Trauma Patient Testing/Scoring

Question 1

Glasgow Coma Scale Criteria

Answer 1

• Best motor response 1-6: 6-obeys command, 5-localizes pain, 4-withdraws, 3-flexes to pain, 2-extends to pain, 1-none
• Verbal response 1-5: 5-normal response, 4-confused, 3-innapropriate words, 2-incomprehensible words, 1-none
• Eye opening 1-4: 4-spontaneous, 3-to speach, 2-to pain, 1-none

Question 2

Injury Severity Score

Answer 2

ISS - Asqd + Bsqd + Csqd (1-75), where A/B/C are three most severely injured anatomically different body regions.
1-minor, 2-moderate, 3-serious, 4-severe, 5-critical, 6-untreatable/unsurvivable
Regions: 1-head, 2-face, 3-neck, 4-thorax, 5-abd/pelvis, 6-spine, 7-UE, 8-LE, 9-external

Question 3

Modified Injury Severity Score

Answer 3

For pediatric patients
Regions: 1-neurologic, 2-face and neck, 3-chest, 4-abd/pelvis contents, 5-extremities/pelvic girdle
Scoring: 1-minor, 2-moderate, 3-severe, 4-probable survival, 5-unsure survival
MISS = Asqd + Bsqd + C sqd for three most injured areas

Question 4

Mangled Extremity Score

Answer 4

MES = sum of component of each fof 4 categories
High specificity, low sensitivity to predict amputation
Categories:1-Skeletal/soft-tissue injury: Low energy = 1; Medium energy = 2; High energy = 3; very high energy = 4; 2-Limb ischemia: Pulse reduced or absent but perfusion normal = 1; Pulseless = 2; Cool, paralyzed, insensate = 3; 3-Shock: normotensive = 0; transient hypotension = 1; persistent hypotension = 2; 4-Age: < 30 = 0; 30-50 = 1; >50 = 2. Limb category scores are doubled for ischemia > 6 hours.

Question 5

Sickness Impact Profile

Answer 5

Evaluates patients after severe lower extremity injury.

Psychosocial subscale does not improve over time.

Question 6

Systemic Inflammatory Response Syndrome

Answer 6

A generalized response to trauma characterized by an increase in cytokines, complement and hormones.
Associated with conditions such as disseminated intravascular coagulopathy (DIC), acute respiratory distess syndrome (ARDS), renal failure, multisystem organ failure, shock.
Diagnostic criteria: 2 or more of following: HR > 90, WBC 12,000, RR > 20 or PaCO2 < 32, Temp < 36 degrees or >38 degrees

Question 7

Risk factors for lower SIP scores?

Answer 7

rehospitalization for a major complication, a low educational level, nonwhite race, poverty, lack of private health insurance, poor social-support network, low self-efficacy (the patient’s confidence in being able to resume life activities), smoking, and involvement in disability-compensation litigation.