Ross Trauma 1 Flashcards
Major Trauma Mechanism Criteria
- >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
Major anatomic criteria
- 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
Major phys criteria
including conscious state GCS <13
Hypotension sys <90
RR <9 or >30
HR >100
What are the first steps for trauma scene?
- Activate trauma team
- Who is the captain
- AMPLE HX
- ABC
- Vitals and monitor
- And undress
What is the biggest problem in trauma?
Hypoxia
What is involved in the A portion of the A,B,C,D, E rapid assessment?
- Airway control and C-spine protection
- insure airway or provide it
What type of injuries require mandatory indication for airway management?
- Massive facial wounds
- Head injury with GCS 8 or less
- penetrating injury to cranial vault
- missile injury to neck
- Blunt injury to neck
- any altered voice with head or neck trauma you absolutely want to intubate
What are the categories for eye opening in the GCS
Spontaneous = 4
To loud voice = 3
To pain = 2
no response = 1
What are the categories for verbal response in the GCS
Oriented= 5
Confused, disoriented= 4
inappropriate words = 3
incomprehensible sounds = 2
none= 1
What are the categories for motor response in the GCS
Obey commands = 6
Localizes pain = 5
Withdraws = 4
Abnormal flexion posturing = 3
Extension posturing = 2
none = 1
What are some relative indications for airway management?
- Upper airway obstruction
- Flail chest or pt with multiple ribs fx
- Bilateral pneumothorax
- Hemothorax
- Shock
What are you assessing during the B portion of the A,B,C,D,E trauma eval?
B is the breathing with ventilation portion
- Look for symmetric rise and fall of chest
- Listen for breath sounds
- Palpate for sub Q air
- Cover sucking chest wounds
- O2 sat/End tidal CO2
What are the signs of a TPNX and out of them what will you most likely see on exam?
The signs of TPNX are:
- Distended neck veins
- Absent bs unilaterally
- Deviated trachea
Distended neck veins is what you’ll most likely see
True or false: if someone has a TPNX you decompress before anything else?
True
What is involved with the C portion of the primary trauma assessment?
This is the circulation with hemorrhage you need to:
- Assess blood volume status
- Heart Rhythm
- Peripheral access
- Stop Bleeding with pressure
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
Ross said the test question answer will be assess/manage airway so answer C
True or false the larger the base deficit the worse the hemorrhage is?
True the more base your body starts using up the worse you are.
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. Increase
B. Decrease
C. Decrease
D. Increase
E. Decrease
F. Decrease
Base deficit is -6 to -10
These pts will need blood products
At what hemorrhage class to activate massive transfusion protocol?
Class IV blood loss which is >40% with base deficit -10meq/L or less
What are the four stages of hypovolemic shock?
- Initial 2. Compensatory 3. Progressive 4. Refractory
Where do you place a tourniquet?
On the upper arm near the armpit or on the upper thigh over the femoral artery
How long can a tourniquet stay on for?
6 hours
What is the triangle of death?
- Bleeding 2. Hypothermic 3. Coagulopathy
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?
Move onto blood products
What is the fluid protocol for truama pts who have lost blood?
- Give only 1 L of crystalloids 2. Then give blood as you resuscitative fluid 3. After 3 units of blood start massive transfusion protocols
What would you assess during the D component of the Trauma assessment?
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)
What is transfused in the massive transfusion protocol?
- Platelets 2. Plasma 3. Red Blood Cells
What is involved in the E assessment of the primary trauma assessment?
E is for exposure 1. This means undress the Pt 2. Prevent hypothermia
If you add an FGH to your primary trauma assessment what are you checking?
F stands for Fetus check pregnancy G stands for glucose H well that stands for tetanus
What places are you looking at when performing a FAST ultrasound exam?
- Peri-hepatic space 2. Peri-splenic space 3. Pericardium 4. Pelvis
Now that your primary survey for the trauma pt is done, what would you do during your secondary survey?
- 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.
