Trauma And Burns

Question 1

Axis of impact

Answer 1

Forward: well tolerated
Vertical: moderately tolerated
Lateral: poorly tolerated

Question 2

MVA: Frontal Impact

Answer 2

Down and under
- Lower extremity and abdominal trauma
Up and over

Question 3

MVA: Lateral impacts

Answer 3

Shearing forces

Question 4

MVA: Rear impact

Answer 4

High likelihood for c-spine injury

Question 5

Shock index

Answer 5

Heart Rate/Systolic BP

Question 6

Critical Shock

Answer 6

SBP <100
HR > 100
HCT <32%
pH <7.25

Question 7

Disseminated Intravascular Coagulation (DIC)

Answer 7

Abnormal coagulation
Continuous bleeding

Question 8

Lethal Triad

Answer 8

Hypothermia
Acidosis
Coagulopathy
(Calcium now as well for lethal diamond”

Question 9

TXA

Answer 9

Prevents plasmin from stabilizing the fibrin matrix
Must be given within 3 hours of injury

Question 10

pH of Fluids

Answer 10

NSS (pH 5.5)
Lactated ringers (pH 6.5)

Question 11

Ratio for blood products

Answer 11

1:1:1 ratio of PRBC:Plasma:platelets

Question 12

Permissive hypotension

Answer 12

SBP minimum goal: 90-100 mmHg
-110 mmHg if associated CNS involvement

Question 13

Transfusion reactions

Answer 13

Hemolytic
Fever, chills, flank pain
Febrile
Non-hemolytic
Managed with acetaminophen
TACO
Circulatory overload
TRALI
Acute lung injury, similar to ARDS

Question 14

Aortic injury chest x-ray finding

Answer 14

*Widened mediastinum
Enlarged aortic knob

Question 15

Treatment for Aortic injury

Answer 15

Anti-impulse
60-70 Bpm
SBP less than 100 mmHg

Question 16

Blast injuries

Answer 16

Primary
-pressure injury
Secondary
-shrapnel
Tertiary
-Acceleration, deceleration
Quaternary
-Thermal injury
Quinary
-Thermal injury

Question 17

Monro-Kellie Doctrine

Answer 17

10% CSF
10% Blood
80% Brain

Question 18

Cushings triad

Answer 18

Increases ICP
-Hypertension
-Bradycardia
-Respiratory changes

Question 19

Secondary injury killers in TBI

Answer 19

Hypotension
Hypoxia
Hypercarbia

Question 20

Subarachnoid

Answer 20

Venous tears
-“Starfish” pattern on CT

Question 21

Subdural Hematoma

Answer 21

Slow, venous bleed
“Venous lakes” patterns
Results from higher magnitude forces
Increased risk with brain atrophy
-Alcoholics
-Elderly

Question 22

Anterior cord syndrome

Answer 22

Motor dysfunction
Preservation of pressure sensation
Retained proprioception

Question 23

Central Cord syndrome

Answer 23

“You can dance but you can’t clap”
Arm weakness
“Burning” hands
Legs less weak than arms

Question 24

Brown sequard syndrome

Answer 24

Contralateral
-Loss of pain
-loss of hot/cold sensation
Ipsilateral
-Loss of motor function
-loss of proprioception
-loss of light touch sensation

Question 25

Adult rule of 9’s

Answer 25

Head-9%
Chest-18%
Back-18%
Arms-9% (each)
Genital-1%
Legs-18% (each)

Question 26

Pediatric rule of 9

Answer 26

Head-18%
Anterior-18%
Back-18%
Arms-9%
Legs-14.5%

Question 27

Rule of palms

Answer 27

Patients palm-1%

Question 28

Prehospital Fluid administration for burn patients

Answer 28

Adults: 500mL/hr
Peds: 250mL/hr
Little peds: 125mL/hr

> 20%
Partial and full thickness burns only

Question 29

Census formula

Answer 29

Adults: 2mL/kg/%BSA
PEDS: 3mL/kg/%BSA
Under 30 kg: 4mL/kg/%BSA

Question 30

Urine output fluid resus

Answer 30

Adults: 0.5mL/kg/hr
Peds <30kg: 1mL/kg/hr
High voltage: 75-100 mL/hr until clear urine

Question 31

Most common dislocation

Answer 31

Hip

Question 32

Most common spontaneous recurrence

Answer 32

Anterior shoulder