PHEC Circulation Flashcards

Question

IO Access Definition

Answer 1

Process of injecting directly into the marrow of a bone to provide a non-collapsible entry point into the systemic venous system. This technique is used to provide fluids and medication when intravenous access is not available or not feasible

Answer 2

EZIO needle size: Pink 15mm for use in paediatric Blue 25mm for adults (Tibial tuberosity) Yellow 45mm for muscular or obese adults (Head of humerus)

Answer 3

In order of preference: Tibial plateau Sternum (FAST) Humeral head

Answer 4

EZIO Identify site for use Select correct needle size Clean site Drill into place Small gap between needle hub and skin Draw off sample Flush

Answer 5

Expose site – to be used in sternum only Clean site Adopt position stood over top of patient facing their feet Correctly place dressing Hold like golf club Insert Withdraw sample Flush 2mls rapidly to expel bone plug Apply protective cover

Answer 6

Fractures Infection Osteoporosis FAST only: Under 12 years Sternotomy

Answer 7

Painful to use Compartment syndrome Infection Extravasation due to poor placement - The leakage of blood, lymph, or other fluid, Complications are rare and tend to be related to prolonged use

Answer 8

Thermal – Cold, Scald, Dry Burns Electrical Friction (also a dry burn) Chemical Radiation

Answer 9

Superficial, Partial and Full Thickness

Answer 10

Epidermis only Red, swollen and tender Self-limiting E.g. sunburn Will be painful and irritable

Answer 11

Epidermis and dermis are damaged Wet, visible skin loss Broken skin Infection risk Raw skin with blisters Can be painful This type of burn makes your skin turn red and blotchy. Your skin may also be dry or moist, become swollen and blistered, and it may be very painful or painless

Answer 12

All three layers of skin (the epidermis, dermis and subcutaneous) are damaged. All the way through the dermis and into subcutaneous tissue Black/white leathery appearance Possible damage to underlying structures Involves all layers of skin Pain is very low on full thickness burns Skin often burnt away and the tissue underneath may appear pale or blackened. Remaining skin will be dry and white, brown or black with no blisters.

Answer 13

Wallace’s Rules of Nines Head & neck 9% Chest & abdomen 18% Back 18% Arm & hand 9% Leg & foot 18% Genital region 1%

Answer 14

Early recognition and evacuation is Essential. Soot around the nose or mouth - Check inside the mouth and tongue. Look for stained sputum and swelling of the face, lips, mouth and a horse voice Singed nasal hair. Redness, swelling or actual burning of the tongue Change in voice (Hoarseness/Stridor). Coughing Breathing difficulties.

Answer 15

Early recognition and Evacuate to Hospital Urgently Maintain the Airway! Ice or water to reduce swelling and pain (sips) Oxygen Pain Relief and Reassurance. BE PREPARED TO SECURE THE AIRWAY EARLY

Answer 16

Has the casualty been in a confined space? Burns or soot around mouth/nose Singed nasal and facial hair Stained sputum Swelling around face, lips or mouth Hoarse voice Coughing

Answer 17

Upper airway oedema Inflammatory response in the lungs Tissue hypoxia

Answer 18

Maintain airway and give humidified oxygen Bronchospasm may occur and is treated with nebulised salbutamol (5mg in 5ml) Nebulised medication Urgent evacuation

Answer 19

Consider the cause of the burn Airway – Has the airway been compromised? Extent – How much of the body is affected? Location – Where on the body? Depth – Superficial, Partial or Full Thickness Environment – Enclosed space, toxic fumes, secondary risks.

Answer 20

Check ABCDE Cool for at least 20 mins Entonox/high concentrations of oxygen Remove constrictions Remove hot/wet clothing not adhering to skin Apply cling film/sterile dressing – strips or concertina Leave facial burns uncovered Place extremities in burns bags Encourage mobility Treat for shock

Answer 21

Apply creams or lotions Pop blisters Cut away the skin

Answer 22

Evidence of chemicals within the vicinity Intense stinging pain Discoloration, blistering and peeling of the skin Swelling of the affected area

Answer 23

Treatment the same as burns. Emphasis on removing chemically contaminated constrictions/clothing where possible

Answer 24

Suspected inhalation injury (airway burn) – T1 Burns >25% of total body surface area – T1 Burns 12-25% of total body surface – T2 (Unless factors indicate T1) Burns <12% of total body surface – T3 (Unless factors indicate T1 or T2) Chemical / Electric burn T2 (Unless factors indicate T1)

Answer 25

Hourly fluid maintenance, given for 24 hrs post-burn Fluid maintenance will start from the time of burn The hourly rate of fluids will change after 8 hours Start fluid maintenance in Prolonged casualty care / Role 1

Answer 26

4ml x Weight kg x % of burns = total fluid requirement in 24hrs Then divide by 2 and the first half will be given over 8hrs and the second half will be given over 16hrs

Answer 27

The amount of fluid that should have been given in the time that elapsed, from the time of burn, to the fluid maintenance starting. Any fluid already given within that time is to be deducted from the amount Fluid deficit to be added to the first hour of your 24hr fluid maintenance Start 24hr fluid maintenance from actual hour after deficit time + first hour.

Answer 28

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, most obviously the skin, kidneys and the brain. A loss of / lack of circulatory fluid

Answer 29

Stage 1: Initial Stage of Shock Stage 2: Compensatory Stage of Shock Stage 3: Progressive Stage of Shock Stage 4: Refractory Stage of Shock

Answer 30

The first of the stages of shock is reversible, but there aren't any signs to indicate shock at this stage. Cells begin to change due to issues with perfusion and oxygenation. Perfusion is the method used by arteries to deliver blood to capillary beds in body tissues. Without this nutritive blood and an adequate oxygen supply, the cells switch to anaerobic metabolism, producing pyruvic and lactic acid

Answer 31

During the compensatory stage of shock, the body tries to reverse the results of the initial stage. Physiological, neural, hormonal, and biochemical reactions are employed to correct the imbalances. Hyperventilation is one such mechanism. This causes an increased rate of breathing which, in turn, may help to get more oxygen flowing to the cells and neutralize the newly acidic conditions. Another mechanism is the catecholamine response. Hypotension, or low blood pressure, due to the reduced volume of blood flow triggers this response. Catecholamines are hormones released by the adrenal glands. These hormones increase heart rate and attempt to increase blood pressure. A third mechanism used in the compensatory stage of shock is the renin-angiotensin response. During this response, a hormone called vasopressin is released into the bloodstream. Vasopressin helps to retain fluid and triggers vasoconstriction.

Answer 32

If the stages of shock progress to the third stage before the initial cause is corrected, damages become more severe and can be irreversible. Cellular function continues to deteriorate, anaerobic metabolism leads to increased metabolic acidosis, and the compensatory mechanisms can no longer maintain the balance required to protect the organs.

Answer 33

The stages of shock will eventually lead to the refractory stage if the cause of shock cannot be fixed. At this stage, the organs completely fail and lead to death. It is important to understand the stages of shock in order to recognize and prevent the progression to this final stage.

Answer 34

Anaphylactic Septic Hypovolaemic Neurogenic Cardiogenic

Answer 35

A severe and rapid and sometimes fatal hypersensitivity reaction to a substance (especially a vaccine or penicillin or shellfish or insect venom) to which the casualty has become sensitized by previous exposure.

Answer 36

Unable to speak more than one or two words, sitting straight up or with hands on knees, gasping for breath, wheezing (SOB), pursing lips to breathe, using neck muscles to take breaths, urticarial (hives), itching, confusion, weakness, swelling, pallor and unconsciousness . Reduced BP and SpO2, and high HR

Answer 37

Septic Is a serious medical condition that occurs when sepsis, which is a body-wide inflammatory response to infection, leads to dangerously low blood pressure. The primary infection is most commonly caused by bacteria, but can also be by fungi, viruses, or parasites, and can be located in any part of the body, but most commonly in the lungs, brain, urinary tract, skin, or abdominal organs. It can cause multiple organ dysfunction syndrome (formerly known as multiple organ failure) and death

Answer 38

Refractory hypotension (low blood pressure that does not respond to treatment), a change in your mental state – such as confusion or disorientation, diarrhoea, nausea and vomiting, cold, clammy and pale skin, tachypnoea, temp equal to/above 38.3C or under 36C

Answer 39

A type of shock that is caused by the sudden loss of signals from the sympathetic nervous system that maintain the normal muscle tone in blood vessel walls. The blood vessels relax and become dilated, resulting in pooling of the blood in the venous system and an overall decrease in blood pressure. Neurogenic shock can be a complication of injury to the brain or spinal cord.

Answer 40

Hypotension, cardiac arrest, warm, dry skin, tachycardia, weak pulse, tachypnoea, reduced tissue perfusion, shallow breathing, dull eyes, altered mental state (confusion), weakness, anxiety, hypothermia, dry mouth, fatigue, cyanosis, chest pain

Answer 41

A life-threatening medical condition resulting from an inadequate circulation of blood due to primary failure of the ventricles of the heart to function effectively as the heart is too weak to pump enough blood to meet the body’s needs

Answer 42

Confusion or lack of alertness, loss of consciousness, sudden and ongoing tachycardia, sweating, pale skin, weak rapid pulse, tachypnoea, decreased or no urine output, cool hands and feet

Answer 43

State the signs and symptoms of shock In most cases of shock, the skin is typically pale and cool, whereas in early septic shock and neurogenic shock it is often warm and pink. Reduced blood pressure Increase in pulse and respiratory rate Pale, cold and clammy skin Poor urine output Altered conscious level Anxiety Hypoxia, organ failure Death

Answer 44

Hypovolemic shock is a dangerous condition in which your heart can’t get your body the blood (and oxygen) it needs to function. This is due to losing a large amount of fluid (15-20% of blood volume) through blood loss, burns, sweating or diarrhoea / vomiting. May result from: Whole blood or plasma loss or Fluid and electrolyte loss. Most common form of shock in trauma

Answer 45

Peripheral Vasoconstriction Hyperventilation/Tachypnoea Reduced Pulse Pressure Sweating General: Pallor Confusion and Anxiety Loss of consciousness Tachycardia

Answer 46

Control any bleeding. Internal/external Fluid resuscitation: Boluses of 250ml crystalloid fluid until radial pulse is detected

Answer 47

Forearm, Wrists and Hands. Cephalic Vein, Basilic Vein, Accessory Cephalic Vein

Answer 48

Stage 1: Up to 750ml / up to 15% Stage 2: 750-1500ml / 15-30% Stage 3: 1500-2000ml / 30-40% Stage 4: More than 2000ml / >40%

PHEC Circulation Flashcards

(72 cards)