Evaluation, resuscitation, and DCO

Question 1

Use of an airbag in a head on collision is a/w a decrease in?

Answer 1

1) closed head injuries
2) facial fractures
3) thoracoabdominal injuries
4) need for extraction

Question 2

What % of preventable deaths occur in the ‘Golden Hour’?

Answer 2

60%; period of time when life threating and limb threatening injuries should be treated in order to decrease mortality
Three peak times of death after trauma
1) 50% within the first minutes of sustaining the injury
caused by massive blood loss or neurologic injury
2) 30% within the first few days
most commonly from neurologic injury
3) 20% within days to weeks following injury
multi system organ failure and infection are leading causes

Question 3

What special consideration should be given during the ABC phase in pregnant women who have sustained trauma?

Answer 3

Placing them in a left lateral decubitus position

Question 4

What % blood loss is reflected by an increase in heart rate?

Answer 4

15-30%

Question 5

What % blood loss is reflected by a decrease in SBP?

Answer 5

30-40%

Question 6

What are indicators of adequate resuscitation?

Answer 6

1) MAP > 60
2) HR 7.3
4) UOP 30cc/hr
5) Lactate

Question 7

What is the the key variable to differentiate septic shock and hypovolemic shock?

Answer 7

SVR is increased in hypovolemic shock

CO and CVP are decreased in both

Question 8

What is the most common cause of delay in fracture diagnosis?

Answer 8

Failure to image extremity

Question 9

What are the trauma series x-rays?

Answer 9

AP chest, AP pelvis, Lateral c-spine (must see C7 on T1)

CT pelvis should be delayed until preliminary fixation with sheet binder or ex-fix

Question 10

What factor has been shown to increase mortality in poly-trauma patients with severe head injuries?

Answer 10

Intra-operative hypotension

Question 11

What parameters can help decide on patients that need to be treated with damage control orthopedics?

Answer 11

1) ISS >40 (without thoracic trauma)
2) ISS >20 with thoracic trauma
3) multiple injuries with severe pelvic/abdominal trauma and hemorrhagic shock
4) bilateral femoral fractures
5) pulmonary contusion noted on radiographs
6) hypothermia

Question 12

Patients are at increased risk of ARDS during the 2-5 day “inflammatory window”, what life-threatening injuries should be treated in this window?

Answer 12

1) compartment syndrome
2) fractures with vascular injuries
3) unreduced dislocations
4) long bone fractures
5) unstable spine fractures
6) open fractures