Trauma

Question 1

Modified Nexus Rule

Answer 1

1. Is there midline tenderness?
2. Is there an altered LOC? (A&O x 3)
3. Are there new focal neurological deficits?
4. Are they intoxicated?
5. Is there a major distracting injury?

Question 2

High risk patient groups (spinal precautions)

Answer 2

1. Pre-existing spinal condition
2. Osteoporosis
3. Age > 65

+

High energy mechanism

Question 3

Definition of major multi-trauma

Answer 3

More than one simultaneous injury.

Eg. multiple bone fractures, major lacerations, damage to internal organs or major blood vessels

Question 4

Typical causes of major multi-trauma

Answer 4

High speed vehicular/pedestrian accidents, long falls, crush injuries

Question 5

Full SMR

Answer 5

Clamshell, cervical collar, head supports

Question 6

Adult SMR Decision matrix

Answer 6

Multi-Trauma? Full SMR
Meets CCR/Nexus? Simple SMR
High Risk Patient? Consider simple SMR
No SMR Required.

Question 7

Simple SMR

Answer 7

1. Apply cervical collar (unless contraindicated)
2. Lay patient directly on stretcher with blanket underneath (for later transfer)
3. Raise head of cot to 30 degrees unless hypotensive
4. Use blanket + slider board to transfer to ED stretcher

Question 8

When to leave clamshell under SMR

Answer 8

1. Short transport time AND removal would delay care for critical patient
2. Meeting air-evac crew

Question 9

Pediatric SMR Decision matrix

Answer 9

Multi-Trauma? Full SMR
Major mechanism with Altered LOC? Full SMR
Acute neurological deficits? Full SMR
No SMR Required

Question 10

Target systolic pressure for TBI

Answer 10

110 - 120 Systolic

Question 11

Major Trauma Criteria

Answer 11

• GCS <= 13
• Respiratory distress - rate < 10 or rate > 30
• Hypoperfusion - SBP < 90
• Penetrating injury to: Head, Neck, Torso, Proximal extremity
• Long bone fractures - 2 or more
• Flail chest
• Major amputation of extremity
• Airway compromised with 2nd or 3rd degree burns

Question 12

Only interventions required for major trauma

Answer 12

• Basic C-Spine if required
• Airway management and ventilatory support for increasing airway obstruction or failing respirations
• Relief of tension pneumothorax
• Simple stabilization of long bone and pelvic fractures