Severe Trauma

Question 1

In severe trauma, how soon can neurological injury be assessed?

Answer 1

Neurological injury cannot be reliably assessed until the patient has been resuscitated to normal physiological endpoints

Question 2

What adj intervention is useful after intubating a trauma patient?

Answer 2

Inserting an oral gastric tube to prevent gastric dilatation

Question 3

What are the three conditions which most often compromised ventilation in trauma patients?

Answer 3

Tension pneumothorax

Open pneumothorax

Large flail segment with underlying pulmonary contusion

Question 4

In severe trauma, what are the indications for mechanical ventilation?

Answer 4

Intubation for airway protection

Severe head injury

Need for urgent surgery under general anaesthesia

Question 5

How much blood needs to be lost to result in loss of consciousness?

Answer 5

Around half the blood volume

Question 6

How much blood loss is suggested by an ashen grey face and white extremities?

Answer 6

At least 30%

Question 7

In the bleeding patient how much blood loss is required for a change in respiratory rate?

Answer 7

15 to 30%

Question 8

What are some of the earliest signs of blood loss?

Answer 8

Anxiety and narrow pulse pressure may be seen in blood loss of less than 15%

Question 9

How much blood loss is required for a delay in capillary refill time

Answer 9

15 to 30%

Question 10

How much blood loss is required for a drop-in systolic blood pressure?

Answer 10

30 to 40%

Question 11

If a trauma patient is shocked and has distended neck veins what are the likely causes?

Answer 11

Tension pneumothorax
Cardiac tamponade
Myocardial contusion

Question 12

What blood tests can be used to guide the degree of shock and the adequacy of resuscitation in the first few hours?

Answer 12

Base access and serum lactate

Question 13

What systolic blood pressure should you target in the bleeding trauma patient?

Answer 13

80 to 100 mmHg

Unless the patient has a brain injury, in which case higher pressures should be targeted.

Question 14

How many people are required to log roll a patient?

Answer 14

At least 4.

One person at the head, two people to roll the body, and the fourth person to examine the back and perform a rectal exam.

Question 15

What size opening in the chest wall causes a sucking chest wound?

Answer 15

Any opening of more than two-thirds the diameter of the trachea will cause at to pass preferentially through the hole in the chest wall.

Question 16

When should you suspect cardiac tamponade?

Answer 16

Any penetrating injury to the chest or abdomen

Question 17

How is cardiac tamponade identified in the resus room,

Answer 17

Immediate echocardiography as part of the FAST scan.

Question 18

What is the treatment for a cardiac tamponade?

Answer 18

Pericardiocentesis to buy time followed by emergency thoracotomy or sternotomy.

Question 19

What is the definition of massive haemothorax?

Answer 19

More than 1500 ml of blood in the chest cavity.

Question 20

What is a sign of a traumatic aortic rupture?

Answer 20

Widened mediastinum on chest x-ray.

Question 21

How is myocardial confusion identified?

Answer 21

Echocardiography and 12 lead ECG

Question 22

What are the indications for laparotomy?

Answer 22

Shocked patients with signs of intra-abdominal haemorrhage

Signs of intra-abdominal haemorrhage include peritonism or increasing distention or a positive FAST scan.

Also any patients with penetrating trauma.

Question 23

What is the role of urine dipstick in the trauma patient?

Answer 23

Microscopic haematuria is a sensitive marker of solid organ injury within the abdomen.

Question 24

What is the alternative to CT or ultrasound scanning in diagnosing abdominal injuries in the trauma patient?

Answer 24

Diagnostic peritoneal lavage.

Question 25

Outline an abbreviated neurological examination in the trauma patient

Answer 25

Assess level of consciousness pupils the presence or absence of limb movements.