Trauma

Question 1

what is included in the primary survey?

Answer 1

airway & c-spine, breathing, circulation, disability, exposure

Question 2

external bleeding interventions

Answer 2

direct pressure, elevate, tourniquet if on extremity

Question 3

tourniquet considerations

Answer 3

2h time limit or necrotic limb, will be painful

Question 4

what is involved in the D in primary survey

Answer 4

disability - quick focused neuro check - pupils, LOC, GCS, s/s of high ICP

Question 5

what is included in the secondary survey

Answer 5

full set of vitals, pain meds, inspect posterior surface, history & head to toe

Question 6

tertiary survey

Answer 6

ICU level head to toe

Question 7

fluid resuscitation

Answer 7

1-2L NS or LR as rapidly as possible, then blood if still unstable

Question 8

MTP

Answer 8

1:1:1 ratio of pRBCs, FFP, & plt

Question 9

risks of MTP

Answer 9

DIC, ARDS, hypoCa, hyperK

Question 10

s/s that MTP was successful

Answer 10

increased MAP, CVP, UO, LOC, decreased HR & cap refill

Question 11

what to monitor w MTP

Answer 11

CBC, TEG, PT/INR, PTT, plt

Question 12

trauma triad of death

Answer 12

hypothermia, coagulopathy, acidosis

Question 13

laryngeal trauma s/s

Answer 13

hoarseness, loss of adams apple, painful swallow/cough

Question 14

laryngeal trauma treatment

Answer 14

emergent cric or trach

Question 15

mgmt of rib fracture

Answer 15

pain control, pulmonary hygiene

Question 16

pulmonary hygiene

Answer 16

incentive, flutter valve, chest PT, coughing & deep breathing

Question 17

flail chest mgmt

Answer 17

secure airway, pain control, give O2, early ambulation, pulm. hygiene, splint chest when coughing

Question 18

s/s of pneumothorax

Answer 18

respiratory distress

Question 19

common causes of pneumothorax

Answer 19

fall, MVC, contact sports, assault

Question 20

pneumothorax treatment

Answer 20

secure airway, chest tube

Question 21

chest tube mgmt

Answer 21

check output hourly, notify MD of any big changes

Question 22

massive hemothorax

Answer 22

often arrive alr dead or in hem. shock; may get MTP, thoracotomy, REBOA

Question 23

s/s of pulmonary contusion

Answer 23

rales, dyspnea, may mimic ARDS if severe

Question 24

pulmonary contusion tx

Answer 24

ABGs, pulm. hygiene, vent w PEEP if severe, strict I&Os

Question 25

FAST exam

Answer 25

checks abd for free fluid

Question 26

if positive FAST & unstable - patient goes

Answer 26

straight to OR for ex-lap

Question 27

DPL

Answer 27

quick test for intra-abdominal bleeding

Question 28

s/s of liver trauma

Answer 28

RUQ pain, cullen's sign

Question 29

cullen's sign

Answer 29

bruising around belly button

Question 30

mgmt of liver trauma

Answer 30

monitor coags, LFTs, & CBC

Question 31

spleen trauma s/s

Answer 31

hemorrhagic shock, kehr sign, high WBC, gray turners sign

Question 32

spleen trauma tx

Answer 32

may need splenectomy

Question 33

splenectomy pt education

Answer 33

immunocompromised

Question 34

kehr sign

Answer 34

LUQ pain radiating to left shoulder

Question 35

gray turners sign

Answer 35

bruising on left flank

Question 36

s/s of bladder/urethral trauma

Answer 36

supraorbital hematoma, bruised peritoneum, blood @ meatus, gross hematuria, inability to urinate

Question 37

musculoskeletal trauma assessment

Answer 37

neurovascular checks, spasming, crepitus

Question 38

limbs should be immobilized if they are

Answer 38

swollen, ecchymotic, or deformed

Question 39

complications of musculoskeletal trauma

Answer 39

fat embolism, DVT, PE, compartment syndrome

Question 40

fat embolism triad

Answer 40

petechiae, poor neuro status, hypoxemia

Question 41

mgmt of minor fractures

Answer 41

RICE, splint care, pain meds, neurovasc checks at home

Question 42

s/s of pelvic fracture

Answer 42

abrasion lac or contusion, asymmetry in lower extremities, crepitus when rocking pelvis

Question 43

pelvic fracture tx

Answer 43

control bleed, stabilize w ex-fix or binder, infection prevention, surgery when stabilized

Question 44

mgmt of crush injury

Answer 44

put on monitor! increase fluids, check myoglobin & CK levels

Question 45

depressed skull fracture considerations

Answer 45

high risk of meningitis - monitor for infection

Question 46

basilar skull fracture

Answer 46

fracture at base of skull

Question 47

basilar skull fracture s/s

Answer 47

Raccoon's & Battle's (bruised mastoid process); may have altered EOMs

Question 48

s/s of concussion

Answer 48

may/may not LOC, photophobia, headache, n/v

Question 49

secondary brain injuries

Answer 49

cerebral edema, herniation from high ICP, hypoxemia, seizure

Question 50

when is a SCI suspected

Answer 50

decreased/absent movement or sensation, head injury, or LOC

Question 51

complications of SCI

Answer 51

pulmonary dysfx, atelectasis, pneumonia, DVT, PE, ileus, stress ulcer