Trauma

Question 1

A method to eval airway

Answer 1

1- have pt speak- patency and to evaluate for voice change and stridor
2- evidence of pooling secretions or cyanosis

Question 2

GCS for intubation

Answer 2

GCS of 8 or less requires intubation

Question 3

Important note for intubation

Answer 3

ALWAYS MAINTAIN C-SPINE IMMOBILIZATION

Question 4

A patent airway DOES NOT mean adequate ventilation! Ventilation requires:

Answer 4

lung fxn
chest wall
diaphragm

Question 5

Percussion with hyper-resonance

Answer 5

pneumothorax

Question 6

Percussion with dullness

Answer 6

hemothorax

Question 7

subcutaneous emphysema might indicate

Answer 7

airway injury

Question 8

JVD in trauma may indicate

Answer 8

tension pneumothorax or cardiac tamponade

Question 9

Tension Pneumothorax presents as

Answer 9

worsening of a simple pneumothorax

formation of a 1-way valve at the point of a rupture in the lung

Question 10

Hypotension in a Tension Pneumothorax is due to

Answer 10

↑ intrathoracic pressure ↓ preload
Loss of left heart blood flow due to loss of pulmonary vasculature to affected lung
Compression of mediastinum

Question 11

Tension pneumothorax is a CLINICAL diagnosis and _______ are not appropriate in this setting.

Answer 11

Xrays

If tension pneumothorax is suspected, immediate needle decompression is undertaken

Question 12

Tension Pneumothorax needle decompression treatment details

Answer 12

• 4-16 gauge long angiocath
• midclavicular line, 2nd intercostal space
• over the rib to avoid neurovasculature

Question 13

Massive Hemothorax definition

Answer 13

A systemic or pulmonary vessel disruption leads to:

> 1500 mL blood loss initially
400 cc per hour for 2 hours

Question 14

Consider a massive hemothorax with?

Answer 14

pts in shock w/ no breath sounds and/or percussion dullness.

Question 15

massive hemothorax treatment

Answer 15

placing a large (36 f) chest tube

possibly a trip to the OR for hemorrhage control.

Question 16

If a radial pulse is palpable, it suggests a systolic blood pressure of at least?

Answer 16

80 mm Hg

Question 17

if femoral or carotid are palpable, these suggest a systolic blood pressure of at least?

Answer 17

60 mm Hg

Question 18

ATLS Classifications of hemorrhagic shock considers?

Answer 18

HR
BP
Blood loss

Question 19

ATLS Class of hemorrhagic shock that requires blood products

Answer 19

Class 3 and Class 4 (blood loss 30%, >40%)

Question 20

Reasons in shock–> dont mount a tachycardic response

Answer 20

• Neurogenic shock
• Beta blockade/ Calcium channel blockade
• Elderly
• Children/ young adults
• Conditioned athletes

Question 21

Assess mental status via the AVPU scale

Answer 21

Alert.
Voice
Pain
Unresponsive

Question 22

_________ will present as a “blown pupil.” .

Answer 22

Uncal herniation

Paralysis of parasympathetic fibers of CN III

Question 23

Lowest GCS score

Answer 23

3

Question 24

Adjuncts to the Primary Survey

Answer 24

Standard Trauma X-rays
FAST Exam (Focused Assessment Sonography in Trauma)

Question 25

FAST Exam four views

Answer 25

subxiphoid cardiac spleno-renal hepato-renal bladder views

Question 26

Any blood detected during the FAST exam may represent

Answer 26

peritoneal penetration *negative FAST does not exclude injury

Question 27

Primary Survey address

Answer 27

- A: Airway Maintenance with CERVICAL SPINE protection - B: Breathing and Ventilation - C: Circulation with hemorrhage control / shock assessment - D: Disability: Neurological - E: Exposure/Environmental The 2o Survey not started until all aspects of the 1o survey addressed + vitals addressed

Question 28

Secondary Survey history

Answer 28

Start with the AMPLE history: ``` Allergies Medications Past illnesses *Last meal Events / Environment / Mechanism of injury ```

Question 29

Secondary Survey physical

Answer 29

head to toe directed assessment

Question 30

Motor/ Strength Grading

Answer 30

0: Total paralysis 1: Palpable/visible contraction 2: FROM w/gravity eliminated 3: FROM against gravity 4: FROM, less than normal strength 5: Normal strength

Question 31

A __________ is most important lab in trauma patient

Answer 31

Type and Crossmatch

Question 32

Type O blood rules

Answer 32

- Type O Negative- women | - Males may receive O Positive blood

Question 33

Type-specific blood processing time/ details

Answer 33

ABO and Rh only tested | 10 minute processing

Question 34

Standard Trauma X-rays

Answer 34

AP chest + AP pelvis cxr as adjuncts to the 1o survey C-Spine X Rays: lateral view (detects 80% fractures), AP, open mouth “Odontoid” view, and obliques

Question 35

EKG is especially important for?

Answer 35

fall, drowning, syncope or single car MVA

Question 36

_________ imaging if concern for urethral injury.

Answer 36

Retrograde-urethrogram

Question 37

Diagnositic Peritoneal Lavage

Answer 37

- 98% sensitive for bleeding /detect bowel injury (often missed on CT) - replaced by US - performed when intra-abdominal bleeding

Question 38

Diagnositic Peritoneal Lavage is considered positive if it returns

Answer 38

``` Gross blood (10 ml) > 100,000 RBCs/mm3 > 500 WBCs/mm3 + Gram stain Food fibers Bacteria, bile, feces ```

Question 39

To clear the cervical spine/ remove collar, they must have the following:

Answer 39

- Alert, not intoxicated - Absence of neck pain - Absence of midline neck tenderness - Absence of distracting injury - Absence of sensory /motor complaint

Question 40

A tracheobronchial tree disruption will present on physical as....

Answer 40

- subcutaneous emphysema. | - may notice that after placing a chest tube, the lung refuses to inflate

Question 41

A pulmonary contusion may initially present as

Answer 41

- mild hypoxia - IV fluids--> pulmonary edema and hypoxia worsens - Rx by proper O2 and ventilation + maintaining normovolemia.

Question 42

blunt cardiac injury

Answer 42

difficult to ddx. only sign may be an abnormal ECG -Echocardiography may show a hypokinetic heart. -Rx= medicating dysrhythmias that affect hemodynamics

Question 43

immediately fatal, but those who survive may show a widened mediastinum on CXR.

Answer 43

traumatic aortic disruption caused by rapid acceleration/ deceleration causing a tear

Question 44

Cullen’s sign / Grey-Turner’s sign are both associated with __________

Answer 44

-retroperitoneal hemorrhage Cullen’s sign =periumbilical bruising Grey-Turner’s sign = flank bruising

Question 45

compartment syndrome presentation

Answer 45

5 P’s: - Pallor - Pain - Paresthesia - Poikilothermic - Pulseless (late finding).

Question 46

Injuries prone to developing compartment syndrome include

Answer 46

- forearm / tibial injuries - tight dressings with swelling - prolonged external pressure - crush injuries - circumferential burns.