Approach to Trauma

Question 1

___ leading cause of death in first 4 decades of life

Answer 1

trauma

Question 2

trauma centers are level ___

Answer 2

1: 24 hour in house surgical coverage / OR
rapid access to all surgical specialities

if in bad shape want to go to a level one center!

Question 3

what is a trauma pt critera

Answer 3

physiologic: SBP less than 90
Injury: chest wall unstable
Mechanism: fall over 2 times their height
Goal.. miss rate of less than 5% of the time where have to transfer pt

Question 4

assume ___ in pts with multisystem trauma

Answer 4

c-spine injury

Question 5

GCS less than 8

Answer 5

intubate

Question 6

for breathing look for…

Answer 6

deviated trachea, flalal chest, absence of breath sounds, CXR to evaluate lung fields

Question 7

if you can see white in the armpit fat on xray..

Answer 7

air has seeped superficially into the chest = subcutaneous emphysema

Question 8

needle decompression if __

Answer 8

tension pneumothorax

Question 9

___tube for pneumothorax/hemothorax

Answer 9

chest tube

Question 10

what are 5 contraindications of foley catheter

Answer 10

signs of urethral injury: 
blood at meatus 
perineal ecchymosis 
blood in scrotum 
high riding prostate 
pelvic fractures

Question 11

if thinking there is urethral injury what test prior to catheter insertion?

Answer 11

retrograde urethrogram

Question 12

when is ED thoracotomy indicated?

Answer 12

witness loss of pulses

usually for penetrating trauma of chest only - typically when it was low velocity weapon

Question 13

treat ICP

Answer 13

mannitol
head of bead elevated
hyperventilation
emergen decompression

Question 14

E -exposure tips

Answer 14

log roll - always look at back!
rectal temp
complete disrobe of pt but then warming prvt hypothermia

Question 15

high suspicion of abdominal trauma when there is what 3 things

Answer 15

hypotension, abdominal tenderness and tachy

Question 16

___ most common injured organ in blunt trauma

Answer 16

spleen

Question 17

second most common organ injury

Answer 17

liver - usually associated with other abdominal injureis as well

Question 18

def hollow viscous injury

Answer 18

injury involves: stomach, bowel, or mesentery

symptoms are result of blood loss and peritoneal contamination

Question 19

__ injuries can lead to bucket handle tears or mesentery

Answer 19

deceleration injureis

Question 20

free fluid without solid organi injury is a ___ until proven otherwise

Answer 20

hollow viscus injury

Question 21

what 4 views are included in FAST US?

Answer 21

cardiac, RUQ, LUQ, suprapubic

goal: looking for free fluid

Question 22

trauma steps:

Answer 22

primary survey 
secondary survey (ample) 
FAST 
CT head to pelvis  
home or observation or non emergent OR