Trauma (Exam #1) Flashcards
What is the most common cause of preventable mortality in trauma?
Hemorrhage
What are the three levels of trauma mortality - describe each?
- Immediate: death at scene of injury
- Early: death 1-4 hours post-injury
- Late = less common: death days/weeks post-injury (often due to sepsis, multiple organ failure)
What two types of injury are often associated with trauma deaths? What two factors can increased this?
- CNS injury
- Exsanguination
Increased with low GSC score or old age
What are the three levels of SALT Mass Casualty Triage?
- 1st: still/obvious life threat
- 2nd: wave/purposeful movement
- 3rd: walk
What are the five levels of Trauma Centers?
- Level 1: highest level of care
- Level 2: definitive care in wide range of complex traumatic patients
- Level 3: initial stabilization + tx, can care for uncomplicated trauma patients
- Level 4/5: initial stabilization → transfer ALL trauma patients
What approach is used with Primary Survey (PPE)/Initial Evaluation?
“ABCDE”
- Airway
- Breathing
- Circulation
- Disability
- Exposure
What is the definitive way to maintain airway patency and support? What is an alternative option?
Endotracheal intubation = definitive
- Cricothyroidotomy
What three conditions are considered immediate threats to Breathing?
- Tension PTX
- Massive hemothorax
- Cardiac tamponade
With an unstable trauma patient, what two diagnostic tests should be performed to anticipate for PTX or hemothorax?
- CXR
- Tube thoracostomy
With Circulation, what two tasks should be performed on a trauma patient?
- Place catheters
- Obtain blood type and cross match
With Circulation and trauma, as blood is lost, what two vitals increase and which three findings decrease?
- HR and RR increase
- BP, UO and GCS decrease
What approach is used to treat shock, and what are the three steps?
Step down approach
- 1 L NS/LR
- 1-2 units O- RBCs
- Start MTP (1:1:1 ratio of PRBC:FFP:platelets)
What is MTP, and what is it used to treat?
Massive Transfusion Protocol for SHOCK
- 1:1:1 ratio of PRBC:FFP:platelets
What is the AVPU scale?
Assess alertness vs. verbal vs. pain vs. unresponsive
What is a normal GCS score? At what score is there a need to intubate?
15 points = normal
- <8 points = coma, need to intubate
What is the Lethal Triad in trauma?
- Hypothermia
- Coagulopathy
- Acidosis
What temperature is considered hypothermia?
<35 C
With a trauma patient, why would you order a Lipase?
Pancreatic trauma
- Can also indicate infarcted bowel or peritonitis
What does AMPLLE history stand for?
- Allergies
- Medications
- PMH
- Last meal
- LMP
- Events leading to trauma
What is the anticoagulation reversal for Antiplatelets (2)?
Platelets
+/- DDAVP
What is the anticoagulation reversal for Coumadin (4)?
- Vitamin K
- FFP
- PCC
- Factor VIIa
What is the anticoagulation reversal for Heparin?
Protamine sulfate
What is the anticoagulation reversal for Pradaxa (2)?
- Praxbind
- PCC
What is the anticoagulation reversal for Xarelto/Eliquis?
PCC
What standard is used to evaluate for C spine injury, and what are the five components?
NEXUS
- No midline spinal tenderness
- No focal neuro deficits
- Normal alertness
- No intoxication
- No painful distracting injury
What standard is used to evaluate for head injury in peds, and what are the four components?
PECARN = order CT if…
- LOC of 5+ seconds
- Non-frontal hematoma
- Not acting normal
- Severe MOI
What sign involves edema and bruising of subcutaneous fatty tissue around umbilicus, and what could this indicate?
Cullen’s Sign
- Possible retroperitoneal hemorrhage
What sign involves bruising of flanks, and what could this indicate?
Grey Turner’s Sign
- Possible retroperitoneal hemorrhage
What is the most frequently injured organ in penetrating trauma?
Liver
What is the most frequently injured organ in blunt trauma?
Spleen
What should be placed around the hips with a pelvic fracture?
Binder
With traumatic Vascular Injury, what are considered hard signs (5), and what is the recommended treatment?
Hard signs = go to OR
- Active/pulsatile bleeding
- Expanding hematoma
- Pulseless limb
- Shock
- Compartment syndrome
With traumatic Vascular Injury, what are considered soft signs (4), and what is the recommended treatment?
Soft signs = obtain ABI/CT
- Small/non-expanding hematoma
- Venous oozing
- Hx pulsatile bleeding
- Unexplained neuro defect
What is an abnormal ABI value, and what test should then be obtained?
ABI <0.9 = abnormal
- Order CT angiogram of extremity if abnormal
What condition is associated with the 6 P’s, and what are they?
Compartment Syndrome
- Pain
- Paesthesias
- Pallor
- Poikilotherma-polar
- Paralysis
- Pulselessness
What are the six symptoms associated with Compartment Syndrome?
- Pain
- Paesthesias
- Pallor
- Poikilotherma-polar
- Paralysis
- Pulselessness
Under what 5 conditions would a wound be more likely to develop Tetanus?
- 6+ hours
- Stellate/avulsion/abrasion wound
- 1+ cm deep
- Crush/burn/missile wound
- Presence of signs of infection + devitalized tissue + contamination + ischemic tissue
What two types of burns require grafting?
- Deep partial thickness (2nd)
- Full thickness (3rd)
What position should a pregnant trauma patient be placed in, and why?
Left lateral decubitus position
- Avoid IVC compression
What is the time frame for a Perimortem C-Section (initiate vs delivery)?
- Initiate procedure within 4 minutes of maternal arrest
- Deliver within 5 minutes
What medication should be considered in a geriatric trauma patient?
Warfarin
With OP use of narcotics, what is the recommended administration?
Use for 3 days then throw away
With IP use of narcotics, what is the recommended administration?
Alternate opioids and non-opioids
+/- NSAIDs
