Chapter 4, Initial Assessment

Question 1

What is the initial assessment A-J mnemonic?

Answer 1

A = Alertness and Airway (with cervical spinal motion restriction ad indicated)
B = Breathing and ventilation
C = Circulation and Control of hemorrhage
D = Disability (neurologic status)
E = Exposure and Environmental control
F = Full set of vital signs and Family presence
G = Get adjuncts and Give comfort using the mnemonic LMNOP
H = History and Head to toe
I = Inspect posterior surfaces
J = Just keep reevaluating

Question 2

What tenant must be kept in mind when preparing to receive a trauma patient?

Answer 2

Safe practice, safe care.

Safe practice: Consider the protection of the team.
Safe care: The patient gets to the right hospital in the right amount of time for the right care.

Question 3

What is the main goal of the general impression and primary survey?

Answer 3

Immediately identify all life-threatening conditions within the first few minutes of arrival.

Question 4

What is the recommended method to clear the cervical spine?

Answer 4

Noncontrast multidetector computed tomography (MDCT)

Question 5

What are two ways to maintain spinal motion restriction?

Answer 5

Manual stabilization
Correctly sized, semi-rigid cervical collar

Question 6

What does the mnemonic AVPU stand for?

Answer 6

A = Alert and oriented
V = Responds to Verbal stimuli
P = Responds only to Painful stimuli
U = Unresponsive (check pulse)

Question 7

How do you open the airway in patient who is unable to open their mouth, responds only to pain, or is unresponsive?

Answer 7

Jaw-thrust maneuver

Question 8

How do you assess proper definitive airway placement?

Answer 8

Assess presence of exhaled CO2 (CO2 detector)
Observe for adequate rise and fall of the chest
Auscultate for presence of gurgling over the epigastrium and presence of bilateral breath sounds

Question 9

How do you determine adequate ventilation?

Answer 9

ETCO2 35-45 mmHg (>50 mmHg signifies depressed ventilation)
SpO2 94-98%

Question 10

How do you assist ventilation with a bag-mask device?

Answer 10

1 breath every 6 seconds (10 breaths per minute)
O2 source at 10-15 L/min

Question 11

What patient population is appropriate to use advanced airways with cuffed tubes?

Answer 11

All ages.

Question 12

At what GCS score should an advanced airway be placed?

Answer 12

GCS of 8 or less.

Question 13

What major assessment parameters produce important information regarding a patient’s circulatory status within seconds of arrival?

Answer 13

LOC
Skin color
Pulse

Question 14

What assessment can help perform an emergent abdominal or pelvic exam?

Answer 14

Focused assessment with sonography for trauma (FAST)

Question 15

How should IV access be obtained in a trauma scenario?

Answer 15

Cannulate two veins with large-caliber intravenous catheters.

Question 16

Blood must be administered with what fluid?

Answer 16

0.9% sodium chloride

Question 17

What are common sites for internal hemorrhage in the trauma patient?

Answer 17

Chest
Abdomen
Pelvis
Long bones

Question 18

Damage control resuscitation (DCR) involves which two strategies?

Answer 18

Hypotensive resuscitation
Hemostatic resuscitation

Question 19

What is the gold standard to evaluate neurologic status?

Answer 19

GCS
3 (unconsciousness) - 15 (alert, converses normally, obeys commands)

Question 20

What interventions help evaluate neurologic status in addition to the GCS?

Answer 20

Computed tomography
ABGs
Glucose, alcohol level, toxicology screening

Question 21

What should be assumed with any changes in level of consciousness?

Answer 21

CNS injury

Question 22

When clothing is removed during the primary assessment where should clothing be stored that might be needed for evidence?

Answer 22

Paper bag and label appropriately

Question 23

Is an assessment of the patient’s posterior required during the primary assessment?

Answer 23

It may be deferred until after the head-to-toe assessment and imaging if needed to evaluate spinal and pelvic stability.

Question 24

How should family members be viewed during a trauma resuscitation?

Answer 24

As an extension of the patient.

Question 25

What does LMNOP stand for under G: Get adjuncts and Give comfort?

Answer 25

L: Laboratory studies
M: Monitor
N: Nasogastric or orogastric tube consideration
O: Oxygenation and ventilation assessment
P: Pain

Question 26

What lactic acid level is associated with poor outcomes?

Answer 26

2-4 mmol/L

Question 27

What additional lab should be considered for those who have suffered burn trauma?

Answer 27

Carboxyhemoglobin

Question 28

What two points are considered during Reevaluation?

Answer 28

Portable radiographs
The need for patient transfer

Question 29

What portable radiographs should be considered during Reevaluation?

Answer 29

Anterior-posterior chest
Pelvis (may be deferred for definitive imaging)
Confirmation of ET, chest, gastric tubes

Question 30

What mnemonic highlights important aspects of a patient’s history?

Answer 30

S: Symptoms
A: Allergies
M: Medications
P: Past medical history
L: Last meal, output, menstrual period
E: Events/Environmental factors r/t the illness/injury

Question 31

What mnemonic helps in the assessment of soft-tissue injuries?

Answer 31

L: Lacerations
A: Abrasions, Avulsions
C: Contusions
E: Edema, Ecchymosis

Question 32

What are two ways to screen for CSF when performing the head-to-toe assessment during the secondary survey?

Answer 32

Halo sign
Test for glucose

Question 33

Why is monitoring urinary output important?

Answer 33

Urinary output reflects end-organ perfusion and is considered a sensitive indicator of the patient’s volume status.

Question 34

What is a prerequisite for inspecting posterior surfaces for a patient with pelvic or spinal trauma?

Answer 34

Complete imaging (may not apply if patient is hemodynamically unstable or has a compromised airway)

Question 35

What should be avoided when rolling a patient to inspect posterior surfaces?

Answer 35

Rolling the patient onto the side of an injured extremity.

Question 36

The major components of the reevaluation can be recalled using what mnemonic?

Answer 36

V: Vital signs
I: Injuries sustained and Interventions performed
P: Primary survey
P: Level of pain