Approach to Trauma

Question 1

what is major trauma

Answer 1

• death after injury
• iss >12
• icu admission >24 hrs requiring mechanical ventilation
• urgent surgery for intracranial, intrathoracic, or intraabdominal injury
• surgery for fixation of pelvic/spinal fractures

Question 2

most reported risk factor for vehicle related injuries

Answer 2

alcohol

Question 3

leading cause of injury-related deaths

Answer 3

road traffic injuries

Question 4

most common causes of death after trauma

Answer 4

traumatic brain injury

hemorrhage / exsanguination

Question 5

trauma induced coagulopathy is associated with ___

Answer 5

• increased transfusion requirements
• risk of complications
• mortality

Question 6

majority of post traumatic bleeding is __

Answer 6

noncoagulopathic

coagulopathic is unusual = failure to form hemostatic clot

Question 7

t/f coagulopathic bleeding can be stopped with mechanical interventions

Answer 7

false, this is noncoag. coag involved bleeding of uninjured sites

Question 8

pathway involving apc

Answer 8

hypoperfusion -> inc thrombomodulin activity -> inc apc -> inc coagulopathy and fibrinolysis

Question 9

what is apc

Answer 9

• anticoagulant: inactivates factors 5a and 8a
• profibrinolytic: inhibits plasminogen activator inhibitor
• cytoprotective: activates anti-inflammatory and anti-apoptotic cell signaling pathways

Question 10

what is thrombomodulin

Answer 10

• cofactor for protein c

- inhibits procoagulant functions of thrombin

Question 11

mechanisms that lead to tic

Answer 11

• coagulation activation
• hyperfibrinogenolysis
• consumption coagulopathy

Question 12

goal of prehospital care

Answer 12

initial immediate resuscitation

• airway maintenance
• control external bleeding and shock
• immobilization
• immediate transport

Question 13

advanced trauma life support principles

Answer 13

• assess mechanism of injury

- always immobilize cervical spine

Question 14

indications for definitive airway

Answer 14

AA8MAX OBSTRUCT90 OTHERS

• apnea
• protection from aspiration
• gcs <8
• severe maxillofacial fractures
• risk for obstruction (neck hematoma, laryngeal or tracheal injury)
• impending airway compromise (burns, inhalational injury)
• inability to maintain sp02 >90% by face mask

Question 15

triangle of safety

Answer 15

• base of axilla
• lateral edge of latissimus dorsi
• 5th intercostal space
• lateral edge of pectoralis major

Question 16

the neurovascular bundle is __ the rib

Answer 16

below, so incision should be above the rib

Question 17

t/f chest drains are inserted in the prehospital setting

Answer 17

false, increases time on the scene and high risk

Question 18

methods to stop bleed

Answer 18

• tourniquets
• pelvic binders
• hemostatic dressings
• resuscitative endovascular balloon occlusion of the aorta
• thoracotomy

Question 19

t/f gcs score helps because motor score correlates to outcome

Answer 19

true

Question 20

what is abcde (primary survey)

Answer 20

airway
breathing
circulatory
disability
exposure

Question 21

deadly triad

Answer 21

acidosis, hypothermia, coagulopathy

Question 22

ample history

Answer 22

allergies
medications
past medical history, pregnancy
last meal
environment, events leading to injury

Question 23

what is “replace like for like”

Answer 23

• blood = blood and fresh frozen plasma (1:1:1)
• to achieve hemostasis or reduce risk of exsanguination within 24 hrs
• give calcium gluconate to prevent hypocalcemia secondary to transfusion

Question 24

t/f imaging can be done if patient is not stable

Answer 24

false

Question 25

what is fast

Answer 25

• focused assessment with sonography

- to detect pericardial effusion or free-flowing fluid in the abdomen

Question 26

t/f giving txa early (<1 hr from injury) reduces risk of death due to bleeding

Answer 26

true, detrimental after 3 hrs

Question 27

golden time to give txa

Answer 27

1-3 hrs