PHTLS Exam 2022 Questions and Answers

Class I Hemorrhage - ANSWER up to 15% blood loss, minimal tachicardia, no measurable changes in BP or pulse pressure, or RR Class II Hemorrhage - ANSWER 15-30% Most adults are capable of compensating, incresed RR, Tac ...

Class I Hemorrhage - ANSWER up to 15% blood loss, minimal tachicardia, no measurable changes in BP or pulse pressure, or RR Class II Hemorrhage - ANSWER 15-30% Most adults are capable of compensating, incresed RR, Tachycardia, narrowed pulse pressure, Class III Hemorrhage - ANSWER 30-40% no longer able to compensate for volume loss, hypotension occurs, HR >120 BPM, RR 30-40, severe anxiety or confusion Class IV Hemorrhage - ANSWER more than 40% loss, severe shock, HR >140 BPM, RR >35, confusion lethargy, decresed systolic blood pressure, typically in the range of 60 mm Hg. Ratio for loss blood replacement - ANSWER 3 litres of electrolyte solution replacement for each liter of blood lost Distributive Shock - ANSWER uncontrolled vasodialation causes reduced resistance causing a decrease in the diastolic blood pressure Distributive Shock - ANSWER Decrease in preload+decrease in cardiac output Psychogenic Shock - ANSWER Vasovagal - stimulation of the tenth cranial nerve (vagus nerve) produces bradycardia. May also cause vasodilation. Typically occurs in a very brief period. Septic Shock - ANSWER Cytokines released because of an infection can cause damage to blood vessel walls and cause vasodilation Anaphylactic Shock - ANSWER Respiratory distress, airway obstruction and vasodilation Potential Blood loss from a single femoral fracture - ANSWER 30-40% Amount of blood loss that can happen before signs of compensatory mechanisms fail and BP become <90 mmHq - ANSWER Greater than 30% Hypertension medications that may prevent compensatory tachycardia to maintain BP - ANSWER Beta Adrenergic blocking agents and calcium channel blockers Managing Volume Resuscitation Uncontrolled hemorrhage-suspected chest, abdomen, retroperitonium - ANSWER Maintain a systolic bp 80-90 or MAP 60-65 Managing Volume Resuscitation CNS injuries or TBI - ANSWER maintaining the systolic BP (SBP) above 90 or MAP 85-90 Managing Volume Resuscitation Controlled Hemorrhage large scalp or extremity controlled with a tourniquet, PT falls into class II,III,IV shock - ANSWER rapid bolus of 1-2 litres Three responses of initial fluid bolus Rapid Response - ANSWER vital signs return indicating that PT lost less than 20% PT is best managed at SBP between 80-90, IV fluid should be titrated Three responses of initial fluid bolus Transient Response - ANSWER Vital signs improve (pulse slows, BP increases) however PT shows deterioration. PT has typically lost 20-40% of blood volume Three responses of initial fluid bolus Minimal or no response - ANSWER No change in PT after 1-2 liter Bolus Leading cause of TBI - ANSWER MVC Three seperate membranes that surround the brain - ANSWER meninges Outer most meninges - ANSWER Dura mater- composed of tough fibrous tissue The inner most meninges that is directly in contact with the brain - ANSWER Pia Mater- Vessels that lay on top of the Pia Mater - ANSWER Cerebral Blood Vessels The meninge that lays in the middle between the dura and pia matter - ANSWER Arachnoid membrane-loosely covers the brain and its blood vessels MAP-Mean Arterial Pressure - ANSWER The average pressure for the entire cardiac cycle MAP=Diastolic Pressure + 1/3 of the Pulse Pressure PP- Pulse Pressure - ANSWER The difference between the systolic and diastolic PP= Systolic (SBP) - Distolic (DBP) CPP- Cerebral Perfusion Pressure - ANSWER The amount of pressure it takes to push blood through the cerebral circulation. CPP=Mean Arterial pressure (MAP) - Intercranial pressure (ICP) CPP- is normally below ? mmHg - ANSWER CPP is normally 15 mmHg or below Autoregulation - ANSWER The brain changes the cerebral blood vessel resistance (CVR) to compensate for changes in the cerebral pulse pressure (CPP) For neurological injured PT's the systolic blood pressure is best if maintained at or above - ANSWER 90 mmHg Hyperventilation and TBI - ANSWER Hyperventilation can reduced CBF by causing vasoconstriction due to hypocapnia, PaCO2 >35 increases risk of cerebral ischemia Primary Brain injury - ANSWER The direct trauma or mechanical injury, includes contusions, hemorrhages and lacerations Secondary brain injury - ANSWER pathologic mechanisms that related to intercranial mass effect, elevated ICP, and herniation, hemotoma, hypoxia and hypotension Mass effect - ANSWER The effect of a growing mass or tumor Uncal Herniation - ANSWER temporal lobe epidural hematoma forces pressure on the medial portion of the temporal lobe (uncus) which in turn puts pressure on the 3rd cranial nerve causing dilation or blown pupil on the side of the herniation. May also cause loss of function of the motor track on the same side. Final stage of uncal herniation - ANSWER The RAS is affected patient lapses into coma decorticate posturing - ANSWER flexion of the upper extremities with rigidity and extension of the lower extremities. decerebrate posturing - ANSWER all extrem become flaccid and motor activity is absent Cheyne strokes ventilation - ANSWER repeating cycle of slow hallow breaths that become deeper and more rapid and then return to slow Central neurogenic hyperventilation - ANSWER rapid deep breaths Ataxic breathing - ANSWER erratic ventilatory efforts that lack any discernible pattern Cushings phenomenon - ANSWER greatly increased arterial blood pressure and the resultant bradycardia (increase BP + decreased HR) may occur with severely increasing ICP Hypercapnia (high CO2) - ANSWER causes vasodilation Hypocapnia (low CO2) - ANSWER causes vasoconstriction When people have 20 mmHg CO2 in their blood (half of the official norm), - ANSWER they have about 40% less blood supply to the brain in comparison with normal conditions Indication of TBI Hemiparesis - ANSWER One sided weakness Indication of TBI Hemiplegia - ANSWER One sided paralysis Indications for a nose fracture - ANSWER ecchymosis, edema, nasal deformity, swelling, epistaxis Epidural Hematoma 1-brief Loss of consciousness 2-Lucid Interval 3-Rapid decline in level of consciousness - ANSWER The period of time after a brief loss of consciousness where the PT may be oriented, lethargic or confused followed by a rapid decline of consciousness Subdural Hematoma - ANSWER Account for 30% of TBI-Generally results from venous blood from bridging viens that are torn during a violent blow to the head. Epidural Hematoma - ANSWER Account for 2% of TBI-Arterial blood starts to dissect or peal the dura off of the inner table of the skull creating an epidural space filled with blood Epidural Hematoma Signs - ANSWER Altered LOC, dilated and sluggish non reactive pupil on the side of herniation, hemiparesis or hemiplegia on opposite side of injury. Subdural Hematoma - ANSWER Can be chronic or acute. Pt on coumadin are at high risk of un identified subdural hematomas that may be chronic. Often may be confused with stroke, infection or general decline of PT Cerebral Contusions - ANSWER actual bleeding into the substance of the brain, CC's often take 12-24 hrs to appear on CT scans, only indicator is a depressed GCS of 9-13 Subarachnoid Hemorrhage - ANSWER rarely causes mass effect and does not require surgery, it does increase the risk of cerebral contusion by 63-73% Normal ventilatory rates Adults= - ANSWER 10 BPM Normal ventilatory rates Children= - ANSWER 20 BPM Normal ventilatory rates Infants= - ANSWER 25BPM Warning signs of possible ICP - ANSWER Decline in GCS sluggish or non reactive pupils Hemiplegia or hemiparesis Cushings phenomenon Osmotherapy - ANSWER the use of osmotically active agents that may assist in the treatment of intracranial hypertension` Number of cervical vertebrae - ANSWER 7 Number of thoracic vertebrae - ANSWER 12 Number of lumbar vertebrae - ANSWER 5 Number of coccygeal vertebrae - ANSWER 4 Number of pounds the human head averages - ANSWER 16-22 pounds Space between the spinal cord and the spinal canal wall - ANSWER 3mm Name of the 1st cervical vertebrae - ANSWER Atlas Name of the 2nd cervical vertebrae - ANSWER Axis Function of the ascending nervee tracts - ANSWER Sensory impulses from body parts through the cord up to the brain Function of the descending nerve tracts - ANSWER impulses from the brain through the cord down to the body Dorsal root= - ANSWER sensory Ventral root= - ANSWER motor Dermatome - ANSWER The sensory area on the body for which a nerve root is responsible The phrenic nerve originates from - ANSWER the cervical vertebrae c2-c5 Skeletal Injuries Compression - ANSWER Compression fractures that produce wedge compression or total flattening of the body of the vertebra Skeletal Injuries Fractures - ANSWER Produce small fragments of bone that may lie in the spinal canal near the cord Skeletal Injuries Sublaxation - ANSWER a partial dislocation of the vertebra from its normal alignment in the spinal column Skeletal Injuries Overstretching - ANSWER Tearing of the ligaments and muscles producing instability between the vertebrae Skeletal Injuries Percentage of falls from a height greater than 15 feet involve an associated lumbar spine fracture - ANSWER 20% Cause and Symptoms Anterior Cord syndrome - ANSWER Results from bony fragments or pressure on spinal arteries Symptoms-loss of motor function and pain, temperature and light touch PT's will have some light touch sensations such as vibration. Cause and Symptoms Central cord syndrome - ANSWER usually occurs with hyperextension Symptoms include weakness or paresthesia (tickling, tingling, burning, pricking, or numbness) in the upper extremities but normal strength in the lower extremities Cause and Symptoms Brown Sequard syndrome - ANSWER Caused by penetrating injury and involves hemi-transection of the cord. Symptoms include complete cord damage and loss of function of the affected side with loss of pain, temp and sensation on the opposite side of the injury Conditions that should mandate spinal immobilization - ANSWER Altered LOC Spinal Pain or tenderness Neurologic deficit or complaint Anatomic deformity of the spine Pulmonary Volume Terminology Dead Space - ANSWER Amount of air brought into the lungs that does not have the opportunity to exchange oxygen and carbon dioxide Pulmonary Volume Terminology Minute Volume (Ve) - ANSWER Total volume of air moved into and out of during a 1 minute interval. Pulmonary Volume Terminology Tidal Volume (Vo) - ANSWER Amount of air that is inhaled then exhaled druing a normal breath (.4-.5 litres) Pulmonary Volume Terminology Total Lung Capacity (TLC) - ANSWER Total volume the lungs contain when maximally inflated. This volume declines with age from 6 L. in young adults to 4 L. in elderly. Pulmonary Contusion - ANSWER Blunt force can tear lung tissue resulting in bleeding into the alveoli Thoracic Trauma Assessment Four components to the phys exam - ANSWER Observation, palpation, percussion, auscultation