Wartime Trauma / Trauma Local and Abroad

Question 1

What two mechanisms of injury make up the most traumas between the ages of 16 and 24?

Answer 1

motor vehicle accidents and firearms

Question 2

What mechanism of injury makes up the most traumas between the ages of 35 and 44?

Answer 2

motor vehicle accidents

Question 3

What two mechanisms of injury make up the most traumas between the ages of 75 and 85?

Answer 3

motor vehicle accidents and falls

Question 4

Which mechanism of injury has the highest percentage of mortalities per case? (motor vehicle accidents, falls, or firearms)

Answer 4

firearms

Question 5

From birth to age 30, trauma ______ more people than any other disease or illness.

Answer 5

kills

Question 6

What are three preventable causes of combat death?

Answer 6

• hemorrhage from extremity wounds (60%) - tension pneumothorax (33%) - airway obstruction (6%)

Question 7

What is the trauma triad of death?

Answer 7

• hypothermia - coagulopathy - acidosis

Question 8

What are the 4 ways your body can lose heat?

Answer 8

• evaporation - radiation - convection -conduction

Question 9

Hypothermia can increase what 3 things?

Answer 9

• mortality - blood loss - blood transfusion

Question 10

Statistically, a trauma patient with a temp of < ___ on admission will have 100% mortality.

Answer 10

32

Question 11

A temp of 33-36 C causes what cardiovascular effects?

Answer 11

increased heart rate, blood pressure, and CO

Question 12

A temp of 32-33 C causes what cardiovascular effects?

Answer 12

decreased heart rate, blood pressure, and CO

Question 13

A temp of < 31 C causes what cardiovascular effects?

Answer 13

increased atrial and ventricular irritability

Question 14

A temp of < 30 C causes what cardiovascular effects?

Answer 14

profound bradycardia and V-fib is likely

Question 15

A temp of 19-20 C causes what cardiovascular effects?

Answer 15

asystole usually occurs

Question 16

A temp of 33-35 C causes what effects on renal function?

Answer 16

afferent pressure increases secondary to systemic vasoconstriction

Question 17

A temp of < 33 C causes what effects on renal function?

Answer 17

GFR decreases. impairment of distal tubular reabsorption can cause polyuria.

Question 18

What are two hematological effects of hypothermia?

Answer 18

HCT rises: results from fluid shift to interstitial space and loss of fluid due to decreased distal tubular reabsorption. Platelets are sequestered in the spleen and liver resulting in increased bleeding times.

Question 19

Regarding coagulopathy, the majority (90%) of trauma patients are ___________.

Answer 19

pro-thrombotic (and they need anticoagulation to prevent a DVT/PE)

Question 20

Regarding coagulopathy, the minority (10%) of trauma patients are ___________.

Answer 20

coagulopathic

Question 21

Which lab value is a better indicator for inadequate perfusion, lactate level or base deficit?

Answer 21

base deficit (serum lactate works well, but need to be sent to the lab and processed. studies show that base deficit is a quick and sensitive measure of inadequate perfusion)

Question 22

What are the three steps in damage control in a combat casualty?

Answer 22

1. abbreviated operation 2. resuscitation in the ICU 3. return to the operating room for definitive operation

Question 23

What are the four goals of damage control resuscitation?

Answer 23

normal INR

normal base deficit

normal temp

rapid hemorrhage control

Question 24

Level 1 trauma centers are facilities equipped to handle emergent care and offer these 5 services. (per the slides)

Answer 24

-emergency medicine - ICU - trauma / surgical - ancillary services - surgical services - anesthesia services

Question 25

What are the indications for massive transfusion?

Answer 25

temp < 96

SBP < 90

Hgb < 11

base deficit > 6

INR > 1.5

Question 26

What are relative indications for giving rFVIIa?

Answer 26

• severe bleeding
• at risk for massive transfusion
• intracranial hemorrhage with altered mental status
• double amputee
• chest tube output > 1L or > 200mL/hr
• major truncal injury with positive FAST

Question 27

In massive transfusions, the ratio of __:__:__ (PRBC : plasma : PLT) are indicated.

Answer 27

1 : 1 : 1

Question 28

Things to know when using rFVIIa. (5)

Answer 28

• correct acidosis first (decreased efficacy when pH < 7.2) - need adequate fibrinogen and PLTs for it to work - consider with FWB use (not totally sure what FWB means) - dose 90 - 120 mcg/kg - can use every 2 hours

Question 29

With burn victims, the chance of survival drops precipitously with > ___% total body burn.

Answer 29

30

Question 30

Direct inhalational thermal injury results in edema, meaning you should do what?

Answer 30

maintaining airway control is a priority. intubate early.

Question 31

Carbon monoxide shifts the oxygen-hemoglobin dissociation curve to the ____.

Answer 31

left

Question 32

What is the Parkland formula for fluid resuscitation in a burn patient?

Answer 32

kg x 4 x %BSA burned = volume over 24 hours (50% of the volume in the first 8 hours, 25% in the next 8, and 25% in the final 8)