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Per Thurston County protocol, if pt exhibits posturing, and/or provider-witnessed dilation of one pupil and is unconscious, you should....
ventilate with BVM at 24 breaths per minute
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Per Thurston County protocol, if pt has an impaled object to the chest, you should...
stabilize impaled object(s) with bulky dressing and transport with object in place
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Per Thurston County protocol, general pt care procedure for an open chest wound is to...
apply occlusive dressing and secure on three sides. if pt develops increased respiratory difficulty or tension pnuemothorax, remove dressing and roll onto affected side.
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Per Thurston County protocol, rapid extrication is indicated with spinal trauma when...
- the scene is unsafe
- critical injuries are affecting airway, breathing, circulation
- pt is blocking access to a pt with critical injuries affecting airway, breathing, or circulation
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Per Thurston County protocol, an ALS upgrade for head and neck trauma is required when...
- the pt is repetitive (perseverative)
- severe or multiple episodes of vomiting
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Per Thurston County protocol, indications and contraindications for helmet removal are...
- indications: pt wearing helmet who requires airway preservation, stabilization of head to backboard, in line stabilization for transfer
- contraindications: do not remove football helmets unless airway is compromised. if you must, ensure shoulder pads are removed.
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MOIs with high index of suspicion
- MVAs
- ped vs vehicle
- falls
- blunt trauma
- penetrating trauma to head, neck, torso
- hanging
- unconscious trauma victims
- ETOH involved
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Signs and symptoms of Spine Injury
- normal heart rate and low BP
- tenderness in area of injury
- pain with movement
- pain independent of movement/palpation
- obvious deformity of spine upon palpation
- associated soft tissue injuries
- numbness, weakness, or tingling in extremities
- loss of sensation or paralysis below suspected lvl of injury and/or upper or lower extremities
- incontinence
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What does DCAP-BTLS stand for?
- Deformity
- contusion
- abrasion
- punctures
- penetrations
- paradoxical movement
- burns
- tenderness
- lacerations
- swelling
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What are the layers of the meninges?
- Pia matter
- Arachnoid
- Dura matter
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What is Cushing's reflex?
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What is Cushing's Triad?
- Hypertension
- Bradycardia
- Irregular respirations
All these things are the body's response to a build up of ICP
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What is decorticate posturing?
person is stiff with bent arms, clenched fists, and legs held out straight; indicates severe damage to the brain
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What is decerebrate posturing?
the head is arched back, the arms are extended by the sides, and the legs are extended, allover rigidity, and clenched teeth
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What are the three main open or closed insults to the brain?
- concussion
- contusion
- laceration
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What are the three main insults to the meninges?
subderal, epideral, or subarachnoid hematomas
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What is a coup contracoup injury?
a brain injury that occurs both at the site of the trauma and the opposite side of the brain
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Signs and symptoms of a skull injury
- MOI
- contusions, lacerations, hematomas to scalp
- deformity to skull
- blood/CSF leakage from ears or nose
- "raccoon eyes"
- battle signs
- unequal pupils
- seizure activity
- soft area or depression upon palpation
- altered or decreasing mental status
- irregular respiratory pattern
- nausea and/or vomiting
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When should you remove an impaled object?
- when it is through the cheek
- anything that gets in the way on compressions
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Define the Glasgow Coma Scale.
a test which scores the severity of a patient's injury (and prognosis) using the result of three tests: eye opening, verbal score, and motor response. best score of 15, worst score of 3
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Patients with thoracic trauma die from...
- conditions which interrupt or obstruct proper ventilation of the alveoli
- conditions which interrupt or obstruct proper lvls of circulation and result in hypoperfusion
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Define a flail chest.
Two or more ribs fracture in two or more places OR two or more fractured ribs with fractured sternum
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Signs and symptoms of flail chest
- decreased ventilation
- paradoxical chest wall movement
- pain
- pulmonary contussion
- loose, moveable segment and crepitus upon palpation
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When talking about chest trauma, changes in diffusion can happen from...
- pulmonary contusion
- pulmonary edema
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When talking about chest trauma, changes in circulation can happen from...
- massive hemothorax
- cardiac temponade
- myocardial contusion
- tension pneumothorax
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Define pnuemothorax.
a collection of air or gas in the chest or pleural space that causes part or all of a lung to collapse
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What are the key warning signs of pnuemothorax?
- increased dyspnea despite oxygenation
- increasing hypotension
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Define a hemothorax.
Blood in the pleural space
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What are the causes of an aortic tear?
- frontal impact deceleration
- lateral impact acceleration
- fall deceleration
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Define pericardial tamponande.
pressure on the heart that occurs when blood or fluid builds up in the space between the heart muscle (myocardium) and the outer covering sac of the heart (pericardium)
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What steps should the EMT take when dealing with eviscerations?
- do not try to place organs back into abdomen
- cover with 4-sided occlusive dressing if possible
- protect against heat loss
- rapid transport
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When should you suspect internal hemorrhage with abdominal trauma?
when pt is showing signs and symptoms of shock that are not explained by any injury
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Define a subdural hematoma.
blood gathering between the dural and arachnoid matter.
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Define an epidural hematoma.
blood gathering between the dura mater and the skull
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