Trauma- assessment, resuscitation, and stabilization

Question 1

What is the third most common cause of death in US?

Answer 1

trauma

Question 2

What contributes significantly to mortality r/t trauma?

Answer 2

delay or failure to diagnose

Question 3

75 percent mortality from trauma occurs what hours after the trauma?

Answer 3

within 48 hours

Question 4

2 most common causes of early mortality trauma related? one third of these die how early after admission?

Answer 4

CNS injuries and hemorrhage; within 4 hours

Question 5

Most common mechanism of injury and largest number of associated deaths?

Answer 5

motor vehicle injury

Question 6

Second most common mechanism of injury?

Answer 6

falls

Question 7

Third most common cause of trauma injury?

Answer 7

gun shot wounds

Question 8

What type of trauma is associated w the highest percentage of death?

Answer 8

gunshot wounds

Question 9

What is included in the primary survey?

Answer 9

presence of immediate life threatening injuries, ABCDs

Question 10

What does ABCDE stand for?

Answer 10

airway, breathing, circulation, disability, exposure

Question 11

6 situations in which airway is usually compromised?

Answer 11

altered LOC, smoke inhalation injury, maxillo facial injuries, penetrating wound or hematoma to neck, SQ emphysema of face, neck, upper chest, evidence of vomiting

Question 12

3 of concern wounds related to breathing?

Answer 12

sucking chest wounds, open pneumo, flail segments

Question 13

How do you evaluate airway?

Answer 13

is it patent?

Question 14

How do you evaluate breathing?

Answer 14

expose, palpate, auscultate, pattern, tracheal deviation, skin color

Question 15

How do you evaluate circulation?

Answer 15

2 large bore IVs, pulse rate, character, etc., cap refill, BP, pulse pressure, bleeding, hypovolemia, blood samples, EKG

Question 16

A palpable radial pulse corresponds with an SBP of what?

Answer 16

> /- 80

Question 17

A palpable femoral pulse corresponds with an SBP of what?

Answer 17

> /- 70

Question 18

A palpable carotid pulse corresponds with an SBP greater than or equal to what?

Answer 18

60

Question 19

Poor cerebral blood flow with an SBP less than?

Answer 19

60

Question 20

How do you evaluate disability?

Answer 20

neuro status, AVPU, check pupils

Question 21

AVPU stands for?

Answer 21

alert, responds to verbal stimulus, responds to pain, unresponsive

Question 22

3 components of GCS?

Answer 22

eyes open, best motor response, best verbal response

Question 23

How do you evaluate exposure?

Answer 23

expose the patient for complete exam

Question 24

Goal of resuscitation?

Answer 24

restore tissue oxygenation

Question 25

Anesthesia's 3 primary concerns during assessment of trauma patient?

Answer 25

preserve CNS ftn, maintain adequate respiratory gas exchange, achieve circulatory homeostasis

Question 26

How do you preserve CNS function?

Answer 26

avoid movement of spinal cord in unstable fracture that decreases blood flow to the brain

Question 27

How do you complete c spine stabilization?

Answer 27

hold head while someone intubates and the front comes off the collar

Question 28

Avoid NTT/NGTs in patients w what type of fracture?

Answer 28

basilar skull fractures

Question 29

Whats a technique to try if pt breathing spontaneously, but it increases ICP?

Answer 29

nasal intubation

Question 30

Awake intubation should be avoided in which type of trauma pt? Why?

Answer 30

vascular neck trauma; gagging coughing can increase ICP and accelerate bleeding

Question 31

Blind nasal or oral intubation should be avoided in what patients?

Answer 31

blood in airway, maxillofacial injuries bc tissue, bone fragments, or teeth may be pushed into trachea

Question 32

Cricothyroidotomy is not recommended in which pts?

Answer 32

laryngeal fracture

Question 33

Cricothyroidotomy is reserved for what pts?

Answer 33

severe facial or upper airway obstruction

Question 34

The pt is at risk for coagulopathy if they get greater than how much of hetastarch?

Answer 34

1 L

Question 35

What lethal triad should you avoid in resuscitating a trauma pt?

Answer 35

acidosis, hypothermia, coagulopathy

Question 36

How do you know there is still bleeding if the pt has been crystalloid resuscitated with 2L?

Answer 36

hr >120

Question 37

Sign of significant blood loss and cardiac tamponade?

Answer 37

decreased pulse pressure

Question 38

Most common cause of coagulopathy in trauma pt?

Answer 38

dilutional thrombocytopenia

Question 39

Dose of Factor VII?

Answer 39

70-90 mcg/kg

Question 40

In young people hypotension will not develop until what percent of blood volume is lost?

Answer 40

30-40%

Question 41

In young people tachycardia will not develop until how much blood is lost?

Answer 41

20-25%

Question 42

Art line in what 3 cases for sure?

Answer 42

chest, neck, head

Question 43

What happens in the secondary survey?

Answer 43

complete head to toe exam including rectal

Question 44

AMPLE stands for?

Answer 44

allergies, medications, pmh, pregnancy, last meal, tetanus, and menses, events and environment r/t injury

Question 45

Ex of penetrating trauma?

Answer 45

knives, bullets, projectiles

Question 46

Ex of blunt trauma?

Answer 46

accel decel, continuous pressure, shearing, direct impact, rotary forces, disruption of conn tissue, blood vessels, nerves, seen w collisions and falls

Question 47

What do you want to know from MVA pt?

Answer 47

location, safety devices, site of impact, extent of damage