Traumatic Brain Injury Management in Prolonged Field Care
A Glasgow Coma Scale (GCS) score of 13-15 indicates a traumatic brain injury (TBI) severity classification of ___?
Mild
Consider ______ as many drowning patients swallow water prior to inhaling and between 60-80% will vomit at some point during recovery or resuscitation.
Gastric decompression
In CBRN situations, _______ and ________________ the foundation for further management, and is key not only for initiating patient treatment but also for preventing contamination of medical personnel, equipment and facilities.
Early recognition and Categorization of CBRN exposed patients
If the preferred cyanide antidote is not available, ___________ can be used.
The cyanide antidote kit
During prolonged field care, replace infusing bag of fluids and tubing with new equipment ________ if possible.
Every 72 hours
What are the target systolic blood pressure in polytrauma patients with ongoing bleeding and a suspected traumatic brain injury (TBI)?
< 90mmHg or oxygen saturation via pulse oximetry (SpO2)
A drowning victim that was rescued from _______ waters may have increased chance of lung injury and require bronchoalveolar lavage to cleanse.
contaminated
In a high-threat environment due to a CBRN attack, what military used personal protective equipment (PPE) should personnel be aware of?
field expedient PPE
What should be done before decontaminating a patient who has been exposed to cyanide with irrigation solutions?
Treatment with antidote is the first priority and should not be delayed
Which nursing intervention minimizes the risk for a patient to develop deep vein thrombosis (DVT) during prolonged field care?
ankle plantarflexion-dorsiflexion and lower extremity message
Every effort should be made to optimize airway placement for a traumatic brain injury (TBI) patient on the first attempt by doing?
Preoxygenating with supplemental O2, selecting the most experienced provider available, and using the techniques most familiar to the provider.
What are the risk factors for swimming induced pulmonary edema (SIPE)?
Hypertension, female, swimming >= 1.2 miles, prior history of SIPE
What does CRESS stand for?
Consciousness, Respiration, Eyes, Secretions and Skin
The speed of symptoms onset depends on the route of exposure and dose of the agent. _________ tends to result in faster onset of symptoms and can quickly cause death due to rapid systemic distribution.
Inhalation exposure
When preforming nursing intervention during prolonged field care, personnel must flush saline locks with 10ml of normal saline at lest every __ hours.
8 hours
What are common signs of non-convulsive seizures in traumatic brain injury (TBI) patients?
Coma, delirium, agitation, aphasia (impairment of language affecting production and/or comprehension of speech, reading and/or writing) and/or blank staring
For patients who have been diagnosed with swimming induced pulmonary edema, management of treatment will consist of?
Rest within 24-48 hours. Hospitalization with diuretics and supplemental oxygen for severe cases
Any casualty with an area suspicious of having been exposed to a liquid chemical agent is automatically medically triaged as immediate until?
Immediate (local, spot) decontamination has been accomplished
Chlorine exposure may lead to copious secretions and laryngospasm shortly following exposure, therefore providers should be prepared for?
Airway management and possibly emergent surgical airway control
Patients who are conscious and able should brush their teeth a minimum of every _ hours. For unconscious patients, preform oral care at least every _ hours.
12 hours
4 hours
Which medication is preferred to lower a traumatic brain injury (TBI) patient's core body temperature?
surface-cooling measures (EX: evaporative heat loss by misting and fan cooling)
Water in lungs washes out _____ causing atelectasis (alveolar collapse), diminished gas transfer, ventilation perfusion mismatch and hypoxia.
Surfactant
Providers dealing with CBRN contaminated foreign material or dressings can wear 3 pairs of nitrile gloves. The outer glove should be discarded every _____ minutes.
20 minutes
Nerve agent antidotes/treatment include?
2PAM, atropine, and benzodiazepines
If available, check blood glucose level (BGL) every 8 hours or more frequently as dictated by patient status while preforming prolonged field care.
A high BGL is less dangerous than low glucose, but may be treated if the capability is available. What is considered a high BGL?
Greater than 200mg/dL