PHTLS Block Exam with Complete Solutions

Level 1 Trauma Center - ANSWER-Regional Trauma Center, All types of specialty surgical care 24/7, (Surgical suites, Surgeons, Blood, CT, X-Ray ... all in house), Tertiary - all levels of care Ex... County USC, Cedars, UCLA- Ronald Regan, UCLA- Harbor General Level 2 Trauma Center - ANSWER-Area Trauma Center, Most common trauma emergencies with surgical capabilities 24/7, (can handle most common types of trauma) Ex.... St. Francis Level 3 Trauma Center - ANSWER-Community Trauma Center, Specialized ED and some surgical capability (the speciality staff is on call and has 30 mins to get to hospital) Level 4 Trauma Center - ANSWER-small community hospitals, (they have to stabilize and transfer) Have ER DR but no surgeon What are run sheets used for? - ANSWER-QI, Research, Trauma Registry, What are the 4 E's? - ANSWER-Engineering -(roads, airbags, pool alarms) Enforcement -(laws) Education -(safety classes) Economics -(government grants) What is an injury? - ANSWER-being hurt or killed What is trauma? - ANSWER-inflicted wounds or injury What is an accident? - ANSWER-an event that is unforeseen or without apparent cause What is a disease? - ANSWER-an unhealthy condition, illness, or disorder Why is the Highway Safety Act of 1966 important? - ANSWER-lead to development of EMS "White Paper" - Accidental Death & Disability, The Neglected Disease of a Modern Society Why is the American College of Surgeons important? - ANSWER-1990: trauma care systems planning and development act (established guidelines, funding and state-level leadership for the development of trauma systems) What are the leading causes of death in adults & children? - ANSWER-Adults - MVC Children - Falls In trauma how many die in 1st hr? - ANSWER-50% Fix = Injury Prevention In trauma how many die in 4 hrs? - ANSWER-30% Fix = good prehospital and hospital care In trauma how many die days or weeks later? - ANSWER-20% (due to hypoxia, hypotension, end organ failure) Fix = aggressive shock management What is Precrash? - ANSWER-Age, medical hx, drugs, alcohol What are the 3 phases of a Crash? - ANSWER-1. car into tree 2. person into steering wheel 3. organs into body What is the main purpose of car restraints? - ANSWER-to slow the occupant down with the vehicle Platinum 10 mins are used for what? - ANSWER-1. identify life-threats 2. perform key interventions 3. rapid extrication were indicated 4. timely transport to an appropriate facility 5. early notification to the receiving facility Trauma is the leading cause of death in what age group? - ANSWER-1 - 44 What is anatomical trauma criteria? - ANSWER-Specific injuries (bi-lat femur fx) What is mechanical trauma criteria? - ANSWER-Type of incident / MOI (blunt head, penetrating trauma, PSI) What is physiological trauma criteria? - ANSWER-vitals signs (ALOC, hypotension GCS 15) What is newtons 1st law? - ANSWER-Body at rest will remain at rest and a body in motion will remain in motion until acted upon by an outside force What is law of conservation? - ANSWER-Energy cannot be created or destroyed, but can change forms. Car breaks = friction = heat = fire What is the formula for kinetic energy? - ANSWER-1/2 of mass x velocity(squared) What is more important velocity of mass? - ANSWER-velocity If you increase the stopping distance what happens to the potential for injury? - ANSWER-potential for injury is decreased What is important info in regards to GSWs? - ANSWER-hand guns & rifles - velocity shotguns - what was the distance What is permanent cavitation? - ANSWER-tissue that is destroyed and not coming back What is temporary cavitation? - ANSWER-tissue that falls back into place 6x the diameter of per,anent caviation Concerns with up & over injuries? - ANSWER-Laryngeal fx (may hear stridor) Sub-Q Emphysema Diaphragmatic tear Concerns with down & under injuries? - ANSWER-Pelvic fx Femur fx Patellar fx Concerns with lateral impacts? - ANSWER-Less metal to protect people in car Look for injuries to that same side of body Concerns with rotational forces? - ANSWER-shearing forces to heart, liver, kidneys What % of ejection victims die? - ANSWER-75 How much more likely are you to die if you are involved in a rollover? - ANSWER-6x Concern with rear impacts? - ANSWER-whiplash injuries Good thing about wearing helmets? - ANSWER-they save lives & decrease injuries Auto vs. Ped facts? - ANSWER-Child - Freeze & stand there, get drug under car, multi-system trauma Adult - turn & run, extremity trauma Important aspects of falls? - ANSWER-15 feet or 3x their height & the surface they land on = (severity of fall) Body part they land on = (type of injury) what are the 5 phases of bast injuries? - ANSWER-1. Primary - pressure wave, effects hollow organs 2. Secondary - Bomb fragments 3. Tertiary - person in thrown, or falling debris 4. Quaternary - heat/thermal burns 5. Quinary - bio/chemical/implanted objects sprayed from the object What is an intimate injury? - ANSWER-Stabbing... Look for than one wound, be cautious of "cone of injury, any direction", length of knife? In regards to violence what should you do? - ANSWER-1. DONT BE THERE!!!! 2. Retreat 3. Defuse the situation (word ninja) 4. Defend yourself 30 - 2, Can Do = what color? - ANSWER-Green 30 - 2, Cant Do = what color? - ANSWER-Yellow Deficit to 30 - 2, Can Do (ALOC, Respirations, Circulation) = what color? - ANSWER-Red What is the goal of the primary assessment? - ANSWER-to find & correct life threats What is the most common threat to life? - ANSWER-inadequate tissue perfusion/shock (a early sign is ALOC) If you dont know ______ then your already behind the 8 ball?! - ANSWER-the MOI Injury to solid organs = ? - ANSWER-hemmorage Injury to hollow organs = ? - ANSWER-infection/peritonitis) What is Grey Turners sign? - ANSWER-ecchymosis at the flank due to retroperitoneal bleed What is Cullens Sign? - ANSWER-ecchymosis at the umbilicus due to retroperitoneal bleed Mass pants can be used for what? - ANSWER-1. belly, retroperitoneal, pelvis bleed w/ BP less than 90 & pelvis fx stabilization 2. wide spread hemorrhage with BP less than 60 (NOT FOR USE ON PENETRATING TRAUMA) What is the % for Fi02? - ANSWER-at least 85% What is the % for SP02? - ANSWER-95% Can you typically remove impaled objects? - ANSWER-Only if it is occluding the airway otherwise No, it maybe stopping the bleeding!! Abdominal evisceration key points are what? - ANSWER-1. moist sterile dressing 2. occlusive dressing 3. keep PT warm 4. keep PT still What is more important minute volume or tidal volume? - ANSWER-Minute volume What is the most important mechanism for ventilation? - ANSWER-the plural linings staying intact In the PHTLS world what are the essential airway skills? - ANSWER-bls skills What is the PHTLS airway key factor? - ANSWER-Dont do the same thing over & over, try something different In PHTLS what is the best ET-Tube confirmation in a PT with a pulse? - ANSWER-capography What is the best ET-Tube confirmation in a PT without a pulse? - ANSWER-lung sounds If you cant intubate or ventilate then what? - ANSWER-needle / surgical cric Normal capography value? - ANSWER-35-45 Closed head injury capography range is what? - ANSWER-35 or less What is the most common type of shock? - ANSWER-hypovolemic / hemorrhagic What is most sensitive to ischemia? - ANSWER-The brain, heart and lungs (can last about 4-6 mins w/o 02) What the 2nd most sensitive to ischemia? - ANSWER-The kidneys, liver & GI tract (can last 45-90 mins w/o 02) What is the least sensitive to ischemia? - ANSWER-Skin and bones (can last 4-6 hrs w/o 02) What is cell & organ death? - ANSWER-1. it starts with aerobic to anaerobic metabolism 2. Na and H20 go into the cell (edema) 3. Potassium and lactic acid leak out of cell and enter blood stream (makes body acidic & hyperkalemic) What happens during the ischemic phase? - ANSWER-vascular sphincters shut closed What happens during the stagnant phase? - ANSWER-Sphincters relax and blood pools in the extremities What happens during the wash out phase? - ANSWER-systemic acidosis What is Shock Class 1? - ANSWER-1-15% 750 ml compensated HR normal What is Shock Class 2? - ANSWER-15-30% 750-1500 ml HR greater 100 What is Shock Class 3? - ANSWER-30-40% ml (BP goes down here) HR greater 120 What is Shock Class 4? - ANSWER-greater than 40% 2L or more HR greater 140 What systolic BP number do you want to see in a trauma and/or traumatic brain injury patient? - ANSWER-Trauma 80-90 TBI 90-100 (just shoot for BP or 90 systolic, & titrate your fluid bolus to meet these values) How warm should you warm your fluids to if possible? - ANSWER-102 degrees What is the ratio of fluids given to blood lost during trauma? - ANSWER-3:1 (3 liters of fluid per 1 liter of blood) Distributive Shock key factors are what? - ANSWER-ilation below the injury site 2. warm skin below the injury site 3. Bradycardia & Hypotension 4. Priapism (Difference between this and hemorrhagic shock is the bradycardia due to parasympathetic system) What is the TX for rib fx? - ANSWER-1. pain management 2. positive pressure ventilation How do you treat a sucking/open chest wound? - ANSWER-First action is to cover it Make occlusive dressing Diameter of sucking chest wound is about 2/3 size trachea Signs of hemothorax are? - ANSWER-1. Diminished or absent lung sounds 2. Hemodynamic compromise 3. Flat neck veins 4. Dull to chest percussion (3L of blood in each plural cavity, JVD is not a reliable source) What are signs of Beacks Triad? - ANSWER-(penetrating trauma causes cardiac tamponade) 1. Muffled heart tone 2. JVD 3. Hypotension 4. 50cc of fluid can cause of dysrhythmias 5. 300cc or fluid can causes PEA What is a pulmonary contusion? - ANSWER-blood filled alveoli, causes a decrease in 02 & C02 exchange What is traumatic asphyxia? - ANSWER-related to crush injury, blood is unable to drain from head and top half of body What is an aortic rupture? - ANSWER-a tear in the aorta, bleed out fast, your ****ED!! What happens in Tracheobronchial Detachment? - ANSWER-1. Detachment usually occurs at the carina 2. Air leaks into the chest cavity 3. pneumothorax / tension What happens in Commotio Cordis? - ANSWER-1. impact to chest 2. heart goes into v-fib 3. is survivable of recognized early, need to do CPR and defibrillate ASAP If patient is shocky and you suspect a bleed but cant find it, where should you assume it is? - ANSWER-abdominal until proven other wise!! 1. abdominal pain and tenderness are an early sign 2. abdominal distension are late signs What are the important time frames of protection during pregnancy? - ANSWER-1. up to 12 weeks fetus is protected by the pelvis 2. up to 20th week fetus is at the umbilicus 3. up to the xiphoid process by week 38 What are signs of Cushings Tirad? - ANSWER-1. hypertension 2. bradycardia