Trauma-Ross

Question 1

2 main forces (list)

Answer 1

• blunt trauma

- Penetrating trauma

Question 2

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

Answer 2

adults >20 ft (1 story is 10 ft)

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

Question 3

List other ex’s of major trauma

Answer 3

Death in same vehicle

Patient Ejection

Vehicle rollover

Intrusion: >12 in occupant or >18 in anywhere

Auto-pedestrian/bicycle >20mph

MCA >20mph

Question 4

MT Anatomic Criteria (list 8)

Answer 4

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

Question 5

MT Physiologic Criteria (hint: vital signs?)

Answer 5

vital signs:
-including Conscious state GCS <13

• hypotension sys <90
• rr <9 or >30

Question 6

First steps

Answer 6

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

Question 7

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

& a correction of _______

Answer 7

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.

Question 8

“A” stands for _____

Answer 8

• 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.

Question 9

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

Answer 9

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

Question 10

Relative Indications for Intubation

Answer 10

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

Question 11

“B” =

what are you assessing?

Answer 11

=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

Question 12

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

Answer 12

= tension pneumothorax***

MUST decompress before anything else
-chest seal=asherman

Question 13

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

Answer 13

any Pt on an anticoag***= HIGH risk

Question 14

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

Answer 14

TPNX!!!! (tension pneumo)

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

Question 15

“C” =

Answer 15

=Circulation with Hemorrhage

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

Question 16

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

Answer 16

**answer: manage airway

Question 17

Class 1 shock=

Answer 17

<15%

Question 18

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

Answer 18

15-30%

Question 19

Class 3 (moderate) shock=

Answer 19

31-40% blood loss

Question 20

Class 4 (severe) shock=

Answer 20

> 40%

Question 21

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

Answer 21

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

Question 22

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

Answer 22

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

Question 23

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

Answer 23

FALSE

Question 24

Test ?- where do you place a torniquet?

Answer 24

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

OR

high groin area– femoral or deep femoral a

Question 25

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

Answer 25

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

Question 26

Stage of Hypovolemic Shock (list all 4)

Answer 26

Initial Compensatory progressive refractory

Question 27

what does the Triangle of death consist of?

Answer 27

- bleeding - hypothermic - coagulopathy

Question 28

Describe Fluid resucitation

Answer 28

- **only 1 L of crystalloids - then give blood as your resuscitative fluid - after 3 units of blood start massive transfusion protocols (or normal saline)

Question 29

"D" = | --what do you assess?

Answer 29

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

Question 30

Answer on the test according to Ross regarding fluids:

Answer 30

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

Question 31

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

Answer 31

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

Question 32

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

Answer 32

eye- 2 Verbal-3 Motor- 5 GCS=10

Question 33

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

Answer 33

test ? on exam--> eyes- 4 verbal- 4 Motor-5 GCS- 13

Question 34

GCS- Eye criteria

Answer 34

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

Question 35

GCS- Verbal

Answer 35

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

Question 36

GCS-Motor

Answer 36

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

Question 37

"E"=

Answer 37

Exposure : this means undress - -and environment control - -Prevent hypothermia

Question 38

FGH stands for _____

Answer 38

- is there a fetus? - G- check their glucose? - Hypertet- check tetanus status?

Question 39

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

Answer 39

peri-hepatic space peri-splenic space pericardium pelvis

Question 40

Secondary Survey includes?

Answer 40

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.

Question 41

"Pt presents and part of the components of the primary survey include all of the following except: - airway - breathing - circulation check - X-ray

Answer 41

- x-ray | - -any diagnostic studies are part of the secondary survey

Question 42

battle sign=

Answer 42

basilar skull fracture

Question 43

AMPLE hx=

Answer 43

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

Question 44

Class 1 shock: need for blood products?

Answer 44

monitor

Question 45

Class 2: need for blood products?

Answer 45

possibly

Question 46

Class 3 shock: need for blood products?

Answer 46

yes

Question 47

Class 4 shock: need for blood products?

Answer 47

MASSIVE transfusion protocol!!