Trauma

Question 1

What is the leading cause of death in the first 4 decades of life?

Answer 1

Trauma

Question 2

In pts with trauma, permanent disability is ___ times greater than the mortality rate

Answer 2

3!

Question 3

T/F There is a bimodal distribution of death in trauma patients

Answer 3

False, the distribution is TRIMODAL

Question 4

In cases of trauma, what percentage of patients die instantly?

Answer 4

50% (no amount of medical care could have saved them)

Question 5

In cases of trauma, what percentage of patients die wi/in minutes to hours following the event? Of that percentage, what percentage of those deaths is due to airway? Blood loss?

Answer 5

30%
Airway: 40%
Blood loss: 25%

Question 6

In cases of trauma, what percentage of patients die w/in days to weeks following the event? What is their death usually attributed to?

Answer 6

20%

Multi-organ-system-failure or Sepsis

Question 7

In cases of trauma, what group of patients have the greatest success in surviving? (providers should focus on these patients and saving them)

Answer 7

The second peak (20% Minutes-hours)

Question 8

ACS CoT Criteria is comprised of what three categories?

Answer 8

Physiologic, Injury, and Mechanism

Question 9

What are two examples of mechanism criteria?

Answer 9

Fall >2x height, rollover in vehicle or death in vehicle

Question 10

What is the title of the person in the trauma room who provides no patient care but who is in charge of the “big picture”

Answer 10

Trauma captain

Question 11

How do we evaluate a patient’s airway?

Answer 11

Ask them their name!
We now know their airway is patent as they are phonating, not drowning in blood/substance as they can speak, and also enough air to brain to cognate listen for hoarseness or gurgling with speech!

Question 12

What type of injury should be assumed in patients with multisystem trauma?

Answer 12

C-spine injury

Question 13

If a pt has a GCS of ____, you should intubate them

Answer 13

<8

Question 14

What is a flail chest? Describe it. Complications?

Answer 14

Section of ribs broken in 2 or more locations, breath in = suck in, breath out = push out –> not normal! Obvi.
CO2 becomes trapped in that area and there is thus poor oxygenation

Question 15

What is subcutaneous emphysema?

Answer 15

Air in superficial soft tissues leaked from the lungs, significant underlying lung injury, likely not oxygenating well

Question 16

If a tension pneumothorax is suspected, what procedure should be performed?

Answer 16

Needle decompression

Question 17

If a pneumothorax / hemothorax is present, what should be done?

Answer 17

Place a chest tube

Question 18

If a pt has a sucking chest wound, what should be done?

Answer 18

Place an occlusive dressing

Question 19

What should be assumed in any hypotensive trauma patient?

Answer 19

Hemorrhagic shock

Question 20

In order to rapidly and effectively asses hemodynamic status, where and how many pulses should be measured?

Answer 20

4 extremity pulses

Question 21

What are 5 contraindications for placing a foley catheter (signs of pelvic injury)

Answer 21

1. Blood at urethral meatus
2. Perineal ecchymosis
3. Blood in the scrotum
4. High riding prostate
5. Pelvic Fxs

Question 22

In a trauma, what type and how many IVs should be placed?

Answer 22

2 large bore IVs

Question 23

What causes compression/collapse of right side of the heart?

Answer 23

Cardiac tamponade

Question 24

If you are suspicious of urethral injury, what should be performed prior to insertion of a catheter?

Answer 24

A retrograde urethrogram

Question 25

In trauma pts brought to the trauma bay "cracking the chest" is otherwise known as what type of procedure?

Answer 25

ED thoracotomy

Question 26

What pt is the "ideal pt" for an ED thoracotomy, in regards to the type of trauma they experience and with what type of weapon?

Answer 26

Penetrating trauma to chest with low velocity weapon

Question 27

How effective is an ED thoracotomy? (percentage)

Answer 27

~10%

Question 28

During the ABCDEs, what are your two main concerns in regards to disability? (anatomically speaking)

Answer 28

The brain and the spine

Question 29

If you find a spinal cord injury within the first 8 hours of its occurrence, what should you administer to the pt?

Answer 29

High dose steroids

Question 30

If you suspect increased ICP, what should you do to the head of the patient's bed?

Answer 30

Elevate it

Question 31

When evaluating any trauma pt, what is one location on their body that you should always inspect? (think: where do puncture wounds like to "hide"?)

Answer 31

The back! (also, if considering puncture wounds, the axillae)

Question 32

If there is an obvious major injury/violation of chest/abd, where should you immediately send the patient?

Answer 32

The OR

Question 33

When a patient presents with these three sx, you should have a high suspicion for abd trauma...

Answer 33

Tachycardia, hypotension, and abdominal tenderness

Question 34

T/F Patients with abd trauma can be asymptomatic early on

Answer 34

True

Question 35

A ____ exam can be a useful early screening tool for abd trauma (hint: type of imaging)

Answer 35

FAST exam (Focused Assessment with Sonography for Trauma)

Question 36

Free fluid without solid organ injury is a _____ _____ injury until proven otherwise

Answer 36

hollow viscous

Question 37

A hollow viscous injury can involve the ___, ___, or ___ (hint: think organs)

Answer 37

Stomach, bowel, or mesentery

Question 38

What type of injuries can result in bucket-handle tears of mesentery?

Answer 38

Deceleration

Question 39

Small bowel and colon injuries result most often from what type of trauma?

Answer 39

Penetrating

Question 40

Hollow viscous injury sx are a result from a combination of ___ ___ and___ ___

Answer 40

blood loss and peritoneal contamination

Question 41

What is the most commonly injured organ in blunt trauma?

Answer 41

Spleen

Question 42

T/F Splenic injury often needs to be managed operatively

Answer 42

False, splenic injury often can be managed non-operatively

Question 43

Pain in what area may be indicative of splenic injury?

Answer 43

Left lower rib

Question 44

T/F Splenic injury is often associated with other injuries

Answer 44

True

Question 45

What is the second most common type of solid organ injury?

Answer 45

Liver

Question 46

T/F Liver injury is often associated with other injuries

Answer 46

True

Question 47

Is liver injury difficult to manage surgically?

Answer 47

Yes, it is

Question 48

What imaging study visualizes solid organs and vessels well?

Answer 48

Abdominal CT scan

Question 49

What do CT scans NOT see well? (think certain types of injury and anatomical structures)

Answer 49

Hollow viscous, duodenum, diaphragm, omentum

Question 50

Even though some recent surgery literature advocates whole body scans on all trauma, why do you still want to be wary with ordering CT scans for pts?

Answer 50

There is an increase in mortality related to cancer from CT scans

Question 51

What is the goal of a FAST exam?

Answer 51

To evaluate for free fluid

Question 52

How many views does a FAST exam have? What are they? (Think chest/abd regions)

Answer 52

4 views: Cardiac, RUQ, LUQ, suprapubic

Question 53

List the following in the order in which they should be performed on a trauma pt: - Secondary Survey - Home/Observation/Non-Emergent OR - FAST - CT head or pelvis - Primary Survey

Answer 53

1. Primary Survey 2. Secondary Survey 3. FAST exam 4. CT Head or Pelvis 5. Home/Observation/Non-Emergent OR

Question 54

Is there an "I" in trauma? ;)

Answer 54

Trauma is best managed by a team approach