Questions and Answers
What is the preferred site for establishing IV access in trauma patients?
Which sign is commonly associated with abdominal injury indicating internal bleeding?
What is a critical action to take following the failure of both IV and IO access attempts in a patient with life-threatening conditions?
Which of the following factors indicates hypovolemic shock?
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For a pregnant patient experiencing trauma, why should warm LR be considered before crystalloids?
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What method is recommended for maintaining fluid access in a trauma patient?
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Which technique may be employed to control pelvic hemorrhage during a penetrating abdominal injury?
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In assessing abdominal trauma, which finding would suggest possible kidney injury?
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What is a potential intervention for a patient exhibiting signs of hypovolemic shock?
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What should be monitored closely in patients over 50 presenting with abdominal pain?
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What does a rigid, distended abdomen potentially indicate?
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In managing nausea or vomiting in patients, which medication is appropriate?
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When should unstable patients have their vital signs reassessed?
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Which of the following is NOT a classic symptom of appendicitis?
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What monitoring should be conducted for a patient experiencing tachycardia and hypotension?
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What is the primary action to take if Return of Spontaneous Circulation (ROSC) is not achieved?
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Which scenario necessitates following the Obstetric Emergency Guideline?
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Which condition must be prioritized before administering blood in trauma patients?
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Which of the following is NOT considered an obvious sign of a condition incompatible with life?
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Which assessment symptom suggests potential abdominal trauma?
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In the context of abdominal pain, which associated symptom indicates a more severe underlying issue?
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What should be assessed if there is suspicion of tension pneumothorax despite effective CPR?
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Which sign is a common symptom of hypovolemic shock?
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What initial management step should be considered in cases of severe hypocalcemia following recent blood transfusions?
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Study Notes
Pre-Hospital Care
- Intraosseous (IO) line allows for administration of all approved pre-hospital fluids and medications, including blood products.
- At least two functioning IV or IO lines recommended for all trauma or potentially ill patients.
- Upper extremity IV sites preferred over lower extremity.
- Utilize a pressure infusion bag for IO with a starting pressure of 300 mmHg.
- For life-threatening situations with failed IV and IO attempts, external jugular lines are an option.
- Maintain an open fluid bolus as per protocol, with a minimum "to-keep-open" (TKO) drip.
Abdominal Injury Signs and Symptoms
- Altered mental status, tachycardia, and hypotension may indicate serious conditions.
- Signs: absence of palpable pulses, pale/moist/mottled skin, poor peripheral pulses, hematuria, and abdominal tenderness/distention.
- Grey-Turner sign, Cullen sign, and Kehr’s sign are specific indicators of internal bleeding.
Treatment Protocols
Blunt Abdominal/Pelvic Injury
- Emphasize serial physical exams and reassessment.
- Apply pelvic binder and conduct FAST exam if feasible.
- Focus treatment on resuscitation.
Penetrating Abdominal/Pelvic Injury
- Use hemostatic dressing and pack pelvic cavity.
- Apply pressure dressing, direct and indirect pressure techniques.
- Deploy abdominal dressing and pelvic binder as necessary, considering AAJT for uncontrolled bleeding.
Damage Control Resuscitation
- Implement based on indications (SBP < 100) for penetrating abdominal injuries.
Special Considerations
Pregnant Patients
- Increased risk of aspiration and gastric acidity; maximum O2 should be provided due to higher O2 demands.
- Use warm lactated Ringer's solution before crystalloids for better fetal oxygenation.
- Tilt >15 degrees after 20 weeks gestation to prevent Vena Cava Syndrome.
Cardiopulmonary Resuscitation (CPR) Protocols
- If ROSC (Return of Spontaneous Circulation) is not achieved: continue CPR, administer blood/IV fluids, and manage fractures and known hemorrhage points.
- If ROSC is achieved: return to tactical evacuation or prior guidelines.
Injury Assessment
- Injuries incompatible with life include severe decapitation or total body disruption.
- Differentiate between trauma and medical causes of cardiac arrest before proceeding with ALS guidelines after stabilizing hemorrhage.
Abdominal Pain in Adults
Signs and Symptoms
- Varied pain locations (RUQ, RLQ, LUQ, LLQ) and potential symptoms include tenderness, nausea/vomiting, diarrhea, and vaginal bleeding.
- Associated symptoms can manifest as fever, headache, weakness, and mental status changes.
Trauma vs Medical Considerations
- Assess for mechanism of injury (MOI): blunt force or penetrating trauma.
- Consider potential causes of abdominal pain; significant tachycardia or hypotension may necessitate fluid bolus.
- Maintain vigilance for ectopic pregnancy in reproductive-age females presenting with abdominal pain.
- Antacids are contraindicated in renal disease patients, and those over 50 have a higher risk of serious diagnoses.
Appendicitis Presentation
- Classic sign: vague periumbilical pain migrating to RLQ may not always be evident; vital signs should be monitored after each intervention.
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Description
This quiz focuses on the administration of IV and intraosseous (IO) fluids and medications in pre-hospital settings. Key concepts include site selection, equipment recommendations, and protocols for managing trauma and ill patients. Test your knowledge on best practices in emergency medicine.
