29.7 Primary and Secondary Survey

Question 1

The Primary Survey for both ATLS and TCCC consists of ___ systematic steps to assess life threatening injuries with slight variations

Answer 1

5

Question 2

In ATLS, the focus is

Answer 2

Airway, Breathing and Circulation due to the nature of most injuries.

Question 3

In TCCC, the focus is to

Answer 3

stop life-threatening hemorrhage first and then continue with Airway, Respirations (breathing in ATLS), Circulation and ending with Head Injury/Hypothermia.

Question 4

Most casualties during combat are the result of ______ ______, rather than the blunt trauma seen in the civilian setting.

Answer 4

penetrating injuries

Question 5

In addition to the medical differences between civilian and combat trauma, several other factors affect casualty in combat, including the following:

Answer 5

(1) Hostile fire may be present, preventing the treatment of casualty.
(2) Medical equipment is limited to that carried by mission personnel.
(3) Tactical considerations may dictate that mission completion take precedence over casualty care.
(4) Time until CASEVAC is highly variable (from minutes to hours or days).
(5) CASEVAC may not be possible, based on the tactical situation.

Question 6

In general, loss of up to what percent of circulating blood volume is tolerated well in healthy patients

Answer 6

loss of up to 15 percent (about 750 mL) volume (class I hemorrhage)

Question 7

Blood loss of what percent of total blood volume generally results in tachycardia and narrowed pulse pressure

Answer 7

Blood loss of 15 to 30 percent (about 750 to 1500 mL) of total blood volume(class II hemorrhage)

Question 8

As blood loss increases beyond what percent there is worsening hypotension, tachycardia, peripheral hypo perfusion, and decline in mental status

Answer 8

beyond 30 percent (1500 mL) (class III hemorrhage)

Question 9

At greater than what percent of blood loss the ability of the body to compensate has reached its limits and hemodynamic decompensation is imminent without effective resuscitation

Answer 9

greater than 40 percent (2 Liters) blood loss (class IV hemorrhage)

Question 10

Ability to speak and effective movement of air with respiration indicates

Answer 10

Airway patency

Question 11

With suspected basilar skull fracture avoid

Answer 11

nasal airway insertion

Question 12

Circulation is divided into 2 parts

Answer 12

Hemodynamic Status and Hemorrhage Control

Question 13

Decreased cerebral perfusion may result in altered mental status. The patient’s pulse is easily accessible, and if palpable, the systolic blood pressure in millimeters of mercury (mm Hg) can be roughly determined as followed in hemodynamic patients

Answer 13

(1Radial Pulse: pressure ≥ 80 mmHg
(2Femoral Pulse: pressure ≥ 70 mmHg
(3Carotid Pulse: pressure ≥ 60 mmHg

Question 14

When should an abbreviated neurologic evaluation should be performed

Answer 14

once the massive hemorrhage is controlled, airway is patent, breathing evaluated and the patient is stable hemodynamically

Question 15

A patient’s pertinent past medical history must be obtained. A useful mnemonic is the word “AMPLE”

Answer 15

(1) Allergies
(2) Medications and nutritional supplements
(3) Past medical illnesses and injuries
(4) Last meal
(5) Events associated to the injury

Question 16

What is a Secondary survey of a Trauma Patient

Answer 16

Secondary Survey is a head-to-toe physical examination, to include a reassessment of vital signs.

Question 17

Hemotympanum and/or disruption of the auditory canal on otoscopic exam are additional findings suggestive of a

Answer 17

basilar skull fracture

Question 18

Basilar skull fractures are suggested by the presence of bruising around

Answer 18

eyes(raccoon’s eyes) or behind the ears (Battle’s sign).

Question 19

1)Most commonly injured organ in blunt trauma
2)Often associated with other injuries
3)Left lower rib pain may be indicative
4)Often can be managed non-operatively

Answer 19

Splenic Injuries

Question 20

1)Second most common solid organ injury
2)Can be difficult to manage surgically
3)Often associated with other abdominal injuries

Answer 20

Liver injuries

Question 21

What is the first sign of compartment syndrome

Answer 21

• Pain is the first sign of ischemia and should be aggressively evaluated
• The unconscious patient who cannot verbalize the presence of pain is at particular risk because of potential for delay in diagnosis