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when there is increasing intracranial pressure. what must go up to keep the brain perfused?
mean arterial pressure. If there is something blocking the MAP must increase to overcome the intrinsic pressure and per fuse the brain tissue.
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what is the estimated blood loss and assessment findings with a class three hemorrhage.
- class three is 30-40% of blood is lost or 1500-2000.
- the findings are moderate to severe tachycardia and hypo tension.
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what are the most common assessment findings associated with compartment syndrome. characterized by the 6 Pi's
- 1-pain
- 2-pins and needles (paresthesia)
- 3-pulselessness
- 4-palloe
- 5-pressure- swelling and firmness
- 6-paralysis.
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how much blood can be lost in a pelvic fracture
All of it. the abdominal cavity can hold the bodys entire blood supply.
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why shouldn't blood pressure be used for an example of shock for old people.
if their baseline BP is high and has a significant drop it will just be considered at normal levels
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define after load
after load is the pressure within the systemic vasculature that the heart must overcome in order to pump blood.
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what is the pathophysiology of a tension pnumothorax?
this causes obstructive shock. this increased pressure in the plural space displaces the heart and other organs out of their area which can then kink the great vessels and poor cardiac preload. then the decrease in CO causes shock.
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what are the three types of closed soft tissue injuries
- 1-contusions
- 2-hematoma
- 3-crush injurys
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what is main reason behind distributive shock?
commonly caused by decreased vascular tone causing dilation of the blood vessels and a decreased pressure in the cardiovascular system.
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What are some of the management strategies with treating a pelvic fracture.
- 1-stabilize the PASG immobilization
- 2-consider spinal immobilization
- 3-manage blood loss and shock
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what are different examples of pelvic fractures.
- 1-single pelvic ring fracture
- 2-unilateral fracture of both pelvic rami
- 3-subluxation of symphisis pubis
- 4-fracture near the si joint.
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what are the most dangerous side effects of electrical burns?
cardiac dysrhythmias and cardiac arrest
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what are two different kinds of distributive shock
sepsis and anaphylaxsis
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what is a le fort 1 fracture
a fracture that separates the hard palate and lower maxilla from the remainder of the skull
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what are three mechanisims by which the body compensates in the setting of hypovolemic shock
- 1- tachycardia
- 2-increased cardiac contractility
- 3-vaso constriction
consider renal absorbtion of water and increased RR
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what is compartment syndrome?
its when the increased pressure compromises local circulation and neuromuscular function
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how much blood in the pericardial space can cause a reduction in cardiac output in pericardial tamponade.
50-55 ml of blood
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what is a hemothorax
when blood accumulates in the pleural space and displaces lung tissue, can cause obstructive shock.
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what is considered a high risk auto crash according to the CDC and the prevention field guild lines.
1-More than 12 inches on the occupant side or more than 18 inches in any side.
2-partail or complete ejection from a automobile.
3-death with any passenger in the car
4-vehicle telemetry data consistent with high risk of injury.
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what is commotio cordis?
a lethal cardiac arrest dysrhythmia. usually By V-FIB or V-tach caused by blunt trauma to the heart.
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what is a chemo receptors job?
to sense the chemical changes in the body like hypoxemia and high levels of CO2.
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in regard to tourniquet what is windlass?
is the rod or handle that that is turned within the tourniquet to lock it into place
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what is hydro static pressure?
the pressure that the fluid exerts on the walls of its container.
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what would commonly be injured with a lower right rib fracture?
Liver
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when giving fluid to a hypertensive traumatic brain injured patient. what blood pressure should be targeted?
90mmhg systolic.
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Define:preload
The amount of blood in the ventricles prior to the systolic squeeze. its also called END DIASTOLIC VOLUME.
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what is a coup-contrecoup injury
when the brain strikes one side of the skull in one insult then strikes the other side in a secondary insult.
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what does hypercapnea in the brain cause?
vasodilation
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cheyne-stokes respiration's what is it?
repeated respiratory pattern followed by deeper and faster breathing, then a gradual slowing and periods of apnea
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how does pulmonary contusions develop?
after traumatic insult it could take 12-24 hours to develop
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what kind of injury do you get with tertiary blasts
when a patient is thrown thru the air then hurt upon impact
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whats becks triad
- 1-JVD
- 2-narrowed pulse pressure
- 3-muffled heart tone
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Cushings triad what is it?
- 1-bradycardia
- 2-high blood pressure
- 3- respiratory pattern changes.
its a sign tha intracranial pressure is rising.
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what is the Le fort 3 fracture
craniofacial dysjunction, entire separation from the midface
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what would indicate that you have a cerebral injury
any deficits in speech, vision, and hearing fuction.
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what is the goal of fluid restoration in a hypoperfused patient
the goal is to get systolic up to 90 mmhg.
usually by giving 30 ml of isotonic fluid in 250-200 increments.
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what is the recomended amount for fluid recessitation for a pediatric patient?
20 ml/kg of isotonic fluid
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how do you tell the gestational age of a unconcious mom
first trimester= fundus at the pubic symphisis
2nd trimester- level of the umbilicus
third=when the belly is at the xiphoid process
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what is a le fort 2 fracture
separates the nasal and lower maxilla from the facial skull
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what is class 2 hemhorrage
15-30% of blood is lost. 750-1500ml
you will see tachycardia, pale skin, delayed capillary refill time.
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what is a difuse anoxal injury
extensive samage to the white matter of the brain. common with deceleration injuries.
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How much blood can the retroperitoneal space hold
About four liters of blood
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What are the three classifications of burn severity
- Superficial
- Partial thickness
- Full thickness
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What does primary blast waves do to people
Blast waves affect the victim close go the blast and cause major blood vessel disruption
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what is a class 4 hemorrhage
Class 4 occurs when 40 - 50% the blood is lost which is also 2000- 2500 milliliters
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what are the 5 types of burn injuries
- -Thermal
- -inhalation
- -chemical
- -electrical
- -radiological
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what is a class 1 hemorrhage?
happens when less than 15% of blood is lost. (less than 750ml) may be a symptomatic or have mild tachycardia
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in step two of the CDC field triage decision guideline what would make someone get rushed to the trauma room.
- - all penetrating injuries
- -chest wall deformitiy
- -2 or more long bone fracture
- -a raped extremity
- - amputation of part
- -pelvic fractures
- -open skull fracture
- -paralysis.
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what should be done to treat a flail chest in the ribs
nothing because it can impeded a persons ability to breathe.
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what are secondary blast injuries
when the blast launches high velocity shrapnel into the patient causing blunt or penetrating trauma.
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in the CDC guidelines under step 4 what are considered the high risk patients?
- elderly, children
- burn patients, bleeding disorders patient that are more than 2 weeks preggo.
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What is an example of a type 1 pelvic fracture
fractures to the pubis, iliac wing, sacrum, coccyx or avulsion fractures.
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Why are alkaline burns worse than acidic burns.
Acid proteins are denatured and they get coagulated which prevent the acid from getting thru. strong bases get injured to liquefaction necrosis.
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what is oncotic pressure
is when proteins pull fluid into the intravascular space from the outside the blood vessels.
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what is the starlings law
when preload increases it stretches the heart. so then it increases the cardiac output. simply by increaseing preload
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what are the three stages of hemostasis?
the vascular phase- vasoconstriction
platelet aggregation-activated platelets make their way over to the messed up blood vessel
and coagulation-fibrin and other clotting factors make a stable clot.
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according to the CDC what do they consider a high risk motorcycle accident?
anything above 20mph
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what are three examples of obstructive shock?
- -Tension pnumothorax
- -massive pulmonary embolisim
- -pericardial tamponade
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in terms of a deceleration injury, what is shearing?
shearing is when after deceleration that the organs and blood vessels keep moving. causes organs to twist and come off of what was tethering them down.
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what 7 things will you find in a pulmonary contusion
- 1-respiratory distress
- 2-hemoptysis
- 3-chest pain from blunt trauma
- 4-cough
- 5-rales or rhonchi
- 6-hypoxia
- 7-high index based on MOI
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why the heart speed up when its loosing blood?
because its trying to increase cardiac output (hr x sv=co) by increasing the HR it will help circulate more blood.
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what is rhabdomolysis?
a harmful condition which damage muscles releases harmful products into the blood and can damage the kidneys.
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how can you tell someone has a cerebellar injury
having problems with motor function and control. any deficits will be noted on the opposite side of the body.
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what is a hemostatic agent
anything thing like a chemical or mineral that you can add to a wound to aide in clotting to slow the rate of bleeding.
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what 2 cranial nerves is responsible for the pupil reaction to light
optic and occulomotor
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what are the 6 major functions of the skin
- 1-protection
- 2- thermoregulation
- 3-sensation
- 4-control of evaporation
- 5-storage of lipids and water
- 6-absorption
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what is osmosis
the movement of a solvent (mainly water) thru a semipermeable membrane into a higher solute concentration.
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according to the CDC what is considered a fall that needs to go to a trauma center?
adult- more than 20 feet or 2 storys
children-more than 10 feet or 2-3 times the height of the child.
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