BDLS Final Exam 2023 with complete solutions

Day to day activities - Answer- Greatest good for each individual patient Large scale disasters - Answer- greatest good for greatest number of potential survivors Treat first - Answer- most seriously injured who have reasonable chance of survival Treat last - Answer- least severe illnesses or injuries that are very unlikely to survive Seperate - Answer- Those who require minimal or no treatment to get safety Mass casualty triage principles - Answer- Systematic method, organization of casualties, occurs at the scene Mass casualty triage decision making encompasses - Answer- Presence of life, lib, or vision-threatening condition; available LSI, availability of transportation assets SALT - Answer- US is moving towards a national standardization, SALT meats Model Uniform Core Criteria (MUCC) Sort, Assess, LSI, Treatment/Transport Step 1 - Answer- Sort: 1st-still/obvious 2-wave/purposeful movement 3rd- walk allows to rapidly ID most at risk by sorting into groups Limitations-hearing, language, fear, injured family Step 2 - Answer- LSI-Life Saving Interventions: Control major hemorrhage Open airway Autoinjectors Chest decompressions Step 2: After lifesaving interventions - Answer- obeys commands or makes purposeful movements, has peripheral pulse, not in respiratory distress, major hemorrhage in control Triage category assignment - Answer- ID-ME I-Immediate D-Delayed M-minimal E-expected D-dead Mass casualty event - Answer- more casualties than available resources can take care of without additional support I-Immediate - Answer- Highest priority of casualties to receive care: Immediate, life threatening conditions, require immediate management in order to survive, response to LSI-any answer no with chance for survival with current resources available D-delayed - Answer- Require prompt medical attention for survival: -Condition can tolerate a short delay in treatment -expected to survive despite the short delay -Response to life saving interventions: All yes answers and does not need access to additional or definitive health care M-minimal - Answer- Minor injuries or illnesses -expected to survive even if medical treatment not received -Response to LSI: -all yes answers and do not need access to additional or definitive healthcare E-expectant - Answer- Casualties with low probability of survival -not expected to survive given available medical resources -response to lifesaving interventions: any no answer and resources are NOT available D-dead - Answer- complete absence of life -not breathing after basic airway opening maneuvers -attempt basic life sustaining efforts only if sufficient personnel available Triage - Answer- Dynamic and continous Primary triage - Answer- Guides initial treatment and transport decisions Secondary triage - Answer- further prioritizes casualties within their triage groups based on clinical assessment of urgency of need Tertiary triage - Answer- process of providing limited resources within the treatment setting (lower amount of ventilators) Transport and evacuation - Answer- Casualties must be prioritized for treatment as well as transport to definitive care Avoid overwhelming hospitals: Transport priority patients to local hospital, transport stable patient to more distant hospitals or makeshift facilities, treat minor injuries and release from scene ID and tracking - Answer- -Should begin on scene -Tracking officer must ensure everyone accounted for -Electronic systems to triage tags to recording info on tape -allow for more info such as family relations to be added to system if available Mass Fatality Management - Answer- Generally performed by DMORT -ID and examine remains -Moving deceased to the morgue(s) -Maintaining custody of bodies until realeased -Determining and reporting cause of death -returning personal items to family members -making final disposition decisions for bodies -issuing death certificates Professionalism and ethics in mass casualty care - Answer- -adherence to established health practices -clinical decision making -professionalism -challenging ethical dilemmas -difficult decision making Background on explosives - Answer- -Occur worldwide -Account for 75% of terror events worldwide -number of criminal bombings in the US doubled in last decade Types of explosions - Answer- -Nuclear: most powerful, alters atomic and subatomic structures -Mechanical explosions-physical processes -Chemical explosions-most common, occur from rapid chemical conversion of a solid or liquid explosive material into a rapidly expanding as -High or low energy classified by speed of the explosion exceeds the speed of sound Mechanism of blast injury - Answer- -Primary:overpressure of blast wave (ear, lung, intestines) -Secondary:penetrating injuries from blast wind (flying debris) -Tertiary: blunt injuries from blast wind (forceful impact) -Quaternary: All other blast injuries (burns, physical trauma) Situational awareness of explosions - Answer- -Beware of intentional targeting of first responders -Observe site safety -Assess hazards: downed power lines debris fire etc Casualty Management - Answer- -Initial care and decision making should follow established clinical guidelines -ongoing care: Early intubation for inhalation injury Fluids for combined blast lung and burn Pulmonary Blast Injury (Blast Lung) - Answer- -Explosions tear alveolar walls -Hemorrhage, barotrauma, AV fistulae -Signs and symptoms: respiratory distress, x ray findings -Treatment: airway and oxygen, mechanical ventilation challenges, avoid excessive positive ventilation Arterial Gas Embolism - Answer- -Air embolizes directly between bronchial tree and disrupted pulmonary vasculature -Manifestation: rapid decompensation, sudden death -Management: positioning, 100% oxygent Traumatic asphyxiation - Answer- -compression of chest that impedes venous return to heart -Signs and symptoms: facial edmea, cyanosis, subconjuntival hemorrhages, resp. distress, peteciathe of head, neck, and chest -Treatment:rapid extrication (most important factor, evaluate for other life threatening injuries, supportive care Traumatic Amputation - Answer- Control hemorrhage Tourniquet should be used first on extremity Crush injury - Answer- -Compression of large mass of skeletal muscle -Ongoing compression-tissue ischemia and rhabdomyolysis, with toxins released from cellular breakdown Crush syndrome - Answer- -systemic complication of rhabdomyolysis and ischemic reperfusion injury -Lifethreatening-hyperkalemia, hypovolemia, etc leading to cardiac dysrhythmias and profound shock Compartment syndrome - Answer- complication of a crush injury. Edema->increased pressure->decreased blood flow -signs include severe pain, erythema, blistering, swelling, diminished pulses -Treatment: fasciotomies which is controversial Gastrointestinal blast injury (Blast Belly) - Answer- -intestinal injury from strecthing and ischemia resulting in bowel wall weakening leading to rupture -Intraabdominal trauma to liver, spleen, etc from blunt or penetrating associated trauma following explosion -signs and symptoms: nausea/vomiting, abd pain, diarrhea Auditory Blast Injury (blast ear) - Answer- Blast related damage to inner ear -acute hearing loss (unable to hear commands) -ear pain, vertigo, tinnitus -Avoid irrigation and consider antibiotics -may be associated with other blast injuries Ocular blast injury (blast eye) - Answer- -vulnerable to secondary and tertiary blast injuries -foreign body sensation, pain and visual loss -referral to ophthalmologist is mandatory Flash burn - Answer- short lived intense heat of blast -wounds are superficial -confined to exposed areas of the body (hands and feet are common) -Managed like other burns Penetrating ballistic, stab, or impaling injuries - Answer- -"low velocity" or "high velocity" -Injuries depend on tissue involved -Entrance and exit wounds -Extensively contaminated -Adequate debridement -Tetanus prophylaxis and broad spectrum antibiotics Blunt Ballistic Injuries - Answer- rubber bullets, bean bag shotgun shells -standard bullets impacting a protective vest -heart, liver, spleen, lung, and spinal cord are vulnerable -injuries may occur beneath benign-appearing skin lesions -requires close observation due to possibility of delayed onset of symptoms Pediatric blast trauma - Answer- -head injuries are common -most injuries are more severe and consume more resources compared to adults -provide care in pediatric specialty hospitals if possible Nuclear event - Answer- involves nuclear detonation and accompanying massive explosion Radiologic event - Answer- involve release of radioactive materials to populated areas (with or without explosion) Radiation Basics particles - Answer- Alpha particles- short range, easy to shield, cant penetrate outer layers of skin, can be an internal hazard if ingested or inhaled Beta particles- longer range and harder to shield against, usually stopped by aluminum foil or glass, can penetrate outer layer of skin, external and internal hazard -Gamma-very long range and difficult to shield against, concrete, lead, or steel is needed to shield against, can penetrate through whole body, most radioactive materials emit high-energy gamma rays Injuries from nuclear and radiologic disasters - Answer- Blast injuries Thermal burns Radiation toxicity Electromagnetic pulse-can also damage med equipment, communications equipment, etc Situation awareness and detection of nuclear - Answer- Scene assessment: high index of suspicion, visible clues on vehicles or containers, use detection equipment to detect radiation or ID radioactive isotopes present Radiation technology - Answer- field detection devices (meters) Airborne particulate detectors isotope identifiers Public Health System - Answer- Complex network of individuals and organizations that when working together, can represent what we as a society do collectively to ensure the conditions in which people can be healthy Public Health System Basics - Answer- Function: protect populations against injury, disease, environmental and occupational hazards Workforce: diverse set of skills, backgrounds, and experience Large scale disasters and public health emergences - Answer- -damages public health infrastructure -Widespread population displacement -Health service disruption -Population resource disruption -Critical: integration of public health and emergency care system Public health shift in perspective - Answer- individual to population Public health functions in disaster - Answer- Many: develop new policies evacuate individuals mass vaccinations epidemiological enviornmental controls Epidemiologic Surveillance - Answer- -ongoing assessment of community health -ID new health concerns/issues(look for patterns, oddities) -Track and document potential exposures Epidemiologic Investigation - Answer- -Comprehensive and multidisciplinary -Investigative work -map spread of disease -mechanism of spread -morbidity and mortality -ID the index case Rapid Needs assessment - Answer- -Determine nature and scale of disaster -Extent of populations immediate needs -Stability of health care infrastructure -Impact on essential human services Emergency Public Health Powers - Answer- -decrease exposure and spread of contagious disease -public health interventions: quarantine and isolation -individual rights vs. common welfare ESF-6 - Answer- Mass care, emergency assistance, housing, and human services (FEMA, Red Cross, and Public Health) -assess health and medical needs of populations -provision of emergency medical care -surveillance in sheltering facilities -Immediate needs: food, water, shelter, and sanitation ESF-8 Public Health and Medical Services role in sheltering populations - Answer- Disease outbreaks (GI and respiratory), Injury safety (interpersonal violence), At-risk (worsening of chronic and mental illnesses) Crowding+limited resources=high stress enviornment Sheltering guidelines - Answer- -General population shelters -guidelines for sheltering children and adults with functional support needs -functional needs support services "FNSS" services enabling individuals to maintain independance Health in Disasters - Answer- -lodging and shelters: privacy when needed -Sanitation, hygiene, and pharmaceutical supplies -health testing including pregancny management -Protection from physical and sexual assault -Psychological impact