Shock and Trauma Management, Exams of Advanced Education

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ITLS Exam Test Review Questions With

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Hypoxemia - Correct Answer-The most common cause of cardiopulmonary arrest in the trauma patient Cardiac output - Correct Answer-Heart rate x stroke volume Shock - Correct Answer-Condition that occurs when perfussion of the bodies tissues with oxygen, glucose, electrolytes and fluid becomes inadequate. Compensated shock - Correct Answer-Weakness, lightheaded, pallor, tachy, diaphoresis, tachypenia, decreased urine output, weak peripheral pulses Decompinsated shock - Correct Answer-Hypotension, altered mental status, cardiac arrest Early shock - Correct Answer-Loss of 15-25% of blood volume, tachy, pallor, narrowed pulse pressure, thirst, weakness Late shock - Correct Answer-Loss of 30-45% blood loss, hypotension. Bodies ability to compensate has failed

Pressence of tachycardia - Correct Answer-Tachycardia in the resting patient is always an indication something medically wrong or possibly occult hemorhage. Whats considered tachycardia? - Correct Answer-Above 100 in an adult and higher in younger ages Low volume shock - Correct Answer-absolute hypovolemia, caused by a Weak, thready pulse,rapid rate,hemorhage, or other major body fluid loss High space shock - Correct Answer-relative hypovolemia, caused by spinal injury, vasovagal syncope, sepsis and certain drug overdoses, normal weak pulse Mechanical shock - Correct Answer-cardiogenic shock, also known as obstructive shock, caused by pericardial tamponade, tension pneumothorax, massive pulmonary embolism, or weakened heart muscle(like myocardial contusion or infarction) whats the #1 cause of preventable death from injury? - Correct Answer-hemorrhagic shock

hypovolemic shock signs and symptoms - Correct Answer-tachycardia, pale, and have flat neck veins "vasodilatory shock" - Correct Answer-relative hypovolemia or high space shock Neurogenic Shock signs and symptoms - Correct Answer-Decreased blood pressure, heart rate will be normal or slow and the skin is usually warm, dry and pink. The patient may also have accompanying parylisis and/or sensory deficits. tension pneumothorax - Correct Answer-High air tension that may sometimes develop in the pleural space between the lung and the chest wall. It prevents venous return to the heart causing JVD and tracheal deviation Cardiac tamponade or pericardial tamponade - Correct Answer-blood fills the space between the heart and the pericardium squeezing the heart and preventing the heart from filling. Causes cardiac output to fall resulting in shock. "Becks Triad" - Correct Answer-signs and symptoms of a pericardial tamponade: Shock, Muffled Heart Tones, Narrowed Pulse Pressures and JVD. (Normal Lung sounds!)

Myocardial Contusion - Correct Answer-Heart loses pumping ability due to direct injury to the heart muscle and cardiac dysrhythmias. Rapid Transport and cardiac monitoring! for Cyanosis to occur - Correct Answer-a patient must have 5 grams of deoxygenated hemoglobin per 100cc of blood What is the optimal pulse oximetry reading for patients at risk of shock - Correct Answer-95% What is the fluid bolus for a patient with shock symptoms? - Correct Answer-20 mL/KG IV Last Resort for bleeding that cant be controlled with a tourniquet(groin, face, neck, scalp, axilla)? - Correct Answer- hemostatic agents such as Quickclot Location for decompression of a tension pneumothorax? - Correct Answer-above the 3rd rib, midclavicular 2 situations that require modification of the usual SMR? - Correct Answer-1) Patient whom is in immediate danger of death due to hostile enviroment 2) Immediate life threatening position in a structure or vehicle

Emergency Rescue - Correct Answer-situations where there is immediate enviromental threat to the life of the victim or rescuer. Patients should be moved to a safe area in a manner that puts the rescuer at the least risk.(1-2 seconds) Rapid Extrication - Correct Answer-should be considered for patients whose medical conditions or situations require fast intervention to prevent death(1-2 Minutes) decorticate posturing - Correct Answer-arms flexed, legs extended ominous sign of cerebral hemispheric or brain stem injury deceribrate posturing - Correct Answer-WORSE!! arms and legs extended. Ominous sign of cerebral hemispheric or brain stem injury adult ventilation rate - Correct Answer- 8 - 10 breaths adult hyperventilation rate - Correct Answer-20 breaths per minute children ventilation rate - Correct Answer-15 breaths per minute children hyperventilation rate - Correct Answer-25 breaths per minute infants ventilation rate - Correct Answer-20 breaths per minute

infants hyperventilation rate - Correct Answer-30 breaths per minute Superficial Burns - Correct Answer-First Degree, sunburn, red skin color, dry with no blisters, painful and heals in 3-6 days, treat the symptoms Partial Thickness - Correct Answer-Second Degree, hot liquids, flash or flame, skin is mottled red, blisters with weeping, painful and heals in 2 - 4 weeks pending on the depth, cool the burn, cover with clean dry dressings Full Thickness - Correct Answer-Third Degree, chemicals, electricity, flame, hot metals, skin is pearly white and or charred, skin surface is dry and thrombosed blood vessels, sensation Anesthetic and it requires skin grafting. CLEAN DRY DRESSINGS, LOTS OF PAIN MANAGEMENT, BURN CENTER! Criteria for identifying a priority patient - Correct Answer-Dangerous mechanism of injury, history that reveals(loss of consciousness, difficulty breathing, severe pain in head, neck or torso) and High Risk Group(very old, very young, chronically ill): altered mental status, difficulty breathing, abnormal perfusion, any abnormality during your initial assessment.

hypoxemia - Correct Answer-the most common cause of traumatic cardiopulmonary arrest. what is the adequate # of rescuers for trauma related cardiac arrest? - Correct Answer-4, 1 to drive, 1 to ventilate, 1 to do compressions and 1 to diagnose and treat the cardiac arrest when should resuscitation be withheld? - Correct Answer-1)blunt trauma with no breathing, pulse, or organized rhythm, 2)penetrating trauma(no br, pu,ekg rhy)3) injuries incompatible with life, 4)any trauma evident of significant time lapse( no br, pu, ekg rhy) what is most commonly injured, during a fall from a height, of an infant - Correct Answer-head from what height could a child sustain a serious head injury? - Correct Answer-over 27 inches what is the proper amount of inflation of a BVM on a child? - Correct Answer-less than 20cm H2O to keep from inflating the stomach or causing a pneumothorax. BVM ventilation rate for a child less than a year old? - Correct Answer- 20 per minute

BVM ventilation rate for a child greater than 1 year old? - Correct Answer-15 per minute BVM ventilation rate for an adolescent? - Correct Answer-10 per minute blind nasotracheal intubation in children - Correct Answer-not recommended in children under 8 years old because the nares are to small and the larynx is to far anterior. new born vital sign range - Correct Answer- 30 - 50 resp, 120-160 pulse,

60 systolic 6 months-1 year vital sign range - Correct Answer- 30 - 40 resp, 120- 140 pulse, 70-80 systolic 2 - 4 year olds vital sign range - Correct Answer- 20 - 30 resp, 100- 110 pulse, 80-95 systolic 5 - 8 year olds vital signs range - Correct Answer- 14 - 20 resp, 90- 100 pulse, 90- 100 systolic 8 - 12 year olds vital range - Correct Answer- 12 - 20 resp, 80-100 pulse, 100 - 110 systolic

12 year olds vital range - Correct Answer- 12 - 16 resp, 80-100 pulse, 100 - 120 systolic Introsseous infusion in children - Correct Answer-IV placed in the childs proximal tibia what is the most common cause of death in pediatric patients? - Correct Answer-Head injuries what is the best indicator of head trauma? - Correct Answer-changing level of consciousness SMR criteria following a significant mechanism of injury - Correct Answer-altered mental status, intoxication, distracting painful injury, neurological deficit, spinal pain or tenderness blood volume during pregnancy - Correct Answer-increases 40-50% how much blood can a pregnant patient lose before any detectable change is noticed in blood pressure? - Correct Answer-up to 1500 cc`s result of shock state in a pregnant mother - Correct Answer-results in 80% fetal mortality rate

when backboarding a pregnant patient - Correct Answer-rotate the backboard 20-30% to the patients left, elevate the right hip 4-6 inches with a towel what is the most common cause of fetal death in trauma? - Correct Answer-maternal death where is a hemorrhage concealed in the pregnant victim? - Correct Answer-the retroperitoneal area, its a low pressure venous system and can accommodate the loss of 4 or more liters of blood gunshot wounds to the pregnant abdomen? - Correct Answer- 40 - 70% mortality rate for the fetus and 4-10% mortality rate to the mother pregnant burn patients? - Correct Answer-fluid replacement should be given early and in large amounts normal CO2 levels - Correct Answer- 35 - 40mmHg..an increase in CO promotes vasodilation which increases ICP routine management of the patient with a head injury? - Correct Answer-100% high flow oxygen, DO NOT HYPERVENTILATE!

"Cushings Reflex" - Correct Answer-a term used to describe the vital signs related to an isolated head injury: Hypertension, bradycardia and mixed breathing patterns. 3 things to make you interrupt your primary survey - Correct Answer-

1. scene becomes unsafe, 2)to treat an airway obstruction, 3) cardiac arrest goal off scene time for critical patients? - Correct Answer-5 minutes or less whats the only thing to increase the survival of trauma patients? - Correct Answer-decrease time to definitive care The initial assessment and rapid trauma survey time? - Correct Answer-less than 2 minutes normal adult respiratory rate - Correct Answer- 10 - 20 normal small child respiratory rate - Correct Answer- 15 - 30 normal infant respiratory rate - Correct Answer- 25 - 50 Tibula-fibula blood loss from a fracture - Correct Answer-500cc

femur blood loss from a fracture - Correct Answer-1,000cc or 1 liter, 2 can be life threatening pelvic blood loss from a fracture - Correct Answer-1,500-2,000cc 3 mechanisms that cause musculoskeletal injuries - Correct Answer- direct force, indirect force, twisting force opiate triad - Correct Answer-depressed LOC, pinpoint pupils, and respiratory depression parkland formula - Correct Answer-formula for figuring out how much fluid to give to a (patient weight in KG x 4ml) x (burn percentage)= then cut that in half primary brain injury - Correct Answer-immediate damage due to force, fixed at the time of injury secondary brain injury - Correct Answer-results from hypoxia, and hypoperfusion cerebral herniation syndrom - Correct Answer-decreased LOC, respiratory depression, unequal pupils, decerebrate posturing, decorticate posturing. Maintain systolic BP of 110- 120

neurogenic shock - Correct Answer-results from cervical or thoracic spinal injury, malfunction of the sympathetic nervous system signs and symptoms of neurogenic shock - Correct Answer- hypotension, decreased sensory and or motor function, inappropriate low heart rate, normal skin color and condition motorcycle helmets - Correct Answer-must remove in order to maintain neutral SMR and airway control. football helmets - Correct Answer-leave o if shoulder pads are on to maintain neutral SMR, remove if unable to ventilate or loose fitting helmet blunt thoracic trauma - Correct Answer-fracture of solid organs, blowout of hollow organs, and tearing of large blood vessels penetrating thoracic trauma - Correct Answer-direct injury to vasculature and organ additional damage from mass and velocity of penetrating objects flail chest - Correct Answer-3 or more ribs fractured in 2 or more places

flail chest treatment - Correct Answer-BVM is best treatment, secure with a bulky dressing, consider rapid transport, may need to intubate massive hemothorax - Correct Answer-shock, decreased or absent breath sounds on effected side, anxiety and confusion, FLAT NECK VEINS, load and go, treat for shock direct compression of the abdomen - Correct Answer-fracture of solid organs, blowout of hollow organs deceleration forces - Correct Answer-tearing of blood vessels and organs eviscerations - Correct Answer-cover with sterile moist dressing, cover with occlusive 4 sided trauma dressing splinting dislocations - Correct Answer-neurovascular compromise, check PMS prior to and after any splinting, splint in position found, limit movement, cool packs to reduce swelling impaled objects - Correct Answer-do not remove(airway is the exception)bulky dressing to stabilize, avoid movement

limiting burn progression - Correct Answer-cool skin with clean water 1 - 2 mins, clean dry sheets, maintain body temperature, remove wet clothing recommendations for a burn center - Correct Answer-2nd or 3rd degree burns, areas of function(joints, hands, feet, genitalia)electrical burns, chemical burns, inhalation injuries, preexisting medical probs, children management of CO poisoning - Correct Answer-Remove from source, High flow O2, Possitive pressure ventilation, cardiac monitor, consider possible cyanide poisoning, hyberbaric chamber may be considered management of electrical burns - Correct Answer-safety, high flow oxygen, large bore IV( fluid needs are higher than thermal injuries) cardiac monitor, treat arrhythmias pregnant vital signs - Correct Answer-normal pulse 10-15 beats faster, normal BP 10-15 mmhg lower(30-35% blood loss before blood pressure changes) If mother is unsalvageable - Correct Answer-continue CPR and notify facility of possible C-section trauma in the elderly - Correct Answer-falls, MVC`s, Thermal injuries

management of geriatric trauma - Correct Answer-spinal precautions, monitor IV fluids(DONT WITHHOLD IF NEEDED), frequent lung sounds, cardiac monitoring, capnography, pulse oximetry landing zone size - Correct Answer-80x80 day 100x100 night, maximum slope/angle of 5 degrees if extremity is angulated and pulses are absent - Correct Answer-apply gentle traction, in an attempt to straighten it( dont exceed 10lbs) open wound splinting - Correct Answer-sterile dressing before you apply the splint, splints should be on the side of the extremity away from the open wound to prevent pressure necrosis poor cap refill time in pediatrics - Correct Answer-anything greater then 2 seconds childs head compared to an adult - Correct Answer-larger and heavier elderly pupil reaction - Correct Answer-eye surgery may give the pupils an abnormal shpe

leading cause of death in preg patients involved in MVC~s - Correct Answer-head trauma