Bread and Butter
What is the leading cause of preventable death on the battlefield?
HEMORRHAGE
This type of burn appears red, does not blister, and blanches readily
Superficial (1st degree burns)
Name 2 TCCC Airway management adjuncts
Head-tilt/Chin-lift
Recovery Position
Sit up/Lean Forward
NPA
OPA
Supraglottic Airway
ETT
Cricothyrotomy
What are the classification of TBIs according to GCS:
Mild: GCS ?-?
Moderate: GCS ?-?
Severe: GCS ?-?
Mild: GCS 13-15
Moderate: GCS 9-12
Severe: GCS 3-8
Septic Shock is classified under 1 of the 4 classifications of shock. Name the 4 different classes of shock.
Distributive
Hypovolemic
Cardiogenic
Obstructive
A number of factors predict the need for Massive Transfusion support in trauma. Name 2 clinical indicators. (i.e. HR, BP, HCT, pH)
Systolic BP <100
HR >100
Hematocrit <32%
pH <7.25
A 25 y/o male (75kg) was entrapped in a building when it caught fire. He sustained 10% superficial burns, 25% partial thickness burns, and 5% full thickness burns. Utilizing the rules of 10, what would the beginning fluid rate start at (mL/hr)?
30% TBSA x 10 = 300mL/hr
*do not count superficial burns*
Checklists are commonly used in medical practice like this one, "MSMAID". It is utalized as a simple preoperative anesthesia checklist. Name 2 of the 6 supplies/items within this acronym.
Machine, Suction, Monitor, Airway, IV access, Drugs
Name a simple physical intervention to implement early for TBIs.
HOB 30-45 degrees or reverse Trendelenburg
Keep head straight to avoid kinking of the IJ veins
Avoid tight cervical collars and tight circumferential ETT/trach tube ties
Systemic Inflammatory Response Syndrome (SIRS) si a sign of an inflammatory reaction to a severe physiologic insult. It is a useful tool in identifying patients at risk of acute decompensation. Name one of the four indictors. (hint... HR, RR, Temp, WBC)
Tachycardia >90 bpm
RR > 20 bpm and PaCO2 <32
Temp >100.4 and <96.8
Leukocytosis or leukopenia >12,000 or <4,000 (or >10% bands)
Name the four points of the "Diamond of Death"
Hypocalcemia
Acidosis
Hypothermia
Coagulopathy
To calculate a patient's initial burn size, we will utilize the Rule of Nines. When wounds are later cleaned, what chart can we utilize to re-calculate the TBSA?
Lund-Browder Chart
After securing an airway verification of correct tube placement must be performed. Name 1 way to confirm correct tube placement.
Auscultate over left and right lung fields and epigastrium
EtCO2 (capnography/capnometry or colorimetric device)
Dr. Stroer asks you to give a loading dose of keppra and start 3% saline on your patient. Knowing this improves survival for patients with evidence of moderate or severe TBI, what other medication should you suggest Dr. Stroer to order?
Fluid resuscitation is key for septic patients to "fill the tank". Name 2 therapy goals for treating a septic patient. (i.e. UOP, SBP goals, MAP goals)
UOP 0.3-0.5mL/kg/hr
SBP >90
MAP >65
cap refill <2 seconds
Diagnostic labs (lactate <2)
Name 2 hemostatic pharmacological adjuncts, the doses, and when they should be given.
TXA (2g w/ in 3 hours of injury)
10% Calcium Chloride 1g/10mL or Calcium Gluconate 3g/30mL (first unit of blood and then every 4th)
What goal urine output is ideal for the burn patients, indicating end organ perfusion.
30-50mL/hr
What is a normal EtCO2 range?
*Bonus: what EtCO2 range indicated effective CPR*
35-45 mmHg
*10-20 mmHg*
How do you calculate Cerebral Perfusion Pressure?
CPP = MAP - ICP
We are in Burundi Africa, and a patient presents with a cyclic fever, shaking chills, headache, and muscle aches. To determine the origin of the infection, what would be on your differential diagnosis?
Malaria
Volume resuscitation is critical in hemorrhaging patients. Name the order of priority for types of fluid administration.
Fully TTD tested WB (FDA approved)
Component Therapy (1:1:1:1 plasma, RBCs, plts, cryo)
WB from tested donor
RBCs plus plasma (1:1)
Plasma without RBCs
RBCs alone
Evacuation has been delayed and you have been holding a 50% TBSA burn patient for nearly 18 hours. They have had >250mL/kg fluid resuscitation within the last 18 hours. The patient is intubated and on the ventilator, and the high pressure alarm goes off. You trouble shoot and suction the patient and have minimal return. The ventilator continues to alarm "high peak and plateau pressures". Knowing the patients history, what can you suspect?
Abdominal Compartment Syndrome
You go to suction your patient and your powered commercial suction machine is not working. You go around to steal one of the other sections suction, and all of them are broken!! Utilizing the best, better, minimum method, what could you utilize better or minimum tool?
Better: Manual suction bulb with adapter
Minimum: Improvised suction (i.e. syringe + NPA and patient positioning if not contraindicated)
Your patient overnight begins to have a seizure in the ICU. You call for the doctor, but he is no where to be found. You look for standing orders for what medication to give, and nothing is wrote down. You are left high and dry. What medication would you decide to prepare to give the patient having an active seizure? *bonus for naming 2*
1-2mg Ativan IV or 5-10mg Midazolam IV
Your patient (80kg) is septic and you have given 2-3L of IV crystalloids. Despite your best efforts, the patients vitals are the following: BP 80/55, HR 115, RR 12 (vent), sp02 92%. The patients UOP has been 20mL over the past 3 hours. What intervention do you think is appropriate to initiate next?