The Multiply Injured Patient

Question 1

Pre-hospital trauma services?

Answer 1

Ambulances, fire service, etc.

Question 2

What is meant by a pre-alert?

Answer 2

Call from trauma team ahead of patient arriving so roles can be assigned, and drugs equipment can be set up

Question 3

What is discussed in the paramedic handover?

Answer 3

Tome of injury
Mechanism of injury
Suspected serious injuries
Vital signs
Interventions carried out

->paramedics have such a broad base of knowledge so very useful

Question 4

Primary survey for trauma assessment?

Answer 4

ABC- detects and treats immediate threats to life

->done before secondary survey to identify all injuries

Question 5

ATLS survey?

Answer 5

ABC

Airway
Breathing
Circulation
Disability
Expose and environment

->A-C in primary survey, D and E part of secondary

Question 6

What is mostly controlled in circulation section of ATLS?

Answer 6

Catastrophic haemorrhage control

->leading cause of death in military trauma due to explosives etc.
While third in the list, delays in treating C for haemorrhage while assessing A and B lead to deterioration. Important teamwork required

Question 7

How is airway assessed?

Answer 7

Noises- speech, gurgling, stridor
Visual- vomit/blood/debris

Question 8

How is airway managed?

Answer 8

Manoeuvres
Suction
Adjuncts
Intubation

Question 9

What part of the spine is managed initially during A part?

Answer 9

Cervical spine

Question 10

In which patients would you have to assume there is a cervical spine injury?

Answer 10

Dangerous mechanism
Reduced conscious level- as cannot tell you about their neck
Injury above clavicles
Neurological signs

Question 11

What is done for cervical spine management?

Answer 11

Neck support to limit movement

Question 12

What is done in the B section of ATLS?

Answer 12

Look at chest for visible injuries, RR
Feel and percuss for fluid or air in chest
Listen to chest
Oxygen, analgesia and drainage in required

Question 13

How is circulation assessed?

Answer 13

HR
Palpable radial pulse
CRT
BP
Urine output
Confusion

Question 14

Which blood tests are done to assess circulation?

Answer 14

Haemoglobin
Lactate

Question 15

Which imaging may be done to assess circulation for potential sources of bleeding?

Answer 15

Ultrasound
CT

Question 16

What are the five main sites for blood loss?

Answer 16

Floor if open bleeding!!
Chest
Abdomen
Pelvis
Long bones

Question 17

What is done initially for haemorrhage control in the cases of RTA, etc?

Answer 17

Tourniquet

->tight bands to prevent bleeding

Question 18

What needs to be considered for volume replacement in the management of circulation?

Answer 18

IV access
IO access (if cannot gain IV access)
Type and amount of fluid
Transfusion protocols

Question 19

How is volume replacement monitored?

Answer 19

Vital signs e.g. pulse and BP
Urine output
Lactate

Question 20

The lethal triad may be seen in significant bleeding.
What makes up the lethal triad?

Answer 20

Coagulopathy
Acidosis
Hypothermia

Question 21

What is done to assess disability?

Answer 21

Neurological examination:
GSC
Pupils
Tone and reflexes
Log roll

Question 22

What is the point of the expose section of management of a trauma patient?

Answer 22

To allow identification of any other injuries that might of been missed earlier

Question 23

What is one thing often checked in any trauma patient after ABCDE?

Answer 23

Glucose

->ABCDon’tEverForgetGlucose- patient may be diabetic and may have played a part in their injury