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EM/Surg > Trauma (Exam #1) > Flashcards

Trauma (Exam #1) Flashcards

1
Q

What is the most common cause of preventable mortality in trauma?

A

Hemorrhage

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2
Q

What are the three levels of trauma mortality - describe each?

A
  • 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)
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3
Q

What two types of injury are often associated with trauma deaths? What two factors can increased this?

A
  • CNS injury
  • Exsanguination

Increased with low GSC score or old age

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4
Q

What are the three levels of SALT Mass Casualty Triage?

A
  • 1st: still/obvious life threat
  • 2nd: wave/purposeful movement
  • 3rd: walk
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5
Q

What are the five levels of Trauma Centers?

A
  • 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
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6
Q

What approach is used with Primary Survey (PPE)/Initial Evaluation?

A

“ABCDE”

  • Airway
  • Breathing
  • Circulation
  • Disability
  • Exposure
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7
Q

What is the definitive way to maintain airway patency and support? What is an alternative option?

A

Endotracheal intubation = definitive

- Cricothyroidotomy

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8
Q

What three conditions are considered immediate threats to Breathing?

A
  • Tension PTX
  • Massive hemothorax
  • Cardiac tamponade
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9
Q

With an unstable trauma patient, what two diagnostic tests should be performed to anticipate for PTX or hemothorax?

A
  • CXR

- Tube thoracostomy

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10
Q

With Circulation, what two tasks should be performed on a trauma patient?

A
  • Place catheters

- Obtain blood type and cross match

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11
Q

With Circulation and trauma, as blood is lost, what two vitals increase and which three findings decrease?

A
  • HR and RR increase

- BP, UO and GCS decrease

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12
Q

What approach is used to treat shock, and what are the three steps?

A

Step down approach

  1. 1 L NS/LR
  2. 1-2 units O- RBCs
  3. Start MTP (1:1:1 ratio of PRBC:FFP:platelets)
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13
Q

What is MTP, and what is it used to treat?

A

Massive Transfusion Protocol for SHOCK

- 1:1:1 ratio of PRBC:FFP:platelets

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14
Q

What is the AVPU scale?

A

Assess alertness vs. verbal vs. pain vs. unresponsive

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15
Q

What is a normal GCS score? At what score is there a need to intubate?

A

15 points = normal

- <8 points = coma, need to intubate

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16
Q

What is the Lethal Triad in trauma?

A
  • Hypothermia
  • Coagulopathy
  • Acidosis
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17
Q

What temperature is considered hypothermia?

A

<35 C

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18
Q

With a trauma patient, why would you order a Lipase?

A

Pancreatic trauma

- Can also indicate infarcted bowel or peritonitis

19
Q

What does AMPLLE history stand for?

A
  • Allergies
  • Medications
  • PMH
  • Last meal
  • LMP
  • Events leading to trauma
20
Q

What is the anticoagulation reversal for Antiplatelets (2)?

A

Platelets

+/- DDAVP

21
Q

What is the anticoagulation reversal for Coumadin (4)?

A
  • Vitamin K
  • FFP
  • PCC
  • Factor VIIa
22
Q

What is the anticoagulation reversal for Heparin?

A

Protamine sulfate

23
Q

What is the anticoagulation reversal for Pradaxa (2)?

A
  • Praxbind

- PCC

24
Q

What is the anticoagulation reversal for Xarelto/Eliquis?

A

PCC

25
Q

What standard is used to evaluate for C spine injury, and what are the five components?

A

NEXUS

  • No midline spinal tenderness
  • No focal neuro deficits
  • Normal alertness
  • No intoxication
  • No painful distracting injury
26
Q

What standard is used to evaluate for head injury in peds, and what are the four components?

A

PECARN = order CT if…

  • LOC of 5+ seconds
  • Non-frontal hematoma
  • Not acting normal
  • Severe MOI
27
Q

What sign involves edema and bruising of subcutaneous fatty tissue around umbilicus, and what could this indicate?

A

Cullen’s Sign

- Possible retroperitoneal hemorrhage

28
Q

What sign involves bruising of flanks, and what could this indicate?

A

Grey Turner’s Sign

- Possible retroperitoneal hemorrhage

29
Q

What is the most frequently injured organ in penetrating trauma?

A

Liver

30
Q

What is the most frequently injured organ in blunt trauma?

A

Spleen

31
Q

What should be placed around the hips with a pelvic fracture?

A

Binder

32
Q

With traumatic Vascular Injury, what are considered hard signs (5), and what is the recommended treatment?

A

Hard signs = go to OR

  • Active/pulsatile bleeding
  • Expanding hematoma
  • Pulseless limb
  • Shock
  • Compartment syndrome
33
Q

With traumatic Vascular Injury, what are considered soft signs (4), and what is the recommended treatment?

A

Soft signs = obtain ABI/CT

  • Small/non-expanding hematoma
  • Venous oozing
  • Hx pulsatile bleeding
  • Unexplained neuro defect
34
Q

What is an abnormal ABI value, and what test should then be obtained?

A

ABI <0.9 = abnormal

- Order CT angiogram of extremity if abnormal

35
Q

What condition is associated with the 6 P’s, and what are they?

A

Compartment Syndrome

  • Pain
  • Paesthesias
  • Pallor
  • Poikilotherma-polar
  • Paralysis
  • Pulselessness
36
Q

What are the six symptoms associated with Compartment Syndrome?

A
  • Pain
  • Paesthesias
  • Pallor
  • Poikilotherma-polar
  • Paralysis
  • Pulselessness
37
Q

Under what 5 conditions would a wound be more likely to develop Tetanus?

A
  • 6+ hours
  • Stellate/avulsion/abrasion wound
  • 1+ cm deep
  • Crush/burn/missile wound
  • Presence of signs of infection + devitalized tissue + contamination + ischemic tissue
38
Q

What two types of burns require grafting?

A
  • Deep partial thickness (2nd)

- Full thickness (3rd)

39
Q

What position should a pregnant trauma patient be placed in, and why?

A

Left lateral decubitus position

- Avoid IVC compression

40
Q

What is the time frame for a Perimortem C-Section (initiate vs delivery)?

A
  • Initiate procedure within 4 minutes of maternal arrest

- Deliver within 5 minutes

41
Q

What medication should be considered in a geriatric trauma patient?

A

Warfarin

42
Q

With OP use of narcotics, what is the recommended administration?

A

Use for 3 days then throw away

43
Q

With IP use of narcotics, what is the recommended administration?

A

Alternate opioids and non-opioids

+/- NSAIDs

EM/Surg (16 decks)

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