Trauma

Question 1

Level 1 MCI

Answer 1

5-10 patients

Question 2

Level 2 MCI

Answer 2

11-20 patients

Question 3

Level 3 MCI

Answer 3

21-100 patients

Question 4

Level 4 MCI

Answer 4

101-1000 patients

Question 5

Level 5 MCI

Answer 5

1000+ patients

Question 6

TXA indications

Answer 6

~hemorrhagic shock
~TBI
~pt on anticoag meds
~traumatic hemorrhagic shock
~TBI with GCS < 13
~blunt/penetrating trauma

Question 7

TXA contraindications

Answer 7

~injuries > 3 hrs
~ age < 5 yrs

Question 8

TXA adult dose

Answer 8

2 g in 100 mL D5W or NS

Question 9

TXA pedi dose

Answer 9

age 5-11

~15 mg/kg

Question 10

START Triage:

Pt able to walk

Answer 10

green

Question 11

START Triage:

Pt able to walk but has massive bleeding requiring bleeding control

Answer 11

yellow

Question 12

START Triage:

Not able to walk
not breathing –> pt breathes after readjusting airway

Answer 12

red

Question 13

START Triage:

Not able to walk
not breathing –> pt apneic after readjusting airway

Answer 13

black

Question 14

START Triage:

Not able to walk
Breathing, RR > 30

Answer 14

red

Question 15

START Triage:

Not able to walk
Breathing, RR < 30
radial pulse absent

Answer 15

red

Question 16

START Triage:

Not able to walk
Breathing, RR < 30
capillary refill > 2 sec

Answer 16

red

Question 17

START Triage:

Not able to walk
Breathing, RR < 30
capillary refill < 2 sec
obeys commands

Answer 17

yellow

Question 18

START Triage:

Not able to walk
Breathing, RR < 30
radial pulse present
obeys commands

Answer 18

yellow

Question 19

START Triage:

Not able to walk
Breathing, RR < 30
capillary refill < 2 sec
doesn’t obey commands

Answer 19

red

Question 20

START Triage:

Not able to walk
Breathing, RR < 30
radial pulse present
doesn’t obey commands

Answer 20

red

Question 21

JUMPSTART Triage:

Able to walk

Answer 21

green

Question 22

JUMPSTART Triage:

Able to walk but has bleeding needing control

Answer 22

yellow

Question 23

JUMPSTART Triage:

Not able to walk
not breathing –> breathes after adjusting airway

Answer 23

red

Question 24

JUMPSTART Triage:

Not able to walk
not breathing –> apneic after adjusting airway
no palpable pulse

Answer 24

black

Question 25

JUMPSTART Triage: ~Not able to walk ~not breathing --> apneic after adjusting airway ~palpable pulse ~begins breathing after 5 rescue breaths

Answer 25

red

Question 26

JUMPSTART Triage: ~Not able to walk ~not breathing --> apneic after adjusting airway ~palpable pulse ~still apneic after 5 rescue breaths

Answer 26

black

Question 27

JUMPSTART Triage: ~Not able to walk ~breathing ~ RR> 45 or RR<15

Answer 27

red

Question 28

JUMPSTART Triage: ~Not able to walk ~breathing ~ RR = 15 - 45 ~no palpable pulse

Answer 28

red

Question 29

JUMPSTART Triage: ~Not able to walk ~breathing ~ RR = 15 - 45 ~palpable pulse ~"A", "V", "P" response appropriate

Answer 29

yellow

Question 30

JUMPSTART Triage: ~Not able to walk ~breathing ~ RR = 15 - 45 ~palpable pulse ~"A", "V", "P" response inappropriate

Answer 30

red

Question 31

Adult Trauma Alert Red Criteria (1 needed)

Answer 31

~Active airway assistance required ~no radial pulse with sustained HR > 120 or SBP < 90 ~multiple long bone fracture sites ~2nd/3rd deg burns > 15% BSA ~electrical burns (high voltage/direct lightning) regardless of BSA ~amputation proximal to wrist or ankle ~penetrating injury to head/neck/torso ~BMR < 4 or exists presence of paralysis/ suspicion of spinal cord injury ~loss of sensation ~GCS < 12 ~paramedic judgment

Question 32

Adult Trauma Alert Blue Criteria (2 needed)

Answer 32

~sustained RR > 30 ~sustained HR > 120 ~single long bone Fx site due to MVA ~single long bone Fx site due to fall > 10 feet ~major degloving ~flap avulsion > 5 inches ~GSW to extremities ~BMR = 5 ~ejection from vehicle (excluding open vehicles) ~deformed steering wheel ~older pt > 55 yrs on anticoags ~blunt abdominal injury

Question 33

Pedi Trauma Alert Red Criteria (1 needed)

Answer 33

~assisted or intubated airway ~AMS ~paralysis ~suspected spinal cord injury ~loss of sensation ~faint or nonpalpable carotid or femoral pulses ~SBP < 50 ~any open long bone fx ~multiple Fx sites ~multiple dislocations ~major soft tissue disruption (i.e. major degloving, major flap avulsion) ~amputation proximal to wrist or ankle ~2nd/3rd deg burns to 10% BSA ~electrical burns (high voltage, direct lightning) regardless of BSA ~penetrating injury to head/neck/torso ~paramedic judgment

Question 34

Adult Trauma Alert Blue Criteria (2 needed)

Answer 34

~amnesia ~reliable HX of loss of consciousness ~carotid or femoral pulses palpable ~no pedal pulses ~SBP < 90 ~single closed long bone fx site ~blunt abdominal injury ~red, purple < 11 kg (<24 lbs)

Question 35

Level 2 Adult/Pedi criteria

Answer 35

~falls > 12 feet (adult) ~falls > 6 feet (pedi) ~extrication time > 15 min ~rollover MVC ~burns involving face/eyes/ears/hands/feet/ perineum that may result in functional or cosmetic impairment ~death of occupant in same passenger compartment ~major intrusion into passenger compartment ~separation from bicycle ~pedestrian struck by vehicle not meeting preceding automatic criteria (i.e. adults < 15 mph and pedi < 5 mph) ~fall from any height if pt > 55 yrs & on anticoags ~paramedic judgment

Question 36

Cardiac (Trauma) arrest resulting from electrocution or lightning injury

Answer 36

immediate defibrillation

Question 37

4 presumptive signs of death not needing to be resuscitated

Answer 37

apneic pulseless/agonal fixed/dilated pupils injury incompatible with life

Question 38

Tx if patient has sustained penetrating or blunt chest trauma & are in cardiac arrest

Answer 38

bilateral needle decompression

Question 39

tx for penetrating junctional trauma (neck, axillary, thoracic, abdominal, pelvis, groin) not easily controlled using direct pressure or tourniquet

Answer 39

clotting agent

Question 40

tx - burn injuries

Answer 40

~stop burn process by irrigating using room temp water or NS ~don't attempt to remove tar, clothing, etc if stuck to skin ~monitor airway, consider intubation if respiratory involvement ~remove jewelry/watches from burned area

Question 41

Tx : 1st/2nd deg burns < 15% BSA 3rd deg burns < 5% BSA

Answer 41

dry sterile dressing OR Burn gel/burn sheet

Question 42

Tx : 2nd deg burns > 15% BSA 3rd deg burns > 5% BSA

Answer 42

dry sterile dressing OR Burn gel/burn sheet 1 L NS, assess LS (adult) 20 mL/kg NS (pedi)

Question 43

TX: Electrical burns

Answer 43

treat associated burns as indicated

Question 44

TX: chemical burns

Answer 44

~irrigate liquid chemical burns with copious amounts of water or sterile solution ~brush off dry chemicals prior to irrigation ~remove patient's clothing & ensure pt is decontaminated prior to transport (personnel shall wear protective clothing and/or respiratory protection as needed)

Question 45

TX: Crush injury/compartment syndrome

Answer 45

1 L NS pain management

Question 46

Definition of crush syndrome

Answer 46

~entrapment with compression lasting longer than 4 hours OR ~compression on thorax for 20 min