Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
34 Cards in this Set
- Front
- Back
|
upon patient arrival, the student should indicted the need to wear...
|
protective clothing
to prevent transmission of dz to healthcare providers and patients |
|
|
upon arrival, the patient should be put in
A) in a gown B) Same clothes from scene to prevent bleeding C) Exposed D) Ice bath to prevent neurologic damage |
Exposed
must note hypothermia should be prevented |
|
|
Airway maintenance with cervical spine protection:
Step one is Assessment. What should be done |
Ascertain patency
assess for airway obstruction |
|
|
Airway maintenance with cervical spine protection:
Step one is Assessment. This has been completed The next step is Management. What should be done? |
1. Perform chin-lift or jaw thrust
2. Clear airway of foreign bodies 3. Insert oropharyngeal airway 4. Establish a definitive airway (intubation or surgical cricothyroidotomy) 5.Describe jet insufflation of the airway, noting that it is only a temporary procedure |
|
|
Airway maintenance with cervical spine protection:
Step one is Assessment. This has been completed The next step is Management. This is done. What should the next step be? |
Maintain the cervical spine in a neutral position with manual immobilization as necessary when establishing an airway
|
|
|
Airway maintenance with cervical spine protection:
Step one is Assessment. This has been completed The next step is Management. This is done. You have maintained cervical spine with manual immobilization while intubating. The intubation is done. What is next? |
Reinstate immobilization of the c-spine with appropriate devices after establishing an airway
|
|
|
Primary survey exists of what?
|
ABCDEs
Airway Breathing/ventilation Circulation Disability Exposure/Environment |
|
|
Breathing: Ventilation and oxygenation
Step one is Assessment. How is this achieved? |
1. Expose the neck and chest and ensure immoblization of the head and neck
2. Determine the rate and depth of respirations 3. Inspect and palpate the neck and chest for tracheal deviation, unilateral and bilateral chest movement, use of accessory muscles, and any signs of injury 4. Percuss the chest for presence of dullness or hyperresonance 5. Auscultate the chest bilaterally |
|
|
Breathing: Ventilation and oxygenation
Step one is Assessment. This is complete. The next step is management. What is involved? |
1. Administer high concentration O2
2. Ventilate with a bag mask device 3. Alleviate tension pneumothorax 4. Seal open pnuemothorax 5. Attach a CO2 monitoring device to the ET tube 6. Attach pulse ox to pt |
|
|
Circulation with hemorrhage control
Step one is assessment. What should be done? |
1. Identify source of external exanguination
2. Identify potential source of internal hemorrhage 3. Assess pulse: Quality, rate, regularity, and paradox 4. Evaluate skin color 5. Measure BP if time permits |
|
|
Circulation with hemorrhage control
Step one is assessment. This is done Next step is Management. Please describe |
1. Apply direct pressure to external bleeding sites
2. Consider presence of internal hemorrhage and potential need for operative intervention, and obtain surgical consult 3. Insert two large caliber IV caths 4. Simultaneously obtain blood for hematologic and chemical analyses; pregnancy test; type and cross 5. Initiate IV fluid therapy with warmed crystalloid solution and blood replacement 6. Prevent hypothermia |
|
|
Disability: Brief neurologic exam
What is step one? |
Determine the level of consciousness using the GCS
Eye Opening Response Spontaneous--open with blinking at baseline 4 points Opens to verbal command, speech, or shout 3 points Opens to pain, not applied to face 2 points None 1 point Verbal Response Oriented 5 points Confused conversation, but able to answer questions 4 points Inappropriate responses, words discernible 3 points Incomprehensible speech 2 points None 1 point Motor Response Obeys commands for movement 6 points Purposeful movement to painful stimulus 5 points Withdraws from pain 4 points Abnormal (spastic) flexion, decorticate posture 3 points Extensor (rigid) response, decerebrate posture 2 points None 1 point |
|
|
Disability: Brief neurologic exam
GCS is determined. What is step 2? |
check pupils for size and reaction
|
|
|
Disability: Brief neurologic exam
GCS is determined. checked pupils for size and reaction. Step 3? |
Assess for lateralizing signs and spinal cord injury
|
|
|
Exposure/enviornmental control
what should be done |
expose the pt but prevent hypothermia
|
|
|
What are 4 adjuncts to primary survey and resuscitation?
|
1. Obtain ABG analysis and vent rate
2. Monitor the pts exhaled CO2 3. Attach ECG 4. Insert uninary and gastric catheters unless contraindicated 5. Consider need for AP chest/pelvic xray 6. Consider need for FAST/DPL |
|
|
Sample history and mechanism of injury.
Step one is to obtain an AMPLE history (what is that?) Step two is to obtain history of injury producing event and identify injury mechanism |
AMPLE
Alergies Meds Past medical history/pregnancy Last Meal Event |
|
|
The following will describe how to Assess the head and maxillofacial region...
just flip it |
1. inspect and palpate entire head and face for lacerations, contusions, fractures, and thermal injury
2. reevaluate pupils 3. reevaluated LOC and GCS 4. assess eyes for hemorrhage, penetrating injury, visual acuity, dislocation of lens, and presence of contact lenses 5. evaluate cranial nerve function 6. inspect ears and nose for CSF 7. inspect mouth |
|
|
The following will describe how to Manage the head and maxillofacial region...
just flip it |
1. Maintain airway and continue ventilation and O2
2. Control hemorrhage 3. Prevent secondary brain injury 4. Remove contact lenses |
|
|
Cervical Spine and Neck:
Flip to see assessment |
1. insepct for signs of blunt and penetrating injury, tracheal deviation, and use of accessory repiratroy muscles
2. Palpate for tenderness, deformity, swelling, subQ emphysema, tracheal deviation, and symmetry of pulses 3. Auscultate the carotid arteries for bruits 4. Obtain a CT of the c-spine or a lateral cross table cspine xray |
|
|
Cervical Spine and Neck:
Flip to see management |
Maintain adequate in line immobilization and protection of the c-spine
|
|
|
Chest:
flip to see assessment |
1. Inspect for blunt/penetrating injury, use of accessory muscles, bilateral respiratory excursions
2. Auscultate the anterior chest wall and posterior bases for bilateral breath sounds and heart sounds 3. palpate the entire chest wall for evidence of blunt and penetrating injury, subQ air, tenderness, and crepitation 4. Percuss for evidence of hyperressonance or dullness |
|
|
Cervical Spine and Neck:
Flip to see management |
1. perform needle decompression of plueral space or tube thoracostomy as indicated
2. Attach the chest tube to an underwater seal drainage device 3. correctly dress an open chest wound 4. perform pericardiocentesis as indicated 5. transfer to operating room |
|
|
Abdomen:
flip to see assessment |
1. Inspect for signs of blunt/penetrating injury and internal bleed
2. auscultate for bowel sounds 3. percuss to elicit subtle rebound tenderness 4. palpate the abdomen for tenderness, guarding, rebound tenderness, gravid uterus 5. pelvic xray 6. DPL/US 7. CT if hemodynamically stable |
|
|
Abdomen:
flip to see management |
1. Transfer to OR if needed
2. Wrap a sheet around the pelvis or bind to reduce blood loss |
|
|
Perineal assessment:
flip to see assessment |
look for
contusions and hematomas lacerations urethral bleeding |
|
|
Rectal assessment:
flip to see assessment |
Assess for
blood anal sphincter tone bowel wall integrity bony fragments prostate position |
|
|
Vaginal assessment:
flip to see assessment |
presence of blood in vaginal vault
vaginal lacerations |
|
|
Musculoskeletal:
flip to see assessment |
1. inspect upper and lower extremities for blunt/penetrating injury
2. Palpate for tenderness, crepitation, etc 3. palpate ALL peripheral pulses for presence, absence, and equality 4. Assess pelvis for fracture 5. Inspect and palpate the thoracic and lumbar spine for evidence of blunt and penetrating injury 6. Evaluate the pelivc x-ray film for fracture 7. Obtain xrays of suspected fracture sites |
|
|
Musculoskeletal:
flip to see management |
1. Apply splints for extremity fracture
2. Maintain immobilization of thoracic and lumbar spine 3. wrap sheet around pelivs 4. give TETANUS 5. Consider compartment syndrome 6. perform complete neurovascualr exam of extremities |
|
|
Neurologic
flip to see assessment |
1. Reevaluate the pupils and lvl of consciousness
2. Determine GCS 3. Evaluate upper and lower extremities for sensory and motor 4. Observe for lateralizing signs |
|
|
Neurologic
flip to see management |
1. Continue ventilation and oxygenation
2. Maintain adequate immobilization of entire pt |
|
|
Assessing the LOC you use the GCS. Describe what scores constitute severe, moderate, and minor head injuries
|
8= severe
9-12 moderate 12-15 minor |
|
|
WHen assessing pupils, what are you looking at?
|
Size
Shape Reactivity |
