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Clinical Decision making- Summer final > Trauma-Ross > Flashcards

Trauma-Ross Flashcards

1
Q

2 main forces (list)

A
  • blunt trauma

- Penetrating trauma

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2
Q 
Major Trauma (MT): Mechanism Criteria
-Describe falls for adults vs children
A

adults >20 ft (1 story is 10 ft)

children : >10 ft or 2-3 times the height of the child

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3
Q

List other ex’s of major trauma

A

Death in same vehicle

Patient Ejection

Vehicle rollover

Intrusion: >12 in occupant or >18 in anywhere

Auto-pedestrian/bicycle >20mph

MCA >20mph

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4
Q

MT Anatomic Criteria (list 8)

A

Penetrating injury to head, neck torso

2 or more proximal long bone fx

Amputation **proximal to wrist or ankle

Open or depressed skull fx

Crushed or mangled extremity

Neuro deficits

Pelvic Fracture

Flail chest

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5
Q

MT Physiologic Criteria (hint: vital signs?)

A

vital signs:
-including Conscious state GCS <13

  • hypotension sys <90
  • rr <9 or >30
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6
Q

First steps

A 
Activate trauma team
Who is the Captain of the team 
AMPLE HX
ABC 
Vitals and Monitor 
--and undress
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7
Q

Initial assessment includes a rapid assessment of A,B,C,D,E

& a correction of _______

A

immediate life threats

  • -> Next steps:
  • Simultaneous resuscitation and team approach to the patient evaluation and stabilization.

-**DO NOT MISS A LIFE THREAT. X-rays, CT scans and other diagnostics can wait.

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8
Q

“A” stands for _____

A
  • Airway control and C-spine protection
  • Insure airway or provide it
  • Protect c-spine at all times. Collar, stabilization and avoidance of manipulation.

-Have airway adjuncts ready for use.

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9
Q

Massive facial injuries and head injuries with a GCS of ___ or less are indicative for immediate airway management

A

8 or less

Other indications:

  • Penetrating injury to the cranial vault
  • Missile injury to neck
  • Blunt injury to neck with alteration of voice or expanding hematoma
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10
Q

Relative Indications for Intubation

A

-Upper airway obstruction
-Any pt with injury that impairs ventilation
-Flail chest or pt with multiple ribs fx
-Bilateral pneumothorax
-Hemothorax
shock

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11
Q

“B” =

what are you assessing?

A

=Breathing with ventilation

  • Look for symmetric rise and fall of chest
  • Listen for breath sounds
  • Palpate for sub Q air
  • Cover sucking chest wounds
  • O2 sat/End tidal CO2
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12
Q

“Pt presents with distended neck veins, absent breath sounds unilaterally and a DEVIATED trachea”

A

= tension pneumothorax***

MUST decompress before anything else
-chest seal=asherman

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13
Q

What lowers a Pt’s threshold for a major trauma incident?

A

any Pt on an anticoag***= HIGH risk

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14
Q

“Pt presents with distended neck veins after receiving a blunt chest injury”

A

TPNX!!!! (tension pneumo)

test question–> MUST immediately decompress with a 16-gauge needle

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15
Q

“C” =

A

=Circulation with Hemorrhage

  • ->Assess blood volume status
  • Rhythm
  • Peripheral access (IV access)
  • Stop bleeding with pressure
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16
Q

“Pt presents to ED with massive facial wounds, what is your first priority?”

A

**answer: manage airway

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17
Q

Class 1 shock=

A

<15%

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18
Q

Class 2 shock (mild)= __-___% blood loss

A

15-30%

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19
Q

Class 3 (moderate) shock=

A

31-40% blood loss

20
Q

Class 4 (severe) shock=

A

> 40%

21
Q

What happens to HR in Class 1,2,3,4 shock?

A

1- no change
2-stays same OR increases
3- increases!
4- INCREASES

22
Q

What happens to BP in class 1, 2, 3, and 4 shocks?

A

1- stays same
2-stays same
3- stays same or decreases
4- decreases

23
Q

intracranial bleeds cause class 1 or 2 shock (T/F?)

A

FALSE

24
Q

Test ?- where do you place a torniquet?

A

upper arm as close to axilla as possible— brachial a or axial a

OR

high groin area– femoral or deep femoral a

25
Q

What happens to the GCS score in Class 1,2,3, and 4 shock?

A

1- stays same
2- stays same
3-decreases
4-decreases

26
Q

Stage of Hypovolemic Shock (list all 4)

A

Initial
Compensatory
progressive
refractory

27
Q

what does the Triangle of death consist of?

A
  • bleeding
  • hypothermic
  • coagulopathy
28
Q

Describe Fluid resucitation

A
  • **only 1 L of crystalloids
  • then give blood as your resuscitative fluid
  • after 3 units of blood start massive transfusion protocols

(or normal saline)

29
Q

“D” =

–what do you assess?

A

=disability

  • Neuro status
  • GCS now and compare
  • -drops of 2 in the GCS are concerning, drop of 3=very bad!!
30
Q

Answer on the test according to Ross regarding fluids:

A

DO NOT give another L of normal saline, move onto blood products

31
Q

After giving more than 3 units of blood, what do you move onto?

A

**massive transfusion protocol (includes platelets, plasma, and packed RBCs)

32
Q

17 y/o male with eye opening to pain muttering incomprehensible words but localizes pain–> what is his GCS?

A

eye- 2

Verbal-3

Motor- 5

GCS=10

33
Q

25 y/o with spontaneous eye opening, with confused words, and localizes pain.

GCS score?

A

test ? on exam–>

eyes- 4

verbal- 4
Motor-5

GCS- 13

34
Q

GCS- Eye criteria

A

4 spontaneous eye opening

3 eye opening to speech (not waking up a sleeping person)

2 eye opening in response to pain, squeezing finger tip

1 none

35
Q

GCS- Verbal

A 
5 Oriented
4 confused coherent answers but some confusion
3 No conversational exchange
2 Moaning
1 none
36
Q

GCS-Motor

A

6 obeys commands
5 localizes to pain, purposeful movement toward changing the painful stimuli, arm crosses midline
4 withdraws from pain pulls body part away when pinched (normal flexion)
3 flexion in response to pain decorticate response
2-extension to pain decerebrate response, adduction, internal rotation of shoulder and pronation of forearm
1 no motor response

KNOW: 2= decerebrate response

37
Q

“E”=

A

Exposure : this means undress

  • -and environment control
  • -Prevent hypothermia
38
Q

FGH stands for _____

A
  • is there a fetus?
  • G- check their glucose?
  • Hypertet- check tetanus status?
39
Q

FAST EXAM stands for focused assessment w/ sonography for trauma.
Describe this exam (4 P’s)

A

peri-hepatic space
peri-splenic space
pericardium
pelvis

40
Q

Secondary Survey includes?

A

Complete AMPLE history and physical
Detailed head to toe exam
Blood/ Urine analysis
Diagnostic studies. X-rays of c-spine, chest and pelvis.
-Consider CT scan, ultrasound, diagnostic peritoneal lavage (DPL), vascular imaging or emergent surgery.

41
Q

“Pt presents and part of the components of the primary survey include all of the following except:

  • airway
  • breathing
  • circulation check
  • X-ray
A
  • x-ray

- -any diagnostic studies are part of the secondary survey

42
Q

battle sign=

A

basilar skull fracture

43
Q

AMPLE hx=

A

allergies, medications, past med hx, last meal, environment

44
Q

Class 1 shock: need for blood products?

A

monitor

45
Q

Class 2: need for blood products?

A

possibly

46
Q

Class 3 shock: need for blood products?

A

yes

47
Q

Class 4 shock: need for blood products?

A

MASSIVE transfusion protocol!!

Clinical Decision making- Summer final (8 decks)

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