Trauma

Question 1

What is the trauma triad

Answer 1

Describes the combination of Hypothermia, Acidosis and Coagulopathy

Question 2

What is a FAST scan

Answer 2

Focussed Assessment with Sonography in Trauma

Question 3

What is the SIRS criteria

Answer 3

=\> 2 out of 4 criteria
Temp >38 or <32
HR >90
RR >20 or PaCO2 <30
WBCs >12,000 or <4,000 or >10% band cells

Question 4

What is Sepsis

Answer 4

SIRS and confirmed infection

Question 5

What is septic shock

Answer 5

Sepsis and Hypotension despite aggressive fluid replacement/fluid challenge (30mL/kg)

Question 6

What is MODS

Answer 6

Failure of 2 or more organ systems due to an uncontrolled systemic inflammatory response due to trauma, surgery, burns or sepsis

Lung failure
GI infarct
Kidney failure
Liver failure

Question 7

What is Septic Shock

Answer 7

Decreased tissue perfusion and hypotension caused by infective material

Question 8

Describe the pathophysiology of septic shock

Answer 8

Foreign material present in the bloodstream (bacteraemia) is encountered by WBCs, provoking a systemic inflammatory response

Molecules released for WBC recruitement causes vasodilation and increased vascular permeability leading to decreased SVR and leakage of fluid into the interstitial tissue. The addition of interstitial oedema contributes to the hypoxia as the oxygen cannot transfer through it.

The WBCs systemically release lytic enzymes that damage blood vessels. This releases coagulation factors causing widespread clot formation with concurrent bleeding (DIC)

The damaging molecules also destroy vessels in the lungs so oxygen cannot be absorbed (V/Q mismatch) leading to ARDS

Immune molecules can also depress CO through damage to the coronary vessels

Question 9

What are the manifestations of septic shock

Answer 9

Warm phase: warm skin

Cold phase: cool and pale skin

Respiratory distress, impaired mental status, decreased urine output

Question 10

What is the Blumbergs sign

Answer 10

Rebound tenderness when pressure is applied on a site away from the tender area and pain experienced upon release of pressure

Question 11

What is the Murphys sign?

Answer 11

Sign of an inflammed gall bladder. Occurs when pain is experienced on deep inspiration while palpitating the Liver

Question 12

What is the Ileopsoas test?

Answer 12

Pain upon lifting of the leg ? Appendicitis

Question 13

What are the 4 H’s of reversible causes of cardiac arrest?

Answer 13

Hypoxaemia
Hypovolaemia
Hyper/Hypokalaemia
Hypo/Hyperthermia

Question 14

What are the 4 T’s of reversible cardiac arrest causes?

Answer 14

Tension pneumothorax
Tamponade
Toxins
Thromboembolic

Question 15

What are the 4 elements of the ‘chain of survival’?

Answer 15

• Early first aid to prevent immediate deterioration
• Early BLS/ALS to secure vital functions
• Early advanced therapy to limit or repair injury
• Early rehabilitation to restore quality of life