Trauma

Question 1

what are the ABCDEs of the primary survey?

Answer 1

Airway
Breathing
Circulation
Disability
Exposure and environment

Question 2

GCS less than […] is indication for intubation

Answer 2

9

Question 3

if endotracheal intubation fails, what is the next step?

Answer 3

cricothyroidotomy

Question 4

if the patient is unable to breathe, establish airway with […] control

Answer 4

c-spine

Question 5

if patient is […], their airway is controlled

Answer 5

talking

Question 6

when assessing Airway, you should have a low threshold for […]

Answer 6

intubation

(basically if the patient is not talking –> intubate)

Question 7

where is a chest tube place?

Answer 7

4th or 5th intercostal space mid-axillary

go above the rib, VAN is below

Question 8

When assessing Circulation, what labs should you get?

Answer 8

CBC, CMP, type and cross

Question 9

GCS 3 means the patient is…

Answer 9

probably dead

Question 10

correcting Circulation with fluids should be achieved by establishing […]

Answer 10

2 large bore peripheral IVs

Question 11

immediate treatment of cardiac tamponade

Answer 11

IVF bolus and pericardiocentesis

(later– surgical exploration)

Question 12

what are the three categories of GCS?

Answer 12

eye, motor, verbal

Question 13

Spontaneous eye opening with blinking at baseline is GCS […]

Answer 13

4

Question 14

eye opening to verbal command, speech, or shout is GCS […]

Answer 14

3

Question 15

eye opening to pain is GCS […]

Answer 15

2

Question 16

no eye opening is GCS […]

Answer 16

1

Question 17

oriented verbal response is GCS […]

Answer 17

5

Question 18

confused conversation, but able to answer questions is GCS […]

Answer 18

4

Question 19

inappropriate responses but discernible words is GCS […]

Answer 19

3

Question 20

incomprehensible speech is GCS […]

Answer 20

2

Question 21

no speech/verbal response is GCS […]

Answer 21

1

Question 22

obeys commands for movements is GCS […]

Answer 22

6

Question 23

purposeful movement to painful stimulus is GCS […]

Answer 23

5

Question 24

withdraws from pain is GCS […]

Answer 24

4

Question 25

abnormal flexion, decorticate posturing is GCS [...]

Answer 25

3

Question 26

extensor response, decerebrate posturing is GCS [...]

Answer 26

2

Question 27

no motor response is GCS [...]

Answer 27

1

Question 28

a blown pupil reflects ipsilateral compression of CN [...]

Answer 28

III

Question 29

what is Beck's triad and what does it indicate?

Answer 29

hypotension, distant heart sounds, JVD cardiac tamponade

Question 30

what areas are assessed via FAST?

Answer 30

pericardium splenorenal pouch of Douglas Morrison's pouch lungs

Question 31

can fast assess the retroperitoneum?

Answer 31

no

Question 32

next step for a patient with positive FAST that stabilizes with fluid?

Answer 32

CT: chest, abdomen, pelvis with contrast

Question 33

next step for a patient with positive FAST that does NOT stabilize with fluid?

Answer 33

ex-lap have cell saver on hand

Question 34

what is the goal SBP for fluid resuscitation?

Answer 34

90-100 (overloading can cause tamponade)

Question 35

if the patient continues to decline after ABCDEs...what should you do?

Answer 35

repeat ABCDEs (i.e. if BP keeps falling, it is likely to be ABCDE issue)

Question 36

if the chest tube drains more than [...] at time of insertion --> OR

Answer 36

400 ml

Question 37

if the chest tube drains more than [...] ml/hour over 4 hours --> OR

Answer 37

200

Question 38

mnemonic for secondary survey:

Answer 38

Allergies Meds Past illness Last meal Events/environment

Question 39

you've taken a hemodynamically unstable patient back for ex-lap: 1. what incision do you make? 2. how do you begin the case?

Answer 39

1. midline xiphoid to pubic symphysis 2. pack all four quadrants, take down packing 1 at a time to assess for source of bleed

Question 40

what is the seatbelt sign?

Answer 40

bruising around waist/chest/clavicle for seatbelt

Question 41

if you need to do a needle decompression for tension pneumo, where would you insert the needle?

Answer 41

2nd intercostal space, midclavicular line

Question 42

if SBP > [...] and HR is normalized, you can get a CT

Answer 42

90

Question 43

what is Massive Transfusion Protocol?

Answer 43

1:1:1 RBCs Platelets FFP

Question 44

if a patient has midfacial fractures and you want to decompress the stomach, what should you use?

Answer 44

OG tube

Question 45

[...] fracture can cause NG to coil in intracranial space

Answer 45

cribriform plate

Question 46

what triad of PE findings indicates urethral injury?

Answer 46

high riding prostate Ecchymotic scrotum Blood at meatus

Question 47

Splenectomy and embolectomy patients require [...] prophylaxis

Answer 47

vaccine S pneumo., N. meningitidis, H. flu

Question 48

What labs/imaging can be considered during secondary survey?

Answer 48

cervical and lateral spine imaging AP CXR AP pelvis Type and Cross CBC CMP UA, drug screen ABGs EKG lactate troponin

Question 49

place pressure on the [...] and [...] to evaluate for pelvic fracture

Answer 49

iliac crests and greater trochanters

Question 50

you have a patient with pelvic fracture. you do a DRE and feel bony prominence. What will this patient require?

Answer 50

diverting ileostomy

Question 51

Patient is hemodynamically stable. On CT you note fluid in the around the spleen...what is the best next step?

Answer 51

consult IR for embolization

Question 52

when evaluating for Disability, you note your patient has an open femur fracture with pulsatile bleeding and is hemodynamically unstable. What is your next best step?

Answer 52

reduce fracture

Question 53

when is the tertiary survey completed?

Answer 53

24-48 hrs later once the patient is stabilized and able to interact for H&P