Adult Trauma

Question 1

Pelvic Binder Indications

Answer 1

• Physical exam findings suggestive of a pelvic fracture
• Hemodynamic instability: HR>100 & SBP <90 (or SBP <100 in pts ≥ 65 years of age)
• GCS ≤13

Question 2

SMR Indications

Answer 2

• Midline spinal pain, tenderness or deformity
• Limited cervical spine active range of motion
• Altered mental status
• Alcohol or drug intoxication
• Significant distracting injury
• Insurmountable communication barrier
• Age <5 or >65

Question 3

Trauma Triage Criteria - Injury Patterns

Answer 3

• Penetrating injuries to head, neck, torso, &/or proximal extremities
• Skull deformity, suspected skull fracture
• Suspected spinal injury with new motor/sensory loss
• Chest wall instability, deformity, or suspected flail chest
• Suspected pelvic fracture
• Suspected fracture of two or more proximal long bones in a pt of any age, or one or more proximal long bone fracture in a pt ≤14 or ≥65 years of age
• Suspected open proximal long bone fracture
• Crushed, degloved, mangled, or pulseless extremity
• Amputation proximal to wrist or ankle
• Continued, uncontrolled bleeding despite EMS hemorrhage control measures

Question 4

Trauma Triage Management - Mental Status/Vital Signs

Answer 4

• <65 years of age:
• GCS ≤13
• 265 years of age:
• GCS <15 (or decreased from baseline) with evidence/suspicion of a head strike
RESPIRATORY STATUS
• All pt ages:
• RR <10 or >29 breaths/min
• Resp. distress or need for resp. support o Room-air SpOz <90%
CIRCULATORY STATUS
0-9 years of age:
• SBP <70mm Hg + (2 x age years)
10-64 years of age:
• SBP <90 mmHg OR HR>SBP
265 years of age:
• SBP <100 mmHG OR HR>SBP

Question 5

Trauma Triage Criteria - Mechanism of Injury

Answer 5

• High-Risk Auto Crash
• Rider separated from transport vehicle with significant impact (motorcycle, ATV, horse etc.)
• Pedestrian/bicycle rider thrown, run over, or with significant impact
• Fall from height >10 feet (all ages)

Question 6

Trauma Triage Criteria - EMS Judgement

Answer 6

• Low-level falls in young children (≤5 years of age) or older adults (≥65 years of age) with significant head impact
• Anticoagulant use
• Suspicion of child abuse
• Special, high-resource healthcare needs
• Pregnancy >20 weeks
• Burns in conjunction with trauma

Question 7

3 TBI H-Bombs

Answer 7

• Hyperventilation
• Hypoxia
• Hypotension

Question 8

Who should remove improvised tourniquets?

Answer 8

Prehospital personnel

Question 9

TXA Contraindications

Answer 9

• <15
• Time since injury >3 hrs
• Isolated traumatic brain injury
• Thromboembolic event (i.e., stroke, MI, PE) in past 24 hrs
• Traumatic arrest with >5 mins of CPR without ROSC
• Hypotension secondary to suspected cervical cord injury with motor deficit or spinal shock