Module 2b: Kinematics of Trauma

Question 1

Emphasis in the pre-hospital phase of care should be…?

Answer 1

On the primary survey, including airway maintenance, control of external bleeding
and shock, immobilisation and immediate transfer to the nearest highest level of care.

Emphasis at the scene should be on obtaining and reporting information to the receiving hospital (time of injury, injuries etc.).

Question 2

What are the 3 trauma categories for establishing priority patients?

Answer 2

• Conditions that may result in the loss of life
• Conditions that may result in the loss of limb,
• All other conditions that do not threaten life or limb

Question 3

What are preventable early death in trauma?

Answer 3

• Airway obstruction
• Tension pneumothorax
• Haemorrhage

Question 4

Outline the CABCDE approach

Answer 4

C: Catastrophic Haemorrhage:

• Pressure, compression and packing for torso wounds.
• Tourniquet for limbs

A: Airway:

• Head tilt, chin lift/jaw thrust
• High flow oxygen

B: Breathing:

• Look for rate, depth, efficacy
• look for trachea deviation, wounds, emphysema, jugular distention

C: Circulation:

• Pulse
• Capillary refill time
• Temperature

D: Disability:

• AVPU
• PERRL
• HGT

E: Expose!
- Look for signs/symptoms and other injuries.

Question 5

What is the trauma triad of death?

Answer 5

Hypothermia + Acidosis + Coagulopathy

Question 6

What makes children a unique patient group in trauma?

Answer 6

• Less calcified bones in young children –fewer fractures, more soft tissue injury
• Must have an estimated weight
• All drugs and fluids are weight calculated
• Degree and rapidity of heat loss is age-dependent and hypothermia has profoundly negative effects
• Do not tolerate hypothermia, hypoxia or hypovolaemia as well as adults
• Injury mechanisms and patterns differ
• Equipment is smaller –usually.

Question 7

What makes the elderly a unique patient group in trauma?

Answer 7

• Likely to sustain more injury than someone younger, from the same amount of force
• Physiological changes reduce tolerance, alter assessment and increase morbidity and mortality
• Comorbidities and medication (particularly rate controlling cardiac drugs and anti-coagulants) confound assessment and management
• More fragile tissue, arthritic changes, osteoporosis.

Question 8

What makes pregnant woman a unique patient group in trauma?

Answer 8

• Must be considered in all females 10–50 years
• The best treatment for the fetus is to optimise care for the mother –as the fetus is dependent on her
• Anatomical and physiological changes in pregnancy modify the patient’s response to injury
• Early recognition of pregnancy is essential
• The heavily gravid uterus has a unique risk –the pregnant woman should not be left on her back.

Question 9

What makes a bariatric patient apart of a unique patient group in trauma?

Answer 9

• Produces a chronic inflammatory state
• Affects all body systems
• Physical size increases management challenges both pre-hospital and in the ED
• Mortality rate is 8 times higher than non-obese patients
• Alternative methods for splinting and immobilisationmay be required.
• Significant number of underlying comorbidities