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PHTLS & exam prep with complete
solution passed 2023
what are newton's 1st & second laws? - correct answer 1: a body at rest will remain at rest, and a body in motion will remain in motion until acted upon by an outside force 2: force = mass x accelleration what are the rule of 9's? - correct answer ADULT 9% = entire head 9% = entire arm 9% =chest 9% =abdomen 18% = entire back 18% = entire leg 1% perineum CHILD 18% = entire head 9% =entire arm 9% = chest 9% = abdomen 18% = entire back 14% = entire leg 1% = perineum
what are the signs/symptoms of spinal injury? - correct answer neurologic function above the injury is intact and function below the injury is absent or markedly diminished. Specific manifestations will depend on the exact level of injury. what are the (5) major areas of blood loss? - correct answer - external
- chest
- abdomen
- pelvis
- long bones what are the (3) types of blast injuries? - correct answer Primary injuries are caused by the effect of transmitted blast waves on gas-containing structures; secondary injuries, by the impact of airborne debris; tertiary injury, by the transposition of the entire body because of blast wind or structural collapse; and quaternary injuries, by all other forces what 3 collisions are involved with an MVA? - correct answer 1. vehicle collides with an object
- unrestrained occupant collides with inside of car
- internal organs collide with one another or with the wall of the cavity that contains them what is o'donohue's triad? - correct answer adult pedestrian vs car accident
- adults tend to protect themselves by turning away 1 - bumper vs lower legs; tib/fib#, knee tear 2 - falls towards bonnet; intra-abdominal/thoracic injury, #femur/pelvis/thorax/spine. 3 - strikes ground; deceleration/compression forces, head injuries what is waddell's triad? - correct answer child vs car
- children tend to face the oncoming vehicle 1 - bumper vs fermur/pelvis 2 - bonet vs thorax; head/neck flexes forward; head/face/neck may collide with bonnet.
- face, hands, perineum, feet, genitalia
- circumferential burns? define shock - correct answer a life-threatening medical condition of low blood perfusion to tissues resulting in cellular injury and inadequate tissue function. what is the process involved in shock? - correct answer 1. hypoperfusion
- cellular hypoxia
- anaerobic metabolism
- cell death
- organ failure
- patient death what processes are involved with anaerobic metabolism that contribute to shock? - correct answer - anaerobic metabolism is caused by ischemia to the tissues.
- produces lactic acid
- increases metabolic acidosis
- excess hydrogen ions in the blood causes a shift of hydrogen ions into the cells to balance the gradient. causing potassium to move out. increasing hyperkalemia and hyponatremia causing cells to swell, increasing hypovolemia. what processes are involved with cell death that contributes to shock? - correct answer cells are destroyed by the acidic environment which disturbs the enzyme systems releasing lysozymes which autodigest the cells, releasing potassium and furthering tissue damage what is the process involved in hypovolaemic shock? - correct answer haemorrhage/dehydration causes lack of fluid to tissues
- burns, diarrhoea/vomiting, internal 3rd space shift, endocrine
- shock process as per normal shock signs/symptoms hypovolaemic shock - correct answer Tachypnoea - rapid, shallow respirations
Cardiovascular response (pulse or blood pressure) to changes in posture Symptomatic hypotension Tachycardia - rapid, weak, thready pulse Decreased mental status - anxiety/restlessness
- cool, clammy skin
- hypothermia
- thirst/dry mouth
- fatigue
- cold/mottled skin what is the process involved in cardiogenic shock? - correct answer - loss of pump (poor cardiac output)
- symapthetic activity (renin/angiotensin/aldosterone) leads to vasoconstriction
- organs are still poorly perfused despite htn due to reduced CO
- high venous pressure & poor forward pumping leads to extravasation & oedema signs/symptoms cardiogenic shock - correct answer same as hypovolemic but:
- JVD
- weak, absent pulse
- arrhythmia, often tachycardia CPG says: Decreased mental status Pulmonary oedema Dysrhythmias Symptomatic hypotension Wheeze what is the process involved in neurogenic shock? - correct answer caused by the sudden loss of the autonomic nervous system signals to the smooth muscle in vessel walls. This can result from severe central nervous system (brain and spinal cord) damage. Normal vasomotor tone is lost below the level of the injury which results in vasodilation and a decrease in peripheral vascular resistance. signs/symptoms neurogenic shock - correct answer Similar to hypovolaemic shock but:
Hives or welts (weal-like swellings). Tingling mouth. Abdominal pain, vomiting (these are signs of severe allergic reaction to insects). Anaphylaxis: Difficult/noisy breathing. Swelling of tongue. Swelling/tightness in throat. Difficulty talking and/or hoarse voice. Wheeze or persistent cough. Persistent dizziness and/or collapse. Pale and floppy (young children). what is the process involved in septic shock? - correct answer Septic shock is most often the result of a severe bacterial infection. Most cases of septic shock are caused by hospital-acquired gram-negative bacilli or gram-positive cocci and often occur in immuno-compromised patients and those with chronic and debilitating diseases. Rarely, it is caused by Candida or other fungi. A unique form of shock caused by staphylococcal and streptococcal toxins is called toxic shock. Septic shock occurs more often in neonates, patients > 35 yr, and pregnant women. Predisposing factors include diabetes mellitus; cirrhosis; leukopaenia, especially that associated with cancer or treatment with cytotoxic drugs; invasive devices, including endotracheal tubes, vascular or urinary catheters, drainage tubes, and other foreign materials; and prior treatment with antibiotics or corticosteroids. Common causative sites of infection include the lungs and the urinary, biliary, and GI tracts. The pathophysiology of septic shock is not entirely understood, but it is known that a key role in the development of severe sepsis is played by an immune and coagulation response to an infection. Both pro-inflammatory and anti-inflammatory responses play a role in septic shock signs/symptoms septic shock - correct answer Similar to hypovolaemic shock except in the first stages: Pyrexia Systemic vasodilation resulting in hypotension Warm and sweaty skin CPG says:
Decreased mental status Hyperventilation Hypotension Skin; warm dry Evidence of infection what is the respiration/ventilation rate for 2-5 year olds? - correct answer 25- how much circulating volume in a 8 year old? what % is that? what is the weight and blood pressure of an 8 year old? - correct answer weight = age + 4 x 2 CV = weightx BP = age x2 + 80 what is catastrophic bleeding? - correct answer severe bleeding that is likely to cause death within minutes what is the nexus & canadian c-spine criteria? - correct answer Spinal immobilisation is indicated where any of the following (stepwise) assessment findings are present and associated with relevant trauma: Altered mental status at time of initial assessment; Intoxication or drug affected; Midline cervical tenderness; Focal neurological deficit; Distracting injury Once the above is ruled out: As per Canadian C-Spine rule - Clinical assessment, including: Bruising or deformity to spinal region; Full range of active neck motion cannot be performed, by the patient, without pain (including 45o rotation to the left and right). The above criteria constitute a decision tool for use in the initial assessment of conscious adult patients to indicate those at very low risk of cervical spine injury. If the assessing clinician is in any doubt, immobilisation must be applied until full history and assessment be prove it can be discontinued.
what is the management of abdominal trauma? - correct answer Principles of management as per CPG 5.1; Cover exposed organs and tissue with plastic film and dry dressings (as required); Immobilisation of impaled objects and positioning (as required). what are the general management guidelines for trauma? - correct answer Scene assessment; Catastrophic bleeding (with haemorrhage control as required); Primary Survey (with C-Spine consideration); Airway management/ventilatory support (as required); Oxygen therapy as per CPG 1.5; Haemorrhage control as per CPG 5.4; Immobilisation (as required); Consider IV fluids if hypotensive and signs of poor organ perfusion; Secondary / CNS Survey (as required); Consider analgesia; Consider ECG monitoring; Consider prevention of hypothermia. Burns CPG - correct answer Document the time of burn injury; Assessment of the patient includes inhalation injury; % TBSA affected; site and depth of wounds; the patient's age; the presence of other injuries, the mechanism of injury; any areas of circumferential burns, co-morbidities and psychosocial issues; Reddened and intact skin areas should not be included when calculating % TBSA burnt; There may be entry and exit point for electrical burn injuries; Patient suffering electrocution injuries should be monitored for dysrhythmias (and 12-lead performed); Water gel dressings can be used, but water is preferred to cool burns. what is the difference in a paediatric airway? - correct answer - larger tongue
- smaller pharynx
- epiglottis is larger & floppier
- larynx more anterior & superior
- narrowest at cricoid
- larger occiput
- trachea narrow & less rigid what is the difference between placental abruption & placental praevia? - correct answer ABRUPTION: (placenta detaches prematurely from the uterus) colour - dark loss - concealed/visible
uterus - increased tone pain - tender to touch level of shock - may not be proportionate to visible blood loss clotting - may not see clots presenting part - engaged
- Placental abruption is the premature separation of a placenta from its implantation site in the uterus. Within the placenta are many blood vessels that allow the transfer of nutrients to the fetus from the mother. If the placenta begins to detach during pregnancy, there is bleeding from these vessels. The larger the area that detaches, the greater the amount of bleeding. PRAEVIA: (placenta is near or covers the cervical opening) colour - bright red loss - visible uterus - soft pain - nil level of shock - proportionate to visible blood loss clotting - usually clotting normally presenting part -high/displaced
- The greatest risk of placenta previa is bleeding (or hemorrhage). Bleeding often occurs as the lower part of the uterus thins during the third trimester of pregnancy in preparation for labor. This causes the area of the placenta over the cervix to bleed. The more of the placenta that covers the cervical os (the opening of the cervix), the greater the risk for bleeding. Other risks include the following what are the 4 T's of post partum haemorrhage - correct answer Tone Trauma Tissue (retained) Thrombin (coagulation problems) what is defined as PPH and Severe PPH? - correct answer PPH = >500mls blood loss severe = >1000mls blood loss
