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CLASS 22010 TRAUMA > PRIMARY AND SECONDARY SURVEY OF A TRAUMA PATIENT > Flashcards

PRIMARY AND SECONDARY SURVEY OF A TRAUMA PATIENT Flashcards

1
Q

The TCCC Primary Survey is what?

A 
M - Massive Hemorrhage 
A - Airway 
R - Respirations
C - Circulation 
H - Head and Hypothermia
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2
Q

Most casualties during combat are the result of ______ rather than the blunt trauma seen in the civilian setting

A

Penetrating Injuries

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3
Q

What should be used as a primary adjunct for massive or arterial bleeding until controlled by dressings or hemostatic agents?

A

Tourniquets

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4
Q

What is occult hemorrhage into the thoracic, abdominal, or pelvic region or into the thigh surrounding a femur fracture, can account for significant blood loss?

A

Internal Hemorrhage

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5
Q

In general, loss of up to ____ of circulating blood volume (class 1 hemorrhage)is tolerated well in healthy patients

A

15% (about 750ml)

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6
Q

Blood loss of ___ to ___ % of total blood volume (class 2 Hemorrhage) generally results in tachycardia and narrowed pulse pressure

A

15-30% (about 750-1500ml)

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7
Q

As blood loss increases beyond ___% (class 3 hemorrhage) there is worsening hypotension, tachycardia, peripheral hypoperfusion, and decline in mental status

A

30% (1500ml)

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8
Q

What class of hemorrhage is at greater than 40% (2 liters) of blood loss, the ability of the body to compensate has reached its limits and hemodynamic decompensation is imminent without effective resuscitation?

A

Class IV hemorrhage

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9
Q

True or False

Air way

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

A

True

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10
Q

What with in-line head and neck stabilization followed by insertion of an oral or nasal airway should be part of the first response for a patient making inadequate respiratory effort?

A

Chin lift/jaw thrust maneuver

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11
Q

The following are all parts of what portion of the TCCC primary survey?

  1. Inspect to ID any abnormalities
  2. Auscultate for the presence or absence of breath sounds
  3. Palpate thorax and neck to detect abnormalities such as deviated trachea and evaluate for:
    a. Crepitus
    b. Paradoxical movement of a chest wall segment
    c. Sucking chest wound
    d. Fractured sternum
A

Respirations

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12
Q

Circulation is divided into what two parts?

A
  1. Hemodynamic status

2. Hemorrhage control

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13
Q

What part of circulation includes the evaluation of the level of consciousness, skin color, and presence and magnitude or peripheral pulses?

A

Hemodynamic status

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14
Q

True or False

Hemodynamic Status

A formal blood pressure measurement SHOULD be performed at this point in the primary survey. Important information can be rapidly obtained regarding perfusion and oxygenation from the level of consciousness, pulse, skin color, and capillary refill time.

A

False

A formal blood pressure measurement SHOULD NOT be performed at
this point in the primary survey. Important information can be rapidly
obtained regarding perfusion and oxygenation from the level of
consciousness, pulse, skin color, and capillary refill time.

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15
Q

What is roughly the systolic pressure if the Radial pulse is present?

A

Greater than or equal to 80 mmHg

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16
Q

What is roughly the systolic pressure if the Femoral pulse is present?

A

Greater than or equal to 70 mmHg

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17
Q

What is roughly the systolic pressure if the Carotid pressure is felt?

A

Greater than or equal too 60 mmHg

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18
Q

What provides a rapid initial assessment of peripheral perfusion?

A

Skin Color and Capillary Refill

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19
Q

What should be performed once the massive hemorrhage is controlled, airway is present, breathing is evaluated and the patient is hemodynamically stable?

A

Abbreviated Neuro Exam

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20
Q

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

A

Glasgow coma scale (GCS)

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21
Q

A patient’s pertinent past medical history can be obtained using the mnemonic AMPLE, which stands for what?

A 
A - Allergies 
M - Medications and nutritional supplements 
P - Past medical illnesses and Injuries 
L - Last meal 
E - Events associated to the injury
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22
Q

A GSC of of less than or equal to ___ indicated severe head injury/coma

A

8

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23
Q

What is a head-to-toe physical examination, to include a reassessment of vital signs?

A

Secondary Survey

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24
Q

Clear evidence of intra-abdominal injury (peritonitis or evisceration) will lead to what?

A

Laparotomy

25
Q

True or False

Brisk bleeding from the scalp can be masked by thick hair, and a significant amount of blood may be lost before adequate evaluation is performed.

A

True

26
Q

Hemotympanum and/or disruption of the auditory canal on otoscopic exam are additional findings suggestive of what; with CSF leaking from the ear being confirmatory?

A

Basilar Skull Fracture

27
Q

What is suggested by the presence of bruising around the eyes (racoon eye’s) or behind the ears (Battle signs)?

A

Basilar Skull Fractures

28
Q

What should the eyes be evaluated for?

A
  1. Visual acuity
  2. Pupillary size
  3. External ocular muscle function
  4. Conjunctival and fundal hemorrhage
  5. Contact lenses (remove before edema presents)
29
Q

What is present if when a gloved finger is placed into the mouth can move the central incisors and palate?

A

Mid-face fracture

30
Q

Malocclusion of the teeth is seen with what?

A

Either mandibular or maxillary fractures

31
Q

If a patient has midface trauma, suspect a ____; if intubation is required in this scenario then it should be performed orally and NOT via the nasal route

A

Cribriform plate fracture

32
Q

A patient with what should be treated as if they have an injury to the cervical spine until proven otherwise?

A
  1. Unconscious
  2. Neuro deficit
  3. Injury above the clavicle
33
Q

True or False

Suspect an unstable cervical spine injury in patients with blunt head or maxillofacial trauma and/or mechanism of injury (static-line or free-fall jump incident, fast-rope or rappelling incident, aircraft mishap, motor vehicle collision, blast injury, fall of 20 feet).

A

True

34
Q

Does an absence of neuro deficits rule out spinal injuries?

A

No

35
Q

In the absence of hypovolemia, neck vein distention can be suggestive of what?

A

Tension pneumothorax or Cardiac Tamponade

36
Q

Any loss of sensation, paralysis, or weakness in the extremities suggests what?

A

Injury to the spinal cord

37
Q

Shortness of breath, pain, and tenderness to direct palpation or anterior posterior compression suggests what?

A

Rib fractures

38
Q

Auscultation should be utilized to evaluate for decreased breath sounds which denotes what?

A
  1. Pneumothorax
  2. Tension Pneumothorax
  3. Hemothorax
39
Q

Auscultation of distant heart sounds may be indicative of what?

A

Cardiac Tamponade

40
Q

Percussion of hypertympanic sounds may indicate what?

A

Tension Pneumothorax

41
Q

What would the following be indicative of?

  1. MOST COMMONLY INJURED ORGAN IN BLUNT TRUAMA
  2. Often associated with other injuries
  3. Left lower rib pain may be indicative
  4. Often can be managed non-operatively
A

Splenic Injuries

42
Q

What would the following be indicative of?

  1. Second most common solid organ injury
  2. Can be difficult to manage surgically
  3. Often associated with other abdominal injuries
A

Liver injuries

43
Q

What is the following is indicative of?

  1. Injury that can involve the stomach, bowel, or mesentery
  2. Symptoms are a result from a combination of blood loss and peritoneal contamination
  3. Small bowel and colon injuries result most often from penetrating trauma
  4. Deceleration injuries can result in bucket-handle tears of the mesentery
A

Hollow Viscous Injuries

44
Q

Suspected retroperitoneal injuries require what to confirm the diagnosis?

A

CT scan

45
Q

True or False

Transfusion is necessary in most patients with severe pelvic fractures, especially those fractures that open the pelvis and increase pelvic volume; hemorrhagic shock may be present.

A

True

46
Q

True or False

Free fluid without solid organ injury is a hollow viscous injury until proven otherwise

A

True

47
Q

The absence of a peripheral pulse distal to a fracture or dislocation mandates manipulation toward the position of function but if it still absent what should follow?

A

MEDEVAC/CASEVAC

48
Q

A decreased or absent pulse suggests what?

A

Vascular injury

49
Q

Asymmetry of the pulse or blood pressure as compared to the opposite extremity is presumptive evidence of what?

A

Vascular Injury

50
Q

What may develop insidiously, and every patient with an injured extremity should be considered at risk, particularly those with fractures and crush injuries?

A

Compartment syndrome

51
Q

Extremities

What is the first sign of ischemia and should be aggressively evaluated?

A

Pain

52
Q

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

A

Fasciotomy

53
Q

What must be considered for crush injuries?

A

Rhabdomyolysis

54
Q

Any evidence of loss of sensation, weakness, or paralysis suggests a major injury either to the ____ or ____

A
  1. Spinal Column

2. PNS

55
Q

True or False

For a patient with cardiac arrest, definitive care is defibrillation with resultant normal rhythm; cardiopulmonary resuscitation (CPR) provides minor vascular circulation until defibrillation can be accomplished.

A

True

56
Q

What is the definitive care for a diabetic coma?

A

IV glucose until normal blood glucose levels returns

57
Q

Casualties with obstructed airway part of the definitive care are what?

A

Jaw thrust and assisted ventilation

58
Q

Hemorrhage and resuscitation from shock is definitive for what?

A

Severe Bleeding

59
Q

True or False

Suspect spinal injury in all trauma casualties until confirmed

A

True

CLASS 22010 TRAUMA (12 decks)

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