EM

Question 1

Tx of seriously injured pts

Answer 1

rapid assessment
life-preserving therapy
Advanced trauma life support is done for every patient
Do ABCs

Question 2

Time

Answer 2

is essential

less time to get to the trauma center, the better

Question 3

Initial assessment

Answer 3

multiple things going on at the same time

Question 4

Initial assessment components

Answer 4

P,T = preparation and triage 
P,R,A = primary survey, resuscitation, and adjuncts to primary survey
S,A = secondary survey and resuscitation
P = postresuscitation monitoring and re-evaluation
D= Definitive care

Question 5

When should one do primary and secondary surveys

Answer 5

repeated frequently to determine any deterioration in the pt’s status
any necessary tx is to be instituted in case of adverse change

Question 6

What center is best to treat trauma

Answer 6

trauma center

Go there immediately

Question 7

What are ABCDE?

Answer 7

PRIMARY SURVEY:
airway maintenance with cervical spine protection
breathing and ventilation 
circulation 
disability - neurologic status 
exposure/environment control

Question 8

Pre-hospital phase

Answer 8

emphasis should be placed on airway maintenance, control of external bleeding and shock
immobilization of patient

advanced planning is essential - trauma team should be ready after EMS

MINIMIZE CLUSTER

Question 9

Triage

Answer 9

defined as the sorting of the patients based on the need for tx and available resources to prove that tx

Question 10

Level 1 trauma

Answer 10

has small resources

Question 11

Implications of multiple casualties

Answer 11

the number of its and the severity of their injuries do not exceed the ability of the facility to rend care
pts in life-threatening problems or with multi-system injuries are tx first

Question 12

Implications of mass casualties

Answer 12

the number of its and the severity of their injuries exceed the capability of the facility and staff
its with the greatest chance of survival with the least expenditure of time, equipment, supplies, and personnel are managed first

Question 13

Exhaustive resources

Answer 13

means that a pt with 99% burn will not get the care because they will die the next day

Question 14

Priorities of care

Answer 14

peds vs adults

the same care is given

Question 15

Pregnant women

Answer 15

tx similar to non pregnant women - remember the changes in the maternal physiology mimic regular non traumatic ob patient
mothers are hypotensive and tachycardiac

Question 16

Mother and baby

Answer 16

uterus is not a core organ, so blood is shunted away from the uterus in trauma victims who are pregnant
this is not good for the baby
***SAVE MONEY TO SAVE THE BABY
Focus on the baby

Question 17

Airway

Answer 17

Focus on the airway
If pt can talk, their airway is intact
Look for foreign bodies
The airway should be assessed first

Question 18

Rapid assessment for signs of airway obstruction

Answer 18

inspection for foreign bodies and facial, mandibular, or tracheal/laryngeal fx that can result in airway obstruction

Question 19

Steps to ensure airway maintainence

Answer 19

no strap around the neck
protect the C spine
make sure airway is patent

Question 20

C spine

Answer 20

prevent excessive movement of the c-spine
presume cervical spinal injury in any patient with multi system trauma, especially with an altered LOC or blunt injury above the clavicle

Question 21

Tx of C spine injury

Answer 21

chin lift

jaw thrust manuevers

Question 22

What is the name of the grading scale for coma?

Answer 22

Glascow Coma Scale (GCS)

Question 23

8 or less GCS indication

Answer 23

usually requires a definitive airway

Question 24

Assess breathing and ventilation

Answer 24

Pt’s chest should be exposed to assess the chest wall excursion
LOOK FOR CREPITANCE AND ASYMMETRY

Auscultation should be performed- listen to the lungs as peripherally as you can

Percussion => presence of air or blood in the chest; dull = blood

Question 25

**Injuries that should be identified and treated in the Primary survey

Answer 25

Tension pneumothorax (Black lungs on XR)
Flail chest with pulmonary contusion (bruising of the lung as a result of trauma due to damage to the capillaries)
Massive hemothorax
open pneumothorax

Question 26

Heart effusion

Answer 26

large heart because fluid in the pericardium

Question 27

Assess circulation

Answer 27

LOC - level of consciousness
Skin color
pulse

Question 28

Other things to worry about regarding circulation

Answer 28

Assess breast sounds - percuss
Determine where the bullets in a GSW are - belly, pelvis, or chest
Preserve evidence - don’t cut into the holes of GSW
If a pt arrives with vital signs, take it seriously

Question 29

65 y/o with hypertension have low pressure

Answer 29

NOT normal

Must ensure Hx is taken

Question 30

LOC

Answer 30

circulating blood volume is reduced, cerebral perfusion may be critically impaired, resulting in altered LOC

IF WE DONT CIRCULATE BLOOD TO THE BRAIN, BAD SIGN - CAN RESULT FROM IMPAIRED BLOOD VOLUME

Question 31

Skin color

Answer 31

pink skin is reassuring that the pt is not hypovolemic

Ashen, gray skin and white skin - bad signs

Question 32

Pulse

Answer 32

central pulses - femoral or carotid should be assessed bilaterally for quality, rate, and regularity

Femoral is more accessible
pushing 90 systolic BP is good
Full, slow, and regular peripheral pulses are good

Question 33

How to manage rapid blood loss ?

Answer 33

direct pressure on the wound

DONT USE TOURNIQUETS - last method but it is used in army combat or for amputation

Question 34

For the army, the ABCs are unique

Answer 34

C->A->B

Circulation comes first because they are usually bleeding out

Question 35

Major sources of occult blood loss

Answer 35

Thoracic or abdominal cavity
soft tissue around long bone fx

BIG BONES BLEED ALOT

Question 36

Blood loss from femoral fx

Answer 36

3-4 units

Question 37

Blood loss from pelvis fx

Answer 37

4-5 units

CRITICAL