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RRPA Clinical Decision Making I > Ross Trauma 1 > Flashcards

Ross Trauma 1 Flashcards

1
Q

Major Trauma Mechanism Criteria

A
  • >20ft fall (adult)
  • > 10 ft fall (peds) or 2-3 x height of child
  • Death in same vehicle
  • ejection
  • rollover
  • intrusion >12 inches for occupant or >18 inches anywhere
  • auto/ ped/ bicycle accident >20mph
  • MCA >20 mph
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2
Q

Major anatomic criteria

A
  • Penetrating to head, neck, torso
  • 2 or more long bone fx (either both humerus or femurs or humerus and femur)
  • amputation proximal to wrist or ankle
  • open or depressed skull fx
  • crushed/ mangled extremity
  • neuro deficits
  • pelvic fx
  • flail chest
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3
Q

Major phys criteria

A

including conscious state GCS <13

Hypotension sys <90

RR <9 or >30

HR >100

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4
Q

What are the first steps for trauma scene?

A
  1. Activate trauma team
  2. Who is the captain
  3. AMPLE HX
  4. ABC
  5. Vitals and monitor
  6. And undress
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5
Q

What is the biggest problem in trauma?

A

Hypoxia

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6
Q

What is involved in the A portion of the A,B,C,D, E rapid assessment?

A
  1. Airway control and C-spine protection
  2. insure airway or provide it
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7
Q

What type of injuries require mandatory indication for airway management?

A
  1. Massive facial wounds
  2. Head injury with GCS 8 or less
  3. penetrating injury to cranial vault
  4. missile injury to neck
  5. Blunt injury to neck
  6. any altered voice with head or neck trauma you absolutely want to intubate
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8
Q

What are the categories for eye opening in the GCS

A

Spontaneous = 4

To loud voice = 3

To pain = 2

no response = 1

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9
Q

What are the categories for verbal response in the GCS

A

Oriented= 5

Confused, disoriented= 4

inappropriate words = 3

incomprehensible sounds = 2

none= 1

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10
Q

What are the categories for motor response in the GCS

A

Obey commands = 6

Localizes pain = 5

Withdraws = 4

Abnormal flexion posturing = 3

Extension posturing = 2

none = 1

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11
Q

What are some relative indications for airway management?

A
  1. Upper airway obstruction
  2. Flail chest or pt with multiple ribs fx
  3. Bilateral pneumothorax
  4. Hemothorax
  5. Shock
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12
Q

What are you assessing during the B portion of the A,B,C,D,E trauma eval?

A

B is the breathing with ventilation portion

  1. Look for symmetric rise and fall of chest
  2. Listen for breath sounds
  3. Palpate for sub Q air
  4. Cover sucking chest wounds
  5. O2 sat/End tidal CO2
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13
Q

What are the signs of a TPNX and out of them what will you most likely see on exam?

A

The signs of TPNX are:

  1. Distended neck veins
  2. Absent bs unilaterally
  3. Deviated trachea

Distended neck veins is what you’ll most likely see

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14
Q

True or false: if someone has a TPNX you decompress before anything else?

A

True

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15
Q

What is involved with the C portion of the primary trauma assessment?

A

This is the circulation with hemorrhage you need to:

  1. Assess blood volume status
  2. Heart Rhythm
  3. Peripheral access
  4. Stop Bleeding with pressure
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16
Q

You come across a pt who ran there car into a tree at a high speed and was ejected through the front windshield. Upon inspection you see a large laceration to the upper thigh that is bleeding. You also notice pt does not appear to be breathing. What should be your first intervention?

A. Stop bleeding with pressure

B. Gain peripheral access

C. Assess/manage airway

D. Freak out do nothing

A

Ross said the test question answer will be assess/manage airway so answer C

17
Q

True or false the larger the base deficit the worse the hemorrhage is?

A

True the more base your body starts using up the worse you are.

18
Q

Class III hemorrhage is when you lose 31-40% blood. What would you expect to see with

A. HR?

B. BP?

C. Pulse pressure?

D. RR?

E. Urine output?

F. GCS?

Base deficit?

Need for blood products?

A

A. Increase

B. Decrease

C. Decrease

D. Increase

E. Decrease

F. Decrease

Base deficit is -6 to -10

These pts will need blood products

19
Q

At what hemorrhage class to activate massive transfusion protocol?

A

Class IV blood loss which is >40% with base deficit -10meq/L or less

20
Q

What are the four stages of hypovolemic shock?

A
  1. Initial 2. Compensatory 3. Progressive 4. Refractory
21
Q

Where do you place a tourniquet?

A

On the upper arm near the armpit or on the upper thigh over the femoral artery

22
Q

How long can a tourniquet stay on for?

A

6 hours

23
Q

What is the triangle of death?

A
  1. Bleeding 2. Hypothermic 3. Coagulopathy
24
Q

If you gave a trauma pt 1 liter of fluids and no response was seen do you give another liter or move onto blood products?

A

Move onto blood products

25
Q

What is the fluid protocol for truama pts who have lost blood?

A
  1. Give only 1 L of crystalloids 2. Then give blood as you resuscitative fluid 3. After 3 units of blood start massive transfusion protocols
26
Q

What would you assess during the D component of the Trauma assessment?

A

D is for disability 1. Assess neuro status 2. obtain a GCS now and compare (drops of 2 are concerning, drop of 3 is who’s your dady bad)

27
Q

What is transfused in the massive transfusion protocol?

A
  1. Platelets 2. Plasma 3. Red Blood Cells
28
Q

What is involved in the E assessment of the primary trauma assessment?

A

E is for exposure 1. This means undress the Pt 2. Prevent hypothermia

29
Q

If you add an FGH to your primary trauma assessment what are you checking?

A

F stands for Fetus check pregnancy G stands for glucose H well that stands for tetanus

30
Q

What places are you looking at when performing a FAST ultrasound exam?

A
  1. Peri-hepatic space 2. Peri-splenic space 3. Pericardium 4. Pelvis
31
Q

Now that your primary survey for the trauma pt is done, what would you do during your secondary survey?

A
  1. Complete AMPLE history and physical 2. Detailed head to toe exam 3. Blood/ urine analysis 4. Diagnostic studies: X-rays, or c-spine, Chest and Pelvis 5. Consider CT scan, ultrasound, diagnostic peritoneal lavage, vascular imaging or emergent surgery.

RRPA Clinical Decision Making I (17 decks)

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