Trauma In Adults

Question 1

True or False

The National Emergency X-Radiography Utilization Study (NEXUS) criteria and the Canadian Cervical Spine Rule are useful only in awake and alert patients and are not a substitute for good clinical judgment.

Answer 1

True

Question 2

True or False

If the patient is obtunded, assume a cervical spine injury until proven otherwise.

Answer 2

True

Question 3

What are the Essential Characteristics of Level 1 Trauma Centers?

Answer 3

Question 4

What is the NEXUS criteria?

Answer 4

Question 5

What is the Canadian Cervical Spine Rule?

Answer 5

Question 6

How do you classify hemorrhage based on estimated blood loss at initial presentation?

Answer 6

Question 7

True or false

Aggressive volume resuscitation is not a substitute for definitive hemorrhage control.

Answer 7

True

Question 8

True or False

A balanced crystalloid, such as lactated Ringer’s, is the fluid of choice for initial resuscitation.

Answer 8

True

Question 9

True or False

In patients who are unstable or in whom upper extremity peripheral veins are not easily cannulated, establish central venous access via the subclavian, internal jugular, or femoral vein. Avoid placement of a central venous line distal to a potential venous injury.

Answer 9

True

Question 10

Placement of an IO catheter is a second-line option (after peripheral IV attempt) because it is quick and easy and can accommodate infusion of large volumes.

Answer 10

True

Question 11

potentially indicated for traumatic life-threatening hemorrhage below the diaphragm in patients in hemorrhagic shock who are unresponsive to resuscitation. Depending on the location of hemorrhage, an inflatable balloon catheter is inserted in the femoral artery and advanced to the distal thoracic aorta or distal abdominal aorta

Answer 11

resuscitative endovascular balloon occlusion of the aorta (REBOA)

Question 12

Complications of REBOA

Answer 12

arterial disruption, hematoma, thromboemboli, dissection, and extremity ischemia

Question 13

What did Clinical Randomization of an Antifibrinolytic in Significant Hemorrhage 2 (CRASH-2) study state on Tranexamic Acid?

Answer 13

Tranexamic acid may reduce mortality without significant adverse side effects when given as early as possible after injury, with administration within 1 hour of injury reported to decrease the relative risk of death from bleeding by 32% and within 1 to 3 hours by 21%.

Administration of tranexamic acid more than 3 hours after injury is less effective and potentially harmful.

Question 14

When and how do you give Tranexamic acid?

Answer 14

Tranexamic acid must be given before transfer/arrival to a trauma center in order to meet the time requirement of early administration.

The dose is 1 gram of tranexamic acid IV bolus over 10 minutes, followed by 1 gram IV over 8 hours.

Question 15

True or False

Prophylactic hyperventilation (partial pressure of arterial carbon dioxide of 25 mm Hg or less) is not recommended.

Answer 15

True

Mild hyperventilation may reduce intracranial pressure, although at the expense of cerebral vasoconstriction and hypoperfusion.

Avoid hyperventilation during the first 24 hours after
injury when cerebral blood flow is often critically reduced.

Prophylactic hyperventilation (partial pressure of arterial carbon dioxide of
25 mm Hg or less) is not recommended.

Question 16

True or False

Defer any procedures that do not correct a specific problem discovered during the primary survey until after the head CT is performed.

Answer 16

True

Question 17

True or False

tension pneumothorax is clinically suspected, immediately perform tube thoracostomy. If equipment is not immediately available, needle thoracostomy can be a temporizing measure.

Answer 17

True

Question 18

True or false

Objects deeply impaled in the chest and abdomen should be left in place and the patient emergently transported to the operating room for surgical removal under direct visualization to ensure vascular control and hemostasis. The impaled object may be cut or shortened outside the skin to facilitate transport.

Answer 18

True

Question 19

True Or False

the strongest recommendation for performing ED thoracotomy can be made for patients with penetrating chest trauma with witnessed signs of life during transport to or in the ED and at least cardiac electrical activity upon arrival. 

Answer 19

True

Question 20

If meatal blood is present or the prostate is displaced, which suggests a urethral injury, perform______________ before inserting a Foley catheter

Answer 20

retrograde urethrography

Question 21

Blood loss with tachycardia of 100 to 120 beats per minute is ________ ml loss and _______% blood volume

Answer 21

750 to 1500ml

15 to 30%

Question 22

Blood loss that is asymptomatic or with normal VS is until _____ml of blood or _____% blood loss ?

Answer 22

750 ml or 15%