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25 Cards in this Set

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What are the 4 phases of a proper assessment of a trauma pt?
1. Primary Survey
2. Resuscitation
3. Secondary Survey
4. Definitive Care
What does the primary survey involve?
- Dx & Tx of all life-threatening injuries.
- organized by ABCDEFG
What does ABCDEFG stand for?
A = Airway & Spine Immobilization
B = Breathing
C = Circulation
D = Disability = Neuro deficits
E = Exposure (take ALL clothes off) & Environment (keep pt warm)
F = Foley
G = Gastric tube
What parts of respiratory tract are evaluated in Airway Management?
Mouth
Oropharynx
Larynx
Trachea
An adequately immobilized pt has a...
...cervical collar & is secured to a rigid backboard
What's the proper technique to immobilize pt's spine while airway is assessed?
Dr. A assesses airway.
Dr. B immobilizes spine by
- kneeling at head of bed
- placing his hands on pt's shoulders
- with wrists alongside pt's head
- keep pt's head from moving while Dr. A intubates
Which 2 maneuvers are used to open mouth in pt who's unconscious & supine?
Jaw-Thrust
or Chin-Lift
maneuvers
a) Describe Jaw-Thrust maneuver.
b) Disadvantage?
a) - place fingers behind angle of the jaw b/l & grasp jaw on both sides
- lift jaw forward
- use thumbs to draw chin down & open mouth

b) Disadvantage: reqs 2 hands
a) Describe Chin-Lift Maneuver
b) Pros?
c) Cons?
a) - place fingers of one hand under chin & thumb just below lips
- lift chin fwd & downward, opening mouth
- now insert thumb behind lower teeth for more secure grip

b) Pros: reqs only 1 hand so you can intubate with other hand

c) Cons: risk thumb'll be bitten in semiconscious pt
The Oral Airway:
a) scientific name?
b) goes from where to where?
c) describe the tube.
d) risks/watch out for....
e) should not be used for which pts?
a) oropharyngeal airway
b) from mouth to pharynx
c) rigid plastic hook
d) risks: if improperly done, can push tongue back & block airway
e) do NOT use in awake pts w/ an intact gag reflex ---> gag & aspiration
The Nasal Airway:
a) scientific name?
b) goes from where to where?
c) describe the tube.
d) SHOULD be used for which pts?
a) nasopharyngeal airway
b) goes from nostril to hypopharynx
c) soft, flexible rubber tube w/ trumpet-like flange on one end
d) good for awake pts w/ intact gag reflex
Name types of Definitive Airways.
Which are used in an Emergency?
1. Orotracheal intubation
2. nasotracheal intubation
3. surgical cricothyroidotomy
4. needle cricothyroidotomy
5. tracheostomy

Emergency options are surgical & needle cricothyroidotomy
Proper location for cricothyroidotomy?
Through cricothyroid membrane.

Find it by placing finger at sternal notch & moving up trachea. You'll feel:
1. Tracheal rings
2. Cricoid cartilage (more prominant than tracheal rings)
3. a depression (the Cricothyroid membrane)
4. Thyroid Cartilage

Descending: 1. Thyroid Cartilage, 2.
Difference bt a surgical cricothyroidotomy & a needle cricothyroidotomy?
Surgical: you insert a size 6 endotracheal tube

Needle: you insert an IV tube (#1 choice in emergency in kids, temporary choice in adults)
If you can palpate a radial pulse, that means SBP is > ____?
> or = 80 mmHg
If you CANNOT palpate carotid or femoral pulse, means SBP < ___?
< 60 mmHg
How do you calculate the GCS (Glasgow Coma Scale)?
E) Eye Opening:
4 - spontaneous
3 - to verbal command
2 - to painful stimuli
1 - No response

V) Best Verbal Response:
5 - Ox3
4 - Disoriented, confused conversation
3 - Innapropriate words w/o sustained conversation
2 - Incomprehensible sounds, moans, groans
1 - No response

M) Best Motor Response:
6 - follows verbal commands
5 - localizes pain by reaching twds painful areas
4 - Withdraws from painful stimulus
3 - Decorticate posturing (elbows bent, legs extended)
2 - Decerebrate posturing (elbows & legs extended)
1 - No Response
What does the calculated GCS score tell you?
GCS = 3 DEAD
GCS < 9 COMA, SEVERE head injury
GCS 9-12 MODERATE head injury
GCS > 12 MINOR head injury
GCS = 15 NORMAL
Radiographic signs of Blunt Aortic Injury?
1. wide mediastinum
2. partial obliteration of the descending aorta
3. a left pleural apical cap
4. downward displacement of the left bronchus
5. tracheal deviation to the right
6. obscuration of the aortic arch
7. a right paratracheal stripe thickening
8. deviation of the nasogastric (NG) tube to the right
9. enlarged abnormal aortic contour
10. left hemothorax
11. a displaced left paraspinal stripe
12. a displaced right paraspinal stripe
13. a fracture of the first rib
Anatomy.
Name the 5 layers of the scalp.
"SCALP"
Skin
subCutaneous tissue
galea Aponeurotica
Loose areolar tissue
Periosteum (pericranium)
Mxn of the Cushing Reflex?
a response to increased ICP...

increased ICP -->> cerebral BVs get squished -->> ischemia -->> low pH & high PCO2 ->(+) central chemoreceps -->(+) Symp NS
-->(+) alpha-Rs -->> vasctcn
-->> HTN -->> baroreceps
in carotid -->(+) vagus
-->> bradycardia
-->> increase HR (tachycardia)
& CO

NET RESULT: (kinda paradoxical)
bradycardia
HTN
decreased resp rate
INDICATES IMPENDING HERNIATION!!
In a Co-Tenancy, what are the incidents of co-ownership? (3)
[1] Possession;

[2] Accountability;

[3] Contribution. “Co-Tenant” refers to any of the multiple owners of any of the three concurrent estates)
Pupils don't need to be identical but need to be w/in ___mm of each other
1 mm
Why should you never put an NG tube in a pt w/ raccoon eyes.
If raccoon eyes are due to ecchymoses, could indicate cribriform plate fx & NG tube would enter brain!
How to tell if CSF is coming out of pt's nose with all that blood.
Look for RING SIGN or TARGET SIGN:
- put drop of bloody d/c on lab filter paper
- if circle of red blood is surrounded by concentric circles of clearer pink, yes there's CSF