Primary and Secondary Survey

Question 1

TCCC primary survey

Answer 1

Massive hemorrhage

Airway

Respirations

Circulation

Head injury and hypothermia

Question 2

Used as a primary adjunct for massive or arterial bleeding until controlled by dressing or hemostatic agents

Answer 2

Tourniquet

Question 3

In general, loss of up to ________ of circulating blood volume, is tolerated well in healthy patients.

Answer 3

15 percent (about 750 mL)

Class I hemorrhage

Question 4

There is minimal or no tachycardic response, and changes in blood pressure usually do not occur. Without further bleeding, fluid replacement therapy is usually not needed.

Answer 4

Class I hemorrhage (15%)

Question 5

Blood loss of ________ of total blood volume, generally results in tachycardia and narrowed pulse pressure.

Answer 5

15 to 30 percent (about 750 to 1500 mL)

Class II hemorrhage

Question 6

There may be mild mental status changes. Provided the casualty had a normal RBC volume before hemorrhage, this degree of blood loss is tolerated without RBC replacement provided circulating volume is restored.

Answer 6

Class II hemorrhage (15-30%)

Question 7

As blood loss increases beyond ____________ there is worsening hypotension, tachycardia, peripheral hypo perfusion, and
decline in mental status

Answer 7

30 percent (1500 mL)

Class III hemorrhage

Question 8

At greater than ____________ the ability of the body to compensate has reached its limits and hemodynamic decompensation is imminent without effective resuscitation.

Answer 8

40 percent (2 Liters) blood loss

Class IV hemorrhage

Question 9

Look, listen, and palpate from nose/mouth to trachea/bronchial tree

Answer 9

Airway

Question 10

Should be part of the first response for a patient making inadequate respiratory effort.

Answer 10

Chin Lift/Jaw thrust maneuver simultaneously with in-line head and neck stabilization followed by insertion of an oral or nasal airway

Question 11

Inspect to identify any abnormalities

Auscultate for presence or absences of breath sounds

Answer 11

Respirations

Question 12

Intervention for tension penumothorax

Answer 12

Needle thoracostomy

Question 13

Intervention for hemopneumothorax

Answer 13

Chest tube

Question 14

Intervention for sucking chest wound

Answer 14

Occlusive dressing

Question 15

Circulation is divided into two parts:

Answer 15

Hemodynamic Status

Hemorrhage Control

Question 16

Evaluation of level of consciousness, skin color and presence and magnitude of peripheral pulses

Answer 16

Hemodynamic Status (Circulation)

Question 17

Should not be used for measurement during the primary survey of circulation.

Rapidly obtain information by consciousness, pulse, skin color, and capillary refill time

Answer 17

Blood pressure measurement

Question 18

Systolic pressure if radial pulse is felt

Answer 18

> 80 mmHg

Question 19

Systolic pressure if femoral pulse is felt

Answer 19

> 70 mmHg

Question 20

Systolic pressure if coratid pulse is felt

Answer 20

> 60 mmHg

Question 21

Provides a rapid initial assessment of peripheral perfusion.

Answer 21

Skin Color and Cap Refill

Question 22

Should be performed once the massive hemorrhage is controlled, airway is patent, breathing evaluated and the patient is stable hemodynamically

Answer 22

An abbreviated neurologic exam

Question 23

Abbreviated neuro exam should include:

Answer 23

Assessing the Level of Consciousness

Pupillary size and reactivity

Motor function

Question 24

Should be used to quantify the patient’s level of consciousness, ranging from a score of 3 (no response) to 15 (normal response on all measures)

Answer 24

Glasgow Coma Scale (GCS)

Question 25

A GSC score of ≤ __ indicates severe head injury/coma.

Answer 25

8

Question 26

HISTORY: A patient’s pertinent past medical history must be obtained. A useful mnemonic is the word:

Answer 26

AMPLE

• Allergies
• Medications
• Past medical history
• Last meal
• Events associated with injury

Question 27

A head-to-toe physical examination, to include a reassessment of vital signs.

Answer 27

Secondary Survey

Question 28

Hemotympanum and/or disruption of the auditory canal on otoscopic exam are additional findings suggestive for:

Answer 28

Basilar Skull fracture

Question 29

CSF leaking from the ear is confirmatory for:

Answer 29

Basilar Skull fracture

Question 30

Presence of bruising around the eyes (raccoon’s eyes) or behind the ears (Battle’s sign)

Answer 30

Basilar Skull fracture

Question 31

A gloved finger placed into the mouth can move the central incisors and palate.

Answer 31

Mid-face fracture

Question 32

Malocclusion of the teeth is seen with either:

Answer 32

Mandibular or maxillary fractures

Question 33

Indicates a C-spine injury until proven otherwise

Answer 33

Any patient who is unconscious

Neurologic deficit

Injury above the clavicles

Question 34

In the absence of hypovolemia, neck vein distension can be suggestive of a:

Answer 34

Tension pneumothorax

Cardiac Tamponade

Question 35

Shortness of breath, pain, and tenderness to direct palpation or anterior posterior compression suggest:

Answer 35

Rib fractures

Question 36

Auscultation of distant heart sounds may be indicative of:

Answer 36

Cardiac tamponade

Question 37

Percussion of hypertympanic sounds may indicate:

Answer 37

Tension pneumothorax

Question 38

Any trauma patient in shock must have ________ injuries excluded
because these injuries are potentially dangerous.

Answer 38

Abdominal

Question 39

Most commonly injured organ in blunt trauma

Often associated with other injuries

Left lower rib pain may be indicative

Often can be managed non-operatively

Answer 39

Splenic injuries

Question 40

Second most common solid organ injury

Can be difficult to manage surgically

Often associated with other abdominal injuries

Answer 40

Liver injuries

Question 41

Small bowel and colon injuries result most often from:

Answer 41

Penetrating trauma

Question 42

Free fluid without solid organ injury is a ______ injury until proven
otherwise

Answer 42

hollow viscous

Question 43

The three basic regions of the abdomen are the peritoneal cavity with its:

Answer 43

Intrathoracic component

Retroperitoneum

Pelvic portion

Question 44

Diaphragm rises as high as the __ intercostal space

Answer 44

4th

Question 45

Extremities

Decreased or absent pulses suggest a:

Answer 45

Vascular injury

Question 46

Extremities

First sign of ischemia and should be aggressively evaluated.

Answer 46

Pain

Question 47

If there is any suspicion that a compartment syndrome is developing or exists, what should be performed?

Answer 47

Fasciotomy

Question 48

Extremities

For crush injuries, what must be considered?

Answer 48

Rhabdomyolysis

Question 49

For a patient with cardiac arrest, definitive care is:

Answer 49

Defibrillation with resultant normal rhythm

Question 50

Diabetic coma, definitive care is:

Answer 50

IV glucose until normal blood glucose levels returns.

Question 51

Casualties with obstructed airway, part of the definitive care are the:

Answer 51

Jaw thrust and assisted ventilation.

Question 52

Is comprised of evaluating circulation, airway and c-spine, breathing, disability (mental status), and environmental exposures.

Answer 52

Primary survey

Question 53

Includes a total evaluation of the patient injuries from head to toe

Answer 53

Secondary survey

Question 54

First thing you want to touch during the secondary survey

Answer 54

Skull and hair looking for blood