Chapter 1 - Initial Assessment and Management

Question 1

What are multiple casualties

Answer 1

Number of patients and their injuries do not exceed the capabilities of the facility

Question 2

What are mass casualties

Answer 2

Number of patients and the severity of their injuries does exceed the capability of the facility

Question 3

What happens during the primary survey

Answer 3

life-threatening conditions are identified and treated in prioritised sequence - ABCDE

Question 4

How to you assess the airway

Answer 4

1. clearing the airway
2. suctioning
3. administering oxygen
4. securing the airway

Question 5

When airway management is required, how do we protect the c-spine

Answer 5

The cervical collar is opened and team member manually restricts movement of c-spine

Question 6

What immediate steps should be taken when a tension pneumothorax is suspected

Answer 6

chest decompression - as tension pneumothroax acutely and dramatically compromises ventilation and circulation.

Question 7

what should every injured patient receive

Answer 7

supplemental oxygen

Question 8

Are there any risks associated with intubating someone who has a simple pneumothorax

Answer 8

simple pneumothroax can covert to tension pneumothorax when intubated and positive pressure ventilation started if we have not already decompressed the pneumothroax with a chest tube

Question 9

Main cause of preventable deaths after injury

Answer 9

haemorrhage

Question 10

3 elements of clinical observation that help assess haemodynamic status

Answer 10

1. level of conciousness. critical impairment of cerebral perfusion
2. skin perfusion
3. pulse

Question 11

how do we manage rapid external blood loss

Answer 11

direct manual pressure on the wound. Tourniquets useful in massive exanguination

Question 12

major areas of internal haemorrhage

Answer 12

• chest
• abdomen
• retroperitoneum
• pelvis
• long bones

Question 13

How would you prepare for a patients arrival

Answer 13

Prepare equipment necessary to support ABC evaluation.
Oxygen and suction available and checked.
Warm IV fluids.
Aware of institutions capabilities and what to do if needs exceeds

Question 14

What information is helpful to know before patients arrival into ED

Answer 14

Vital signs including GCS
What interventions have been performed
Time of arrival

Question 15

What is the emphasis during the prehospital phase

Answer 15

Airway maintenance, control of external bleeding and shock, immobilisation of the patient and immediate transfer

Question 16

What are critical aspects of the hospital preparation

Answer 16

Resuscitation are for trauma patients
Airway equipment
Warmed IV crystalloids
Protocol to summon additional assistance, prompt radiology and labs
Transfer agreements with major trauma centres

Question 17

What are important communications from the prehospital team

Answer 17

Time of injury
Events related to the injury
Patient history and vital signs
Mechanism of injury

Question 18

What are standard precaution devices

Answer 18

Face mask
Eye protection
Water impervious gown
Gloves

Question 19

What adjuncts are used during the primary survey

Answer 19

ECG - continuous
Pulse oximetry
CO2
Ventilation rate assessment
ABG
Urine output
NG
Lactate, X-ray, FAST scan,

Question 20

What condition is associated with the following dysrhythmias

Tachycardia, AF, premature ventricular contractions, ST changes

Answer 20

Blunt cardiac injury

Question 21

What condition is associated with the following dysrhythmias

PEa

Answer 21

Cardiac tamponade
Tension pneumothorax
Profound hypovolaemia

Question 22

What condition is associated with the following dysrhythmias
Bradycardia, aberrant conduction, premature beats

Answer 22

Hypoxia

Hypothermia

Question 23

What is the goal of the primary surgery

Answer 23

To identify and treat life threatening injuries in a prioritised sequence based on the effects of the injuryies of the patient physiology, because st first it may not be pooible to identify specific anatomical injuries

Question 24

How can you manage equipment failure

Answer 24

Test regularly and keep spare equipment and batteries

Question 25

How can you manage unsuccessful intubation

Answer 25

Identify patients with difficult anatomy Identify your most skilled airway manager Ensure adequate equipment is available to rescue the failed airways attempt Be prepared to perform a surgical airway

Question 26

How do you manage progressive airway loss

Answer 26

Recognise the dynamic status of the airway Recognise the injuries that can result in progressive airway loss Frequently reassess the patient for signs of deterioration of the airway

Question 27

Which patient populations warrant special considerations

Answer 27

Children, pregnant women, older adults, obese patients and athletes

Question 28

When do we begin the secondary survey

Answer 28

The secondary survey starts once the primary survey is finished, resuscitative efforts are underway and vital signs improvements are seen

Question 29

What is the secondary survey

Answer 29

A head to toe assessment of the patient | Full history and physical examination including reassessment of all vital signs

Question 30

What pneumonic can we use to take a history.

Answer 30

``` AMPLE Allergies Medications Past illnesses / pregnancy Last meal Events / environment related to the injury ```

Question 31

What are the two broad categories of injuries

Answer 31

Blunt trauma | Penetrating trauma

Question 32

What is the sequence of the physical examination during the secondary survey

Answer 32

``` Head Max fax structures C spine and neck Chest Abdomen and pelvis Perineum, vagina, rectum Musculoskeletal system Neurological examination ```

Question 33

What is particularly important to examine during head assessment in secondary survey

Answer 33

The eyes - oedema can develop later Visual acuity, pupil size, haemorrhage of conjunctiva or fundi, penetrating injury, contact lenses, lens dislocation, ocular entrapment

Question 34

What should examination of the face include

Answer 34

Palpating of all bony structures, assessment of occlusion, intraoral examination and soft tissue assessment

Question 35

What is the acronym for handover

Answer 35

``` MIST Mechanism and time of injury Injuries found and suspected Symptoms and signs Treatment initiated ```

Question 36

What does pulse oximetry measure

Answer 36

The saturation of oxygen. | It can be confounded by carboxyhaemoglobin and so should be used with caution in patients with inhalation injuries

Question 37

How can we make the pulse oximetry readings more accurate

Answer 37

Place it above the BP cuff | Confirm with ABG findings

Question 38

What X-rays are used during primary survey

Answer 38

ONLY chest and pelvis X-rays

Question 39

What specialised diagnostic tests can be performed during the secondary survey to identify specific injuries

Answer 39

``` X-ray of spine and extremities CT scans Contrast URL graphs and angiography TOE, trans oesophageal ultrasound Bronchoscopy OGD ```

Question 40

how can we help reduce facial odedema

Answer 40

minimise it by elevation of the head to trendelenburg position

Question 41

where do we auscletat on the chest and what for

Answer 41

high at apex for pneumothorax and at the bases for haemothorax

Question 42

how do we prevent large blood loss in pelvic fractures

Answer 42

place a pelvic binder and do not repeatedly or vigorously manipulate the pelvis