Emergency Medicine

Question 1

Give an overview approach of the Primary survey?

Answer 1

1. Catastrophic bleeding control
2. Airway maintenance with C spine protection
3. Breathing with ventilator
4. Circulation
5. Disability: Neurological state
6. Exposure and environmental control

Usually done in 10 sec

Question 2

Discuss how is airway maintained while the C spine is protected?

Answer 2

1. Look fr any potential obstruction /vomiting / Facial injuries
2. Listen to patient speak
3. Assess mental state

Airway treatment :
> Basic maneuver : Head ,chin tilt and jaw thrust (not in C spine injury )
> Nasopharyngeal airways : Appropriate in head /face injury
> Advanced technique: Bag valve mask/intubation

Question 3

Who needs a definitive airway ?

Answer 3

1. Impending airway obstruction eg those with distorted airway
2. Respiratory insufficiency due to thoracic injury
3. Multisystem trauma
4. Reduced GCS (Glasgow Coma scale) of <8

Question 4

C spine assessment ?

Answer 4

Palpate the cervical spinous process for tenderness

Question 5

Breathing Assessment

Answer 5

1. Inspect : RR and O2 saturation ,external signs of chest trauma ,symetrical chest mvements and check the back by log roll
2. Palpate over the entire chest : for rib fractures ,Emphysema ,deformity and Trachea
3. Purcuss
4. Auscultate : Decreased sounds may indicate haemothorax / pneumothorax and pleural effusion

Question 6

Management options of pneumothorax ,heamothorax and PE ?

Answer 6

1. Supply oxygen : High flow at 15 L/min via non-breather mask
2. Intubation and ventilation
3. Needle thoracotomy /finger thoractoomy /intercostal catheter

Question 7

How to assess circulation?

Answer 7

• Assess Glsgow Coma Scale ,RR ,BP ,capillary refill and warmth of periphery
• Insert 2 IV cannulation (16 gauge isotonic fluid )
• Cross match
• Venous and arterial blood gas

> Look fr evidence od bleeding in : chest ,pelvis ,abdomen ,long bones

Question 8

Sources of non-hemorrhagic shock?

Answer 8

1. Tension pneomothorax :Air trapped in pleural cavity leading to inability to maintain oxygenation
2. Cardiac tempanode : Compression of thr jheart by fluid in the sac surrounding the heart
3. Neurogenic shock : Decrease in BP due to disruption of ANS

Question 9

Name the deadly triad

Answer 9

Hypovolemia , Hypothermia and Acidaemia

Question 10

How to assess diability ?

Answer 10

• Assess the GCS and document its components
• Assess capillary size and responsiveness
• Assess gross motor and sensory function in all limbs
• If you suspect a spinal injury ,present a full neurological exam
• check glucose

Question 11

How to assess Secondary survey?

Answer 11

Focused on ample history and head to toe physical exam 
>Allergies 
>Medication 
>Past medical history 
>Last meal 
>Event 

*Systemic examination

Question 12

How to d tertiary survey

Answer 12

*Repetition of the secondary survey