Trauma Flashcards
(247 cards)
1
Q
Influences on triage (5)
A
Number of injured
Available resources
Nature/extent of injuries
Change in condition
Hostile threat
2
Q
Multiple Casualty
A
number of patients and severity do not exceed recourses
3
Q
Mass Casualty
A
number of patients and severity exceed recourses
4
Q
Principles of triage (5)
A
degree of life threat
Injury severity
Salvageability
Resources
Time/distance/environment
5
Q
Injury severity entails
A
seeing the patient in a total global fashion
6
Q
Triage categories
A
delayed
immediate
minimal
expectant
7
Q
Immediate timeline
A
needs life saving within 1min-2H
8
Q
Immediate examples
A
massive hemo
airway obstruction
tension pnuemo
retrobulbar hematoma****
9
Q
Delayed examples
A
soft tissue injury
fracture
compartment syndrome
moderate burns
10
Q
Minimal
A
self aid/buddy aid
aka walking wounded
11
Q
What is essential to immediate life sustaining care
A
speed and accuracy
12
Q
Secondary Triage
A
document, reassess, sort patients, 9-line
13
Q
Tertiary Triage
A
manage patients, consider complicated procedures, resources
14
Q
CPR only three situations
A
hypothermia, near drownings, electrocution
15
Q
Early tauma deaths are to due to interuptions in what three systems
A
respiratory, vascular, central nervous
16
Q
Trauma casualties typically die within
A
the first hour from inabilty to breath or bleeding
17
Q
Light Combat Stress return to duty
A
immediate return to duty or units noncombat element
18
Q
Heavy Combat Stress return to duty
A
combat stress control restoration for up to 3 days
19
Q
Combat stress BICEP (SR)
A
Brief: 3 days or less
Immediate: treatment
Central: keep in one area
Expectant: expect to return to duty
Proximal: to unit
(Simple or refer)
20
Q
3 phases of TCCC
A
CUF
TFC
TACEVAC
21
Q
Soft tissue injuries are not lethal unless acompanied with
A
shock
22
Q
Choose a CCP based on proximity to
A
PT
vehicular access
HLZ
Geography
23
Q
Echelon 1
A
Self aid/Buddy aid/CLS/Medical Personel
24
Q
Self aid Buddy aid performs
A
hemorrhage control
25
CLS performs
basic first aid
26
Echelon 2 mission
inital resusicative care to save life or limb
27
Largest Echelon 2 CRTS by size
1. LHD
2. LHA
3. LCVN
28
Echelon 2 (6)
CRTS
Med BN
STP (no surgery)
FRSS
Role 2 Light
Role 2 Enhanced (ward beds)
29
Who provides surgical care to the MEF
Med BN
30
How long does Med Bn hold a patient
72 hours
31
Med Bn breakdown
1 HS and 3 surgical companies
32
Echelon 3 mission
highest level of care in combat zone
33
Echelon 3 examples
Fleet hospitals
hospital ships
34
Echelon 4 mission
definitive medical care
35
Echelon 4
OCONUS hospitals
36
Echelon 5 mission
resotre and rehab
37
Echelon 5
NMRTC SD
WRNMC
38
MEDEVAC priorities
urgent: 2 hours; life limb eyesight
priority: 4 hours; open fx, flail chest; burns
routine: 24 hours
39
9 line: Line 7 options
7. Method of marking
A - panels
B - pyrotechnics
C - smoke
D - none
E - other
40
Forms of energy
Mechanical
Thermal
Electrical
Chemical
41
Theodor Kocher
first proposed kinetic injury possessed by a bullet was dissipated in four ways
42
Four ways kinetic energy is dissapaited
Heat
Energy used to move tissue radically outward
Energy used to form a primary path by direct crush of the tissue
Energy expended in deforming the projectile
43
Temporary Cavity
momentary stretch or movement of tissue away
44
Permanent cavity
forms at time of impact and is caused by compression or tearing of tissue
45
Yaw
deviation of projectile in its longitudinal axis
46
Tumbling
forward rotation around center mass
47
Deformation
mushrooming of projecting that increases in diameter by a factor of 2
48
Low energy projectile
Knives or needles
throat, thoracic, abdominal, and back stabbing
49
Medium energy projectile
9mm
50
High energy projectile
.44 magnum
51
Indications for a laparotomy for blunt abdominal trauma
peritonitis
hemodynamic instability
52
Primary blast
effects of pressure form a blast wave; damages tympanic membranes in surviving casualties
53
Secondary blast
flying debris and fragments with blast wind; causes gross mutilation
54
Tertiary blast
body displacement
55
Quaternary blast
burns
56
CoTCCC TQs
CAT
SOFT-T
EMT (Emergency and Military TQ)
57
Most common cause of death on battlefield; when to use permissive hypotension
hemorrhage; internal bleeding
58
CoTCCC approved hemostatic agents
combat gauze (first choice)
celox/chito
XStat
59
Chito/Celox active ingredient
chotosan; mucoidal binding
60
XStat
first expanding wound dressing to be cleared by FDA
61
3 junctional TQs
CROC
JETT
SAM
62
Hemostatic dressings require how much direct pressure
3 minutes
63
Respiratory control center
medulla and pons
64
Hypoxia
deficient oxygen in tissue
65
Indications for oxygen therapy
Cardiac/Respiratory arrest
O2 sat <90
Systolic <100
RR >24
66
Nasal cannula flow rate
1-6 lpm
67
Partial rebreather flow rate
6-10 lpm
68
Non-rebreather mask flow rate
10-15 lpm
69
BVM flow rate
15+ lpm
70
Hypoxemia
insufficient oxygenation in blood
71
Hyperbaric chamber used for (2)
decompression illness
carbon monoxide poisoning
72
Most common cause of airway obstruction
tongue
73
Sellick's manuever
during BVM ventilation to prevent aspiration; apply gentle posterior pressure to patients cricoid cartilage.
74
BURP manuever
backward, upward, and rightward pressure on the larynx to prepare for intubation
75
NPA contraindication
basilar skull fracture (battle sign/raccoon eyes/CSF)
76
Indications for cric
tracheobronchial hemorrhage
unable to use BVM
anaphylaxis
burns
neck trauma
77
Longest a cric can be left in place
24 hours
78
OPA contrainications
conscious patient due to gag reflex
79
Airway for air evac
iGel
80
ET Tube contraindications
cervical fracture
81
Complications of ET tube intubation
broken teeth
injury to vocal cords
hypoxemia
82
ET intubation position
Sniffing
83
ET tube too deep causes
right mainstem bronchi intubation
84
ET tube in wrong anatomy complication
gastritis; foul smell from contents
85
Combitube indications
trapped patient
86
Combitube complications
esophageal rupture
upper airway hematoma
87
3 methods to check airway placement
visualize chest rise and fall
auscultate breath sounds
CO2 monitoring
88
Cric incision length
3cm
89
3 indications for Needle D
decreased or absent breath sounds
Sytolic <90
worsening respiratory distress
90
Spontaneous simple pneumothorax disposition
tall lanky runners build
91
Pleural space can accomodate how mane MLSs of blood
2500-3000
92
Chest tube indications
large pneumothorax >25%
hemothorax
93
Contraindications of chest tube
uncontorlled bleeding diathis
infection
94
Chest tube sizes
Teen/Adult male 28-32fr
Teen/Adult Female 28fr
child 18fr
95
Chest tube insertion site
mid axillary between 4th and 5th rib
96
Flail chest
breaking of 2 or more ribs in 2 or more places
97
Pulmonary contusion impact on respiration
prevention of gas exchange because no air enters alveoli
98
Pulmonary contusion tx
vetntilation/ O2/ BVM
99
FWB components 4
RBC
platelets
plasma
immunological components
100
2 main blood types
ABO and Rh
101
ABO
classification determined by presence or absence of antigens
102
Type O markers
none
103
Females of child bearing age should only recieve what blood
O NEG
104
What class shock indicates a blood transfusion?
Class III
105
Class 3 shock
1500-20000 ml blood loss; 30%
106
Class 4 shock
2000ml blood loss; 40%
107
Radial pulse systolic BP
80mmhg
108
Hemolytic reaction sx
fever, chills, flank pain, oozing from IV site
109
Hemolytic reaction tx
aggressive hyrdation and diuresis
110
Anaphylaxis reaction tx
Antihistamines/Vasopressors
111
Citrate Toxicity prevention
1 amp of Calcium Gluconate per 4 FWB units
112
How many units of blood can a liver process without additional calcium?
13
113
Febrile non-Hemolytic reaction most common cause
cytokines releaed from WBCs
114
Febrile non-hemolytic reaction tx
1g tylenol PO Q8
115
Febrile non-hemolytic reaction sx
fever and chills without systemic symptoms
116
Urticarial Reaction
reaction with hives but no other allergic findings caused by serum proteins
117
ATR actions
stop transfusion
Fluid bolus with crystalloid
confirm correct product and patient
MEDADVICE
118
Single unit wole blood collection capacity
600ml with 63ml of CPDA-1 anticoagulant
119
Stimulate collection bag how often
2 minutes
120
Allergic reaction to transfusion prophylaxis
25-50mg Diphenhydramine
121
TXA administration
1g in 100NS within 3 hours over ten minutes
Don't forget this is only for the test and not real life
122
TXA side effects
hypotension
seizures
visual changes
123
TXA storage temp
59-86F
124
Colloid use
increase blood volume; expand
125
Crystalloid vs Colloid expanding
more crystalloid required to accomplish same as colloid
126
Crystalloid use
maintenance fluid to correct body fluid and electrolytes
127
Tonicity
concentration of electrolytes
128
Isotonic
crystalloid contains same amount of electrolytes as plasma
129
Hypertonic
more electrolytes than plasma; causes cells to shrink
130
Hypotonic
contains fewer electrolytes than plasma; cells expand
131
IO cotraindications
inability to locate landmark
brittle bones
infection
previous attempts in same bone
132
Best IO sites
anteromedial aspect of tibia
anterior aspect of femur
sternum
133
Tibia site location
1-3cm below tibial tuberosity
134
Pain triple option
1:Tylenol 625mg x2
Meloxicam 15mg
2: OTFC 800ug
3: Ketamine 50mg IM or 20mg IV
Alternative: Morphine 5mg IV with max of 15mg
135
Odanestron dose
4mg Q8
136
Combat pill pack antibiotic
Moxifloxacin 400mg Q24
137
Ertapenem dose
1g Q24
138
Levofloxacin dose
750mg Q24
139
Initial blood drip rate
10-30ml for first 15min; monitor every 5
increase to 200ml
140
Urine output rate
0.5 cc per kg
141
Foramina
small openings for nerves and blood vessels to pass
142
Foramen magnum
brain stem and spinal passes through
143
How much CSF surrounds brain
150ml
144
ICP
pressure exerted by brain tissue, blood, and CSF
145
Cushing's triad
inc BP
irregular respirations
bradycardia
146
Cushing's triad
inc BP
irregular respirations
bradycardia
147
Secondary Brain Injury
ongoing injury process set in motion
(hypoxia, hypotension, ICP)
148
2 biggest predictors of poor outcome in head trauma
time spent with ICP >20
time spent with systolic BP <90
149
in TBI maintain SPO2 above
90
150
Epidural Hematoma
bleeding between skull and dura mater
151
Epidural Hematoma hallmark
brief LOC; regains conciousness before rapid decline
152
Pupil dialition from TBI associated with what CN
tres leches
153
Subdural Hematoma MOI in trauma
MVC or falls
154
SAH bleeding location
between arachnoid membrane
155
SAH hallmark
worst headache of my life and meningeal signs
156
SAH Ottawa rule (5)
headache that peaks within 1 hour (thunderclap)
40 y/o +
Witnessed LOC
onset at exertion
limited neck flexion
157
All suspected TBI patients recieve
O2
158
Target sytolic for TBI
90-100
159
Minimal recovery period for mild TBI/Concussion
24 hours
160
TBI red flags
LOC
double vision
AMS
vomiting
seizures
weakness in extremity
headache
unsteady on feet
unequal pupils
changes in senses
blacking out/passing out
161
Brain layers
dura mater
pia mater
arachnoid
162
Headache pain management for TBI
naproxen
Tylenol
163
If symptom free after 24 hours with 1st concussion
return to full duty
164
Hypothermia stages
mild 90-95
moderate 82-90
severe <82
165
Most common mechanisms of accidental hypothermia
convective heat loss to cold air
conductive heat loss to water
166
Hypothermia ECG findings
Osborne Waves
167
Hypothermia temp
<95
168
Mild hypothermia tx
passive external
169
Moderate and refactory hypothermia tx
active external
170
Severe hypothermia tx
active external and internal
171
IO attempt after
3 failed IVs or 90 sec
172
IO complications
skin necrosis
OM
Tib fracture
173
IO flush
Lidocaine without epi
174
Moderate pain oral treatment
Mobic 7.5-10mg
175
Max morphine dose
15mg
176
Class 3 and class 4 blood loss
1500
2000
177
Palpable systolics
radial >80
femoral >70
carotid >60
178
AMPLE
allergies
medications
PMH
last meal
events
179
First sign of compartment syndrome; treatment
pain; fasciotomy
180
Anaphylaxis involved systems
cardio and respiratory
181
Anaphylaxis symptoms within
60 min
182
Anaphylaxis med tx Line 1 and Line 2
1. Epinephrine .5mg IM
2. Solumedrol and Diphenhydramine IV
183
Allergic Bronchospasm Tx
Nebulized SABA
184
2 drug allergy reactions
Steven Johnson Syndrome and Toxic Epidermal Necrolysis
185
Upper airway typically injured by
thermal
186
Tracheobronchial tree typically injured by
chemicals in smoke
187
2 common gases of sytemic toxicity
carbon monoxide and hydrogen cyanide
188
Hydrogen properties
colorless and smells like almonds
189
Carbon Monoxide properties
colorless and odorless
190
Smoke Inhalation tx
ABC
intubation
O2
IV
SABA
Hypothermia tx
191
Carbon Monoxide affinity for hemoglobin vs Oxygen
260
192
Rhabdo involved anatomy (2)
muscle fiber (sarcomere)
intracellular components (potassium, CK, Myoglobin)
193
Rhabdo breaks down what kind of muscle?
striated
194
Rhabdo pathophysiology
contents of muscle fibers enter circulation in large quantities adversely affecting kidneys and causing obstruction
195
Rhabdo causes
trauma
crush
compartment syndroe
electrical injury
196
Exertional rhabdo causes
not conditioned
hot and humid
heat stroke
seizures
197
Non exertional rhabdo causes
drug use
-statins
toxins/poisons
198
Rhabdo sx
dark urine (Coca-Cola)
weakness
edema
AMS
199
Rhabdo lab findings (4)
Elevated CK
UA pos for blood
Hyperkalemia
peaked T waves
200
Rhabdo tx
IV 1.5L/HR to maintain 2ml/KG per hour output
201
Retroperitoneal contents
kidneys
aorta
espophagus
ureters
pancreas
rectum
stomach
colon
202
Most common abdominal blunt injuries
1. spleen**
2. Liver
GSW/Penetrating: small bowel
203
Most reliable indicator of intra-abdominal bleeding
bleeding from an unknown source
204
MAP formula
SP + DP (2)
___________
3
205
Cerebral pressure
MAP - ICP
206
GCS score
9
207
Class 1 Sock
750ml 15%
208
3 abdominal regions
retroperitoneal/ true abdomen/ thoracic
209
Most common finding in compartment syndrome
paresthesia or pain
210
Gold standard study for pelvic injury
CT
211
Initial burn fluid rate (scenario)
500ml/hour
212
Burn target urine output
30ml/hour
213
PFC target urine output per hour aka UOP
0.5-1ml/hour
214
MAP goal
65
215
Zone of coagulation
central zone; not capable of repair
216
Zone of hyperemia
outermost zone; perfusion increased
217
Zone of stasis
adjacent to necrosis; cells are injured and deprived of blood flow
218
UOP
primary index of adequate resuscitation
219
Initial hourly rate
TBSA x 10
220
Parkland Formula
4 x TBSA x KG over 24 hours; half in first 8 hours
221
3 phases of PFC
Evaluation
Resuscitation
Transport
222
Evaluation phase of PFC
MARCH/initial evac
223
Resuscitation Phase
procedures to normalize vitals
224
Transport phase
hypothermia/pain/package to move PT/documentation
225
Do not TQ convert after how long
6 hours
226
According to TG place second TQ
above
227
Most common pelvic bleed
venous plexus
228
Glans penis bleed with scrotal edema tx
retrograde urethrogram
229
Pelvic injury tx following blood transfussion (scenario)
pelvic binder
230
FWB aka
low titer O
231
FWB shelf life
24-48 H
232
Vomiting patient tx following jaw thrust and O2
suction
233
Tactical indicators of shock
consciousness and radial pulse
234
What organ not in peritoneum
kidney
235
What is not isotonic
DS5 half
236
Most benefeical use of pelvic binder
open book
237
NS type of fluid
isotonic crystalloid
238
Standard thermometer lowest reading
93
239
IO contraindication (scenario)
infection
240
Not a chest injury
diaphragm hernia
241
Greatest destruction and necrosis zone
coagulation
242
Deteriation of resp within
24 hours
243
Colloid examples
albumin hetatarch
244
Crystalloid examples
NS LR DS5
245
Bleeding from scalp can be masked by
thicc hair
246
Reassess before evac
neuro-vascular
247
Avoid what range of ketamine
Mid: 0.3-1mg/kg
