Trauma

Question 1

Level 1/2 trauma center
Adult

Answer 1

1. Unable to ventilate / intubated / assisted ventilations
2. Resp < 10 or >30
3. SBP < 90
4. GCS motor < or = 5 / Total GCS < or = 8
5. Deterioration / tourniquet / pelvic binder

Question 2

Level 1 or 2 trauma center
Child

Answer 2

1. Unable to ventilate / Intubated / assisted ventilations
2. Hypoxia / accessory muscle use / grunting
3. Cap refill > 2 sec
   < 1 yr. = < 60
   1-10 yr. = < 70 + 2 x age
   > 10 yr. = < 90
4. AVPU - pain or unresponsive

Question 3

Level 1 or 2
Secondary survey

Answer 3

1. Penetrating: head / neck / torso / proximal knee/elbow
2. Open/depressed skull fracture
3. Paralysis / neurological deficits / Suspected spinal cord injury
4. Chest wall instability/deformity
5. Unstable pelvic fracture
6. Amputation proximal wrist/ankle
7. Crushed / degloved / mangled / pulseless extremity

Question 4

General trauma care

Answer 4

1. Tourniquet / pack wounds
2. ABCs / LOC / Rapid Trauma Assessment / SAMPLE / pelvic binder
   (put on cardiac monitor)
3. O2 / spinal precaution / IV / warm
4. BGL / GCS / Splinting
5. Anti coag alert / shock / pain

Question 5

Sexual assault

Answer 5

1. Confine hx to medical needs
2. No washing/changing clothes
3. Coordinate transport with law

Question 6

Abuse/neglect

Answer 6

1. Observe or behavior around caregivers
2. Injury inconsistent with MOI / delayed tx / spreading blame / conflicting stories / prior/healing injuries
3. Transport if suspected, no matter how minor injury

Question 7

Pregnant trauma

Answer 7

1. EGA > or = 20 weeks (5 months)
2. Thoracic/abdominal/pelvic complaint injury even if asymptomatic/minor moi requires fetal monitoring at hospital
3. Left lateral recumbent / tilt backboard 30 deg. To left
4. Pregnant pt have: increase HR / decreased BP / increase blood volume

Question 8

Traumatic pulseless arrest

Answer 8

1. Transport
2. Airway management
3. Control bleed
4. Warm
5. 2 large bore IV / 1 IO if no access
6. Fluids
7. Pelvic binder
   ALS
8. Whole blood
9. Needle decompression

• after 15 mins of CPR + transport time > 15 = possible field pronouncement

Question 9

Traumatic shock

Answer 9

1. 2 IVs / IO if no access
2. 20ml/kg up to 1L
3. Pelvic binder
4. Needle decompression
5. Whole blood
6. TXA
   Reassess
   Repeat fluid up to 1L

Warmth, monitor ABC, VS, Mental status
Cardiac monitor

Question 11

Complete amputation

Answer 11

1. Tourniquet
2. Traumatic shock
3. Large bore IV
4. Amputated part: wrap in moist sterile dressing / place in sealed plastic bag / bag in ice water
   Stump : cover with moist sterile dressing then dry dressing
5. Pain management
6. Capno and 4 lead

** distracting injury, resuscitation most important **
Life over limb as they say ;)

Question 12

Partial amputation

Answer 12

Same as full except -
1. Pressure then tourniquet
2. Cover with moist sterile dressing and splint in anatomical position

Question 13

Head trauma GCS < 8

Answer 13

1. Open airway and assist ventilations with Capno
2. Non cardiac arrest airway

BLS airway preferred in peds

Question 14

Head trauma > 8

Answer 14

1. Shock and hypotension tx in route
2. Airway + breathing
   
   • GCS < 15 = o2 15lpm
3. Target SBP >100
4. Elevate head 30 deg.
5. Rapid trauma assessment
6. Capno, 4 lead

Question 15

GCS basic

Answer 15

Eyes - 4
Verbal - 5
Motor - 6

Question 16

GCS EYES

Answer 16

1. Does not open eyes
2. Eyes open to pain
3. Eyes open to voice
4. Eyes open spontaneously

Question 17

GCS verbal

Answer 17

1. No sounds
2. Incomprehensible sounds
3. Inappropriate words
4. Confused, disoriented
5. Oriented

Question 18

GCS motor

Answer 18

1. No movement
2. Extension to pain
3. Flexion to pain
4. Withdrawal to pain
5. Localizes pain
6. Obeys commands

Question 19

Face and neck

Answer 19

1. Open airway
2. Rapid trauma assessment
3. Spinal precaution
4. Laryngeal trauma?
5. Severe airway bleeding?
   
   • direct pressure if appropriate
6. Complete neuro exam
7. Subcutaneous air?
8. Cover/protect eyes
9. Do not block ears/nose drainage
10. Save avulsed teeth in saline soaked gauze
11. Suction, Capno, IV Access

Question 20

Suspect laryngeal trauma with:

Answer 20

1. Laryngeal tenderness, swelling, bruising
2. Voice changes
3. Respiratory distress
4. Stridor

Question 21

Signs of spinal cord injury

Answer 21

1. Sensory loss, weakness, paralysis
2. Numbness, tingling, painful burning
3. Central cord syndrome: painful burning or sensory changes bilaterally in shoulders and upper extremities

Question 22

Spinal trauma

Answer 22

1. Before and after Neuro assessment
2. Large bore IV, consider 2nd line
3. Shock?
4. Capno

Question 23

Spinal precaution indicators

Answer 23

1. Midline c/t/l tenderness on palpating
2. Neurological compliant/deficit
3. Distracting injuries
4. Altered mention
5. ETOH or drugs
6. Barriers to proper spinal assessment
7. > 65 with signs of trauma above clavicle

Full immobilization if any above yes AND
1. Patient not ambulatory on scene
2 . Patient cannot lay still and cannot follow directions

Question 24

Spinal precautions with athletic equipment

Question 25

Chest trauma

Answer 25

1. Airway clear/able to ventilate? - no = obstructed airway, needle thoracostomy 2. Penetration? - yes = transport and stabilize en route / open sucking chest wound = occlusive dressing 3. Large bore IV consider 2 4. Flail chest? - yes = assess for assisted ventilation 5. Shock? 6. Capno

Question 26

Impaled objects obstructing airway

Answer 26

Can be removed Stabilize all others

Question 27

Tension pneumothorax if :

Answer 27

Unilateral breath sounds with JVD, hypotension OR difficult/unable to ventilate

Question 28

Abdominal trauma

Answer 28

1. Large IV consider 2nd 2. Penetrating trauma = cover with saline moistened gauze dressing 3. Shock? 4. Capno

Question 29

Trauma documentation

Answer 29

-MOI -Time on injury -initial GCS -weapon/projectile/trajectory -condition of vehicle -speed -Ejection -airbag deployment -restraints/helmets

Question 30

Burns documentation

Answer 30

1. Type and degree of burn 2. %BSA 3. Resp status and voice changes 4. Singed nares/soot in mouth 5. SPO2 6. PMH 7. Confined space (CO poisoning)

Question 31

Critical burns

Answer 31

1. 2• >30% BSA 2. 3• >10% BSA 3. Respiratory injury / facial burn 4. Electrical or deep burns , PMH, Cardiac, DM 5. <10 or >50

Question 32

Types of burns

Answer 32

Thermal = remove from environment / put out fire Chemical = brush off or dilute / HAZMAT consult Electrical = deenergize pt / suspect internal injuries Enclosed = assume CO Unconscious or arrest = consider Cyanide poisoning (CN)