Trauma

Question 1

What is the lethal trauma triad?

Answer 1

Hypothermia
Coagulopathy
Acidosis

Question 2

What is the drug regimen for trauma?

Answer 2

O2

Fluids

Tranexamic acid

Entonox

Morphine

Question 3

What can cause confusion or combativeness in trauma patients?

Answer 3

Head injury, hypoxia and hypercarbia.

Question 4

Discuss siting of tourniquet.

Answer 4

Initial tourniquet placement:
Place over single bone above wound close to joint as is practical then consider placement of second tourniquet at “C”.

Injury above knee/elbow:
Consider second tourniquet 2 inch from wound of possible if bleeding not controlled.

Below knee/elbow:
Consider second tourniquet 2 inch from wound if possible leaving first one in place. Seek advice if transit over 1 hour.

General advice from military is 2-4 inches above wound as no proof that tourniquets are not effective over two bones.

Question 5

Should a tourniquet be applied after amputation of limb if bleeding has stopped?

Answer 5

Yes, natural defence of blood vessel constriction may stop blood initially but blood loss may restart once vessels subsequently relax.

Question 6

What is the medical name and possible cause of raccoon eyes?

Answer 6

Basilar skull fracture.

Bilateral peri orbital ecchymoses.

Question 7

What risk factors have been noted to indicate possible abnormal CT scan in mild TBI?

Answer 7

Significant risk factors for abnormal CT findings included a GCS score of 13 or 14 compared with a score of 15, the presence of vomiting, and suspected skull fracture. However, the presence of amnesia, headache, or injury to multiple body sites was not significantly associated with a higher risk for positive CT findings.

Question 8

When assessing TBI how can a smell test help?

Answer 8

Research suggests that hyposmia or anosmia can indicate possibility of abnormal CT scan.

(Limited sensitivity but high specificity” as a marker for detecting acute structural neuropathology from trauma).

Question 9

What are the criteria for minimal, mild, moderate and severe head injury?

Answer 9

Minimal = GCS 15, no LOC, No neuro deficits.

Mild = GCS 14/15’ LOC less than 5 mins, no neuro deficits.

Moderate = GCS 9-13, LOC greater than 5 mins, neuro deficits.

Severe = GCS 8 or less.

Question 10

What is the mortality rate for severe head injuries?

Answer 10

30-35%

Question 11

When assessing the moi with a pregnant pt in an RTC what should be checked within the car?

Answer 11

Position of seat.
Deformities to steering wheel/dashboard/windscreen.
Airbag deployment.
Anatomical position of seatbelt (worn correctly?)

Question 12

How many vertebrae are there?

Answer 12

33
7 cervical
12 thoracic
5 lumbar
5 sacral and 4 coccygeal (all 9 fused together )

Question 13

With regard to a trauma survey what is a reliable patient?

Answer 13

CCSAW
Calm
Cooperative 
Sober
Alert
With no distracting injuries