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235 Trauma > 235 Exam 1 > Flashcards

235 Exam 1 Flashcards

1
Q

Which of the following patients would most benefit from a fluid bolus?
1) 22 year old unrestrained driver in MVC, pulse 130 B/P 72/58

2) 30 year old fall, no movement or sensation in legs, pulse 78, B/P 102/ 48
3) 64 year old assaulted, unconscious, pulse 96, B/P 118/50
4) 45 year old stabbed in the chest, short of breath, pulse 126, B/P 100/76

A

2) 30 year old fall, no movement or sensation in legs, pulse 78, B/P 102/ 48

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2
Q 
A 147lb patient has lost 900ml of blood. This blood loss places the patient into which class of hemorrhagic shock?
Question 2 options:
 1) class III

2) class I
3) class IV
4) class II

A

4) class II

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3
Q

Which of the following is characteristic of a subarachnoid hemorrhage?
Question 3 options:
1) gradual onset of unilateral weakness of the arms

2) unexplained signs of hypovolemia
3) ‘the worst headache I’ve ever had’
4) intermittent pain and bilateral dipolpia

A

3) ‘the worst headache I’ve ever had’

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4
Q

What affect should neurogenic shock have on the pulse pressure?
Question 4 options:
1) no change

2) widen
3) narrow

A

2) widen

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5
Q

Which of the following medications could be helpful in a patient with spinal cord
injury?
Question 5 options:
1) ipatropium

2) magnesium Sulfate
3) methylprednisolone
4) zofran

A

3) methylprednisolone

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6
Q

You find a victim of an automobile accident unconscious and slumped forward on the steering wheel. After making certain that you are not in danger, what should be your initial action?
1 establish cervical stabilization
2 remove the victim from the automobile
3 evaluate airway and breathing
4 obtain the blood pressure
Question 6 options:
1) 1, 2

2) 1, 3
3) 2, 4
4) 3, 2

A

2) 1, 3

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7
Q

Describe the common differences between auto pedestrian accidents involving children versus adults. Please include mechanisms and potential injuries. (2 pts)

A

Children when struck by a vehicle tend to face and turn towards the car, and also go under the vehicle. This can result in WADDELLS TRIAD - Lower extremity fracture, impact to torso/thoracic cage, then striking head on ground. So, expect these injuries plus possible burns from the undercarriage of the vehicle, abrasions from the pavement, and injuries from the weight of the vehicle possibly on the patient.

Also depends on height of bumper, speed of vehicle, size of child.

Adults turn away from the vehicle typically, with an “over the hood and windshield” type impact to be expected. Injuries common to lateral and posterior part of body. Bones, head, neck, spine, thoracic cage, pelvic injuries.

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8
Q

Which of the following explains the narrowing pulse pressure in hemorrhagic shock?
Question 8 options:
1) release of aldosterone

2) increased inotropic effects on the heart
3) alpha effects of norepinephrine
4) fluid shift from interstitial to intravascular

A

3) alpha effects of norepinephrine

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9
Q

Which are the earliest signs of internal bleeding?
Question 9 options:
1) cyanosis, low BP, lethargy

2) low BP, cold and clammy skin, tachycardia
3) restlessness, tachycardia, clammy skin
4) anxiety, narrowed pulse pressure, low BP

A

3) restlessness, tachycardia, clammy skin

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10
Q

Which of the following best defines the “Golden Period” for the trauma patients?
Question 10 options:
1) on scene to Emergency Department

2) scene arrival to scene departure
3) the incident to the operating room
4) the incident to scene departure

A

3) the incident to the operating room

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11
Q

Please define yaw.

A

The tumbling profile of a bullet, how it is diverting from the line of trajectory

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12
Q

Please define retroauricular ecchymosis.

A

Bruising behind the ears

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13
Q

A 22 year old male patient has sustained a closed head injury while working at a construction site. He is unconscious, posturing to painful stimulus with sluggish pupil response. His pulse is 58 with a blood pressure of 178/72. He is breathing regular at 38 times per minute with deep respirations and his initial pulse oximetry reading is 78%. Which of the following is most likely correct?
Question 13 options:
1) lower brain stem injury

2) upper brain stem injury
3) middle brain stem injury

A

3) middle brain stem injury

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14
Q

What affect should obstructive shock have on the pulse pressure?
Question 14 options:
1) narrow

2) widen
3) no change

A

1) narrow

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15
Q

Which of the following is a complication of jugular vein laceration?
Question 15 options:
1) pneumothorax

2) air embolism
3) neurogenic shock
4) subcutaneous emphysema

A

2) air embolism

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16
Q

Please define Brown-Sequard’s syndrome.

A

A partial injury of the spinal cord, resulting in loss of motor function on the affected side and sensory deficits on the other side of the body.

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17
Q

How many primary potential collisions occur in a deceleration motor vehicle collision, not including the secondary insults?
Question 17 options:
1) 5

2) 1
3) 3
4) 2

A

3

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18
Q

The more severe the forces applied to the body makes which of the following statements true?
Question 18 options:
1) open wounds bleed more

2) more damage is present, visible or not
3) more obvious are the signs of blunt trauma
4) existing medical problems are less concerning

A

2) more damage is present, visible or not

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19
Q

Based upon Newton’s theory, which of the following would generate the greatest amount of kinetic energy?
Question 19 options:
1) 200-pound object traveling 80 MPH

2) 150-pound object traveling 100 MPH
3) 1,000-pound object traveling 40 MPH
4) 500-pound object traveling 90 MPH

A

4) 500-pound object traveling 90mph

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20
Q

Injury resulting from blunt trauma is most often caused by which of the following
forces?
Question 20 options:
1) compression

2) distraction
3) deceleration
4) torsion

A
  1. Compression
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21
Q

Respiratory distress should be anticipated in the patient with which of the
following?
Question 21 options:
1) spinal cord injury above C5

2) herniated thoracic disk
3) hyperextension strain
4) Brown-Sequard syndrome

A
  1. Spinal cord injury above c5
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22
Q

Please define subluxation.

A

Partial dislocation of a joint

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23
Q

define hyphema

A

Blood pooling in the anterior chamber of the eye

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24
Q

Vehicle 1 with a restrained driver and unrestrained front seat passenger was hit on the passenger side causing the vehicle to rollover. The vehicle striking vehicle 1 was driven by a restrained driver with a restrained backseat passenger. A third vehicle with an unrestrained driver attempting to stop hit vehicle 2 from behind as a low speed. Which of the following patients have the greatest mechanism for injury?
Question 24 options:
1) Driver of car 1

2) Driver of car 3
3) Driver of car 2
4) Passenger of car 2

A

1) Driver of car 1

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25
Q

Define cavitation

A

Displacement of tissue from penetrating or blunt trauma

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26
Q

Your patient has been struck in the head with a baseball bat. They are awake, alert and oriented. Their only complaint is head pain. Pulse is 68, blood pressure is 128/78 and respirations are 18 and uncompromised. Physical exam reveals a dilated, unresponsive right pupil. Which of the following is most correct?
Question 26 options:
1) the optic nerve was injured directly

2) this is a previous eye injury
3) there is a left midline brain shift
4) there is a right midline brain shift

A

2) This is a previous eye injury ?????

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27
Q

Which of the following suggests the patient may have a blowout fracture?
Question 27 options:
1) long face and epistaxis

2) double vision and limited eye movement
3) fluid from the ear and epistaxis
4) misaligned jaw and diplopia

A

2) Double vision and limited eye movement

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28
Q

Which of the following are most important in the management of the critical trauma patient?
Question 28 options:
1) spinal immobilization, drug therapy, fluid replacement

2) oxygenation, hemorrhage control, temperature regulation
3) oxygenation, monitoring cardiac rhythm, splint fractures
4) monitoring vital signs, drug therapy, oxygenation

A

2) oxygenation, hemorrhage control, temperature regulation

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29
Q

Early diagnosis of internal hemorrhage in a trauma patient in the pre- hospital setting is dependent on which of the following?
1 evaluation of the mechanism of injury
2 unexplained signs and symptoms of shock
3 absent bowel sounds
4 altered mental status
Question 29 options:
1) 1, 2

2) 1, 4
3) 2, 3
4) 2, 4

A

4) 2, 4

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30
Q

What is the purpose of the rapid assessment in the trauma patient?
Question 30 options:
1) predict injuries based on mechanism

2) provide definitive treatment
3) discover and treat all injuries
4) discover life threatening conditions

A

4) discover life threatening conditions

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31
Q

Please define contrecoup injury.

A

an injury occurring at another site (usually opposite) from the site of impact.

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32
Q

Please define diplopia.

A

double vision

33
Q

Discuss potential concerns surrounding over aggressive fluid resuscitation in an adult patient in hemorrhagic shock. (1 pt)

A

Inability to clot. Too much fluid can result in washing out clots, which are needed to assist the body in stopping the bleed.

Relative anemia. By diluting the blood with too much fluid, the body will interpret this as anemia due to the ratio of RBC’s to total fluid decreasing.

Hypothermia. Unless the fluid is warmed to 101 degrees fahrenheit, the core temperature will drop, which will also affect clotting.

34
Q

The driver of a vehicle struck by another vehicle on the driver’s side door would be expected to present with injuries to which of the following?
Question 34 options:
1) ribs, radius, tibia

2) pelvis, lung, head
3) head, liver, tibia
4) heart, lungs, liver

A

2) pelvis, lung, head

35
Q

Your 22 year old patient has struck their head while skateboarding. Which of the following will be the first sign suggesting the patient is developing an increase in intracranial pressure?
Question 35 options:
1) unilateral pupil dilation

2) altered mental status
3) increased blood pressure
4) nausea and vomiting

A

2) altered mental status

36
Q

Please provide the requesed information for Succinylcholine (Anectine). (5 pts).

A

Class: Depolarizing neuromuscular blocker

Action: Works on skeletal muscle, blocks voluntary muscles

ONSET = 30 - 60 seconds

DURATION = 8 min

Indications/Dose

  • RSI
    • 0.3 - 1.1 mg/kg IV

Contraindications: None

Side effects

  • Fasciculation (muscle shaking)
  • Apnea
  • Malignant hyperthermia
  • Hyperkalemia
37
Q

What is the first phase of multiple organ failure due to shock?
Question 37 options:
1) cellular phase

2) ischemic phase
3) stagnation phase
4) washout phase

A

4) washout phase ???

38
Q

Injuries to which of the following neck areas carry the highest mortality rate?
Question 38 options:
1) zone III

2) zone I
3) zone II

A

2) zone I

39
Q

Please define hemorrhagic anemia.

A

Decrease in RBC’s due to loss of whole blood

40
Q

Your patient was in the room when the boiler exploded. He was thrown
backwards striking the wall on the opposite side of the room rendering
him unconscious. Which of the following blast injury phases is responsible for his
unconsciousness?
Question 40 options:
1) secondary

2) quinary
3) tertiary
4) primary

A

3) tertiary

41
Q

The damage done as a projectile strikes tissue, contuses and tears that tissue
is called what?
Question 41 options:
1) cavitation

2) direct injury
3) pressure shock wave
4) zone of injury

A

2) direct injury

42
Q

What affect should increased intracranial pressure have on the pulse pressure?
Question 42 options:
1) widen

2) narrow
3) no change

A

1) widen

43
Q

Please discuss the differences between a subdural hematoma and an epidural hematoma. Please include pathophysiology, relevant anatomy, and patient presentation of both. (2 pts)

A

Subdural- collection of blood between the dura and the arachnoid mater. Usually occurs from blunt trauma to the head and skull fractures. Involves venous bleeding and is typically slower onset. Can be acute, subacute or chronic depending on how long it takes for symptoms to appear. Presentation includes headache, nausea, vomiting, AMS, dizziness, posturing, dilated pupil on affected side.

Epidural- collection of blood between the cranium and the dura mater. This is rapid developing hematoma of the arterial system, most commonly a laceration of the middle meningeal artery. The bleed and symptoms progress fast and can include a lucid interval and unconsciousness. Other presentations include headache, nausea, vomiting, dizziness, coma, dilated pupil of affected side, posturing, AMS, and lethargy.

44
Q

Your patient was the unrestrained driver involved in a frontal impact MVC. Which
of the following injury patterns would be expected if your patient moved in an
‘up-and-over’ pathway, post the collision?
Question 44 options:
1) hip fracture, broken ankle, pneumothorax

2) C-spine injury, liver laceration, femur fracture
3) femur fracture, lumbar injury, cardiac contusion
4) hip dislocation, tracheal tearing, broken wrists

A

2) C-spine injury, liver laceration, femur fracture

45
Q

A 147lb patient has lost 900ml of blood. Which of the following clinical findings will be seen?
Question 45 options:
1) pulse rate over 150

2) unconscious
3) hypotension
4) narrowed pulse pressure

A

narrowed pulse pressure

46
Q

What is the bullets profile?
Question 46 options:
1) size and shape as it contacts a target

2) path of the bullet
3) diameter of the bullet
4) wobble around the axis of the bullet’s travel

A

Size and shape as it contacts a target

47
Q

Your patient responds by pulling away and moaning after you apply pressure to their nail bed. What is their GCS?
Question 47 options:
1) 8

2) 9
3) 7
4) 6

A

3) 7

48
Q

Your patient has been involved in a head-on collision. He is accessible. Which of the following procedures should be done before removing him from the car?
Question 48 options:
1) start an IV

2) apply oxygen
3) stabilize the neck
4) intubation

A

3) stabilize the neck

49
Q

Define blowout fracture

A

Fracture to the orbital floor

50
Q

Please discuss the relationship between cerebral perfusion pressure (CPP) and mean arterial pressure (MAP) as they relate to an increase in intracranial pressure (ICP). (3 pts)

A

CPP = MAP - ICP

CPP normal 70-90

MAP normal 85 - 95 (need above 60)

ICP normal 5 - 15

If ICP increases, cerebral perfusion pressure will decrease. Because of this, to maintain a healthy CPP, MAP must increase.

Also, if MAP decreases, CPP decreases.

51
Q

Which of the following injuries would you most likely suspect if you saw a patient sitting behind a broken steering wheel?
Question 51 options:
1) fractured pelvis

2) myocardial contusion
3) fractured spleen
4) head injury

A

2) myocardial contusion

52
Q

Based on the laws of energy, which of the following circumstances has the greatest potential for tissue damage if a bullet follows the same path and encounters the same organs?
Question 52 options:
1) 150 grain bullet with 500 ft/sec velocity stopping in tissue

2) 150 grain bullet with 1000 ft/sec velocity stopping in tissue
3) 150 grain bullet with 1000 ft/sec velocity passing through the tissue

A

2) 150 grain bullet with 1000 ft/sec velocity stopping in tissue

53
Q

A 22 year old male patient has sustained a closed head injury while working at a construction site. He is unconscious, posturing to painful stimulus with sluggish pupil response. His pulse is 58 with a blood pressure of 178/72. He is breathing regular at 38 times per minute and his initial pulse oximetry reading is 78%. Which of the following is the most detrimental finding?
Question 53 options:
1) posturing

2) blood pressure
3) pulse rate
4) pulse oximetry

A
  1. Pulse oximetry
54
Q

Your 22-year-old patient was the restrained driver of a vehicle with lateral impact on the driver’s side. They were pulled from the vehicle by bystanders who tell you the patient was unconscious. His pulse is 80, B/P is 140/60 and respirations are 22. He is awake, alert and oriented. Which type of head injury should you suspect? (1 pt)

A

Epidural bleed. It is very lethal and until proven otherwise (which we cannot rule out an epidural bleed in the field, only change suspicion), I’ll assume he can have a lucid interval at any moment

55
Q

Please provide the requested information for Etomidate (amidate). (5 pts).

A

Class: Non benzo sedative hypnotic

Action: Exact measure is unknown but appears to have GABA effects

ONSET = 30 seconds

DURATION = 3-5 min

Indications/ Dosage

  • RSI, procedures
    • 0.2 - 0.6 mg/kg IVP/IO

Contraindications:

  • None

Side effects:

  • Respiratory depression
56
Q

Which two portions of the spinal column are most commonly damaged?
Question 56 options:
1) thoracic, lumbar

2) cervical, thoracic
3) cervical, lumbar
4) lumbar, sacral

A

cervical, thoracic

57
Q

Increase in peripheral vascular resistance can be indirectly measured by
which of the following?
Question 57 options:
1) diastolic blood pressure

2) jugular vein distention
3) pulse rate
4) systolic blood pressure

A

diastolic blood pressure

58
Q

Which of the following nerves is responsible for facial sensation?
Question 58 options:
1) trochlear

2) trigeminal
3) abducnes
4) facial

A

trigeminal

59
Q

Which of the following medications taken by a patient would have the greatest inhibiting effects during the initial stages of hemorrhagic shock?
Question 59 options:
1) ACE inhibitors

2) beta blockers
3) tricyclics
4) MAOI

A

beta blockers

60
Q

Which of the following would hinder the body’s clotting process?
Question 60 options:
1) anemia

2) fever
3) certain drugs
4) dehydration

A

1) Anemia

61
Q

A 23 year old male has been struck multiple times with closed fists to the face, chest and abdomen. He was stabbed twice to the chest. He is short of breath with a pulse of 136, B/P of 72/60 and respirations of 28. Which of the following would most direct your next treatment?
Question 61 options:
1) palpation of the abdomen

2) waveform capnography
3) evaluation of the neck
4) pulse oximetry

A

3) Evaluation of the neck

62
Q

Stages of hemorrhagic shock

A
  • 1: up to 15% blood loss, pulse less than 100, bp normal, normal pulse pressure or increased, respirations 14-20, slightly anxious
  • 2: 15-30% blood loss, pulse 100-120, bp normal, decreased pulse pressure, respiratory rate of 20-30, mildly anxious mental status
  • 3: 30-40% blood loss, pulse 120-140, decreased BP, decreased pulse pressure, respiratory rate of 30-40, anxious and confused
    • 4: greater than 40% blood loss, pulse rate greater than 140, blood pressure decreased, pulse pressure decreased, respiratory rate greater than 35, confused and lethargic
63
Q

Our goal in hemorrhagic shock is to treat the 3 H’s

A

Hypotension

Hypoxia

Hypovolemia

64
Q

Most prominent mechanism of injury associated with spinal cord injury:

A

MVA

65
Q

5 kinds of auto collisions/impacts

A
  • Frontal (head-on) – up and over or down and under
  • Lateral
  • Rear-end
  • Rotational
  • Rollover
66
Q

Most likely head injury with frontal/head on collision

A

open/closed injury, concussion, hemorrhaging

67
Q

3 possible primary collisions in deceleration injury

A

Vehicle hits object, body hits vehicle, and organs collide in body

68
Q

Kinetic energy equation, what part plays the biggest role in energy?

A

KE = ½M x V2

Velocity biggest factor

69
Q

What happens in a concussion to the sodium potassium pump?

A

Doesn’t function properly, become hyperkalemic

70
Q

Dry lime burn to the face =

A

CRITICAL

71
Q

22yo fell from scaffolding, numbness/paralysis of leg. Normal HR, low BP, do what?

A

Give fluids!

72
Q

Trauma mortality highest with injury to what region?

A

HEAD

73
Q

76yo with emphysema burned food and inhaled smoke. SOB with cough, lung sounds diminished/wheezing, do what?

A

Albuterol, give high flow oxygen, ventilate if needed

74
Q

What does NOT require a specialty trauma center?

A

Bilateral femur fracture

75
Q
  • Fluid resuscitation problems in hemorrhagic shock:
A
  • Stops clotting, causes more bleeding
  • Decreases temp
  • Decreases oxygenation (relative anemia)
  • Reverses compensation
  • Kills the pt faster. Titrate to permissive hypotension (BP 90 or MAP 60)
76
Q

Cushings response, 10 steps

A
  1. Brain bleed causes ICP to increase. This causes CPP to drop.
  2. To compensate, a sympathetic response increases HR and BP (aka MAP) to perfuse brain and maintain CPP
  3. When MAP increases, ICP increases, which decreases CPP more and more (positive feedback loop)
  4. Baroreceptors sense hypertension and release acetylcholine which slows the heart(bradycardia)
  5. Systolic pressure rises causing hypertension with wide PP: Epi increases Ino/Chrono/Dromo and both Epi and Acetylcholine are fighting over venous system so no constriction occurs so diastolic stays the same.
  6. Tachypnea starts in order to blow off CO2(vasodilator) to decrease ICP by constricting vasculature. This decreases blood flow/oxygenation of the brain. Continues the cycle
    (Central Neurogenic Hyperventilation Syndrome – Hyperpnea, similar to Kussmauls)
  7. ICP continues to increase due to the bleed and MAP increase
  8. Brainstem herniates, breathing rhythm area is damaged causing irregular respirations (Cheyne-Stokes = crescendo, decrescendo, apnea, repeat)
  9. End stage – Apneustic breathing: continuous inspiration with small expirations back to inhalation. Leads to agonal respirations
  10. CPP continues to decrease (Less than 60 = inadequate perfusion) and brain cells die.

Patient stops breathing and dies

77
Q

Cushings triad

A

Bradycardia, hypertension/ wide PP, irregular respirations

78
Q

What happens when someone is experiencing hemorrhagic shock AND a brain bleed?

A

MAP drops from elsewhere bleeding.

CPP is already dropping due to ICP increase in brain.

Duo effect = dead faster

79
Q

Epidural vs Subdural Bleed

A
  • Epidural:
    • Arterial
    • Between skull and dura, Middle meningeal artery commonly involved here, Herniates brain to foramen magnum
    • Unconscious with lucid intervals, progresses fast
    • Headache/Dizziness/N/V will worsen and mental status will decline as the intracranial pressure rises
    • Dilated pupil on injury side, Weakness on opposite side.

Subdural (most common)

  • Venous
  • Between dura and arachnoid layers, sagittal sinus
  • Slow onset (days to weeks), AMS, mimic stroke
  • Headache/Dizziness/N/V
  • Dilated pupil on injury side, Weakness on opposite side

235 Trauma (6 decks)

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