Initial survey - ABCs

Question 1

How to tell airway is present

Answer 1

Patient is conscious and speaking in normal tone

Question 2

Risks of losing airway

Answer 2

Expanding hematoma or emphysema in neck

Question 3

Indications for intubation (5)

Answer 3

Unconscious, noisy or gurgly breathing, severe inhalation injury (burn/smoke), cervical spine injury, need for respirator

Question 4

Indication for cricothyroidotomy

Answer 4

If intubation is indicated but usual orotracheal intubation cannot be done

Question 5

How is breathing established (2)

Answer 5

breath sounds presnt on both sides of chest and satisfactory pulse ox

Question 6

Clinical signs of shock

Answer 6

Low BP, fast feeble pulse, low urinary output, pale, cold, sweating, thirsty, apprehensive

Question 7

Traumatic cuases of shock (3)

Answer 7

Hypovolemic-hemorrhagic, pericardial tamponade, tension pneumothorax

Question 8

CVP in traumatic shock, hemorrhagic vs. pericardial/tension

Answer 8

low in hemorrhagic, high in pericardial/tension

Question 9

Pericardial tamponade vs. pneumothorax

Answer 9

No respiratory distress in pericardial tamponade. In pneumothorax: respiratory distress, unilateral loss of breath sounds/hyperresonance, mediastinum displaced to opposite side

Question 10

Treatment of hemorrhagic shock - urban vs. rurall

Answer 10

Urban - surgical, rural - Ringer lactate, followed by blood

Question 11

Routes of fluid resuscitation in trauma

Answer 11

2 peripheral IV. Alternatives are percutaneous femoral vein, saphenous vein cut-down, intraosseus cannulation of proximal tibia (children under 6)

Question 12

Management of pericardial tamponade

Answer 12

Diagnosis (clinical or sonogram), evaculation of pericardial sac (pericardiocentesis)

Question 13

Management of tension pneumothorax

Answer 13

Clinical diagnosis, big needle/IV catheter into affected pleural spaced followed by chest tube connected to underwater seal

Question 14

CVP in cardiogenic shock, and management

Answer 14

CVP is high, and no additional fluid or blood adminstration (this is lethal!)

Question 15

Vasomotor shock - causes, clinical picture, and management

Answer 15

Causes - anphylactic reactions, high spinal cord transetion/anesthetic. Clinical picture - “pink and warm patient”, similar to warm septic shock, low CVP. Treatment - restore peripheral resistance and additional fluids