Initial assessment & Management

Question 1

Preparation for a trauma call?

Answer 1

• Get equipments for ABC
• Trauma alert call
• Oxygen and suction
• Warmed IV fluids
• Local capabilities

Question 2

Other information which might be required when expecting a trauma call?

Answer 2

• Vital signs (BP, HR & sats)
• GCS
• Treatment at scene
• ETA

Question 3

What are the important pre-hospital interventions in trauma

Answer 3

• Airway maintenance
• Control of bleeding & shock
• Immobilization of patient
• Transfer to appropriate facility
• Minimization of scene time

Question 4

What are the critical aspects of hospital preparation?

Answer 4

• Availability of a resuscitation area
• Functioning airway equipment
• Warm crystalloid fluids
• Protocol to summon additional assistance
• Agreement with verified trauma centres

Question 5

Components of the initial assessment ?

Answer 5

• Preparation
• Triage
• Primary survey + Resuscitation (A-E)
• Adjuncts to primary survey
• Consider transfer
• Re-evaluation

Question 6

Components of the secondary survey?

Answer 6

• Head to toe examination
• Patient history
• Adjuncts to secondary survey

Question 7

Other components after Primary & Secondary survey?

Answer 7

• Post-resuscitation evaluation
• Definitive care

Question 8

What are the important information required by the receiving facility ?

Answer 8

• Time of injury
• Events related to injury
• Patient history and vital signs
• Mechanism of injury

Question 9

What are the pre-hospital interventions ?

Answer 9

• Supplemental oxygen
• 2 large bore cannulas
• IV fluids
• Immobilization of the spine
• Secure airway if required

Question 10

What are the goals of primary survey ?

Answer 10

Identify and treat life threatening injuries in priority of threat to life and simultaneous resuscitation

Question 11

What is the sequence of primary survey?

Answer 11

• Airway & C-spine
• Breathing & ventilation
• Circulation & haemorrhage control
• Disability: Neurological status
• Exposure & environmental control

Question 12

The sequence of the 10 sec assessment ?

Answer 12

• Introduce yourself
• Ask what the patient’s name is ?
• Ask the patient what happened?

Question 13

What are the major circulatory issues to consider in trauma patients?

Answer 13

• Blood volume
• Cardiac output
• Bleeding

Question 14

What are the signs of compromised circulation?

Answer 14

• GCS
• Skin color & temperature
• Pulse rate & character

Question 15

Assessment of disability?

Answer 15

• GCS
• Pupils
• Lateralizing signs
• Signs of spinal cord injury

Question 16

What are the main goals of disability management?

Answer 16

• Prevention of secondary brain injury
• Maintaining oxygenation
• Maintaining perfusion

Question 17

What tests should be performed pre-transfer?

Answer 17

• Only tests which facilitate safe transfer
• Investigations requested by receiving hospital

Question 18

What caution should be taken when checking saturations in a patient suffering from inhalation injury?

Answer 18

Carboxyhaemoglobin could cause falsely high saturation

Question 19

What are the adjuncts to primary survey?

Answer 19

• Vital signs
• ETCO2
• ABG
• Imaging (XR, CT, FAST & DPL)
• Urinary or gastric catheter
• Urine output

Question 20

How do you exclude possible urethral or bladder injury?

Answer 20

Retrograde urethrogram before catheterization

Question 21

What is the significance of urinary output?

Answer 21

• Volume status
• Renal perfusion

Question 22

Indications and advantages of a gastric catheter ?

Answer 22

• Decreases abdominal distention & risk of aspiration
• Identification of hidden injury such as diaphragmatic herniation
• GI haemorrhage

Question 23

What is the importance of XR investigations?

Answer 23

• Identification of occult injury not visible
• Chest & Pelvis only

Question 24

How can we identify intra-abdominal blood?

Answer 24

• FAST & eFAST - Operator dependent

Question 25

What are the adjuncts to secondary survey?

Answer 25

• XR of spine & extremities
• Trauma CT
• Urography & angiogram
• Bronchoscopy, oesophagoscopy & TOE

Question 26

What is the meaning of AMPLE?

Answer 26

• A = Allergy
• M = Medications
• P = PMHx & pregnancy
• L = Last meal
• E = Events

Question 27

What are the categories of injury ?

Answer 27

• Blunt
• Penetrating
• Thermal
• Injury from hazardous environment

Question 28

List major mechanisms of injury?

Answer 28

• Frontal impact, automobile
• Side-impact, automobile
• Rare-impact, automobile
• Ejection from vehicle
• MVC with pedestrian
• Fall from height

Question 29

Suspected injury for frontal impact?

Answer 29

• Myocardial contusion
• C-spine injury
• Flail chest
• PTX
• Traumatic aortic disruption
• Spleen or liver fracture
• Posterior fracture/dislocation of hip or knee
• Head injury
• Facial fracture

Question 30

Suspected injury for side impact?

Answer 30

• Contralateral neck sprain
• Head injury
• C-spine fracture
• Flail chest
• PTX
• Traumatic disruption of aorta
• Diaphragmatic rupture
• Fracture spleen, liver or kidney
• Fracture pelvis & acetabulum

Question 31

Suspected injury for rare impact?

Answer 31

• C-spine injury
• Head injury
• Soft tissue injury neck

Question 32

Suspected injury for ejection from vehicle?

Answer 32

All injuries suspected

Question 33

Suspected injury for MVC vs pedestrian ?

Answer 33

• Head injury
• Traumatic disruption of aorta
• Abdominal visceral injury
• Fracture lower extremities and pelvis

Question 34

Suspected injury for fall from height?

Answer 34

• Spine injury
• Head injury
• Abdominal visceral injury
• Fracture of pelvis and acetabulum
• Lower limb fracture including calcaneal fracture