Podcast
Questions and Answers
What is the preferred site for establishing IV access in trauma patients?
What is the preferred site for establishing IV access in trauma patients?
- Upper extremities (correct)
- Lower extremities
- External jugular vein
- Intraosseous line
Which sign is commonly associated with abdominal injury indicating internal bleeding?
Which sign is commonly associated with abdominal injury indicating internal bleeding?
- Battle's sign
- Colle's sign
- Babinski reflex
- Grey-Turner sign (correct)
What is a critical action to take following the failure of both IV and IO access attempts in a patient with life-threatening conditions?
What is a critical action to take following the failure of both IV and IO access attempts in a patient with life-threatening conditions?
- Attempt an external jugular line (correct)
- Start CPR immediately
- Initiate a FAST exam
- Administer oral medication
Which of the following factors indicates hypovolemic shock?
Which of the following factors indicates hypovolemic shock?
For a pregnant patient experiencing trauma, why should warm LR be considered before crystalloids?
For a pregnant patient experiencing trauma, why should warm LR be considered before crystalloids?
What method is recommended for maintaining fluid access in a trauma patient?
What method is recommended for maintaining fluid access in a trauma patient?
Which technique may be employed to control pelvic hemorrhage during a penetrating abdominal injury?
Which technique may be employed to control pelvic hemorrhage during a penetrating abdominal injury?
In assessing abdominal trauma, which finding would suggest possible kidney injury?
In assessing abdominal trauma, which finding would suggest possible kidney injury?
What is a potential intervention for a patient exhibiting signs of hypovolemic shock?
What is a potential intervention for a patient exhibiting signs of hypovolemic shock?
What should be monitored closely in patients over 50 presenting with abdominal pain?
What should be monitored closely in patients over 50 presenting with abdominal pain?
What does a rigid, distended abdomen potentially indicate?
What does a rigid, distended abdomen potentially indicate?
In managing nausea or vomiting in patients, which medication is appropriate?
In managing nausea or vomiting in patients, which medication is appropriate?
When should unstable patients have their vital signs reassessed?
When should unstable patients have their vital signs reassessed?
Which of the following is NOT a classic symptom of appendicitis?
Which of the following is NOT a classic symptom of appendicitis?
What monitoring should be conducted for a patient experiencing tachycardia and hypotension?
What monitoring should be conducted for a patient experiencing tachycardia and hypotension?
What is the primary action to take if Return of Spontaneous Circulation (ROSC) is not achieved?
What is the primary action to take if Return of Spontaneous Circulation (ROSC) is not achieved?
Which scenario necessitates following the Obstetric Emergency Guideline?
Which scenario necessitates following the Obstetric Emergency Guideline?
Which condition must be prioritized before administering blood in trauma patients?
Which condition must be prioritized before administering blood in trauma patients?
Which of the following is NOT considered an obvious sign of a condition incompatible with life?
Which of the following is NOT considered an obvious sign of a condition incompatible with life?
Which assessment symptom suggests potential abdominal trauma?
Which assessment symptom suggests potential abdominal trauma?
In the context of abdominal pain, which associated symptom indicates a more severe underlying issue?
In the context of abdominal pain, which associated symptom indicates a more severe underlying issue?
What should be assessed if there is suspicion of tension pneumothorax despite effective CPR?
What should be assessed if there is suspicion of tension pneumothorax despite effective CPR?
Which sign is a common symptom of hypovolemic shock?
Which sign is a common symptom of hypovolemic shock?
What initial management step should be considered in cases of severe hypocalcemia following recent blood transfusions?
What initial management step should be considered in cases of severe hypocalcemia following recent blood transfusions?
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.
