Chapter 1

Question 1

What is the systematic approach to all injured patients? (8)

Answer 1

1) Preparation
2) Triage
3) Primary survey with resuscitation of life threatening injuries
4) Adjuncts to primary survey and resus
5) Secondary survey
6) Adjuncts to secondary survey
7) Post resuscitation monitoring and re-evaluation
8) Definitive care

Question 2

What are the objectives of the pre-hospital team? (5)

Answer 2

1) Notify the receiving hospital
2) Maintain airway
3) Control of external hemorrhage and shock
4) Immobility
5) Immediate transport to the nearest health facility

Question 3

What important info should the prehospital team obtain for triage? (3)

Answer 3

1) Time of injury
2) Events related to injury
3) Patient history

Question 4

Which injured patients warrant care at a trauma center providing the highest level of care? (11)

Answer 4

1) GCS <13
2) sBP <90
3) Resp rate <10/ >29 (<20 in infants)/ needing ventilatory support
4) Penetrating trauma to head, neck, torso, extremities proximal to elbow/knee
5) Chest wall deformity/instability
6) 2 or more proximal long bone fractures
7) Crushed/Degloved/Mangled/Pulseless extremity
8) Amputation proximal to wrist/ankle
9) Pelvic fractures
10) Depressed/open skull fracture
11) Paralysis

Question 5

What is needed for hospital phase preparation? (5)

Answer 5

1) A resus area for trauma patients
2) Functioning airway equipment
3) Warmed IV crystalloid solutions
4) Protocol for additional medical assistance and prompt lab/radiology assistance
5) Transfer agreements that are operational and established

Question 6

Minimum PPE requirements? (4)

Answer 6

1) Gloves
2) Facemask
3) Eye protection
4) Gown (water impervious)

Question 7

What does triage involve?

Answer 7

Sorting of patients based on resources required for treatment and resources that are actually available

Question 8

What are multiple casualties?

Answer 8

The number of patients and severity of injuries do not exceed the hospitals capability to render care

Question 9

What are mass casualties?

Answer 9

The number of patients and severity of injuries does exceed the facility- and staffs capability to render care

Question 10

Which injuries would you suspect in a frontal impact collision? (9)

Answer 10

1) C spine fracture
2) Anterior flail chest
3) Myocardial contusion
4) Pneumothorax
5) Traumatic aortic disruption
6) Spleen/liver fracture
7) Posterior fracture/dislocation of hip/knee
8) Head injury
9) Facial fractures

Question 11

What injuries would you suspect in a side impact automobile collision? (9)

Answer 11

1) Contralateral neck sprain
2) Head injury
3) Cspine fracture
4) Lateral flail chest
5) Pneumothorax
6) Traumatic aortic disruption
7) Diaphragm rupture
8) Fractured liver/spleen/kidney
9) Fractured pelvis/acetabulum

Question 12

What injuries would you suspect in a rear impact collision? (3)

Answer 12

1) C spine fracture
2) Head injury
3) Soft tissue injury to neck

Question 13

Ejection from vehicle?

Answer 13

Virtually all injury mechanisms

Question 14

What injuries are expected when there is motor vehicle impact with a pedestrian? (4)

Answer 14

1) Head injury
2) Traumatic aortic disruption
3) Abdominal visceral injuries
4) Fractured lower extremities/pelvis

Question 15

Which injuries are expected after a fall from a height? (5)

Answer 15

1) Head injury
2) Axial spine injury
3) Abdominal visceral injuries
4) Fractured pelvis/acetabulum
5) Bilateral lower extremity fractures (including calcaneus)

Question 16

Injuries from anterior chest stab wound? (4)

Answer 16

1) Tamponade
2) Hemothorax
3) Pneumothorax
4) Hemopneumothorax

Question 17

Injuries from left thoracoabdominal stab wound? (3)

Answer 17

1) Left diaphragm injury
2) Spleen injury
3) Hemopneumothorax

Question 18

Stab wound to abdomen?

Answer 18

Abdominal visceral injury if peritoneal penetration

Question 19

What different burn injuries are to be expected and what are their complications? (3+7)

Answer 19

1) Thermal - circumferential eschar/occult trauma
2) Electrical - cardiac arrhythmias/myonecrosis
3) Inhalational - CO poisoning/upper airway swelling/pulmonary oedema

Question 20

What is the first thing to assess in a trauma patient?

Answer 20

Airway patency

Question 21

Which injuries can significantly impair ventilation in the short term? (4)

Answer 21

1) Tension pneumothorax
2) Open pneumothorax
3) Massive haemothorax
4) Bronchial/Trachea injuries

Question 22

What 3 clinical parameters are used to determine blood volume and cardiac output? (3)

Answer 22

1) Level of consciousness
2) Skin perfusion
3) Pulse

Question 23

True or false: Tourniquet use is recommended in all cases of hemorrhage?

Answer 23

False

Only when direct pressure is not effective and the patients life is threatened

Question 24

What are the major areas of internal hemorrhage in trauma patients? (5)

Answer 24

1) Chest
2) Abdomen
3) Retroperitoneum
4) Pelvis
5) Long bones

Question 25

True or false: In a patient with hypovolaemic shock secondary to hemorrhage, if the patient did not respond to initial crystalloid therapy, one can safely give more crystalloids.

Answer 25

False

The patient needs a blood transfusion

Question 26

Within how many hours of injury can tranexamic acid be given?

Answer 26

3 hours

Question 27

How can one avoid equipment failure?

Answer 27

• Test equipment regularly

- Ensure spare equipment and batteries are available

Question 28

How can one adequately prepare for a unsuccessful intubation? (4)

Answer 28

1) Identify patients with difficult airway anatomy
2) Identify the most experienced/skilled airway manager in your team
3) Ensure appropriate equipment available
4) Be prepared for a surgical airway

Question 29

What should one look for during the neurological evaluation? (4)

Answer 29

1) Level of consciousness
2) Pupillary size and reaction
3) Lateralizing signs
4) Spinal cord injury level if present

Question 30

How can one manage hypothermia on admission ? (3)

Answer 30

1) warm environment
2) warm blankets
3) warm IV fluids

Question 31

What additional step is needed to manage hypothermia after admission? (1)

Answer 31

Control the hemorrhage rapidly

Question 32

What are the adjuncts to the primary survey? (10)

Answer 32

1) continuous ecg
2) pulse oximetry
3) capnography
4) ventilation rate
5) ABG
6) urine catheter
7) gastric catheter
8) xrays
9) EFAST
10) DPL

Question 33

What signs suggest a urethral injury? (2)

Answer 33

1) Blood at the meatus

2) Perineal ecchymosis

Question 34

Important info to obtain from MVA (7)

Answer 34

1) Seat belt use
2) Steering wheel deformation
3) Air bag activation
4) Direction of impact
5) Deformation/intrusion into passenger compartment
6) Patient position
7) Ejection