3 - Primary / Secondary

Question 1

Who determines the disposition of the trauma patient?

Answer 1

Trauma surgeon

Question 2

Who is normally the first to report injuries?

Answer 2

HEENT

Question 3

Who documents everything in the trauma bay?

Answer 3

Scribe

Question 4

Who administers the meds ordered by the provider?

Answer 4

Circulating nurse

Question 5

What imaging modalities are available at bedside in the trauma bay?

Answer 5

Ultrasound

Plain films

Question 6

Steps of patient arrival in trauma bay

Answer 6

EMS brings patient in

All clothing removed (if not already done by EMS)

Primary survey immediately performed

Secondary survey starts by HEENT and clavicles-down

Trauma surgeon asks for EMS report

Imaging (CXR, ABD xray, obvious Fx and FAST exam)

Question 7

Primary survey includes:

Answer 7

XABCDE

Addresses life, limb, eyesight

Question 8

Secondary survey includes

Answer 8

Hx

Head to toe

Add’l imaging that wasn’t already accomplished during primary survey

Consult specialists based on injuries

Question 9

Tertiary survey includes

Answer 9

Basically anything that wasn’t done in primary or secondary

This is after the imaging stuff has been evaluated by radiologists and the various consultants have seen the patient

Question 10

Potential dispositions from the trauma bay:

Answer 10

Rush to OR

Send for advanced imaging (CT / angio)

Admit

“Downgrade” (hold in ED until imaging read, make disposition later; close lacs, reduce Fx, splint and discharge)

Question 11

Common examples of blunt trauma

Answer 11

Fall (either from standing or from height)

Motor vehicle crashes

Alleged assault

Closed head/neck injuries

Extremity fx’s

Chest trauma

ABD/GU trauma

Question 12

Common sequelae of falls from standing height?

Answer 12

Head bleed (especially if on anticoagulants)(think old folks falling from standing height that say they feel fine, meanwhile they’ve got a slow bleed developing)

Question 13

Prophlyatic treatment to consider following patient presenting with lac?

Answer 13

Tetanus

Question 14

Fall from height is considered anything higher than:

Answer 14

3 to 6 feet (so even just missing a few steps would be considered “from height” as opposed to “from standing height”)

Question 15

Minimum care for fall from height should include:

Answer 15

Head CT

Imaging of any bone pain

Close lacs

Update tetanus

Question 16

Rapid deceleration injury is usually associated with MVC’s, but can also be caused by:

Answer 16

Fall from extreme height

Question 17

Sequelae of chest trauma:

Answer 17

Pneumothorax
Hemothorax
Pericardial effusion / tamponade
Diaphragmatic hernia
Aortic transection
Rib Fx

Question 18

Sequelae of ABD trauma

Answer 18

Liver / spleen injuries
Kidney injuries
Hollow viscous organ injury
Bladder injury

Question 19

Name some examples of injuries that can be treated without surgery:

Answer 19

Stable intracranial bleeds
Simple / tension PTX
Hemothorax
Rib Fx’s
Lacs
Small fx’s

Question 20

How is a PTX normally treated?

Answer 20

Thoracostomy

Question 21

What imaging best shows a hemothorax and also tells you where to place your chest tube?

Answer 21

Upright plain films

Question 22

How is pericardial effusion emergently treated?

Answer 22

Pericardiocentesis (pull off that fluid)

Question 23

Diaphragmatic hernia is normally on which side of the chest?

Answer 23

Left

Question 24

Txt for diagrammatic hernia ?

Answer 24

Decompress the stomach

Then surgery to close the rent

Question 25

Which traumatic injury results in over 80% of patients dying on scene?

Answer 25

Aortic transection

Question 26

Management of rib fractures

Answer 26

Adequate pain control very important (either narcs or epidural)

Commonly concurrent PTX

Can lead to atelectasis / pneumonia

Question 27

Txt for flail segment (multiple fractured ribs)?

Answer 27

Rib plates (metal ribs, basically? Slide 20)

Question 28

You can treat liver or spleen lacs non-operatively if:

Answer 28

The hematoma is contained and patient remains hemodynamically stable

Low threshold to take to the OR

Question 29

Kidneys are less commonly injured during trauma because of:

Answer 29

Their location (retroperitoneal)

Question 30

Hollow viscous organs of the abdomen include?

Answer 30

Stomach, intestines, gall bladder, uterus, bladder

Question 31

CT sign of hollow viscous organ injury?

Answer 31

Fat stranding

If seen, highly likely that there is a violation of the lumen and subsequent inflammation

Question 32

During a pelvic fx, we need to be highly suspicious of:

Answer 32

Urethral or bladder injury

Question 33

Three hard signs of a urethral injury:

Answer 33

High riding prostate

Blood at urethral meatus

Gross blood during rectal

*do a RUG prior to cath

Question 34

Widened mediastinum, ABD free air/fluid, or extravasated contrast are all indications that the patient probably going to need:

Answer 34

Surgery

Question 35

Why does almost all penetrating ABD injury go to the OR?

Answer 35

Succus leak -> peritonitis -> sepsis -> shock -> death

*most penetrating CHEST trauma managed non-operatively

Question 36

Emergent procedures (in the trauma bay)

Answer 36

Thoracotomy (open em up)

*rush to OR for uncontrollable bleeding

Question 37

Examples of urgent procedures include:

Answer 37

Stuff done in the OR, normally

Thoracostomy after needle decomp

Suprapubic catheter if urethral injury

Exploratory lap

Question 38

Admission dispositions include

Answer 38

ICU (many types)

Tele

Med

Question 39

Features of ICU includes:

Answer 39

Q1H VS

Ventilator management

ECMO

Constant tele monitoring

CIWA protocol (EtOH withdrawal)

1:1 or 1:2 nursing

Multidisciplinary approach

Question 40

Features of tele floors

Answer 40

Constant ECG monitoring

1: 3-4 nursing

Q4H VS

Question 41

Features of medical floors

Answer 41

Low acuity patients

1: 6-8 nursing

Q4H VS

Question 42

I used to hate facial hair

Answer 42

But then it grew on me