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Emergency Care: Castro > Quiz 3: Head traumas, drowning, FBAO, and OD > Flashcards

Quiz 3: Head traumas, drowning, FBAO, and OD Flashcards

1
Q

Which of the following are signs and symptoms of FBA?

  1. Acute onset
  2. Cough
  3. Dyspnea
  4. Bradycardia
  5. Unilateral wheezing/stridor
A

1, 2, 3, and 5

Bradycardia is not a sign of FBA. Tachypnea and tachycardia are some S/S associated with FBA.

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2
Q

T/F: Cyanosis and retractions are a possible sign of FBAO.

A

True. Cyanosis and retractions are signs depending on the degree of obstruction. Worse retractions = worse obstruction.

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3
Q

If object went below the ____, it is considered aspiration.

A

Cords

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4
Q

T/F: Crackles or wheezing can be a sign of FBAO.

A

True

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5
Q

What percent of FBAs go to right main stem bronchus in adults?

a. 30%
b. 50%
c. 70%
d. 90%

A

c. 70%

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6
Q

What are some classic signs of FBAO on a CXR?

  1. Air-trapping on expiration
  2. Atelectasis
  3. Pneumothorax
A

1 and 2

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7
Q

What is the treatment for FBAO?

A

Rigid bronchoscopy. Or ACT if necessary.

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8
Q

When are tracheotomies performed for patients with FBAO?

A

When large foreign body is subglottic or in proximal trachea and -
unable to removed,
too big or sharp to pass back through glottic opening,
or significant laryngeal edema.

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9
Q

Drowning causes ____ leading to cardiac arrest.

A

Asphyxia

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10
Q

What is cold shock cardiac reflexes?

A

Sudden immersion in <25 degrees C water. Breathing becomes shallow, vasoconstriction and increase SVR can lead to cardiac collapse.

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11
Q

T/F: Wet drowning is when laryngospasm with glottic closure prevents aspiration of large amounts of liquid, and dry drowning is when the liquid is completely aspirated.

A

False. Other way around. Wet drowning is when liquid is completely aspirated.

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12
Q

Why is the type of water aspirated important to know?

A

Different types of aspiration cause disruptions in respiratory function and blood chemistry.

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13
Q

Aspiration of large volumes of water regardless of type almost always leads to:

a. ARDS
b. bronchospasm
c. pneumonia
d. bronchiectasis

A

a. ARDS

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14
Q

Which type of water can introduce pathogens, therefore infections?

a. freshwater
b. salt water
c. fluvial/brackish
d. stagnant

A

c and d

Both fluvial/brackish and stagnant/contaminated can introduce pathogens and lead to secondary complications/infections. Pneumonitis and ARDS.

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15
Q

Which of the following are treatments for drowning?

  1. Vital signs
  2. O2
  3. Bronchodilators
  4. Bronchoscopy
  5. Proning techniques
  6. Apnea testing
A

All except apnea testing.

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16
Q

How is decompression sickness (bends) caused?

A

Ascending too quickly from depth.

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17
Q

T/F: Decompression sickness applies to both scuba and free diving.

A

False. Only applies to scuba diving. Free divers must worry about ascent hypoxia.

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18
Q

“As a diver goes deeper in the water, the pressure around them increases which left unchecked would decrease the volume in the lungs to the point of collapse” is describing which law?

A

Boyle’s Law

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19
Q

“The result is gas being inhaled at above-atmospheric pressure. This means the partial pressure of the gases in the breathing mix have gone up and are more soluble in the divers’ blood” describes which law?

A

Henry’s Law

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20
Q

Why does ascent time matter?

A

Because it is very easy to dissolve gas in blood at a high pressure. Gas bobbles can form in the tissues, joints, and blood stream and eventually lead to an air embolism.

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21
Q

How is decompression sickness prevented?

A

By using proper ascent time and hold times when diving.

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22
Q

What is the common therapy for decompression sickness?

A

Hyperbaric chamber

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23
Q

How does a hyperbaric chamber work?

A

Physician prescribes pressure (atm) and duration of tx to replicate or exceed divers depth. Increased pressure forces gas bubbles back into solution, then hyperbaric chamber is slowly decompressed.

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24
Q

What are some other uses of the hyperbaric chamber?

A

CO poisoning, wound healing, crush injuries, and acute peripheral ischemia.
CO has 200x the affinity for Hbg than O2.
Ex: FiO2 1.0 at 3 ATA is 23 minute half life

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25
Q

What are toxidromes?

A

A group of S/S used as a basis for diagnosis of poisoning.

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26
Q

Which of the following are opiods?

  1. Alprazolam
  2. Meperidine
  3. Codeine
  4. Hydrocodone
  5. Fentanyl
A

All except 1, Alprazolam (xanax). Xanax is a benzo.

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27
Q

What poisoning is associated with methemoglobinemia?

A

Nitrate poisoning

28
Q

T/F: Albuterol is an alternative treatment for hyperkalemia.

A

True

29
Q

What kind of breathing is a sign of DKA?

A

Kussmaul’s breathing

30
Q

T/F: Men have a higher chance of TBI than women.

A

True

31
Q

What are the “lines” between the skull bones called?

A

Sutures

32
Q

What 3 layers make the protective layer of meninges?

A

Dura
Arachnoid
Pia Matter

33
Q

Which cranial nerve is in charge of pupil activity?

A

3rd cranial nerve

34
Q

The 3rd cranial nerve is what kind of nerve?

a. sympathetic
b. muscarinic
c. parasympathetic
d. anticholinergic

A

c. parasympathetic

35
Q

What does the acronym PERRLA stand for?

A

Pupils should be Equal, Round, Reactive to Light and Accommodation.

36
Q

T/F: Skull fractures are when only certain bones of the skull are broken.

A

False. Break in continuity of any bones of the skull. Diagnose with xrays/CT scan.

37
Q

T/F: Primary head injuries is immediate trauma damage, while secondary injury is anoxia because of the time without effective O2 delivery.

A

True

38
Q

T/F: Linear skull fractures are the most common and usually require no intervention.

A

True

39
Q

T/F: Diastatic fractures are most common in young children.

A

True

40
Q

T/F: Brain injuries can only occur with open head injuries.

A

False. Can occur in both closed and open head injuries.

41
Q

T/F: A cerebral contusion is another way of saying concussion.

A

False. A cerebral contusion is a bruised brain (critical) while a concussion is temporary alteration in LOC.

42
Q

Which of the following intracranial hemorrhages are bleeding within the SKULL?

  1. Intracerebral hemorrhage
  2. Epidural hemorrhage
  3. Subdural hemorrhage
  4. Subarachnoid hemorrhage
A

2, 3, and 4.

Intracerebral hemorrhage is bleeding within the brain parenchyma. “Intracerebral” is a big giveaway!
Same goes for intraventricular hemorrhage.

43
Q

T/F: Both bleeding within the skull and brain parenchyma can increase ICP.

A

True

44
Q

T/F: Epidural hematomas are venous bleeding while Subdural hematomas are arterial bleeding.

A

False. Subdural is venous, epidural is arterial.

Just think “E with A” (both vowels) and S with V (not vowels).

45
Q

If a patient is unconcious for more than __ minutes, you should suspect more serious injury.

a. 3
b. 5
c. 10
d. 15

A

b. 5 minutes

46
Q

What is the most important assessment for head injuries?

A

Altered level of consciousness

47
Q

T/F: Raccoon eyes (Periorbital Ecchymosis) and Battle’s sign (mastoid ecchymosis) are late signs of brain injury.

A

True

48
Q

T/F: Nasal airways are the preferred artificial airways.

A

False

Oral or tracheal airways are preferred, while nasal airways are contraindicated.

49
Q

Intubation is indicated at what GCS score?

A

<8

50
Q

Are higher or lower scores better for GCS?

A

Higher

51
Q

When monitoring ICP, you should always keep pressure at what level?

A

<15 mmHg

52
Q

T/F: GCS is not useful after patient is sedated. It must only be done during early interactions with the patient.

A

True

53
Q

Which of the following factors are relevent in evaluating and describing LOC with GCS?

  1. eye opening
  2. verbal response
  3. motor response
  4. all of the above
A
  1. all of the above
54
Q

Babinski/plantar reflex is normal in older children and adults.

A

False. It is abnormal and indicates damage to corticospinal tract or upper motor neurons.

55
Q

What is normal ICP pressure in adults?

a. 10 mmHg
b. 15 mmHg
c. 20 mmHg
d. 5 mmHg

A

a. 10 mmHg

56
Q

An ICP cannot surpass ___ mmHg without causing harm.

A

40 mmHg

57
Q

What is the formula for Cerebral Perfusion Pressure (CPP)?

A

CPP = MAP - ICP

58
Q

ICP at ___ mmHg is usually treated. We try to keep closed head injuries at this level.

A

20 mmHg

59
Q

What type of respirations are an early sign of increased ICP?

A

Cheyne-Stokes respirations

60
Q

What respirations are a late sign of increased ICP?

A

Biot’s respirations

Cushing reflex/triad is also a late sign, aka cns ischemic response. Last ditch effort to keep brain perfused.

61
Q

T/F: You can use hypertonic saline to reduce ICP.

A

True. Along with Mannitol infusions.

62
Q

A vegetative state is called “persistent” if it lasts longer than:

a. 1 week
b. 72 hours
c. 2 months
d. 4 weeks

A

d. 4 weeks

63
Q

T/F: Fixed and dilated pupils are indicators of brain death

A

True

64
Q

T/F: Brain death is reversible.

A

False. Brain death is irreversible

65
Q

While performing an apnea test for brain death, you should observe carefully for any respiratory movement for how long?

a. 3-5 minutes
b. 8-10 minutes
c. 10-15 minutes

A

b. 8-10 minutes

Emergency Care: Castro (5 decks)

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