initial care of MMT

Question 1

first peak trauma deaths

Answer 1

death risk of seconds to minutes included brain lacs, high spinal cord injuries, large vessel injuries. These are very hard to treat and prevention is actually yore best treatment

Question 2

2nd peak trauma deaths

Answer 2

death risk of minutes to hours includes subdural hematoma/epidural hematoma, hemothorax, pneumothorax, spleen and liver lacs. Apply ATLS for best treatment

Question 3

3rd peak trauma deaths

Answer 3

death risk of days to weeks. This is the body’s response to major trauma and includes sepsis and multi-organ failure

Question 4

Triage principles

Answer 4

life over limb, do the greatest good for the greatest number, and ignore hopeless injuries

Question 5

Step 1 of trauma

Answer 5

CPR. it is as easy as CAB. non responsive and not breathing check for pulse. If not pulse begin compressions at 100/min. Head tilt chin lift to establish airway. give 2 breaths/ 30 compressions and attach AED asap.

Question 6

Step 2 of trauma

Answer 6

key vital functions assessment. immediately ID and address airway obstruction, tension pneumothorax, massive internal or external hemorrhage, open pneumothorax, flail chest and cardiac tamponade

Question 7

Step 3 of trauma

Answer 7

ABCDE Vitals.

Question 8

Airway vitals

Answer 8

Assess for patency “what is your name”- if they can speak they have an open airway. keys are suction, protect the c-spine

Question 9

Breathing vitals

Answer 9

Apply pulse-ox, start vent support and give 100% O2. cover open chest wounds and check for crepitus and bruising.

Question 10

Circulation vitals

Answer 10

control major bleeding and determine perfusion. Pale, sweaty, cool skin and cap refill > 2 secs are signs of shock and poor perfusion.

Question 11

Disability vitals

Answer 11

AVPU- alert, responds to verbal stimuli, responds to painful stimuli, unresponsive.

Question 12

Exposure vitals

Answer 12

look for any other major threats to life. synchronized log roll. Assess pelvic stability. Remove all clothing.

Question 13

class I shock

Answer 13

up to 15% blood loss,

Question 14

class II shock

Answer 14

15-30% blood loss, 750-1500mL

Question 15

Class III shock

Answer 15

30-40% blood loss, 1500-2000mL

Question 16

Class IV shock

Answer 16

more than 40% blood loss, >2L

Question 17

rapid responder

Answer 17

Class I or II, will rapidly respond to fluid bolus, usually do not require blood but still need a surgical consult. Do a full crossmatch for blood products (takes 1 hr). Most patients are not rapid responders.

Question 18

Transient responder

Answer 18

Class II or III, will respond initially to fluid bolus but will deteriorate as fluids are slowed and will require continuous fluids and blood to be stable. Type pts blood (takes 10 minutes) and give appropriate blood products if needed. Look for the source of the bleeding and replace blood 3:1 (300cc crystalloid for every 100cc blood lost)

Question 19

minimal/no responder

Answer 19

Class IV shock, small % of patients, sent to OR immediately and give Type O neg blood.

Question 20

Secondary survey

Answer 20

includes SAMPLE history, PE, at site history, Images and labs.

Question 21

SAMPLE history

Answer 21

Signs and symptoms, Allergies, Medications, PMH, Last meal, Events preceding trauma

Question 22

MC injured organ in a blunt trauma

Answer 22

spleen

Question 23

MC injured organ in a penetrating trauma

Answer 23

Liver

Question 24

penetrating neck trauma management in an asymptomatic pt

Answer 24

If it is in zone II can observe. If it is zone I or III must get angiography an either observe or send to OR

Question 25

penetrating neck trauma management in a symptomatic pt

Answer 25

If it is zone II, go straight to OR. If it is zone I or III get angiography

Question 26

Platysmal involvement in a neck injury

Answer 26

injuries not penetrating the platysma are superficial and do not require further w/up

Question 27

Zone 1 neck structures at risk

Answer 27

Great vessels, trachea, esophagus, lung apices, C-spine, spinal cord, C nerve roots

Question 28

Zone 2 neck structures at risk

Answer 28

Carotid and vertebral arteries, jugular veins, pharynx, larynx, trachea, esophagus, c-spine and spinal cord

Question 29

Zone 3 neck structures at risk

Answer 29

Salivary and parotid glands, esophagus, trachea, vertebral bodies, carotid arteries, jugular veins, spinal cord

Question 30

crepitus in neck zone II is indicative of

Answer 30

tracheal perforation

Question 31

crepitus in neck zone I is indicative of

Answer 31

pneumothorax or pneumomediastinum

Question 32

distant muffled heart sounds may indicate

Answer 32

cardiac tamponade

Question 33

DPL

Answer 33

is 95% sensitive for intraabdominal injury. Is + if 10mL blood withdrawn. If less than 10mL instill 1 L NS- if effluent has >100,000 RBC or any detection of bile it is +. if effluent drains from any other tube, it is +.

Question 34

FAST

Answer 34

used for rapid detection of hemoperitoneum, pericardial tamponade, pneumothorax or hemothorax. Is done immediately after 1ary survey. is up to 99% sensitive and specific but requires subsequent CT with IV contrast for diagnosis.

Question 35

Pan Scan

Answer 35

liberal use of CT to detect injuries that may not have been found in a timely manner otherwise.

Question 36

coordinated log roll

Answer 36

1 person at head of bed holding the head and neck, two people are rolling on the side and one person is examining the back. 4 people required.

Question 37

Every MMT patient gets

Answer 37

C-spine, chest and pelvis XR at the very least

Question 38

Step 5 of trauma

Answer 38

completion of 2ary survey. re-evaluate the patient, do a primary survey every 5 minutes, monitor vital signs continuously and monitor consciousness continuously. Transfer if applicable.