Trauma Practical Exam Prep Flashcards
List the stages of the decision-making algorithm for trauma destination guidelines
- Failed airway?
- Blunt traumatic arrest?
- Penetrating traumatic arrest?
- Physiological criteria
- Anatomical criteria
- Mechanism criteria
- Special Considerations
In general, when should one bypass a local facility to access a lead trauma hospital?
If there is physiological, anatomical, mechanism, or special criteria for trauma bypass and the time to the LTH is under 30 minutes (60 minutes in fraser)
list physiological criteria for major trauma
- SBP less than 90
- RR greater than 30 or less than 10
- GCS 13 or less
list anatomical criteria for major trauma
- Open or depressed skull fracture
- New paralysis or neurological deficits
- Major penetrating injury
- Facial injury with potential airway compromise
- Two or more proximal long bone fractures
- Crushed , degloved, mangled, or pulseless extremity
- Amputation proximal to wrist or ankle
- Chest wall instability or deformity
- Major burns
- Unstable pelvis
list mechanism criteria for major trauma
- Falls over 6m
- MVA; intrustion, ejection, death in vehicle
- Pedestrian or cyclist struck at 30kph or more, thrown, or run over
- motorcycle collision at 30kph or more
list special criteria for major trauma
- Elderly
- SBP under 110 in pts. over 65
- Anticoagulation
- Pregnancy over 20 wks.
What is the preferred order of primary assessment in major trauma?
CABCDE
What are the indications for tourniquet placement?
Bleeding from an extremity that cannot be controlled through direct pressure or wound packing
List critical steps in tourniquet placement to control bleeding
- Attempt direct pressure or wound packing first
- Apply Tq 2-3in. above the wound and directly on skin
- Tighten until bleeding stops
- Note the TIME OF APPLICATION
- Reassess at each point of reassessment
What are indications for pelvic binding?
Major mechanism suggestive of pelvic fracture with any of the following:
- Hemodynamic instability (heart rate > 100 or systolic blood pressure < 90 mmHg)
- Pelvic pain on exam
- Pelvic instability
- Decreased level of consciousness
- Major injury distracting from pelvic exam
Describe oxygen administration in trauma patients
- Apply high-flow oxygen early if any signs of shock, dyspnea, or need for resuscitation are present. Do not delay to obtain a room-air sat. Target 100% SpO2 and then titrate down.
Describe fluid resuscitation targets in the following populations;
1. General resuscitation
2. Bleeding
2. TBI/SCI
3. Burns
4. Electrocution (high voltage)
- Target SBP of 90mmHg or more, or MAP of 65 or more. 500mL aliquots to a MAX of 2000mL
- Consider permissive hypotension (SBP=70-90mmHg) only if mentation and distal pulses are intact
- Target SBP of 120mmHg or greater, or MAP of 85-90
- Target SBP over 120mmHg
- Initial 5mL/kg bolus, followed by 100mL/hr
Describe general management of a patient with an active crush injury
- Apply tourniquets above the entrapped limb prior to release of crush
- Provide up to 2L IV N/S prior to release of crush
- Consider continuous ventolin
- Prepare for cardiac arrest
- Once crush is released, identify and treat bleeding
- Consider calcium and bicarb post release
Describe BP targets in TBI
MAP of 85-90 or SBP more than 120 (conflicting data in CPG)
List specific management priorities in TBI
- elevate head to 30 degrees
- loosen tube ties, C-collars, or other restrictive items around neck
- avoid hypotension, hypothermia and hypoxia at all costs
- Target a MAP of 85-90 or SBP of 120
- Target end tidal CO2 of 35-40. Do not hyperventilate
