Initial Assessment and Management in Traumatic Injuries

Question 1

What is the acronym for the approach you should take in traumatic injuries?

Answer 1

D
R

<C>
A
B
C
D
E
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Question 2

Where in the primary survey is internal bleeding found?

Answer 2

During the C (circulation) component

Question 3

At what GCS level is a definitive airway adjunct such as an IGEL or OP usually indicated?

Answer 3

GCS 8 or less

Question 4

What are the potentially life threatening injuries that severely impair ventilation and should be managed in primary survey?

Answer 4

ATOM-TC or TOMCAT

Airway Disruption
Tension Pneumothorax
Open Pneumothorax
Massive Pneumothorax
Tracheobronchial Tear
Cardiac Tamponade

Question 5

What is the first peak regarding trauma?

Answer 5

The first peak occurs within seconds to minutes of injury.

During this early period, deaths generally result from:
-Apnoea due to severe brain injury
-High spinal cord injury
Rupture of:
-Heart
-Aorta
-Large blood vessels
Very few of these patients can be saved.

Question 6

What is the second peak regarding trauma?

Answer 6

The second peak occurs within minutes to several hours following injury. Deaths that occur during this period are usually due to:

Subdural haematomas
Epidural haematomas
Haemopneumothorax
Ruptured spleen
Lacerations of the liver
Pelvic fractures

Question 7

What is the third peak in regard to trauma?

Answer 7

The third peak occurs several days to weeks after initial injury and is most often due to sepsis and multiple organ system dysfunctions.

Question 8

What are the three mechanisms of injury?

Answer 8

Blunt
Penetrating
Blast

Question 9

What does TWELVE stand for?

Answer 9

Tracheal deviation
Wounds
Emphysema (surgical)
Larynx
Veins
Everything else

Question 10

What is the management of an open pneumothorax?

Answer 10

One-Way Valve Dressing
High flow O2
Mechanical ventialtion
Chest drain
Cover/close wound

Question 11

What is the management of a massage haemothorax?

Answer 11

High flow oxygen
2 Large bore cannulas
TXA

Question 12

What is the management for cardiac tamponade?

Answer 12

Pericardiocentesis
Thoracotomy

Question 13

What is the assessment for cardiac tamponade?

Answer 13

Becks Triad

Question 14

What is Becks triad?

Answer 14

For cardiac tamponade

1. Hypotension
2. Distended neck veins
3. Muffled heart sounds

Question 15

What are some symptoms of a tracheobronchial tree injury?

Answer 15

• Haemoptysis
• Surgical emphysema
• Tension pneumothorax
• Cyanosis
• Incomplete expansion
  of the lung
• Continued air leak
  after chest tube
  insertion.

Question 16

What is the management for a tracheobronchial tree injury?

Answer 16

Intubation
Surgery

Question 17

What is 1 on the floor and 4 more?

Answer 17

Chest haemorrhage
Abdominal haemorrhage
Pelvic haemorrhage
Long bone fracture and associated haemorrhage