Chapter 1

Question 1

Trimodal death distrubution is…

Answer 1

Peak 1: seconds-minutes-> brain or spinal cord injury or rupture of heart, aorta, large BV
Peak 2: minutes-hours-> bleeding into head, chest or abdomen.
Peak 3: days-weeks-> sepsis, multiorgan system failure

Question 2

In multiple casualties, who do you take first?

Answer 2

Number of patients and severity of injuries does not exceed hospital capability so take most injured patient first

Question 3

In mass casualties, who do you take first?

Answer 3

Number of patients and severity of injuries DOES exceed hospital capability so take those least injured with greatest chance of survival.

Question 4

ABCDE

Answer 4

Airway maintenance with cervical spine precautions
Breathing and ventilation
Circulation with hemorrhage control
Disability: Neuro status
Exposure/Environmental Control: Completely undress patient, but prevent hypothermia

Question 5

How can you quickly assess ABCD?

Answer 5

Ask patient there name. If able to respond, then ABC is good.

Question 6

What does airway management comprise of?

Answer 6

Suctioning, clearing airway, administering o2, securing airway

Question 7

Get a cervical spine x ray to rule out cervical spine injury. however this detects only (blank) % of those injuries

Answer 7

85%

Question 8

If patient has a pneumothorax and you intubate with vigorous bag mask ventilation then you can deteriorate the patient. So what should you do as soon as you intubate a patient?

Answer 8

get cxr.

try to figure out they have a pneumo before you intubate though

Question 9

Three ways to quickly assess circulation?

Answer 9

Pulse, mental status, skin color

Question 10

hemorrhage-> first line?

Answer 10

Pressure

only use a tourniquette if the patient is gonna die from bleeding out because it can cause ischemia and damage

Question 11

These patients do not respond to blood loss like everyone else

1) elderly do not show signs of (blank)
2) pediatrics have high (blank) and do not show signs of hypotension until it is catastrophic.
3) athletes do not show signs of (blank)

Answer 11

Elderly: No tachycardia
Peds: high reserve, no tachy or low BP until it is too late.
Athletes: no tachycardia, sometimes bradycardic and have high reserve

Question 12

You have just inserted an IV in your patient and are running fluids, what labs do you want to get?

Answer 12

pregnancy test
Lactate and ABG
Type and Cross
PT/INR

Question 13

What should you do to your IV fluids before putting them in?

Answer 13

warm them

Question 14

PEA should suggest what problems?

Answer 14

Cardiac tamponade
Tension pneumo
Profound hypovolemia

Question 15

Which x rays do you need?

Answer 15

AP CXR
AP Pelvic
(even in pregnant patients)

Question 16

When do you do the secondary survey?

Answer 16

Once primary survey is completed, resuscitative efforts are underway, vital signs are normalizing

Question 17

What is involved in the secondary survery?

Answer 17

Complete head to to eval
Neuro exam
X-rays
Labs

Question 18

What do you need to know with automobile collisions?

Answer 18

1) were they wearing a seat belt
2) steering wheel deformation
3) Direction of impact
4) ejection
5) deformation of vehicle

Question 19

What injuries do you suspect in a patient with a frontal impact?

Answer 19

• posterior fracture/dislocation of hip and/or knee
• Pneumothorax
• Myocardial contusion
• Cervical spine fracture
• anterior flail chest
• traumatic aortic disruption
• splenic or liver lac

Question 20

What injuries do you suspect in a patient with a side impact MVC?

Answer 20

contralateral neck sprain
cervical spine fracture
lateral flail chest
pneumothorax
traumatic aortic disruption
diaphragm rupture
fractured spleen/liver/kidney
fractures plevis or acetabulum

Question 21

What injuries do you suspect in a patient with a Rear impact MVC?

Answer 21

Cervical spine injury

soft tissue injury to neck

Question 22

What injuries do you suspect in a patient with Ejection from vehicle?

Answer 22

no predictable injuries, but injuries are likely massive

Question 23

What injuries do you suspect in a patient with Motor vehicle impact with pedestrian?

Answer 23

• Head injury
• Traumatic aortic disruption
• Abdominal visceral injuries
• Fractured lower extremities/pelvis

Question 24

What BV are you worried about in patients with seat belt sign?

Answer 24

Carotids-> make sure to listen for bruits.