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60 Cards in this Set

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hoarseness
change in voice
stridor
signs of laryngeal edema
continual reassessment is crucial during trauma. T/F?
true
airway assessment:
pt talks = ?
patent airway
stridor
hoarsenss
evidence of increased airway resistance
signs of airway obstruction
signs of airway obstruction
1.stridor
2.hoarseness
3.evidence of increased airway obstruction
signs of laryngeal edema
1.hoarseness
2.change in voice
3.stridor
how to test for clear upper airway?
gag reflex
indications for intubation
1.glasgow < 8
2.AMS
3.inability to protect airway3
4.compromised respir. mechanics
simple pneumothorax Tx
large-diameter chest tube
large-diameter chest tube insertion method
1.insert finger into pleural space
2.insert chest tube
large-diameter chest tube management
1.water seal + suction
2.serial CXR
3.remove when...no air leaks, lung inflated
chest laceration to lung that "sucks" air
sucking chest wound
chest laceration to lung that "sucks" air

next step?
1.seal w/occlusive dressing
2.chest tube @ different site
chest tube insertion + continuous air leak
major airway injury (bronchus/trachea)
chest tube insertion + continuous air leak

next step?
1.thoracotomy
2.partial lung resection
chest tube insertion + no lung inflation

what's wrong?
1.wrong location
2.tube not functional
can you observe a small, uncomplicated pneumothorax?
yes, if not enlarging + no other injuries + no free fluid + aSx
tension pneumothorax Sx
1.hypotension
2.JVD
3.(-)BS
tension pneumothorax

management?
1.needle aspiration
2.chest tube
JVD + hypotension
1.tamponade
2.tension pneumothorax
3.myocardial contusion
JVD + hypotension + clear BS

next step?
1.pericardiocentesis or U/S
tamponade Sx
1.hypotension
2.JVD
3.muffled heart sounds
4.pulsus paradoxus
5.Kussmaul sign
Kussmaul sign
increase in CVP during inspiration

seen in tamponade
pulsus paradoxus
decrease in sBP >10 on inspiration

seen in tamponade
most common cause of hypotension in trauma
hypovolemia
hypotension fr/trauma

next step?
1.2 large-bore IV + 1-2L NS
how to measure adequate fluid resuscitation
1.urine output
2.HR
3.MS
4.BP
continued hypotension despite fluid resuscitation

what's going on?
1.intra-abdominal injury
2.pelvic fracture
Cushing reflex
brain swelling + ischemia
nl pregnancy hct
31-35% (due to increased plasma volume)
prior to catheter insertion, must do...
rectal exam

check for prostatic injury
cervical spine management
1.immobilization
2.palpation
3.motor & sensory check
4.lateral cervical spine XR
level of consciousness assessment
Glasgow coma scale
how to decrease brain edema?
1.head elevation to 30
2.hyperventilation
3.mannitol
4.phenytoin (seizure prevention)
glasgow 10 + dilated R pupil (sluggish response to light)

what's wrong?
space-occupying CNS lesion
blood behind eardrum

what's wrong?
basal skull fracture
ecchymosis/blood around eyes
("racoon eyes")

what's wrong?
basal skull fracture
ecchymosis in mastoid region
(Battle's sign)

what's wrong
basal skull fracture
brain injury --> hyponatremia, concentrated urine, elevated urine [Na+], brain edema

what's wrong?
SIADH
SIADH Tx
fluid restriction

3% Na+ over 3-4 hrs
caveat of rapid hyponatremia correction
central pontine myelinosis
diabetes insipidus Tx
vasopressin/desmopressin/ddAVP + free water
how hypothermia affects platelets?
platelet dysfxn & increased PT, PTT
poor coagulopathy not corrected by temperature normalization.

next step?
FFP (restore coag factors)
continued hemorrhage + low platelet count

what's wrong?
1.DIC
2.sepsis
continued hemorrhage + low platelets

next step?
platelet transfusion

(keep >60,000)
abdominal compartment syndrome?
tense abdominal compartment due to accumulating fluid & blood
abdominal distention + oliguria

what's wrong?
abdominal compartment syndrome decreases renal blood flow
blood loss v. NS replacement ratio
3ml NS : 1ml blood
elevated SVR seen in...
1.vasoconstrictors
2.cardiogenic shock
3.hypovolemic shock
4.HTN
depressed SVR seen in...
1.septic shock
2.neurogenic shock
3.vasodilators
type of shock most commonly seen in trauma pts
neurogenic shock
traumatic AV fistula Dx
1.palpable thrill
2.audible bruit
3.angiogram
4.occlusion --> drop HR
Branham's sign
drop of >10 beats/min

seen in AV fistula occlusion via pressure
AV fistula sites
1.traumatic sites
2.AAA + IVC
3.ESRD dialysis pts
airway burns signs
1.carbonaceous sputum
2.facial burn
3.facial/nasal hair burns
4.low o2 sat
5.dyspnea
prophylactic abx for burn pts?
no! abx resistance
most common burn bugs
1.pseudomonas
2.staph aureus
3.strep
4.candida
electrical burn suspected

next step?
1.EKG, cardiac enzymes
2.maintain high urine output, alkalinze urine (prevent renal failure)
stab wounds -
zone I marker
zone III marker
zone I - cricoid cartilage
zone III - mandible angle