Multiple Injured Patient

Question 1

Pre-hospital Trauma care

Answer 1

Mechanism of injury
Injuries sustained by patient
Symptoms/signs pre-hospital
Treatment pre-hospital

Question 2

Primary survey
(ABCDE)

Answer 2

Airway and cervical spine control
Breathing and ventilation control
Circulation and haemorrhage/shock control
Disability of the neurologic system-assesed by GCS
Exposure and temperature control

Question 3

Airway (PEIO)

Answer 3

Establish patient airway and protect C-spine
Pitfalls:a progressive story of a doctor and an emergency patient on road losing their breathing
Occult airway injury
Progressive loss of airway
Equipment failure
Inability to intubate

Question 4

Breathing and ventilation
Hint:RACO

Answer 4

Respiratory rate
Chest movement
Air entry
Oxygen saturation

Question 5

Circulatory management

Answer 5

Control haemorrhage -Restore volume-Reassess patient

Pitfalls
-elderly
Children
Athletes
Medications

Question 6

Disability

Answer 6

Baseline neurologic evaluation
Glasgow coma scale score
Pupillary response

Pitfalls:Observe for neurologic deterioration

Question 7

Exposure/environment

Answer 7

Completely undress the patient

Question 8

Resuscitation

Answer 8

Protect and secure airway
Ventilate and oxygenate
Stop the bleeding
Crystalloid/blood resuscitation
Protect from hypothermia.

Question 9

When to start sec survey

Answer 9

After:
Primary survey is completed ABCDEs are reassessed
Vital functions are returning to normal

Question 10

Component of secondary survey

Answer 10

History
Physical exam
Complete neurological exam
Specific diagnostic tests
Re-evaluation

Question 11

Sec survey
Hint AMPLE

Answer 11

History
Allergies
Medications
Past illness
Last meal
Events/environment/mechanism

Question 12

Maxillofacial (sec survey)

Answer 12

Bony crepitus
Deformity
Malocclusion

Question 13

Neck(soft tissues)
Mechanism

Answer 13

Mechanisms:blunt Vs penetrating

Question 14

Neck(soft tissues)
Symptoms

Answer 14

Symptoms:Airway obstruction,hoarseness

Question 15

Neck(soft tissues)
Findings

Answer 15

Findings:crepitus hematoma stridor,bruit

Question 16

Secondary survey detailed examination

Answer 16

Head
Neck
Chest
Abdomen
Pelvis
Back
Extremities

Question 17

Secondary survey
Perineum

Answer 17

Confusion,hematoma ,lacerations,urethral blood

Question 18

Sec survey(rectum)

Answer 18

Sphincter tone,high riding prostate,pelvic fracture ,rectal wall integrity,blood

Question 19

Sec survey
Vagina

Answer 19

Blood,lacerations

Question 20

Neurologic:Spinal assessment

Answer 20

Whole spine
Tenderness and swelling
Complete motor and sensory exams
Reflexes
Imagining studies

Question 21

Neurologic:Spiral Assessment
Pitfalls

Answer 21

-Altered sensorium
-inability to cooperate with clinical exam

Question 22

Concepts of initial assessment

Answer 22

Primary Survey(resuscitation,adjuncts ) and re-evaluation

Detailed sec survey(re-evaluation and adjuncts)

Re-evaluation,definitive care

Question 23

Adjuncts to primary survey

Answer 23

Vital signs
ECG
ABGs
Urinary output
Urinary/gastric catheters unless contraindicated
Pulse oximeter

Question 24

Sec survey
Abdomen

Answer 24

Inspect,palpate ,re-evaluate special studies

Question 25

Chest

Answer 25

Inspect
Palpate
Percuss
Auscultate
X-rays

Question 26

Sec survey
Pelvis

Answer 26

Pain on palpation
Leg length unequal
Instability
X rays as needed

Question 27

Sec survey
Extremities

Answer 27

Contusion,deformity
Pain
Perfusion
Peripheral
X rays