12. Multiply Injured Patient

Question 1

What percentage of deaths due to trauma are potentially avoidable?

Answer 1

Up to 30%

Question 2

What can be done to improve the deaths which could be avoided?

Answer 2

1. Improve pre-hospital care
2. Use Advanced Trauma Life Support (ATLS) principles
3. Integration of Trauma Services
4. Invest in Rehabilitatiion
5. Clinical Audit and Research

Question 3

When should Trauma management start?

Answer 3

From the Time of Injury:

1. Golden Hour
2. Platinum 10 minutes

Question 4

What information should be conveyed, pre-hospital arrival?

Answer 4

1. Time of Injury
2. Mechanism of Injury
3. Speed / Forces involved
4. Ejection / Pedestrian
5. Likely Serious Injuries
6. Vital Signs
7. Interventions Carried Out

Question 5

What is a trauma team made up of?

Answer 5

1. Emergency Department
2. Anaesthetics
3. Radiology
4. Intensive Care Unit
5. Surgical Specialties

Question 6

What is the Primary Assessment Survey, in Trauma Assessment?

Answer 6

ABC:

Detects and Treats immediate threat to life

Question 7

What does the ABC approach include?

Answer 7

Airway with C-Spine Control
Breathing with O2
Circulation with Haemorrhage Control
Disability
Expose and Environment

Question 8

What is assessed in “Airway with C-Spine Control”?

Answer 8

1. Noises - Speech; Gurgling; Stridor

2. Visual - Swelling / Deformity; Vomit / Blood / Debris

Question 9

How is “Airway with C-Spine Control” managed?

Answer 9

1. Manoeuvers
2. Suction
3. Adjuncts
4. Advanced Procedures

Question 10

What is assessed in “Breathing with O2”?

Answer 10

1. Look - Work of Breathing / Expansion . Effort
2. Feel - Palpate / Percussion
3. Auscultate

Question 11

What is Clinically Assessed in “Circulation”?

Answer 11

1. Heart Rate / Palpable Radial Pulse
2. Blood Pressure / Pulse Pressure Narrows
3. CRT
4. Urine Output
5. Confusion

Question 12

What is Blood Test Results are Assessed in “Circulation”?

Answer 12

1. Haemoglobin Levels

2. Serum Lactate

Question 13

What is Imaging Results are Assessed in “Circulation”?

Answer 13

1. Ultrasound

2. CT

Question 14

What are the most common 5 sites for Blood Loss?

Answer 14

1. Chest
2. Abdomen
3. Pelvis
4. Long Bones
5. Floor

Question 15

What is considered when assessing “Circulation”?

Answer 15

Haemorrhage Control

Question 16

What is considered in Volume Replacement in “Circulation”?

Answer 16

1. I.V. Access vs I.O. Access
2. Type of Volume
3. Amount of Fluid
4. Massive Transfusion Protocols

Question 17

What needs to be monitored as Volume Replacement is being performed?

Answer 17

1. Vital Signs
2. Urine Output
3. Lactate

Question 18

What is the “Legal Triad” of Volume Replacement?

Answer 18

1. Coagulopathy
2. Acidosis
3. Hypothermia

Question 19

What is assessed in “Disability”?

Answer 19

1. Alert, Voice, Pain, Unconscious (AVPU)
2. Glasgow Coma Score
3. Pupils
4. Tone and Reflexes

Question 20

What is included in “Expose and Environment”?

Answer 20

1. Expose to allow a full examination

2. The cover to keep warm

Question 21

What does “DEFG” often stand for, in this setting?

Answer 21

Don’t Ever Forget Glucose

Question 22

What Bedside tests are often done in Trauma cases?

Answer 22

1. ECG
2. Arterial Blood Gas
3. Urine Dipstick

Question 23

What investigations are done very quickly, once the patient arrives in the Hospital Setting?

Answer 23

1. X-Ray / CT Scan - C-Spine, Chest, Pelvis

2. Ultrasound - Pneumothorax

Question 24

What is included in the Secondary Survey?

Answer 24

Meticulous Head to Toe examination to identify all injuries and plan management

Question 25

What are the options for Transfer and Further Management?

Answer 25

1. Theatre - Operative Management
2. Interventional Radiology - Control of Bleeding
3. Intensive Care Unit - ICP monitoring, Ventillation, Continued Resuscitation