Trauma

Question 1

S/S of Tension Pneumothorax

Answer 1

Tracheal Shift (Late on external exam, early on radiographic)
Decreased / Absent lung sounds
JVD

Question 2

Treatment of Tension Pneumothorax

Answer 2

Needle thoracostomy (2nd ICS mid-axillary, 4th-5th Mid-axillary)
Tube thoracostomy (5th ICS Anterior Axillary)

Question 3

S/S of Hemothorax

Answer 3

Midline Trachea
Decreased / Absent breath sounds
Hypovolemic shock
Flat neck veins

Question 4

Treatment of Hemothorax

Answer 4

Tube thoracostomy (5th ICS Anterior Axillary)
Crystalloid / Blood replacement
Intubate

Question 5

S/S Open Pneumothorax

Answer 5

Sucking chest wound
Respiratory distress
Tachypnea

Question 6

Treatment of Open Pneumothorax

Answer 6

Occlusive dressing upon end exhalation

Taped 3 sides until chest tube placement, then 4th

Question 7

S/S Flail Chest

Answer 7

Paradoxical movement
Respiratory distress
Chest pain

Question 8

Treatment of Flail Chest

Answer 8

Attempt to stabilize flail chest segment
Injured side down
Limit fluids if available

Question 9

S/S Early Cardiac Tamponade

Answer 9

Pulsus Paradoxus (Quality of pulse changes with respirations)
Sinus Tachycardia

Question 10

Treatment of Early Cardiac Tamponade

Answer 10

Force Fluids (Increase preload)
Anticipate Tamponade progression

Question 11

S/S Late Cardiac Tamponade

Answer 11

Beck’s Triad (Muffled heart tones, JVD, Narrowed Pulse Pressure)

Question 12

Treatment of Late Cardiac Tamponade

Answer 12

Pericardiocentesis

Question 13

S/S Aortic Rupture

Answer 13

Harsh systolic murmur
CXR findings of widened mediastinum
Chest / mid-scapular pain

Question 14

Treatment of Aortic Rupture

Answer 14

If caval or liver laceration suspected, establish IV access above and below diaphragm
Rapid transport to surgeon

Question 15

S/S Diaphragmatic Rupture

Answer 15

Bowel sounds in chest

Scaphoid abdomen

Question 16

Treatment of Diaphragmatic Rupture

Answer 16

NG/OG
NPO
Intubate / PPV

Question 17

S/S of Tracheobronchial Disruption

Answer 17

Continuous air leak or persistent pneumothorax
Rapidly progressing subcutaneous emphysema
Pneumomediastinum

Question 18

Treatment of Tracheobronchial Disruption

Answer 18

Supportive

Consider mainstem intubation

Question 19

S/S of Esophageal Perforation

Answer 19

Hematemesis
Dysphagia
Dyspnea
Shock

Question 20

Treatment of Esophageal Perforation

Answer 20

NG/OG
Antibiotics
Antiemetics

Question 21

Newton’s 1st law

Answer 21

Object in motion remains in motion, object at rest stays at rest, unless an outside force acts upon it.

Question 22

Newton’s 2nd law

Answer 22

F=MA (Force = Mass x Acceleration)

Question 23

Newton’s 3rd law

Answer 23

Every action has an equal and opposite reaction

Question 24

Head-on Collison:

Up and Over pattern

Answer 24

Head, neck, chest, pelvis injuries

Question 25

Head-on Collison: | Down and Under pattern

Answer 25

Knee's, femur, pelvis, lower back, chest, facial

Question 26

Rear-end Collision injuries

Answer 26

T12-L1 back injuries C2 fracture of neck Evaluate for 2nd impact injury patterns (hitting steering wheel)

Question 27

T-bone or lateral Collison injuries

Answer 27

Look for injuries secondary to loose objects or other people in vehicle

Question 28

Motorcycle Head-on injuries

Answer 28

Up and Over | femur, head, neck

Question 29

Motorcycle Slide / Side injuries

Answer 29

Femur, Pelvic, Tib/Fib

Question 30

Rollover Collisions

Answer 30

Causes the most lethal injuries of all collisions. | Axial loading, multiple injury patterns

Question 31

Trauma Management : Airway indications

Answer 31

Conscious ability to swallow Oxygenation or Ventilation failure (Sao2 <60, Co2 >55, Ph <7.2) Expected clinical course

Question 32

Trauma Management : Circulation

Answer 32

Assess cardiac output (HR more important than BP) Think Tamponade Assess bleeding

Question 33

Blood pressure won't fall until EBL is ___.

Answer 33

>30-40%

Question 34

Managing Increasing ICP

Answer 34

Watch for herniation (Posturing, Pupil changes) Raise HOB 30* Hyperventilate to 30-35 ETCO2 Sedation, NMBA, Diuretics

Question 35

Farming accident considerations

Answer 35

Delayed arrival of medical care and extrication Tractors are heavier than autos Tractors are prone to rollovers End-over-end rollovers have a greater potential of entrapment Higher potential for Hazmat involvement

Question 36

Falls occur primarily in adults and children ___.

Answer 36

Under 5

Question 37

Children fall and impact ____.

Answer 37

On their head

Question 38

Adult's "lover leap"

Answer 38

Lands on feet then falls backwards on butt and hands. Feet, leg, hip fx. Axial loading on lumbar / cervical Colles fx of wrists

Question 39

Impalement / stab wound considerations

Answer 39

Area of body Blade length Angle of penetration

Question 40

Firearm wound considerations

Answer 40

``` Type (caliber, handgun, long gun) Distance from weapon Bullet construction (FMJ, hollow point) ```

Question 41

Primary blast injuries

Answer 41

Initial air blast causing damage to hollow organs

Question 42

Secondary blast injuries

Answer 42

Projectiles / shrapnel from blast force

Question 43

Tertiary blast injuries

Answer 43

Impacts ground or other object

Question 44

Parkland burn formula

Answer 44

4ml/kg/BSA% Give 1/2 over 1st 8 hours, 1/2 over next 16 hours Don't calculate 1st degree burns

Question 45

Always assume Carbon Monoxide poisoning in ____.

Answer 45

Fires in confined spaces

Question 46

Consider ___ with fires of carpets and plastics.

Answer 46

Cyanide poisoning

Question 47

Consensus burn formula

Answer 47

2-4ml/kg/BSA%

Question 48

Burn Mortality percentage

Answer 48

Age + BSA % (add 20% if Resp involvement)

Question 49

Hydrofluoric acid treatment

Answer 49

Copious water | Infiltrate tissue with 10% Calcium Gluconate

Question 50

Alkali metal burns (Na, K+) treatment

Answer 50

Reacts with water | Absorb heat with oil

Question 51

Acid burns

Answer 51

Most cause Coagulative necrosis and can't penetrate deep into tissues. They denature cellular proteins and cause cellular coagulation.

Question 52

Alkali burns

Answer 52

Dissolve protein and collagen causing dehydration and Saponification (turns fat into soap). Tend to cause more severe burns.

Question 53

Two-step Hazmat Decon Process

Answer 53

Usually at a fast break scenario Remove all clothing or jewelry from body Wash and rinse patient with soap and water Reposition out of runoff and rewash and rinse

Question 54

Myoglobinuria is often a problem due to ____.

Answer 54

Massive muscle damage

Question 55

Electrical injuries result in ____ and _____.

Answer 55

Acute Tubular Necrosis | Renal failure

Question 56

Electrical injury treatment

Answer 56

Maintain urine output of a minimum of 100 ml/hr Osmotic diuretics Alkalinize urine with Bicarb solution

Question 57

Start Triage Assessment

Answer 57

Respirations Perfusion Mentation

Question 58

Start Triage Quick Rules

Answer 58

15-30 second assessment per patient Apneic patients can have airway repositioned once Check cap refill at core

Question 59

In START Triage, all penetrating trunk injuries are classified as?

Answer 59

Immediate

Question 60

In START Triage, all rescuers injured on scene are classified as?

Answer 60

Immediate

Question 61

Crystalloid to blood replacement ratio

Answer 61

3:1

Question 62

Initial fluid resuscitation should be with?

Answer 62

Isotonic crystalloid (0.9% NS or LR)

Question 63

Fluid resuscitation should have a MAP goal of?

Answer 63

80-90 mmHg

Question 64

Poor urine output in trauma is indicative of ___ failure.

Answer 64

Pre-renal

Question 65

Humoral blood loss

Answer 65

750 ml

Question 66

Blood loss femur

Answer 66

1500 ml

Question 67

Complications of crush injuries

Answer 67

Compartment syndrome DIC Renal failure Hyperkalemia

Question 68

S/S of Larynx fracture

Answer 68

Subcutaneous emphysema | Flattened cricothyroid prominence

Question 69

At room temperature, an amputated part is viable for reimplantation for approximately how many hours?

Answer 69

4-6 hours

Question 70

With proper cooling measures, an amputated part is viable for reimplantation for approximately how many hours?

Answer 70

Up to 18

Question 71

Spontaneous recurrence is common in what dislocation?

Answer 71

Anterior shoulder

Question 72

The most common musculoskeletal dislocation is?

Answer 72

Hip

Question 73

Leading cause of death in trauma victims is?

Answer 73

Head injury

Question 74

Massive Hemothorax is defined as ___ of blood.

Answer 74

>1500ml or 1/3 patient's blood volume