68W Alc Phase 3 Lpc|2023 Latest Update|Guaranteed Success

In blast injuries there are 3 Impacts when do they occur? Baro-Trauma occurs from the concussion of the blast. Impact Trauma occurs from the body hitting another object / brain hitting the skull. Additionally objects like shrapnel and gravel hitting the soldier after the blast causing further damage. Characteristics of a Mild TBI? Most common type of TBI, is often missed, particularly in the presence of other more obvious injuries. Has been referred to as "Dead Man Walking" S/S of a Mild TBI Transient Confusion (Bell Rung), Delayed verbal and motor responses, Disorientation. Slurred or incoherent speech, any period of LOC. Characteristics of Moderate/Severe TBI Easily recognized Penetrating injuries, Initially lucid but deteriorate, Moderate-Severe Symptoms. S/S of Moderate/Severe TBI LOC, Personality Change, Severe or progressively worsening headache, Repeated vomiting or nausea, Seizures, Inability to awaken, Pupil dilation one/both, Slurred speech, Weakness or numbness in extremities, Loss of coordination, increased restlessness, confusion agitation, Vomiting and neuro deficit What is MACE? a good tool to form the neurological/cognitive baseline. What should a Tracker for TBI's have? Baseline results, Mace result, Exposure, Proximity, Frequency to Blasts, Retests for comparison throughout deployment. How often should a MACE evaluation be done? Every 6 months or when mission dictates. What are the 5 domains of function examined in the MACE test? Orientation, Immediate Memory, Neurological Screening, Concentration, and Delayed Recall. What is a Pronator Drift? When attempting to hold arms out in an extended position with eye closed, one arm will drift or drop downward and pronate (Palm turned downward) List Level 2 Evacuation Red Flags for TBI Any positive answer to Mace items V-VIII Double Vision, Worsening Headache, Worsening Headache or disoriented to place, LOC greater than 5 min, Slurred speech. List Level 3 Evacuation Red Flags for TBI Progressively declining levels of consciousness, Pupil Asymmetry, Seizures, Repeated vomiting. When approaching the possibility of a TBI it is imperative to focus on what 3 areas of evaluation? Cognitive, Physical, and Behavioral.. What Cognitive symptoms would you look for when evaluating a TBI? Attention difficulties, concentration problems, memory problem, and orientation problems. During a TBI evaluation what physical symptoms would you look for? Headaches, dizziness, insomnia, fatigue, uneven gait, nausea, blurred vision, and seizures. When evaluating a TBI patient what behavioral changes should you take note of? Irritability, depression, anxiety, sleep disturbances, problems with emotional control, loss of initiative, and multiple personal problems. TBI Airway treatment considerations? Avoid hyperventilation unless there are signs of cerebral herniation, posturing with asymmetric or bilateral pupil dilation, SaO2 Greater than 90 for moderate and sever TBI, ensure definitive airway What would you do for Pain management in a TBI casualty? Tylenol, avoid opiates/ketamine. Giving no medication will give the neurosurgeon a clean canvas to work with. What options do we have for brain targeted therapy in TBI patients? Mannitol: Use with signs of herniation (recommended only with the use of high fluid volume compensation for any ensuing fluid loss. 1.4-2.1 g/kg recommended dosage. Mannitol may exacerbate hypo tension, Hypertonic solution appears to reduce ICP when given as a Bolus. (Mannitol is an Osmotic Diuretic). Broad Spectrum Antibiotic for penetrating brain injury. Triage and transport decisions for TBI? GCS 14 or below should not RTD Frequent exposure to blast may cause traumatic iridoplegia which could lead to fixed dilated pupils Reassess GCS and pupils throughout evactuation. What should we review daily? SIGACT to identify who has been exposed to blasts or any other MOI's that may cause TBI. What testing should we conduct post deployment? Neurocognitive testing to compare with the pre-deployment results and notify PA of any abnormalities. Hypoxia due to decreased air is known as? Hypobaric Hypoxemia What are the acclimatization rate for most soldiers? At high or very high altitude 70%-80% of the respiratory component of acclimatization occurs in 7-10 days. 80%-90% of overall acclimatization is generally accomplished in 14-30 days. Maximum acclimatization can take months to years. How is Staged Ascent conducted? Soldiers ascent to a moderate altitude and stay there for 3 days or more to acclimatize before ascending higher. When possible soldiers should make several stops for staging during the ascent to allow for greater acclimatization How is Graded Ascent conducted? Limits daily altitude gain to allow for partial acclimatization. The altitude at which soldiers sleep is a critical element in this regard. Having soldiers spend 2 nights at 9000ft & limit the sleeping altitude to no more than 1000ft per day above the previous 2 nights. Sleeping altitude will significantly reduce the incidence of altitude ilness. What is the most effective method in prevent high altitude sickness and achieving acclimatization? Combine both Graded and Staged Acents Define Partial Pressure It is the inadequate oxygen arterial partial pressure of oxygen (PO2) which leads to many altitude related problems. How does Partial Pressure get calculated Atmospheric pressure x .21 (% of oxygen) = partial pressure. Oxygen percentage does not change with elevation, but is does disperse. What are the altitude levels? At what elevations? Low: Sea-5000 Moderate: High: Very High: Extreme 18000- Higher What altitude effects would a person have at Sea - 5000ft None What altitude effects would a person have at Decreased exercise performance, and increased alveolar ventilation without impairment in arterial oxygen transport (Temporary illness may occur) What altitude effects would a person have at Altitude illnesses are associated with decreased arterial SaO2 marked by hypoxemia, may occur during exercise and sleep. (Decreased performance is increasingly common) Define Diffusion Flow of gas from and area of higher concentration to an area of lesser concentration. Gas diffusion in the body operates the same way. What is a Gradient? Difference in pressure from a higher concentration to a lower concentration.