Trauma

Question 1

What are the components of the primary trauma survey?

Answer 1

A - airway

B - breathing (and ventilation)

C - circulation (w/hemorrhage control)

D - disability (neurologic status)

E - exposure/environmental control (undress, but no hypothermia)

Question 2

when should you take c-spine precautions?

Answer 2

• patients with altered LOC
• blunt multi-system trauma
• blunt injury above the clavicle

Question 3

Patients with what Glascow coma score or lower require the placement of a definitive airway?

Answer 3

8 or less

(must be cuffed and secured in trachea)

Question 4

what’s the definition of a flail chest?

Answer 4

at least two fractures per rib in at least 2 ribs

Question 5

what is the most common preventable cause of death in trauma?

Answer 5

hemorrhage

Question 6

what are the signs of a tension pneumothorax?

Answer 6

acute respiratory distress

absent breath sounds

hyperresonance to percussion

tracheal shift

Question 7

where do you do a needle decompression?

Answer 7

2nd intercostal space, midclavicular line

Question 8

when should you do your first rapid neurological evaluation?

Answer 8

at the end of the primary survey

Question 9

what are the components of the rapid neurologic evaluation?

Answer 9

LOC

pupillary size and reaction

lateralizing signs

spinal cord injury level

GCS

Question 10

What are the components of GCS?

Answer 10

eye opening

verbal response

motor response

Question 11

what are the classifications based upon GCS?

Answer 11

13-15 - Minor to no TBI

9-12 - Moderate TBI

3-8 Severe TBI

Question 12

What is the scale in GCS for eye opening?

Answer 12

4 = spontaneous

3 = to voice

2 = to pain

1= no opening

Question 13

What is the scale in GCS for verbal response?

Answer 13

5 = normal conversation

4= disoriented conversation

3= words, but not coherent

2 = no words, only sounds

1 = none

Question 14

What is the GCS Scale for motor response?

Answer 14

6 = normal

5= localizes to pain

4= withdraws to pain

3=decorticate posture

2 = decebrate posture

1= none

Question 15

for fluid resuscitation, what type of access do you want?

Answer 15

1. two large bore (18 or greater) IVs
2. IO if no peripheral avail.
3. central - femoral, jugular or subclavian if necessary

Question 16

What is the volume of initial fluid therapy given to adult trauma patients?

Answer 16

warm 1-2 liters of NS or LR (includes EMS)

but absolute volumes should be based on patient volume

Question 17

What classes of hemorrhage gets transfused with blood?

Answer 17

Class III and IV

Question 18

What fluid replacement do all classes of hemorrhage get?

Answer 18

crystalloid fluids

Question 19

What are the four classes of hemorrhage based on blood volume loss, pulse rate, bp, pulse pressure and mental status?

Answer 19

Question 20

if there is not enough time to cross-match blood for transfusion, what is provided?

Answer 20

Type O packed cells

Rh - for females of child-bearing age

Rh- or + for everyone else

Question 21

How long does it take to acquire cross-matched blood

Answer 21

usually about an hour

Question 22

how is massive transfusion defined?

Answer 22

>10 units PRBC’s within 24 hours of admission

Question 23

What are two other blood replacement strategies aside from blood transfusion?

Answer 23

Activated Factor VII

Transexemic acid (TXA) - antifibrinolytic

Question 24

What’s the definition of shock?

Answer 24

A medical emergency when the tissues of the body are not receiving an adquate flow of blood

Question 25

What is the leading cause of shock?

Answer 25

hypovolemic

Question 26

when would you suspect cardiogenic shock in a trauma patient?

Answer 26

blunt cardiac injury - rapid deceleration with blunt injury to the thorax

Question 27

what can guide fluid resuscitation in cardiogenic shock?

Answer 27

CVP - central venous pressure monitoring

Question 28

What are the signs of cardiac tamponade?

Answer 28

Suspect in cases of penetrating thoracic trauma: * tachycardia * muffled heart sounds * jugular venous distension * hypotension resistant to fluid therapy

Question 29

In trauma cases, what CT images are typically done?

Answer 29

the "pan scan" head C spine Chest/Abdomen/Pelvis \*face if injuries suggest it

Question 30

What does a diagnostic peritoneal lavage tell you?

Answer 30

if there is free-floating fluid in the abdominal cavity

Question 31

What are the components of a FAST trauma assessment?

Answer 31

* Look for free pericardial fluid * Look at lungs for pneumothorax * RUQ view - diaphragm/liver and Morrison's pouch * LUQ view - diaphragm/spleen and spleen/kidney * Suprapubic view

Question 32

Hemoglobin levels as low as \_\_\_\_are tolerated by patients?

Answer 32

7 g/dL

Question 33

what agents are not recommended in the treatment of septic shock?

Answer 33

FFP (unless active bleeding is present or invasive procedures are planned) antithrombin agents

Question 34

What are the critical things you need to do in the first 3 hours to manage septic shock?

Answer 34

1. obtain a lactate level 2. obtain blood cultures (before you start abx) 3. administer broad-spectrum abx 4. administer 30 mL/kg of crystalloid solution for lactate of 4mmol/L and higher 5. provide an inital crystalloid fluid challenge of 1-2L over 30-60 minutes with additional fluid challenges

Question 35

what are the characteristics of distributive shock?

Answer 35

* does not typically begin immediately after injury * penetrating abdominal injury patients are high risk * tachycardia, cutaneous vasoconstricion, decreased urinary output, decreased systolic pressure and narrowed pulse pressure * easy to mistake with hypovolemic shock

Question 36

what are the two main drugs used in the treatment of cardiogenic shock?

Answer 36

epinephrine dopamine

Question 37

what are the classic signs of neurogenic shock?

Answer 37

hypotension without tachycardia or peripheral vasoconstriction no narrowing of pulse pressured \*not caused by an isolated intracranial injury