CLS106

Question 1

Provide a minimum of 10 examples of hazards specific to trauma scenes and explain how these can be mitigated against (ie, what actions would you take to reduce the potential for harm).

Answer 1

Obvs

Question 2

Short Answer - When is the Rapid Trauma Survey indicated?

In what instances could you justify NOT undertaking a Rapid Trauma Survey?

Answer 2

MoI and unconscious/altered LoC

Question 3

Can you name 5 critical conditions where the patient is likely to require high flow Oxygen?
What type of mask would you use to administer this and what flow rate would you select?

Answer 3

Any of the deadly dozen

High-flow NRB or BVM, 10-15 L/min

Question 4

Short Answer Name two contraindications of
Methoxyflurane.
What dose would you administer? What would you do prior to administration of analgesia?

Answer 4

MUDCAPP. Malignant hyperthermia, Uremia/renal failure, decreased LoC, Concurrent tetracycline use, allergy, Parents, Pediatric
3mL.
Check contraindications, check PMS, get pain score

Question 5

Short Answer - Outline the key differences between the Rapid Trauma Survey and the secondary survey.

Answer 5

Speed, delegate interventions to partner. Life-threatening and gross abnormalities. Not looking for all DCAPBLS-TIC

Question 6

What factors should be taken into account before starting to lift a patient when using the Stryker stair chair? Are there any special features that can enhance the safety of this device?

Answer 6

Strap arms in

Question 7

Describe the process of raising and lowering the Stryker stretcher. What additional feature is activated when you press the blue button?

Answer 7

Loading ramp mode (retract legs)

Question 8

Short Answer According to the ANZCOR guidelines, what are the three main causes of traumatic cardiac arrest?
What percentages are linked to each of these causes?

Answer 8

Haem (60%), tension pneumo (33%), airway (7%)

Question 9

What are the treatment priorities when managing a traumatic cardiac arrest?
Talk through your management of a traumatic cardiac arrest as a basic paramedic crew.

Answer 9

SALcAcBC. Confirm, expose, defib, airway, BVM, reversibles

Question 10

Describe each of the different types of open and closed soft tissue injuries and
give TWO examples of how each of these could be caused.

Answer 10

Open - laceration, puncture

Closed - Contusion, crush

Question 11

What are the main complications arising from soft tissue injuries? What steps can you take to avoid or minimise some of these complications? Which patients would be at higher risk for complications?

Answer 11

Lots, obvious ones

Question 12

Short Answer Outline the key indications for the use of a tourniquet?
How long can tourniquets be left in situ before they start to compromise circulation to the distal limb

Answer 12

Uncontrolled haem.

Question 13

Describe your stepwise management of a patient presenting with a non-catastrophic haemorrhage.

Answer 13

Obvs

Question 14

Long Answer - Describe each of the different types of impact related to motor vehicle collisions (MVC).
List the pattern of injuries you would expect to find in any TWO of the impact types.

Answer 14

Frontal, lateral, rear, rollover, rotational

Question 15

Long Answer - Describe the most common types of impacts that occur for motorcyclists.
Why are motorcyclists more likely to sustain serious injury when involved in an MVC?

Answer 15

Up and over, down and under, ejected

Question 16

Describe the key differences you would expect to find in patterns of injury for adults and children when attending a pedestrian versus vehicle call.
Explain why you would find different injuries in the two groups.

Answer 16

Key difference is height and location of primary and secondary impacts

Question 17

Outline some of the key controversies surrounding spinal motion restriction (SMR). Name some of the complications that may result from the application of SMR.

Answer 17

.

Question 18

Long Answer Describe your stepwise management of a patient presenting with potential spinal injury.
You should demonstrate the use of a recognised algorithm (Nexus, Canadian c-spine or the NSW Ambulance protocol ‘SPINAL’) when making decisions on whether or not to apply SMR.
What are the signs and symptoms that would suggest damage to the spinal cord itself?

Answer 18

Nexus - NSAIDS. (Focal) Neuro deficit, (midline) spinal tenderness, Altered LoC, Intoxication, Distracting injuiry, Suspicious MoI

Question 19

Describe each of the different types of fractures and state what MOI you would expect to be
reported for at least TWO of the different fractures described.

Answer 19

Open (Compound)
Closed (Greenstick, spiral, simple)
Greenstick common in children, spiral for MoI with high rotation

Question 20

Describe what occurs during a dislocation injury.

Explain some of the potential complications that can arise from these injuries.

Answer 20

The head of bone becoming displaced at a joint. Neurovascular compromise can, if not treated quickly, lead to limb ischaemia and potentially amputation

Question 21

You are called to a motorcyclist that has been involved in a head on collision with a car. Both vehicles were travelling at speed. On examination, you suspect a fractured pelvis and fractured mid-shaft femur.

Discuss your management in terms of splinting, describe the benefits of the equipment selected and explain your key concerns when managing patients
with these injuries.

Answer 21

Long answer

Question 22

Compartment syndrome as a serious complications of extremity injuries - provide a definition and in-depth explanation of .

Answer 22

Compartment - Area swells, pressure transmitted to blood vessels and nerves. May compress blood vessels that inhibits circulation (and maybe nerves)

Question 23

Explain the benefits of using splints and describe the correct technique of application.

Answer 23

Immobilise - analgesia, limiting injury, HAEMCON, transport.

Splint above/below, cover if open, check PMS

Question 24

List and explain the four components necessary for normal tissue perfusion

Answer 24

fluid volume, Vascular system, pump, gas exchange.
(fuel, fuel lines, fuel pump, air filter)
(hypovolemic, distributive and obstructive, cardiogenic, nil)

Question 25

Long Answer Describe the signs and symptoms of low volume / hypovolaemic shock and
compare with the signs and symptoms you would expect to find in a patient with obstructive shock

Answer 25

High PR, low BP, visible poor perfusion

Obstructive shock - Beck’s triad, JVD, hypotens, tachycard

Question 26

Describe the four common clinical shock syndromes and

give TWO examples of potential causes for each of the syndromes

Answer 26

Hypovolemic (blood loss ), obstructive/mechanical (tension pneumo), distributive/neurogenic (spinal), cardiogenic (heart obstruction, reversible causes)

Question 27

Long Answer Explain the pathophysiology of low volume hypovolaemic shock.
Describe your management of a patient presenting with hypovolaemic shock

Answer 27

Circulatory system compromised to perfuse effectively. Control haem, titrate to radial pulse, clotting, transport

Question 28

Long Answer Explain the pathophysiology of neurogenic shock.
Describe your management of a patient presenting with neurogenic shock.

Answer 28

CNS compromised for muscles and circulatory system to perfuse effectively. Strange perfusion (eg priaprism). Treat with O2, monitor, medicate

Question 29

Long Answer - Explain the difference between primary and secondary brain injury

Answer 29

Primary - Immediate, mechanical, direct, irreversible

Secondary - Effects eg hypoxia, perfusion, treatable

Question 30

List some of the common complications associated with facial injuries.

Answer 30

.Highly vascular, airway compromise, aspiration, shock

Question 31

Long Answer - What signs and symptoms would you expect to find if your patient had cerebral herniation syndrome?
Describe your management of this patient.

Answer 31

ICP (Cushing’s reflex- irregular resp,

Question 32

Identify some of the potential problems you need to be aware of when managing a patient with a head injury

Answer 32

Hypotension or airway compromise ->Cerebral Hypoxia. Hypo/hyperventilation and cerebral ischemia

Question 33

Name the different types of intracranial haemorrhage. Describe the signs and symptoms for two of them.
Which patients might be most at risk?

Answer 33

Epidural (skull-dura, normally = arterial bleed) - Rapid, syncope and temp consciousness, contralateral disability (PMS and pupil fixed and dilated), increasing ICP
Subdural (dura-arachnoid, normally = venous bleed) - Slow - headache, focal neurologic signs
Subarachnoid (arachnoid-pia mater) - bad hangover symptoms
Intracerebral (brain tissue) - stroke-like or bad hangover
At risk - drunks (masking), elderly, anticoagulants

Question 34

Provide an explanation for SIX immediately life-threatening thoracic injuries

Answer 34

Deadly dozen - Airway (obstruction, trach/bronchial tree injury), chest (flail, open/massive/tension pneumothorax, pulmonary contusion), cardiac (tamponade [Beck’s Triad], contusion, aortic rupture), diaphragmatic tear, blast injuries

Question 35

Explain the pathophysiology of, and differentiate between a tension pneumothorax and a simple / closed pneumothorax.

Describe your management plan for a patient presenting with a tension pneumothorax (this can include enlisting the help of more senior clinicians)

Answer 35

Pleural space affected.
Tension -Has an effect on circulation, compression of lung, vena cavae (hence JVD, trach deviation). Requires O2 and decompression/thoracostomy
Simple/closed (lung air leaks into pleural space), open more trauma (has chest wall defect, outside air enters pleural space)

Question 36

Explain the pathophysiology of massive haemothorax.

How does this condition result in hypovolemic shock and respiratory compromise?

Describe your management.

Answer 36

Lots of blood (1.5L or roughly 1/4. 1.5L roughly 1 “quart”) in pleural space. No JVD because of massive hypovolemia, affected lung is compressed and compromises respiration.
Management = load and go, treat for shock, fluid to radial pulse. Watch for tension haemopneumothorax

Question 37

Explain how abdominal and chest injuries are related.

Give examples of different MOI that may lead to injuries in both the abdominal and the thoracic cavity.

Answer 37

Abdo harder to detect, different blunt/penetrating effects. Projectiles and blunt likely affect both.

Question 38

Explain some of the key clinical concerns for a patient presenting with an abdominal evisceration.

Describe your management of a patient with this injury.

Answer 38

Don’t push, cover with moist gauze, non-adherent dressing. Flex knees to take pressure off

Question 39

Describe how you would estimate depth of burn based on skin appearance

Answer 39

1st - Superficial - Looks like sunburn. Outer layer redder and damaged
2nd - Partial - Into dermis, blisters, no scars
3rd - Full thickness - Complete dermis - White/translucent, Dry, Scarring, potentially leathery, anaesthetic with peripheral pain

Question 40

Explain how you would estimate the total body surface area (TBSA) for a patient with burns to his torso and both legs using the rule of nines

Answer 40

18 Front, 18 back, 18 legs front/back, 18 legs front/back, 1 groin, 9 head
Patient Palm = 1%

Question 41

Identify potential complications and describe the initial management of: thermal burns

Answer 41

Complications - hypotherm, hypovolemia, ecshar (oedema leading ischaemia/necrosis), infection, organ failure, normal vulnerable populations.
Management - Thermal (cool, cover with clean and dry dressing), antibiotics/burn centre.

Question 42

What information in the history and signs ; symptoms would indicate the patient had:
A thermal airway or inhalation injury

Answer 42

Airway/inhalation (SAMPLE for hot air/flame, steam for lower airway, stridor/hoarseness)

Question 43

Explain how carbon monoxide causes hypoxia.

Describe the initial treatment for carbon monoxide poisoning

Answer 43

CO far more effective at binding to haemoglobin than O2. Will trick SpO2 monitor because of colour.

Question 44

Crush syndrome as a serious complications of extremity
injuries.

Provide a definition and in-depth explanation of

Answer 44

Crush - Crushed/trapped tissues metabolise anaerobically, generating toxins. Blood flow from crushed tissue joins venous return, toxins distributed through body

Question 45

What information in the history and signs and symptoms would indicate the patient had carbon monoxide poisoning

Answer 45

CO poisoning (SAMPLE for environment [inc winter heating], symptoms like early stage bad hangover plus cherry red skin)

Question 46

Identify potential complications and

describe the initial management of: chemical burns

Answer 46

Complications - hypotherm, hypovolemia, ecshar (oedema leading ischaemia/necrosis), infection, organ failure, normal vulnerable populations.
Management - Chem (Remove source, PPE, brush (if dry), flush copiously).

Question 47

Identify potential complications and

describe the initial management of: electrical burns

Answer 47

Complications - hypotherm, hypovolemia, ecshar (oedema leading ischaemia/necrosis), infection, organ failure, normal vulnerable populations.
Management - Electrical (safety, O2, transport, IV access for higher fluid needs, ECG)