Week 7: Trauma (Part 1)

Question 1

For people age 5-29 years, 3 of the top 5 causes of death are injury-related, namely ….

Answer 1

road traffic injuries, homicide and suicide.

Question 2

Injuries and violence are responsible for an estimated ____________ of all years lived with disability.

Answer 2

10%

Question 3

Injuries and violence place a massive burden on national economies, costing countries billions of US dollars each year in …

Answer 3

health care, lost productivity and law enforcement.

Question 4

The strategy of initial management can be defined as …

Answer 4

a continuous, priority-driven process of patient assessment, resuscitation, and reassessment.

Question 5

The general approach to evaluation of the acute trauma victim has three sequential components:

Answer 5

rapid overview, primary survey, and secondary survey

Question 6

trauma initial evaluation flow chart

Answer 6

Question 7

The primary survey is designed to:

Answer 7

assess and treat life-threatening injuries rapidly.

Question 8

The leading causes of death in trauma patients are (4)

Answer 8

• airway obstruction
• respiratory failure
• hemorrhagic shock
• brain injury

Therefore, these are the areas targeted by the primary survey.

Question 9

Airway evaluation involves:

Answer 9

• the diagnosis of any trauma to the airway or surrounding tissues
• recognition and anticipation of the respiratory consequences of these injuries
• prediction of the potential for exacerbation of these or other injuries by any contemplated airway management maneuvers

Question 10

____________ is probably the most frequent cause of asphyxia

Answer 10

airway obstruction

Question 11

airway obstruction may result from:

Answer 11

-posteriorly displaced or lacerated pharyngeal soft tissues
- hematoma
- bleeding
- secretions
- foreign bodies
- displaced bone or cartilage fragments.

Question 12

bleeding in the cervical region

Answer 12

may produce airway obstruction not only because of compression by the hematoma, but also from venous congestion and upper airway edema as a result of compression of neck veins.

Question 13

Signs of upper and lower airway obstruction include:

Answer 13

dyspnea, hoarseness, stridor, dysphonia, subcutaneous emphysema, and hemoptysis.

Question 14

Early symptoms that may help indicate that specialized airway management techniques are required.

Answer 14

Cervical deformity, edema, crepitation, tracheal deviation, or jugular venous distention

Question 15

initial steps in airway management

Answer 15

chin lift, jaw thrust, clearing of the oropharyngeal cavity, placement of an oropharyngeal or nasopharyngeal airway

• in inadequately breathing patients, ventilation with a self-inflating bag.

Question 16

if initial resolution of airway obstruction is inadequate…

Answer 16

definitive airway management should be achieved by intubation or cricothyroidotomy

Question 17

____________ can be useful intermediary for airway obstruction

Answer 17

supraglottic airway (LMA)

Question 18

what should be avoided in patients with airway obstruction

Answer 18

Blind Passage of Nasal Tubes should be avoided

Question 19

most common trauma-related causes of difficult tracheal intubation

Answer 19

• Maxillofacial, neck, and chest injuries, as well as cervicofacial burns, are the most common trauma-related causes of difficult tracheal intubation.
• Airway assessment should include a rapid examination of the anterior neck for feasibility of access to the cricothyroid membrane

Question 20

all trauma patients should be considered ____________

Answer 20

a full stomach

Question 21

how should intubation occur in patient with airway obstruction

Answer 21

rapid sequence

reduced dose induction drugs or NONE

Question 22

cervical spine injury immobilization is indicated (before/after) airway management in all acute trauma patients with depressed consciousness, neck pain, tenderness, extremity paresthesias, or focal neurologic deficits, and whenever the pain of other injuries is likely to mask the neck pain

Answer 22

before

Question 23

what kind of intubation should be avoided for a patient with cervical spine injury

Answer 23

Nasal intubation

There is no singular “best” method for tracheal intubation. Selection of the optimal technique and outcome depends on the pattern of injury, resource availability, and provider experience.

Question 24

maxillofacial obstruction can occur by:

Answer 24

blood, bone, teeth, pharyngeal tissues

Question 25

t/f many isolated facial injuries do not require intubation

Answer 25

TRUE

Question 26

penetrating injury may cause

Answer 26

Escape of air, hemoptysis, and coughing

Question 27

t/f you can intubate through a defect

Answer 27

true

Question 28

blunt airway injury may cause what s/s

Answer 28

hoarseness, muffled voice, dyspnea, stridor, dysphagia, odynophagia, cervical pain and tenderness, ecchymosis, subcutaneous emphysema, and flattening of the thyroid cartilage

Question 29

Blunt thoracic injury usually involves :

Answer 29

the posterior membranous portion of the trachea and the mainstem bronchi, usually within approximately 3 cm from the carina.

Question 30

What are the usual signs of penetrating injury?

Answer 30

Pneumothorax, pneumomediastinum, pneumopericardium, subcutaneous emphysema, and a continuous air leak from the chest tube are the usual signs of this injury; they occur frequently but are not specific for thoracic airway damage.

Question 31

____________ suggests a perforated airway

Answer 31

difficulty in obtaining a seal around the endotracheal tube or the presence on a chest radiograph of a large radiolucent area in the trachea corresponding to the cuff suggests a perforated airway.

Question 32

s/s of tension pneumothorax

Answer 32

mediastinal shift

Question 33

____________ is a life-threatening emergency wherein a large air collection in the pleural space compromises respiration and cardiac function

Answer 33

tension pneumothorax

Question 34

the classic signs of tension pneumothorax

Answer 34

Cyanosis, tachypnea, hypotension, neck vein distention, tracheal deviation, and diminished breath sounds on the affected side are

Question 35

how should needle decompression be performed

Answer 35

insertion of an angio cath in the 2 intercostal space midclavicular line

Question 36

what is an open pneumothorax

Answer 36

When an injury creates a hole in the chest wall that allows air from the environment to enter the pleural cavity

Question 37

treatment for open pneumo

Answer 37

3 sided dressing and chest tube

Question 38

flail chest may occur when…

Answer 38

3 or more ribs are broken in at least 2 places

Question 39

A flail chest arises when injuries cause…

Answer 39

a segment of the chest wall to move independently of the rest of the chest wall.

Question 40

patho of flail chest

Answer 40

Continuity of the chest wall is disrupted, and the physiologic action of the ribs is altered. The motion of the flail segment is paradoxical to the rest of the chest. It is paradoxical because the flail segment moves inward while the rest of the chest wall moves outward.

Question 41

problems with ventilation a/w flail chest

Answer 41

Ineffective ventilation because of increased dead space, decreased intrathoracic pressure, and increased oxygen demand from injured tissue.

Question 42

____________ is almost universal with flail chest.

Answer 42

Pulmonary contusion in adjacent lung tissue

Question 43

Pulmonary contusion impairs ____________ and ____________

Answer 43

gas exchange and decreases compliance.

Question 44

what results from pain of the injury a/w flail chest

Answer 44

hypoventilation and atelectasis

Question 45

treatment of flail chest

Answer 45

• Maintain adequate ventilation
• fluid management
• pain management
• management of the unstable chest wall [surgical fixation]

Question 46

____________ the most common cause of shock in trauma patients (second cause of death- TBI is first)

Answer 46

blood loss

Question 47

how to evaluate for blood loss

Answer 47

• by assessing the level of responsiveness, obvious hemorrhage, skin color, and pulse (presence, quality, and rate).

Question 48

Any obvious hemorrhaging should be controlled by:

Answer 48

• direct pressure if possible
• if needed, by applying tourniquets to the extremities.

Question 49

warning sign of hypovolemia

Answer 49

pale or ashen extremities or facial skin warning

Question 50

what vascular s/s are of concern for hypovolemia

Answer 50

Rapid, thready pulses in the carotids or femoral arteries are also of concern for hypovolemia.

Question 51

In trauma, hypovolemia is addressed first with ____________

Answer 51

1 L to 2 L isotonic solutions, but it should then be followed by blood products

Question 52

a cap refill time of more than ____________ may indicate poor perfusion

Answer 52

2 seconds

Question 53

Any patient presenting with ____________ is in shock until proven otherwise.

Answer 53

pale, cold extremities

Question 54

With no obvious signs of hemorrhage, and when there is a hemodynamic compromise, a ____________ must be considered and, if suspected, corrected through the creation of a pericardial window.

Answer 54

pericardial tamponade