Trauma (oral surgery)

Question 1

What are the types of primary injury as a result of a blast?

Answer 1

Eardrum rupture, abdominal haemorrhage, blast lung

Question 2

How do primary injuries differ from the secondary, tertiary and quaternary injuries during blasts?

Answer 2

Primary = the blast wave itself
Secondary = Debris and fragments launched from the blast
Tertiary = Result of being thrown by the blast
Quaternary = Not due to primary, secondary, or tertiary mechanisms

Question 3

How common is trauma?

Answer 3

Almost half a million people hospitalised and 12000 deaths

Males make up 59% of trauma injuries

Indigenous people 2x as likely

Question 4

What causes most injuries requiring hospitalization from trauma?

Answer 4

Most injuries are a result of traffic accidents, falls, self-harm, and assault.

Question 5

What causes most deaths as a result of trauma?

Answer 5

Falls

Suicides

Transport accidents

Question 6

TRUE OR FALSE: trauma is the 2nd most common cause of death among people aged 1 - 46

Answer 6

FALSE, it is the most common cause of death of people between 1 - 46 years of age.

Question 7

How is trauma typically managed?

Answer 7

A systematic approach is typically used involving multiple disciplines.

Question 8

What is the trimodal distribution of death from trauma injuries?

Answer 8

Typically death from trauma follows a trimodal distribution. Immediate death occurs 50% of the time, 30% middle

Question 9

What causes immediate deaths following trauma?

Answer 9

Fatal injury to the great vessels, heart, brain, brainstem, or upper spinal cord.

This results from failed oxygenation of vital organs or CNS injury.

Injuries occur in predictable patterns based on mechanism of injury, patient, and environmental conditions.

Question 10

What causes late trauma mortality?

Answer 10

Primarily due to sepsis and multi organ failure

Question 11

What is ATLS?

Answer 11

Advanced Trauma Life Support.

Training program for medical providers in the management of acute trauma cases, developed by the American College of Surgeons

Standard of care built around a consistent approach to patient evaluation

Ensures that the most life-threatening conditions are quickly identified and addressed in the order of risk potential

Question 12

What does the golden hour refer to in trauma?

Answer 12

First hour after a traumatic injury when emergency treatment is most likely to be successful. It can have a significant impact on morbidity and mortality

Question 13

Why is triage necessary with trauma patients?

Answer 13

To avoid delay and to have the best initial management of poly trauma

Question 14

How is triage done with trauma patients?

Answer 14

Prioritize patients according to the severity and urgency of their injuries and availability of care.

Consider vital signs, prehospital clinical course, mechanism of injury, patient’s age, and comorbid conditions.

Question 15

What tools are used to predict outcomes of trauma injuries?

Answer 15

Glasgow Coma Scale: Quantify the severity of a head injury

Revised Trauma Score: Characterizing the physiological status of injured patient, and predicting mortality using revised trauma score.

Injury Severity Score: Deals with multiple traumatic injuries, rate the severity of the injury in each of the 3 most severely damaged organ systems.

Question 16

What does the Glasgow Coma scale do?

Answer 16

It quantifies the head injury by looking at:

Eye opening response

Best verbal response

Best motor response

The total is then calculated and given a rating.

Question 17

What does the revised trauma score look at?

Answer 17

Physiological status

Predicts mortality from Glascow Coma Scale, SBP, and RR

Question 18

What is the injury severity score?

Answer 18

ISS = sum of 3 highest squared abbreviated injury score which is calculated from the organ system affected by the trauma

Question 19

What is the function of the primary survey ABC?

Answer 19

Crucial initial assessment of a seriously injured patient.

Patients assessed and treatment priorities are established based on injuries, stability of their vitals, and injury mechanism

Patient’s vital functions must be assessed quickly and efficiently

Question 20

What does the primary survey assess?

Answer 20

ABCDE

Airways (airway maintenance with C-spine control)

Breathing (Chest wall may move but no air moves through the resp system, ensure breathing is effective) Endotracheal intubation helps protect airways if necessary.

Circulation (Control bleeding and restore tissue circulation, most common cause of shock in traumatized patient caused by haemorrhage)

Disability (Neurological exam. Awake, Voice stimulation, Pain stimulation, Unresponsive)

Exposure (All body needs to be visualized, palpated, and examined)

Question 21

Which injuries require special considerations?

Answer 21

Patient with burns, cold injuries, and electrical injuries.

Question 22

What should be done for burns patients?

Answer 22

Full thickness burns of thorax or extremity require escharotomies to prevent impairment of ventilation.

Early intubation, mechanical ventilation if upper airway affected.

Patients with large burns require large volumes of crystalloid resuscitation fluids

Question 23

How is the surface area of a burn estimated?

Answer 23

Rule of 9s.

Chest, abdomen, limbs, upper back, lower back, anterior surface of each lower limb and posterior surface of each lower limb

Question 24

How does the degree of a burn get assessed?

Answer 24

First degree = epidermis only

Second degree = epidermis extending into the dermis

Third degree = extending through the epidermis and dermis to the connective tissue layer

Question 25

How are electrical burn patients treated?

Answer 25

Usually affects superficial skin and a large portion of skin. So treatment usually involves debridement of eschar and skin grafts.

Question 26

How are high-voltage electrical injuries diagnosed?

Answer 26

Tissue injury may sometimes not be apparent due to myonecrosis and soft tissue damage occurring underneath the superficial layers of skin.

Measurement of compartment pressures and performing decompressive fasciotomies.

Monitor urine output for myglobinuria

Continual cardiac monitoring as risk of direct myocardial injury and hyperkalemia arising from myonecrosis

Question 27

How is skin grafting done?

Answer 27

Split-thickness skin grafts are harvested from front or outer thigh, abdomen, buttocks or back and used to cover large areas.

Question 28

What is spray-on skin?

Answer 28

Technology used for treatment of burn victims where small samples of patient’s skin is sprayed on the wound

Question 29

How is severe hypothermia treated?

Answer 29

Treated by rewarming

Immerse in water warmed to 40 degrees centigrade.

Do not stop resuscitation efforts until patient is rewarmed thoroughly

Question 30

What is a tertiary trauma survey?

Answer 30

A patient evaluation that identifies and catalogues all injuries after initial resuscitation and operative intervention. Decreases morbidity and mortality by earlier identification and treatment

Question 31

How can injury be prevented and controlled nationwide?

Answer 31

Prevented:

Enhance biomechanics research

Enhance trauma care

Develop national policy

Controlled:

Engineering and technology

Enforcement and legislative

Education and behavioural