised infection
Systemic Infection
64
What are 6 indications for gaining IO Access?
Emergency Vascular Access
Major Burns
Profound Shock
Overwhelming Sepsis
Cardiopulmonary Arrest
Other methods have failed,
65
What are 2 contra-indications for FAST-IO
Under 12 Years old
Sternotomy
66
What are 3 contra-indications for IO Access (EZ and FAST)
Fractures
Infection
Osteoporosis
67
Where are the 2 sites for EZ-IO Insertion in adults, and what size needles are used for each?
Tibial Tuberosity - Blue 25mm
Head of Humerus- Yellow 45mm
68
what are 4 complications of IO Access?
Painful to use
Extravasion due to poor placement
Compartment Syndrome
Infection
69
Define 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.
70
What are the 3 indications for needle thoracentesis?
Tension Pneumothorax
Developed open pneumothorax
MOI
71
What are 3 potential complications of needle thoracentesis
Pneumothorax
Local haematoma
Local or Pleural infection.
72
Define Pneumothorax
Air or gases in the pleural cavity.
73
How can a simple / open Pneumothorax be recognised?
MOI
Tachypnoea
Dyspnoea (Shortness of breath)
Obvious wound
Reduced or unequal chest movement
Emphysema
Cyanosis
Reduced or absent air entry
Hyperresonance
Localised pain on palpation
74
How should open Pneumothorax be manged?
Safety
Check, clear, maintain airway.
100% O2
RISENFALL
Apply chest seal
Exit wounds sealed with airtight dressing.
Reassess breathing
Complete primary survey
Evacuate ASAP
75
Define Tension Pneumothorax
Air enters the Pleural cavity through a one way valve defect in the lung, causing progressive increase in intra-pleural pressure, leading to collapse of the lung and circulatory impairment.
76
What are the 5 effects of Tension Pneumothorax
Compression of the lung
Mediastinal Shift (Displacement of central chest organs)
Compression of heart and its blood vessels
Cardiac Arrest
Death
77
What are 7 signs and symptoms of tension Pneumothorax
Absent breath sounds of injured side
Distended neck veins
Hyper-resonance on injured side
Tracheal deviation away from injured side (Late stage)
Altered level of consciousness
Cyanosis
78
How can Tension Pneumothorax be treated?
Check clear maintain airway
Give oxygen
RISENFALL (Recognition)
If 3 positive signs are found then qualified person can decompress the chest.
79
Define Haemothorax
Presence of blood in the chest cavity. Pleural space fills with blood due to lacerated blood vessels in thorax. Blood fills lung putting pressure of heart and good lung. Each lung can hold up to 2 Litres of blood.
80
How can Haemothorax be recognised? (9)
MOI
Tachypnoea / Shortness of breath
Obvious wound
Reduced chest movement
unequal chest movement
unexplained shock
Hypo-resonance and Reduced breath sounds
Pain on palpation
Cyanosis
81
Define Flail chest segment
2 or more ribs broken in 2 or more adjacent places
82
What is Compressible Haemorrage
External bleeding.
83
How does celox work?
A compound on the surface of the gauze interacts directly with red blood cells to form a clot at the site of the Injured vessels. It must be held in for 1 min to allow it to work properly.
84
How should amputated parts be preserved?
Rinse the part free of debris with cool, sterile, saline.
Wrap loosely in saline gauze
Seal inside a plastic bag
Keep it cold but don't freeze
Never warm amputated part
Never place in water
never place directly on ice.
85
What is the typical blood loss for a fractured rib?
150ml
## Footnote
Typical blood loss varies by injury type.
86
What is the typical blood loss for a closed femoral fracture?
1.5l
## Footnote
This refers to the estimated blood loss associated with this specific injury.
87
What is the maximum blood loss for a haemothorax?
Up to 2l each side of chest
## Footnote
Haemothorax occurs when blood accumulates in the pleural cavity.
88
What is the typical blood loss for a closed tibial fracture?
500ml
## Footnote
This is the estimated blood loss associated with a tibial fracture.
89
What is the typical blood loss for a fractured pelvis?
3l +
## Footnote
Pelvic fractures can lead to significant blood loss due to vascular structures in the area.
90
What is the volume of a fist-sized blood clot?
500ml
## Footnote
This volume can indicate significant bleeding.
91
What is indirect pressure?
Site where artery can be compressed against firm underlying surface
## Footnote
This technique is used to control bleeding.
92
What is the definition of an open wound?
Disruption in continuity, including burns
93
What are the signs and symptoms of a fracture?
Tenderness/pain at the site of injury
Deformity
Inability to move
Possible reduced sensitivity
Possible loss of distal pulse
94
What is a comminuted fracture?
Bone has fractured into many pieces
## Footnote
This type of fracture is often severe and complicated.
95
What is an open/compound fracture?
The bone is fractured and protruding through the skin
## Footnote
This type of fracture carries a high risk of infection.
96
What is a closed/simple fracture?
The bone is fractured without a break in the skin
## Footnote
This type of fracture is generally less complicated than open fractures.
97
What characterizes a closed wound?
Blunt trauma causing damage to underlying soft tissue without skin break
## Footnote
Closed wounds can include fractures and internal bleeding.
98
What are the signs of internal hemorrhage?
Increase in pulse rate
Swelling over the site
Tenderness on touch
Hypo-resonance within the chest
Rigid areas felt over the abdominal area
## Footnote
Recognizing these signs is crucial for timely intervention.
99
What is a complicated fracture?
Bone ends cause injury to important structures of the body
## Footnote
This type of fracture requires careful assessment and management.
100
What is a dislocation?
Injury at a joint where bone ends are out of proper position
## Footnote
Dislocations can severely impact joint function and require immediate care.
101
What should be checked before evacuation regarding IV/IO?
IV and IO are secure
## Footnote
Check using adhesive tape, SAM splint, and crepe bandage for IV; use the kit supplied for IO.
102
List types of immobilisation methods.
Triangular bandages
Fracture straps and bandages
Slings
Splints
Cervical collars
Long board
## Footnote
These methods are used to stabilize and protect injured areas.
103
What are the aims of splinting?
Support
Immobilize
Elevate
Relieve pain
## Footnote
These aims help in minimizing movement and pain of the injured area.
104
What is the purpose of a Kendrick traction splint?
Used for stabilizing fractures, particularly in the leg
## Footnote
It allows for proper alignment and reduces pain during transport.
105
What makes us suspect a pelvic injury?
Mechanism of injury (MOI) such as blast, fall from height, RTC, double leg amputation
## Footnote
These situations are indicators of potential severe pelvic injuries.
106
What is the importance of securing IV/IO lines?
Prevents dislodgement and ensures effective administration of fluids and medications
## Footnote
Secure lines help maintain treatment continuity and patient safety.
107
What does the acronym HITMAN stand for in pre-evacuation checks?
Head to toe examination
Infection
Tubes
Medication
Analgesia
Nutrition & hydration
Notes & Documentation
## Footnote
A systematic approach to ensure comprehensive assessment before evacuation.
108
What does Role 1 MTF provide?
Routine primary health care, specialised first aid, triage, resuscitation, stabilisation, prep for transfer, CASEVAC/IMEDEVAC from patient of wounding
## Footnote
Role 1 is the most basic level of medical treatment in the field.
109
What distinguishes Role 2 MTF from Role 1 MTF?
More equipped than Role 1, provides advanced trauma care, emergency surgery, MO led resuscitation and stabilization, field laboratory capability, limited holding capability, basic imaging capability, primary surgery, surgical and medical intensive care capability, and nursing beds
## Footnote
Role 2 MTF is still close to the combat zone.
110
What is the primary function of Role 3 MTFs?
To provide theatre secondary health care within the restrictions of the Theatre Holding Policy
## Footnote
Role 3 includes surgical support at primary surgery level, ICU, nursed beds, and diagnostic support.
111
What types of care are included in Role 4 MTF?
Definitive care, specialist surgical and medical procedures, reconstructive surgery, and rehabilitation
## Footnote
Role 4 MTF is likely to be located in the UK.
112
Fill in the blank: Role 1 MTF includes _______.
[routine primary health care, specialised first aid, triage, resuscitation, stabilisation, prep for transfer, CASEVAC/IMEDEVAC from patient of wounding]
113
True or False: Role 2 MTF provides emergency surgery.
True
114
List the capabilities of Role 3 MTF.
* Surgical support at primary surgery level
* ICU
* Nursed beds
* Diagnostic support
115
What is the main focus of Role 4 MTF?
Definitive care and rehabilitation
## Footnote
This includes specialist surgical procedures.
