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Answered PHTLS Questions and answers. Questions Bank. 100% Proven pass rate.

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When the application of kinetic energy to the body from either a blunt or penetrating mechanism displaces tissue, this is known as - ✔✔CAVITATION Which of the following is an example of the ter... tiary phase blast injury? - ✔✔CRUSHING INJURY DUE TO STRUCTURAL COLLAPSE. The most common threat to life among trauma patients is? - ✔✔INTERNAL HEMORRHAGE Your patient is an injured construction worker bleeding profusely from a large laceration to the left thigh. He is confused and has pale, moist skin. Direct pressure applied to the wound by a first responder has failed to control the bleeding. The next step in controlling bleeding is to apply: - ✔✔A TOURNIQUET TO THE LACERATION. Hypotension due to spinal cord trauma occurs due to interruption of the _______________nervous system pathway. - ✔✔SYMPATHETIC The most common fractured ribs are ribs: - ✔✔4 THROUGH 8. A hemothorax is differentiated from a tension pneumothorax by: - ✔✔DULL PERCUSSION ON THE AFFECTED SIDE. Which of the following mechanisms is most likely to result in cardiac tamponade? - ✔✔A PATIENT IS STRUCK IN THE LEFT ANTERIOR CHEST BY A NAIL EJECTED FROM A NAIL GUN. Management of flail chest includes: - ✔✔PAIN MANAGEMENT VENTILATORY SUPPORT 100%O2 Which of the following types of traumatic brain injury is most likely to be associated with hemorrhage from the middle meningeal artery? - ✔✔EPIDURAL HEMATOMA Which of the following groups of findings represents Cushing's phenomenon? - ✔✔BRADYCARDIA ABNORMAL RESPIRATORY PATTERN ELEVATED BLOOD PRESSURE Your patient is a 32 year old female who was thrown from a horse and struck her head on the ground. She was not wearing a helmet. She does not respond verbally or open her eyes to painful stimuli, but responds to painful stimuli with decerebrate posturing. Her right pupil is dilated and does not react to light. Her respirations are 6 per minute and irregular, pulse 56, blood pressure 188/98. You should ventilate the patient at a rate of? - ✔✔20 BPM. A burn with reddened, glistening base that may have blisters is most characteristic of a - ✔✔SECOND degree burn. A chemical solution with a pH of 4.0 is considered an ACID and causes damage to the tissues via - ✔✔COAGULATION NECROSIS. An electrical burn caused by superheated air near the source of electricity is an - ✔✔ARC burn. Your patient is an 82 year old female who was an unrestrained front seat passenger in a motor vehicle collision. Which of the following is the most reliable indication of shock in this patient? - ✔✔LEVEL OF CONSCIOUSNESS. Which of the following findings is not expected in assessment of a pregnant patient? - ✔✔A DECREASED BLOOD PRESSURE IN THE THIRD TRIMESTER. Which of the following is contraindicated in the management of a pregnant trauma patient in the third trimester? - ✔✔SUPINE POSITION. During the assessment of the trauma patient, auscultation of the lung sounds is first performed during: - ✔✔THE PRIMARY SURVEY. Which of the following is indicated for the prehospital management of a circumferential second degree burn extending from the wrist to the elbow in a 70 Kg patient? - ✔✔A DRY STERILE DRESSING ANALGESIA The preferred fluid for resuscitation of the patient with significant burns is: - ✔✔LACTATED RINGER'S SOLUTION. Which of the following is the most common cause of spinal injuries? - ✔✔MOTOR VEHICLE COLLISIONS. Hypotension in hemothorax is associated with: - ✔✔THE ABILITY OF EACH SIDE OF THE THORAX TO HOLD UP TO 3 LITERS OF BLOOD. Cardiac tamponade is suspected with the findings of muffled heart sounds___________, and___________ known as___________. - ✔✔JUGULAR VEIN DISTENTION, and HYPOTENSION, known as BECK'S TRIAD. When administering isotonic crystalloid solution, about ___________ will remain in the vascular system after 1 hour. - ✔✔ONE-THIRD PASG is contraindicated in patients with - ✔✔CHEST TRAUMA. The greatest threat to life from injury to hollow abdominal organ is - ✔✔PERITONITIS. IV fluids administered to patients in shock should be _______ in order to ______________ ______________. - ✔✔WARM, PREVENT HYPOTHERMIA. During pregnancy, signs and symptoms of shock may appear _______ due to an _________ in maternal blood volume. - ✔✔LATER, INCREASE A fractured femur can result in___________________mL of hemorrhage. - ✔✔1000 TO 2000 A male patient suffered a stab wound to his left flank. He is found to be in stage III shock. During the 25 minute transport to the trauma center, intravenous fluids should be administered at a rate sufficient to maintain a: - ✔✔SYSTOLIC BP OF 80 TO 90. The most common type of shock in trauma patients is - ✔✔HYPOVOLEMIC. What percentage of blood volume loss in an adult patient is associated with findings of tachycardia (>120/beats/minute), tachypnea (30-40 Breaths/min), and hypotension (systolic BP <90mmHg)? - ✔✔30 TO 40 Minute volume of ventilation is best represented as - ✔✔TIDAL VOLUME x ventilatory rate Which injury is most likely to be sustained by the driver in a lateral impact collision to the left side of the vehicle with no side impact airbags (assuming the driver sits on the left)? - ✔✔FRACTURED LEFT CLAVICLE. Give me the general ideas of trauma criteria? - ✔✔Any patient that has a compromise to Airway, Breathing, Circulation and Deficit. Any Patient that is Altered or What three areas of a penetrating injury would be trauma criteria? - ✔✔Thoracic cavity and up. Cranial, between Thoracic and midclavicular line, neck. For trauma criteria what must the BP be below in an adult? Child? - ✔✔Adult >90 / Child >70 (Systolic) What is the trauma criteria for blunt head injury? - ✔✔ALOC, GCS less than 14, except pt. 1 y/o, seizures, unequal pupils, or focal neurological deficit. For trauma criteria what should also be present in a Cardiac arrest? - ✔✔Penetrating torso trauma. What is the most common threat to life? - ✔✔Inadequate tissue perfusion When would a shotgun injury meet trauma criteria? - ✔✔wounds to the trunk. A fall from 15 feet is trauma criteria so what type of injuries may also be sustained that APPLY to trauma criteria? - ✔✔Blunt chest injury- flail chest, abdominal tenderness, spinal fx w/ extremity weakness and sensory deficit. If the driver of a vehicle is found in the passenger space can't feel his toes and has no radial pulse in left extremity is this patient trauma criteria? How many categories does this patient fall into? - ✔✔yes/3. Name some guidelines for trauma patients? transport is advised. - ✔✔Surviving patients in MVC where fatalities and complaint of injury occur- Pedestrian vs Auto.- ejection from vehicle, extrication, young and old patients w/ medical history What are indications of use of a PASG? - ✔✔suspected pelvic fx- profound hypotension (sys <50 to 60)- retroperitoneal hemorrhage. What are CONTRAindications of use of a PASG? - ✔✔Penetrating thoracic trauma- splinting of lower extremity fx.- Eviceration of abdominal organs, impaled objects in abdomen- Pregnancy- traumatic cardiac arrest. When using a PASG what syndrome will occur if you decide to splint a lower extremity? - ✔✔compartment syndrome. What is a Colles fracture? - ✔✔bilateral fracture of wrist- fall w/ outstretched hands What is Don Juan syndrome? - ✔✔bilateral heel/ankles/ tib. Fib./Femur/pelvic fall on feet. What are early signs of increase intracranial pressure? - ✔✔headache and vomiting At what height are falls the most significant? - ✔✔15 feet In trauma what's the difference between hollow and solid organs? - ✔✔hollow causes peritonitis - solid organs bleed. What injuries would occur at the time of impact? - ✔✔crush or compression injuries. What is the first action with a severe burn patient? - ✔✔stop the burning. When there is a decrease in intravenous pressure what are common S/S? - ✔✔JVD When the acute physiologic and structural change occurs in a patient's body when an external source of energy dissipates faster than the bodies ability to sustain and dissipate it? - ✔✔trauma Kehr's sign is associated with what organ? - ✔✔spleen When giving analgesic therapy what is the goal in prehospital care? - ✔✔diminish pain to a tolerable level (control not abuse) What medication may cause a delay in healing? - ✔✔corticosteroid What is the best treatment for commotio cortis? - ✔✔CPR and AED What kind of hypovolemic shock comes from external bleeding? - ✔✔exogenous hypovolemic shock What is the first action for external bleeding? - ✔✔direct pressure and elevation. Compartment syndrome can occur in what type of injuries? - ✔✔Closed Injuries What is the difference between retrograde and antegrade amnesia? - ✔✔retro- is cant remember before- ante- cant remember after. When a patient has chemical burns to the eyes what is the treatment? - ✔✔Constant flushing with IV fluid and continuous irrigation. What are the most critical burn patients? - ✔✔Patients with a significant MEDICAL ILLNESS In a femur fracture where is it most likely to break? - ✔✔Femoral Neck What is most important in treating a patient in shock? - ✔✔Recognize S/S of shock at earliest phase and immediate treatment before damage occurs. The process in which the muscles are crushed past repair - ✔✔tissue necrosis develops and causes release of harmful products?, Rhabdomylosis Also known as Periumbilical ecchymosis? - ✔✔Cullens Sign Class I Hemorrhage - ✔✔up to 15% blood loss, minimal tachicardia, no measurable changes in BP or pulse pressure, or RR Class II Hemorrhage - ✔✔15-30% Most adults are capable of compensating, incresed RR, Tachycardia, narrowed pulse pressure, Class III Hemorrhage - ✔✔30-40% no longer able to compensate for volume loss, hypotension occurs, HR >120 BPM, RR 30-40, severe anxiety or confusion Class IV Hemorrhage - ✔✔more than 40% loss, severe shock, HR >140 BPM, RR >35, confusion lethargy, decresed systolic blood pressure, typically in the range of 60 mm Hg. Ratio for loss blood replacement - ✔✔3 litres of electrolyte solution replacement for each liter of blood lost Distributive Shock - ✔✔uncontrolled vasodialation causes reduced resistance causing a decrease in the diastolic blood pressure Distributive Shock - ✔✔Decrease in preload+decrease in cardiac output Psychogenic Shock - ✔✔Vasovagal - stimulation of the tenth cranial nerve (vagus nerve) produces bradycardia. May also cause vasodilation. Typically occurs in a very brief period. Septic Shock - ✔✔Cytokines released because of an infection can cause damage to blood vessel walls and cause vasodilation Anaphylactic Shock - ✔✔Respiratory distress, airway obstruction and vasodilation Potential Blood loss from a single femoral fracture - ✔✔30-40% Amount of blood loss that can happen before signs of compensatory mechanisms fail and BP become <90 mmHq - ✔✔Greater than 30% Hypertension medications that may prevent compensatory tachycardia to maintain BP - ✔✔Beta Adrenergic blocking agents and calcium channel blockers Managing Volume Resuscitation Uncontrolled hemorrhage-suspected chest, abdomen, retroperitonium - ✔✔Maintain a systolic bp 80-90 or MAP 60-65 Managing Volume Resuscitation CNS injuries or TBI - ✔✔maintaining the systolic BP (SBP) above 90 or MAP 85-90 Managing Volume Resuscitation Controlled Hemorrhage large scalp or extremity controlled with a tourniquet, PT falls into class II,III,IV shock - ✔✔rapid bolus of 1-2 litres Three responses of initial fluid bolus Rapid Response - ✔✔vital signs return indicating that PT lost less than 20% PT is best managed at SBP between 80-90, IV fluid should be titrated Three responses of initial fluid bolus Transient Response - ✔✔Vital signs improve (pulse slows, BP increases) however PT shows deterioration. PT has typically lost 20-40% of blood volume Three responses of initial fluid bolus Minimal or no response - ✔✔No change in PT after 1-2 liter Bolus Leading cause of TBI - ✔✔MVC Three seperate membranes that surround the brain - ✔✔meninges Outer most meninges - ✔✔Dura mater- composed of tough fibrous tissue The inner most meninges that is directly in contact with the brain - ✔✔Pia Mater- Vessels that lay on top of the Pia Mater - ✔✔Cerebral Blood Vessels The meninge that lays in the middle between the dura and pia matter - ✔✔Arachnoid membrane-loosely covers the brain and its blood vessels MAP-Mean Arterial Pressure - ✔✔The average pressure for the entire cardiac cycle MAP=Diastolic Pressure + 1/3 of the Pulse Pressure PP- Pulse Pressure - ✔✔The difference between the systolic and diastolic PP= Systolic (SBP) - Distolic (DBP) CPP- Cerebral Perfusion Pressure - ✔✔The amount of pressure it takes to push blood through the cerebral circulation. CPP=Mean Arterial pressure (MAP) - Intercranial pressure (ICP) CPP- is normally below ? mmHg - ✔✔CPP is normally 15 mmHg or below Autoregulation - ✔✔The brain changes the cerebral blood vessel resistance (CVR) to compensate for changes in the cerebral pulse pressure (CPP) For neurological injured PT's the systolic blood pressure is best if maintained at or above - ✔✔90 mmHg Hyperventilation and TBI - ✔✔Hyperventilation can reduced CBF by causing vasoconstriction due to hypocapnia, PaCO2 >35 increases risk of cerebral ischemia Primary Brain injury - ✔✔The direct trauma or mechanical injury, includes contusions, hemorrhages and lacerations Secondary brain injury - ✔✔pathologic mechanisms that related to intercranial mass effect, elevated ICP, and herniation, hemotoma, hypoxia and hypotension Mass effect - ✔✔The effect of a growing mass or tumor Uncal Herniation - ✔✔temporal lobe epidural hematoma forces pressure on the medial portion of the temporal lobe (uncus) which in turn puts pressure on the 3rd cranial nerve causing dilation or blown pupil on the side of the herniation. May also cause loss of function of the motor track on the same side. Final stage of uncal herniation - ✔✔The RAS is affected patient lapses into coma decorticate posturing - ✔✔flexion of the upper extremities with rigidity and extension of the lower extremities. decerebrate posturing - ✔✔all extrem become flaccid and motor activity is absent Cheyne strokes ventilation - ✔✔repeating cycle of slow hallow breaths that become deeper and more rapid and then return to slow Central neurogenic hyperventilation - ✔✔rapid deep breaths Ataxic breathing - ✔✔erratic ventilatory efforts that lack any discernible pattern Cushings phenomenon - ✔✔greatly increased arterial blood pressure and the resultant bradycardia (increase BP + decreased HR) may occur with severely increasing ICP Hypercapnia (high CO2) - ✔✔causes vasodilation Hypocapnia (low CO2) - ✔✔causes vasoconstriction When people have 20 mmHg CO2 in their blood (half of the official norm), - ✔✔they have about 40% less blood supply to the brain in comparison with normal conditions Indication of TBI Hemiparesis - ✔✔One sided weakness Indication of TBI Hemiplegia - ✔✔One sided paralysis Indications for a nose fracture - ✔✔ecchymosis, edema, nasal deformity, swelling, epistaxis Epidural Hematoma 1-brief Loss of consciousness 2-Lucid Interval 3-Rapid decline in level of consciousness - ✔✔The period of time after a brief loss of consciousness where the PT may be oriented, lethargic or confused followed by a rapid decline of consciousness Subdural Hematoma - ✔✔Account for 30% of TBI-Generally results from venous blood from bridging viens that are torn during a violent blow to the head. Epidural Hematoma - ✔✔Account for 2% of TBI-Arterial blood starts to dissect or peal the dura off of the inner table of the skull creating an epidural space filled with blood Epidural Hematoma Signs - ✔✔Altered LOC, dilated and sluggish non reactive pupil on the side of herniation, hemiparesis or hemiplegia on opposite side of injury. Subdural Hematoma - ✔✔Can be chronic or acute. Pt on coumadin are at high risk of un identified subdural hematomas that may be chronic. Often may be confused with stroke, infection or general decline of PT Cerebral Contusions - ✔✔actual bleeding into the substance of the brain, CC's often take 12-24 hrs to appear on CT scans, only indicator is a depressed GCS of 9-13 Subarachnoid Hemorrhage - ✔✔rarely causes mass effect and does not require surgery, it does increase the risk of cerebral contusion by 63-73% Normal ventilatory rates Adults= - ✔✔10 BPM Normal ventilatory rates Children= - ✔✔20 BPM Normal ventilatory rates Infants= - ✔✔25BPM Warning signs of possible ICP - ✔✔Decline in GCS sluggish or non reactive pupils Hemiplegia or hemiparesis Cushings phenomenon Osmotherapy - ✔✔the use of osmotically active agents that may assist in the treatment of intracranial hypertension` Number of cervical vertebrae - ✔✔7 Number of thoracic vertebrae - ✔✔12 Number of lumbar vertebrae - ✔✔5 Number of coccygeal vertebrae - ✔✔4 Number of pounds the human head averages - ✔✔16-22 pounds Space between the spinal cord and the spinal canal wall - ✔✔3mm Name of the 1st cervical vertebrae - ✔✔Atlas Name of the 2nd cervical vertebrae - ✔✔Axis Function of the ascending nervee tracts - ✔✔Sensory impulses from body parts through the cord up to the brain Function of the descending nerve tracts - ✔✔impulses from the brain through the cord down to the body Dorsal root= - ✔✔sensory Ventral root= - ✔✔motor Dermatome - ✔✔The sensory area on the body for which a nerve root is responsible The phrenic nerve originates from - ✔✔the cervical vertebrae c2-c5 Skeletal Injuries Compression - ✔✔Compression fractures that produce wedge compression or total flattening of the body of the vertebra Skeletal Injuries Fractures - ✔✔Produce small fragments of bone that may lie in the spinal canal near the cord Skeletal Injuries Sublaxation - ✔✔a partial dislocation of the vertebra from its normal alignment in the spinal column Skeletal Injuries Overstretching - ✔✔Tearing of the ligaments and muscles producing instability between the vertebrae Skeletal Injuries Percentage of falls from a height greater than 15 feet involve an associated lumbar spine fracture - ✔✔20% Cause and Symptoms Anterior Cord syndrome - ✔✔Results from bony fragments or pressure on spinal arteries Symptoms-loss of motor function and pain, temperature and light touch PT's will have some light touch sensations such as vibration. Cause and Symptoms Central cord syndrome - ✔✔usually occurs with hyperextension Symptoms include weakness or paresthesia (tickling, tingling, burning, pricking, or numbness) in the upper extremities but normal strength in the lower extremities Cause and Symptoms Brown Sequard syndrome - ✔✔Caused by penetrating injury and involves hemi-transection of the cord. Symptoms include complete cord damage and loss of function of the affected side with loss of pain, temp and sensation on the opposite side of the injury Conditions that should mandate spinal immobilization - ✔✔Altered LOC Spinal Pain or tenderness Neurologic deficit or complaint Anatomic deformity of the spine Pulmonary Volume Terminology Dead Space - ✔✔Amount of air brought into the lungs that does not have the opportunity to exchange oxygen and carbon dioxide Pulmonary Volume Terminology Minute Volume (Ve) - ✔✔Total volume of air moved into and out of during a 1 minute interval. Pulmonary Volume Terminology Tidal Volume (Vo) - ✔✔Amount of air that is inhaled then exhaled druing a normal breath (.4-.5 litres) Pulmonary Volume Terminology Total Lung Capacity (TLC) - ✔✔Total volume the lungs contain when maximally inflated. This volume declines with age from 6 L. in young adults to 4 L. in elderly. [Show More]

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