Initial assessment and management

Question 1

Components of the initial assessment

Answer 1

Preparation
Triage
Primary survey + Simultaneous resuscitation
Adjuncts
Consider transfer
Re-evaluation

Secondary survey

Re-evaluation
Definitive care

Question 2

Priorities in the prehospital phase

Answer 2

Airway maintenance
Breathing support
Control of bleeding and shock
Immobilisation
Immediate transfer to closest appropriate facility

Question 3

ATMIST handover

Answer 3

Age
Time of event
Mechanism of injury
Injuries head to toe
(Vital) Signs and symptoms
Treatments given / Time of arrival

Question 4

Hospital phase

Answer 4

Resuscitation area
Airway equipment (organised, tested, accessible)
Warmed IV crystalloids (via Belmont)
Monitoring devices
Protocol for requesting additional assistance
Transfer agreements

Question 5

PPE required for major trauma

Answer 5

Face mask
Eye protection / visor
Water resistant gown
Gloves

Question 6

Primary survey

Answer 6

Airway and C spine immobilisation
Breathing
Circulation
Disability
Exposure / Environment

Question 7

Goal of primary survey

Answer 7

Identify and treat life threatening injuries in a prioritised manner

Question 8

10 second assessment

Answer 8

Introduce yourself
Ask their name
Ask them what happened

Question 9

Airway management

Answer 9

Clearing the airway
Suction
Oxygen
Securing airway
Maintain C spine

If in doubt regarding patient airway - intubate

Question 10

Requirements for adequate breathing

Answer 10

Adequate function of:
- Lungs
- Chest wall
- Diaphragm

Question 11

Breathing management

Answer 11

JVP
Trachea position
Chest wall movement
RR
Air entry
O2 saturation

Question 12

Considerations for circulation / perfusion assessment

Answer 12

Blood volume
Cardiac output
Bleeding

Question 13

Signs of reduced perfusion

Answer 13

Reduced GCS
Skin colour / temp
Pulse rate and character

Question 14

Disability assessment

Answer 14

GCS
Pupil size and reactivity
Lateralising signs
Spinal cord injury

Question 15

Causes of reduced / reducing GCS

Answer 15

Cerebral injury
Reduced cerebral perfusion

If change in GCS - re-assess from ABCDE

Question 16

Exposure assessment

Answer 16

Expose patient fully and keep warm with blankets
Temperature

Question 17

Management of hypothermia

Answer 17

Warm blankets
Warm fluids
Control haemorrhage

Question 18

Adjuncts to primary survey

Answer 18

ECG
Obs
ABG
Urine output
Imaging

Question 19

Imaging adjuncts to primary survey

Answer 19

XR - chest or pelvis only
CT
FAST
eFAST
Diagnostic peritoneal lavage

Question 20

When to consider need to transfer patient

Answer 20

Early
When pt needs exceed facility capabilities
Don’t delay transfer for diagnostic tests or secondary survey

Question 21

When to complete secondary survey

Answer 21

After primary survey complete and patient resuscitation efforts are normalising the patient

Question 22

Secondary survey

Answer 22

History
Head to toe examination
Complete neuro exam
Diagnostic tests including imaging
Re-evaluation

Question 23

AMPLE history

Answer 23

Allergies
Medications
PMH / Pregnancy test
Last meal
Events

Question 24

Categories of Mechanism of Injury

Answer 24

Blunt trauma
Penetrating trauma
Thermal injuries
Injuries from hazardous environments

Question 25

Suspected injury patterns from RTC frontal impact

Answer 25

C spine fracture Flail chest Myocardial contusion Pneumothorax Traumatic aortic disruption Spleen / liver injury

Question 26

Suspected injury patterns from RTC side impact

Answer 26

Head injury C spine fracture Flail chest Pneumothorax Traumatic aortic disruption Spleen / liver / kidney injury depending on side

Question 27

Suspected injury patterns from RTC rear impact

Answer 27

C spine injury HI Soft tissue neck injury

Question 28

Suspected injury patterns from RTC ejection from vehicle

Answer 28

Greater risk for all injury mechanisms No specific injury patterns

Question 29

Suspected injury patterns from car vs pedestrian

Answer 29

HI Traumatic aortic disruption Abdo visceral injuries Fractured lower extremities / pelvis

Question 30

Suspected injury patterns from fall from height

Answer 30

HI Axial spine injury Abdo visceral injuries Fractured pelvis / acetabulum B/L lower extremity fractures inc calcaneal fractures

Question 31

Suspected injury patterns from anterior chest stab wounds

Answer 31

Cardiac tamponade if within "box" Haemo/pneumo -thorax

Question 32

Suspected injury patterns from left / right thoraco-abdominal stab wounds

Answer 32

Diaphragm injury Spleen / liver injury Haemopneumothorax

Question 33

Suspected injury patterns from truncal gunshot wounds (GSW)

Answer 33

High likelihood of injury Trajectory / retained projectiles help predict injury

Question 34

Suspected injury patterns from extremity gunshot wounds (GSW)

Answer 34

Neurovascular injury Fractures Compartment syndrome

Question 35

Suspected injury patterns from thermal burns

Answer 35

Circumferential eschar on extremity or chest

Question 36

Eschar definition (Pronounced es-car)

Answer 36

Dead tissue that sheds or falls off the skin

Question 37

Suspected injury patterns from electrical burns

Answer 37

Arrhythmias Myonecrosis / compartment syndrome

Question 38

Suspected injury patterns from inhalation burns

Answer 38

CO poisoning Upper airway swelling Pulmonary oedema

Question 39

Secondary survey examination

Answer 39

Head / scalp Eye / ear Maxillofacial structures Neck Chest Abdo / Pelvis Perineum +/- Rectum / Vagina MSK system / extremities Log roll + spinal examination Neurological system Specialised tests

Question 40

Contraindication to NG tube insertion

Answer 40

Fracture of cribriform plate

Question 41

Examination of maxillofacial structures

Answer 41

Facial bones Dental occlusion Intra-oral examination Look for potential airway obstruction and CIs to NG tube placement

Question 42

Examination of neck

Answer 42

Inspect Palpate (inc carotid arteries) Auscultate In head or maxillofacial trauma assume unstable C spine injury until all studies completed

Question 43

Findings on examination of neck

Answer 43

Crepitus Haematoma Stridor Bruits

Question 44

Examination of perineum

Answer 44

Contusions Haematomas Lacerations Urethral blood

Question 45

Examination of rectum

Answer 45

Sphincter tone Pelvic fracture Rectal wall integrity Blood

Question 46

Examination of vagina

Answer 46

Blood Lacerations

Question 47

Contraindication to catheter insertion

Answer 47

High suspicion of urethral injury

Question 48

Injuries with high risk of developing compartment syndrome

Answer 48

Long bone fractures Crush injuries Prolonged ischaemia Circumferential thermal injuries

Question 49

How to minimise blood loss from pelvic fracutes

Answer 49

Pelvic binder or sheet Do not repeatedly / vigorously manipulate the pelvis in patients with fractures as can dislodge clots

Question 50

Examination of neurological system

Answer 50

GCS Pupil size and reactivity Lateralising signs Motor / sensory of extremities Frequent re-evaluation

Question 51

How to minimise secondary brain injury

Answer 51

Optimising oxygenation / perfusion

Question 52

Specialised diagnostic tests

Answer 52

XRs of extremities CT trauma series Contrast urography / angiography TOE Bronchoscopy OGD

Question 53

Multiple casualties definition

Answer 53

Number or patients and their injury severity does NOT exceed capabilities of the facility

Question 54

Mass casualties definition

Answer 54

Number or patients and their injury severity DOES exceed capabilities of the facility