PHTLS & exam prep Questions and Answers 2023

PHTLS & exam prep Questions and Answers 2023 what are newton's 1st & second laws? Ans- 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? Ans- 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? Ans- 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? Ans- - external - chest - abdomen - pelvis - long bones what are the (3) types of blast injuries? Ans- 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? Ans- 1. vehicle collides with an object 2. unrestrained occupant collides with inside of car 3. internal organs collide with one another or with the wall of the cavity that contains them what is o'donohue's triad? Ans- 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? Ans- 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. 3 - strikes ground/dragged under car. what is the munro-kellie doctrine? Ans- 1. The total intracranial volume if fixed because of the inelastic nature of the skull 2. Inside the skull is the brain, blood & CSF 3. If ICP is increased (via haematoma, swelling or tumour) the skull cannot expand to accommodate this 4. As a result some other structure must be forced out 5. First the CSF & Blood are forced out 6. The only way out is through the foramen magnum 7. Once the ability to force out CSF & blood has been exhausted, the ICP rises rapidly & the next structure to be forced out of the vault is the brain 8. One of the first parts of the brain to be forced out is the medulla oblongata causing an alteration in respirations what is major trauma? Ans- any trauma that requires p1 transport under what conditions should a patient with major trauma NOT be taken to the major trauma centre? Ans- - diversion to nearest ED for stabilisation is required what considerations should be remembered in major trauma and burns? Ans- Burns patients with burns should be taken to fiona stanley. Should major trauma be present, they should be taken to RPH. what are 4 signs to assist determination of death? Ans- persons in cardiac arrest - obvious signs of death - rigor mortis, with or without decomposition/putrification - palliative care - advanced directive when should a patient be taken directly to the burns unit? Ans- - 10%TBSA - airway burns - face, hands, perineum, feet, genitalia - circumferential burns? define shock Ans- 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? Ans- 1. hypoperfusion 2. cellular hypoxia 3. anaerobic metabolism 4. cell death 5. organ failure 6. patient death what processes are involved with anaerobic metabolism that contribute to shock? Ans- - 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? Ans- 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? Ans- 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 Ans- 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? Ans- - 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 Ans- 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? Ans- 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 Ans- Similar to hypovolaemic shock but: -High spinal injuries may present with profound bradycardia - Skin is warm and dry or a clear sweat line exists above which the skin is diaphoretic - Priaprism due to peripheral nervous system stimulation CPG says: Decreased mental status Symptomatic hypotension Bradycardia (dependant on level of injury) Skin: warm & dry what is the process involved in anaphylactic shock? Ans- an acute multi-system severe type I hypersensitivity reaction. Anaphylactic shock is anaphylaxis associated with systemic vasodilation which results in low blood pressure. It is also associated with severe bronchoconstriction to the point where the individual is unable to breathe. When the body is exposed to an allergen to which it has been sensitised, the allergen becomes bound to IgE antibodies which are found on Mast cells and basophils. This triggers the degranulation of the Mast cells and basophils. The granules released contain inflammatory mediators and vasoactive substances including histamine. Histamine causes dilation of local blood vessels and smoothmuscle contraction; hence the patient becomes hypotensive and short of breath