1. Initial Assessment & Management

Question 1

What is the overall structure of the initial assessment?

Answer 1

Preparation
Triage

Primary survey (with immediate resusucitation)
Adjuncts to primary survey

Consideration of need for transfer

Secondary survey (including AMPLE history)
Adjuncts to secondary survey

Postresuscitation monitoring and re-evaluation
Definitive care

Question 2

Triage: What are the criteria for immediate transport to a trauma centre?

Answer 2

GCS 13 or less
BP < 90
Respiratory rate <10 or >29
Requiring ventilatory support

Penetrating injuries
Chest wall instability
2+ proximal long-bone fractures
Severe extremity injury (pulseless, crushed, mangled)
Amputation
Pelvic fractures
Skull fractures
Paralysis

Question 3

What adjuncts to the primary survey are available?

Breathing (3)

Circulation (2)

Exposure (5)

Answer 3

Breathing:

• SpO2
• CO2 monitoring
• ABG

Circulation:

• ECG
• Lactate

Exposure:

• Urinary catheters
• Gastric catheters
• X-ray chest and pelvis
• FAST
• Diagnostic peritoneal lavage

Question 4

PEA in trauma patient suggests:

Answer 4

tamponade
tension pneumothorax
profound hypovolaemia

Question 5

Bradycardia in trauma patient suggests:

Answer 5

hypoxia

hypoperfusion

Question 6

Tachycardia / AF / ST segment changes in trauma patient suggest:

Answer 6

Blunt cardiac injury

Question 7

What is the function of a gastric catheter in trauma?

Answer 7

Reduce stomach distension (thus improving ventilation)
Reduce risk of aspiration
Assess for upper GI haemorrhage

Question 8

What bloods should be taken in a trauma patient?

Answer 8

FBC, U&Es, LFTs
ABG / VBG
Coagulation studies & crossmatch
Pregnancy
Amylase

Question 9

How does a secondary survey begin?

Answer 9

AMPLE history:

• Allergies
• Medications
• Past Hx / pregnancy
• Last ate
• Event

Question 10

Secondary survey: head

Answer 10

• Examine head and scalp

Eyes:

• Acuity
• Pupil size
• Haemorrhage
• Contact lenses (remove)
• Movement

Maxfax:

• Bony structures
• Oral exam

Question 11

Secondary survey: neck

Answer 11

Inspection, palpation, auscultation.

Check for C-spine tenderness, subcut emphysema, tracheal deviation, laryngeal fracture.

Question 12

Who should be considered for diagnostic peritoneal lavage?

Answer 12

Unexplained hypotension
Neuro injury
Impaired sensorium (due to ETOH/drugs)
Equivocal abdominal findings

Question 13

Adjuncts to the secondary survey

Answer 13

X-ray spine and extremities
CT scans (head, chest, abdomen, spine)
Contrast urography
Angiography
Transoesophageal US
Bronchoscopy
Esophagoscopy

Question 14

Minimum healthy urine output

Answer 14

0.5ml/kg/hour

Question 15

Minimum healthy urine output for children

Answer 15

1ml/kg/hour

Question 16

Mnemonic for handovers

Answer 16

ATMIST

Age
Time of injury
Mechanism of injury
Injuries sustained
Signs and symptoms
Treatment administered