Trauma

Question 1

How much blood volume can be lost in each body cavity?

Answer 1

Chest - 2 to 3 litres
Abdomen - Entire blood volume
Femur - 1.5 L/leg
Pelvis - 2 litres
External - Entire blood volume

Question 2

When performing a trauma primary survey, why should you consider temporary fixes as opposed to definitive ones?

Give examples of airway, breathing and circulatory temporary fixes

Answer 2

Trauma primary should take 30-45 seconds, definitive treatments would delay identifying other serious complications

Airway - jaw thrust, OPA, suctioning vs ETT
Breathing - needle thoracentesis vs chest tube
Circulation - direct pressure/tourniquet vs surgical abatement

Question 3

What components make up the disability assessment and why?

Answer 3

Only consider neurological insults that could kill the patient.

Pupils, quick GCS, quick motor x 4 limbs

Question 4

Discuss when to log roll patient in blunt vs penetrating injuries

Answer 4

Blunt injuries perform log roll after primary as part of detailed secondary survey in general, penetrating may perform log roll earlier in primary survey as it may affect the survey/findings

Question 5

What areas are commonly missed as part of the expose part of the primary survey

Answer 5

Head, back, groin, axilla

Question 6

What are the components of the secondary survey in trauma?

Answer 6

History

• AMPPLE (allergies, medications, past medical hx, pregnancy, last meal, events leading to incident)
• Head to toe (back and pelvis if not already done)
• Detailed neurological exam (cranial nerves, babinski, motor x 4)
• Special diagnostic tests
• Re-evaluation if necessary

Question 7

What the only two scenarios where you would intubate in the primary survey?

Answer 7

Foreign body or worsening edema

Question 8

What happens to the oxygen demand requirements of the lungs in a sick patient?

Answer 8

metabolic oxygen demand in lungs can increase from 2 to 3% to 20 to 30% in sick patient

Question 9

Which organs are early indicators of shock states and in which order?

Answer 9

Skin > Kidneys > Small bowel

Question 10

What is the difference between spinal and neurogenic shock?

Answer 10

Spinal shock is temporary and thought to be a result of spinal cord stunned - symptoms include deficits that resolve without any hemodynamic changes

Neurogenic shock is spinal cord injury that does not resolve spontaneously and is associated with vasodilation below the level of the injury often requiring volume and pressors to resolve

Question 11

Describe stage 3 of hemorrhage in terms of blood loss and relevant physiological findings

Answer 11

Stage 3 occurs with 30-40% (1500-2000ml) blood loss associated with cap refill 3-4, hypotension, HR > 120, RR 30-40 and anxiety

Question 12

What are the 3 types of “responders” to fluid resuscitation? How are they distinguished

Answer 12

Rapid responser, transient responder and Non-responder

Rapid and transient responders have improved hemodynamics from initial fluid bolus, however rapid responders maintain hemodynamics after bolus has been stopped.

Non-responders do not improve with initial fluid bolus