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Trauma Flashcards

(103 cards)

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1
Q

What signs and symptoms suggest a basilar skull fracture?

A

Battle signs, CSF leak (otorrhea/rhinorrhea), facial weakness, vision changes, hearing loss, raccoon eyes.

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2
Q

How do you treat a suspected basilar skull fracture?

A

Apply loose, sterile dressing to CSF leak; avoid packing nose/ears; elevate head 30° if SMR not indicated; monitor for herniation.

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3
Q

What BLS directive applies to basilar skull fractures?

A

BLS Head Trauma Standard — includes SMR rules, CSF dressing, and elevated positioning.

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4
Q

What are the signs and progression of an epidural hematoma?

A

LOC → lucid interval → rapid deterioration, unequal pupils, headache, nausea, confusion.

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5
Q

What is the treatment for an epidural hematoma?

A

SMR if indicated, O₂, monitor vitals, watch for herniation signs, manage airway if GCS < 8.

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6
Q

What directive applies to epidural hematomas in PCP care?

A

ALS PCS (if applicable): Herniation protocol — hyperventilate if GCS <9 and herniation signs present.

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7
Q

What signs suggest cerebral herniation in trauma patients?

A

Cushing’s Triad (↑ BP, ↓ HR, ↓ RR), dilated or asymmetric pupils, posturing, rapidly decreasing GCS.

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8
Q

How do you treat suspected cerebral herniation?

A

Hyperventilate: Adult 20 bpm, Child 25 bpm, Infant 30 bpm. Maintain ETCO₂ at 30–35 if available. Oxygenate, position head elevated.

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9
Q

What ALS directive supports hyperventilation in cerebral herniation?

A

ALS PCS Herniation Protocol — requires signs like deteriorating GCS + abnormal pupils/posturing.

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10
Q

What are the symptoms of a concussion?

A

Headache, dizziness, photophobia, nausea, confusion, temporary LOC, amnesia, irritability.

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11
Q

How should concussions be managed in the field?

A

Supportive care, monitor for deterioration, ensure transport for assessment.

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12
Q

What directive mandates transport for concussions?

A

BLS Head Trauma Guideline — All suspected concussions require transport.

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13
Q

What are the symptoms of a subdural hematoma?

A

Gradual headache, confusion, drowsiness, personality changes, delayed onset weeks/months post-injury.

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14
Q

What is the appropriate prehospital management for a subdural hematoma?

A

SMR if indicated, O₂ therapy, monitor neuro status and vitals, rapid transport.

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15
Q

What directive applies to suspected subdural hematoma management?

A

BLS Head Trauma and Field Trauma Triage — assess neuro status and GCS, transport to trauma center if indicated.

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16
Q

What are the key signs of flail chest?

A

Paradoxical chest wall movement, chest pain, crepitus, SOB, hypoxia.

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17
Q

How do you treat flail chest in the field?

A

Oxygenation, position for comfort, consider analgesia, monitor for respiratory failure.

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18
Q

Which directive outlines treatment for flail chest?

A

BLS Chest Trauma Standard and ALS Analgesia Medical Directive (PCP scope if authorized).

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19
Q

What are the symptoms of an open pneumothorax (sucking chest wound)?

A

Bubbling/frothing from chest wound, ↓ air entry, chest pain, SOB, tracheal deviation possible.

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20
Q

What is the field treatment for a sucking chest wound?

A

Apply 3-sided occlusive dressing or commercial chest seal, reassess for tension pneumo.

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21
Q

What directive applies to managing a sucking chest wound?

A

BLS Chest Trauma Standard — occlusive dressing required, monitor for deterioration.

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22
Q

How do you recognize a tension pneumothorax?

A

Tracheal deviation, JVD, hypotension, ↓ breath sounds, tachycardia, SOB, cyanosis.

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23
Q

How do you treat a suspected tension pneumothorax?

A

Oxygenate, ventilate carefully if needed (lower tidal volume), release occlusive seal if rapidly deteriorating.

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24
Q

What BLS directive guides treatment of tension pneumothorax?

A

BLS Chest Trauma — includes criteria for releasing occlusive dressing if deterioration occurs.

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25
What are the signs of cardiac tamponade (Beck’s Triad)?
JVD, hypotension, muffled heart sounds; may also see pulsus paradoxus, SOB, chest pain.
26
What is the prehospital treatment for cardiac tamponade?
High-flow oxygen, rapid transport, monitor for hypotension, avoid fluid overload.
27
What directive applies to cardiac tamponade management?
BLS Chest Trauma Standard — includes consideration of tamponade under life/limb/function threats.
28
What are signs of a hemothorax?
Decreased air entry, hypotension, chest pain, tachycardia, dullness on percussion, SOB.
29
How do you treat a suspected hemothorax?
Oxygenation, position for comfort, monitor vitals and perfusion, transport rapidly.
30
What directive applies to hemothorax management?
BLS Chest Trauma — identifies hemothorax as a potential life/limb threat requiring urgent transport.
31
What are signs and symptoms of a splenic injury?
LUQ pain, Kehr’s sign (left shoulder pain), hypotension, dizziness, confusion, tachycardia.
32
How do you manage a suspected splenic injury?
Oxygenation, monitor vitals, prepare for shock, rapid transport.
33
What directive applies to splenic injury management?
BLS Abdominal Trauma Standard — includes solid organ injury assessment and shock prep.
34
What symptoms suggest a liver laceration or rupture?
RUQ pain, right shoulder pain, hypotension, jaundice, guarding, signs of internal bleeding.
35
What is the treatment for liver trauma?
Monitor for hemorrhagic shock, oxygen, position for comfort, prepare for rapid deterioration.
36
What directive outlines liver trauma care?
BLS Abdominal Trauma Standard — assess for hemorrhage from solid organs.
37
How do you recognize a diaphragmatic rupture?
Bowel sounds in chest, SOB, chest pain, coughing, possible shoulder pain.
38
What is the treatment for diaphragmatic rupture?
High-flow O₂, position semi-sitting if tolerated, monitor airway and breathing.
39
Which directive covers diaphragmatic rupture care?
BLS Abdominal Trauma — includes thoracoabdominal injury signs and oxygenation support.
40
What are signs of kidney trauma?
Flank pain, hematuria, contusions, hypotension, signs of internal hemorrhage.
41
What’s the treatment for suspected renal injury?
Oxygenation, monitor vitals, treat for shock, rapid transport.
42
What directive applies to kidney trauma management?
BLS Abdominal Trauma — solid organ injury treatment and internal hemorrhage monitoring.
43
What is evisceration and how is it recognized?
Protrusion of abdominal organs (usually intestines) through an open abdominal wound.
44
What is the proper treatment for evisceration?
Do not replace organs; cover with moist, sterile, large bulky dressing; secure gently.
45
What directive applies to evisceration management?
BLS Abdominal Trauma Standard — specific protocol for evisceration care.
46
What are signs of a clinically unstable pelvic fracture?
Pelvic instability, hypotension, leg shortening/rotation, pelvic pain, bruising.
47
How do you treat an unstable pelvic fracture in the field?
Apply circumferential pelvic wrap, secure to board, immobilize legs, avoid straps over pelvis.
48
What BLS directive covers pelvic fracture management?
BLS Abdominal Trauma — includes wrapping and stabilization protocol.
49
What symptoms indicate spinal cord injury?
Paralysis, priapism, numbness, incontinence, sensory loss, muscle weakness.
50
What’s the treatment approach for suspected spinal injury?
Apply SMR if indicated, collar, minimize movement, monitor neuro status.
51
What directive outlines SMR application?
BLS Spinal Motion Restriction Standard — with risk factor checklist and position rules.
52
What is the “high-risk mechanism” requiring SMR under BLS?
Fall >3 ft or 5 stairs, axial load, high-speed MVC, rollover, pedestrian struck, age ≥65.
53
How do you handle SMR with a cooperative patient still in a vehicle?
Coach them to self-extricate using “stand, turn, pivot” maintaining neutral alignment.
54
What guideline applies to self-extrication during SMR?
BLS SMR Standard — allows coached self-extrication when no neuro deficits are present.
55
What are signs of a traumatic cardiac arrest?
VSA + trauma mechanism (blunt/penetrating), signs of massive hemorrhage, MOI-compatible injuries.
56
How do you manage a traumatic cardiac arrest?
Begin resuscitation, control bleeding, airway/O₂, apply TOR criteria early if indicated.
57
What directive covers trauma-related cardiac arrest?
ALS PCS – Traumatic Cardiac Arrest Directive & TOR Criteria.
58
What are criteria for traumatic TOR (termination of resuscitation)?
Blunt trauma + VSA + no signs of life + no shockable rhythm + no ROSC after 20 min CPR.
59
What should you do if trauma patient has signs of life but no pulse?
Continue CPR, treat reversible causes, transport if signs of life remain.
60
What directive supports withholding transport after trauma TOR?
ALS PCS + Base Hospital Medical TOR Companion Document.
61
What are signs of internal hemorrhage from abdominal trauma?
Hypotension, distention, bruising, guarding, tachycardia, pallor, altered LOA.
62
What is the treatment for suspected hemorrhagic shock?
Oxygen, lay supine if tolerated, keep warm, rapid transport.
63
What directive guides shock management in trauma?
BLS Abdominal Trauma — includes internal bleeding as life/limb threat.
64
What causes obstructive shock in trauma?
Tension pneumothorax, cardiac tamponade, pulmonary embolism, aortic rupture.
65
How do you manage obstructive shock?
Support airway, oxygenation, rapid transport, position semi-sitting if tolerated.
66
What directive covers management of obstructive shock in trauma?
BLS Chest Trauma + ALS Shock Directives (if PCP-authorized).
67
What is Step 1 of the Field Trauma Triage Standard (Physiological Criteria)?
GCS <13, SBP <90 mmHg, RR <10 or >30 (or <20 in infant).
68
What do you do if a patient meets Step 1 physiological criteria?
Transport to Lead Trauma Hospital (LTH) if <30 min transport time.
69
What directive outlines trauma triage criteria?
BLS Field Trauma Triage Standard.
70
What is Step 2 of the Field Trauma Triage Standard (Anatomical Criteria)?
Penetrating injury, 2+ long bone fractures, flail chest, open skull fx, pelvic fx, paralysis, degloving.
71
What do you do if anatomical criteria are met?
Transport to LTH or equivalent trauma center if <30 min.
72
What directive dictates anatomical triage criteria in trauma?
BLS Field Trauma Triage Standard – Step 2.
73
What are Step 3 trauma mechanisms requiring trauma center transport?
Falls ≥6 m (adult), ≥3 m (child), MVC with ejection/intrusion >30 cm, auto-pedestrian ≥30 km/h.
74
What do you do if mechanism criteria are met?
Transport to LTH if <30 min, and consider air transport per protocols.
75
What directive outlines trauma mechanism transport decisions?
BLS Field Trauma Triage – Step 3 Mechanism Criteria.
76
What are special considerations in Step 4 of trauma triage?
Age >55, pregnancy >20 weeks, anticoagulants, burns with trauma.
77
What’s the approach for special triage criteria?
Consider LTH transport if <30 min and patient meets step 4 factors.
78
What directive includes special triage considerations?
BLS Field Trauma Triage – Step 4 Special Criteria.
79
How do you differentiate an epidural hematoma from a subdural hematoma?
Epidural: Immediate LOC → lucid interval → rapid deterioration, often arterial bleed. Subdural: Gradual onset of headache, confusion, personality change, often venous bleed.
80
Subarachnoid hemorrhage vs. concussion — key difference?
SAH: Thunderclap headache, photophobia, vomiting, stiff neck, often sudden onset. Concussion: Headache, dizziness, confusion, no focal neuro signs, usually transient LOC.
81
Flail chest vs. multiple rib fractures — how to tell the difference?
Flail Chest: Paradoxical chest movement, crepitus, respiratory distress. Rib Fx only: Pain on inspiration, localized tenderness, no paradoxical movement.
82
Tension pneumothorax vs. open pneumothorax?
Tension: Tracheal deviation, JVD, hypotension, cyanosis, absent a/e. Open: Bubbling chest wound, audible air entry, sucking sound, partial lung collapse.
83
Cardiac tamponade vs. tension pneumothorax?
Tamponade: Beck’s Triad (JVD, hypotension, muffled heart sounds), equal breath sounds. Tension Pneumo: Unilateral absent a/e, tracheal deviation, JVD, hypotension.
84
Hemothorax vs. pneumothorax?
Hemothorax: ↓ breath sounds, dull percussion, hypotension from blood loss. Pneumothorax: ↓ breath sounds, hyperresonance, subcutaneous emphysema.
85
Pulmonary edema vs. pulmonary contusion?
Edema: Pink frothy sputum, rales/crackles, bilateral presentation. Contusion: Hemoptysis, localized pain, SOB after blunt chest trauma.
86
Liver vs. spleen injury?
Liver: RUQ pain, right shoulder pain, jaundice possible. Spleen: LUQ pain, Kehr’s sign (left shoulder pain), shock symptoms.
87
Diaphragmatic rupture vs. tension pneumothorax?
Diaphragm rupture: Bowel sounds in chest, abdominal trauma history. Tension: No bowel sounds in chest, tracheal deviation, chest trauma.
88
Kidney injury vs. bladder injury?
Kidney: Flank pain, hematuria, bruising on back. Bladder: Suprapubic pain, abdominal distention, inability to urinate.
89
Spinal cord injury vs. pelvic fracture?
SCI: Neurologic deficits, paralysis, priapism. Pelvic Fx: Pelvic pain, instability, shortening of legs, shock.
90
Concussion vs. intracerebral hemorrhage?
Concussion: Short LOC, no focal signs, full recovery expected. ICH: Seizures, persistent neuro deficits, unequal pupils, ↑ ICP signs.
91
Tension pneumothorax vs. massive hemothorax?
Tension: Air in pleural space, tracheal deviation, JVD. Hemothorax: Blood in pleural space, hypotension, flat neck veins.
92
Flail chest vs. cardiac tamponade vs. pneumothorax (vitals comparison)?
Flail: Normal vitals unless severe. Tamponade: Narrow pulse pressure, JVD. Tension Pneumo: ↓ BP, ↑ HR, tracheal deviation.
93
Pelvic fracture vs. abdominal bleeding?
Pelvic Fx: Pelvic pain, instability, leg shortening, shock. Abdo Bleed: Generalized abdo pain, distention, rebound tenderness.
94
Mild allergic reaction vs. anaphylaxis?
Mild: Localized rash/swelling, no respiratory or CV symptoms. Anaphylaxis: Urticaria + hypotension, airway compromise, GI signs, altered LOA.
95
Brain herniation vs. basic TBI?
Herniation: Cushing’s Triad, unilateral dilation, posturing. TBI (non-herniating): Confusion, headache, nausea.
96
TBI vs. opioid overdose (altered LOA)?
TBI: Trauma history, unequal pupils, posturing. Opioid OD: Pinpoint pupils, slow RR, responds to naloxone.
97
Abdominal organ rupture vs. perforation?
Rupture: Massive hemorrhage, shock signs. Perforation: Peritonitis, rebound tenderness, guarding.
98
Femur fracture vs. pelvic fracture?
Femur: Isolated thigh swelling, shortened limb, severe pain. Pelvis: Pelvic instability, shock, hematuria, shortened limb.
99
Heatstroke vs. TBI (altered LOA)?
Heatstroke: Hot, dry skin, core temp >40°C, no trauma. TBI: History of trauma, headache, bleeding, abnormal pupils.
100
Cardiac tamponade vs. tension pneumothorax vs. severe hypovolemia?
Tamponade: Beck’s triad, muffled heart sounds. Tension: Tracheal shift, JVD, unilateral absent breath sounds. Hypovolemia: Flat neck veins, no JVD, narrow pulse pressure.
101
Internal bleeding vs. neurogenic shock (vital signs)?
Bleeding: Hypotension, tachycardia, cold/clammy skin. Neurogenic: Hypotension, bradycardia, warm/dry skin.
102
Concussion vs. post-ictal seizure state?
Concussion: Trauma MOI, brief LOC, confusion. Post-ictal: Witnessed seizure, fatigue, confusion, drowsy recovery.
103
Hemothorax vs. pericardial effusion?
Hemothorax: Unilateral ↓ air entry, trauma chest, hypotension. Pericardial effusion: No breath sounds change, muffled heart sounds, global low voltage on ECG.

Differential Diagnosis (4 decks)

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