Trauma/Emergence Medicine

Question 1

What is the primary survey?

Answer 1

Airway protection and maintenance of the cervical spine
Breathing and adequate ventilation
Circulation (hemorrhage control and assessment)
Disability (neurological status should be assessed)
Environment and exposure control (patient should be undressed completely to assess for injuries, but hypothermia should be prevented)

The goal of this question was to understand the components of the primary survey. Almost all patients will have significant CT imaging, but the primary survey does not include CT scanning. The adjuncts to the primary survey for imaging are the FAST exam, chest radiograph, and pelvis radiograph.

Question 2

Laceration types and the abx that they need?

Answer 2

Type I lacerations less than 1cm first generation cephalosporin

Type II lacerations between 1 cm - 10 cm without extensive soft-tissue damage, flaps, avulsions first generation cephalosporin

Type IIIA lacerations greater than 10cm; good soft tissue coverage covering the bone with little periosteal stripping first generation cephalosporin and an aminoglycoside (For Farm injuries, heavy contamination, or possible bowel contamination add penicillin)

Type IIIB lacerations greater than 10cm; lack soft tissue coverage and require a free flap transfer first generation cephalosporin and an aminoglycoside (For Farm injuries, heavy contamination, or possible bowel contamination add penicillin)

Type IIIC lacerations greater than 10cm; with arterial injuries first generation cephalosporin and an aminoglycoside (For Farm injuries, heavy contamination, or possible bowel contamination add penicillin)

Question 3

Class one hemorrhagic shock?

Answer 3

Class I Blood loss: < 15% blood loss in a 70kg person< 0.75 L Heart rate: Normal RR: Normal Blood pressure: Normal Urine output >30 mL/h Central Nervous function Normal

Question 4

Class II hemorrhagic shock features?

Answer 4

Class II blood loss 15%-30% blood loss in 70 kg person 0.75-1.5 L Heart rate >100/min Blood pressure Decreased RR 20-30/min Urine output 20-30 mL/h CNS: Anxious

Question 5

Features of Class III hemorrhagic shock?

Answer 5

Class III Blood loss: 30%-40% Blood loss in a 70 kg person 1.5-2 L HR >120/min Blood pressure Decreased RR 30-40/min Urine output 5-15 mL/h CNS: Confused

Question 6

Features of Class IV hemorrhagic shock?

Answer 6

Class IV Blood loss >40% Blood loss in a 70 kg person >2 L HR >140/min Blood pressure Decreased RR>35/min Urine output Negligible CNS: Lethargic/coma

Question 7

Signs and treatment of Lidocaine toxicity?

Answer 7

Tinnitus, lightheadedness, and a metallic taste are classic symptoms consistent with lidocaine toxicity. Failure to recognize these symptoms early will lead to more dire consequences such as seizures and cardiogenic shock. Because lidocaine is one of the most commonly used local anesthetics in clinical practice, it is important to be familiar with dosing, side effects, and overdose recognition and management. It is commonly combined with epinephrine for its vasoconstrictive properties. Vasoconstriction near the wound site results in less systemic absorption and decreased bleeding. It was once believed that epinephrine should not be used on the digits or genitals, but that teaching has fallen out of favor in light of evidence suggesting that this is safe in clinical practice. The toxic dose of 1% lidocaine is 4 mg/kg without epinephrine and 7 mg/kg with epinephrine. During large wound repairs, it is possible to reach these concentrations. If signs of lidocaine toxicity are seen, the procedure should be stopped immediately and the patient should be monitored on cardiac telemetry. In severe cases, the patient will need treatment with lipid emulsion therapy.