ITLS Test Questions With Verified Answers

DD 5) Tension pneumothorax - Answers - Dyspnea - Anxiety - Tachypnea - Distended neck veins - Tracheal deviation - Breath sounds diminished *Hyperresonance if percussed - Shock with hypotension - High flow oxygen - Decompress affected side * Respiratory distress and cyanosis * Loss of radial pulse * Decreasing LOC - Load and go Blast Injuries - Answers injuries commonly produced by the different mechanisms associated with an explosion (air blast, shrapnel, burns) essential equipment - Answers equipment that is worn or carried when the responders approach the trauma patient. It includes personal protective equipment, long backboard and strapping, rigid cervical extrication collar, oxygen and airway equipment, and trauma box scene size-up - Answers observations made and actions taken at a trauma scene before actually approaching the patient; the initial step in the ITLS survey what is the initial step in the ITLS survey? - Answers scene size-up ITLS Primary Survey - Answers Brief exam to find immediately life-threatening conditions What steps are a part of the ITLS primary survey - Answers scene size-up, initial assessment, either rapid trauma survey or the focused exam Standard Precautions - Answers steps each health care worker takes to protect themselves & their pt from exposure to infectious agents; includes treating each pt as if they were infectious What are some examples of standard precautions - Answers Always wearing gloves, frequently requires face shield, occasionally requires a protective gown OPIM - Answers Other potentially infectious materials - which a responder may be exposed to other than blood PPE (personal protective equipment) - Answers equipment that an emergency care provider dons for protection from various dangers that may be present at the trauma scene MOI (mechanism of injury) - Answers the means by which the pt was injured i.e fall, MVC, explosion high-energy event - Answers a mechanism of injury in which it is likely that there was a large release of uncontrolled kinetic energy transmitted to the patient, thus increasing the chances for serious injury. rapid trauma survey - Answers a brief exam from head to toe performed to identify life threatening injuries focused exam - Answers an exa used when there is a focused (localized) MOI or an isolated injury. This exam is limited to the area of injury index of suspicion - Answers medical providers estimate of a disease or injury being present in a pt high index of suspicion - Answers a high probability an injury is present low index of suspicion - Answers low risk of the injury Occupant Restraint Systems - Answers systems built into a vehicle to prevent the driver and passengers from being thrown about the interior of the vehicle or from being ejected from the vehicle in the event of a collision Steps of ITLS scene size-up - Answers 1. I am donning my BSI 2. Do i hear, see or smell any hazards? 3. How many pt's do I have? 4. I am requesting backup (1 ambulance, 1 firetruck) 5. What is the MOI? Two basic mechanisms of motion injury - Answers 1. blunt 2. penetrating What are the 3 collisions associated with MVC's? - Answers 1. machine collision 2. body collision 3. organ collision resulting in rupture, shearing, or bruising What are the 5 common forms of MVC's? - Answers 1. frontal impact/head on 2. lateral impact/t-bone 3. rear-impact 4. rollover collision 5. rotational collision What are potential injuries associated with proper and improper use of seat restraints, headrests, and air bags in a head on collision - Answers Unrestrained driver - airway & spinal injuries from hitting the windshield, direct trauma to the face and head - steering wheel injuries for unrestrained driver - face, neck, thoracic, or abdominal injury - lacerations of the mouth & chin, contusions of the anterior neck,traumatic tattoos of the chest wall, abdo bruising - dashboard injuries - most commonly include face & knees What are organs susceptible to shearing injuries due to their ligamentous attachments? (MVC's) - Answers aortic arch, liver, spleen, kidneys, bowel What injuries are sources for occult bleeds and hemorrhagic shock? - Answers aoric arch, liver, spleen, kidneys What organs are compression injuries common for? - Answers lungs, heart, diaphragm, urinary bladder What may respiratory distress be a sign of? - Answers pulmonary contusions, pneumothorax, diaphragmatic hernia, flail chest Potential injuries for rear impact collisions? - Answers hyperextention of cspine, lumbar spine injury What is a coup-contrecoup injury? - Answers Dual impacting of the brain into the skull; coup injury occurs at the point of impact; contrecoup injury occurs on the opposite side of impact, as the brain rebounds. What are the three assessment criteria for falls? - Answers 1. distance of fall 2. anatomic area impacted 3. surface struck Potential injuries for falls? - Answers - fracture of feet or legs - hip/pelvic injuries - axial loading to the lumbar and cervical spine - vertical deceleration forces to the organs - colles fractures of the wrists What is a colles fracture to the wrist? - Answers a complete fracture of the radius bone of the forearm close to the wrist resulting in an upward (posterior) displacement of the radius and obvious deformity What are the two most common forms of penetrating injuries? - Answers knife, gun Extent of injuries from a gun? - Answers - shrapnel - damage done is proportional to tissue density Extend of injuries from a knife wound? - Answers low energy injury, tissue damage is confined to the direct path of the blade upper abdo stab wound may cause intrathoracic organ injury stab wounds below the fourth intercostal space may have penetrated the abdomen What is the golden rule with any impaled object? - Answers Stabilize it in place 5 types of blast injuries - Answers 1. primary 2. secondary 3. tertiary 4. quarternary 5. quinary Describe the primary blast injury - Answers caused by the initial air blast, caused by the direct effect of blast overpressure on tissue air is easily compressible, unlike water, and therefore the primary blast injury almost always affects air filled structures ie. lungs, ears, gi tract describe secondary blast injuries - Answers result of the pt being struck by shrapnel propelled by the blast force describe tertiary blast injuries - Answers due to the body being thrown, resulting in an impact with the ground or another object describe quarternary blast injuries - Answers a result of the explosion fireball, thermal burns or the inhalation of toxic dust/fumes can cause inhalation injuries describe quinary blast injuries - Answers the hyperinflammatory state that results from exposure to contaminants in the blast, ie. chemical, biological, radiological material dispersed by the explosion what one out of the blast injuries is a delayed type of injury? - Answers quinary blast injuries What are the steps of the patient assessment? - Answers - primary survey - ongoing exam - secondary survey * the process by which the emergency care provider evaluates a trauma patient to determine injuries sustained, and the pt's physiologic status What steps are in the ITLS Primary Survey? - Answers 1. scene size up 2. initial assessment 3. rapid trauma survey/focused exam Describe the initial assessment - Answers rapid assessment of airway, breathing, and circulation - prioritize the pt and identify immediately life-threatening conditions What is a rapid trauma survey? - Answers Brief exam from head to toe performed to identify life-threatening injuries - use when a dangerous general mechanism of injury exists ... ie MVC What is the focused exam? - Answers use when there is a focused (localized) MOI or an isolated injury; an exam that is limited to the area of injury ITLS Ongoing Exam - Answers an abbreviated exam to determine changes in the pts condition ITLS Secondary Survey - Answers A comprehensive head to toes exam to find additional injuries that may have been missed in the ITLS primary survey How often should the ITLS ongoing exam be performed - Answers no less than every 5 mins on a critical pt every 15 mins for stable pts - each time the pt is moved - each time an intervention is performed - any time to pts condition worsens When can an intial assessment be interrupted? - Answers 1. the scene becomes unsafe 2. you must treat exsanguinating hemorrhage 3. you must treat an airway obstruction 4. you must treat cardiac arrest Where do you approach a trauma pt from and why? - Answers Approach from their feet so they dont try to look up at you What are early assessments of decreased perfusion (shock)? - Answers pale, cool, clammy skin, thready radial pulse, decreased loc When should you perform a rapid trauma survey - Answers if there is a dangerous MOI ie. MVC, fall from a height if pt is unconscious with unk MOI When should you perform a focused exam - Answers if there is a dangerous focused MOI suggesting an isolated injury (bullet wound to the thigh, amputation of the hand) if there is no significant MOI, initial assessment is normal What are some examples of a priority (high risk) pt - Answers - dangerous MOI - high risk group (very young, very old, chronically ill) - initial assessment reveals: altered mental status, abnormal breathing, abnormal circulation (shock or uncontrolled bleeding) - history that reveals loss of consciousness, difficulty breathing, severe pain of head, neck, or torso What is a possible injury if the neck veins are engorged? (accessory muscle use) - Answers - indicate positive pressure in the chest - possible tension pneumothorax or cardiac tampenade - if veins are distended, look and palpate at the sternal notch for tracheal deviation What is cardiac tamponade? - Answers compression of the heart by an accumulation of fluid in the pericardial sac What is a tension pneumothorax? - Answers Pneumothorax with rapid accumulation of air in the pleural space can cause high intrapleural pressure. This results in compression of the lung on the affected side and pressure on the heart and great vessels pushing them away from the affected side. Intrathoracic pressure increases and the lung collapses, mediastinum shifts to unaffected side which compresses the other lung. Types of load & go situations? - Answers • Initial Assessment » Altered mental status » Abnormal respiration » Abnormal circulation • Shock potential » Abnormal chest exam » Tender, distended abdomen » Pelvic instability » Bilateral femur fractures Examples of critical interventions - Answers • Manage airway • Assist ventilation • Administer oxygen • Begin CPR • Control major external bleeding • Seal sucking chest • Stabilize flail chest • Pneumothorax • Stabilize impaled object • Complete packaging How often to perform & record the ITLS ongoing exam? - Answers » Critical: every 5 minutes » Stable: every 15 minutes » Each time patient moved » With each intervention » If condition changes For a critical patient, how quickly should the primary survey be done, and what is the maximum on-scene time? - Answers primary survey should be done 2 mins on scene time of 5 mins What is the purpose of the initial assessment? - Answers To prioritize the patient and to determine the existence of immediately life threatening conditions What is the purpose of the secondary survey? - Answers More comprehensive exam meant to pick up additional injuries that may have been missed in the brief ITLS primary survey What is the pleural space? - Answers potential space between visceral and parietal pleura within the thorax - in disease or injury states, this space can fill with air, fluid, or blood What is a flail chest - Answers A fracture of two or more adjacent ribs in two or more places, causing instability of the chest wall and paradoxical movement of the "flail segment" in a spontaneously breathing pt open pneumothorax - Answers the accumulation of air in the pleural space secondary to penetrating injury, presenting as an open or sucking chest wound ( 3 cm in diameter) Massive hemothorax - Answers the presence of at least 1,500 cc of blood loss into the pleural space of the thoracic cavity tension pneumothorax - Answers a condition in which air continuously leaks out of the lung into the pleural space. The air continues to accumulate without means of exit, resulting in increasing intrathoracic pressure on the affected side and eventual collapse of the superior and inferior vena cava as well as the lung Pericardial tamponade - Answers the rapid collection of blood between the heart and pericardium from a cardiac injury. The accumulating blood compresses the ventricles of the heart, preventing the ventricles from filling between contractions and causing cardiac output to fall becks triad - Answers the three clinical signs of cardiac tamponade - hypotension, JVD, muffled heart sounds paradoxical pulse - Answers a clinical sign of cardiac tamponade. It is an exaggeration of the normal variation of the strength of the pulse during the inspiratory phase of respiration, in which the blood pressure decreases as one inhales and increases as one exhales. The paradox is that, in the case of a pericardial tamponade with decreased cardiac output, the palpated radial pulse disappears during inspiration. Also called pulsus paradoxus. Mediastinum - Answers anatomic region within the thorax, located between the lungs, that contains the heart & great vessels, trachea, major bronchi, and the esophagus What are blunt traumas a result of? - Answers rapid deceleration, shearing forces, crush injuries What are the major symptoms of chest injury - Answers chest pain, sob signs indicative of chest injury - Answers chest wall contusion, open wounds, subcutaneous emphysema, hemoptysis, distended neck veins, tracheal deviation, asymmetrical chest movement including pardoxical motion, cyanosis, shock What are the Deadly Dozen Chest Injuries? - Answers Airway obstruction Flail chest Open pneumothorax Massive hemothorax Tension pneumothorax Cardiac tamponade Myocardial contusion Traumatic aortic rupture Tracheal or bronchial tree injury Diaphragmatic tears Pulmonary contusion Blast injuries DD 1) airway obstruction - Answers • Secondary hypoxia » Common cause of preventable death » Foreign body, tongue, aspiration • Consider cervical spine injury » You cannot clear cervical spine in an unresponsive patient » Penetrating chest trauma does not need SMR unless direct spinal involvement DD 2) Flail chest - Answers • Assist ventilation • Stabilize flail segment • Load-and-go • Monitor for: » Pulmonary contusion » Hemothorax » Pneumothorax » Open pneumothorax • "Sucking chest wound" • Air enters pleural space • Ventilation impaired • Hypoxia results • Signs and symptoms: » Proportional to size of defect