Trauma

Question 1

ABCDE

Answer 1

Airway
Breathing/ventilation
Circulation with hemorrhage control
Disability d/t neuro
Exposure/environmental control

Question 2

How do you treat a tension pneumo?

Answer 2

Needle compression at 2ICS MCL

Question 3

GCS scale breakdown and interpretation

Answer 3

Eye opening 4
Verbal response 5
Motor response 6
TBI: minor 13-15, moderate 9-12, severe 3-8

Question 4

Eye opening GCS

Answer 4

4 = spontaneous
3 = to voice
2 = to pain 
1 = none

Question 5

Verbal response GCS

Answer 5

5 = normal convo
4 = disoriented
3 = words but no coherent
2 = only sounds
1 = none

Question 6

Motor response GCS

Answer 6

6 = normal
5 = localizes to pain
4 = withdraws to pain
3 = decorticate
2 = decerberate 
1 = none

Question 7

Initial fluid management of unconscious patient

Answer 7

2 large caliber peripheral IV catheters or central line
Initial warm fluid 1-2 L for adults
Monitor for end organ perfusion

Question 8

Activated Factor 7

Answer 8

Rescue therapy if life threatening bleeding is unresponsive to standard tx
200 mcg/kg followed by repeat dose of 100 at 1 and 3 hrs

Question 9

TXA

Answer 9

Antifibrinolytic agent
Useful in cardiac surgery, prostatectomy, joint replacement
Early admin in trauma patients reduces mortality

Question 10

Tx for hypovolemic shock

Answer 10

Most common cause of shock
FLuid: 2L of NS or LR, continue until stabilized
Blood: PRBC if pt is unstable after 2L of fluid (O neg)

Question 11

Signs of cardiac tamponade

Answer 11

Tachycardia
Muffled heart sounds
Dilated engorged neck veins

Question 12

Tx for cardiogenic shock

Answer 12

Need to maintain BP!
Dopamine/epinephrine
Vasoconstricting drugs

Question 13

Dosing of dopamine

Answer 13

< 5 mcg/kg/min: dilation of renal and coronary beds
5-10: B1 effects inc contractility and HR
10+ alpha effects - arterial vasoconstriction, BP inc

Question 14

Neurogenic shock tx

Answer 14

Hypotension without tachycardia or vasoconstrcition
Tx hypovolemia - NS/LR and blood products
Then spinal cord decompression

Question 15

Indications for intubation

Answer 15

GCS 8 or less
Need airway protection: unconscious, face fracture, aspiration risk, obstruction risk
Ventilation need: apnea, inadequate respiratory effort or severe closed head injury

Question 16

4 views of FAST

Answer 16

Pericardial
RUQ: diaphragm/liver and MOrrison’s
LUQ: diaphragm/spleen/kidney
Suprapubic

Question 17

First 3 things you give a severe TBI

Answer 17

Mannitol diuretic
Hypertonic saline
Hyperventilation (pco2 32-35)

Question 18

Which induction agent for patients with low BP?

Answer 18

Ketamine

Etomindate

Question 19

Which induction agent contra for pts with adrenal suppression?

Answer 19

Etomidate

Question 20

Which induction agent is best for CV dz?

Answer 20

Etomidate

Question 21

Which induction agent provides analgesia in addition to amnesia and sedation?

Answer 21

Ketamine