Trauma 1

Question 1

2 main forces of trauma?

Answer 1

Blunt and penetrating trauma

Question 2

A fall greater than ___ in an adult is a major trauma

Answer 2

20ft (2 stories)

Question 3

A fall greater than ___ in a child is a major trauma.

Answer 3

10ft or 2-3x height of child

Question 4

Other mechanism criteria to call major trauma? (6)

Answer 4

Death in same vehicle, patient ejection, vehicle rollover, intrusion of 12cm in occupant compartment or 18cm anywhere, auto-pedestrian/bicycle >20mph, MCA >20mph

Question 5

Anatomic criteria for major trauma? (8)

Answer 5

Penetrating injury to head/neck/torso, 2 more more proximal long bone fx, amputation proximal to wrist or ankle, open or depressed skull fx, neuro deficits, pelvic fx, flail chest

Question 6

Physiologic criteria for major trauma?

Answer 6

GCS <13, SBP <90, RR<9 or >30, HR>100

Question 7

Primary survey of a trauma patient includes?

Answer 7

Airway
Breathing
Circulation
Disability (neuro)
Environment

Question 8

List some mandatory indications for airway management.

Answer 8

Massive facial injuries
Head injury with GCS<8
Penetrating injury to cranial vault
Missile injury to neck
Blunt injury to neck with alteration of voice or expanding hematoma

Question 9

Signs of tension pneumothorax?

Answer 9

JVD
Absent breath sounds unilaterally
Tracheal deviation

Question 10

First step in management of tension pneumothorax?

Answer 10

Decompression

Question 11

What type of dressing should be applied to a sucking chest wound?

Answer 11

Some type of 1 way valve, such as a asherman chest seal.

Question 12

In the circulation assessment, how do you chest for blood volume status?

Answer 12

Color, pulses, cap refill, BP

Question 13

At what stage of hemorrhage are blood products always needed?

Answer 13

Class III, moderate hemorrhage

Question 14

Will you see any changes in HR, BP, or GCS in class 1 hemorrhage?

Answer 14

No

Question 15

What changes in HR, BP, and GCS will be seen in class II/mild hemorrhage?

Answer 15

Increase HR, no change in GCS or BP

Question 16

What changes in HR, BP, and GCS will be seen in class III/moderate hemorrhage?

Answer 16

Increased HR, Decreased BP, decreased GCS

Question 17

What changes will be seen in class IV/severe hemorrhage?

Answer 17

Very increased HR, decreased BP, decreased GCS.

Question 18

How long can a tourniquet stay on?

Answer 18

6 hours

Question 19

Where do you want to place a tourniquet?

Answer 19

As close to the axilla/groin as possible.

Question 20

Stages of hypovolemic shock?

Answer 20

Initial
Compensatory
Progressive
Refractory

Question 21

What is the triangle of death in trauma?

Answer 21

Bleeding
Hypothermia
Coagulopathy

Question 22

In a hemorrhage, what fluids should be given to your patient?

Answer 22

ONLY 1 liter of crystalloids, then blood

Question 23

After __ units of blood, start massive transfusion protocols.

Answer 23

3

Question 24

What is checked in the disability assessment?

Answer 24

GCS

Question 25

Drops in GCS of __ are concerning. Drops of __ are VERY bad.

Answer 25

2. 3.

Question 26

List the scores for the eye portion of the GCS.

Answer 26

``` Eye opening: Spontaneous - 4 To loud voice - 3 To pain -2 None - 1 ```

Question 27

List the scores for the verbal portion of the GCS.

Answer 27

``` Verbal response: Oriented - 5 Confused/disoriented - 4 Inappropriate words - 3 Incomprehensible sounds - 2 None - 1 ```

Question 28

List the scores for the motor portion of the GCS.

Answer 28

``` Best motor response: Obeys - 6 Localizes - 5 Withdraws - 4 Abnormal flexion posturing -3 Extension posturing - 2 None -1 ```

Question 29

What is the decorticate response?

Answer 29

Flexion in response to pain.

Question 30

What is the decerebrate response?

Answer 30

Extension in response to pain

Question 31

What is a FAST exam?

Answer 31

Focused assessment with sonography for trauma.

Question 32

Where do you US in a FAST exam?

Answer 32

Peri-hepatic space Peri-splenic space Pericardium Pelvis

Question 33

What is included in a secondary survey?

Answer 33

``` H & P head to toe exam blood/urine analysis X rays Consider CT, vascular imaging or surgery ```

Question 34

FGH should also be done at some point during a trauma exam, what does it stand for?

Answer 34

Fetus- are they pregnant? Glucose - check it Hypertet - give them a tetanus shot

Question 35

Damage to a carotid artery causes what signs/symptoms?

Answer 35

Bruits TIAs Horner Syndrome (Ptosis, miosis, anhydrosis)

Question 36

Damage to a vertebral artery causes what signs/symptoms?

Answer 36

``` Dizziness Vertigo/ataxia nystagmus Dysarthria Diplopia ```

Question 37

How should you diagnose a tension penumothorax?

Answer 37

Physical exam!!! | Do NOT need X ray

Question 38

What type of shock is caused by tension pneumothorax?

Answer 38

Obstructive shock

Question 39

Cardiac tamponade can be recognized by what triad?

Answer 39

Becks triad | JVD, muffled heart tones, and hypotension

Question 40

A patient with hypotension after a blunt chest force should make you consider?

Answer 40

Thoracic aorta injury

Question 41

X ray findings of a thoracic aorta injury?

Answer 41

Wide mediastinum on CXR

Question 42

What is considered a wide mediastinum?

Answer 42

Greater than 1.5x the width of the vertebrae

Question 43

What is the complication of a pulmonary contusion?

Answer 43

Pneumonia

Question 44

A fracture of what rib is the most concerning?

Answer 44

1st rib - indicates high force injury

Question 45

What patients qualify for a thoracotomy?

Answer 45

Patient with loss of vitals within 2-3 minutes of arrival to ER with active CPR and penetrating trauma.