Approach to the trauma patient

Question 1

The Primary Survey

Answer 1

○ Airway Maintenance with C-Spine Protection
○ Breathing and Ventilation
○ Circulation with Hemorrhage Control
○ Disability (Neurologic Evaluation)
○ Exposure and Environmental Control

Question 2

Adjuncts to Primary Survey and Resuscitation

Answer 2

○ Electrocardiographic Monitoring
○ Urinary and Gastric Catheters
○ Other Monitoring
○ X-Ray Examinations and Diagnostic Studies

Question 3

Assume a _____ in patients with blunt multisystem trauma, especially those with an altered level of consciousness or a blunt injury
above the clavicle

Answer 3

cervical spine injury

Question 4

______ is the predominant cause of preventable deaths after injury.

Answer 4

Hemorrhage

Question 5

Identify potential source(s) of internal hemorrhage

Answer 5

The 4 big ones: Chest, abdomen, pelvis, and femur Fx

Question 6

Exposure/Environmental Control: step 1 (and only)

Answer 6

○ Completely undress the patient, but prevent hypothermia.
■ The patient should be completely undressed, usually by cutting off
his or her clothing to facilitate a thorough examination and assessment. After the patient’s clothing has been removed and the assessment is completed, the patient should be covered with warm blankets or an external warming device to prevent hypothermia.
■ Intravenous fluids should be warmed before being infused, and a warm environment (i.e., room temperature) should be maintained.
The patient’s body temperature is more important than the comfort
of the healthcare providers

Question 7

What is the secondary survey and when does it start?

Answer 7

The secondary survey does not begin until the primary survey (ABCDEs) is completed, resuscitative efforts are underway, and
the normalization of vital functions has been demonstrated.
○ When additional personnel are available, part of the secondary survey may be conducted while the other personnel attend to the primary survey.
● The secondary survey is a head-to-toe evaluation of the trauma patient, that
is, a complete history and physical examination, including reassessment of
all vital signs

Question 8

Obtain AMPLE history from patient, family, or prehospital personnel.

Answer 8

■ Allergies
■ Medications currently used
■ Past illnesses/Pregnancy
■ Last meal
■ Events/Environment related to the injury

Question 9

Patients with _____ be presumed to have an
unstable cervical spine injury (e.g., fracture and/or ligament injury), and the neck
should be immobilized until all aspects of the cervical spine have been
adequately studied and an injury has been excluded

Answer 9

maxillofacial or head trauma should

Question 10

Consider the need for and obtain these diagnostic tests as the patient’s condition permits and warrants:

Answer 10

■ Spinal x-rays
■ CT of the head, chest, abdomen, and/or spine
■ Contrast urography
■ Angiography
■ Extremity x-rays
■ Transesophageal ultrasound
■ Bronchoscopy
■ Esophagoscopy