Lecture 3 Mgt of LE Injuries Dr. Nelson

Question 1

Level 1 Trauma

Answer 1

Regional center.
Provides complete care of trauma patient.

Trauma prevention and rehab.

Education, research, systems development.

surgery residency required.

Question 2

Level II Trauma Center

Answer 2

Initial definitive care of pt and can transfer to Level I.

Education and prevention programs available.

*Research not essential and less surgical specialties available. Residency not required.

Question 3

Level III Trauma Center

Answer 3

Evaluative and able to transfer immediately.

General surgeon available.

Think rural and community hospitals.

Question 4

Level IV and V trauma centers

Answer 4

Can give advanced trauma support prior to transver.

Trauma nurse available but no general surgeons.

Question 5

What are the three general trauma evaluative forms?

Answer 5

• Asses the severity
• Check cardio-pulmonary for resuscitation.
• Physical examination

Question 6

The Glasgow coma scale is a scale from…

Answer 6

3-15

Question 7

A Glasgow coma scale of 8 or lower denotes

Answer 7

Severe head injury with the patient in a coma.

Question 8

A Glasgow coma scale of 9-12 denotes…

Answer 8

Moderate head injuries

Question 9

A glasgow coma scale of 13-15 denotes?

Answer 9

Minor head injuries.

Question 10

What are the three criteria for scoring Glasgow coma scale?

Answer 10

Eye opening (4 pts max)

Vertebral responses (5 pts max)

Motor responses (6 pts max)

Question 11

What does the revised trauma score take into account?

Answer 11

a physiological scoring system from 0-12.

Takes into consideration of the Glasgow coma scale, systolic BP and respiration.

Question 12

What revised trauma score is considered normal and which leads to the need for treatment at a trauma center?

Answer 12

12 would be normal.

<4 would require treatment at a trauma center.

Question 13

What is the primary physical survery in a general trauma eval?

Answer 13

Checking the ABCDE's to stabilize the patient.
Airway
Breathing
Circulation
Disability - CNS
Exposure or Environmental Control.

Question 14

What is the Secondary Survey of general trauma evaluation?

Answer 14

Complete head to toe eval with definitive diagnosis and treatment of injuries.

Question 15

What is the tertiary survey of general trauma evaluation?

Answer 15

Repeat head to toe evaluation with reevaluation with laboratory and advanced studies. (Labs Radiographs etc)

Question 16

Trauma scores can help in treatment choices but….

Answer 16

Cannot be used in isolation!

Question 17

Which of the two exotoxins from clostridium tetani is the most potent toxin known?

Answer 17

Tetanospasmin neurotoxin.

Question 18

Farm injuries are automatically Gustilo Classification level….

Answer 18

Class III

Whether A B or C depends on periosteal stripping extent and vascular injury.

Question 19

What are the four main steps of reduction?

Answer 19

Slightly exagerate the deformity

Traction to relax/lengthen muscle.

Manipulation: After traction bone can be slipped into place.

Splinting/casting/framing. Highly dependent on the energy of the trauma.

Question 20

What is First hit concept?

Answer 20

trauma activates SIRS

Soft tissues and bone trauma.

Question 21

What is Second hit concept?

Answer 21

Surgery in the early phase accelerates SIRS.

Surgery causes increased local soft tissue damage.

Question 22

What is the Lag period in the Second Hit concept?

Answer 22

Surgery just past the peak of SIRS may be at a time of relative immune suppression.

surgery may overwhelm the soft tissues that have already been damaged by trauma.