Mass Casualty

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1
Mass casualty events are defined as >___ patients, at least _____ of them severely wounded, and a noticeable impact on healthcare system and access to vital services
- 10
- 3
2
Up to ____% of MCE patients are < _____ years old
- 30
- 17
3
Pediatric pts are at an inc. risk of morbidity and mortality in a MCE generally d/t inc. susceptibility to the effects of ________ , ______, and other agents used in bioterrorism
Noxic chemicals & radioactivity
4
Pediatric pts have an increased respiratory exposure risk d/t their _______
higher ventilation/RR
5
Kids have _____ & more _____ skin w/ less ______ to protect them from chemicals that cause burns
- Thinner
- Permeable
- Fat
6
Kids have a larger _______ compared to their _____ r/in more exposure to the chemical/toxic agent
- Body surface area
- Mass
7
Kids have inc. vulnerability in MCE involving a contagious component d/t to their
immature immune systems
8
Pediatric patients are at increased risk of exposure problems such as ______ and _______ d/t their larger ______
- hypothermia
- dehydration
- BSA to mass ratio
9
Kids have a higher incidence of head & neck injury b/c they have a larger ________
head to body ratio
10
Kids have higher risk for penetrating & blunt head injuries b/c their _______
Skull is thinner
11
Kids are at inc risk of fractures & secondary injuries d/t ________
Incomplete ossification of their bones
12
The acceptable range for over triage is ___ to ____ & under triage is ___ to ____
- 30 to 50%
- 5 to 10%
13
Pediatric pts are generally ____ triaged. They require more ______ & longer ____ d/t this
- Over
- Surgical interventions
- Hospital stays
14
In the JumpSTART pediatric multiple casualty incident triage algorithm--> Black indicates _____
- Expectant: unlikely to survive
- Palliative care and pain relief should be provided
15
In the JumpSTART pediatric multiple casualty incident triage algorithm--> Red indicates _____. These pts require interventions for _______
- Immediate: likely survive if they receive medical attention within 60 minutes
- Airway, breathing, circulation
16
In the JumpSTART pediatric multiple casualty incident triage algorithm--> Yellow indicates _____. These pts have _______ injuries but are not expected to _____
- Delayed: transport can be delayed
- Serious/Life threatening
- deteriorate significantly over the next several hours
17
In the JumpSTART pediatric multiple casualty incident triage algorithm--> Green indicates _____. These pts may be able to _______
- Minor: likely stable for days
- Assist w/ their own care; "walking wounded"
18
____% of total patients effected arrive in 1st hour & usually have _____ injuries
- 50%
- Minor?
19
To determine how many ICU beds you need during MCE, you multiply the ________
- # of ICU beds in the hospital x 3
20
Primary explosion injury is a ________ of the explosion or the ________ from the blast wave
- Direct result
- barotrauma
21
Secondary explosion injuries are a result of ______
- Projectiles
22
Tertiary explosion injuries are caused by the ______; so this is the result of the pt being _____ or being ______
- Blast wind
- Physically thrown against objects
- Thrown a long distance
23
Quarternary explosion injuries occur as a result of the bombings effect on ______, _______, or bridge collapse, etc.
- other buildings
- Fire from the bomb
24
An aural blast injury is a _____ injury resulting from _______ around the pt, specifically affecting their _____ membrane & ______
- Primary
- Rapid pressure changes
- Tympanic
- Inner ear
25
An aural blast injury may present with _____, _____, ______, or a _______
Deafness, vertigo, tinnitus, or a perforated eardrum
26
Aural blast injury tx includes _____, ______, & ______
Ototopical antibiotics, tympanoplasty, supportive care (pain control etc.)
27
Pt. w/ a blast lung injury will present with ______, _______, & ______
apnea, bradycardia, and hypotension
28
________ is the most common life threatening injury as a result of a blast
Blast lung
29
Blast lung is a _____ injury that is the result of ________ from the _____ between the _____ leading to _____, ______, hypoxia, & ______. A _____ can also occur
- Primary
- Rapid pressure change
- Blast wave
- Alveolar capillary barrier
- Acute pulmonary hemorrhage, pulmonary edema, hypoxia, & hypoxic resp. failure
- hemo/pneumothorax
30
Blast lung classic X-ray findings is the _____ or _____ shape in the center that extends to the ______
- Butterfly
- Bat wing
- R & L lung
31
The classic _____ shape on X ray seen in pts w/ Blast lung is a result of the _______
- Butterfly or Bat wing
- Blast radiating off of the sternum
32
A __________ w/ ____% O2 is the best option for pt. w/ blast lung bc you want to avoid ______ if possible
- non rebreather
- positive pressure ventilation
33
Cardiac contusion blast injury (aka cardiac stun) present w/ ________. They lose the ability to mount a ____ response to _____ or _____
- Bradycardia
- tachycardic
- hypovolemia or fever
34
Pt. w/ cardiac contusion blast injury often present in _______ What is important to remember when resuscitating them?
- Do NOT us their HR to guide adequate fluid resuscitation---> it won't respond top fluid
- use CVP & BP instead
35
Traumatic amputation: if there's obvious tearing of limb--> washout, control bleeding, but _________ &look for life threatening ______ & ____ injuries
- Delay Closure!!
- CNS & cardiopulmonary injuries
36
Diffuse axonal injury (DAI) from a blast d/t ________
Their brain being shaken within the cranium
37
Sinus, mandible, and other facial fractures from a blast can lead to _______ that can cause _______ in the brain
- air embolism
- infarcts/strokes
38
Vesicant chemical agents are agents that will _____. There is no _______
- Burn the skin
- Antidote
39
Choking chemical agents cause ______ resulting in the __________. There is no ______
- Impaired gas exchange
- Inability to breathe
- Antidote
40
Asphyxiant chemical agents will actually _______
Replace oxygen in the air
41
______ & ______ are the antidotes for nerve gas/chemical agents
Atropine and pralidoxime
42
You are going to prioritize decontamination based on the patients who need _______ and only decontaminate what is _______
- Stabilizing
- Life threatening
43
Nerve chemical agents (VX, Sarin gas, Tabun) will result in ______ & ______ injuries: ______, ______, ____, _____, & ______
- Pulmonary & Neurologic
- Bronchospasms, Bronchorrhea (inc. secretions)
- Muscle weakness, seizures, encephalopathy
44
Vesicant chemicals (mustard gas, nitrogen mustard) result in ______, ______, & ______ of the eyes; _____ & ____ of the skin; also ____, ____, & ____
- Tearing, itching, and burning
- Blisters and redness
- Runny nose, cough and decongestant
45
Choking chemical agents (chlorine, phosgene) result in _____, ____, & _____
- Cough
- Dyspnea
- Pulmonary edema
46
Asphyxiant chemical agents (cyanide) result in ______ without ______ initially, _______ skin, & ______
- Dyspnea w/o hypoxia
- Cherry red skin
- Encephalopathy
47
There are 3 antidotes for asphyxiant chemical agents (cyanide): ______, inhaled _______, & ________
- Amyl Nitrate
- Inhaled Sodium nitrate
- Sodium Thiosulfate
48
Acute radiation syndrome occurs when there is _________ to radiologic materials. Toxicity will occur _________ and usually within the 1st _____
- Rapid exposure
- Within minutes
- 24 hrs
49
Pts w/ acute radiation syndrome will also sustain ________ related to the blast
Secondary injuries
50
Acute radiation syndrome: Radiologic material affects the ___ & _____cells r/in ________ suppression, radiation _______, changes to the _____ leading to ______, & swelling leading to increased _______
- DNA and the replicating cells
- Bone marrow suppression
- Pneumonitis
- CNS
- Seizures
- ICP
51
Acute Radiation Syndrome tx: Supportive care: IVF, ______, nutrition, skin care; tx seconday injuries, & ________ within _____
- Growth factors (hematopoietic to improve cell counts)
- Potassium Iodide within 8 hours
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