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FMTB BLK 4 REVIEW

Terms in this set (256)

ELO: identify treatments for a compromised airway; what are the manual maneuvers to open the airway?
Trauma Chin Lift
Trauma Jaw Thrust
What is afterload?
the resistance to blood flow that the heart must overcome to pump blood out to the arterial system
What is Preload?
the amount of blood returning into the heart from the systemic circulatory system (venous return).
What is the two categories that the Nervous system falls into?
Sympathetic
Parasympathetic
What does the Sympathetic Nervous system do?
Sympathetic nervous system (controls the fight-or-flight response): The goal of this system is to maintain sufficient amounts of oxygenated blood to critical areas while shunting blood away from nonessential areas.
What are signs and symptoms of fight-or-flight? (whats your body experiencing)
- Heart beats faster and stronger
- Increases ventilation
- Constricts blood vessels of nonessential organs
- Dilates blood vessels of muscles
What does the parasympathetic nervous system do?
Parasympathetic nervous system (rest and digest): Division of the nervous system that maintains normal body functions.
What are signs and symptoms of rest and digest? (whats your body experiencing)
- Heart beats slower
- Decreases ventilation
- Increases dilation of blood vessels to nonessential organs
what is anaerobic?
occurs without the use of oxygen. It is the back-up power system in the body and uses stored body fat as its energy source. The lack of perfusion in cells by oxygenated blood results in anaerobic metabolism and decreased function for organ. Flow of blood survival. If anaerobic metabolism is not reversed, cells cannot continue to function and will die.
What are the chambers of the heart?
right atrium, right ventricle, left atrium, left ventricle
Whats the purpose of red blood cells?
Carries oxygen(O2) and Hemoglobin
Whats the purpose of white blood cells?
Fights infection
Whats the purpose of platelets?
Blood Clotting
What are the three broad categories of shock?
Hypovolemic
Distributive
Cardiogenic
What causes hypovolemic shock?
- a state of shock caused by any loss of fluid volume either by blood loss, dehydration, burns, etc.
Whats the most common cause of hypovolemic shock on the battlefield?
massive hemorrhage which causes hemorrhagic shock. Ex. Amputations.
The average adult has how many liters of blood?
5-6 liters
What percentage of blood loss will cause a significant threat to life?
25-40% Class said 20-40%
If hemorrhage is uncontrolled, how long does it take for someone to bleed out?
60-120 seconds
What percentage of blood loss will cause class 1 shock and how much?
15% 750 ml
What percentage of blood loss will cause class 2 shock and how much?
15-30% 750-1500 ml
What percentage of blood loss will cause class 3 shock and how much?
30-40 % 1500-2000 ml
What percentage of blood loss will cause class 4 shock and how much?
>40% 2000 ml
Distributive shock is split up into what three categories?
Septic Shock
Neurogenic Shock
Psycogenic Shock
What cause septic shock?
life threatening infections occurring primarily in a hospital setting. Toxins are released into the bloodstream and cause blood vessels to dilate.
How long does it usually take for signs of septic shock to appear?
5-7 days
What causes neurogenic shock?
- shock caused by an injury that interrupts the spinal cord's sympathetic nervous system pathway, resulting in significant dilation of peripheral arteries.
What causes psycogenic shock?
also known as vasovagal syncope or fainting, this occurs when there is stimulation of the tenth cranial nerve (vagus nerve) which produces bradycardia and hypotension.
What is distributive shock?
shock that occurs when the vascular container (blood vessels) dilate (enlarge) without a proportional increase in fluid volume. As a result, the hearts preload decreases, and cardiac output falls.
What causes cardiogenic shock?
failure of the heart to adequately pump blood throughout the body, resulting from causes that can be categorized as either intrinsic (a result of direct damage to the heart itself, a heart attack, for instance) or extrinsic (related to a problem outside the heart, a tension pneumothorax, for example).
Whats the intrinsic cause of cardiogenic shock?
Any injury that weakens the cardiac muscle will affect its output. The damage may result from a myocardial infarction or from a direct bruise to the heart muscle from a blunt cardiac injury that prevents the heart from pumping properly.
What do you use to cover a patient in the prevention of hypothermia?
HPMK blanket
What are the three rules to use when giving fluid to a patient with hemorrhage?
-the casualty is bleeding at a rate of 25 to 100 mL/min b. -the IV fluid administration rate is equal to the bleeding rate c.
-the scene time and transport time exceed 30 minutes
List the two medications administered to prevent a casualty from developing septic shock.
The Committee on Tactical Combat Casualty Care recommends administering the oral antibiotic moxifloxacin and the parental (injectable) antibiotic ertapenum at the time of injury to prevent wound infections.
Which is more important for a casualty in shock, IV fluid or rapid transport? Why?
Transport of the trauma casualty should never be delayed to start an IV. Studies have found that fluid resuscitation in the field is only recommended if the three rules of fluid administration due to hemorrhage is followed.
What is homeostasis?
Maintaining a stable internal environment
What is crystalloids?
aqueous solutions of mineral salts or other water-soluble molecules. This solution does not have oxygen carrying or blood clotting capabilities.
What is colloids?
contain larger insoluble molecules, such as gelatin; blood itself is a colloid. These solutions are all hypertonic in nature.
What is a hypertonic sollution?
a solution that draws water from the surrounding cells and tissue compartments back into the vascular system
An EBL of 6% on a small bandage indicates how much blood loss?
300 ml
An EBL of 15% on a medium bandage indicates how much blood loss?
750 ml
An EBL of 20% on a large bandage indicates how much blood loss?
1000 ml
An EBL of 50% on a abdominal bandage indicates how much blood loss?
2500 ml
What is TXA?
A synthetic analog of the amino acid Lysine. It prevents enzymes in the body from breaking down blood clots.
How much TXA do you administer and what is your time frame?
Administer 1 gram of TXA in 100 cc of Normal Saline or Lactated Ringers as soon as possible but NOT later than 3 hours after injury
What is infiltration?
- escape of fluid from the vein into the tissue when the needle/catheter dislodges from the vein.
What is phlebitis?
inflammation of a vein due to bacterial, chemical, or mechanical irritation.
How do you treat phlebitis?
- Discontinue IV
- Warm compress to the affected area
- Antibiotics
What are the landmarks of an INTRAOSSEOUS IV?
The sternum consists of the manubrium, the body and the xiphoid process At the top of the manubrium is the jugular notch, which is used as a reference point for intraosseous placement.
What is arterial bleeding?
Bright red spurting blood
What is venous bleeding?
Dark red steady flow
What is capillary bleeding?
brick red oozing
What is Hematemesis?
vomiting blood
What is melena?
black, tarry stools
What is the larynx?
voice box
What is the esophagus?
Narrow tube leading from the pharynx to the stomach
What is the trachea?
windpipe
Where does gas exchange occur at?
alveoli
What is the anatomy of the airway?
Pharynx
Nasal Septum
Nares
Larynx
Epiglottis
Trachea
The Pharynx is divided into what three categories?
Nasopharynx
Oropharynx
Hypopharynx
What is your landmark for a Needle D?
Midclivicular line
2nd intercostal space
Between the 2nd and 3rd rib
What gauge of needle is used for a needle D?
14 g, 3.25'
What angle is the needle D inserted at?
90 degrees
What is the purpose of using a needle D?
Tension pneumothorax
What does a flailed chest cause?
Paradoxical movement.
What are the hollow organs?
stomach, gallbladder, small intestine, colon, bladder
What are the solid organs?
Liver, Spleen, Pancreas, Kidneys
What does the cerebrum do?
The largest of the three subdivisions of the brain, superiorly situated and sometimes called the "gray matter." It controls willful movement and sensory information such as hearing, speech, visual perception, emotions and personality.
What does the cerebellum do?
situated posterior to the brain stem and is sometimes called the "little brain" or "white matter." It coordinates the various activities of the brain, particularly movement, coordination and balance.
What is bruising around the eyes called?
Racoon Eyes
What is bruising around the ears called?
Battle signs
What test is used to detect CSF?
Halo test
What do you do if you hear bubbling sounds coming from a wound on the neck?
Put an occlusive dressing on it?
What bones make up the face?
Mandible
Maxilla
Zygomatic
Nasal
How many bones are in the skull?
6
What dressing is used for a broken mandible?
Barton Bandage
What equipment is needed for a cricothyroidoptomy?
#10 Blade
Endotracheal tube
Securing strap
Trach hook or curved kelly forceps
antiseptic solution
gauze
10 cc syringe
After placing a the ET tube during a cryc, whats the next step?
Give two breaths and assess.
If a patient is not breathing on their own when a cryc was placed, what do you do?
give 1 breath every 5 seconds
Why do we place the needle D lateral of the nipple:?
Avoid the heart, myocardial tamponade
What is myocardial tamponade
pressure on the heart that occurs when blood or fluid builds up in the space between the heart muscle and the pericardium. Ensuring that the insertion site for the needle is at or lateral to the nipple line will help avoid this complication
What is an improvised splint?
Improvised splints are made from any available material that can be used to stabilize a fracture. Examples include sticks, branches and poles.
What two maneuvers are used to open the airway?
Trauma jaw thrust
Trauma chin lift
What are signs and symptoms of a c-spine injury?
- Deformity
- Head fixed in an abnormal position
- Muscle spasms
- Parasthesia in the arms
- Pain
- Paralysis or other neural deficits
ELO: define the principles of Tactical Combat Casualty Care (TCCC).
(1) Treat the casualty
(2) Prevent additional casualties
(3) Complete the mission
ELO: define the first phase of TCCC
care rendered at the scene while both the Corpsman and the casualty are still under effective hostile fire.
What is your job in care under fire?
-Return Fire and take cover
-Direct/Expect the casualty to remain engaged as a combatant
-Direct the casualty to move to cover and apply self-aid
-Airway Management is best deferred until the Tactical Care Phase
-Stop Life Threatening Extremity Hemorrhage, if Tactically Feasible
-Direct the casualty to control hemorrhage with self-aid, if able
Whats the best medicine during care under fire?
Fire superiority is considered the best medicine since the fewer rounds coming at your Marines, the fewer injuries they will have.
ELO: define the second phase of TCCC
- care rendered once the Corpsman and casualties are no longer under effective hostile fire. This also applies to situations in which an injury has occurred on a mission, but 4-7 there has been no hostile fire
ELO: define the third phase of TCCC
- casualties are transported to a higher level of care. Tactical evacuation care encompasses both medical evacuation (MEDEVAC) and casualty evacuation (CASEVAC) as defined in Joint Publication 4-02.
List the acronym for medical priorities in Tactical Field Care.
M.A.R.C.H
What does TACEVAC encompass?
-CASEVAC platforms are typically armed tactical assets that bear no Red Cross markings.
-MEDEVAC refers to regulated casualty movement using dedicated medical evacuation platforms (ground vehicles, rotary wing aircraft, etc.) that are crewed by medical personnel.
Which phase of TCCC has the most readily available medical equipment?
TACEVAC:
Additional personnel and medical equipment may be available in this phase, which allows for an enhanced level of medical care compared to the first two phases. Electronic monitoring systems capable of providing blood pressure, heart rate and pulse oximetry may be available during evacuation. Portable fluid warmers and blood products may also be available.
ELO: identify the types of hemorrhage
Arterial
Venous
Capillary
ELO: identify the signs and symptoms of external hemorrhage
- Massive blood loss
- Obvious sign and symptoms of shock
- Class III or IV shock
ELO: identify the signs and symptoms of internal hemorrhage
- Hematemesis
- Hemoptysis
- Melena
- Hematochezia
- Hematuria
- Ecchymosis
- Rapidly forming hematoma and edema
- Rigidity with or without rebound tenderness upon palpation of abdomen
- Signs of shock
ELO: What is Hematemesis
Vomiting blood
ELO: What is Hemoptysis
Coughing Blood
ELO: What is Melena
Dark tarry stool
ELO: What is Hematochezia
Bright red blood from rectum
ELO: What is Hematuria
Blood in urine
ELO: What is Ecchymosis
Bruising
ELO: estimate the amount of blood loss; what can we look at when estimating the amount?
- Look for blood surrounding the patient.
- Inspect clothing for blood saturation.
- Inspect bandage saturation for associated blood loss..
- Determine level of shock
ELO: identify the methods of hemorrhage control; what are ways to control hemorrhage?
- Tourniquet application
- Combat gauze, hemostat agent
- Junctional Tourniquet
Identify the appropriate treatment for life-threatening hemorrhage during "Care Under Fire."
apply the tourniquet proximal to the bleeding site. Time may not permit exposure of the wound and the tourniquet may have to be placed over the uniform. Although this is not the ideal application, it is necessary. Once time permits, the wound should be exposed and re-evaluated and a replacement tourniquet should be applied directly to the skin
Where on the extremities should a tourniquet NOT be placed?
Do NOT place a tourniquet below the knee or elbow or over a joint due to there being two bones, i.e., Tibia/Fibula below the knee, and Radius/Ulna below the elbow, which can splint the hemorrhaging vessel and make it impossible to control the bleed.
If hemostatic agents are necessary, which phase of care are they used in?
Tactical Field Care
What makes up a hemostatic bandadge?
Kaolin
What are the parts of a tourniquet?
Windlass rod
Windlass clip
Windlass strap
Self-adhering strap
What is the biggest lifesaver on a battlefield?
Tourniquets: In combat settings, they are the biggest lifesaver on the battlefield!
ELO: identify standard medical terminology related to the airway; what is Pharynx.
Muscle lined with mucous running from the back of the soft palate to the upper end of the esophagus; divided into three sections
-Nasopharynx
-Oropharynx
-Hypopharynx
ELO: identify standard medical terminology related to the airway; what is Nasal Septum.
Separates the left and right airways of the nose
ELO: identify standard medical terminology related to the airway; what is Nares.
External openings of nasal cavity
ELO: identify standard medical terminology related to the airway; what is Larynx (voicebox).
Cartilaginous box located above the trachea, containing vocal cords and muscles that make them work
ELO: identify standard medical terminology related to the airway; what is Epiglottis.
Leaf-shaped structure that acts like a gate, directing air into the trachea and solids/liquids into the esophagus
ELO: identify standard medical terminology related to the airway; what is Trachea (windpipe).
Main trunk of the system of tubes air passes to and from the lungs
ELO: identify standard medical terminology related to the airway; what is in the Upper Airway.
Consists of the nasal cavity and oral cavity
ELO: identify standard medical terminology related to the airway; what is in the Lower Airway.
Consists of the trachea, its branches and the lungs. On inspiration, air travels through the upper airway and into the lower airway. The actual gas exchange occurs in the alveoli. The alveoli are where the circulatory and respiratory systems meet.
ELO: identify the signs and symptoms of a compromised airway; what is the route cause of a compromised airway?
Decreased Neurological Function
Mechanical Obstruction
ELO: identify the signs and symptoms of a compromised airway; what is the result of decreased neurological function?
Flaccidity of the tongue
Decreased level of consciousness (tongue will fall back over pharynx)
ELO: identify the signs and symptoms of a compromised airway; what is the result of a mechanical obstruction?
Foreign bodies may become lodged and create occlusions. Crush injuries and edema may be present. Patients with facial injuries often present with blood and vomit.
ELO: identify the signs and symptoms of a compromised airway; what are you doing to identify issues and what are you looking for?
Look:
Identify obvious injuries to the airway
Talk to the patient
Pay attention to LOC
Identify any obstructions
Skin color
Chest movement
Muscle tone when breathing

Listen:
Sounds on inhalation/exhalation
depth, rate, rhythm

Feel:
Chest rise and fall
Breath against your face
ELO: identify treatments for a compromised airway; What do you do for an obstructed airway?
- Finger sweep debris you can see
- Tilt patient on their side to let gravity assist in clearing airway.
ELO: identify treatments for a compromised airway; What adjunct do you use for the airway when a patient is conscious or unconscious and is unable to maintain a airway?
NPA
ELO: identify treatments for a compromised airway; What adjunct is used for a patient who is unconscious and a NPA is not recommended?
I-Gel
What are contraindications of a NPA?
Do not use NPA if the casualty is conscious and breathing on his own, has a severe head or facial injury , or if there is evidence of a basilar skull fractures such as bruising around the eyes (raccoon eyes), bruising behind the ears , or blood or fluid coming out of the ears.
What are contraindications of a I Gel?
casualties who are responsive with an intact gag reflex and who have airway burns.
Identify four types of mechanical airway obstructions.
- Teeth
- Gum
- Tobacco
- Bone
- Blood
- Vomit
- Glass
- Rocks
- Debris
ELO: identify important anatomical landmarks for an emergency cricothyroidotomy,
- Trachea
- Thyroid Cartilage
- Cricoid Cartilage
- Cricothyroid Membrane
- Carotid Arteries
- Jugular Veins
- Esophagus
- Thyroid Gland
ELO: identify the indications for performing an emergency cricothyroidotomy.
- Obstructed airway and/or swelling
- Congenital deformities
- Trauma to the head and neck
- Cervical spine fractures
ELO: identify the procedural sequence for performing an emergency cricothyroidotomy.
1. Assess patient and make decision to perform emergency cricothyroidotomy. (ABC's, LLF, Failed attempts at all other airway management).
2. Assemble and check equipment (Scalpel #10 blade, ET tube, 10 cc syringe, tape, Curved Kelly hemostats/Trach Hook, gauze).
3. Prepare patient (Place patient in supine or semi-recumbent position and place neck in neutral position).
4. * Locate landmarks (palpate thyroid and cricoid cartilages, locate cricothyroid membrane).
5. Cleanse the incision site with alcohol or betadine.
6. Stabilize the thyroid cartilage using your non-dominant hand.
7. Make 1 inch, vertical incision over the cricothyroid membrane.
8. Visualize cricothyroid membrane.
9. Make ½ inch, horizontal incision to cut through the cricothyroid membrane.
10. Open incision with blunt dissection.
11. * Insert endotracheal tube into the incision, directing the tube distally down the trachea (no more than 3 - 4 inches).
12. Inflate balloon with 10cc's of air.
13. Ventilate patient with two breaths & check for proper placement (Auscultate epigastric area - If patient has epigastric sounds, remove and retry, observe for bilateral rise/fall of chest, misting or fogging in E.T. tube and auscultate for breath sounds bilaterally).
14. Lung sounds on right side only (deflate cuff, pull back ¼- ½ inch, re-inflate cuff, recheck placement.
15. Secure tube.
16. Apply dressing (petroleum gauze on insertion site, dry sterile dressing over petroleum gauze).
17. Reassess & monitor patient (if not breathing on own, 1 breath every 5 seconds, suction as necessary).
If a patient has epigastric sounds during the ET tube check; what do you do?
remove and retry, observe for bilateral rise/fall of chest, misting or fogging in E.T. tube and auscultate for breath sounds bilaterally).
ELO: identify potential complications of an emergency cricothyroidotomy.
(hemorrhage, esophageal perforation subcutaneous emphysema)
ELO: identify standard medical terminology related to the respiratory system; what is Dyspnea.
Difficult or labored breathing
ELO: identify standard medical terminology related to the respiratory system; what is Wheeze.
A form of rhonchus, characterized by a whistling respiratory sound. It is caused by the movement of air through a narrowed airway.
ELO: identify standard medical terminology related to the respiratory system; what is Stridor.
- A harsh shrill respiratory sound.
ELO: identify standard medical terminology related to the respiratory system; what is Hyperventilation.
An increase in the rate and depth of normal respirations. Responsible for increasing oxygen levels and decreasing carbon dioxide levels.
ELO: identify standard medical terminology related to the respiratory system; what is Hypoventilation.
Loss of ventilatory drive, usually from decrease neurological function most often after a TBI. This can also be cause by an upper or lower airway obstruction, and decreased expansion of the lungs.
ELO: identify standard medical terminology related to the respiratory system; what is Tachypnea.
An abnormally rapid rate of respiration. above 20.
ELO: identify standard medical terminology related to the respiratory system; what is Bradypnea.
- An abnormally slow rate of respiration, usually less than 8 breaths per minute.
ELO: identify standard medical terminology related to the respiratory system; what is Hypoxia.
An insufficient concentration of oxygen in the tissue in spite of an adequate blood supply
ELO: identify standard medical terminology related to the respiratory system; what is Apnea.
Total cessation of breathing, also known as respiratory arrest.
ELO: identify standard medical terminology related to the respiratory system; what is Subcutaneous emphysema.
The presence of free air or gas in the subcutaneous tissues. The face, neck, or chest may appear swollen with painful skin and produce a crackling sound ("Rice Krispies").
ELO: identify the anatomy of the respiratory system, what makes up the thorax cavity?
- Rib Cartlidge
- Xiphoid process
- angle of louis
- body
- Manubrium
- costal arch

(Ribs and sternum)
ELO: identify the anatomy of the respiratory system, what is the primary muscle of respirations?
Diaphram
ELO: identify the anatomy of the respiratory system, what makes up the pleura?
Parietal pleura - a thin membrane that lines the inner side of the thoracic cavity

Visceral pleura - a thin membrane that covers the outer surface of each lung.
ELO: identify the anatomy of the respiratory system, what lung has 2 lobes and which has 3?
Right-3
Left-2
ELO: identify the anatomy of the respiratory system, where does gas exchange take place?
Alveoli
ELO: identify the anatomy of the respiratory system, what is housed in the Mediastinum?
- Heart
- Great vessels (aorta, superior/inferior vena cava)
- Trachea (windpipe)
- Mainstem bronchi (there are two bronchi- a right and left)
- Esophagus (lies directly behind the trachea
ELO: identify the signs and symptoms of respiratory trauma, What are the two main causes?
Blunt trauma
Penetrating trauma
ELO: identify the signs and symptoms of respiratory trauma.
Skin color
Skin temp
Rate, rhytm, depth
Listen to breath sounds or absence of sound
Chest or neck trauma
Crepitus
Tenderness
Subcutaneous Emphysema
ELO: identify treatments for chest injuries; Simple Rib Fracture?
- Analgesics
- Immobilization of arm on affected side
- Coughing and deep breathing
- Monitor and Tacevac as needed
ELO: identify treatments for chest injuries; Flail Chest?
- Immobilize segments with tape
- Analgesics
- BVM if respiratory failure
- O2
- Monitor and TACEVAC
ELO: identify treatments for chest injuries; Pneumothorax?
- Place patient in sitting up or Semi
- Fowlers position
- Use BVM if hypoxia is present
- Administer oxygen if available
- If caused by a wound, apply an occlusive dressing to the site
- Monitor for signs and symptoms of a tension pneumothorax
- TACEVAC ASAP
ELO: identify treatments for chest injuries; Tension Pneumothorax?
- Treat all chest injuries
- Perform needle thoracentesis
- Administer oxygen therapy if available
- Pain management
- Monitor and TACEVAC
What are early signs of Tension Pneumothorax?
- Unilateral (one sided) decreased or absent breath sounds
- Dyspnea
- Tachypnea
What are progressive signs of Tension Pneumothorax?
-Increased dyspnea
- Increased tachypnea
- Increased difficulty ventilating
What are late signs of Tension Pneumothorax?
- Jugular vein distention (JVD)
- Tracheal deviation
- Signs of acute hypoxia
- Narrowing pulse pressures
- Signs of uncompensated shock
ELO: identify treatments for chest injuries; sucking chest wound?
- Occlusive dressing
- Check for entry and exit wound
- Monitor
- Administer oxygen if available
- Place patient on affected side
- Pain management
- Monitor and TACEVAC
ELO: identify treatments for chest injuries; Hemothorax?
- Place patient in the Fowler's position
- Treat any chest injuries
- Treat for shock
- Administer O2, if available
- Pain management
- Monitor and TACEVAC
ELO: identify treatments for chest injuries; Hemopneumothorax?
- Place patient in Fowler's position
- Perform needle thoracentesis to relieve pressure. If blood is withdrawn, immediately remove needle and catheter.
- Administer oxygen, if available
- Treat for shock
- Monitor and TACEVAC
ELO: identify important anatomical landmarks for needle thoracentesis.
- Mid-Clavicular Line (MCL)
- 2nd Intercostal Space
- alternative location is the 4th or 5th intercostal space at the anterior auxiliary line.
ELO: identify the indications for needle thoracentesis.
Tension Pneumothorax
ELO: identify the proper equipment for performing needle thoracentesis.
- Gloves
- 14 g, 3.25' Needle
- Alcohol
ELO: identify the procedural sequence for performing needle thoracentesis.
1. Assess casualty and make decision to decompress (ABC's, LLF, S/SX of pneumothorax)
2. Assemble and check equipment (14-gauge, 3.25-inch needle/catheter, alcohol).
3. Prepare patient (position, explain, expose).
4. * Identify landmarks (midclavicular line, 2nd intercostal space).
5. Cleanse the area.
6. Insert catheter at 90-degree angle and puncture the parietal pleura.
7. Remove needle (allow lung to decompress).
8. Secure catheter to chest.
9. Reassess & monitor patient for improvement (decrease in respiratory difficulty).
ELO: identify the potential complications when performing needle thoracentesis.
- Hemothorax
- Cardiac Tamponade
- Subcutaneous emphysema
- Misdiagnosis
What is cardiac tamponade?
pressure on the heart that occurs when blood or fluid builds up in the space between the heart muscle and the pericardium.
Identify the two serious consequences of a tension pneumothorax.
(1) breathing becomes increasingly difficult
(2) cardiac blood flow is severely decreased.
ELO: identify standard medical terminology related to the cardiovascular system; what is Systolic Blood Pressure (SBP).
the force of the blood against blood vessels produced by ventricular contraction. (Normal systolic B/P = 120-140 mmHg)
ELO: identify standard medical terminology related to the cardiovascular system; what is Diastolic Blood Pressure (DBP).
the pressure remaining in the blood vessels while the heart is refilling. (Normal diastolic B/P = 60-80 mmHg)
ELO: identify standard medical terminology related to the cardiovascular system; what is Preload.
- the amount of blood returning into the heart from the systemic circulatory system (venous return).
ELO: identify standard medical terminology related to the cardiovascular system; what is Afterload.
the resistance to blood flow that the heart must overcome to pump blood out to the arterial system.
ELO: identify standard medical terminology related to the cardiovascular system; what is Stroke Volume.
amount of blood pumped by the heart with each contraction.
ELO: identify standard medical terminology related to the cardiovascular system; what is Capillary Refill Test.
quick test performed on the nail beds as an indicator of tissue perfusion (normal = less than 3 seconds).
ELO: identify standard medical terminology related to the cardiovascular system; what is Sympathetic nervous system.
(controls the fight-or-flight response)
ELO: identify standard medical terminology related to the cardiovascular system; what is Parasympathetic nervous system.
(rest and digest)
ELO: identify standard medical terminology related to the cardiovascular system; what is Metabolism.
energy produced in the body by oxygen and glucose
ELO: identify standard medical terminology related to the cardiovascular system; what is Aerobic metabolism.
use of oxygen by the cells. This is the body's main combustion process.
ELO: identify standard medical terminology related to the cardiovascular system; what is Anaerobic metabolism.
without the use of oxygen. It is the back-up power system in the body and uses stored body fat as its energy source. The lack of perfusion in cells by oxygenated blood results in anaerobic metabolism and decreased function for organ 4-64 Figure 1. Flow of blood survival. If anaerobic metabolism is not reversed, cells cannot continue to function and will die.
ELO: identify the signs and symptoms of each type of shock, Hypovolemic Class I.
Amount of Blood Loss:
Heart rate:
Pulse (quality):
Capillary Refill:
Respiratory Rate:
SBP:
Skin Color:
Skin Temperature:
Mental Status:
Amount of Blood Loss: <750 ml or 15%
Heart rate: Normal
Pulse (quality): Normal
Capillary Refill: Normal
Respiratory Rate: Normal
SBP: Normal
Skin Color: Pale
Skin Temperature: Cool
Mental Status: Normal
ELO: identify the signs and symptoms of each type of shock, Hypovolemic Class II.
Amount of Blood Loss:
Heart rate:
Pulse (quality):
Capillary Refill:
Respiratory Rate:
SBP:
Skin Color:
Skin Temperature:
Mental Status:
Amount of Blood Loss: 750 - 1500 ml 15-30%
Heart rate: > 100
Pulse (quality): Thready
Capillary Refill: 3-5
Respiratory Rate: 20-30
SBP: normal
Skin Color: pale
Skin Temperature: cool; moist
Mental Status: Anxious; Fright
ELO: identify the signs and symptoms of each type of shock, Hypovolemic Class III.
Amount of Blood Loss:
Heart rate:
Pulse (quality):
Capillary Refill:
Respiratory Rate:
SBP:
Skin Color:
Skin Temperature:
Mental Status:
Amount of Blood Loss: 1500 - 2000 30-40%
Heart rate: >120
Pulse (quality): Thready; weak
Capillary Refill: >5
Respiratory Rate: 30-40
SBP: <80
Skin Color: white extremities; ashen
Skin Temperature: cool extremities
Mental Status: confused; Anxiety
ELO: identify the signs and symptoms of each type of shock, Hypovolemic Class IV.
Amount of Blood Loss:
Heart rate:
Pulse (quality):
Capillary Refill:
Respiratory Rate:
SBP:
Skin Color:
Skin Temperature:
Mental Status:
Amount of Blood Loss: > 2000 ml 40%
Heart rate: > 140
Pulse (quality): No radial pulse, weak carotid
Capillary Refill: >5
Respiratory Rate: >35
SBP: < 60
Skin Color: White extremities, Ashen, Cyanotic
Skin Temperature: Cool Extremities
Mental Status: Lethargic, Unconscious
ELO: identify the signs and symptoms of each type of shock, Neurogenic.
Skin Temp
Skin Color
Blood Pressure
LOC
Cap Refill
Skin Temp warm dry
Skin Color pink
Blood Pressure drops
LOC lucid
Cap Refill slowed
ELO: identify the signs and symptoms of each type of shock, Psycogenic.
Skin Temp
Skin Color
Blood Pressure
LOC
Cap Refill
Skin Temp cool clammy
Skin Color pale cyanotic
Blood Pressure drops briefly
LOC altered briefly
Cap Refill slowed briefly
ELO: identify the signs and symptoms of each type of shock, Septic.
Skin Temp
Skin Color
Blood Pressure
LOC
Cap Refill
Skin Temp cool clammy
Skin Color pale molted
Blood Pressure drops
LOC altered
Cap Refill slowed
ELO: identify the signs and symptoms of each type of shock, cardiogenic.
Skin Temp
Skin Color
Blood Pressure
LOC
Cap Refill
Skin Temp cool clammy
Skin Color pale cyanotic
Blood Pressure drops
LOC altered
Cap Refill slowed
What is the best indicators to focus on for hypovolemic shock?
- Altered LOC
- Tachypnea
- Distal pulses
ELO: identify the appropriate treatment of each type of shock; hypovolemic.
- Stop life threatening bleeding
- Control hemorrhage with dressings
- fluid resuscitation
- CASEVAC
ELO: identify the appropriate treatment of each type of shock; Septic.
CASEVAC and will later receive aggressive treatment with a broad range of antibiotics.
ELO: identify the appropriate treatment of each type of shock; Neurogenic.
- Maintain ABC's
- Spinal Immobilization (if mechanism of injury causes a high suspicion of spinal injury)
- Oxygen therapy to keep oxygen saturation >92% (if available)
- Obtain IV access and give fluids, if necessary
- Trendelenburg position (head down, feet elevated)
- Keep patient warm
- TACEVAC
ELO: identify the appropriate treatment of each type of shock; Psycogenic.
Place in a horizontal position. Will mostly resolve on its own.
ELO: identify the appropriate treatment of each type of shock; Cardiogenic.
- Maintain ABC's
- Obtain IV access
- Oxygen therapy to keep oxygen saturation >92% (if available)
- TACEVAC
ELO: define medical terminology associated with fluid resuscitation,define medical terminology associated with fluid resuscitation, Homeostasis
a state of physiological equilibrium produced by a balance of functions and chemical composition within the body. Homeostasis is usually maintained as long as the fluid volume and chemical composition of the fluid compartments stay within narrow limits or within a state of equilibrium.
ELO: define medical terminology associated with fluid resuscitation,define medical terminology associated with fluid resuscitation, Electrolyte
- an element or compound that, when melted or dissolved in water or another solvent, disassociates into ions and is able to carry an electric current. Fluids containing these electrolytes and water are called crystalloids.
ELO: define medical terminology associated with fluid resuscitation,define medical terminology associated with fluid resuscitation, Crystalloids
aqueous solutions of mineral salts or other water-soluble molecules. This solution does not have oxygen carrying or blood clotting capabilities.
ELO: define medical terminology associated with fluid resuscitation,define medical terminology associated with fluid resuscitation, Colloids
contain larger insoluble molecules, such as gelatin; blood itself is a colloid. These solutions are all hypertonic in nature.
ELO: define medical terminology associated with fluid resuscitation,define medical terminology associated with fluid resuscitation, Isotonic
a solution that triggers the least amount of water movement from the vascular system in to or out of the cells or surrounding tissue.
ELO: define medical terminology associated with fluid resuscitation,define medical terminology associated with fluid resuscitation, Hypotonic
a solution that causes water to leave the vascular system and enter the cells or surrounding tissue compartments
ELO: define medical terminology associated with fluid resuscitation,define medical terminology associated with fluid resuscitation, Hypertonic
- a solution that draws water from the surrounding cells and tissue compartments back into the vascular system.
ELO: identify the routes for giving fluid.
Oral
IV
IO
Indications for oral fluid resuscitation.
Injured casualty who is not in shock , has a normal level of consciousness and the ability to swallow
Indications for IV fluid resuscitation.
- In shock
- Uncontrolled hemorrhage
- Diarrhea or vomiting
- Burns
- Unable to tolerate fluids by mouth
- To give IV medications
Indications for IO fluid resuscitation.
- In shock
- Requires IV fluids
- Unable to obtain IV access
ELO: identify the different types of IV solutions; Crystalloids.
Lactated Ringers
Normal Saline
When using a crystalloid, what do you keep in mind to determine how much to administer?
Within 30 to 60 minutes after administration, only about 1/4 to 1/3 remains in the cardiovascular system. The remainder becomes edema in the soft tissues and organs. 300 ml has been infused for every 100 ml of lost blood volume.
ELO: identify the different types of IV solutions; Water and Glucose solutions.
D5W
D50W
(Dextrose with water)
When will Water and glucose solutions be used and what is the contraindication?
- Hypoglycemia emergencies
- Head injuries/Massive Tissue Injuries
ELO: identify the different types of IV solutions; Why do we use Whole Blood.
Because of its ability to transport oxygen, blood is the fluid of choice for severe hemorrhagic shock.
ELO: identify the different types of IV solutions; What is the purpose of Hextend and administration intervals/amount.
- Synthetic colloid solution used as a volume expander.
- bolus 500 ml Hextend. If no improvement is noted in 30 minutes, administer another 500 ml. Do not use more than 1,000 ml.
ELO: identify the different types of IV solutions; Colloids.
Hextend is the fluid of choice for volume replacement due to trauma in a tactical situation.
ELO: identify the potential complications of initiating IV therapy.
Infiltration
Phlebitis
Nerve Damage
Circulatory Overload
Air embolism
Systemic Infection
What is the fluid of choice for a trauma patient in a tactical situation?
Hextend
What gauge needle/catheter is used for IVs in the field setting?
18 g
ELO: identify the anatomy of the head.
Frontal Bone
Parietal Bone
Occipital Bone
Temporal Bone
Sphenoid Bone
Ethemoid Bone
ELO: identify the types of head injuries; soft tissue signs and symptoms.
- Profuse bleeding no matter how minor the injury
- Lacerations
- Avulsions
- Pain
- Anxiety
- Edema
- Ecchymosis
- Signs/symptoms of hypovolemic shock
ELO: identify the types of head injuries; Open Skull Inury signs and symptoms.
-Profuse bleeding no matter how minor the injury
- Crepitus
- Edema
- Depressions
- Deformities
- Skull or bony fragments visible
ELO: identify the types of head injuries; Closed skull injury signs and symptoms.
-Crepitus around injury site
- Headache
- Neurological symptoms:
- Altered LOC
- Restlessness
- Unequal pupils
What is a coup-contrecoup injury?
Dual impacting of the brain into the skull; coup injury occurs at the point of impact; contrecoup injury occurs on the opposite side of impact, as the brain rebounds.
ELO: identify the types of head injuries; Brain injury signs and symptoms.
- Unusual behavior patterns. You must be careful not to misinterpret these symptoms for a psychiatric casualty. (This is the number one indicator of an injury.)
- Altered level of consciousness
- Paralysis
- Convulsions/seizures
- Hyperthermia
ELO: select the appropriate treatment for a head injury.
- Provide and maintain patent airway
- Apply c-spine precautions
- Hemorrhage control. Cover open wounds securely enough to aid in the clotting process without pressing skull fragments or impaled objects inward by using donut o-ring.
- Fluid resusciatate to maintain a palpable radial pulse (Do not want to raise intracranial pressure)
- Do not remove foreign bodies or impaled objects
- Check for drainage of CSF from the wound, nose, or ears. Do not pack or suction nose and/or ears if CSF leakage is suspected. Do not let patient clear their nose by blowing. If the casualty has drainage from their nose, check to see if it is CSF by:
- Use the Halo, or Target Test to check for CSF. Dip a 4 x 4 in the drainage then lay it flat and wait a few minutes. If there is CSF in the blood, the blood will collect in the center, while the CSF remains to the outside creating a halo around the blood.
- Give nothing by mouth (NPO)
- TACEVAC in the High Fowler's position
- Do NOT give pain medications
Treatment for chemical burns of the eye.
- Flush eyes 5-10 minutes for acid burns
- Flush eyes 20 minutes for alkali
List the six key points for treatment of a neck wound.
- Consider C-spine
- Control hemorrhage with occlusive dressing. Apply pressure only to the affected vessels
- Consider cricothyroidotomy if airway is compromised - Administer fluids (see Combat Fluid Resucitation lesson)
- NO PAIN MEDICATIONS!
- TACEVAC
ELO: identify the anatomy of the musculoskeletal system, Types of long bones.
femur, humerus, ulna, radius, tibia and fibula
ELO: identify the anatomy of the musculoskeletal system, Types of short bones.
metacarpals, metatarsals and phalanges
ELO: identify the anatomy of the musculoskeletal system, Types of Flat bones.
sternum, ribs and scapulas
ELO: identify the anatomy of the musculoskeletal system, what are sutural bones?
- variable and irregularly shaped bones in the sutures between the bones of the skull
ELO: identify the anatomy of the musculoskeletal system, Types of sesamoid bones?
- located within tendons; patella is the larges
ELO: identify the anatomy of the musculoskeletal system, Skeletal (voluntary).
muscle fiber is striated, or striped, and is under the control of the individual's will.
ELO: identify the anatomy of the musculoskeletal system, Smooth (involuntary)
muscle fibers are smooth, or non-striated, and are not under the control of the individual's will.
ELO: identify the anatomy of the musculoskeletal system, Cardiac.
muscle cells are striated and are joined end to end, resulting in a complex network of interlocking cells.
ELO: identify the anatomy of the musculoskeletal system, Tendon.
- a band of tough, inelastic, fibrous tissue that connects a muscle to a bone
ELO: identify the anatomy of the musculoskeletal system, Ligament.
- a band of tough, fibrous tissue connecting bone to joint
ELO: identify the management of soft tissue injuries; abrasion cause and treatment.
- Occur when skin is rubbed or scrapped of.
- Bandage if necessary and infection treatment depending on severity.
ELO: identify the management of soft tissue injuries; Laceration cause and treatment.
- Torn skin with ragged irregular edges and masses of torn tissue underneath.
- Generally the same as for abrasions
- Control hemorrhage
- If major tendons and muscles are completely severed, immobilize limb to prevent further damage.
- Treat for shock
ELO: identify the management of soft tissue injuries; Avulsion cause and treatment.
- An injury in which flaps of skin are torn loose or completely pulled off.
- Control bleeding
- Apply field dressing to avulsed area. - Prevent further contamination
- Ensure avulsed flap is lying flat and that it is aligned in its normal position.
- Make every effort to preserve the avulsed part (wrap the part in a saline or water soaked field dressing, pack wrapped part in ice, whenever possible. Be careful to avoid direct contact between the tissue and ice.)
- Transport the avulsed part with the patient, but keep it well protected from further damage and out of view of the patient.
- Immobilize extremity or body part as indicated by the severity of the avulsion
What is Strain?
- Injury to a muscle or tendon resulting from over stretching or over exertion.
What is Sprain.
A joint injury resulting in partial tearing or stretching of supporting ligaments.
Which requires a TACEVAC. Strain or Sprain?
Sprain
What is a dislocation?
When a bone is forcibly displaced from its joint.
ELO: identify the management of fractures for closed and open.
- Control hemorrhage
- Treat for shock
- Check distal pulses before and after splinting
- Immobilize the fracture using splints
- Recheck PMS
- Relieve pain (whenever possible)
- Reductions of fractures are not done in the field, unless distal pulses are not present
- Document treatment
- Monitor and TACEVAC
What is a Rigid Splint?
- cannot be changed in shape. The injured body part must be positioned to fit the splint. Examples include board splints made of wood, plastic, or metal.
What is a Formable Splint?
- Formable splints can be molded into various shapes and combinations to accommodate the shape of the injured extremity. Examples include
What is a Improvised Splint?
Improvised splints are made from any available material that can be used to stabilize a fracture. Examples include sticks, branches and poles.
What is a Anatomical Splint?
Use of the casualty's body as a splint. Examples include securing the legs together, securing the arm to the body, and taping the fingers together.
What is a Manufactured Splint?
Designed for specific injuries and specific applications. Examples include the traction splint and pneumatic air splints.
What are bandages used for in regards to splinting?
Bandages can be used to wrap or bind a body part. Bandages hold splints in place, apply additional pressure, and protect the casualty from further harm.
ELO: identify anatomy of the major abdominal organs, what can be found in your RUQ.
Colon
Kidney
Pancrease
Gallbladder
Liver
ELO: identify anatomy of the major abdominal organs, what can be found in your LUQ.
Colon
Kidney
Spleen
Stomach
ELO: identify anatomy of the major abdominal organs, what can be found in your RLQ.
Appendix
Ascending colon
Small intestine
Major RL Artery/Vein
ELO: identify anatomy of the major abdominal organs, what can be found in your LLQ
Descending Colon
Small Intestine
Major LL Artery/Vein
Whats the concern about hollow organ injuries?
- injury to these organs may cause septicemia and toxicity.
Whats the concern about solid organ injury?
- highly vascular organs where injury may cause severe bleeding.
What are signs and symptoms of an abdominal injury?
- MOI consistent with rapid deceleration or significant compression forces
- Soft tissue injuries to the abdomen, flank, or back
- Shock without an obvious cause
- Level of shock greater than explained by other injuries
- Significant abdominal tenderness on palpation or with coughing
- Involuntary guarding
- Diminished or absent bowel sounds
Describe the appropriate treatment for an impaled object.
direct pressure should be applied around the object to the wound with a bulky dressing that stabilizes the object and prevents movement.
Describe the appropriate treatment for an abdominal evisceration.
abdominal contents should be covered with a sterile dressing that has been moistened with saline.
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