Community and palliative care

Question 1

What is major trauma?

Answer 1

Serious and often multiple injuries where there is a strong possibility of morbidity and mortality

Question 2

Why is trauma important?

Answer 2

4th leading cause of death in the west, Leading cause of death in first four decades. economically important population

Question 3

What is the trauma system in UK?

Answer 3

Major trauma centers where some see adults and children others only a few

Question 4

What is acronym for assessment in major trauma/

Answer 4

CABCDE
Control catastrophic haemorrhage
Airway with C-spine protection
Breathing with ventilation
Cirulation with haemorrhage conrol
Disability Neuro status
Exposure and environment

Question 5

What are key areas of trauma assessment?

Answer 5

Preparation Triage, Primary survey, Resusitation, Scanning and definitive care

Question 6

What is the key part to preparing for major trauma about the patient?

Answer 6

What is the mechanism of injury

Question 7

What kind of injuries are found in RTC?

Answer 7

Cervical spine injuries, Bulunt thoracic cardiac injury, Hollow viscus perforation solid organ injury Pelive acetabler femur injuries

Question 8

What injuries are more common inmotorcycling/

Answer 8

Pelvic injuries but also anything

Question 9

What injuries do you get in a fall from height?

Answer 9

amlost anything

Question 10

What kind of injuries can you get from assault?

Answer 10

Head injuries and stamps to abdomen or chest stab wounds follow the track

Question 11

What are the risks with gunshot wounds?

Answer 11

Depends on bullets, depeds on kinetics, Bullet can tumble which causes displacement of tissue

Question 12

What are common spot major trauma injuries?

Answer 12

Opn fractures motorcross, fighting in football splenic renal injury in rugby.

Question 13

What are the types of injur found in a blast?

Answer 13

Primary Disrupts gas filled structures
Secondary Impact airborn Debris
Tertiary Transmission of body
Quaternary all other forces

Question 14

What are priority treatments for major trauma

Answer 14

Stop bleeding prevent hypoxia, prevent acidaemia, avoid traumatic cardiac arrest

Question 15

How to hand over trauma patient?

Answer 15

A Age
T Time
M Mechanism
I Injuries
S Signs observtions
T treatments

Question 16

What can be used to treat the Catesrophic haemorrhage/

Answer 16

Clear any clots obscuring bleed, Direct pressure then more pressure indirect pressure tonriquet or haemostatic agents Ceelox

Question 17

What are some aboslutie indications for intubation?

Answer 17

Inability to protect own airway, inability to maintain adequate oygenation with less invasive measures, inability to maintain normocapnia deteriorating consios level. Significant facial injuries sieszures

Question 18

What are relative indications for intubation?

Answer 18

Agitatied patients, haemorragic shock with metabolic acidosis, multile paiful injuries, trasfer to another area of hospital

Question 19

When do you immobilise the c spine/

Answer 19

Risk of injury to there. older patitens, Spodylosis RA, diving into water axial load

Question 20

What are causes of lifethreatening thoracic injuries?

Answer 20

Airway obstruction/disruption, tensin pneumothorax, open pneumothorax,flail chest, cardiac tamponade. ATOMFC

Question 21

What is management of pneumothroax?

Answer 21

Needle thoracocentisis 2nd IC mid clavicular line or thoracostomy followed by large bore chest drain.

Question 22

What is an open pneumothorax?

Answer 22

When wound to chest wall communicating with pleaural cavity. air moves down pressure gradient int peleural space wound seald on expiration

Question 23

What is flail chest?

Answer 23

When ribs broken in two places in two or more ribs, get paradoxical movement of ribs during respiration

Question 24

Signs of cardiac tamponade?

Answer 24

Beck’s triad, Hypotension diminished heart sounds distended neck veins, tachycardia

Question 25

What is purpose of secondary survey?

Answer 25

ind injuries that are likely to cause morbididty and potentially deadly but in slower time

Question 26

What are some secondary survey injuries

Answer 26

simple pneumothorax, aortic injuries diaphragmatic injuries, fractured ribs, lung contusions cardiac contusion

Question 27

What are signs of bleeding patients?

Answer 27

Anxious confused, sweaty diaphoretic, pallor peripherally cool, tachypneoeic, tachycardic, narrow pulse pressure hypotensio bradycardia arrest.

Question 28

What are sites of major bleeding in patients?

Answer 28

Long bones ( pelvis, febur, humerous
Visceral injuries (liver
Chest ( c
External haemorrhge,

Question 29

What is abdominal bleeding facts?

Answer 29

not all abdo bleeding causes peritonitis included retroperitoneal organs, perforations can be no examination signs, subtle, blunt force can cause it. Needs a scan

Question 30

How to treat pelvic fracture?

Answer 30

Pelvic binder to close the area and rejoin the break

Question 31

What is permissive hypotension?

Answer 31

When you allow a lower BP so that massive haemorrage can be controlled

Question 32

What is best fluid to use in trauma?

Answer 32

Red cells platelets and cryoprecipitate

Question 33

What are three factors to control in haemorrhage to avoid secondary problems?

Answer 33

Coagulopathy, Acidosis, Hypothermia

Question 34

When to treat blod product administration,

Answer 34

HR over 130 reduced GCS, obvious blood loss, systolic BP <90

Question 35

How can you stop bleeding (mild)?

Answer 35

Tranexamic acid

Question 36

What are secondart brain injuries?

Answer 36

hypoxic or hypoperfusion injuries

Question 37

What is cerebral perfusion pressure?

Answer 37

The pressure supplied to brain wich is MAP-ICP

Question 38

What BP for brain perfusion?

Answer 38

about 100 systolic so around normal

Question 39

What is cushings reflex?

Answer 39

HR lower BP high resp rate slowing

Question 40

What is the importance of pain in trauma?

Answer 40

Best outcome is with pain relief reduces PTSD as well