Patients with a GSC of less than ___ usually require intubation.
8
The "A" in ABCD stands for _______.
Airway maintenance with CERVICAL SPINE PROTECTION
00:54
01:13
You should assume that any patient in a multisystem trauma with an altered level of consciousness or blunt injur...
patients with a gsc of less than usually require intubation
the a in abcd stands for
you should assume that any patient in a multisy
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Patients with a GSC of less than ___ usually require intubation. - Answer 8
The "A" in ABCD stands for _______. - Answer Airway maintenance with CERVICAL
SPINE PROTECTION
You should assume that any patient in a multisystem trauma with an altered level of
consciousness or blunt injury above the clavicle has what type of injury? - Answer
Cervical spine injury
Flail chest is invariably accompanied by ______ which can interfere with blood
oxygenation. - Answer pulmonary contusion - do NOT over fluid resuscitate these
patients!
Hypotension is caused by _____ until proven otherwise. - Answer hypovolemia
When you don't have/can't get a blood pressure, what are three things to look for when
evaluating perfusion. - Answer 1. Level of consciousness (brain perfusion), 2. Skin color
(ashen face/grey extremities) 3. Pulse (bilateral femoral - thready/tachy)
Elderly patients have a limited ability to ______ to compensate for blood loss. - Answer
increase heart rate
Resuscitation fluids should be warmed 39 degrees Celsius (102.2 F). Can you use a
microwave to do this? - Answer YES - for CRYSTALLOID ONLY (but NOT for blood
products).
Urinary catheters are good for assessing renal perfusion and volume status. List 5 signs
of urethral injury that might prevent you from inserting one. - Answer Blood at urethral
meatus, perineal ecchymosis, blood in scrotum, high-riding/non-palpable prostate,
pelvic fracture
Which arm should you NOT put a pulse-ox on? - Answer The arm with a blood pressure
cuff on it
Name two anatomical things that can interfere with doing a FAST scan. - Answer
Obesity & intraluminal bowel gas
When should radiographs be obtained? - Answer During the SECONDARY survey.
How do you get an ample patient history? - Answer A=Allergies, M=Medications,
P=PMH/Pregnancy, L=Last meal, E=Events/Environment of injury
,Why might you want a Bair Hugger for a patient who smells of alcohol? - Answer
Vasodilation can lead to hypothermia
What things are you looking for when you do a DRE in a trauma? - Answer Blood, high-
riding prostate (in males), and sphincter tone
What should you do for every female patient? - Answer Pregnancy test (females of
childbearing age)
Adult patients should maintain UOP of at least ___ mL/kg/hr. Kids should have at least
___ mL/kg/hr. - Answer Adults 0.5 mL/kg/hr, Kids 1.0 ml/kg/hr
Preventing hypercarbia is critical in patients who have sustained a _____ injury. -
Answer head
What two places would you LOOK at a patient if you suspect hypoxemia? - Answer Lips
and fingernail beds
Patients may be abusive and belligerent because of _____, so don't just assume it's
due to drugs, alcohol, or the fact that they are just inherently a jerk. - Answer hypoxia
Can a patient breathe on their own after complete cervical cord transection? - Answer
Yes, if the phrenic nerves (C3-C5) are spared. This will result in "abdominal" breathing.
The intercostal muscles will be paralyzed though.
Can you use an OPA (Guedel) in a conscious patient? - Answer No, it could make them
vomit. An NPA (trumpet) would be okay.
Bougies are typically inserted blindly, how do you know you are in the trachea and not
the esophagus? - Answer You can feel the "clicks" as the distal tip rubs against the
cartilaginous tracheal rings, or it will deviate right or left when entering either bronchus
(usually at 50 cm).
What do you NOT want to hear if you ascultate a patient after placement of an ET tube?
- Answer Borborygmi - rumbling or gurgling noises suggesting esophageal insertion.
What is the RSI dose for etomidate? - Answer 0.3 mg/kg (usually 20 mg)
What is the RSI dose for sux? - Answer 1-2 mg/kg (usually 100 mg)
How does etomidate affect blood pressure? - Answer It doesn't - at least it SHOULDN'T
have any significant effect on BP. Ketamine will increase BP, and propofol and
thiopental will both drop BP.
A RSI dose of sux usually lasts about ___ minutes. - Answer 5
, What hypnotic/sedative/induction agent do you NOT want to use for a severely burned
patient? - Answer SUX - patients with severe burns, crush injuries, hyperkalemia, or
chronic paralytic/neuromuscular diseases should NOT get sux because of hyperkalemia
risk.
Oxygen should flow at 15L for needle cricothyroidotomy, and have a Y-connector for
insufflation if possible. What size needle do you use for adults? Kids? - Answer Adults
12-14 gauge, kids 16-18 gauge
Cricoid cartilage is the only circumferential support for the upper trachea in kids,
therefore surgical cricothyroidotomy is not recommended in kids under the age of ___. -
Answer 12
In a "normal" patient without significant chest wall injury or lung disease, needle
cricothyroidotomy can provide adequate oxygenation for approximately ____ minutes. -
Answer 30-45
For a patient with difficulty breathing, what things might you try before you provide a
surgical airway? - Answer Chin-lift, jaw-thrust (NOT head-tilt while maintaining c-spine
precautions), OPA (guedel), NPA (trumpet), LMA, Combitube, ET tube +/- bougie
How do you know if an OPA/Guedel is the correct size for the patient? - Answer A
correctly sized OPA will extend from the corner of the patient's mouth to the external
auditory canal.
What should do with the balloon on an ET tube/LMA/foley before you insert it? - Answer
Inflate it to make sure it doesn't leak - then deflate and insert.
What size LMA do you use for kid, woman/small man, large woman/man? - Answer Kid:
3, Woman/small man: 4, Large woman/man: 5 (C3,4,5 keep the diaphragm alive)
The proper size ET tube for an infant is ______. - Answer The same size as the infant's
nostril or little finger. (Usually size 3 for neonates, 3.5 for infants)
What size cuffed endotracheal tube do you use for an emergency cricothyroidotomy? -
Answer 5 or 6
Use size 3 ET tubes for neonates, 3.5 for infants 0-6 months, and size 4 for infants 6-12
months. How do you calculate what size ET tube to use for toddlers and kids? - Answer
Age/4 + 4 mm = internal diameter
Shock is defined as an abnormality of the circulatory system that results in inadequate
organ perfusion and tissue oxygenation. What are the 4 different types? - Answer
Neurogenic, cardiogenic, hypovolemic, septic
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