Acute Care Block - Trauma Assessment COPY Flashcards
A 16 year old bicycle rider is hit by a truck. She is actively bleeding from bilateral open leg fractures and has abrasions to her chest and abdomen. Her BP is 80/50mmHg, HR is 140/min, RR is 8 breaths per minute and GCS is 6. The first appropriate step in managing this patient is to: Select one:
- Obtain a lateral C spine Xray
- Administer 2 litres crystalloid
- Perform endotracheal intubation and ventilation
- Insert central venous pressure line
- FAST exam (Focused assessment with sonography in trauma is a rapid bedside ultrasound examination)
The first appropriate step in managing this patient is to perform an endotracheal intubation and ventilation
Which of the following injuries will NOT likely be detected in the primary survey? Select one:
- Flail chest with ventilatory insufficiency
- Laryngeal obstruction
- Transection of the thoracic aorta
- Open pneumothorax
- Tension pneumothorax
Transection of the thoracic aorta
Absolute contraindication to nasogastric intubation is the presence of a: Select one:
- Fracture of the cervical spine
- Open depressed skull fracture
- Midface instability
- Diaphragmatic rupture
- Gastric perforation
Midface instability - could imply a base of skull fracture
The cause of upper airway obstruction most likely to be alleviated by a properly placed oral airway is:
Select one:
- Copious tenacious oral secretions
- Facial fractures
- Posterior displacement of the tongue
- Haematoma of the posterior pharynx
- Foreign body
Posterior displacement of the tongue
A 14 year old boy is involved in a gas explosion and is thown 5 metres against a tree. BP is 80/40, HR is 100/min and RR is 32, sats are 89% in air. He has reddened skin on his face and exposed extremeties. He is gasping and says that he ‘can’t breathe’ & is ‘going to die’. The most likely cause of his hypotension is: Select one:
- Haemorrhagic shock
- Severe anxiety
- Neurogenic shock
- Tension pneumothorax
- Delayed resuscitation of burn injury
Unsure what this answer is (Haemorrhagic shock was wrong)
Could be a tension pneumothorax - hypotensive, low O2 sats and breathing difficulties
A 27 year old man involved in a car crash is being prepared for transfer to another facility by air ambulance. He is intubated. Despite normal chest examinations, a small left pneumothorax is discovered on whole body CT scan. Management of the pneumothrax should consist of: Select one:
- Left chest drain insertion
- Needle decompression of the left chest pre transfer
- Needle aspiration of the left chest during transfer if necessary
- Insertion of bilateral thoracostomies pre transfer
- Administration of 100% oxygen
Administration of 100% oxygen
(got this wrong, ‘all i know is needle aspiration of the left chest during transfer’ if necessary was not correct)
A 15 year old boy is knocked of his bike by a car travelling at 40mph. He was unconscious at scene. He arrives in the ED shouting incomprehensibly. He is tachypnoeic. The most appropriate next step is: Select one:
- Insert a chest drain
- Insert an IV line
- Examine the chest
- Sedate and intubate the patient
- Decompress the chest with a 22 gauge needle
Examine the chest
(the boy is talking so clearly his airway is clear - next is to carry out breathing part of ABCDE)
The physiologic hypervolaemia of pregnancy has clinical significance in the management of the severely injured gravid woman by: Select one:
- Reducing the need for blood transfusion
- Increasing the risk of pulmonary oedema
- Complicating the management of closed head injury
- Reducing the volume of crystalloid required for resuscitation
- Increasing the volume of blood loss to produce maternal hypotension
Increasing the volume of blood loss to produce maternal hypotension
A 39 year old man is crushed by a glass plate weighing 450Kg. He has subcutaneous emphysema, dyspneoa and complains of abdominal pain. In the ED, bilateral chest drains are inserted to decompress the pneumothoraces, but he remains tachycardic and hypotensive.The most likely cause for his condition is: Select one:
- Flail chest
- Aortic disruption
- Neurogenic shock
- Cardiac tamponade
- Intra-abdominal haemorrhage
Intra-abdominal haemorrhage
The initial management of a 19year old male with an open book fracture should include:
Select one:
- Laparotomy
- Pelvic packing
- Urgent angiography
- Pelvic splinting
- External operative fixation
Pelvic splinting
A 32 year old man has sustained a left, open femoral fracture with angulation and a profusely bleeding laceration over the fracture site. His BP is 80/60mmHg and HR 130/min. Immediate management should be: Select one:
- Operative reduction of the fracture
- Administration of 2 units packed red blood cells
- Application of a tourniquet to the patients left thigh
- Application of direct pressure to the bleeding wound
- To probe the laceration and clamp the bleeding vessels
Application of direct pressure to the bleeding wound
A 40 year old woman is brought into hospital after a fall from her bike. She was initially unconscious then regained consciousness en route to hospital. Thirty minutes after admission her GCS decreases to 6. Her right pupil is larger than the left. She most likely has sustained: Select one:
- A subdural haematoma
- A subarachnoid haematoma
- A diuse axonal injury
- An extradural haematoma
- An occipital haematoma
An extradural haematoma
A 15 year old girl sustains a head injury after a fall from her skateboard. GCS6, pupils equal and reactive to light. BP 130/80mmHg, HR 80/min.
For optimal outcome, early management of head injury must include: Select one:
- Dierentiating between extradural and subdural haematoma
- Aggressive treatment of systemic hypertension
- Administration of an osmotic diuretic
- Prevention of hypoxia and hypoperfusion
- Hyperventilation
Prevention of hypoxia and hypoperfusion
An intoxicated man is assaulted in a bar. A semi rigid cervical collar is applied & he is immobilized on a scoop stretcher. On initial examination, vital signs are normal and his GCS is 14. Absolute indications for an immediate CT scan are:
Select one:
- Presence of a mandibular fracture
- Presence of haemotympanum
- Witnessed LOC for 3 minutes
- His high blood alcohol levels
- Presence of 5cm scalp laceration
Presence of haemotympanum - can indicate a base of skull fracture which woould be an absolute indication for a CT scan
(Any sign of basal skull fracture (haemotympanum, ‘panda’ eyes, cerebrospinal fluid leakage from the ear or nose, Battle’s sign)(Battle’s sign = bruising over the mastoid process)
(attached is a link for when to CT scan in adults or children after head injury https://www.nice.org.uk/guidance/cg176/resources/imaging-algorithm-pdf-498950893)
In trauma patients, abnormally high intracranial pressure should be suspected when:
Select one:
- RR and HR are irregular and BP rises
- RR and HR are slow and BP falls
- RR are rapid and shallow and rapid, heart rate is rapid and BP falls
- RR and HR become rapid and BP rises
- RR and HR are slow and systolic BP rises
- RR and HR are slow and systolic BP rises - this is Cushing Triad
Cushing triad is a clinical syndrome consisting of hypertension, bradycardia and irregular respiration (bradypnea) and is a sign of impending brain herniation. This occurs when the ICP is too high the elevation of blood pressure is a reflex mechanism to maintain CPP.
A 25 year old man is injured in a car accident. His pupils react sluggishly and his eyes open to painful stimuli. He does not obey commands, but he does moan periodically. His left arm is deformed and does not respond to painful stimuli but his right hand reaches purposefully towards painful stimulus. Both legs extend stiffly. His GCS score is: Select one:
4
2
9
12
6
9
Eye opening response, best verbal response, best motor response
- E- 2 (open to pain)
- V- 2 (incomprehensible sounds)
- M-5 (right arm moves to localised pain)
