Trauma/Burns

Question 1

What is Newton’s first law?

Test Question

Answer 1

An object in motion will remain in motion and an object at rest will remain at rest until acted on by an outside force.

Question 2

What is Newtons 3rd law?

Test Question

Answer 2

For every action, there is an equal and opposite reaction.

Question 3

What injuries are most likely to see in a vertical fall?

Answer 3

In children= head injuries
Adults=FX for the feet and legs, axial loading, colles fx of the wrist.

Question 4

Describe this FX.

Answer 4

La Fort l Fx involves the separation of the floor of the nose and maxilla caused by downward force.

Question 5

Describe this Fx

Answer 5

The Le Fort II fracture is also referred to as a pyramidal fracture. it involves the upper nasal and maxilla area. payrmid shape.

Question 6

Describe this FX

Answer 6

Involves the sides of the orbit nose, upper cheekbones, and maxilla. La Fort 3

Question 7

In trauma, a min MAP of _______ must be maintained.
What is the formula for MAP?

Answer 7

MAP of 60 must be maintained
MAP=(DPB X 2)+SBP) /3

Question 8

GIVE THE MAP FOR A PATIENT WITH A DIASTOLIC PRESSURE OF 80mm Hg AND A SYSTOLIC PRESSURE OF 140 mmHg

Answer 8

100

Question 9

GIVE THE MAP FOR A PATIENT WITH A SYSTOLIC PRESSURE OF 150
mmHg AND A DIASTOLIC PRESSURE OF 90 mm Hg?

Answer 9

110

Question 10

GIVE THE MAP FOR A PATIENT WITH A SYSTOLIC PRESSURE OF 160
mmHg AND A DIASTOLIC PRESSURE OF 100 mm Hg?

Answer 10

120

Question 11

What is the formula for shock index?
What is a normal shock index?

Answer 11

HR/SBP
<.9

Question 12

A patient can lose up to 2 liters of blood before the BP starts to decline.T/F

Answer 12

True this is considered a Class 3 blood loss

Question 13

What are the three signs of cardiac tamponade?

Answer 13

Beck’s triad, Narrowing pulse pressure
JVD
muffled heart sounds.
widen medistinum on chest x ray

Question 14

In a tension pneumothorax, needle decompression is performed in the __________ and chest tube in the _________?

Answer 14

2nd intercostal space mid clavicular or 4th 5th intercostal mid axillary line.
Chest tube 4-5 intercostal space.

Question 15

Name 5 signs of hemothorax.
When should you clamp the chest tube?

Answer 15

Decreased breath sounds, flat neck veins, trachea midline, decreased LOC.
1500cc initial output to avoid re-expansion pulmonary edema.

Question 16

Paradoxical motion, grunting, shallow breaths, and respiratory distress is a sign of?
Treatment?

Answer 16

Flail chest.
Allow self-splint,
Place on the injured side.
pain management and intubate.

Question 17

Which is the number one injured organ in a trauma victim?

Test question

Answer 17

Spleen.

Question 18

A pelvic Fx can hold up to __________cc of blood.

Answer 18

4,000cc of blood or 80% of the blood volume.

Question 19

What does REBOA stand for?

Answer 19

Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA)

Question 20

Which are the two allowable zones for use of the REBOA?

Answer 20

Aortic Zone 1 – Extends from the origin of the left subclavian artery to the celiac artery (approximate vessel diameter – 20mm for young adult male)1

Aortic Zone 3 – Extends from the lowest renal artery to the aortic bifurcation (approximate vessel diameter – 15mm for young adult male)1

Question 21

Question 22

?

Answer 22

Cardiac Tamponade, notice the widened mediastinum.

Question 23

1. A 25-year-old female patient has sustained burns to the back of the right arm, posterior trunk, front of the left leg, anterior head and neck, and perineum. Using the Rule of Nines, calculate the total body surface area percentage that is burned?*
   A. 46%
   B. 37%
   C. 36%
   D. 28%

Answer 23

1. A 25 year old female patient has sustained burns to the back of the right arm, posterior trunk, front of the left leg, anterior head and neck, and perineum. Using the Rule of Nines, calculate the total body surface area percentage that is burned?

A. 46%

B. 37%

C. 36%

D. 28%

The answer is B. Back of right arm (4.5%), posterior trunk (18%), front of left leg (9%), anterior head and neck (4.5%) and perineum (1%) which equals 37%.

Question 24

2. A 68-year-old male patient has partial thickness burns to the front and back of the right and left leg, front of right arm, and anterior trunk. Using the Rule of Nines, calculate the total body surface area percentage that is burned?*
   A. 40.5%
   B. 49.5%
   C. 58.5%
   D. 67.5%

Answer 24

2. A 68 year old male patient has partial thickness burns to the front and back of the right and left leg, front of right arm, and anterior trunk. Using the Rule of Nines, calculate the total body surface area percentage that is burned?

A. 40.5%

B. 49.5%

C. 58.5%

D. 67.5%

The answer is C. Front and back of right and left leg (36%), front of right arm (4.5%), anterior trunk (18%) which equals 58.5%.

Question 25

3. A 35-year-old male patient has full-thickness burns to the anterior and posterior head and neck, front of left leg, and perineum. Using the Rule of Nines, calculate the total body surface area percentage that is burned. A. 37% B. 14.5% C. 29% D. 19%

Answer 25

The answer is D. Anterior and posterior head and neck (9%), front of left leg (9%), perineum (1%) which equals 19%.

Question 26

4. A 66-year-old female patient has deep partial-thickness burns to both of the legs on the back, front, and back of the trunk, both arms on the front and back, and front and back of the head and neck. Using the Rule of Nines, calculate the total body surface area percentage that is burned. A. 72% B. 63% C. 81% D. 45%

Answer 26

The answer is C. Both of the legs on the back (18%), front and back of the trunk (36%), both arms on the front and back (18%), front and back of the head and neck (9%) which equals 81%.

Question 27

. A 58-year-old female patient has superficial partial-thickness burns to the anterior head and neck, front and back of the left arm, front of the right arm, posterior trunk, front and back of the right leg, and back of the left leg. Using the Rule of Nines, calculate the total body surface area percentage that is burned. A. 63% B. 81% C. 72% D. 54%

Answer 27

the answers is A. Anterior head and neck (4.5%), front and back of the left arm (9%), front of the right arm (4.5%), posterior trunk (18%), front and back of the right leg (18%), back of the left leg (9%) which equals 63%.

Question 28

Infant's head? Infants trunk front? Infants trunk back? Whole arm Whole leg Genitals

Answer 28

18% Head 18% Chest/Abdomen 18% Posterior Torso 9% Left Arm 9% Right Arm 14% Left Leg 14% Right Leg 1% Genitals

Question 29

Adult head? chest abdomen whole legs arms genitals

Answer 29

9% Head 18% Chest/Abdomen 18% Posterior Torso 9% Left Arm 9% Right Arm 18% Left Leg 18% Right Leg 1% Genitals

Question 30

What is the urine output formula for an adult? Urine output for Rhabdo? Urine output for Pedi? >10kg Pedi

Answer 30

05-1 ml/kg/hr 1-2ml/kg/hr 2ml/kg/hr <10kg patient 1ml/kg/hr

Question 31

What is the formula for the Parkland formula?

Answer 31

4ml x BSA x KG give 1/2 over the first 8 hours second half over the next 16hrs.

Question 32

What is the consensus formula?

Answer 32

Kg x BSA x 2-4 mls

Question 33

current burn patient practice is?

Answer 33

Start IV fluids at 500mls / hr after 1 hour assess urine output if < 30-50 MLS per /hr increase fluids by 20% if urine is greater than 30-50 MLS per /hr reduce fluids by 20%

Question 34

What is the volume of choice for burns?

Answer 34

Crystalloid solution Lactated ringers

Question 35

Electrolyte imbalance happens in 2 phases. Phase 1 starts? Phase 2 ?

Answer 35

0-36 hours hypernatremia and hypokalemia begins 3-7 days hypernatremia, hypokalemia,hypomagnesium,hypo calcemia

Question 36

Treatment for Rhabdomyolysis ?

Answer 36

Watch urine output -1-2 ml/kg/hr NAHCO3 ( bicarb) to alkalize the urine. Mannitol and Lasix

Question 37

A patient is requiring massive transfusions of packed red blood cells (PRBCs). Which electrolyte abnormality would you monitor for?

Answer 37

PRBCs, or banked blood, contain high levels of potassium due to the hemolysis that takes place. Monitor for tall, peaked T waves and a gradual widening of the QRS complexes.

Question 38

Death within minutes in multi-system trauma is most often a result of?

Answer 38

Great vessel laceration is a common cause of death in multi-system trauma patients. Aortic disruption is the most common cause due to the shearing injury that occurs from the deceleration forces seen in high force accidents.

Question 39

A basilar skull fracture is often associated with?

Answer 39

Seventh cranial nerve

Question 40

A 70kg patient with second and third-degree burns involving 45% TBSA is being transferred 26 hours post-injury. The physician reports that the patient has had a total of six liters of fluid in a 24-hour period. Using the Parkland formula, how much fluid should this patient have received in the first 24 hours of burn care?

Answer 40

The Parkland formula states kg x TBSA x 4mL = volume/24 hours. 70kg x 45 x 4 = 12,600 mL. [12,600/2 = 6,300 in the first eight hours]. The question asked how much the patient should get in the first 24 hours so the correct answer is 12,600 mL.