Itls

Front 1

What is a “windshield survey” and when should it be done?

Back 1

A Windshield Survey is where you do a size-up of the entire scene before leaving the vehicle to make sure that the scene is safe to enter. It is performed from inside your vehicle

Front 2

What is the first step in trauma assessment?

Back 2

Scene Size-up is the first step in the ITLS Primary Survey

Front 3

What survey has the lowest priority in assessing the multitrauma patient?

Back 3

Secondary Survey

Front 4

What types of injuries would allow the medic to perform the primary, secondary and on-scene treatments?

Back 4

if there is no significant life threat in the mechanism of injury

Front 5

What finding in the primary survey may justify it being interrupted? (3)

Back 5

if the scene is unsafe, if you must treat an airway obstruction, or if you must treat cardiac arrest.

Front 6

List the interventions(Fix it!) that may be performed on the “load and go” patient on thescene. (all nine!)

Back 6

-When you check the neck, the “fix it” may be to apply a C-Collar
-When you check the airway, the “fix it” may be a Non-Rebreather mask at 15 lpm, or it may be Endotracheal Intubation.
-If your patient has major external bleeding, you must immediately direct another team member to control it (“fix it”)
-If there is a MOI that suggests spinal injury, Rescuer 2 immediately and gently but firmly stabilizes the head and neck (“fix it”) in a neutral position.
-If the airway is obstructed (apnea, snoring, gurgling, stridor), use an appropriate method (reposition, sweep, suction) to open it immediately (“fix it”).
-If ventilation is inadequate, Rescuer 2 should begin to assist ventilation immediately (“fix it”), using his knees to restrict movement of the patient’s neck and free his hands to apply O2 or a BVM to assist ventilation
-As a general rule, all patients with multi-system trauma should receive supplemental high-flow oxygen (“fix it”).
-If a dressing becomes blood soaked, remove the dressing and redress once to be sure direct pressure is being placed on the bleeding area. Hemostatic agents such as QuikClot, Combat Gauze should be used in this situation (“fix it”)
-If pulses are absent at the neck, immediately start CPR (“fix it”)
-Evaluate neck veins, which if engorged, indicate positive pressure in the chest (possible pneumothorax or cardiac tamponade). If they are distended, look and palpate at the sternal notch for tracheal deviation. A rigid Cervical Extrication Collar may be applied at this time (“fix it”)
-If abnormalities are found during the chest exam (open chest wound, flail chest, tension pneumo, hemothorax), treat them as you discover them. Delegate the appropriate intervention (seal open wound, hand stabilize flail) to another team member) (“fix it”)
-If a tension pneumothorax is identified, and the patient (1) has Altered Mental Status (2) is cyanotic, and (3) has absent radial pulses, prepare to decompress immediately (“fix it”)
-If the pelvis is unstable, you can feel the pelvic ring collapse as you apply pressure (“fix it”). Direct another team member to get the scoop stretcher and possibly the pelvic compression belt, and don’t check it again.

Front 7

Identify what makes a person a priority patient or “Load and Go”.

Back 7

-Dangerous Mechanism of Injury,
-High-Risk Group (Very Young or Very Old),
-History that reveals: LOC, DIB, Severe pain of h/n/b,
- Initial Assessment Reveals AMS, Abnormal Breathing, and Abnormal Circulation

Front 8

At what point in the primary survey may a medic begin transport on a critical load and go patient?

Back 8

When you have completed the initial assessment and rapid trauma survey or focused exam, enough information is available to decide if a critical situation is present. Patients with critical trauma situations are transported immediately.

Front 9

What should a medic do if his patient deteriorates?

Back 9

If the patient has a critical condition, after the rapid trauma survey or focused exam, immediately load her into the ambulance, and transport rapidly to the nearest appropriate emergency facility. When in doubt, transport early.

Front 10

Which actions or interventions can you delegate to a team member while performing the primary survey?

Back 10

Seal open chest wounds, stabilize flail segment, control bleeding, splint wound, get scoop stretcher for pelvic wound, (“Fix it’s”)

Front 11

Patients with an altered mental status should have a brief neurological exam performed at the end of the primary survey. What three assessments are part of the brief neurological exam?

Back 11

Check fof S/S of Cerebral Herniation, Pupils, and GCS Scale

Front 12

Non traumatic causes of altered mental status includes ________________ and __________________ or ______________ _____________.

Back 12

Hypoglycemia, drug and alcohol overdose, and Metabolic Disorders

Front 13

Worsening compliance when ventilating the intubated patient may be due to ____________ ________________.

Back 13

Tension Pneumothorax

Front 14

In order to reduce hyperventilation in the multitrauma patients who needs ventilation assistance, the medic must ventilate a rate of _________ breaths/minute or a breath every _____ seconds with volumes that cause adequate chest rise or maintain the ETCO2 of _______ to _________ mmHg.

Back 14

10-12 / minute – every 5-6 seconds – 35-45 mm/Hg

Front 15

The technique of E__________ L_______________ M______________ may be used to help the paramedic view the vocal cords during intubation.

Back 15

External Laryngeal Manipulation

Front 16

What abnormal airway sound would indicate that the patient needs immediate endotracheal intubation?

Back 16

Stridor

Front 17

The most reliable way to ensure that an ETT is being placed in the trachea and
not in the esophagus is

Back 17

Maintaining direct visualization of the tube passing through the glottis opening

Front 18

The medic must constantly monitor correct placement of an endotracheal tube. What is the BEST way to ensure continuous ETT placement?

Back 18

Quantitative Waveform Capnography (continuous)

Front 19

If your intubated patient who has a normal EtCO2, has a rapid decrease(over several minutes) in EtCO2, you must suspect ________________ ____________ is imminent.

Back 19

Cardiac Arrest

Front 20

When a MVC patient shows the following signs and symptoms: cyanosis, JVD, rapid, weak pulses and equal breath sounds, the medic must administer high concentration oxygen, perform spinal motion restriction and ____________ the patient.

Back 20

Transport rapidly to the closest appropriate hospital

Front 21

When bagging an intubated patient who suffered blunt chest trauma, the ambu bag becomes progressively more difficult to squeeze. The patient is most likely experiencing a ____________ _________________.

Back 21

Tension Pneumothorax

Front 22

If a patient has an isolated sternal fracture, the appropriate field management of this injury is application of the ____________. (Hint: Think cardiac contusion!)

Back 22

12 Lead ECG

Front 23

Signs of a cardiac tamponade include JVD, tachycardia, midline trachea, hypotension, narrow pulse pressure, and normal __________ ___________.

Back 23

Breath Sounds

Front 24

A ____________ ___________ may result from blunt or penetrating trauma and may be caused by fractured ribs.

Back 24

Pulmonary Contusion

Front 25

When a patient develops severe DIB, cyanosis, weak/absent radial pulse, JVD and decreased breath sounds on the RIGHT, the paramedic must perform immediate ____________________________________.

Back 25

Needle Decompression

Front 26

The BEST way to treat a large flail chest in the unresponsive multitrauma patient is ____________ ______________ ________________.

Back 26

Endotracheal Intubation and assisted ventilation with PEEP

Front 27

Patients with a simple pneumothorax OR a tension pneumothorax(TPN) often have tachycardia, anxiety, and DIB while the patient with a TPN is more likely to develop ______________.

Back 27

Shock with Hypotension

Front 28

Sites for needle chest decompression include the anterior approach with the following landmarks:

Back 28

Identify the second or third intercostal space in the anterior chest at the midclavicular line on the same side of the pneumothorax. This may be done by feeling for the “Angle of Louis,” the bump located on the sternum about a quarter of the way from the suprasternal notch. (just above the third rib)

Front 29

Sites for needle chest decompression include the lateral approach with the following landmarks:

Back 29

Expose the side of the Tension Pneumothorax and identify the intersection of the nipple (fourth rib) and anterior axillary line on the same side as the pneumothorax

Front 30

When a patient with CONTROLLED BLEEDING presents with signs and
symptoms of shock, the correct IV fluid resuscitation includes:

Back 30

20 ml/kg

Front 31

What is the appropriate way to control bleeding in a part of the body that cannot be tourniqueted and cannot be controlled with direct pressure?

Back 31

Hemostatic Agents: Quick Clot, Combat Gauze, Hemcon Dressing, or Celox). Pack the hemostatic agent in the wound and hold firm pressure. Always remember that the hemostatic agent is an “adjunct” to assist in controlling hemorrhage, not a hemorrhage control by itself.

Front 32

Describe the signs and symptoms of hemorrhagic shock.

Back 32

Tachycardia, Pale Skin, Flat Neck Veins, and possibly uncontrolled bleeding

Front 33

Mechanical or obstructive shock due to tension pneumothorax or cardiac tamponade may cause JVD, cyanosis, diaphoresis, hypotension, tachycardia, and DIB. If breath sounds are absent on one side of the chest, the paramedic must perform _______________ _____________ ________________.

Back 33

needle chest decompression

Front 34

Signs of neurogenic shock, which may occur after a spinal cord injury, do NOT include catecholamine release (no pallor, cool skin, diaphoresis, or tachycardia). Thus patients have a _____________heart rate and _______________BP.

Back 34

Decreased B/P, and Heart Rate is Normal or Slow

Front 35

The ITLS recommendations for care of the multitrauma patient with a severe
head injury include maintaining a systolic BP of ______ to ________ mmHg.

Back 35

110 – 120 mm Hg

Front 36

Patients with an isolated severe head injury are best managed with _________ and ventilation to maintain an ETCO2 of _____ to______mmHg.

Back 36

Hi-Flow Oxygen – 35-45 ETCo2

Front 37

In the absence of ETCO2 monitoring capability, an unresponsive patient with an isolated severe head injury with evidence of brain herniation should be intubated and ventilated with oxygen at a rate of ____________ times/minute.

Back 37

Adult - 20 Ventilations / min (q 3 seconds)

Child - 25 Ventilations / min (q 2.5 seconds)

Infant - 30 Ventilations / min (q 2 seconds)

CO2 between 30 - 35 mm Hg

Front 38

An ETCO2 level of ______ to _____ mmHg and an O2 saturation level of ______ to _________% is recommended when caring for patient with signs of brain herniation syndrome.

Back 38

30 – 35 mm Hg, 95%-100%.

Front 39

CO2 is inversely proportional to ventilation. The more you ventilate a patient, the lower the PaCO2. Hyperventilation, therefore, is defined as a PaCO2 of less than ____________mmHg.

Back 39

<35

Front 40

Because increased PaCO2 causes vasodilation and IICP, the unresponsive brain-injured patient who is bradypeic should be managed with intubation, BVM, to maintain a PaCO2 of __________ to___________mmHg.

Back 40

PaCO2 Between 35 – 45

Front 41

Describe a mechanism of injury when spinal motion restriction would NOT be indicated and may reduce the patient’s chance of survival.

Back 41

Patients with penetrating trauma to the trunk were twice as likely to die if they were spinal packaged in the field. Because patients with penetrating trauma to the chest or abdomen are critical load-and-go patients, the extra time it takes to perform SMR can have a devastating effect on survival

Front 42

Describe the vital signs and skin signs that may be found in patients with neurogenic shock.
Pulse__________; Respirations____________; BP_____________; Skin_________

Back 42

Pulse: Inappropriately low, Respirations: Normal to None, Blood Pressure: Low, Skin: Normal

Front 43

To avoid aspiration in the packaged patient, the medic must ___________-- _______________ when the patient is vomiting.

Back 43

Log-Roll

Front 44

The technique of emergency rescue is indicated when scene size up reveals ____________________________.

Back 44

A situation in which the patient’s life is in immediate danger because of an environmental hazard. “Desperate situations demanding desperate measures”

Front 45

Shock management of the patient with a GSW to the abdomen who is showing signs of decompensated shock includes IVF enough to cause return of ___________ ____________________.

Back 45

Blood pressure to 80-90 mm Hg Systolic

Front 46

IV fluid administration for the MVC patient complaining of diffuse abdominal tenderness, and signs of compensated shock (BP 100/60mmHg) include establish
two large bore IVs but keep the rate at KVO unless the patient’s BP falls below ____ and he shows of shock.

Back 46

90 mm Hg

Front 47

Care of the patient who has sustained a massive crush injury includes administration of ______________ as well as ____________________.

Back 47

Large volumes of IV Fluids, and administration of Alkalizing Agents (Sodium Bicarb, and Osmotic Diuretics such as Mannitol)

Front 48

What orthopedic injury is most likely to have associated neurovascular injury if not treated promptly? ________________ ______________________

Back 48

the nerves and major blood vessels generally run beside each other, usually in the flexor area of the major joints. They may be injured together, and loss of circulation or sensation can be due to disruption, swelling, or compression by bone fragments or hematomas.

Front 49

Immediate care of burn victim whose skin is warm to touch includes _______ ___________ for one to two minutes but avoiding __________________.

Back 49

Cooling the burns with room-temperature water for 1-2 minutes, and avoid cooling for longer periods of time because it could induce hypothermia and subsequent shock.

Front 50

Patients who have been involved in house fires who complain of nausea, SOB, a headache are assumed to be suffering from ___________ _____________ and are treated with ____________________________.

Back 50

Smoke Inhalation / CO Poisoning, High Flow Oxygen via NRB, Supportive Care

Front 51

Pediatric multitrauma patients with head injuries who are exhibiting signs of shock must be treated with a IV fluid bolus of ________________ to help maintain cerebral perfusion pressure.

Back 51

20 ml/kg initially, and if there is no response, you can give another 20 mg/kg bolus

Front 52

One of the most reliable early signs of shock in the pediatric patient is __________________ ____________________.

Back 52

Persistent Tachycardia

Front 53

Grunting respirations in a toddler with a decreased LOC indicate that the medic must provide immediate _______________________ support.

Back 53

Airway

Front 54

Even when the initial assessment exam of a geriatric patient reveals nothing of
note, the medic must perform a __________ _______________ _________.

Back 54

Focused Exam based on the Chief Complaint

Front 55

After performing spinal motion restriction on your patient who is in her third trimester, she becomes hypotensive. You should immediately rotate your spine board ___________ degrees to the left.

Back 55

15 – 30 degrees to the left