Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

EMED Unit 3 > Evaluation of the Trauma Patient > Flashcards

Evaluation of the Trauma Patient Flashcards

1
Q

Immediate death from trauma is usually due to…

A

Fatal disruption of great vessels, heart, lungs, or major body cavity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Death 1-4 hours following traumatic injury is usually due to…

A

CV or pulmonary collapse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Death days to weeks after traumatic injury is usually due to …

A

Sepsis and multiple organ failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the cause of half of all trauma deaths?

A

CNS injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Most common cause of preventable mortality in trauma?

A

HEMORRHAGE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

______ is the cause of 1/3 or all trauma deaths

A

Exsanguination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are indicators of increased mortality in trauma?

A

Lower GCS score

Older age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Standard of care and standardized protocol for trauma patient evaluation

A

Advanced Trauma Life Support (ATLS)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What does S stand for in SALT mass casualty triage algorithm

A

Sort

“Walk to me if you can” - they get seen third

“Raise your hand if you need help” - they get seen second

Those who don’t respond/lie still - they get seen first

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the four colors for triage

A

Green = minor injuries (seen last)

Yellow = delayed (serious but not life threatening injuries)

Red = immediate (life threatening injuries - seen first)

Black = morgue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Name the trauma center level:

Highest level of care
Leaders in research, clinical care, and education

A

Level 1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Name the trauma center level:

Provides definitive care in wide range of complex traumatic patients

A

Level 2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Name the trauma center level:

Provides initial stabilization and treatment
May care for uncomplicated trauma patients

A

Level 3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Name the trauma center level:

Provides initial stabilization and transfers all trauma patients for definitive care

A

Level 4/5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Objectives of the primary survey in evaluating trauma patients

A

Stabilize trauma patient

Identify life treating injuries and initiate adequate supportive therapy

Efficiently and rapidly organize definite therapy or transfer to facility for definitive therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are components of the primary survey?

A

“ABCDE”

Airway - assess and protect
Breathing - maintain adequate oxygenation
Circulation - control hemorrhage, maintain perfusion
Disability - neuro eval
Exposure - undress patient then redress and warm them
FAST exam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the best way to quickly assess airway in a conscious patient?

A

Ask simple question - “What’s your name? What happened?”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What all are you looking for when assessing a patient’s airway?

A

Observe for signs of respiratory difficulty

Inspect oropharyngeal cavity for obstacles to ET tube

Inspect and palpate anterior next for signs of injury

If patient unconscious - protect airway immediately, c-spine protection

Hypoxia can lead to death within minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What can you do to maintain airway patency?

A

Suction of secretions
Chin lift/jaw thrust
Nasopharyngeal airway
LMA

—> Definitive airway

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are some different ways to give airway support once patency established?

A

Oxygen

NRBM (100% O2)

Bag valve mask

DEFINITIVE AIRWAY

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the two definitive airways?

A

Endotracheal intubation

Surgical crichothyroidotomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Who gets a c-spine immobilized?

A

All blunt trauma patients

Can be a cervical collar (remove anterior portion for intubation) or manual in-line stabilization (head in neutral position, grasped at mastoid process)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Which should you do first, ET intubation or cric?

A

Duh, attempt ET intubation first

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How is a cricothyroidotomy performed?

A

Incision through cricothyroid membrane, insert small tube

Later convert to orotracheal tube or tracheostomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Evaluation of breathing/ventilation should include…

A

Inspection of chest wall (asymmetry or paradoxical movement)

Auscultate - breast sound as Alice’s and axillae

Palpate - for crepitus and deformity

Immediate threats to life - tension pneumo, massive hemothorax, cardiac tamponade

Unstable patients - chest xray

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

When to presumptively treat for pneumothorax

A

Hypotension, dyspnea, ipsilateral decreased breath sounds

Treat with needle decompression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Where do you perform needle decompression for pneumothorax?

A

ADULTS: 5th ICS anterior to mid axillary line***

KIDS: 2nd ICS at midclavicular line

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What should immediately follow needle decompression for pneumothorax?

A

Tube thoracostomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

How should sucking chest wounds be treated?

A

Emergently with occlusive dressing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

How do you assess circulation?

A

Palpate central pulses (carotid, femoral)

Observe for obvious exsanguinating external injury

Determination of exact BP unnecessary

Permissive hypotension - SBP 80-100

IV catheters placed at time of circulation (16 gauge or larger)

Blood type and cross match

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

How do we control hemorrhage?

A

Arterial hemorrhage —> manual pressure, proximal compression (tourniquet), elevation

Venous hemorrhage —> direct pressure

TXA Transexamic acid

Blood transfusion

Emergency thoracotomy for patients without central pulses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Who gets an emergency thoracotomy?

A

Patients without central pulses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is the step down method for treating shock?

A
  1. 1L crystalloid NS or LR
  2. 1-2 units O-Net PRBCs
  3. Start MTP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is MTP?

A

Massive Transfusion Protocol

1:1:1 ratio of PRBCs: Fresh Frozen Plasma: Platelets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Rapid infusers can deliver products at over _____/min

A

1000mL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What makes up the Disability portion of the primary survey?

A

Determine level of consciousness/mental status

GLASCOW COMA SCALE - best if performed prior to intubation

Evaluate pupils (size, symmetry, reactivity)

Motor/sensory exam

Imaging

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Maximum score on GCS

A

15

38
Q

Maximum GCS score for an intubated patient

A

10T

39
Q

At what GCS score do you intubate a patient?

A

8 - coma

40
Q

What does the Exposure portion of the primary survey entail?

A

Visualize entire body - must completely undress patient

Common missed regions = scalp, axillary folds, perineum, abdominal folds

41
Q

What body temp is considered hypothermia?

A

<35C

42
Q

How do you treat hypothermia?

A

Warm blankets
Warm IV fluids and blood
External warming devices
Warm room

43
Q

What is the lethal triad of trauma?

A

Hypothermia - remove wet clothing and warm patient

Coagulopathy - permissive hypotension and blood products

Acidosis - stop bleeding, treat shock

44
Q

What is “AMPLLE” history for the secondary survey?

A 
Allergies
Medicines
Past medical history
Last meal
Last menstrual period
Events that lead to the trauma

We wanna know if they’re on blood thinners or if they’re preggo

45
Q

What medications in particular are you worried about when taking your AMPLLE history?

A

Antiplatelets or anticoagulants

46
Q

What are you looking for on secondary survey:

Skin

A

Lacerations
Abrasions
Ecchymosis
Hematoma

47
Q

What are you looking for on secondary survey:

Head and face

A

Inspect and palpate entire bony structure

48
Q

What are you looking for on secondary survey:

Neck

A

All blunt trauma —> assume injury
Distended neck veins?
Evaluate c-spine

49
Q

What are you looking for on secondary survey:

Chest

A

Inspect and palpate entire chest wall

Careful auscultation

50
Q

What are you looking for on secondary survey:

Abdomen

A

Inspect and palpate entire abdomen

Can be unreliable

51
Q

What are you looking for on secondary survey:

Rectum and GU

A

Inspect rectum and perineum

Sign of pelvic injury

52
Q

What are you looking for on secondary survey:

Musculoskeletal

A

Inspect entire length of all 4 extremities - tenderness, deformity,

53
Q

What are you looking for on secondary survey:

Neuro

A

Serial exams

Status can change over time

54
Q

What is the NEXUS c-spine rule?

A 
Radiography is unnecessary if patient satisfies all of the following:
• No midline cervical tenderness
• No focal neuro deficits
• Normal alertness
• No intoxication
• No painful distracting injury
55
Q

PECARN for kids younger than 2

A

AMS or GCS<15 or palpable skull fx —> CT Recommended

LOC >5s, non-rental hematoma, not acting normal, or severe mechanism —> observe, maybe CT

None of the above —> NO CT

56
Q

PECARN for kids >2

A

AMS or GCS<15 or signs of basilar skull fx —> CT recommended

History of LOC, vomiting, severe HA, or severe mechanism —> observe, maybe CT

None of the above? No CT

57
Q

How do you reverse antiplatelets?

A

Platelets

58
Q

How do you reverse Coumadin?

A

FFP

Vitamin K

Prothrombin complex concentrate

Factor VIIa

59
Q

How do you reverse Heparin?

A

Protamine sulfate

60
Q

How do you reverse LMWH?

A

Protamine sulfate

61
Q

How do you reverse direct thrombin inhibitors (ie Pradaxa)

A

Idarucizumab (Praxbind)

62
Q

What is a chance fracture?

A

Displacement of lumbar vertebrae due to seat belt

63
Q

What is Cullen’s sign?

A

Periumbilical bruising - due to internal hemorrhage

64
Q

What is Gray Turner’s sign?

A

Flank ecchymosis - due to internal bleeding

65
Q

Most frequently injured organ in penetrating trauma

A

Liver

Also 2nd most frequently injured organ in blunt abdominal trauma

66
Q

Most frequently injured organ in blunt trauma in adults

A

Spleen

Most important to save in kids

67
Q

If you gotta take out somebody’s spleen because it exploded post MVA, what should you consider?

A

Vaccination:
• Pneumovax
• H. flu
• +/- meningococcus

68
Q

What does FAST stand for?

A

Focused Assessment with Sonography for Trauma

69
Q

What are the only indications for rectal exam?

A

Spinal cord injury (assess for sacral sparing)

Pelvic fracture (to assess for open fracture)

Penetrating abdominal trauma (to assess for gross blood)

70
Q

Hemodynamically unstable open pelvic fractures can lead to blood loss of up to ______

A

1-3L of blood

71
Q

How do you stabilize pelvic fractures?

A

Bind pelvis if suspect fracture

Check for blood at the meatus (urethral injury)

72
Q

Blood at the urethral meatus?

A

Urethral injury - beware with Foley

73
Q

When is an NG tube contraindicated?

A

Mid face fracture

74
Q

Hard signs of vascular injury from penetrating trauma

A 
Active or pulsatile bleeding
Expanding hematoma
Pulseless limb
Shock
Compartment syndrome (6 Ps)
Bruit thrills (rare)
75
Q

Soft signs of vascular injury in penetrating trauma

A

Small non expanding hematoma
Venous oozing
History of pulsatile bleeding
Unexplained neuro deficit

76
Q

What Ankle-Brachial Index is considered Abnormal?

A

<0.9

77
Q

What is brachial/brachial index?

A

Comparing injured to uninjured brachial BP

BBI >0.9 = normal

78
Q

What do you do with patients who have hard signs of vascular injury?

A

Straight to OR

79
Q

What do you do for patients with soft signs of vascular injury?

A

ABI

If >0.9 —> no arterial injury

If <0.9 —> CT Angiogram of extremity

80
Q

If no signs of vascular injury —> ….

A

Xray

81
Q

How do you assess neuro/vascular status for arm fractures?

A

“Rock paper scissors” and “OK” sign

82
Q

What are the six P’s for compartment syndrome?

A 
Pain 
Paresthesias
Pallor
Poikilotherma
Paralysis
Pulselessness (Late)
83
Q

What are the components of a PAN SCAN?

A 
Non-contrast CT of:
• Head
• Maxillary (face)
• C spine
• Thoracic spine
• Lumbar spine

CT w/ contrast of:
• Chest
• Abdomen
• Pelvis

Other studies based on scenario (CTA of neck if potential vascular injury, CTA of extremity if potential vascular injury)

84
Q

What labs do you run as adjunct to secondary survey?

A 
CBC
CMP
hCG
PT/INR
PTT
Type/Cross
Lipase
Alcohol level 
U/A
Urine drug screen
Lactate/base deficit
85
Q

What is the parkland formula for burn patient resuscitation?

A

4mL LR x weight in KG x TBSA affected

Give 1/2 over first 8 hours, remainder over following 16 hours

86
Q

What position should pregnant women be placed in for chest compressions?

A

Left lateral decubitus position (back at 30˚)

87
Q

In cases of perimortem c-section, prognosis for intact survival of an infant is best if…

A

Delivered within 5 min of maternal arrest

Goal - to remove fetus and continue resuscitation of both mother and fetus

88
Q

How is a perimortem cesarean section performed?

A

During procedure, maternal CPR maintained

Vertical midline abdominal incision from 4-5cm below xyphoid process to pubic symphysis

Incise through the fascia and muscles into the peritoneum

89
Q

What things to consider in geriatric trauma patients?

A

Meds - 60% increased risk of mortality if they’re on WARFARIN

Which came first - the MI or MVC?

Hidden trauma

90
Q

What is the maximum opiate Rx you should write in the ER?

A

3 days

EMED Unit 3 (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions