CSIM2.5 MOF & Critical Illness

Question 1

5 Reasons for Trauma Call

Answer 1

Physiological Triggers 
Anatomical triggers
High Risk Mech of Injury
Multiple trauma victims
Discretionary

Question 2

Physiological Triggers

Answer 2

Potential or actual airway compromise
RR<10 or >29
Systolic BP < 90 or P>130
GCS < 14

Question 3

Anatomical triggers

Answer 3

Flail chest
All penetrating trauma to head, torso & extremities (except distal limb)
2 or more proximal long bone #
Amputations proximal to wrist or ankle
Suspected significant pelvic #
Significant burn or enclosure
Paralysis
Age > 65 + trauma to >1 body zone

Question 4

High Risk Mech of Injury

Answer 4

High risk RTC eg. Significant intrusion, ejection, death in same compartment
Car vs. Pedestrian/cyclist thrown, run over or with significant impact (>20mph)
Motorcycle crash >20 mph
Fall >20 feet or 10 feet/2x height in children

Question 5

Discretionary

Answer 5

If deemed necessary by Senior ED Doctor or Sister

Consider age, anticoagulation & bleeding disorders, pregnancy >20wks with torso injury

Question 6

Pathophysiology of major trauma Haemorrhage

Answer 6

Reduced MAP
Baroreceptor response
Increases SNS / reduces PNS activity
 Increased HR and inotropy
 Arteriolar and venous constriction
Endocrine response
Catecholamine release
Steroid release
Reduced renal perfusion
RAA axis activation
 Na and hence water retention

Question 7

Implication of Anaesthetic in major trauma

Answer 7

Vasodilatation, hypotension

|&raquo_space; Hypovolaemic Cardiac Arrest

Question 8

Trauma Triad of Death

Answer 8

Hypothermia
Exposure
Cold fluid administration
»Decreased clotting

Coagulopathy
Increased Lactic acid in blood

Acidosis
Vasoconstriction
Hypotension
Hypoperfusion
Anaerobic metabolism
>> Decr heart performance

Question 9

Cerebral Perfusion Pressure

Answer 9

=MAP-ICP

Aim for 60-70 mmHg

Question 10

Clinical Signs of Raised ICP

Answer 10

Depressed level of consciousness
Pressor (Cushing’s) response
Projectile vomiting
CN 6 palsies

Question 11

Clinical Signs of Brainstem herniation

Answer 11

CN 3 palsy
Motor posturing
Lower extremity rigidity
Hyperventilation

Question 12

Sepsis 6

Answer 12

IN: O2, Fluids, ABX
OUT: Bloods, Urine, Lactate

Question 13

High Risk NEWS

Answer 13

> 5 (or 3 in any one domain), incr risk of hospital Death

Question 14

Red Flags for sepsis

Answer 14

Suspected/proven infection plus any one of:
O2 requirement
Purpuric rash
RR>25
Sys BP<90
Lactate >2
HR>130
AVPU V or less

(All parameters that give a NEWS of 3 alone)