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PHTLS
PHTLS Study Stuff
| Question | Answer |
|---|---|
| How many people die from trauma annually? | Over 5 million |
| What is the leading cause of trauma deaths? | MVA |
| Where do over 90% of trauma deaths occur? | Low-Middle income countries. |
| What is the leading cause of death in people aged 1-44? | Trauma |
| What are the goals of PHTLS? | Reduce morbidity and mortality from trauma, and provide appropriate care to the patient in the field. |
| What is the PHTLS philosophy? | Deliver the patient to the right facility, utilizing the right mode of transportation, in the right amount of time, as safely as possible. |
| What are the components of scene assessment? | Safety, Pre arrival information, arrival on scene, MOI, and Patients. |
| What is paramount for scene assessment? | Personal and Personnel safety. |
| What is the global view? | What you get before you get out of your vehicle. |
| What is the goal of the Primary Survey? | To immediately identify life threatening situations and manage them as they are identified. |
| What are the components of the primary survey? | Airway, Breathing, Circulation, Disability, Exposure |
| When does assessment of the incident begin? | Before arriving at the patients side. |
| The findings of the scene assessment and primary survey help to determine what? | If the patient is sick, not yet sick, or no sick, |
| When should the secondary survey be completed? | Only if time and situation permit. |
| What are the components of the secondary survey? | Vital Signs, History, Physical Examination, Treatment, Level of Care, Transportation, and Communication. |
| What are the components of a radio report? | Timely, Scene Description, Number of Patients, Current Patient Status, Treatment Provided, ETA |
| What is a tracheal consideration with pediatric patients in regards to ETT intubation? | Potential for right main-stem intubation. |
| What is the most common cause of airway obstruction in the trauma patient? | The tongue. |
| When are basic maneuvers applied in regards to trauma airway management? | First |
| When are advanced airway maneuvers performed for trauma patients? | After basic, only if needed. |
| What is the goal of managing a patients airway? | Maintain an open and patent airway that allows for adequate breathing, ventilation, ad oxygenation. |
| What does airway management entail? | Anticipating difficulties and planning for alternate methods of airway control. |
| What is ALWAYS the FIRST airway maneuver for the trauma patient? | Trauma Jaw Thrust/Chin Lift |
| What should be considered SECOND for maintaining a patent airway in the trauma patient? | OPA or NPA |
| What adjunct should be considered THIRD for airway management in the trauma patient? | Supra-Glottic Airways |
| When should glottic airways be considered? | After jaw thrusts, OPA/NPA, and Supra Glottic airways have failed. |
| What are some assessment criteria for Endotracheal Intubation? | Decreased LOC (GCS<8), Inability to maintain patent airway, Upper Airway Burns, Signs of pending airway obstructions. |
| Which type of airway management should be considered last? | Surgical. |
| What types of methods should be used to verify tube placement? | One physiological and one mechanical method. |
| When the patients breathing draws your attention you should...? | Assume there is a problem until proven otherwise. |
| What are some s/s you are looking for in a trauma patients breathing assessment? | Increased respiratory effort, visible trauma, paradoxical chest wall movement, sucking chest wound. |
| What are some s/s you are feeling for in a trauma patients breathing assessment? | Boney crepitus, subcutaneous emphysema. |
| What is the BIGGEST difference between a simple and a tension pneumothorax? | A TENSION has hemodynamic compromise. |
| Which ribs are most at risk for rib fracture? | Ribs 4-8 laterally |
| What is the most common cause of hemothorax? | Fractures to rubs 4-8 |
| What are common complaints of rib fractures? | Pain and SOB |
| Under what circumstances should you withhold oxygen from a patient? | Never withhold oxygen from a patient in respiratory distress. |
| When should you assist ventilations? | When the RR is above 28 or less than 10. |
| What is the ventilatory rate for adults? | 10-12 bpm for 500-800cc |
| What is the ventilatory rate for Children? | 16-20 bpm for 100-500 cc or good chest rise |
| What is the ventilatory rate for infants? | 25bpm for 6-8ml/kg |
| What end tidal CO2 reading should you maintain? | 35-45 mm Hg |
| Where should a needle decompression be placed? | 2d intercostal space mid clavicular line, over the rib. |
| What is shock? | A result of inadequate energy production to sustain life. |
| What are the brain, heart, and lungs tolerance to hypoxia? | 4-6 minutes. |
| What are the kidneys, liver, and GI tracts tolerance to hypoxia? | 45-90 minutes. |
| What are the muscle, bone, and skins tolerance to hypoxia? | 4-6 hours. |
| What is the most common cause of shock in the trauma patient? | Hypovolemia due to hemorrhage until proven otherwise. |
| What is the most common cause of neurogenic shock in the trauma patient? | Spinal Cord injury. |
| What does adequate perfusion of the body tissues require? | An effective pump, intact blood vessels, adequate blood volume, vascular resistance. |
| What is cardiac output? | Stroke Volume x Heart Rate |
| What is blood pressure? | Cardiac Output x Systemic Vascular Resistance. |
| Vasocontriction leads to which phase of shock? | The ischemic phase. |
| What causes an altered LOC in the shock patient? | Decreased cerebral perfusion. |
| What may be the earliest sign of shock? | Increasing Respiratory Rate caused by hypoxia and acidosis stimulating the respiratory centers of the brain. |
| How much blood loss is required before a drop in BP occurs? | 30.00% |
| In shock without obvious cause what should you assume? | The patient is bleeding somewhere, internal hemorrhage, fracture. |
| Where is a significant container of blood volumes lost to hemorrhage? | The abdomen. |
| What is the mortality rate of aortic rupture in the prehospital setting? | 80-85% |
| How much blood can each hemithorax hold? | 3000-4000ml of blood |
| How much blood loss can occur from a single rib fracture? | 125ml |
| How much blood loss can occur from a fractured radius or ulnar? | 250-moo ml |
| How much blood loss can occur from a fractured humerus? | 750ml |
| How much blood loss can occur from a fractured tibia or fibula? | 500-1000ml |
| How much blood loss can occur from a fractured femur? | 1000-2000ml |
| How much blood loss can occur from a fractured pelvis? | Massive. |
| What is the most common thoracic injury? | Rib fractures. |
| What four questions guide management of shock? | What is the cause of this shock? What is the care for this type of shock? What can and should be done between now and the time the patient reaches definitive care? Were is the best place for the patient to get definitive care? |
| What does proper management of shock achieve? | Improves the oxygenation of RBCs and improves the delivery of RBCs to the tissue. |
| How should the shock patient be positioned? | Supine, as the trendelenburg position is no longer recommended. |
| What temperature should the patient compartment be maintained at? | 85F |
| What are the three responses to fluid therapy? | Rapid response, Transient Response, Minimal or No Response. |
| What is the frontal lobe responsible for? | Foresight, personality, judgement |
| What is the Parietal lobe responsible for? | Sensation from the body |
| What is the Temporal lobe responsible for? | Hearing and speech |
| What is the Occipital lobe responsible for? | Vision |
| What is primary damage? | Damage that occurs at the moment of impact. |
| What is secondary damage? | Damage that occurs subsequent to the initial impact. |
| What are some systemic causes of secondary brain injury? | Hypoxia,CO2 abnormalities, Anemia, Hypotension, CBG abnormalities. |
| What are some intrinsic causes of secondary brain injury? | Seizures, Edema, Hematomas, increased ICP |
| What is a typical ICP? | 10-15 mmHg |
| What does hypercarbia cause? | Cerebral vasodilation |
| Onto which brain structure does pressure produce vomiting? | The hypothalamus |
| What are the six components of a complete prehospital neurological exam? | Mental Status, Cranial Nerves, Motor Responses, Sensory Response, Coordination, Reflexes |
| When do you score the GCS? | AFTER the correctable causes of ALOC have been addressed. |
| What is normal pupil size? | 3-5 mm. Difference greater than 1mm is abnormal. |
| What does paralysis of lateral gaze indicate? | Possible rising ICP |
| What does paralysis of upward gaze indicate? | Possible fracture of orbital floor. |
| Most of the bad TBI stuff presents in which ways? | Headache, Vomiting, Altered Mentation, Neurological Deficits |
| What is the earliest and best indicator of a patients ICP? | A change in LOC |
| What are warning signs of possible increasing ICP and impending herniation? | GCS drop of 2 or more, development of sluggish or no reactive pupils, development of hemiplegia or hemiparesis, Cushing's phenomenon |
| What is the ventilatory rate for Adults with suspected intercranial herniation? | 20 bpm |
| What is the ventilatory rate for Children with suspected intercranial herniation? | 25 bpm |
| What is the ventilatory rate for Infants with suspected intercranial herniation? | 30 bpm |
| How much blood must be lost before children show signs of hypotension? | 30.00% |
| What is a fourth degree burn? | A burn to the bone. |
| What is special in the fluid therapy of a child in burn management? | They should receive 5% dextrose in LR solution. |
Created by:
PMED