Trauma Management Flashcards
Trauma patients requiring fluid resuscitation should not receive more than _____ mL of total fluid
2000 mL
Patients that meet the NEXUS criteria and are not multi-trauma require _____ (simple / full) SMR
simple
TXA must be administered within ___ hours of the injury
3 hours
When managing a crush injury, you may need to apply a __________ proximal to the injury site before releasing the crush if it is not possible to alkalize the blood on scene
tourniquet
TXA may only be delivered by ______ (route)
IV
Oxygen administration should be routine in major trauma to avoid __________
hypoxia
Caution should be taken when administering TXA because rapid administration can __________
potentiate futher hypotension
Patients’ clothes should be removed _____ (on scene / in the ambulance)
in the ambulance
Non-ABC interventions (splinting, wound care, etc.) should be performed _____ (on scene / en route) in major trauma
en route
Trauma patients with head injury should receive fluid resuscitation targeting a systolic BP of at least _____ mm Hg
120 mm Hg
Major trauma patients should routinely recieve 2 large bore IVs _____ (en route / on scene)
en route
never delay transport of a major trauma patient to obtain IV access
In head injury, the patient should be positioned _______
head elevated at 30 degress
When preparing TXA for administration using a 50mL N/S mini bag you should first __________ (spike the bag / inject the medication into the bag)
inject the medication into the bag
spiking the bag and priming the line first means that the line will not contain any medication, delaying administration of the TXA
Hypotensive trauma patients without head injury should be resuscitated targeting a systolic blood pressure of ______ (range) mm Hg
70 - 90 mm Hg
The three components of simple SMR are:
- Cervical collar on - head not taped
- Mattress not clamshell
- Head of stretcher up 30 degress - only if head-injured
The 5 modified NEXUS criteria for SMR are:
- Is there midline tenderness?
- Is there altered LOC?
- must be alert/oriented x 3
- Are there new focal neurological deficits?
- Are they intoxicated?
- judgement and pain sensation must be intact
- Is there a major distracting injury?
- significant enough to interfere with their ability to assess pain response when palpating spine
Adult dosage for TXA is ____
1g
Criteria for “high risk group” patients with regards to SMR are: (list 3)
- Age >65
- Osteoporosis
- Pre-existing spinal condition (ex: ankylosing spondilitis)
Crush injuries will often warrant an early call to clinicall for guidance on __________ (acidifying / alkalyzing) the blood prior to releasing the crush
alkalyzing
Indications for administration for TXA are:
trauma with signs of shock/hypoperfusion in association with injury suggestive of occult or ongoing bleeding
The primary goal of care in major trauma management is ________
Efficient scene management and expeditious transport to hospital
1g TXA should be administered over a period of ___ minutes
10 minutes
Contraindications for administration of TXA are: (list 4)
- Hypersensitivity to Tranexamic Acid
- Not administered if greater than 3 hours after the injury
- Dialysis
- Not for actual/estimated age 16 yrs or less
Three options for delivering IV TXA are:
- IV slow push over 10 minutes from 10cc syringe
- Added to 50mL mini bag and delivered through piggy-back macro drip set at 1 gtt/sec
- Added to 250mL N/S bag and run through macro drip set at 5 gtts/sec (wide open)
Findings that would warrant caution for thoracolumbar spine injury in patients not requiring SMR would be: (list up to 7). These patients should not be sat up or have their head elevated.
- Dangerous MOI
- Fall from height >3m
- Axial load to head or base of spine
- High speed MVC (>100km/h)
- Rollover MVC
- Pre-existing spinal pathology
- New back deformity, bruising, or bony midline tenderness on log roll
