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231 Cards in this Set
- Front
- Back
Trauma remains a major cause of death for people ages 1 to __ years of age
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44 Ch1 - pg1 |
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First TNCC course was 19_ _
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1986 Ch1 - Pg2 |
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Trauma is ___
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injury to the living tissue caused by an extrinsic agent Ch3 - pg9 |
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Unintentional injury remains the ____ leading cause of death across all ages in the U.S. and the leading cause of death for people ages 1 to ___ years.
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5th leading cause of death. 44 years of age Ch3 - pg9 |
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Leading cause of injury related deaths for individuals 65yo and older is ___
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Falls Ch3 - pg9 |
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Leading cause of death for ages 25 to 64 is ___
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Poisoning Ch3 - pg9 |
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Leading cause of death for ages 5 to 24 is
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MVCs Ch3 - pg9 |
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In 2009 nearly ___ of all traffic related deaths involved alcohol.
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1/3 Ch3 - pg10 |
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Homicide is one of the top ___ causes of injury related death for individuals 1 to 44yo, the ___ leading cause of death for those 15 to 24yo, and the ____ leading cause for ages 1 to 4 and 25 to 34
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5 2nd 3rd Ch3 - pg10 |
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Primary Injury Prevention
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prevention of the Occurrence of the injury
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Secondary Injury Prevention
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Reduction in the Severity of the injury that has occurred.
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Tertiary Injury Prevention
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Improvement of outcomes related to the traumatic injury
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Kinematics
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The study of energy transfer as it applies to identifying actual or potential injuries. Ch4 - pg25 |
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Biomechanics
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The general study of forces and their effects. Ch4 - pg25 |
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Mechanism of Injury
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How external energy forces in the environment are transferred to the body. Ch4 - pg25 |
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Potential energy = Kinetic energy = |
Potential energy = "at rest" pot of water on the edge of a stove. Kinetic energy = "in motion", pot of water falling on the floor Ch4 - pg25 |
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Newtons 1st Law of Motion
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A body at rest will remain at rest, and a body in motion with staty in motion. Pot stays on the stove until the toddler grabs the handle. Once in motion it stays in motion until it strikes the toddler on the head. Ch4 - pg26 |
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Newtons 2nd Law of Motion
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Force = Mass x Acceleration Force is proportional to Acceleration(the more force is applied to an object the more it accelerates). More force is needed to move a large mass object than a small mass object. Ch4 - pg26 |
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Newtons 3rd Law of Motion
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For every action, there is an equal and opposite reaction. Ch4 - pg26 |
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Law of Conservationo of Energy
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Energy cannot be created nor destroyed, but it can change form. Energy is transferred from kinetic object to the object being impacted. Ch4 - pg26
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Concomitant (definition)
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naturally accompanying or associated Ch4 - pg26 |
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KE = 1/2MV^2 |
Kinetic Energy = 1/2 Mass x Velocity^2 KE =1/2(6kg)(2m/s)^2 When Mass is doubled energy is doubled. When Velocity is doubled energy is quadrupled. (high velocity rifles have the capability to transfer more energy to their target) Ch4 - pg27 |
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Structural Strength : 1of3 Compression Strength |
Compression injuries to organs when seatbelt worn high on abdomen, causing compression of small bowel or fracture to the lumbar spine Ch4 - pg 27 |
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Structural Strenght : 2of3 Tensile Strength |
Ability for tissue to resist pulling apart when stretched. Tendons, ligaments, muscles Ch4 - pg27 |
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Structural Strength : 3of3 Shear Strength |
Tissues ability to resist a force applied parallel to the tissue. Coup/countrecoup Ch4 -pg27 |
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Attenuated (definition)
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Weakened in force or effect
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Deleterious (definition)
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Causing harm or damage
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____ _____ can result from broad energy impacts across large surface areas and involve energy transfer causing deceleration or acceleration
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Blunt Trauma Ch4 - pg28 |
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A fall is considered significant in the pediatric patient if the fall is from _____ times the childs height.
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3 times Ch4 - pg28 |
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MVC 3 Impacts
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1st : Vehicle striking object. 2nd : Occupant collides with interior of vehicle. 3rd : Internal structures collide within the body cavity. Predicting survivability is based on velocity and stopping distance. Ch4 - pg29 |
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Frontal Collision "up and over" path |
Head and chest lead the way to the windshield. Associated with head, neck, chest, and abdominal injuries. Can occur when no seatbelt is used. Ch4 - pg29 |
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Frontal Collision "down and under" path |
Associated with lower extremity and pelvic fractues. Can occur when seatbelt is placed above the pelvis. |
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Lateral Collision |
Associated with shear injuries to the aorta, and other organs, fracture of the side of the clavicle, lateral pelvic and abdominal injuries, and lateral head and neck injury. Ch4 - pg30 |
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Rotational Collision (vehicle is struck on one corner, causing vehicle to move around pivot point) |
combination of frontal and lateral collision injuries. Ch4 - pg30 |
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Rear Impact Collision
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Result in immediate forward acceleration. Extension and flexion of the neck as well as frontal impact injuries. Ch4 - pg30 |
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Motorcycle : low side crash "laying the bike down"
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Sliding does not slow the bike down quickly. Abrasions, shoulder and clavical injuries, and lateral head and lower extremity injuries are common. Ch4 - pg31 |
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Motorcycle : high side crash (begins to crash to the low side then grabs traction and flips)
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Catapults rider. All injuries with a low side crash as well as those associated with the speed and impact of landing. Ch4 - pg31 |
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Motorcycle : head on impact
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Ejects the rider forward. Lowe extremities can collide with handle bars, fracturing femur, pelvis. Remaining injuries depend on subsequent collisions. Ch4 - pg31 |
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Motorcycle : lateral or angular impacts
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May result in initial lower extremity crush injuries followed by shoulder and head when rider tumbles over car. Ch4 - pg31 |
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Vehicle versus pedestrian injuries
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Adults : Crush force to the lower extremity. Adults tend to try to escape resulting in lateral and posterior impacts. Children : tend to turn toward vehicle, causing anterior impact. Commonly thrown onto hood and slides off hood onto ground. Waddell triad - head, thorax, lower extremity injuries. |
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Waddells Triad
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Children struck by vehicles. 1)Fractured femoral shaft 2)Intra-abdominal or Intra-thoracic injuries. 3)Contralateral head injuries Ch4 -pg31, internet |
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Cavitation
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Refers to the separation of tissue resulting from a sound and/or hydraulic wave force. Ch4 - pg32 |
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Yaw
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Yaw of a projectile is its ability to wobble up and down. Produces a waved cavitation pattern Ch4 - pg32 |
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Tumble
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Tumble of a projectile is when it rotates end over end.Causes a larger surface area to come into contact with tissue and transfer more energy to the tissue.
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Referring to kinetic energy: when velocity is doubled energy is |
Quadrupled Ch4 - online module |
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____ organs, such as the ___ are more likely to shear under cavitation forces. Whereas ____ organs such as the ____ can tolerate them more due to their elasticity |
Solid Liver Air-filled Lungs Ch4 - online module |
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Blast Trauma : Overpressure
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victim enveloped on all sides with crush forces Ch4 - pg33 |
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Blast Trauma : Dynamic pressure
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Directional, similar to a gust of wind. Can cary fragments and debris at high velocity.
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Primary Blast injuries
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Found closest to the detonation. Air filled organs (TM, lungs, stomach and bowel) most susceptible. Ch4 - pg33 |
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Secondary Blast injuries
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Include fragment injuries and generally cause the greatest number of casualties. Puncture wounds, lacerations, impaled objects. Ch4 - pg33 |
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Tertiary Blast injuries
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Impacts with larger objects propelled by the blast wind resulting in blunt trauma. Can also propel the patient into objects causing blunt trauma. Ch4 - pg33 |
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Quaternary Blast injuries
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result of heat, flame, gas and smoke. External and internal burns from inhaled hot gases Ch4 - pg33 |
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Quinary Blast injuries
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Associated with exposure to hazardous materials from NBC components of the blast. Ch4 - pg33 |
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Which of the following is the best measure of the adequacy of cellular perfusion and helps to predict the outcome of resuscitation?
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Base Deficit TNCC practice test |
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Treatment for frostbite includes:
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Administer Aspirin TNCC practice test |
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Normal vital signs in pregnancy Rationale: In pregnancy, the resting heart rate increases by __ to __ beats/minute and a small decrease in systolic blood pressure and a larger decrease in diastolic blood pressure. Normal fetal heart rate is between ___ and ___ beats/minute (pp. 226, 228 ).
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Normal vital signs in pregnancy Rationale: In pregnancy, the resting heart rate increases by 10 to 20 beats/minute and a small decrease in systolic blood pressure and a larger decrease in diastolic blood pressure. Normal fetal heart rate is between 120 and 160 beats/minute (pp. 226, 228 ). TNCC - practice test |
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Initial Assessment : A to I
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A = Airway and alertness with C-spine stabilization B = Breathing and Ventilation C = Circulation and control of hemorrhage D = Disability (neurologic status) E = Exposure and Environmental control F = Full set of vitals and family presence G = Get resuscitation adjuncts (L=Lab studies, M=Monitor cardiac rate rhythm, N=Naso or orogastric tube insertion, O=Oxygenation and ventilation analysis[pulse ox, ETCO2], P=pain assessment and management) H = History and Head to toe assessment I = inspect posterior surfaces Ch5 - pg39 |
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Across the Room Observation
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completed as the patient is brought into the room. This can allow for rapid determination of the pt overall physiologic stability and the identification of any uncontrolled external hemorrhage. Ch5 - pg40 |
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MARCH acronym
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M = Massive Hemmorhage - control life threatening bleeding. A = Airway - establish and maintain a patent airway. R = Respiration - decompress suspected tension pneumothorax, seal open chest wounds, and support ventilation and oxygenation as required. C = Circulation - vascualer access, and administer fluids as required to treat shock H = Head injury/Hypothermia - prevent or treat hypotension and hypoxia to prevent worsening TBI and prevent or treat hyhpothermia. Ch5 - pg40 |
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MIST acronym
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Used during the History M = MOI I = Injuries sustained S = Signs and symptoms (in the field) T = Treatment (in the field) Ch5 - pg47 |
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Large volumes of fluid infused lead to ____ coagulopathy which worsens _____ and may cause _____
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dilutional metabolic acidosis hypothermia Ch5 - pg45 |
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Lactic Acid is associated with hypoperfusion Lactic acid level greater than _ to _ mmol/L is associated ith poor outcomes |
2 to 4 mmol/L Ch5 - pg 46 |
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ABG : A base deficit of less than ___ is associated with poor outcomes |
-6 Ch5 - pg47 |
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SAMPLE acronym
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Used in patient History. S = Symptoms associated with the injury A = Allergies and tetanus status M = Medications currently used (anticoagulants) P = Past medical history L = Last oral intake E = Events and Environmental factors related to the injury Ch5 - pg48 |
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Contraindication for insertion of Nasogastric tube
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Suspected CSF Ch5 - pg49 |
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Contraindications for insertion of urinary catheter (5)
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Blood at the urethral meatus Perineal ecchymosis Scrotal ecchymosis High riding or nonpalpable prostate Suspected pelvic fracture Ch5 - pg50 |
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Upper Airway components
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Nose, mouth, pharynx, larynx, epiglottis, and trachea Ch6 - pg55 |
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Lower Airway components
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Bronchi and lungs Ch6 - pg55 |
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Vagal response
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Stimulation of vagus nerve (CN X) which serves as primary parasympathetic nerve. Can be stimulated during intubation. Stimulation can cause bradycardia, bronchial vasoconstriction, and increased ICP Ch6 - pg55 |
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SaO2 is
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Arterial saturation. the percentage of hemoglobin saturated with oxygen as determined by an ABG Ch6 - pg59 |
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SpO2 is
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pulse oximetry reading of arterial saturation (SaO2) and is measured as a percentage Ch6 - pg59 |
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PaO2 is
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Reflection of tissue oxygenation. The partial pressure of oxygen dissolved in arterial blood and is measured in mm/Hg. Ch6 - pg59 |
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PaCO2 is
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partial pressure of carbon dioxide dissolved in the blood and is measured in millimeters of mm/Hg. Ch6 - pg59 |
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FiO2 is
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The inspired concentration of oxygen measured in a percentage. Room air is 21% Ch6 - pg59 |
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Hypoxemia is
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oxygen deficiency within arterial blood and is measured by SpO2, SaO2, or PaO2 Ch6 - pg59 |
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Hypoxia is
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a deficiency in oxygen perfusion of the tissues. It is not directly measurable but is considered to be present in decreased paO2 Ch6 - pg59 |
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Jaw Thrust in sunspected cervical spine injury
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"may be best performed by 2 providers". One maintains cspine, one performs jaw thrust. Ch6 - pg59 |
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Bag Valve Mask Ventilation rate
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10-12 breaths per minute one breath every 5-6 seconds Ch6 - pg61 |
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Nasopharyngeal Airway contraindicated in
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patients with facial trauma or a suspected basilar skull fracture. Ch6 - pg62 |
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3 indications for definitive airway management in emergency or trauma
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1) Failure to maintain or protect the airway 2) Failure to maintain oxygenation or ventilation 3) a specific anticipated clinical course Ch6 - pg63 |
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CO2 is the end product of ____ and a reflection of ___ and ____
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Ventilation metabolism and pulmonary function Ch6 - pg66 |
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DOPE acronym for troubleshooting ventilator or capnography alarms
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D = Displaced tube O = Obstructed or kinked tube P = Pneumothorax E = Equipment failure Ch6 - pg66 |
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Hyperoxia outcomes Recommended SpO2 and PaO2 |
1) Hyperoxic patients had two times the inhospital mortality than patients who were normoxic. 2) May decrease hemodynamic stability Recommended SpO2 between 94% and 98% Recommended PaO2 between 100 and 200 mm Hg Ch6 - pg66 |
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7Ps of RSI
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Preparation Preoxygenation - 94% Pretreatment - medication to mitigate adverse effects associated with endotracheal intubation (lidocaine for ICP) Paralysis with Induction Protection and Positioning Placement with Proof Post intubation Management - secure tube, CXR. Ch6 - pg69-71 |
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Shock definition
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Inadequate tissue perfusion, resulting from insufficient oxygen delivery, uptake, and utilization to meet the metabolic demands of cells and organs. Ch7 - pg73 |
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4 Types of Shock
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Hypovolemic Obstructive Cardiogenic Distributive Ch7 - pg73 |
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____ shock from ____ is the leading cause of preventable deaths in trauma patients
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Hypovolemic hemorrhage Ch7 - pg73 |
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Obstructive Shock definition
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hypoperfusion of the tissue due to an obstruction in either the vasculature or the heart. Ch7 - pg73 |
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Cardiogenic Shock definition
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pump failure in the presence of adequate intravascular volume Heart Failure is an example of chronic. Ch7 - pg74 |
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Distributive Shock definition
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maldistribution of an adequate circulating blood volume with the loss of vascular tone or increased permeability. Ch7 pg75 |
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Hypovolemic Shock definition
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decrease in the amount of circulating blood volume Ch7 - pg73 |
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Hypovolemic Shock Etiologies
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Hemorrhage Burns Ch7 - pg74 |
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Cardiogenic Shock Etiologies
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Myocardial Infarction - decr cardiac contractility Dysrhythmias - decr cardiac output Blunt cardiac trauma - decr contractility and dysrhythmias Ch7 - pg74 |
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Obstructive Shock Etiologies
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Cardiac Tamponade Tension Pneumothorax Tension Hemothorax Ch7 - pg74 |
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Distributive Shock Etiologies
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Neurogenic shock Anaphylactic shock Septic shock Ch7 - pg74 |
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Class 1 Hypovolemic Shock
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Blood Loss = 750ml Blood % = 15% HR = <100 Systolic = normal Pulse Pressure <Normal or increased RR = 14-20 Urine output = >30 CNS = slightly anxious Initial fluid replacement = Crystalloid |
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Class 2 Hypovolemic Shock
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Blood Loss= 750-1500 Blood %= 15-30% HR= 100-120 Systolic= Normal Pulse Pressure = decreased RR= 20-30 Urine output = 20-30 CNS= Mildly anxious Initial fluid replacement = Crystalloid Ch7 - pg75 |
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Class 3 Hypovolemic Shock
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Blood Loss= 1500-2000 Blood %= 30-40 HR= 120-140 Systolic= Decreased Pulse Pressure = Decreased RR= 30-40 Urine output5-15 CNS= anxious, confused Initial fluid replacement = Crystaloid and blood |
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Class 4 Hypovolemic Shock
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Blood Loss= >2000 Blood %= >40% HR= >140 Systolic= Decreased Pulse Pressure = Decreased RR= >35 Urine output= Negligile CNS= confused, lethargic Initial fluid replacement = crystalloid and blood |
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Pregnant Pt HR increases
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10-20 beats per minute, increasing cardiac output. Ch16 - Online slides. |
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Increased hormonal levels in pregnancy can cause __ which may ___ __....
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vasodilation, which may make the pregnant patient in shock appear warm and dry. Ch16 - Online slides. |
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Plasma volume increases ___ to ___ by the ____ week
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30-50% by the 30th week. Ch16 - Online slides |
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Abdominal palpation is more or less reliable in a pregnant patient?
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Less because the organs are displaced, abdominal wall muscles are stretched, bowel sounds are less audible. Ch16 - Online slides |
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Kleihauer Betke (KB) test
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can test for fetal RBC in maternal circulation, can be a sign of hemorrhage of fetal blood through the placenta. and RH incompatibility Ch16 - Online slides |
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Increased plasma in pregnancy...
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by the 30th week can cause dilutional anemia and decrease in Hct 32%-34% Ch16 - Online slides |
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_____ and _____ are the leading causes of maternal death in pregnancy
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Brain injury and Hemorrhagic shock Ch16 - Online slides |
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Estimating pregnancy length by fundal height. Symphysis Umbillicus Costal |
Symphysis 12weeks Umbillicus 20weeks Costal 36weeks Ch16 - Online slides |
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Amniotic fluid Ph is Urine ph is |
Amniotic fluid ph is 7.5, urine Ph is 4.6-6. So any obvious fluid in the vaginal vault is ph tested. Ch16 - Online slides |
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Preterm labor is present in up to ___% of pregnant trauma patients
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25% Ch16 - Online slides |
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Cardiac Output =
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Stroke Volume x HR Ch7 - pg76 |
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Afterload ...aka
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peripheral vascular resistance So a tension pneumothorax can change intrathoracic pressure causeing increase in afterload and compressing the hear and venae cavae decreasing preload. Ch7 - pg76 |
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Increased diastolic BP and _____ may be one of the first concrete measurements signaling compensation for shock.
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Increased diastolic BP and narrowing pulse pressure. Ch7 - pg76 |
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Trauma Triad of Death
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Caogulopathy Hypothermia Metabilic Acidosis Ch7 - pg79 |
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Stages of Shock Stage 1 = Stage 2 = Stage 3 = |
Stage 1 = Compensated Stage 2 = Decompensated or Progressive Stage 3 = Irreversible Ch7 - pg78 |
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Stage 1 Shock
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Compensated Subtle changes in LOC and vital signs. Anxiety, lethargy, confusion, restlessness. Systolic BP = usually normal Diastolic = usually rising with narrowing pulse pressure. Pulse = bounding or tachycardic RR = increased Urinary output = decreased Ch7 - pg79 |
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Stage 2 Shock
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Decompensate or Progressive LOC = Obtunded or unconscious SBP = Normal or slightly decreased DBP = Narrowing pulse pressure Pulse = >100, weak and thready RR = rapid and shallow, to correct acidosis Skin = cool and clammy, cyanotic Base Excess = -2 to +2 Serum Lactate = 2-4 Ch7 - pg79 |
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Stage 3 Shock
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Irreversible Shock LOC = obtunded, stuporous, or comotose SBP = marked hypotension Pulse = bradycardia with possible dysrhythmias RR = decreased and shallow Skin = pale, cool, clammy Severe acidosis coagulopathies with petechiae, purpura, or bleeding Ch7 - pg79 |
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Damage Control Resuscitation
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Principle that focuses on prevention rather than intervention. 2 Strategies. 1) Hypotensive Resuscitation - Large volumes of crystalloid is associated with increased bleeding and decreased survival. Less fluids to prevent "popping the clot". Goal is not hypotension, but adequate resuscitation without hypertension. 2) Hemostatic Resuscitation - Hemorrhage control. Transfusion of RBC : FFP given in a 1:1 ratio. Ch7 - pg80 |
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Hypocalcemia with Massive Transfusion of blood
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Citrate is a preservative added to blood for transfusion. Citrate binds to calcium rendering it inactive. Calcium is a part of the clotting cascade. 3G of Citrate is added to every unit of blood. A healthy liver can metabolize 3G every 5minutes. Sooo...If a trauma patient requires more than 1 unit of blood every 5 minutes...prepare for citrate toxicity and Hypocalcemia. Give Calcium gluconate or calcium chloride. Ch7 - pg81 |
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Autotransfusion of blood time limit recommendation
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within 6hours Ch7 - pg81 |
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TXA
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A synthetic version of amino acid lysine. Antifibrinolytic that inhibits activation of plasminogen(dissolves clots). Ch7 - pg81 |
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One unit of PRBCs is estimated to increase HgB by __ and Hct by ___%
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1G 3% Ch7 - pg83 |
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What measurement is the gold standard for dependable and precise blood pressure readings
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Mean Arterial Pressure. Ch7 - pg83 |
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Output of less than ____ per hour for ___ consecutive hours indicates _____
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0.5mL/kg per hour for 2 consecutive hours indicates oliguria. Ch7 - pg84 |
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Neurons receive sensation in 4 ways
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1)Discriminative touch - helps identify objects by feel. 2) Proprioception - relates a sensof movement and position of the body within the environment 3) Temperature 4) Nociception - perception of pain and irritation (itch, sting, tingle) Ch8 - pg91 |
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Nociception involves 4 inter-related processes
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Transduction - Transmission - Perception - Modulation Transduction = mechanical and thermal sensations from injury. Chemical stimulation from inflammatory responses. Transmission - through the spinothalamic tracts Perception - pain threshold, pain tolerance, and expression of pain. Modulation - neuromodulators can slow down or inhibit the pain ie-endorphin. Ch8 - pg92-93 |
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Pain as defined by International Association for the Study of Pain
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an unpleasant sensory and emotional experience associated with actual or potential tissue damage Ch8 -pg93 |
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Oligoanalgesia (definition)
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the concept of undertreatment of pain. Ch8 - pg94 |
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The most reliable and valid tool for pain assessment is ___
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self report Ch8 - pg95 |
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Response to Sympathetic (acute pain)
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Increased SBP, HR, RR, alertness, rapid speech Cerebral v asodilation Pupillary dilation Ch8 - pg96 |
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Response to Parasympathetic (chronic pain)
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Decreased, SBP, HR, slowed speach Syncope Variable respiratory patterns Pupillary constriction Ch8 - pg96 |
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WHO pain steps
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Step 1 - non-opiods for mild (1-3). Tylenol, motrin, toradol. Step 2 - weak opiods for mild to mod (4-6). Codeine, Nalbuphine. Step 3 - strong opiods for moderate to severe(7-10). Morphine, Fantanyl dilaudid. Ch8 -pg98 |
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Minimal Sedation (anxiolysis)
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cognitive function and coordination may be impaired, but cardiovascular and ventilator functions are unaffected. Ch8 - pg99 |
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Moderate Sedation
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depression of consciousness in which patients can respond purposefully to verbal commands and can independently maintain a patent airway.
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Deep Sedation
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Depression of consciousness, patients cannot be easily awakened, can respond purposefully to repeated or painful stimuli. Spontaneous ventilation and maintenance of airway patency may require assistance. Ch8 - pg 99 |
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General Anesthesia
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Loss of consciousness. Patients cannot be aroused. Cardiovascular function may be impaired. Airway and ventilator support is required. Ch8 - pg99 |
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American Society of Anesthesiologists recommends limiting last oral intake of clear liquids to ___ hours and of solid food or milk to ____ before the procedure
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Clear liquids to 2hours. Solid food or milk to 6 hours. Ch8 - pg99 |
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The scalp consists of 5 layers of tissue, use the acronym SCALP
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Skin Connective tissue Aponeurosis(galea aponeurotica) Loose areolar tissue Pericranium Ch9 -pg105 |
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Meninges consist of 3 layers of protective coverings. PAD
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Pia mater - innermost Arachnoid membrane Dura mater - outermost Ch9 - pg105 |
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____ in the ____ and ___ vetricles of the brain produces CSF |
Choroid plexus in the lateral and third ventricles of the brain produces CSF Ch9 - pg105 |
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associated with normal aging or diseases such as alcoholism. _____ bleeding may be less evident in patients who have brain atrophy. |
Subdural bleeding Ch9 -pg105 |
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Tentorium cerebelli divides the cranial vault into 2 compartments ____ and ____. Injury or edema near the tentorium gap may cause compression and shifting of structures and the ____nerve against the tentorium |
Supratentorial and infratentorial. Oculomotor Nerve. The oculomotor nerve CN3 passes through a gap in the tentorium. Ch9 - pg106 |
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Frontal lobe responsible for (4)
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Judgement Reasoning Social restraint Voluntary motor functions Ch9 - pg106 |
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Parietal lobe responsible for (2)
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Spatial orientation Sensory functions Ch9 - pg106 |
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Temporal lobe responsible for (3)
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Speech Auditory functions Memory functions Ch9 - pg106 |
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Occipital lobe responsible for (1)
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vision Ch9 - pg 106 |
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Blood-brain barrier is __
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a filter for the CNS and controls the exchange of oxygen, carbon dioxide and metabolites between the blood and brain. Ch9 - pg106 |
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Brain uses approximately ___% of the bodys total oxygen supply
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20% Ch9 - pg106 |
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CO2 is a cerebral ____ thus increasing ___ , ____, and ____
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CO2 is a cerebral vasodilatory thus increasing cerebral blood volume and perfusion, and ICP Ch9 - pg107 |
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Acute hypoxia is PaO2 less than _____ and _____ occurs
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PaO2 less than 50mm Hg and cerebral vasodilatoion and increased blood flow occurs Ch9 - pg107 |
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Normal ICP levels
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0 - 15 mmHg Ch9 - pg107 |
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Abnormal ICP is ___
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Sustained >20 mm Hg Ch9 - pg107 |
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Monro-Kellie Doctrine for ICP
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As the volume of one component expands (tissue, venous blood, CSF) the volume of one or both of the other componenets must decrease to maintain a constant ICP. Ch9 - pg107 |
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Cerebral Perfusion Pressure formula CPP = ___ |
CPP = MAP - ICP CPP of 60-100 is normal ICP of 0 -15 mm Hg is normal Ch9 - pg107 |
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Cushing Response : symptoms
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Widening pulse pressure reflex bradycardia diminished respiratory effort Ch9 - pg 107 |
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Cushing Response : pathophys
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Loss of autoregulation(perfusion becomes solely dependent on pressure) can result in cerebral and brainstem ischemia. This causes the response of the Cushings triad, in an attempt to increase MAP and CPP. Widening pulse pressure = increased SBP to get more blood to brain. Reflex bradycardia Diminished respiratory effort - to increase CO2 and cause cerebral vasodilation. Ch9 - pg107 |
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Traumatic Brain Injury happens to ___ people annually. Contributes to ____% of the injury related deaths in the US
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1.7million people annually 30.5% of the injury related deaths in the US Ch9 - pg107 |
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Brain Injury classified as Primary Secondary |
Primary - result from a direct transfer of energy. Skull and facial fractures, intracranial lesions, epidural or subdural hematomas. Secondary - caused by complex pathophysiologic changes that include the following. Hypotension, Hypoxemia, Hypercarbia, Cerebral edema, increased ICP, decreased CPP, cerebral ischemia. Ch9 - pg108 |
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Brain loses its ability to autoregulate when CPP is outside the range of ___ and ____
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50 and 160 mmHg Then Cerebral flood flow becomes directly dependent on MAP for perfusion. Ch9 - pg108 |
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Early Assessment findings of increased ICP
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>20mm Hg Headache, Nausea, Vomitting, Amnesia Altered LOC Behavior changes(impaired judgement, restlessness, or drowsiness) Ch9 - pg109 |
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Late Assessment findings of increased ICP
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>20mm Hg Dilated, nonreactive pupils Unresponsive Abnormal posturing Cushing response(widening pp, bradycardia, decreased respiratory effort) Ch9 - pg109 |
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When autoregulation fails perfusion of the brain depends on the ____
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MAP Autoregulation fails if CPP is not maintained between 50 -150mm Hg. Ch9 - pg107 |
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A single episode of ____ can be harmful to patient outcomes, especially in the context of head injuries.
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Single episode of Hypotension SBP <90. In the context of head injuries hypotension has been linked to more than double the mortality as compared to normotensive patients. Ch9 - pg108 |
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Rigid cervical collars may contribute to an ___ in ICP due to ____
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Increase in ICP Due to interfering with venous flow and pain and discomfort Ch9 - pg109 |
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Bag Valve Mask standard operation : a breath every ___ to ___ seconds (___ to ___ ventilations per minute). Deliver each breath over ___ to ___ seconds with just enough tidal volume for chest rise |
a breath every 5 to 6 seconds (10 to 12 ventilations per minute). Deliver each breath over 1 to 2 seconds with just enough tidal volume for chest rise Ch9 - pg110 |
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Unilaterally fixed and dilated pupil may indicate
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Oculomotor nerve compression from increased ICP and herniation syndrome Ch9 - pg 110 |
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Bilaterally fixed and pinpoint pupils may indicate
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an injury at the pons or the effects of opiods Ch9 - pg110 |
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A moderately dilated pupil with sluggish response may be an early sign of
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Herniation syndrome Ch9 - pg110 |
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Periorbital Eccymosis (raccoon eyes) indicate a ___, more specifically a ____
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basilar skull fracture anterior fossa fracture raccoon eyes have a positive predictive value of basilar skull fracture of 85%(Wikipedia) Ch9 - pg113 |
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Mastoid process ecchymosis (battle sign indicates a ____, more specifically a ___
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basilar skull fracture middle fossa fracture Ch9 - pg113 |
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Hemotympanum indicates a ____, more specifically a ____
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basilar skull fracture middle fossa fracture Ch9 - pg113 |
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Basilar skull fractures - 3 main signs
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Periorbital ecchymosis (raccoon eyes) Mastoid process ecchymosis (battle sign) Hemotympanum Ch9 - pg113 |
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FOUR Score
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Ranges from 0-16, and provides greater neurologic detail than the GCS score Eye response, motor response, brainstem reflexes, respiration Ch9 - pg110 |
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B2 Transferrin test
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Test of fluid from otorrhea or rhinorrhea for CSF. Considered gold standard for identifying CSF. Ch9- pg113 |
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Cerebral Contusion : maximum effects of contusion and edema formation usually peak ___ to ___ hours after injury
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18 to 36 hours Ch9 - pg114 |
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Intracerebral Hematoma : what is it, signs and symptoms
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Occur deep within the brain tissue. -Progressive and RAPID DECLINE in LOC -contralateral hemiparesis, hemiplegia, abnormal posturing Ch9 - pg114 |
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Epidural Hematoma
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Collection of blood between the dura mater and the skull. 90% associated with fractures of the temporal or parietal skull that lacerate the middle meningeal artery. bleeding accumulates rapidly -transient LOC followed by a lucid period lasting minutes to hours -dizziness -nausea and vomiting -ipsilateral unilateral fixed and dilated pupil Ch9-pg114 |
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Acute Subdural Hematoma
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Usually following acceleration, deceleration forces. Symptoms occuring within 72hours ipsilateral dilated or nonreactive pupil Ch9 - pg114 |
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Herniation Syndrom |
Shifting of the brain tissue with displacement into another compartment as a result. Supratentorial herniation is the most common in trauma.
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Uncal Transtentorial Herniation |
uncus of the temporal lobe is displaced unilaterally over the tentorium into the posterior fossa causeing a shift of the mid brain. Ch9 - pg115 |
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Central or Transtentorial Herniation |
the cerebral hemispheres are pushed downward through the tentorial notch directly compressing the brainstem. Ch9 - pg115 |
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Mild TBI |
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Moderate TBI |
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Severe TBI |
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Diffuse Axonal Injury |
Widespread microscopic damage, primarily to axons. MOI usually rotational or acceleration/deceleration.
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Linear Skull Fracture |
nondisplaced fracture of the cranium
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Depressed Skull Fracture |
Extends below the surface of the skull and may cause dura mater laceration and brain tissue injury.
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Basilar Skull Fracture |
May include any of the 5 bones in the base of the skull
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Late Symptoms of Basilar Skull Fractures |
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LeFort 1 is |
Transverse maxillary bone fracture that seperates the teeth from the maxilla. malocclusion Ch9 - pg117 |
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LeFort 2 is |
Fracture of pyramidal maxillary bone involving the mid face area. Apex of the fracture trasverses the bridge of the nose.
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LeFort 3 is |
Complete craniofacial seperation involving the maxilla, zygoma, orbits, and bones of the cranial base
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Interventions for pt with brain, cranial, or maxillofacial trauma |
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Eye Movement and Innervation of : Medial Rectus Lateral Rectus Superior Rectus Inferior Rectus |
Medial - toward nose - Occulomotor (CN3) Lateral - away from nose - Abducent (CN6) Superior - upward - Oculomotor (CN3) Inferior - Downward - Oculomotor (CN3) Ch10 - pg124 |
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Eye Movement and Innervation of : Superior Oblique Inferior Oblique |
Superior Oblique - medial rotation - Trochlear (CN4) Inferior Oblique - lateral rotation - Oculomotor (CN3) Ch10 - pg124 |
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Intraocular Pressure Measurement |
If the production of aqueous humor exceeds the outflow (glaucoma and hyphema), IOP is increased. A decrease may be caused by a disruption in the globe. Normal IOP is 10-20mm Hg Ch10 - pg 128 |
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Corneal Abrasion |
Common. S+S:
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Corneal Laceration |
Full thickness injuries to the cornea. Misshapen iris and positive seidel test(slit lamp w fluoracein) Small lacerations are treated like corneal abrasions larger lacerations possible surgery
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Intraocular Foreign Body |
a true eye emergency, and early intervention is essential. S+S: misshapen pupils Tx : elevate HOB immobilize foreign body limit eye movement by patching oposite eye perform globe closure asap. Ch10 - pg130 |
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Blowout Fracture
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Fracture of orbital floor that can cause muscle and or nerve entrapment. Decreased EOM. Seen in periorbital contusion (black eye) Ch10 - pg130 |
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Closed Globe Injuries
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According to Birmingham Eye Trauma Terminology as if the glove is intact it is a closed globe injury and is classified as a contusion or lamellar laceration Ch10 - pg 124 |
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Open Globe Injuries
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Classified as either lacerations or ruptures. Ch10 - pg124 |
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Orbital Fracture : Usually result of ___? What bones are weakest? Can cause ___? |
Usually a result of a direct blow. Orbital floor and ethmoid bones are the weakest part of the orbit. Can cause entrapment of the inferior rectus and inferior oblique muscle Ch10 - pg130 |
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Orbital Fracture : Assessment Treatment |
Assessment :
Treatment
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Hyphema
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Collection of blood in the anterior chamber of the eye. Traumatic or spontaneous GRaded 1-4 based on amount of blood present Treatment
Ch10 - pg131 |
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Retrobulbar Hematoma
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2nd to blunt trauma. Hemorrhage behind the globe. Increased IOP compresses the optic nerve and blood vessels. Early recognition is imperative to save vision. This is a true opthalmic emergency. Symptoms
Treatment
Ch10 - pg131 |
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Globe Rupture
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A full thickness injury occurs to the cornea or sclera or both. Considered a genuine emergency. Protect from further injury. Symptoms
Treatment - rigid shield to protect eye. Ch10 - pg132 |
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Grading Traumatic Hyphema : 1-4
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1 : Blood <1/3 of anterior chamber 2 : Blood 1/3-1/2 of anterior chamber 3 : Blood >1/2 and 4 : Blood occupying the entire anterior chamber Ch10 - pg131 |
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Pericardial Fluid Volume
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Approximately 25ml. Provides lubrication Ch11 - pg 138 |
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Most often site of aortic injury
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Aortic Isthmus Transition from the mobile aoritic arch to the relatively fixed descending aorta. (behind the heart) Ch11 - pg138 |
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The sternum and first and second ribs are more resistant to energy forces when they are injured. So there is an increased risk of injury to ____ |
Underlying structures. Ch11 - pg140 |
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If a penetrating thoracic wound is found below the ____ intercostal space, penetration into the abdominal cavity is suspected until proven otherwise
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4th Ch11 - pg140 |
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Pericardial Tamponade
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Fluid in the pericardial sac. Inhibits ventricular filling, decreasing preload. Stroke volume is also decreased, which decreases cardiac output. Obstructive shock. Hypotension Muffled heart tones neck vein distention Tachycardia Pulsus Paradoxus (decrease of 10mm Hg on inspiration) Ch11 - pg141 |
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Becks Triad
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Actually 4 Symptoms of Pericardial Tamponade Hypotension Muffled Heart tones Tachycardia Neck vein distention Ch11 - pg141 |
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Sternal Fracture Associated injury is
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Blunt Cardiac injury Ch11- pg141 |
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First and Second rib fractures associated injury is
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Great vessel injuries Brachial plexus injuries Head and spinal cord injuries Ch11 - pg 141 |
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Multiple rib fractures and flail chest associated injuries
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Pulmonary contusion Pneumothorax Hethorax Ch11 - pg141 |
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Lower rib fractures (7-12)
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Liver (R sided) Spleen (L sided) Ch11 - pg141 |
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Emergency Thoracotomy Indications
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Tracheobronchial Injuries causes
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Most likely to be caused by penetrating mechanisms. Direct blows to the neck or clothesline-tye injuries are common mechanisms. Ch11 - pg143 |
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Blunt Esophageal Injury
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Signs : Air in the mediastinum with possible widening Left pneumothorax or hemothorax Subcutaneous Emphysema Treatment : Prepare for surgery Ch11 - pg143 |
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Flail Chest definition
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2 or more fractures of 3 or more ribs, creating a free floating segment. Ch11 - pg144 |
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Massive Hemothorax : more than _____mL of blood
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1,500mL Ch11 - pg146 |
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As little as ___mL of blood in the pericardial sac can cause a pericardial tamponade
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50mL There is normally 25mL of fluid in the sac for lubrication. Ch11 - pg146 |
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Aortic Disruption
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Aortic Isthmus is the most frequently injured site of the Aorta. Mortality rates of 75%-90% Unequal extremity pulse strength or blood pressure (significantly greater in the upper extremities) Ch11 - pg147 |
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Ruptured Diaphragm
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Abdominal contents can herniate into the thoracic cavity, compressing the lung, may lead to respiratory compromise. Penetrating trauma below the 4th intercostal space Sharp epigastric or chest pain radiating to Left shoulder (kehr sign) bowel sounds auscultated in lung fields on injured side. Ch11- pg147 |
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Kehrs Sign
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Left shouder pain. May occur in ruptured diaphragm May be due to ruptured spleen Ch11 - pg 147 |
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FOCA acronym for chest tubes
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Fluctuation in the water seal chamber Output Color of drainage Air leak, presence Ch11 - pg148 |
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DOPE troubleshooting for chest tube
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Dislodgement Obstruction Pneumothorax Equipment failure Ch11 - pg148 |
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Chest Tubes : Notify the physician and anticipate need for surgery |
Initial chest tube drainage >500ml Continuing blood loss of >200ml per hour for 2-4hours Ch11 - pg148 |
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