Based on Nancy Caroline's Emergency Care in the streets chapters 23,24
Liver or spleen
Urinary bladder
Ascending aorta
Kidneys or pancreas
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Shearing forces
Rear-end collisions
Penetrating trauma
Motorcycle crashes
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The intraabdominal cavity can accommodate large amounts of blood
Blood in the peritoneum can compress the aorta and maintain perfusion
It takes approximately 4 liters of blood loss before signs of shock manifest
The abdominal muscular can sustain massive blunt force without bruising
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Space behind the navel
External umbilical orifice
Areas lateral to the umbilicus
Area around the umbilicus
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Request medical control authorization to give solu-medrol
Ventilate at 10-12 breaths/min and monitor end-tidal CO2
Maintain an end-tidal CO2 reading of greater than 45 mmHg
Provide mild hyperventilation in case a head injury is present
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Fifth rib to the pelvis
Umbilicus to the pelvis
Diaphragm to the pelvis
Nipple line to the diaphragm
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Recognizing the need for rapid transport
Initiating fluid resuscitation in the field
Contracting medical control immediately
Performing a careful abdominal assessment
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Third intercostal space
Intrathoracic margin
Second intercostal space
Second subcostal margin
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Decreased pulmonary function
Contralateral tracheal deviation
Compression of the great vessels
Marked decrease in venous return
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Manubrium
Angle of louis
Costal cartilage
Suprasternal notch
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4,800
5,200
6,000
6,400
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The liver is the largest hollow organ in the abdomen and is responsible for producing and storing bile
The liver is a relatively avascular organ that is uncommonly injured during blunt abdominal trauma
The liver is a solid organ that lies in the right upper abdominal quadrant and detoxifies the blood
The liver is partially protected by the left lower ribcage and serves the function of filtering bacteria from the blood
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Inserting an oropharyngeal airway, preoxygenating him with a BVM for 2 minutes, and then intubating his trachea
Applying a cervical collar, performing a blind finger sweep to clear his airway, and providing ventilatory assistance with a BVM
Fully immobilizing his spine, inserting a nasopharyngeal airway, and hyperventilating him wit a BVM device at a rate of 20 beaths/min
Manually stabilizing his head in a neutral position, suctioning his oropharynx, and assisting ventilations with a BVM device and 100% O2
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Apply direct pressure to his facial wounds and promptly intubate him
Suction the blood from his mouth and assist ventilations with a BVM
Insert a nasal airway, apply oxygen via nonrebreathing mask, and transport
Suction his oropharynx for 30 seconds and then perform endotracheal intubation
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Perform a detailed neurologic exam and carefully palpate his neck
Apply a cervical collar and start and IV line with warm normal saline
Immobilize his spine a quickly move him to a warmer environment
Administer oxygen and perform a focused history and physical exam
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Free patient first and then assess him
Carefully access the patient and assess him
Contact medical control for further guidance
Immediately request a special rescue team
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Size of the patient
Profile of the bullet
Trajectory of the bullet
Distance the bullet traveled
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Ureters
Urethra
Bladder
Kidney
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Start an IV of normal saline in case the patient deteriorates
Apply a cardiac monitor and obtain a full set of vital signs
Performed a detailed physical exam to detect other injuries
Reassess pulse, motor, and sensory functions in all extremities
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Is an accessory muscle used during respiratory distress
Works in conjunction with the sternum during inspiration
Forms a barrier between the thoracic and abdominal cavities
Creates positive intrathoracic pressure when it increases in size
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Forego spinal immobilization and transport only
Obtain vital signs and assess her blood glucose level
Apply oxygen at 15 liters per min via nonrebreathing mask
Perform a rapid trauma assessment to detect injuries
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Positive pressure created by expiration forces air into the pleural space
The heart stops perfusing the lung on the side of an open chest injury
Negative pressure created by inspiration draws air into the pleural space
The glottic opening is much larger than the open wound on the chest wall
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Carefully removing his contact lenses, flushing both eyes for at least 20 minutes, and transporting with continuous eye irrigation
Leaving his contact lenses in place to avoid further injury and transporting at once with irrigation of both eyes performed en route
Removing his contact lenses, covering both eyes with moist, sterile dressings, administering a narcotic analgesic, and transporting
Asking the patient to remove his contact lenses, irrigating both eyes for no more than 10 minutes, covering both eyes with sterile dressings, and transporting
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Administering high flow oxygen via non rebreathing mask as soon as possible
Covering the laceration with an occlusive dressing and controlling the bleeding
Carefully examining his ear to determine if his tympanic membrane is ruptured
Applying a bulky dressing to the laceration and securing it firmly with a bandage
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Start 2 large bore IVs of normal saline, apply a cardiac monitor, and contact medical control before removing the rock from her legs
Quickly remove the rock from her legs to restore distal neurovascular function, and administer a 20 mL/kg blous of lactated ringers solution
Administer 2 meq/kg of sodium bicarbonate followed by 25 gm of 50% dextrose as you slowly and carefully remove the rock from her legs
Start at least one large bore IV line and administer 2-4 liters of normal saline before attempting to remove the rock from her legs
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Less than the pressure within the right atrium
One fourth of the pressure within the left ventricle
Nearly equal to the pressure within the left ventricle
Three times greater than the pressure in the left ventricle
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Carefully irrigate the wound with sterile water for 5 minutes
Apply a moist, sterile dressing and transport to the hospital
Apply a dry, sterile dressing and transport her to the hospital
Apply a light coat of antibiotic ointment and cover the wound
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Hollow abdominal organs rupture upon impact
The persons abdomen collides with the steering wheel
Rapid deceleration propels an unrestrained person forward
Abdominal organs shear from their points of attachment
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Commonly observed in the prehospital setting following blunt force trauma to the abdomen
Referred to as cullen's sign and may take hours or days to develop following abdominal trauma
Usually seen in conjunction with flank bruising and is highly suggestive of injury to the liver or spleen
Also called grey turner's sign and manifests almost immediately following blunt abdominal trauma
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Ask the driver to step out the vehicle so can access the backseat passenger
Rapidly extricate the driver so you can gain quick access to the child in the backseat
Carefully assess the driver for occult injuries before removing her from the vehicle
Apply a vest-type extrication device to the driver and quickly remove her from the car
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Pulmonary injury with secondary myocardial injury
10% of circulating blood volume in the pleural space
Cardiac arrest secondary to severe intrapleural bleeding
More than 1,500 mL of blood within the pleural space
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The abdomen almost immediately becomes grossly distended
It is most often the result of blunt force trauma to the pancreas
Blood pressure falls with as little as 500 mL of internal blood loss
Nonspecific signs such as tachycardia and hypotension may occur
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Excess tachycardia that accompanies the injury
Damage to myocardial tissue at the cellular level
Aneurysm formation caused by vascular damage
Direct damage to the vasculature of the epicardium
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Avoid narcotic analgesics because of his medical history
Auscultate his breath sounds before administering IV fluids
Obtain a 12 lead ECG to assess for signs of cardiac ischemia
Apply cold, moist dressings to his burns to provide pain relief
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Massive internal hemorrhage and profound shock
Peritonitis caused by rupture and spillage of toxins
Immediate death secondary to a massive infection
Delayed treatment due to the absence of external signs
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Liver
Spleen
Stomach
Pancreas
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Traumatic conjunctivitis
An orbital blowout fracture
Traumatic retinal detachment
Fracture of the cribiform plate
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340mL
355mL
370mL
395mL
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Instructing your partner to resume one rescuer CPR, establishing an IV of normal saline, and reassessing her cardiac rhythm in 5 minutes
Continuing CPR, providing full spinal precautions, intubating her trachea, and ventilating her at a rate of 20-24 breaths/min
Performing adequate BLS, following standard ACLS protocol, and considering terminating your efforts if asystole persists after 10 minutes
Continuing CPR, protecting her spine while ventilating, reassessing her cardiac rhythm after 2 minutes of CPR, and defibrillating if necessary
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Comprises the pericadial sac itself
Is attached directly to the diaphragm
Is the outermost layer of the pericardium
Adheres to the heart and forms the epicardium
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Anulus
Coronary sinus
Aortic hiatus
Ligamentum arteriosum
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Conclude that he is experiencing burn shock, start two large bore IV lines of normal saline, and administer fluids based on the parkland formula
Assist his ventilations with a BVM, cover him with a blanket, and start a large bore IV of normal saline set at TKO
Apply oxygen via nonrebreathing mask, cover his burns with cold moist dressings, start and IV with normal saline and give up to 4 mg of morphine for pain
Administer high flow oxygen, keep him warm, start at least one large bore IV of normal saline, and administer fluid boluses to maintain adequate perfusion
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Panceas
Stomach
Small bowel
Gallbladder
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The thoracic cavity extends to the ninth or tenth rib posteriorly
The diaphragm inserts into the anterior thoracic cage below the fifth rib
The dimensions of the thorax are defined inferiorly by the thoracic inlet
The dimensions of the thorax are defined anteriorly by the thoracic vertebrae
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Hyperventilating her with a BVM at a rate of 20 breaths/min, starting two large bore IVs applying a cardiac monitor, administering 5 mg of valium to prevent seizures, and transporting to a trauma center.
Preoxygenating her with a BVM and 100% oxygen for 2-3 minutes with a BVM , transporting immediately, starting at least one large bore IV en route, and obtaining her glasgow coma scale score
Intubating her trachea after preoxygenating her for 2-3 minutes with a BVM, transporting immediately, starting at least one large bore IV en route, applying a cardiac monitor, and performing frequent neurologic assessments
Applying oxygen via nonrebreathing mask, covering her with blankets, starting an IV of normal saline set to keep the vein open, applying a cardiac monitor, initiating transport, and monitoring her pupils while en route to the hospital
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18%
27%
36%
45%
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Pylorus
Duodenum
Gallbladder
Cardiac sphincter
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Allows the body to compensate for the injury
May cause atelectasis, hypoxemia, or pneumonia
Is often accompanied by subcutaneous emphysema
Is characterized by a markedly increased tidal volume
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