Case 1: RTA

Question 1

what are the different types of RTA injury?

Answer 1

deceleration/acceleration
ejection from vehicle
direct blow

Question 2

what should be found out before calculating an RTA patient’s GCS score and why?

Answer 2

were substances involved eg alcohol/drugs

GCS score could be decreased from this instead

Question 3

how should an RTA patient be managed pre-medically?

Answer 3

paramedic assessment - ABCDE

immediate care

Question 4

in what order should an RTA patient be managed in A&E?

Answer 4

ABCDE, concurrent resus, secondary and tertiary

Question 5

how would you immobilise the C spine?

Answer 5

collar and spinal board

Question 6

where should you perform thoracocentesis in a suspected pneumothorax?

Answer 6

2nd intercostal space

Question 7

how should the D of ABCDE be managed in an RTA patient?

Answer 7

GCS
move limbs
pupil size
reduced movement?
lateralising signs

Question 8

maximum score for GCS?

Answer 8

15

Question 9

a GCS score under what indicates a comatose state?

Answer 9

8

Question 10

what are the 3 categories of the GCS?

Answer 10

eye opening response
vocal response
motor response

Question 11

maximum GCS score for the eye opening response category?

Answer 11

4

Question 12

maximum GCS score for the vocal response?

Answer 12

5

Question 13

maximum GCS score for the motor response?

Answer 13

6

Question 14

what acute treatment should be considered for RTA patients?

Answer 14

analgesia
urinary catheter
NGT
analgesia

Question 15

what imaging should be carried out for RTA patients?

Answer 15

CXR
CT pelvis
lateral C spine
CT full body with contrast (except head)
XR of relevant #'s

Question 16

when should you use contrast in a full body CT?

Answer 16

anywhere below the neck (DONT USE CONTRAST FOR THE HEAD)

Question 17

name the 5 types of shock

Answer 17

hypovolaemic
cardiogenic
anaphylactic
septic
neurogenic

Question 18

pathophysiology of hypovolaemic shock?

Answer 18

decreased venous return + preload = dec CO;

causes hypotension which decreases organ perfusion = organ failure

Question 19

how should you investigate an RTA patient with bleeding?

Answer 19

1. CT

2. if bleed, send to IR (interventional radiology) for embolisation or surgery for packing

Question 20

how can you detect lacerations on contrast imaging?

Answer 20

they will appear darker in comparison to the lighter background of the organ

Question 21

what kind of haematoma presents with blood all round the brain?

Answer 21

subdural

Question 22

hollow/solid organs are more commonly damaged in blunt trauma

Answer 22

solid

Question 23

most common hollow viscera damaged?

Answer 23

duodenum

Question 24

how can you tell if a CT scan has contrast or not?

Answer 24

vessels appear white