PARA3000 - TRAUMA

Question 1

What is an isolated trauma?

Answer 1

Injuries such as musculoskeletal trauma, falls, and sporting injuries, not involving multiple systems.

Question 2

Why can sprains and strains be hard to diagnose?

Answer 2

Because symptoms like pain and swelling overlap with more serious injuries and are hard to confirm without imaging.

Question 3

What is an example of a direct injury?

Answer 3

A force applied directly to a limb causing a fracture or bruise at the site of impact.

Question 4

What is an indirect injury?

Answer 4

An injury caused away from the point of force — e.g., twisting an ankle while tripping.

Question 5

What is the significance of hearing a ‘pop’ or ‘snap’ during trauma?

Answer 5

It may indicate a bone fracture or ligament/tendon rupture.

Question 6

What might immediate swelling after an injury suggest?

Answer 6

Internal bleeding, inflammation, or structural damage.

Question 7

What should you assess in peripheral limb assessment?

Answer 7

Colour, temperature, movement, pulse, capillary refill, and sensation.

Question 8

What does PAINAD assess?

Answer 8

Pain in patients with dementia using five behavioural indicators scored 0–2.

Question 9

What are the five PAINAD categories?

Answer 9

Breathing, negative vocalisation, facial expression, body language, consolability.

Question 10

What are signs of stress-related pain in a trauma patient?

Answer 10

Tachycardia, sweating, agitation.

Question 11

Why are rigid cervical collars often discouraged?

Answer 11

They can cause pressure on neck vessels and may not fit properly.

Question 12

What immobilisation techniques can be used instead of collars?

Answer 12

Towel rolls, vacuum mattresses, and self-stabilisation.

Question 13

What is the NEXUS criteria used for?

Answer 13

To rule out the need for cervical spine immobilisation in trauma patients.

Question 14

What kind of injury does the NEXUS tool apply to?

Answer 14

Low-risk cervical spine injuries in both adults and paediatrics.

Question 15

What defines a major trauma?

Answer 15

Large-scale injury with significant risk of morbidity or mortality.

Question 16

What does MOA stand for and why is it important?

Answer 16

Mechanism of Injury — it helps shape suspicion and guides assessment.

Question 17

What MOA findings raise concern?

Answer 17

High speeds, ejection from vehicle, airbag deployment, impact surfaces.

Question 18

What does the primary survey acronym XABCDE stand for?

Answer 18

X – eXternal haemorrhage
A – Airway with c-spine
B – Breathing
C – Circulation
D – Disability
E – Exposure/Environment

Question 19

Why is controlling hypothermia important in trauma?

Answer 19

Cold impairs clotting and promotes acidosis, worsening outcomes.

Question 20

Why is excessive movement dangerous in trauma patients?

Answer 20

It can dislodge clots and worsen bleeding.

Question 21

What are signs of a base of skull fracture?

Answer 21

Blood or CSF from ears, raccoon eyes, Battle’s sign.

Question 22

What should be assessed when examining the eyes in trauma?

Answer 22

Bleeding, asymmetry, and pupil size/reactivity.

Question 23

What is subcutaneous emphysema?

Answer 23

Air trapped under the skin, felt as crackling — may indicate airway or lung injury.

Question 24

What do you listen for in the neck during trauma assessment?

Answer 24

Stridor, hoarseness, and air movement through the trachea.

Question 25

What are signs of chest injury to look for?

Answer 25

Abrasions, bruising, deformity, unequal chest movement, and paradoxical breathing.

Question 26

What conditions might crepitus in the chest suggest?

Answer 26

Rib fractures or subcutaneous emphysema.

Question 27

What organs are at risk with direct chest trauma?

Answer 27

Heart, lungs, liver (right), spleen (left).

Question 28

What are red flags on auscultation for pneumothorax?

Answer 28

Diminished or absent breath sounds, hyperresonance, or mediastinal shift.

Question 29

What signs suggest abdominal bleeding?

Answer 29

Distension, guarding, rebound tenderness, or bruising (especially seatbelt sign).

Question 30

How much blood can be lost into the abdomen before signs show?

Answer 30

Up to 1.5 litres.

Question 31

What is the danger of a 'splayed leg' posture in trauma?

Answer 31

Suggests open book pelvic fracture — apply a pelvic binder immediately.

Question 32

What structures must be inspected during pelvic trauma assessment?

Answer 32

Genitals, perineum, buttocks (respectfully), and signs of PR/PV bleeding.

Question 33

What should you avoid during spinal palpation?

Answer 33

Aggressive movements — stop palpation if instability is suspected.

Question 34

What are key signs of limb trauma?

Answer 34

Deformity, swelling, crepitus, abnormal movement, pain, and open fractures.

Question 35

What do you palpate in limb assessment?

Answer 35

Bones, joints, soft tissue, pulses, and check for crepitus.

Question 36

What are early signs of hypovolaemic shock?

Answer 36

Pale, sweaty, tachycardia, delayed capillary refill, hypotension, altered consciousness.

Question 37

What is the COAST score used for?

Answer 37

To determine if TXA (tranexamic acid) should be given in trauma.

Question 38

When should TXA be administered according to COAST?

Answer 38

When a trauma patient scores 3 or more.

Question 39

What should you ask when taking the history of a presenting trauma complaint?

Answer 39

Timeline of events, nature of injury (pain, swelling, bruising), aggravating/relieving factors, prior injuries, and associated symptoms.

Question 40

Why is understanding whether the limb could bear weight important in trauma?

Answer 40

It helps differentiate between soft tissue injury and potential fractures or structural instability.

Question 41

What should you consider when a limb 'gives way' during or after injury?

Answer 41

Possible ligamentous injury or neuromuscular compromise.

Question 42

Why is the position of the limb at the time of injury important?

Answer 42

It can indicate the direction of force and suggest the type of injury (e.g., dislocation, fracture).

Question 43

Why might X-rays be difficult to interpret in musculoskeletal trauma?

Answer 43

Because overlapping tissues and subtle fractures can obscure the diagnosis.

Question 44

What is crepitus and why is it clinically relevant?

Answer 44

A crackling sensation felt under the skin or in joints, suggesting fracture or subcutaneous emphysema.

Question 45

What does capillary refill time indicate in trauma?

Answer 45

Peripheral perfusion and early shock status.

Question 46

Why might you do a second palpation after analgesia is administered?

Answer 46

To better assess tenderness and locate specific pain points once the patient is more comfortable.

Question 47

What is the purpose of peripheral limb assessment?

Answer 47

To evaluate vascular and neurological integrity distal to an injury.

Question 48

What are the six Ps of limb assessment in trauma?

Answer 48

Pain, pallor, pulselessness, paresthesia, paralysis, and pressure (compartment syndrome risk).

Question 49

What is meant by analysing 'the totality of the mechanism of injury'?

Answer 49

Considering all factors: speed, impact, surface, position, restraint use, vehicle damage, etc.

Question 50

Why is ejection from a vehicle a major red flag?

Answer 50

It suggests high-energy trauma and increased risk of spinal and internal injuries.

Question 51

What are the key questions to ask regarding MOI in an MVA?

Answer 51

Speed, seatbelt use, airbag deployment, vehicle intrusion, and patient’s position.

Question 52

Why is airbag deployment significant in trauma?

Answer 52

It implies a high-energy impact and may cause facial/chest injuries.

Question 53

What should you consider in low-speed but high-risk trauma, such as elderly falls?

Answer 53

Underlying fragility, anticoagulation, and high risk of intracranial bleeding or fractures.

Question 54

Why does trauma increase risk of hypothermia?

Answer 54

Blood loss and exposure reduce thermoregulation; shock decreases perfusion; alcohol worsens this.

Question 55

How can hypothermia affect trauma outcomes?

Answer 55

It impairs clotting (coagulopathy), worsens acidosis, and increases mortality (lethal triad).

Question 56

What measures can reduce hypothermia in trauma patients?

Answer 56

Minimise exposure, use blankets, warm IV fluids, and control ambient temperature.

Question 57

Why is a full head-to-toe exam essential after primary survey?

Answer 57

To identify missed injuries, especially in unresponsive or altered patients.

Question 58

What should you avoid during secondary survey?

Answer 58

Excessive movement that could dislodge clots or worsen unstable injuries.

Question 59

Why is posterior palpation of the abdomen and pelvis important?

Answer 59

To detect hidden haemorrhage or injuries not seen anteriorly.

Question 60

What signs on head exam indicate late signs of TBI?

Answer 60

Battle’s sign, raccoon eyes, CSF leakage, unequal pupils, altered LOC.

Question 61

What does rebound tenderness in the abdomen suggest?

Answer 61

Peritoneal irritation, often due to internal bleeding or infection.

Question 62

What is guarding and what does it indicate?

Answer 62

Involuntary muscle contraction in response to pain — a sign of abdominal irritation.

Question 63

Why must you stop pelvic palpation if instability is detected?

Answer 63

To prevent exacerbating internal bleeding or worsening fractures.

Question 64

When is it appropriate to apply a pelvic binder?

Answer 64

When signs of pelvic instability or an open-book fracture are suspected.

Question 65

What should you auscultate in both the chest and back during trauma?

Answer 65

Breath sounds for pneumothorax, haemothorax, or absent/decreased air entry.

Question 66

What are signs of tension pneumothorax?

Answer 66

Respiratory distress, tracheal deviation, absent breath sounds on one side, JVD, hypotension.

Question 67

Why might neck vein distension occur in trauma?

Answer 67

Could indicate tension pneumothorax, cardiac tamponade, or right heart failure.

Question 68

What are the signs of an open fracture?

Answer 68

Visible bone, bleeding from the wound, contamination risk, and high infection potential.

Question 69

Why are rib fractures dangerous in elderly trauma patients?

Answer 69

Risk of pulmonary complications like pneumonia or respiratory failure.

Question 70

What is the significance of 'flail chest'?

Answer 70

Multiple rib fractures causing paradoxical chest movement, impairing ventilation.

Question 71

What effect does alcohol have on trauma patients?

Answer 71

Increases risk of hypothermia due to vasodilation and reduced thermoregulation.