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96 Cards in this Set
- Front
- Back
What is the primary survey?
** |
ABCDEs
Airway Breathing Circulation Disability Exposure |
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In a trauma situation, what should be treated first
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Greatest threat to life
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anytime you come into a trauma pt what should you do? (2 things)
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Airway with c-spine protection
Universal precautions: hat mask w shield gown gloves (double glove, single gloving viral transmission is 67%) |
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What are the 2 areas that are part of xray in resuscitation adjunct?
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Chest and pelvis
house the most blood note: use FAST for abdomen |
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what size needle is used for needle decompression
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14/16 gauge
2nd intercostal space mid clavicular line aim down the pt |
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What should you ask for from your ancillary staff upon start of a trauma?
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EKG
Pulse Ox IV BP Draw Labs |
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what is considered large bore IV?
how much fluid should initially be given in the trauma pt? |
14/16 gauge (you need 2!)
2L as fast as possible over 10 min |
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if you are able to obtain a pulse at the following areas, what is the SBP?
Carotid: Femoral: Dorsalis pedis: |
Carotid: 60
Femoral: 70 Dorsalis pedis: 80 |
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if you are the only physician available in a trauma scenario, what are you going to likely do?
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transfer him out
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Describe the GCS and scoring
*** |
Eye Response:
Eyes open spontaneously. +4 Eye opening to verbal command. +3 Eye opening to pain. +2 No eye opening. +1 Verbal Response: Oriented. +5 Confused. +4 Inappropriate words. +3 Incomprehensible sounds. +2 No verbal response. +1 Motor Response: Obeys commands. +6 Localizes pain. +5 Withdrawal from pain. +4 Flexion to pain (Decorticate). +3 Extension to pain (Decerebrate). +2 No motor response. +1 |
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give the GCS for the following scenario
localizes to pain no verbal response eyes open to pain |
localizes to pain: 5
no verbal response: 1 eyes open to pain: 2 |
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give the GCS for the following scenario
Eye opening to verbal command inappropriate words flexion to pain |
Eye opening to verbal command: 3
inappropriate words: 3 flexion to pain: 3 |
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give the GCS for the following scenario
Eyes open spontaneously confused withdrawal from pain |
Eyes open spontaneously: 4
confused: 4 withdrawal from pain: 4 |
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GCS score?
Extension to pain incomprehensible sounds eye opening to verbal commands |
Extension to pain: 2
incomprehensible sounds: 2 eye opening to verbal commands: 3 |
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quickest way to assess a pt in 10 seconds?
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ask the pt his or her name
and what happened |
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Pregnant women have what important physiologic concern?
*** |
if pt is on left side they will not get IVC compression
Symptoms of late pregnancy inferior vena cava syndrome consist of intense pain in the right hand side, muscle twitching, drop of blood pressure, and fluid retention |
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what signs key you to progressive loss of airway
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stridor
anxious hoarseness |
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how can you assess the breathing part of ABCDE
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resp rate
chest movement air entry O2 sat |
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What makes up the secondary survey?
What is an AMPLE history? *** |
Full H&P (do this after ABCDE, and when vitals are normalizing)
Allergies Meds Past illness/ Pregnancy Last Meal Events |
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Which pts do I transfer to higher lvl care?
When should the transfer occur? |
those whose injuries exceed institutional capabilities
Airway and hemorrhage control are key --consider this when surgery isn't available |
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What is shock?
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inadequate tissue/end organ perfusion
AMS, anxiety Cold diaphoretic skin Tachycardia Tachypnea decreased urinary output (inadequate profusion to kidneys) |
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Major cause of shock?
*** Others |
Hemorrhage ( Hypovolemic ) *** BLOOD LOSS
Nonhemorrhagic: Tension PTX cardiac tamponade cardiogenic Neurogenic Septic |
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Number one thing to do about shock?
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FLUID RESUSCITATION
2L of crystalloid wide open 2 large bore IVs |
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Preferred access for giving fluids?
*** |
2 large bore peripheral IVs
NOT CENTRAL LINE |
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What is balanced resuscitation?
*** (? was on practice test) |
Permissive Hypotension
accept a lower than normal BP |
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FFP dosage?
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10mL/kg
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750mL blood loss (15%) is what class hemorrhage?
symptoms? tx? |
Class I
only symptom is slight anxiety (vitals will be normal) tx: Crystalloid |
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Amount of blood loss in Class I hemorrhage?
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up to 750mL
15% remember: tx is crystalloid |
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750-1500mL blood loss (15-30%) is what class hemorrhage?
Sx? BP change? Tx? |
Class II
Slightly anxious, tachy Normal BP Crystalloid |
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1500-2000mL blood volume loss (30-40%) is what class hemorrhage?
Sx? BP change? Tx? |
Class III
Decreased BP Need fluid and blood |
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>2000 mL blood volume is what class hemorrhage?
Tx? |
Class IV
tx: right to blood and definitive control of bleeding |
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When do you give blood? what class hemorrhage?
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Class III and above
aka 1500mL and above if >2000 go right to blood |
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pt loses 2200 mL blood is what class hemorrhage?
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IV
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pt loses 1700 mL blood is what class hemorrhage?
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III
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pt loses 1000 mL blood is what class hemorrhage?
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II
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If you get an Hemoglobin and Hematocrit right after trauma with blood loss, what would you expect?
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It should be normal
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HR > 120 is what class hemorrhage?
tx? |
Class III
Crystalloid and blood |
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HR> 140 is what class hemorrhage?
tx? |
Class IV
BLOOD |
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Class IV hemorrhage HR?
Class III? |
IV: >140
III: >120 |
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Major concern in head injury patients?
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PREVENT HYPOXEMIA
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how does the O2 dissociation curve change in shock
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in shock the O2 curve shifts to the right...
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Define the definitive airway
(objective-*?) |
Cuff tube in the airway
higher pressures, prevents secretions/vomi from trachea |
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How do you know the airway is adequate
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Pt is alert and oriented
Pt is talking normally No evidence of injury o the head/neck You have assessed and reassessed for deterioration |
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signs/sx of airway compromise?
(just for review i'd imagine) |
high index of suspicion
change in voice/sore throat noisy breathing (snoring and stridor) dyspnea/agitation tachypnea abnormal breathing pattern low O2 sat (late sign) |
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3 times to intervene in a pt with patent airway?
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Impending airway compromise (airway problem)
need for ventilation (breathing problem) inability to protect the airway (disability) GCS<8 INTUBATE don't hesitate,.. couldn't think of more rhymes |
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best way to displace the tongue during intubation?
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Jaw thrust
the tongue is the most obstructive thing when trying to intubate |
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What is the LEMON mnemonic?
(there was a box saying to remember it) |
Look externally
Evaluate the 3-3-2 rule Mallampati score Obstruction Neck Mobility |
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What is the 3-3-2 rule?
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distance btwn the pts incisor teeth should be at least 3 finger breadths (3)
the distance btw the hyoid bone and the chin should be at least 3 finger breadths (3) the distance btwn the thyroid notch and floor of the mouth should be at least 2 finger breadths (2) |
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give the Mallampati classification:
soft palate, uvula, fauces, pillars visible |
Class I
|
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give the Mallampati classification:
soft palate, uvula, fauces visible |
Class II
|
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give the Mallampati classification:
soft palate, base of uvula visible |
Class III
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give the Mallampati classification:
hard palate visible |
Class IV
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Best predictor of tube being in the right place?
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visualizing it going through the cords!
others: Watch the chest Auscultation CO2 detector/ ETCO2 monitor Pulse ox Xray |
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Kirk's Highlights
-Focus on securing airway -recognize the need to secure an airway -correctly place the airway and adequately ventilate/prevent aspiration -just because the gag reflex is present doesn't mean they don't need to be intubated -maxofacial trauma: unstable midface can still be intubated (unstable jaw cannot) -neck trauma: always think about vascular injury (hematoma precludes you from surgical airway) -Hoarseness...look to tube |
not sure this is helpful or not...
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2 places where injuries are often missed that lead to death
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spleen and pelvis
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How do you determine if there is an abdominal or pelvic injury?
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DPL
FAST PE (not very accurate) CT |
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what is diagnostic of injury to the bladder/urethra
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hematuria
note: its absence does not rule it out! |
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Advantages of DPL?
Disadvantages? Indications? |
advantage: Early dg, quick, 98% sensitive, detects bowel injury, no transport
dis: invasive, specificity is low, misses injury to diaphragm and retroperitoneum indications: unstable blunt trauma, penetrating trauma |
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Advantages of FAST?
Disadvantages? Indications? |
adv: early dg, non invasive, rapid, repeatable, 86-97% sensitive, no transport
dis: operator-dependent, bowel gas and subQ air distortion, misses diaphragm, bowel, and pancreatic injuries indications: unstable blunt trauma |
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Advantages of CT?
Disadvantages? Indications? |
adv: most specific for injury, 92-98% sensitive, non-invasive
disadvantage: cost/time, misses diaphragm, bowel, some pancreatic structures, TRANSPORT REQUIRED indications: STABLE blunt trauma, penetrating back/flank trauma |
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diagnostic study you should use for back and flank stab wounds?
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DPL, serial exams, or double/triple contrast CT
(they harped on this in the book a bit) |
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indications for laparotomy? (blunt trauma)
(**?**) |
Hemodynamically abnormal with suspect abdominal injury
free air diaphragmatic rupture peritonitis positive FAST, DPL, CT |
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indications for laparotomy? (penetrating trauma)
(**?**) |
Hemodynamically abnormal
Free air Peritonitis Positive DPL, FAST, or CT Evisceration |
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what is usually the best strategy for GSW?
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Laparotomy!
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Important physiologic consideration in geriatrics
(probably know this, but they said it like 10x) |
low physiologic reserve
hypovolemic to begin with |
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Initial management of pelvic fracture involves surgical consult and pelvic wrap.
What determines if the pt needs a laparotomy or angiography? |
Intraperitoneal gross blood
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Initial management of pelvic fracture involves surgical consult and pelvic wrap.
if intraperitoneal gross blood is present what does that indicate? what if there is none? |
intraperitoneal blood present: Laparotomy
NO blood present: Angiography |
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Flip to see abd/pelvis pitfalls
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delayed intervention for abd or pelvic hemorrhage
occult intraabdominal/retroperioneal injuries back and flank wounds repeated manipulation of a fractured pelvis spinal cord injury improperly applied pelvic wrap skin necrosis from pelvic wrap |
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danger of intubating a pt with a simple pneumo
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they are breathing hi pressure air and you can change a simple pneumo to a tension pneumo
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What are the immediately life threatening chest injuries
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Laryngeotracheal injury/airway obstruction
tension PTX open pneumo flail chest and pulmonary contusion massive hemothorax cardiac tamponade |
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what is a flail chest
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multiple ribs fractured in multiple segments
gives paradoxical inspiration when you inhale chest goes down |
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define massive hemothorax
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1500 mL out of lung
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what 2 things can give tracheal deviation?
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tension PTX
hematoma of neck |
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what type of acid base disorder will you see in a Tension PTX
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metabolic and respiratory acidosis
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What is the function of the dorsal columns?
*******TEST |
Proprioception, vibration, fine touch
crosses in the medulla |
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What does it tell you when a patient is able to tell you he doesn't remember the accident and his leg hurts. GCS is 15
*******TEST |
Cerebral profusion is intact
airway is intact |
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What do you do when a preggo is leaking amniotic fluid
*******TEST |
admit the pt
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pt is stabbed in the upper abdomen. What should you do first?
*******TEST |
Local wound exploration
(NOT FAST) |
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you see a pt in neurogenic shock. What happens to their vasomotor tone?
if you see this question, just look for the starred answer *******TEST |
Decreased
***RARE BELOW THE LEVEL OF T6 |
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When do you transfer a burn pt?
*******TEST |
>20%, face, hands, genitals, or airway involvement
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Elderly versus young
Who gets more subdurals? who gets more cerebral contusions *******TEST |
More subdurals: Old
more cerebral contusions: young |
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where is CSF located?
*******TEST |
btw the arachnoid and pia
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What is cushnoid reflex?
*******TEST |
Hypertension
Bradycardia Increased ICP |
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more common dissection or aneurysm?
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disruption of aortic root
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80 pt with HR of 70, SBP of 70, bleeding profusely from scalp, what do you do first?
CT Pressure on wound or something else? *******TEST |
Pressure on wound... this is due to the bleeding
hypotension in brain injury is due to blood loss |
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what is usually the cause of hemothorax (what vessels)
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intercostal vein/artery
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What is a key component of treating rib fractures ?
(this was in the book too *?*) |
treat the pain without depressing their breathing
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symptoms of this include upper torso, facial, and arm plethora with petechiae secondary to acute temporary compression of the superior vena cava....what is this known as?
(*?*) |
Traumatic asphyxia (crush injury to the chest)
massive swelling and even cerebral edema may be present |
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What is the number one thing that prevents successful BVM ventilation?
*** |
The tongue
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If a patient is vomiting while on the board in c-spine precautions, what should you do?
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roll them on their side
maintain precautions suction |
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what is the equation for tube size in kids?
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(Age+16)/4
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What can estimate the size of a tube needed for intubation?
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the pts little finger or nostril
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In kids, what vital sign other than O2 sat can be a sign of decreasing O2
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bradycardia
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What constitutes a positive DPL on initial aspiration?
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20cc of fluid
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If you have a CXR that shows a pneumothorax, when can you just watch it and not intervene?
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<20%
STABLE Not increasing in size note: you must always TUBE a pt with TENSION PTX |
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what causes pneumomediastinum?
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Esophageal tear or tracheal injury
this is when you have air that extends around the mediastinum and normally goes around the pericardium |