Trauma

Question 1

How many trauma-related deaths occur each year?

Answer 1

5,000,000

This works out to almost ten per minute!

Question 2

One crucial aspect of the primary survey ABCDEs is that _____________.

Answer 2

they should be done in order; that is, stabilize the patient’s airway prior to controlling their hemorrhage

Question 3

What are the primary survey ABCDEs?

Answer 3

A: airway (maintain a patent airway with cervical spine stabilization)
B: breathing (check to see if the patient is breathing; if not, ventilate)
C: circulation (assess for bleeding or shock)
D: disability (neurologic impairment)
E: exposure (was this caused by an external source that might be causing harm?)

Question 4

How should you assess airway?

Answer 4

With a few different tools:
•Ask the patient to speak. If they speak in a normal voice, then the airway is likely patent. If there is stridor or voice changes, then the airway might be compromised.
•Look for things that might be occluding the airway (e.g., foreign bodies, pooling secretions).
• Assess facial or throat injury.

Question 5

What do you do in case of a compromised airway?

Answer 5

• Immobilize the C-spine and thrust jaw forward
• Intubate
• Cricothyrotomy

Question 6

How do you assess breathing?

Answer 6

• Inspect: Is the patient breathing? Is there accessory muscle use? Is the chest asymmetrically rising?
• Auscultate: Stridor and breath sounds
• Percuss: dullness, hyper-resonance, etc.

Question 7

Where are needles inserted in tension pneumothorax?

Answer 7

Mid-clavicular line, second intercostal space, superior to the rib

Question 8

What are some ways to assess circulation?

Answer 8

• Is the patient bleeding?
• Feel the pulses
• Check cap refill

Question 9

Why might a person in shock not mount a tachycardic response?

Answer 9

• If they are a conditioned athlete
• If they are taking drugs that lower catecholamine response (e.g., beta-blockers or CCBs)
• Neurogenic shock
• Weak heart (like in the elderly)

Question 10

Typically, you need to lose about ______ percent of your blood to become hypotensive.

Answer 10

30

Question 11

How is disability assessed?

Answer 11

AVPU 
Is the patient... 
Alert?
Vocal responsive? 
Pain responsive? 
Unresponsive?

Question 12

After the ABCDEs, you’re supposed to “log roll” a patient. Why?

Answer 12

Using special boards to stabilize the patient, you’re supposed to roll them over to feel the spine for sudden drop-offs.

Question 13

What is the “exposure/environment” assessment?

Answer 13

Disrobe the patient to check for hidden injuries.

Question 14

What does FAST stand for?

Answer 14

Focused Assessment Sonography in Trauma

Question 15

Most spinal injuries are _______________.

Answer 15

cervical

Question 16

What is a flail chest?

Answer 16

Two or more fractures in contiguous ribs that leads to a free-floating segment of chest that moves in the opposite direction as the rest of the chest wall during inspiration and expiration.

Question 17

What is Grey-Turner’s sign?

Answer 17

Bruising along the flanks that suggests retroperitoneal hemorrhage

Question 18

What are the five P’s of compartment syndrome?

Answer 18

• Pallor
• Pulseless
• Painful
• Paresthesia
• Poikilothermic

Question 19

A “definitive airway” is ____________.

Answer 19

intubation

Question 20

What is a disadvantage of bag ventilating a patient prior to an anticipated intubation?

Answer 20

Bagging a patient also inflates the stomach. Inflated stomach increases the risk of vomiting which may cause aspiration.

Question 21

What needle gauge is used in chest tubes?

Answer 21

16 gauge

Question 22

With tamponade, the treatment is different for blunt and penetrating causes: ______________.

Answer 22

penetrating trauma usually requires open-heart surgery, while blunt trauma can often be treated with pericardiocentesis

Question 23

In someone with a pneumothorax, PPV can _______________.

Answer 23

make the pneumothorax worse

Question 24

Using vitals, how can you distinguish an internal bleed in the head versus elsewhere in the body?

Answer 24

• Head bleeds will cause increased ICP that will lead to hypertension and bradycardia.
• Bleeds elsewhere in the body lead to hypotension and tachycardia.

Question 25

True or false: retroperitoneal bleeds can be diagnosed with the FAST exam.

Answer 25

False. CTs are needed to determine retroperitoneal.

Question 26

What is the secondary survey?

Answer 26

Looking head to toe for other injuries.