Trauma

Question 1

What should be the initial actions you take for a trauma patient (in order)?

Answer 1

assess ABCDEs
address problems with the above
log roll the patient
xray and FAST
secondary survey
Resuscitation and stabilization

Question 2

How can you judge if someone’s airway is patent?

Answer 2

have them speak to you if they can and check for voice change and stridor

If they can’t speak, is there any evidence of pooling secretions or cyanosis?

Question 3

Even if a patient’s airway is currently patent, what are some problems that would make you worried about losing it eventually?

Answer 3

facial injury causing obstruction or bleeding

laryngeal fractures

expanding hematomas

GCS of 9 or less

Question 4

What are the general strategies if the patient’s airway is NOT patent?

Answer 4

1. try jaw thrust
2. consider naso or oro-pharyngeal airway with bag-valve mask ventilation
3. Rapid sequence intubation
4. cricothyroidotomy if that doesn’t work

Question 5

How do you assess whether a patient is breathing?

Answer 5

inspect: look for cyanosis, JVD, asymmetric movements of the chest, accessory muscle use or open chest wounds

Auscultate

Percuss to feel for hyper-resonance or dullness

Question 6

Do you get hypertensive or hypotensive with a tension pneumo?

Answer 6

hypotensive because the increased intrathoracic pressure decreases preload

Question 7

What is the treatment for a tension pneumo?

Answer 7

needle decompression using a 14-16 gauge long angiocath inserted at the midclavicular lin in the second intercostal space, OVER the rib

Question 8

How can you assess circulation?

Answer 8

Look for any obvious bleeding
feel pulses

(if you can feel the radial - sys BP is at least 80; 60 if you can feel the femoral or carotid

Question 9

ATLS Class 1 hemorrhagic shock is when you lose what percentage of your blood? What will your vitals be doing?

Answer 9

<15%

may be normal or tachycardic

BP normal

Question 10

How much blood do you lose for ATLS Class II hemorrhagic shock? Vitals?

Answer 10

15-30%

normal to fast HR
normal to low BP
narrowed pulse pressure

Question 11

How much blood do you use for ATLS Class III? Vitals?

Answer 11

30-40%

Fast HR
Low BP
Altered mentation

Question 12

How can you quickly assess the mental status of a patient when checking for disability?

Answer 12

The AVPU scale

alert
responds to voice
responds to pain
unresponsive

Question 13

What other scale is used to assess neuro status? what are the components?

Answer 13

Glasgow coma scale

Eyes (1-4 points)
Verbal (1-5 points)
Motor (1-6 points)

Question 14

What are the imaging adjucts to the primary surgery?

Answer 14

standard trauma x-rays like an AP chest and AP pelvis

Question 15

What are the components of the FAST exam?

Answer 15

sub-xiphoid view, spleno-renal, hepato-renal, and bladder

Question 16

What does a FAST do for you?

Answer 16

tells you if there is free fluid in the abdomen (rules in an injury, but does not rule it out)

if you see fluid and they are vitally stable - go to CT scanner; if they are not stable - go to OR

Question 17

What is the secondary survey?

Answer 17

Basically everything else after the primary survey and the patient has stabilized: history and physical

Question 18

What history should you obtain in the secondary survey from a trauma perspective?

Answer 18

AMPLE:

Allergies
Medications
Past Illness
Last meal
Events/Environment (what was the mechanism of injury?)

Question 19

In order to clear a patient’s c-spine and remove a collar, what criteria must be met?

Answer 19

patient must be alert and not intoxicated
absence of neck pain
absence of midline neck tenderness
abscess of distracting injury
absence of sensory or motor complaint

Question 20

How will a tracheobronchial tree disruption present?

Answer 20

subcutaneous emphysema

you may place a chest tube and the lung refuses to inflate

Question 21

How will a pulmonary contusion present?

Answer 21

mild hypoxia that worsens after fluid resuscitation due to the resultant pulmonary edema

Question 22

How will a blunt cardiac injury present?

Answer 22

difficult to diagnose

often the only sign is an abnormal EKG or tracing

echocardiogram will show a hypokinetic heart

Question 23

How will a traumatic aortic disruption present?

Answer 23

usually they just die right away, but those who survive will have a widened mediastinum on CXR

Question 24

How will a flail chest present?

Answer 24

It’s 2+ ribs fractures in 2+ contiguous ribs, creating a free-floating segment of chest wall that moves in the opposite direction of the rest of the chest wall during inspiration and expiration

Question 25

What two signs on abdominal inspection would suggest a retroperitoneal hemorrhage?

Answer 25

Cullen’s sign or Grey-Turner’s sign

Question 26

What are the 7 life-threatening diagnoses should you have on your differential in a trauma?

Answer 26

airway obstruction
tension pneumo
open pneumo
flail chest
cardiac tamponade
massive hemothorax
traumatic aortic disruption

Question 27

What is the most important lab in trauma patients?

Answer 27

type and cross

Question 28

What are the standard trauma x-rays?

Answer 28

AP chest
AP pelvis
Cspine XR