TCAR

Question 1

What is Trauma

Answer 1

Unintentional and intentional injuries caused by sudden application of external force to tissues.

Question 2

Falls

Answer 2

Most frequent injury mechanism

Question 3

Transportation

Answer 3

Most common cause of serious traumatic injury in the US

Question 4

Firearms

Answer 4

Leaving cause of fatal injuries

Question 5

RED Criteria High Risk for Serious Injury

Answer 5

Injury Pattern and Mental status and Vital Signs

Question 6

Red Criteria Injury Patterns

Answer 6

Penetrating injuries to head, neck torso, and proximal extremities.
Skull deformity, suspected skull fracture.
Suspected spinal injury with motor or sensory loss.
Chest wall instability, deformity, or suspected flail chest.
Suspected pelvic fracture.
Suspected fracture of two or more proximal long bones
Crushed, degloved, mangled, or pulseless extremity.
Active bleeding requiring a tourniquet or wound packing with continuous pressure.

Question 7

Red Criteria Mental Status & Vital Signs

Answer 7

All Patients: Age 0-9: SBP<70mmHg + (2 X years)
Unable to follow commands (GCS <6). Age 10 - 65 years: SBP <90 or HR > SBP
RR <10 or > 29. Age 65 or more: SBP <110 or HR > SBP
Respiratory distress or need for respiratory support
Room air plus oximetry <90%

Question 8

Yellow Criteria
Mechanism of Injury

Answer 8

High Risk Auto Crash - Partial or complete ejection, significant intrusion, need for extraction, death in passenger compartment, age 0-9,
Rider separated from transport vehicle with significant impact (ATV, horse, motorcycle)
Ped/bicycle rider thrown, run over, or hit with significant impact.
Fall from height > 10 feet (all ages)

Question 9

Yellow criteria
EMS Judgement

Answer 9

Consider risk factors include:
Low level fall in young children (5 or less) or older adults with significant head impact (65)
Anticoagulant use
Suspicion of child abuse
Pregnancy greater than 20 weeks
Burns in conjunction with trauma
Children should be triaged preferentially to pediatric capable centers

If concerned take to a trauma center

Question 10

What is a Trauma System?

Answer 10

An organized approach to the acutely injured patient that provides personnel, facilities, and equipment for optimal care on an emergency basis, within a defined geographical area, available 24 hours a day.

Question 11

Essential Trauma Center Services

Answer 11

Blood bank
Lab
Pharmacy
Imaging
Therapist: RT, OT, PT,
Dietitians
Pastoral care
Social workers
Orthotics
Case managers
Rehabilitation

Question 12

Injury prevention Interventions (Primary pre-event)

Answer 12

Interventions that prevent injuring events (e.g. divided highways, bun locks, balance training)

Question 13

Injury prevention (during event)

Answer 13

Interventions that reduce injury severity once a traumatic incident occurs (e.g. helmets, car seats, air bags)

Question 14

Injury prevention tertiary (post event)

Answer 14

Interventions that optimize outcomes after an injury event (e.g. trauma centers, nursing education, evidence-based protocols)

Question 15

Level One Trauma Center

Answer 15

Full range of specialist and equipment available 24 hours a day
Aggressive program of research
Trauma residency program
Leader in trauma education and injury prevention
Referral resource for nearby regions

Question 16

Level II trauma center

Answer 16

Comprehensive trauma care
24 hour availability of all essential personnel, equipment, and specialities (including neurosurgery)

Question 17

Level II trauma center

Answer 17

Comprehensive trauma care
24 hour availability of all essential personnel, equipment, and specialities (including Neurosurgery)

Question 18

Level III Trauma Center

Answer 18

Resources for emergency resuscitation, surgery, and intensive care of most trauma patients
A general surgeon must be promptly available
Neurosurgery is not mandatory
Transfer agreements with Level I or Level II trauma centers that provide back-up resources

Question 19

Level IV Trauma Center

Answer 19

Initial evaluation, stabilization, diagnostic capabilities
A trauma-trained nurse is immediately available
Physicians are available on call
Transfer agreements exist with higher level centers
Open 24 hours a day

Question 20

Level V (only available in a handful of rural states)

Answer 20

Physicians are available on call
A trauma trained nurse is immediately available
Transfer agreements exist with higher levels centers
Initial evaluation, stabilization, and basic diagnostic capabilities
May not be open 24 hours, but must have an after-hours trauma response protocol.

Question 21

Analyzing Injury Potential

Answer 21

The nature and amount of force
Patient characteristics
Characteristics of the wounding agent
Tissue Characteristics

Question 22

The nature of force

Answer 22

KE = Mass x Velocity 2/2
Force is the dose of kinetic energy
Force = Weight x Speed2

Question 23

What is the dose of energy?

Answer 23

Weight is a linear increase
Speed is an exponential increase
A small increase in speed produces a significant increase in force