PHTLS Block Exam – Flashcards
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Level 1 Trauma Center
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Regional Trauma Center, All types of specialty surgical care 24/7, (Surgical suites, Surgeons, Blood, CT, X-Ray ... all in house), Tertiary - all levels of care Ex... County USC, Cedars, UCLA- Ronald Regan, UCLA- Harbor General
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Level 2 Trauma Center
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Area Trauma Center, Most common trauma emergencies with surgical capabilities 24/7, (can handle most common types of trauma) Ex.... St. Francis
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Level 3 Trauma Center
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Community Trauma Center, Specialized ED and some surgical capability (the speciality staff is on call and has 30 mins to get to hospital)
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Level 4 Trauma Center
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small community hospitals, (they have to stabilize and transfer) Have ER DR but no surgeon
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What are run sheets used for?
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QI, Research, Trauma Registry,
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What are the 4 E's?
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Engineering -(roads, airbags, pool alarms) Enforcement -(laws) Education -(safety classes) Economics -(government grants)
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What is an injury?
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being hurt or killed
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What is trauma?
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inflicted wounds or injury
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What is an accident?
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an event that is unforeseen or without apparent cause
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What is a disease?
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an unhealthy condition, illness, or disorder
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Why is the Highway Safety Act of 1966 important?
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lead to development of EMS "White Paper" - Accidental Death & Disability, The Neglected Disease of a Modern Society
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Why is the American College of Surgeons important?
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1990: trauma care systems planning and development act (established guidelines, funding and state-level leadership for the development of trauma systems)
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What are the leading causes of death in adults & children?
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Adults - MVC Children - Falls
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In trauma how many die in 1st hr?
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50% Fix = Injury Prevention
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In trauma how many die in 4 hrs?
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30% Fix = good prehospital and hospital care
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In trauma how many die days or weeks later?
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20% (due to hypoxia, hypotension, end organ failure) Fix = aggressive shock management
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What is Precrash?
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Age, medical hx, drugs, alcohol
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What are the 3 phases of a Crash?
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1. car into tree 2. person into steering wheel 3. organs into body
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What is the main purpose of car restraints?
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to slow the occupant down with the vehicle
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Platinum 10 mins are used for what?
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1. identify life-threats 2. perform key interventions 3. rapid extrication were indicated 4. timely transport to an appropriate facility 5. early notification to the receiving facility
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Trauma is the leading cause of death in what age group?
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1 - 44
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What is anatomical trauma criteria?
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Specific injuries (bi-lat femur fx)
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What is mechanical trauma criteria?
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Type of incident / MOI (blunt head, penetrating trauma, PSI)
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What is physiological trauma criteria?
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vitals signs (ALOC, hypotension GCS < 15)
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What is newtons 1st law?
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Body at rest will remain at rest and a body in motion will remain in motion until acted upon by an outside force
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What is law of conservation?
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Energy cannot be created or destroyed, but can change forms. Car breaks = friction = heat = fire
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What is the formula for kinetic energy?
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1/2 of mass x velocity(squared)
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What is more important velocity of mass?
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velocity
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If you increase the stopping distance what happens to the potential for injury?
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potential for injury is decreased
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What is important info in regards to GSWs?
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hand guns & rifles - velocity shotguns - what was the distance
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What is permanent cavitation?
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tissue that is destroyed and not coming back
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What is temporary cavitation?
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tissue that falls back into place 6x the diameter of per,anent caviation
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Concerns with up & over injuries?
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Laryngeal fx (may hear stridor) Sub-Q Emphysema Diaphragmatic tear
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Concerns with down & under injuries?
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Pelvic fx Femur fx Patellar fx
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Concerns with lateral impacts?
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Less metal to protect people in car Look for injuries to that same side of body
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Concerns with rotational forces?
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shearing forces to heart, liver, kidneys
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What % of ejection victims die?
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75
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How much more likely are you to die if you are involved in a rollover?
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6x
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Concern with rear impacts?
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whiplash injuries
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Good thing about wearing helmets?
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they save lives & decrease injuries
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Auto vs. Ped facts?
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Child - Freeze & stand there, get drug under car, multi-system trauma Adult - turn & run, extremity trauma
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Important aspects of falls?
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15 feet or 3x their height & the surface they land on = (severity of fall) Body part they land on = (type of injury)
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what are the 5 phases of bast injuries?
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1. Primary - pressure wave, effects hollow organs 2. Secondary - Bomb fragments 3. Tertiary - person in thrown, or falling debris 4. Quaternary - heat/thermal burns 5. Quinary - bio/chemical/implanted objects sprayed from the object
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What is an intimate injury?
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Stabbing... Look for than one wound, be cautious of "cone of injury, any direction", length of knife?
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In regards to violence what should you do?
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1. DONT BE THERE!!!! 2. Retreat 3. Defuse the situation (word ninja) 4. Defend yourself
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30 - 2, Can Do = what color?
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Green
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30 - 2, Cant Do = what color?
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Yellow
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Deficit to 30 - 2, Can Do (ALOC, Respirations, Circulation) = what color?
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Red
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What is the goal of the primary assessment?
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to find & correct life threats
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What is the most common threat to life?
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inadequate tissue perfusion/shock (a early sign is ALOC)
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If you dont know ______ then your already behind the 8 ball?!
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the MOI
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Injury to solid organs = ?
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hemmorage
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Injury to hollow organs = ?
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infection/peritonitis)
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What is Grey Turners sign?
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ecchymosis at the flank due to retroperitoneal bleed
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What is Cullens Sign?
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ecchymosis at the umbilicus due to retroperitoneal bleed
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Mass pants can be used for what?
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1. belly, retroperitoneal, pelvis bleed w/ BP less than 90 & pelvis fx stabilization 2. wide spread hemorrhage with BP less than 60 (NOT FOR USE ON PENETRATING TRAUMA)
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What is the % for Fi02?
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at least 85%
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What is the % for SP02?
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95%
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Can you typically remove impaled objects?
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Only if it is occluding the airway otherwise No, it maybe stopping the bleeding!!
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Abdominal evisceration key points are what?
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1. moist sterile dressing 2. occlusive dressing 3. keep PT warm 4. keep PT still
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What is more important minute volume or tidal volume?
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Minute volume
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What is the most important mechanism for ventilation?
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the plural linings staying intact
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In the PHTLS world what are the essential airway skills?
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bls skills
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What is the PHTLS airway key factor?
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Dont do the same thing over & over, try something different
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In PHTLS what is the best ET-Tube confirmation in a PT with a pulse?
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capography
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What is the best ET-Tube confirmation in a PT without a pulse?
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lung sounds
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If you cant intubate or ventilate then what?
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needle / surgical cric
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Normal capography value?
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35-45
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Closed head injury capography range is what?
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35 or less
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What is the most common type of shock?
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hypovolemic / hemorrhagic
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What is most sensitive to ischemia?
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The brain, heart and lungs (can last about 4-6 mins w/o 02)
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What the 2nd most sensitive to ischemia?
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The kidneys, liver & GI tract (can last 45-90 mins w/o 02)
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What is the least sensitive to ischemia?
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Skin and bones (can last 4-6 hrs w/o 02)
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What is cell & organ death?
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1. it starts with aerobic to anaerobic metabolism 2. Na and H20 go into the cell (edema) 3. Potassium and lactic acid leak out of cell and enter blood stream (makes body acidic & hyperkalemic)
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What happens during the ischemic phase?
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vascular sphincters shut closed
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What happens during the stagnant phase?
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Sphincters relax and blood pools in the extremities
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What happens during the wash out phase?
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systemic acidosis
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What is Shock Class 1?
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1-15% 750 ml compensated> HR normal
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What is Shock Class 2?
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15-30% 750-1500 ml> HR greater 100
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What is Shock Class 3?
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30-40% 1500-2000ml (BP goes down here)> HR greater 120
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What is Shock Class 4?
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greater than 40% 2L or more> HR greater 140
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What systolic BP number do you want to see in a trauma and/or traumatic brain injury patient?
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Trauma 80-90 TBI 90-100 (just shoot for BP or 90 systolic, & titrate your fluid bolus to meet these values)
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How warm should you warm your fluids to if possible?
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102 degrees
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What is the ratio of fluids given to blood lost during trauma?
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3:1 (3 liters of fluid per 1 liter of blood)
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Distributive Shock key factors are what?
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1.vasodilation below the injury site 2. warm skin below the injury site 3. Bradycardia & Hypotension 4. Priapism (Difference between this and hemorrhagic shock is the bradycardia due to parasympathetic system)
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What is the TX for rib fx?
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1. pain management 2. positive pressure ventilation
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How do you treat a sucking/open chest wound?
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First action is to cover it Make occlusive dressing Diameter of sucking chest wound is about 2/3 size trachea
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Signs of hemothorax are?
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1. Diminished or absent lung sounds 2. Hemodynamic compromise 3. Flat neck veins 4. Dull to chest percussion (3L of blood in each plural cavity, JVD is not a reliable source)
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What are signs of Beacks Triad?
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(penetrating trauma causes cardiac tamponade) 1. Muffled heart tone 2. JVD 3. Hypotension 4. 50cc of fluid can cause of dysrhythmias 5. 300cc or fluid can causes PEA
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What is a pulmonary contusion?
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blood filled alveoli, causes a decrease in 02 & C02 exchange
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What is traumatic asphyxia?
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related to crush injury, blood is unable to drain from head and top half of body
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What is an aortic rupture?
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a tear in the aorta, bleed out fast, your ****ED!!
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What happens in Tracheobronchial Detachment?
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1. Detachment usually occurs at the carina 2. Air leaks into the chest cavity 3. pneumothorax / tension
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What happens in Commotio Cordis?
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1. impact to chest 2. heart goes into v-fib 3. is survivable of recognized early, need to do CPR and defibrillate ASAP
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If patient is shocky and you suspect a bleed but cant find it, where should you assume it is?
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abdominal until proven other wise!! 1. abdominal pain and tenderness are an early sign 2. abdominal distension are late signs
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What are the important time frames of protection during pregnancy?
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1. up to 12 weeks fetus is protected by the pelvis 2. up to 20th week fetus is at the umbilicus 3. up to the xiphoid process by week 38
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What are signs of Cushings Tirad?
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1. hypertension 2. bradycardia 3. Ab. Normal Respirations 4. +1 (ALOC, Blown Pupils ect.) = brain steam herniation
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What is autoregulation?
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CPP increases due to ICP increase
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What is a potent vasodilator?
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C02
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What is broken in a basilar skull fx?
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Cribriform plate (look for blood/fluid from nose and/or ears w/o direct injury to nose or ears)
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Important facts of an epidural bleed are what?
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1. Fast bleeds (medial meningeal artery) 2. Usually die in about 1 hr 3. Lucid intervals (knockd out, wake up & act normal, knock back out)
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What are important facts about subdural bleeds?
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1. slower bleeds (bridging veins) 2. doesnt usually experience lucid intervals
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What is a primary brain injury?
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the insult to the brain itself (ex. gsw to head)
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What is the secondary brain injury?
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something we can prevent (ex. hypoxia post primary injury)
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What is retrograde amnesia?
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forgetting what happened before the accident happened
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What is anterograde amnesia?
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cant remember the accident or post accident
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Where is the atlas?
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C1
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Where is the axis?
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C2
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Where is the odontoid process?
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is off the axis C2, allows head rotation 180 degrees
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What are the biggest vertebra?
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Lumbar, they carry the most weight
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How many pairs of spinal nerves do we have?
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31 pairs
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Where do the motor nerves travel?
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the ventral root, up the front of the body
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Where do the sensory nerves travel?
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the dorsal root, up the back of the body
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What are dermatomes?
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the bodies sensory boarders T4 - nipple line down T10 - umbilicus down
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C 3-5 are what nerves?
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the phrenic never, control the diaphragm
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What is axial loading?
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spinal cord compression (ex. shallow water diving accident, leading on head & pressing down)
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What is a distracting injury?
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the spinal cord in stretched or disconnected (ex. hanging accident)
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Do you need to C-Spine a penetrating injury?
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No, unless there is a neuro deficit
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What happens during an anterior cord injury?
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Loss of motor, pain, and temp. (involves injury to spinal arteries)
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What happens during central cord injury?
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1. hyperextension of spinal cord 2. weakness in the upper extremities, but good lower extremity function 3. loss of bladder control
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What happens during Brown Sequard injury?
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1. loss of function on one side of the body (typically from penetrating injury)
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On a stable patient what do you do before moving he patient?
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splint fxs and pain meds
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Ligaments connect what?
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bone to bone
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Tendons connect what?
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muscle to bone
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What is a subluxation injury?
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dislocation partially out of the socket
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What is compartment syndrome?
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The tissues is tight (ex. circumferential burns) 1. after 6 hrs there is lots of damage to tissue
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What is crush syndrome?
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1. release of pressure from compartment syndrome 2. lactic acid rushes into the body
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Second degree burns?
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1. affect the epidermis 2. blisters
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Third degree burns?
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1. affect down to the dermis 2. waxy and leathery looking
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Fourth degree burns?
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1. affect down to the bone and muscle
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Nerves are a good conductor for what type of burns?
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electrical burns
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The hands, feet, face, and gentilia are what kind of burns?
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speciality type of burns
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What is the fluid formula for fluids in the burn patient?
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4cc/kg/BSA = amount in 1st 24 hr period (divide # by 2 = amount in first 8 hrs) (divide # by 8 = amount in 1st hr)
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What 3 things affect the severity of radiation?
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1. distance 2. shielding 3. time
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What is toxic inhalation?
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death by delayed respiratory compromise post fire exposure
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What is important about acid burns?
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coagulate necrosis
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What is important about alkaline burns?
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liquefaction necrosis
