Major Trauma - Initial Assessment

Question 1

What mnemonic is used to transfer information between the prehospital team and trauma team?

Answer 1

ATMIST

• Age
• Time of injury
• Mechanism of injury
• Injuries sustained
• Signs (clinical)
• Treatment so far

Question 2

How would you conduct a primary survey of someone?

Answer 2

• Airway and c-spine
• Breathing
• Circulation and haemorrhage control
• Disability/dysfunction of CNS
• Exposure and environmental control

Question 3

When would you assume C-spine damage?

Answer 3

• High-speed impact
• Head injury
• Neck pain
• Any positive neurology

Question 4

If the patient is talking, what does this imply?

Answer 4

• Airway is patent
• Brain is perfusing adequately with oxygenated blood

Question 5

If a patient is struggling to maintain their airway, what can be done?

Answer 5

In order of which manoeuvre you would use first

1. Head tilt/chin lift/jaw thrust
2. Guedel airway
3. Nasopharyngeal airway
4. LMA
5. I-Gel
6. ET tube
7. Sugrical airway

Question 6

When would you use jaw thrust only as an airway manoeuvre?

Answer 6

Suspected c-spine

Question 7

Once airway is secured, how much oxygen should every patient receive?

Answer 7

15 L/min 100% oxygen

Question 8

What would you examine the neck for in a trauma situation?

Answer 8

• Wounds
• Tracheal position
• Venous distention
• Surgical emphysema
• Laryngeal crepitus

Question 9

If you had a restless thrashing patient, how would you manage the c-spine?

Answer 9

Cervical spine can be damaged by immobilising the head and neck while allowing the rest of the body to move. Suboptimal immobilisation with just a semi-rigid collar is therefore accepted

Question 10

What are life threatening breathing problems that need to be dealt with immediately?

Answer 10

• Airway obstruction/dysfunction
• Tension pneumothorax
• Open chest wound
• Massive Haemothorax
• Flail Chest
• Cardiac Tamponade

Question 11

When assessing breathing, what would you assess?

Answer 11

• SpO2 using sats probe (centrally loacted preferable)
• Resp Rate
• Inspection - symmetry, effort, injuries/bruising
• Palpation
• Percussion
• Ascultation

Question 12

When listening to the chest, what is important to remember?

Answer 12

Listening to front of chest assesses air entry to large airways, whereas listening to the axilla gives an idication of pulmonary ventialtion. Tension pneumothorax/haemothorax can be identified this way

Question 13

What are common causes of reduced bilateral air entry?

Answer 13

• Obstruction of URT
• Leak between face and mask

Question 14

What are common causes of unilateral reduced air entry?

Answer 14

• Pneumothorax
• Haemothorax
• Intubaton of right main bronchus
• Foreign body in main bronchus
• Significant lung contusion

Question 15

How would you assess circulation and haemorrhage control?

Answer 15

• HR
• BP
• PEripheral/central Cap refill
• Colour
• Peripheral perfusion
• Look for signs of haemorrhage (internal/external)
• ECG

Question 16

How much blood do you need to lose before blood pressure starts to drop?

Answer 16

Roughly 30% - tachycardia and reduced pulse pressure occur at <30%

Question 17

When would you use a tourniquet to control bleeding?

Answer 17

When the limb is deemed unsalvagable

Question 18

What access options are available in trauma situations?

Answer 18

• Wide bore cannulas - antecubital fossa
• Wide bore central lines
• Intraosseous

Question 19

Once you have access, what tests should you do?

Answer 19

• Crossmatch
• ABG
• FBC, U+Es

Question 20

What BP do you need to have to have a radial pulse?

Answer 20

80 mmHg

Question 21

What BP do you need to have to have a palpable femoral pulse?

Answer 21

70-80 mmHg

Question 22

What BP do you need to have to have a plapable carotid pulse?

Answer 22

60-70 mmHg

Question 23

What is the aim of fluid resuscitation?

Answer 23

To restore critical organ perfusion until haemorrhage that is amenable to surgery is stemmed

Question 24

How would you reduce the risk of hypothermia when giving fluids?

Answer 24

Warm the fluids

Question 25

If, when giving resus fluids, the individuals vital signs initially improve but then begin to deteriorate again, what does this indicate?

Answer 25

The individual is still actively bleeding and has lost more than 20% BV. They require transfusion and often surgical intervention

Question 26

If someone does not respond to resus fluids, what does this indicate?

Answer 26

Suggests either that the shock has not been caused by hypovolaemia or that the patient is bleeding faster than blood is being infused

Question 27

What are the major anatomical sites for major haemorrhage?

Answer 27

On the floor and 4 more:

• External haemorrhage
• Chest
• Abdomen
• Pelvis and retroperitoneum
• Around long bone fractures - esp femur

Question 28

What percentage blood loss has occured in someone who does not respond at all to fluid resus?

Answer 28

40%

Question 29

How would you assess disability/CNS dysfunction?

Answer 29

• AVPU
• GCS
• Pupillary response
• Focused/Gross neuro exam - stick tongue out, squeeze finger, wiggle toes, limb movements
• Blood glucose

Question 30

What is involved in exposure and environmental control?

Answer 30

All clothing impeding the primary survey should have
been removed with minimal patient movement. Remaining clothing should now be removed.

To prevent patients subsequently becoming cold, they should be covered with warm blankets (and/or a Bair Hugger) when not being examined and the resuscitation room kept warm.

Question 31

when would you consider moving onto secondary survey?

Answer 31

Only when all ventilatory and circulatory problems have been corrected (which may mean surgery) can the team continue with the more detailed secondary survey (in the resuscitation room or later after surgery)