FISDAP Trauma

What is Anaphylactic shock?

(also called anaphylaxis) occurs when histamine and other vasodilator proteins are released on exposure to an allergen. Anaphylactic shock is also accompanied by wheezing and urticaria (hives). The result is widespread vasodilation that causes distributive shock and blood vessels that continue to leak. Fluid leaks out of the blood vessels into the interstitial spaces, resulting in intravascular hypovolemia.

28 yo M, blunt trauma to R anterior chest. Pale, cool, diaphoretic and responsive to verbal. R 38 and shallow with paradoxical movement. What should you do?

02 with positive pressure ventilations

What is the Parkland formula?

2-4ml x body weight (kg) x % of body burned Half of that amount needs to be given during the first eight hours, and the other half needs to be given over the next 16 hours in the 24 hour period.

Patient was found dead at the scene. GCS scale?

3

why is a dislocation is considered an urgent injury?

A dislocation is considered an urgent injury because of its potential to cause neurovascular compromise distal to the site of injury. If the dislocated bone presses on a nerve, then there may be numbness or weakness distally; if an artery is compressed, there may be absent distal pulses (such as in a knee dislocation occluding the popliteal artery). For these reasons, you should always assess the patient's neurovascular status distal to the site of dislocation (check pulse, motor function, and sensation [PMS]) prior to and after splinting.

What is a Pathologic fracture?

A fracture that occurs when normal forces are applied to abnormal bone structures, such as a weakened bone. A fracture that occurs in an area of abnormally weakened bone. Can present as either a localized erosive destruction of the cortical bone or as an abnormal overgrowth of bone.

What are full-thickness (third degree) burns?

A full-thickness (third-degree) burn damages the entire epidermis and dermis, including the nerve endings; this explains why full-thickness burns are usually painless. A full-thickness burn is characterized by charred, white, or leathery skin.

What is a massive hemothorax?

A massive hemothorax is defined as accumulation of more than 1,500 mL of blood within the pleural space. For the average adult, this amount represents a nearly 25% to 30% blood volume loss, meaning that the patient's condition will have progressed to decompensated (hypotensive) shock. Because each lung can hold up to 3,000 mL, it is possible for a patient to completely bleed out into the thoracic cavity.

What is Traumatic asphyxia?

A pattern of injuries seen after a severe force is applied to the thorax, forcing blood from the great vessels and back into the head and neck. related to crush injury, blood is unable to drain from head and top half of body

What is nuchal rigidity?

A stiff or painful neck; commonly associated with meningitis.

Whats is pericardial tamponade?

AKA cardiac tamponade, is defined as excessive fluid in the pericardial sac, causing compression of the heart and decreased cardiac output.

What causes distributive shock?

Anaphylactic, septic or neurogenic shock

18 yo M holding right shin after sports related injury. Deformity and swelling; pedal pulse present. You should?

Apply board splint in position found

25 yo assault victim is spitting up light pink sputum. Has bright red blood spurting from 2in laceration to L forearm. What should you do?

Apply direct pressure to wound

25 yo in R distress after being stabbed in the chest. Blood is bubbling from 2 cm laceration to L chest wall. Lung sounds diminished on L side. You should?

Apply occlusive dressing

Patient has a 3 cm laceration above his left eye. It is bleeding profusely you should?

Apply several 4x4 dressing to the wound using pressure to hold

Pt cut wrist. Wound is bleeding rapidly and is spurting with each heartbeat. Pt most likely severed?

Artery

Snowmobile rider is thrown 15 ft from vehicle. His finger is deformed and sternum is tender to palpation. Pt states "I think I'll be okay" and refuses trans. What should you do?

Ask if you're able to assess the pt

21 yo football player hit from the side and landed head first onto the ground. Was ambulatory on scene and oriented to name only. Refusing transport and care. What should you do?

Ask the team coach for assistance

You are treating a patient with agonal respirations and gunshot wound to the chest. You notice an open skull fracture leaking brain matter. There is no radial pulse, you should?

Asses a carotid pulse and assist ventilations

When you should perform a surgical cricothyrotomy on a burn patient?

Attempts at laryngoscopy may worsen the swelling. Ask a partner to press on the patient's chest while you look for a stream of bubbles coming from the airway. Use an ET tube at least two full sizes smaller than would typically be appropriate for that patient. If this effort fails after a single attempt, then a needle or surgical cricothyrotomy is necessary. It is preferable to defer surgical attempts to the staff at the closest medical facility, but time may force you to use an invasive airway approach if permitted in your system.

Which of the following clinical findings would MOST likely differentiate a massive hemothorax from a tension pneumothorax? A. Tachypnea B. Hemoptysis C. Dyspnea D. Unequal breath sounds

B. Hemoptysis

Generalized abdominal pain following rupture of a hollow organ is MOST suggestive of: A. inflammation of deep nerve endings. B. diffuse peritoneal contamination. C. gas accumulation in the peritoneum. D. severe intraabdominal bleeding.

B. diffuse peritoneal contamination.

The major complication associated with hollow organ injury is: A. immediate death secondary to a massive infection. B. peritonitis caused by rupture and spillage of toxins. C. delayed treatment due to the absence of external signs. D. massive internal hemorrhage and profound shock.

B. peritonitis caused by rupture and spillage of toxins.

Pedestrian hit by car. Pale, cool, and diaphoretic. Oriented to name only and has difficulty breathing. BP 80/40, P 120, R 28 and shallow. 90% SP02. You should?

BVM

Appropriate management for an avulsion of the ear

Bandage in correct anatomical position

Cause of bilateral periorbital ecchymosis

Basilar skull fracture

What is the most likely cause of periorbital echymosis?

Basilar skull fracture

Why is assessing breath sounds so important with an open chest injury?

Because the progression from pneumothorax to tension pneumothorax can occur quite rapidly.

What is external hemorrhage?

Bleeding

What is septic shock?

Body becomes overwhelmed by infection, then the body produces a multitude of substances that cause vasodilation and decreased cardiac output. Its a form of distributive shock.

a 45 year old male fell asleep outisde while doing yard work. His face and lower legs are bright red with blisters and painful on examination. You should suspect

Both superficial and partial thickness burns

Pt is bruising around the eyes and behind ears. What should you suspect?

Brasilar skull fracture

What are superficial (first-degree) burns?

Burns characterized by pain and erythema (redness). Damage is limited to the superficial layer of the epidermis.

What can electrical currents the travel from hand to hand cause? How do we treat this?

Can cause the patient to go into Vfib. Patient will respond well to CPR and defibrillation.

What is Cardiogenic shock?

Cardiogenic shock occurs when the heart cannot circulate enough blood to maintain adequate peripheral oxygen delivery.

40 yo M fell off ladder has a broken leg, and the left knee now bends the wrong way. You should?

Check for PMS in the leg

28 yo pt driving motorcycle traveling 45 mph hit parked car. Not wearing a helmet. Supine with copious amount of blood around face. Gurgling and R 4 per min. Most appropriate?

Control bleeding

81 yo F helthcare facility fell out of bed. Nurse suspects hip fracture. Which medication should concern you the most?

Coumadin

Treating abdominal evisceration

Cover with moist sterile dressing

Pt was stabbed in chest and knife was removed prior to arrival. You notice blood and bubbles leaking from the wound. You cannot find occlusive dressing. You should?

Cover wound with plastic wrapper sealed on 3 sides

23 yo M received burns to feet while stomping fire. He is still wearing the shoes. The rubber soles and laces melted together. What do you do?

Cut shoe laces and remove shoes

Injury that is most likely to require routine assessment and transport

Deformed Wrist Injury

How do you control external hemorrhage?

Direct pressure and bandage > Pressure dressing > Tourniquet Step 1 Take standard precautions. Maintain the airway with cervical spine immobilization if the MOI suggests the possibility of spinal injury. Apply direct, even pressure over the wound with a dry, sterile dressing. Step 2 If the bleeding stops, apply a pressure dressing and/or splint. Hold the pressure dressing in place using gauze. Step 3 If direct pressure does not rapidly control bleeding on an extremity injury, apply a tourniquet above the level of the bleeding. Step 4 Tighten the tourniquet until the bleeding stops. Position the patient supine unless contraindicated. Administer oxygen as necessary. Keep the patient warm, transport promptly, monitor the serial vital signs, and watch diligently for developing shock.

What is a bulls eye lesion a sign of?

Electrical burn

Chest wound, crackling sensation produced by air blowing into surrounding tissues is called subcutaneous ______?

Emphysema

Pt with several wounds oozing blood. After scene size up, you should?

Ensure adequate airway

What is bigger in electrical burns, the entrance wound or the exit wound?

Entrance would is relatively small and the exit wound is big.

M fell while water skiing. Unconsciouse. Suspect?

Head and spine injury

what the major complication is that is associated with an injury to a hollow organ?

Hollow visceral injuries produce most of their symptoms from peritoneal contamination. When a hollow organ such as the stomach or bowel is injured, it releases its contact into the abdomen. These contents May irritate the abdomen, producing symptoms.

what is the main reason of treatment for a patient with traumatic brain injury should focus on?

Hypoxia (o2 sat of less than 90%) and hypotension (systolic blood pressure less than 90 mm Hg) are among the five most powerful predictors of poor outcome in the patient with a TBI.

what can happen if a patient inhales super-heated gas to the airway?

If the patient's Airway continues to swell and intubation will become impossible if you wait for arrival at the hospital, you have little choice but to attempt intubation. Try using a tube size smaller than you would usually insert.

Wha is commotio cordis?

If the thorax receives a direct blow during the critical portion of the hearts repolarization., the result may be immediate Cardiac Arrest

When you should perform a surgical cricothyrotomy?

If you can't ventilate the patient in any other way and they aren't breathing.

24 yo F is unconscious after being struck by a car. She has ineffective breathing and bloody secretions in mouth. You should?

Immediate suction oropharynx

what is the treatment for an open pneumothorax?

Immediately place a gloved hand over the wound > apply occlusive dressing taped on 3 sides or chest seal > place on high flow O2 > if ventilation is still not enough then intubate

18 yo M fell off skateboard. He struck his head on the concrete and immediately started screaming. Alert and oriented to name only. You should?

Immobilize and expedited transport

53 yo F hit by car. Unresponsive w/ deformity to the left femur and pelvic instability. Diminished lung sounds on L side. You should?

Immobilize long backboard

Arrive at motor vehicle collision, pt extricated herself from vehicle and is walking around complaining of neck pain. You should?

Immobilize on a backboard

28 yo M is fleeing from police and sustained 1 cm laceration shallow on forearm while climbing a rusted chain link fence. Refusing transport. What should you be concerned with?

Infection

38 yo M large bruise LUQ, following motorcycle collision. What should you suspect?

Injury to spleen

Woman struck in face with softball bat. Unconscious. BP 74/50, P 60, R 8. What do you do?

Insert an oral airway and admin 02 via BVM

What causes obstructive shock?

Interference with the blood flowing through the cardiovascular system, commonly caused by tension pneumothorax, cardiac tamponade, or pulmonary embolism.

What is the Consensus formula?

Its the same thing as the parkland formula 2-4ml x body weight (kg) x % of body burned

28 yo PT driver motorcycle traveling 45 mph hit parked car. Not wearing a helmet. Supine with copious amount of blood around face. Gurgling and R 4 per min. ANOTHER most appropriate action?

Jaw thrust without head tilt

An altered 24 yr M. stabbed in the abdomen. Sitting, holding contents and complaining of dizziness. He does not want to be touched. Vitals BP 70/40, P 120, R 20 you should?

Lay him down and apply a moist dressing

22 yo F had an accident on moped. She is lying on ground; breathing well. Still wearing helmet. You should?

Leave helmet in place while she is stabilized

What to do if a patient has an objet impaled in their face?

Leave objects impaled in the face in place and appropriately stabilize them, unless they pose a threat to the airway (such as an object impaled through the cheek).

What is the platinum 10 minutes?

Limit scene time to 10 minutes

Pt presents with pain and bruising to RUQ following motor vehicle collision. You should suspect injury to the?

Liver

Pt stabbed in RUQ. What organ is injured?

Liver

30 yo F was in minor motor vehicle accident. She is standing outside of the vehicle and complains of lower back pain. You should immobilize her using a?

Long spine board

Early signs of decompensated shock?

Low blood pressure

32 yo M is unconscious after being struck in the head by a baseball bat. Has pulse but breathing is slow. Minor bleeding from a laceration at the left temple. Partner is maintaining manual C-spine stabilization. You should?

Measure and apply a rigid c collar

32 yo M has sustained facial trauma after falling off the roof. He has snoring respirations. What should you do?

Modified jaw thrust

What is needle thoracentesis?

Needle decompression

What are the landmarks for needle decompression?

Needle decompression is traditionally performed through the second or third intercostal space in the midclavicular line of the affected side. Ride the top of the 3rd rib with the needle to avoid the vasculature under the ribs.

75 yo is involved in motor vehicle collision and can't feel legs. BP is 80/40, P 60, R 24, you should suspect?

Neurogenic Shock

62 yo M is unresponsive next to a ladder. BP 80/48, P 60, R 24. What should you suspect?

Neurogenic shock

How does Neurogenic shock present?

Neurogenic shock (also called vasomotor shock) results from the loss of normal sympathetic nervous system tone; it is commonly caused by a spinal injury. In neurogenic shock, there is no release of the catecholamines epinephrine and norepinephrine. This causes widespread vasodilation and hypotension (relative hypovolemia); pink, dry skin below the level of the injury; and relative bradycardia.

are the lungs affected by cardiac tamponade?

No

23 yo soccer player was kicked in the chest. He is alert with rapid, shallow R and complains of chest pain. Pale, cool, and wet. You should?

Non Rebreather

What is a pulmonary embolism?

Obstruction of a pulmonary artery or arteries by solid, liquid, or gaseous material, such as a blood clot or foreign material, which is swept through the right side of the heart into the lungs and becomes trapped within the pulmonary circulation.

After securing pt on long board, you should immediately assess

PMS

What are partial-thickness burns?

Partial-thickness (second-degree) burns are categorized as being superficial partial-thickness and deep partial-thickness burns. In both types of partial-thickness burn, injury extends through the epidermis and into the dermis and fluid infiltrates in between the dermis and epidermis, creating edema and blisters.

Why do we start IVs with burn patients?

Patients with Burns covering more than 20% of the tbsa will need fluid resuscitation. The sooner the better. If fluid is delayed more than 2 hours recovery becomes less likely.

why are full thickness burns considered critical when a patient has an underlying medical history?

Patients with a currently patent airway but who have a history consistent with risk factors for eventual airway compromise. Administering cool, humidified oxygen from a high-output nebulizer (not a bubble humidifier) is appropriate for this group. Alternatively, you may use an aerosol nebulizer with saline. Such patients will probably not require acute interventions in the field, but make sure you report their history to hospital personnel. Many patients will ultimately undergo elective intubation.

Adult was pinned between 2 vehicles. Pt is conscious but confused and unable to follow directions. Has bruising on both sides of anterior chest, weak carotid pulse, no peripheral pulse, clear breath sounds, distended neck vein. What should you suspect?

Pericardial tamponade

Pt with JVD, muffled heart sounds, clear breath sounds. You should suspect:

Pericardial tamponade

Pt with diminished breath sounds on one side. Chest rise is unequal. You should suspect?

Pneumothorax

what are primary blast injury's?

Primary blast injury is caused by the blast wave moving through the body.

59 yo M is trapped in the car by broken gas pedal through his foot. He's gone into cardiac arrest. You should

Pull out of car

You arrive on scene of a car crash. The driver is alert and complaining of severe chest and abdominal pain. His radial is weak and rapid. Skin is cool, pale, and moist. The patient has a history of cardiac problems. You should?

Rapidly extricate onto a long spinal board and transport

50 yo M has obvious deformed right lower leg after falling from the roof. You notice a tear in the skin over the deformity. What should you do?

Realign and splint the leg

a 35 year old patient has fallen and has a deformed right lower leg. The distal extremity is pulsless and the skin is cool and cyanotic. You should

Realign the injured extremity

Pt with chemical burn on eye and is wearing contact lenses. You should?

Remove contact lenses and administer irrigation solutions

Knife impaled at 4th intercostal space, left sternal border, pulseless and not breathing. You should?

Remove knife from chest

16 yo M complains of extreme pain to chest. You notice his shirt is splashed with battery acid. BP 150/100, P weak, R 24. You should?

Remove shirt and flush with saline water

Pt with severe steam burns to the hand and wrist. You should?

Remove the watch

24 yo M has burns to the eyes, nose and mouth when the radiator cap on his car blew off. Treat for?

Respiratory swelling

A baseball player was hit by a baseball in the left eye and complains for double vision. What should you do?

Restrict spinal movement

4 yo M, arm amputated from farming accident, how should you manage the amputated limb?

Seal in plastic bag and place in container of cool water

what are secondary blast injury's?

Secondary blast injuries are caused by debris that is displaced by the blast wind of the explosion.

What is Distributive shock?

Shock due to widespread vasodilation

Most important factor with person struck in chest with baseball

Speed of the ball

47 male shot in back has cool and clammy skin with arm weakness. BP 130/90, P 76, R 24. You should suspect

Spinal cord injury

22 yo M is ejected from the vehicle. He complains of numbness and tingling in his extremities. What should you do?

Stabilize cervical spine

42 yo M has metal impaled in lower right leg. Obvious open fracture and no pulse in R foot, what should you do?

Stabilize with bulky dressing prior to transport

Pt with 4in stick in their eye. You should?

Stabilize with gauze, place paper cup over affected eye, put dressing over the unaffected eye

Unresponsive 18 yo F supine, bleeding in mouth from the nose, R20. What should you do?

Suction oropharynx

An early indicator of shock indicates?

Tachycardia

What are tertiary blast injurys?

Tertiary blast injuries are caused when the person in displaced through the air and impacts on another object by the blast wind, or when a structure collapses and causes injury to the person.

What is Decompensated shock?

The late stage of shock, when blood pressure is falling. Occurs when blood volume drops by more than 30% classes I and II are compensated shock, and classes III and IV are decompensated shock.

What is Neurovascular compromise?

The loss of sensation, blood supply, or both to a region of the body, typically distal to a site of injury; characterized by alterations in sensation.

What is exsanguination?

The loss of total blood volume resulting in death.

What is the most reliable sign of fracture?

The most reliable form of fracture is deformity.

How will JVD will present with a hemothorax?

The neck veins will present flat because a large amount of blood has hemorrhaged and is no longer within the veins.

30 yo M shot in mid thigh. Bleeding continues after partner applies direct pressure. You should?

Tourniqet

What is the treatment is for compartment syndrome?

Transport ASAP! Elevate extremity to level of the heart, placing cold packs over extremity, opening or loosening constrictive clothing. Give bolus of isotonic crystalloid solution to help the kidneys flush out toxins.

40 yo M crashed snowmobile, skin cold and pale, BP 198/96, P 48, respiration is slow and irregular. What should you suspect?

Traumatic Brain Injury

How will traumatic asphyxia present?

Traumatic asphyxia is characterized by a series of dramatic physical findings. Patients will have cyanosis of the head, the upper extremities, and the torso above the level of the compression. Ocular hemorrhage may be mild, such as bleeding into the anterior surface of the eye (subconjunctival hematoma), or extremely dramatic, causing the eyes to protrude from their normal position (exophthalmos). Other facial structures, including the tongue and lips, may also become dramatically swollen and cyanotic.

What might cause traumatic asphyxia?

Traumatic injuries that suddenly and forcefully compress the thoracic cavity may induce traumatic asphyxia. Traumatic asphyxia may result from an unrestrained driver hitting a steering wheel or a pedestrian who is compressed between a vehicle and a wall. The sudden compression of the chest causes pressure to be translated into the major veins of the head, neck, and kidneys. This massive increase in pressure then passes into the capillary beds, resulting in their rupture.

what do you do if a patient has a laceration to the face without the airway being compromised?

Treat facial lacerations and a Avulsion as you would any other soft tissue injury. Controlling all bleeding with direct pressure, and apply sterile dressings. If you suspect an underline facial fracture, apply just enough pressure to control the bleeding.

Pt suffering from most severe brain injury

Unconscious 34 yo with decerebrate posture

What do you do for scalp lacerations with an underlying skull deformity?

When you assess the laceration, consider the mechanism as a key piece of information in choosing the course of treatment. If you were to apply direct pressure to a laceration that overlies a skull fracture in which the bone ends can be moved, the resulting injury to the brain or meninges could be devastating and have long-term consequences. Inspect the laceration for indications of missing tissue (avulsions) and possible impaled objects or residual contaminants. If you cannot determine the primary mechanism, then you should assume the skull is involved. In isolated lacerations without possible skull fractures, stopping the bleeding is your primary concern. Apply direct pressure with minor to moderate lacerations.

Appropriate care for amputated extremity?

Wrap in dry gauze, seal in plastic bag, and place in cool water

A confused 76 year old female complains of upper leg pain after falling on the sidewalk. She has a mid-shaft femur deformity and crepitus of the pelvis. She has a history of osteoporosis and kyphosis. What should you do? a. Wrap her pelvis in a sheet. b. Stabilize her femur with long bone splints. c. Apply a traction splint and administer pain medication. d. Stabilize her c-spine and secure her to a long back board.

You should stabilize her c-spine and secure her to a long backboard. Although her leg may hurt, it is a distracting injury. She has osteoporosis (fragile bones) and will be prone to fractures. She has crepitus in her pelvis and you should suspect the mechanism of injury was significant enough to fracture her c-spine as well.

What levels of CO2 should be maintained for patients with herniation to the brain?

You should ventilate the patient to maintain the etco2 between 30 and 35 mm Hg.

How do you treat traumatic asphyxia?

Your suspicion for associated injuries should be quite high. Do not let the dramatic physical findings in the head and neck distract you from those injuries that are immediately life threatening. After other life-threatening injuries are managed, the treatment of patients exhibiting traumatic asphyxia is relatively brief. In the absence of intubation, provide high-flow supplemental oxygen via a nonrebreathing mask. Take cervical spine precautions, including spinal immobilization. Obtain IV access with two large-bore IV lines. Transport to the nearest appropriate trauma center.

What is pulsus paradoxus?

a 10 to 15 mm Hg drop in the systolic blood pressure during inhalation, is seen in patients with pericardial tamponade.

What are electrical alternans?

a cardiac arrhythmia that is unique to pericardial effusion (buildup of extra fluid in the space around the heart), there is an increase in the QRS complex then on the next heartbeat there is a decrease in the QRS complex. (heart swings back and fourth within the fluid)

An 18 year old male screams in pain and has a large volume of bright, red blood spurting from his right wrist. What should you do? a. Apply direct pressure. b. Apply a tourniquet. c. Ensure an adequate airway. d. Apply high-flow oxygen.

a. Apply direct pressure. Since he is screaming in pain, you know he has a patent airway. Bright, red blood spurting from his wrist is a life-threatening injury. The first step in bleeding and shock management is to apply direct pressure.

A 20 year old female complains of shortness of breath after being physically assaulted with a tennis racket. She has bruises on the midclavicular line of her chest. Vital signs are BP 120/80, P 80, R 22. What should you suspect? a. Simple pneumothorax b. Cardiac contusion c. Tension pneumothorax d. Pulmonary embolism

a. Simple pneumothorax You should suspect a simple pneumothorax with stable vital signs and the symptom of shortness of breath. A tension pneumothorax is something you should monitor for because a simple pneumothorax can develop into a more serious condition. Non-invasive continuous waveform capnography would be useful to monitor patient ventilations.

What is the body's initial response to hemorrhage? a. Vasoconstriction b. Platelet aggregation c. Catecholamine release d. Fibrin formation

a. Vasoconstriction The first thing that happens after hemorrhage is vasoconstriction. The vessel clamps down to reduce blood loss.

Which is an open wound?

abrasion

First concern with conscious pt who received partial thick burns to the face is treating?

airway problems

What causes anaphylactic shock?

allergen

What are the signs and symptoms of decompensated shock?

altered mental status hypotension labored or irregular breathing thready or absent peripheral pulses ashen, mottled or cyanotic dilated pupils diminished urine output impending cardiac arrest

Pt is bleeding profusely from scalp. You should?

apply direct pressure with sterile gauze

A 29 year old male has a traumatic amputation of the left arm. Vital signs are BP 66/22, P 128, R 18. At what rate should you administer IV fluids? a. Until his BP reaches 120/80 b. 20 mL/kg c. 500 mL d. Keep open rate (KVO)

b. 20 mL/kg For a hypotensive patient, the initial fluid bolus should be 20 mL/kg. Ideally, you should attempt to restore the systolic pressure to around 90 mm Hg. This blood pressure will help perfuse vital organs (heart/brain/kidney), and, in theory, prevent blood clots from washing away.

An alert 19 year old female has a midshaft deformity to her right femur. Vital signs are BP 130/78, P 108, R 18. What should you do? a. Stabilize her leg with long bone splints. b. Apply a traction splint. c. Immobilize her to a padded back board. d. Move her with a scoop stretcher.

b. Apply a traction splint. A midshaft deformity is a sign of a femur fracture. The best way to split an isolated femur fracture is with a traction splint. A traction splint will stabilize the injury and apply traction, which can reduce the pain from the fracture.

A 43 year old male is unresponsive after being kicked in the chest by a horse. On inhalation a segment of his chest moves inward. Vital signs are P 130, R 24 and shallow. What should you do? a. Stabilize the segment with a bulky dressing. b. Assist ventilations with a bag-valve mask. c. Apply high-flow oxygen by non-rebreather mask. d. Obtain intravascular access.

b. Assist ventilations with a bag-valve mask. The initial treatment for a flail segment is providing positive pressure ventilations (PPV). The chest wall structure has been compromised and they need help breathing to prevent them from tiring out. Continuous waveform capnography will help assess their ventilations. Analgesics my help reduce their pain and allow them to breathe easier (follow local protocol).

Why are circumferential full thickness burns of an extremity considered so serious? a. The extremity will begin to utilize anabolic metabolism proximal to the burn site. b. Blood flow to underlying and distal tissue may become restricted. c. The patient becomes more susceptible to systemic infection. d. Even if the extremity heals, it will lose most of its functional ability.

b. Blood flow to underlying and distal tissue may become restricted. Circumferential full thickness burns can inhibit blood flow and muscle movement. These injuries need to be monitored for the need of an escharotomy. This surgical procedure allows for tissue expansion in order to restore local perfusion.

A 22 year old female was thrown from a horse. She complains of back pain and dizziness. Her skin is warm and dry. Vital signs are BP 74/50, P 84 and R 20. What should you suspect? a. Hypovolemic shock b. Neurogenic shock c. Cerebral contusion d. Anterior cord syndrome

b. Neurogenic shock Equestrian (horse riding) injury patterns often involve spinal injuries. She is hypotensive because her vasculature below the level of the injury has dilated and created a state of distributive shock.

A 16 year old male complains of severe pain in his upper left quadrant after being hit in the stomach while playing football. What should you suspect? a. Lacerated liver b. Ruptured spleen c. Pulmonary contusion d. Bruised ribs

b. Ruptured spleen The spleen is located in the upper left quadrant. It is a solid organ with two arteries that supply blood flow. The spleen is dense with blood and the injury has the ability to be life-threatening.

An altered 24 year old male has an evisceration. In which position should the patient be transported? a. Reverse Trendelenburg b. Supine with knees flexed c. Left lateral d. Trendelenburg

b. Supine with knees flexed Transporting a patient in a supine position with their knees flexed (bent) will help relieve pressure on the abdomen

What is Cullen sign?

bruising around umbilicus

A 39 year old female was stabbed with a broken bottle in her left lower quadrant. Her bowels are protruding from the wound. What should you do? a. Push the bowels back into the abdomen. b. Place her supine with her legs elevated. c. Apply a moist sterile dressing. d. Cover with a dry bulky dressing.

c. Apply a moist sterile dressing. You should apply a moist sterile dressing for a bowel evisceration. This will help prevent the bowels from drying out and being exposed to an unsterile environment.

An unresponsive 31 year old female was found at the bottom of a stairwell. She has blood draining from her ears and nose and dry vomit on her face. Emergency Medical Responders are unsure how long she has been there. Vital signs are BP 202/122, P 54, R 10 and irregular, SpO2 81%. What should you do? a. Obtain IV access. b. Perform endotracheal intubation. c. Assist ventilations with a bag-valve mask. d. Apply high-flow oxygen by non-rebreather mask.

c. Assist ventilations with a bag-valve mask. You should assist her ventilations with a bag-valve mask because she is breathing at of rate of 10 and irregular. Her pulse oximetry is low and her vital signs indicate that she has a traumatic brain injury. Assisting ventilations can help increase her SpO2 and reduce brain swelling

A 46 year old male is only responsive to verbal stimuli after being stabbed. He has an open, bubbling chest wound. What should you do? a. Assist ventilations with a bag-valve mask. b. Apply sterile gauze over the wound. c. Cover the wound with a gloved hand. d. Perform pleural chest decompression.

c. Cover the wound with a gloved hand. You should first cover the open chest wound with a gloved hand to prevent any more air leakage into the thoracic cavity.

A 20 year old male was involved in a fight. Bystanders report he was struck in the head and went unconscious. During the primary survey he was awake and complained of head pain. He loses consciousness while you obtain vital signs. What should you suspect? a. Subdural hematoma b. Concussion c. Epidural hematoma d. Alcohol intoxication

c. Epidural hematoma Patients with epidural hematomas will typically lose consciousness at the moment of impact then regain consciousness. This moment of alertness is called the lucid interval. A headache followed by a rapid decline is classical presentation; it may be accompanied by vomiting and early unilateral pupil dilation.

What chemical do muscle cells release after being damaged? a. Calcium b. Magnesium c. Potassium d. Sodium

c. Potassium Potassium is the predominated intercellular ion. When muscle cells die they release potassium, which may lead to rhabdomyolysis.

What does Beck's triad indicate?

cardiac tamponade

what is Hypotension and distended neck veins in the presence of normal lung sounds a sign of?

cardiac tamponade

A 25 year old male is unconscious after a car crash. His car struck a tree head-on at highway speeds. He has abdominal guarding upon palpation and bruising around the umbilicus. Vitals signs are BP 50/30, P 120 and weak, R 28. What should you suspect? a. Gallbladder rupture b. Ruptured diaphragm c. Bilateral kidney contusions d. Abdominal hemorrhage

d. Abdominal hemorrhage You should suspect bleeding into the abdomen with a trauma patient who is hypotensive without any other signs of injury. The guarding and umbilicus bruising is a sign that there has been significant bleeding into the abdomen.

A 51 year old female has a 4 inch laceration to her right leg. Bright, red blood is rapidly soaking through the initial dressings. What should you do? a. Apply an additional dressing. b. Administer high-flow oxygen. c. Warm her with a blanket. d. Apply a tourniquet.

d. Apply a tourniquet. You should apply a tourniquet if the laceration continues to bleed after initial treatment. The bright, red blood is a sign of an arterial bleed.

A 31 year old male was in a car crash at highway speeds. He has a contusion above his left breast and left lateral torso. Vital signs are BP 90/76, P 118 with diminished heart tones, R 24. What should you suspect? a. Cardiac contusion b. Pulmonary contusion c. Tension pneumothorax d. Cardiac tamponade

d. Cardiac tamponade You should suspect a cardiac tamponade. The key information is the diminished heart tones and a very narrow pulse pressure. As the pericardial sac fills with blood, the heart has less and less space to expand. The pulse pressure narrows from the inability to expand and contract properly and heart tones become diminished because the blood muffled the sound.

A 45 year old female was stabbed in the upper right chest. Her breath sounds are diminished on the right side. Vital signs are BP 70/48, P 150, R 32 and shallow. What should you do? a. Apply high-flow oxygen. b. Assist ventilations with a Bag-valve mask. c. Initiate rapid transport. d. Perform a needle decompression.

d. Perform a needle decompression. She is hypotensive with diminished breath sounds on the affected side. You should suspect a tension pneumothorax which is treated with a needle decompression or pleural decompression.

What causes cardiogenic shock?

damage to the heart, most common cause is myocardial infarction

What is Grey Turner's signs?

ecchymosis of the flanks

What causes hypovolemic shock?

exogenous (external) and endogenous (internal) bleeding.

Where is a secondary location you can needle decompress?

fifth interspace, slightly anterior to the midaxillary line.

What is the grey turners sign a sign of?

hemorrhagic pancreatitis.

What is Cushing's triad?

hypertension bradycardia irregular respirations

What is becks triad?

hypotension, muffled heart sounds, JVD

What does Cushing's triad indicate?

increased ICP

What is Cushing's triad a sign of?

increased ICP

What is the Cullen sign a sign of

intraperitoneal hemorrhage

If a patient is in shock after an acute burn in the prehospital setting, what should you do?

look for another injury as the source of shock. People who are caught in fires may, for example, fall through floors, jump out of windows, and have debris fall on them.

What is Hypovolemic shock?

loss of too much blood/fluid in the body

What is paresthesia?

numbness and tingling

What causes septic shock?

occurs as a result of widespread infection, usually bacterial.

What is obstructive shock?

occurs when blood flow becomes blocked in the heart or great vessels.

what significant risk is associated with open fractures?

potential for more blood loss In addition to having a higher risk of infection, open fractures have the potential for more blood loss than a closed fracture for two reasons. First, open fractures usually result from high-energy injuries, so they typically involve more soft-tissue damage.

35 yo driver collided into telephone pole and is unconscious and unresponsive with severe bleeding in the mouth. You should?

rapid extrication to long spine board

What does hemorrhaging from the nose (epistaxis) or the ears following a head injury indicate? in this case, should you attempt to stop the bleed?

skull fracture, No you should not attemt to stop the bleed

What is Neurogenic shock?

spinal cord damage means nervous system cant control vasculature properly and widespread vasodilation occurs. Its a form of distributive shock.

What are signs and symptoms of acute Pulmonary embolism?

sudden onset of dyspnea, pleuritic chest pain (pain when breathing) (either side), tachypnea, tachycardia, low-grade fever, right-sided heart failure, shock, and, in some cases, cardiac arrest.

What is a cerebral concussion?

type of traumatic brain injury caused by a blow to the head. A cerebral concussion occurs when the brain is jarred in the skull. main treatment is rest.

What is the Parkland formula used for?

used to calculate how much fluid to give to a burn patient within the first 24 hours of injury.

What causes Neurogenic shock?

usually results from spinal cord injury.