1. What is kinematics?
Correct answer: A branch of mechanics (energy transfer) that refers to motion and does not consider the concepts of force and mass of the object or body.
2. What is Newton's First Law?
Correct answer: A body at rest will remain at rest. A body in motion will remain in motion until acted on by an outside force.
3. What is the Law of Conservation of Energy?
Correct answer: Energy can neither be created nor destroyed. It is only changed from one form to another.What is Newton's Second Law? Correct answer: Force equals mass multiplied by acceleration or deceleration.
4. What is kinetic energy (KE)?
Correct answer: KE equals 1/2 the mass (M) multiplied by the velocity squared.
5. What is the Mnemonic for the Initial Assessment?
Correct answer:
A = Airway with simultaneous cervical spine protection,
B = Breathing,
C = Circulation,
D = Disability (neurologic status),
E = Expose/Environmental controls (remove clothing and keep the patient warm).
6. What is the Mnemonic for the Secondary Assessment?
Correct answer:
F = Full set of VS/Focused adjuncts (includes cardiac monitor, urinary catheter, and gastric tube)/Family presence,
G = Give comfort measures (verbal reassurance, touch, and pharmacologic and nonpharmacologic management of pain),
H = Hx and Head-to-toe assessment,
I = Inspect posterior surfaces.
7. Where do you listen to auscultate breath sounds?
Correct answer: Auscultate the lungs bilaterally at the second intercostal space midclavicular line and at the fifth intercostal space at the anterior axillary line.
8. What are the late signs of breathing compromise?
Correct answer: - Tracheal deviation, - JVD.
9. What are the signs of ineffective breathing?
Correct answer:
- AMS,
- Cyanosis, especially around the mouth,
- Asymmetric expansion of the chest wall,
- Paradoxical movement of the chest wall during inspiration and expiration,
- Use of accessory muscles or abdominal muscles or both or diaphragmatic breathing,
- Sucking chest wounds,
- Absent or diminished breath sounds,
- Administer O2 via NRB or assist ventilations with a bag-mask device, as indicated,
- Anticipate definitive airway management to support ventilation.
10. Upon initial assessment, what type of oxygen should be used for a patient to breathe effectively?
Correct answer: A tight-fitting nonrebreather mask at 12-15 lpm.
11. What intervention should be done if a patient presents with effective circulation?
Correct answer:
- Insert 2 large caliber IVs,
- Administer warmed isotonic crystalloid solution at an appropriate rate.
12. What are signs of ineffective circulation?
Correct answer:
- Tachycardia,
- AMS,
- Uncontrolled external bleeding,
- Pale, cool, moist skin,
- Distended or abnormally flattened external jugular veins,
- Distant heart sounds.
13. What are the interventions for Effective/Ineffective Circulation?
Correct answer: Control any uncontrolled external bleeding by:
- Applying direct pressure over the bleeding site,
- Elevating the bleeding extremity,
- Applying pressure over arterial pressure points,
- Using a tourniquet (last resort),
- Cannulate 2 large-caliber IVs and initiate infusions of an isotonic crystalloid solution,
- Use warmed solution,
- Use pressure bags to increase speed of IVF infusion,
- Use blood administration tubing for possible administration of blood,
- Use a rapid infusion device based on protocol,
- Use NS 0.9% in the same tubing as the blood product,
- IV = surgical cut-down, central line, or both,
- Blood sample to determine ABO and Rh group,
- IO in sternum, legs, arms, or pelvis,
- Administer blood products,
- PASG (without interfering with fluid resuscitation).
14. How do you assess Mnemonic "D"?
Correct answer: DISABILITY,
A = Alert,
V = Verbal,
P = Pain,
U = Unresponsive,
15. Determine the presence of lateralizing signs including: - Unilateral deterioration in motor movements or unequal pupils, - Symptoms that help to locate the area of injury in the brain. What are the interventions for Disability?
Correct answer:
- If assessment indicates a decreased LOC, conduct further investigation during secondary focused assessments,
- If patient is not alert or verbal, continue to monitor for any compromise to ABC's,
- If patient demonstrates signs of herniation or neurologic deterioration, consider hyperventilation.
16. What is assessed and intervened for Expose/Environmental Controls?
Correct answer:
- Remove clothing,
- Ensure appropriate decontamination if exposed to hazardous material,
- Keep patient warm,
- Keep clothing for evidence.
17. What is the first thing assessed under the Secondary Assessment?
Correct answer:
FULL SET VS / FOCUSED ADJUNCTS / FAMILY PRESENCE,
- ABCDE should be completed,
- Labs, X-rays, CT, Foley,
- Family Presence.
18. What is the second thing assessed under the Secondary Assessment?
Correct answer: GIVE COMFORT MEASURES,
- Talking to patient,
- Pharmacologic/Nonpharmacologic pain management
- Observe for physical signs of pain.
19. What is assessed under the Mnemonic "H"?
Correct answer:
HISTORY / HEAD-TO-TOE ASSESSMENT, - MIVT,
- M = Mechanism of injury,
- I = Injuries sustained,
- V = Vital Signs,
- T = Treatment,
Patient generated information, - PMH, - Head-to-toe assessment.
20. What is assessed under the Mnemonic "I"?
Correct answer:
INSPECT POSTERIOR SURFACES,
- While maintaining C-spine,logroll patient with assistance to inspect back,flanks, buttocks, and posterior thighs,
- Palpate the vertebral column for deformity and areas of tenderness,
- Assess rectum for presence/absence of tone, presence of blood.
21. What should be done after the Secondary Assessment?
Correct answer: Reassess:
- Primary survey,
- VS,
- Pain,
- Any injuries.
22. What are the factors that contribute to ineffective ventilation?
Correct answer:
- AMS,
- LOC,
- Neurologic injury,
- Spinal Cord Injury,
- Intracranial Injury,
- Blunt trauma,
- Pain caused by rib fractures
, - Penetrating Trauma,
- Preexisting hx of respiratory diseases,
- Increased age.
23. What medications are used during intubation?
Correct answer: LOAD Mnemonic:
L = Lidocaine,
O = Opioids,
A = Atropine,
D = Defasiculating agents.
24. What are the Rapid Sequence Intubation Steps?
Correct answer:
PREPARATION:- Gather equipment, staffing, etc.
PREOXYGENATION: - Use 100% O2 (prevent the risk of aspiration).
PRETREATMENT: - Decrease S/E's of intubation.
PARALYSIS WITH INDUCTION: - Patient has LOC, then administer neuromuscular blocking agent.
PROTECTION AND POSITIONING: - Apply pressure over cricoid cartilage (minimizes the likelihood of vomiting and aspiration).
PLACEMENT WITH PROOF: - Each attempt NOT to exceed 30 seconds, max of 3 attempts. Ventilate the patient for 30–60 seconds between attempts. After intubation, inflate the cuff. Confirm tube placement with an exhaled CO2 detector.
POST-INTUBATION MANAGEMENT:
- Secure ET tube
- Set ventilator settings
- Obtain Chest x-ray
- Continue to medicate
- Recheck VS and pulse oximetry.
25. What is a Combitube?
Correct answer: A dual-lumen, dual-cuff airway that can be placed blindly into the esophagus to establish an airway. If inadvertently placed into the trachea, it can be used as a temporary ET tube. There are only two sizes: small adults and larger adults.
26. What is a Laryngeal Mask Airway?
Correct answer: Looks like an ET tube but is equipped with an inflatable, elliptical, silicone rubber collar at the distal end. It is designed to cover the supraglottic area.
ILMA, does not require laryngoscopy and visualization of the chords.
27. What is Needle Cricothyrotomy?
Correct answer:
Percutaneous transtracheal ventilation. (temporary)
Complications include:
- inadequate ventilation causing hypoxia
- hematoma formation
- esophageal perforation
- aspiration
- thyroid perforation
- subcutaneous emphysema.
28. What is Surgical Cricothyrotomy?
Correct answer:
Making an incision in the cricothyroid membrane and placing a cuffed endo or trach tube into the trachea. This is indicated when other methods of airway management have failed and pt cannot be adequately ventilated and oxygenated.
Complications include:
- Aspiration
- Hemorrhage or hematoma formation or both
- Lac to trachea or esophagus
- Creation of a false passage
- Laryngeal stenosis.
29. How do you confirm ET Tube/Alternative Airway Placement?
Correct answer:
Visualization of the chords
- Using bronchoscope to confirm placement
- Listening to breath sounds over the epigastrium and chest walls while ventilating the pt
- CO2 detector
- Esophageal detection device
- Chest x-ray.
30. How do you inspect the chest for adequate ventilation?
Correct answer: Observe:
- mental status
- RR and pattern
- chest wall symmetry
- any injuries
- patient's skin color (cyanosis?)
- JVD or tracheal deviation (Tension pneumothorax).
31. What are you looking for when auscultating lung sounds?
Correct answer: Absence of BS:
- Pneumothorax
- Hemothorax
-Airway Obstruction
Diminished BS
- Splinting or shallow BS may be a result of pain.
32. What are you looking for when percussing the chest?
Correct answer: Dullness: - hemothorax
Hyperresonance - Pneumothorax.
33. What are you looking for when palpating the chest wall, clavicles, and neck?
Correct answer: Tenderness - Swelling
- subcutaneous emphysema
- step-off deformities
= These may indicate: esophageal, pleural, tracheal, or bronchial injuries.
Palpate trachea above suprasternal notch. Tracheal deviation may indicate a tension pneumothorax or massive hemothorax.
34. What is the DOPE mnemonic?
Correct answer:
D - Displaced tube
O - Obstruction:
Check secretions or pt biting tube
P - Pneumothorax: Condition may occur from original trauma or barotrauma from ventilator
E - Equipment failure: pt may have become detached from equipment or there's a kink in the tubing
