polytrauma patient

Question 1

evaluation of trauma starts when you first ____

Answer 1

see the patient

• neuro status (awake, moving, yelling)
• obvious injuries (blood, skin color)
• stabilization / IV access
• EMS or family or nurse story

Question 2

what is included in the primary survey*****

Answer 2

ABCDE

airway (includes C-spine), breathing, circulation, disability, exposure

treat anything you find in the survey that is life threatening

Question 3

MVA, falls should have a ___

Answer 3

c-collar / backboard

• protects the patients spine but impedes your ability to get an airway

part of primary survey

Question 4

what is included as part of the CIRCULATION checks of the primary survey

Answer 4

mental status
skin
peripheral pulses
heart sounds

Question 5

what do you put in the IV?****

Answer 5

crystalloid fluid (NS or LR)
blood

(later possible abx, pain and nausea meds)

Question 6

circulation evaluation is trying to rule out or rule in what?

Answer 6

SHOCK

Question 7

what is hemorrhagic shock?*****

Answer 7

diminished tissue perfusion secondary to blood loss

need to re-stablish enough volume to get preload high enough to get pressure high enough

initially can do through IV fluids, but if enough blood loss you need blood

Question 8

class 1 shock

Answer 8

15% blood loss, normal vitals, slightly anxious

750mls

Question 9

class 2 shock

Answer 9

15-30% blood loss, mild tachycardia, normal BP (pulse pressure drops), RR increase, anxious

Question 10

class 3 shock

Answer 10

30-40% blood loss, pulse >120, hypotensive, less UOP, confused

Question 11

class 4 shock

Answer 11

> 40% loss, obtunded, very tachycardic, cool, hypotensive

Question 12

How to treat shock?***

Answer 12

initially IVF

• 2 L NS or LR wide open (bolus goes in very fast to correct vitals)
• kids bolus 20ml/kg in bolus - may repeat

if not responding to fluids, need blood
- O-
typed
typed and crossmatched only if time

Question 13

what are you looking for in response?**

Answer 13

better skin, vitals, mental status
urine output (remember, kidneys will sense of volume is low and stop making urine - also kidneys easily damaged from hypoxia)

Question 14

definitive treatment for hemorrhagic shock?**

Answer 14

surgery

Question 15

can you use pressers (dopamine / dobutamine) if in a pickle?

Answer 15

not for low volume status

- dopamine and dobutamine will do more damage if volume already low

Question 16

disability eval

Answer 16

neuro status

glasgow coma scale (3-15)
- eyes, verbal, motion

eight = intubate (comatose patient = 8 or less)

Question 17

makes everything more difficult in evaluating patient for disability **

Answer 17

intoxication

are they combative / tearful / slurring speech because they are drunk or head injury or in shock???
uncooperative (may have to restrain)
law enforcement

dont get UDS or ETOH unless it may change what you do or liability

Question 18

exposure eval

Answer 18

expose patient, check for injury but keep warm

Question 19

review primary surveyq

Answer 19

first look
packaging
ABCDE

Question 20

what is the secondary survey***

Answer 20

head to toe
re-asses vitals
get patients PMH, PSH, meds, allergies
address wounds
RE-ASSESS OVER AND OVER**

Question 21

what do you order if they have LOC or neuro deficits

Answer 21

head CT

Question 22

C-collar stays on until

Answer 22

cleared with exam or imaging

Question 23

backboard is used for

Answer 23

transferring patient (get off backboard quickly)

Question 24

5% of head trauma also has

Answer 24

c-spine injury

Question 25

what does NEXUS stand for

Answer 25

no bony tenderness
no distracting injury
no neuro deficits
no cognitive dysfunction
non intoxication

Question 26

when do people die from trauma?**

Answer 26

trimodal peaks
- at scene - large vessel or head/neck
- shortly after arrivial to ER
       - when transport time matters
       - chest, abdomen, head, pelvis
In ICU
- head, overwhelming, infection, clots

Question 27

definitive treatment for trauma is

Answer 27

surgery

fluid/vital management is band-aid
be mindful of shock
keep checking vitals and repeating secondary surveys
non life-threatening injuries can wait
ETOH/drugs make eval very challenging