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,
...
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% 1500-2000ml (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 1.vasodilation 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
3. Ab. Normal Respirations
4. +1 (ALOC, Blown Pupils ect.) = brain steam herniation
What is autoregulation? - ANSWER CPP increases due to ICP increase
What is a potent vasodilator? - ANSWER C02
What is broken in a basilar skull fx? - ANSWER Cribriform plate (look for blood/fluid from nose and/or ears w/o direct injury to nose or ears)
Important facts of an epidural bleed are what? - ANSWER 1. Fast bleeds (medial meningeal artery)
2. Usually die in about 1 hr
3. Lucid intervals (knockd out, wake up & act normal, knock back out)
What are important facts about subdural bleeds? - ANSWER 1. slower bleeds (bridging veins)
2. doesnt usually experience lucid intervals
What is a primary brain injury? - ANSWER the insult to the brain itself (ex. gsw to head)
What is the secondary brain injury? - ANSWER something we can prevent (ex. hypoxia post primary injury)
What is retrograde amnesia? - ANSWER forgetting what happened before the accident happened
What is anterograde amnesia? - ANSWER cant remember the accident or post accident
Where is the atlas? - ANSWER C1
Where is the axis? - ANSWER C2
Where is the odontoid process? - ANSWER is off the axis C2, allows head rotation 180 degrees
What are the biggest vertebra? - ANSWER Lumbar, they carry the most weight
How many pairs of spinal nerves do we have? - ANSWER 31 pairs
Where do the motor nerves travel? - ANSWER the ventral root, up the front of the body
Where do the sensory nerves travel? - ANSWER the dorsal root, up the back of the body
What are dermatomes? - ANSWER the bodies sensory boarders
T4 - nipple line down
T10 - umbilicus down
C 3-5 are what nerves? - ANSWER the phrenic never, control the diaphragm
What is axial loading? - ANSWER spinal cord compression (ex. shallow water diving accident, leading on head & pressing down)
What is a distracting injury? - ANSWER the spinal cord in stretched or disconnected (ex. hanging accident)
Do you need to C-Spine a penetrating injury? - ANSWER No, unless there is a neuro deficit
What happens during an anterior cord injury? - ANSWER Loss of motor, pain, and temp.
(involves injury to spinal arteries)
What happens during central cord injury? - ANSWER 1. hyperextension of spinal cord
2. weakness in the upper extremities, but good lower extremity function
3. loss of bladder control
What happens during Brown Sequard injury? - ANSWER 1. loss of function on one side of the body
(typically from penetrating injury)
On a stable patient what do you do before moving he patient? - ANSWER splint fxs and pain meds
Ligaments connect what? - ANSWER bone to bone
Tendons connect what? - ANSWER muscle to bone
What is a subluxation injury? - ANSWER dislocation partially out of the socket
What is compartment syndrome? - ANSWER The tissues is tight (ex. circumferential burns)
1. after 6 hrs there is lots of damage to tissue
What is crush syndrome? - ANSWER 1. release of pressure from compartment syndrome
2. lactic acid rushes into the body
Second degree burns? - ANSWER 1. affect the epidermis
2. blisters
Third degree burns? - ANSWER 1. affect down to the dermis
2. waxy and leathery looking
Fourth degree burns? - ANSWER 1. affect down to the bone and muscle
Nerves are a good conductor for what type of burns? - ANSWER electrical burns
The hands, feet, face, and gentilia are what kind of burns? - ANSWER speciality type of burns
What is the fluid formula for fluids in the burn patient? - ANSWER 4cc/kg/BSA = amount in 1st 24 hr period
(divide # by 2 = amount in first 8 hrs)
(divide # by 8 = amount in 1st hr)
What 3 things affect the severity of radiation? - ANSWER 1. distance
2. shielding
3. time
What is toxic inhalation? - ANSWER death by delayed respiratory compromise post fire exposure
What is important about acid burns? - ANSWER coagulate necrosis
What is important about alkaline b
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